SLPs, Agnotology, and Responsibility

In recent months, the United States has experienced a bit of a shock (now, don’t run away, this isn’t that kind of a political post…I promise). Amidst that shock was the discussion about fake news sites and how frequent sharing of those fake news stories, perpetrated the untruths about various political candidates, etc. Special interest was taken by Facebook and other social media about their role in stopping those fake news sites. What no one seemed to mention is that these fake news stories have been around for a long time. I don’t know about anyone else, but I’ve used to fact check many of those facebook stories that come around every few months for YEARS.

So…what does this have to do with speech-language pathology? Let me explain.

brain Recently, Tatyana Ellseff over at Smart Speech Therapy posted a link on her facebook page to an article about the spread of ignorance. I found it rather interesting and applicable on many levels for SLPs (I’ll explain that a bit more in a minute).

Anyone who knows me either in real life, or in the various facebook groups, knows I’m an avid believer of the need for evidence based practice and the caution we need to take with anecdotal evidence. I’m also huge on asking for the research to back popular treatment methods such as PROMPT, Talk Tools, NSOME, Taping, etc. Usually those requests are met with the sound of crickets interspersed with “but it worked for me” disclaimers and the occasional links to research created by the companies themselves.

The article talks about how purposeful misinformation is commonplace. According to the article, the tobacco companies purposefully glossed over how harmful tobacco products were. They did this because the most important thing in to them, was the money. Now of course, there are huge lawsuits with the tobacco industry because we know how harmful and addictive the products are.

Reading the article linked above it really hit home that this encompasses the difficulty within our field fairly well.  “Agnotology is the study of wilful [sic] acts to spread confusion and deceit, usually to sell a product or win favour.” The tobacco companies aren’t the only ones guilty of agnotology. I firmly believe that there are companies that create products geared toward our clients who are also guilty of purposeful misinformation in some degree and I believe that there are many well-meaning SLPs who inadvertently encourage it.

Now before you start getting out the tar and feathers, No, I don’t think there are SLPs who are purposely setting out to defraud millions of clients. But I do think there are many SLPs who fall into the trap of believing misinformation perpetrated by companies/individuals and by providing anecdotal evidence encourages other SLPs to fall into that same trap.

The article states “Dunning warns that the internet is helping propagate ignorance – it is a place where everyone has a chance to be their own expert, he says, which makes them prey for powerful interests wishing to deliberately spread ignorance.” Now, I’m NOT saying we should ban facebook groups for SLPs, actually, I’m saying just the opposite. We need to engage in the FB groups BUT we need to do so responsibly. I believe this is a three-fold responsibility.

  1. We need to THINK CRITICALLY. This means that we are skeptical of everything that crosses our path (skepticism is a GOOD thing – it helps keep us from being easily fooled). We need to really consider the theory behind the products that are being so widely marketed to us. Is the product based on theory? Does the theory make sense or does it seem to the the opposite of what is accepted theory in the field? Does it seem to good to be true (if it does – it usually IS)? Does it promise a fix? (There is a reason why in our code of ethics we are prohibited from promising an outcome – it’s not ethical to play god or seer or … whatever. No promises – ever!) Before buying that product – LOOK – and I mean REALLY LOOK at what it is saying. Is it possible that the same results can be achieved in a different way? Is the reported “research” actually based on good research design, done by an outside source with no financial gain?
  2. The second thing we need to do is stop accepting facebook discussion as an endorsement. I often see what appears to be SLPs and SLPAs using facebook as a sounding board to ask a question – and then taking those answers and running with them as the solution to a problem. Now, I think it is fabulous to get ideas from facebook – and I have learned some things from the various groups (often, what I’ve learned is that I don’t know enough about a subject to speak up about it and I need to go do some research). But in no way, is it okay to take facebook answer at face value when it comes to our clients. I mean, consider it objectively – would you want a medical doctor versed in Facebook or one versed in research? We cannot hold others to a higher standard than we are willing to hold to ourselves.
  3. Do the research. There is NO substitute for actually reading, applying critical thought, and questioning the research we have available. Yes, it is time-consuming, yes, it’s a lot of work…I get that, I really truly do…But it is your RESPONSIBILITY as a speech-language pathologist to do it. There are so many options available. The Informed SLP is a wonderful resource. Meredith takes research on a given topic, compiles it, and summarizes it into nice palatable bits.  If you haven’t already signed up for it – do so now, I’ll wait. Once you’ve read the research, it is your job to question it. Email the authors if you must. Discuss it on Facebook. ASK QUESTIONS.

We have an ethical and moral responsibility to do what is right for our clients. That means no more relying on anecdotal information. Yes, I hear you…”anecdotal evidence has a place in the EBP triangle.” However, it really doesn’t because anecdotal evidence is NOT clinical expertise – clinical expertise requires actually critically considering all aspects of a clinical treatment not just “it works for me” but WHY it works). I have a theory that the reasons these marketed products/techniques are SO successful is because 1) we are desperate to help, 2) we’re afraid to show that we might not have all the answers or don’t know what we’re doing, and 3) they make it seem easy and sometimes therapy is hard! In the land of high-caseloads and idiotic productivity requirements, I get it…I do. But we have a responsibility to stop allowing ourselves to fall into agnotology and do what is truly in the best interest for our clients.

I strongly encourage all of you – even at the schools level – to look into actually doing research. Those of you that are trained in a special technique/tool usage, etc. pair up with a researcher (there’s a link on ASHA’s website) to do case-studies or something or do it on your own (that works too!) … yes, a single case-study is weak, but it’s that much higher than anecdotal evidence. Do something instead of compounding the purposeful ignorance perpetrated by many marketed products. Those companies don’t want you to look closely at them because if you do you won’t line their pockets by buying their products!

We all have the choice of following the fake news stories. (Thank goodness!) Now it’s time to stop adding to the “fake” SLPs and their misinformation and reclaim our roles.

I’d love to hear your thoughts on this subject. Is misinformation a problem within our field? If so, what do you think we, collectively, can do to help stop pandering misinformation?   Drop me a note here.

Until then…Adventure on!




4 thoughts on “SLPs, Agnotology, and Responsibility

  1. Thanks Mary for an interesting post to begin 2017. I’ve learned a new word “agnotology”. There is a place for anecdotal evidence and single case-studies. I see them as jumping off points to investigate further. At the very least if either of these evidences lead us to reflect on our practice it’s a good thing.

    • Agreed. Reflection is a very good thing. One of the reasons I have my clinical students fill out reflection logs of their therapy sessions is specifically to see no only what went well/didn’t go well, but WHY. How else can they grow as clinicians. We, as experienced clinicians, need to reflect on what we do – what works/what doesn’t and WHY. That WHY does it work bit is particularly important. Thanks for the comment.

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