[open-science] Rhetoric and evidence ? [Article in the Economist: "Not so smart now"]

Tom Moritz tom.moritz at gmail.com
Mon Oct 31 23:46:10 UTC 2011

Economist review of "Human decision-making: Not so smart now" The father of
behavioural economics considers the feeble human brain [Oct 29th 2011]
Review of *Thinking, Fast and Slow.* By Daniel Kahneman. *Farrar, Straus &
Giroux; 352 pages; $30. Allen Lane; £25.*

The review reads:   *"He also shows that it is more threatening to say that
a disease kills
'1,286 in every 10,000 people”, than to say it kills “24.14% of the
even though the second mention is twice as deadly. Vivid language often
overrides basic arithmetic."

*A propos our recent consideration of the distinction between the
"political" ("rhetorical"?) and "scientific" statements.
I wonder to what degree rhetoric impacts the presentation and acceptance of
scientific results?

Seems our most fundamental problem is firm grounding in evidence [data] --
as defined by logical validity with respect
to well-formed hypotheses?


*Tom Moritz
1968 1/2 South Shenandoah Street,
Los Angeles, California 90034-1208  USA
+1 310 963 0199 (cell) [GMT -8]
tommoritz (Skype)

“Πάντα ῥεῖ καὶ οὐδὲν μένει” (Everything flows, nothing stands still.) --*
Heraclitus *
"It is . . . easy to be certain. One has only to be sufficiently vague." --
C.S. Peirce  *
*"Kathambhutassa me rattindiva vitipatanti" (“The days and nights are
relentlessly passing; how well am I spending my time?”) -- *"Ten Subjects
for Frequent Recollection by One Who Has Gone Forth"*
*"Il faut imaginer Sisyphe heureux."  ("One must imagine Sisyphus happy.")
-- Camus*

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On Sat, Oct 29, 2011 at 1:50 AM, Jenny Molloy <jcmcoppice12 at gmail.com>wrote:

> Thanks very much Alma. I notice the author advocates the following:
> *"If every single biomedical research article were made freely available
> and published under a Creative Commons license, all articles could be
> collected together in a single open access information space. The
> literature could then be seamlessly integrated with important databases,
> such as gene or protein databases, and it could be more easily searched and
> mined. The result would be the discovery of new scientific medical
> knowledge. We now have machines that can scan research papers and find
> linkages among them that no human could have discovered...For this to
> happen, however, papers must be held in an open access repository and not
> remain hidden behind publishers’ authentication systems.”88"<http://www.hhrjournal.org/index.php/hhr/article/viewArticle/20/88#refs9>
> *
> ORRs aim to provide that single space for the currently available
> literature on a particular disease and eventually semantic tools which
> could allow the kind of searches mentioned above. They won't get there for
> a while, but you've got to start somewhere.
> In addition to the other replies I thought I should also try to address
> Pawel's request for data and hard evidence on the idea that open access
> saves lives, but as you'll see below it's difficult and most organisations
> including those quoted by Brian and Alma use testimonials/anecdotal
> evidence as their main source of support in this.
> Peter's assertion is similar to that made by Healthcare Information For
> all (HIFA2015 http://www.hifa2015.org/ ) whose website leads with 'People
> are dying for lack of knowledge'. This campaign has a community of over
> 1800 healthcare organisations (many national/worldwide medical bodies
> including the British Medical Association, Cochrane Collaboration, WHO
> African Regional Office Library - full list here
> http://www.hifa2015.org/support/#supporting-organisations) that are happy
> to endorse the message, although they also admit that there is a lack of
> data to substantiate and quantify that claim:
> "A challenge to advocacy is the limited availability of hard evidence such
> as case studies and other data demonstrating in quantitative terms the
> difference that the effective provision of healthcare information can make
> to health outcomes, quality of care, training or other relevant result"
> (pg.43
> http://www.hifa2015.org/wp-content/uploads/HIFA2015-Evaluation-Report-Final.pdf
>  )
> HIFA focus on information provision at all levels, not just access to the
> primary literature, but the testimonials on their website and personal
> correspondence between those involved in ORRs and the HIFA2015 Coordinator
> Dr Neil Pakenham Walsh indicate that a major element of the global
> healthcare knowledge system is increasing the availability and usability of
> primary research.
> A review on the information needs of healthcare workers in developing
> countries http://www.human-resources-health.com/content/7/1/30 references
> a study:
> To test the hypothesis that there was variation between and within
> developing countries in the proposed management of a patient with hospital
> acquired pneumonia, and that part of the variation can be explained by the
> sources of evidence used (
> http://www.jclinepi.com/article/S0895-4356(99)00231-0/abstract)
> Which I suspect is the kind of evidence you would like to see, but seems
> to be one of the only studies of its kind. The abstract concludes "Textbooks
> were the commonest form of information source, and access to a library,
> textbooks and journals were statistically significantly associated with
> appropriate choice of investigations, but not treatment. Access to local
> antibiotic sensitivities was associated with appropriate initial treatment
> choice. Improving access to information in the literature and to local data
> may increase the practice of evidence-based medicine in the developing
> world."
> Not the strongest support but it's the only peer reviewed publication I
> could find addressing a question of that sort.
> Although we are focusing on open primary research literature and expert
> annotation/summaries of the most highly cited papers via the web form
> generated by David Shotton and Tanya Gray, the next stage would involve
> annotation by the broader health community that would meet the needs of
> specific user groups, including lay summaries and possibly translations
> (which Pawel says would have impact  -
> http://www.pawelszczesny.org/2011/10/25/open-access-means-people-die/).
> ORRs aim to give a framework around which additional layers of
> functionality can be added while maximising the discoverability and
> usability of the content by ensuring that the base is machine readable and
> semantically searchable . How this knowledge becomes accessible to
> healthcare workers as open educational resources, particularly those
> without access to computers and the internet is a considerable challenge,
> but the primary targets in developing countries would be doctors,
> researchers and students in the first instance for whom the primary
> literature is a direct educational resource.
> This is very wrong. Majority of maternal mortality rate in Bangladesh
>> (see your last slide) is attributed to child marriage, lack of female
>> education and lack of skilled birth attendants. Access to scholarly
>> literature is absolutely irrelevant in such case. You'd need to
>> improve the standard of living and the quality of education first.
> You are absolutely right that it is not an underlying cause of the
> majority of maternal mortality, but the quality of medical education is
> vital in ensuring that correct maternal care is provided where skilled
> birth attendants are available, which includes access to up to date
> techniques and information, at least to those training midwives and birth
> attendants.
> Again, there is no hard evidence to be had on this but comments from the
> HIFA network include
> “There is lack of a system to update nurses/midwives in private and public
> practice about the development in Maternal and Child Health were by when
> challenged are not in position to clarify and support safe motherhood. (No
> access to technology, refresher courses, literature, support supervision of
> their facilities etc)”
> David Muwonge, Uganda (October 2008 - Registered nurse, working with
> Naminya community outreach and nursing home)
> There is also a lack of access to literature for medical students, who
> thus may be entering practise with information from out of date text books:
> http://www.hifa2015.org/knowledge-base/healthcare-providers/information-needs-of-health-students-in-low-income-countries/
> ORRs aren't aiming to address any of these wider problems, but may offer a
> resource to reach people who can disseminate that knowledge to primary
> healthcare workers who may not have or desire access to primary papers (we
> are aware that translation from academic literature to practice is a huge
> barrier to the potential effectiveness of increased access but HINARI gives
> a good example with Hepatitis E "The key outreach is done by the Uganda
> Gastroenterology Society...It gathers information from HINARI and transmits
> it to the country through radios, healthcare workers and any person who
> handles blood as they are most exposed to the virus."
> http://www.research4life.org/casestudies_4_aids.html ). While the
> healthcare use case has many challenges that must be overcome,
> availablility of primary literature to researchers has more immediate
> benefits. Barbara Aronson addresses the issue well:
> "Will improved online access have an effect on health in low-income
> countries? It is probably impossible to show a direct connection either
> between the lack of access to information and poor health or between
> improved access to information and improved health. There are many other
> reasons why health in these countries is poor and will not improve quickly.
> These include poor health services infrastructure, poor nutrition, lack of
> clean water, and poor sanitation, as well as war, drought, and political
> corruption. Most global health and medical research remains focused on the
> problems of wealthy nations. But low-income countries also have medical
> schools and universities. They have researchers and research institutes
> that carry out essential work on local problems and government offices that
> try to set effective policies. Warren Stevens of the Medical Research
> Council Laboratories in the Gambia has noted that intellectual isolation
> represents an important hindrance to the development of world-class
> researchers in African countries. Access to timely, relevant, high-quality
> scientific information represents a substantial gain for the researchers,
> students, teachers, and policymakers in low-income countries. Can this be
> called anything but progress?"
> Improving Online Access to Medical Information for Low-Income Countries, Barbara
> Aronson, N Engl J Med 2004; 350:966-968
> Although it can't be concretely backed up with data, the idea that open
> access saves lives is not confined to HIFA, As Brian Glanz pointed out -
> quotes to that effect are not hard to find:
> HINARI has collected case studies of the impact that free access has on
> healthcare and devlopment and 'saving lives', 'improving quality of life'
> are mentioned multiple times:
> http://www.research4life.org/casestudies_2_diarrhea.html (Educating
> people in good hygiene practise)
> http://www.research4life.org/casestudies_4_aids.html (Prescribing correct
> antiretrovirals and monitoring)
> http://www.research4life.org/casestudies_1_watersheds.html (Developing
> filters and storage systems for drinking water)
> During our talk, Peter explained why he feels 'free' is not sufficient and
> open access is better, but easy access at all is the point
> SOROS Open Society Institute had in it's 2006 Annual Report the article:
> Open Access to Scientific Research—Sharing Information, Saving Lives
> They also have case studies of harmful medical decisions being made due to
> lack of access to the full text medical literature
> http://www.soros.org/initiatives/information/focus/access/articles_publications/articles/openaccess_20070419
> Virginia Barbour, Chief Editor of PLoS Medicine states of Springers
> decision to offer free access to E.coli research during the recent outbreak
> in Europe:
> "Springer knows how important open-access publication is - they own Biomed
> Central, a large group of open-access journals. By acknowledging that open
> access to the literature can save perhaps 10s or 100s of lives in this
> outbreak, they surely can't deny that opening access to the entire medical
> and scientific literature has the potential to save many millions of lives."
> (HIFA forum - 3 Jun Press release: Springer offers free access to research
> articles on E. coli bacteria
> http://dgroups.org/ViewDiscussion.aspx?c=e95b885f-14b0-4452-a819-06cf188ee6b0&i=38f192cf-bd2e-4afb-8710-620a538dfb1e
> )
> Therefore, I'm not sure the general message that open access to biomedical
> literature can save lives, and conversely a lack of it can cause
> preventable deaths through incorrect or outdated treatment is that radical
> within the global health community.
> From: Paweł Szczęsny <ps at pawelszczesny.org>
> Date: 2011/10/27
> >OA (understood as open access to primary literature) is very
> >important, especially in developing countries, but if there's no
> >healthcare infrastructure to apply the cutting-edge knowledge, OA
> >becomes almost irrelevant in the healthcare (while being crucial in
> >research).
> As above, there is an intersection in health research addressing local
> problems, which one would think could lead to better local policy and
> improved healthcare, although again there is no data to offer. I'm glad
> you brought up the lack of evidence and that others on the list have joined
> in the discussion of how relevant open access is to developing countries,
> hopefully this will be the focus of more research in the near future.
> From: Paweł Szczęsny <ps at pawelszczesny.org>
> Date: 2011/10/27
> >I can supply the same amount of anecdotal evidence showing how access
> >to information is harfmul in case of patients, starting from effects
> >of Wakefield's MMR paper and ending with plenty of stories from local
> >doctors.
> Leaving aside developing countries as a use case for ORRs, patient
> advocates who have been consulted on ORRs believe Peter's statement to be
> the case for some diseases in the developed world. There are no doubt
> also anecdotal examples of the opposite, and a separate debate would be the
> scientific literacy of the general population and their ability to
> interpret the literature, but misinformation and poor science reporting by
> the media is far more dangerous than access to the primary literature,
> which would at least give those with the inclination a chance to check the
> facts and the place of findings within the broader field of study. In the
> case of MMR, the paper was closed access and not a single study I've seen
> suggests that parents based decisions on anything in the scientific
> literature, they were listening to the media and, where they trusted them,
> healthcare professionals. This would have been the case regardless of the
> open or closed nature of the publication - the vast majority of the
> population will not access the primary literature even if openly available
> - but the fact remains that some people want to, can make good use of it
> and there are cases where they have, which as Peter mentions he will try to
> compile with the help of patient groups.
> I appreciate your point about the nature of anecdotal evidence, but in the
> cases supporting the idea that open access can save lives, there is a
> direct link between access to the primary literature and changes in
> clinical decisions/treatment being beneficial, or closed access being
> harmful e.g. changing practices innappropriately due to only having access
> to an abstract as in Alma's source http://www.hhrjournal.org/index.php/hhr/article/view/20/88
> . <http://www.hhrjournal.org/index.php/hhr/article/view/20/88>I'd be
> interested to know if the evidence from doctors that you mention is
> patients making harmful decisions due to information from the media/quack
> websites/other sources of information (as was the case with MMR) or
> directly from the literature.
> Sorry this ended up being so long, it's been a useful exercise :)
> Jenny
> PS BioMedCentral ran their Open Access Africa Conference this week (
> http://www.biomedcentral.com/developingcountries/events/openaccessafrica/program)
> and while the talks aren't up yet, the following could be interesting:
> *Importance of open access to case reports:*
> Joseph Ana, Mentor of BMJ West Africa edition, Nigeria
> *Open access: Meeting the cardiovascular disease information needs of
> health professionals*
> Dr. Collins Kokuro, Associate Director, Ashanti-ProCor Project and
> Specialist Physician, Dept. of Internal Medicine, Komfo Anokye Teaching
> Hospital, Kumasi, Ghana
> *Access to research and information for health workers*
> Victoria Kimotho, AMREF, Kenya
> On Fri, Oct 28, 2011 at 5:29 AM, Alma Swan <a.p.swan at talk21.com> wrote:
>>  A substantiated example of how lack of access can have a profound
>> effect is related here:
>> http://www.hhrjournal.org/index.php/hhr/article/view/20/88
>> Alma
>> On 27/10/2011 18:42, "Peter Murray-Rust" <pm286 at cam.ac.uk> wrote:
>> On Thu, Oct 27, 2011 at 5:55 PM, Heather Morrison <hgmorris at sfu.ca>
>> wrote:
>> To help people make the connection between open access and saving lives
>> in the developing, would it help:
>> -       to briefly mention Open Education? perhaps the UNESCO initiative?
>> This related initiative addresses the question of facilitating basic
>> education quite directly.
>> http://www.unesco.org/new/en/communication-and-information/access-to-knowledge/open-educational-resources/
>> -       to speak to south to south and south to north knowledge
>> dissemination? Leslie Chan is one of the experts here, perhaps he can
>> provide some specifics. In brief, as long as the focus is on the knowledge
>> production of the developed world, the needs of the developing world are
>> likely to be short-changed. Lots of research on obesity, little on
>> malnutrition or how to manage food security with little or no $ to work
>> with.
>> This is great Heather,
>> There is actually an immediate urgency (which has suddenly arisen) _
>> Jenny and I and other have to make a video within 24 hours. (Of course
>> that's not the end of the story). We want to bolt together clips from OSS
>> video with bits of Graham Steel presenting patientsLikeMe and Leslie's clip
>> that Iryna posted. The video will be 5 mins long and present particularly
>> what I and OKF can do NOW so there is a concentration on the December
>> Hackathon. I'll explain the context later.
>> P.
>> my two bits,
>> Heather Morrison
>> Doctoral Candidate, Simon Fraser University School of Communication
>> http://pages.cmns.sfu.ca/heather-morrison/
>> hgmorris at sfu.ca
>> On 2011-10-27, at 9:37 AM, Peter Murray-Rust wrote:
>> >
>> >
>> > 2011/10/27 Iryna Kuchma <iryna.kuchma at eifl.net>
>> > If we are talking about open access to scholarly publications please
>> believe me that people in universities and research institutions in
>> developing countries do have computers and internet. this is one of the
>> examples of a Kenyan researcher speaking about open access: Prof. Mary
>> Abukutsa-Onyango discusses the importance of open access for research from
>> Kenya and other African countries (http://vimeo.com/10169351) and I can
>> share more evidences like this.
>> >
>> > Many thanks for this. The video is exactly what Jenny and I need for a
>> clip. It's no coincidence that it was created by Leslie Chan who is one of
>> the group of us who dreamt up Open Research Reports.
>> >
>> > Yes, OA is absolutely critical.
>> >
>> > Best wishes,
>> > Iryna Kuchma
>> > EIFL Open Access programme manager
>> > www.eifl.net <http://www.eifl.net>
>> >
>> >
>> >
>> >
>> > --
>> > Peter Murray-Rust
>> > Reader in Molecular Informatics
>> > Unilever Centre, Dep. Of Chemistry
>> > University of Cambridge
>> > CB2 1EW, UK
>> > +44-1223-763069 <tel:%2B44-1223-763069>
>> > _______________________________________________
>> > open-science mailing list
>> > open-science at lists.okfn.org
>> > http://lists.okfn.org/mailman/listinfo/open-science
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