The threat to medicine from the cult of irrationality

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Evidence-based clinical care, education, and research involving children are facing a major threat in contemporary American society. This challenge is primarily external to scientific investigation itself. To be addressed, it requires a return to rationality in the public domain.

There is a threat to rational thought from what I characterize as a “cult of irrationality.” I believe that there is a small but significant anti-rational, anti-scientific subculture within our society made up of diverse groups and interests. This subculture exerts its influence through a larger, poorly informed and scientifically uneducated segment of the general public as well as through the political system. It represents a major indirect and direct threat to scientific programs, including clinical investigation and science and medical education as well as education at primary and secondary public school levels. Three examples can serve to illustrate this problem.

First, in the past year “creationists” and “anti-evolutionists,” now calling themselves “Advocates for Intelligent Design,” have significantly distorted or eliminated the teaching of evolution within the science curricula of a number of public schools across the country, including Alabama, Georgia, Kansas, Ohio, and Pennsylvania. They have pressured some movie theaters and science museums not to show movies or exhibits that mention the “big bang” theory of the origins of the universe, the evolving geology of the earth, and the observations of Darwin. They argue that Intelligent Design is a legitimate scientific theory and should be taught as an alternative to the theory of evolution. However, as Professor Daniel Dennett of Tufts University has pointed out, to be considered a scientific theory, the “Intelligent Design” idea needs to provide an explanation for existing biologic facts, explain the observations of the process of natural selection, and be formulated as a testable hypothesis. It is not any more scientific to point to man as the end result of design than it would be to contend that intelligent genetic engineers came to earth 6 million years ago from another galaxy and genetically reengineered some primates to give them language and enlarged frontal lobes for planning and reflection; it worked, resulting in human beings! Nor would it be more probable than to contend that life started on Mars and was blown here by cosmic impact. The endorsement of this religious belief by influential politicians and movie stars does not make it a scientific theory, a testable hypothesis to be taught as an alternative scientific theory to evolution. There is no scientific content or controversy to teach about in a biology class. However, Intelligent Design theory might be an excellent topic to teach in a high school class on current events and contemporary politics.

Another example is the lack of public support for the objective evaluation of alternative or complementary medicine treatment, such as widely used herbal remedies. This has been carried to an extreme by the success of the book Natural Cures, which made the New York Times bestsellers how-to-do and advice book list for 8 weeks. The author is neither a physician nor scientist, but did spend 2 years in prison for credit card fraud. Millions of copies of this book have been sold to the scientifically illiterate, medically vulnerable public.

Yet a third example of irrational thinking is the current anti-immunization movement. A story about Benjamin Franklin was probably a very early instance of irrational anti-immunization propaganda and the tragedy that can result. As a young man, working as a printer’s apprentice for his older brother in Boston, he was influenced by his brother’s newspaper and pamphlet attacks on Cotton Mather, who advocated smallpox inoculations; he therefore decided not to vaccinate his child. Years later in his autobiography Franklin wrote about the death of his son from smallpox at the age of 4: “I have long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that inoculation.”

All three of these examples demonstrate the effectiveness of the anti-science, anti-rational subculture in confusing the public.

It is important to appreciate that the hard-core zealot spokespersons are only part of this problem. A segment of the public goes along with the zealots, not because they have arrived at a supporting opinion by a careful weighing of the pros and cons of the issues, but because there is often not an effective countervailing public voice for rational thought coming from respected leaders in science, medicine, and the business community. Many of our political leaders, both Republicans and Democrats, seem to develop a paralysis of rational thought on these issues because of the perceived ballot threat of a highly organized vocal minority.

The changing and pervasive role of the media in our society often amplifies the irrational and distorts, underrepresents, and misrepresents the rational. Objective information, sadly, has always been less compelling, less sensational, less easily captured in a sound bite or headline. Misinformation and irrational judgments rapidly and broadly disseminated may become reality in public opinion, constraining sound public policy and programs. National and state budgets for clinical care, medical education, and research will not be immune from this climate of irrationality, especially during this time of shocking national deficit. The recent decreases in Medicaid funding and changes in federal commitment to Early Periodic Screening, Diagnosis, and Treatment (EPSDT) are, in part, a consequence of irrationality.

Examples of media distortion are the exaggeration of the magnitude of the school violence and missing children problems, and the attention given to spurious claims of cures for learning disabilities and autism. Media-promoted myths related to juvenile crime are another dramatic example of this problem. In the mid-1990s in California and elsewhere, a steady stream of news reports predicted an explosion of juvenile crime based on a growing youth population. There were lurid reports suggesting the development of a “super-predator” breed of young criminals hardened beyond redemption by urban poverty and gang culture. Even as these predictions were being made, juvenile crime rates were falling, declining 33% between 1995 and 1998. Arrests for youth homicide dropped 55% and significant drops occurred in aggravated assault and robbery by juveniles. Nevertheless, influenced significantly by the media, the public supported spending additional billions to increase and maintain prisons. And many juvenile offenders entered the adult justice system under new policies that shunted youth away from family courts in response to distorted media representations that these courts could not effectively handle the flood of mythical “super-predators.” If the public had been better informed, the unmet educational, clinical, and research needs of children and youth might have been better served with the billions of dollars that were invested instead in imprisoning youth.

Pediatric academic leadership cannot remain above it all. Physicians, nurses, and biomedical scientists need to shoulder the responsibility of helping the media and communication networks play a more constructive role in improving health and related systems for children and youth. They can and must do this by giving greater public emphasis to rational and scientific evidence-based arguments on various issues, including those just mentioned.

It is important to note that I have avoided presenting a genes-eye-view of clinical care and research. Nor have I used the current jargon of “translational research.” I do believe that progress in genomics and proteomics will eventually have an enormous impact on genetic screening, individualized pharmacotherapy, and other treatments. However, I also think that to be truly relevant those committed to clinical care and research involving children have a responsibility to apply these advances to the most important health problems facing children in this country and worldwide. If we do so in an ethical and responsible manner and are also willing to speak up publicly for the rational and scientific, then we will earn the public trust and the sustained support for medical education and clinical research.