The concept of truth, ‘that which is true or in accordance with fact or reality’ has never felt so at risk. With the endless flood of information, it is almost impossible to know what is ‘real’ and what has been generated to convince us of another reality. For those who work with children and their families knowing what is reliable, valid and ethical practice is critical.
Is this a New Problem?
While it is tempting to believe this is a recent challenge, there are examples from our own and related fields, which raise concern. Some of these have been shown to be deliberate attempts to defraud and mislead, others are approaches driven purely from ideological beliefs with no validity. There are also those which appear to be potentially interesting ideas that run out of control.
An example of the first is surgeon Andrew Wakefield who claimed the measles vaccine caused Crohn’s disease and was related to autism through a new inflammatory bowel disease. When challenged he devised invalid tests in a laboratory he owned. He investigated twelve children all of whom were referred through a support group for vaccine damaged children either through the patient or at Wakefield’s suggestion. His findings were published in ‘The Lancet’ and Wakefield successfully convinced both parents and the press of the damage caused by vaccination. By the time he was discredited the UK had vaccinations rates below that required for herd immunity.
Conversion therapy, which attempted to change a person’s sexual orientation was based on the now discredited belief that same-sex sexual orientations and transgender identities are developmental disorders, addictions or spiritual problems. Research clearly disproved its efficacy and identified significant mental health harm including increased suicide risks. Both legal and regulatory interventions have been introduced internationally to ban these practices.
A different but equally disturbing scenario is where an approach that is worth careful exploration and may have value is taken to unacceptable extremes. Psychosurgery is an example of this. Walter Freeman was an American neurologist who, with neurosurgeon, James Watts, became interested in the use of frontal leucotomy as a treatment for psychiatric disorders and developed their own model of psychiatric pathophysiology. Freeman also adapted the procedure, using an icepick-like instrument that was hammered through the roof of the orbit and into the brain. It was then swept across brain tissue to sever white matter tracts. While Watts withdrew from the work Freeman remained committed to the approach and an estimated 60,000 operations were conducted across the United States between 1936 and1956. Freeman himself conducted 4,000 of these despite ‘extensive adverse effects from insufficient anaesthetic care, sepsis, and poor perioperative management.’ It has been suggested that it was Freeman’s desire to prove himself that drove him, rather than care for patients.
A final, more light-hearted example is that of the cartoon character Popeye, who is famed for his strength, based on his consumption of spinach. It has been suggested that this belief can be attributed to a German chemist Erich von Wolf who in 1870 was measuring iron level in leafy vegetables and accidently put the decimal point in the wrong place.
What Can we Do to Safely Adopt New Ideas?
No-one would recommend eschewing all new ideas for fear that they could do harm. However, we need to remain critical and attentive to the possibility that approaches which seem miraculous or unlikely given previous knowledge may not be sound. Those who reference their work to earlier, well validated ideas, who can demonstrate their effectiveness in different contexts and can be effectively applied by different independent practitioners are more trustworthy. Finally, it’s always advisable to check the maths!
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