Last week, the Olympic Committee banned Russia from participating in the next Olympics, because the national team had systematically cheated on its drug tests. Apparently, the Russians had implemented a strategy to allow their athletes to take performance-enhancing drugs without getting caught.
Last year, the lead investigators of the TOPCAT trial -- an NIH study of spironolactone in heart failure -- reported that sites in Russia and the Republic of Georgia had recruited patients that probably did not have heart failure, and that the patients did not take (or were not given) the study medications. Some believe that the investigators pocketed the funds from the NIH without doing the work.
In the 1960s, the chess grand master, Bobby Fischer, accused the Russians of rigging tournaments. Fifty years later, the Democrats have accused the Russians of rigging presidential elections in the US.
Is there a pattern here?
In an opinion piece, the New York Times claims that cheating is an inherent feature of the Russian government's way of doing things. Is cheating central to the Russian way of life?
My parents came from Poland, but they spoke Russian. Interestingly, they did so in my presence only when they wanted to communicate so that I would not understand what they were saying to each other.
The New York Times made the point that -- in the Russian language -- there are : "pravda" and "istina". Istina is the unshakable truth, which is rooted in knowledge and reality. Pravda is the truth that is evident on the surface; it is the subjective norm for thinking and acting.
Apparently, growing up in Eastern Europe means learning how to survive. If your survival depends on cutting corners, you do what you need to do to live. It is always a calculated risk, but the risk may be worth taking if no one is watching.
My parents understood the Russian meaning of pravda. I do not know if they relied on it to survive the horrors of World War II. When they immigrated to the US in the late 1940s, the only concept of truth at home was istina. There was a simple reason: they felt safe.
This dualism is not unique to Russia. I recently wrote an opinion piece for in which I described a similar phenomenon in England.
According to Richard Firth Green, the meaning of "truth" changed during the reign of Richard II of England in the late 14th century. Before then, "trouthe" was an ethical concept that resided within individuals, i.e., integrity and dependability. Afterwards, "truth" became an objective reality that existed outside of ourselves, which could be discerned by unbiased observers.
Interestingly, Green never claimed that an unbiased observer actually existed.
At a meeting of the in Washington DC last week, Larry Husten (of CardioBrief and MedPage Today) and I concluded that we are now living through a crisis of trust. All segments of our healthcare system no longer trust each other, because each believes that someone has tricked them into believing an expedient "truth". The phrase "fake news" doesn't even scratch the surface of the problem.
We desperately need to fix this.
Whether we call it "istina" or "trouthe", we have lost something important. Our pervasive distrust has led us to raise doubts about everything and demand verification of every statement and deed. But these superficial demands for transparency do not provide useful information, and they
just make matters worse, since they don't repair the current rift in morality.
Maybe the Russians do have a problem. But the problem is not unique to Russia. We all have a lot of homework to do. So, over the next several weeks and months, I am going to try to propose a path forward.
Someone needs to.
Disclosures
Packer recently consulted for Amgen AstraZeneca, Bayer, Boehringer Ingelheim, Cardiorentis, Daiichi Sankyo, Gilead, Novo Nordisk, Relypsa, Sanofi, Takeda, and ZS Pharma. He chairs the EMPEROR Executive Committee for trials of empagliflozin for the treatment of heart failure. He was previously the co-PI of the PARADIGM-HF trial and serves on the Steering Committee of the PARAGON-HF trial, but has no financial relationship with Novartis.