One of the encouraging shifts I’ve seen in health journalism over the past few years is the growing recognition that antivaccine sentiment is antiscientific at its core, and doesn’t justify false “balance” in the media. There’s no reason to give credibility to the antivaccine argument when their positions are built on a selection of discredited and debunked tropes. This move away from false balance and towards a more accurate reflection of the evidence seems to have started with the decline and disgrace of Andrew Wakefield and his MMR fraud. And there is now no question that antivaccine sentiment has a body count: Simply look at the resurgence of preventable communicable disease. Today, antivaccinationists are increasingly recognized for what they are – threats to public health. It seems less common today (versus just 5 years ago) that strident antivaccine voices are given either air time or credibility in the media.
But false balance on topics like influenza can occur without giving a voice to groups like antivaccinationists. A more subtle technique to shift perceptions is both widespread and hard to detect, unless you’re aware of it: the naturalistic fallacy, known more accurately as the appeal to nature. In short, it means “It’s natural so it’s good” with the converse being “unnatural is bad.” In general, the term “natural” has a positive perception, so calling a product (or a health intervention) “natural” is implying goodness. The appeal to nature is so common that you may not even recognize it as a logical fallacy. Unnatural can be good, and natural can be bad: Eyeglasses are unnatural. And cyanide is natural. Natural doesn’t mean safe or effective. But the appeal to nature is powerful, and it’s even persuasive to governments. If we believe that health interventions and treatments should be evaluated on their merits, rather than whether or not they’re “natural”, then decisions to regulate “natural” products differently than the “unnatural” ones (like drugs) makes little sense. Yet the Dietary Supplement Health and Education Act was a legislative appeal to nature, introducing a different regulatory and safety standard for a group of products while drawing a fallacious distinction with “unnatural” products like drugs. Canada fell for the appeal to nature too: It has the Natural Health Products Regulations which entrenched a lowered bar for efficacy and safety for anything a manufacturer can demonstrate is somehow “natural”.
The combination of false balance and the appeal to nature has a subtle but insidious effect on how we view health care. Promoters of CAM (complementary and alternative medicine) know and use this strategy very effectively. If we’re willing to mentally distinguish between “conventional” and “natural” health approaches, then we may be more willing to overlook issues with respect to evidence – the Achilles’ heel of CAM. It’s a simple strategy for advocates to wrap their products with the “natural” banner, and our own perceptions give it a mental pass. As consumers, we’re the ones with the fallacious reasoning. The promoter is just priming us to accept the fallacy.
I don’t envy Dr. Oz, but I do envy his reach and his platform, and only wish he used his prominence to promote credible health strategies, instead of what is often rank quackery. As a pharmacist I can literally see the effectiveness of the mainstream media on shaping perceptions of heath, and driving consumers to act on those demands. (The symbol for science-based medicine should be Sisyphus, because that’s how it can feel when you’re providing a science-backed response against a torrent of pseudoscience.) When I used to work in a retail pharmacy, it was immediately obvious which new miracle supplement had been hyped on Oprah, as demand would explode following an episode. Good health journalism matters. No matter how effective health professionals are as promoters of science-based medicine, we’ll be fighting a losing battle against pseudoscience and CAM unless we have health journalists as partners. The very best health journalists are not just superb communicators; they share the goals of health professionals in using evidence to advocating for the best health care. My hypothesis is that the decline of major media organizations (particularly print) over the past decade may be making the task of public health and science communication more difficult. Not only do the number of dedicated health and science journalists seem to be declining, but those journalists that are tasked with covering health issues may lack the experience, background and context to communicate in the most responsible and effective way. Today it’s a hunt for eyeballs and clicks.
A series of columns in The Globe and Mail summarizes the continued challenge to communicating science-based medicine. If you’re not familiar with The Globe, it’s Canada’s largest national newspaper, and while it’s no New York Times, it’s generally considered Canada’s paper of record. The Globe has some excellent health journalists like André Picard and Carly Weeks who consistently provide some of the best health content in the country. But recently The Globe launched a new online feature, the Health Advisor, which appears to be a series of contributed posts from writers that are external to the paper:
Most of the columns I’ve seen seemed to have reasonable content, and some have medically qualified authors. The series seems to be an effort to gain web traffic, as there’s no coherent theme other than the intent for posts to be clickbait, with titles such as “Former Olympian Jennifer Heil’s five tips for eating healthy on the road” or “How to tell when your memory loss is normal – and when it’s dementia.” But a recent column made me look more closely at the series: “Eight easy, natural ways to keep the flu at bay (without leaving home).” It’s written by Bryce Wylde, a homeopath who is a regular on shows like Dr. Oz. It would be a straightforward matter to look at Wylde’s recommendations and the science evidence supporting them. But the story is far more interesting than that. It starts with what Wylde suggests. He leads off with:
There are some highly effective natural solutions you can try to help prevent contracting the flu, or mitigate the symptoms once you have it. Still, recent news about the effectiveness of some supplements and home remedies has left many confused with what remedies are best to take both proactively and reactively.
Cue the appeal to nature and the false balance. His most conventional recommendation is getting more sleep. No argument there. But he goes on to suggest the following:
- Apply petroleum jelly to the insides of your nostrils: How this would block influenza isn’t clear. Given there’s a published case report of lipid pneumonia from nasal application of petroleum jelly, and no evidence of efficacy, this seems like an irresponsible recommendation.
- Thinly cut and plate two onions. Sprinkle sugar over the sliced onions. Cover with plastic wrap and refrigerate for two hours. With the liquid that results, dose out one tablespoon every three to four hours. Again, zero information to suggest that sliced onions have any effectiveness against influenza.
- Like onions, honey-based homeopathics may provide a safe and effective solution. Honey may have some effectiveness to treat cough, but it does nothing to affect the risk of infection or the severity of an infection. Honey-based homeopathics are simply honey, as the homeopathic nostrums in these products are ineffective and then diluted to the point that any of the original substance is gone.
- Garlic: What’s good for the heart blows infections apart. Yet another folk remedy with no evidence to suggest it has any effect on influenza or its complications. A systematic review of garlic for colds (not the flu) noted that claims of effectiveness are based on poor-quality data.
- Get proactive with probiotics. Wylde gives the standard alt-med trope that “80% of your immunity is in your gut” which always makes me wonder how immunity is being quantified. He touts Bio-K brand of probiotics. Indeed, the Bio-K website claims it is helpful for influenza and points to this study as evidence. However that study used a different formulation of probiotics and looked at symptoms only, finding a modest improvement. There’s no information to demonstrate it has any effect in influenza, as the study didn’t determine the cause of each illness.
- Shower your nose. Wylde recommends a neti-pot, which may help with the symptoms of a cold but is would have no effect on preventing or treating an influenza infection.
- Whip up an immune-boosting soup. Yet another trope, the scientifically ignorant idea that immunity is a singular thing that can be “boosted”. Wylde recommends astragalus root with ginger and garlic. A good soup makes anyone feel better, but there’s nothing to astragalus or the other ingredients for the prevention of influenza.
By any responsible health journalism standard, this has serious problems. I was not alone in noticing Wylde didn’t actually recommend strategies that do have some evidence to support them, such as vaccination, handwashing and social isolation. When I put the question to The Globe on Twitter, Wylde responded and claimed that the mention of vaccines had been removed at The Globe’s request, which I found pretty concerning. And then The Globe responded:
And then it doubled down on the column, promoting it all day
Spot the fallacies? A lot of people did, and commented online and via Twitter. The Globe’s response was more problematic than Wylde’s – it ought to know better. To The Globe’s credit, they subsequently took the feedback seriously enough for the paper’s “public editor” to address it a few days later, in a column entitled Homeopath’s advice needs to be balanced:
Last Friday, a blog on natural ways to keep the flu at bay written by an alternative-medicine specialist garnered criticism on social media and in the story comments. The blog suggested a variety of solutions that the writer, who has a diploma in homeopathic medicine, felt could either help to prevent contracting the flu or mitigate the symptoms. The blog was criticized by medical professionals on a number of points and most said it missed the key advice that what really works is the flu vaccine.
One public health physician-in-training wrote to me to say the article “makes a number of health claims regarding ways to prevent or treat the flu, but which lack any evidence to support them. Indeed, [the] … recommendations (such as the use of probiotics) …demonstrate a basic misunderstanding of what the flu is (a virus, not a bacteria). “As a member of the medical community, it concerns me when unfounded claims from Complementary & Alternative Medicine (CAM) providers are presented as fact and given legitimacy via publication. Incomplete or incorrect health information can produce very real harm, as it often prevents people from seeking out appropriate, evidence-based care (e.g. flu vaccine, antiviral medications).”
The physician’s question was about The Globe and Mail’s obligation in presenting health information. It is an excellent question. Medicine is a science based on studies and factual observations, unlike, for example, politics, where it is important for media coverage to balance the different sides of a debate.
The Globe has published many articles on the importance of getting a flu vaccination. But if the paper chooses to run an article by a homeopath in addition to the articles by medical professionals, such as a doctor, nurse or pharmacist, the article needs to be seen in the context of who the writer is and what his credentials are.
The article properly sets Health Advisor in context, saying this is a blog where contributors share their knowledge. At the bottom in italics is an explanation of the credentials of the writer so that readers will see this person is not a medical doctor but rather an alternative-medicine expert.
However, in my view, the label Special to The Globe and Mail is not clear, as it is commonly used to indicate articles by freelance journalists. It also would have been preferable to have the related links to the story balance the homeopath’s advice with a medical professional’s advice. The top three links were about learning to dream, outdoor fun and good germs. In my view, the top link should have been this article: “As a doctor, I’ve seen why vaccination is a ‘no brainer.’ ”
I think there should be a bias toward medical professionals writing about medicine and, while there is room for some coverage on alternative or homeopathic treatments, care should be taken to always balance such coverage with a doctor’s or other medical professional’s experience and expertise.
Regrettably, this response seemed to miss the point of the criticism, suggesting that all the Globe needs to do is to “balance” columns like this with a bit more science. I see the issue of “freelance journalist” as a bit of a red herring – this is the Globe and Mail, and the paper shouldn’t be lending its credibility to contributors touting unscientific health information. The proper way to deal with pseudoscience and magical thinking isn’t to “balance” it with links to credible health information, it’s to present the facts accurately the first time, and not give a platform to quackery. And when it comes to CAM, the science is very clear: if a “natural” approach or remedy has medicinal effects, it’s simply medicine. (All the rest is a nice bowl of soup and some potpourri, argues Dara O’Briain). There is no need to present two different perspectives. Just describe what’s effective.
The appeal to nature is one of the most insidious logical fallacies, and it can contribute to misguided attempts to “balance” science-based information against treatments and strategies that lack good evidence of effect. While The Globe and Mail is to be commended for publicly acknowledging and responding to online criticism, a stronger response would have acknowledged the paper’s responsibility to ensure that contributed health content is reviewed and vetted by the appropriate subject-matter experts. Logical fallacies are critical thinking “blind spots”, and it’s only when we know they exist that we can spot them.