evidence-based medicine


PR Advice To Medical Panels: Fight Stories With Stories

The Russian legend of The Princess Frog

Hear, hear. A paper in the prestigious Journal of the American Medical Association today calls on scientists to fight stories with stories.

That is, in the service of more powerfully conveying what research actually shows, they should no longer shy away from “anecdote” just because it lacks statistical power. They should use stories of real people that illustrate evidence-based points in order to convey information better to the public.

The paper begins with a federal panel’s recent controversial recommendations against routine prostate screening for healthy men. Celebrities from Rudy Giuliani to Joe Torre fought the recommendations using that most powerful of weapons, their own personal stories, in which they attributed their survival to screening.

Panel members, in contrast, tended to explain their decision with numbers, not stories. They did not offer heartbreaking tales from men left incontinent, impotent or otherwise harmed — though goodness knows, they would not be hard to find. And that data-driven high road, the JAMA paper argues, tends to lead to defeat.

“Each time, those who espouse only evidence — without narratives about real people — struggle to control the debate,” the authors write. “Typically, they lose.”

They offer a vivid example of how to fight a story with a story, a “counter-narrative” that uses an anecdote  to parry an unscientific argument:

Take the largely negated theories of a causal link between childhood vaccines and autism. As recounted by Offit in his book on this topic, a celebrity actor claimed that she does not need real science to know that the measles-mumps-rubella (MMR) vaccine triggered her son’s autism: “[My son] is my science,” she stated on television to thunderous audience applause. Such narratives, challenging scientists who come to the table (or television studio) armed only with data, often succeed in the court of public opinion and weaken efforts to promote evidence-based health decisions.

The public needs to hear the stories of patients, and their families, who encountered a drug that offered hope but was ultimately ineffective and even dangerous.

When scientists encounter stories that promote unscientific approaches to health and health care, they should deploy an evidence-based counternarrative. The story of a mother in San Diego whose infant, too young for the MMR vaccine, became sick after exposure to an unvaccinated child with measles would add persuasive weight in a debate with the actor mentioned above. Continue reading

Battling Bad Science (The Video)

Here’s doctor and epidemiologist Ben Goldacre making the case (in a TED talk) for real science — the kind that “critically appraises the evidence for someone else’s position” — and against “crazy, wacky” newspaper headlines, for instance, the ones that say coffee both prevents and causes cancer. (There’s also a funny aside about a dead cat called Hettie and her medical credentials.)