On another of my Washington DC adventures (made possible thanks to the Adam J Berry Memorial Fund Award to visit the NIH), I visited the National Academy of Sciences to hear Atul Gwande give the keynote lecture for the Science of Science Communication colloqium. Around 3 years ago I won a commendation for a pitch I gave (an awful memory now, thinking of what I pitched) but the prize was 4 of Atul Gwande’s books. They sat upon my shelf for some time until one day I opened his book ‘Being Mortal: Medicine and What Matters in the End’ and I have been in awe of him ever since.
Not only is Atul Gwande a best-selling author, he is an accomplished surgeon, a Rhodes Scholar and a recipient of a MacArthur Fellow ‘Genius Grant’ (are you in awe yet?). His undergraduate degree was in both biology and political science, and this pattern seems to continue throughout his life as an advocate for best practice healthcare and the policy that surrounds this. Everything about his experience and his personality make him an esteemed voice when it comes to how to communicate medicine, and science, to the general public.
I’ve been to a lot of talks and workshops on science communication, and they normally have the same key problems: they use the talk to condemn the seemingly reprehensible ‘general public’ for not understanding science or its importance, and/or they use the talk to list all of the ridiculous public misconceptions around science without providing any constructive advice or examples of how this can be overcome. This was, to the best of my memory, the first talk on science communication that didn’t fall into these traps.
As you are most likely aware, a small portion of the population have begun to refrain from vaccinating their children with a major reason being the belief that vaccinations may cause autism. This belief stems from a study published by Andrew Wakefield that indicated that a preservative in the MMR vaccine was linked to autism spectrum disorders. This study was retracted after it was discovered he had broken several ethical codes, including having manipulated the evidence. This was an incredibly damaging study, even though there have been a large number of studies published since to confirm there is no link between vaccines and autism. Part of the reason for the perpetuation of this myth is the perceived causation from anecdotal evidence, e.g. ‘well I don’t know what to tell you, my child had a vaccination one day, and the next week starting showing signs of autism’. This is such a classic example of how correlation does not equal causation. The first signs of autism appear in the first 1-2 years of life, when the child is receiving vaccinations every 2-3 months. The likelihood that a child would develop symptoms in the time following a vaccination would therefore be common. Perhaps akin to saying, ‘it rained in the time following my child’s vaccination, therefore vaccinations cause rain’.
Anti-vaxxers (those against vaccination) are the people I will exclusively argue with on social media comment chains. Flat earthers and conspiracy theorists, go for your life. The only ones that are truly dangerous to me, as a person who is immune deficient, are the anti-vaxxers. The rise of anti-vaxxers is a commonly used example in science communication workshops, and the advice i’ve always heard is to use the science communicated clearly. I have never seen this work. For every comment showing no causal link between vaccines and autism, there seems to be an angry antivaxxer response that includes a nonsense meme with an unreferenced statistic. Atul Gwande gave us a powerful way to respond to antivaxxers, a case study that showed what happened when vaccines were take away. In the United States between 1989 and 1991, the funding for vaccination subsidies was slashed resulting in a massive drop in public sector vaccinations. When this happened, there was a huge outbreak of the measles and resulted in 166 measles related deaths, particularly in the areas with low immunisation rates. He told us to use case studies, because if you can not convince antivaxxers there is no link between autism and vaccines, then at least show what happens when vaccines are taken away. By doing this, people can see that their actions have consequences when herd immunity is weakened.
A remarkable skill of Atul’s was to observe the reasons why a human might react to certain information adversely. The main reason people can not be swayed from believing vaccines cause autism is of course because they are scared. They have every right to be scared, scientists are inherently out to prove themselves and everyone else wrong. It’s how we test hypotheses, and we are wrong ALL THE TIME. When Atul was a young surgeon, he would prescribe a week worth of opioid medication to a patient following an elective surgery. He remembers some patients being hesitant to take it, as they may become addicted. He admits to reassuring them that becoming addicted to opioids was incredibly rare, and that they needed them for recovery. That was exactly what the literature showed at the time. Now, we know that in the United States when people are prescribed a 7-day course of opioid medication, that around 8% of those people will be still taking it a year later. Now, we live in the opioid epidemic. We were wrong.
‘Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength.’ – Atul Gwande
The fear that drives the mistrust of science is also driven by our online presence, we live in the age of Dr Google. I have actually seen people posting their symptoms on Facebook, asking for medical advice from the general population. This isn’t to say that these people are any less educated, some of Atul’s most skeptical patients are those that are highly educated and have been exposed to science. It is hard to convince these people to undertake a task considered to be painful now, for gain later on. For example, surgery while cancer is in Stage 1, to avoid it spreading. Skeptical patients are individualistic and idealogical, they know enough to understand the possibilities of science but are unable to evaluate their situation objectively. They are scared. One of Atul’s patients was a surgeon himself, he refused surgery of his Stage 1 cancer, and wanted to monitor the cancer to decide on surgery later on. It quickly progressed to Stage 4 and unfortunately the patient died.
The reluctance to do something hard or painful now, for gain later on is not limited to the field of medicine. It is happening now, as we start to face the stark reality of climate change. It is undoubtable scary, and I can understand why people want to believe that the science is wrong. I really can. I want it to be wrong too. At this stage, it is clear that man-made climate change is real and we need to be ready to rise to the challenge to reverse the damage we have made. Getting in front of the problem in this case is very difficult, intervention is required on a global scale and for this reason, incredibly expensive and the diplomatic process slow. I find it almost humorous looking at proposed solutions to climate change because unlike clinical trials, it is very difficult to iterate.
It has progressed beyond the point were we are fighting against the mistrust of science. We must ensure to approach science, with scientific method. Maintain healthy skepticism. Be imaginative, but remain realistic. Be outspoken, but remain empathetic. We will continue the battle for what it means to be scientists, but we must also start to fight for what it means to be citizens of our planet.