I want to tell you a bit about how I ended up at the Massachusetts Institute of Technology and why. But to explain where I’m going, I first need to share an experience that was probably not unlike one you have had every day since you could read.
While perusing the newspaper one morning this week, I stumbled on an article about the link between Alzheimer’s and a particular bacterium in the mouth. The piece suggested that if you’re fanatical about your oral hygiene, the chance of getting Alzheimer’s decreases. After that, I logged on to my laptop to find a story about the actress Gwyneth Paltrow’s latest bit of health wisdom. In the article, she dishes her top tips for staying svelte, which include exercise, smoking and tinted moisturizer.
In the past, I probably would have been plied, or at least confused, by the suggestions in these pieces. I might have considered another round of daily tooth-brushing, and in a fit of magical thinking, ordered Paltrow’s cream for extra muscle tone (which she conveniently features on her lifestyle website Goop).
But after looking at the evidence behind such health-related claims here at Science-ish for more than two years, I am more skeptical. Now, I’d ask of the dental study – what methods did the researchers use? – and I’d remind myself that correlation does not equal causation. Of Paltrow, I’d wonder – what interest does she have in promoting this stuff? I’d remember her disappointing track record with science-based information and the generally faulty health advice doled out by people who make believe for a living.
Besides becoming more leery, my weekly foray into medical research has taught me other important lessons. While I may be less likely to buy vitamins or believe Dr. Oz, I now understand more than ever the compulsion to do so. I’ve come to appreciate that medicine is a relatively new science, and for all the incredible advances of the last 150 years, that it can’t keep up with the demands of a growing middle class to preserve health, and stave off death and old age. Our desire for health products, to be fit and young, has outstripped the doctor’s toolkit.
This leaves the door wide open for quackery. Or for treatments and cures for which we don’t have evidence yet, and for which we may never have good evidence. I’ve spoken to friends who had injured limbs which personal trainers fixed where surgeons failed; friends who swear by food-sensitivity testing or ‘cupping‘ to alleviate symptoms nothing else could.
I’ve heard from doctors – science-minded men and women – who practice alternative medicine, no matter how little evidence underpins it, because they have no other medicine to help; doctors who believe that, while anecdotes are the ‘lowest form’ of evidence, they can be used for good in their practices.
One, in particular, stands out: he admitted that he had given up on using science to change the minds of anti-vaccine parents. Instead, he persuaded them with stories and videos about what their kids would look like with polio. He was not unlike the health minister who told me that the surest way to get a drug covered on a provincial formulary was by a compelling patient story, not by compelling research. In these cases, context mattered more than evidence.
All this has led me to wonder whether evidence-based medicine and policy could learn something from behavioural economics. People, after all, are not rational actors. Treating them as such may not be the surest way to better health decisions. If Jenny McCarthy convinced people that vaccines cause autism through stories about her son, and the pharmaceutical industry figured out how to get doctors to prescribe their medications through manoeuvres like the ‘rule of seven touches,’ could health professionals do more to communicate evidence?
To be clear, I don’t mean to undermine science. In fact, I appreciate it more now than ever. One of the key distinctions the philosophers of science used to tell science from pseudoscience was whether a claim could be falsified. Their method – coming up with a hypothesis, setting up a well-designed test, running the experiment, reaching conclusions, re-testing, and now synthesizing that evidence – seems to me to be the best route humans have to truth.
But all this experience has shown me how complex the world is, and how even with the best evidence at hand, strange decisions get made. Perhaps by understanding more about the nature of evidence, how it is generated, and its role in medical practice and political decision making, I can better mediate that world through journalism and better question how well science, policy makers and the public are doing in their use of science instead of science-ish.
For this reason, I’m heading to MIT on a Knight Science Journalism fellowship. This fellowship was designed to get journalists into labs, and studying alongside scientists and other researchers, so they could develop a deeper understanding of the culture of science and report on it more thoroughly. I hope you’ll stay with me as I continue to blog here on Science-ish and on my website, here.
Science-ish is a joint project of Maclean’s, the Medical Post and the McMaster Health Forum. Julia Belluz is the senior editor at the Medical Post. She will be on a Knight Science Journalism Fellowship at the Massachusetts Institute of Technology. Check back for periodic updates here and here, and reach her at email@example.com or on Twitter @juliaoftoronto