I Read It On The Internet…

echo

Most people, it turns out, aren’t really all that skeptical. The 2016 election has taught us that what passes as ‘news’ isn’t always very true. Fewer and fewer things seem implausible to people who have stopped being surprised by what once was seemingly impossible; and folks don’t distinguish between what’s possible and what’s probable. There are three different issues that independently and sometimes simultaneously lead people to believe untruths. Let me explain.

  1. The Echo Chamber. People tend to give credence to those who echo their current beliefs (whether true or false). It is easy to understand how the Confirmation Bias leads  people to accept evidence or arguments for their current beliefs without any skepticism or fact-checking. If you already believe in aliens, then you will take every report of a possible alien sighting as further evidence that you are right, without questioning the veracity of those reports. But once you enter into an echo chamber filled with fellow alien believers, you are more likely to give blind credence to any other unrelated stories they might have to tell. You didn’t enter the echo chamber believing in unicorns, but once you heard about unicorns from fellow UFO gazers, you were convinced. Otherwise highly discredited sources are in this way given too much credence because they dovetail nicely with some current belief (where true or untrue). If you are right about the truth being reverberated in the echo chamber, that still doesn’t validate accepting other information without scrutiny. Being right about one thing doesn’t mean you are likely to be right about another thing.
  2. An awe of science. A recent poll indicated that 45% of Americans believe that aliens have visited Earth (and, yes, those space cadets are allowed to vote). What’s really sad is that this number is at an all time high. Widespread belief in extraterrestrials began in the 1950s with incredibly cheesy reports of UFO sightings and abductions. But a large portion of the non-skeptical and willing public accepted these amateurish claims because they truly were in awe of science. Yes, that’s right: they accepted them because of science. Imagine being an adult in the 1950s: in your life time, you had seen the emergence of the car, the plane, the computer, and the atomic bomb. The world that was had been overturned by a never-ending onslaught of science. Penicillin, insulin, and the polio vaccine were modern miracles. Nothing seems out of reach. So the idea of flying saucers and alien visitation actually seemed to comport with science, not contradict it.An awe of science is vastly different than an understanding of science. An actual understanding of interplanetary distances and physical limitations in travel speed (something less than the speed of light) should all but convince anyone of the virtual impossibility of alien visitation to earth. Yet, public tax dollars are today being spent on searching for life in outer space. Modern society is no longer awe-struck by the next big scientific breakthrough; but with little general scientific understanding, most people cannot tell the difference between the conclusions of this work on the transformative hermeneutics of quantum gravity and the conclusions of this work on Bohmian mechanics. Scientism is dangerous when we accept anything just because it is veiled in science.
  3. Respect of the establishment. Einstein said, “Blind belief in authority is the greatest enemy of truth.” Just as science has become an establishment of sorts that is accepted too nonchalantly, so also we tend to accept news or truths from those people, businesses, and institutions that have gained come credibility in our eyes. If the government says it, or CNN, or NASA, or Oprah … it must be true (or maybe it must not be true, depending on your predisposition). In fact, when CNN runs pieces like this one, ‘How to outsmart fake news in your Facebook feed‘, they are seeking to gain that sense of establishment from you (“Trust us, not those other guys”). But CNN, like every other outlet, makes serious mistakes, reports false news, accepts bogus tips, and draws false conclusions based on bias. Just last week, CNN falsely reported on itself. It is true that some organizations deserve more scrutiny than others (I’ll take CNN over these guys any day, but I will remain skeptical of everything I read). The Internet adds a new source of establishment – crowd sourcing. We see positive elements in crowd sourcing, and Wikipedia and Reddit are, for the most part, examples where crowd sourcing works well. But just because something has a lot of hits on YouTube doesn’t make it accurate.

Our patients (and our colleagues) source information in this way. Don’t be surprised when they present with far-fetched ideas (“my IUD is causing me to have headaches”) because they definitely “researched it” and have it on good authority (here and 124,000 other places). This trending video on Facebook, published by the respectable sounding healthforallwomen.com, currently has over 12 million views (and counting). Why so many views? Because it is a video about the “health benefits” of not wearing bras (hopefully you can figure out why it so popular). Among the video’s several claims is that wearing a bra increases the risk of breast cancer, up to 100x! This type of social media-promulgated drivel is what our patients see and accept at face value. Before you hate on Facebook, realize that a video like this is no less factual than a typical episode of Dr. Oz. This same website also recommends using milk thistle and dandelion root to counteract the oncogenic effects of estrogen. Wow. Does wearing a bra increase the risk of breast cancer? No it doesn’t, but as of this writing about 12 million more people have watched that video than have read this article.

Often, our patients are most convinced by the experiences and opinions of other patients, found on message boards and chat rooms. These sources of information seem to be the best to them, since other patients appear to answer their common questions honestly and without ulterior motivation. But, this source of information is often the least informed and least evidence-based. We call it anecdotal evidence. This type of evidence is betrayed by the patients’ biases, false conclusions, and misassumptions.

So are doctors any better? Not in the least. The lack of robust skepticism is not related to educational attainment. Physicians live in echo chambers. They associate with colleagues who echo back to them their own practice patterns and beliefs. Physicians accept things as true because of science that they don’t really understand, believing that a p-value below 0.05 is as good as gold (especially if the conclusion of the study already agrees with what they thought anyway). Physicians have their own establishment and authority figures: if a study is printed in the New England Journal of Medicine, it is often given a pass as factual, high-quality, and impactful. And physicians crowd source information (e.g., regional standard of care) and ask their colleagues what to do (e.g., curbside consult) rather than analyze a problem using high-quality evidence (when available). The majority of physicians narcissistically prefer anecdotal experiences over systematic evidence.

We all need to step out of the echo chamber. The more firmly you believe something, the more vigilantly you should seek to challenge it. Be skeptical of all sources of information  and seek to disprove what you read, like a true scientist. Don’t accept anything just because it makes sense, nor reject anything just because it seems implausible or unconscionable. Seek quality evidence for all your beliefs and theories. Consider the real possibility that you might be wrong about almost everything you believe.