How to communicate and use science

Jani Ruotsalainen is the managing editor of the Cochrane Work Review Group, which is housed at the Finnish Institute of Occupational Health in Kuopio, Finland. He manage the production of Cochrane systematic reviews about occupational safety and health topics. He also promotes their review findings using a range of contemporary tools including newsletter, webinars, and social media. You are welcome to read his blog post below.

Apparently we live in the time of post-truth and alternative facts. However, we do not have to take this lying down. What we, the scientific community, can offer is a viable alternative, meaning real facts. There are two things that are critical in this: what to do when faced with outright lies or opinions parading as facts and what to offer in their place. In other words, what is our strongest content and how do we convey it to those people that really need it?

The key to both issues is bias. Alternative facts consciously ignore biases and their effects. Somehow a personal gut feeling just Trumps scientific reasoning. The best thing we believers in science can do is to accept the existence of biases and to try and minimize their effects in what we do. One tried and tested way to do this is by means of systematic review. It is a means of abstracting a higher level of truth from multiple scientific studies that each examine a similar issue, thus overcoming the credibility issues of single studies.

For example, we have all seen the media one day promoting a study finding coffee to be healthy. The next day there can be another study saying the opposite. To the average person this can seem confusing and frustrating. It is impossible for him or her to make sense of the bigger picture: how valid and reliable are all these findings and how can you combine them? This is where systematic reviews step in and save the day.

Whilst synthesizing the results of individual studies and formulating overall conclusions, the author of a systematic review explicitly displays the biases affecting both the existing research (what others have done) and the process of synthesis (what the review author does to combine the results of the studies in one conclusion).

For example, a Cochrane review found high quality evidence that the use of blunt needles appreciably reduces the risk of exposure to blood and bodily fluids for surgeons and their assistants over a range of operations1. High quality evidence means that the finding is not significantly affected by biases in the evidence or in the process to combine their results. Future research is unlikely to change this conclusion.

Now, we can take this example and consider how we might be able to communicate its message effectively. This particular example is sadly a rarity in that the result comes with a high degree of certainty. This is how it is even if you fry it in butter, as we say in Finnish. Blunt needles really can help surgeons stay safe, especially in areas with high rates of bloodborne diseases like Hepatitis C and HIV. But how do we convince surgeons?

Let us take Aristotle’s trusted recipe for effective communication. According to our wise friend we need logos, ethos and pathos. In other words, in addition to the message (the word, logos), we also need ethos, which means a credible, convincing communicator. For a surgeon this might need to be someone or something else than an obscure academic like me. For example In the USA, NIOSH, OSHA and FDA released a joint statement saying surgeons should follow the review’s advice2. The final ingredient, pathos, means appealing to and arousing emotions in the message recipient.

For example, by not using blunt needles when appropriate a surgeon runs the risk of contracting a seriously debilitating and possibly fatal disease. It is hard to think of a more compelling argument than unequivocal risk of death.

So, it should have been a doddle to get the message across because we had all three Aristotelian elements of communication:

• a clear message
• a credible medium
• an appeal to emotion.

Unfortunately, it was anything but easy. When we approached the surgical community in Finland they immediately contested the logos, the ethos and the pathos. They said blunt needles are more difficult to use. A sharp needle will allow a surgeon to use the full range of his or her dexterity. Whereas anything that reduces the chances to display ones prowess in mending various intricate bits of human anatomy is anathema.

In other words they didn’t believe the key review’s finding being true. Even though the review also found that according to the participating surgeons the reduction in dexterity was not significant. So, message contested. Then they also said that the likelihood of contracting a nasty disease because of a needlestick injury is so infinitesimally small, there is actually no risk at all.

This translates as: surgeons are immortal, i.e. there is no risk at all and thereby no pathos. And who were we – academics from a government research institute – telling surgeons how to do their job? As we failed to convince the Finnish Medical Association to trumpet the message on our behalf, we failed also on the element of ethos.

Now, it is not my intention to foster cynicism about nothing ever changing because people are stubborn and they won’t believe scientific evidence even if it took a bite out of their posterior. I still firmly believe that the message is true and that if we just keep yapping (the exact words used by former president of ICOH prof Jorma Rantanen of his mission to make occupational health a basic human right) then eventually it will sink in.

As you can see, it is not easy to communicate science. But the point is not to do it because it is easy. Like JFK said about going to the moon, we do it because it is hard. In this day and age of instant gratification and many people considering themselves experts on anything because they have access to immeasurable quantities of information via the internet, it is important to resist the erosion of facts.

We science communicators must keep yapping about the real facts and to celebrate the inherent uncertainty in science because absolute truths are hard to find in the real world. What is more, here in the pleasant tranquil north we may afford to contest even absolute truths. Knowledge that can have dramatic effects, reducing mortality and morbidity with operating room staff working in sub-Saharan Africa can be meaningless here in Sweden or Finland. However, it is the context that changes and not the facts.

Know thyself and be open about your failings. That is a sound basis for the honest communication of true facts.

References

Saarto A, Verbeek JH, Lavoie MC, Pahwa M. Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD009170.FDA, NIOSH & OSHA joint safety communication: blunt-tip surgical suture needles reduce needlestick injuries and the risk of subsequent bloodborne pathogen transmission to surgical personnel. Cincinnati, OH: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 2012 May; :1-4.

Text: Jani Ruotsalainen. On twitter: @MrJaniR