Thursday, May 1, 2014
The gravity of misinformation
The recent concentration of misleading media hooey about health has been excruciating, but the problem is perennial. I trust I needn’t make the case that you are under constant assault by distorted, contorted, titillating, and insipid headlines. This is certainly true in my domain of health and medicine; it may well be true more generally, but I tend to limit my commentary to the realm of my actual expertise. But to whatever extent the problem is universal, I am hopeful the remedies may be as well.
Pick almost any topic you like. The obesity epidemic is over; the obesity epidemic is worse than ever. Childhood obesity rates are plummeting; childhood obesity rates are stable if not rising. Saturated fat is good for us, not so bad for us, or worse for us than cigarettes. Fish oil causes prostate cancer, except that it doesn’t. Nutrient supplements are all useless, except for the ones that are useful. Vaccines cause autism, except they don’t, and not getting them leads to measles outbreaks.
While topics generally related to nutrition tend to occupy much of my time and effort, the story of hormone replacement at menopause has particular relevance to this tale. We once thought that so-called hormone replacement therapy would substantially reduce the chronic disease burden in post-menopausal women. Then, when randomized trials suggested that wasn’t so, we wound up with such hyperbolic headlines that women and their doctors tended to flee in panic from discussion of the topic. Use of hormone replacement plummeted, even for those women likely to benefit and even from those forms of hormone replacement never tarnished with negative findings in the first place. A detailed analysis colleagues and I conducted and published in the American Journal of Public Health suggests that this most recent round of distortions has resulted in the premature deaths of as many as 90,000 women over the past decade; women who would have benefited from the right form of hormone replacement but were too horrified of the topic even to consider it.
This goes beyond tossing out baby with bathwater, which is bad enough. This is mass casualty mayhem. Media distortions in the realm of health and medicine come with potentially serious consequences.
Clearly, then, for those of us not wanting to figure among the victims of this prevailing mischief, there is a need for self-defense. When it comes to media martial arts, I prefer judo to karate.
I say that as a long-time student of tae kwon do. With all forms of karate, your adversary charges at you; you charge back in defiance. Limbs are let fly. Generally, there is blood on the floor before it’s all over—theirs, yours, or everybody’s.
In the case of headlines, as bad as they often are, you can’t confront them this way or you’ll never get to the potentially useful details. So I recommend “stupid headline judo.” Judo does not oppose force; it redirects it to better ends. That suits the stupid headline scenario perfectly, where there is no direct frontal assault, just hazardous misdirection.
Before elaborating the relevant elements of judo, it’s hard to resist the obvious question: who’s to blame for this mess? It’s all the usual suspects, and one a bit unusual.
First, of course, we must meet this enemy and concede that it is once again us in our gullible multitudes. If we actually preferred illumination over titillation and directed our attention accordingly, hyperbolic headlines would go extinct. They would elicit a roll of the eyes from a population prone to common application of common sense. Would that it were us! It’s not, so let’s move on.
Second, there is the news media, for whom the means of propagating high ratings and large audiences are a poorly kept secret: comfort the afflicted, afflict the comfortable. So, if last week’s headlines provided comfort (or vice versa), this week’s will reliably provide the antidote, however the story has to be torqued to make it so.
Third, of course, there are the advertisers with stuff to sell whose revenue keeps it all spinning. They’ve got skin in the game, and will do whatever it takes to get under ours. Perpetual confusion is just collateral damage on the way to a stock split.
But ultimately, I pin it all on the 1 less usual suspect: Sir Isaac Newton. Newton encumbered us all with those pesky laws of thermodynamics, including this one: for every action, there is an equal and opposite reaction.
That’s the problem, right there. It’s not a measured and sensible reaction; it’s equal and opposite. So if last week’s news was that vaccines eradicated smallpox, this week’s news has to be that they cause autism. It’s not true; it’s just equal and opposite. And the comfortable are accordingly afflicted, and the universe remains in balance.
If last week saturated fat was killing us, this week we can’t simply say “we’re not so sure.” That’s not equal and opposite! This week we need to say: Shmear saturated fat all over yourself and you’ll live forever! You get the idea.
Whatever Sir Isaac’s good intentions, it does indeed seem that every hyperbolic headline generates a hyperbolic headline in the opposite direction at the first good opportunity. We are thus consigned to a universe where misinformation has massive momentum, nonsense begets nonsense, disillusionment prevails, and want of conviction forestalls the translation of knowledge into power.
Let’s fix this. We can’t defy the laws of thermodynamics, but they were never meant to govern our news. We can redirect these forces to more constructive ends.
I) Read headlines only to know that there is (or may be) news, not to know what the news is.
1. Headlines are designed to titillate, not educate
2. If you only read headlines, just about everything you think you know will be wrong
II) Remember there were equally credible (or incredible) headlines last week, saying the opposite
1. Just because today’s news is tomorrow’s fish wrapper doesn’t make yesterday’s opposing headlines any less reliable than today’s
2. Today’s headlines will be fish wrappers tomorrow, when new headlines come along again to refute them
III) Consider that science is incremental
1. Understanding comes with an accumulation of knowledge over time
2. The weight of evidence slowly and inexorably tilts toward truth; that is not so for any single source or study
IV) Look for patterns
1. If there is important news about a medical advance, it will become a theme in both the scientific literature and the popular media
2. If what sounded important at first does not develop into a theme, there was nothing there in the first place but misplaced optimism (or pessimism), a statistical fluke, or artful spin
V) Take it to bedrock
1. It’s bad enough when a distorted headline refers directly to a study, but in this cyberspatial age, often a blog just refers back to another blog, which in turn refers to another blog
2. At best, this cascade creates an echo chamber effect, making it seem as if multiple independent assessments support the same conclusion, when in fact each is merely a repetition of another
3. At worst, this is like that famous game of “telephone” where each repetition introduces more distortion, until by the end, the message is entirely unintelligible
4. So if the subject truly matters to you and has any potential to influence what you do, reach no conclusions until you are sure you got to bedrock, and read an assessment by someone you trust who actually reviewed the study/finding/report on which they are opining
In deference to Sir Isaac, it’s tempting to express all of this as a mathematical formula. But since what I came up with started looking too much like calculus, I’ll spare you.
We can stick with the simple expediency of judo. We can defend ourselves against the forces of silliness that confront us, and no bleeding is required. We really just need to be measured and sensible as opposed to reactionary, adept at bending information toward truth, and committed to standing our ground. Gravity should help.
David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.
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