Resistance to corrections in health

Christie Aschwanden has written an excellent article on how resistance to corrective information hinders progress in health and medicine for Miller-McCune. Here's a sample:

A surprising number of medical practices have never been rigorously tested to find out if they really work. Even where evidence points to the most effective treatment for a particular condition, the information is not always put into practice. “The First National Report Card on Quality of Health Care in America,” published by the Rand Corporation in 2006, found that, overall, Americans received only about half of the care recommended by national guidelines.

A $1.1 billion provision in the federal stimulus package aims to address the issue by providing funds for comparative effectiveness research to find the most effective treatments for common conditions. But these efforts are bound to face resistance when they challenge existing beliefs. As Nieman and countless other researchers have learned, new evidence often meets with dismay or even outrage when it shifts recommendations away from popular practices or debunks widely held beliefs. For evidence-based medicine to succeed, its practitioners must learn to present evidence in a way that resonates.

Or, to borrow a phrase from politics, it’s not the evidence, stupid — it’s the narrative.

The problems in health are at least as bad as they are in politics (and maybe more so). It's a very difficult issue.

(Disclosure: I'm quoted in the article, which also discusses my paper on resistance to corrections with Jason Reifler.)

Comments

[Rob]

No doubt Ms. Aschwanden is correct that there will be resistance to evidence-based conclusions about best practices. At least some of this resistance might result from skepticism about the validity of the research.

A brief look at Ms. Aschwanden's leading example is perhaps illustrative. She discusses a study of the prophylactic use of ibuprofen by marathon runners that concluded that the ibuprofen was of no benefit. When presented with the findings by the researcher, the runners persisted in their belief that the ibuprofen was helping them.

Although the study Ms. Aschwanden discusses is behind a firewall, the abstract indicates that the study involved 29 runners who used ibuprofen (in two different doses) and a control group of 25, in a single race event. It seems to me that so small a study can at best provide only tentative support for the proposition that prophylactic use of ibuprofen has no benefit. Might the runners' skepticism about the findings have been not entirely irrational?

Ms. Aschwanden does not label as a "myth" the idea that prophylactic use of ibuprofen is helpful, though that's clearly the context of her discussion of the runners' resistance to changing their behavior. Perhaps in deciding that the research about ibuprofen was conclusive, Ms. Aschwanden was guilty of the very resistance to information outside the narrative that she laments. Perhaps anyone who characterizes a proposition as a myth needs to be alert to that danger.

[rone]

Perhaps you should stop using weasel words like "perhaps", Rob.