Over at Communication Breakdown, my Scilogs-brother and science communicator par excellence Matt Shipman has brought out an interesting post, highlighting the problems in health research coverage by reporters as well as public information officers writing news releases. Matt exhorts these communicators to pay attention to three important concepts: context, limitations, and next steps.
Not apropos of anything, an ethics question flitted through my mind as I was reviewing a rather interesting paper for a journal, which shall remain nameless. As for all questions of such deep significance and importance, I would love to turn to my most valuable resource, the scientists and/or blogger tweeps with whom I communicate and/or interact and/or whom I follow on Twitter. I do see the social medium of Twitter to be a valuable tool for collaboration, and I hope there’d be someone there, who can answer my question – either in 140 characters on Twitter, or more at length, here in the comments.
Two things I encountered today, good and bad in equal measures. First, the good.
In the recent past, I received an invitation for reviewing a submitted manuscript from a noted journal (which shall remain nameless). The topic of the study verged on pharmacognosy and ethnobotany, both areas of knowledge that I – as an erstwhile drug discovery researcher in another lifetime – find fascinating. I accepted the invitation to review because the study piqued my interest.
Every so often, some paper happens to grab my attention for various reasons. As I read the paper, often I have questions. Not all of those questions, unfortunately, can be easily submitted for answers. In recent times, one such paper was published earlier this month in PLOS One. The great benefit of the Open-Access model of PLOS is that it allows a reader to ask questions directly of the authors. This level of engagement is very laudable, especially to someone like me who has an interest in the communication of scientific facts.
A Université de Montréal team, studying the quality of care provided to elderly diabetic patients by Quebec practitioners of family medicine, recently released a report on their findings. [NOTE: The link to the report points to the University of Montreal news page in English, detailing the study. However, the reference provided at the end points to a French-language abstract in a Conference book with scant data; therefore, for my comments, I am forced to rely mostly on the Université de Montréal communiqué in English.] The report brought out screaming headlines, “Female doctors are better than male doctors” (EurekAlert) and “Women Make Better Doctors Than Men” (Time Magazine). The sensationalized headline piqued my curiosity enough – by which I suppose the headlines did their job! – for me to take a gander at the report.
The overall objective of the study was to look for two parameters related to the physicians serving the Family Medicine Group (les groupes de médecine de famille, GMF) that Québec had established in 2002 to organize its healthcare delivery: (a) quality of care (as indicated by strict adherence to the practice guidelines of the Canadian Diabetes Association) and (b) the productivity (as measured from billing data; the number of procedures done – and charged for – per year). The specific group of physicians to be scrutinized was comprised of 906 doctors (431 women and 475 men; I don’t know why the English news report kept floating a vague estimate: “over 870 practitioners,” it said) who looked after elderly diabetic patients.
For diabetic patients 65 or older, the CDA recommendations are fairly straightforward: biennial ophthalmic exams, three prescriptions for appropriate medications, and annual medical exams. From the data pulled from the patient records kept under the auspices of Québec’s health-insurance administration (la Régie de l’assurance-maladie du Québec), the researchers found that, apparently, compared to the men physicians, more women physicians emphasized the eye-care visit (73% vs 70% by the men), provided smoking counseling (1.8% vs 1.4% by the men), prescribed the recommended medications (68-70% vs 64-66% by the men, for statins and other drugs), and insisted on the annual review (43% vs 31% by the men).
In contrast, the women physicians apparently charged for only 3100 procedures in a year versus 4920 by the men, and therefore, they were considered to be less productive than their male counterparts.
The abstract and the report both mention that these differences are “Statistically Significant”, although in absence of a clear significance criterion and a definition of variables, it is unclear to me how the Student’s Test (I assume, the t-test) – mentioned in the Methods section of the abstract – was used to compare the difference between these percentages.
I have no choice but to disregard the questions of study methodology (since those answers cannot be found in a Conference abstract). However, I heartily disagree with the way these research questions have been framed. Let me clarify.
I have a specific and abiding distrust of these men vs women narratives; in fact, I think they are deeply divisive and reprehensible, because they tend to enforce certain assumptions or memes about women being more caring than men. Régis Blais, Professor at the Department of Health Administration and co-supervisor of the study, even commented, “People assume that women doctors spend more time with their patients, but it is difficult to observe in a scientific study. This study does just that.” This may not be an incorrect observation per se, but formalizing that via a research question would, in turn, tend to bring in certain other memes about men (‘less caring’, ‘more aggressive’, et cetera, including the execrable ‘boys would be boys’). These memes are at best counter-productive, and at worst end up being eventually harmful for all concerned, in terms of engendering and enabling certain widely-prevalent anti-woman biases. Valérie Martel, the lead author, said, “[…] women temporarily leave the network to start a family. They work fewer hours to spend more time at home when they have children. Inevitably, this change has an effect on the management of resources […]” I don’t know how much of a problem this is in Canada as a whole (see Ontario Human Rights Commission statement) and Québec in particular, but in the US, pregnant workers are known to face workplace discrimination on a routine basis. This is why gender segregation, especially gender segregation in caregiving, is a nasty concept.
Anecdotally, if one looks at any hospital across the US, one may always find a certain subsection of patients who’d not prefer to be treated by African American, Jewish, or Latino physicians or caregivers. (More mind-bogglingly, sometimes hospitals do pander to these racist requests. For a more comprehensive treatment of this issue, see here.) Gender segregation is no less objectionable or disgraceful than racial or ethnic segregation in healthcare. If, in the above study, one substitutes gender with race/ethnicity and makes a cohort with such physicians, I can almost guarantee that one would come up with a similar sort of differential observation. Because of a priori separations, conclusions drawn about groups from such observations would be meaningless.
Note that I am not disregarding the observations of this study. The authors have already commented upon the need to redefine and expand the concept of ‘productivity’ in healthcare delivery in a way that takes into account the overall experience of the patient. In addition – in my opinion – what this sort of study should focus on – and the data are there if one reads between the lines – is how compliance to existing patient care guidelines improves the standard of care and the outcome for patients, regardless of whether women or men are doing it. Also, as an important corollary, these studies should try to discern why women doctors seem to be more compliant with the guidelines than the men doctors are, despite receiving the same or similar training. Divvying up patient care between men and women doesn’t serve at all the main purpose of this enterprise, the care of patients.
Roxane Borgès Da Silva, Valérie Martel, & Régis Blais (2013). Qualité et productivité dans les groupes de médecine de famille: qui sont les meilleurs? Les hommes ou les femmes? Revue d’Épidémiologie et de Santé Publique, 61 (Supplement 4) DOI: 10.1016/j.respe.2013.07.021
The science-associated blogosphere and Twitterverse were abuzz today with the news of a Gotcha! story published in today’s Science, the premier science publication from the American Association for Advancement of Science. Reporter John Bohannon, working for Science, fabricated a completely fictitious research paper detailing the purported “anti-cancer properties of a substance extracted from a lichen”, and submitted it under an assumed name to no less than 304 Open Access journals all over the world, over a course of 10 months.
Note: This is an old post that was supposed to have been auto-published on September 19, 2011 (!), but didn’t for some unknown reason. I found it in my list, and decided to go ahead and publish it today, because the message still remains valid.
My professional and personal interests often require me to browse through many scientific journals of various disciplines. I don’t always remember – I admit, shamefacedly – how fortunate I am, to be a member of a University system with an amazing collection of biomedical journals. The Hopkins library system, a fantastic system by any count, allows me online access to a huge array of journals when I am at work, and even when I am at home (by remotely logging in to the library system).
Yet, every so often, I become acutely aware of the systemic problem – the largely prevalent closed access publication system, because of which the results of Federally funded research work – and therefore, by extension, funded by our tax dollars – are not accessible to the general public. In the closed-access system, if an individual wishes to read a particular journal article, s/he needs to either be a member of some institution which has purchased an institutional subscription (for a massive fee – therefore, difficult for many smaller institutions in these times of cash crunch), or purchase an individual article for upwards of 15, 20, or 25 dollars. If one needs to follow up on the references, well, tough luck in absence of lucre.
Hello there! Did you miss me? I’m kidding. Of course you didn’t. Anyway, I have been really busy in boring academic work (yes, I do have to keep doing what I do at the bench – sigh!), and haven’t found time to sit down and write. This brief interlude hasn’t ended yet, but I am checking in to say a quick ‘Hi!’ to you, and put down a few good news that caught my eyes via the Nature News highlights that comes to my inbox.
I am tickled pink. I wrote something for a magazine, an informational piece on the Cryptococcus gattii outbreak currently ongoing in the US (on which I expanded in my last blog post). My essay was published yesterday, on May 16, with the launch of the UK edition of the online news magazine, The Conversation. One of the editors for The Conversation is none other than the Scilogs community’s very own, Dr. Akshat Rathi (he of the Allotrope fame; read his interview with Scilog’s Matt Shipman here).
This opportunity was doubtlessly exciting for me, but at the same time, I approached it with considerable trepidation – because I knew next to nothing about the journalistic style. In quick succession flew through my mind various discussions (sometimes even heated) I have had over the years regarding the all-too-obvious stylistic differences between jounalistic writing and scientific writing. Earlier this year, I even wrote down some of my observations in my blog, in which I argued in favor of positive use of technical terms, a.k.a. jargon, which many seem to abhor. In addition, there was the matter – which I think is extremely important – of maintenance of scientific accuracy (including the uncertainties inherent in science) in the reporting, which some journalists have been accused of egregiously disregarding (see some examples in this Columbia Journalism Review piece and this Slate piece).
My problem was that, as a working scientist and writer of scientific articles destined for peer-reviewed trade journals, I didn’t necessarily know how to write, or even explain a concept or present it accurately, while completely eschewing jargon. I find that jargon is helpful in cutting down rambles and getting at the central idea quickly and precisely; I value that precision in communication. While I do recognize that the excessive use of jargon may confound and alienate a reader, I did not know how to reach readers across a highly diverse readership.
When I communicated this concern to Akshat, he offered, most generously, to work with me to tone the essay down and make it suitable for the intended readership. The only stipulations were that there was a deadline, and that the essay had to be restricted to 1200 words. Thus encouraged, I spent the next few days at the keyboard of my computer, writing, chronicling the events, consulting references to ensure factual accuracy. I made several edits to maintain the word limit and to avoid technical terms as much as possible, and also rearranged the text to make the flow of paragraphs more appealing (or so I thought).
I wrote the essay in Word, incorporating references via Endnote – how blasé, no? Because the default word count function in Word counts everything, not differentiating between body text and references, my word count went up quickly. Panicking, I asked Akshat if the word count of the references mattered in the overall piece. He reassured me saying that the references would be eventually hyperlinked, so that I had nothing to worry on that count (pun intended!) – but nevertheless, I should try to keep the references to a minimum.
I was reasonably happy with the final piece. It was very slightly over 1200 words, but I trusted Akshat’s experience to manage that. I copied and pasted the text into the Author Interface of the platform that The Conversation uses. The layout of the platform was slighly different to me – I have gotten used to writing in WordPress and Blogger, where I hand-code the HTML – but it was not a big deal.
The first indication that everything was, in fact, not quite peachy was right there, and I am ashamed to say that I kind of ignored it. This platform incorporates a “Readability” button, which by default has a green circle by it. Curious, I pressed that button, et voilà! The green circle turned pale red. A message box appeared, which said several things: of these, the most reassuring was the note indicating that the system apparently recognized my writing as ‘scientific’ or ‘technical’ writing – which was also why it got a poor readability score. I was required to construct short sentences with no more than 17 words in each. However, realizing that I was already in troubled waters, I submitted the first draft, hoping to rely on Akshat’s editorial skills.
Akshat – bless his soul! – responded with a cheery note that he had received it, and was editing it – and that he enjoyed reading it. He put up the edited draft – he had cut it down to tighten the narrative, he said – requesting me to check if the science was still accurate. Eagerly, I betook myself to the draft, and…
Good golly gosh! Jumping Jehoshaphat!
The meaning of the verb ‘bowdlerize‘ had never before been so crystal-clear to me. To me, it was a radical edit. Words, paragraphs, descriptions, definitions were gone; the size was drastically reduced; introduced in the narrative were one-sentence paragraphs, something that – while working fine for some situations – is considered an anathema in scientific writing. For a few moments, my emotions were that of a grief-stricken, whimpering Copeland discovering his car, completely dismembered and destroyed by Hightower (don’t worry if you don’t get this obscure Police Academy (1984) movie reference).
And then, upon a second reading, several realities sunk in. First, I have a LOT to learn about news article. It is a completely different ballgame, with different focus, different emphasis, and different means to deliver that emphasis.
Secondly, and more importantly, Akshat had done a masterful job of editing the article; it now actually read like something you’d find in a column on the front page of a daily newspaper! The basic facts were all there, not overburdened by multitude of details. The narrative was tight and structured, but did not overwhelm the reader; I had to admit that even the pesky one-sentence paragraphs, placed strategically for emphasizing a point, seemed to work adequately (although, these were replaced in later edits by succinct and pithy short paragraphs, which was better). A few more rounds of edit to correct minor errors and supply a couple of supporting references, and it was done – ready to be revealed to the world. The result is for y’all to see.
I am forever grateful to Akshat for his yeoman’s service re editorial assistance. I hope that I have learnt something from it, and that that knowledge of a different authoring style will stand me in good stead for future writings. I cannot abandon yet the scientific writing style, which I shall keep for my blog, but I hope to grow as a writer as I grow more adept at espousing the journalistic style at will.
Perhaps someday, I, too, shall be able to write like my absolute favorite science journalists and communicators, Carl Zimmer, Ed Yong, Maryn McKenna, and Deborah Blum, whose phenomenal science essays have enriched me greatly over the years. Come on, a guy can dream, no?