How do we resist the rising tide of antiscience and pseudoscience? [Respectful Insolence]

The impetus for the creation of this blog, lo these 12+ years ago, was growing alarm at the rising tide of pseudoscience then, such as quackery, antivaccine misinformation, creationism, Holocaust denial, and many other forms of attacks on science, history, and reality itself. I had cut my teeth on deconstructing such antiscience and pseudoscience on Usenet, that vast, unfiltered, poorly organized mass of discussion forums that had been big in the 1990s but were dying by 12 years ago, having turned into a mass of spam, trolls, and incoherence. So I wanted to do my little part (and I’m under no illusion that I’m that influential) in my little way to combat what I perceived to be real problems. The biggest surprise to me is that, more then twelve years later, I’m still at it. I don’t deal with non-medical topics (like the aforementioned evolution, Holocaust denial, and general skeptical topics) so much any more, but I’m still here, and I still post nearly every day.

In 2017, however, the sorts of misinformation I set out to combat in 2004 seem downright quaint, given how much more effectively bullshit was weaponized last year than in years past. It’s basically gotten so bad that once-stodgy journals have been stung enough to see a need to chime in with articles about “What It All Means” and “How Do We Deal with This?” Just yesterday, it was the New England Journal of Medicine chiming in with an article by Lisa Rosenbaum, M.D. entitled Resisting the Suppression of Science. Make no mistake about it; the suppression of “inconvenient” science is what we as scientists and science advocates are dealing with in 2017. She begins by making an analogy that will resonate with physicians:

All doctors encounter patients who express preferences for non–evidence-based therapies — organic food for coronary disease or detox cleanses for cancer, for example. Personally, I’ve never come up with an effective response. I offer facts, and then, sensing that I’m getting nowhere, I offer more facts. I blink rapidly to avoid rolling my eyes. Eventually, I resort to the “I statements” taught in medical school: “I understand that’s what you believe,” though my body language surely gives me away. Not surprisingly, I haven’t had much success in overcoming disbelief of science. And though many physicians may approach this challenge more skillfully one on one, as a scientific community, we often seem trapped in a similar dynamic. Whether it’s the science of vaccines, climate change, or gun control, we tend to endlessly emphasize the related evidence, and when that fails, exude a collective sense of disgust.

This is actually not a bad analogy. I myself occasionally see patients like this. The most dreaded patient for me, as a breast cancer surgeon, is the woman who felt a lump a year or two ago, had a biopsy and was diagnosed with breast cancer, but, instead of choosing standard-of-care conventional science-based medicine to treat it at a time when it had a high probability of long term survival (or, more colloquially, cure), decided to go to a naturopath quack (but I repeat myself) or some other alternative medicine practitioner. A year or two (or three) later, she shows up in the surgeon’s office, with a huge, bleeding, ulcerated mass in her breast that stinks because it’s outgrown its blood supply, leading to tissue death, and because it’s been colonized or even outright infected with bacteria. Fortunately, such patients are few and far between, at least for me. (I understand from conversations with colleagues in other parts of the country that they are not so uncommon for some of my colleagues, such as those in some parts of California and, for example, Scottsdale or Sedona in Arizona, I often wonder what, if anything, anyone could have told such patients when they first presented with their cancers that might have persuaded them to accept science-based medicine.

Still, Dr. Rosenbaum seems to admit that she’s not very good at dealing with patients like this. In fact, as hard as it is to believe, I’m probably better one-on-one. Yes, I’m sarcastic as hell on the blog because I’m venting and being sarcastic is entertaining—and, more often than I would have guessed, effective. In contrast, you’ll never see me act that way dealing one-on-one with a patient. No, I don’t claim to be any sort of expert at persuading the quack-seeking cancer patient to forego elaborate placebo medicine because cancer, unlike diseases with subjective symptoms, laughs at placebo medicine, but I seem to be better able to control my body language and facial expressions better than Dr. Rosenbaum when confronted with these patients. I can even occasionally persuade one at least to consider surgery, chemotherapy, and radiation. Part of the reason, I think, is that, unlike most physicians, I am intimately familiar with pretty much all forms of cancer quackery under the sun and can deconstruct exactly why they are nonsense and drill right in to the ridiculousness of the claims. I suppose that’s one benefit of 12+ years of blogging about these topics.

But back to the issue of how to deal with the science denial running rampant now. Rosenbaum asks the question:

In the face of suppression of science, should scientists resist, or quietly proceed with their work? Resistance seems essential. That the CDC postponement prompted a coalition to form and organize an alternative meeting (see article by Hunter et al.) reminds us that resistance is as much about ensuring effective dissemination of findings as about continuing to conduct science. But it’s critical to recognize that suppressing science does not cause disbelief; rather, disbelief, particularly of science pertaining to highly politicized topics such as climate change, creates a cultural environment in which suppression of science is tolerated. So the real question is how do we resist effectively? How do we convince a skeptical public to believe in science?

Answering that question requires that we as scientists recognize that the same sorts of deeply embedded characteristics of the human psyche that lead cancer patients to pursue quackery are also the characteristics that fuel science denial. In particular, scientists and science advocates frequently assume that science denial can be remedied by just laying out the facts. It’s a common misconception. In reality, just laying out the facts, while an essential part of any campaign science denial, is not by itself enough. Not nearly. Not by a long shot. Just laying out the facts and deconstructing the nonsense behind a claim rarely work by themselves in isolation.

A huge (yuge?) part of the reason that pseudoscience resonates is because it speaks to something in people, usually a deeply ingrained part of their identity. For instance, quackery is appealing in people who value the “natural” over the “artificial” and particularly among those who distrust the institutions associated with medicine, such as the government, pharmaceutical companies, large corporations and health insurance companies, and the like. Facts alone won’t overcome that. Indeed, thanks to the phenomenon of the backfire effect, just laying out the facts can, in fact, backfire. Basically, when people are forced to confront information that conflicts with their deeply held beliefs, it often results in their holding on to those beliefs even more strongly, a phenomenon known as the backfire effect. Then there’s motivated reasoning, it is often the most intelligent people who are the best at cherry picking evidence that supports their pre-existing beliefs and refutes attacks on them.

Indeed, when it comes to persuasion, it’s often the intelligent who are the hardest to persuade:

First, we need to stop assuming that disbelief necessarily reflects a knowledge deficit and can thus be remedied by facts. When doubt is wrapped up in one’s cultural identity or powerful emotions, facts often not only fail to persuade, but may further entrench skepticism. This phenomenon, often referred to as “biased assimilation,” has been demonstrated across a range of issues, from the death penalty to climate change to vaccines.2 One study found that parents hesitant about vaccinating their children became even less inclined to vaccinate when given information debunking the myth that vaccines cause autism. Somewhat counterintuitively, this tendency does not reflect lack of intelligence; in fact, when it comes to climate science, people who demonstrate higher levels of science comprehension are actually also the most adept at dismissing evidence that challenges their beliefs. Moreover, the propensity to dismiss evidence that threatens our identity or beliefs is nonpartisan: liberals, for instance, are far more likely than conservatives to dismiss science suggesting that genetically modified foods are safe. Even within the medical community, whether we’re debating mammography screening, statins, or the credibility of a drug-company–sponsored study, our ideologies affect our assimilation of data.

Indeed, they do. It’s often intelligent, educated people who cling to pseudoscience the tightest and are the hardest to convince. Some of it is a sense of overconfidence that to which intelligent people fall prey in which they think they can master any topic by themselves, but it’s also motivated reasoning. In a way, thinking skeptically and scientifically about various topics is not natural; rather, people tend to start with beliefs and then seek out confirming information and discount disconfirming information. Basically motivated reasoning is confirmation bias on steroids, in which people confirm what they believe and ignore contradictory evidence and data—or actively seek to discredit it. Not surprisingly, educated, intelligent people tend to be better at both activities, which are key to motivated reasoning. As Hugo Mercier and Dan Sperber once put it, “Reasoning was designed by evolution to help us win arguments,” and as Chris Mooney once put it, “We apply fight-or-flight reflexes not only to predators, but to data itself.”

At times it seems like the proverbial Kobayashi Maru scenario, the no win situation. However, it helps to remember that most science doesn’t threaten deeply held beliefs undergirding identities:

This risk of adding an identity-laden valence to otherwise neutral scientific matters makes resisting science denialism in the Trump era particularly tricky. Because we pay far more attention to contested than to generally accepted science, it’s easy to forget that most scientific facts, and related policies, don’t induce tribalism. You don’t see partisan battles over treatment for myocardial infarction, say, or the dangers of radiation exposure. But as Kahan points out, Trump thrives on making nonpartisan issues polarizing. The indication that he might appoint a vaccine skeptic to head a commission to review vaccine safety is a worrisome example, since vaccine skepticism has thus far been limited to a minority, albeit vocal, fringe. “I have never seen someone so aggressively intent on just increasing the number of issues that feature that sort of antagonism,” Kahan told me. “He is our science communication environment polluter in chief.”

And that’s what we have to beware of. As I’ve pointed out before, support for vaccines and vaccine mandates has been historically bipartisan. For many decades, conservatives and liberals, Republicans and Democrats, supported vaccination, and those who didn’t were, quite rightly, viewed as being cranks, with antivaccine beliefs being largely equally prevalent on both sides. Antivaxers are still cranks, but, thanks to social media, their arguments are finding wider purchase. But what to do? One thing I agree that we should be careful not to do is this:

This constant quest for identity preservation helps explain why calling vaccine skeptics idiotic or dangerous is, as others have pointed out, likely to backfire, particularly as we face a cultural backlash against academic “elites.” It’s also why, when Trump issues an antiscience provocation over a nonpartisan subject, we should avoid being so strident in correcting misinformation that we further galvanize skepticism based on political identity alone. Even with already-polarizing topics, more measured resistance may be the most effective approach. To that end, circumspect resistance like the rallying of a coalition to relatively quietly reorganize the postponed climate-science meeting may end up being the most effective in these divisive times.

Yes, antivaccine views, for example, are also increasingly caught up in political, ideological, and cultural identity. Basically, thanks to a successful co-optation of the sorts of cultural grievances that led to the election of Donald Trump as President, increasingly the antivaccine movement has become aligned with Trump-friendly politics and the right wing. It is true that this shift in the politics of the antivaccine movement predates Trump, as over the last several years antivaxers have increasingly co-opted the language of “personal freedom,” “parental rights,” and “health freedom,” but the rise of Trump put the transition on steroids. There’s a reason why antivaxers, by and large, love Donald Trump. Even those predisposed to despise him have, for the most part, put aside their distaste to embrace him because he talks the antivaccine talk.

That being said, I’m not entirely sure that being less strident is the answer. Some things are too important. For example, reorganizing the postponed climate meeting feels like a defeat, like giving in to antiscience forces. It will be very difficult to rally the mot enthusiastic boosters of science using tactics like that. It’s also a bad example. Climate science was never truly a nonpartisan topic and has been highly politicized for at least 25 years, with business-friendly conservatives viewing the science of anthropogenic climate change and global warming as a profound threat to their world view and profits, while resonating with environmentalist-friendly liberals. So when Trump blathers his idiocy about climate science—oh dear, was that too strident?—he’s exploiting political division, not creating it. Where he Trump is really issuing antiscience provocations over a nonpartisan subjects is over vaccines, and, worse, he’s contributing to something I fear, the politicization of vaccine policy. If Trump supporters really start viewing antivaccine beliefs and distrust of vaccines as part of their identity, our children will be in serious trouble, and vaccine-preventable diseases will make horrific comeback.

What’s the answer? I don’t claim to be an expert, but I’ve always thought that a wide variety of techniques should be used, each tailored to the strengths and weaknesses of individual groups and people. Not everyone is a diplomat, for instance, and sometimes mockery works. Not everyone is a flamethrower, and calm building of alliances and finding common ground likely works even better. Jacqueline M. Vadjunec, a climate scientist who moved from Massachusetts to take a job at Oklahoma State University, the heart of Trump country, notes that her colleagues warned her that she was destroying her career because of Oklahoma’s history with anti-evolution and opposition to climate science, notes that she’s doing well, but recognizes that she’s in a minority when it comes to supporting climate science. She recommends channeling Woody Guthrie:

I realize that in my day-to-day actions in the classroom and in my research with family farmers and ranchers, I probably hold a minority viewpoint on human-induced climate change. In the classroom, I am sensitive to the fact that many of my students have family ties to the oil and gas industry. I regularly see them struggle with the local contradictions. I try to create a place of mutual respect to embrace this struggle on their own terms, while also trying to focus on our role as global citizens facing global challenges. It is not always an easy balancing act; these experiences have taught me that most students care about global environmental change, but often have little previous exposure to such issues — in part because of the decisions of local politicians and school boards. In our debriefing at the end of the semester, students often express frustration that they weren’t exposed to many of the issues surrounding climate change at a younger age.

I also learned that actively listening to (instead of talking at) farmers and ranchers who care about sustaining their land and livelihoods is a good way to open dialogue. We can then find common ground on pressing environmental issues, such as the depletion of the Ogallala Aquifer, encroachment of invasive and nuisance woody-plant species on pasture lands, and the compounding impacts of long-term cyclical drought. People in Oklahoma care about the long-term sustainability of their natural resources, but they often use language that is different from that of climate scientists and elected officials.

And:

In resisting the mood of anti-science, researchers need to reach out to a diverse public in more accessible ways. We also need to accept different ways of knowing or even talking about climate change: ways that open doors to start a conversation; ways that are more context specific, culturally sensitive and nuanced than science in general might be comfortable with.

This is not and will not be easy, but trying to find common ground is a start. After all, strategies to mitigate climate change tend to align with preserving the environment and sustainability, which many people support, at least in the abstract. No one wants disease outbreaks. We can rarely change the minds of the truly committed, but the vast middle, those “on the fence” are reachable.

I do agree with Rosenbaum that physicians are really not well trained in countering quackery, antiscience, and pseudoscience, or, as she put it “empirically and effectively navigating assaults on truth.” If there’s one good thing about Trump’s victory, it might be that we’re finally shaken out of our complacency and learn to do it right. But first we have to know what “right” is.