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This, then, is the problem: how do we know that what we are being told is reliable and factual? The first step is to exclude the phoneys, the Flat Earth Society proponents and those who claim that meditation, wearing blue beads or standing on your head for half an hour each day or similar will cure cancer. Their ideas are so ludicrous that they can be readily spotted. It is a failing of our society, with all its laws to protect the consumer, that we allow such charlatans to prey upon the desperate plight of sick or ignorant people.

More plausible are the self-promoting experts who try to scare us with stories of impending doom. They talk in meaningless slogans such as ‘freeing your spiritual self’ (from what? one asks); ‘the flooding of Leningrad and London’ (there was little evidence of a rise in the sea level, in the vulnerable Seychelles, in the five years up to 2003); ‘concreting over the countryside’ (looking down on the British countryside from an aeroplane at a few thousand feet, you cannot even spot the motorways); Frankenstein foods (GM food has been on sale in many countries for years and no ill effect has been reported); ‘epidemic of obesity’ (since when has fatness been a contagious disease?); and so on. The ideas behind their slogans are scientifically improbable, but refuting them with absolute certainty is virtually impossible.

So, when an interviewer asks a scientist, ‘Can you rule out the possibility that London may be flooded in the future?’, to which of course the scientist cannot categorically answer no, it results in the headline: ‘SCIENTIST CONFIRMS LONDON MAY FLOOD’.

Having eliminated the pedlars of the irrational, one is left with the advocates of the plausible. Unless one is particularly well informed, one has to rely on the advice of an expert as to what is likely to be fact and what is opinion. The problem then becomes, who is an expert?

We tend to look to the universities for scholarly advice. By and large the older, major universities are more demanding in the qualifications of their academic staff than the newer ones, and the older mainstream areas of study have a more predictable level of scientific attainment. Experts from universities with a well-established reputation for research are likely to be more reliable, but may also be more reluctant to accept valid but novel or iconoclastic ideas. Few of us can check the curriculum vitae or the source of information used by everyone claiming to be an expert, but in certain circumstances credibility can be inferred from the publication in which it appeared. Table 1 indicates a progression of reliability of the information in peer-reviewed journals to statements by propagandists and pressure groups.

TABLE 1

Medicine is a more rigorous course of study than that of nursing or one of the allied therapies. It is reasonable, therefore, to believe that the opinion of a medical doctor is more likely to be credible than that of a therapist. Like all broad generalisations, this is subject to notable exceptions. There is no essential course of study that qualifies one to be called a ‘health expert’, or to call oneself a ‘noninterventionist surgeon’. It is not necessary to study human physiology to become ‘an expert’ on nutrition or food (indeed a former chairman of the Food Standards Agency was a zoologist), whereas there is an essential core course of scientific study in order to become a doctor. Academic doctors are not necessarily more expert than practising ones, but because of the nature of their work they are more likely to question an opinion and to be more demanding in the standard of evidence before they will accept a statement as true.

Life would be much simpler and safer if we could immediately recognise an expert and rely upon his or her views as being authoritative. This was the concept behind the Lord Chief Justice’s plea for arbitration panels to appoint a single expert witness whose opinion would be accepted by all in the civil courts. This would work if all expert opinions were based on agreed fact. Unfortunately, when it comes to interpreting the meaning of the facts it becomes a matter of individual, fallible opinion, or judgement. As a result, this worthy notion has had a limited impact, and we still have gladiatorial contests in all criminal cases and some civil ones between the opposing opinions of experts, a battle for the most believable – or the most glib.

So, how can we assess the views with which we are bombarded? We have to start by separating fact from opinion, then assess the reasonableness of interpretation of the evidence against scientific probability. Fact is something that is proven, can be reproduced and is consistent with other facts; opinion relies on a belief by the person making the proposition rather than proof of the proposal. We should ignore presentational gimmicks and slogans, and look for the core message. We have to assess the credibility and bias of the messenger along with his message. This is the concept behind the current philosophy of evidence-based medicine, or EBM. This is based on evaluation of the sources of information and has much to recommend it. Unfortunately, it perpetuates the Myth that it is possible to argue from the general to the particular rather than the other way round and could, if misapplied, lead to the practice of healthcare by protocol rather than the application of knowledge and judgement. Because a particular treatment is successful in the majority of patients, it does not necessarily imply that it is the best course of action in all patients.

In the preparation of this book, we have asked the authors to present what is known or is generally accepted as factual and what they consider probable and to separate it from that which is improbable or irrational. Scientists are aware that many of the commonly accepted beliefs in healthcare are based on the misconceptions that need to be exposed to scientific scrutiny. For this purpose we have asked our panel of experts, to write ‘that which they know’.

At the end of the day, we must remember that, in the world of healthcare, things are getting better. The fact that we are living longer, healthier lives suggests that there cannot be anything terribly wrong with the air we breathe, the food we eat or the way we live. We must remember this in spite of the blandishments, threats, warnings and various campaigns by governments to make us eat this diet or that, to forgo a familiar habit or to exercise ourselves until we drop. It is a sobering thought, first expressed by John Locke in 1689 in his treatise A Letter Concerning Toleration: ‘No man can be forced to be healthful, whether he will or no.’ In a free society, individuals must judge for themselves what information they choose to heed and what they ignore. Whether they should be made to feel guilty for ignoring the evidence is a matter for debate.