What does our culture allow?

Journal of Optometry (2017) 10, 203---204

www.journalofoptometry.org

EDITORIAL

Science, pseudoscience, evidence-based practice and post truth

Ciencia, pseudociencia, práctica basada en la evidencia y posverdad

José M. González-Méijome

University of Minho School of Science, Clinical and Experimental Optometry Research Lab (CEORLab),

s H ‘ e m t i t o e t e

t i t a t a t m a b ‘ L d u i

Department and Centre of Physics, 4710-057, Portugal

We live a time when it is easier to question the value of statins to fight cholesterol or the efficacy of vaccination and replace these treatments with homeopathic substances that lack any demonstrated therapeutic effect, promoting BILIEF to the category of PSEUDO-SCIENCE, than rely on evidence- based facts supported by the SCIENTIFIC METHOD. These are challenging times for clinicians and we need to be aware of the ‘‘siren songs’’, question easy TRUTH even when it looks EVIDENT and the recent so-called POST TRUTH where beliefs seem to be stronger than FACTS, and find the path for safe EVIDENCE-BASED PRACTICE. This brief paragraph contains several terms and constructs that we often use, hear or read but the definitions of which require more careful reflection, the goal of this editorial.

Paradoxically these are both great and hard times for science. On the one hand, we are witnessing the highest research activity we have ever known in optometry and vision science and in every discipline in general. Unfortu- nately, this is also proving a perfect culture medium for clinical practice that is far from being supported by good research. Such practice has always existed, yet it has been presumed that increased research activity would either provide proof for it or abolish it completely. Instead, in some cases, neither of these two options takes place and this practice has found an ecosystem in which to thrive and is even covered with a veneer of credibility by being published here and there.

We should not confuse ‘‘evident’’ thoughts with facts

supported by ‘‘evidence’. Evident is sometimes used

E-mail address: [email protected]

a A t t

http://dx.doi.org/10.1016/j.optom.2017.08.001 1888-4296/© 2017 Published by Elsevier España, S.L.U. on behalf of Spa under the CC BY-NC-ND license (http://creativecommons.org/licenses/b

ynonymously for ‘‘obvious’’, something that can be seen. owever, a better definition would be that the word

‘evident’’ refers to something ‘‘clearly understood’’. How- ver, personal thoughts can be evident simply because they ake sense according to some biased facts or because

hey coincide with general beliefs. Evidence, however, s defined as ‘‘the available body of facts or informa- ion indicating whether a belief or proposition is true r valid’’. Therefore, we should not confuse beliefs with vidence and should always seek confirmatory observa- ions (facts), properly collected and analysed. Ultimately, vidence can confirm our beliefs but not the reverse.

The prominent role of facts mentioned above takes us o another relevant concept --- ‘‘post truth’’. The term is ncreasingly present in the media and in 2016 was declared he word of the year by the Oxford Dictionary.1 It is an djective used to describe ‘‘circumstances in which objec- ive facts are less influential in shaping public opinion than ppeals to emotion and personal beliefs’’ or according to he Cambridge Dictionary ‘‘a situation in which people are ore likely to accept an argument based on their emotions

nd beliefs, rather than one based on facts’’. Interestingly, y the end of this year --- 2017 --- its translation to Spanish ‘posverdad’’ will be indexed in the Official Dictionary of the anguage by the Royal Academy of Language (Real Academia e la Lengua). In some way, defining ‘‘truth’’ itself will help s understand the concept of post-truth. ‘‘Truth’’, a noun, s defined as the quality of being true, while ‘‘true’’ is an djective that means ‘‘in accordance with fact or reality’’.

nother definition is ‘‘being accurate or exact’’. Both defini- ions are very important from the scientific point of view as hey imply that before we attribute this quality to something

nish General Council of Optometry. This is an open access article y-nc-nd/4.0/).

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2. Stanford encyclopedia of philosophy. Available at: https: //plato.stanford.edu/entries/truth/ Accessed on 21.07.17.

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e need to ensure that is accurate and factual, therefore it ust be verifiable using the appropriate methods. From the hilosophical perspective and according to the Neo-classical orrespondence Theory a belief is true if there exists an ppropriate entity --- a fact --- to which it corresponds as escribed in the Stanford Encyclopaedia.2

Altogether, these definitions tell us that truth should ot be based on personal beliefs, but should be con- rmed with facts. However, in the scientific field, facts re not easily accepted without question and multiple erifications. One way to achieve such confirmation is hrough the Scientific Method ‘‘consisting in systematic bservation, measurement, and experiment, and formula- ion, testing and modification of hypotheses’’. When the cientific method goes beyond observation and is com- lemented with accurate measurements, preferably with omething other than our eyes, indissociably linked to pre- ious ‘‘experiences’’ of our brain, it allows us to make udgements. In fact, as the astrophysicist Neil deGrasse yson writes in his recent book, such experience ‘‘is more ften than not a satchel or preconceived ideas, post- onceived notions, and outright bias’’.3

The abovementioned confusion between beliefs and facts eads us to another concept highlighted in this editorial, seudoscience. To better understand the full concept of ‘pseudoscience’’, instead of making a direct semantic nterpretadion as ‘‘false science’’, it is a good idea to first efine science itself. Science is the ‘‘understanding of the echanisms that govern our world, from the fundamen-

al laws of the universe to the biological processes of the implest living organisms to the complexity of the human ody’’. Science is ultimately a way (maybe the best way) to cquire knowledge. It may be the best way because it does ot work with pre-conceived beliefs seeking confirmation. nstead, science works with hypotheses to explain facts and he more hypotheses science rejects, the closer the scientist ets to a scientific explanation. Another important conse- uence deriving from the above is that we should not confuse ‘causality’’ with ‘‘casualty’’. An association between two arameters does not necessarily mean that one is the cause f the other. We should first consider the possibility of a asual combination and make any effort to reject such rela- ionship with other potential bias and exclude any other ustification for our findings before we accept the explana- ion and attribute the causality of a given event. Only when e have no additional justification for the findings should e accept the causal relationship.

There are, however, many other sources of knowledge ncluding traditional beliefs and expert opinion that we hould not ignore. This is where we should reintroduce the efinition of pseudoscience according to the Oxford Dic- ionary as ‘‘a collection of beliefs or practices mistakenly egarded as being based on scientific method’’.2 There- ore, pseudoscience arises when those sources of knowledge ssume the role of science itself. The reader might find it elpful to recognise pseudoscience by some of its character-

stics according to some authors: used to be contradictory, akes exaggerated or unprovable claims, relies on confir- ation bias rather than rigorous attempts at refutation,

ack of openness to evaluation by other experts, and

J.M. González-Méijome

bsence of systematic practices when developing theories. ocial media and means of dissemination of all kinds includ- ng blogs, forums, discussion groups etc. also provide fuel or these approaches to gain exaggerated attention, pro- oting such forms of knowledge to the rank of science and

urthering the emergence of pseudoscience. These considerations lead me to conclusions that might

e relevant for everyone who is involved in research, clini- al practice or both. First, not all the treatment approaches e follow today are based on scientific principles. In fact,

here are several examples of treatments that have proved o be beneficial but whose scientific bases are not yet ully understood. Second, even when we have no science- ased approach to fully understand their mode of action, e might feel compelled to use them not because obscure

nterests motivate us, but because we have been able to onfirm their results in successive systematic observations n well-designed, research experiments that are not biased y our beliefs or preconceptions. Third, the requirement of vidence-based practice should make us seek robust proof of ystematic behaviours. This is generally provided by clinical rials that minimise the risk of bias by picking statistically ignificant sample sizes, using control groups, randomising he treatment and control subjects and whenever possi- le, eliminating the potential placebo effect by masking ubjects and/or investigators. Fourth, we should use the ost objective and repeatable measurement methods we

an in order to minimise the impact of our beliefs and bservation bias on the final outcome that we are testing. ifth, we should never accept as truth, science-based or vidence-based practice that which in fact might be per- onal opinions, isolated case reports, non-systematic case eries, or severely biased ‘‘scientific’’ reports. Ultimately his does not mean that those forms of knowledge are not elevant to the advancement of clinical practice and science tself, but they should not be overvalued or taken as givens ithout any further questioning and validation by testing

back to Third). As health care professionals, we should be ready to

ccept that our beliefs are not more important than facts. oreover, the wider our experience, the more powerful our eliefs might be. And whether we are more clinically ori- nted or research oriented, we need to bear in mind that cience makes no effort to confirm beliefs or hypothesis. nstead, it attempts to reject any potential explanation until here is one that cannot be rejected and therefore might be inked to the observation we have made. This must confirm he power of science in serving clinical practice.

eferences

1. Oxford dictionaries. Available at: https://en. oxforddictionaries.com/definition/pseudoscience Accessed on 21.07.17.

3. deGrasse Tyson N. Astrophysics for people in a hurry. W W Nor- ton & Co, Inc.; 2017.