Whom to trust on medical issues: doctors or everyone else?

I recently came across an excellent paper on the vaccine-autism debacle. The paper is Sick With Fear, Popular Challenges to Scientific Authority in the Vaccine Controversies of the 21st Century. The paper was recently presented at a conference on health policy and won a prize for original research. Amazingly, it was written by an undergraduate.

The paper is terrific on many levels, but the part I found most interesting was Watkin’s explanation of why people are more likely to accept medical information from lay people than from actual medical experts. She’s talking about the vaccine-autism misinformation, but it applies equally to natural childbirth and homebirth, indeed almost every aspect of pseudoscience in medicine:

When dealing with such elusive issues, who can one trust? Doctors? The government? Friends? What is interesting about the vaccine-autism controversy of the last 30 years is the public’s faith in anecdotes and word-of-mouth. Searching for confirmation of their fears, Americans willingly believed the fear mongering of stricken mothers and celebrities, and ignored the mountain of research published in the scientific community…

Why? Watkins suggests that it has to do with Americans’ lack of understanding of science, primarily the result of:

… the poor quality of science education in America. American science education is embarrassingly weak: according to the Third International Mathematics and Science Study, American students rank below their counterparts in 17 other countries, and the National Science Teachers Association reported in 2003 that barely a quarter of high school graduates scored high enough on the ACT to succeed in a first-year college science course…

That leads to the “othering” of scientists:

Without satisfactory science education, the scientific community becomes inaccessible and elite. In America, there is a great deal of “othering” of scientists and experts because Americans are not educated enough to feel confident in scientific circles. Americans were willing to turn against the scientific community in the vaccine controversy because there was already distance established between experts and average Americans… (my emphasis)

Moreover, the average person, lacking understanding of science, relies heavily on journalists:

Because the majority of Americans are scientifically illiterate, news outlets are how most people learn about scientific breakthroughs. News outlets, however, do not always bear the duty to report the facts responsibly…

The quest for journalistic “balance” has contributed to the widespread misunderstanding of scientific issues:

[A] flaw in the relationship between science and journalism is the philosophy that there are always two sides to a story. Scientific evidence formed a bounty of evidence against the claim that vaccines cause autism. Regardless, Rolling Stone still published Kennedy’s article on the “other side” of the controversy in 2005 (an article so flawed that Salon.com, who posted it online in tandem with Rolling Stone, removed it from their archives in 2011). In cases like the vaccine debate, there is only one side. The stories of mothers’ woes and vague suspected corruption are not valid arguments to counter experimental data and research. By representing “both sides,” the popular media led the public to think there was room for doubt about the issue.

These same problems contribute to the widespread, but totally erroneous beliefs in the purported superiority of natural childbirth and the purported safety of homebirth. Far from being “educated,” the average NCB or homebirth supporter doesn’t understand enough science to accurately evaluate the information. Most advocates don’t know any obstetricians personally and are therefore easily susceptible to conspiracy theories about them. Finally, irresponsible journalists (like those at Consumer Reports) present the “other side” of the overwhelming scientific evidence in support of the liberal use of interventions in modern obstetrics.

The story of NCB and homebirth in the US, like the story of the vaccine debacle, is not about science. It’s fundamentally about ignorance of science, bias against scientists, and a mainstream media that is more concerned about writing “balanced” articles than about presenting the truth.