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Why Doctors Use Evidence but Managers (Mostly) Don’t · What's Your Problem?

0:15
Speaker 1: Pushkin. I'm Jacob Goldstein, and this is what's your problem.
0:33
Speaker 1: My guest today is Helen Pearson. She's a science journalist.
0:37
Speaker 1: She writes for the journal Nature, and she recently wrote
0:40
Speaker 1: a book called Beyond Belief, How Evidence Shows What Really works.
0:45
Speaker 1: Helen's problem is this, how do you get people to
0:48
Speaker 1: make important decisions based on high quality evidence rather than
0:52
Speaker 1: hunches or habits. To a large extent, the book is
0:56
Speaker 1: a history of what Helen calls the evidence revolution, and
1:00
Speaker 1: this is a remarkably recent revolution. In her telling, fifty
1:04
Speaker 1: years ago, she writes, doctors did not typically try to
1:08
Speaker 1: sort through through the high quality published studies to figure
1:12
Speaker 1: out what they should do. Instead, they often did whatever
1:15
Speaker 1: they'd been taught in medical school, or what the senior
1:18
Speaker 1: doctor in the room said to do, even if the
1:20
Speaker 1: evidence said otherwise. But a few doctors spent their careers
1:25
Speaker 1: trying to change that, sorting through all the evidence to
1:28
Speaker 1: figure out what worked best in different situations, and trying
1:31
Speaker 1: to get their fellow doctors to pay attention. In more
1:34
Speaker 1: recent decades, that spirit has started to spread to other fields,
1:37
Speaker 1: feels like management and crime prevention and education. Later in
1:41
Speaker 1: the conversation, Helen and I talk about some of those fields,
1:45
Speaker 1: places where the evidence is still often unclear, and where
1:48
Speaker 1: people often ignore the evidence even when it is clear.
1:52
Speaker 1: We also talk about how she uses evidence in her
1:54
Speaker 1: own life and about the prospects for the spread of
1:57
Speaker 1: evidence based decision making in the world. To start, we
2:01
Speaker 1: talk about one doctor who did a lot to get
2:03
Speaker 1: the evidence revolution going in medicine. His name was Ian Chalmers.
2:09
Speaker 2: Ian is really the reason I ended up writing the book.
2:13
Speaker 2: He was training to be a doctor in the kind
2:15
Speaker 2: of late nineteen sixties early nineteen seventies. He was working
2:18
Speaker 2: in obstetrics and gynecology in Wales at the time, and
2:22
Speaker 2: he noticed this sort of odd thing, which was that
2:24
Speaker 2: when doctors would hand out advice to women with the
2:27
Speaker 2: same condition, they would give different advice. So, you know,
2:29
Speaker 2: some doctors would think it was really important to have
2:31
Speaker 2: prenatal vitamins or not to drink during pregnancy, and other
2:35
Speaker 2: doctors would say no such thing. And this was kind
2:38
Speaker 2: of so extreme that Ian once told me that when
2:41
Speaker 2: he was woken in the night to treat a woman,
2:44
Speaker 2: the first thing he would say was what's wrong, and
2:46
Speaker 2: the second thing he would say was who's treating her?
2:48
Speaker 2: Because that was going to change. You know what he
2:50
Speaker 2: did next raight, So what generally happened was that everyone
2:55
Speaker 2: followed the advice of the most senior doctor in the room,
2:57
Speaker 2: which is sometimes now called eminence based medicine.
3:00
Speaker 1: Tell me about his work in Gaza and how that
3:05
Speaker 1: writer influenced him.
3:07
Speaker 2: Yeah, so that was another part of his train, which
3:10
Speaker 2: was also kind of influential in him realizing that a
3:12
Speaker 2: lot of what he'd been taught in medical school was wrong.
3:15
Speaker 2: So he worked on a refugee camp in Gaza during
3:19
Speaker 2: his medical training, and during that time he was treating
3:24
Speaker 2: children who had measles, and he had been taught in
3:28
Speaker 2: medical school that you shouldn't give antibiotics to a child
3:30
Speaker 2: with measles, even if they were becoming quite sick, because
3:34
Speaker 2: antibiotics treated bacterial infection, so why would you give it
3:37
Speaker 2: to a child with a viral infection. So he followed
3:40
Speaker 2: the advice he'd been taught, and he didn't give the antibiotics.
3:43
Speaker 2: But then later when he returned to the UK, he
3:47
Speaker 2: discovered that actually this advice he'd been given was tragically wrong,
3:50
Speaker 2: and that there were in fact about six control clinical
3:53
Speaker 2: trials that suggested it did help to give some children
3:57
Speaker 2: antibiotics prophylactically because they were developing a secondary bacterial infection
4:01
Speaker 2: along of the viral one.
4:03
Speaker 1: And in fact, as I understand it, like he concluded
4:06
Speaker 1: when he went back to the UK and studied the
4:08
Speaker 1: advice that children under his care had probably died or
4:12
Speaker 1: possibly died because he had done the wrong thing.
4:14
Speaker 3: That's exactly right.
4:16
Speaker 2: Yeah, So it's so a huge kind of you know,
4:18
Speaker 2: turning point for him of realizing that.
4:20
Speaker 1: So let me ask the native question, why had he
4:25
Speaker 1: been taught something that was not consistent with the evidence.
4:28
Speaker 2: Because that was that was standard practice in medical schools
4:33
Speaker 2: at the time. Most doctors weren't really being taught about
4:35
Speaker 2: clinical trials in the sixties and seventies.
4:38
Speaker 3: Hard though it is to believe.
4:39
Speaker 1: It is weird, right, it is hard to believe. I mean,
4:42
Speaker 1: I guess is part of it the sort of formal
4:44
Speaker 1: you know, randomized controlled trial. Well you have a placebo
4:48
Speaker 1: arm and a treatment arm, and that people running the
4:50
Speaker 1: trial don't know which is which. That was actually relatively
4:53
Speaker 1: new still.
4:54
Speaker 2: Right, exactly, Yes, So we feel like randomized trials have
4:57
Speaker 2: been around for ages, but they are relatively new. I
5:00
Speaker 2: mean around the time that you know that Ian was
5:02
Speaker 2: having the you know that this realization that he hadn't
5:04
Speaker 2: been taught about trials. They were really only then becoming commonplace.
5:09
Speaker 1: Oh so you have this sort of research changing and
5:14
Speaker 1: the practices of doctors are lagging. That is sort of
5:18
Speaker 1: the moment when Ian Chalmers walks onto the scene. And
5:21
Speaker 1: it's this moment when there is now research but doctors,
5:25
Speaker 1: weirdly to our sensibilities, are not paying attention to it.
5:29
Speaker 1: What does Chalmers do when he realizes this?
5:33
Speaker 2: So what he did was he became very passionate about
5:39
Speaker 2: randomized trials. Actually, and I discovered this with other people
5:43
Speaker 2: I spoke to, is that there's something about this method
5:45
Speaker 2: which is very captivating to people.
5:47
Speaker 1: It's so elegant, right, like intellectually, like the it's blinded,
5:51
Speaker 1: there's a placebo control. Like I recognize that they're imperfect,
5:55
Speaker 1: and people love to talk about the problems with them,
5:57
Speaker 1: but it's wildly elegant and not intuitive. Right People want
6:02
Speaker 1: to just like give something to somebody and see if
6:04
Speaker 1: they get better, and say it works if they get better,
6:06
Speaker 1: and like, for so many reasons, a randomized trial is
6:09
Speaker 1: so much better than that.
6:10
Speaker 2: And that argument goes on all the time today. I mean,
6:13
Speaker 2: that's what mostly happens in policy is we just introduce
6:16
Speaker 2: policies right without bothering to test whether they're effective and
6:19
Speaker 2: assuming they do good when some do harm. So that
6:21
Speaker 2: I don't think that's an old argument.
6:23
Speaker 1: We will get to policy. Yes. So this is this
6:26
Speaker 1: moment people are falling in love with randomized trials, and
6:28
Speaker 1: more importantly for our story, Ian Chalmers is realizing that
6:33
Speaker 1: this evidence is not making its way into medical practice.
6:36
Speaker 1: What does he do about that?
6:38
Speaker 2: So he decides to do this pioneering exercise where he
6:43
Speaker 2: is going to collect all of the controlled clinical trials.
6:47
Speaker 2: They weren't all randomized, but controlled trials which had been done,
6:50
Speaker 2: which had tested treatments in pregnancy and childbirth. Okay, and
6:55
Speaker 2: at the time, so this is in the eighties, I mean,
6:57
Speaker 2: that was an extraordinarily difficult thing to do because he
7:01
Speaker 2: couldn't just go online and you know, search up these trials.
7:04
Speaker 2: So he eventually ended up recruiting hundreds of people to
7:08
Speaker 2: sort of go to libraries and scour through the medical
7:11
Speaker 2: journals and really exhaustively try and track down these clinical trials.
7:15
Speaker 1: It's amazing that it's almost an archaeological exercise, right, like
7:19
Speaker 1: people have generated all this evidence not in ancient times,
7:23
Speaker 1: but in the last ten or twenty years, and it's
7:25
Speaker 1: already been sort of lost. Right. He is an obgyn, right,
7:28
Speaker 1: and he's having to have people will look for the
7:30
Speaker 1: research in his field exactly exactly.
7:33
Speaker 2: It's extraordinary and that is still a real difficult problem today,
7:36
Speaker 2: which I think is absolutely mind boggling, because a lot
7:39
Speaker 2: of research is published and yet people still struggle to
7:41
Speaker 2: find it on databases.
7:43
Speaker 1: So they're doing this archaeological expedition to look for recent research.
7:47
Speaker 1: And what happened.
7:49
Speaker 2: So it takes him about ten years, him and his
7:52
Speaker 2: many colleagues, and eventually he doesn't just get the evidence together.
7:57
Speaker 2: I think this is what's so interesting about it is
7:59
Speaker 2: he realizes that he needs to synthesize the evidence, and
8:04
Speaker 2: you know, not just to look at one trial at
8:06
Speaker 2: a time, because if you look at one trial, it
8:08
Speaker 2: risks being wrong, or you get a group of trials
8:11
Speaker 2: which may be conflicting, maybe some of them are poorly done,
8:14
Speaker 2: maybe it's just through chance that they point in different directions.
8:17
Speaker 2: And so he took this quite radical step of synthesizing
8:21
Speaker 2: the evidence using a method called a systematic review and
8:25
Speaker 2: ended up doing hundreds of systematic reviews to look at
8:28
Speaker 2: all of these different approaches in pregnancy and childbirth and
8:33
Speaker 2: eventually publishes all of this after ten years in these
8:35
Speaker 2: two massive books.
8:36
Speaker 3: Which I also have on my book case following me.
8:40
Speaker 2: So, they revealed that a lot of practices in pregnancy
8:44
Speaker 2: and childbirth were not based on evidence or were actually
8:47
Speaker 2: doing harm. So for example, even things like invasive episiotomies,
8:53
Speaker 2: which is a surgical incision which is supposed to give
8:56
Speaker 2: babies a bigger hole to get out, there wasn't really
8:59
Speaker 2: evidence to support these practices, and like shaving women's pubic
9:03
Speaker 2: care in labor. So countless women had been subjected to
9:06
Speaker 2: these really quite invasive and degrading practices because doctors assumed
9:10
Speaker 2: they were the right thing to do. And Ian's work
9:14
Speaker 2: by synthesizing evidence in this way helped bring an end
9:17
Speaker 2: to them. So he was sort of inspired by what
9:20
Speaker 2: he had done and thought, why can't we do this
9:23
Speaker 2: across all specialties of medicine, you know, synthesize the evidence
9:27
Speaker 2: in heart disease and diabetes, in cancer and so on,
9:29
Speaker 2: And that led to this group which he helped found.
9:33
Speaker 2: He was seminal in founding called the Cochrane Collaboration, and
9:36
Speaker 2: they set out and are still trying to do this
9:38
Speaker 2: today to synthesize evidence which shows which treatments are of
9:43
Speaker 2: help and do not harm across these different groups. And
9:46
Speaker 2: nowadays the word sort of like a Cochrane review if
9:49
Speaker 2: you're here that it's sort of like associated with doing
9:53
Speaker 2: the kind of highest standard, you know, gold standard type
9:56
Speaker 2: of review of evidence.
9:58
Speaker 1: And I would say a lot of it at least
10:01
Speaker 1: is just online, right, like you can go look if
10:04
Speaker 1: you're thinking of taking a supplement, say, you can just
10:08
Speaker 1: go look. And there are a lot of Cochrane reviews
10:12
Speaker 1: of whatever, magnesium for something something, and I find it useful.
10:18
Speaker 1: I mean quite often they say there's not enough evidence
10:21
Speaker 1: to say one way or the other. Right, that's typically
10:23
Speaker 1: with the kinds of things that I'm looking at, you know,
10:26
Speaker 1: over the counter things or whatever. There just isn't enough
10:29
Speaker 1: research to have a clear answer. And that is what
10:31
Speaker 1: they often say. It makes sense, Yes.
10:33
Speaker 3: It is often the conclusion.
10:34
Speaker 2: And I mean it's not just so Cochran reviews now
10:37
Speaker 2: are a tiny fraction of the number of systematic reviews
10:39
Speaker 2: in the world. So Cochran was really sort of seminal
10:41
Speaker 2: in sort of showing that this was a really good
10:44
Speaker 2: way to make sense of conflicting bodies of evidence. But
10:47
Speaker 2: now that you know, thousands are coming out every year,
10:50
Speaker 2: So in general, a systematic review is a better way
10:53
Speaker 2: to get an overview of what the evidence says than
10:55
Speaker 2: looking at just one study. Now, of course, it's it's
10:58
Speaker 2: not completely straightforward because like randomized trials, some systematic reviews
11:01
Speaker 2: aren't very good either, So that's a challenge too.
11:05
Speaker 1: Well, it's always something yes, well, I mean that's Cochrane
11:08
Speaker 1: is useful as a brand in that way, right, Like
11:11
Speaker 1: I trust their ability to assess the evidence, even if
11:15
Speaker 1: what they say is we don't know, Like we don't know.
11:17
Speaker 1: It's a very respectable answer as a general matter. What's
11:22
Speaker 1: a Charmer's like.
11:26
Speaker 2: Quite extraordinary actually just the most I don't think I've
11:31
Speaker 2: ever met anyone who is so extraordinarily modest about his
11:34
Speaker 2: accomplishments and downplays them so much, to the point where
11:37
Speaker 2: he denies sort of starting the cock con collaboration. I
11:40
Speaker 2: think he says something along the lines of he came
11:43
Speaker 2: up with the idea so and also very exacting and critical.
11:49
Speaker 2: I mean it was interesting when he retired or decided
11:52
Speaker 2: to step away. He didn't retire from Cockraney decided he
11:54
Speaker 2: wanted to move on. He actually set up a prize
11:56
Speaker 2: for the group that offered the most astute criticism of
11:59
Speaker 2: the cock Con collaboration.
12:00
Speaker 1: Oh that's really admirable.
12:02
Speaker 3: Yes, exactly.
12:03
Speaker 2: And they still have that attitude of kind of inviting
12:05
Speaker 2: criticism because of course that's exactly what you know, he
12:09
Speaker 2: and the group have done all these years is sort
12:10
Speaker 2: of speak truth to power. So they need to invite
12:13
Speaker 2: that criticism themselves.
12:15
Speaker 1: Who won the prize and what did they say?
12:19
Speaker 2: I don't know, it's one every years.
12:22
Speaker 1: Yeah, so I could imagine him having a pretty high
12:25
Speaker 1: tolerance for disagreeableness. Say right, I mean what he did
12:30
Speaker 1: was in a sort of cultural way in terms of
12:34
Speaker 1: the culture of physicians, the culture of medicine. I don't know,
12:39
Speaker 1: antagonistic is maybe too strong a word, but he said
12:42
Speaker 1: things that presumably lots of people didn't want to hear.
12:45
Speaker 1: He said, to doctors, you're doing it wrong, both in
12:47
Speaker 1: a specific way, you shouldn't be doing this particular intervention,
12:50
Speaker 1: and also in a general way, like he implicitly or
12:53
Speaker 1: explicitly was saying you're thinking about the practice of medicine wrong.
12:57
Speaker 2: That's right, that's exactly right. I discovered this as I
13:00
Speaker 2: sort of was reporting the book and kind of speaking
13:03
Speaker 2: to these people who were quite seminal in bringing evidence
13:07
Speaker 2: based practice into their fields. They often have this sort
13:09
Speaker 2: of rebellious streak to them and are kind of willing
13:12
Speaker 2: to speak truth to power, because yes, it does. I mean,
13:14
Speaker 2: you're basically saying to people, you know, ort to doctors,
13:17
Speaker 2: you've been doing it wrong all these years. And he
13:21
Speaker 2: himself said he thought he was able to do that
13:23
Speaker 2: because he was sort of he was a bit of
13:25
Speaker 2: an outsider actually, Like he worked in Oxford, but he
13:29
Speaker 2: wasn't sort of part of all the kind of you know,
13:31
Speaker 2: high for lutin academic circles. He was a bit on
13:35
Speaker 2: the outside and he felt that that allowed him to
13:37
Speaker 2: maybe do this speaking of truth to power, which maybe
13:42
Speaker 2: others what unable to do.
13:43
Speaker 1: So where's medicine today? To what extent is medicine today
13:47
Speaker 1: evidence based?
13:49
Speaker 2: Well more than it was then. I think I used
13:54
Speaker 2: a figure in my book of about sort of sixty
13:56
Speaker 2: percent of healthcare is probably evidence based or at least
14:02
Speaker 2: draws on evidence based clinical guidelines. So nowadays what happens
14:05
Speaker 2: is there are typically systematic reviews of clinical trials or
14:10
Speaker 2: are the evidence, and on the back of that, then
14:13
Speaker 2: professional groups prepare clinical guidelines and the clinical guidelines of
14:16
Speaker 2: what might be used in the clinic to help actually
14:18
Speaker 2: make a decision.
14:19
Speaker 1: Right, so, like the National Association of Cardiologists will have
14:23
Speaker 1: guidelines on whatever who should get statins or who should
14:26
Speaker 1: get what interventions exactly.
14:28
Speaker 2: And that, I mean, that's quite interesting because it means
14:30
Speaker 2: that the evidence is kind of baked into the processes,
14:33
Speaker 2: which which I find quite interesting. It's sort of made it.
14:36
Speaker 2: I mean, I won't say it's easy, but it is
14:37
Speaker 2: relatively easy for doctors now to use evidence because that's
14:40
Speaker 2: the expectation. Whereas I'm sure we'll get onto this, but
14:42
Speaker 2: you look at other fields and that's just not the case.
14:45
Speaker 2: But of course there are huge challenges, you know, lots
14:47
Speaker 2: of criticism still of evidence based medicine. Some people criticize,
14:51
Speaker 2: for example, you know, this sort of special place that
14:54
Speaker 2: the randomized control trial has and point out that randomized
14:57
Speaker 2: control trials can be wrong or poorly done. And then
15:00
Speaker 2: of course, you know, pushback in the world against evidence
15:03
Speaker 2: based practices. Anyway, and people wanting to go their own way. So,
15:07
Speaker 2: in no way is the kind of evidence revolution that
15:10
Speaker 2: I write about, you know, obviously done.
15:12
Speaker 3: It's evolving, it's new in some way.
15:16
Speaker 1: So if you say it's sixty percent evidence based for
15:18
Speaker 1: the other forty, I could imagine two things. Right Clearly,
15:22
Speaker 1: there are a lot of settings, Like medicine is complicated.
15:24
Speaker 1: People are complicated, the body is complicated, lots of sick
15:27
Speaker 1: people have lots of things wrong with them. So you
15:29
Speaker 1: can imagine lots of cases where there just isn't evidence,
15:32
Speaker 1: where it's just not clear what should I do for
15:33
Speaker 1: this patient right now? Well, there's lots of different conflicting
15:36
Speaker 1: things that I could do in their trade offs. The
15:38
Speaker 1: other piece is there is evidence and people just don't
15:42
Speaker 1: follow it. So like how much of each of those
15:45
Speaker 1: is there?
15:46
Speaker 2: Yeah, so I can't give you a percentage on each
15:47
Speaker 2: of those. But I mean, just to speak to the
15:49
Speaker 2: first one though, I mean, what's really interesting about evidence
15:52
Speaker 2: based medicine is that evidence alone doesn't tell you what
15:55
Speaker 2: to do. So evidence is one part of the decision
15:59
Speaker 2: making process, and I think that's a common misunderstanding actually
16:02
Speaker 2: around it is that like you look at the evidence
16:04
Speaker 2: and it will tell you, you know, whether you should take
16:05
Speaker 2: this drug. But that's not the case because what what
16:08
Speaker 2: a doctor or who whoever is you know, a doctor,
16:10
Speaker 2: hopefully impatient together are doing is saying, Okay, you know,
16:12
Speaker 2: this is the evidence on what treatments are effective. This
16:15
Speaker 2: is the clinical expertise of the doctor who absolutely you know,
16:18
Speaker 2: they've built up all this expertise over the years. We're
16:21
Speaker 2: not throwing that out the window. And then you as
16:23
Speaker 2: a patient have values and preferences which have to feed
16:26
Speaker 2: into this decision. Right, if you've decided this isn't a
16:29
Speaker 2: treatment path you want, then that has to be respected. So,
16:32
Speaker 2: but that's still evidence based.
16:33
Speaker 1: Medicine, and that's still in your sixty percent easy one. Yeah, yeah,
16:37
Speaker 1: Like tell me about the forty percent that's not evidence based.
16:39
Speaker 1: What is what's going on there?
16:41
Speaker 2: Well, in some places, evidence based medicine is less common
16:45
Speaker 2: or accepted, so people might choose traditional Chinese medicine, for example,
16:50
Speaker 2: So there may be other practices around medicine which people prefer.
16:54
Speaker 2: In some cases, You're absolutely right, the evidence isn't really
16:58
Speaker 2: there or it might be misapplied. So there's the kind
17:01
Speaker 2: of all the human factors that come into it where
17:04
Speaker 2: people may do choice or inadvertently not follow the evidence.
17:09
Speaker 3: Ice Pak.
17:13
Speaker 1: Will be back in just a minute. Okay, So let's
17:28
Speaker 1: talk about evidence outside of medicine. A big chunk of
17:31
Speaker 1: your book is that, And it does seem to some
17:35
Speaker 1: extent at least, that this evidence based revolution, as you
17:39
Speaker 1: call it, that Ian Chalmers helped us start, has directly
17:43
Speaker 1: influenced people in other fields. You know, and you write
17:47
Speaker 1: about economics and crime and management and parenting, and you know,
17:55
Speaker 1: I will say, like I covered economics for a long time,
17:58
Speaker 1: and in economics they've gotten better about evidence. It seems
18:01
Speaker 1: to me that in a lot of fields outside of medicine,
18:05
Speaker 1: it's just frustrating. It's just frustrating when you sort of
18:08
Speaker 1: try and study the evidence. It seems like there's often
18:10
Speaker 1: not good evidence. When there is, people don't follow the evidence.
18:13
Speaker 1: I mean, in a broad way, what's your assessment of
18:16
Speaker 1: how evidence as a way of looking at the world
18:19
Speaker 1: is doing outside of medicine.
18:21
Speaker 2: So I think it really depends which field you're looking
18:24
Speaker 2: in of how like I suppose I ended up thinking
18:28
Speaker 2: that each of these fields was, you know, weaving its
18:31
Speaker 2: own path through evidence, and some of them had directly
18:33
Speaker 2: looked at medicine and gone, yeah, we want to do
18:35
Speaker 2: that too. We should think our practices shouldn't be based
18:38
Speaker 2: on conventional wisdom an anecdote. And in others, like in
18:42
Speaker 2: economics example, there's kind of you know, evidences that the
18:45
Speaker 2: use of randomized trials has really swept through international development,
18:48
Speaker 2: through development economics. But yeah, I think I don't think
18:51
Speaker 2: any of them have advanced as far as medicine. And
18:54
Speaker 2: I think that that is partly because of the histories
19:00
Speaker 2: of the of these fields and the people who've been
19:03
Speaker 2: championing it, and the different barriers that it's faced.
19:05
Speaker 1: It seems harder in most other domains to do useful
19:12
Speaker 1: you know, studies that have real external validity where you
19:16
Speaker 1: can look at something in one place and say this
19:18
Speaker 1: same intervention is going to work in other places, Like
19:20
Speaker 1: the world is messy, is a fundamental problem with trying
19:24
Speaker 1: to generate evidence.
19:25
Speaker 2: Yeah, it makes things really really hard. So let's say
19:28
Speaker 2: you want to, I don't know, you know, test whether
19:31
Speaker 2: giving people incentives to have vaccines works. And I mean
19:35
Speaker 2: I talked about a trial in the book that was
19:37
Speaker 2: done where in India people were offered steel dinner plates
19:42
Speaker 2: and bags of lentils in order to incentivize parents to
19:45
Speaker 2: compliclents had their children vaccinated, and it seemed to be effective.
19:47
Speaker 2: Right now, you can't just lift and shift that and
19:50
Speaker 2: put it into you know, the UK. You know, you
19:52
Speaker 2: have to think about the different cultures and you know,
19:55
Speaker 2: the different ways incentives might work, and so on and
19:57
Speaker 2: so forth.
19:58
Speaker 1: I mean that particular example, like you do see conditional
20:01
Speaker 1: cash transfers in other countries where you know, if parents
20:04
Speaker 1: bring their children for vaccination and send them to school,
20:07
Speaker 1: then they get a monthly stipend from the government. Like
20:11
Speaker 1: those seem to work, Like those that one does seem
20:14
Speaker 1: to generalize at least.
20:15
Speaker 3: Some yes, it has. I mean that's built up.
20:18
Speaker 2: That's unusual really and having such a body of evidence
20:20
Speaker 2: to it, that's built up over time.
20:22
Speaker 1: Although it's funny like that one, I understand that we
20:24
Speaker 1: shouldn't rely on common sense is one of the themes
20:27
Speaker 1: of the book. But like, if you give people money
20:29
Speaker 1: to do something that is actually helpful to them, they
20:31
Speaker 1: will do it. Is basically what that finding says, and
20:35
Speaker 1: it's true.
20:36
Speaker 2: Right, but it took evidence to convince policymakers of that. Yeah, fair,
20:40
Speaker 2: So the counter argument, you know, You're absolutely right that
20:43
Speaker 2: this point about generalization is like a really big problem
20:46
Speaker 2: across all of these fields, right that what works in
20:48
Speaker 2: one place might not work in another. Now, some people
20:51
Speaker 2: would say, well why bother? You know, well why bother
20:53
Speaker 2: getting evidence at all? Like what's the point of testing it?
20:56
Speaker 2: But you generally, over time, you know, if something it
21:01
Speaker 2: might not work exactly the same. But if you start
21:03
Speaker 2: to build up a body of evidence that shows, yeah,
21:05
Speaker 2: actually this seems to like the conditional cash transfers have
21:08
Speaker 2: some effectiveness here and some effectiveness here, then you've come
21:11
Speaker 2: up with a robust policy that does seem worth pursuing.
21:15
Speaker 1: Tell me about evidence based policy making for like government policy,
21:19
Speaker 1: social policy, like what how has the sort of march
21:22
Speaker 1: of evidence been there?
21:25
Speaker 2: So I think in line I concluded in the end
21:29
Speaker 2: that there was a kind of what I call the
21:30
Speaker 2: evidence zeitgeist around the sort of nineteen nineties to maybe
21:34
Speaker 2: twenty ten, when a lot of these fields were turning
21:37
Speaker 2: to evidence. And I think it's because these ideas of
21:40
Speaker 2: evidence based medicine were percolating out and people were coming
21:43
Speaker 2: across them, and then you see this kind of emerge
21:45
Speaker 2: in the policy language. So you know, we had for example,
21:49
Speaker 2: Tony Blair and New Labor were talking about evidence based policy,
21:53
Speaker 2: or doing what works as it was called, in the
21:55
Speaker 2: nineteen nineties. Obama talked about it in his inauguration speech
22:00
Speaker 2: in two thousand and nine. So it sort of was
22:02
Speaker 2: filtering into policy, and you know, particular people became very
22:07
Speaker 2: enamored by it, I would say it sort of it
22:10
Speaker 2: succeeded in certain pockets, shall we say.
22:13
Speaker 1: And during that time people are championing it. Are you
22:17
Speaker 1: seeing policy changes based on evidence? Are they actually doing
22:21
Speaker 1: the thing they're talking about?
22:23
Speaker 2: In some cases there were yes. So that there was
22:26
Speaker 2: a series of what were called, for example, in the
22:28
Speaker 2: Obama in administration, a series of what were called tiered
22:31
Speaker 2: evidence initiatives which came in where in order for policy
22:35
Speaker 2: to progress, it was only allowed to, for example, have
22:38
Speaker 2: extra funding if it was able to produce evidence of effectiveness.
22:42
Speaker 1: Are there examples of things that got cut because they
22:44
Speaker 1: were sort of proven to not work? That's the real one,
22:48
Speaker 1: right Are you going to say, hey, this doesn't work,
22:50
Speaker 1: so we're going to stop doing it.
22:51
Speaker 2: That is much harder to find examples of, I would say, yeah, yeah.
22:55
Speaker 1: So what are examples of things that got funded because
22:58
Speaker 1: there was evidence that they were good.
23:00
Speaker 2: One example was the Nurse Family Partnership, which is a
23:03
Speaker 2: program where first time mothers are given a lot of
23:07
Speaker 2: support in the you know, the early time of pregnancy
23:10
Speaker 2: and in the first two years of life. And because
23:12
Speaker 2: there was a lot of evidence that this really was
23:15
Speaker 2: helpful towards child outcomes, that progressed and was awarded more
23:20
Speaker 2: government funding.
23:21
Speaker 1: And what's the status of that program now?
23:24
Speaker 3: Still going?
23:25
Speaker 1: I'm still going. I didn't expect that, I'll admit, in
23:28
Speaker 1: my jade at heart, I thought you were going to
23:30
Speaker 1: tell me it got killed. That's in the US. Yep, Okay,
23:35
Speaker 1: well that's good news. Tell me about you have a
23:40
Speaker 1: chapter about evidence based management. The evidence seems particularly weak
23:47
Speaker 1: in that domain.
23:48
Speaker 2: Frankly, I think some of the evidence is weak, and
23:52
Speaker 2: I think the culture of using evidence is very weak.
23:56
Speaker 2: So of the fields I looked at, I would say
23:58
Speaker 2: that that is the one where I felt evidence was
24:01
Speaker 2: struggling the most. I mean, there is a surprising amount
24:05
Speaker 2: of evidence on effective management practices, and a lot of
24:09
Speaker 2: people are kind of really sort of surprised to discover this.
24:11
Speaker 2: Like you can, you know, find doctors who are absolutely
24:14
Speaker 2: evidence based and everything they do, but they think that
24:16
Speaker 2: maybe management is some type of you know, magic or
24:19
Speaker 2: art or something. So yeah, there's evidence on you know,
24:23
Speaker 2: whether feedback works, or you know, whether the performance appraisals work,
24:27
Speaker 2: which by the way, they don't seem to be all
24:29
Speaker 2: that effective, but improving performance, which I found quite interesting.
24:32
Speaker 1: Yes, I'm overdue that the performance appraisal software keeps bothering
24:38
Speaker 1: me that I'm overdu So if you're telling me it's
24:40
Speaker 1: a waste of time, you're validating my behavior, and I'm
24:43
Speaker 1: happy to hear it. So what does work? Tell me?
24:46
Speaker 1: Like one management thing where there's like really clear evidence
24:50
Speaker 1: that is actually actionable to use a management word, that's like,
24:56
Speaker 1: here's a great thing, and you should do it if
24:58
Speaker 1: you're a manager.
24:59
Speaker 2: So goal setting is very effective and good good feedback,
25:04
Speaker 2: good feedback meaning fair feedback, feedback which is specific to people,
25:11
Speaker 2: you know, not generic feedback. So there does seem to
25:14
Speaker 2: be good evidence that those things are effective at improving
25:17
Speaker 2: performance fair enough.
25:19
Speaker 1: Why do I find that unsatisfying? Maybe because it seems obvious.
25:23
Speaker 2: Yes, it seems of no, but that's a really good point.
25:26
Speaker 2: So that to me is one of the things that
25:28
Speaker 2: holds back evidence based management because some of the principles
25:31
Speaker 2: which are supported by evidence feel obvious to people and
25:34
Speaker 2: they're not new, and what sales business book is exciting
25:38
Speaker 2: new ideas which aren't necessarily tested or proven to work,
25:43
Speaker 2: So there's financial incentive sort of working against evidence based management.
25:47
Speaker 3: In my view.
25:48
Speaker 1: You've been an editor and a writer on the sort
25:50
Speaker 1: of magazine side of the journal nature, right, And I
25:54
Speaker 1: was a newspaper reporter before. And I mean I was
25:57
Speaker 1: thinking about evidence in our profession, right. And I don't
26:01
Speaker 1: mean evidence in the sense of like you want to
26:03
Speaker 1: write about what's true, or you want to assess the
26:05
Speaker 1: evidence when you're writing about something. I mean evidence for
26:08
Speaker 1: the way one should write, or what kinds of stories
26:11
Speaker 1: we should do, or what headlines we should write. And
26:15
Speaker 1: in my career there has been none of that essentially.
26:17
Speaker 1: I mean, you had the Internet come along. I'm old
26:19
Speaker 1: enough that I remember when that was relatively new and people,
26:22
Speaker 1: you know, you had a dashboard and you started to see, oh,
26:25
Speaker 1: people are reading these kinds of stories and not reading
26:27
Speaker 1: those kinds of stories, and in a sort of quasi
26:29
Speaker 1: anecdotal way, you might shift course. But nobody wanted to
26:35
Speaker 1: use evidence. I mean, not only did people really not
26:37
Speaker 1: think that way, but to the extent they did, they
26:40
Speaker 1: didn't want to think that way, right, Like we like
26:42
Speaker 1: writing the kinds of stories we write. I learned some
26:44
Speaker 1: particular craft of podcasting that was, like one guy who
26:48
Speaker 1: was really good at making podcasts, we thought, told everybody
26:51
Speaker 1: how to do it, and we did it right, imminence
26:52
Speaker 1: based podcasting. And then all these other podcasts come along
26:56
Speaker 1: that are nothing like the rules that I learned and
26:59
Speaker 1: are wildly popular, and I'm like, oh, the rules that
27:01
Speaker 1: I learned were just what one guy made up and
27:03
Speaker 1: we all liked. But I haven't really changed much based
27:08
Speaker 1: on that. I mean, do you use evidence in your craft?
27:14
Speaker 3: That's such a good question.
27:16
Speaker 2: I mean, really, what you're talking about is using data
27:19
Speaker 2: right to inform what you do.
27:22
Speaker 1: I think, well, you could do a randomized control trial.
27:26
Speaker 1: I mean, certainly a B testing of health AB test
27:28
Speaker 1: is the thing people do, yes, exactly, but you could
27:31
Speaker 1: do You could do a randomized trial of different kinds
27:35
Speaker 1: of articles in nature if you want it right, you
27:37
Speaker 1: could random You could prospectively decide we're going to randomly
27:41
Speaker 1: assign somebody to do A or B or whatever. As
27:44
Speaker 1: far as I know, nobody's ever done that.
27:47
Speaker 3: That's a great point. Yep.
27:48
Speaker 2: Absolutely, yeah, Mostly people are chasing audiences.
27:52
Speaker 1: But even analyzing the best way to chase audiences, like
27:56
Speaker 1: why don't we do that?
27:57
Speaker 3: We should, let's do it.
28:00
Speaker 1: But do you mean that? I feel like I don't
28:02
Speaker 1: wanna at some level? Right, this is like part of
28:05
Speaker 1: the It's like I like doing my job the way
28:07
Speaker 1: I want to like. Yes, I also would like to
28:10
Speaker 1: have more listeners. And perhaps if I was better, you know,
28:12
Speaker 1: more analytical or more evidence based, I would have more listeners.
28:16
Speaker 1: But I don't know. I think there's something going on
28:18
Speaker 1: there that is interesting and that points to resistance to evidence.
28:22
Speaker 1: Like I think of myself as an analytical person. I
28:24
Speaker 1: think I follow evidence in healthcare, and yet in this
28:26
Speaker 1: thing I do all day every day, I sort of
28:28
Speaker 1: don't pay attention.
28:30
Speaker 2: Well, it depends what outcome you want, right, I mean,
28:32
Speaker 2: if your outcome is very clearly that you want to
28:34
Speaker 2: grow listeners, then you might be incentivized and to do
28:38
Speaker 2: that experiment. If you're happy with the outcome and no
28:40
Speaker 2: one's being harmed by which I don't think they are,
28:42
Speaker 2: if you continue to podcast in the way you do,
28:44
Speaker 2: or I tell stories in the way that I do.
28:46
Speaker 2: Then you know there has to be an incentive, I
28:49
Speaker 2: think to do the test.
28:51
Speaker 1: How did writing the book change the way you think
28:53
Speaker 1: about evidence?
28:56
Speaker 2: I think it changed the way I work as a
28:59
Speaker 2: journalist to some extent. I mean, obviously, I write features
29:03
Speaker 2: about complex bodies of evidence, so I find interesting questions
29:06
Speaker 2: and I want to go and look at what the
29:07
Speaker 2: evidence says about them. And I would say, what's changed
29:10
Speaker 2: about that is I am much more likely to now
29:13
Speaker 2: look for evidence synthesies, so for example, for systematic reviews
29:17
Speaker 2: when I'm diving into a new field, and I don't
29:19
Speaker 2: think I did that as much in the past, and
29:21
Speaker 2: I found that quite liberating, you know, because and of
29:24
Speaker 2: course evidence is just ballooning, I mean in terms of
29:26
Speaker 2: the amount of a search that's coming out. So that's
29:28
Speaker 2: been quite helpful.
29:30
Speaker 3: I mean.
29:30
Speaker 1: The classic bread and butter of science journalism is writing
29:33
Speaker 1: about a new study, right, But one lesson of what
29:35
Speaker 1: you're talking about is like, except in rare cases where
29:39
Speaker 1: the new study is like really giant or something, we
29:43
Speaker 1: should almost ignore new studies, Like we should add this
29:46
Speaker 1: one new study to this part of a thousand studies
29:49
Speaker 1: and see how much it, you know, adjusts the totality
29:52
Speaker 1: of the evidence, which is usually going to be not
29:54
Speaker 1: that much, right, Yes.
29:56
Speaker 2: I mean it's going to depend how big the body
29:57
Speaker 2: of evidence is that you're adding the study to.
29:59
Speaker 1: So you're right.
30:00
Speaker 2: If it's a brand new trial it's the first time
30:02
Speaker 2: it's tested a drug, totally we should write about that,
30:04
Speaker 2: reports on it. But if it's another trial, another study
30:07
Speaker 2: saying you know, wine is good for you, that's probably
30:11
Speaker 2: best to put to one time.
30:12
Speaker 1: Now.
30:12
Speaker 2: The reason, of course those stories still come out is
30:15
Speaker 2: because they get clicks on websites.
30:18
Speaker 3: But I'm with you.
30:19
Speaker 2: I mean I have definitely reached this point of thinking, yes,
30:22
Speaker 2: I need to look at the body of evidence as
30:23
Speaker 2: a whole.
30:24
Speaker 1: And what about outside of science, Like do you use
30:32
Speaker 1: Is there any part of your life where you use
30:34
Speaker 1: evidence now outside of work, outside of health where you
30:38
Speaker 1: didn't use it before?
30:40
Speaker 2: Well, probably I use it more in parenting. I mean,
30:44
Speaker 2: that's a really interesting case where I feel it's a
30:48
Speaker 2: bit like management in that there's just it's completely a
30:53
Speaker 2: wash with you know, fads and fashions and books and
30:56
Speaker 2: actually there is quite a lot of evidence around, you know,
30:59
Speaker 2: practices that can support child developments. Some of which is
31:02
Speaker 2: mirrored in standard parenting advice, but some of which might
31:04
Speaker 2: be slightly different, And I just think it gets lost
31:06
Speaker 2: in the kind of fire hose of information.
31:09
Speaker 1: That's a non obvious piece of parenting advice with robust
31:12
Speaker 1: evidence behind it.
31:13
Speaker 2: I don't know if it's not obvious, I would just
31:14
Speaker 2: say it's obviously a really live debate right around. I've
31:18
Speaker 2: looked specifically for nature. The evidence around is social media
31:23
Speaker 2: and screen news causing the rise in mental health problems
31:29
Speaker 2: for adolescents and young people. And that is a really
31:33
Speaker 2: complicated body of evidence, which I think people are interpreting
31:36
Speaker 2: in different ways. But I do think that this general
31:40
Speaker 2: sense that that's been shown that this is causative and
31:43
Speaker 2: it's a huge driver of adolescent mental health problems is
31:47
Speaker 2: an overreach based on the people that I've spoken to
31:50
Speaker 2: and having looked at the evidence myself.
31:53
Speaker 1: So are you saying screens and social media aren't as
31:56
Speaker 1: bad for teenagers as a lot of people think. Is
31:58
Speaker 1: that a fair reduction of what you said?
32:00
Speaker 3: Yeah?
32:01
Speaker 1: Yeah, yeah, good news, good news.
32:03
Speaker 2: Can I go back to your point, because you asked
32:05
Speaker 2: me how it's changed, how I are you know, personal decisions.
32:08
Speaker 1: You elect your kids stay the phones more than you
32:10
Speaker 1: did before.
32:12
Speaker 2: To some extent, yeah, I mean it just made me
32:14
Speaker 2: relax a little bit about it, because you know, we're
32:17
Speaker 2: really seeking these concrete answers, aren't we. Or what I
32:20
Speaker 2: would have loved the evidence to say was like, you know,
32:23
Speaker 2: two hours and that's it, right, But it doesn't. It
32:26
Speaker 2: doesn't provide you with simple answers. Evidence generally doesn't. But
32:29
Speaker 2: sometimes I think that that can be quite empowering itself,
32:33
Speaker 2: you know, as a parent, to go, Okay, well, I
32:34
Speaker 2: have looked at the evidence and it doesn't give me
32:36
Speaker 2: the crisp answers I would really love to have about
32:38
Speaker 2: what to do. But I understand that, and now I
32:41
Speaker 2: feel empowered to perhaps make decisions on my own based
32:45
Speaker 2: on my common sense and weighing up the things which
32:47
Speaker 2: are important to me and my family.
32:50
Speaker 1: What's the future of evidence as a as an idea
32:53
Speaker 1: evidence in the world, Like, do you feel like we're
32:56
Speaker 1: in this moment when there's a sort of evidence backlash.
32:59
Speaker 2: To some extent, I literally published a big piece last
33:02
Speaker 2: week for Nature about trust in science because I wanted
33:05
Speaker 2: to look at this kind of They're like, there's a
33:06
Speaker 2: sort of sense in the air that there's this like
33:10
Speaker 2: big crisis of trust in science. People have lost trust
33:12
Speaker 2: in science, and I wanted to kind of scrutinize that claim,
33:15
Speaker 2: So I went off and looked at kind of data,
33:16
Speaker 2: and I've spoken to lots of people, and I would
33:18
Speaker 2: say the big picture, given that surveys are imperfect, but
33:22
Speaker 2: from lots of surveys, is that generally, you know, globally,
33:26
Speaker 2: trust in science is quite high. People generally trust science,
33:30
Speaker 2: and scientists as a profession is one of the most
33:32
Speaker 2: trusted professions. Like it's up there with like doctors and teachers,
33:35
Speaker 2: you know, and you've got journalists like me and politicians
33:38
Speaker 2: who go down the bottom of the list. So the
33:41
Speaker 2: global picture is kind of like glassharlf full. Everything looks fine,
33:44
Speaker 2: but then obviously they yes, they were a big problems.
33:46
Speaker 2: So in the US, trust in science has gone down
33:50
Speaker 2: in the last few years, and there's a specifically a
33:53
Speaker 2: political polarization going on around trust in science in the US,
33:57
Speaker 2: with it falling amongst Republican leaning people but remaining high
34:01
Speaker 2: amongst Democrats, and people feel concerned that the Trump administration
34:06
Speaker 2: is kind of capitalizing on this idea of distrust of
34:10
Speaker 2: science to now attack scientific institutions. So I don't want
34:13
Speaker 2: to give the impression that I came away from this
34:15
Speaker 2: exercise thinking everything's rosy with trust in science.
34:18
Speaker 3: Because that's not the case.
34:19
Speaker 2: This big global trust in Science survey I looked at
34:22
Speaker 2: in some countries lower trust in science was associated with
34:26
Speaker 2: being right leaning, but in others it was associated with
34:28
Speaker 2: being left leaning. So it really kind of depends on
34:31
Speaker 2: the country.
34:32
Speaker 1: What's the future of evidence?
34:34
Speaker 2: I think in some ways, you know, looking at the
34:37
Speaker 2: evidence revolution, like going back to where we started, it's
34:40
Speaker 2: quite recent, you know. I mean, evidence based medicine as
34:43
Speaker 2: a term was only introduced in nineteen ninety one, thirty
34:46
Speaker 2: five years ago. So if you want to have the
34:48
Speaker 2: optimistic view, which maybe I do, you know, you could
34:51
Speaker 2: say that the current kind of setbacks are that there's
34:54
Speaker 2: always been opposition to evidence, and what's happening now is
34:58
Speaker 2: just another setback in the kind of longer march towards rationality,
35:02
Speaker 2: which is going to take decades. So I suppose, yeah,
35:05
Speaker 2: I do come out hoping that's the case. It feels
35:07
Speaker 2: a little hard for me to believe that we're going
35:10
Speaker 2: to get to a point where we reject all of
35:13
Speaker 2: this knowledge we've created in the world and choose not
35:15
Speaker 2: to use that at all in decisions.
35:18
Speaker 3: I hope that we don't get to that point.
35:24
Speaker 1: We'll be back in a minute with the lightning round.
35:37
Speaker 1: Let's finish with the lightning round if you would. Okay,
35:42
Speaker 1: what's a piece of really solid evidence that you ignore?
35:46
Speaker 3: Oh?
35:48
Speaker 2: I think I try not to think too hard about
35:52
Speaker 2: the evidence on alcohol, even though I've written a whole
35:58
Speaker 2: piece about it, because I know having reported on it,
36:03
Speaker 2: and I literally like calculated it all out and looked
36:05
Speaker 2: at my own drinking and I thought, hmm, I probably
36:08
Speaker 2: should less, and I find it difficult to do that.
36:11
Speaker 2: I'm not saying I drink to excess. I'm just saying
36:13
Speaker 2: it probably should be less than it is.
36:14
Speaker 1: Well, the old like one glass of wine a day
36:17
Speaker 1: is actually good for you. The evidence seems to have
36:20
Speaker 1: shifted on that on that claim. Correct.
36:23
Speaker 2: Yes, in general, most people could benefit by cutting back,
36:26
Speaker 2: and the risks go up from a really low level.
36:29
Speaker 1: Yeah, And was the problem with that evidence confounding that
36:33
Speaker 1: the people who drink one glass of wine a day
36:35
Speaker 1: tend to be have really healthy lives. They're like very
36:38
Speaker 1: moderate people. They don't do anything in excess and that's
36:41
Speaker 1: why it looked like that was good for you.
36:43
Speaker 2: Partly, yes, confounding is really hard to ship out at
36:46
Speaker 2: those studies, and also, of course the other ways that
36:48
Speaker 2: heavy drinkers also tend to be smokers and do all
36:50
Speaker 2: the other unhealthy behaviors, So it is.
36:52
Speaker 3: It is a difficult relationship to tease out.
36:57
Speaker 1: So you previously wrote a book about these longitudinal studies
37:01
Speaker 1: right where researchers, as I understand it, followed a group
37:05
Speaker 1: of people for their entire lives extremely interesting. What were
37:10
Speaker 1: some of the things they learned from those studies?
37:13
Speaker 2: The big message from all of the studies, I mean,
37:14
Speaker 2: I set off to write this book that I thought
37:16
Speaker 2: was going to be about these fascinating sort of about
37:19
Speaker 2: science somehow, and I sort of ended up writing this
37:22
Speaker 2: book about inequality, which I didn't really realize till i'd
37:25
Speaker 2: published it, because really the big message was that children
37:28
Speaker 2: who were born into difficult circumstances tend to follow on average,
37:32
Speaker 2: tend to follow more difficult life paths, so they ended
37:35
Speaker 2: up in poorer health, less wealth, in less good jobs.
37:39
Speaker 2: And maybe that sounds really obvious, but the sad thing
37:41
Speaker 2: is that that's kind of been repeated generation after generation
37:44
Speaker 2: and it's still being repeated today.
37:46
Speaker 1: Huh, So mobility didn't significantly increase over time.
37:52
Speaker 2: Not no, I mean there has been some changes, But
37:56
Speaker 2: that point about your early circumstances having this profound influence
38:00
Speaker 2: on the rest of your life that remains true.
38:04
Speaker 1: Tell me about beer glasses in British pubs.
38:11
Speaker 3: I love this story.
38:13
Speaker 2: This is one of my favorite randomized trials that I
38:15
Speaker 2: came across when I was writing the book. So this
38:18
Speaker 2: is a story about a highly unlikely trial that was
38:23
Speaker 2: done by a researcher called Jonathan Shepherd, who is still
38:28
Speaker 2: actually a facial surgeon, and he noticed that a lot
38:31
Speaker 2: of the people that he was treating with terrible injuries
38:34
Speaker 2: had come from glass. Often these awful incidents where people
38:37
Speaker 2: were glassings, where two people in a pub get angry
38:40
Speaker 2: and somebody decides to shove what's in their hand, which
38:44
Speaker 2: is like their pint glass, into somebody else's face, and
38:46
Speaker 2: so they have these awful lacerations and life altering injuries.
38:50
Speaker 2: And so he started thinking, well, what if we had
38:53
Speaker 2: stronger beer glasses and maybe that would lead to less
38:56
Speaker 2: glass injuries.
38:58
Speaker 1: Just to be clear, why is it better if if
39:00
Speaker 1: that pub, if that glass that they're shoving into somebody's
39:03
Speaker 1: face is tougher, it's less likely to shutter to shadow.
39:07
Speaker 2: So basically you might have been part of this unusual
39:09
Speaker 2: randomized trial of beer glasses if you bought a pint
39:12
Speaker 2: in a selection of pubs in the UK and Wales
39:16
Speaker 2: around nineteen ninety eight. Because he got a selection of
39:19
Speaker 2: pubs and bars to randomly, some of them were signed
39:24
Speaker 2: to install toughened glasses and the rest carried on with
39:28
Speaker 2: their normal glasses and managed to show it was a
39:31
Speaker 2: bit of a complicated trail, but he managed to show
39:33
Speaker 2: that indeed, having tougher glass reduced the number of glass injuries,
39:37
Speaker 2: and this helped lead to momentum which encouraged the pub
39:40
Speaker 2: industry to switch to toughened glass in the UK, leading
39:44
Speaker 2: to or least associated with a drop in a glass injuries.
39:49
Speaker 1: Of like tens of thousands a year or something extraordinary
39:53
Speaker 1: big number.
39:53
Speaker 3: Yeah, yeah, amazing.
39:55
Speaker 1: Somebody gave you, say, one hundred million dollars to fund
39:59
Speaker 1: a study, any study you want. What would you do?
40:04
Speaker 3: Wow?
40:06
Speaker 2: Oh my god, Okay, that's that's I'm trying to think
40:10
Speaker 2: of the question that I most want an answer to
40:12
Speaker 2: for which there is no evidence. It has to be
40:14
Speaker 2: something around parenting. I mean, okay, I'll give you an answer,
40:19
Speaker 2: but I think it's a bit of a cheat because
40:23
Speaker 2: it's sort of happening, which is around these social media
40:27
Speaker 2: bans which are going on at the moment. I mean,
40:29
Speaker 2: the UK is just introducing a policy to ban all
40:32
Speaker 2: teenagers from social media, and it's already happened in Australia.
40:35
Speaker 2: So I think the key, the key question, which evidence
40:38
Speaker 2: curious people like me have and lots of researchers have,
40:41
Speaker 2: is what's the effect. So I think a careful study
40:44
Speaker 2: to understand the impact of those changes is really important.
40:49
Speaker 1: It was great to speak with you, and I appreciate
40:53
Speaker 1: your work.
40:53
Speaker 3: Thank you, Thank you very much.
40:55
Speaker 2: No, thanks very much for your questions and thanks for
40:56
Speaker 2: having me on the show.
41:04
Speaker 1: Helen Pearson is the author of the book Beyond Belief.
41:07
Speaker 1: Please email us at problem at pushkin dot fm. Tell
41:11
Speaker 1: us what kinds of shows we should do more of
41:13
Speaker 1: or less of our particular people you think would be
41:15
Speaker 1: good on the show. You can also find me on
41:17
Speaker 1: x and on LinkedIn. Our show is produced by Gabriel
41:20
Speaker 1: Hunter Chang and Trina Menino. Our editor is Lydia Jean
41:24
Speaker 1: Kott and our engineer is Sarah Bruguier. I'm Jacob Goldstein
41:27
Speaker 1: and we'll be back next week with another episode of
41:29
Speaker 1: What's Your b