The problem with science communication is that its essence is tethered to the premise that people are rational and want to make rational choices.

In fact, our communication is based on the premise that if you provide people with the facts, they will respond accordingly and adopt good behaviors.

Not so.

Researchers have kicked this puppy to death, (most famously Paul Slovic and colleagues, and the team of Amos Tversky and Daniel Kahneman, reporting in scientific circles that individuals make decisions that defy our assumption that rationality reigns supreme.

Those of us looking down from our ivory towers will tsk tsk at the anti-vaccine parents who won’t listen to reason (or to scientific evidence about risk) and refuse to inoculate their children.

We deride their choices as irrational, but, as Lisa Rosenbaum, MD, reports in this week’s New England Journal of Medicine, beliefs are powerful motivators.

Rosenbaum, a cardiologist and science writer, decided to dig deeply into some of the reasons rational people fail to follow doctor’s orders.

She talked to people about why, for example, our bottles of heart pills remain unopened and why the idea of ingesting chemicals bothers us.

Turns out our decisions are fueled by our beliefs that may not be correct, true, factual or rational, but we hold onto them tightly.

Rosenbaum discovered that some heart patients want a “natural” solution and that “chemicals disrupt the natural order.”

Before his heart attack one patient had switched from statins to fish oil because he didn’t want to take medications (statins reduce fats in the blood, and fish oil? Well, the evidence is shaky).

Medications seem to be associated with “chemicals,” while fish oil, herbs and vitamins are seen as “natural.”

Beliefs also arise from our feelings about our own agency and independence. We don’t like to depend on a pill and dislike being given lifestyle instructions.

Seems we would rather believe that making our own choices is more important than having an expert tell us to skip the burger, walk instead of drive, and stick to our drug regimen.

Besides, taking pills reminds us we’re sick.

And that reminder makes us feel vulnerable.

Rosenbaum recommends physicians and patients adopt a sort of emotional intelligence and recognize that beliefs—while they may not seem rational—prove to be strong engines for behavior. She writes:

Although we tend to view nonadherence as patients’ failure to know what’s good for them, learning about people’s feelings about medications has made me recognize that my ideas of good and bad were defined solely in my terms.

#nativescience