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Do Scientists Understand the Public? And Does It Matter?

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Exploring these questions is relevant to all who are working to support people's engagement in their health and health care.' '  They are also relevant to the debate about the value of comparative effectiveness research.'  Science journalist Chris Mooney reports a couple of provocative points in this account of four meetings on the topic sponsored by the American Academy of Arts and Sciences over the past year.

'Scientists'are working in a 'deficit model.''  They assume that if only their fellow Americans knew about science and ceased to be in a state of knowledge deficit, a healthier relationship between science and the public would emerge.'

This perspective also describes the somewhat magical thinking that influences the efforts of well-meaning health plans, employers, Web designers and app developers to spark our engagement in our health and health care:'  The reason we eat so many cupcakes, drink so much beer and adhere so casually to recommendations about how to care for our diabetes and blood pressure must be that we simply don't have the right information. The corollary is that when given the right information, we will spring into action.

While this model is fully rational ' why, after all, wouldn't we act in our own best interest (where science-based information represents the best interests of the average person)? ' it doesn't actually seem to work that well.'  Witness the instances of overweight and smoking as you walk down the street ' and should that not convince you, there are scientific journals full of evidence showing that the model falls short of predicting behavior.

Mooney's points are also echoed in some of the discussions about conducting and disseminating comparative effectiveness research: If only we, the public (and physicians) truly understood what comparative effectiveness research is, we would support its conduct and quickly adopt its results.

I can't decide whether that line of rhetoric is just the usual mechanistic/optimistic representation of human behavior typical of policy advocates or a vast oversimplification of the complexity and nuance of this field of inquiry in deference to the lack of scientific sophistication of the public.

Regardless, Mooney's essay makes it clear that the results of comparative effectiveness research, like health information in general, will not change public attitudes or behaviors by simple injection into the news or health websites:

''there is no guarantee that increasing scientific literacy among the public would change core responses on contested scientific issues, for those responses are rarely conditioned by purely scientific considerations.'  Scientists and nonscientists often have very different perceptions of risk, different ways of bestowing trust, and different means of judging credibility of information sources.'  Moreover, members of the public strain their responses to scientific controversies through their ethics or value systems as well as through their political or ideological outlooks ' which regularly trump calm, dispassionate scientific reasoning.'

I wonder if we have the wherewithal to handle the firestorms of discontent and disagreement in store for us as we continue to peel back the layers of science, misinformation, opinion and self-interest that have created today's medical care.'  I suspect we have a rough road ahead.

More Blog Posts by Jessie Gruman

author bio

Jessie C. Gruman, PhD, was founder and president of the Center for Advancing Health from 1992 until her death in July 2014. Her experiences as a patient — having been diagnosed with five life-threatening illnesses — informed her perspective as an author, advocate and lead contributor to the Prepared Patient Blog. Her book, AfterShock, helps patients and caregivers navigate their way through the health care system following a serious or life-threatening diagnosis. The free app, AfterShock: Facing a Serious Diagnosis, offers a pocket guide based on the book. | More about Jessie Gruman


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Shoshanna Sofaer says
September 17, 2010 at 9:35 PM

Science as an enterprise is about "facts." But it also is linked to a very particular set of values, beginning with a valuing of "facts" over instinct or intuition or belief. I often tell my graduate students in public affairs that the hallmark of a scientist is that s/he is willing to be proven wrong. Embracing the notion of being vulnerable to what the facts turn out to be is another key value of science.

I think, however, that scientists are not fully aware of how driven they are by their own values, and do not therefore recognize that attempts to get people to accept science means revealing and arguing for those values. Which, like all values, cannot ultimately be proven "right" through scientific enquiry.

Jim Jaffe says
September 21, 2010 at 12:21 PM

It would be hard to find a more basic American value than that educated people can find their own way, enshrined in the phrase, "Give people light and they will find their own way." People doing well inevitably see themselves as doing good and are certain that the general public would concur if it only had more information -- whether they are physicians, parole officers or prison guards.

This is, of course, based on the assumption that there's a single set of facts and that rational people would reach a common conclusion on absorbing them. If people knew that obesity shortened life, they'd do what's required to live longer is one such argument.

Advertisers (boo, hiss) know better of course. They realize that you not only have to lead the horse to water, but also provide a straw and perhaps frequent flier points. They understand that broadcasting the fact that some people will never get lung cancer irrespective of how much they smoke is probably not a very effective way of discouraging smoking.

I wouldn't say that advertisers are always wiser than scientists, but just that they are two very endeavors. One is interested in doing a sell to change behavior while the other's more concerned with discussing a changing menu of possibilities.

mgoozner1 says
September 24, 2010 at 10:51 AM

Well, forgive me for coming a little late to this discussion. But after reading today's HealthDay news story on reasons for the decline in cancer rates, I have to ask: Where is the evidence? I'm not referring to the decline in rates, which is real, but for the claims in the story attributed to leaders of the American Cancer Society and other thought leaders in the field, who presumably are scientists or informed by a working knowledge of scientific research, that everything that any one does in the name of reducing cancer is worthwhile. One quoted source, a scientist, asserted as fact that all colon cancer can be stopped by colonoscopies. This is transparent nonsense.

Perhaps when scientists stop parading uninformed opinion as science, and journalists stop reporting those opinions, people will begin having a healthier relationship with "science." I like Chris Mooney. But he seems to believe that there is something called "scientific truth" out there that the whole world should bow down to, rather than acknowledging that science has become a contested terrain polluted by special interest pleadings. No wonder the public can't make sense of the noise.