Jordan
In case you thought that I was somehow personally offended, I wasn't in
the slightest. I hope that you were not in return. It is a healthy
debate. It is my hope that the discussion unearths the issues but they
are complex and involve us all. I genuinely believe that there is an
individual responsibility to act thoughtfully, in the true sense of the
word, and with integrity - and to expect it in others.
I don't know the context in the textbook you cite used the term 'stiff
upper lip' but - as an Englishman and a Kiwi - I suspect the book wasn't
written by someone who is English or understands the derivation of the
term for English people. It is not, by the way, a uniquely English
trait in my experience. In my understanding of the use of the term in
context, it has nothing to do with not showing disappointment but rather
to remaining resolute in the face of adversity or against all odds. For
someone of my generation it will always be associated with the Blitz, an
8 month period of constant bombing raids over London during the Second
World War, and the unwillingness of those people to be emotionally
shattered the way most of would be today. I understand how this studied
resilience plays out in patient's unwillingness to complain about the
effects of disease, the health promotion context perhaps. I do not see
how it is relevant to tacit approval of poorly conducted research; I
must have misunderstood.
I do have some questions on your propositions:
If the work done, in your example, shows us the intervention is worse
than before, have we not learnt something valuable? Surely the money
was not wasted, unless we already knew the outcome somehow. Are only
positive findings valuable?
Who decides on "usefulness and applicability" to the public? What
criteria are to be used?
Do all pure science programs (as a gross example, quantum mechanics
perhaps?) get shut down tomorrow because they have no immediate and
measurable benefit to the public? What about languages, philosophy, art
history? What about marketing, there is value to business but where is
the value to the public or to society?
The issues are important and relevant to us all - simply wagging our
fingers at others doesn't get it done. Each of needs to stop publishing
poor research (although I suspect few in this list do by the
self-selected nature of the group) and start calling people out when we
read it in journals. Another thing missing from medical journals these
days - apart from negative studies - is robust debate in the Letters to
the Editor. Perhaps all of us should promise to be more proactive in
this regard. I know I read articles and think "but they didn't account
for x, y and z." and never write to the editor or to the investigators
to point these things out. I should.
Jeff
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Jordan
Panayotov
Sent: Saturday, 6 November 2010 1:49 a.m.
To: [log in to unmask]
Subject: Re: Too much skepticism/ Too much bad research/Is it like that?
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
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