The contested nature of ‘the truth’

In healthcare, all we can do is gather evidence, analyse it, and see if an agreed conclusion can be reached

What are the consequences of telling the truth?  We all know that honesty is the best policy. Our teachers told us that all we have to do is tell the truth, then we won’t get into any trouble. Anyone with an even vaguely Catholic upbringing knows that if you let it all out in the confession box, your soul will be healed.

Hmmm. I’m not sure I believe them.

What happens when a perceived ‘truth’ turns out to be not quite so true? We are all used to philosophical arguments that cannot be proven in a scientific sense, particularly those around faith and theology. We know from history and experience how much conflict can be caused by the pitting of one religion against the other. “My god is better than yours” has kept the arms industry ticking over for centuries.

Some other ‘facts’ seem more certain, and for those of us with a scientific mindset, we tend to rely heavily on good old-fashioned evidence. We have our standardised experiments, our randomised double-blind controlled trials, our Cochrane reviews.

We can proudly announce, for example, that we ‘know’ that HRT causes heart attacks, and pregabalin is not addictive, and gastritis is best treated with a vagotomy… oh no, sorry, wait. None of that is entirely true. But it used to be. It used to be so true that we all believed it, for a while, and we managed our patients confidently with our fixed false beliefs imprinted in our brains. Until we were told, actually, scratch that, reverse, sorry folks, we might have been a bit wrong there.

When the first few people start to question a seemingly irrefutable fact, they get laughed at and cast aside as crazy folk. When a few more people start to do it, they are seen as heretics, and deemed to have nefarious and evil motivations. If a bigger group of people set themselves apart based on their disagreement with a generally accepted belief, they can gain momentum and become a legitimate participant in what is now termed a “debate”. They are blessed by the holy hand of broadcasting laws, where they are invited onto the esteemed evening discussion TV shows “for balance”. Their faces and opinions become engrained in our psyches and a little part of all of us started to think that some of what they’re saying must be true, otherwise why would they be on our telly?

It becomes more and more challenging to be sure of what is real, and true, and honest. Narratives are created around a single falsehood, a chance misperception, a nuance misinterpreted. The story builds around this grain of mistruth and develops into a solid shiny pearl, never to be interrogated or questioned again.

In healthcare, we are aware of the harms that fixed false beliefs can do. People can have an immovable idea about what a given symptom or diagnosis means. They are convinced that their dodgy tummy after an unnamed tablet at age 10 is evidence of a penicillin allergy, and will never again let a beta-lactam past their lips. The ‘double pneumonia’ they had in 1985 has set them on a path of believing they have ‘bad lungs’ (whereas if they had been told it was a chest infection, it wouldn’t have been half as scary).

There have also been multiple health ‘scandals’ over the years, which have merged into one in people’s minds. Some of these have been truly horrific acts of negligence or intentional harm. Some of these have been an inevitable result of the complexity of healthcare, with no malice or malpractice involved.

In all cases, people have found themselves to be harmed, and they naturally want to seek ‘the truth’. And yet, in a way, there is no such thing. All we can do is gather the evidence, analyse it, and see if we can reach an agreed conclusion. There will always be external factors at play, though. Those infernal vested interests we hear so much about. The people who want to keep something quiet. The people who want to make noise. The people who want to make money. The people who want to keep their money.

Apparently, it was US Senator Hiram Warren Johnson who said “the first casualty when war comes is truth”.

We are currently surrounded by some of the most heinous acts of violence the world has ever experienced. And rather than uniting in decrying the futility and inhumanity of such bloodshed, we are deafened by shouts of “my truth is truer than yours”.