For decades, The National Science Foundation (http://www.nsf.gov/) has been studying “scientific literacy” in the US (defined here as knowing basic facts and concepts about science in order to understand and predict how the world works). Such literacy can help us make good choices for our lives, including for our health and healthcare. The NSF tells us that half of Americans (1) know the meaning of “margin of error” (limits of knowledge), (2) believe the earliest humans lived at the same time as the dinosaurs (eh, what’s 60+ million years), and (3) know how long it takes for the Earth to orbit the sun (Come On, Man!). In addition, belief in pseudoscience seems to be widespread among Americans (e.g., over 40% of Americans consider astrology “scientific or sort of scientific”).
As a pulmonologist, I’ve run head on into this lack of scientific literacy. I’ve had asthmatics nearly die because of a poor understanding of the difference between the small possibility of a side effect of inhaled steroids, pitted against the strong probability of morbidity and mortality from not using the inhaled steroid. Or moderate-perennial asthmatics stop using their inhaled steroid once their airway inflammation entered remission, not understanding the difference between remission and cure, despite my multiple, patient explanations. Typically it’s the word itself that freaks them out (“steroid”), having witnessed TV News reports of homicidal behavior in wrestlers or weight-lifters who injected high-doses of anabolic (rather than inhaled anti-inflammatory) steroids for years. The power of the TV News, particularly the fear-mongering and hyperbole of Fox News, is mightier than any carefully worded explanation from a scientist.
I’ve written previously about our non-scientific American culture of “more is better” (see “What would it take to convince Americans that more [healthcare] is not necessarily better?”). I enjoyed Alice Park’s article in Time this week attempting to reconcile the shifting sands of medical advice (from the US Preventive Service Task Force), pitted against “… (the) cultural bias that medical care can only benefit and not … harm.”
How shall we doctors change our communication content and style with patients in order to accommodate poor scientific literacy? Furthermore, how shall we document in the medical record that we took reasonable measures to explain in lay terms the authentic choices before the patient? For the former, I ask the patient and family to tell me what they found valuable from what I said (rather than what they understood, which can sound condescending), ensuring an understanding of facts and rationale. For the latter, one might type “I described the pros, cons and tradeoffs of each choice; asked the patient to explain in her/his words what they understood, and why they made the choice they did, ensuring a grasp of the medical facts and rationale.”
The real solution of course is to use the scientific method to determine the best societal investments to make in order to improve the scientific literacy of our kids and adolescents. Maybe it’s not more dollars toward school education; rather finding incentives for parents to turn off the TV and do homework with their kids. That’s a two-for by the way… both dad and kid learn for the price of one.
There’s good news, though. Ninety percent (90%) of Americans know that the oxygen we breathe comes from plants (shout out to Trees Atlanta!). And, during the last 10 years, the percentage of Americans who know that Antibiotics kill only bacteria – not viruses – has now exceeded 50%.