Denialism is a new word to me. I didn’t have to Google it to figure out what it meant; that was easy. I deduced the word was defined as the act of denial, probably in the face of facts. When I did Google it, sure enough, many options to explore denialism popped up, including a Wiki entry. (You know you’ve made it when you have a Wikipedia entry.)
Mark Hoofnagle is one of three authors who write the “Denialism Blog.” (Chris Hoofnagle and PalMD are the other two.) Hoofnagle’s bio says, “Mark Hoofnagle has a(n) MD and PhD in physiology from the University of Virginia, and is now a general surgery resident. His interest in denialism concerns the use of denialist tactics to confuse public understanding of scientific knowledge.” I like the subtitle of the blog: “Don’t mistake denialism for debate.”
Hoofnagle has outlined six tactics that might be used to maintain the appearance of legitimate controversy;
- Conspiracy - Suggesting opponents have some ulterior motive for their position or they are part of some conspiracy.
- Cherry picking – Picking apart a critical paper supporting their idea, or famously discredited or flawed papers meant to make the opponents look like they are based on weak research.
- Contextomy - Using a statement out of context to further their position.
- False Experts - Paying an expert in the field, or another field, to lend supporting evidence or credibility.
- Moving the goalpost - The use of the absence of complete and absolute knowledge to prevent implementation of sound policies, or acceptance of an idea or a theory.
- Other logical fallacies - Usually one or more of false analogy, appeal to consequences, straw man or red herring.
Denialism is spreading in our country. From the “birthers” who don’t believe Obama is an American citizen to the continued denial of the Holocaust, standing on the moon and that HIV doesn’t cause AIDS. Depending on where you stand, the other side looks foolish, if not downright stupid, to believe in such absurd ideas. Denialism isn’t just not believing something, but not believing in the face of scientific, hands-on, well-studied and multi-checked facts.
This begs the question, whose facts are to be believed?
In the birth world, denialism meets evidenced-based medicine.
Evidence-based practice is a common request from those in the natural birth arena. We want an end to continuous fetal heart monitoring and keeping women from eating or drinking in labor because numerous studies show they do not improve outcomes. What if the research counters what the natural birth community believes and wants to continue doing? Many different studies have proven that the Active Management of Third Stage is safer for women, yet midwives and their clients insist on the Physiological approach. Natural birth advocates get all up-in-arms about allopathy continuing routines that have been disproven over and over, yet we do the exact same thing. Who’s in the wrong then?
There is no scientific evidence that homeopathy works. Yet midwives embrace it wholeheartedly. There is no scientific evidence that says keeping a woman in bed improves outcomes, yet hospitals continue with this practice… even when there is contrary evidence saying it might be detrimental. Why do we expect them to accept our quirks if we aren’t able to accept theirs?
Shifting sideways some, denialism takes a different form when discussed in the natural birth context. To me, one of the greatest forms of denialism comes from the Unassisted Childbirth (UC) faction. While no studies show the dangers of a UC (reporting would be self-disclosing and therefore difficult to measure), anecdotally, one simply needs to look at the UC boards at MotheringDotCom (MDC) to see the extremely high rate of affected babies to come to the logical conclusion that perhaps UCing isn’t such a good idea after all. In my own life, I have known of two babies that died during a UC. I have never known of a baby that died from the lack of a medical team’s care (meaning from a baby being left to perish without a team working to keep the baby alive). When babies die in the hospital, it is almost always because of congenital or prematurity issues. Rarely, full-term, pregnancy-healthy babies die. There are stillborns in each category, but monitoring absolutely can alert a care provider to act to help a baby birth alive. (And not just continuous monitoring.) When tragic things happen on MDC, the women soothe each other, finding ethereal reasons for the tragedy; she didn’t think positively enough, it would have happened in the hospital anyway or it was the baby’s time. It’s heretical to say, “Maybe you should have gone to the hospital sooner” or even, “I wonder what would have happened if you’d had a midwife there.” Women go out of their way to help a mother not feel guilty for her choice, believing she already feels guilty enough, but in their comforting, they are leading the acolytes to believe it would have happened no matter where the woman was.
Of course the medical folks use these same arguments with homebirthers, saying that it’s a risk to deliver at home without continuous monitoring and the capability of an operating room to facilitate a cesarean in the case of the rare emergency. They surely believe Natural Birth Advocates (NBAs) are denialists, too. They point to studies that demonstrate that homebirth is absolutely more dangerous for babies. The major study, sometimes referred to as The Pang Study, has been de-bunked by several professional NBAs, yet is still quoted by med folks. When studies support homebirth as a viable option, factions of researchers and physicians attack methodology. NBAs do the exact same thing; it’s a war of the statistics. What’s amusing to me is when the study benefits either side and is hailed as the latest proof that they are right. No consideration is made regarding methodology then; it’s obvious the study is perfect when the beneficiary needs it to.
Denialism takes many forms… depending on your viewpoint. Pick any hot button issue and you find divisiveness that accuses its counterpoint of denialism: Homebirth/Hospital birth (including UC), ultrasounds, vaccinations, circumcision, naturopathic remedies/medications, television, cell phones, microwave ovens, shampoo, global warming… and on and on. (Interestingly, I hardly hear about a computer’s possible negative effects.) As mentioned above, a plethora of studies demonstrate the scientists’ point of view regarding controversial topics; a few studies do the same for the natural community. Each believes they are right and the other is wrong. Who is right? How do we separate the wheat from the chaff? Do we tend to be on one side or the other depending on how we were raised (similar to choosing religion or political parties)? Did homes that fostered individual thinking produce open minds that can embrace alternatives even when they have no scientific proof? Are there personalities that lean one way or the other? Are left-brained thinkers more apt to live a scientific life? (Of course there is a range from far left-brained to far right-brained folks.) I would love to see a study about this.
Does denialism equal lying to oneself? Or might it be simply looking at a topic, squinting and turning your head sideways to justify your thoughts.
I tend to be somewhat balanced between the two poles. (At least I like to think I am.) Looking at me from the natural vantage point, I am sometimes considered a medwife. I do not struggle with “interventions” when they are called for. I don’t hesitate to send a woman in for medications if she can heal quickly from them. Yet, I also advise natural methods of healing –from supplements to acupuncture- things that are often poo poo’d by the medical community. To them, since I am a homebirth midwife, I am seen as a kook. It’s definitely a balance walking between the two. I often joke about being the tie-dye and Birkenstock-wearing midwife who wears make-up tested on animals and who’s been known to eat too much McDonald’s. I love that I have a wide range of friends… from Christy Funk who owns the natural mom and baby store Belly Sprout to the most medicalized CNMs and family members. I believe walking on both sides of the line helps keep me balanced, looking at both sides of most issues and forcing me to keep an open mind.
Yes, as we all know, it’s the open mind that can pull our pendulum hard towards one direction or the other. A conundrum we all struggle with… and rarely perfect.