The Plural of Anecdote is not Evidence
SCOTT C. RATZAN
The 21st Century communication age has created unprecedented
opportunity for instantaneous information transfer. Globalization translated
observation and opinion into the data that forges the foundation of
so-called knowledge.
With such speed and freedom of expression, unfiltered
information abounds. The consequences are great in a new world where
terror and disease know no boundaries safety and health remain the ubiquitous
ideal.
While many of us herald new technologies as liberators
providing access to information, we may be professing unfettered opportunitie
s for ignorance. New in-formation - so-called ``news’ - reaches
people differently in multiple contexts. This is
particularly important to consider as scientific discovery, medical
breakthroughs, and political events all require decisions that affect
our lives. How we react to biotechnology and cloning, complications
of medical interventions , and violent acts of hatred is shaped with
this. This new information often lacks moral guidance.
For example, the increase in online news commentary authored
by anyone has evolved to what many term a blog. This term, short for
weblog, presents personalized news filters that often challenges the
knowledge and wisdom foundation that supports Western thought.
Thomas Friedman summed it up well in a recent editorial
in the New York Times: ``At its best, the internet can educated more
people faster than any other media tool we ever had. At its worst, it
can make people dumber faster than any media tool we ever had.’’
Furthermore, Friedman warns `` . . ..the uneducated believe information
from it even worse. They don’t realize the internet at its ugliest
is an open sewer; an electronic conduit for untreated unfiltered information.’’
Say, for example, a consumer wanted vaccine information
and went to the most popular search engine - google.com - and typed
in vaccine info. Voila, the National Vaccine Information Center (NVIC)
would appear as well as lawyer’s litigation services. With one
click the user could be in what looks like a credible site. The NVIC
is an organization dedicated to limiting the use of vaccines as it was
started by Dissatisfied Parents Together (DPT). There are countless
other examples with the scientific lexicon and common phrases throughout
the world.
This is particularly important for health communication.
Clearly, individual observation on medical issues repeated over cyberspace
challenges the peer-reviewed, conventional wisdom, and status quo. Nonetheless,
the new ``paradigms’’ of Shared Decision Making (SDM) and
Evidence Based Medicine (EBM) continue to percolate in 21st Century
health care. SDM activates the patient as a partner and decision-maker
in health prevention and treatment, a move from the age-old white coat
ethos of the ``traditional’’ physician.
The move to EBM, namely the latest randomized controlled
trial and peer reviewed often is at odds with experience and consensus
reports. This EBM relegation to new, recent, and improved often confuses
the public and professionals; witness the latest confusion over mammograms.
EBM also figures in economic variables in a population based approach.
Are these ``movements’’ at odds? Is the patient armed with
information from the internet, whether written by a blog or a patient
support group, making the right decision? Alternative medicine, new/novel
approaches, as well as prudent risk-taking and aversion fit different
evidence models.
The current paradigms do not stress ethical and moral
directives to help guide decision making. Idealism, self determination,
quality of life, and moral decisions are difficult to characterize in
a population-based approach. In an information/everywhere world, the
technology as purveyor often services as the de facto credibility ,
rather than the provider of the information.
We need refocus on credibility by tempering scientific
progress with context. On event for one individual - the anecdote -
should not translate into population based decision making. Even with
the a media seemingly offering repetitive information in a 24/7 news
cycle, a single study with a large number subjects with 95% certainly
of x in a million happening does not always lead to more informed or
better decisions. This limitation of reliable evidence in context should
be an ethical goal.
The ancient Greeks promulgated the dialectic to find the
truth. Today such ``multi’’-logue is faceless, with limited
consequences for the originator of the communication act should s/he
be lying or spreading falsehoods. Ancient rhetoric stressed the credibility
of the sender. The Aristotelian notion of human flourishing as a guide
for public policy with ethical communication would be a welcomed goal
today. The bottom line is that, as health communicators, it is incumbent
upon us to be well - versed in the science of health, while practicing
ethical communication to inform quality decision-making.
__________
Scott C. Ratzan MD, MPA is Editor of the Journal of Health Communication:
International Perspectives.
