monograph · The Skeptical Razor
Politics, Science, and Health
Harriet Hall
Carl Sagan said, “We live in a society absolutely dependent on science and technology and yet have cleverly arranged things so that almost no one understands science and technology. That’s a clear prescription for disaster.” The beliefs that politicians hold affect legislation on public health, medical research, and medical care. If they don’t understand science, they are likely to adopt false beliefs and are not qualified to decide public policy.
The general public is appallingly ignorant of science. In a recent US survey, half of the respondents didn’t know how long it takes for the Earth to travel around the Sun, and only 40% accepted evolution. Most people get their information from the media. According to Mark Twain, “If you don’t read the newspaper, you’re uninformed. If you read the newspaper, you’re misinformed.” He said that a century ago and things haven’t changed. Science reporting in the media is particularly unreliable. People often form strong opinions based on unquestioning acceptance of something they have heard or read.
Outspoken celebrities influence the public with their faulty ideas about health, from Jenny McCarthy’s “vaccines cause autism” to Gwyneth Paltrow’s vaginal steaming. Quacks offer a multitude of bogus “miracle cures.” Questionable health gurus provide questionable information. There is good information but also a tremendous amount of misinformation on the Internet, and the average reader lacks the background in science and the critical thinking skills needed to separate the truths from the lies and distortions.
Politicians are no better informed than the general public, sometimes worse. Some of the congressmen who enact the laws in the United States have made truly idiotic public pronouncements. Todd Akin said women can’t get pregnant from rape. Michele Bachmann said the HPV vaccine causes mental retardation. Heywood Broun said “All that stuff I was taught about evolution and embryology and the big bang theory, all that is lies straight from the pit of Hell.» And he’s an MD and is on the House Committee on Science!
Doctors are not exempt from faulty beliefs. MDs are not scientists; medicine applies science, using scientific knowledge to treat the individual patient. Some MDs lack the training and the critical thinking skills needed to judiciously assess the medical literature. This has resulted in a naïve interpretation of “evidence-based medicine” where the results of randomized controlled trials are accepted even when they are inconsistent with basic science and common sense. Unfortunately, half of published studies are wrong. Promising initial studies are often followed by larger, better-designed studies that reach the opposite conclusions, and studies carried out by imperfect humans are subject to any number of human errors. Rather than relying on a single study, a true scientific thinker waits for replication and confirmation, looks for consistency with other knowledge, weighs all the published evidence pro and con, and considers the size, quality, and design of the studies. It’s complicated. Non-experts are at a disadvantage. In fields outside our own, we must rely on experts; and it’s hard to know who is really a reputable scientific expert we can trust and who is a poseur or biased by ideology. But having a good grounding in science and reasoning can go a long ways towards identifying sources that should be rejected as untrustworthy.
Doctors who are not good scientists have succumbed to what has been called “quackademic medicine,” the infiltration of quackery into medical schools and hospitals. Health insurance and government programs pay for several kinds of non-science-based treatments. In the UK, the National Health Service still pays for homeopathy, which not only has been shown not to work but couldn’t possibly work (except as a placebo). Society is paying chiropractors to adjust spines for nonexistent “subluxations.” It is paying acupuncturists to remove mythical blockages in the flow of a mythical life force called qi by inserting acupuncture needles into mythical acupoints and meridians. In some places, society is paying for untested naturopathic treatments and nonsensical energy medicine treatments.
“Integrative medicine” is the new buzzword. It is a marketing term designed to promote the infiltration of unproven treatments and sometimes even outright quackery into conventional science-based medical practice. They say they want to adopt those alternative treatments that have been proven to work. The problem is that there is no such thing as an alternative medicine that has been proven to work. By definition, alternative medicine is medicine that is not supported by good enough evidence to have earned it a place in conventional medicine. If it had been proven to work, it would have been adopted by mainstream medicine and we would no longer call it “alternative;” we would just call it “medicine.”
Integrative medicine proponents practice deception when they claim that modalities like exercise, diet, massage, prevention, plant-based remedies, comfort measures, and treating the whole patient are the unique province of alternative medicine. They are not; they are all part of conventional clinical practice, and alternative medicine is merely trying to co-opt them.
Governments are licensing chiropractors, acupuncturists, homeopaths, naturopaths, and others whose practice is not based on science. This gives the practitioners validation and a prestige in the public eye that they do not deserve. Much of what they do may seem to work, but only because of two factors: placebo effects and the natural course of illness. Most symptoms fluctuate and many conditions improve naturally over time; and when they do, the alternative treatment may falsely get the credit. It has been argued that placebos are a good thing: the patients say they feel better, and surely that is what we want. But medical ethicists uniformly condemn the use of placebos because it constitutes lying and undermines trust in the doctor-patient relationship. Placebos may affect subjective symptoms but they cannot objectively change the course of illness, and using placebos can interfere with the recognition and effective treatment of serious illness.
Governments are an important source of research funding, especially in the basic sciences. Research funds are being mis-spent. Studies of implausible alternative treatments are being funded, leaving less money for research that is more likely to produce useful findings. In 1992 the US established the Office of Alternative Medicine, later renamed the National Center for Complementary and Alternative Medicine (NCCAM) and now the National Center for Complementary and Integrative Health (NCCIH). Its mandate was driven by a political agenda. It was not intended to ask if alternative treatments worked, but to create evidence that they did work and to fund studies that scientists would not otherwise think were worth doing, including new studies on treatments that had already been proven not to work. Despite spending over $2 billion, they have yet to find that any alternative treatment is effective. As research methodologist R. Barker Bausell pointed out, «It’s become politically correct to investigate nonsense.»
Scientific ignorance kills. In South Africa in the early years of the 21st century, the President and the Health Minister refused to believe the overwhelming evidence that HIV caused AIDS. Patients were denied lifesaving antiretroviral treatment, and instead were advised to follow a diet of garlic, olive oil and lemon to cure the disease. This misguided public policy led to 300,000 HIV/AIDS deaths that could have been prevented.
Polio is a contagious disease that is only transmitted from human to human, with no animal reservoir. Just as with smallpox, an effective vaccination campaign ought to be able to eliminate it completely from the globe. By 2003, polio had been eradicated from all but six countries; one of those countries was Nigeria. A plan was developed to immunize more than 15 million children, which was expected to eliminate the disease in that country. Rumors spread that the vaccine had been deliberately adulterated with anti-fertility drugs, HIV virus, and carcinogens in an evil Western genocidal plot to kill Africans. There wasn’t a shred of evidence for any of those paranoid imaginings. Political and religious leaders in three northern states led a boycott of the immunization program, the boycott was endorsed by the Governor of Kano State, and the program was suspended by the government for several months. The result was a resurgence of a Nigerian strain of polio that broke out and spread to 16 nations, infecting and paralyzing children as far away as Indonesia.
Both of these public health disasters could have been prevented if politicians had had the scientific tools and critical reasoning skills to unmask the faulty ideas.
Public policy should be determined by evidence and reason, not by rumors, uninformed opinions, and unfounded beliefs. We desperately need policymakers who understand science and who have the critical thinking skills to recognize misinformation, to evaluate the claims of lobbyists and special interest groups, and to recognize the difference between facts and opinions.
Harriet Hall
Family physician, former U.S. Air Force flight surgeon and skeptic