Countering science scepticism, one patient at a time

Amanda Lyons

28/03/2019 3:37:00 PM

A GP medical writer and a science communicator discuss the ‘wicked problem’ of science scepticism and how best to tackle it.

GPs are often a key source of information.
GPs have a key role in helping to advise patients who are sceptical of preventive public health measures.

Immunisation and fluoridation of drinking water are both, according to the World Health Organization and National Health and Medical Research Council, beneficial and economically effective public health measures that have provided measurable improvements in levels of sickness, child mortality and tooth decay.
And yet thanks to the spread and increasing currency of science-sceptical narratives, the use of such measures has been challenged – and in some cases, actively eroded, with harmful results.
For GPs and other health professionals, encountering science-sceptical arguments can be difficult, although Dr Justin Coleman, GP and medical writer, has learnt to accept their presence, to a certain degree.
‘I suppose it’s part of the complex human condition which, as doctors, you do get used to, so I don’t tear my hair out,’ he told newsGP.
‘But it can be exhausting getting into arguments about it, because the scientific method of arguing is to produce factual information to try to sway the other person’s viewpoint, but that doesn’t seem to work for sub-sections of the population who believe that science is out to harm them.’
Justin-Coleman-Hero.jpgDr Justin Coleman believes GPs have a key role to play in helping to counter science-sceptical views.

Dr Rod Lamberts, Deputy Director of the Australian National Centre for the Public Awareness of Science (CPAS), understands the difficulty of such arguments. However, he cautions it is important not to be too adversarial, as this may simply alienate people. He is also careful not to use the term ‘anti-science’.
‘Usually, people who are against a particular issue that has a science-evidence backdrop are quite positive about many other things that are science-evidence based,’ he told newsGP.
‘So you get anti-vaxxers who are very pro climate action, for example – and the prevailing research shows that some of the noisiest anti-vaxxers are very highly educated, which is something people don’t expect.
‘I like to think of them as “anti-issues” – particular issues are their problem, not the generic science.’
Dr Coleman has little doubt that social media has enabled the magnification and wider spread of science-sceptical views, particularly the anti-vaccination movement.
‘The rise of the concept of, “my opinion is evidence” is also, I think, fuelled by social media – it wasn’t invented by it, but it’s magnified by it,’ he said.
Dr Lamberts said social media has also made it far easier for people to ensure they are only exposed to information that supports their pre-existing views.   
‘It’s easy for anyone to do that now, and not even deliberately; you can set your search parameters to only cover things that move in ways you approve of or agree with,’ he said.
Dr Lamberts has also found that social media has helped contribute to the construction of deeper narratives around science-sceptical stories, that help keep them alive.
‘It’s not only just that you hear one little story or you still listen to that discredited MMR [measles, mumps and rubella] Wakefield paper, but it keeps re-emerging – because what people do is they turn the science argument into some kind of conspiracy theory: “He’s being silenced”, or, “It was wrongly represented”,’ Dr Lamberts said.
Dr Coleman has found there is little point in GPs arguing on dedicated social media forums, as the participants have already made up their minds. But GPs should not feel they have to turn their backs on social media altogether.
‘There is still a place for [GPs in] social media forums like mother’s groups or community concern groups; so where there’s more of a mix of views, people are interested in that topic but don’t necessarily have a fixed belief, so a voice of doctor’s reason can still hold some sway,’ he said.
However, one-one-one encounters between patients and GPs can still prove fruitful, although Dr Coleman said it is important to know where to draw the line.
‘You at least have someone who is seeking your advice – it doesn’t mean that it’s easy, but it’s easier [than social media encounters],’ he said.
‘Of the group who sees a GP to discuss, say, fluoridation or vaccination, there still are those who will not be swayed by any amount of explanation; that is very frustrating and you just have to learn to close off the consultation and move on to something else.
‘But there is also that in-between group GPs are likely to see, such as well-meaning parents who have concerns about the health of their child and have read that something’s harmful, and if you can demonstrate to them that the good far outweighs the harm they may change their mind during that consultation, or for the next child.’
Dr Rod Lamberts advises us not to overestimate the influence of interest groups with loud voices.

Dr Lamberts also observes that it is helpful to try to understand the source of a patient’s concerns.
‘The way you characterise the opposition, so to speak, matters, particularly if you want to try and have a conversation,’ he said.
‘The anti-vaccination thing, for example, is almost invariably a mix of things like power and permission: “People are trying to tell me what to do with my children, how dare they”.
‘Some parents are genuinely scared that it will cause harm. Or they’ve had a close experience with someone, the one out of millions of children, who react poorly, and the personal upset will often trump any kind of statistical information.’
It is also important, when designing an approach to a science sceptic, to appreciate the difference between various health issues and their personal implications for patients.
‘With fluoridated water, the default position might be that water from the tap is a public good, which we have the right, as a society, to regulate. If a person has a strong objection, they can look for water from an alternative source,’ Dr Coleman said.
‘Whereas vaccination requires an individual putting a needle into a child, so it’s a different scenario.’
However, while the spread of science-sceptical thinking can seem challenging and even worrying, Dr Lamberts offers reassurance.
‘It’s easy for people that actually care about evidence to think the whole world’s gone crazy because those voices are so loud,’ he said.
‘But if you look behind how many people [those voices] actually represent and how many people they reach, they’re actually very small audiences.
‘So I think that’s a reason not to despair – don’t believe because it’s loud, it’s influential.’
Dr Coleman believes strongly in GPs’ role as important bastions against such loud voices.
‘Increasingly, our job as GPs is to sift through the reams of information out there and advise our patients as to what rings true – and I think that’s a great job, I love doing that job, and I think most GPs are very good at it,’ he said.

Anti-vaccination immunisation Public health Science scepticism vaccination Water fluoridation

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Bill Brown   30/03/2019 7:05:14 AM

What a load of self ego boosting tripe. And as for Dr Coleman saying that those of us who strongly object to Fluoridation in our water can get their water from other sources..... Well hang on a minute sunshine, we have to pay for this already fluoridated water so why on earth should we have to pay to get our safe water elsewhere? Stop putting poison in our water is the obvious answer and no amount of your science bull can argue with that.

Richard Gillard   30/03/2019 9:58:44 AM

It actually makes me sick, even reading this article. The high handed, supercilious tone of the pro fluoride / pro vaccination lobby is truly revolting.

They talk about science a lot. However, their rhetoric is not science based. They use the word "science" like a bunch of witch doctors, making it into some kind of fetish object with which to bamboozle their audience. It really is quite sickening. Many scientists talk of the dangers of fluoride. Those scientists are simply ignored!

It is not science that drives this desire to medicate the population by putting chemicals in their water and vile concoctions into their veins. It's hubris. These idiots think they have the right to enforce their hair brained schemes on the population at large, based on a "science" that is no more informed than the Roman Catholic Church was, when it threatened to torture or execute anyone who had the temerity to suggest that the earth orbited the sun.

The arrogance of these people is disgusting.

A/Prof Umberto Boffa   30/03/2019 10:24:05 AM

I don’t think science scepticism is “wicked”

I think it is quite understandable considering the climate change controversy when even NASA is under suspicion of duplicity this generation and the Y2K scam the last.

We need to work harder to convince people with trial evidence and can no longer lie on our authority, such as it now is.

Bert Boffa

Dr James Andrew Best   30/03/2019 5:27:25 PM

Looks like Justin must have done something right here to rise the ire of two anti-vax/anti-fluoride types who clearly must have there Google alert searches on to find this article in a GP magazine. Oh, the screeching sounds that come out of online echo chambers! However I am sure they are not going to convince too many GPs here. We all have had consults with this type of patient, even though most of them will usually go to the chiropractor or naturopath.
Well done on a balanced article addressing a real concern in how science is viewed by some on the fringes of society. It is important , however, as Dr Lamberts says, to not be too adversarial. It is not the 'locked and loaded' anti-vaxxer or anti-fluoride that we should be trying to convince, but more the ones who are susceptible to their messages.

Colin Varian   30/03/2019 5:45:48 PM

It seems some GPs might have ethical qualms about injecting a vaccine into a patient without consent, but have no ethical qualms about injecting a toxic fluoride, without consent, into the water supply, food, beverages, restaurants, take-away food outlets and therefore the bodies of the whole population.
Unethical Hypocrites, on Forced Fluoridation?

Paul Clein   30/03/2019 9:13:16 PM

I am a pharmacist with 44 years of professional practice. I believe in scientific methodology which is why I utterly oppose water fluoridation. (i) There are two studies I know of - one peer-reviewed - indicating an excess of osteosarcomas in young men growing up in fluoridated areas. (ii)There are no essential metabolic functions in the human body (or any other mammal as far as I know) which are mediated via fluoride - NONE. This is why nursing mothers screen fluoride out of breast milk and why the claimed fluoride "deficiency" so beloved by those promoting fluoridation does not exist. Have a look some time at the various proprietary multivitamin and mineral formulations which claim to provide the entire human range of essential vitamins and minerals in RDA quantities. None contain fluoride. (iii) I defy you to produce a single peer-reviewed study showing fluoridation reduces adult tooth loss from gum disease which causes the majority of such losses.

Joy Warren   30/03/2019 11:47:02 PM

From my point of view, it's more a case of "countering the myth-makers". Water fluoridation is a myth. It must be because when the 'fluoride stream' is analysed, it turns out that so little of the fluoride added to a community's drinking water is actually found in the saliva of the target group (disadvantaged tinty tots). Instead of there being an inflated Return on Investment claimby pro-fluoridationinsts, it turns out that 99.9% of the money spent on the fluoridating acid and the dosing equipment etc. IS WASTED. It is either lost during leakages or it goes down the drain to feed the little fishies. What a neat way of getting rid of hazardous waste at no expense to the hazardous waste producers!

Ann   31/03/2019 2:28:21 AM

The biggest fall in tooth decay is in non-fluoridated Scandinavia! Medication should be prescribed individually according to a person’s weight & health. The chemical used in water fluoridation is fluorosilicic acid - toxic waste from phosphate fertilizer factory chimney scrubbers. It's contaminated with arsenic, mercury & lead etc. Paediatrician, Philip J Landrigan, & Prof Philippe Grandjean reported in “The Lancet” that after analyzing 27 studies, they’ve classified fluoride as a "developmental neurotoxin" (nerve poison) which can harm children's IQ. Scotland has greatly cut tooth decay with its “ChildSmile” scheme where children clean their teeth properly in school. Simple, effective, safe & cheap!

George Crisp   31/03/2019 6:35:21 PM

Good article... It is a curious irony this social phenomena of the rise of stridently held anti-scientific viewpoints in an era that is quite specifically the product of scientific thinking advance ... and the enlightenment.

Is it individualism or societal fragmentation and ideological partisanship that drives this retreat to often tribal and anecdotal approach in deference to evidence and those most qualified to deliver it?

Joyce Alderson   31/03/2019 11:31:00 PM

I'm reminded of the words, "There are none so blind as those who will not see."

One would assume that a knowledgeable doctor would be hard-pressed to willingly mislead his patients, let alone actively persuade them that fluoridation and vaccination are not without their dangers. Clearly, Doctor Coleman is no student of the scientific and medical evidence that links fluoridation to brain damage and endocrine disruption. Clearly he is not concerned about the growing numbers of children made autistic and chronically sick, for life, consequence of vaccination.

Helen Gerson said, "There are only two sources of disease - deficiency and toxicity." It beggars belief that family doctors may soon be obliged to turn away from truth in order to encourage their patients to add these chemical toxins to their lives!!

Dr Eric John Drinkwater   1/04/2019 2:07:23 PM

I guess this article counts as troll bait.

Andrew Parry   1/04/2019 5:29:03 PM

Well said Paul Clein, Pharmacist!
While there may be risks associated with vaccines, there are definitely major benefits involved for society. In the case of water fluoridation however, there are no benefits. All major, large-scale, population-based studies clearly show there is no difference in caries between fluoridated and non-fluoridated areas. The early studies, on which the whole fluoridation paradigm is based, are of extremely poor quality. The York Review (2000 and 2003) and the Cochrane Review (2015) concluded there is no reliable evidence to show that fluoridation reduces caries.
All pro-fluoride studies are notoriously lacking in scientific methodology with no studies controlling for all major confounding factors. Thousands of studies show links between fluoridation and a host of health issues, including 300 studies showing the neurotoxicity of fluoride. Fluoridation is a violation of ethics.
How long will it take us to realise we have got this one seriously wrong?