I’m taking a break from tradition today, and linking to several blog posts that caught my eye for a number of reasons.
The first is from the excellent Science-based Medicine, written by David Gorsky (don’t you like how he uses his own name – no pseudonyms here! BTW you can get my details on the About page).
The whole blog is about examining the evidence for pseudoscientific claims about treatments for various health ailments, and the post I want to highlight is There must be a reason – or how we support our own false beliefs.
I echo his frustration at how ‘…being a skeptic and championing science-based medicine is just how unyielding belief in pseudscience is. Whatever realm of science in which there is pseudoscience I wander into, I find beliefs that simply will not yield to science or reason…It takes a lot of tenacity to keep going back to the well to argue the same points over and over again and refute the same nonsense you’ve refuted over and over again.’
Gorsky discusses a sociological study that uses the concept of cognitive dissonance which, as he puts it, is ‘derive[d] from the observation that people do not like to be aware when they hold contradictory beliefs’. As a result of this dissonance, people discount evidence to the contrary – in fact, actively look for evidence to support their beliefs while at the same time trying to resolve the discomfort of having contradictory evidence brought to their attention. We can call this ‘rationalisation’ and if you think you don’t do it, ask yourself how you justify any unhealthy habit, or any time you’ve failed to maintain a New Year’s Resolution!
The authors of the study Gorsky quotes describe a process called ‘Inferred justification’ that they say ‘operates as a backward chain of reasoning that justifies the favored opinion by assuming the causal evidence that would support it.’ You can see this demonstrated when you read articles where information is ‘cherry picked’ from positive, supportive publications while at the same time discounting any studies that don’t show these findings. I’m reminded of the way one colleague flourishes any paper that supports the use of interventions for low back pain while dismissing (usually on obscure methodological grounds) any research that doesn’t show positive effects.
What seems to happen is that people hold a belief, then spend energy finding reasons to support this belief. He quotes ‘motivated reasoning may be strongest when the stakes are highest.’
Food for thought when using self-reflection to review our own practice. If we hold a belief, we’re more than likely to look for confirmation than questioning our findings, which is one reason I think it’s so important not to simply self reflect, or to look within our own profession for opinion and evidence, but to look beyond and into the literature from other fields.
One of the best blogs for pointing out selective use of the literature in health has to be Bad Science, written by Ben Goldacre. As a self-confessed exercise-free zone, I jumped (well, not exactly, jumping is exercise!) for joy when I saw the headline ‘Warning: Exercise Makes You Fat’. Woohoo! I can stop feeling guilty for hating the gym! Bugger – Ben does a good job of critiquing the article published in the UK’s Sunday Telegraph, and once again shows that many pieces written by journalists are ‘cherry picked’ (or selectively quote from the literature) and more frighteningly, that people read and act on what they read in the newspaper – and why?
Well a survey quoted by Goldacre (conducted by the World Cancer Research Fund and carried out by YouGov – and available for review) concluded that half of all respondents said they thought scientists and doctors were constantly changing their minds about healthy living advice, although in reality, healthy living advice hasn’t changed at all for at least a decade (don’t smoke, do some exercise, eat more fruit and veg). And a quarter of all respondents said that because scientists keep changing their minds, you might as well eat whatever you want, because it won’t make any difference anyway.’ I’ll bet you’ve heard that before!
BTW bellydance practice and walking the dog count as exercise – so does mowing the lawns, vacuuming the house, making the bed, dancing at a nightclub but not jumping to conclusions. And beware the calories in the alcohol consumed while dancing at the nightclub.
And the final blog for today – the ever-excellent MindHacks reviews why Aaron Beck should be celebrated as an influential psychological therapist. On my theme of science being vital for health treatments, this post links to an article in The American Scholar describing how Aaron Beck applied science to the previously ‘woo’ psychotherapies of Freud and others. As the Vaughan from MindHacks says ‘changes in psychotherapy were largely driven by the persuasiveness and personalities of the leading lights rather than systematic evidence for effectiveness. – Sound familiar? Popular and persuasive people ‘selling’ their successes rather than being clear about the effect. I love the quote attributed to Freud ‘…a theory they didn’t like was bad because it was tainted by the unresolved conflicts of the author…’ In other words, the problem was with the person rather than the ideas they were putting forward.
Beck, from the very beginning of his therapy, systematically reviewed outcome, and as a result there is a large body of empirical evidence supporting CBT for the treatment of many problems. And yet there are still critics of CBT who maybe apply the sort of inferred justification I mentioned at the beginning of this post – the mix of supportive and unsupportive findings for CBT approach in chronic pain is used as justification for pursuing a cure-seeking approach. And this is despite the large body of evidence showing that using passive, cure-seeking strategies to manage a chronic problem, or even worse, failing to address the psychosocial aspects of treatment-seeking, the pain experience and disability, maintains and perpetuates distress and suffering.
Today is a 6-month follow-up day at work. It will be interesting to see the lives being lived by the people who have been participants in our three-week pain management programme. After all, the reason we do pain management (and look for the best evidence for what we do) is so that people move from being patients to being people again.