Science Denial in a Post-Truth World
Sara E. Gorman, PhD MPH Co-author of Denying to the Grave: Why We Ignore the Facts That Will Save Us Co-founder of Critica, Inc. October 12, 2019
Think Deeply, Think Well • Sara Gorman, PhD, MPH • Co-founder & CEO, Critica, & co-author, Denying to the Grave: Why We Ignore the Facts That Will Save Us (OUP, 2016) • Public health specialist with expertise in behavioral science, behavior change, and social psychology
Think Deeply,2 Think Well Modern Challenges to Science
Think Deeply, Think Well Patient vs. Provider Behavior
• Key biases & cognitive errors that contribute to these unsubstantiated practices occur in both patients and providers • Problems that patients face: • Discrepancies in news reporting about medical & scientific evidence • Skewed risk perception • Pressure to maintain points of view, especially in light of group affiliations • Problems that providers face: • Social pressures from patient demands • Difficulty changing points of view based on updated guidelines • Conflicts of interest based on reputation, need to appear consistent & social pressure • Pressure from third parties to provide least expensive carej1
Think Deeply, Think Well Slide 4 j1 added final bullet [email protected], 8/25/2019 Unsubstantiated Healthcare Practices Are Alarmingly Common
Think Deeply, Think Well Social Pressure in Medical Practice
Think Deeply, Think Well How do we know what to believe?
Think Deeply, Think Well Confirmation Bias & The Backfire Effect
Think Deeply, Think Well Barriers to Convincing People about the Facts • Nyhan 2014 Pediatrics vaccine communication study • 1759 parents randomly assigned to one of four vaccine information conditions • Information explaining the lack of evidence that MMR causes autism • Textual information about the dangers of the diseases prevented by MMR • Images of children who have diseases prevented by the MMR vaccine • A dramatic narrative about an infant who almost died of measles • Refuting claims of an MMR/autism decreased intent to vaccinate among parents who had the least favorable vaccine attitudes • Images of sick children increased expressed belief in a vaccine/autism link • Dramatic narrative about an infant in danger increased self-reported belief in serious vaccine side effects
Nyhan B, Reifler J, Richey S, Freed GL. Effective messages in vaccine promotion: a randomized trial. Pediatrics 2014; 133(4).
Think Deeply, Think Well Why We Can’t Change Our Minds
Kaplan JT, Gimbel SI, Harris S. Neural correlates of maintaining one’s political beliefs in the face of counter-evidence. Scientific Reports 2016; 6.
Think Deeply, Think Well Our Difficulty with Risk Perception
• We overestimate small risk & underestimate large risk • Even non-human primates do this • We fear whatever is most available (availability bias) & ignore what seems mundane or familiar • This is adaptive but misleading when evaluating scientific evidence
Think Deeply, Think Well Communicating Complex Medical Information •Absolute vs. Relative Risk •Frequencies vs. Percentages •Framing & Risk Communication
Think Deeply, Think Well Would you rather…?
• Take Drug A: Reduces risk of breast cancer by 50% • Take Drug B: Reduces risk of breast cancer from 2% to 1%
Think Deeply, Think Well Choose between the following 2 treatments…
• 10% of patients undergoing treatment A experience significant complications. • 10 out of every 100 patients undergoing treatment B experience significant complications.
Think Deeply, Think Well Imagine the following scenario… There’s been an outbreak of a deadly disease in the U.S. that’s expected to kill 600 people. Two alternative programs to combat the disease have been proposed. The consequences are as follows:
• Program A: If Program A is adopted, 200 people will be saved. • Program B: If Program B is adopted, there is a one-third probability that 600 people will be saved and a two-thirds probability that no people will be saved.
Think Deeply, Think Well Imagine the following scenario…
There’s been an outbreak of a deadly disease in the U.S. that’s expected to kill 600 people. Two alternative programs to combat the disease have been proposed. The consequences are as follows:
• Program A: If Program A is adopted, 400 people will die. • Program B: If Program B is adopted, there is a one-third probability that nobody will die and a two-thirds probability that 600 people will die.
Think Deeply, Think Well How to Increase Patients’ Acceptance of Evidence • Understand their values, fears, and beliefs • Avoid mere recitation of the facts, simple or otherwise • Be versed in the psychology of science denial • Anticipate the misinformation patients may encounter & counter it immediately • Be transparent about conflicts of interest, including non- financial conflicts, and explain your strategy for working to minimize their influence
Think Deeply, Think Well Continuing Healthcare Education Topics to Improve Adherence to Evidence-Based Care • Teach providers how to recognize effects of “social pressure” from patient demands • Help providers better understand how people think about risks and benefits & how to communicate differently • Train providers to implement up-to-date methods of communicating with patients
Think Deeply, Think Well Structural Approaches
• Social benchmarking approaches • Social modeling & influence approaches • Publicize practice-based policies • Reimbursement for evidence-based counseling approaches • Serious funding of serious research on improving public trust in science
Think Deeply, Think Well Climate Change: A Threat To Human Health
• Particulate matter from fossil fuel burning worsens respiratory disease and increases death from all causes • Heat waves increase ED visits and violence • Increase in mosquito and other vector-borne diseases • Water shortages reduce food supply
Think Deeply, Think Well Climate Crisis is Misrepresented in the Press
• Approximately 97% of climate scientists concur that global warming is the result of human activity (burning fossil fuels, deforestation, and meat production) • Climate scientist “contrarians” were featured in 49% more media articles than climate scientists • False balance misleads the public about the scientific consensus Reference: Petersen AM, et al: Discrepancy in scientific authority and media visibility of climate change scientists and contrarians. Nature Communications 2019;10:3502
Think Deeply, Think Well Weaponizing the Weather
• Extreme weather used to justify positions • Heat waves “mean” climate change is real; Cold snaps mean climate change is a hoax • Immediacy bias makes people think weather and climate are the same • Weather attribution is a relatively new and complex science • About 2/3 of extreme weather is made worse or caused by human-induced climate change Reference: Schlermeir Q: Droughts, heatwaves and floods: How to tell when climate change is to blame Nature. 2018 https://www.nature.com/articles/d41586-018-05849-9
Think Deeply, Think Well Teaching Climate Change
• Pictures and stories work best • Address social groups, not just individuals • Convince teachers to teach about climate science • Instill self-efficacy and understand “eco-anxiety”
Think Deeply, Think Well How to Increase Acceptance of Evidence
Think Deeply, Think Well Behavioral Interventions for Providers
Results from 3 interventions to reduce inappropriate antibiotic resistance: • Suggested alternatives: Diagnosis of ARI triggered list of alternatives to antibiotics & streamlined options for ordering OTC & other prescriptions • Accountable justification: Physicians ordering antibiotics for ARI were prompted to enter “justification” note visible in patient’s record • Peer comparison: Email-based intervention in which lowest antibiotic prescribers were told monthly they were “top performers” and high prescribers were told they were “not top performers” with notes on their prescription practices compared to top performers in their practice
Meeker D, Linder JA, Fox CR. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices. JAMA 2016; 315(6): 562- 570. Think Deeply, Think Well Thank You!
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