Junk Science, Expert opinions, and MCS

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The term 'junk science' has found its way into debates in Congress, onto editorial pages of newspapers and magazines, and recently, onto prime-time network news magazine shows. Everyone understands something about what is meant by 'junk science'--it's bad information masquerading as proven fact. Sometimes it takes the form of opinions expressed as fact. Sometimes it's information that, while technically accurate, is so selective that it misleads.

Junk science is insidious. And it is a major concern of the Human Ecology Action League, Inc. (HEAL). As an information and education organization, HEAL has a keen interest in the accuracy of information about environment and health that receives wide distribution in the media. Recently HEAL wrote to the editor of a major network news organization about their coverage of 'junk science.' The letter said in part:

"We appreciate your effort to bring the issue of junk science to the attention of the public. Erroneous or incomplete information from any source can have unfortunate consequences, if it is used as the basis for action at any level --from private life to public policy."

In private life, bad information can lead to bad consequences that range from trivial (spending money on items that do not measure up to their stated promise) to dire (delaying effective medical treatment while pursuing ineffective -- and over-sold -- alternatives).

But in public life, erroneous, incomplete information can lead to making decisions, passing laws, and implementing policies that affect large numbers of people, sometimes at great financial (and other) cost. Thus it is clear that, when decisions are made on behalf of the public, those decisions must be made on the basis of the best information available at the time the decisions are made.

HEAL is most concerned about decisions affecting environment and human health. Such decisions are information-driven, and involve such questions as: How will this decision affect the quality of the environment/human interface (eg.air and water quality, food safety)? How will this decision affect the health of vulnerable members of our society (children, the elderly, the unborn, the chronically ill)? How much will this decision cost to implement (in jobs, money, environmental degradation--and human health)? Who will benefit from implementation of this decision (the general public, the industrial sector, the wealthy, the poor)? If the decision has unexpected negative consequences, who is likely to be most affected by those consequences? Will it be possible to undo the harm? And whose responsibility will it be to do -- and pay for -- the repairs (the general public, the principal beneficiaries)?

These types of concern are often grouped under the general heading of cost/benefit analysis, or its related (but not identical) process, risk assessment. Each depends heavily on the ability to identify and marshal relevant facts about each question. Often these facts are best understood by experts. And so frequently, expert opinions are sought.

But what counts as an expert opinion? Or, to put it another way, who can we trust to give us reliable information about the matter at hand? HEAL noted in its recent communication: "[T]he opinions that are worth having in the scientific arena are those of people who have credentials in the area under discussion. Uncredentialed so-called experts, or self- styled experts, can contribute little that is substantive to the issues under consideration. At worst, they can undermine both public trust and effective public policy." Thus, when expert opinions are sought, relevant expertise is essential for the credibility of the opinions obtained. (Or to put it another way, ask a plumber about plumbing.)
But sometimes, this common-sense standard for credibility is not met. As HEAL noted, sometimes the "experts" are not experts at all -- as when a figure famous for one kind of activity offers an opinion on a radically different, unrelated issue.(In fairness, sometimes famous people offer opinions in this fashion in order to draw attention to issues that they think are being ignored, or to constituencies that they believe are under-represented. Since the goal is to draw attention, their fame is relevant. Once attention has been drawn, however, the task of providing factual buttressing of the position falls best, and most credibly, to those who have mastered the factual material relevant to the matter at hand.)

A much more common situation arises when people who do have academic or professional credentials are called upon to offer opinions on questions outside their areas of expertise. This is especially likely to happen in discussions that hinge on highly technical matters. In these cases, it's not uncommon for all MDs and all PhDs to be summarily lumped together by those in search of expert opinion, as if credentials were interchangeable. This "lumping together" sometimes occurs as a function of how the opinions of such individuals are reported by the press, and sometimes it seems to arise out of an inability on the part of the press, lawmakers, and the public to distinguish among professionals who hold similar (or even identical) advanced degrees in disciplines that mystify -- and intimidate -- the average citizen. (Brain surgery and rocket science have become bywords for such disciplines, for instance.)

But are all advanced-degree holders interchangeable? A moment's thought convinces us that they are not: Who would go to an attorney--even the best attorney--for medical care? Similarly, common-sense tells us that not all practitioners within a given discipline are equally competent. Sometimes this occurs because of specialization within the discipline itself (cancer specialists and pediatricians do not offer (and are not expected to offer) interchangeable services, though both specialists may be MDs). And sometimes it occurs because, as one health professional once put it, "Not all of us graduate at the head of our class." Some practitioners are better at what they do than are their colleagues.

So, when seeking expert opinions about technical matters, common sense tells us that the best (that is, the most informed) opinion is apt to come from the technical specialist who has, not only credentials, but RELEVANT credentials; and whose career in using those credentials has displayed some competence (as measured by publications, awards, length of practice/experience and so on).

Junk science is apt to raise its ugly head when unqualified "experts" are asked to give their expert opinions regarding technical matters that few outside the relevant discipline understand. Such experts may be rendered unqualified if they have no credentials at all; or if they have credentials but in an unrelated area of expertise; or if they have credentials in the relevant area of expertise, but lack additional satisfactory evidence to support their identification as experts. (For example, a person with a twenty-year-old law degree but no experience in practicing law is unlikely to be a good source of first-hand information about current courtroom procedure.)

Unfortunately, the more remote from daily experience a technical topic is perceived to be, the more likely it may be that an unqualified "expert" could be asked to deliver an opinion on the topic. In public policy debates, unqualified "experts" sometimes offer opinions to legislators and policy-makers who are distracted, pressed for time, or even absent. In presenting news, reporters may hurriedly consult, quote, or interview unqualified "experts" whose lack of qualifications may be poorly understood by the reporters, and completely hidden from the reader or viewer. In both cases, the expert's opinion may be taken at face value, and decisions may thus be made on the basis of inaccurate, incomplete or false "information."

HEAL's Governing Board believes that press coverage of the (highly technical) topic of health effects arising from low levels of chemical exposure has often suffered from just this type of false expertise. As a result, public opinion has been influenced by incomplete, and therefore misleading information obtained from questionable sources. With respect to the recent network broadcast about one aspect of low-level chemical exposures, multiple chemical sensitivities (MCS), HEAL wrote:

" [W]e were disappointed at your erroneous and incomplete coverage of the controversy regarding multiple chemical sensitivities (MCS). Central to this coverage was the issue of the effect of environmental exposures on neurological and psychiatric health. Over the years we have amassed considerable information about this issue, and we regret that you did not avail yourselves of it during preparation of the segment on MCS. Your story would have been more accurate had you done so, and [your coverage of] 'junk science' might have been much improved.

"Instead, the [story portraying] MCS [as an example of 'junk science'] repeated a mistake that has been made often in the press coverage of MCS: You devoted a great deal of time to the opinions of people unqualified to pronounce on the topic under discussion. You interviewed a toxicologist, a reporter, some activists, and some MCS sufferers, none of whom have professional credentials in the areas of neurological or psychiatric health. Viewers were left with the impression that MCS is a real problem, but of psychological, not physical, origins...

"MCS is not an easy subject to understand. There is a lack of consensus regarding virtually everything about it -- except the need for more research. It struck us as unfortunate that [the report on] MCS erroneously implied that there is consensus among the informed medical and research communities, and that those who quarrel with this "consensus" are practitioners of junk science. We believe that this is an error of fact, and thus casts doubt on the reliability of your investigation into the important topic of junk science and its impact on society. "

What would have happened if those responsible for assembling the story exploring whether MCS is physical or psychological had consulted some specialists in, say, mental health, or neurology? HEAL offered some insight into the substantive issues at stake, and the opinions of some qualified experts:

"Had you consulted psychiatric or psychological professionals (as we have), you might have been surprised to learn that "Psychogenic illness or hysteria [is] a diagnostic haven to which uncertain physicians all too often repair when signs and symptoms seem anatomically or physically senseless." And that "For reasons not fully understood, 'hysterical' symptoms appear to be especially frequent in patients who turn out to have neurological disorders...." A clinical psychoneurologist recently concluded, after a review of the scientific literature on organic illness in psychotherapeutic settings, that "...with hysterical/conversion symptoms, one-fourth or more of the patients may be expected to have some kind of neurological involvement."

" As for the role of environmental exposure in neurological disease, the National Research Council's 1992 report ENVIRONMENTAL NEUROTOXICITY noted that subclinical neurotoxic effects [of neurotoxicant exposure] can include alterations in a wide spectrum of behaviors....," that "there is convincing evidence that chemicals in the environment can alter the function of the nervous system....," and that "it has been hypothesized that that an undefined fraction of chronic neurologic and psychiatric illness can be exacerbated or even caused by chronic, low-level exposures to environmental neurotoxicants."

"As two researchers concluded in 1982,"The diagnosis of psychogenic illness or hysteria often tells more about the physician's lack of knowledge than the patient's disease...." If this is true for physicians in clinical practice, it is not surprising that others might also be similarly uninformed.

Those who rely on the opinions of experts need to be able to determine what counts as expertise -- and who counts as an expert -- on any given topic. The more technical the topic, the more carefully credentials should be scrutinized. And similarly, the more the decision's consequences are likely to affect the lives and well-being of people, and the livability of the world, the more care should be exercised in selecting experts, and the greater deliberation should be given to their opinions.

Does it matter that a major network blundered in its coverage of a highly technical, poorly understood phenomenon?  In the long run, probably not. Many viewers realize that, often, television new-magazine shows offer a combination of information and entertainment. Most viewers realize that important shades of meaning are lost when information is packaged in an entertaining "story" format featuring good guys, bad guys, conflict, crisis and resolution. Important facts that do not fit comfortably into the format may never be presented to the viewer. Complicated stories, with many facts in dispute, are difficult to portray neatly, and, as was the case with the story on MCS, lend themselves to misleading portrayals.

More troubling are those situations in which the opinions of the unqualified may make substantial impacts on how people live, and how well they -- and their children -- feel. In such situations, oversimplifications that suppress important aspects of a technical topic can become the basis upon which important policy decisions are made. It's not a comforting thought.

Are there really "opinion leaders" who don't know what they are talking about, but who are advising law-makers, journalists, and other influential groups about matters that will directly affect you and your well-being?  It's easy enough to tell: Ask questions. Ask about credentials. Ask about experience. Ask about affiliations. Ask who pays their bills. Once you have the answers to these questions, you can decide if it makes sense to ask for their opinion. (The press should already be doing this, and often -- but not always -- does.)

The news magazine story about MCS alleged that people who have MCS have a real problem -- a psychological one. Consider for a moment what this means: All people who have been diagnosed with a particular medical condition are alleged to have been misdiagnosed -- and moreover, are said to have an entirely different problem. Viewers were asked to accept this conclusion based on the "expertise" of reporters and a toxicologist. Surely, when anyone other than a mental health professional offers an opinion about the mental health of an individual, that opinion is more like name-calling than it is like expert opinion. And this is even more true in situations in which whole groups of people are involved.

Once again, common sense should be our guide: People with medical conditions get diagnosed one at a time -- and so do people with mental health disorders. Sometimes the diagnosis is wrong. But it is beyond the expertise of even the finest clinician to pronounce on the appropriateness of diagnosis for an entire group of people--and it is outrageous, when you think about it, to diagnose the same group, as a group (sight unseen, no examination of any kind) with a completely different condition. There is no "expert" who can deliver such an opinion credibly.

This is important to everyone. We live in an age of information, an era that is increasingly splintered into technical specializations that more and more of us find incomprehensible and intimidating. Those who have mastered these specialties have earned our respect. But their opinions have not earned our uncritical acceptance. Once we start to allow so-called experts to form public opinion on the basis of their personal opinions--which can contain information screened through prejudice, bias, political beliefs and/ or self-interest--we open ourselves to the risk of conducting public life--and public policy, not on information, but on name-calling. And once that happens, we're all at risk.

-- Public Information Committee, Human Ecology Action League, Inc.,
Staff, THE HUMAN ECOLOGIST

 

At a Glance

Perspective: Environment and health nt and health

Quotable (1)

"Problems with human health and problems within the environment are, in most cases, so intertwined as to be inseparable. Problems within the environment may not become apparent until many years after their initiation or until human health is affected. Resolving these problems requires an understanding of the relationships between individual components of the environment. In other words, it is necessary to encompass all areas of environmental health, so that human health issues may be recognized before major health problems become established. Only when all areas of environmental health are considered can the interdependence of the environment and human life be recognized."

Gary E. R. Hook and George Lucier, Editors-in-chief,
Environmental Health Perspectives.
In Twenty Years of Environmental Health Research
(Washington DC: DHHS-PHS-NIH-NIEHS 1993)

Quotable (2)

The Agency for Toxic Substances and Disease Registry noted, "Exposures to toxic substances can affect children's growth and development, and many harmful substances can be more easily absorbed by children's immature body tissues, causing severe illness...."