August 6, 2026 • 41 mins
Helen Pearson is the author of the book “Beyond Belief: How Evidence Shows What Really Works.” Helen's problem is this: How do you get people to make important decisions based on high-quality evidence, instead of on hunches or habits?
In this episode, Helen explains:
- How a doctor's fatal mistake sparked the evidence-based medicine movement
- Why management is so resistant to evidence-based practices
- How systematic reviews changed the way she works as a science journalist
- Why global trust in science remains high – outside the US
- What a randomized trial of pint glasses revealed about preventing violent injuries.
Check out Helen’s book here.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Pushkin. I'm Jacob Goldstein, and this is what's your problem.
My guest today is Helen Pearson. She's a science journalist.
(00:37):
She writes for the journal Nature, and she recently wrote
a book called Beyond Belief, How Evidence Shows What Really works.
Helen's problem is this, how do you get people to
make important decisions based on high quality evidence rather than
hunches or habits. To a large extent, the book is
a history of what Helen calls the evidence revolution, and
(01:00):
this is a remarkably recent revolution. In her telling, fifty
years ago, she writes, doctors did not typically try to
sort through through the high quality published studies to figure
out what they should do. Instead, they often did whatever
they'd been taught in medical school, or what the senior
doctor in the room said to do, even if the
(01:20):
evidence said otherwise. But a few doctors spent their careers
trying to change that, sorting through all the evidence to
figure out what worked best in different situations, and trying
to get their fellow doctors to pay attention. In more
recent decades, that spirit has started to spread to other fields,
feels like management and crime prevention and education. Later in
(01:41):
the conversation, Helen and I talk about some of those fields,
places where the evidence is still often unclear, and where
people often ignore the evidence even when it is clear.
We also talk about how she uses evidence in her
own life and about the prospects for the spread of
evidence based decision making in the world. To start, we
talk about one doctor who did a lot to get
(02:03):
the evidence revolution going in medicine. His name was Ian Chalmers.
Speaker 2 (02:09):
Ian is really the reason I ended up writing the book.
He was training to be a doctor in the kind
of late nineteen sixties early nineteen seventies. He was working
in obstetrics and gynecology in Wales at the time, and
he noticed this sort of odd thing, which was that
when doctors would hand out advice to women with the
same condition, they would give different advice. So, you know,
(02:29):
some doctors would think it was really important to have
prenatal vitamins or not to drink during pregnancy, and other
doctors would say no such thing. And this was kind
of so extreme that Ian once told me that when
he was woken in the night to treat a woman,
the first thing he would say was what's wrong, and
the second thing he would say was who's treating her?
Because that was going to change. You know what he
(02:50):
did next raight, So what generally happened was that everyone
followed the advice of the most senior doctor in the room,
which is sometimes now called eminence based medicine.
Speaker 1 (03:00):
Tell me about his work in Gaza and how that
writer influenced him.
Speaker 2 (03:07):
Yeah, so that was another part of his train, which
was also kind of influential in him realizing that a
lot of what he'd been taught in medical school was wrong.
So he worked on a refugee camp in Gaza during
his medical training, and during that time he was treating
children who had measles, and he had been taught in
(03:28):
medical school that you shouldn't give antibiotics to a child
with measles, even if they were becoming quite sick, because
antibiotics treated bacterial infection, so why would you give it
to a child with a viral infection. So he followed
the advice he'd been taught, and he didn't give the antibiotics.
But then later when he returned to the UK, he
discovered that actually this advice he'd been given was tragically wrong,
(03:50):
and that there were in fact about six control clinical
trials that suggested it did help to give some children
antibiotics prophylactically because they were developing a secondary bacterial infection
along of the viral one.
Speaker 1 (04:03):
And in fact, as I understand it, like he concluded
when he went back to the UK and studied the
advice that children under his care had probably died or
possibly died because he had done the wrong thing.
Speaker 3 (04:14):
That's exactly right.
Speaker 2 (04:16):
Yeah, So it's so a huge kind of you know,
turning point for him of realizing that.
Speaker 1 (04:20):
So let me ask the native question, why had he
been taught something that was not consistent with the evidence.
Speaker 2 (04:28):
Because that was that was standard practice in medical schools
at the time. Most doctors weren't really being taught about
clinical trials in the sixties and seventies.
Speaker 3 (04:38):
Hard though it is to believe.
Speaker 1 (04:39):
It is weird, right, it is hard to believe. I mean,
I guess is part of it the sort of formal
you know, randomized controlled trial. Well you have a placebo
arm and a treatment arm, and that people running the
trial don't know which is which. That was actually relatively
new still.
Speaker 2 (04:54):
Right, exactly, Yes, So we feel like randomized trials have
been around for ages, but they are relatively new. I
mean around the time that you know that Ian was
having the you know that this realization that he hadn't
been taught about trials. They were really only then becoming commonplace.
Speaker 1 (05:09):
Oh so you have this sort of research changing and
the practices of doctors are lagging. That is sort of
the moment when Ian Chalmers walks onto the scene. And
it's this moment when there is now research but doctors,
weirdly to our sensibilities, are not paying attention to it.
(05:29):
What does Chalmers do when he realizes this?
Speaker 2 (05:33):
So what he did was he became very passionate about
randomized trials. Actually, and I discovered this with other people
I spoke to, is that there's something about this method
which is very captivating to people.
Speaker 1 (05:47):
It's so elegant, right, like intellectually, like the it's blinded,
there's a placebo control. Like I recognize that they're imperfect,
and people love to talk about the problems with them,
but it's wildly elegant and not intuitive. Right People want
to just like give something to somebody and see if
they get better, and say it works if they get better,
and like, for so many reasons, a randomized trial is
(06:09):
so much better than that.
Speaker 2 (06:10):
And that argument goes on all the time today. I mean,
that's what mostly happens in policy is we just introduce
policies right without bothering to test whether they're effective and
assuming they do good when some do harm. So that
I don't think that's an old argument.
Speaker 1 (06:23):
We will get to policy. Yes. So this is this
moment people are falling in love with randomized trials, and
more importantly for our story, Ian Chalmers is realizing that
this evidence is not making its way into medical practice.
What does he do about that?
Speaker 2 (06:38):
So he decides to do this pioneering exercise where he
is going to collect all of the controlled clinical trials.
They weren't all randomized, but controlled trials which had been done,
which had tested treatments in pregnancy and childbirth. Okay, and
at the time, so this is in the eighties, I mean,
that was an extraordinarily difficult thing to do because he
(07:01):
couldn't just go online and you know, search up these trials.
So he eventually ended up recruiting hundreds of people to
sort of go to libraries and scour through the medical
journals and really exhaustively try and track down these clinical trials.
Speaker 1 (07:15):
It's amazing that it's almost an archaeological exercise, right, like
people have generated all this evidence not in ancient times,
but in the last ten or twenty years, and it's
already been sort of lost. Right. He is an obgyn, right,
and he's having to have people will look for the
research in his field exactly exactly.
Speaker 2 (07:33):
It's extraordinary and that is still a real difficult problem today,
which I think is absolutely mind boggling, because a lot
of research is published and yet people still struggle to
find it on databases.
Speaker 1 (07:43):
So they're doing this archaeological expedition to look for recent research.
And what happened.
Speaker 2 (07:49):
So it takes him about ten years, him and his
many colleagues, and eventually he doesn't just get the evidence together.
I think this is what's so interesting about it is
he realizes that he needs to synthesize the evidence, and
you know, not just to look at one trial at
a time, because if you look at one trial, it
risks being wrong, or you get a group of trials
(08:11):
which may be conflicting, maybe some of them are poorly done,
maybe it's just through chance that they point in different directions.
And so he took this quite radical step of synthesizing
the evidence using a method called a systematic review and
ended up doing hundreds of systematic reviews to look at
all of these different approaches in pregnancy and childbirth and
(08:33):
eventually publishes all of this after ten years in these
two massive books.
Speaker 3 (08:36):
Which I also have on my book case following me.
Speaker 2 (08:40):
So, they revealed that a lot of practices in pregnancy
and childbirth were not based on evidence or were actually
doing harm. So for example, even things like invasive episiotomies,
which is a surgical incision which is supposed to give
babies a bigger hole to get out, there wasn't really
evidence to support these practices, and like shaving women's pubic
(09:03):
care in labor. So countless women had been subjected to
these really quite invasive and degrading practices because doctors assumed
they were the right thing to do. And Ian's work
by synthesizing evidence in this way helped bring an end
to them. So he was sort of inspired by what
he had done and thought, why can't we do this
across all specialties of medicine, you know, synthesize the evidence
(09:27):
in heart disease and diabetes, in cancer and so on,
And that led to this group which he helped found.
He was seminal in founding called the Cochrane Collaboration, and
they set out and are still trying to do this
today to synthesize evidence which shows which treatments are of
help and do not harm across these different groups. And
nowadays the word sort of like a Cochrane review if
(09:49):
you're here that it's sort of like associated with doing
the kind of highest standard, you know, gold standard type
of review of evidence.
Speaker 1 (09:58):
And I would say a lot of it at least
is just online, right, like you can go look if
you're thinking of taking a supplement, say, you can just
go look. And there are a lot of Cochrane reviews
of whatever, magnesium for something something, and I find it useful.
I mean quite often they say there's not enough evidence
(10:21):
to say one way or the other. Right, that's typically
with the kinds of things that I'm looking at, you know,
over the counter things or whatever. There just isn't enough
research to have a clear answer. And that is what
they often say. It makes sense, Yes.
Speaker 3 (10:33):
It is often the conclusion.
Speaker 2 (10:34):
And I mean it's not just so Cochran reviews now
are a tiny fraction of the number of systematic reviews
in the world. So Cochran was really sort of seminal
in sort of showing that this was a really good
way to make sense of conflicting bodies of evidence. But
now that you know, thousands are coming out every year,
So in general, a systematic review is a better way
to get an overview of what the evidence says than
(10:55):
looking at just one study. Now, of course, it's it's
not completely straightforward because like randomized trials, some systematic reviews
aren't very good either, So that's a challenge too.
Speaker 1 (11:05):
Well, it's always something yes, well, I mean that's Cochrane
is useful as a brand in that way, right, Like
I trust their ability to assess the evidence, even if
what they say is we don't know, Like we don't know.
It's a very respectable answer as a general matter. What's
a Charmer's like.
Speaker 2 (11:26):
Quite extraordinary actually just the most I don't think I've
ever met anyone who is so extraordinarily modest about his
accomplishments and downplays them so much, to the point where
he denies sort of starting the cock con collaboration. I
think he says something along the lines of he came
up with the idea so and also very exacting and critical.
(11:49):
I mean it was interesting when he retired or decided
to step away. He didn't retire from Cockraney decided he
wanted to move on. He actually set up a prize
for the group that offered the most astute criticism of
the cock Con collaboration.
Speaker 1 (12:00):
Oh that's really admirable.
Speaker 3 (12:02):
Yes, exactly.
Speaker 2 (12:03):
And they still have that attitude of kind of inviting
criticism because of course that's exactly what you know, he
and the group have done all these years is sort
of speak truth to power. So they need to invite
that criticism themselves.
Speaker 1 (12:15):
Who won the prize and what did they say?
Speaker 2 (12:19):
I don't know, it's one every years.
Speaker 1 (12:22):
Yeah, so I could imagine him having a pretty high
tolerance for disagreeableness. Say right, I mean what he did
was in a sort of cultural way in terms of
the culture of physicians, the culture of medicine. I don't know,
antagonistic is maybe too strong a word, but he said
(12:42):
things that presumably lots of people didn't want to hear.
He said, to doctors, you're doing it wrong, both in
a specific way, you shouldn't be doing this particular intervention,
and also in a general way, like he implicitly or
explicitly was saying you're thinking about the practice of medicine wrong.
Speaker 2 (12:57):
That's right, that's exactly right. I discovered this as I
sort of was reporting the book and kind of speaking
to these people who were quite seminal in bringing evidence
based practice into their fields. They often have this sort
of rebellious streak to them and are kind of willing
to speak truth to power, because yes, it does. I mean,
you're basically saying to people, you know, ort to doctors,
(13:17):
you've been doing it wrong all these years. And he
himself said he thought he was able to do that
because he was sort of he was a bit of
an outsider actually, Like he worked in Oxford, but he
wasn't sort of part of all the kind of you know,
high for lutin academic circles. He was a bit on
the outside and he felt that that allowed him to
maybe do this speaking of truth to power, which maybe
(13:42):
others what unable to do.
Speaker 1 (13:43):
So where's medicine today? To what extent is medicine today
evidence based?
Speaker 2 (13:49):
Well more than it was then. I think I used
a figure in my book of about sort of sixty
percent of healthcare is probably evidence based or at least
draws on evidence based clinical guidelines. So nowadays what happens
is there are typically systematic reviews of clinical trials or
(14:10):
are the evidence, and on the back of that, then
professional groups prepare clinical guidelines and the clinical guidelines of
what might be used in the clinic to help actually
make a decision.
Speaker 1 (14:19):
Right, so, like the National Association of Cardiologists will have
guidelines on whatever who should get statins or who should
get what interventions exactly.
Speaker 2 (14:28):
And that, I mean, that's quite interesting because it means
that the evidence is kind of baked into the processes,
which which I find quite interesting. It's sort of made it.
I mean, I won't say it's easy, but it is
relatively easy for doctors now to use evidence because that's
the expectation. Whereas I'm sure we'll get onto this, but
you look at other fields and that's just not the case.
But of course there are huge challenges, you know, lots
of criticism still of evidence based medicine. Some people criticize,
(14:51):
for example, you know, this sort of special place that
the randomized control trial has and point out that randomized
control trials can be wrong or poorly done. And then
of course, you know, pushback in the world against evidence
based practices. Anyway, and people wanting to go their own way. So,
in no way is the kind of evidence revolution that
I write about, you know, obviously done.
Speaker 3 (15:12):
It's evolving, it's new in some way.
Speaker 1 (15:16):
So if you say it's sixty percent evidence based for
the other forty, I could imagine two things. Right Clearly,
there are a lot of settings, Like medicine is complicated.
People are complicated, the body is complicated, lots of sick
people have lots of things wrong with them. So you
can imagine lots of cases where there just isn't evidence,
where it's just not clear what should I do for
this patient right now? Well, there's lots of different conflicting
(15:36):
things that I could do in their trade offs. The
other piece is there is evidence and people just don't
follow it. So like how much of each of those
is there?
Speaker 2 (15:46):
Yeah, so I can't give you a percentage on each
of those. But I mean, just to speak to the
first one though, I mean, what's really interesting about evidence
based medicine is that evidence alone doesn't tell you what
to do. So evidence is one part of the decision
making process, and I think that's a common misunderstanding actually
around it is that like you look at the evidence
and it will tell you, you know, whether you should take
this drug. But that's not the case because what what
(16:08):
a doctor or who whoever is you know, a doctor,
hopefully impatient together are doing is saying, Okay, you know,
this is the evidence on what treatments are effective. This
is the clinical expertise of the doctor who absolutely you know,
they've built up all this expertise over the years. We're
not throwing that out the window. And then you as
a patient have values and preferences which have to feed
into this decision. Right, if you've decided this isn't a
(16:29):
treatment path you want, then that has to be respected. So,
but that's still evidence based.
Speaker 1 (16:33):
Medicine, and that's still in your sixty percent easy one. Yeah, yeah,
Like tell me about the forty percent that's not evidence based.
What is what's going on there?
Speaker 2 (16:41):
Well, in some places, evidence based medicine is less common
or accepted, so people might choose traditional Chinese medicine, for example,
So there may be other practices around medicine which people prefer.
In some cases, You're absolutely right, the evidence isn't really
there or it might be misapplied. So there's the kind
(17:01):
of all the human factors that come into it where
people may do choice or inadvertently not follow the evidence.
Speaker 3 (17:09):
Ice Pak.
Speaker 1 (17:13):
Will be back in just a minute. Okay, So let's
talk about evidence outside of medicine. A big chunk of
your book is that, And it does seem to some
(17:35):
extent at least, that this evidence based revolution, as you
call it, that Ian Chalmers helped us start, has directly
influenced people in other fields. You know, and you write
about economics and crime and management and parenting, and you know,
I will say, like I covered economics for a long time,
(17:58):
and in economics they've gotten better about evidence. It seems
to me that in a lot of fields outside of medicine,
it's just frustrating. It's just frustrating when you sort of
try and study the evidence. It seems like there's often
not good evidence. When there is, people don't follow the evidence.
I mean, in a broad way, what's your assessment of
how evidence as a way of looking at the world
(18:19):
is doing outside of medicine.
Speaker 2 (18:21):
So I think it really depends which field you're looking
in of how like I suppose I ended up thinking
that each of these fields was, you know, weaving its
own path through evidence, and some of them had directly
looked at medicine and gone, yeah, we want to do
that too. We should think our practices shouldn't be based
on conventional wisdom an anecdote. And in others, like in
(18:42):
economics example, there's kind of you know, evidences that the
use of randomized trials has really swept through international development,
through development economics. But yeah, I think I don't think
any of them have advanced as far as medicine. And
I think that that is partly because of the histories
of the of these fields and the people who've been
(19:03):
championing it, and the different barriers that it's faced.
Speaker 1 (19:05):
It seems harder in most other domains to do useful
you know, studies that have real external validity where you
can look at something in one place and say this
same intervention is going to work in other places, Like
the world is messy, is a fundamental problem with trying
to generate evidence.
Speaker 2 (19:25):
Yeah, it makes things really really hard. So let's say
you want to, I don't know, you know, test whether
giving people incentives to have vaccines works. And I mean
I talked about a trial in the book that was
done where in India people were offered steel dinner plates
and bags of lentils in order to incentivize parents to
compliclents had their children vaccinated, and it seemed to be effective.
(19:47):
Right now, you can't just lift and shift that and
put it into you know, the UK. You know, you
have to think about the different cultures and you know,
the different ways incentives might work, and so on and
so forth.
Speaker 1 (19:58):
I mean that particular example, like you do see conditional
cash transfers in other countries where you know, if parents
bring their children for vaccination and send them to school,
then they get a monthly stipend from the government. Like
those seem to work, Like those that one does seem
to generalize at least.
Speaker 3 (20:15):
Some yes, it has. I mean that's built up.
Speaker 2 (20:18):
That's unusual really and having such a body of evidence
to it, that's built up over time.
Speaker 1 (20:22):
Although it's funny like that one, I understand that we
shouldn't rely on common sense is one of the themes
of the book. But like, if you give people money
to do something that is actually helpful to them, they
will do it. Is basically what that finding says, and
it's true.
Speaker 2 (20:36):
Right, but it took evidence to convince policymakers of that. Yeah, fair,
So the counter argument, you know, You're absolutely right that
this point about generalization is like a really big problem
across all of these fields, right that what works in
one place might not work in another. Now, some people
would say, well why bother? You know, well why bother
getting evidence at all? Like what's the point of testing it?
(20:56):
But you generally, over time, you know, if something it
might not work exactly the same. But if you start
to build up a body of evidence that shows, yeah,
actually this seems to like the conditional cash transfers have
some effectiveness here and some effectiveness here, then you've come
up with a robust policy that does seem worth pursuing.
Speaker 1 (21:15):
Tell me about evidence based policy making for like government policy,
social policy, like what how has the sort of march
of evidence been there?
Speaker 2 (21:25):
So I think in line I concluded in the end
that there was a kind of what I call the
evidence zeitgeist around the sort of nineteen nineties to maybe
twenty ten, when a lot of these fields were turning
to evidence. And I think it's because these ideas of
evidence based medicine were percolating out and people were coming
across them, and then you see this kind of emerge
in the policy language. So you know, we had for example,
(21:49):
Tony Blair and New Labor were talking about evidence based policy,
or doing what works as it was called, in the
nineteen nineties. Obama talked about it in his inauguration speech
in two thousand and nine. So it sort of was
filtering into policy, and you know, particular people became very
enamored by it, I would say it sort of it
(22:10):
succeeded in certain pockets, shall we say.
Speaker 1 (22:13):
And during that time people are championing it. Are you
seeing policy changes based on evidence? Are they actually doing
the thing they're talking about?
Speaker 2 (22:23):
In some cases there were yes. So that there was
a series of what were called, for example, in the
Obama in administration, a series of what were called tiered
evidence initiatives which came in where in order for policy
to progress, it was only allowed to, for example, have
extra funding if it was able to produce evidence of effectiveness.
Speaker 1 (22:42):
Are there examples of things that got cut because they
were sort of proven to not work? That's the real one,
right Are you going to say, hey, this doesn't work,
so we're going to stop doing it.
Speaker 2 (22:51):
That is much harder to find examples of, I would say, yeah, yeah.
Speaker 1 (22:55):
So what are examples of things that got funded because
there was evidence that they were good.
Speaker 2 (23:00):
One example was the Nurse Family Partnership, which is a
program where first time mothers are given a lot of
support in the you know, the early time of pregnancy
and in the first two years of life. And because
there was a lot of evidence that this really was
helpful towards child outcomes, that progressed and was awarded more
government funding.
Speaker 1 (23:21):
And what's the status of that program now?
Speaker 3 (23:24):
Still going?
Speaker 1 (23:25):
I'm still going. I didn't expect that, I'll admit, in
my jade at heart, I thought you were going to
tell me it got killed. That's in the US. Yep, Okay,
well that's good news. Tell me about you have a
chapter about evidence based management. The evidence seems particularly weak
(23:47):
in that domain.
Speaker 2 (23:48):
Frankly, I think some of the evidence is weak, and
I think the culture of using evidence is very weak.
So of the fields I looked at, I would say
that that is the one where I felt evidence was
struggling the most. I mean, there is a surprising amount
of evidence on effective management practices, and a lot of
(24:09):
people are kind of really sort of surprised to discover this.
Like you can, you know, find doctors who are absolutely
evidence based and everything they do, but they think that
maybe management is some type of you know, magic or
art or something. So yeah, there's evidence on you know,
whether feedback works, or you know, whether the performance appraisals work,
which by the way, they don't seem to be all
(24:29):
that effective, but improving performance, which I found quite interesting.
Speaker 1 (24:32):
Yes, I'm overdue that the performance appraisal software keeps bothering
me that I'm overdu So if you're telling me it's
a waste of time, you're validating my behavior, and I'm
happy to hear it. So what does work? Tell me?
Like one management thing where there's like really clear evidence
that is actually actionable to use a management word, that's like,
(24:56):
here's a great thing, and you should do it if
you're a manager.
Speaker 2 (24:59):
So goal setting is very effective and good good feedback,
good feedback meaning fair feedback, feedback which is specific to people,
you know, not generic feedback. So there does seem to
be good evidence that those things are effective at improving
performance fair enough.
Speaker 1 (25:19):
Why do I find that unsatisfying? Maybe because it seems obvious.
Speaker 2 (25:23):
Yes, it seems of no, but that's a really good point.
So that to me is one of the things that
holds back evidence based management because some of the principles
which are supported by evidence feel obvious to people and
they're not new, and what sales business book is exciting
new ideas which aren't necessarily tested or proven to work,
So there's financial incentive sort of working against evidence based management.
Speaker 3 (25:47):
In my view.
Speaker 1 (25:48):
You've been an editor and a writer on the sort
of magazine side of the journal nature, right, And I
was a newspaper reporter before. And I mean I was
thinking about evidence in our profession, right. And I don't
mean evidence in the sense of like you want to
write about what's true, or you want to assess the
evidence when you're writing about something. I mean evidence for
(26:08):
the way one should write, or what kinds of stories
we should do, or what headlines we should write. And
in my career there has been none of that essentially.
I mean, you had the Internet come along. I'm old
enough that I remember when that was relatively new and people,
you know, you had a dashboard and you started to see, oh,
people are reading these kinds of stories and not reading
those kinds of stories, and in a sort of quasi
(26:29):
anecdotal way, you might shift course. But nobody wanted to
use evidence. I mean, not only did people really not
think that way, but to the extent they did, they
didn't want to think that way, right, Like we like
writing the kinds of stories we write. I learned some
particular craft of podcasting that was, like one guy who
was really good at making podcasts, we thought, told everybody
(26:51):
how to do it, and we did it right, imminence
based podcasting. And then all these other podcasts come along
that are nothing like the rules that I learned and
are wildly popular, and I'm like, oh, the rules that
I learned were just what one guy made up and
we all liked. But I haven't really changed much based
on that. I mean, do you use evidence in your craft?
Speaker 3 (27:14):
That's such a good question.
Speaker 2 (27:16):
I mean, really, what you're talking about is using data
right to inform what you do.
Speaker 1 (27:22):
I think, well, you could do a randomized control trial.
I mean, certainly a B testing of health AB test
is the thing people do, yes, exactly, but you could
do You could do a randomized trial of different kinds
of articles in nature if you want it right, you
could random You could prospectively decide we're going to randomly
assign somebody to do A or B or whatever. As
(27:44):
far as I know, nobody's ever done that.
Speaker 3 (27:47):
That's a great point. Yep.
Speaker 2 (27:48):
Absolutely, yeah, Mostly people are chasing audiences.
Speaker 1 (27:52):
But even analyzing the best way to chase audiences, like
why don't we do that?
Speaker 3 (27:57):
We should, let's do it.
Speaker 1 (28:00):
But do you mean that? I feel like I don't
wanna at some level? Right, this is like part of
the It's like I like doing my job the way
I want to like. Yes, I also would like to
have more listeners. And perhaps if I was better, you know,
more analytical or more evidence based, I would have more listeners.
But I don't know. I think there's something going on
there that is interesting and that points to resistance to evidence.
(28:22):
Like I think of myself as an analytical person. I
think I follow evidence in healthcare, and yet in this
thing I do all day every day, I sort of
don't pay attention.
Speaker 2 (28:30):
Well, it depends what outcome you want, right, I mean,
if your outcome is very clearly that you want to
grow listeners, then you might be incentivized and to do
that experiment. If you're happy with the outcome and no
one's being harmed by which I don't think they are,
if you continue to podcast in the way you do,
or I tell stories in the way that I do.
Then you know there has to be an incentive, I
think to do the test.
Speaker 1 (28:51):
How did writing the book change the way you think
about evidence?
Speaker 2 (28:56):
I think it changed the way I work as a
journalist to some extent. I mean, obviously, I write features
about complex bodies of evidence, so I find interesting questions
and I want to go and look at what the
evidence says about them. And I would say, what's changed
about that is I am much more likely to now
look for evidence synthesies, so for example, for systematic reviews
(29:17):
when I'm diving into a new field, and I don't
think I did that as much in the past, and
I found that quite liberating, you know, because and of
course evidence is just ballooning, I mean in terms of
the amount of a search that's coming out. So that's
been quite helpful.
Speaker 3 (29:30):
I mean.
Speaker 1 (29:30):
The classic bread and butter of science journalism is writing
about a new study, right, But one lesson of what
you're talking about is like, except in rare cases where
the new study is like really giant or something, we
should almost ignore new studies, Like we should add this
one new study to this part of a thousand studies
and see how much it, you know, adjusts the totality
(29:52):
of the evidence, which is usually going to be not
that much, right, Yes.
Speaker 2 (29:56):
I mean it's going to depend how big the body
of evidence is that you're adding the study to.
Speaker 1 (29:59):
So you're right.
Speaker 2 (30:00):
If it's a brand new trial it's the first time
it's tested a drug, totally we should write about that,
reports on it. But if it's another trial, another study
saying you know, wine is good for you, that's probably
best to put to one time.
Speaker 1 (30:12):
Now.
Speaker 2 (30:12):
The reason, of course those stories still come out is
because they get clicks on websites.
Speaker 3 (30:18):
But I'm with you.
Speaker 2 (30:19):
I mean I have definitely reached this point of thinking, yes,
I need to look at the body of evidence as
a whole.
Speaker 1 (30:24):
And what about outside of science, Like do you use
Is there any part of your life where you use
evidence now outside of work, outside of health where you
didn't use it before?
Speaker 2 (30:40):
Well, probably I use it more in parenting. I mean,
that's a really interesting case where I feel it's a
bit like management in that there's just it's completely a
wash with you know, fads and fashions and books and
actually there is quite a lot of evidence around, you know,
practices that can support child developments. Some of which is
(31:02):
mirrored in standard parenting advice, but some of which might
be slightly different, And I just think it gets lost
in the kind of fire hose of information.
Speaker 1 (31:09):
That's a non obvious piece of parenting advice with robust
evidence behind it.
Speaker 2 (31:13):
I don't know if it's not obvious, I would just
say it's obviously a really live debate right around. I've
looked specifically for nature. The evidence around is social media
and screen news causing the rise in mental health problems
for adolescents and young people. And that is a really
complicated body of evidence, which I think people are interpreting
(31:36):
in different ways. But I do think that this general
sense that that's been shown that this is causative and
it's a huge driver of adolescent mental health problems is
an overreach based on the people that I've spoken to
and having looked at the evidence myself.
Speaker 1 (31:53):
So are you saying screens and social media aren't as
bad for teenagers as a lot of people think. Is
that a fair reduction of what you said?
Speaker 3 (32:00):
Yeah?
Speaker 1 (32:01):
Yeah, yeah, good news, good news.
Speaker 2 (32:03):
Can I go back to your point, because you asked
me how it's changed, how I are you know, personal decisions.
Speaker 1 (32:08):
You elect your kids stay the phones more than you
did before.
Speaker 2 (32:12):
To some extent, yeah, I mean it just made me
relax a little bit about it, because you know, we're
really seeking these concrete answers, aren't we. Or what I
would have loved the evidence to say was like, you know,
two hours and that's it, right, But it doesn't. It
doesn't provide you with simple answers. Evidence generally doesn't. But
sometimes I think that that can be quite empowering itself,
(32:33):
you know, as a parent, to go, Okay, well, I
have looked at the evidence and it doesn't give me
the crisp answers I would really love to have about
what to do. But I understand that, and now I
feel empowered to perhaps make decisions on my own based
on my common sense and weighing up the things which
are important to me and my family.
Speaker 1 (32:50):
What's the future of evidence as a as an idea
evidence in the world, Like, do you feel like we're
in this moment when there's a sort of evidence backlash.
Speaker 2 (32:59):
To some extent, I literally published a big piece last
week for Nature about trust in science because I wanted
to look at this kind of They're like, there's a
sort of sense in the air that there's this like
big crisis of trust in science. People have lost trust
in science, and I wanted to kind of scrutinize that claim,
So I went off and looked at kind of data,
and I've spoken to lots of people, and I would
say the big picture, given that surveys are imperfect, but
(33:22):
from lots of surveys, is that generally, you know, globally,
trust in science is quite high. People generally trust science,
and scientists as a profession is one of the most
trusted professions. Like it's up there with like doctors and teachers,
you know, and you've got journalists like me and politicians
who go down the bottom of the list. So the
global picture is kind of like glassharlf full. Everything looks fine,
(33:44):
but then obviously they yes, they were a big problems.
So in the US, trust in science has gone down
in the last few years, and there's a specifically a
political polarization going on around trust in science in the US,
with it falling amongst Republican leaning people but remaining high
amongst Democrats, and people feel concerned that the Trump administration
(34:06):
is kind of capitalizing on this idea of distrust of
science to now attack scientific institutions. So I don't want
to give the impression that I came away from this
exercise thinking everything's rosy with trust in science.
Speaker 3 (34:18):
Because that's not the case.
Speaker 2 (34:19):
This big global trust in Science survey I looked at
in some countries lower trust in science was associated with
being right leaning, but in others it was associated with
being left leaning. So it really kind of depends on
the country.
Speaker 1 (34:32):
What's the future of evidence?
Speaker 2 (34:34):
I think in some ways, you know, looking at the
evidence revolution, like going back to where we started, it's
quite recent, you know. I mean, evidence based medicine as
a term was only introduced in nineteen ninety one, thirty
five years ago. So if you want to have the
optimistic view, which maybe I do, you know, you could
say that the current kind of setbacks are that there's
(34:54):
always been opposition to evidence, and what's happening now is
just another setback in the kind of longer march towards rationality,
which is going to take decades. So I suppose, yeah,
I do come out hoping that's the case. It feels
a little hard for me to believe that we're going
to get to a point where we reject all of
this knowledge we've created in the world and choose not
(35:15):
to use that at all in decisions.
Speaker 3 (35:18):
I hope that we don't get to that point.
Speaker 1 (35:24):
We'll be back in a minute with the lightning round.
Let's finish with the lightning round if you would. Okay,
what's a piece of really solid evidence that you ignore?
Speaker 3 (35:46):
Oh?
Speaker 2 (35:48):
I think I try not to think too hard about
the evidence on alcohol, even though I've written a whole
piece about it, because I know having reported on it,
and I literally like calculated it all out and looked
at my own drinking and I thought, hmm, I probably
should less, and I find it difficult to do that.
(36:11):
I'm not saying I drink to excess. I'm just saying
it probably should be less than it is.
Speaker 1 (36:14):
Well, the old like one glass of wine a day
is actually good for you. The evidence seems to have
shifted on that on that claim. Correct.
Speaker 2 (36:23):
Yes, in general, most people could benefit by cutting back,
and the risks go up from a really low level.
Speaker 1 (36:29):
Yeah, And was the problem with that evidence confounding that
the people who drink one glass of wine a day
tend to be have really healthy lives. They're like very
moderate people. They don't do anything in excess and that's
why it looked like that was good for you.
Speaker 2 (36:43):
Partly, yes, confounding is really hard to ship out at
those studies, and also, of course the other ways that
heavy drinkers also tend to be smokers and do all
the other unhealthy behaviors, So it is.
Speaker 3 (36:52):
It is a difficult relationship to tease out.
Speaker 1 (36:57):
So you previously wrote a book about these longitudinal studies
right where researchers, as I understand it, followed a group
of people for their entire lives extremely interesting. What were
some of the things they learned from those studies?
Speaker 2 (37:13):
The big message from all of the studies, I mean,
I set off to write this book that I thought
was going to be about these fascinating sort of about
science somehow, and I sort of ended up writing this
book about inequality, which I didn't really realize till i'd
published it, because really the big message was that children
who were born into difficult circumstances tend to follow on average,
tend to follow more difficult life paths, so they ended
(37:35):
up in poorer health, less wealth, in less good jobs.
And maybe that sounds really obvious, but the sad thing
is that that's kind of been repeated generation after generation
and it's still being repeated today.
Speaker 1 (37:46):
Huh, So mobility didn't significantly increase over time.
Speaker 2 (37:52):
Not no, I mean there has been some changes, But
that point about your early circumstances having this profound influence
on the rest of your life that remains true.
Speaker 1 (38:04):
Tell me about beer glasses in British pubs.
Speaker 3 (38:11):
I love this story.
Speaker 2 (38:13):
This is one of my favorite randomized trials that I
came across when I was writing the book. So this
is a story about a highly unlikely trial that was
done by a researcher called Jonathan Shepherd, who is still
actually a facial surgeon, and he noticed that a lot
of the people that he was treating with terrible injuries
(38:34):
had come from glass. Often these awful incidents where people
were glassings, where two people in a pub get angry
and somebody decides to shove what's in their hand, which
is like their pint glass, into somebody else's face, and
so they have these awful lacerations and life altering injuries.
And so he started thinking, well, what if we had
stronger beer glasses and maybe that would lead to less
(38:56):
glass injuries.
Speaker 1 (38:58):
Just to be clear, why is it better if if
that pub, if that glass that they're shoving into somebody's
face is tougher, it's less likely to shutter to shadow.
Speaker 2 (39:07):
So basically you might have been part of this unusual
randomized trial of beer glasses if you bought a pint
in a selection of pubs in the UK and Wales
around nineteen ninety eight. Because he got a selection of
pubs and bars to randomly, some of them were signed
to install toughened glasses and the rest carried on with
(39:28):
their normal glasses and managed to show it was a
bit of a complicated trail, but he managed to show
that indeed, having tougher glass reduced the number of glass injuries,
and this helped lead to momentum which encouraged the pub
industry to switch to toughened glass in the UK, leading
to or least associated with a drop in a glass injuries.
Speaker 1 (39:49):
Of like tens of thousands a year or something extraordinary
big number.
Speaker 3 (39:53):
Yeah, yeah, amazing.
Speaker 1 (39:55):
Somebody gave you, say, one hundred million dollars to fund
a study, any study you want. What would you do?
Speaker 3 (40:04):
Wow?
Speaker 2 (40:06):
Oh my god, Okay, that's that's I'm trying to think
of the question that I most want an answer to
for which there is no evidence. It has to be
something around parenting. I mean, okay, I'll give you an answer,
but I think it's a bit of a cheat because
it's sort of happening, which is around these social media
(40:27):
bans which are going on at the moment. I mean,
the UK is just introducing a policy to ban all
teenagers from social media, and it's already happened in Australia.
So I think the key, the key question, which evidence
curious people like me have and lots of researchers have,
is what's the effect. So I think a careful study
to understand the impact of those changes is really important.
Speaker 1 (40:49):
It was great to speak with you, and I appreciate
your work.
Speaker 3 (40:53):
Thank you, Thank you very much.
Speaker 2 (40:55):
No, thanks very much for your questions and thanks for
having me on the show.
Speaker 1 (41:04):
Helen Pearson is the author of the book Beyond Belief.
Please email us at problem at pushkin dot fm. Tell
us what kinds of shows we should do more of
or less of our particular people you think would be
good on the show. You can also find me on
x and on LinkedIn. Our show is produced by Gabriel
Hunter Chang and Trina Menino. Our editor is Lydia Jean
Kott and our engineer is Sarah Bruguier. I'm Jacob Goldstein
(41:27):
and we'll be back next week with another episode of
What's Your b
Pushkin. I'm Jacob Goldstein, and this is what's your problem.
My guest today is Helen Pearson. She's a science journalist.
(00:37):
She writes for the journal Nature, and she recently wrote
a book called Beyond Belief, How Evidence Shows What Really works.
Helen's problem is this, how do you get people to
make important decisions based on high quality evidence rather than
hunches or habits. To a large extent, the book is
a history of what Helen calls the evidence revolution, and
(01:00):
this is a remarkably recent revolution. In her telling, fifty
years ago, she writes, doctors did not typically try to
sort through through the high quality published studies to figure
out what they should do. Instead, they often did whatever
they'd been taught in medical school, or what the senior
doctor in the room said to do, even if the
(01:20):
evidence said otherwise. But a few doctors spent their careers
trying to change that, sorting through all the evidence to
figure out what worked best in different situations, and trying
to get their fellow doctors to pay attention. In more
recent decades, that spirit has started to spread to other fields,
feels like management and crime prevention and education. Later in
(01:41):
the conversation, Helen and I talk about some of those fields,
places where the evidence is still often unclear, and where
people often ignore the evidence even when it is clear.
We also talk about how she uses evidence in her
own life and about the prospects for the spread of
evidence based decision making in the world. To start, we
talk about one doctor who did a lot to get
(02:03):
the evidence revolution going in medicine. His name was Ian Chalmers.
Speaker 2 (02:09):
Ian is really the reason I ended up writing the book.
He was training to be a doctor in the kind
of late nineteen sixties early nineteen seventies. He was working
in obstetrics and gynecology in Wales at the time, and
he noticed this sort of odd thing, which was that
when doctors would hand out advice to women with the
same condition, they would give different advice. So, you know,
(02:29):
some doctors would think it was really important to have
prenatal vitamins or not to drink during pregnancy, and other
doctors would say no such thing. And this was kind
of so extreme that Ian once told me that when
he was woken in the night to treat a woman,
the first thing he would say was what's wrong, and
the second thing he would say was who's treating her?
Because that was going to change. You know what he
(02:50):
did next raight, So what generally happened was that everyone
followed the advice of the most senior doctor in the room,
which is sometimes now called eminence based medicine.
Speaker 1 (03:00):
Tell me about his work in Gaza and how that
writer influenced him.
Speaker 2 (03:07):
Yeah, so that was another part of his train, which
was also kind of influential in him realizing that a
lot of what he'd been taught in medical school was wrong.
So he worked on a refugee camp in Gaza during
his medical training, and during that time he was treating
children who had measles, and he had been taught in
(03:28):
medical school that you shouldn't give antibiotics to a child
with measles, even if they were becoming quite sick, because
antibiotics treated bacterial infection, so why would you give it
to a child with a viral infection. So he followed
the advice he'd been taught, and he didn't give the antibiotics.
But then later when he returned to the UK, he
discovered that actually this advice he'd been given was tragically wrong,
(03:50):
and that there were in fact about six control clinical
trials that suggested it did help to give some children
antibiotics prophylactically because they were developing a secondary bacterial infection
along of the viral one.
Speaker 1 (04:03):
And in fact, as I understand it, like he concluded
when he went back to the UK and studied the
advice that children under his care had probably died or
possibly died because he had done the wrong thing.
Speaker 3 (04:14):
That's exactly right.
Speaker 2 (04:16):
Yeah, So it's so a huge kind of you know,
turning point for him of realizing that.
Speaker 1 (04:20):
So let me ask the native question, why had he
been taught something that was not consistent with the evidence.
Speaker 2 (04:28):
Because that was that was standard practice in medical schools
at the time. Most doctors weren't really being taught about
clinical trials in the sixties and seventies.
Speaker 3 (04:38):
Hard though it is to believe.
Speaker 1 (04:39):
It is weird, right, it is hard to believe. I mean,
I guess is part of it the sort of formal
you know, randomized controlled trial. Well you have a placebo
arm and a treatment arm, and that people running the
trial don't know which is which. That was actually relatively
new still.
Speaker 2 (04:54):
Right, exactly, Yes, So we feel like randomized trials have
been around for ages, but they are relatively new. I
mean around the time that you know that Ian was
having the you know that this realization that he hadn't
been taught about trials. They were really only then becoming commonplace.
Speaker 1 (05:09):
Oh so you have this sort of research changing and
the practices of doctors are lagging. That is sort of
the moment when Ian Chalmers walks onto the scene. And
it's this moment when there is now research but doctors,
weirdly to our sensibilities, are not paying attention to it.
(05:29):
What does Chalmers do when he realizes this?
Speaker 2 (05:33):
So what he did was he became very passionate about
randomized trials. Actually, and I discovered this with other people
I spoke to, is that there's something about this method
which is very captivating to people.
Speaker 1 (05:47):
It's so elegant, right, like intellectually, like the it's blinded,
there's a placebo control. Like I recognize that they're imperfect,
and people love to talk about the problems with them,
but it's wildly elegant and not intuitive. Right People want
to just like give something to somebody and see if
they get better, and say it works if they get better,
and like, for so many reasons, a randomized trial is
(06:09):
so much better than that.
Speaker 2 (06:10):
And that argument goes on all the time today. I mean,
that's what mostly happens in policy is we just introduce
policies right without bothering to test whether they're effective and
assuming they do good when some do harm. So that
I don't think that's an old argument.
Speaker 1 (06:23):
We will get to policy. Yes. So this is this
moment people are falling in love with randomized trials, and
more importantly for our story, Ian Chalmers is realizing that
this evidence is not making its way into medical practice.
What does he do about that?
Speaker 2 (06:38):
So he decides to do this pioneering exercise where he
is going to collect all of the controlled clinical trials.
They weren't all randomized, but controlled trials which had been done,
which had tested treatments in pregnancy and childbirth. Okay, and
at the time, so this is in the eighties, I mean,
that was an extraordinarily difficult thing to do because he
(07:01):
couldn't just go online and you know, search up these trials.
So he eventually ended up recruiting hundreds of people to
sort of go to libraries and scour through the medical
journals and really exhaustively try and track down these clinical trials.
Speaker 1 (07:15):
It's amazing that it's almost an archaeological exercise, right, like
people have generated all this evidence not in ancient times,
but in the last ten or twenty years, and it's
already been sort of lost. Right. He is an obgyn, right,
and he's having to have people will look for the
research in his field exactly exactly.
Speaker 2 (07:33):
It's extraordinary and that is still a real difficult problem today,
which I think is absolutely mind boggling, because a lot
of research is published and yet people still struggle to
find it on databases.
Speaker 1 (07:43):
So they're doing this archaeological expedition to look for recent research.
And what happened.
Speaker 2 (07:49):
So it takes him about ten years, him and his
many colleagues, and eventually he doesn't just get the evidence together.
I think this is what's so interesting about it is
he realizes that he needs to synthesize the evidence, and
you know, not just to look at one trial at
a time, because if you look at one trial, it
risks being wrong, or you get a group of trials
(08:11):
which may be conflicting, maybe some of them are poorly done,
maybe it's just through chance that they point in different directions.
And so he took this quite radical step of synthesizing
the evidence using a method called a systematic review and
ended up doing hundreds of systematic reviews to look at
all of these different approaches in pregnancy and childbirth and
(08:33):
eventually publishes all of this after ten years in these
two massive books.
Speaker 3 (08:36):
Which I also have on my book case following me.
Speaker 2 (08:40):
So, they revealed that a lot of practices in pregnancy
and childbirth were not based on evidence or were actually
doing harm. So for example, even things like invasive episiotomies,
which is a surgical incision which is supposed to give
babies a bigger hole to get out, there wasn't really
evidence to support these practices, and like shaving women's pubic
(09:03):
care in labor. So countless women had been subjected to
these really quite invasive and degrading practices because doctors assumed
they were the right thing to do. And Ian's work
by synthesizing evidence in this way helped bring an end
to them. So he was sort of inspired by what
he had done and thought, why can't we do this
across all specialties of medicine, you know, synthesize the evidence
(09:27):
in heart disease and diabetes, in cancer and so on,
And that led to this group which he helped found.
He was seminal in founding called the Cochrane Collaboration, and
they set out and are still trying to do this
today to synthesize evidence which shows which treatments are of
help and do not harm across these different groups. And
nowadays the word sort of like a Cochrane review if
(09:49):
you're here that it's sort of like associated with doing
the kind of highest standard, you know, gold standard type
of review of evidence.
Speaker 1 (09:58):
And I would say a lot of it at least
is just online, right, like you can go look if
you're thinking of taking a supplement, say, you can just
go look. And there are a lot of Cochrane reviews
of whatever, magnesium for something something, and I find it useful.
I mean quite often they say there's not enough evidence
(10:21):
to say one way or the other. Right, that's typically
with the kinds of things that I'm looking at, you know,
over the counter things or whatever. There just isn't enough
research to have a clear answer. And that is what
they often say. It makes sense, Yes.
Speaker 3 (10:33):
It is often the conclusion.
Speaker 2 (10:34):
And I mean it's not just so Cochran reviews now
are a tiny fraction of the number of systematic reviews
in the world. So Cochran was really sort of seminal
in sort of showing that this was a really good
way to make sense of conflicting bodies of evidence. But
now that you know, thousands are coming out every year,
So in general, a systematic review is a better way
to get an overview of what the evidence says than
(10:55):
looking at just one study. Now, of course, it's it's
not completely straightforward because like randomized trials, some systematic reviews
aren't very good either, So that's a challenge too.
Speaker 1 (11:05):
Well, it's always something yes, well, I mean that's Cochrane
is useful as a brand in that way, right, Like
I trust their ability to assess the evidence, even if
what they say is we don't know, Like we don't know.
It's a very respectable answer as a general matter. What's
a Charmer's like.
Speaker 2 (11:26):
Quite extraordinary actually just the most I don't think I've
ever met anyone who is so extraordinarily modest about his
accomplishments and downplays them so much, to the point where
he denies sort of starting the cock con collaboration. I
think he says something along the lines of he came
up with the idea so and also very exacting and critical.
(11:49):
I mean it was interesting when he retired or decided
to step away. He didn't retire from Cockraney decided he
wanted to move on. He actually set up a prize
for the group that offered the most astute criticism of
the cock Con collaboration.
Speaker 1 (12:00):
Oh that's really admirable.
Speaker 3 (12:02):
Yes, exactly.
Speaker 2 (12:03):
And they still have that attitude of kind of inviting
criticism because of course that's exactly what you know, he
and the group have done all these years is sort
of speak truth to power. So they need to invite
that criticism themselves.
Speaker 1 (12:15):
Who won the prize and what did they say?
Speaker 2 (12:19):
I don't know, it's one every years.
Speaker 1 (12:22):
Yeah, so I could imagine him having a pretty high
tolerance for disagreeableness. Say right, I mean what he did
was in a sort of cultural way in terms of
the culture of physicians, the culture of medicine. I don't know,
antagonistic is maybe too strong a word, but he said
(12:42):
things that presumably lots of people didn't want to hear.
He said, to doctors, you're doing it wrong, both in
a specific way, you shouldn't be doing this particular intervention,
and also in a general way, like he implicitly or
explicitly was saying you're thinking about the practice of medicine wrong.
Speaker 2 (12:57):
That's right, that's exactly right. I discovered this as I
sort of was reporting the book and kind of speaking
to these people who were quite seminal in bringing evidence
based practice into their fields. They often have this sort
of rebellious streak to them and are kind of willing
to speak truth to power, because yes, it does. I mean,
you're basically saying to people, you know, ort to doctors,
(13:17):
you've been doing it wrong all these years. And he
himself said he thought he was able to do that
because he was sort of he was a bit of
an outsider actually, Like he worked in Oxford, but he
wasn't sort of part of all the kind of you know,
high for lutin academic circles. He was a bit on
the outside and he felt that that allowed him to
maybe do this speaking of truth to power, which maybe
(13:42):
others what unable to do.
Speaker 1 (13:43):
So where's medicine today? To what extent is medicine today
evidence based?
Speaker 2 (13:49):
Well more than it was then. I think I used
a figure in my book of about sort of sixty
percent of healthcare is probably evidence based or at least
draws on evidence based clinical guidelines. So nowadays what happens
is there are typically systematic reviews of clinical trials or
(14:10):
are the evidence, and on the back of that, then
professional groups prepare clinical guidelines and the clinical guidelines of
what might be used in the clinic to help actually
make a decision.
Speaker 1 (14:19):
Right, so, like the National Association of Cardiologists will have
guidelines on whatever who should get statins or who should
get what interventions exactly.
Speaker 2 (14:28):
And that, I mean, that's quite interesting because it means
that the evidence is kind of baked into the processes,
which which I find quite interesting. It's sort of made it.
I mean, I won't say it's easy, but it is
relatively easy for doctors now to use evidence because that's
the expectation. Whereas I'm sure we'll get onto this, but
you look at other fields and that's just not the case.
But of course there are huge challenges, you know, lots
of criticism still of evidence based medicine. Some people criticize,
(14:51):
for example, you know, this sort of special place that
the randomized control trial has and point out that randomized
control trials can be wrong or poorly done. And then
of course, you know, pushback in the world against evidence
based practices. Anyway, and people wanting to go their own way. So,
in no way is the kind of evidence revolution that
I write about, you know, obviously done.
Speaker 3 (15:12):
It's evolving, it's new in some way.
Speaker 1 (15:16):
So if you say it's sixty percent evidence based for
the other forty, I could imagine two things. Right Clearly,
there are a lot of settings, Like medicine is complicated.
People are complicated, the body is complicated, lots of sick
people have lots of things wrong with them. So you
can imagine lots of cases where there just isn't evidence,
where it's just not clear what should I do for
this patient right now? Well, there's lots of different conflicting
(15:36):
things that I could do in their trade offs. The
other piece is there is evidence and people just don't
follow it. So like how much of each of those
is there?
Speaker 2 (15:46):
Yeah, so I can't give you a percentage on each
of those. But I mean, just to speak to the
first one though, I mean, what's really interesting about evidence
based medicine is that evidence alone doesn't tell you what
to do. So evidence is one part of the decision
making process, and I think that's a common misunderstanding actually
around it is that like you look at the evidence
and it will tell you, you know, whether you should take
this drug. But that's not the case because what what
(16:08):
a doctor or who whoever is you know, a doctor,
hopefully impatient together are doing is saying, Okay, you know,
this is the evidence on what treatments are effective. This
is the clinical expertise of the doctor who absolutely you know,
they've built up all this expertise over the years. We're
not throwing that out the window. And then you as
a patient have values and preferences which have to feed
into this decision. Right, if you've decided this isn't a
(16:29):
treatment path you want, then that has to be respected. So,
but that's still evidence based.
Speaker 1 (16:33):
Medicine, and that's still in your sixty percent easy one. Yeah, yeah,
Like tell me about the forty percent that's not evidence based.
What is what's going on there?
Speaker 2 (16:41):
Well, in some places, evidence based medicine is less common
or accepted, so people might choose traditional Chinese medicine, for example,
So there may be other practices around medicine which people prefer.
In some cases, You're absolutely right, the evidence isn't really
there or it might be misapplied. So there's the kind
(17:01):
of all the human factors that come into it where
people may do choice or inadvertently not follow the evidence.
Speaker 3 (17:09):
Ice Pak.
Speaker 1 (17:13):
Will be back in just a minute. Okay, So let's
talk about evidence outside of medicine. A big chunk of
your book is that, And it does seem to some
(17:35):
extent at least, that this evidence based revolution, as you
call it, that Ian Chalmers helped us start, has directly
influenced people in other fields. You know, and you write
about economics and crime and management and parenting, and you know,
I will say, like I covered economics for a long time,
(17:58):
and in economics they've gotten better about evidence. It seems
to me that in a lot of fields outside of medicine,
it's just frustrating. It's just frustrating when you sort of
try and study the evidence. It seems like there's often
not good evidence. When there is, people don't follow the evidence.
I mean, in a broad way, what's your assessment of
how evidence as a way of looking at the world
(18:19):
is doing outside of medicine.
Speaker 2 (18:21):
So I think it really depends which field you're looking
in of how like I suppose I ended up thinking
that each of these fields was, you know, weaving its
own path through evidence, and some of them had directly
looked at medicine and gone, yeah, we want to do
that too. We should think our practices shouldn't be based
on conventional wisdom an anecdote. And in others, like in
(18:42):
economics example, there's kind of you know, evidences that the
use of randomized trials has really swept through international development,
through development economics. But yeah, I think I don't think
any of them have advanced as far as medicine. And
I think that that is partly because of the histories
of the of these fields and the people who've been
(19:03):
championing it, and the different barriers that it's faced.
Speaker 1 (19:05):
It seems harder in most other domains to do useful
you know, studies that have real external validity where you
can look at something in one place and say this
same intervention is going to work in other places, Like
the world is messy, is a fundamental problem with trying
to generate evidence.
Speaker 2 (19:25):
Yeah, it makes things really really hard. So let's say
you want to, I don't know, you know, test whether
giving people incentives to have vaccines works. And I mean
I talked about a trial in the book that was
done where in India people were offered steel dinner plates
and bags of lentils in order to incentivize parents to
compliclents had their children vaccinated, and it seemed to be effective.
(19:47):
Right now, you can't just lift and shift that and
put it into you know, the UK. You know, you
have to think about the different cultures and you know,
the different ways incentives might work, and so on and
so forth.
Speaker 1 (19:58):
I mean that particular example, like you do see conditional
cash transfers in other countries where you know, if parents
bring their children for vaccination and send them to school,
then they get a monthly stipend from the government. Like
those seem to work, Like those that one does seem
to generalize at least.
Speaker 3 (20:15):
Some yes, it has. I mean that's built up.
Speaker 2 (20:18):
That's unusual really and having such a body of evidence
to it, that's built up over time.
Speaker 1 (20:22):
Although it's funny like that one, I understand that we
shouldn't rely on common sense is one of the themes
of the book. But like, if you give people money
to do something that is actually helpful to them, they
will do it. Is basically what that finding says, and
it's true.
Speaker 2 (20:36):
Right, but it took evidence to convince policymakers of that. Yeah, fair,
So the counter argument, you know, You're absolutely right that
this point about generalization is like a really big problem
across all of these fields, right that what works in
one place might not work in another. Now, some people
would say, well why bother? You know, well why bother
getting evidence at all? Like what's the point of testing it?
(20:56):
But you generally, over time, you know, if something it
might not work exactly the same. But if you start
to build up a body of evidence that shows, yeah,
actually this seems to like the conditional cash transfers have
some effectiveness here and some effectiveness here, then you've come
up with a robust policy that does seem worth pursuing.
Speaker 1 (21:15):
Tell me about evidence based policy making for like government policy,
social policy, like what how has the sort of march
of evidence been there?
Speaker 2 (21:25):
So I think in line I concluded in the end
that there was a kind of what I call the
evidence zeitgeist around the sort of nineteen nineties to maybe
twenty ten, when a lot of these fields were turning
to evidence. And I think it's because these ideas of
evidence based medicine were percolating out and people were coming
across them, and then you see this kind of emerge
in the policy language. So you know, we had for example,
(21:49):
Tony Blair and New Labor were talking about evidence based policy,
or doing what works as it was called, in the
nineteen nineties. Obama talked about it in his inauguration speech
in two thousand and nine. So it sort of was
filtering into policy, and you know, particular people became very
enamored by it, I would say it sort of it
(22:10):
succeeded in certain pockets, shall we say.
Speaker 1 (22:13):
And during that time people are championing it. Are you
seeing policy changes based on evidence? Are they actually doing
the thing they're talking about?
Speaker 2 (22:23):
In some cases there were yes. So that there was
a series of what were called, for example, in the
Obama in administration, a series of what were called tiered
evidence initiatives which came in where in order for policy
to progress, it was only allowed to, for example, have
extra funding if it was able to produce evidence of effectiveness.
Speaker 1 (22:42):
Are there examples of things that got cut because they
were sort of proven to not work? That's the real one,
right Are you going to say, hey, this doesn't work,
so we're going to stop doing it.
Speaker 2 (22:51):
That is much harder to find examples of, I would say, yeah, yeah.
Speaker 1 (22:55):
So what are examples of things that got funded because
there was evidence that they were good.
Speaker 2 (23:00):
One example was the Nurse Family Partnership, which is a
program where first time mothers are given a lot of
support in the you know, the early time of pregnancy
and in the first two years of life. And because
there was a lot of evidence that this really was
helpful towards child outcomes, that progressed and was awarded more
government funding.
Speaker 1 (23:21):
And what's the status of that program now?
Speaker 3 (23:24):
Still going?
Speaker 1 (23:25):
I'm still going. I didn't expect that, I'll admit, in
my jade at heart, I thought you were going to
tell me it got killed. That's in the US. Yep, Okay,
well that's good news. Tell me about you have a
chapter about evidence based management. The evidence seems particularly weak
(23:47):
in that domain.
Speaker 2 (23:48):
Frankly, I think some of the evidence is weak, and
I think the culture of using evidence is very weak.
So of the fields I looked at, I would say
that that is the one where I felt evidence was
struggling the most. I mean, there is a surprising amount
of evidence on effective management practices, and a lot of
(24:09):
people are kind of really sort of surprised to discover this.
Like you can, you know, find doctors who are absolutely
evidence based and everything they do, but they think that
maybe management is some type of you know, magic or
art or something. So yeah, there's evidence on you know,
whether feedback works, or you know, whether the performance appraisals work,
which by the way, they don't seem to be all
(24:29):
that effective, but improving performance, which I found quite interesting.
Speaker 1 (24:32):
Yes, I'm overdue that the performance appraisal software keeps bothering
me that I'm overdu So if you're telling me it's
a waste of time, you're validating my behavior, and I'm
happy to hear it. So what does work? Tell me?
Like one management thing where there's like really clear evidence
that is actually actionable to use a management word, that's like,
(24:56):
here's a great thing, and you should do it if
you're a manager.
Speaker 2 (24:59):
So goal setting is very effective and good good feedback,
good feedback meaning fair feedback, feedback which is specific to people,
you know, not generic feedback. So there does seem to
be good evidence that those things are effective at improving
performance fair enough.
Speaker 1 (25:19):
Why do I find that unsatisfying? Maybe because it seems obvious.
Speaker 2 (25:23):
Yes, it seems of no, but that's a really good point.
So that to me is one of the things that
holds back evidence based management because some of the principles
which are supported by evidence feel obvious to people and
they're not new, and what sales business book is exciting
new ideas which aren't necessarily tested or proven to work,
So there's financial incentive sort of working against evidence based management.
Speaker 3 (25:47):
In my view.
Speaker 1 (25:48):
You've been an editor and a writer on the sort
of magazine side of the journal nature, right, And I
was a newspaper reporter before. And I mean I was
thinking about evidence in our profession, right. And I don't
mean evidence in the sense of like you want to
write about what's true, or you want to assess the
evidence when you're writing about something. I mean evidence for
(26:08):
the way one should write, or what kinds of stories
we should do, or what headlines we should write. And
in my career there has been none of that essentially.
I mean, you had the Internet come along. I'm old
enough that I remember when that was relatively new and people,
you know, you had a dashboard and you started to see, oh,
people are reading these kinds of stories and not reading
those kinds of stories, and in a sort of quasi
(26:29):
anecdotal way, you might shift course. But nobody wanted to
use evidence. I mean, not only did people really not
think that way, but to the extent they did, they
didn't want to think that way, right, Like we like
writing the kinds of stories we write. I learned some
particular craft of podcasting that was, like one guy who
was really good at making podcasts, we thought, told everybody
(26:51):
how to do it, and we did it right, imminence
based podcasting. And then all these other podcasts come along
that are nothing like the rules that I learned and
are wildly popular, and I'm like, oh, the rules that
I learned were just what one guy made up and
we all liked. But I haven't really changed much based
on that. I mean, do you use evidence in your craft?
Speaker 3 (27:14):
That's such a good question.
Speaker 2 (27:16):
I mean, really, what you're talking about is using data
right to inform what you do.
Speaker 1 (27:22):
I think, well, you could do a randomized control trial.
I mean, certainly a B testing of health AB test
is the thing people do, yes, exactly, but you could
do You could do a randomized trial of different kinds
of articles in nature if you want it right, you
could random You could prospectively decide we're going to randomly
assign somebody to do A or B or whatever. As
(27:44):
far as I know, nobody's ever done that.
Speaker 3 (27:47):
That's a great point. Yep.
Speaker 2 (27:48):
Absolutely, yeah, Mostly people are chasing audiences.
Speaker 1 (27:52):
But even analyzing the best way to chase audiences, like
why don't we do that?
Speaker 3 (27:57):
We should, let's do it.
Speaker 1 (28:00):
But do you mean that? I feel like I don't
wanna at some level? Right, this is like part of
the It's like I like doing my job the way
I want to like. Yes, I also would like to
have more listeners. And perhaps if I was better, you know,
more analytical or more evidence based, I would have more listeners.
But I don't know. I think there's something going on
there that is interesting and that points to resistance to evidence.
(28:22):
Like I think of myself as an analytical person. I
think I follow evidence in healthcare, and yet in this
thing I do all day every day, I sort of
don't pay attention.
Speaker 2 (28:30):
Well, it depends what outcome you want, right, I mean,
if your outcome is very clearly that you want to
grow listeners, then you might be incentivized and to do
that experiment. If you're happy with the outcome and no
one's being harmed by which I don't think they are,
if you continue to podcast in the way you do,
or I tell stories in the way that I do.
Then you know there has to be an incentive, I
think to do the test.
Speaker 1 (28:51):
How did writing the book change the way you think
about evidence?
Speaker 2 (28:56):
I think it changed the way I work as a
journalist to some extent. I mean, obviously, I write features
about complex bodies of evidence, so I find interesting questions
and I want to go and look at what the
evidence says about them. And I would say, what's changed
about that is I am much more likely to now
look for evidence synthesies, so for example, for systematic reviews
(29:17):
when I'm diving into a new field, and I don't
think I did that as much in the past, and
I found that quite liberating, you know, because and of
course evidence is just ballooning, I mean in terms of
the amount of a search that's coming out. So that's
been quite helpful.
Speaker 3 (29:30):
I mean.
Speaker 1 (29:30):
The classic bread and butter of science journalism is writing
about a new study, right, But one lesson of what
you're talking about is like, except in rare cases where
the new study is like really giant or something, we
should almost ignore new studies, Like we should add this
one new study to this part of a thousand studies
and see how much it, you know, adjusts the totality
(29:52):
of the evidence, which is usually going to be not
that much, right, Yes.
Speaker 2 (29:56):
I mean it's going to depend how big the body
of evidence is that you're adding the study to.
Speaker 1 (29:59):
So you're right.
Speaker 2 (30:00):
If it's a brand new trial it's the first time
it's tested a drug, totally we should write about that,
reports on it. But if it's another trial, another study
saying you know, wine is good for you, that's probably
best to put to one time.
Speaker 1 (30:12):
Now.
Speaker 2 (30:12):
The reason, of course those stories still come out is
because they get clicks on websites.
Speaker 3 (30:18):
But I'm with you.
Speaker 2 (30:19):
I mean I have definitely reached this point of thinking, yes,
I need to look at the body of evidence as
a whole.
Speaker 1 (30:24):
And what about outside of science, Like do you use
Is there any part of your life where you use
evidence now outside of work, outside of health where you
didn't use it before?
Speaker 2 (30:40):
Well, probably I use it more in parenting. I mean,
that's a really interesting case where I feel it's a
bit like management in that there's just it's completely a
wash with you know, fads and fashions and books and
actually there is quite a lot of evidence around, you know,
practices that can support child developments. Some of which is
(31:02):
mirrored in standard parenting advice, but some of which might
be slightly different, And I just think it gets lost
in the kind of fire hose of information.
Speaker 1 (31:09):
That's a non obvious piece of parenting advice with robust
evidence behind it.
Speaker 2 (31:13):
I don't know if it's not obvious, I would just
say it's obviously a really live debate right around. I've
looked specifically for nature. The evidence around is social media
and screen news causing the rise in mental health problems
for adolescents and young people. And that is a really
complicated body of evidence, which I think people are interpreting
(31:36):
in different ways. But I do think that this general
sense that that's been shown that this is causative and
it's a huge driver of adolescent mental health problems is
an overreach based on the people that I've spoken to
and having looked at the evidence myself.
Speaker 1 (31:53):
So are you saying screens and social media aren't as
bad for teenagers as a lot of people think. Is
that a fair reduction of what you said?
Speaker 3 (32:00):
Yeah?
Speaker 1 (32:01):
Yeah, yeah, good news, good news.
Speaker 2 (32:03):
Can I go back to your point, because you asked
me how it's changed, how I are you know, personal decisions.
Speaker 1 (32:08):
You elect your kids stay the phones more than you
did before.
Speaker 2 (32:12):
To some extent, yeah, I mean it just made me
relax a little bit about it, because you know, we're
really seeking these concrete answers, aren't we. Or what I
would have loved the evidence to say was like, you know,
two hours and that's it, right, But it doesn't. It
doesn't provide you with simple answers. Evidence generally doesn't. But
sometimes I think that that can be quite empowering itself,
(32:33):
you know, as a parent, to go, Okay, well, I
have looked at the evidence and it doesn't give me
the crisp answers I would really love to have about
what to do. But I understand that, and now I
feel empowered to perhaps make decisions on my own based
on my common sense and weighing up the things which
are important to me and my family.
Speaker 1 (32:50):
What's the future of evidence as a as an idea
evidence in the world, Like, do you feel like we're
in this moment when there's a sort of evidence backlash.
Speaker 2 (32:59):
To some extent, I literally published a big piece last
week for Nature about trust in science because I wanted
to look at this kind of They're like, there's a
sort of sense in the air that there's this like
big crisis of trust in science. People have lost trust
in science, and I wanted to kind of scrutinize that claim,
So I went off and looked at kind of data,
and I've spoken to lots of people, and I would
say the big picture, given that surveys are imperfect, but
(33:22):
from lots of surveys, is that generally, you know, globally,
trust in science is quite high. People generally trust science,
and scientists as a profession is one of the most
trusted professions. Like it's up there with like doctors and teachers,
you know, and you've got journalists like me and politicians
who go down the bottom of the list. So the
global picture is kind of like glassharlf full. Everything looks fine,
(33:44):
but then obviously they yes, they were a big problems.
So in the US, trust in science has gone down
in the last few years, and there's a specifically a
political polarization going on around trust in science in the US,
with it falling amongst Republican leaning people but remaining high
amongst Democrats, and people feel concerned that the Trump administration
(34:06):
is kind of capitalizing on this idea of distrust of
science to now attack scientific institutions. So I don't want
to give the impression that I came away from this
exercise thinking everything's rosy with trust in science.
Speaker 3 (34:18):
Because that's not the case.
Speaker 2 (34:19):
This big global trust in Science survey I looked at
in some countries lower trust in science was associated with
being right leaning, but in others it was associated with
being left leaning. So it really kind of depends on
the country.
Speaker 1 (34:32):
What's the future of evidence?
Speaker 2 (34:34):
I think in some ways, you know, looking at the
evidence revolution, like going back to where we started, it's
quite recent, you know. I mean, evidence based medicine as
a term was only introduced in nineteen ninety one, thirty
five years ago. So if you want to have the
optimistic view, which maybe I do, you know, you could
say that the current kind of setbacks are that there's
(34:54):
always been opposition to evidence, and what's happening now is
just another setback in the kind of longer march towards rationality,
which is going to take decades. So I suppose, yeah,
I do come out hoping that's the case. It feels
a little hard for me to believe that we're going
to get to a point where we reject all of
this knowledge we've created in the world and choose not
(35:15):
to use that at all in decisions.
Speaker 3 (35:18):
I hope that we don't get to that point.
Speaker 1 (35:24):
We'll be back in a minute with the lightning round.
Let's finish with the lightning round if you would. Okay,
what's a piece of really solid evidence that you ignore?
Speaker 3 (35:46):
Oh?
Speaker 2 (35:48):
I think I try not to think too hard about
the evidence on alcohol, even though I've written a whole
piece about it, because I know having reported on it,
and I literally like calculated it all out and looked
at my own drinking and I thought, hmm, I probably
should less, and I find it difficult to do that.
(36:11):
I'm not saying I drink to excess. I'm just saying
it probably should be less than it is.
Speaker 1 (36:14):
Well, the old like one glass of wine a day
is actually good for you. The evidence seems to have
shifted on that on that claim. Correct.
Speaker 2 (36:23):
Yes, in general, most people could benefit by cutting back,
and the risks go up from a really low level.
Speaker 1 (36:29):
Yeah, And was the problem with that evidence confounding that
the people who drink one glass of wine a day
tend to be have really healthy lives. They're like very
moderate people. They don't do anything in excess and that's
why it looked like that was good for you.
Speaker 2 (36:43):
Partly, yes, confounding is really hard to ship out at
those studies, and also, of course the other ways that
heavy drinkers also tend to be smokers and do all
the other unhealthy behaviors, So it is.
Speaker 3 (36:52):
It is a difficult relationship to tease out.
Speaker 1 (36:57):
So you previously wrote a book about these longitudinal studies
right where researchers, as I understand it, followed a group
of people for their entire lives extremely interesting. What were
some of the things they learned from those studies?
Speaker 2 (37:13):
The big message from all of the studies, I mean,
I set off to write this book that I thought
was going to be about these fascinating sort of about
science somehow, and I sort of ended up writing this
book about inequality, which I didn't really realize till i'd
published it, because really the big message was that children
who were born into difficult circumstances tend to follow on average,
tend to follow more difficult life paths, so they ended
(37:35):
up in poorer health, less wealth, in less good jobs.
And maybe that sounds really obvious, but the sad thing
is that that's kind of been repeated generation after generation
and it's still being repeated today.
Speaker 1 (37:46):
Huh, So mobility didn't significantly increase over time.
Speaker 2 (37:52):
Not no, I mean there has been some changes, But
that point about your early circumstances having this profound influence
on the rest of your life that remains true.
Speaker 1 (38:04):
Tell me about beer glasses in British pubs.
Speaker 3 (38:11):
I love this story.
Speaker 2 (38:13):
This is one of my favorite randomized trials that I
came across when I was writing the book. So this
is a story about a highly unlikely trial that was
done by a researcher called Jonathan Shepherd, who is still
actually a facial surgeon, and he noticed that a lot
of the people that he was treating with terrible injuries
(38:34):
had come from glass. Often these awful incidents where people
were glassings, where two people in a pub get angry
and somebody decides to shove what's in their hand, which
is like their pint glass, into somebody else's face, and
so they have these awful lacerations and life altering injuries.
And so he started thinking, well, what if we had
stronger beer glasses and maybe that would lead to less
(38:56):
glass injuries.
Speaker 1 (38:58):
Just to be clear, why is it better if if
that pub, if that glass that they're shoving into somebody's
face is tougher, it's less likely to shutter to shadow.
Speaker 2 (39:07):
So basically you might have been part of this unusual
randomized trial of beer glasses if you bought a pint
in a selection of pubs in the UK and Wales
around nineteen ninety eight. Because he got a selection of
pubs and bars to randomly, some of them were signed
to install toughened glasses and the rest carried on with
(39:28):
their normal glasses and managed to show it was a
bit of a complicated trail, but he managed to show
that indeed, having tougher glass reduced the number of glass injuries,
and this helped lead to momentum which encouraged the pub
industry to switch to toughened glass in the UK, leading
to or least associated with a drop in a glass injuries.
Speaker 1 (39:49):
Of like tens of thousands a year or something extraordinary
big number.
Speaker 3 (39:53):
Yeah, yeah, amazing.
Speaker 1 (39:55):
Somebody gave you, say, one hundred million dollars to fund
a study, any study you want. What would you do?
Speaker 3 (40:04):
Wow?
Speaker 2 (40:06):
Oh my god, Okay, that's that's I'm trying to think
of the question that I most want an answer to
for which there is no evidence. It has to be
something around parenting. I mean, okay, I'll give you an answer,
but I think it's a bit of a cheat because
it's sort of happening, which is around these social media
(40:27):
bans which are going on at the moment. I mean,
the UK is just introducing a policy to ban all
teenagers from social media, and it's already happened in Australia.
So I think the key, the key question, which evidence
curious people like me have and lots of researchers have,
is what's the effect. So I think a careful study
to understand the impact of those changes is really important.
Speaker 1 (40:49):
It was great to speak with you, and I appreciate
your work.
Speaker 3 (40:53):
Thank you, Thank you very much.
Speaker 2 (40:55):
No, thanks very much for your questions and thanks for
having me on the show.
Speaker 1 (41:04):
Helen Pearson is the author of the book Beyond Belief.
Please email us at problem at pushkin dot fm. Tell
us what kinds of shows we should do more of
or less of our particular people you think would be
good on the show. You can also find me on
x and on LinkedIn. Our show is produced by Gabriel
Hunter Chang and Trina Menino. Our editor is Lydia Jean
Kott and our engineer is Sarah Bruguier. I'm Jacob Goldstein
(41:27):
and we'll be back next week with another episode of
What's Your b
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