Our craving for simple solutions to complex problems, while understandable, have negative consequences and result in what essayist Charles Simic, writing in the New York Review of Books, calls the age of ignorance.
The implications of that ignorance was demonstrate in a study conducted by The University of Chicago's Prof. J. Eric Oliver. He found that 49% of respondents agreed with at least one conspiratorial theory of medicine. He asked 1,351 adults between August and September 2013 if they agreed or disagreed with these theories:
- the government prevents people from getting natural cures,
- governments knowingly give autism causing vaccines to children,
- government ignores the fact that cell phones cause cancer,
- that flouridation is a plot to dump harmful chemicals into the water supply and
- a US spy agency intentionally gave Black Americans AIDS.
He concluded that "Although it is common to disparage adherents of conspiracy theories as a delusional fringe of paranoid cranks, our data suggest that medical conspiracy theories are widely known, broadly endorsed, and highly predictive of many common health behaviors."
Another study found that nothing will convince anti-vaxxers to change their minds. Brendan Nyhan of Dartmouth College and his colleagues tested four different messages on parents in a study reported in the Journal Pediatrics. These messages were
- factual science based;
- on the risks of disease;
- on the risk of acquiring disease from someone not vaccinated and
- pictures of the worst impact of measles.
None of these scenarios increased parental intent to vaccinate.
And, not only do we crave simple explanations but we are often influenced by celebrities or those who may have their own agenda. Researchers at McMaster University in Hamilton, Ontario suggest that we listen to celebrities because of a herding instinct. This is the tendency to make decisions based based both on what others have done in similar situations and the halo effect which gives celebrities an aura of trust extending beyond their expertise.
Steven Hoffman, the author of that study, told a recent public panel that listening to Jenny McCarthy (the anti-vaccine proponent) and Dr. Oz is bad for your health.
Journalists also unfortunately sometimes contribute to the age of ignorance as I said in an earlier blog.
A current example is a recent CBC interview with journalist Robert Whitaker -- a critic of modern psychiatry and, while he plays lip service to the need for medication, is mostly against it.
I was astounded that the CBC considered his opinions on research and treatment as expert. My colleague, Susan Inman, has already commented but it is so important that some of his assertions be challenged. Whitaker refers to the STAR-D trial on the efficacy of anti-depressants and tells the audience that only about 3 per cent of the participants achieved remittance from their symptoms and stayed well. That was Whitaker's analysis.
There is considerable scientific debate surrounding this study and that is the way of science. It is also how science advances. This study found that a significant proportion of people did well but you can read about it for yourself.
No one was interviewed with Whitaker to refute him or to provide another perspective but, Dr Ronald Pies, a prominent psychiatrist at two US universities wrote to Enright to say that he was misquoted by Whitaker. Ms Inman posted it as a comment to her article. He said that anti-depressants do work and that "The claim that antidepressants or antipsychotic agents make mental illness worse in the long term has never been substantiated in carefully controlled studies."
One of the concepts that Mr Whitaker always stresses is that people with schizophrenia do better in the long run without drugs than while on and quotes a study out of the Netherlands by Dr Lex Wunderink. First off, this study was on people with first episode psychosis and not schizophrenia. A number of young people do develop psychotic symptoms but it has long been known that a significant number of them will only have one episode and not go on to full blown schizophrenia.
A Swedish study reported last year on close to 2000 males who were admitted to hospital with psychosis. One third of them neither received nor needed further treatment or diagnosis. The Wunderink study found that after seven years, those who had their doses reduced or discontinued did better than those who did not. This is interesting and requires more investigation but there were two caveats provided by the author that Whitaker does not relay when he describes the results.
The author does state that "Additional studies are necessary before these results are incorporated into general practice." He also points out that:
As noted, approximately half the eligible patients with FEP (First Episode Psychosis) were not willing to participate. Compared with participants, these nonparticipants differed in showing a lower level of functioning, being less adherent to therapy, and being more difficult to engage. In the present study, one could say "the best half" of the FEP patients presenting in clinical practice was evaluated.
So, one third would likely have gotten better anyway based on the natural course of the disease and the results might not have been as good if those who were less well at the beginning had been included.
In his book, Denialism, Michael Specter states that "it's never hard to build a case with a partial quote; denialists do it every day, relying on fragmentary evidence and facts taken out of context".
Sound bites just do not cut it when dealing with complex scientific and medical facts.
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