The Politics of Truth, Myth, and Health Policies

    • May 2, 2013

A passion for truth in politics launches a career in research. Brendan Nyhan, PhD, was a political junkie even before he knew there was such a thing as political science. His Mountain View, Calif., high school required a senior thesis, and Nyhan wrote his on the presidential campaign of conservative candidate Patrick Buchanan during the 1996 Republican primaries. At one time, he envisioned a career in politics for himself, and he graduated in 2000 with a bachelor's degree in political science from Swarthmore College in Pennsylvania.

Nyhan next worked on the 2000 Senate campaign of Ed Bernstein, a Democrat from Nevada (Bernstein lost). That experience, together with his belief that rampant distortions pervaded the presidential campaign between George W. Bush and Al Gore, were early inspirations for his interest in the power of misinformation. "I was struck by how little effort the press made to assess the credibility of political spin," he says, "and how few checks there were on politicians' ability to manipulate the public."

Nyhan's experiences demonstrated to him that the public is often fed misinformation about important public policy issues and political leaders. He wondered why we are so often fooled and what could be done to improve the truthfulness of public discourse.

Early in 2000, Nyhan and two friends founded a website called Spinsanity, one among the earliest organized efforts to monitor, publicize, and correct distortions of fact in politics—though Nyhan takes pains not to claim to have invented this idea. These efforts gained significant national attention and spawned a book, All the President's Spin: George W. Bush, the Media and the Truth, which Nyhan co-authored with his Spinsanity partners, Ben Fritz and Bryan Keefer, and published in 2004.

Spinsanity further piqued Nyhan's interest in the ways in which people absorb—or refuse to absorb—political information. He noticed that even when the website corrected falsehoods regarding an issue, objections would pour in from those who refused to believe the correction. That's when Nyhan decided he wanted to look more closely at voters' reluctance to surrender their political convictions, and the opportunities for demagoguery that reluctance presents for politicians.

Spinsanity closed in 2005, but, "The Spinsanity experience caused me to think a lot about how politics works," Nyhan recalled, and it was instrumental in shaping his future interests. He wanted to know, "why people might or might not listen to what we were saying on the site and what effect that would have on politicians' behavior. I could see how difficult it was to change the political system from the inside, and I wanted to be able to think about what was going on analytically and not have to toe the party line. Grad school allowed me to make that transition."

Nyhan earned a PhD in political science from Duke University in 2009. His dissertation examined the politics of political scandal. From there he applied to the Robert Wood Johnson Foundation Scholars in Health Policy Research program, and spent two years at the University of Michigan, where issues involving the nation's health care agenda offered fertile ground for his study of misinformation in the political process. His work focused in particular on the myths that plagued the efforts of two presidents to reform the American health care system.

The RWJF Scholars in Health Policy Research program provides paid full-time two-year fellowships to outstanding new PhDs in economics, political science, and sociology to advance their involvement in health policy research. See Program Results Report for more information.

The research: understanding the origins and spread of misinformation. During his time as a Scholar at Michigan, Nyhan produced a series of articles and studies looking into the origins and spread of misinformation from a variety of angles, among them an examination of the "death panels" myth that attached itself to the Obama Administration's Affordable Care Act (ACA).

The claim that, under the ACA, bureaucrats would decide which senior citizens are "worthy" of receiving medical care had been most prominently voiced by former Alaska Governor Sarah Palin. Her remarks to that effect received extensive coverage despite being debunked by more than 40 media outlets and the fact-checking organizations PolitiFact and A national poll found that that 86 percent of Americans had heard "death panels" reports and that 30 percent believed them, including 47 percent of Republicans.

To determine if the death panel myth could be effectively challenged by more aggressive media fact-checking, Nyhan and two colleagues, Jason Reifler, PhD, and Peter A. Ubel, MD, (then a professor of medicine at the University of Michigan and co-director of the RWJF Clinical Scholars program there), conducted an experiment in which two groups of people were asked to read fictitious but realistic-looking news articles about Palin's claims. The article read by one group contained a paragraph at the end explaining why "nonpartisan health care experts" had concluded that Palin's death panel claim was wrong. The corrective paragraph was omitted from the article read by the other group.

Reading the version of the article with the correction successfully reduced belief in the death panel myth among two types of readers: those who already held an unfavorable opinion of Palin, and those who viewed her favorably but had relatively little knowledge of politics. Opposition to the ACA also declined among those readers. Among readers who were both Palin supporters and relatively knowledgeable about political affairs, however, the opposite occurred: after reading the corrected article they were more likely to believe the death panel myth and more likely to oppose the ACA. Findings from this study appeared in a 2013 article published in Medical Care.

Nyhan calls this tendency to cling more tightly to beliefs when they're challenged "the backfire effect."

"We have an intuition that political knowledge should be good, that people who know more have more accurate beliefs," he says. "In some cases that's true, but in other cases, when we have a motive to preserve an existing belief or attitude, political knowledge can actually equip us to better defend that attitude or belief. It gives us more tools to fend off information we don't like and convince ourselves that we're right."

Nyhan adds that people who don't care about politics are often more willing to change their opinions because they are aware their knowledge is limited, whereas those who hold partisan beliefs are often convinced they know better. "There's a big difference between people not knowing things and people thinking they know things that aren't true," he says.

Nyhan became interested in the origins of misperceptions that people hold onto so tenaciously, and spent part of his time as an RWJF Scholar analyzing the role played by opinion leaders who spread misinformation. In a detailed analysis that appeared in 2010 in the political journal The Forum, Nyhan examined the origins of the myths that bedeviled the health reform proposals put forward by President Clinton as well as the "death panel" myth attached to President Obama's proposal.

In the case of the Clinton proposal, Republican partisans successfully convinced many voters that under Clinton's plan they would no longer be able to choose their own doctors. Nyhan's analysis traced how opponents of the plan and the media spread this claim despite repeated, specific denials by President Clinton and others. As with the "death panel" claims associated with President Obama's reforms, Nyhan concluded, "misinformation distorted the national debate, misled millions of Americans, and damaged the standing of both proposals before Congress."

Can this problem be solved? Nyhan has specific suggestions about how best to limit the damage caused by misinformation. Changing the reluctance of people to surrender the ideas they hold isn't among them. "Human psychology is fixed—we can't change that," he says.

What can be changed, he believes, is the ease with which opinion leaders spread misinformation, and the price they pay for spreading it. In a wide variety of public forums, including a regular column he writes for the Columbia Journalism Review, Nyhan urges reporters to pay more attention to fact checking the claims of public figures, and to challenging those claims when they're wrong. Such challenges may not sway the ideologically committed, he says, but they can have an impact for those who are "on the margins" of a given issue, and that can make a difference.

Nyhan also urges journalists to aggressively "name and shame" public figures who spread false beliefs. "We need to increase the reputational cost of misinforming," he says. "If someone is misleading the public they should be called out directly by name in print and on TV, and held accountable for what they did. The reality now is that it's practically cost-less. There's so much toothless 'he said/she said' journalism that in many cases readers aren't even being told who's being accurate and who's not. Even when someone is held to account, they're often put back on the air a week later as if they're a reputable source."

Investigating a new arena of misinformation. As of April 2013, Nyhan continues his investigations from his position as assistant professor of government at Dartmouth College. His work focuses on the fears that have undermined many people's faith in the safety of vaccinations and the misinformation that has helped promulgate distrust of vaccinations.

A study he conducted with two colleagues, Jason Reifler, PhD, (a colleague from Nyhan's days at Duke and a co-author on the death-panels paper) and Sean Richey, PhD, examined the influence of social networks—friends, families, peers—on college students' decisions to seek influenza inoculations. The results suggested that social networks may play a key role in the decisions of students regarding vaccinations. Findings from this study appeared in a September 2012 article in the Journal of Adolescent Health.

To further explore this issue, Nyhan and co-authors have completed a study that he describes as "examining the effectiveness of correcting the false claim that vaccinations for measles, mumps, and rubella can promote autism in children." Findings from this study were not publicly available as of March 2013. But, Nyhan indicated that in the long run this may be his most important work yet on the costs of misinformation. "When you're talking about childhood vaccines you're talking about children's lives," he says. "The stakes are very, very high."

The fact that Nyhan has three young children of his own likely has something to do with his feelings in that regard.

Reflections on the RWJF Scholars program. Nyhan continues to collaborate on research with Ubel, an alumnus of the RWJF Generalist Physician Faculty Scholars program and the recipient of an RWJF Investigators Awards in Health Policy Research grant. He also remains in touch with other RWJF Scholars through an informal research group that regularly discusses, via Skype or Google Hangout, the projects its members have in progress.

Nyhan calls the fellowship "truly the best experience of my career so far" and an "absolutely invaluable" experience. "I constantly evangelize to grad students and junior faculty that they should apply," he says. "I hope you'll quote me saying how amazing it is, because it's really a career-changing position and I'm incredibly grateful that I got it."

RWJF perspective. The Robert Wood Johnson Foundation Scholars in Health Policy Research program is designed to foster a new generation of creative thinkers in health policy research within the disciplines of economics, political science, and sociology. The fellowship program, established in 1991, annually selects a total of nine recent PhD graduates from among those three disciplines to spend two years studying at one of three participating sites (currently Harvard University, University of California, Berkeley/San Francisco, and University of Michigan).

Participants learn about health and health policy, gain exposure to the perspectives of the other two disciplines through seminars with peers, receive mentoring from prominent scholars, develop research ideas, and conduct research while receiving a stipend and benefits that free them from other professional obligations. "We're looking for people who aren't too far along in pursuing a specific research agenda. Our goal is to catch people early and tempt them into the field of health policy," says Lori Melichar, PhD, RWJF director for the program.

While in the Scholars program, participants have conducted research on issues and policies related to individual health, public health, social and economic determinants of health and health care, health care financing, and health care systems and institutions. After completing the program, alumni stay connected to their peers through a network facilitated by the Boston University Health Policy Institute, which serves as the national program office.

Scholars from the Health Policy Research Program have made significant contributions to their disciplines and to the field of health policy research. The program's 200-plus alumni, many of whom hold faculty appointments at universities and colleges, have authored hundreds of widely cited books and articles; held editorial posts at top scholarly journals; sat on scientific advisory panels; served as senior advisers to presidential, Congressional, federal agency, and national scientific councils; and received numerous professional awards for their research.

Although the original purpose of the program—to increase the number of economists, sociologists, and political scientists conducting health policy research—remains important, RWJF's focus has expanded to include "building the community" of health policy researchers and supporting them at institutions nationwide. "Now it's more about creating a critical mass so that we have a self-sustaining community [of researchers]," Melichar says.

Brendan Nyhan, PhD

Brendan Nyhan, PhD
RWJF Scholar in Health Policy Research, 2009-11

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RWJF Scholar Brendan Nyhan: An expert in origins & spread of misinformation in health policy and practice