Don’t get frustrated, get involved, say Peter Brindley and Matt Morgan
Recently, Simon Stevens, the NHS chief executive, criticised celebrities and wellness companies for promoting unproven and potentially harmful therapies. He spoke about the impact of fake health news and criticised Gwyneth Paltrow’s company, GOOP. Because Paltrow has previously gone as far as to claim that women are so “unclean” that they should vaginally insert a jade egg, we understand if clinicians and scientists feel tempted to throw up their arms and give in. However, rather than despairing about the apparent elasticity of inelastic facts, we are issuing a rallying call: it’s time to fight back. It’s time to be super heroes for scientific truth.
Step one is to engage the public and stat. Get out there and mingle because grumbling at conferences surrounded by like-minded others will not save the day. This is why medical caped-crusaders such as US obstetrician Jennifer Gunter deserve high praise. She started the popular podcast “Jensplaining” and wrote the Vagina Bible. Her noble, simple, and profound goal is to empower the average person/patient. Ask yourself, is there anything that matters more? Others have initiated a “Pint of Science”, where scientists communicate their ideas with the public in pubs, cafés, and anywhere else where people will listen. Another strategy is for our universities (and professional societies) to support more professorships (and sabbaticals) that focus on the public understanding of science. The point is that public opinion matters, not just published opinion.
After publication, the average scientific paper is read by just 10 people, and half are not read at all; not even by the author’s mum. Accordingly, we need to spread the truth more than ever. Brandolini’s law states that: The amount of energy needed to refute nonsense is an order of magnitude bigger than to produce it. Hyperbole aside, we are facing something of a culture war. A century ago, Mark Twain argued that “a lie travels around the globe while the truth is putting on its shoes”. Nowadays lies, and truths, do that travelling at warp speed via social media. Short of hiring Cambridge Analytica, we also need to understand the taxonomy of truth, half-truth, and untruths. Our challenge will be how to encourage broad discussion while resisting non-evidence-based piffle (we are trying to be charitable here). No doctor wants to, nor should, get embroiled in twitter wars, but if you don’t stand for something there is a danger that we could fall for anything.
Every human has bias so let us declare ours loud and proud: proper science is proper wonderful. Moreover, if you want good science then it needs to be funded and defended. However, to date, conventional medical science has not done an adequate job at arguing its case. Traditional science’s cautious and iterative style is also important, but can fall short when it comes to packaging messages that suit the many. Empirical science’s timeline also seems better suited to another age. First, you apply for research funding: 20% of projects are successful; 80% are rejected. Next you have to overcome the vicissitudes of the ethics board, and divine a question that is simultaneously precise, but generalizable. Years later, you hope your results were “positive” because it’s time to publish or perish. It’s hardly surprising, but largely inexcusable, if scientists don’t have energy left over to ensure that anyone actually still cares, let alone changes their behaviour.
Let us state our bias even clearer: Good science delivers just as bad science hurts. Good science keeps planes in the air and infections out of wounds. However, ironically scientific advancement has also helped life become so comfortable that, at times, we tolerate ideas that don’t pass the rational sniff test. While we point smug fingers at celebrities and wellness experts we academic allopaths should accept where we have erred. Firstly, we forget that our patients don’t read our medical journals, and nor do most of our colleagues. We have also allowed a ludicrous world of 5,000 journals on Pubmed alone, so it’s difficult to separate signal from noise. And don’t get us started on predatory journals. We don’t have the time to understand why so many even exist, unless, as we fear it is to expand reputations and bank balances.
At the same time that we implore lay people to dial back the pseudoscience, let’s accept the potential for sins and transgressions from medics and scientists. As outlined, there are enough predatory journals that if you have the funds and persistence you can probably get your work displayed somewhere. Moreover, even if a scientific publication is eventually discredited, it presumably once passed our lauded peer review process. “Dodgy academics”—again we’re trying to be charitable here—have shown that the pen is as mighty as the syringe, as demonstrated by the antivax movement. In our medical specialty of intensive care, Joachim Boldt published 90 fraudulent articles in 16 prominent journals before he was found out. 
There is a small but necessary cadre of doctors and scientists doing the tough forensic work required to expose academic fraud. They deserve huge praise. They also need fearless support from our universities. The point is that, in the battle for hearts and minds, we each have a part to play. It may be as small as putting aside a few hours each month to review manuscripts. It may be that in the midst of a busy clinic you smile your way through your 20th debunk. It may be that you teach learners how to critically appraise the literature. For us it includes writing opinion pieces that simultaneously challenge and chastise.
There is so much important knowledge still to discover. As such, it’s a crying shame that we can’t just focus on novel research; but needs must. Whether patient or provider, we are all being bombarded by pseudoscience masquerading as fact. We know you feel overwhelmed and frustrated, because we do too. However, steel yourself: nothing matters more than the truth. Become a myth buster for science. Alternatively imagine that your lab coat is a super hero cape, and then accept that with great power comes great responsibility.
Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada.
Competing interests: None declared.
Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Research and Development lead in Critical Care at University Hospital of Wales, and an editor of BMJ OnExamination.
Competing interests: None declared