Denialism

As someone who communicates science for a living, I frequently struggle to understand the widespread distrust of scientific evidence in public and private decisions. I was looking forward to some enlightenment in The New Yorker writer Michael Specter's new book, Denialism: How Irrational Thinking Hinders Scientific Progress, Harms the Planet, and Threatens Our Lives.

I was disappointed. The book scarcely addresses the origins of denialism, or even, as the subtitle advertises, its consequences. Instead, it reads as a cobbled-together series of feature articles, all too long to be called vignettes. The pieces are mostly interesting, well researched and well written, but they include a lot of background material that is peripheral to denialism. As to where the attitude comes from, Specter offers only speculation.

Specter is unlikely to make many converts to "rational thinking," since he frequently comes across as a cheerleader for progress, even as he acknowledges its risks and uncertainties. For example, near the close of his 21-page introduction, he shares a letter from a New Yorker reader: "…the question remains, will this generation of scientists be labeled the great minds of the amazing genetic-engineering era, or the most irresponsible scientists in the history of the world? With the present posture of the scientific community, my money, unfortunately, is on the latter." I regard this is a valid question, but Specter dismisses it: "Those words might as well have been torn from a denialist instruction manual: change is dangerous; authorities are not to be trusted; the present 'posture' of the scientific community has to be one of collusion and conspiracy." He doesn't seem to allow for reckless overconfidence.

Specter doesn't address climate change, which is the only big issue where denialism (as opposed to progress) threatens to "harm the planet." Cynics will note that it's also the issue where denialism promotes corporate interests, rather than opposing them. But the various chapters cover a wide range of topics.

In Vioxx and the Fear of Science, Specter reviews Merck's coverup of the heart risks of their pain medication, Vioxx. This sorry episode has been discussed elsewhere, for example in Melody Peterson's Our Daily Meds, but on its face it has little to do with irrational denial. In fact, in this case, distrust of pharmaceutical companies and the FDA are quite well founded. But in the final section of the chapter that reads like an afterthought, Specter blames much of the public's disregard for scientific evidence such betrayals of trust, although he gives little evidence for this connection.

Specter also uses the Vioxx case to illustrate a common problem: undue attention to acute harms rather than small, distributed benefits. He even argues that the thousands of deaths from Vioxx might have been a reasonable price to pay for its pain relief benefits to millions. Such weaknesses in risk assessment certainly skew many policy and private decisions. But our oft-lamented poor balancing of accepted risks and benefits strikes me as somewhat distinct from denialism, in which scientific evidence for benefit or harm is dismissed entirely.

Both denialism and poor weighing of pros and cons also come to play into the second chapter, Vaccines and the Great Denial. Specter makes it clear there is virtually no science supporting the anti-vaccine movement, and documents the highly misleading selective quotation of a government report in Robert Kennedy's famous Rolling Stone story. This is an easy case to make, but he does it convincingly.

In The Organic Fetish, Specter combines two distinct food-related issues. He shows convincingly that the benefits of "organic" foods are less clear-cut than advocates would like to believe, although I prefer Michael Pollan's wonderful book, The omnivore's dilemma: a natural history of four meals. But Specter's denialism them lets him zig-zag erratically between organic and genetically modified (GM) foods. He compelling despairs over African nations' rejecting GM foods for their starving populations, but he is too willing to accept the standard, long disproven reassurances about the limited spread of modified foods. Still, Specter resoundingly dispels the mythical distinction between modern modifications and those that have been accepted for decades or millennia.

Specter's chapter on food supplements and alternative medicine, The Era of Echinacea, also has an easy target, although he notably includes multivitamin supplements among the snake oils. But again, his discussion lacks a clear explanation of why many people trust these uncontrolled additives more than they do the tightly-regulated products of the pharmaceutical industry.

Race and the Language of Life combines two disparate topics. Specter's discussion of the complex role of genetics in disease is impressively thorough and accurate, and he gives it a human touch with his own genetic testing. But he also invokes the importance of genetics to support the use of race in medicine. Although Specter is no doubt correct that race is often avoided for political reasons, there is a legitimate scientific question that he fails to clarify: how much of the genetic variation in medical response can be explained with traditional notions of race? If within-group variation is large and the differences between groups are largely statistical, the divisive introduction of race may bring little benefit. The messy story behind the heart drug BiDil, approved by the FDA for African Americans, for example, makes it unconvincing as his poster child for race-based medicine.

Surfing the Exponential delves into the nascent field of synthetic biology, covering much the same ground as Specter's recent story in The New Yorker. This chapter is rich in technical detail on the promise of the technology, and to a lesser degree with the risks of making new, self-replicating life forms. Ultimately, though, Specter advocates "a new and genuinely natural environmental movement--one that doesn't fear what science can accomplish, but only what we might do to prevent it."

Such denialism is no more defensible for assessing risks than for judging benefits--both should to be analyzed thoroughly. Fear of the unknown is not always irrational.

Blogstorm Warning: SuperFreakonomics

Is all publicity good publicity? Stephen Dubner and Steven Levitt, the authors of the bestselling book Freakonomics and the like-named blog, may find out. I, for one, have shelved any inclination to buy their new book, SuperFreakonomics: Global Cooling, Patriotic Prostitutes, and Why Suicide Bombers Should Buy Life Insurance, after seeing the blogosphere's reaction to its climate-change chapter.

The battle was joined in this post by the vocal climate-change activist (and fellow MIT physics PhD) Joe Romm. Romm followed up here, here, here, and here, giving some credence to the idea that he has an axe to grind. But in light of the wide audience the book is likely to get, a preemptive takedown might be justified.

Among Romm's claims is that the Steves misrepresent the views of Ken Caldeira, the Stanford ecologist who has been promoting research into geoengineering approaches to global warming. Romm quotes the book as saying of Caldeira, "his research tells him that carbon dioxide is not the right villain in this fight." Meanwhile, Caldeira's web page prominently features this statement: "Carbon dioxide is the right villain," says Caldeira, "insofar as inanimate objects can be villains." Sounds pretty clear.

Romm may not be entirely clean, though. Dubner claims that Romm goaded Caldeira into disavowing the book's characterization. Roger Pielke Jr., who has had his own battles with Romm, regards him as a liar. It does look as though Romm may have compromised his credibility, although his latest post makes a good defense.

But even if Romm made mistakes, it doesn't make those in SuperFreakonomics any more excusable. It is simply disingenuous to claim, as Dubner does, that the "Global Cooling" in the subtitle is supposed to refer to geoengineering solutions, not to the canard that there was a scientific consensus in the 1970s that climate was in danger of cooling. As painstakingly tabulated by Brad DeLong, this is just one of a whole host of misleading or mistaken statements in the book. Paul Krugman also takes issue with the Steves' take on a particular economics case for early action.

Krugman sums up the problem with Freakonomics' trademark contrarianism:

Clever snark like this can get you a long way in career terms — but the trick is knowing when to stop. It's one thing to do this on relatively inconsequential media or cultural issues. But if you're going to get into issues that are both important and the subject of serious study, like the fate of the planet, you'd better be very careful not to stray over the line between being counterintuitive and being just plain, unforgivably wrong.

Truth or Beauty?

How do scientists screw up in reaching the public? That's the theme of the new book, Don't Be Such a Scientist: Talking Substance in an Age of Style (which came out right away in paperback). Read it.

The author, Randy Olson, knows both sides. He resigned a tenured professorship at the University of New Hampshire in the early 90s to start over as a filmmaker, most notably making Flock of Dodos and Sizzle. But the impact of these movies, Olson says, comes from bypassing the "head"--the cerebral target of most documentaries--and aiming instead for lower organs: the heart, the gut, and perhaps even the naughty bits. Instead of being "about" intelligent design and global warming, respectively, they illuminate these topics obliquely through a more human story line.

Olson doesn't dismiss the power of the science, and even admits that he's known among friends for his negative, skeptical, and even boring demeanor. But reaching a wider audience needs a more visceral appeal. Olson's self-deprecating humor makes it easy for nerds like me to recognize how our analytical habits of thought and speech can turn people off. But in the end he appeals to scientists to heed their own "voice," while becoming more "bilingual" by learning additional ways to first engage people in order to inform them.

Chris Mooney and Sheril Kirshenbaum's Unscientific America: How Scientific Illiteracy Threatens Our Future addressed some of the same issues of communicating science. For example, both books extol Carl Sagan as a master communicator who suffered for it professionally. But Unscientific America's more academic approach ultimately left me disappointed, with its bland recommendation that more scientists should reach out to the public, and be rewarded for it. Don't Be Such a Scientist gives a much more satisfying vision of how to get there, on a personal level. But it also shows what makes it hard.

One of the big challenges is the conflict between "accuracy" and "boredom," which Olson likens to the tradeoff between false positives and false negatives in a classification task. For example, you can't catch every instance of disease without mistakenly diagnosing some healthy people. By temperament and training, scientists regard accuracy as paramount, even at the cost of some boredom. Effective communication, he says, requires a different balance, which scientists will have to learn to live with.

No doubt this tradeoff exists, and it's important to recognize it. But this part of the book struck me as a bit of a copout, because--with effort--you can change the terms of the tradeoff. For example, an improved medical test can significantly reduce both the false positives and false negatives. The idea that compelling communication requires sacrificing accuracy is a red herring, one that fueled a huge amount of discussion in the blogosphere a year or two ago around the issue of "framing" (which I will not get into here).

It would be more useful to address the specific issues of how accuracy and boredom conflict in particular cases, and tricks to sidestep each conflict. Olson doesn't get into this level of detail, taking it for granted that a movie about global warming, for example, must make factual errors if it is to reach a wide audience.

I'm sure the challenge in movie-based storytelling is much harder than in what I do, which is writing for an audience that's already somewhat scientifically engaged. Still, much of my writing time is aimed at changing the terms of the accuracy/readability tradeoff. It takes a lot of work, but it's a major part of the art of scientific communication.

Of course, there's still a limit to how far you can take this, and in the end there will still be a tradeoff. Olson is right that sacrificing absolute accuracy sometimes makes it possible to communicate a larger truth, and do it in a way that people engage with and remember.

The Healing of America

In honor of the constructive and collegial discussion of health-care reform going on in our nation's capital, I've just finished reading Washington Post correspondent T.R. Reid's new book, The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care. I first heard about it in a great interview on NPR's Fresh Air.

This highly readable book illustrates with brutal clarity how out of step the U.S. is with other advanced nations. At the same time, Reid shows that we have several proven ways to simultaneously improve the accessibility of health care and reduce its cost--if we are willing to look outside our borders for guidance.

Reid divides the world's health systems into four types, noting that different groups in the U.S. already experience each one:

• The systems that most resemble the widely reviled "socialized medicine" follow the "Beveridge model" of the National Health Service in the U.K.: the government runs both delivery and payment. The Veteran's Administration in the U.S. is similar.
  
• In Canada, a government-run single payer (actually one for each province) pays private practitioners. The U.S. Medicare system follows this model.
  
• The "Bismarck model" used in Germany and many other European countries, as well as Japan, requires everyone to get insurance from mostly private providers, generally with partial payment from employers, and most providers are also private. This is similar to the coverage many employed U.S. citizens get, but the insurers are non-profit and are required to take everyone and the fees for treatment are generally negotiated at the national level.
  
• The "out-of-pocket" model is common in developing countries, where people get whatever care they can afford--and many get nothing. Millions of Americans get the same treatment.
  

Reid doesn't dismiss the downsides to the different approaches-- restricted options in the U.K, long waits for elective procedures in Canada, and merely middle-class pay for doctors in most countries. But at the same time, he notes that patients in these other countries are often completely free to choose their doctors--in contrast with the restrictive insurance-company networks in this country. And all of these countries have significantly lower costs, often half of per-capita costs in the U.S, partly because they spend much less on paperwork.

All the rich countries of the world have opted for universal coverage--except the U.S. For Reid, this moral question should be addressed first: "is access to health care is a basic right?" Or is it acceptable that tens of thousands of Americans die each year for lack of insurance? He thinks that trying to sell reform on cost alone, as the Clintons did in 1994, is misguided.

Nonetheless, Reid clearly expects that bringing everyone into a single plan will provide the joint sense of purpose and the negotiating leverage to reduce costs. Like waiting in line at the grocery store, it's a lot easier to accept limits if everyone is treated equally. Currently, even though the U.S. spends more than anyone on health care, it falls far short on measures such as life expectancy or infant mortality. We're not getting what we pay for.

Who Will Personalize Medicine?

There's a lot of excitement in the biomedical community about the potential for "personalized medicine"--the tailoring of a patient's treatment to reflect his or her individual biology. The best known prospect is selecting between drug or dosing alternatives based on a DNA tests that may predict how a person will respond, but there are other ways to improve individual outcomes as well. There have been a few specific commercial drugs with genetic tests so far, notably erbitux and warfarin, with mixed results. Nonetheless, I have no doubt that the researchers are sincere in their hopes for improved treatment.

Unfortunately, the history of the pharmaceutical industry offers less basis for optimism. I've been reading the disturbing book Our Daily Meds, by former New York Times reporter Melody Peterson (Amazon, B&N). This is just one of several recent books documenting the cynical manipulation of the prescription-drug process by Big Pharma in service of their own profits. The list of manipulation techniques is long, including inventing new diseases to be treated by their newest drugs, evading requirements for full disclosure of side effects by advertising by hiring celebrity promoters and funding patient groups focused on individual diseases, flooding the scientific literature with ghost-written articles that favor their drug, encouraging prescriptions for off-label uses, creation and marketing of useless "me too" drugs, and much more.

The take-home message is that the pharmaceutical companies rarely limit their sales to patients who would truly benefit from them, which is what personalized medicine really requires. In fact, the companies have taken many opportunities to extend their drugs to diseases in which studies have shown little benefit, to downplay or deny side effects, and to open their markets to include new. unstudied populations. They also tolerate the fact that many recipients don't benefit from the drug they pay for.

Personalized medicine would demand the opposite, shrinking the market for each drug to those who actually respond. At the same time, the complexity and expense of clinical trials that subdivide the patients into subgroups will be much higher. It seems unrealistic to expect our current commercial and regulatory system to rise to this challenge without some major changes.