In 1992, a group of rebel doctors published a radical idea in the prestigious Journal of the American Medical Association. They argued that the practice of medicine needed to be transformed so that doctors didn’t rely on intuition and conventional wisdom, but on evidence from science – such as clinical trials showing whether a drug really worked. This was called “evidence-based medicine”, and the backlash against it was fierce. Some doctors complained that it was a “dangerous innovation” that restricted their traditional freedom to practise and prescribe as they saw fit. Happily, the mavericks ignored them, their approach proved itself to be better for patients, and quickly became the norm.
Today, it feels like the world is rejecting science again. Donald Trump calls climate change a “con job”. The US health secretary, Robert F Kennedy Jr, is undermining vaccines and slashing science agencies by 25,000 staff. Alternative facts and misinformation are rife. In the UK, only 40% of people think that information they hear about science is “generally true”.
But there’s a bigger picture – and a more hopeful counter-narrative: the quiet, decades-long movement by which evidence from research is becoming integrated into our lives. I’ve spent the past five years speaking with more than 200 experts in evidence from around the world while researching my book, Beyond Belief. The experience showed me a fresh way to make decisions – and five ways to fight back against the forces of unreason.
The first step is to get some historical perspective. The idea that medicine should fundamentally be based on research is a surprisingly recent one; right up to the 1980s, many doctors weren’t taught to study clinical trials. Generally, everyone followed the advice of the most senior doctor in the room – they practised “eminence-based medicine”. Also popular was Gobsat: good old boys sat around a table, pontificating about what they thought best.
The term “evidence-based medicine” was formally introduced in 1991. Now, despite the initial pushback, doctors and patients draw on knowledge from rigorous research when working out what to do. By 2014, this change had been called “one of modern medicine’s greatest intellectual achievements” and ranked alongside the discovery of sanitation and anaesthesia.
Knowing this puts the current situation in context. It’s not that people are suddenly rejecting evidence – it’s that people only recently started using scientific evidence to routinely guide decisions in health and policy, and this is one of many setbacks along the way.
And if you look around, you’ll see there are so many ways evidence increasingly informs our world. Take education. Over half of English schools and more than 1.5 million children have taken part in careful studies testing which educational techniques – such as tutoring, feedback and phonics – are best at helping kids learn. More than 70% of school leaders say they use research when making decisions.
And three economists won the 2019 Nobel prize for showing that anti-poverty programmes could be tested – just like drugs – to see if they work. Policies shaped by these experiments have touched the lives of an estimated 850 million people, at least.
Next, in many ways, the future for evidence looks bright. Last autumn, a group of leading scientific funders announced $126m of investments in AI-powered systems to synthesise and supply science to governments and citizens worldwide. Their dream is that eventually anyone, anywhere, could quickly round up a rigorous overview of studies that answers their question.
The current climate can leave rational-minded people feeling hopeless or powerless. But fighting back in small ways can make a big difference. All of us can choose to consider facts, not vibes, in our next decision. One hack is simply to ask for the evidence behind claims. Even if a claim is all over social media, it could be nonsense if there’s no credible research that backs it up. (If you do this often, be ready for your children to start demanding evidence behind your own statements. This happened to me.)
You can also check if scientific claims stand up to scrutiny. A basic step is to check if a referenced study is peer-reviewed – scrutinised for quality by other scientists – and published in an academic journal. Peer review is only a crude indicator, because plenty of poor-quality science slips through and is published anyway, but it’s better than nothing. And a growing number of science search engines powered by AI can help make sense of the overwhelming volume of research. One that is popular with some experts, called Consensus, quickly answers questions by searching a database of more than 250m research papers and roughly summing up the relevant ones.
Governments should help – for example, by incorporating critical-thinking courses into schools. In a world overrun with misinformation, equipping children with bullshit-detection skills has become an imperative.
Finally, it’s important to be humble about science and about what changes minds. Research is complex, changing, frequently uncertain, sometimes flawed and often fails to provide clear answers. Simple stories resonate, which is why one person’s experience (“it worked for me”) often feels more convincing than data about thousands of people. But we have plenty of good stories and big wins in our corner too – so let’s tell people those stories.
Some people say the forces for and against evidence are in the balance, and it’s not clear yet which way things will tip. That means it’s up to us to decide.
