Interviewer: Tricia Ward; Interviewee David J. Skorton, MD


April 18, 2017

Background: Before becoming Secretary of the Smithsonian Institution, Dr David Skorton wrote in 2014 that "...scientific, medical, and public health developments sometimes fail to gain public acceptance for reasons that lie far outside the realm of science. And that is not the fault of the public—that is our fault as scientists."[1]

David J. Skorton, MD | Medscape: How do you see the public's loss of faith in science (such as the antivaccine movement) as a failing of science and medicine rather than public education?

Dr Skorton: The responsibility is on us as scientists. I see it as a failure in communication. There is certainly a movement toward providing a lay summary of research studies and getting that out through the media to the public. But at that point, it's too late. We have to help people grasp the scientific method, which continually reassesses what we believe to be the truth. Nonscientists can feel like they have whiplash from changes and contradictions in scientific consensus.

For instance, for a generation we were told that you have to eat nonfat dairy products and that eggs were really bad. Now we think it's okay to have an egg once in a while and that a little more fat is probably not such a big deal.

The vaccine situation is another perfect example. In 1998, an article was published in the Lancet suggesting a link between autism and vaccination. That article was found to be fraudulent. They stripped the lead author of his medical license. They retracted the paper. There was a definitive study[2] done that showed no link. Yet, to this day, many people are convinced that vaccines cause autism.

When people see changing and contradictory scientific conclusions, it causes them to believe that science is sloppy, imprecise, inaccurate, or generally not to be trusted. If we as scientists hope to win back the trust of the public, it's our job to help them understand why science is less about permanent results than about continuously questioning our assumptions and testing them when new evidence comes to light.

The Hound of the Baskervilles would help the public understand what science entails. | Medscape: How can that message be conveyed to the public?

Dr Skorton: I used to give my students copies of The Adventures of Sherlock Holmes, by Sir Arthur Conan Doyle, who studied medicine at the University of Edinburgh. The character of Sherlock Holmes was based on Conan Doyle's surgery professor, Joseph Bell.

Reading one Holmes story, The Hound of the Baskervilles, would help the public understand what science entails. In my view, Conan Doyle's description of a systematic approach to crime-solving elucidates the principles of the scientific method. Holmes would notice something, posit an explanation, gather data, and if it fit the explanation, then mystery solved. If the data didn't fit, he would revamp his hypothesis. That is the scientific method. That is the medical diagnostic method.

Now, the climax of those stories is that Sherlock Holmes solves the crime and gets the culprit. That is also our goal in science.

Where I think we have failed is that we don't explain the joys of the hunt and how scientific discovery is a never-ending process. That responsibility falls squarely on our shoulders. We need to get out there and not so much "educate" the public, which sounds paternalistic, but share the process through a variety of media and mechanisms.

We should encourage people to do their own innovative thinking and help them understand that problem-solving is a continuous process that has its own rewards. | Medscape: What about the tendency to overhype trial results?

Dr. Skorton: Hype is your word, not mine, but the factors that contribute to that are clear. We want to find the answers to questions in order to help people. There are also career motives. People want to feel that they are making progress in their careers, that they are doing good things and are being recognized. That is understandable.

But I would argue that we should not put commercializing results ahead of the public interest. I was active in clinical medicine for over 30 years and served as a consultant on an FDA panel. I understand the enormous investment that a device or drug company will make in trying to push the ball down the field.

There is nothing wrong with selling; this is a capitalistic society. It is how a lot of research gets funded. But as we share data with the public, it would be good for all of us to remember that science is a never-ending process. With rare exceptions, it is unlikely that the current wisdom is going to remain unchanged for long because our understanding is too incomplete, and life processes in health and disease are just too complex. | Medscape: Are there resources to help scientists do a better job of communicating findings and limitations to the general public?

The National Institutes of Health has a useful website that provides practical communication tips and resources, as does the American Association for the Advancement of Science.

The days of science being an isolated endeavor cut off from the outside world or other disciplines are pretty much a thing of the past. To do our jobs to the best of our abilities, scientists and researchers need to be able to make it clear why the work they do matters. The stakes are higher than ever, and we need to advocate for our work and for science as a whole.

Follow Tricia Ward on Twitter: @_triciaward

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