Volume 2, Issue 5: Take the Advice, not Just the Medicine

Take the Advice, not Just the Medicine

Paul A. Offit, M.D., Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Information. New York: Columbia University Press, 2018, 

xiv + 251 pages. $16.95 Paperback ISBN 9780231186988

Science popularization and the health sciences have two interesting components from the viewpoint of the history of philosophy of science: science popularization and the health sciences. Let’s take them in order.

            Popular science or science popularization has a long tradition in the English-speaking world; nonetheless, it didn’t get much attention from professional philosophers of science, or even from historians (of philosophy of science). From one aspect, this might be wholly understandable—popular works do not have much influence on academic debates and professional and institutional philosophical trends and arguments; as the name suggests, it is popular, directed towards non-professionals.

            But popular scientific works or science-popularizations (the two often came together or could be taken now under one umbrella) had many advantages and provided a special forum for unpacking one’s philosophical ideas. In the 1920s and 30s, for example, Sir Arthur Eddington and Sir James Jeans wrote several of popular works on the philosophical implications of the new physical theories (such as relativity and quantum mechanics). They were able to produce detailed treatises not just on physical theories, but also on epistemology, ontology, and metaphysics, written in a lucid style, often with humorous remarks. They were testing, in fact, the limits of British idealism. They also had thus a special social role: British people (and many others since those works were translated into many languages, among others to my native Hungarian) incepted not just physical results and viewpoints from these books, but a very special philosophical position and worldview as well. 

            But besides Eddington and Jeans’ efforts (which were criticized by almost every philosophical school and tradition with the most different backgrounds!) professional philosophers wrote popular works occasionally. I do not have in mind now Bertrand Russell and his influential works on marriage, politics, or the nature of mathematics and philosophy, it is a whole different story, and while Russell was an impactful defender of scientific philosophy, he did not have much substantial science popularization. But we have here Hans Reichenbach, the Berlin-based scientific philosopher (with a degree in physics and mathematics) who often delivered radio talks in the early 1930s and published them as a well-known book, Atom and Cosmos (published first in German, then in English, then in Hungarian as well). Reichenbach took the chance to spread the word about the new scientific philosophy within the unlimited range of science popularization. His book was also lucid, understandable, illustrated with pictures and hundreds of examples, conveying a very neutral, basic, but a helpful rational attitude towards life and balanced decision-making.

            Thus science-popularization had a role in the history of philosophy of science—historians of philosophy of science shall pay more attention to that. If we are to look for the basic or substantial and explicit socially engaged dimension of philosophy of science, popular, unphilosophical, or usually despised papers, pamphlets, magazine articles, and popularization-works are our primary sources.

            The other strange component here is the health sciences. History of philosophy of science—of course, there are certain, important and well-known exceptions, the latest being Jutta Schickore’s book on snake venom—did not pay much attention to the health sciences and their social and epistemological impact. While the situation is not that desperate—under the banner of ‘life sciences’ many interesting things are done—issues of contemporary health, medicine, and related fields are way underrepresented among philosophers of science.

            Paul A. Offit’s Bad Advice is not a game-changer for philosophers of science, of course—and, rightly, it is not intended to be one. But it has its advantages and importance for anyone who works on the social and cultural dimensions of science and philosophy of science.

            Offit is widely known, both among scientists and the public—not because he is the director of influential and important institutions (Vaccine Education Center at the Children’s Hospital of Philadelphia) or because he is a professor at valuable centers (Maurice R. Hilleman Professor of Vaccinology, Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania). His name is mainly due to being a coinventor of a rotavirus vaccine, “saving hundreds of lives a day” (p. 188). As vaccines had quite a bad reputation from the 1980s on, but especially after Andrew Wakefield’s (since then retracted) 1998 study on the relation of certain vaccines and autism (see Chap. 8), Offit quickly found himself in the waves of public interest, journalism, science popularization, death threats, science denial, congress hearings, and general knowledge dissemination. Most presumably you can easily become an orthopedist without much ado about public hearings and a widely considered social dimension of weighing worldviews, values, and respecting alternate opinions until the borderline of risking one’s health. Being a cardiac surgeon might be more of a directly life-saving issue, though one is hearing less about publicly controverted surgeons (doing something illegal and thus becoming news-star is a different issue).

            But working with vaccines seems to be an entirely different issue. Do not misunderstand me—I am not claiming this is the only publicly significant area of medicine; recent world events show the social importance of epidemiologists, virologists, and many other on the ‘front-line’; but Offit’s book on vaccines and their social dimension is a particularly controversial field for study.

            Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Information is an easily readable book. You won’t learn much about the exact workings of vaccines, or medicine, or even science (though many information is hinted on the pages of the book). This work is not popularizing science in a direct way; it is not about popularizing science thus but it is about science-popularization itself. It contains almost hundreds of examples and experiences of Offit. Bad Advice is not lying—making science popular, or simply matter is a painful business, and it is almost an entirely separate field of expertise (perhaps it is). Offit provides many scenarios when he was invited to the typical morning news, congress hearing, to the national television, to courts, to shows, to magazines, thus to many places where what you said matters not only for your individual career at your institute, or for your next grant but for generations of citizens, often indirectly link the very existence of those citizens.

            Because of this, anyone who ever has to talk in front of the public about his/her own scientific work should get this book to learn from it. Offit was educated in the early 1960 and 1970s, in a radically different social and scholarly setting, of course, and as he funnily notes it often, he was naive about many things later—often his young children had to enlightenment him where he is going, or with whom he is going to talk and so on. Many of his stories are well known nowadays (or at least the morals of the stories) and many of his bad experiences (when his words were turned upside down) could have been avoided with a little more attention or common sense. But perhaps what is common sense now for us was not at all common sense forty or thirty years earlier. But getting everything in one place is always good to have.

            Chapter 4, “Feeding the Beast” is especially interesting from this perspective. It has individual stories, mainly unrelated, about such public hearings that could have been going better if the author already has the morals at hand. But one learns from experience, or books. Every story has a lesson, such “Don’t go on a show where the host isn’t on your side” (p. 52), “Be sympathetic, no matter how trying the circumstance” (p. 56), “Don’t panic. The facts are your safety net” (p. 57), “Take on religious issues at your own peril” (p. 59), “Avoid debating celebrities (unless no one remembers them anymore)” (p. 61), “Make sure you have the backing of your institution” (p. 65), “You are going to say things that, although scientifically accurate, you will regret. It’s unavoidable” (p. 67), “Advertising revenue is the ultimate conflict of interest” (p. 74).

            Most of these lessons are taught at the undergraduate level of informal logic, rhetoric, and communication courses. Nonetheless, Offit makes them quite vivid, believable, and alive. The whole book is, in fact, a big battle or struggle that many of us face quite often in various fields of our daily lives. What to say, and what not in order to stay reliable, available, and credible but still not hurting others (up until a point), and not letting them distorting your words and ideas. In case of (apparent) conflicts—of moral, existential, and scholarly type—how to proceed, what are those decisions and communicational moves that cause the less damage to you and your cause (your scholarly status and career included). In Offit’s book, we follow his crusade with anti-vaccine groups, politicians, celebrities, activists, and scholars.

            But why are popular and dissemination-like books important? As Offit says,

Vaccines are no different. Sometimes people tell me that after doing their research, they’ve decided not to get the chicken pox (varicella) vaccine. What they mean by research is that they’ve read other people’s opinions about the vaccine on the internet. That’s not research. If someone really wants to research the varicella vaccine, they should read the seven hundred papers that have been published on the subject. To do this, they would need to have a working knowledge of virology, immunology, microbiology, statistics, epidemiology, pathogenesis, molecular biology, and clinical medicine. Most people don’t have this expertise. In fact, most doctors don’t have it. (p. 44)

Although scientific knowledge was always a complex business, due to the many interrelated issues of interdisciplinary research and due to the evolving and deepening details of individual fields, lay-research is almost impossible. To make things worse, a popular book would come up presumably only at a later stage of online (re)search than would, e.g. unscientific but popular blogs and videos. Thus, one might even conclude that science popularization and knowledge dissemination shall be the task of individual scientists and not well-educated outsiders (even with the best intention).

            But there is—sort of— a dilemma here. What picture of science one shall draw in a popular work, or better, how deeply shall one go into the details, to paint a faithful picture but still do not scare the laypeople? In this respect, Offit has walking on very thin ice, and even though he survived the experiment, the ice is cracked.

            One of the main points of Offit is to call attention to the very-very surprising fact that science is made by human—humans with human interests, values, decisions, morals, way too human. “In other words,” as he says, “while it is reasonable to be skeptical of scientists, it is unreasonable to be skeptical of the scientific process” (p. 5). It is reasonable to make this distinction; scientists are indeed human, not always following the way where the data lead them, not always make the right scholarly decisions, not always say what they should say on the base of the available evidence. But if you admit this publicly, seemingly you admit that science is just lame, or at least you should not trust science better than anything else. The only option—or at least the most often chosen option—is to claim that science is not identical to scientists, and only science or the scientific method is trustworthy, right, rational, and delivers the adequate results, sometimes only after a while, but it does. 

            In another place, Offit argues that while everything is debatable in politics, “science, on the other hand, isn’t politics. Once scientific truths have emerged, they aren’t debatable. Nonetheless, scientists are occasionally asked to debate them” (p. 75). The same old distinction: scientists can debate stuff, but as soon as science is done, nothing remains there to be legitimately questioned.

            One problem might be this. If we push this picture of science, where science is something secured, have solid foundations, where the scientific method has its own life and everything that goes in and comes out (in an uncertain amount of time) is just fact and that’s it, is not just misleading but potentially carries annoying connotations. Who is out there to decide when did an issue become a fact, a final result of the scientific process which is, after all, carried out by scientists—who are known to be all too human. Are these decision-makers again just the very same human scientists? It doesn’t sound like a bulletproof warrant. Also, it is widely known, or at least widely shared by the majority of the philosophy of science community that the “scientific method” is much like wishful thinking; there is no such thing as the final, crystallized, algorithmic scientific method. But if there is—who knows after all—is it necessary or even probable, or anything that at this very moment we already have that final method? Offit’s choices of words, his narrative, and his whole story-telling sound like an apologetic journey for the scientific method.

            But if you leave this old story behind, and go for an as contingent picture of science as of the scientists, then most presumably you will destroy the distinguished picture of science as the queen of all rational and cognitive human activities, and really soon would arrive at a relativistic, almost anything goes picture. You do not want to do that; nonetheless, it is a long, hard, and trapped journey to save something of the old picture of science while upholding at the same time all its contingencies and human-made character. In a popular work like Offit’s, this is simply impossible, one would say. We do not have to decide it here, of course—but it is important to call attention to the traps of science popularization.

            But one would rightly ask the question—why I should read this book as a philosopher of science? Scholars often tend to seek out texts, manifestos, reports, books, and similar issues. But rarely do they consult biographies and first-person reports about scientific careers and popular works (that was our starting point above). But these seem to be highly relevant, especially because in popular works and reports one might found many clues about what are the actual values of scientists and the laypeople. We do not find any mention of simplicity, unification, predictive force, and similar traditional cognitive values in Offit’s book—while surely he was guided by these ideas in his own scientific research, his popularization work did not embrace them. Also, the public did not reject his policy of vaccines because it was not based on sufficiently unified theories, or because it was falsely too simply. Different types of reasons and values emerge from Offit’s own experiences and reports.

            If philosophers of science want to get closer to the people, then more attention should be given to such works and considerations as Bad Advice. Offit’s book is also nicely edited, has a very funny cover, contains no typos (I was able to spot only one!), and is so readable that you are not even noting the hard issues and the significance of all these. While in fact the whole topic of the book—the communication and fight with anti-vaccine groups—is just too sad and gloomy, Offit was able to emphasize the winnings, the bad turns as “experiences to rely on in the future” issues, and drops occasionally such jokes that indeed shows that scientists are just human, all too human.

             

Adam Tamas Tuboly

Institute of Philosophy, Hungarian Academy of Sciences

Supported by the MTA Lendulet Morals and Science Research group and by the MTA Premium Postdoctoral Scholarship.