Evidence is a Downer – But We Need It

In a season 6 episode of Parks and Recreation, City Councilwoman Leslie Knope decides to champion adding fluoride to the drinking water to prevent endemic cavities. Leslie, in her usual way, provides ample evidence in large binders supporting her position and expects everyone to join her side. However, her rival on City Council, a corrupt dentist, starts sowing uncertainty in the fluoride plan. He goes on a local news show and calls it a dangerous chemical, and when that doesn’t work to sway opinion, recruits the local candy company, Sweetums, to take over the city water system and replace the water supply with basically… gatorade.

What’s Leslie to do? Arguing against the sugary tap water is nearly futile because no one wants to listen to the evidence-based science she has supporting fluoride-treated water. In the end, Leslie reads the ingredients of the sugar-water to the town in a monotone, while her co-worker, Tom Haverford, introduces a re-branded fluoride as T-Dazzle, “which makes your teeth stronger and … starts a party in your mouth.” Constituents swayed to the newly-sexy fluoride and against the newly-boring sugar-water, Leslie wins.

So what does this have to do with public health?

Well, evidence is not so sexy in the real-world, either. Often the people who are tasked with creating laws about health (politicians) are not experts on health and ill-equipped to understand research about best practices in health policy.

A study on barriers and facilitators to use of evidence-backed research for policymakers found that many policymakers, particularly state politicians who are part-time, have little time and few resources to actual research issues that they’re making laws about. On top of that, many were unable to critically analyze research and tell what sources were reliable or not. One particular quote that hurt me to read was:

One official observed that in assessing the effectiveness of a new medical procedure, “I just did exactly what…everyone…is hoping I’m not. I talked to my brother-in-law and I Googled it” (Jewell & Bero, 2008, p. 184). (Emphasis mine.)

This is really bad for the rest of us – who have to live with hasty and ill-informed decisions made by politicians! In health sciences, evidence-based medicine is when specific decisions about the best available evidence are made to influence decisions for patients. Research is being done all the time to find out what the best types of therapy are for certain populations, or what screenings should be done for certain types of cancer, or what helps people stick to a diet or exercise plan. This information is useful, but can sit on a shelf unless medical professionals adopt it and communicate it to their patients, and in the legal realm, if policymakers don’t care to understand the latest and best available information, they’re not able to make informed decisions on what kind of legislation is going to bring the most benefit.

Making evidence easy to understand and accessible is important. We probably don’t have to go to T-Dazzle lengths to communicate benefit, but taking into consideration confirmation bias and general antipathy toward evidence and preference toward the familiar is important for making your case. As most people who have had arguments with a political opposite have experienced, throwing facts at someone usually does little to change their mind. We need evidence, but we need to push for better ways to communicate it so it can reach the people who need to hear it.

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