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EVIDENCE-BASED-HEALTH  December 2009

EVIDENCE-BASED-HEALTH December 2009

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Subject:

Re: using beliefs and narratives to bolster uptake

From:

Piersante Sestini <[log in to unmask]>

Reply-To:

Piersante Sestini <[log in to unmask]>

Date:

Tue, 15 Dec 2009 10:52:41 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (442 lines)

Maskrey Neal wrote:
> 
> Now someone in this group MUST be able to find something along those
> lines from Aristole, or Plato or one of the other Greats. 


it might be Plato, in the Seventh letter, talking about hit teaching 
(about the truth): "There neither is nor ever will be a treatise of mine 
on the subject. For it does not admit of exposition like other branches 
of knowledge; but after much converse about the matter itself and a life 
lived together, suddenly a light, as it were, is kindled in one soul by 
a flame that leaps to it from another, and thereafter sustains itself.

And before that, probably Socrates

Piersante Sestini


> 
> Bw
> 
> Neal
> 
> Neal Makrey
> NPc
> Liverpool Uk 
> 
> 
> -----Original Message-----
> From: Evidence based health (EBH)
> [mailto:[log in to unmask]] On Behalf Of Piersante
> Sestini
> Sent: 14 December 2009 12:24
> To: [log in to unmask]
> Subject: Re: using beliefs and narratives to bolster uptake
> 
> I think that the main point was made by David Hume long ago:
> "Reason is, and ought only to be the slave of the passions"
> 
> And since "passions" are clearly in a Type 1 system, it is clear that 
> every thought starts from there.
> 
> So the first point is, in my opinion, to set a shared goal with the 
> patient, trying to get sentiments, feelings, beliefs and moral issues 
> out in the light of reason (System 2). This is where counseling (in the 
> sense of empathic interview, not in the sense of giving advice) and 
> narrative medicine are helpful.
> Once they are out, it should be easier to settle their place in  the 
> overall reasoning, while simply denying or ignoring them is probably 
> bound to cognitive errors.
> 
> 
> About using narratives to convince somebody of the goodness of evidence,
> 
> it probably can be done, exactly as it can be done to sell any product, 
> but I am strongly against. We don't have to convince or sell our point 
> of view, we only have to inform (using narrative and methaphors, when 
> useful) and help in taking decisions.
> 
> That strategy looks more like the idea of the fascist theoric Vilfredo 
> Pareto, as reported by Popper: "The art of government is to take 
> advantage of sentiments, not wasting one's energies in futile efforts to
> 
> destroy them"
> 
> 
> Piersante Sestini
> 
> 
> 
> Maskrey Neal wrote:
>> Great quote, Jim!
>>
>>  
>>
>> So there's another list of research questions....for starters....
>>
>>  
>>
>> -          what initiates a "toggle" from system 1 processing to
> system 
>> 2 processing (and the various strategies employed therein)?
>>
>> -          does that toggle improve/ worsen or have no effect on 
>> decisions made, and especially patient outcomes?
>>
>> -          what initiates a toggle from system 2 processing (and the 
>> various strategies employed therein) to system 1 processing?
>>
>> -          does that toggle improve/ worsen or have no effect on 
>> decisions made, and especially patient outcomes?
>>
>>  
>>
>> Looking at the literature, most of the problems come from people
> getting 
>> stuck in system 1 without activating system 2. Seems to me that's 
>> largely because system 1 is the system preferred by humans for
> decision 
>> making -it's a sort of baseline probability effect. So probably (ho
> ho) 
>> the priority is the "debiasing", but that's not to say that system 2 
>> always beats system 1 by any means.
>>
>>  
>>
>> Good stuff group.
>>
>> Many thanks once again
>>
>>  
>>
>> Bw
>>
>> /Neal/
>>
>> Neal Maskrey NPC Liverpool UK
>>
>>
> ------------------------------------------------------------------------
>> *From:* Jim Walker [mailto:[log in to unmask]]
>> *Sent:* 11 December 2009 21:10
>> *To:* [log in to unmask]; Maskrey Neal
>> *Subject:* Re: using beliefs and narratives to bolster uptake
>>
>>  
>>
>> Great example, Neal.
>>
>> I'm suggesting an approach to cognition that goes beyond this to, for 
>> instance, study how and why we switch from system 1 to system 2 (and 
>> back) with what effects on accuracy and efficiency. Then we might be 
>> better able to teach ourselves how make those switches more
> effectively.
>>  
>>
>> Jim
>>
>> James M. Walker, MD, FACP
>> Chief Health Information Officer
>> Geisinger Health System
>>
>>  
>>
>>  
>>
>> If the human mind was simple enough to understand, we'd be too simple
> to 
>> understand it.
>>                        - Emerson Pugh
>>
>>
>>
>>>>> Maskrey Neal <[log in to unmask]> 12/11/2009 4:09 AM >>>
>> Of course Jim.
>>
>>  
>>
>> The example I use when teaching is to show a picture of the classic
> rash 
>> of meningococcal septicaemia and ask the audience "What treatment does
> 
>> this seriously ill child need". In a flash they chorus "Penicillin".
>>
>>  
>>
>> Classic dual process theory where system 1 thinking just made the 
>> diagnosis and sorted the treatment in half a second or less. Perhaps 
>> saving a child's life. So it's really dual dual process theory.
>>
>>  
>>
>> Except then system 2 ought to come in and consider alternatives for
> both 
>> the diagnosis - maybe an acute leukaemia, a severe ITP, one of the
> many 
>> other causes of DIC etc. - AND the management - IV fluids, inotropic
> and 
>> respiratory intensive support etc.
>>
>>  
>>
>> Think as well as blink. (Pat Croskerry, not me).
>>
>>  
>>
>> I really don't know how I survived as a medic for over 30 years
> without 
>> knowing this framework.
>>
>>  
>>
>> Bw
>>
>>  
>>
>> Neal
>>
>>  
>>
>>
> ------------------------------------------------------------------------
>> *From:* Jim Walker [mailto:[log in to unmask]]
>> *Sent:* 11 December 2009 01:54
>> *To:* [log in to unmask]; Maskrey Neal
>> *Subject:* Re: using beliefs and narratives to bolster uptake
>>
>>  
>>
>> Please pardon this perhaps cryptic suggestion:
>>
>>  
>>
>> While it is critically important, an exclusive focus on controlling 
>> bias may distract us from studying and using the positive aspects of 
>> human cognition to improve our decision making, for example, the 
>> thoughtful teaching and use of satisficing.
>>
>>  
>>
>> Happy holidays!
>>
>>  
>>
>> Jim
>>
>> James M. Walker, MD, FACP
>> Chief Health Information Officer
>> Geisinger Health System
>>
>>  
>>
>>  
>>
>> If the human mind was simple enough to understand, we'd be too simple
> to 
>> understand it.
>>                        - Emerson Pugh
>>
>>
>>
>>>>> Maskrey Neal <[log in to unmask]> 12/10/2009 4:29 AM >>>
>> Good morning - it seems to have stopped raining in Liverpool 
>> today..after about a month!
>>
>>  
>>
>> Reading Christine's original question, it's an important one for the 
>> group. Describing the cognitive and affective biases that affect 
>> decision making (judiciously, involving clinical expertise and the 
>> patient's individual circumstances and preferences, of course) is one 
>> step. But the next steps (I think) are to design a repeatable 
>> intervention which both raises awareness of those biases but is also 
>> capable of "debiasing" individuals and groups so that they are more
> open 
>> to making decisions on high quality evidence, and of course inherent
> in 
>> this is a tool to measure accurately and reproducibly any change from 
>> pre- to post-intervention. Tools to assess basic preferences and 
>> susceptibilities of individuals and groups to biases or groups of
> biases 
>> would also be worth exploring, especially if it becomes possible to 
>> design effective interventions which help those individuals recognise 
>> and reduce such susceptibilities.
>>
>>  
>>
>> I've had our information specialist run a literature search for these 
>> types of study and we've not seen anything in health care. I'm
> awaiting 
>> a very few papers which might or might not be relevant from other 
>> settings - since decision making and biases are important everywhere
> we 
>> can learn from those. Any more help from the group would be much 
>> appreciated. But whatever, there's a rich research stream here prime
> for 
>> mining.
>>
>>  
>>
>> To that end, I'm trying to pull together a small workshop in London on
> 
>> Monday 15^th March 2010 to explore the triad of information 
>> overload/selection : clinical decision making : shared decision making
> - 
>> and out of that I'd expect the research agenda to be clearer. If UK
> (or 
>> elsewhere) members of the group are interested in attending please 
>> contact me off list. The workshop isn't finally confirmed yet, but I'd
> 
>> expect it to happen, and we wouldn't charge attenders. You'd need to
> pay 
>> your own travel expenses though.
>>
>>  
>>
>> The irony here is that the National Prescribing Centre doesn't have a 
>> primary research remit - but as long as we're delivering on our core 
>> programme that doesn't inhibit us from in addition stimulating others
> to 
>> produce primary research - which of course then enables our core
> function. J
>>  
>>
>> Best wishes     
>>
>>  Neal
>> //Neal Maskrey. Director of Evidence Based Therapeutics//// //
>>
>> Please note change of address from 17^th August 2009
>>
>> National Prescribing Centre
>> Ground Floor
>> Building 2000
>> Vortex Court
>> Enterprise Way
>> Wavertree Technology Park
>> Liverpool
>> L13 1FB
>>
>> web:    www.npc.co.uk <http://www.npc.co.uk/> and www.npci.org.uk 
>> <http://www.npci.org.uk>
>>
>>  
>>
>> Please note change of telephone numbers from 17^th August 2009
>>
>> Main telephone number          0151 295 8671
>>
>> Fax line                                    0151 220 4334
>>
>> Secretary                                    0151 295 8691
>>
>>  
>>
>>  
>>
>> Disclaimer: This e-mail may contain confidential and/or proprietary 
>> information some or all of which may be legally privileged. It is for 
>> the intended recipient only.
>>
>> If any addressing or transmission error has misdirected this e-mail, 
>> please notify the author by replying to this e-mail and destroy any
> copies.
>> If you are not the intended recipient you must not use, disclose, 
>> distribute, copy, print or rely on this e-mail
>>
>>
> ------------------------------------------------------------------------
>> *From:* Evidence based health (EBH) 
>> [mailto:[log in to unmask]] *On Behalf Of *write
> words
>> *Sent:* 04 December 2009 17:55
>> *To:* [log in to unmask]
>> *Subject:* using beliefs and narratives to bolster uptake
>>
>>  
>>
>> I'm a freelance journalist, and I'm writing a piece examining
> pushbacks 
>> against evidence-based medicine (for instance, see the latest
> mammogram 
>> controversy in the U.S.) 
>>
>>  
>>
>> In particular, I'm exploring the role of belief in the uptake of EBM.
> In 
>> my reporting, I've found that new scientific evidence is often
> rejected 
>> when it contradicts strongly held (but erroneous) beliefs. It's not
> that 
>> people don't see the evidence, it's that they don't believe it (or
> they 
>> don't believe that it applies to them). 
>>
>>  
>>
>> I'm looking for research on the role of belief systems in the uptake
> of 
>> EBM. Has anyone studied ways to defeat scientifically wrong but
> strongly 
>> held beliefs via narrative? The idea being, that in some cases it's
> not 
>> the evidence itself that convinces, but instead, the story or
> narrative 
>> constructed from the evidence. How can new evidence be more
> effectively 
>> communicated when it contradicts established practice?
>>
>>  
>>
>> cheers,
>>
>> Christie
>>
>>  
>>
>> Christie Aschwanden
>>
>> Freelance writer
>>
>> [log in to unmask] <mailto:[log in to unmask]>
>>
>> www.christieaschwanden.com <http://www.christieaschwanden.com>
>>
>>  
>>
>>  
>>
>>  
>>
>>  
>>
>>  
>>
>>  
>>
>>  
>>
>>
> ------------------------------------------------------------------------
>> IMPORTANT WARNING: The information in this message (and the documents 
>> attached to it, if any) is confidential and may be legally privileged.
> 
>> It is intended solely for the addressee. Access to this message by 
>> anyone else is unauthorized. If you are not the intended recipient,
> any 
>> disclosure, copying, distribution or any action taken, or omitted to
> be 
>> taken, in reliance on it is prohibited and may be unlawful. If you
> have 
>> received this message in error, please delete all electronic copies of
> 
>> this message (and the documents attached to it, if any), destroy any 
>> hard copies you may have created and notify me immediately by replying
> 
>> to this email. Thank you.
>>
> 
> 

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