Science, Rhetoric and the Creation of Preferred Realities

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The Greek philosopher Aristotle called rhetoric the art of persuasion. Greek rhetoricians were public speakers or orators who tried to persuade audiences to accept a certain point of view. Today, we tend to think of rhetoric in the context of politics. In the political arena, skilled rhetoricians do their best to persuade us that abortion or gay marriage is good for society or bad for society or simply neutral.

Rhetoricians are not constrained by facts or truth. Their goal is to get their audience to believe in a "preferred reality" -- that is, the reality they want people to believe. Because the goal of rhetoricians is to sway opinion, we don't usually think that rhetoric has much to do with science. We think of scientists as dealing with hard truths. The laws of physics speak for themselves.

Ben Goldacre presents a convincing argument that in today's world the line between science and rhetoric is becoming increasingly blurred. By presenting mainly positive data about a drug's safety and effectiveness, pharmaceutical companies attempt to persuade their audience (doctors and patients) to adopt a particular image of their drugs. They want to present the image of a medicine that has been proved safe and effective in numerous carefully regulated clinical trials. This image is a "preferred reality" -- the reality that the drug company wants us to believe. The whole truth about the drug would have to include negative data from clinical trials in which the drug was not effective or was even harmful. If drug companies revealed the downsides of a drug, including missing outcomes, doctors would have a different picture. They might not be so quick to prescribe the drug, and patients who heard the whole story might not be so willing to take it.

To be perfectly honest, most writers, including myself, present a preferred reality to their readers. It is only natural for a writer to selectively choose or cherry-pick outcomes in order to portray a certain image. -- Marilyn Wedge

To be perfectly honest, most writers, including myself, present a preferred reality to their readers. It is only natural for a writer to selectively choose or cherry-pick outcomes in order to portray a certain image. For example, in my recent book on family therapy as an alternative to psychiatric drugs for kids, I don't fill the pages with my most spectacular failures. On the contrary, I want to persuade readers that family therapy is an effective solution to a wide variety of kids' problems. Of course I primarily include cases in which my method has been successful. That means I must plead guilty to what Goldacre calls "selective referencing."

In my defense, my book does include one lengthy case in which I did fail to convince parents that family therapy was the best solution. These parents chose to take their son to a child psychiatrist for medication rather than stick with family therapy. Sometimes this happens. Family therapy can involve facing painful marital issues. Many parents feel too overwhelmed by the stresses and sorrows of modern family life to deal with these issues. As one mom recently put it, "I don't want to open that can of worms."

Overall, however, I have a fairly high success rate, partly because my clients are a well-filtered group. Parents tend to land in my office for one of two reasons. Either they have read my book, or their doctor has prescribed an antipsychotic for their child because stimulants or antidepressants haven't worked. These days, parents are willing to give their kids stimulants or antidepressants as easily as they give them baby aspirin. However, parents tend to draw the line at giving their kids antipsychotics after reading up on the side effects. Ironically, the thought of their child taking antipsychotic medications is a powerful incentive for parents to accept the relative discomforts of family therapy.

Even though family therapy, unlike many psychiatric drugs, can do no harm, Goldacre's argument has hit home with me. He has made me more reflective about my own work. It has helped me realize that I am not innocent of using rhetoric to get my readers to believe in a preferred reality. In my future books I plan to include more facts about the failures of family therapy and why they sometimes occur.

Aristotle believed that the art of rhetoric -- the selection and arrangement of data to strengthen an argument -- extends across all forms of human communication. Goldacre himself filters or cherry-picks what he presents in order to convince us of a preferred reality of his own. The difference between Goldacre and Big Pharma, however, is that Goldacre is self-reflective about the process.

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