Print

---

On a positive note(stealing a quote from our sister list-serv on HIFA):

Thomas Frieden (Director CDC) says:

 "We have within our power the tools to make enormous improvements in global
health. And we know that the key way to do that is to learn from experience.
To use that experience to strengthen our programs today and tomorrow, to be
able to reach into communities, to work with communities, and to bring the
best knowledge to bear to prevent disease and disability to the greatest
extent possible."

I wonder if this experience is something high impact factor journals seldom
publish? Are we producing bad research because we are not relating the
entire experience of the researcher that s/he may have felt/lived through
the entire period of the research beginning with conception, reflection,
brainstorming and data collection (the kind of data that one may sometimes
come across in author blogs?)?

There is a lot of data that is discounted by journals because its believed
those are redundant but then I wonder if including these back end processes
would strengthen rather than weaken the validity of our assumptions (as
represented currently in the rigid format of most of our journals)? We may
have to wade through more data ( a lot of them in a human narrative format)
but at the end of the day would that bring forth greater insights that are
otherwise archived in individual anecdotes (always humanly cherished at tea
time or even emails but detested in formal high impact journal platforms)?

We have the online space in current journals to accommodate the lived human
experiences of individual researchers but perhaps we require to build
bridges between those who are more used to recording human experiences
(labeled qualitative researchers) and those who can't be bothered with these
softer details ( often labeled quantitative researchers) although again many
of who have often demonstrated their talent in this area ( as evidenced by
their blogs and inputs to email lists were anecdotes are tolerated).

:-)

regards,

rakesh


On Sat, Nov 6, 2010 at 11:18 AM, Jordan Panayotov <[log in to unmask]> wrote:

> Dear All,
>
> My last post aimed to stimulate the discussion, so that we can better see
> the problem in order to find appropriate solution.
> I'm really sorry if someone feels personally offended - once again I did
> not mean it at all.
>
> They say that the 1st step to solve a problem is acknowledging it.
>
> Well, HOW this can be done without anyone feels offended?
> How to tell our friends and colleagues that they did nothing useful - just
> have wasted our public money, or even worse that the result from their work
> is counterproductive - the situation after the intervention is worse than
> before it?
>
> A Health Promotion textbook (in Melbourne) says:
> Quote
> "Take English for example. This language and culture includes the notion of
> the "stiff upper lip" which embeds the idea that it is quite "unmanly" to
> show disappointment"
> Unquote
>
> Therefore, when something is, put it mildly, not quite right (or even a
> complete mess), you'll hear:
> "Good try!"
> "Better next time!"
> "Excellent effort!"
>
> Then, those who did waste our public money (or even were counterproductive)
> think they did a great job and, as such impression is created, they get even
> more money next time.
>
> I have witnessed all of what I've said in my previous post (and even worse
> things) and can be more specific should you wish. But this is not the point.
>
> By all means (and luckily) NOT all researchers and practitioners are the
> same. Still there are many who genuinely look for a good evidence and try to
> implement it in order to maximize health of populations, but as I said, I
> think that regrettably their number declines.
>
> So, what to do?
> Shall we continue to say always "Good, Better, Excellent" and waste more
> limited public resources, or shall we point out the problems, tell it as it
> is and look for solutions?
>
> Number of citations is not the same as usefulness and applicability of a
> study. Therefore, I think that income generating should depend on (or at
> least address somehow) the benefit which a publicly funded work brings to
> the public. Otherwise, from public - tax payers - perspective what's the
> point to have mostly (90 %) research which only generates new research? How
> sustainable is this? One way or another, this has been noted from several
> persons in this discussion.
>
> You may call me cynical, but especially now with the Global Financial
> Crisis, the public will not tolerate this for much longer, simply can't
> afford it.
> Ask the Governments of Greece and UK, for example.
>
> For some answers you may wish to see my presentation "Health Promotion: Is
> Sustainable Development Possible Without Health Equity?" at 20th IUHPE World
> Conference, July 2010, Geneva, Switzerland,
> available here
> http://icare.academia.edu/JordanPanayotov/Talks
>
> All the best,
>
> Jordan
>
>
> ----- Original Message ----- From: "Jeff Harrison" <
> [log in to unmask]>
>
> To: <[log in to unmask]>
> Sent: Saturday, November 06, 2010 3:39 AM
> Subject: Re: Too much skepticism/ Too much bad research/Is it like that?
>
>
>
> Thank you, Steve.  I've been watching the unfolding discussion with
> interest and deciding when to write JUST such a response.  There is a
> difference between scepticism and cynicism.  The latter is a lot easier
> and usually unhelpful because it doesn't add to the discussion.
>
> Some other observations on the discussion to date.
>
> Too much bad research:
> Yes, I believe there is.  This is largely because of the nature of the
> 'machine' in tertiary education - many have commented on this already.
> As a personal summary, I am not a professor.  I will not become a
> professor until I've published a lot more than I have.  I will not
> publish more until I have grant income to sustain a team to undertake a
> meaningful research programme that will generate useful findings.  I
> won't generate grant income until I research/publish more.  I won't
> research/publish more until I teach less.  I won't teach less until I
> have grant income to buy out my teaching time - and even then there is
> actually no guarantee based on past experience
>
> As has been said by Rakesh, research is about learning.  Not every
> research project should be published, some provide internal learning
> telling us how to get to the answer rather than the answer itself.
> Whilst papers describing and critiquing methods are helpful my pet hate
> is finding the perfect abstract and pulling the paper to find it is
> describing how the study will be done not whether the method works or
> what the results are.  PLEASE can journals stop publishing this CV
> packing bull.....
>
> In direct contrast to this view of too many papers, by-and-large I
> believe research involving patients or volunteers (possibly include
> animal studies too here depending on your view of ethical approaches to
> using animals in research) should be published.  If it isn't designed to
> generate an answer you shouldn't be doing it -and BTW your Ethics
> Committee or IRB should have withheld permission until it was.  Once
> completed you have a duty to publish BUT you also have a duty to publish
> what WAS found not what you WISHED you'd found.  We can all be guilty of
> wanting to 'sex up' the results - we need to resist it and behave like
> scientists.
>
> Publication:
> There are too many journals publishing too much 'quick and dirty'
> research.  Compounding the problem there are so many journals that
> peer-review is compromised; there simply are not enough good reviewers
> to go around.  I don't know whether I'm a good reviewer or not but I do
> know it takes me around half a day, sometimes more, to conduct a
> standard manuscript review.  I try to be critical of the research, not
> of the researchers.  My experience as an author is very varied.  My
> heart sinks when I get a 20-point review back from a journal but at
> least I know the reviewer has read my article, thought about it and has
> raised some points for consideration.  When I get one back with two
> lines I feel initially pleased but there is always a nagging doubt
> later.
>
> On a note re: publication.  When are we all, by which I mean
> researchers, editors and reviewers, going to start publishing
> manuscripts that show no difference or negative results?  They are still
> a rarity and it isn't always the drug companies suppressing them, as
> seems the prevailing view amongst the delightfully naive.
>
> Conflict of interest:
> I am an academic. I've received public research grants. I have also
> received contribution from "Big Pharma" and from device manufacturers
> through no-cost supply for trials.   Am I evil?  I don't think so.  I
> don't feel in the slightest bit compromised because in the first two
> situations the companies had no influence on the design of the study and
> - in fairness to them - sought no influence on or even forewarning of
> the results prior to publications.  They got a copy of the paper on the
> day the journal embargo expired.
>
> I have likewise been paid an honorarium to speak at meetings sponsored
> by Big Pharma.  Am I evil?  I don't think so.  I was given some slides
> to review which I politely declined to accept and wrote my own based on
> my reading of the data.  I said some things the company probably
> approved of and some things they almost certainly didn't want to be
> highlighted. They didn't complain they just didn't invite me back or
> send me a Christmas card.  I'm assuming they acknowledged that was the
> risk they were taking by picking an independent speaker and found
> someone else.  Presumably that person provided a more palatable version.
> I'm not annoyed, that is their game and the other person's
> conscience....and, by-the-way, my view may have been wrong.
>
> The answer:
> Until a miracle occurs and the problem is solved by divine intervention
> I will continue to behave in a way that I believe is appropriate.  This
> is, of course, influenced by morals and social norms so it is reasonable
> to expect that most other moral researchers will be doing the same.  I
> will continue to teach my students to think about what they are doing
> and why - both in research and, more importantly to me, in practice.  To
> me that is actually what being an academic is all about - thinking more.
>
> Happy Guy Fawkes to you all.
>
> Jeff
>
>
>
> -----Original Message-----
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of Steve Simon,
> P.Mean Consulting
> Sent: Friday, 5 November 2010 11:35 a.m.
> To: [log in to unmask]
> Subject: Too much skepticism is just as bad as too little skepticism
>
> The list has been filled with comments like this one:
>
>  Since one's main interest is to generate income, the primary objective
>> of the research is to perpetuate itself, i.e. to ensure more grants.
>> Patient outcomes and/or better allocation of limited public resources
>> are irrelevant, let alone maximizing the health of populations.
>>
>
> I can't disagree more. In my book, I write about the value of things
> like randomization, intention to treat analysis, blinding, etc. and then
>
> I turn around and say that randomization is overrated, intention to
> treat is overrated, blinding is overrated, etc. The reason for this
> turnaround is that there is too much black and white mentality in the
> EBM community--if a study is randomized, it is good, and if it is not,
> the study is bad. Everything needs to be placed in context. A well
> conducted observational study is far better than a shoddy randomized
> study.
>
> The same is true with conflicts of interest. Conflict of interest is
> overrated by many in the EBM community. It has to factored in, but you
> can't disqualify a study just because there is a conflict of interest.
> That's just as bad as disqualifying a study because it was not blinded.
>
> A well conducted study is persuasive even if the authors have a
> financial conflict of interest. The key is transparency of the methods
> and objectivity in the approach. A financial conflict is a fatal flaw in
>
> a subjective overview of the research, but it is not a fatal flaw in a
> systematic overview. The systematic overview, with an open protocol and
> objective ways to extract and combine the information from multiple
> studies, is certainly defensible, even with a financial conflict of
> interest.
>
> Furthermore, to claim that the ONLY goal of academic researchers is to
> ensure more grants is just not true. I know these people. I work with
> them on a daily basis. They are concerned about getting grants, but that
>
> is NOT to the exclusion of caring about their patients. In my
> experience, what motivates medical researchers most is that they see a
> problem in how health care is delivered and they want to fix it. Getting
>
> the grants is a means to an end, and not the end itself.
>
> The other problem with all of this discussion is a lack of appreciation
> for the varying ranges of severity associated with conflicts. Everyone
> has pressures that can influence how they conduct their research, but
> some influences are minor and easy to resist, and others are major and
> far more difficult to resist. Accepting a free trip from a drug company
> makes you more conflicted than accepting a free meal. And non-financial
> conflicts, while they can't be ignored, are less of a concern than major
>
> financial conflicts of interest.
>
> I believe that a skeptical attitude is mostly helpful in EBM, but too
> much skepticism can be very harmful.
> --
> Steve Simon, Standard Disclaimer
> Sign up for The Monthly Mean, the newsletter that
> dares to call itself "average" at www.pmean.com/news
>