How Aric Sigman pwned the medical establishment

Two years ago, independent psychologist Aric Sigman was a bit of a joke to me. Wingman to Susan “I point to autism” Greenfield, he seemed a faintly ridiculous character, whipping up hysteria about the modern predilection for screen-based activities, and linking this to all manner of physical and mental health problems. Ben Goldacre, for one, wasn’t buying it.
So how come Sigman ended up being uncritically quoted in this week’s chief medical officer’s report? And why does this matter?
Sigman was a speaker at the 2012 Royal College of paediatrics annual meeting, invited by a tiny specialty group who wanted to hear some challenging ideas. (Ok, my tiny group, but not my idea)
He was then invited to write an article for the college journal, the archives of disease in childhood His article was wildly misleading (for reasons I outline below), but does not appear to have been adequately peer-reviewed. However, when the authors of the CMOs report were looking for evidence about the effect of screen time on children, here is what appeared to be a review article in a highly respected journal. It’s understandable, if unfortunate, that they didn’t look more carefully at the evidence, but just reproduced his claims without qualification.
So claims that are at best tenuous have made it into a highly respected report, with significant influence over health policy.
So what? It’s not as if Sigman is definitely wrong, after all. He claims that screen time is an independent risk factor for obesity, heart disease and ADHD, among many other conditions. Maybe, but the evidence just isn’t there yet.
In order to make his case, Sigman distorts the evidence in a number of ways:

Firstly he unhelpfully  lumps different forms of screen time together,when both experience and evidence suggests a widely varied set of effects.

Secondly cherry picks data, as Pete Etchells has pointed out.

Thirdly,  interprets associations with a feature of a disorder as a definite causal link to the full disorder, whereas more sober analysis reveals a complex picture of association with aspects of the conditions with predisposition to use screens. 

In short, he’s unscientific and unbalanced.

So challenging Sigman matters because evidence matters.

Children’s well-being is threatened by a variety of factors, so to scapegoat lifestyle factors like screen time, rather than take a balanced view of the social, economic and psychological factors at play, as the recent Natcen report does, is to do children a disservice.
The story is also a interesting illustration of how authority works in medicine. None of us have time to read and analyse all of the data on questions that we work with every day, so inevitably we have to rely on a shorthand- some combination of who is writing and where they are published. Someone writing in a big journal like the archives might be assumed to be taking a balanced view, and professional researchers and clinicians are obliged to.
This I think is where Sigman’s lack of a university appointment matters; it’s not a question of academic snobbery, but of accountability. Sigman is not accountable to anyone. He can say what he likes, and the shame is that paediatricians have allowed him into the charmed circle that allows him influence at the very top of the medical profession.
I’m not sure what the moral of all this might be, but I do think organizers of conferences and journal editors need to be more careful to ensure the scientific rigour of people who are invited to contribute, rather than invite controversial people to spice things up. Those of us who rely on evidence need to be alert to the quality of evidence, not the reputation of the source.

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