Accepting That a Square Peg Fits in a Round Hole:
How Cognitive Dissonance is Killing Medicine
by Jason Latsky
I am sure you have all heard that you can't "fit a square peg into a round hole." Obviously, as critical thinkers, we would immediately question what the relative sizes of the hole and peg were, the angles, etc. and find a solution as to how we COULD fit a square peg into a round hole. After all, it's what we do daily: think outside the box to come up with well-thought out logical solutions to fix problems we face.
Throughout our studies, we receive constant practice and are ferociously trained to tame the beast that threatens to ruin us all: cognitive dissonance. From year 1 in medical school, in every Ethics class, and even psychology training, we learn how our preconceptions, cultures, and experiences shape the knowledge and facts we acquire over our lifetime and affect the outcome of our thought processes and decisions. Years of exercises in critical thinking, evidence analysis, and exposure therapy train us to recognize, assess and CORRECT those inborn errors. But most other people, many of them our patients, are not so lucky. They do not receive such training, leaving all of their problem-solving power in their hands, with Google at their fingertips.
"Chemtrails." "Vaccines cause autism." "Antibiotics are the devil." "Natural is better." We have heard it all. These topics are intimidating for many doctors, but unfortunately they come up more often than we would like to think they do.
Let me tell you the story about a doctor. We will call him Dr. Joker. A patient of mine told me about this new alkalized water filter that she was using and how it cured everything under the sun for her, such as her lack of energy, sex drive, headaches... You name it! I was intrigued at first, because as a true academic, I never approach anything with a closed mind. I listened to her tell me about the "data" and "theory" behind the filter, and how drinking water that was at a pH of 8 was so healthy for you. Anyone who remembers basic high school chemistry would immediately realize the error here but I humored her anyways. She led me to Dr. Joker's site, and my investigation led me to a realization: He was teaching people to put square pegs in round holes, and they were OK WITH IT. A combination of bait & switch and a new technique that I would like to coin here that is rampant in pseudo-scientific literature; one that hijacks our most basic instincts in pattern recognition and cognitive dissonance: An appeal to laziness.
Dr. Joker explained the basics of alkalinity and acidity, what pH was, and gave a basic run-through of acids and bases. He was 100% accurate with these explanations, and that was the bait. Then, his "research" stated that alkaline foods cure cancer and he explained that since alkaline foods and substances are so good for you and are "backed up in the literature," then through an appeal to laziness, so must alkaline water. "This is why you must buy my filter! Alkaline environments stop cancer in its tracks, and you need it NOW!"
I was furious. How could anyone be taken advantage of so easily? But when you analyze the situation, it's easy to see how. It's the same for the anti-vaxxer, the ‘chemtrails' conspirator, the ‘Food Babe' army, and the Marches Against Monsanto. They're all appeals to laziness using bait & switch.
Dr. Joker lures you in with ACCURATE scientific information, then jumps to unfounded claims that people miss. He introduces his research about "alkalized foods," and if you accept that research as fact, it makes total sense! He puts the square peg in the round hole. You see it go in and say, "What could be wrong? It went in the hole!" But that is where laziness comes in. A quick Google search will bring up hundreds of results of blog posts, articles, and advertisements that ENDORSE these unfounded claims. You have to work much harder to find the actual truth, and many people don't bother with such efforts.
The way many people resolve cognitive dissonance is by finding one study to support their idea and then ending their search. They don't truly know how to interpret the data and don't care about accuracy and validity. They're satisfied that it is there and published. If I can lure you in with a tad of real science and then switch it out for pseudoscience without you knowing, I can make millions! And that is just what Dr. Joker did.
Patients susceptible to this kind of thing will come in with mountains of questionable data, flawed studies, and biased evidence. They will tell you that YOU are wrong and that their square peg does indeed fit into the round hole. It's up to us to say, "Indeed it does, but does that make it correct?"
Our job as physicians is to try to discover and describe the truth as accurately as possible, without bias and without cognitive dissonance. We cannot be lazy. The truth is there for those who want to find it, and we must earnestly strive to discover it every day. It is not convenient. It is not fast. It is not easy. It does not fit into every hole you put it in; only the correct one. We put square pegs in square holes because that is where they TRULY belong. We cannot convince patients that the square peg DOES NOT FIT into the round hole because sometimes, it does. All we can do is try and teach and enlighten them to discover the beauty in Truth in the hopes that we can make them understand that even though the square peg sometimes fits, it is NOT where it belongs. We must continue to help them find the correct round peg, even if we ourselves have not yet found it.
Supplemental Note: Definition of ‘Cognitive Dissonance' from Merriam-Webster.com: Psychological conflict resulting from incongruous beliefs and attitudes held simultaneously.