Monday, March 11, 2013

Science vs "Science"

It's got a lot to do with how you get your information, whether you trust science or not. And it's got a lot to do with whether you're exposed to real science or "science."

Like this "science"...

This product has been "proven by science," so we're fools not to buy it! I find that if I'm not watching a Nova or Nature or an episode of anything with Morgan Freeman or Stephen Hawking, most everything else that talks of science on the television is trying to sell me something. Most everything else is "science."

It seems like every beauty product advertisement is using "science" to convince me that I'm butt ugly and that to fix it (or prevent it from worsening) I should give them my perfectly good dollars. It's "science" after all.

I'm kind of stunned that it's legal for for-profits to cry "science" when it's their own study, when they merely asked opinions as evidence for effectiveness, or when they didn't do any studies at all. Science isn't allowed to be so biased. Science is supposed to want to improve your life first and foremost, not con you out of your money.

I'm not just thinking about this today because I've been hibernating this February, plopped in front of the tube, absorbing horrifying beauty ads through my aging, sagging wrinkled face. (I really should take care of it better by smearing money all over it.) I'm thinking about all this right now because of my friend Alice Roberts's nice piece "Childbirth: why I take the scientific approach to having a baby" posted on the Guardian Saturday.

Trends to move childbirth out of the hospital setting have put pressure on mothers and fathers to make decisions about what to do when it's time for theirs. You'd assume that because there's a movement to move things home that it's because some smart, science-minded, compassionate folks have figured out that it's healthier. If you can't stand the draconian and bloated government/insurance mogul-run healthcare system, a movement might feed your existing suspicions or opinions that there could be better ways to have a baby than by blindly following orders that these profit-motivated fascists at hospitals bark at us. 

But why assume that home childbirth folks are any less biased, less vested, less driven by self-interests? I don't know but it just seems so common for people to give rebels the benefit of the doubt more often than tradition, than institutions. (Something about "honest signaling" might have just popped into your mind if you've been trained in evolutionary theory.) What Alice found is that information on, that is, data or evidence for, what's healthiest--home or hospital or otherwise (birthing centers, for example)--is kind of difficult to come by!

For starters, she writes, 

"This is partly because the overall risks of maternal and neonatal death are now very small (about five per 100,000 women die in childbirth and four per 1,000 babies), so large numbers of mums are needed to assess relative risks. Maternity provision differs between countries, so looking at risks in other countries, even in Europe and the US, may not be terribly helpful."

Within that small risk there is a lot of jockeying for your support. So the second reason, she says, that makes it hard to find information is, 

"the politics of birth. It can be quite hard for mums-to-be to access impartial evidence and advice when it seems there are plenty of people wanting to influence your decision in one way or the other. Evangelical advocates of home birth often talk about the importance of women's choice and empowerment, as well as instilling distrust in obstetricians. For me, being empowered to make a decision requires access to good evidence and the freedom to make up my own mind. And whilst "maternal satisfaction" is often put forward as an important factor to be taken into consideration, I want to know what the relative risks are. And if there's not yet enough evidence to assess that – I want to know that too."

You'd think we all do. You'd think we all want to know the answer to "where and how will the risks be lowest for having my baby?" But we don't all hold  the belief that it's our right to know the answer to that, the way Alice knows it is, the way Alice demonstrates that it is. And it's not just an issue about the dissenters and the movements spinning information and evidence so we'll see things their way--a very real problem that Alice walks us through in the article. It's the doctors too.

Since the article's been posted in various places I've seen commenters complain how they asked their doctors for papers and numbers to help them make their birth plans and the doctors wouldn't go there. I've never had to make a birth plan but I've had similar experiences with doctors like when, for example, I asked for non-hormonal birth control options because I saw no reason to continue ingesting the stuff when the risks for long-term use aren't known and I was now married and ready to stop taking the pill. My doctor laughed at my question, laughed when I asked for a diaphragm or anything like it, and tried to convince me without any scientific evidence that the pill was fine to take your whole life.

Do I think medical decisions should lie completely in patients' hands? Of course not. We can't all be doctors. But they've got to be better ambassadors of science. They've got to be the best. They've got to be science.

It can't be up to us to figure it out for ourselves, not just because we shouldn't have to but because some of us are terrible at it when we try. This includes bright young people at my university, one for example who had a whole textbook on reproductive biology to answer this homework essay question: Write the life story of an egg. Because she cited it, I know that instead of using her high quality resource, she went straight to for all of her information.

Because of movements like the anti-vaccinators and all the people without celiac disease who won't eat gluten, it's easy to worry that unscientific trends with birth will dial back mortality rates to medieval ones. Heck, it's tempting to worry that when videos like this get around to some people who love all things PALEO, they will make it so.

No wonder so many of us can't trust climate scientists and evolutionary scientists. When it comes to our health, "science" has an agenda that's not always first and foremost what's best for us. When it comes to our beauty, "science" smells like money. If this is all we know of "science" then I'm less surprised of the push back against biology, ecology, climate, space exploration, etc... that to us scientists seems downright ridiculous.

If we're going to get non-scientists on board with real science, we need to take the word back.


Ken Weiss said...

Very thoughtful, as always, Holly! In fact, I think the problem is much deeper even than you point out.

'Science' itself has no clear-cut way of getting to the truth, if there is 'a' or 'the' truth. Since the ancients, philosophers of science have debated how we gain knowledge, but with no consensus. Science is a somewhat informal mix of messing around, systematic investigation (but without agreed-on 'system'), material and ideological vested interests and careerism, the media and bureaucrats with interests to be served, and so on. Too often even 'real' science also smells of money.

And, to make matters much worse, the world is not very compliant: it's often too complicated for the kind of simple answers even we in science yearn to find.

So, even if we did take back 'science' as you say, which would be a very good thing, it isn't clear how much better off, or when and where, we'd be. And how would we know what to exclude? Should fMRI be excluded along with phrenology? What about, say, acupuncture? Or whether 'science' is right when it tells you what to eat or how often to get a mammogram?

You've very ably described, in your elegant way, the bad side of what is portrayed as 'science'. But I think that even most scientists aren't all that interested in a critical exploration of their nature of their own claims--it poses too much of a threat.

Anne Buchanan said...

I love this post! It brings up so many issues, and it's only Monday morning -- after we lost an hour this weekend at that. On top of your points, Holly, as well as Ken's, there's also the issue that even if pregnant women had fantastic statistics on home vs hospital births, they'd be population-based. But, every birth is an individual experience, hard if not impossible to predict from statistics because predictions are probabalistic, so as with all health-related predictions from population statistics, the idea that we can make a truly informed decision based on them is problematic. But even so, of course, better statistics is better than none!

Anonymous said...

Hi Holly,
The data on out-of-hospital births are hard to come by for a few reasons, but one is that studies are typically conducted by physicians who have different goals, and a different mindset than some prospective parents. My wife is a doctor, and she knows how they think. They think disaster: we were not at risk for disaster, so we chose not to birth any of our three kids in a hospital. There's very little science involved at any level. Doctors do not think any more scientifically than pregnant mothers in these cases. The problem is that doctors are trained to think that any thought they have is science, even if it's just totally irrational fear, or pressure from the way they get paid.

Anonymous said...

The problem is that doctors are trained to think that whatever thought they have is science, even if it's just an irrational fear, or pressure to get paid for doing certain procedures. Doctors tend to think disaster. When my wife was a pregnant medical student, she revealed to the people on her OB rotation that she would be birthing in a birth center. The attending said "Well, at least you're not having a homebirth; those babies all end up ischemic and retarded." My wife didn't say anything but was thinking "You mean like my husband?" And then there was the time that she got yelled at for "letting" a woman push her baby out before the attending OB got there. While the new mom cradled her new baby, this guy shouted "I need to be here in order to bill!"

Holly Dunsworth said...

I'm going to end up having at least three ultrasounds, which to me is crazy, but it smells like money. The first was to see how far along I was (at 7ish weeks) which I could have told them free of charge! And then we could have waited to have one until around 12 weeks when the ultrasound doubles as a diagnostic test for chromosomal problems. But I was assigned that first ultrasound before they'd even let me see the doctor for the first time so I felt I had no choice in the matter and just did what they told me which feels entirely like how to squeeze money out of my insurance provider and make me miss more work than is necessary. Not to mention add more instances of stress/worry than we need.

Holly Dunsworth said...

Thanks for the insight Joel! But don't you think some of the fear isn't irrational? With a public (not just them) who thrusts (not just trusts) their lives entirely in their hands and will sue if things go wrong, there's, to me, pretty good reason to be careful from their perspective.