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Beyond Belief - Helen Pearson *****

Apparently it comes as a surprise to many that medicine was not particularly scientific until the end of the twentieth century (to be honest, it's no surprise to me - we had a GP who used homeopathy in the 90s). Instead it was based on anecdotal guidance - the kind of thing that appeared to work. Evidence-based medicine has since improved the field, trying where possible to base decisions on evidence, ideally based on randomised controlled trials.

The first part of Helen Pearson's book covers this well - though I think it's by far the least interesting part of what we discover. Instead what's truly fascinating is the rest of it, looking at a wide range of other fields where evidence was rarely properly used and that are only now starting to dip a toe in the water. These include social policy, policing, conservation, business and education.

The main part of the book gives us examples of how bad these areas have been in terms of basing decisions on what's always been done, or anecdotally is said to work without any evidence to back it up. Pearson is honest that in some cases it is near impossible to provide gold standard blinded randomised controlled trials, but emphasises the benefit of 'aluminium standard' approaches where the best approximation is made, and of systematic reviews when carried out in a timely fashion. This was a fascinating section with plenty of examples of things going well and badly, and a look at why it can be difficult to make the change.

Finally we get a shorter section labelled 'What to do' - this is a little confusing as it feels like it should be a 'what can I do about it' section, but this only applies to two of the chapters: children and parenting, and how to join the evidence revolution (technically an afterword). The first chapter 'A Crisis of Evidence: The Pandemic and Beyond' makes some interesting points about how evidence was handled in the pandemic, but spends quite a lot of time on applying the approach outside of Western countries, and on political difficulties in the US - which seem far removed from 'What to do' that applies to the reader. Though this part does not work as well as the main body of the book, because it seems more focused on high level concerns, it still has good material on the pandemic and parenting.

I just have two small complaints. One is the feeling we get primarily is that the evidence-based approach started with medicine. In reality, good science has always been evidence based, and there were fields of applied science such as engineering and industrial chemistry where the evidence-based approach was there long before medicine came close to being a scientifically-based activity. The other is that although some of the fields covered are very much those where the science element is social sciences, there is only a brief passing mention of the social sciences replication crisis in the evidence-based management section, yet a good number of the examples elsewhere are from pre-crisis dates. At the very least this should be underlined across the board.

However, that doesn't stop this being a highly readable and informative look at the way these areas that affect all our lives have traditionally ignored properly obtained evidence and relied on anecdote.

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