“Bad Advice” by Paul Offit – a book review by Dorit Rubinstein Reiss

A new book, “Bad Advice: Or Why Celebrities, Politicians, and Activists Aren’t Your Best Source of Health Informationby Dr. Paul Offit, is different from his previous writings in two ways – much of it is autobiographical, with a lot of personal anecdotes, and it is about science communication rather than the actual science.

“Bad Advice” opens with a story of a 1997 TV interview Dr. Offit has, and how he bungled – by his account – a question about which vaccines children get, how many, and when. The story sets the tone for the book – it’s funny, it’s candid about what Dr. Offit did, in his view, wrong, and it offers sound advice for other science communicators.

To a large extent, this book was written for those engaged in science communication, and it is full of tips that can help every current or would-be science communicator.

What gives the book its charms are the anecdotes and the humor sprinkled throughout it, and its accessible and conversational tone, but I don’t think I can mirror that here without spoiling the effect – I think these are best enjoyed in context. So this review describes the content but does not capture what makes “Bad Advice” so much fun.

For full disclosure, I highly admire Dr. Offit, have sought his advice and help on many issues in my writing on and advocacy related to vaccines, and consider him a personal friend. I have also read a draft of the book and provided comments. 

Why Science Communication?

The first three chapters of “Bad Advice” provide important background by explaining why science communication is needed, and some of the obstacles to it. 

The first two chapters of the book set out what science is and what scientists do, and why their training and background make it difficult for them to be effective science communicators. Among the things covered – again, with a lot of humor, humility, and personal anecdotes – are that much of the scientific work is done alone, and much of what it requires makes people less, rather than more, suited to work with people. 

Dr. Offit discusses the fact that the scientific method trains scientists away from using absolute statements, but qualified statements can backfire when communicating about science; the challenge of reducing complex, nuanced reality into sound bites that work in a digital age; and more.

The next chapter analyzes why we need science communication, why people – however smart – may fall for misinformation. It looks at several natural, human features that make us easily wrong on scientific issues. “Bad Advice” also examines our difficulty identifying and assessing risks, the pull of celebrities as authority figures, even though they may not have the background to provide good information, and may, in fact, promote bad information (for example, Robert F. Kennedy Jr.  – revisited later in the book – constantly provides bad information about vaccines  ). The chapter also talks about other limits on the ability of humans to think rationally and the ways we acquire knowledge.

After thus setting the stage for why it’s important to engage in science communication and some of the challenges, Dr. Offit is ready for the next stage.

Good advice vs bad advice

Chapters 4 through 7 offer direct advice on communications through personal anecdotes of things that worked and things that didn’t in Dr. Offit’s over 20 years of doing it.

In chapter 4, Dr. Offit offers “some painful, hard-earned, and occasionally humorous lessons gleaned from personal experience” on communicating with the public. These range from the deeply practical (“be comfortable”) to the content based (“be sympathetic,” in the context of an eleven-year-old diagnosed with AIDS at the time when HIV was a death sentence, and “Don’t panic.

The facts are your safety net.”). But they’re invariably written as amusing anecdotes leading to a useful punchline. In one of the stories, Dr. Offit describes how he arrived at the famous “10,000 vaccines” quote that anti-vaccine activists like to misuse. The punchline? “You are going to say things that, although scientifically accurate, you will regret. It’s unavoidable.”

Chapter five addresses whether it’s appropriate for scientists to debate science deniers, using several examples. Dr. Offit’s recommendation is to avoid it, but he does provide three successful examples of such debates. His conclusion is that he, personally, is too angry and passionate on vaccine issues to successfully participate – because he annually sees children die from preventable diseases, “invariably, .. because parents have chosen not to vaccinate their children. And the reason they had made that choice was that they had read or heard bad information..”

Bad Advice ends with a recommendation that “debating the undebatable is worthwhile,” if, and only if, scientists can see the discussion as a teachable moment, and not focus on the people they are debating or the others in the room.

I’m not sure I agree, at least in terms of a televised debate. I think Dr. David Gorski said it well when he wrote:

…debating cranks doesn’t sway anyone, sharing the stage with a real scientist does unduly elevate the crank in the eyes of the public. Besides, whatever the seeming outcome of the debate, you can count on the crank to declare victory and his believers to agree. In any event, science isn’t decided by the metrics used to judge who “wins” a public debate, which rely more on rhetoric and cleverness rather than science to decide the outcome. Finally, such debates are not without risks. Although Julian Whitaker, for example, was terrible at it, other cranks are adept at the Gish Gallop, and an unprepared skeptic or scientist can be made to appear clueless in front of a crowd that is almost always packed with supporters of the crank, not the skeptic.

I think I agree with Dr. Offit’s initial position that agreeing to a debate is a bad idea.

Chapter six looks at the role of comedians in combating misinformation about science, focusing on vaccines – covering the Penn and Teller episode, Jimmy Kimmel, the Daily Show and the Colbert Report. And I’m really going to let you read that by yourselves. It’s fun.

Chapter seven looks at the ways the cinema helps or harms science communication. It opens by comparing two films about outbreaks – “Contagion,” that got the science right, and “Outbreak,” that did not. To give a flavor, when talking about “Outbreak,” Dr. Offit describes how a monkey carrying the harmful virus was caught, and the movie scientists had to “determine which antibodies are neutralizing the mutant virus, synthesize those antibodies, and make several liters of life-saving antisera. Assuming everything goes well, Hoffman’s task should take about a year. Cuba Gooding Jr. does it in a little less than a minute. (Now I understand why people are angry that we still don’t have an AIDS vaccine.).”

Nonetheless, Dr. Offit sees an important role for movies in science communications, and urge scientists to work with filmmakers to get it right.

Science communication in action – confronting the anti-vaccine movement:

The last part of the book uses the anti-vaccine movement as a story of the pitfalls and successes of science communication.

Chapter 8 of “Bad Advice” looks at how charismatic figures can promote anti-science misinformation. Although it covers several examples, the heart of the chapter is the case of Andrew Wakefield, the British doctor who promoted misinformation about MMR. Dr. Offit tells the dramatic story of Wakefield’s rise, the scientific literature that showed him wrong, and the discovery of his misdeeds, that led to his fall. He describes Wakefield’s situation today – thoroughly discredited, on par with other conspiracy theorists – through his participation in the infamous Conspirasea Cruise.  The end of the chapter examines different explanations for why Wakefield sticks to his original claims, years after they’ve been thoroughly disproven. I’ll let you find out yourselves. It’s not exactly flattering to Wakefield, though. 

Chapter 9 looks at the role of politicians in promoting anti-science misinformation, focusing on Dan Burton’s hearings that tried to make a case that vaccines cause autism (YouTube snippets of the hearings, out of context, are still used by anti-vaccine activists. Dr. Offit will give you a more comprehensive view). Dr. Offit also tells of his own experience in the hearing, and what he sees as errors committed because of his naiveté and inexperience. It’s half sad and half comical to read through both his preparation for the hearing, and the actual experience of Mr. Burton, who came into the hearing with a set conclusion and a set role he wanted Dr. Offit to play, trying to delegitimize him. 

Chapter 10 warns science communicators to expect a campaign of personal delegitimization and attacks, drawing on Dr. Offit’s own extensive experiences with anti-vaccine efforts to attack him. It goes from hateful emails, through lawsuits, to death threats. It’s painful but incredibly important for people who go into these areas to be prepared for the ugly reaction from misguided but passionate people on the other side, in all its extreme forms. 

Chapter 11 goes more deeply into Dr. Offit’s own reasons for entering the fray. It is very autobiographical (some of the events in it were described in some of Dr. Offit’s other books, but many will be new to readers), telling his career story – again, with lots of humor, more than a few lumps. This is to explain what motivates him to speak up, and to some degree, to counter the claims accusing him of having a conflict of interests because of his involvement in the creation of the rotavirus vaccine. It’s a powerful chapter.

Chapter 12 ends on an optimistic note, pointing out things that have improved in the war for science – the rise of science bloggers, the better attitude of the media. And in the epilogue, Dr. Offit ends with the March of Science, as an embodiment of the willingness of science supporters to fight back.

Takeaway

In this very autobiographical, often humorous, extremely candid and full of good advice book, Dr. Offit does a service to science communicators by telling them what worked, what didn’t, and some thoughts on what comes next. You may not always agree with his advice, but you are very likely to agree with large parts of it, think about much of it, and enjoy the way it’s delivered. It’s a very fast read, and worth reading and probably rereading. And rereading.





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Dorit Rubinstein Reiss
This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy and the law. 

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.