Since the presidential election, the whole nation has been talking about fake news and Donald Trump’s loose relationship with the truth. But in the health world, we’ve been dealing with a “post-truth” era for awhile.
Food companies exaggerate the healthfulness of their products, consumers spend billions on nutritional supplements that are little more than placebos, and in more troubling cases, we’re seeing the resurgence of preventable diseases like measles in places where vaccination rates are declining because of anti-vaxxer conspiracy beliefs with little relation to scientific fact. So since the election, I’ve been wondering: Is there a link between decades of health misinformation and the current “post-truth” crisis?
And a crisis it is, on both fronts.
In many ways, the health world is one in which facts don’t matter, experts are suspect, and relativistic approaches to testable phenomena are widely accepted. Now imagine the same wishy-washiness creeping into the realms of foreign policy, economics, and even national security. It’s already happening. And a world in which the man with the nuclear codes takes a similar approach to the truth as David Wolfe or Gwyneth Paltrow is a scary world indeed.
Earlier this month, Doubleday published If Our Bodies Could Talk by James Hamblin, M.D., a senior editor at The Atlantic. The book reads sort of like an FAQ section of a how-to manual for the human body, but it’s much more funny and engaging than any manual. In the prologue, Hamblin discusses agnotology—a term coined by Stanford professor Robert Proctor for the study of the active cultivation of ignorance. It turns out to be an especially timely read for our current political climate.
The sowing of ignorance and doubt has been going on in the health and science realms for decades. “The classic example of purposeful ignorance is that created by the tobacco industry,” Hamblin writes. “Ever since tobacco was clearly proven to cause lung cancer in the 1960s, the industry has attempted to cultivate doubt in science itself. It cannot refute the facts of cigarettes, so it turned public opinion against knowledge. Can anything really be known?”
In other words, “there’s this idea that you don’t need to really refute an argument, all you need to do is perpetuate the notion that there’s no real truth, or that if there’s a truth it’s really unknowable, and that there are two sides to every argument,” Hamblin told me over the phone.
“We’ve seen it just recently with the Russian hacking of the election,” he added. “You have the CIA and the FBI and the director of National Intelligence saying that this happened, and then you have Reince Preibus saying, ‘We don’t know.’ Therefore it sounds like you have valid discussion with two sides, and every point is equivalent. And that’s just not the case.”
Of course, dishonesty in politics is as old as time, but at least in politics there’s a sense that we’re all in on the joke. The problem in the health world is just how mainstream and accepted so much of the nonsense is. Timothy Caulfield is a professor of health law and policy at the University of Alberta and author of the book Is Gwyneth Paltrow Wrong about Everything? He thinks about pseudoscience in health a lot.
“The post-truth ethos has been around in health for a really long time,” he told me. “I’ve found it incredibly frustrating there, so when I see it seeping into other areas, it’s very recognizable. You say, ‘Well this is what the science says about detoxing, about vaccination, about homeopathy,’ and the response is, ‘You need to be more open-minded, that’s just one worldview, science is just one way of looking at things, etc…’ It erodes critical thinking and sort of invites this ‘all knowledge is relative’ way of looking at the universe, which in a liberal democracy I think is really problematic,” he said. “I hope we recognize that not all forms of knowledge creation are equal, and that science matters.”
But for some, science matters only depending on the topic or context.
Caulfield explained: “You can have someone say, ‘I can’t believe that person does not believe in climate change,’ then turn around and say, ‘I don’t believe GMOs are safe.’ Even though the scientific consensus is probably as clear with GMOs as it is with climate change.”
One of the problems with the health information landscape is that so much of it is shaped by people trying to sell you something, whether it’s a supplement, or a magazine or a TV show. But confusion about health is also exacerbated by poor reporting. Health News Review is an organization that uses 10 criteria to analyze the quality of news stories covering health. Criteria include whether stories adequately cover costs, benefits, and risks of treatments, or whether the writer seems to be able to critically evaluate the evidence. Based on these, HNR assigns stories a 5-star rating. The average rating of all the stories analyzed so far—2305 of them, is 3.09 stars.
I called Gary Schweitzer, who heads HNR, to ask him if the poor information environment in the health world could have helped pave the way for the erosion of trust in other areas.
“If we can allow pseudoscientific claims to confuse us and to maybe be given as much weight or attention or legitimacy as some truly valid scientific pursuits, that’s a very troubling thought. Does that start to then raise questions about all knowledgeable authority? Well, yeah, I think that it can, because science is supposed to be the endless pursuit of truth, following the rigorous scientific method. If that can be conveyed to the public as being filled with holes like Swiss cheese, and up for debate, that’s going to have an impact. I think we probably saw that in this last election cycle,” he said.
Science is not perfect. Journalism is not perfect. But the job of both is to get us closer to the truth, and both have built-in self-correcting systems. When the results of an experiment cannot be replicated, or if data seem suspect, that paper can be retracted, and/or other studies can refute the findings (read: no, the MMR vaccine does not cause autism). If a news outlet publishes a story based on a single questionable source, and gets something wrong, you can bet other outlets will be all over it, or it may even face legal consequences (read: Rolling Stone made a pretty bad mistake). So yes, missteps happen, and can cause serious damage along the way, but through good science and good journalism, we’re inching, however imperfectly, toward the Truth.
Unfortunately those missteps often get more attention, a fact that Britt Marie Hermes is intimately familiar with. A bad experience with a doctor as a teen pushed her to pursue a career in naturopathic medicine. But today she exposes naturopathy as neither safe nor effective as a contributor to Forbes and also on her site “Naturopathic Diaries—confessions of a former naturopathic doctor.”
“When a doctor does something bad, it makes headlines because it’s interesting, but it also makes headlines because it doesn’t happen that often,” she told me. “I like to remind people that statistically speaking, if you go to a medical doctor, you’re most likely going to get appropriate care that follows a professional standard that is based on evidence and the best understanding of the health information at that time. If you go to a naturopath or an alternative practitioner you are most likely going to get care that falls in line with the current trend of the moment.
“So you might be told to eliminate gluten, or to do a detox, or to drink lemon juice mixed with maple syrup because that’s what Tyra Banks was talking about. Yes, medicine has problems but just because there’s a medical doctor who does a bad thing doesn’t mean that the next best option is to listen to someone who didn’t go to medical school,” she said.
The same thing could be said about journalism, or expertise in general. Yes, mainstream science, mainstream media, mainstream medicine, etc., have their problems. But the alternative is a place where the keepers of reality are simply those with the biggest, most expensive megaphones, or Twitter accounts. Or militaries.
We could very well end up in a world in which the truth seems to be unknowable—whether that truth has to do with the “super-qualities” of green coffee beans, or with informing us about how to deal with autocratic nuclear powers. This is a world that folks like Gwyneth Paltrow, David Wolfe, and even Dr. Oz helped to build. I just wonder how much they’ll like it.