What to do about disinformation?

This by Matthew Perrone of the AP has been showing up in a lot of places. He recounts the FDA's largely feckless battle against the sea of health-related bullshit that seems to have become an emblem of right-wing identity. He attributes the agency's credibility problem at least in part to some actual missteps, although he actually names only two -- approval of aducanumab for Alheimer's disease and what he asserts was a delayed response to the infant formula shortage. This I would say is a very weak causal attribution.

I very much doubt that the people who are dosing themselves with horse dewormer are even aware of the controversy over aducanumab and it they are, the conservative complaint about the FDA is that it's too reluctant to approve medications. I don't know how much better the agency could have done responding to the infant formula problem, but that hardly bears on their credibility when it comes to the safety and effectiveness of medical treatments. 

 

I have plenty of complaints about the FDA. They often approve medications with insufficient evidence, but require post-marketing studies and surveillance. Then they don't enforce those requirements, and even if post-marketing data shows the stuff is ineffective or dangerous, they are very reluctant to withdraw approval or restrict usage. The agency's powers are also limited. They can fine companies for off-label marketing, but they can't sanction physicians for off-label prescribing, and the result is that a lot of drugs are being widely prescribed for conditions for which they have no good evidence of effectiveness.

But the snake oil salesmen and their marks don't even know about any of this, or if they do it's beside the point. The rejection of science and science-based regulation isn't happening because scientists and regulators occasionally get something wrong, or because their conclusions may be controversial. It extends even to matters about which there can be no intellectually respectable doubt. I suppose it may partly be resentment that somebody claims expertise that you don't have, but that doesn't stop people from believing their auto mechanic or their plumber. Maybe it's just that those worthies deal in a realm that seems more accessible, in which most people may feel they even have some understanding and do-it-yourself expertise. 

 

I have to admit that even for the most distinguished scientists, maters outside of their own field are pretty esoteric. I read about physics and cosmology and I just have to trust that they aren't spouting gibberish -- but I do because I know some of them and they have no ulterior motive. Also, even at the level I can understand, it does all fit together and it also works empirically. The Global Positioning System depends on general relativity. The people who build your phone and computer have to account for quantum effects. 

 

When it comes to biology and clinical science, I do know enough to evaluate claims, but that took many years of study. If you haven't gone down that path, yeah, you just have to trust me. But you can. Really. This is a serious problem to which I do not have an easy answer.