Evidence Based Arguing

I love Science. I love reading about science, I love doing science and I love thinking about how science can be applied to helping patients. But what I really love about science are the arguments! It is good and proper that in science ideas are debated, views challenged and criticisms aired, so when an article appeared looking at the science of scientific arguments I couldn’t resist having a read. Serge Galam from the fabulously named Centre de Recherche in Epistemologie Appliquee used a probabilistic modelling technique to explore the factors that may determine the outcome of public scientific debates. It is all fairly complicated, but basically he models agents as either inflexibles (those who are convinced of a position) or floaters (those who are open to different positions), and the results suggests that winning the debate is about increasing the proportion of people with inflexible attitudes on your side. To do this it seems that the best approach is to overstate and exaggerate the validity of your claims!! The conclusion is enough to make you weep, “to adopt a fair discourse is a definite lose-out strategy to promote a cause in a public debate. On this basis one could conclude that to adopt a cynical behaviour is the obliged path to win a public debate”.

Depressing I know, and more so when you think of the clinical implications. Patient education is rightly seen as an important part of managing long standing pain problems and it is important to realise that many of the things we might wish to inform patients about are being hotly debated in the public arena – look at the media coverage that surrounded recent studies on acupuncture or the publication of the NICE guidelines for LBP and chronic fatigue syndrome.  The information patients have access to in the popular press and online is pretty much always of the overstated and exaggerated variety, and I don’t know about you, but when explaining things to patients I try to be balanced, considered and conservative in my interpretation of the literature, the very model of the ‘lose-out strategy’, so looks like I am destined to fail. Science does deliver up some dilemmas – maybe we all need to have an argument about how to best deal with this!

About Ben

grey Evidence Based Arguing

Ben Wand is currently the coordinator of musculoskeletal studies for the Physiotherapy program at the University of Notre Dame Australia. He completed his original physiotherapy degree, as well as post graduate qualifications in sports science and manipulative physiotherapy in Sydney. He undertook his PhD at Brunel University in London on physiotherapy management of acute low back pain. His current research interests include the role of central nervous system dysfunction in chronic low back pain and physiotherapy management of chronic spinal pain.

All blog posts should be attributed to their author, not to BodyInMind. That is, BodyInMind wants authors to say what they really think, not what they think BodyInMind thinks they should think. Think about that!

Comments

  1. ANdy says

    Very depressing – but explains the ascendancy of so many things that actually have so little substance.

    regards

    ANdy

  2. Bernadette says

    Ben, I am curious. Specifically I am curious about whether you perceive yourself as arguing with your patients or with “overstated claims in the public arena.”
    Do your patients typically present as ‘inflexibles’ or ‘floaters’? Do they staunchly defend a position (and perhaps even commit the fallacy of misplaced cite source) and refuse to mentally budge unless you vigorously and rigorously elaborate your understanding of the one True Scientific Consensus on the topic du jour ?

    Ben Reply:

    Hello Bernadette, thanks for your comment, I certainly don’t see the argument as being with the patient but, as you nicely put it, with the overstated claims in the public arena… and other areas as well.

    The next question is a much trickier one. I think people with chronic pain problems are mostly a mix of those two, open to different views in some areas and decidedly less so in others – but not aggressively so, I just get the impression they often don’t believe me!!. I would love to hear what yourself and others think on that issue and also what areas fall into the latter category. My main interest is chronic back pain and for me I reckon the most commonly encountered ‘inflexible’ belief is a wholly pathoanatomical basis for their problem. And I think there are a number of reasons why. It is a fairly simple model, easily understood and quite intuitive, it is endorsed strongly in the public arena and by lots of health care professionals, it usually comes with a fantastically vivid scan and pain is so compelling that it is hard to be rational and exercise judgement over what is the most primal of experiences.
    Thanks again
    Ben

  3. says

    Despite the arguments and “debate” it is still pretty obvious to a practicing clinician or suffering patient whether a treatment works or not. Anecdote is now scorned. evidence based medicine is what counts.
    If you have mechanical low back pain and have tried work hardening and/or muscle strengthening exercises it is pretty obvious to you the patient and the therapist that this form of treatment works.
    As a doctor I prefer to stick to treatments that work in my personalexperience, regardless of all the “arguments” about alternatives etc.