When Does No Mean Know(ing)? - The Intersection Of Facts And Beliefs

Much of the “debate” between those believing in vaccinations and the “anti-vaxxers” revolve around facts, facts whose discovery and promotion may be more influenced by beliefs than reproducible testable theory. A study of women in the UK concerning breast cancer prophylactic medical therapy shows us that belief triumphs over fact. 

In the UK, women deemed to be at moderate or high risk of breast cancer are referred to specialists and centers the prophylactic use of tamoxifen. [1] The study looked at the subsequent actions by a group of these women who completed questionnaires after their appointments about their perceived need and specific concerns about tamoxifen, about medicines and their use generally, and their own sensitivity to medications. 

The study was small, around four hundred and 63% provided the necessary follow up data on whether they had or had not started tamoxifen. So let’s avoid scientism by ignoring the p-values and merely look at the trends, we can consider this an exploration, not the definitive statement. And one more limitation, we have no knowledge of the “quality of clinician-patient communication.”

Only about 20% felt that their health now or in the future was dependent upon tamoxifen. 72% worried about long-term effects, 56% were concerned about unpleasant side effects, and 23% knew little about the drug (that in itself may help to describe the quality of communication). About 23% were “particularly sensitive” to medicines in the past, and 11% thought “even small amounts of medication could upset their body. 30% felt medications were generally overprescribed

Based upon their survey responses, the researchers abstracted two groups, both with low perceived needs for tamoxifen prophylaxis, but varying by having higher or lower specific or general concerns. In both groups, as you would expect because of low perceived needs use of tamoxifen was low 14.7% overall, but in the low concern group use was 18.3%, in the high concern group 6.4% - and in that nod, to scientism, the odds ratio based upon concern was 3.37. There should be no surprise when a benefit or need is perceived as low, and risk or concerns are regarded as high, the rationale individual chooses not to treat. 

Researchers abstracted two groups both with low perceived need but varying by higher and lower concerns. The differences in concern specifically about tamoxifen between the two groups were not that large, ranging anywhere from 24% to 140% higher in the group with more significant concerns. So perhaps factual education played a role here. But the differences in the groups dramatically increased when it came to beliefs about overuse and general harmfulness of medications. Now the differences ranged from 300 to 1800%. A few examples make the point. 

• “Medicines do more harm than good” - 1800% greater in the higher concern group.
• “All medicines are poisons” – 1000% greater for the same group.
• “Natural remedies are safer than medicines.” – 485% greater
• “Doctors place too must trust in medicines.” – 1600% greater again in the high concern group

None of these views are facts, they are beliefs; beliefs that can be challenged but not easily changed. 

Previous work by the researchers has shown that the usual socioeconomic factors, income, age, education, do not play a significant role in accepting this prophylactic therapy. The current study shows that even differences in “our” facts play a much smaller role in making these treatment decisions than the one factor we have the most difficulty challenging or changing, beliefs. I respectfully disagree with the optimistic, in my view, thinking of the researchers that 

“Medication beliefs are key modifiable determinants of treatment decision making.”

Beliefs are more resistant to facts because they are based on our experiences, personal or social; belief is more ingrained, touching a deeper part of our selves, the tiny voice living in our brains; reflecting our view of the world. This puts the vaxxer anti-vaxxer argument in a different perspective because no group will be dissuaded by facts when those facts are rejected by the little voice in our heads. It is not much of a reach to begin to see so many of our controversies, red and blue, GMO or not, human generated or not climate change as fueled by our belief and our absolute knowledge that the voice in our head wouldn’t lead us astray, would it?  

[1] Primarily moderate risk is based upon family history resorting in 17-30% lifetime risk, high is a similar group with genetic mutations, e.g. BRCA1 and 2

Source: Beliefs about Medications and Uptake of Preventative Therapy in Women at Increased Risk of Breast Cancer: Results from a Multicenter Prospective Study  Clinical Breast Cancer DOI: 10.1016/j.clbc.2018.10.008