• Health Facts Aren’t Enough. Should Persuasion Become a Priority?

    The following originally appeared on The Upshot (copyright 2019, The New York Times Company)

    In a paper published early this year in Nature Human Behavior, scientists asked 500 Americans what they thought about foods that contained genetically modified organisms.

    The vast majority, more than 90 percent, opposed their use. This belief is in conflict with the consensus of scientists. Almost 90 percent of them believe G.M.O.s are safe — and can be of great benefit.

    The second finding of the study was more eye-opening. Those who were most opposed to genetically modified foods believed they were the most knowledgeable about this issue, yet scored the lowest on actual tests of scientific knowledge.

    In other words, those with the least understanding of science had the most science-opposed views, but thought they knew the most. Lest anyone think this is only an American phenomenon, the study was also conducted in France and Germany, with similar results.

    If you don’t like this example — the point made here is unlikely to change people’s minds and will probably enrage some readers — that’s O.K. because there are more where that came from.

    A small percentage of the public believes that vaccines are truly dangerous. People who hold this view — which is incorrect — also believe that they know more than experts about this topic.

    Many Americans take supplements, but the reasons are varied and are not linked to any hard evidence. Most of them say they are unaffected by claims from experts contradicting the claims of manufacturers. Only a quarter said they would stop using supplements if experts said they were ineffective. They must think they know better.

    Part of this cognitive bias is related to the Dunning-Kruger effect, named for the two psychologists who wrote a seminal paper in 1999entitled “Unskilled and Unaware of It.”

    David Dunning and Justin Kruger discussed the many reasons people who are the most incompetent (their word) seem to believe they know much more than they do. A lack of knowledge leaves some without the contextual information necessary to recognize mistakes, they wrote, and their “incompetence robs them of the ability to realize it.”

    This helps explain in part why efforts to educate the public often fail. In 2003, researchers examined how communication strategies on G.M.O.s — intended to help the public see that their beliefs did not align with experts — wound up backfiring. All the efforts, in the end, made consumers less likely to choose G.M.O. foods.

    Brendan Nyhan, a Dartmouth professor and contributor to The Upshot, has been a co-author on a number of papers with similar findings. In a 2013 study in Medical Care, he helped show that attempting to provide corrective information to voters about death panels wound up increasing their belief in them among politically knowledgeable supporters of Sarah Palin.

    In a 2014 study in Pediatrics, he helped show that a variety of interventions intended to convince parents that vaccines didn’t cause autism led to even fewer concerned parents saying they’d vaccinate their children. A 2015 study published in Vaccine showed that giving corrective information about the flu vaccine led patients most concerned about side effects to be less likely to get the vaccine.

    A great deal of science communication still relies on the “knowledge deficit model,” an idea that the lack of support for good policies, and good science, merely reflects a lack of scientific information.

    But experts have been giving information about things like the overuse of low-value care for years, to little effect. A recent studylooked at how doctors behaved when they were also patients. They were just as likely to engage in the use of low-value medical care, and just as unlikely to stick to their chronic disease medication regimens, as the general public.

    In 2016, a number of researchers argued in an essay that those in the sciences needed to realize that the public may not process information in the same way they do. Scientists need to be formally trained in communication skills, they said, and they also need to realize that the knowledge deficit model makes for easy policy, but not necessarily good results.

    It seems important to engage the public more, and earn their trust through continued, more personal interaction, using many different platforms and technologies. Dropping knowledge from on high — which is still the modus operandi for most scientists — doesn’t work.

    When areas of science are contentious, it’s clear that “data” aren’t enough. Bombarding people with more information about studies isn’t helping. How the information contained in them is disseminated and discussed may be much more important.

    @aaronecarroll

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  • Healthcare Triage: Doctor Choice Can Be Limited with Medicare Advantage

    Medicare Advantage are plans with private companies that contract with Medicare to deliver services. Some of these plans work great, but many of them have limited lists of approved providers, which can make finding a doctor difficult for some patients.

    This video was adapted from a column Austin wrote for the Upshot. Links to souces can be found there.

    @aaronecarroll

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  • Healthcare Triage News: Residency and the 80 Hour Work Week

    Performative overwork is more and more common in the United States, and long hours have long been the norm in medicine. During residency, doctors have traditionally been asked to work for up to 100 hours per week. A rule in 2003 capped residents hours at 80 hours per week. Older docs claim this practice skimps on training, and might be worse for patients. A new study indicates that there is no discernible reduction in quality of care across a number of metrics. Maybe the good old days weren’t so great.

    @aaronecarroll

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  • JAMA Forum: Averting Alert Fatigue to Prevent Adverse Drug Reactions

    Although various electronic health records (EHRs) have different features, nearly all seem to have alerts for potential problems with drug prescribing. It’s one thing that many believe that EHRs do very well. However, a recent study warns that when it comes to opioids and benzodiazepines, we shouldn’t always assume such alerts work as intended.

    That’s the beginning of my latest piece over at the JAMA Forum. Go read it!

    @aaronecarroll

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  • Healthcare Triage: Does Better Education Mean Better Health?

    Many, many studies have associated better and more education with better health outcomes? But which way does the causality go? Do people attain more education because they’re healthy? Or maybe those who are in an economic position to attain education also tend to be able to afford good healthcare? We’re here to sort out the studies.

    This video was adapted from a column Austin wrote for the Upshot. Links to souces can be found there.]

    @aaronecarroll

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  • Healthcare Triage: The Implications of “Public Charge” on Immigrant Children

    The Trump administration has put forth a rule change for immigration saying that if an immigrant gets one of a number of benefits from the government, it could lead to their being denied legal permanent residency or entry to the US. Will such a rule lead to some immigrant parents disenrolling their families from safety-net programs? How will this affect children? We’ve got data.

    @aaronecarroll

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  • Healthcare Triage: The Malpractice System Doesn’t Deter Malpractice

    Research indicates that the malpractice system in the United States doesn’t do a lot to deter malpractice. There are several recent studies about malpractice that look at how many doctors have malpractice claims against them, and what happens to their careers after they have a problem.

    This episode was adapted from a column I wrote for the Upshot. Links to sources can be found there.

    @aaronecarroll

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  • Healthcare Triage Podcast: Brain Injuries & CTE: Detection, Treatment, and Prevention

    This month Aaron is talking to Dr. Tom McAllister, the Albert Eugene Sterne Professor and Chairman, Indiana University School of Medicine Department of Psychiatry. He specializes in studying brain injuries and chronic traumatic encephalopathy, and he’ll tell about brain injuries, their treatment, and some of the advances in detecting such injuries.

    The Healthcare Triage podcast is sponsored by Indiana University School of Medicine whose mission is to advance health in the state of Indiana and beyond by promoting innovation and excellence in education, research and patient care.

    IU School of Medicine is leading Indiana University’s first grand challenge, the Precision Health Initiative, with bold goals to cure multiple myeloma, triple negative breast cancer and childhood sarcoma and prevent type 2 diabetes and Alzheimer’s disease.

    As always, you can find the podcast in all the usual places, like iTunes and Soundcloud.

    @aaronecarroll

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  • Healthcare Triage: Sunscreen Needs Some Safety Evaluation

    Skin cancer is a big problem. Sunscreen can help protect your skin. All this is very well known. It turns out, though, that the active ingredients in sunscreen can get into peoples’ bloodstreams in pretty high concentrations. And the effects of sunscreen on the environment isn’t well studied. While sunscreen probably is safe for human use, and might be bad for the environment, we should still look closely at the products we’re using to protect ourselves.

    This episode was adapted from a column I wrote for The Upshot. Links to sources can be found there.

    @aaronecarroll

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  • Healthcare Triage News: Vitamin D Supplements Continue to Be Unnecessary

    There are several news studies that confirm what we’ve been saying for years. Vitamin D supplements don’t do much, and are unnecessary for just about everybody.

    @aaronecarroll

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