Science Fact vs. Science Fiction: Can You Tell the Difference?
A portrait of skepticism while reading information online.
Today's growing distrust of science is not an academic problem. It can be a matter of life and death.
Take, for example, the tragic incident in 2016 when at least 10 U.S. children died and over 400 were sickened after they tried homeopathic teething medicine laced with a poisonous herb called "deadly nightshade." Carried by CVS, Walgreens, and other major American pharmacies, the pills contained this poison based on the alternative medicine principle of homeopathy, the treatment of medical conditions by tiny doses of natural substances that produce symptoms of disease.
Such "alternative medicines" take advantage of the lack of government regulation and people's increasing hostility toward science.
These children did not have to die. Numerous research studies show that homeopathy does not work. Despite this research, homeopathy is a quickly-growing multi-billion dollar business.
Such "alternative medicines" take advantage of the lack of government regulation and people's increasing hostility toward science. Polling shows that the number of people who believe that science has "made life more difficult" increased by 50 percent from 2009 to 2015. According to a 2017 survey, only 35 percent of respondents have "a lot" of trust in scientists; the number of people who do "not at all" trust scientists increased by over 50 percent from a similar poll conducted in December 2013.
Children dying from deadly nightshade is only one consequence of this crisis of trust. For another example, consider the false claim that vaccines cause autism. This belief has spread widely across the US, and led to a host of problems. For instance, measles was practically eliminated in the US by 2000. However, in recent years outbreaks of measles have been on the rise, driven by parents failing to vaccinate their children in a number of communities.
The Internet Is for… Misinformation
The rise of the Internet, and more recently social media, is key to explaining the declining public confidence in science.
Before the Internet, the information accessible to the general public about any given topic usually came from experts. For instance, researchers on autism were invited to talk on mainstream media, they wrote encyclopedia articles, and they authored books distributed by large publishers.
The Internet has enabled anyone to be a publisher of content, connecting people around the world with any and all sources of information. On the one hand, this freedom is empowering and liberating, with Wikipedia a great example of a highly-curated and accurate source on the vast majority of subjects. On the other, anyone can publish a blog piece making false claims about links between vaccines and autism or the effectiveness of homeopathic medicine. If they are skilled at search engine optimization, or have money to invest in advertising, they can get their message spread widely. Russia has done so extensively to influence elections outside of its borders, whether in the E.U. or the U.S.
Unfortunately, research shows that people lack the skills for differentiating misinformation from true information. This lack of skills has clear real-world effects: U.S. adults believed 75 percent of fake news stories about the 2016 US Presidential election. The more often someone sees a piece of misinformation, the more likely they are to believe it.
To make matters worse, we all suffer from a series of thinking errors such as the confirmation bias, our tendency to look for and interpret information in ways that conform to our intuitions.
Blogs with falsehoods are bad enough, but the rise of social media has made the situation even worse. Most people re-share news stories without reading the actual article, judging the quality of the story by the headline and image alone. No wonder research has indicated that misinformation spreads as much as 10 times faster and further on social media than true information. After all, creators of fake news are free to devise the most appealing headline and image, while credible sources of information have to stick to factual headlines and images.
To make matters worse, we all suffer from a series of thinking errors such as the confirmation bias, our tendency to look for and interpret information in ways that conform to our intuitions and preferences, as opposed to the facts. Our inherent thinking errors combined with the Internet's turbine power has exploded the prevalence of misinformation.
So it's no wonder we see troubling gaps between what scientists and the public believe about issues like climate change, evolution, genetically modified organisms, and vaccination.
What Can We Do?
Fortunately, there are proactive steps we can take to address the crisis of trust in science and academia. The Pro-Truth Pledge, founded by a group of behavioral science experts (including myself) and concerned citizens, calls on public figures, organizations, and private citizens to commit to 12 behaviors listed on the pledge website that research in behavioral science shows correlate with truthfulness.
Signers are held accountable through a crowdsourced reporting and evaluation mechanism while getting reputational rewards because of their commitment. The scientific consensus serves as a key measure of credibility, and the pledge encourages pledge-takers to recognize the opinions of experts - especially scientists - as more likely to be true when the facts are disputed.
The pledge "really does seem to change one's habits," encouraging signers to have attitudes "of honesty and moral sincerity."
Launched in December 2016, the pledge has surprising traction. Over 6200 private citizens took the pledge. So did more than 500 politicians, including members of US state legislatures Eric Nelson (PA), James White (TX), and Ogden Driskell (WY), and national politicians such as members of U.S. Congress Beto O'Rourke (TX), Matt Cartwright (PA), and Marcia Fudge (OH). Over 700 other public figures, such as globally-known public intellectuals Peter Singer, Steven Pinker, Michael Shermer, and Jonathan Haidt, took the pledge, as well as 70 organizations such as Media Bias/Fact Check, Fugitive Watch, Earth Organization for Sustainability, and One America Movement.
The pledge is effective in changing behaviors. A candidate for Congress, Michael Smith, took the Pro-Truth Pledge. He later posted on his Facebook wall a screenshot of a tweet by Donald Trump criticizing minority and disabled children. However, after being called out that the tweet was a fake, he went and searched Trump's feed. He could not find the original tweet, and while Trump may have deleted it, the candidate edited his own Facebook post to say, "Due to a Truth Pledge I have taken, I have to say I have not been able to verify this post." He indicated that he would be more careful with future postings.
U.S. Army veteran and pledge-taker John Kirbow described how the pledge "really does seem to change one's habits," helping push him both to correct his own mistakes with an "attitude of humility and skepticism, and of honesty and moral sincerity," and also to encourage "friends and peers to do so as well."
His experience is confirmed by research on the pledge. Two research studies at Ohio State University demonstrated the effectiveness of the pledge in changing the behavior of pledge-takers to be more truthful with a strong statistical significance.
Taking the pledge yourself, and encouraging people you know and your elected representatives to do the same, is an easy and effective way to fight misinformation and to promote a culture that values the truth.
Sexually Transmitted Infections are on the rise. This drug could stop them.
Cases of gonorrhea, chlamydia and syphilis soared last year, but researchers are finding that a drug known as doxy seems to reduce the number of infections.
Sexually transmitted infections (STIs) are surging across the U.S. to 2.5 million cases in 2021 according to preliminary data from the CDC. A new prevention and treatment strategy now in clinical trials may provide a way to get a handle on them.
It's easy to overlook the soaring rates of gonorrhea, chlamydia, and syphilis because most of those infections have few or no symptoms and can be identified only through testing. But left untreated, they can lead to serious damage to nerves and tissue, resulting in infertility, blindness, and dementia. Infants developing in utero are particularly vulnerable.
Covid-19 played havoc with regular medical treatment and preventive care for many health problems, including STIs. After formal lockdowns ended, many people gradually became more socially engaged, with increases in sexual activity, and may have prioritized these activities over getting back in touch with their doctors.
A second blow to controlling STIs is that family planning clinics are closing left and right because of the Dobbs decision and legislation in many states that curtailed access to an abortion. Discussion has focused on abortion, but those same clinics also play a vital role in the diagnosis and treatment of STIs.
Routine public health is the neglected stepchild of medicine. It is called upon in times of crisis but as that crisis resolves, funding dries up. Labs have atrophied and personnel have been redirected to Covid, “so access to routine screening for STIs has been decimated,” says Jennifer Mahn, director of sexual and clinical health with the National Coalition of STD Directors.
A preview of what we likely are facing comes from Iowa. In 2017, the state legislature restricted funding to family health clinics in four counties, which closed their doors. A year later the statewide rate of gonorrhea skyrocketed from 83 to 153.7 cases per 100,000 people. “Iowa counties with clinic closures had a significantly larger increase,” according to a study published in JAMA. That scenario likely is playing out in countless other regions where access to sexual health care is shrinking; it will be many months before we have the data to know for sure.
A decades-old antibiotic finds a new purpose
Using drugs to protect against HIV, either as post exposure prophylaxis (PEP) or pre-exposure prophylaxis (PrEP), has proven to be quite successful. Researchers wondered if the same approach might be applied to other STIs. They focused on doxycycline, or doxy for short. One of the most commonly prescribed antibiotics in the U.S., it’s a member of the tetracycline family that has been on the market since 1967. It is so safe that it’s used to treat acne.
Two small studies using doxy suggested that it could work to prevent STIs. A handful of clinical trials by different researchers and funding sources set out to generate the additional evidence needed to prove their hypothesis and change the standard of care.
Senior researcher Victor Omollo, with the Kenya Medical Research Institute, noted, “These are prevention interventions that women can control on their own without having to seek or get consent from another person,” as is the case with condom use.
The first with results is the DoxyPEP study, conducted at two sexual health clinics in San Francisco and Seattle. It drew from a mix of transgender women and men who have sex with men, who had at least one diagnosed STI over the last year. The researchers divided the participants into two groups: one with people who were already HIV-positive and engaged in care, while the other group consisted of people who were on PrEP to prevent infection with HIV. For the active part of the study, a subset of the participants received doxy, and the rest of the participants did not.
The researchers intentionally chose to do the study in a population at the highest risk of having STIs, who were very health oriented, and “who were getting screened every three months or so as part of their PrEP program or their HIV care program,” says Connie Celum, a senior researcher at the University of Washington on the study.
Each member of the active group was given a supply of doxy and asked to take two pills within 72 hours of having sex where a condom was not used. The study was supposed to run for two years but, in May, it stopped halfway through, when a safety monitoring board looked at the data and recommended that it would be unethical to continue depriving the control group of the drug’s benefits.
Celum presented these preliminary results from the DoxyPEP study in July at the International AIDS Conference in Montreal. “We saw about a 56 percent reduction in gonorrhea, about 80 percent reduction in chlamydia and syphilis, so very significant reductions, and this is on a per quarter basis,” she told a later webinar.
In Kenya, another study is following a group of cisgender women who are taking the same two-pill regimen to prevent HIV, and the data from this research should become available in 2023. Senior researcher Victor Omollo, with the Kenya Medical Research Institute, noted that “these are prevention interventions that women can control on their own without having to seek or get consent from another person,” as is the case with condom use, another effective prevention tool.
Antibiotic resistance
Antibiotic resistance is a potentially big concern. About 25 percent of gonorrhea strains circulating in the U.S. are resistant to the tetracycline class of drugs, including doxy; rates are higher elsewhere. But resistance often is a matter of degree and can be overcome with a larger or longer dose of the drug, or perhaps with a switch to another drug or a two-drug combination.
Research has shown that an established bacterial infection is more difficult to treat because it is part of a biofilm, which can leave only a small portion or perhaps none of the cell surface exposed to a drug. But a new infection, even one where the bacteria is resistant to a drug, might still be vulnerable to that drug if it's used before the bacterial biofilm can be established. Preliminary data suggests that may be the case with doxyPEP and drug resistant gonorrhea; some but not all new drug resistant infections might be thwarted if they’re treated early enough.
“There are some tradeoffs” to these interventions, Celum says, and people may disagree on the cost of increased resistance balanced against the benefits of treating the STIs and reducing their spread within the community.
Resistance does not seem to be an issue yet for chlamydia and syphilis even though doxy has been a recommended treatment for decades, but a remaining question is whether broader use of doxy will directly worsen antibiotic resistance in gonorrhea, or promote it in other STIs. And how will it affect the gut microbiome?
In addition, Celum notes that we need to understand whether doxy will generate mutations in other bacteria that might contribute to drug resistance for gonorrhea, chlamydia or syphilis. The studies underway aim to provide data to answer these questions.
“There are some tradeoffs” to these interventions, Celum says, and people may disagree on the cost of increased resistance balanced against the benefits of treating the STIs and reducing their spread within the community. That might affect doctors' willingness to prescribe the drug.
Turning research into action
The CDC makes policy recommendations for prevention services such as taking doxy, requiring some and leaving others optional. Celum says the CDC will be reviewing information from her trial at a meeting in December, but probably will wait until that study is published before making recommendations, likely in 2023. The San Francisco Department of Public Health issued its own guidance on October 20th and anecdotally, some doctors around the country are beginning to issue prescriptions for doxy to select patients.
About half of new STIs occur in young people ages 15 to 24, a group that is least likely to regularly see a doctor. And sexual health remains a great taboo for many people who don't want such information on their health record for prying parents, employers or neighbors to find out.
“People will go out of their way and travel extensive distances just to avoid that,” says Mahn, the National Coalition director. “People identify locations where they feel safe, where they feel welcome, where they don't feel judged,” Mahn explains, such as community and family planning clinics. They understand those issues and have fees that vary depending on a person’s ability to pay.
Given that these clinics already are understaffed and underfunded, they will be hard pressed to expand services covering the labor intensive testing and monitoring of a doxyPEP regimen. Sexual health clinics don't even have a separate line item in the federal budget for health. That is something the National Association of STI Directors is pushing for in D.C.
DoxyPEP isn't a panacea, and it isn't for everyone. “We really want to try to reach that population who is most likely going to have an STI in the next year,” says Celum, “Because that's where you are going to have the biggest impact.”
The Friday Five: The plain solution to holiday stress?
In this week's Friday Five, research on how to improve your working memory, the plain old solution to stress, rise of the robot surgeon, tomato brain power, the gut connection to health after strokes - and more.
The Friday Five covers five stories in research that you may have missed this week. There are plenty of controversies and troubling ethical issues in science – and we get into many of them in our online magazine – but this news roundup focuses on scientific creativity and progress to give you a therapeutic dose of inspiration headed into the weekend.
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Here are the promising studies covered in this week's Friday Five:
- How to improve your working memory
- A plain old solution to stress
- Progress on a deadly cancer for first time since 1995*
- Rise of the robot surgeon
- Tomato brain power
And in an honorable mention this week, new research on the gut connection to better brain health after strokes.
* The methodology for this study has come under scrutiny here.