To hear Oliver Sacks tell it, writing books for a mass audience was once considered one of the worst things a doctor could do.
In his new memoir On the Move, Sacks recalls the day his first book was published in 1970. Born in 1933 to two prominent doctors, Sacks happened to be staying in his family's London home at the time.
"My father came into my bedroom, pale and shaking," Sacks writes, "holding the Times in his hands. He said, fearfully, ‘You’re in the papers.’" The article in question was actually a glowing review of Sacks's book, Migraine. "But so far as my father was concerned, this made no difference; I had committed a grave impropriety, if not a criminal folly, by being in the papers." At the time, popular writing by physicians was viewed as something vulgar, perhaps even a breach of medical ethics.
Nowadays, of course, that's changed. Thanks to the work of Sacks and others — as well as to systemic shifts in science communication — doctors and medical researchers are often encouraged to communicate with a broader audience. Atul Gawande and Jerome Groopman, both doctors, are widely respected staff writers for the New Yorker. Indeed, as Sacks tells it, even his parents eventually accepted his career as a best-selling writer as the glowing reviews kept coming in.
But the story of how those attitudes morphed is an important one. For much of the 20th century, doctors and scientists who appealed to the public were derided by their peers, seen as popularizers who watered down knowledge and exploited patients. The shift was an uneasy one, and many scientists and doctors — including Sacks himself — still aren't entirely comfortable with the results.
How scientists learned — grudgingly — to love pop science
"The tension that permeates Sacks’s book is one that has historically permeated science itself over the value of popular communication of scientific ideas," says Declan Fahy, a communications professor at American University and the author of The New Celebrity Scientists.
Until very recently, Fahy explains, scientists who engaged in public communication were seen as "second-class scientists, doing a lower form of work." Carl Sagan, the astronomer and great popularizer of science, was famously lambasted by his peers, and denied tenure at Harvard University and membership to the National Academy of Sciences.
Many scientists believed it was impossible to be both a first-class researcher and a popularizer. They spoke of "the Sagan effect" — the notion that as a scientist spends more time communicating to the public, the quality of his scientific research goes down. As it turns out, the Sagan effect was actually false, notes Fahy:
"[Sagan] published an average of about one peer-reviewed paper a month." Research has even uncovered a link between being active in the media and being a well-published academic. Still, for a long time, the stigma stuck.
Starting in the 1970s, however, researchers were increasingly facing pressure to demonstrate the broader value of their work in order to attract research funding. And bringing public attention to that work through the media, Fahy said, was one way "to enhance public legitimacy of their work." Suddenly, scientists started fretting less about the Sagan effect and started thinking more about how to communicate with the public.
Nowadays, hospitals and research institutions keep track of media mentions as closely as they count peer-to-peer journal citations. The two are often related: several studies have found that when research is mentioned in the lay press, it’s more likely to be cited in scientific literature. On top of that, most medical and scientific institutions have begun training their staff in communicating with the media.
Fahy referred to this as a "democratic argument" for public engagement. "Citizens in many cases pay through tax money for their research, and citizens live with the results of the research, so scientists have this duty to engage citizens." This push to publish — or even hype — academic work in the press was furthered in the 1990s, when the National Science Foundation began requiring scientists to show that their work had a broader impact outside of science.
It's easier than ever for scientists to communicate with the public
Jeremy Greene, an associate professor of the history of medicine at Johns Hopkins, explained that there have always been scientists who popularized, even very early on. Louis Pasteur used the press to attract attention to his findings. "He knew how to make his experiments media events," Greene said.
But what’s different now, he added, is the sheer volume of interactions. In the beginning of the 20th century, newspapers began including science and health sections. As we move from print to digital, there’s no end to the space we can fill with science and health information audiences are hungry for.
"With that expanding volume comes more demand for content and more space for [scientists and doctors] willing to engage with general public," Greene said.
"There’s no one thing that caused the transition," Bruce Lewenstein, a Cornell University researcher on the public communication of science, summed up. "But it’s part of a general movement that has been growing since World War II. So Oliver Sacks’s career started in early 1950s, and it’s not surprising to me that it’s something he felt early in his career. He really has lived through a tremendous change in the culture, and he’s been part of it."
The rise of popular science still has plenty of critics — and potential downsides
Yet even as scientists were increasingly becoming comfortable with speaking with the public, many were finding serious potential drawbacks to this new age.
For instance: one factor that drove the proliferation of popular science communication in 1980s and '90s was the growth of the biotech industry, says Lewenstein. This was an industry hungry for publicity and attention, and that worried some researchers. "There were a great many scientists who objected, who thought that biotech was engaging in hype, and there were worries about what was called science by press conferences," he said.
Others have expressed worry about the rise of showmen like Dr. Oz, a cardiothoracic surgeon who has faced heavy criticism for making unscientific health claims on his widely viewed Dr. Oz Show. "He’s a one-man morality play about the temptations of mammon and the seduction of applause," Frank Bruni wrote in the New York Times, "a Faustian parable with a stethoscope."
Oz certainly isn't the only MD to use his white coat to influence the public's health habits for the worse. The Common Sense Book of Baby and Child Care, the best-selling tome by the American pediatrician Dr. Spock, encouraged mothers to put their little ones to sleep on their abdomens, despite the emerging evidence that this increased the risk of sudden infant death syndrome. Today, Dr. Bob Sears, a California-based pediatrician, is the author of the The Vaccine Book, which is both the top-selling children's health book on Amazon and essentially an anti-vaccine guide.
Even Sacks has his critics. One fellow scientist, according to the Washington Post, savaged Sacks's use of patient stories in his 1985 book The Man Who Mistook His Wife for a Hat. The scientist called Sacks "the man who mistook his patients for a literary career."
In a Wired profile about Sacks, science writer Steve Silberman describes this tension between Sacks and science. He pointed out that Sacks's tendency to value storytelling over data "pushed against the tide of 100 years of medical practice." After all, modern medicine has differentiated itself from the healing arts of the past by embracing science. A scientific approach to medical care — well-designed experiments such as randomized control trials — has given us life-saving surgeries, life-sustaining antibiotics, and vaccines. In many ways, Sacks's reliance on anecdotes felt like backsliding.
"The compiling of detailed case histories was considered an indispensable tool of physicians from the time of Hippocrates," Silberman explained. "It fell into disrepute in the 20th century, as lab tests replaced time-consuming observation, merely 'anecdotal' evidence was dismissed in favor of generalizable data, and the house call was rendered quaintly obsolete." Through his writing, Sacks embraced the former. That helped him find a public audience. But it made some of his peers uneasy. As Sacks writes in On the Move, he was met with suspicion by his fellow neurologists. "I had, it seemed, defined myself as a 'popular' writer, and if one is popular, then, ipso facto, one is not to be taken seriously."
Scientists and doctors are still grappling with the tensions around pop science
There are vast differences between Oliver Sacks and someone like Dr. Oz, of course. "Someone like Oz starts their career as a scientist, but what he is now has nothing to do with the production and circulation of new science. He runs a media empire," said Greene. "Sacks is the introspective physician-writer who finds writing as something he needs to do that is inescapable from his identity as a physician."
Still, in many ways Oz embodies the problem that Sacks was anxious about his entire career. (In his memoir, Sacks notes that after the New York Times published a 1971 article about his research, lots of people wanted to seek out his medical advice. He felt it was improper to profit off of his celebrity in this way, "since this would be profiting, in a sense, from a newspaper article.") There's always going to be the potential for abuse as more and more doctors and scientists try to communicate with the public, using their authority and white coats to influence public thinking. This is a question that the medical and scientific communities need to grapple with.
Recently, eight of Dr. Oz's colleagues at Columbia University wrote an op-ed in USA Today trying to think through this conundrum. "What happens when a doctor's job in media-medicine collides with office- or hospital-based medicine?" they asked.
Their conclusion was not that doctors should be silenced or stop engaging in public discourse. After all, we want scientists and doctors to come forward and enrich the world outside the clinic and lab with their views. People like, for instance, Oliver Sacks. But that means these professions need to find a way to encourage and enable intelligent debate about medicine and research, and prevent hucksterism and hype.
Some are trying to push that conversation along. One guide to public communication for the science-minded suggested scientists can best popularize — and avoid alienating their peers — by dutifully reporting on their own work, waiting until they are approached by media instead of marketing themselves, and avoiding self-promotion. This sounds rather sensible.
A very insightful medical student at Rochester, Benjamin Mazer, has been lobbying the American Medical Association to publish media guidelines for doctors — as well as to condemn and discipline those who use the mainstream press to spread false medical information.
I asked Mazer why he made this the focus of his advocacy. "We’re on the very beginning of a technological and societal change that will allow mass media to be an important component of public health — if not the most important component," he told me. "We need to begin the conversation about how we’re going to give people information through technology responsibly and accurately."
Here, Mazer was again raising a conflict that Sacks foreshadowed. With the publication of his best-selling books Awakenings and Migraine, Sacks recalls in his memoir, "Suddenly I was in contact with a great many people. I had powers to help — but also powers to harm." If only all doctors would realize the same.