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A popular enlightenment
OPINION
A popular enlightenment Angry nerds and pro-science bloggers are doing a better job than scientists at defending reason. Long may it continue, says Nicoli Nattrass ALTERNATIVE medicine has never enjoyed such popularity and respect. Therapies once dubbed “pseudoscience” or “quackery” are now typically referred to as “alternative”, “complementary” or “holistic”. Practices that used to circulate on the fringes are now accepted as mainstream. The rise of alternative medicine poses a problem for defenders of science. Many see the fightback as a lost cause. I don’t. I believe that the factors that allow quackery to prosper can and are being harnessed for a counterrevolution in defence of science. In the past, those exploring alternative lifestyles joined groups of like-minded people and subscribed to countercultural magazines. They now participate in online communities and surf the internet, where they encounter alternative websites by the dozen, but also come across mainstream scientific viewpoints. The web has proved to be a crucial mobilising instrument for pro-science activists. When the British Chiropractic Association sued writer Simon Singh for libel, his supporters used Twitter and Facebook to keep abreast of the case. A community of pro-science activists and bloggers has also sprung up. Their actions are not merely intellectual. Singh’s supporters flooded the British Chiropractic Association with complaints about individual chiropractors, all of which required investigation. As British activist and physician Ben Goldacre wrote in 2009: “A ragged band of bloggers from all walks of life has, to my mind, done 26 | NewScientist | 28 April 2012
a better job of subjecting an entire challenging quackery, is industry’s claims to meaningful, important. Rather than relying public, scientific scrutiny than on scientists to defend the the media, the industry itself, and boundaries of science, we are even its own regulator. It’s strange seeing a much more socially this task has fallen to them, but embedded struggle – a popular I’m glad someone is doing it, and enlightenment project. they do it very, very well indeed.” Can such a project work? In other words, the defence of Reasserting goals of progress science is increasingly being through reason and evidence is undertaken by members of the one thing, but whether it has any public. Such defence was once effect remains an open question. conducted primarily by scholars; How easy is it to persuade people today the battle is often fought through factual corrections? at an individual level via cut-andThe answer seems to depend thrust debate in blog postings. “The defence of science This social phenomenon of is increasingly being “angry nerds” and “guerrilla bloggers”, dedicated to defending undertaken by members of the public” evidence-based medicine and
a great deal on the individual. For example, AIDS deniers are generally impervious to corrective evidence. They are impossible to argue with, and indeed it may even be counterproductive to do so. According to recent research, providing people who are ideologically committed to a particular view with incongruent information can backfire by causing them to dig their heels in and support their original argument even more strongly. This problem is a general one. A substantial body of psychological research suggests that humans tend to seek out and evaluate information that reinforces their existing views. The digital revolution has exacerbated the problem because, as journalist Farhad Manjoo writes, you can now “watch, listen to and read what you want, whenever you want; seek out and discuss, in exhaustive and insular detail, the kind of news that pleases you; and indulge your political, social or scientific theories… among people who feel exactly the same way”. I believe such pessimism goes too far, though. The boundary between mainstream and alternative knowledge may have become more permeable, but the world has yet to enter what political scientist Michael Barkun of Syracuse University in New York calls “complete epistemological pluralism”. The fact that quacks and AIDS deniers keep trying to get the imprimatur of science for their discredited ideas, by trying to publish their work in peerreviewed journals, for example,
Comment on these stories at newscientist.com/opinion
speaks to the continued public prestige and power of science. Furthermore, their support base is far from fixed in stone. Some people are so committed to unorthodox views that they cannot be moved, but they are the exception. People motivated to explore the “cultic milieu” – that fluid countercultural space in which alternative therapies and conspiracy theories flourish – are open to changing their minds. In his seminal work on the cultic milieu, sociologist Colin Campbell of York University, UK, stresses that it is not a space where firm opinions are held, but rather a “society of seekers” – people who “do not necessarily cease seeking when a revealed truth is offered to them”. This creates the space for proscience activists to compete for attention. When they do so, the internet becomes a tougher place for people to sequestrate themselves in a comfortable cocoon of the like-minded. This is good news for the enlightenment project. People may be biased in favour of interpretations that align with their prejudices but this does not mean that they just believe what they like. Faced with information of sufficient quantity or clarity, people do change their minds. So the challenge for the proscience movement is to keep an active and credible online presence. The web is an anarchic space where defence of science ranges from ridicule and banter to serious discussion about findings along with links to scientific articles and reports. It looks, in other words, like the space that used to be the preserve of the cultic milieu – but with greater informational depth. The weapons of science and reason are still very much in contention. n Nicoli Nattrass is director of the AIDS and Society Research Unit at the University of Cape Town, South Africa. Her new book is The AIDS Conspiracy: Science fights back (Columbia University Press)
One minute with...
David Healy We can all help counter the drug industry’s marketing machine, says the campaigning psychiatrist Your new book is called Pharmageddon. What does the title mean? “Pharmageddon” refers to a change in healthcare that’s rather like climate change. When we hop in our cars to go to work, this seems to be a good thing. But we don’t connect it to the fact that we may be pushing the climate towards the brink. In the same way, the climate of healthcare is being pushed towards the brink by doctors giving patients expensive and risky drugs – and failing to notice when things go wrong. Medicine as we had it will cease to exist. It will become Healthcare Inc. Why has this happened? Worldwide product patents give companies such extraordinary returns that they have got a tremendous incentive to hype the benefits of drugs and hide any possible risks. Then we made these drugs prescription-only, so the true consumers of a drug are not you and me. The consumer, from the industry’s point of view, is the doctor who prescribes the drug. Companies offer free gifts for doctors, trips to the Caribbean to meetings, and so on. But most doctors, while they probably are influenced by these things, are even more influenced by the evidence.
Profile David Healy is director of the North Wales School of Psychological Medicine, Bangor, UK. A long-standing critic of the pharmaceutical industry, his latest book is Pharmageddon (University of California Press)
So hasn’t evidence-based medicine helped? I’m an advocate of controlled trials but we have an overblown estimate of how useful they can be. Clinical trials are done mostly by the industry. Only half of the trials are published and of those that are, ghostwriters for the industry polish a negative trial so that it’s glowingly positive.
How will your new website, RxISK.org, help? The idea is to encourage people to produce the best possible descriptions of things that happened to them on treatment and to take the descriptions to their doctor, with a view to engaging him or her in the process. If we get a bunch of people who have the same issue, we’ll be able to tease things apart. We’ll be giving people feedback in real time, saying: “We’ve got 200 people who have reported the same problem.” It’s going to make lots of patients and doctors much happier to speak up.
Couldn’t these problems with clinical trials be fixed? If we had the capability to do 100 times more trials than we’re doing, if the trials were independent and we had access to all the data, then we would be much further forward. But you have to wonder how realistic that is. Controlled trials are hugely useful but they shouldn’t be the only club that you take to the golf course. We need to restore people’s ability to make judgement calls based on the evidence in front of their own eyes.
Some parents sincerely but wrongly believe vaccines caused their children’s autism. Won’t you find similar problems with false leads? Yes, of course the data is going to be dirty. It’s trying to get a process of teamwork going, as opposed to people coming up with observations and facing an industry that is in control of a body of evidence that seems to say there is no link. The more people we can pull in, the better the chance that we’re going to get it right. Interview by Peter Aldhous
28 April 2012 | NewScientist | 27
A popular enlightenment Angry nerds and pro-science bloggers are doing a better job than scientists at defending reason. Long may it continue, says Nicoli Nattrass ALTERNATIVE medicine has never enjoyed such popularity and respect. Therapies once dubbed “pseudoscience” or “quackery” are now typically referred to as “alternative”, “complementary” or “holistic”. Practices that used to circulate on the fringes are now accepted as mainstream. The rise of alternative medicine poses a problem for defenders of science. Many see the fightback as a lost cause. I don’t. I believe that the factors that allow quackery to prosper can and are being harnessed for a counterrevolution in defence of science. In the past, those exploring alternative lifestyles joined groups of like-minded people and subscribed to countercultural magazines. They now participate in online communities and surf the internet, where they encounter alternative websites by the dozen, but also come across mainstream scientific viewpoints. The web has proved to be a crucial mobilising instrument for pro-science activists. When the British Chiropractic Association sued writer Simon Singh for libel, his supporters used Twitter and Facebook to keep abreast of the case. A community of pro-science activists and bloggers has also sprung up. Their actions are not merely intellectual. Singh’s supporters flooded the British Chiropractic Association with complaints about individual chiropractors, all of which required investigation. As British activist and physician Ben Goldacre wrote in 2009: “A ragged band of bloggers from all walks of life has, to my mind, done 26 | NewScientist | 28 April 2012
a better job of subjecting an entire challenging quackery, is industry’s claims to meaningful, important. Rather than relying public, scientific scrutiny than on scientists to defend the the media, the industry itself, and boundaries of science, we are even its own regulator. It’s strange seeing a much more socially this task has fallen to them, but embedded struggle – a popular I’m glad someone is doing it, and enlightenment project. they do it very, very well indeed.” Can such a project work? In other words, the defence of Reasserting goals of progress science is increasingly being through reason and evidence is undertaken by members of the one thing, but whether it has any public. Such defence was once effect remains an open question. conducted primarily by scholars; How easy is it to persuade people today the battle is often fought through factual corrections? at an individual level via cut-andThe answer seems to depend thrust debate in blog postings. “The defence of science This social phenomenon of is increasingly being “angry nerds” and “guerrilla bloggers”, dedicated to defending undertaken by members of the public” evidence-based medicine and
a great deal on the individual. For example, AIDS deniers are generally impervious to corrective evidence. They are impossible to argue with, and indeed it may even be counterproductive to do so. According to recent research, providing people who are ideologically committed to a particular view with incongruent information can backfire by causing them to dig their heels in and support their original argument even more strongly. This problem is a general one. A substantial body of psychological research suggests that humans tend to seek out and evaluate information that reinforces their existing views. The digital revolution has exacerbated the problem because, as journalist Farhad Manjoo writes, you can now “watch, listen to and read what you want, whenever you want; seek out and discuss, in exhaustive and insular detail, the kind of news that pleases you; and indulge your political, social or scientific theories… among people who feel exactly the same way”. I believe such pessimism goes too far, though. The boundary between mainstream and alternative knowledge may have become more permeable, but the world has yet to enter what political scientist Michael Barkun of Syracuse University in New York calls “complete epistemological pluralism”. The fact that quacks and AIDS deniers keep trying to get the imprimatur of science for their discredited ideas, by trying to publish their work in peerreviewed journals, for example,
Comment on these stories at newscientist.com/opinion
speaks to the continued public prestige and power of science. Furthermore, their support base is far from fixed in stone. Some people are so committed to unorthodox views that they cannot be moved, but they are the exception. People motivated to explore the “cultic milieu” – that fluid countercultural space in which alternative therapies and conspiracy theories flourish – are open to changing their minds. In his seminal work on the cultic milieu, sociologist Colin Campbell of York University, UK, stresses that it is not a space where firm opinions are held, but rather a “society of seekers” – people who “do not necessarily cease seeking when a revealed truth is offered to them”. This creates the space for proscience activists to compete for attention. When they do so, the internet becomes a tougher place for people to sequestrate themselves in a comfortable cocoon of the like-minded. This is good news for the enlightenment project. People may be biased in favour of interpretations that align with their prejudices but this does not mean that they just believe what they like. Faced with information of sufficient quantity or clarity, people do change their minds. So the challenge for the proscience movement is to keep an active and credible online presence. The web is an anarchic space where defence of science ranges from ridicule and banter to serious discussion about findings along with links to scientific articles and reports. It looks, in other words, like the space that used to be the preserve of the cultic milieu – but with greater informational depth. The weapons of science and reason are still very much in contention. n Nicoli Nattrass is director of the AIDS and Society Research Unit at the University of Cape Town, South Africa. Her new book is The AIDS Conspiracy: Science fights back (Columbia University Press)
One minute with...
David Healy We can all help counter the drug industry’s marketing machine, says the campaigning psychiatrist Your new book is called Pharmageddon. What does the title mean? “Pharmageddon” refers to a change in healthcare that’s rather like climate change. When we hop in our cars to go to work, this seems to be a good thing. But we don’t connect it to the fact that we may be pushing the climate towards the brink. In the same way, the climate of healthcare is being pushed towards the brink by doctors giving patients expensive and risky drugs – and failing to notice when things go wrong. Medicine as we had it will cease to exist. It will become Healthcare Inc. Why has this happened? Worldwide product patents give companies such extraordinary returns that they have got a tremendous incentive to hype the benefits of drugs and hide any possible risks. Then we made these drugs prescription-only, so the true consumers of a drug are not you and me. The consumer, from the industry’s point of view, is the doctor who prescribes the drug. Companies offer free gifts for doctors, trips to the Caribbean to meetings, and so on. But most doctors, while they probably are influenced by these things, are even more influenced by the evidence.
Profile David Healy is director of the North Wales School of Psychological Medicine, Bangor, UK. A long-standing critic of the pharmaceutical industry, his latest book is Pharmageddon (University of California Press)
So hasn’t evidence-based medicine helped? I’m an advocate of controlled trials but we have an overblown estimate of how useful they can be. Clinical trials are done mostly by the industry. Only half of the trials are published and of those that are, ghostwriters for the industry polish a negative trial so that it’s glowingly positive.
How will your new website, RxISK.org, help? The idea is to encourage people to produce the best possible descriptions of things that happened to them on treatment and to take the descriptions to their doctor, with a view to engaging him or her in the process. If we get a bunch of people who have the same issue, we’ll be able to tease things apart. We’ll be giving people feedback in real time, saying: “We’ve got 200 people who have reported the same problem.” It’s going to make lots of patients and doctors much happier to speak up.
Couldn’t these problems with clinical trials be fixed? If we had the capability to do 100 times more trials than we’re doing, if the trials were independent and we had access to all the data, then we would be much further forward. But you have to wonder how realistic that is. Controlled trials are hugely useful but they shouldn’t be the only club that you take to the golf course. We need to restore people’s ability to make judgement calls based on the evidence in front of their own eyes.
Some parents sincerely but wrongly believe vaccines caused their children’s autism. Won’t you find similar problems with false leads? Yes, of course the data is going to be dirty. It’s trying to get a process of teamwork going, as opposed to people coming up with observations and facing an industry that is in control of a body of evidence that seems to say there is no link. The more people we can pull in, the better the chance that we’re going to get it right. Interview by Peter Aldhous
28 April 2012 | NewScientist | 27