Science and Doubt

There are those who have faith in America's medical system, and others who have doubts. Many are quick to decry those who doubt scientists, while a few acknowledge that doctors themselves have built the foundation upon which doubters rest. It is time for recognition of why and how there is doubt. It is time for rebuilding, somehow, the faith Americans had in medicine decades ago. Those who decry "anti-science" must acknowledge the failures of science and scientists, and we must all move somehow to restore faith.
Social media and the Internet generally are alive with "anti-vax." There is a population of people that have concluded that vaccines are dangerous, and should be avoided. Some merely decline vaccination, while others deny their children vaccinations. A variety of celebrities have been accused of holding anti-vaccination views. In response to the anti-vaccine expressions, there have been a variety of analysis published. According to CBS News, the World Health Organization (WHO) concluded that the anti-vaccination movement is one of the "top threats to global health in 2019." And, Anti-vaccination is not a new movement. Some claim that the movement is as old as vaccines themselves. 
That is the WHO after all. Who could argue? It notes that "cases of measles have surged 30 percent worldwide in recent years." There remain risks of influenza and even polio. The HPV vaccine to forestall or address cervical cancer has faced resistance. In the United States, CBS reports that "approximately 100,000 young children have not been vaccinated against any of the 14 potentially serious diseases for which vaccines are recommended." That population appears to be increasing. Though there are those who see anti-vaccination as debunked, California has recently worked on legislation for immunization exemptions, and celebrity Jessica Biel made the news in June as she appeared in the state capitol, according to the Los Angeles Times
Of course, those who do not vaccinate are assuming a risk. And, there is some justification in a free society to say people should be free to take their risks and make their choices. That argument was raised frequently in the United States regarding smoking. There were, and perhaps are, many that believe a person's choice to smoke is a personal choice: "they aren't hurting anyone." That sentiment has changed in the last few decades. 
There has been a recognition that smoke affects more than the smoker. Only 16 states still allow smoking in bars or restaurants, according to MarketWatch. Nine jurisdictions have outlawed smoking in cars that contain children, according to LeagleBeagle. On flights, efforts began in 1988, in earnest in 1990, and concluded in 2000, with a complete ban on smoking on commercial flights, according to That is public smoking, and many are disturbed by smoke, other even allergic. But if it only affects the smoker, why should others care about smoking in private? 
Reuters reports that almost ten percent of American healthcare spending is "is due to smoking." That means that "$170 billion a year, is for illness caused by tobacco smoke." That might seem at first blush to still be the smoker's problem. But, the Center for Disease Control report upon which Reuters is commenting concluded that "public programs like Medicare and Medicaid paid for most of" the $170 billion. Of course, the sale of tobacco also generates tax revenue for federal, state, and local governments. But, it is unlikely the taxes collected equal those expenses. 
Vaccinations and smoking are but two examples. There is science on the side of vaccines, and yet a significant number of people opting out based upon their beliefs. There is science and economic data supporting that smoking is unhealthy in a variety of ways, and yet the CDC says that about 14% of adults in America continue smoke. Despite a dearth of evidence yet, many also continue to "vape," though states are moving to restrict that smelly act also. 
Behavior has personal and societal impacts. This is clearly illustrated with the smoking discussion above. It is easy to see people peripherally affected by second-hand smoke, by the societal costs of smoker medical care. Notably, there is also a broader, societal impact alleged in the vaccination discussion. This is referred to by the term "herd immunity." It is perhaps a bit disappointing that scientists refer to us all as a "herd," but there it is. 
Vaccines Today explains that herd immunity "arises when a high percentage of the population is protected through vaccination." This challenges "virus or bacteria." It is difficult for them to propagate "because there are so few susceptible people left to infect." The immunity of the herd help to protect everyone. Vaccines Today places blame for recent measles and pertussis "outbreaks" on failure to vaccinate and the resulting "declining herd immunity." 
There is a credibility to medicine. Most will remember that "four out of five dentists recommend sugarless gum for their patients that chew gum." We all likely have a logo on our toothpaste attesting the endorsement of the American Dental Association. People are somehow inclined to listen to celebrities and to doctors, when they tell us what is good for us or not. A few readers will remember when doctors and dentists even purportedly endorsed smoking. 
Everyone has heard of some historical medical treatment that has since been discredited. There are some who contend that a large number of medical (current and former) "procedures and practices are ineffective." According to The Atlantic, "much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong." An article in the Yale Journal of Biology and Medicine contends that the flaw is in how procedure or treatment is accepted. Once accepted, a practice or treatment may become established and then might continue long after efficacy is questioned or even debunked. The Yale authors urge that science "raise the bar" on how vetting or acceptance occurs. 
Some note that once a medical practice is accepted, change is difficult, asking "Why do doctors keep performing ineffective procedures?" There is no absence of criticism regarding procedurestesting, and even surgery. USA Today concluded that some patients "fall victim to predators who enrich themselves by bilking insurers for operations that are not medically justified." And, it noted that some physicians end up in prison; ironically for billing Medicare for those services, not for the damage done to the patient. There is a steady stream of conviction news it sometimes seems, from the Department of Justice and in the press
Patients are vulnerable. No one is seemingly exempt from this. As the Los Angeles Times reports, Dr. Robert Pearl contends that our American medical system is broken. He is the author of Mistreated. He describes in his book how he sought care for a family member. Dr. Pearl is a physician and a former leader of a major health care delivery system. He knows care, treatment, and benefit management. And, he and his family nonetheless struggled with navigating the care system and making medical decisions. If he is not an informed and sophisticated consumer, then none of us is. 
The fact is that we live in a time of great innovation and change. Medicine, knowledge, and expertise are evolving at an epic pace. Doctors and other scientists are today doing with ease things that were science fiction mere years ago. Despite this, science remains fallible. Despite the progress, medicine remains partially art. Despite the progress, consumers remain with doubts, uncertainty, and suspicion. See My Mum Didn't Vaccinate me, from the British Broadcasting Company. What is the next thermogram? What is the next "harmless" opioid? What is the next "latest and greatest" surgery? There is, among some, doubt about science, medicine, and the recommendations of both doctors and pseudo-expert celebrities.  
In the end, who is responsible for the credibility gap some perceive as regards science or medicine? When a physician gives advice, orders a test, or recommends a procedure, why do patients have doubt? What drives cynicism? Can physicians be wrong? Is it possible that even four out of five could be? Perhaps there is merit in the cautionary "Physician, heal thyself?" If medicine is to improve, if consumer confidence is to be reclaimed, that will be led by doctors. In part, it will be led by the innovators and their innovation. But, it must be tempered by others' critical review and cautions. 
The patient community has been given examples in which doctors' conclusions have later been debunked. There is a sentiment among patients of caution and sometimes doubt. There is a potential for celebrities to leverage their fame to proclaim their beliefs and conclusions, seemingly contrary to science, and to be believed. The public willingness to believe the movie star instead of the scientist can be blamed in part on the celebrity status and a gullible fan base. But, there is also fault for the medical community that has a record of seemingly documented missteps, failures, and even fraud. 
If American medical care is to be strengthened, streamlined, and effective, ultimately the patient will have to have faith. The patient faith will have to be restored. When innovation and progress comes, the scientists and doctors who possess training and expertise must be at the forefront of questioning, testing, and commenting. The rest of us depend on their conclusions, on the acceptance of these procedures and treatments, and ultimately on the approval process and their recommendations for us. 
That people have doubts about vaccines is in part their ignorance and gullibility. That celebrities lacking any scientific education are listened to is in part the many examples of medicine's past questionable promises, complicity, and failures. Americans deserve critical thinking, innovation, and science. They deserve medical care in which they may confidently put their faith. The relationship between scientist and public has been fractured, and if we are to persevere, that fracture of doubt must be healed. 
Having thus diagnosed the issue, the scientists must formulate a plan to do just that. Even if it is accepted by only four out of five of them. Our health deserves it, our herd deserves it. 
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    About The Author

    • Judge David Langham

      David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.

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