How tribalism undermines our health

While caught in traffic I found myself gawping at the various political posters that adorned the nearest pole. Some folks have party leaders sitting on their shoulders, others have gone the anime route, there are catchy slogans and three word proclamations, hairs are washed, teeth are brushed, everyone is trying to look like your new best friend. Assuming your friend likes to print off giant selfies declaring their brilliance and sticking them up all over town.

“Who are you going to vote for?” piped up my daughter.

As I looked at the large quixotic faces staring at me through the rain, I replied with that ancient Irish parental phrase, “We’ll have to wait and see”.

I try to do my civic duty and get a rough idea for what they’re all about before deep diving on a subset and choosing the best person for the job. But sometimes I wonder if my open mind isn’t as open as I’d like to think, after all, it has certain hard lines and incontrovertible leanings that are not up for debate.

It turns out I’m not alone, a recent study showed that most people form their political opinions not from a careful consideration of all sides of the data, but from strongly held beliefs that are backed up through a proficient understanding of the data at hand. In fact, the more developed your numeracy, the more likely you will look at data selectively to bolster your own political opinion.

The research study showed that if a participant looked at a sample of data to answer an uncontroversial question, ‘Does the face cream in question clear up a rash’?’, their ability to reason the data correctly was directly proportional to their level of numerical ability. However, when asked questions on polarising topics (gun control, climate change, fracking) the people who tested as highly numerate tried to use their higher reasoning skills to twist the logic in the data that contravened their core belief (“This could have been a different sample size”, “I’d need to see further evidence”, “Is this a trustworthy source?” etc).

Our brains are wired to seek out like-minded individuals forming tribes that validate our beliefs, no matter how unconventional, e.g. ‘The Luxuriant Flowing Hair Club for Scientists’. The study is suggesting that intelligent individuals may be even more adept at sticking to their tribal thinking – I’m looking at you, longhaired scientists. These communal affiliations are powerfully benevolent in the world of hobbies, sports, interests, but when it comes to health, tribal thinking can have serious consequences. Patients might cling to dubious treatments or dismiss sound medical advice, while doctors may fall prey to fads and ideologies, compromising their objectivity.

In this age of the mis/dis/bliss of information at your fingertips, could intelligent patients be convincing themselves that their health is better or worse than it actually is based on their selective computations?

And what if we look at the explosion of the online social media wellness industry, certain prolific apps are notorious for unscientific wellness trends such as glitter smoothies and wellness vaping.

Should doctors step up to be the objective educated third party voice of reason? Or are they humans like the rest of us and susceptible to falling victim to their own bias? For every funky influencer with a wet and wild wellness idea (ice bath diet anyone?), there is starting to emerge a funky doctor with a wacky take on functional medicine and access to a podcast.

For bias to emerge in a political election, that obviously has wide reaching consequences. But when it comes to health, the consequences are personal, more immediate, and in some circumstances – life or death.

Even before the internet people were self diagnosing for better or worse, and doctors were thinking outside of the box. If we interpret the study on politics to infer that intelligent people are skilled at layering their own narrative over the facts surrounding health (through a selective use of data), perhaps we should look at why they might do this?

The researcher concluded that ‘we believe what we believe to fit in with our tribe’. We do that to stay safe and be accepted. Since humans existed we have depended on each other for survival, to be ostracised from your group in primeval times could have meant death. It’s important to our DNA to belong. If we challenge the status quo of our tribe, we could be jeopardizing our place in society.

When you are a patient your tribe might be other patients, or wellness folks, or you might not identify as a patient at all. You could be a patient for decades and form an alliance with other patients through moans and groans of life as a sick person, but if you get better, you lose the commonality with your tribe. You could see how a person in these circumstances would hang on to an ache or pain and attach more significance to it to stay legitimately connected to their cohorts. On the flip side, a patient who doesn’t want to be different from their healthy friends and family might look for evidence to mitigate a worrying symptom.

I can’t speak for doctors but I’m sure they have their tribes too, I know in my time I’ve come across some stereotypes – the accolade collector, the boss, the sympathizer, the kind one, and of course, the eejit! (Patients can be eejits too, we are all human).

I think it’s healthy and natural to have leanings and core values. Feeling part of a tribe is essential for one’s sanity, but it’s important to be aware of groupthink and the traps of tribalism.

We could try and avoid loaded terms. If we are moving towards shared medical records then language like “Patient denies chest pain” sounds like I pounded the table calling for my lawyer while refusing to admit I had chest pain –  why not just say “Patient reports no chest pain”? There are lots of examples: “Patient complained of pain”, “The treatment failed”, “Patient very anxious”. These all have negative connotations with more than a hint of blame attached.

We should avoid villainizing the other side, otherwise it becomes almost impossible to accept their stance and agree with some of their points. Families can despise and boycott a specific hospital for decades due to an alleged incident with a cocky doctor. It can be very difficult to see beyond the generational hurt.

I am a fan of baby steps – if you need to step out of your tribe for help, you don’t need to look at the big picture and debate ideological values, just work together to solve the immediate challenge.

There is nothing more politically divisive than climate change. However, a group of believers and non-believers got together to set up a non-partisan action group in Florida – not to debate global warming but to work together to deal with the immediate threat of flash floods that were destroying their neighbourhoods. Baby-steps.

I am still undecided on what lucky duck will get my vote at time of writing, but I hope to adopt a curious mindset. An increase in science comprehension may lead to an increase in a polarised opinion, but an increase in science curiosity can lead to a willingness to look at all data, even those that are inconsistent with a steadfast opinion.

Ultimately, the power to break free from the confines of tribal thinking lies within each of us. Patients should be empowered to question information, ponder their own decisions, seek multiple perspectives, and rely on credible sources and trusted healthcare professionals. Doctors should work to maintain objectivity, avoid trendy treatments, and strive to reach an understanding and partnership with patients. By working together, patients and doctors can make informed decisions that increase everyone’s confidence, and bring us all one baby step closer to joining ‘The Luxuriant Flowing Hair Club for Scientists’.