SOCQ121 & BIOQ321 Session 12 Research into Practice Department: Social Science www.endeavour.edu.au
Today s Focus: Critiques of Evidence Based Medicine Endeavour College of Natural Health www.endeavour.edu.au 2
Today s Topics The limitations of evaluation of CM using current EBM frameworks & technologies The limits of EBM Theory & ideology Who are FSM? Developing Health Literacy: Recognising persuasive communication styles Getting your point across to an audience (tips for the final assignment) Endeavour College of Natural Health www.endeavour.edu.au 3
Section 1: The limitations of evaluation of CM using current EBM frameworks & technologies Endeavour College of Natural Health www.endeavour.edu.au 4
Applying EBM principles to CM o Progression in science means that a number of esoteric (understood by only a small number of people with a specialized knowledge or interest) health interventions can now be measured and explained, e.g acupuncture and meditation o However EBM frameworks cannot currently measure all Complementary Medicine interventions e.g. homeopathy Endeavour College of Natural Health www.endeavour.edu.au 5
Acupuncture o Ancient acupuncture literature documented treatment for many ailments using acupoint stimulation o Historically the efficacy of acupuncture has been disputed however results from MRI research now demonstrate the correlation between activation of specific areas of brain cortices and corresponding acupoint stimulation Endeavour College of Natural Health www.endeavour.edu.au 6
Meditation o The health benefits of meditation have recently been proved via EBM o In 2002 the Centre for Mind Brain research was set up at the University of California at Davis. CMB is a research and training unit dedicated to understanding the nature of the human mind from interdisciplinary perspectives. o Question: Can you trust the information below? How do you know? o The following URL takes you to an overview of the Shamatha project http://mindbrain.ucdavis.edu/research/research-projects-folder/shamatha-project o The following URL lists scholarly articles related to the Shamatha project http://saronlab.ucdavis.edu/publications.html Endeavour College of Natural Health www.endeavour.edu.au 7
Homeopathy Have a look at the NHMRC statement on homeopathy (in this week s readings) and read pages 25 and 26 in the full report NHMRC Information Paper Evidence on the effectiveness of homeopathy for treating health conditions o What do the authors say about their own research methods? For example, the authors note limitations such as, studies of homeopathy were generally poor quality, what do they mean by this? o How might the way homeopathy is clinically applied not lend itself to science based systematic review? Endeavour College of Natural Health www.endeavour.edu.au 8
Scientifically minded evaluators of CAM projects should understand the nature of CAM and the fact that, in certain instances, scientific rigor can only be taken to a certain point.many CAM therapies have philosophical underpinnings that challenge orthodox medical perspectives, and thus hinder attempts at scientific validation with conventional methodologies. It is, however, quite clear that such challenges are not a complete block to good CAM research. Ernst, E. (2004). Ethical problems arising in evidence based complementary and alternative medicine. Journal of Medical Ethics, 30 (2), pp. 156 159. Retrieved 6 February 2015, <http://jme.bmj.com/cgi/doi/10.1136/jme.2003.007021>. Endeavour College of Natural Health www.endeavour.edu.au 9
Section 2: The limits of EBM Endeavour College of Natural Health www.endeavour.edu.au 10
EBM o Provides a framework for us to critically evaluate the efficacy of health interventions o However, many of the problems we have covered in this course, investigator bias, conflict of interest, corporate imperatives, ambition, and other elements of our humanity compromise it s ability to predict health outcomes Endeavour College of Natural Health www.endeavour.edu.au 11
EBM & limitations of allopathic medicine o Do you remember what a co-founder of the Cochrane Collaboration has to say about anti-depressants and painkillers? "It's remarkable that nobody raises an eyebrow when we kill so many of our own citizens with drugs o He also estimates that 100,000 people in the United States alone die each year from the side-effects of correctly used drugs. o If you read something like the above statement from Peter Gotzsche, how might you decide if what he says is true? Article URL Endeavour College of Natural Health www.endeavour.edu.au 12
Critical Evaluation Exercise Lets evaluate this website. Look at the following paper: http://www.thementalelf.net/mental-health-conditions/depression/cochranereview-says-theres-insufficient-evidence-to-tell-whether-fluoxetine-is-better-orworse-than-other-treatments-for-depression/ Is the mental elf a website you can trust? Click on Home and About categories. Who writes the articles? Can you see evidence of authoritative knowledge? Are sources peer reviewed? By now you should have a set of questions that you use to interrogate information you see on the news, read on the web, in magazines.
Section 3 Theory and Ideology
Theory, ideology & belief o Theory A well-substantiated explanation of some aspect of the world that is acquired through the scientific method or based on empirical observation o Ideology An ideology is a set of opinions or beliefs held by a group or an individual. Marxism is an example of a political ideology Can you think of some more political or cultural ideologies? o Belief An acceptance that something is true, even or especially without proof Endeavour College of Natural Health www.endeavour.edu.au 15
In week 8 we looked at some of the criticisms of CM Lack of an established pharmacological or physiological basis for therapies in CM = vulnerability to criticism of some CM modalities Pseudoscience Quakery Charlatanism. But are these critiques based on theory, ideology or belief? In the next section we are going to unpack some of the claims made against CM
Section 4: Who are Friends of Science in Medicine and what do they have to say about CM? Endeavour College of Natural Health www.endeavour.edu.au 17
Friends of Science in Medicine o Are a powerful mainstream interest group comprised of experts in a variety of health related fields o Established in late 2011 o Are anti-pseudoscience o Are very vocal in the media Endeavour College of Natural Health www.endeavour.edu.au 18
FSM: Key Principles 20 min., https://www.youtube.com/watch?v=pnohjixmnwc What do Friends of Science in Medicine say about Complementary & Alternative Medicine? Endeavour College of Natural Health www.endeavour.edu.au 19
FSM: Key Principles Official website of FSM says: So-called complementary and alternative medicines (CAMs) represent a disparate variety of interventions, many of which are not effective and are not based on any scientific principle, they therefore deceive the public, often for financial gain; and At their best, many CAMs ameliorate only minor ailments; they usually work because of the well-known placebo effect. At their worst, CAM interventions are unnecessarily dangerous - either because they cause direct harm or because they delay effective treatments. http://www.scienceinmedicine.org.au/index.php?option=com_content&view=article&id=177&itemid=153 Endeavour College of Natural Health www.endeavour.edu.au 20
Exercise Read the journal article (Reading week 12): Flatt, J. (2013). Critical Discourse Analysis of Rhetoric Against Complementary Medicine. Creative Approaches to Research, 6 (2), pp. 57 70. o Flatt analysed the claims that FSM made in the media and concluded that they are speaking from an ideological rather than science based perspective, based on the belief that CM should be excluded from university education and primary health care. Endeavour College of Natural Health www.endeavour.edu.au 21
Exercise Read the journal article (Reading week 12): Flatt, J. (2013). Critical Discourse Analysis of Rhetoric Against Complementary Medicine. Creative Approaches to Research, 6 (2), pp. 57 70. o Does Flatt s conclusion match the research method? o What other questions might you need to ask? o How might you find out more on this issue, or the research method if you where interested? Endeavour College of Natural Health www.endeavour.edu.au 22
The paper has asked whether FSM deploy power and ideology within their discourse, and if their portrayal of complementary medicine is accurate and impartial when compared to the literature. CDA techniques have been used to analyse a selection of FSM statements across a range of media events, and have explored and illuminated underlying motivations for FSM speech acts. The findings have shown that FSM contradict the literature in their viewpoint of complementary medicine and its use, and manifest ideology and power within their discourse. The implications of this are that FSM are using a style of language that promotes their own beliefs to suppress alternative voices. This leads to FSM having an inaccurate understanding of complementary medicine and patients because they have an interpretive bias originating from an ideological perspective. Their underlying desire to maintain power overrides any potential positive outcomes from Critical Discourse Analysis of Rhetoric Against Complementary Medicine within their view of complementary medicine, and contributes to a discourse that presents as diatribe. The statements that FSM use have no respect for complementary medicine or its patients, create no potential for the application of science to this healthcare field, and leave no room for equitable scholarly debate. The negative implications of the presence of this type of imbalanced argument within the public sphere are not limited to the complementary medicine field. The knowledge community needs to carefully review these voices and conduct an ongoing critical analysis of the expressed demands. If this type of ideological discourse is allowed to flourish unchallenged, the possible consequences for freedom of knowledge and unfettered access to healthcare are significant.
Section 5 Communication styles
Communication Styles There are many different communication styles, from formal information giving, to infotainment, to all kinds of creative writing and performance. Writing Styles There are four main writing styles: Expository Facts Narrative Story Descriptive Feelings Persuasive Subjective point of view
Expository communication Main type of writing used when communicating health information. You will use expository communication style in Assignment 4. Provides facts, figures and information, without a great deal of embellishment This is the kind of writing you find in textbooks, manuals, policy documents, IKEA furniture manuals and things that provide explanation or information There is little room for embellishments such as humor, storytelling or other techniques used to make writing interesting
Persuasive communication Persuasive writing is designed to persuade you of a point of view It is a writing style we often use in health promotion Persuasive writing contains biases, opinions and arguments designed to sway you toward a particular point of view Endeavour College of Natural Health www.endeavour.edu.au 27
Persuasive communication We now recognise that there is a difference between good journalism and good health writing The topics in this section relate to recognising persuasive communication styles Getting your point across to an audience without using manipulation
Persuasive communication Below Flatt takes a stand about the government s future policy direction: Complementary and alternative (CAM) therapies should be part of our national policy strategy as we work toward a healthier Australia. CAM therapies take a holistic view of the body and focus on prevention rather than cure. Taking a more holistic view of health will result in savings to the health system as healthy people are less likely to visit the doctor. We know that CAM therapies are effective because they have been around for thousands of years whereas pharmaceutical companies are always going out of business. Flatt, J. (2013). Critical Discourse Analysis of Rhetoric Against Complementary Medicine. Creative Approaches to Research, 6 (2), pp. 57 70. Endeavour College of Natural Health www.endeavour.edu.au 29
Exercise Reflecting on this session s readings, how do you think: o Do FSM use appropriate communication style when presenting their claims? Why? o Did Flatt use appropriate communication style in his paper? Why? o Which writing style/-s have you used in assignment 3? o What are the key principles of academic writing style? Endeavour College of Natural Health www.endeavour.edu.au 30