1
00:00:15,356 --> 00:00:33,556
Speaker 1: Pushkin. I'm Jacob Goldstein, and this is what's your problem.

2
00:00:33,796 --> 00:00:37,396
Speaker 1: My guest today is Helen Pearson. She's a science journalist.

3
00:00:37,556 --> 00:00:40,196
Speaker 1: She writes for the journal Nature, and she recently wrote

4
00:00:40,236 --> 00:00:44,836
Speaker 1: a book called Beyond Belief, How Evidence Shows What Really works.

5
00:00:45,396 --> 00:00:48,556
Speaker 1: Helen's problem is this, how do you get people to

6
00:00:48,636 --> 00:00:52,636
Speaker 1: make important decisions based on high quality evidence rather than

7
00:00:52,996 --> 00:00:56,076
Speaker 1: hunches or habits. To a large extent, the book is

8
00:00:56,076 --> 00:00:59,996
Speaker 1: a history of what Helen calls the evidence revolution, and

9
00:01:00,036 --> 00:01:04,876
Speaker 1: this is a remarkably recent revolution. In her telling, fifty

10
00:01:04,956 --> 00:01:08,596
Speaker 1: years ago, she writes, doctors did not typically try to

11
00:01:08,676 --> 00:01:12,316
Speaker 1: sort through through the high quality published studies to figure

12
00:01:12,316 --> 00:01:15,436
Speaker 1: out what they should do. Instead, they often did whatever

13
00:01:15,436 --> 00:01:18,196
Speaker 1: they'd been taught in medical school, or what the senior

14
00:01:18,236 --> 00:01:20,796
Speaker 1: doctor in the room said to do, even if the

15
00:01:20,796 --> 00:01:24,996
Speaker 1: evidence said otherwise. But a few doctors spent their careers

16
00:01:25,036 --> 00:01:28,076
Speaker 1: trying to change that, sorting through all the evidence to

17
00:01:28,076 --> 00:01:31,276
Speaker 1: figure out what worked best in different situations, and trying

18
00:01:31,276 --> 00:01:33,996
Speaker 1: to get their fellow doctors to pay attention. In more

19
00:01:34,036 --> 00:01:36,956
Speaker 1: recent decades, that spirit has started to spread to other fields,

20
00:01:37,156 --> 00:01:41,756
Speaker 1: feels like management and crime prevention and education. Later in

21
00:01:41,796 --> 00:01:45,076
Speaker 1: the conversation, Helen and I talk about some of those fields,

22
00:01:45,356 --> 00:01:48,876
Speaker 1: places where the evidence is still often unclear, and where

23
00:01:48,916 --> 00:01:51,476
Speaker 1: people often ignore the evidence even when it is clear.

24
00:01:52,076 --> 00:01:54,396
Speaker 1: We also talk about how she uses evidence in her

25
00:01:54,396 --> 00:01:57,156
Speaker 1: own life and about the prospects for the spread of

26
00:01:57,276 --> 00:02:01,236
Speaker 1: evidence based decision making in the world. To start, we

27
00:02:01,316 --> 00:02:03,876
Speaker 1: talk about one doctor who did a lot to get

28
00:02:03,876 --> 00:02:08,636
Speaker 1: the evidence revolution going in medicine. His name was Ian Chalmers.

29
00:02:09,356 --> 00:02:13,156
Speaker 2: Ian is really the reason I ended up writing the book.

30
00:02:13,436 --> 00:02:15,316
Speaker 2: He was training to be a doctor in the kind

31
00:02:15,316 --> 00:02:18,596
Speaker 2: of late nineteen sixties early nineteen seventies. He was working

32
00:02:18,636 --> 00:02:22,276
Speaker 2: in obstetrics and gynecology in Wales at the time, and

33
00:02:22,316 --> 00:02:24,156
Speaker 2: he noticed this sort of odd thing, which was that

34
00:02:24,236 --> 00:02:27,036
Speaker 2: when doctors would hand out advice to women with the

35
00:02:27,036 --> 00:02:29,516
Speaker 2: same condition, they would give different advice. So, you know,

36
00:02:29,556 --> 00:02:31,636
Speaker 2: some doctors would think it was really important to have

37
00:02:31,876 --> 00:02:35,396
Speaker 2: prenatal vitamins or not to drink during pregnancy, and other

38
00:02:35,476 --> 00:02:38,236
Speaker 2: doctors would say no such thing. And this was kind

39
00:02:38,236 --> 00:02:41,196
Speaker 2: of so extreme that Ian once told me that when

40
00:02:41,196 --> 00:02:43,596
Speaker 2: he was woken in the night to treat a woman,

41
00:02:44,476 --> 00:02:46,476
Speaker 2: the first thing he would say was what's wrong, and

42
00:02:46,516 --> 00:02:48,476
Speaker 2: the second thing he would say was who's treating her?

43
00:02:48,916 --> 00:02:50,596
Speaker 2: Because that was going to change. You know what he

44
00:02:50,636 --> 00:02:54,436
Speaker 2: did next raight, So what generally happened was that everyone

45
00:02:55,156 --> 00:02:57,356
Speaker 2: followed the advice of the most senior doctor in the room,

46
00:02:57,396 --> 00:03:00,356
Speaker 2: which is sometimes now called eminence based medicine.

47
00:03:00,796 --> 00:03:05,196
Speaker 1: Tell me about his work in Gaza and how that

48
00:03:05,196 --> 00:03:06,636
Speaker 1: writer influenced him.

49
00:03:07,196 --> 00:03:10,276
Speaker 2: Yeah, so that was another part of his train, which

50
00:03:10,316 --> 00:03:12,916
Speaker 2: was also kind of influential in him realizing that a

51
00:03:12,956 --> 00:03:15,476
Speaker 2: lot of what he'd been taught in medical school was wrong.

52
00:03:15,836 --> 00:03:19,836
Speaker 2: So he worked on a refugee camp in Gaza during

53
00:03:19,836 --> 00:03:24,116
Speaker 2: his medical training, and during that time he was treating

54
00:03:24,196 --> 00:03:28,316
Speaker 2: children who had measles, and he had been taught in

55
00:03:28,356 --> 00:03:30,836
Speaker 2: medical school that you shouldn't give antibiotics to a child

56
00:03:30,836 --> 00:03:34,876
Speaker 2: with measles, even if they were becoming quite sick, because

57
00:03:34,956 --> 00:03:37,836
Speaker 2: antibiotics treated bacterial infection, so why would you give it

58
00:03:37,876 --> 00:03:40,756
Speaker 2: to a child with a viral infection. So he followed

59
00:03:40,756 --> 00:03:43,916
Speaker 2: the advice he'd been taught, and he didn't give the antibiotics.

60
00:03:43,956 --> 00:03:47,116
Speaker 2: But then later when he returned to the UK, he

61
00:03:47,236 --> 00:03:50,356
Speaker 2: discovered that actually this advice he'd been given was tragically wrong,

62
00:03:50,756 --> 00:03:53,916
Speaker 2: and that there were in fact about six control clinical

63
00:03:53,956 --> 00:03:57,516
Speaker 2: trials that suggested it did help to give some children

64
00:03:57,516 --> 00:04:01,916
Speaker 2: antibiotics prophylactically because they were developing a secondary bacterial infection

65
00:04:01,956 --> 00:04:03,036
Speaker 2: along of the viral one.

66
00:04:03,196 --> 00:04:06,196
Speaker 1: And in fact, as I understand it, like he concluded

67
00:04:06,236 --> 00:04:08,836
Speaker 1: when he went back to the UK and studied the

68
00:04:08,836 --> 00:04:12,316
Speaker 1: advice that children under his care had probably died or

69
00:04:12,356 --> 00:04:14,716
Speaker 1: possibly died because he had done the wrong thing.

70
00:04:14,956 --> 00:04:15,876
Speaker 3: That's exactly right.

71
00:04:16,076 --> 00:04:17,956
Speaker 2: Yeah, So it's so a huge kind of you know,

72
00:04:18,156 --> 00:04:20,356
Speaker 2: turning point for him of realizing that.

73
00:04:20,876 --> 00:04:24,916
Speaker 1: So let me ask the native question, why had he

74
00:04:25,076 --> 00:04:28,476
Speaker 1: been taught something that was not consistent with the evidence.

75
00:04:28,996 --> 00:04:33,276
Speaker 2: Because that was that was standard practice in medical schools

76
00:04:33,316 --> 00:04:35,916
Speaker 2: at the time. Most doctors weren't really being taught about

77
00:04:35,916 --> 00:04:37,996
Speaker 2: clinical trials in the sixties and seventies.

78
00:04:38,196 --> 00:04:39,756
Speaker 3: Hard though it is to believe.

79
00:04:39,876 --> 00:04:42,196
Speaker 1: It is weird, right, it is hard to believe. I mean,

80
00:04:42,236 --> 00:04:44,476
Speaker 1: I guess is part of it the sort of formal

81
00:04:44,996 --> 00:04:47,876
Speaker 1: you know, randomized controlled trial. Well you have a placebo

82
00:04:48,036 --> 00:04:50,036
Speaker 1: arm and a treatment arm, and that people running the

83
00:04:50,076 --> 00:04:53,436
Speaker 1: trial don't know which is which. That was actually relatively

84
00:04:53,556 --> 00:04:54,436
Speaker 1: new still.

85
00:04:54,276 --> 00:04:57,596
Speaker 2: Right, exactly, Yes, So we feel like randomized trials have

86
00:04:57,676 --> 00:05:00,276
Speaker 2: been around for ages, but they are relatively new. I

87
00:05:00,276 --> 00:05:02,236
Speaker 2: mean around the time that you know that Ian was

88
00:05:02,276 --> 00:05:04,396
Speaker 2: having the you know that this realization that he hadn't

89
00:05:04,436 --> 00:05:08,396
Speaker 2: been taught about trials. They were really only then becoming commonplace.

90
00:05:09,116 --> 00:05:14,076
Speaker 1: Oh so you have this sort of research changing and

91
00:05:14,116 --> 00:05:18,436
Speaker 1: the practices of doctors are lagging. That is sort of

92
00:05:18,476 --> 00:05:21,556
Speaker 1: the moment when Ian Chalmers walks onto the scene. And

93
00:05:21,756 --> 00:05:25,156
Speaker 1: it's this moment when there is now research but doctors,

94
00:05:25,836 --> 00:05:28,796
Speaker 1: weirdly to our sensibilities, are not paying attention to it.

95
00:05:29,516 --> 00:05:31,916
Speaker 1: What does Chalmers do when he realizes this?

96
00:05:33,516 --> 00:05:39,036
Speaker 2: So what he did was he became very passionate about

97
00:05:39,156 --> 00:05:42,916
Speaker 2: randomized trials. Actually, and I discovered this with other people

98
00:05:43,116 --> 00:05:45,196
Speaker 2: I spoke to, is that there's something about this method

99
00:05:45,276 --> 00:05:46,996
Speaker 2: which is very captivating to people.

100
00:05:47,436 --> 00:05:51,596
Speaker 1: It's so elegant, right, like intellectually, like the it's blinded,

101
00:05:51,636 --> 00:05:55,396
Speaker 1: there's a placebo control. Like I recognize that they're imperfect,

102
00:05:55,436 --> 00:05:57,156
Speaker 1: and people love to talk about the problems with them,

103
00:05:57,436 --> 00:06:02,196
Speaker 1: but it's wildly elegant and not intuitive. Right People want

104
00:06:02,236 --> 00:06:04,156
Speaker 1: to just like give something to somebody and see if

105
00:06:04,196 --> 00:06:06,396
Speaker 1: they get better, and say it works if they get better,

106
00:06:06,476 --> 00:06:09,116
Speaker 1: and like, for so many reasons, a randomized trial is

107
00:06:09,196 --> 00:06:09,996
Speaker 1: so much better than that.

108
00:06:10,996 --> 00:06:13,356
Speaker 2: And that argument goes on all the time today. I mean,

109
00:06:13,356 --> 00:06:16,396
Speaker 2: that's what mostly happens in policy is we just introduce

110
00:06:16,476 --> 00:06:19,396
Speaker 2: policies right without bothering to test whether they're effective and

111
00:06:19,436 --> 00:06:21,916
Speaker 2: assuming they do good when some do harm. So that

112
00:06:21,916 --> 00:06:23,276
Speaker 2: I don't think that's an old argument.

113
00:06:23,596 --> 00:06:25,956
Speaker 1: We will get to policy. Yes. So this is this

114
00:06:26,036 --> 00:06:28,676
Speaker 1: moment people are falling in love with randomized trials, and

115
00:06:28,676 --> 00:06:33,916
Speaker 1: more importantly for our story, Ian Chalmers is realizing that

116
00:06:33,956 --> 00:06:36,836
Speaker 1: this evidence is not making its way into medical practice.

117
00:06:36,876 --> 00:06:37,956
Speaker 1: What does he do about that?

118
00:06:38,796 --> 00:06:43,236
Speaker 2: So he decides to do this pioneering exercise where he

119
00:06:43,476 --> 00:06:47,956
Speaker 2: is going to collect all of the controlled clinical trials.

120
00:06:47,996 --> 00:06:50,716
Speaker 2: They weren't all randomized, but controlled trials which had been done,

121
00:06:50,756 --> 00:06:54,876
Speaker 2: which had tested treatments in pregnancy and childbirth. Okay, and

122
00:06:55,196 --> 00:06:57,716
Speaker 2: at the time, so this is in the eighties, I mean,

123
00:06:57,716 --> 00:07:01,036
Speaker 2: that was an extraordinarily difficult thing to do because he

124
00:07:01,036 --> 00:07:04,036
Speaker 2: couldn't just go online and you know, search up these trials.

125
00:07:04,876 --> 00:07:08,836
Speaker 2: So he eventually ended up recruiting hundreds of people to

126
00:07:08,916 --> 00:07:11,196
Speaker 2: sort of go to libraries and scour through the medical

127
00:07:11,236 --> 00:07:14,836
Speaker 2: journals and really exhaustively try and track down these clinical trials.

128
00:07:15,116 --> 00:07:19,156
Speaker 1: It's amazing that it's almost an archaeological exercise, right, like

129
00:07:19,516 --> 00:07:23,636
Speaker 1: people have generated all this evidence not in ancient times,

130
00:07:23,676 --> 00:07:25,276
Speaker 1: but in the last ten or twenty years, and it's

131
00:07:25,276 --> 00:07:28,716
Speaker 1: already been sort of lost. Right. He is an obgyn, right,

132
00:07:28,756 --> 00:07:30,956
Speaker 1: and he's having to have people will look for the

133
00:07:30,996 --> 00:07:33,796
Speaker 1: research in his field exactly exactly.

134
00:07:33,836 --> 00:07:36,916
Speaker 2: It's extraordinary and that is still a real difficult problem today,

135
00:07:36,956 --> 00:07:39,276
Speaker 2: which I think is absolutely mind boggling, because a lot

136
00:07:39,316 --> 00:07:41,796
Speaker 2: of research is published and yet people still struggle to

137
00:07:41,836 --> 00:07:43,036
Speaker 2: find it on databases.

138
00:07:43,396 --> 00:07:47,796
Speaker 1: So they're doing this archaeological expedition to look for recent research.

139
00:07:47,796 --> 00:07:48,436
Speaker 1: And what happened.

140
00:07:49,756 --> 00:07:52,276
Speaker 2: So it takes him about ten years, him and his

141
00:07:52,356 --> 00:07:57,076
Speaker 2: many colleagues, and eventually he doesn't just get the evidence together.

142
00:07:57,116 --> 00:07:59,276
Speaker 2: I think this is what's so interesting about it is

143
00:07:59,676 --> 00:08:04,396
Speaker 2: he realizes that he needs to synthesize the evidence, and

144
00:08:04,636 --> 00:08:06,516
Speaker 2: you know, not just to look at one trial at

145
00:08:06,556 --> 00:08:08,676
Speaker 2: a time, because if you look at one trial, it

146
00:08:08,796 --> 00:08:11,236
Speaker 2: risks being wrong, or you get a group of trials

147
00:08:11,236 --> 00:08:14,076
Speaker 2: which may be conflicting, maybe some of them are poorly done,

148
00:08:14,716 --> 00:08:17,236
Speaker 2: maybe it's just through chance that they point in different directions.

149
00:08:17,236 --> 00:08:21,156
Speaker 2: And so he took this quite radical step of synthesizing

150
00:08:21,156 --> 00:08:24,916
Speaker 2: the evidence using a method called a systematic review and

151
00:08:25,716 --> 00:08:28,716
Speaker 2: ended up doing hundreds of systematic reviews to look at

152
00:08:28,756 --> 00:08:33,036
Speaker 2: all of these different approaches in pregnancy and childbirth and

153
00:08:33,116 --> 00:08:35,556
Speaker 2: eventually publishes all of this after ten years in these

154
00:08:35,556 --> 00:08:37,316
Speaker 2: two massive books.

155
00:08:36,996 --> 00:08:39,396
Speaker 3: Which I also have on my book case following me.

156
00:08:40,436 --> 00:08:44,436
Speaker 2: So, they revealed that a lot of practices in pregnancy

157
00:08:44,436 --> 00:08:47,756
Speaker 2: and childbirth were not based on evidence or were actually

158
00:08:47,756 --> 00:08:53,356
Speaker 2: doing harm. So for example, even things like invasive episiotomies,

159
00:08:53,396 --> 00:08:56,436
Speaker 2: which is a surgical incision which is supposed to give

160
00:08:56,476 --> 00:08:59,236
Speaker 2: babies a bigger hole to get out, there wasn't really

161
00:08:59,236 --> 00:09:03,436
Speaker 2: evidence to support these practices, and like shaving women's pubic

162
00:09:03,436 --> 00:09:06,596
Speaker 2: care in labor. So countless women had been subjected to

163
00:09:06,676 --> 00:09:10,356
Speaker 2: these really quite invasive and degrading practices because doctors assumed

164
00:09:10,396 --> 00:09:13,796
Speaker 2: they were the right thing to do. And Ian's work

165
00:09:14,236 --> 00:09:17,436
Speaker 2: by synthesizing evidence in this way helped bring an end

166
00:09:17,516 --> 00:09:20,436
Speaker 2: to them. So he was sort of inspired by what

167
00:09:20,476 --> 00:09:23,156
Speaker 2: he had done and thought, why can't we do this

168
00:09:23,236 --> 00:09:27,556
Speaker 2: across all specialties of medicine, you know, synthesize the evidence

169
00:09:27,596 --> 00:09:29,796
Speaker 2: in heart disease and diabetes, in cancer and so on,

170
00:09:29,996 --> 00:09:33,636
Speaker 2: And that led to this group which he helped found.

171
00:09:33,676 --> 00:09:36,676
Speaker 2: He was seminal in founding called the Cochrane Collaboration, and

172
00:09:36,756 --> 00:09:38,676
Speaker 2: they set out and are still trying to do this

173
00:09:38,716 --> 00:09:43,236
Speaker 2: today to synthesize evidence which shows which treatments are of

174
00:09:43,396 --> 00:09:46,396
Speaker 2: help and do not harm across these different groups. And

175
00:09:46,716 --> 00:09:49,996
Speaker 2: nowadays the word sort of like a Cochrane review if

176
00:09:49,996 --> 00:09:53,396
Speaker 2: you're here that it's sort of like associated with doing

177
00:09:53,436 --> 00:09:56,436
Speaker 2: the kind of highest standard, you know, gold standard type

178
00:09:56,476 --> 00:09:57,836
Speaker 2: of review of evidence.

179
00:09:58,836 --> 00:10:00,836
Speaker 1: And I would say a lot of it at least

180
00:10:01,036 --> 00:10:04,196
Speaker 1: is just online, right, like you can go look if

181
00:10:04,236 --> 00:10:08,436
Speaker 1: you're thinking of taking a supplement, say, you can just

182
00:10:08,516 --> 00:10:11,996
Speaker 1: go look. And there are a lot of Cochrane reviews

183
00:10:12,156 --> 00:10:18,276
Speaker 1: of whatever, magnesium for something something, and I find it useful.

184
00:10:18,276 --> 00:10:21,436
Speaker 1: I mean quite often they say there's not enough evidence

185
00:10:21,436 --> 00:10:23,876
Speaker 1: to say one way or the other. Right, that's typically

186
00:10:23,916 --> 00:10:26,116
Speaker 1: with the kinds of things that I'm looking at, you know,

187
00:10:26,156 --> 00:10:29,316
Speaker 1: over the counter things or whatever. There just isn't enough

188
00:10:29,356 --> 00:10:31,756
Speaker 1: research to have a clear answer. And that is what

189
00:10:31,796 --> 00:10:34,036
Speaker 1: they often say. It makes sense, Yes.

190
00:10:33,756 --> 00:10:34,956
Speaker 3: It is often the conclusion.

191
00:10:34,996 --> 00:10:37,356
Speaker 2: And I mean it's not just so Cochran reviews now

192
00:10:37,396 --> 00:10:39,836
Speaker 2: are a tiny fraction of the number of systematic reviews

193
00:10:39,836 --> 00:10:41,836
Speaker 2: in the world. So Cochran was really sort of seminal

194
00:10:41,876 --> 00:10:44,156
Speaker 2: in sort of showing that this was a really good

195
00:10:44,236 --> 00:10:47,796
Speaker 2: way to make sense of conflicting bodies of evidence. But

196
00:10:47,956 --> 00:10:50,276
Speaker 2: now that you know, thousands are coming out every year,

197
00:10:50,396 --> 00:10:53,876
Speaker 2: So in general, a systematic review is a better way

198
00:10:53,956 --> 00:10:55,676
Speaker 2: to get an overview of what the evidence says than

199
00:10:55,716 --> 00:10:57,996
Speaker 2: looking at just one study. Now, of course, it's it's

200
00:10:58,036 --> 00:11:01,716
Speaker 2: not completely straightforward because like randomized trials, some systematic reviews

201
00:11:01,716 --> 00:11:05,156
Speaker 2: aren't very good either, So that's a challenge too.

202
00:11:05,276 --> 00:11:08,636
Speaker 1: Well, it's always something yes, well, I mean that's Cochrane

203
00:11:08,676 --> 00:11:11,476
Speaker 1: is useful as a brand in that way, right, Like

204
00:11:11,596 --> 00:11:15,436
Speaker 1: I trust their ability to assess the evidence, even if

205
00:11:15,476 --> 00:11:17,396
Speaker 1: what they say is we don't know, Like we don't know.

206
00:11:17,396 --> 00:11:22,076
Speaker 1: It's a very respectable answer as a general matter. What's

207
00:11:22,116 --> 00:11:23,116
Speaker 1: a Charmer's like.

208
00:11:26,116 --> 00:11:31,236
Speaker 2: Quite extraordinary actually just the most I don't think I've

209
00:11:31,276 --> 00:11:34,836
Speaker 2: ever met anyone who is so extraordinarily modest about his

210
00:11:34,876 --> 00:11:37,396
Speaker 2: accomplishments and downplays them so much, to the point where

211
00:11:37,396 --> 00:11:40,956
Speaker 2: he denies sort of starting the cock con collaboration. I

212
00:11:40,996 --> 00:11:42,956
Speaker 2: think he says something along the lines of he came

213
00:11:43,036 --> 00:11:49,756
Speaker 2: up with the idea so and also very exacting and critical.

214
00:11:49,796 --> 00:11:52,036
Speaker 2: I mean it was interesting when he retired or decided

215
00:11:52,076 --> 00:11:54,076
Speaker 2: to step away. He didn't retire from Cockraney decided he

216
00:11:54,116 --> 00:11:56,156
Speaker 2: wanted to move on. He actually set up a prize

217
00:11:56,556 --> 00:11:59,396
Speaker 2: for the group that offered the most astute criticism of

218
00:11:59,476 --> 00:12:00,476
Speaker 2: the cock Con collaboration.

219
00:12:00,796 --> 00:12:02,156
Speaker 1: Oh that's really admirable.

220
00:12:02,396 --> 00:12:03,076
Speaker 3: Yes, exactly.

221
00:12:03,076 --> 00:12:05,796
Speaker 2: And they still have that attitude of kind of inviting

222
00:12:05,836 --> 00:12:08,636
Speaker 2: criticism because of course that's exactly what you know, he

223
00:12:09,116 --> 00:12:10,876
Speaker 2: and the group have done all these years is sort

224
00:12:10,916 --> 00:12:13,556
Speaker 2: of speak truth to power. So they need to invite

225
00:12:13,596 --> 00:12:15,276
Speaker 2: that criticism themselves.

226
00:12:15,996 --> 00:12:18,516
Speaker 1: Who won the prize and what did they say?

227
00:12:19,796 --> 00:12:21,996
Speaker 2: I don't know, it's one every years.

228
00:12:22,716 --> 00:12:25,516
Speaker 1: Yeah, so I could imagine him having a pretty high

229
00:12:25,516 --> 00:12:30,236
Speaker 1: tolerance for disagreeableness. Say right, I mean what he did

230
00:12:30,996 --> 00:12:34,116
Speaker 1: was in a sort of cultural way in terms of

231
00:12:34,156 --> 00:12:39,596
Speaker 1: the culture of physicians, the culture of medicine. I don't know,

232
00:12:39,916 --> 00:12:42,996
Speaker 1: antagonistic is maybe too strong a word, but he said

233
00:12:42,996 --> 00:12:45,196
Speaker 1: things that presumably lots of people didn't want to hear.

234
00:12:45,396 --> 00:12:47,476
Speaker 1: He said, to doctors, you're doing it wrong, both in

235
00:12:47,516 --> 00:12:50,436
Speaker 1: a specific way, you shouldn't be doing this particular intervention,

236
00:12:50,676 --> 00:12:53,436
Speaker 1: and also in a general way, like he implicitly or

237
00:12:53,436 --> 00:12:56,756
Speaker 1: explicitly was saying you're thinking about the practice of medicine wrong.

238
00:12:57,476 --> 00:13:00,516
Speaker 2: That's right, that's exactly right. I discovered this as I

239
00:13:00,556 --> 00:13:03,716
Speaker 2: sort of was reporting the book and kind of speaking

240
00:13:03,716 --> 00:13:07,436
Speaker 2: to these people who were quite seminal in bringing evidence

241
00:13:07,476 --> 00:13:09,556
Speaker 2: based practice into their fields. They often have this sort

242
00:13:09,596 --> 00:13:12,876
Speaker 2: of rebellious streak to them and are kind of willing

243
00:13:12,956 --> 00:13:14,956
Speaker 2: to speak truth to power, because yes, it does. I mean,

244
00:13:14,956 --> 00:13:17,716
Speaker 2: you're basically saying to people, you know, ort to doctors,

245
00:13:17,756 --> 00:13:20,156
Speaker 2: you've been doing it wrong all these years. And he

246
00:13:21,276 --> 00:13:23,436
Speaker 2: himself said he thought he was able to do that

247
00:13:23,596 --> 00:13:25,996
Speaker 2: because he was sort of he was a bit of

248
00:13:25,996 --> 00:13:29,516
Speaker 2: an outsider actually, Like he worked in Oxford, but he

249
00:13:29,596 --> 00:13:31,516
Speaker 2: wasn't sort of part of all the kind of you know,

250
00:13:31,956 --> 00:13:35,156
Speaker 2: high for lutin academic circles. He was a bit on

251
00:13:35,196 --> 00:13:37,516
Speaker 2: the outside and he felt that that allowed him to

252
00:13:37,596 --> 00:13:41,956
Speaker 2: maybe do this speaking of truth to power, which maybe

253
00:13:42,036 --> 00:13:43,196
Speaker 2: others what unable to do.

254
00:13:43,756 --> 00:13:47,556
Speaker 1: So where's medicine today? To what extent is medicine today

255
00:13:47,556 --> 00:13:48,316
Speaker 1: evidence based?

256
00:13:49,476 --> 00:13:53,956
Speaker 2: Well more than it was then. I think I used

257
00:13:54,276 --> 00:13:56,116
Speaker 2: a figure in my book of about sort of sixty

258
00:13:56,156 --> 00:14:02,076
Speaker 2: percent of healthcare is probably evidence based or at least

259
00:14:02,156 --> 00:14:05,636
Speaker 2: draws on evidence based clinical guidelines. So nowadays what happens

260
00:14:05,716 --> 00:14:10,356
Speaker 2: is there are typically systematic reviews of clinical trials or

261
00:14:10,396 --> 00:14:12,716
Speaker 2: are the evidence, and on the back of that, then

262
00:14:13,596 --> 00:14:16,796
Speaker 2: professional groups prepare clinical guidelines and the clinical guidelines of

263
00:14:16,876 --> 00:14:18,916
Speaker 2: what might be used in the clinic to help actually

264
00:14:18,916 --> 00:14:19,996
Speaker 2: make a decision.

265
00:14:19,876 --> 00:14:23,636
Speaker 1: Right, so, like the National Association of Cardiologists will have

266
00:14:23,796 --> 00:14:26,996
Speaker 1: guidelines on whatever who should get statins or who should

267
00:14:26,996 --> 00:14:28,556
Speaker 1: get what interventions exactly.

268
00:14:28,596 --> 00:14:30,756
Speaker 2: And that, I mean, that's quite interesting because it means

269
00:14:30,796 --> 00:14:33,516
Speaker 2: that the evidence is kind of baked into the processes,

270
00:14:33,876 --> 00:14:36,116
Speaker 2: which which I find quite interesting. It's sort of made it.

271
00:14:36,236 --> 00:14:37,836
Speaker 2: I mean, I won't say it's easy, but it is

272
00:14:37,916 --> 00:14:40,516
Speaker 2: relatively easy for doctors now to use evidence because that's

273
00:14:40,516 --> 00:14:42,596
Speaker 2: the expectation. Whereas I'm sure we'll get onto this, but

274
00:14:42,636 --> 00:14:44,596
Speaker 2: you look at other fields and that's just not the case.

275
00:14:45,916 --> 00:14:47,876
Speaker 2: But of course there are huge challenges, you know, lots

276
00:14:47,916 --> 00:14:51,636
Speaker 2: of criticism still of evidence based medicine. Some people criticize,

277
00:14:51,676 --> 00:14:54,476
Speaker 2: for example, you know, this sort of special place that

278
00:14:54,516 --> 00:14:57,276
Speaker 2: the randomized control trial has and point out that randomized

279
00:14:57,316 --> 00:15:00,516
Speaker 2: control trials can be wrong or poorly done. And then

280
00:15:00,876 --> 00:15:03,796
Speaker 2: of course, you know, pushback in the world against evidence

281
00:15:03,836 --> 00:15:07,116
Speaker 2: based practices. Anyway, and people wanting to go their own way. So,

282
00:15:07,756 --> 00:15:10,756
Speaker 2: in no way is the kind of evidence revolution that

283
00:15:10,796 --> 00:15:12,756
Speaker 2: I write about, you know, obviously done.

284
00:15:12,836 --> 00:15:15,276
Speaker 3: It's evolving, it's new in some way.

285
00:15:16,316 --> 00:15:18,836
Speaker 1: So if you say it's sixty percent evidence based for

286
00:15:18,876 --> 00:15:22,076
Speaker 1: the other forty, I could imagine two things. Right Clearly,

287
00:15:22,076 --> 00:15:24,796
Speaker 1: there are a lot of settings, Like medicine is complicated.

288
00:15:24,796 --> 00:15:27,356
Speaker 1: People are complicated, the body is complicated, lots of sick

289
00:15:27,356 --> 00:15:29,396
Speaker 1: people have lots of things wrong with them. So you

290
00:15:29,396 --> 00:15:32,076
Speaker 1: can imagine lots of cases where there just isn't evidence,

291
00:15:32,116 --> 00:15:33,756
Speaker 1: where it's just not clear what should I do for

292
00:15:33,796 --> 00:15:36,636
Speaker 1: this patient right now? Well, there's lots of different conflicting

293
00:15:36,676 --> 00:15:38,876
Speaker 1: things that I could do in their trade offs. The

294
00:15:38,956 --> 00:15:41,996
Speaker 1: other piece is there is evidence and people just don't

295
00:15:42,036 --> 00:15:45,156
Speaker 1: follow it. So like how much of each of those

296
00:15:45,236 --> 00:15:45,596
Speaker 1: is there?

297
00:15:46,036 --> 00:15:47,756
Speaker 2: Yeah, so I can't give you a percentage on each

298
00:15:47,836 --> 00:15:49,356
Speaker 2: of those. But I mean, just to speak to the

299
00:15:49,356 --> 00:15:52,316
Speaker 2: first one though, I mean, what's really interesting about evidence

300
00:15:52,316 --> 00:15:55,756
Speaker 2: based medicine is that evidence alone doesn't tell you what

301
00:15:55,876 --> 00:15:59,116
Speaker 2: to do. So evidence is one part of the decision

302
00:15:59,116 --> 00:16:02,236
Speaker 2: making process, and I think that's a common misunderstanding actually

303
00:16:02,316 --> 00:16:04,036
Speaker 2: around it is that like you look at the evidence

304
00:16:04,076 --> 00:16:05,836
Speaker 2: and it will tell you, you know, whether you should take

305
00:16:05,876 --> 00:16:08,036
Speaker 2: this drug. But that's not the case because what what

306
00:16:08,156 --> 00:16:10,276
Speaker 2: a doctor or who whoever is you know, a doctor,

307
00:16:10,316 --> 00:16:12,956
Speaker 2: hopefully impatient together are doing is saying, Okay, you know,

308
00:16:12,996 --> 00:16:15,756
Speaker 2: this is the evidence on what treatments are effective. This

309
00:16:15,836 --> 00:16:18,876
Speaker 2: is the clinical expertise of the doctor who absolutely you know,

310
00:16:18,916 --> 00:16:21,596
Speaker 2: they've built up all this expertise over the years. We're

311
00:16:21,596 --> 00:16:23,676
Speaker 2: not throwing that out the window. And then you as

312
00:16:23,716 --> 00:16:26,596
Speaker 2: a patient have values and preferences which have to feed

313
00:16:26,636 --> 00:16:29,236
Speaker 2: into this decision. Right, if you've decided this isn't a

314
00:16:29,276 --> 00:16:31,676
Speaker 2: treatment path you want, then that has to be respected. So,

315
00:16:32,076 --> 00:16:33,476
Speaker 2: but that's still evidence based.

316
00:16:33,316 --> 00:16:37,276
Speaker 1: Medicine, and that's still in your sixty percent easy one. Yeah, yeah,

317
00:16:37,356 --> 00:16:39,836
Speaker 1: Like tell me about the forty percent that's not evidence based.

318
00:16:39,836 --> 00:16:41,076
Speaker 1: What is what's going on there?

319
00:16:41,676 --> 00:16:45,436
Speaker 2: Well, in some places, evidence based medicine is less common

320
00:16:45,516 --> 00:16:50,116
Speaker 2: or accepted, so people might choose traditional Chinese medicine, for example,

321
00:16:50,396 --> 00:16:53,716
Speaker 2: So there may be other practices around medicine which people prefer.

322
00:16:54,396 --> 00:16:57,676
Speaker 2: In some cases, You're absolutely right, the evidence isn't really

323
00:16:58,596 --> 00:17:01,716
Speaker 2: there or it might be misapplied. So there's the kind

324
00:17:01,756 --> 00:17:04,356
Speaker 2: of all the human factors that come into it where

325
00:17:04,356 --> 00:17:09,116
Speaker 2: people may do choice or inadvertently not follow the evidence.

326
00:17:09,196 --> 00:17:15,316
Speaker 3: Ice Pak.

327
00:17:13,956 --> 00:17:28,356
Speaker 1: Will be back in just a minute. Okay, So let's

328
00:17:28,396 --> 00:17:31,516
Speaker 1: talk about evidence outside of medicine. A big chunk of

329
00:17:31,556 --> 00:17:35,276
Speaker 1: your book is that, And it does seem to some

330
00:17:35,356 --> 00:17:39,876
Speaker 1: extent at least, that this evidence based revolution, as you

331
00:17:39,916 --> 00:17:43,356
Speaker 1: call it, that Ian Chalmers helped us start, has directly

332
00:17:43,436 --> 00:17:47,796
Speaker 1: influenced people in other fields. You know, and you write

333
00:17:47,836 --> 00:17:54,916
Speaker 1: about economics and crime and management and parenting, and you know,

334
00:17:55,116 --> 00:17:58,116
Speaker 1: I will say, like I covered economics for a long time,

335
00:17:58,236 --> 00:18:01,916
Speaker 1: and in economics they've gotten better about evidence. It seems

336
00:18:01,956 --> 00:18:04,476
Speaker 1: to me that in a lot of fields outside of medicine,

337
00:18:05,236 --> 00:18:08,116
Speaker 1: it's just frustrating. It's just frustrating when you sort of

338
00:18:08,156 --> 00:18:10,316
Speaker 1: try and study the evidence. It seems like there's often

339
00:18:10,396 --> 00:18:13,116
Speaker 1: not good evidence. When there is, people don't follow the evidence.

340
00:18:13,196 --> 00:18:16,116
Speaker 1: I mean, in a broad way, what's your assessment of

341
00:18:16,156 --> 00:18:19,116
Speaker 1: how evidence as a way of looking at the world

342
00:18:19,236 --> 00:18:20,716
Speaker 1: is doing outside of medicine.

343
00:18:21,876 --> 00:18:24,596
Speaker 2: So I think it really depends which field you're looking

344
00:18:24,636 --> 00:18:28,316
Speaker 2: in of how like I suppose I ended up thinking

345
00:18:28,316 --> 00:18:31,116
Speaker 2: that each of these fields was, you know, weaving its

346
00:18:31,156 --> 00:18:33,356
Speaker 2: own path through evidence, and some of them had directly

347
00:18:33,356 --> 00:18:34,996
Speaker 2: looked at medicine and gone, yeah, we want to do

348
00:18:35,036 --> 00:18:38,116
Speaker 2: that too. We should think our practices shouldn't be based

349
00:18:38,156 --> 00:18:42,316
Speaker 2: on conventional wisdom an anecdote. And in others, like in

350
00:18:42,356 --> 00:18:45,316
Speaker 2: economics example, there's kind of you know, evidences that the

351
00:18:45,396 --> 00:18:48,156
Speaker 2: use of randomized trials has really swept through international development,

352
00:18:48,276 --> 00:18:51,676
Speaker 2: through development economics. But yeah, I think I don't think

353
00:18:51,676 --> 00:18:54,676
Speaker 2: any of them have advanced as far as medicine. And

354
00:18:54,716 --> 00:19:00,156
Speaker 2: I think that that is partly because of the histories

355
00:19:00,196 --> 00:19:03,196
Speaker 2: of the of these fields and the people who've been

356
00:19:03,236 --> 00:19:05,516
Speaker 2: championing it, and the different barriers that it's faced.

357
00:19:05,876 --> 00:19:12,236
Speaker 1: It seems harder in most other domains to do useful

358
00:19:12,396 --> 00:19:16,036
Speaker 1: you know, studies that have real external validity where you

359
00:19:16,076 --> 00:19:18,756
Speaker 1: can look at something in one place and say this

360
00:19:18,916 --> 00:19:20,916
Speaker 1: same intervention is going to work in other places, Like

361
00:19:20,956 --> 00:19:24,516
Speaker 1: the world is messy, is a fundamental problem with trying

362
00:19:24,556 --> 00:19:25,476
Speaker 1: to generate evidence.

363
00:19:25,756 --> 00:19:28,356
Speaker 2: Yeah, it makes things really really hard. So let's say

364
00:19:28,356 --> 00:19:31,596
Speaker 2: you want to, I don't know, you know, test whether

365
00:19:31,956 --> 00:19:35,316
Speaker 2: giving people incentives to have vaccines works. And I mean

366
00:19:35,356 --> 00:19:37,836
Speaker 2: I talked about a trial in the book that was

367
00:19:37,876 --> 00:19:42,156
Speaker 2: done where in India people were offered steel dinner plates

368
00:19:42,276 --> 00:19:44,996
Speaker 2: and bags of lentils in order to incentivize parents to

369
00:19:45,036 --> 00:19:47,756
Speaker 2: compliclents had their children vaccinated, and it seemed to be effective.

370
00:19:47,836 --> 00:19:49,996
Speaker 2: Right now, you can't just lift and shift that and

371
00:19:50,036 --> 00:19:52,716
Speaker 2: put it into you know, the UK. You know, you

372
00:19:52,756 --> 00:19:55,396
Speaker 2: have to think about the different cultures and you know,

373
00:19:55,396 --> 00:19:57,596
Speaker 2: the different ways incentives might work, and so on and

374
00:19:57,596 --> 00:19:57,996
Speaker 2: so forth.

375
00:19:58,036 --> 00:20:01,836
Speaker 1: I mean that particular example, like you do see conditional

376
00:20:01,836 --> 00:20:04,836
Speaker 1: cash transfers in other countries where you know, if parents

377
00:20:04,836 --> 00:20:07,796
Speaker 1: bring their children for vaccination and send them to school,

378
00:20:07,836 --> 00:20:10,916
Speaker 1: then they get a monthly stipend from the government. Like

379
00:20:11,876 --> 00:20:14,396
Speaker 1: those seem to work, Like those that one does seem

380
00:20:14,436 --> 00:20:15,996
Speaker 1: to generalize at least.

381
00:20:15,876 --> 00:20:18,196
Speaker 3: Some yes, it has. I mean that's built up.

382
00:20:18,356 --> 00:20:20,556
Speaker 2: That's unusual really and having such a body of evidence

383
00:20:20,596 --> 00:20:21,956
Speaker 2: to it, that's built up over time.

384
00:20:22,156 --> 00:20:24,916
Speaker 1: Although it's funny like that one, I understand that we

385
00:20:24,916 --> 00:20:27,356
Speaker 1: shouldn't rely on common sense is one of the themes

386
00:20:27,356 --> 00:20:29,556
Speaker 1: of the book. But like, if you give people money

387
00:20:29,596 --> 00:20:31,876
Speaker 1: to do something that is actually helpful to them, they

388
00:20:31,876 --> 00:20:34,956
Speaker 1: will do it. Is basically what that finding says, and

389
00:20:35,036 --> 00:20:36,196
Speaker 1: it's true.

390
00:20:36,236 --> 00:20:40,076
Speaker 2: Right, but it took evidence to convince policymakers of that. Yeah, fair,

391
00:20:40,516 --> 00:20:43,396
Speaker 2: So the counter argument, you know, You're absolutely right that

392
00:20:43,436 --> 00:20:46,556
Speaker 2: this point about generalization is like a really big problem

393
00:20:46,596 --> 00:20:48,556
Speaker 2: across all of these fields, right that what works in

394
00:20:48,596 --> 00:20:51,116
Speaker 2: one place might not work in another. Now, some people

395
00:20:51,116 --> 00:20:53,796
Speaker 2: would say, well why bother? You know, well why bother

396
00:20:53,916 --> 00:20:56,236
Speaker 2: getting evidence at all? Like what's the point of testing it?

397
00:20:56,716 --> 00:21:01,156
Speaker 2: But you generally, over time, you know, if something it

398
00:21:01,236 --> 00:21:03,676
Speaker 2: might not work exactly the same. But if you start

399
00:21:03,716 --> 00:21:05,516
Speaker 2: to build up a body of evidence that shows, yeah,

400
00:21:05,556 --> 00:21:08,436
Speaker 2: actually this seems to like the conditional cash transfers have

401
00:21:08,636 --> 00:21:11,236
Speaker 2: some effectiveness here and some effectiveness here, then you've come

402
00:21:11,316 --> 00:21:14,196
Speaker 2: up with a robust policy that does seem worth pursuing.

403
00:21:15,156 --> 00:21:19,556
Speaker 1: Tell me about evidence based policy making for like government policy,

404
00:21:19,596 --> 00:21:22,756
Speaker 1: social policy, like what how has the sort of march

405
00:21:22,796 --> 00:21:24,916
Speaker 1: of evidence been there?

406
00:21:25,996 --> 00:21:29,596
Speaker 2: So I think in line I concluded in the end

407
00:21:29,596 --> 00:21:30,836
Speaker 2: that there was a kind of what I call the

408
00:21:30,836 --> 00:21:34,356
Speaker 2: evidence zeitgeist around the sort of nineteen nineties to maybe

409
00:21:34,396 --> 00:21:37,716
Speaker 2: twenty ten, when a lot of these fields were turning

410
00:21:37,716 --> 00:21:40,276
Speaker 2: to evidence. And I think it's because these ideas of

411
00:21:40,276 --> 00:21:43,796
Speaker 2: evidence based medicine were percolating out and people were coming

412
00:21:43,796 --> 00:21:45,996
Speaker 2: across them, and then you see this kind of emerge

413
00:21:45,996 --> 00:21:49,556
Speaker 2: in the policy language. So you know, we had for example,

414
00:21:49,596 --> 00:21:52,956
Speaker 2: Tony Blair and New Labor were talking about evidence based policy,

415
00:21:53,036 --> 00:21:55,836
Speaker 2: or doing what works as it was called, in the

416
00:21:55,916 --> 00:21:59,996
Speaker 2: nineteen nineties. Obama talked about it in his inauguration speech

417
00:22:00,196 --> 00:22:02,476
Speaker 2: in two thousand and nine. So it sort of was

418
00:22:02,516 --> 00:22:07,516
Speaker 2: filtering into policy, and you know, particular people became very

419
00:22:07,876 --> 00:22:10,676
Speaker 2: enamored by it, I would say it sort of it

420
00:22:10,796 --> 00:22:13,276
Speaker 2: succeeded in certain pockets, shall we say.

421
00:22:13,316 --> 00:22:17,276
Speaker 1: And during that time people are championing it. Are you

422
00:22:17,436 --> 00:22:21,676
Speaker 1: seeing policy changes based on evidence? Are they actually doing

423
00:22:21,716 --> 00:22:23,276
Speaker 1: the thing they're talking about?

424
00:22:23,836 --> 00:22:26,316
Speaker 2: In some cases there were yes. So that there was

425
00:22:26,356 --> 00:22:28,236
Speaker 2: a series of what were called, for example, in the

426
00:22:28,276 --> 00:22:31,716
Speaker 2: Obama in administration, a series of what were called tiered

427
00:22:31,876 --> 00:22:35,436
Speaker 2: evidence initiatives which came in where in order for policy

428
00:22:35,436 --> 00:22:38,676
Speaker 2: to progress, it was only allowed to, for example, have

429
00:22:38,756 --> 00:22:42,116
Speaker 2: extra funding if it was able to produce evidence of effectiveness.

430
00:22:42,396 --> 00:22:44,796
Speaker 1: Are there examples of things that got cut because they

431
00:22:44,836 --> 00:22:48,036
Speaker 1: were sort of proven to not work? That's the real one,

432
00:22:48,116 --> 00:22:50,116
Speaker 1: right Are you going to say, hey, this doesn't work,

433
00:22:50,156 --> 00:22:51,396
Speaker 1: so we're going to stop doing it.

434
00:22:51,996 --> 00:22:56,076
Speaker 2: That is much harder to find examples of, I would say, yeah, yeah.

435
00:22:55,836 --> 00:22:58,356
Speaker 1: So what are examples of things that got funded because

436
00:22:58,396 --> 00:22:59,716
Speaker 1: there was evidence that they were good.

437
00:23:00,876 --> 00:23:03,836
Speaker 2: One example was the Nurse Family Partnership, which is a

438
00:23:03,876 --> 00:23:07,076
Speaker 2: program where first time mothers are given a lot of

439
00:23:07,076 --> 00:23:10,396
Speaker 2: support in the you know, the early time of pregnancy

440
00:23:10,396 --> 00:23:12,596
Speaker 2: and in the first two years of life. And because

441
00:23:12,596 --> 00:23:15,236
Speaker 2: there was a lot of evidence that this really was

442
00:23:15,276 --> 00:23:20,396
Speaker 2: helpful towards child outcomes, that progressed and was awarded more

443
00:23:20,516 --> 00:23:21,276
Speaker 2: government funding.

444
00:23:21,956 --> 00:23:23,836
Speaker 1: And what's the status of that program now?

445
00:23:24,156 --> 00:23:24,716
Speaker 3: Still going?

446
00:23:25,156 --> 00:23:28,556
Speaker 1: I'm still going. I didn't expect that, I'll admit, in

447
00:23:28,596 --> 00:23:30,796
Speaker 1: my jade at heart, I thought you were going to

448
00:23:30,796 --> 00:23:35,396
Speaker 1: tell me it got killed. That's in the US. Yep, Okay,

449
00:23:35,716 --> 00:23:40,196
Speaker 1: well that's good news. Tell me about you have a

450
00:23:40,276 --> 00:23:47,516
Speaker 1: chapter about evidence based management. The evidence seems particularly weak

451
00:23:47,676 --> 00:23:48,396
Speaker 1: in that domain.

452
00:23:48,716 --> 00:23:52,636
Speaker 2: Frankly, I think some of the evidence is weak, and

453
00:23:52,676 --> 00:23:56,196
Speaker 2: I think the culture of using evidence is very weak.

454
00:23:56,236 --> 00:23:58,436
Speaker 2: So of the fields I looked at, I would say

455
00:23:58,436 --> 00:24:01,916
Speaker 2: that that is the one where I felt evidence was

456
00:24:01,956 --> 00:24:05,396
Speaker 2: struggling the most. I mean, there is a surprising amount

457
00:24:05,796 --> 00:24:09,356
Speaker 2: of evidence on effective management practices, and a lot of

458
00:24:09,356 --> 00:24:11,836
Speaker 2: people are kind of really sort of surprised to discover this.

459
00:24:11,956 --> 00:24:14,156
Speaker 2: Like you can, you know, find doctors who are absolutely

460
00:24:14,196 --> 00:24:16,756
Speaker 2: evidence based and everything they do, but they think that

461
00:24:16,796 --> 00:24:19,716
Speaker 2: maybe management is some type of you know, magic or

462
00:24:19,876 --> 00:24:22,556
Speaker 2: art or something. So yeah, there's evidence on you know,

463
00:24:23,476 --> 00:24:27,516
Speaker 2: whether feedback works, or you know, whether the performance appraisals work,

464
00:24:27,556 --> 00:24:29,476
Speaker 2: which by the way, they don't seem to be all

465
00:24:29,476 --> 00:24:32,276
Speaker 2: that effective, but improving performance, which I found quite interesting.

466
00:24:32,876 --> 00:24:38,156
Speaker 1: Yes, I'm overdue that the performance appraisal software keeps bothering

467
00:24:38,196 --> 00:24:40,236
Speaker 1: me that I'm overdu So if you're telling me it's

468
00:24:40,236 --> 00:24:43,836
Speaker 1: a waste of time, you're validating my behavior, and I'm

469
00:24:43,876 --> 00:24:46,716
Speaker 1: happy to hear it. So what does work? Tell me?

470
00:24:46,836 --> 00:24:50,836
Speaker 1: Like one management thing where there's like really clear evidence

471
00:24:50,836 --> 00:24:56,596
Speaker 1: that is actually actionable to use a management word, that's like,

472
00:24:56,676 --> 00:24:58,556
Speaker 1: here's a great thing, and you should do it if

473
00:24:58,556 --> 00:24:59,276
Speaker 1: you're a manager.

474
00:24:59,876 --> 00:25:04,876
Speaker 2: So goal setting is very effective and good good feedback,

475
00:25:04,996 --> 00:25:11,756
Speaker 2: good feedback meaning fair feedback, feedback which is specific to people,

476
00:25:11,796 --> 00:25:14,116
Speaker 2: you know, not generic feedback. So there does seem to

477
00:25:14,156 --> 00:25:17,236
Speaker 2: be good evidence that those things are effective at improving

478
00:25:17,276 --> 00:25:19,036
Speaker 2: performance fair enough.

479
00:25:19,076 --> 00:25:23,476
Speaker 1: Why do I find that unsatisfying? Maybe because it seems obvious.

480
00:25:23,556 --> 00:25:26,076
Speaker 2: Yes, it seems of no, but that's a really good point.

481
00:25:26,196 --> 00:25:28,316
Speaker 2: So that to me is one of the things that

482
00:25:28,356 --> 00:25:31,836
Speaker 2: holds back evidence based management because some of the principles

483
00:25:31,836 --> 00:25:34,316
Speaker 2: which are supported by evidence feel obvious to people and

484
00:25:34,356 --> 00:25:38,636
Speaker 2: they're not new, and what sales business book is exciting

485
00:25:38,716 --> 00:25:42,476
Speaker 2: new ideas which aren't necessarily tested or proven to work,

486
00:25:43,236 --> 00:25:46,636
Speaker 2: So there's financial incentive sort of working against evidence based management.

487
00:25:47,076 --> 00:25:47,676
Speaker 3: In my view.

488
00:25:48,156 --> 00:25:50,476
Speaker 1: You've been an editor and a writer on the sort

489
00:25:50,476 --> 00:25:54,476
Speaker 1: of magazine side of the journal nature, right, And I

490
00:25:54,516 --> 00:25:57,596
Speaker 1: was a newspaper reporter before. And I mean I was

491
00:25:57,636 --> 00:26:01,876
Speaker 1: thinking about evidence in our profession, right. And I don't

492
00:26:01,916 --> 00:26:03,756
Speaker 1: mean evidence in the sense of like you want to

493
00:26:03,756 --> 00:26:05,876
Speaker 1: write about what's true, or you want to assess the

494
00:26:05,916 --> 00:26:08,196
Speaker 1: evidence when you're writing about something. I mean evidence for

495
00:26:08,276 --> 00:26:11,516
Speaker 1: the way one should write, or what kinds of stories

496
00:26:11,556 --> 00:26:14,596
Speaker 1: we should do, or what headlines we should write. And

497
00:26:15,476 --> 00:26:17,796
Speaker 1: in my career there has been none of that essentially.

498
00:26:17,836 --> 00:26:19,636
Speaker 1: I mean, you had the Internet come along. I'm old

499
00:26:19,716 --> 00:26:22,916
Speaker 1: enough that I remember when that was relatively new and people,

500
00:26:22,996 --> 00:26:25,116
Speaker 1: you know, you had a dashboard and you started to see, oh,

501
00:26:25,156 --> 00:26:27,316
Speaker 1: people are reading these kinds of stories and not reading

502
00:26:27,356 --> 00:26:29,956
Speaker 1: those kinds of stories, and in a sort of quasi

503
00:26:29,996 --> 00:26:35,596
Speaker 1: anecdotal way, you might shift course. But nobody wanted to

504
00:26:35,716 --> 00:26:37,836
Speaker 1: use evidence. I mean, not only did people really not

505
00:26:37,916 --> 00:26:40,316
Speaker 1: think that way, but to the extent they did, they

506
00:26:40,356 --> 00:26:42,516
Speaker 1: didn't want to think that way, right, Like we like

507
00:26:42,596 --> 00:26:44,916
Speaker 1: writing the kinds of stories we write. I learned some

508
00:26:44,996 --> 00:26:48,596
Speaker 1: particular craft of podcasting that was, like one guy who

509
00:26:48,636 --> 00:26:51,156
Speaker 1: was really good at making podcasts, we thought, told everybody

510
00:26:51,196 --> 00:26:52,916
Speaker 1: how to do it, and we did it right, imminence

511
00:26:52,956 --> 00:26:56,756
Speaker 1: based podcasting. And then all these other podcasts come along

512
00:26:56,796 --> 00:26:59,036
Speaker 1: that are nothing like the rules that I learned and

513
00:26:59,116 --> 00:27:01,676
Speaker 1: are wildly popular, and I'm like, oh, the rules that

514
00:27:01,676 --> 00:27:03,716
Speaker 1: I learned were just what one guy made up and

515
00:27:03,756 --> 00:27:08,396
Speaker 1: we all liked. But I haven't really changed much based

516
00:27:08,396 --> 00:27:13,876
Speaker 1: on that. I mean, do you use evidence in your craft?

517
00:27:14,396 --> 00:27:15,476
Speaker 3: That's such a good question.

518
00:27:16,996 --> 00:27:19,396
Speaker 2: I mean, really, what you're talking about is using data

519
00:27:19,756 --> 00:27:22,676
Speaker 2: right to inform what you do.

520
00:27:22,836 --> 00:27:26,076
Speaker 1: I think, well, you could do a randomized control trial.

521
00:27:26,156 --> 00:27:28,436
Speaker 1: I mean, certainly a B testing of health AB test

522
00:27:28,636 --> 00:27:31,436
Speaker 1: is the thing people do, yes, exactly, but you could

523
00:27:31,476 --> 00:27:35,396
Speaker 1: do You could do a randomized trial of different kinds

524
00:27:35,436 --> 00:27:37,796
Speaker 1: of articles in nature if you want it right, you

525
00:27:37,796 --> 00:27:41,236
Speaker 1: could random You could prospectively decide we're going to randomly

526
00:27:41,276 --> 00:27:44,476
Speaker 1: assign somebody to do A or B or whatever. As

527
00:27:44,476 --> 00:27:47,076
Speaker 1: far as I know, nobody's ever done that.

528
00:27:47,076 --> 00:27:48,516
Speaker 3: That's a great point. Yep.

529
00:27:48,756 --> 00:27:52,476
Speaker 2: Absolutely, yeah, Mostly people are chasing audiences.

530
00:27:52,556 --> 00:27:56,116
Speaker 1: But even analyzing the best way to chase audiences, like

531
00:27:56,156 --> 00:27:57,156
Speaker 1: why don't we do that?

532
00:27:57,676 --> 00:27:58,996
Speaker 3: We should, let's do it.

533
00:28:00,076 --> 00:28:02,916
Speaker 1: But do you mean that? I feel like I don't

534
00:28:02,956 --> 00:28:05,516
Speaker 1: wanna at some level? Right, this is like part of

535
00:28:05,556 --> 00:28:07,676
Speaker 1: the It's like I like doing my job the way

536
00:28:07,676 --> 00:28:10,076
Speaker 1: I want to like. Yes, I also would like to

537
00:28:10,076 --> 00:28:12,636
Speaker 1: have more listeners. And perhaps if I was better, you know,

538
00:28:12,716 --> 00:28:16,036
Speaker 1: more analytical or more evidence based, I would have more listeners.

539
00:28:16,076 --> 00:28:17,996
Speaker 1: But I don't know. I think there's something going on

540
00:28:18,076 --> 00:28:21,996
Speaker 1: there that is interesting and that points to resistance to evidence.

541
00:28:22,116 --> 00:28:24,276
Speaker 1: Like I think of myself as an analytical person. I

542
00:28:24,276 --> 00:28:26,956
Speaker 1: think I follow evidence in healthcare, and yet in this

543
00:28:26,956 --> 00:28:28,716
Speaker 1: thing I do all day every day, I sort of

544
00:28:28,756 --> 00:28:30,316
Speaker 1: don't pay attention.

545
00:28:30,556 --> 00:28:32,796
Speaker 2: Well, it depends what outcome you want, right, I mean,

546
00:28:32,836 --> 00:28:34,956
Speaker 2: if your outcome is very clearly that you want to

547
00:28:34,996 --> 00:28:38,236
Speaker 2: grow listeners, then you might be incentivized and to do

548
00:28:38,316 --> 00:28:40,996
Speaker 2: that experiment. If you're happy with the outcome and no

549
00:28:40,996 --> 00:28:42,916
Speaker 2: one's being harmed by which I don't think they are,

550
00:28:42,956 --> 00:28:44,756
Speaker 2: if you continue to podcast in the way you do,

551
00:28:44,876 --> 00:28:46,436
Speaker 2: or I tell stories in the way that I do.

552
00:28:46,636 --> 00:28:49,436
Speaker 2: Then you know there has to be an incentive, I

553
00:28:49,476 --> 00:28:50,636
Speaker 2: think to do the test.

554
00:28:51,596 --> 00:28:53,476
Speaker 1: How did writing the book change the way you think

555
00:28:53,516 --> 00:28:54,196
Speaker 1: about evidence?

556
00:28:56,636 --> 00:28:59,116
Speaker 2: I think it changed the way I work as a

557
00:28:59,196 --> 00:29:03,356
Speaker 2: journalist to some extent. I mean, obviously, I write features

558
00:29:03,356 --> 00:29:05,996
Speaker 2: about complex bodies of evidence, so I find interesting questions

559
00:29:06,036 --> 00:29:07,196
Speaker 2: and I want to go and look at what the

560
00:29:07,236 --> 00:29:10,156
Speaker 2: evidence says about them. And I would say, what's changed

561
00:29:10,156 --> 00:29:13,116
Speaker 2: about that is I am much more likely to now

562
00:29:13,196 --> 00:29:17,076
Speaker 2: look for evidence synthesies, so for example, for systematic reviews

563
00:29:17,076 --> 00:29:19,396
Speaker 2: when I'm diving into a new field, and I don't

564
00:29:19,396 --> 00:29:20,996
Speaker 2: think I did that as much in the past, and

565
00:29:21,036 --> 00:29:24,796
Speaker 2: I found that quite liberating, you know, because and of

566
00:29:24,836 --> 00:29:26,796
Speaker 2: course evidence is just ballooning, I mean in terms of

567
00:29:26,796 --> 00:29:28,596
Speaker 2: the amount of a search that's coming out. So that's

568
00:29:28,636 --> 00:29:29,596
Speaker 2: been quite helpful.

569
00:29:30,116 --> 00:29:30,356
Speaker 3: I mean.

570
00:29:30,396 --> 00:29:33,196
Speaker 1: The classic bread and butter of science journalism is writing

571
00:29:33,196 --> 00:29:35,796
Speaker 1: about a new study, right, But one lesson of what

572
00:29:35,836 --> 00:29:39,236
Speaker 1: you're talking about is like, except in rare cases where

573
00:29:39,236 --> 00:29:42,996
Speaker 1: the new study is like really giant or something, we

574
00:29:43,076 --> 00:29:46,916
Speaker 1: should almost ignore new studies, Like we should add this

575
00:29:46,916 --> 00:29:49,396
Speaker 1: one new study to this part of a thousand studies

576
00:29:49,756 --> 00:29:52,596
Speaker 1: and see how much it, you know, adjusts the totality

577
00:29:52,596 --> 00:29:54,556
Speaker 1: of the evidence, which is usually going to be not

578
00:29:54,636 --> 00:29:56,236
Speaker 1: that much, right, Yes.

579
00:29:56,156 --> 00:29:57,876
Speaker 2: I mean it's going to depend how big the body

580
00:29:57,876 --> 00:29:59,436
Speaker 2: of evidence is that you're adding the study to.

581
00:29:59,556 --> 00:30:00,396
Speaker 1: So you're right.

582
00:30:00,436 --> 00:30:02,156
Speaker 2: If it's a brand new trial it's the first time

583
00:30:02,196 --> 00:30:04,716
Speaker 2: it's tested a drug, totally we should write about that,

584
00:30:04,996 --> 00:30:07,516
Speaker 2: reports on it. But if it's another trial, another study

585
00:30:07,596 --> 00:30:11,276
Speaker 2: saying you know, wine is good for you, that's probably

586
00:30:11,516 --> 00:30:12,756
Speaker 2: best to put to one time.

587
00:30:12,796 --> 00:30:12,916
Speaker 1: Now.

588
00:30:12,956 --> 00:30:15,196
Speaker 2: The reason, of course those stories still come out is

589
00:30:15,236 --> 00:30:17,956
Speaker 2: because they get clicks on websites.

590
00:30:18,316 --> 00:30:19,396
Speaker 3: But I'm with you.

591
00:30:19,476 --> 00:30:22,076
Speaker 2: I mean I have definitely reached this point of thinking, yes,

592
00:30:22,116 --> 00:30:23,636
Speaker 2: I need to look at the body of evidence as

593
00:30:23,676 --> 00:30:23,996
Speaker 2: a whole.

594
00:30:24,316 --> 00:30:31,396
Speaker 1: And what about outside of science, Like do you use

595
00:30:32,036 --> 00:30:34,036
Speaker 1: Is there any part of your life where you use

596
00:30:34,116 --> 00:30:38,596
Speaker 1: evidence now outside of work, outside of health where you

597
00:30:38,636 --> 00:30:39,516
Speaker 1: didn't use it before?

598
00:30:40,716 --> 00:30:44,916
Speaker 2: Well, probably I use it more in parenting. I mean,

599
00:30:44,996 --> 00:30:48,916
Speaker 2: that's a really interesting case where I feel it's a

600
00:30:48,916 --> 00:30:53,196
Speaker 2: bit like management in that there's just it's completely a

601
00:30:53,396 --> 00:30:56,116
Speaker 2: wash with you know, fads and fashions and books and

602
00:30:56,916 --> 00:30:59,356
Speaker 2: actually there is quite a lot of evidence around, you know,

603
00:30:59,436 --> 00:31:02,356
Speaker 2: practices that can support child developments. Some of which is

604
00:31:02,396 --> 00:31:04,756
Speaker 2: mirrored in standard parenting advice, but some of which might

605
00:31:04,796 --> 00:31:06,636
Speaker 2: be slightly different, And I just think it gets lost

606
00:31:06,676 --> 00:31:08,876
Speaker 2: in the kind of fire hose of information.

607
00:31:09,116 --> 00:31:12,476
Speaker 1: That's a non obvious piece of parenting advice with robust

608
00:31:12,476 --> 00:31:13,396
Speaker 1: evidence behind it.

609
00:31:13,516 --> 00:31:14,916
Speaker 2: I don't know if it's not obvious, I would just

610
00:31:14,916 --> 00:31:18,836
Speaker 2: say it's obviously a really live debate right around. I've

611
00:31:18,876 --> 00:31:23,636
Speaker 2: looked specifically for nature. The evidence around is social media

612
00:31:23,636 --> 00:31:29,676
Speaker 2: and screen news causing the rise in mental health problems

613
00:31:29,716 --> 00:31:32,756
Speaker 2: for adolescents and young people. And that is a really

614
00:31:33,236 --> 00:31:36,876
Speaker 2: complicated body of evidence, which I think people are interpreting

615
00:31:36,916 --> 00:31:39,716
Speaker 2: in different ways. But I do think that this general

616
00:31:40,196 --> 00:31:43,956
Speaker 2: sense that that's been shown that this is causative and

617
00:31:43,996 --> 00:31:47,356
Speaker 2: it's a huge driver of adolescent mental health problems is

618
00:31:47,676 --> 00:31:50,396
Speaker 2: an overreach based on the people that I've spoken to

619
00:31:50,476 --> 00:31:52,796
Speaker 2: and having looked at the evidence myself.

620
00:31:53,436 --> 00:31:56,436
Speaker 1: So are you saying screens and social media aren't as

621
00:31:56,476 --> 00:31:58,756
Speaker 1: bad for teenagers as a lot of people think. Is

622
00:31:58,796 --> 00:32:00,516
Speaker 1: that a fair reduction of what you said?

623
00:32:00,596 --> 00:32:00,836
Speaker 3: Yeah?

624
00:32:01,156 --> 00:32:03,476
Speaker 1: Yeah, yeah, good news, good news.

625
00:32:03,636 --> 00:32:05,196
Speaker 2: Can I go back to your point, because you asked

626
00:32:05,196 --> 00:32:08,436
Speaker 2: me how it's changed, how I are you know, personal decisions.

627
00:32:08,076 --> 00:32:10,356
Speaker 1: You elect your kids stay the phones more than you

628
00:32:10,396 --> 00:32:10,996
Speaker 1: did before.

629
00:32:12,396 --> 00:32:14,596
Speaker 2: To some extent, yeah, I mean it just made me

630
00:32:14,796 --> 00:32:17,156
Speaker 2: relax a little bit about it, because you know, we're

631
00:32:17,236 --> 00:32:20,476
Speaker 2: really seeking these concrete answers, aren't we. Or what I

632
00:32:20,476 --> 00:32:22,996
Speaker 2: would have loved the evidence to say was like, you know,

633
00:32:23,276 --> 00:32:26,236
Speaker 2: two hours and that's it, right, But it doesn't. It

634
00:32:26,276 --> 00:32:29,516
Speaker 2: doesn't provide you with simple answers. Evidence generally doesn't. But

635
00:32:29,636 --> 00:32:32,636
Speaker 2: sometimes I think that that can be quite empowering itself,

636
00:32:33,116 --> 00:32:34,716
Speaker 2: you know, as a parent, to go, Okay, well, I

637
00:32:34,716 --> 00:32:36,436
Speaker 2: have looked at the evidence and it doesn't give me

638
00:32:36,436 --> 00:32:38,516
Speaker 2: the crisp answers I would really love to have about

639
00:32:38,516 --> 00:32:41,396
Speaker 2: what to do. But I understand that, and now I

640
00:32:41,436 --> 00:32:45,236
Speaker 2: feel empowered to perhaps make decisions on my own based

641
00:32:45,276 --> 00:32:47,076
Speaker 2: on my common sense and weighing up the things which

642
00:32:47,076 --> 00:32:48,636
Speaker 2: are important to me and my family.

643
00:32:50,756 --> 00:32:53,796
Speaker 1: What's the future of evidence as a as an idea

644
00:32:53,956 --> 00:32:56,356
Speaker 1: evidence in the world, Like, do you feel like we're

645
00:32:56,356 --> 00:32:59,396
Speaker 1: in this moment when there's a sort of evidence backlash.

646
00:32:59,476 --> 00:33:02,196
Speaker 2: To some extent, I literally published a big piece last

647
00:33:02,196 --> 00:33:05,036
Speaker 2: week for Nature about trust in science because I wanted

648
00:33:05,076 --> 00:33:06,876
Speaker 2: to look at this kind of They're like, there's a

649
00:33:06,876 --> 00:33:10,036
Speaker 2: sort of sense in the air that there's this like

650
00:33:10,516 --> 00:33:12,996
Speaker 2: big crisis of trust in science. People have lost trust

651
00:33:12,996 --> 00:33:15,236
Speaker 2: in science, and I wanted to kind of scrutinize that claim,

652
00:33:15,276 --> 00:33:16,876
Speaker 2: So I went off and looked at kind of data,

653
00:33:16,956 --> 00:33:18,836
Speaker 2: and I've spoken to lots of people, and I would

654
00:33:18,876 --> 00:33:22,236
Speaker 2: say the big picture, given that surveys are imperfect, but

655
00:33:22,276 --> 00:33:26,036
Speaker 2: from lots of surveys, is that generally, you know, globally,

656
00:33:26,956 --> 00:33:30,076
Speaker 2: trust in science is quite high. People generally trust science,

657
00:33:30,156 --> 00:33:32,756
Speaker 2: and scientists as a profession is one of the most

658
00:33:32,756 --> 00:33:35,476
Speaker 2: trusted professions. Like it's up there with like doctors and teachers,

659
00:33:35,476 --> 00:33:38,156
Speaker 2: you know, and you've got journalists like me and politicians

660
00:33:38,836 --> 00:33:41,036
Speaker 2: who go down the bottom of the list. So the

661
00:33:41,076 --> 00:33:44,076
Speaker 2: global picture is kind of like glassharlf full. Everything looks fine,

662
00:33:44,316 --> 00:33:46,276
Speaker 2: but then obviously they yes, they were a big problems.

663
00:33:46,276 --> 00:33:50,236
Speaker 2: So in the US, trust in science has gone down

664
00:33:50,316 --> 00:33:53,556
Speaker 2: in the last few years, and there's a specifically a

665
00:33:53,596 --> 00:33:57,116
Speaker 2: political polarization going on around trust in science in the US,

666
00:33:57,156 --> 00:34:01,436
Speaker 2: with it falling amongst Republican leaning people but remaining high

667
00:34:01,476 --> 00:34:06,156
Speaker 2: amongst Democrats, and people feel concerned that the Trump administration

668
00:34:06,236 --> 00:34:09,996
Speaker 2: is kind of capitalizing on this idea of distrust of

669
00:34:10,036 --> 00:34:13,836
Speaker 2: science to now attack scientific institutions. So I don't want

670
00:34:13,876 --> 00:34:15,836
Speaker 2: to give the impression that I came away from this

671
00:34:15,876 --> 00:34:18,716
Speaker 2: exercise thinking everything's rosy with trust in science.

672
00:34:18,476 --> 00:34:19,436
Speaker 3: Because that's not the case.

673
00:34:19,836 --> 00:34:22,716
Speaker 2: This big global trust in Science survey I looked at

674
00:34:22,796 --> 00:34:26,076
Speaker 2: in some countries lower trust in science was associated with

675
00:34:26,156 --> 00:34:28,636
Speaker 2: being right leaning, but in others it was associated with

676
00:34:28,676 --> 00:34:31,076
Speaker 2: being left leaning. So it really kind of depends on

677
00:34:31,116 --> 00:34:31,716
Speaker 2: the country.

678
00:34:32,156 --> 00:34:33,516
Speaker 1: What's the future of evidence?

679
00:34:34,716 --> 00:34:37,476
Speaker 2: I think in some ways, you know, looking at the

680
00:34:37,516 --> 00:34:40,476
Speaker 2: evidence revolution, like going back to where we started, it's

681
00:34:40,556 --> 00:34:43,156
Speaker 2: quite recent, you know. I mean, evidence based medicine as

682
00:34:43,156 --> 00:34:46,036
Speaker 2: a term was only introduced in nineteen ninety one, thirty

683
00:34:46,076 --> 00:34:48,316
Speaker 2: five years ago. So if you want to have the

684
00:34:48,356 --> 00:34:51,196
Speaker 2: optimistic view, which maybe I do, you know, you could

685
00:34:51,236 --> 00:34:54,916
Speaker 2: say that the current kind of setbacks are that there's

686
00:34:54,916 --> 00:34:58,076
Speaker 2: always been opposition to evidence, and what's happening now is

687
00:34:58,476 --> 00:35:01,956
Speaker 2: just another setback in the kind of longer march towards rationality,

688
00:35:02,756 --> 00:35:05,636
Speaker 2: which is going to take decades. So I suppose, yeah,

689
00:35:05,756 --> 00:35:07,876
Speaker 2: I do come out hoping that's the case. It feels

690
00:35:07,916 --> 00:35:10,076
Speaker 2: a little hard for me to believe that we're going

691
00:35:10,076 --> 00:35:13,116
Speaker 2: to get to a point where we reject all of

692
00:35:13,156 --> 00:35:15,356
Speaker 2: this knowledge we've created in the world and choose not

693
00:35:15,396 --> 00:35:17,556
Speaker 2: to use that at all in decisions.

694
00:35:18,116 --> 00:35:19,596
Speaker 3: I hope that we don't get to that point.

695
00:35:24,236 --> 00:35:26,436
Speaker 1: We'll be back in a minute with the lightning round.

696
00:35:37,436 --> 00:35:40,756
Speaker 1: Let's finish with the lightning round if you would. Okay,

697
00:35:42,476 --> 00:35:45,276
Speaker 1: what's a piece of really solid evidence that you ignore?

698
00:35:46,556 --> 00:35:48,076
Speaker 3: Oh?

699
00:35:48,876 --> 00:35:52,716
Speaker 2: I think I try not to think too hard about

700
00:35:52,716 --> 00:35:58,356
Speaker 2: the evidence on alcohol, even though I've written a whole

701
00:35:58,396 --> 00:36:03,676
Speaker 2: piece about it, because I know having reported on it,

702
00:36:03,716 --> 00:36:05,956
Speaker 2: and I literally like calculated it all out and looked

703
00:36:05,956 --> 00:36:08,716
Speaker 2: at my own drinking and I thought, hmm, I probably

704
00:36:08,716 --> 00:36:10,836
Speaker 2: should less, and I find it difficult to do that.

705
00:36:11,476 --> 00:36:13,356
Speaker 2: I'm not saying I drink to excess. I'm just saying

706
00:36:13,356 --> 00:36:14,756
Speaker 2: it probably should be less than it is.

707
00:36:14,956 --> 00:36:17,556
Speaker 1: Well, the old like one glass of wine a day

708
00:36:17,636 --> 00:36:20,756
Speaker 1: is actually good for you. The evidence seems to have

709
00:36:20,796 --> 00:36:22,916
Speaker 1: shifted on that on that claim. Correct.

710
00:36:23,396 --> 00:36:26,836
Speaker 2: Yes, in general, most people could benefit by cutting back,

711
00:36:26,956 --> 00:36:29,196
Speaker 2: and the risks go up from a really low level.

712
00:36:29,316 --> 00:36:33,116
Speaker 1: Yeah, And was the problem with that evidence confounding that

713
00:36:33,156 --> 00:36:35,116
Speaker 1: the people who drink one glass of wine a day

714
00:36:35,236 --> 00:36:38,156
Speaker 1: tend to be have really healthy lives. They're like very

715
00:36:38,196 --> 00:36:41,156
Speaker 1: moderate people. They don't do anything in excess and that's

716
00:36:41,196 --> 00:36:42,996
Speaker 1: why it looked like that was good for you.

717
00:36:43,636 --> 00:36:46,156
Speaker 2: Partly, yes, confounding is really hard to ship out at

718
00:36:46,516 --> 00:36:48,476
Speaker 2: those studies, and also, of course the other ways that

719
00:36:48,516 --> 00:36:50,556
Speaker 2: heavy drinkers also tend to be smokers and do all

720
00:36:50,596 --> 00:36:52,316
Speaker 2: the other unhealthy behaviors, So it is.

721
00:36:52,276 --> 00:36:54,476
Speaker 3: It is a difficult relationship to tease out.

722
00:36:57,156 --> 00:37:01,636
Speaker 1: So you previously wrote a book about these longitudinal studies

723
00:37:01,716 --> 00:37:05,836
Speaker 1: right where researchers, as I understand it, followed a group

724
00:37:05,876 --> 00:37:10,476
Speaker 1: of people for their entire lives extremely interesting. What were

725
00:37:10,516 --> 00:37:12,436
Speaker 1: some of the things they learned from those studies?

726
00:37:13,156 --> 00:37:14,956
Speaker 2: The big message from all of the studies, I mean,

727
00:37:14,996 --> 00:37:16,676
Speaker 2: I set off to write this book that I thought

728
00:37:16,716 --> 00:37:18,756
Speaker 2: was going to be about these fascinating sort of about

729
00:37:19,036 --> 00:37:22,796
Speaker 2: science somehow, and I sort of ended up writing this

730
00:37:22,796 --> 00:37:25,596
Speaker 2: book about inequality, which I didn't really realize till i'd

731
00:37:25,596 --> 00:37:28,556
Speaker 2: published it, because really the big message was that children

732
00:37:28,596 --> 00:37:32,756
Speaker 2: who were born into difficult circumstances tend to follow on average,

733
00:37:32,796 --> 00:37:35,116
Speaker 2: tend to follow more difficult life paths, so they ended

734
00:37:35,196 --> 00:37:38,796
Speaker 2: up in poorer health, less wealth, in less good jobs.

735
00:37:39,156 --> 00:37:41,516
Speaker 2: And maybe that sounds really obvious, but the sad thing

736
00:37:41,596 --> 00:37:44,916
Speaker 2: is that that's kind of been repeated generation after generation

737
00:37:44,996 --> 00:37:46,396
Speaker 2: and it's still being repeated today.

738
00:37:46,916 --> 00:37:51,316
Speaker 1: Huh, So mobility didn't significantly increase over time.

739
00:37:52,516 --> 00:37:55,796
Speaker 2: Not no, I mean there has been some changes, But

740
00:37:56,116 --> 00:38:00,236
Speaker 2: that point about your early circumstances having this profound influence

741
00:38:00,276 --> 00:38:03,716
Speaker 2: on the rest of your life that remains true.

742
00:38:04,636 --> 00:38:09,516
Speaker 1: Tell me about beer glasses in British pubs.

743
00:38:11,476 --> 00:38:12,436
Speaker 3: I love this story.

744
00:38:13,116 --> 00:38:15,516
Speaker 2: This is one of my favorite randomized trials that I

745
00:38:15,556 --> 00:38:18,396
Speaker 2: came across when I was writing the book. So this

746
00:38:18,756 --> 00:38:23,796
Speaker 2: is a story about a highly unlikely trial that was

747
00:38:23,836 --> 00:38:28,556
Speaker 2: done by a researcher called Jonathan Shepherd, who is still

748
00:38:28,636 --> 00:38:31,916
Speaker 2: actually a facial surgeon, and he noticed that a lot

749
00:38:31,956 --> 00:38:34,876
Speaker 2: of the people that he was treating with terrible injuries

750
00:38:34,916 --> 00:38:37,836
Speaker 2: had come from glass. Often these awful incidents where people

751
00:38:37,836 --> 00:38:40,796
Speaker 2: were glassings, where two people in a pub get angry

752
00:38:40,916 --> 00:38:44,116
Speaker 2: and somebody decides to shove what's in their hand, which

753
00:38:44,156 --> 00:38:46,596
Speaker 2: is like their pint glass, into somebody else's face, and

754
00:38:46,636 --> 00:38:50,476
Speaker 2: so they have these awful lacerations and life altering injuries.

755
00:38:50,916 --> 00:38:53,796
Speaker 2: And so he started thinking, well, what if we had

756
00:38:53,796 --> 00:38:56,916
Speaker 2: stronger beer glasses and maybe that would lead to less

757
00:38:56,956 --> 00:38:57,676
Speaker 2: glass injuries.

758
00:38:58,076 --> 00:39:00,556
Speaker 1: Just to be clear, why is it better if if

759
00:39:00,596 --> 00:39:03,156
Speaker 1: that pub, if that glass that they're shoving into somebody's

760
00:39:03,156 --> 00:39:06,516
Speaker 1: face is tougher, it's less likely to shutter to shadow.

761
00:39:07,396 --> 00:39:09,756
Speaker 2: So basically you might have been part of this unusual

762
00:39:09,836 --> 00:39:12,636
Speaker 2: randomized trial of beer glasses if you bought a pint

763
00:39:12,876 --> 00:39:16,756
Speaker 2: in a selection of pubs in the UK and Wales

764
00:39:16,796 --> 00:39:19,716
Speaker 2: around nineteen ninety eight. Because he got a selection of

765
00:39:19,756 --> 00:39:23,996
Speaker 2: pubs and bars to randomly, some of them were signed

766
00:39:24,036 --> 00:39:28,596
Speaker 2: to install toughened glasses and the rest carried on with

767
00:39:28,636 --> 00:39:31,396
Speaker 2: their normal glasses and managed to show it was a

768
00:39:31,396 --> 00:39:33,436
Speaker 2: bit of a complicated trail, but he managed to show

769
00:39:33,596 --> 00:39:37,636
Speaker 2: that indeed, having tougher glass reduced the number of glass injuries,

770
00:39:37,676 --> 00:39:40,996
Speaker 2: and this helped lead to momentum which encouraged the pub

771
00:39:40,996 --> 00:39:44,076
Speaker 2: industry to switch to toughened glass in the UK, leading

772
00:39:44,156 --> 00:39:48,476
Speaker 2: to or least associated with a drop in a glass injuries.

773
00:39:49,396 --> 00:39:52,996
Speaker 1: Of like tens of thousands a year or something extraordinary

774
00:39:53,036 --> 00:39:53,516
Speaker 1: big number.

775
00:39:53,636 --> 00:39:54,876
Speaker 3: Yeah, yeah, amazing.

776
00:39:55,596 --> 00:39:59,076
Speaker 1: Somebody gave you, say, one hundred million dollars to fund

777
00:39:59,236 --> 00:40:03,316
Speaker 1: a study, any study you want. What would you do?

778
00:40:04,516 --> 00:40:04,956
Speaker 3: Wow?

779
00:40:06,476 --> 00:40:10,356
Speaker 2: Oh my god, Okay, that's that's I'm trying to think

780
00:40:10,396 --> 00:40:12,236
Speaker 2: of the question that I most want an answer to

781
00:40:12,316 --> 00:40:14,036
Speaker 2: for which there is no evidence. It has to be

782
00:40:14,076 --> 00:40:19,956
Speaker 2: something around parenting. I mean, okay, I'll give you an answer,

783
00:40:19,956 --> 00:40:22,236
Speaker 2: but I think it's a bit of a cheat because

784
00:40:23,876 --> 00:40:27,036
Speaker 2: it's sort of happening, which is around these social media

785
00:40:27,476 --> 00:40:29,436
Speaker 2: bans which are going on at the moment. I mean,

786
00:40:29,476 --> 00:40:32,236
Speaker 2: the UK is just introducing a policy to ban all

787
00:40:32,276 --> 00:40:35,236
Speaker 2: teenagers from social media, and it's already happened in Australia.

788
00:40:35,836 --> 00:40:38,756
Speaker 2: So I think the key, the key question, which evidence

789
00:40:38,796 --> 00:40:40,876
Speaker 2: curious people like me have and lots of researchers have,

790
00:40:41,156 --> 00:40:44,716
Speaker 2: is what's the effect. So I think a careful study

791
00:40:44,756 --> 00:40:49,076
Speaker 2: to understand the impact of those changes is really important.

792
00:40:49,876 --> 00:40:53,196
Speaker 1: It was great to speak with you, and I appreciate

793
00:40:53,236 --> 00:40:53,676
Speaker 1: your work.

794
00:40:53,956 --> 00:40:55,036
Speaker 3: Thank you, Thank you very much.

795
00:40:55,076 --> 00:40:56,756
Speaker 2: No, thanks very much for your questions and thanks for

796
00:40:56,756 --> 00:40:57,516
Speaker 2: having me on the show.

797
00:41:04,236 --> 00:41:07,276
Speaker 1: Helen Pearson is the author of the book Beyond Belief.

798
00:41:07,876 --> 00:41:11,316
Speaker 1: Please email us at problem at pushkin dot fm. Tell

799
00:41:11,396 --> 00:41:13,116
Speaker 1: us what kinds of shows we should do more of

800
00:41:13,276 --> 00:41:15,236
Speaker 1: or less of our particular people you think would be

801
00:41:15,236 --> 00:41:17,156
Speaker 1: good on the show. You can also find me on

802
00:41:17,436 --> 00:41:20,676
Speaker 1: x and on LinkedIn. Our show is produced by Gabriel

803
00:41:20,716 --> 00:41:24,156
Speaker 1: Hunter Chang and Trina Menino. Our editor is Lydia Jean

804
00:41:24,236 --> 00:41:27,796
Speaker 1: Kott and our engineer is Sarah Bruguier. I'm Jacob Goldstein

805
00:41:27,836 --> 00:41:29,956
Speaker 1: and we'll be back next week with another episode of

806
00:41:29,956 --> 00:41:30,316
Speaker 1: What's Your b