Pharmacists are crucial in providing both the optimum delivery of pharmacotherapy and clear scientific information to physicians and patients alike. But to what extent are student pharmacists equipped to promote evidence-based information given the prevalence of low-quality health content that is often easily available online?
Jasińska-Stroschein et al (2020) undertook a questionnaire-based investigation of 195 Polish pharmacy students to determine their susceptibility to popular myths about human health and treatment. They found that several false beliefs persisted, despite attending the relevant courses during their education; including, for example, false beliefs related to folic acid absorption, or the correct storage of opened insulin pens, or the iron content of spinach. Jasi˝ska-Stroschein et al (2020) conclude that ‘[m]ore attention should be given to evidence-based medicine skills, including the selection of proper scientific information and the adoption of a critical perspective towards all transmitted information among student pharmacists.’
However, the challenge to adopt a more critical perspective not only applies to pharmacy students but to all healthcare professionals. Take the phrase ‘lower levels of serotonin’. Cameron (2007) argues that it is unscientific: ‘Perfectly healthy people adopted Prozac as a recreational drug, apparently reasoning that if raising serotonin levels made depressed people happier, it would take those who were not depressed to the heights of ecstasy.’ The inference, writes Cameron (2007), is that more serotonin equates to more happiness, and thus misunderstands both how selective serotonin reuptake inhibitors work and the nature of clinical depression. Yet Cameron (2007) fails to criticise the misuse of the word ‘levels’ in the phrase under consideration when what is meant is ‘concentrations’. As Davison (1995) points out: ‘The word “level” means horizontal and not “concentration”. It can be used, however, when the concentration of a substance remains constant and unchanged.’
This might be nitpicking, but as Pruneski (2018) indicates, concision is helpful since ‘overcoming the complex and technical language used in science is a major barrier to scientists being able to communicate their work with the general public’, and he describes the challenge of communicating a message in a form that uses only the 1000 most commonly used words while still maintaining its meaning. Such exercises are useful, especially in our postmodernist world where bogus assertions often achieve respectability. This was neatly demonstrated when Sokal (1996) submitted a deliberately contrived piece of nonsense to a widely read journal. The hoax paper was accepted and published.
Given the current COVID-19 pandemic, one might expect the definition of basic terms to be agreed, especially if the interpretation of data based on these definitions can influence global governmental policies. However, this does not always occur. For example, according to the European Centre for Disease Prevention and Control (ECDC) a person meeting at least one of the symptoms of cough, fever, shortness of breath and sudden onset of anosmia, ageusia or dysgeusia is defined as a possible case; whereas a confirmed case is someone in whose clinical specimen SARS-CoV-2 nucleic acid is detected by the polymerase chain reaction (PCR) test (ECDC, 2020). Yet Mahase (2020) cites the observation of Professor Carl Heneghan – director of the Centre for Evidence Based Medicine at the University of Oxford and the editor of BMJ Evidence-Based Medicine – that ‘We are moving into a biotech world where the norms of clinical reasoning are going out of the window. A PCR test does not equal COVID-19; it should not, but in some definitions it does.’ In the context of what have been reported as increased numbers of COVID-19 ‘cases’ in England in July and August this year, such conflicting perspectives create confusion. Mahase (2020) notes that both Heneghan and Dr Angela Raffle – honorary senior lecturer in social and community medicine at Bristol Medical School – agree that ‘it's hard to compare the figures on cases over time because the way we define a case seems to have changed, moving from people with symptoms who have then tested positive to a PCR positive result alone, regardless of symptoms.’
‘It is clear that without a questioning attitude to the meaning of apparently self-evident words and phrases in the scientific lexicon, confusion could arise’
Whether ‘low serotonin levels’ or COVID-19 ‘cases’, it is clear that without a questioning attitude to the meaning of apparently self-evident words and phrases in the scientific lexicon, confusion could arise, damaging both patients' health and the reputation of science.