Health Equity: 07/03/12

Tuesday, July 3, 2012

[EQ] Evidence-based medicine conceptual cul-de-sacs and some off-road alternative routes

Why do we always end up here?
Evidence-based medicine’s conceptual cul-de-sacs and some off-road alternative routes

Trisha Greenhalgh, Healthcare Innovation and Policy Unit, Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, United Kingdom

J PRIM HEALTH CARE - 2012; 4(2):92–97 http://bit.ly/O01QYX

‘’…………Let me explain what I mean by ‘conceptual cul-de-sacs’. Thomas Kuhn proposed that science progresses in paradigms—a paradigm being a set of assumptions and beliefs shared by a group of scientists about what the important questions are and how they should be tackled.4 Most scientists, most of the time, work within an existing paradigm and build rather doggedly on what has gone before. This is what Kuhn called ‘systematic puzzle-solving’, Wittgenstein called ‘the railway tracks of science’5 and Einstein called ‘99% perspiration’.

Occasionally, someone (often a youngster new to the discipline or perhaps someone in a second career) questions the prevailing assumptions and methodological rules—Einstein’s ‘1% inspiration’. A fight ensues, with the newcomer typically rejected by the old school as ignorant or not rigorous, and a breakaway group forms. The most famous example of this is Einstein himself, who challenged the assumptions and methods of Newtonian physics and started playing to new rules, allowing new questions to be addressed in a whole new way.

Paradigms are not bad things. They don’t just constrain our thinking, they enable us to think.6 Science could not progress without them. We learn the rules, apply them, argue about them, modify them. Indeed, Susan Leigh Star defined a discipline as ‘a commitment to engage in disagreements’.7 If you’re a geneticist and a historian challenges your work, you won’t get very far. But with a fellow geneticist, you can have a good argument and make progress.

The pre-paradigmatic research of off-road breakaway groups is typically slow, messy and characterised by wrong turnings and periodic pile-ups.4 But eventually some tracks are laid and a clear direction of travel is pointed out. Yesterday’s radicals become today’s sticklers for procedure. Disagreement, and therefore progress, becomes possible. A new paradigm is born……….”

Why National eHealth Programs Need Dead Philosophers:

Wittgensteinian Reflections on Policymakers' Reluctance to Learn from History

Trisha Greenhalgh, Jill Russell, Richard E. Ashcroft, and Wayne Parsons Queen Mary University of London

The Milbank Quarterly - Volume 89, Number 4, December 2011

http://bit.ly/vxvWJ8

Evaluating eHealth:
how to make evaluation more methodologically robust
Lilford RJ, Foster J, Pringle M:. PLoS Med 2009, 6: e1000186.
http://bit.ly/KS0z4P

Why do evaluations of eHealth programs fail?
An alternative set of guiding principles.
Greenhalgh Trisha, Russell J. PLoS Med 2010, 7: e1000360

http://bit.ly/KYSEHz


  Realist review
   – a new method of systematic review designed for complex policy interventions
  Ray Pawson, Trisha Greenhalgh1, Gill Harvey2, Kieran Walshe2

Department of Sociology and Social Policy, University of Leeds, Leeds; 1University College London, London; 2Manchester Business School,

University of Manchester, Manchester, UK
  Journal of Health Services Research & Policy
  http://bit.ly/MHqod7

KMC/2012/HSS
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[EQ] Health and Illness in a Connected World: How Might Sharing Experiences on the Internet Affect People's Health?

Health and Illness in a Connected World:
How Might Sharing Experiences on the Internet Affect People’s Health?

Sue Ziebland, University of Oxford, Department of Primary Health Care Sciences, Oxford, United Kingdom

Sally Wyke, University of Glasgow, Institute for Health and Wellbeing

The Milbank Quarterly, June 2012 - Vol. 90, No. 2, 2012 (pp. 219–249)

Available online PDF [31p.] at: http://bit.ly/LkAVvV

Context:
The use of the Internet for peer-to-peer connection has been one of its most dramatic and transformational features. Yet this is a new field with no agreement on a theoretical and methodological basis. The scientific base underpinning this activity needs strengthening, especially given the explosion of web resources that feature experiences posted by patients themselves.

This review informs a National Institute for Health Research (NIHR) (UK) research program on the impact of online patients’ accounts of their experiences with health and health care, which includes the development and validation of a new e-health impact questionnaire.

Methods:
We drew on realist review methods to conduct a conceptual review of literature in the social and health sciences.
We developed a matrix to summarize the results, which we then distilled from a wide and diverse reading of the literature.
We continued reading until we reached data saturation and then further refined the results after testing them with expert colleagues and a public user panel.

Findings:
We identified seven domains through which online patients’ experiences could affect health. Each has the potential for positive and negative impacts.

Five of the identified domains (finding information, feeling supported, maintaining relationships with others, affecting behavior, and experiencing health services) are relatively well rehearsed, while two (learning to tell the story and visualizing disease) are less acknowledged but important features of online resources.

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