Exploring these questions is relevant to all who are working to support people's engagement in their health and health care.' ' They are also relevant to the debate about the value of comparative effectiveness research.' Science journalist Chris Mooney reports a couple of provocative points in this account of four meetings on the topic sponsored by the American Academy of Arts and Sciences over the past year.
'Scientists'are working in a 'deficit model.'' They assume that if only their fellow Americans knew about science and ceased to be in a state of knowledge deficit, a healthier relationship between science and the public would emerge.'
This perspective also describes the somewhat magical thinking that influences the efforts of well-meaning health plans, employers, Web designers and app developers to spark our engagement in our health and health care:' The reason we eat so many cupcakes, drink so much beer and adhere so casually to recommendations about how to care for our diabetes and blood pressure must be that we simply don't have the right information. The corollary is that when given the right information, we will spring into action.
While this model is fully rational ' why, after all, wouldn't we act in our own best interest (where science-based information represents the best interests of the average person)? ' it doesn't actually seem to work that well.' Witness the instances of overweight and smoking as you walk down the street ' and should that not convince you, there are scientific journals full of evidence showing that the model falls short of predicting behavior.
Mooney's points are also echoed in some of the discussions about conducting and disseminating comparative effectiveness research: If only we, the public (and physicians) truly understood what comparative effectiveness research is, we would support its conduct and quickly adopt its results.
I can't decide whether that line of rhetoric is just the usual mechanistic/optimistic representation of human behavior typical of policy advocates or a vast oversimplification of the complexity and nuance of this field of inquiry in deference to the lack of scientific sophistication of the public.
Regardless, Mooney's essay makes it clear that the results of comparative effectiveness research, like health information in general, will not change public attitudes or behaviors by simple injection into the news or health websites:
''there is no guarantee that increasing scientific literacy among the public would change core responses on contested scientific issues, for those responses are rarely conditioned by purely scientific considerations.' Scientists and nonscientists often have very different perceptions of risk, different ways of bestowing trust, and different means of judging credibility of information sources.' Moreover, members of the public strain their responses to scientific controversies through their ethics or value systems as well as through their political or ideological outlooks ' which regularly trump calm, dispassionate scientific reasoning.'
I wonder if we have the wherewithal to handle the firestorms of discontent and disagreement in store for us as we continue to peel back the layers of science, misinformation, opinion and self-interest that have created today's medical care.' I suspect we have a rough road ahead.