How GPs can tackle anti-scientific thought

Doug Hendrie

26/04/2018 1:55:23 PM

In the social media age, it is easier than ever to find people who agree with you – on any topic. Flat earthers, moon landing sceptics, and conspiracies of all kinds have a new lease on life. How can GPs respond when dealing with anti-scientific thought?

It has been found that deluging people with facts may be a counterproductive approach to dealing with anti-scientific thought.
It has been found that deluging people with facts may be a counterproductive approach to dealing with anti-scientific thought.

The social media age may be leading to an uptick in scepticism of science-based medicine, particularly regarding vaccinations and a reliance on alternative, unproven health products.
From homeopathy to alternative ‘cures’ for cancer to wellness bloggers advocating dangerous diets, it can feel like the evidence-based viewpoint is under siege.
So how can GPs best respond?
The first – and most critical – action is to avoid telling people they are wrong, according to Dr Rod Lamberts, Deputy Director of the Australian National Centre for the Public Awareness of Science (CPAS).
Dr Lamberts said the common, but ineffective, deficit model of science communication is premised on the idea that if someone does not believe you, that is due to a lack of knowledge. This belief leads experts to deluge the person in facts, tackle the myths head-on or even label people who disagree as anti-vaxxers or deniers.
But does this change minds? Alas, no. The opposite in fact occurs, according to Dr Lamberts.
‘Slamming people with more facts is counterproductive. It turns people away from you,’ he told newsGP
Dr Lamberts is backed by the influential Debunking Handbook, written by two Australian cognitive psychologists in 2011 in a bid to see how best to tackle bad science. Dr John Cook and Professor Stephan Lewandowsky found that rebutting bad science with good science often backfires. That is, contradicting an unscientific belief actually strengthens the believer’s faith in the incorrect information.
That is because, the researchers found, the misinformation had become part of a believer’s mental model of how the world functions.
‘For those who are strongly fixed in their views, being confronted with counter-arguments can cause their views to be strengthened,’ they wrote.
Surgeon and public health researcher Atul Gawande describes what does work in The New Yorker.
‘Rebutting bad science may not be effective, but asserting the true facts of good science is. And including the narrative that explains them is even better,’ he wrote.
‘You don’t focus on what’s wrong with the vaccine myths, for instance. Instead, you point out: giving children vaccines has proved far safer than not. How do we know? Because of a massive body of evidence, including the fact that we’ve tried the alternate experiment before.
‘Between 1989 and 1991, vaccination among poor urban children in the US dropped. And the result was fifty-five thousand cases of measles and a hundred and twenty-three deaths.’
There is another trick, too.
Dr Lamberts said social media has given tribalism a boost.
‘We bemoan tribalism, but we all do it – the public, scientists, all of us. So, if you can identify with the tribalistic views of people, you can do better,’ he said. ‘That means using the views of people who are more representative of their tribe.’ 
It is crucial, Dr Lamberts said, to avoid oppositional talk.
‘In, say, the climate space, using the term “climate deniers” makes it into an “us vs them” [tribal] thing. Then they call people like me alarmists, and off we go,’ he said.
‘The language of understanding is really important. Anyone with evidence-based knowledge thinks, “Why don’t these people understand?” But people are swayed by stories, not evidence.’
Not every expert believes anti-scientific thinking is growing.
University of Sydney Associate Professor Julie Leask has spent two decades researching vaccine hesitancy. She says that the numbers of children vaccinated is actually increasing, and that there are only around 2% of Australians who refuse all vaccines.
‘Given the anxiety experts have about science denial, it’s ironic that it doesn’t come with a lot of evidence for the problem. Vaccination rates are mostly stable in Australia,’ she told newsGP.
Associate Professor Leask suspects what might be happening is that the ubiquity of the internet and social media mean many more people are aware of small groups questioning science. She cautions doctors and experts to avoid pejoratives, even on hot-button issues such as vaccination.
People who choose not to vaccinate are not all the same, she says.
Her research group has found there are significant differences, from alternative-lifestyle parents who reject much of modern society, to highly-vigilant parents who scrutinise every possible risk, to people who had a bad experience with the healthcare system or who know someone who had a reaction to a vaccine. There are also many parents who would vaccinate – if they could get to a clinic.
‘Are these parents anti-science? No, they’re pro-child, based on their lived experience,’ she said. ‘The best way to approach parents is to give them the opportunity to ask questions.
‘GPs are some of the best communicators in medicine. You can say, “Your child is due to receive her vaccines today, do you have some questions?”
‘Elicit all their concerns before jumping in. Avoid the “righting reflex” if someone says something you think is wrong. Find out more to start – where are they at? What brought them here? Validate them as a parent – tell them you can see they’ve thought a lot about this. And then start to share information.’
Associate Professor Leask suggests focusing most on the parents who are hesitant, not on those who are already staunchly against all vaccination.
‘If you try to debate with someone with a fixed view, they may become more entrenched in their position,’ she said.
Associate Professor Leask is working with the National Centre for Immunisation Research and Surveillance to produce a vaccine communications support package for GPs, titled ‘Sharing Knowledge About Immunisation’.

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Paul Fitz   28/04/2018 7:47:04 AM

First take your opponents position, then throw them....

Dr D Weston Allen   29/04/2018 7:09:20 AM

I tell patients how my unvaccinated friend died from tetanus at 11 from a rose thorn, and how my daughter nearly died from pertussis at 5 months because she was given only DPT in 1979.
I know John Cook personally and respect his work, but he actually contributed to bad science in his 97% consensus paper. I am one of the 97% (actually 100% of scientists) affirming anthropogenic climate change, but there is no consensus at all on how catastrophic it might be, and his paper left that point open to abuse. I have just finished a comprehensive 35page review of climate change and health and would be happy to share that with anyone who is interested in the subject.

James Best   30/04/2018 9:15:27 PM

I like to start with telling vaccine refusers / vaccine hesitant parents that the reason they are holding this position (that they are almost invariably given a hard time about) is that they love their children. It takes the heat out of the room, and they usually immediately relax, realising that I am not going to verbally abuse them. After that, I just listen, listen, listen. Eventually you can then try and build a respectful and potentially effective dialogue.

Nick Tellis   17/01/2020 5:53:24 PM

'I have just finished a comprehensive 35page review of climate change and health and would be happy to share that with anyone who is interested in the subject'

Dr D Weston Allen - love to read this, I'm at drnicktellis at gmail - thanks!