Forgive me father for I have sinned…

Posted by Louis Goffe

Although I am not a man of faith I have been shouldering some of my wife’s catholic guilt for a while and I have chosen the church of the Fuse blog to repent my sins. My shame for which I deeply wish to apologise for is that I was a fattist. I don’t mean this as a glib remark, I feel genuinely remorseful and embarrassed.

As with many –isms their spread is the result of mistruths and manipulation. On a search for the aetiology of my own previous held prejudicial views I realised that they were born out of a combined biblical belief in “the energy balance” and “a calorie is a calorie is a calorie”. The zeal to which many of us hold these two principals up as beyond reproach has blinded us to the wealth of research into the role of leptin, insulin and satiety in response to each of the macronutrients, the thermic effect of food and the overwhelming influence of our genetics in our predisposition to gaining weight. As a result the failure of this regulatory process is not blamed rightly on the foods we eat but the twin sins of greed and sloth.

I have always been thin, but instead of viewing this fortune as the luck of the genetic hand that I was dealt I smugly believed that it was down to my excellent constitution. But arrogance is the preserve of the misinformed and I was content in my protective shield of ignorance and happy to vilify those overweight as lacking in that intangible latent variable of ‘will power’.

This shift of focus from a physiological to a behavioural discipline has not only resulted in a generally accepted persecution, and in many cases resultant self-loathing in overweight individuals, but it also plays into the hands of the food companies that got us there in the first place. A blatant disregard for some quality science has led us down the path of poor food regulation and as a result we have become addicted to the most toxic dietary substance, that of sugar and we are left fighting an almost unwinnable battle.

The saccharine fortified tentacles of these confectionary and soft drinks companies have become entwined in all aspects of our lives to the point in which we cannot untangle. They are promoted by the world’s biggest stars, i.e. the most powerful role-models, to the young and easily influenced. We‘ve allowed them to sponsor school programmes and our national game although “there’s no nutritional need or benefit that comes from eating added sugar”. And how do they get away with this crime? Because we have all colluded behind the excuse that they can be enjoyed “as part of a calorie controlled/balanced diet”. This shows a total disregard to both their addictive properties and the resultant metabolic response.

These companies are smart. They haven’t just been one small step ahead of us but one giant leap. They were acutely aware of physiologist John Yudkin’s work linking sugar consumption to heart disease and started a campaign not only to discredit him but also crucially buy them time. The intervening years have bought these companies great wealth and substantial lobbying power. But finally, it seems that the sweet tide is starting to turn and there is greater acceptance that sugar is the silent assassin in our diets. Unfortunately our love of their products runs deep, this combined with their formidable defence force has meant that any meaningful change will be incredibly difficult, as demonstrated by the New York soda ban. Therefore to win this war over the health of our hearts we must present a strong, clear message to win over people’s minds.

As much as the prejudices are born out of an oversimplification the excuse for a fix are blamed on an over-complication. Many a toothless smile would have beamed across the boardroom of Sugary Drinks Ltd. on the release of the Foresight obesity systems map. As this incomprehensible, impenetrable and unvalidated model was held up as highlighting the innumerable potential pathways to obesity. So instead of being the Ace of Spades in the most wanted list they quietly disappear into the ether as one minion amongst millions. As a result there are now too many competing interests in the quest to tackle the obesity epidemic and we have to filter the wheat from the chaff, or more appropriately the raw sugar from the harvested cane. There should be an increased focus on the metabolic effects of the macronutrients so that we have the full backing of the scientific community when we next have these companies backed into a corner so that we are able to disarm them of their twin-barrelled attack of ‘calories’ and ‘complexity’.

A further symptom of our collective inability to target the sugar-daddies is the perpetuation of the futile debate of whether obesity should be classified as a disease. All this does is to further stigmatise those that are suffering. Now whatever your personal opinion the clear fact remains that those of us that are clinically defined as obese are significantly at greater risk to a huge number of illnesses many of which are fatal. But instead of showing compassion a quick glance to the magazine rack would imply that we are happier in the role of Mr Nasty on a real-world talent show judged exclusively on weight status.

The sensation of hunger is paramount to our survival, but there is a catastrophic failure of our current diet to satiate and provide the appropriate nutrition for a sustainable lifestyle. But instead of pointing the finger at the food, the individual and their supposed ‘weak will’ has become the object of our ire. The shocking fact is not that one third of all adults are obese but how some still remain thin in an environment so predisposed to making us fat.

Feelings of distain towards the obese might provide you with some fleeting sense of misplaced superiority but crucially they contribute nothing to the solution. Chastising the victim of any given disease is never the basis to formulate effective public health policy. Ridiculing those of us that are overweight will not reverse the trend but just serve to elevate the level of infighting while those pumping the noxious substances into our bodies continue laughing all the way to the bank.

I am not a Doctor: Part 2

Posted by Heather Yoeli

Shortly before this blog’s summer campervan trip, Jean wrote about her experience of not being a doctor. She is and she isn’t a doctor. Jean is a doctor in that she graduated from the MBBS course at medical school with a string of stellar accolades, and she is also a doctor in that she has an epidemiological PhD in something I don’t quite understand. However, Jean is not a doctor in the practicing medical sense of doctor that you’d go to see with a worrying cough or a sore toe – and that’s the sort of doctor members of the public tend to think of when they hear the term ‘doctor’, which is where things get complicated. I’m not a doctor either, though not in any sense of the term – my pre-public health degrees are in Religious Studies and Creative Writing, my PhD is still two years from completion, and the only people who call me Dr Yoeli are the endless PPI insurance call centre operatives who think they’re speaking to my husband. Nevertheless, it’s often the case when I try to members of the public what I do within Fuse that people assume that I am a medically-qualified and practicing doctor, and sometimes the case that I’m asked for advice on the basis of this assumption, too. I always feel that I’m disappointing people by telling them I can’t help. But really, most of us in Fuse would tell you that they couldn’t help, either. I thought I’d write this blogpost to explain why not.

1. We study public health, not illness. We try to make populations healthier, not sick people better. There are many fine lines and commonalities and contested territories between public health and medicine. However, we won’t necessarily know much, if anything, about the illness you’re describing. Although we may be able to explain why and how you should stop smoking to lessen your chances of getting lung cancer, we probably won’t know enough about cancer itself to be able to comment on whether your father-in-law is receiving the appropriate chemotherapy regime for his stage and grade of tumour. So given that we know there are others more qualified to answer the question than ourselves, we’ll probably advise you to contact one of the relevant charities or advocacy groups with helplines dedicated to supporting and informing carers.

2. We do academic work, not clinical practice. We deal with people as research participants rather than as patients – and many of us deal with statistics or qualitative data rather than with people at all. As Hippocrates wrote, being a doctor requires not only knowing about illnesses but about patients. Although we may know that the blood glucose reading of Nmmol/l you got from borrowing your neighbour’s monitor is abnormally high and almost inevitably indicative of diabetes, we probably won’t have enough awareness of your personal medical history or sufficient experience of others presenting with similar blood glucose levels to know how likely you are to suddenly fall into a coma. So given that we probably know that untreated diabetes can be extremely serious and sometimes fatal, we will almost inevitably simply advise you to seek immediate medical help from a practicing clinical doctor.

3. Doctors are insured for giving medical advice; we’re not. Medical doctors in clinical practice are indemnified by specialist medico-legal practitioners which underwrite the risk of them giving incorrect advice or doing harmful things to patients. So if you sue a doctor for giving your father-in-law the wrong chemotherapy drug or for erroneously reassuring you that you don’t have diabetes, the doctor’s insurers will pay. If you were to sue us for offering dodgy advice, our university’s insurers would not pay. And because our university’s insurers would not pay, our universities would immediately fire us for the very grossest of gross misconduct, probably at rather massive cost to our career standing. So given that we know that we won’t necessarily be able to offer you good advice, and given that we could face catastrophic consequences for offering you bad advice, we tend not to offer any advice at all.

Most people in Fuse wont offer medical advice, because they don't want to get sued...

This three-point explanation aside, however, there’s a lot of theory about when, why and how ‘lay referral networks’ function to determine the circumstances people might or might not seek medical advice for a particular illness or symptoms. My anecdotal impression is that some people do seem to gain some validation or comfort from having academics tell them that they’re really not able to provide the medical advice requested. Has anyone ever studied the phenomenon or role that academics might play within this process? I would be interested to know.

How to choose a PhD topic

Posted by Heather Yoeli

A few of us were discussing recently how and why we had chosen the PhD topic we did.

Firstly, you won’t necessarily have the opportunity to choose. Increasingly, PhD studentships from the major research councils and other funding bodies are being advertised with fairly tightly-defined research questions and with methodologies already pre-determined. These studentships tend to suit both students seeking a clear assignment and those already confident of the area and approach with which they want to work.

Secondly, you might not necessarily want to choose. Some prospective PhD students may not necessarily know precisely what they want to study but are keen to work with a specific supervisor and therefore ask or allow their prospective supervisor to determine their topic. Within most areas of academia, the person by whom you’ve been supervised can count as much as or even more than your PhD topic or institution itself. It may be helpful to your career aspirations to decide in whose reflected glory you’d hope to bask.

Thirdly, your discipline or subject area may have an obvious current ‘issue’ which will make your work more timely/popular/publishable/trendy. In public health, these ‘issues’ tend to be determined by government policy ‘directives’ and ‘agendas’, which are determined by wider political and social trends and can be hard to predict in advance. If you’re looking for a PhD topic which will be the significant ‘issue’ on your submission date in three or four years time, you might benefit from a daddy who in the highest echelons of the power in determining such things... or alternatively, a crystal ball.

Fourthly, you might have something in which you have a very personal and passionate interest and therefore wish to study. There’s a prevailing view within academia that we should all be ‘detached’ and ‘objective’ and therefore not too emotionally invested in our topic, so by deciding entirely to ‘do your own thing’ you may risk being seen as a bit odd, but equally, it’s hard to remain focused and motivated if you don’t have a certain level of geeky fascination for what you’re studying. Academics have a time-honoured reputation for being somewhat eccentric, and with enough charismatic charm you can work that to your advantage. However, in today’s difficult economic times, you may have to find your own funding.

Most often, I think, people come to their PhD topics by a mixture of all of the above strategies. I applied for and was awarded a Fuse studentship which was very clearly about public health in marginalised communities, but have worked with successive supervision teams to develop a research approach of interest both to them and to myself. For me, this has worked well, and five years later I’m still every bit as interested in the subject as I initially ever was.

Many of my colleagues, though, have had very different paths. Many have come to their PhD topics through very novel routes or for fascinating reasons; many have started with one topic or approach and changed their thinking quite radically.

So, how did others come to be doing the PhD they are doing, or planning, or did...?

Taking control

Posted by Jean Adams

Being an early career researcher (ECR) isn’t always easy. So much emphasis is put on finishing your PhD, you slog your guts out getting the thing done, then a bottle of champagne and a long sleep later and life doesn’t seem to have changed much. As an early post-doctoral researcher you aren’t paid a whole lot more than a PhD studentship. And whilst that studentship might have been three, or even four, years of fairly secure ‘employment’, now you are suddenly in at the sharp end of short term contracts. On more than one occasion, I got sent a redundancy notice before I’d received the relevant contract to sign. You are generally beholden to more senior colleagues to find money to pay your salary and the dark arts of patching together pots of money from here and there to make a job can seem incomprehensible, sinister and even vaguely illegal.* It is easy to feel like your career is suddenly way out of your control.

It ain't easy being an ECR

At the same time, the demands can be overwhelming. The PhD that you thought was going to be the crowning glory of your CV suddenly feels as irrelevant as your GCSEs were the day you got some A-levels. It now has to be added to with teaching experience, publications, grants of your own, and examples of impact, engagement and outreach. All at the same time as fulfilling the demands of the day job, or jobs, that the person, or people, who have found you a salary require.

High demands. Lack of control. Sound familiar? It’s not surprising that so many ECRs feel totally stressed out by the whole thing. It is the very definition of a stressful working environment.

Of course the story above is a gross over-simplification. There are all sorts of pathways by which people come to the role of ECR. Just as there are all sorts of pathways that ECRs take from the point of PhD onwards. I don’t know the magic formula for ‘making it’. But I would suggest that if you want to get a grip on the stress, there are two things you can do: reduce the demands, or take back some control. I am not too great at moderating the demands of academic life. There always feels way too much to do, I’m hopeless at saying ‘no’ (and make it worse for myself by using synonyms for ‘no’ and then getting pissed off when these are interpreted as ‘yes’), and I’m never sure who I could or should delegate to. So my main strategy is to try and maintain a modicum of control.

Here is my five-step plan:

1. Decide what you want to do. Having a PhD doesn’t mean you have to stay in research, or that you will have failed if you don’t. It might feel like that in a university, because that’s what the people who seem to have the most status do. But I know lots of people with PhDs and MDs who have fulfilling lives and careers outside of university research. On the life achievement side, all of them have more children than I do.

2. If you want to stay in research, decide what sort of role you want. Not everyone has to be a professor. In fact, it’s quite obvious when you look around any university department that it’s pretty unlikely that every ECR could become a professor. Without a massive expansion in the sector, there will just never be enough professorial positions to go around. But there are other jobs within research - either within the ‘lab’ as a career researcher, or outwith it in research support.

3. Work out a plan. Once you’ve decided what you want to achieve in the long term, work out what the main steps are for getting there - say over the next 5 to 10 years. Then work out a more detailed plan for achieving the first of the steps - say over the next couple of years.

4. Make sure you have formal and informal mentors and support groups. The ‘answers’ to steps 1 to 3 are going to be obvious to some people and totally opaque to others, with a range of experience in between. Throughout your career (just as throughout your life) you are going to need advice and support. Make use of all the advice and support you can to help you work out where you want to go, how to get there, to keep you on track, and to remind you that you are awesome. It’s way too easy to forget, in an environment full of high achievers and extraordinarily clever people, that you too are amazing.

5. Reappraise regularly. If you’re not getting what you want from your chosen plan then go back to step 1 and reconsider.


*I promise they aren’t. They just seem that way.

Have we taken our eye off the ball?

Guest post by Andy Graham - specialty registrar in Public Health, County Durham

A couple of years ago I found myself in need of a dissertation topic for an MSc in Public Health – ‘make sure it’s something you are interested in’ was the advice. Simple I thought, I just need to weave football and beer into a research project! All joking aside though, I have become interested in the relationship between the two over the years. As a public health professional and former A&E nurse, I am well aware of the potential harms of excessive alcohol consumption. Also, as a fan who both attends matches and watches on TV, I have become increasingly aware at how visible this relationship has become. Of course, football and beer have long been associated, ever since Victorian landlords would set up teams, use the land out back for a pitch and, in the amateur days, employ the team as barmen in lieu of pay.

The Strawberry Pub, Newcastle, Phil Thirkell

But at the risk of sounding like my dad, when I ‘was a lad’, you either went to the match, where as a young working class man it was normal to have a pint with the lads, or you waited for Saturday night’s Match of the Day for your football fix. The pubs were open sporadically, had no TVs, and the football was rarely broadcast anyway. Fast forward a few years and we have football on satellite TV almost every night of the week and all day at weekends, most top flight football clubs sponsored at some level by an alcohol brand, marketing of alcohol, beer in particular, is rife and the norm appears to be drink beer and watch football with the lads in the pub. Opportunities to do both are far more common than when ‘I was a lad’, and not just within pubs, but within living rooms, where the cheaper alcohol deals of the supermarkets are very popular. As a dad myself I was disturbed by these developments, but hadn’t been able to quantify them.

I decided my dissertation would try to measure the amount of alcohol marketing that football TV viewers were exposed to. With the help of Jean Adams at Newcastle University, I planned the research. I chose six live broadcasts representing over 18 hours of footage, developed coding frameworks and watched 40 hours plus of coding footage to consider all the verbal and visual references.

The results shocked me:

• Over 2,000 visual images, 111 per hour on average, or around 2 per minute.

• 32 verbal references.

• 17 traditional advertisements, accounting for 1% broadcast time.

• Over 1,100 visual images in one alcohol sponsored Cup competition alone

The issue of traditional advertising commercials is interesting because the ‘voluntary’ codes of practice in place to regulate how alcohol is portrayed (should not appeal to youth, should not suggest social success, etc.) are most relevant to this type of advertising. Given that we know that quantity of alcohol marketing is more important than content, then the apparently unchecked stream of visual references in this research may be even more important, and we could argue that the current controls are completely inadequate because they are focused on content, rather than quantity.

I can’t help but feel that we have taken our eye off the ball – the globalisation of sports such as premier league football as a product, the satellite age, the endless thirst for profit and market share within corporations, the ‘self’ regulation that fails to control the exposure reported above, the relaxed licensing laws in this country, and the increase in type, availability, and affordability of alcohol. All of these things create a perfect storm in which alcohol and sporting idols become normalised as one and the same, and the brand becomes a member of the team. It feels as though the relationship between sport and alcohol has evolved towards its perfect and logical form.

I am disturbed to be one of a generation of football fans that has been manipulated in this way and that my children are also targets. And meanwhile, the alcohol industry has a seat at the policy making table through the Public Health Responsibility Deal. So we must ask the question: are we sleepwalking into a situation where drinking alcohol is so closely associated with the sporting heroes that children see on TV, that they are being actively normalised to become drinkers? No one seems to question this, but it is time someone did, and through public health advocacy it may just be up to us.

Sci-comm-ing

Posted by Jean AdamsI went to my first science communication conference at the weekend. I’ve wanted to do this for ages. Going to my two favourite academic conferences – the annual meetings of the Society for Social Medicine and the UK Society for Behavioural Medicine – makes me feel so alive. They are environments where I feel entirely immersed in my people, buzzing with ideas, invigorated to go back to my desk and do new and better things. And also often both physically and mentally exhausted.

I thought a science communication conference might make me feel more part of that community. Oddly, it didn’t. Probably because I’m not part of the scicom community and one conference a community member does not one make. Probably this feeling of being a little out of it and like I’m not absolutely sure I’m following the conversation is exactly how I felt the first time I went to SSM in Oxford all those years back. 2001 if you must know.

At SpotOn London 2013, I was taking part in a session on scientist-2-scientist communication – primarily via the medium of blogging. If you happen to be interested (and have an hour to kill), you can see a video of the session here.

Beforehand I’d been worried that talking about blogging at a scicom conference was a little passé – preaching not just to the converted, but to the evangelical. A quick show of hands on the day confirmed that about 90% of the 40-50 people at the session were bloggers.

But it seemed to go okay. The session generated a lot of Twitter chatter (#solo13blogs). Predictably, although the panel discussion covered a lot of ground, the audience conversation seemed to get a little bogged down in the very last (and, I think, maybe least important) issue we discussed – if it matters whether or not people comment on your blog.

Are we in the Wild West of science blogging?

I’ve previously whinged a bit that hardly anyone comments on this blog. But I’ve got used to it. I know that posts can generate discussion in other forums and I’ve started to believe that people genuinely do read these posts – that we’re not just sending words into the void. It was still nice to hear that we’re not alone in our virtual comment-less-ness. One of the science correspondents at The Guardian confirmed that only about 0.5% of visitors to The Guardian website leave a comment and that about 80% of those are left by the same hard core of commenters. There are just a lot more comments on The Guardian website because they get a lot more traffic that the Fuse website (hard to believe, I know).

The other thing the guy from The Guardian pointed out was that building community takes time and effort. I know this. Who could not? But it’s nice to be reminded of it. I think that we could do more to build community within and beyond Fuse and I’d be interested in your thoughts on how we might do this. You could leave a comment if you’d like…

When I was originally asked to take part in SpotOn, I was pretty hesitant. I don’t think I’m some massive expert in blogging, or science blogging. I feel like we at Fuse came to the blogging party pretty late and that we are a fair way behind the curve, not in the vanguard of some great revolution. For me, this is okay. I mean, we’re a research organisation run by committees of academics, not a hack day run by precocious teenagers. But the current situation of science blogging was described by one participant as “the wild west” – a place with no rules yet, where only the strong enter and only the brave survive. I’m still not sure how much I agree with this. But it brought some fun images to mind.


With thanks to Roland Krause and Ingo Helbig of Channelopathist; and Lauren Tedaldi of What’s a PhD to do? for being part of a very well behaved and easy to manage panel.

The north loses out yet again under NHS funding proposals

By Clare Bambra, Durham University and Alison Copeland, Durham University

The north-south divide is a powerful trope within popular English culture and it’s also evident within the country’s health. A recent report by Public Health England showed that between 2009 and 2011, people in Manchester were more than twice as likely to die early (455 deaths per 100,000) compared to people living in Wokingham (200 deaths per 100,000).

This sort of finding isn’t new; for the past four decades, the north of England has persistently had higher death rates than the south, and the gap has widened over time. People in the north are also consistently found to be less healthy than those in the south across all social classes and among men and women. For example, average male life expectancy in 2008-10 in the north-west was 77 years, compared to 80 in the south-east.

A large amount of this geographical health divide can be explained by social and economic differences with the north being poorer than the south.  Certainly, over the past 20 years the north has consistently had lower employment rates (for example this is 70% in the north-east compared to 80% in the south-east).

This is of course associated with the lasting effects of de-industrialisation (with the closure of large scale industry such as mining, ship building and steel) and the lack of any replacement jobs or a strong regional economic policy.

While the NHS clearly cannot address all the issues that cause the north-south divide, there have been attempts to increase NHS funding in areas that have the worst health – and many of these are in the north. The current NHS funding formula considers factors such as deprivation and ill-health indicators by area, so places with worse health and higher deprivation have higher NHS budgets.

However, NHS England has a new funding formula out for consultation which fundamentally changes the way money is allocated to General Practitioners for the care of patients, and it appears that the north will lose out.

In our BMJ letter, we mapped the new NHS funding data and this showed clearly that the more affluent and healthier south-east will benefit at the expense of the poorer and less healthy north. For example, in areas like south-eastern Hampshire, where average life expectancy is 81 years for men and 84 years for women, and healthy life expectancy is 67 years for men and 68 years for women, NHS funding will increase by £164 per person (+14%).

This is at the expense of places such as Sunderland, where average life expectancy is 77 years for men and 81 years for women and healthy life expectancy is 57 years for men and 58 years for women, and where NHS funding will decrease by £146 per person (-11%). More deprived parts of London will also lose out with Camden receiving £273 less per head (-27%) under the proposed formula.

While the objective of the new formula is to provide “equal opportunity of access for equal need”, these geographical shifts are because it has defined “need” largely in terms of age and gender, with a reduced focus on deprivation.

It also uses individual-level, not area-level need, GP-registered populations rather than higher wider population estimates, and secondary care (use of hospitals and A&E) not primary or community care use. This means that areas with older populations have higher health care usage so they are getting money transferred to them from areas with fewer old people.

However, areas with more old people are also areas that have healthier populations who live longer – hence there are more old people. These healthy old people are largely in the south-east so, within a fixed NHS budget, the new NHS formula can only shift money to them by taking it from others.

The new formula appears to shift NHS funds from some unhealthy to healthy areas, from north to south, from urban to rural and from young to old.

Many of the areas that will lose NHS funding if the new formula is implemented are the same areas that have also lost out from above average cuts to local authority budgets. The scale of the potential NHS funding shifts will add further stress onto these local health and social care systems and potentially widen the north-south health divide by reducing access to NHS services where they are needed most.

The authors do not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article. They also have no relevant affiliations.


This article was originally published at The Conversation. Read the original article.
       

Alcohol marketing, football and self-regulation

Posted by Jean Adams 

This post is a 'story behind a paper'. All papers have a story. We would love to post more of them.

When we work at home, my partner and I share a workspace (or kitchen table as it is also known). This is generally friendly and allows for moments of mutually constructive musing and problem-solving. A recent exchange went like this:

Me: “Who is Everton’s shirt sponsor again?”

Him: “Emmm...is it Chang with the elephants?”

Me: “Yeah, right, thanks.”

Pause

Him: “Sorry, what are you doing? I thought you were working?”

Me: “I’m doing my talk on alcohol marketing in sport.”

Him: “What’s Everton’s shirt sponsor got to do with that?”

Me: “Well...duh...Everton’s a football team and Chang’s a beer.”

Him: “Chang’s a beer? That’s outrageous! What are they doing on Everton’s shirts?” [he’s a public health researcher too]

Everton player Louis Saha sports a Chang branded training top. Photo: nicksarebi

My partner is a not a football fanatic, but he knows a bit about football. Certainly enough to be able to easily remember Everton’s shirt sponsor; and Everton is not his team. Chang is definitely not his beer. So the only place he must know the brand from is Everton’s shirts.

When we set out to quantify the volume of alcohol marketing in televised English football, I knew there would be some, but I was caught off guard by quite how much there was. We found an average of almost two visual references to alcohol per minute of broadcast. But what was much more interesting was how embedded these references were. Less than 1% of the broadcasts were devoted to formal alcohol advertising during commercial breaks. Instead, almost all of the alcohol marketing we found was on or alongside the football pitch, or part of the graphics added by broadcasters. It was simple logos, frequently repeated.

We know that alcohol marketing affects children, in particular. When children are exposed to alcohol marketing, those who do not yet drink are more likely to start drinking, and those who already drink are more likely to drink more. Children are also very aware of alcohol marketing. More than three-quarters of Scottish 12-14 year olds are aware of some sort of alcohol marketing, and two-thirds of them are aware of alcohol marketing in sport.

In the UK, alcohol marketing is governed by an industry sponsored self-regulatory code of conduct. When commercial industry is charged with regulating its own marketing, the potential for conflict of interest is obvious. In the sphere of food marketing to children, there seems to be numerous examples of industry involvement in regulation leading to watering down of who and what is covered by the regulations. Indeed, in the USA, industry backlash led to the White House abandoning efforts to even introduce standardised self-regulation. There is now clear evidence that the UK alcohol industry is breaking its own code of conduct by making specific efforts to target products at under-age drinkers.

In addition to the inherent problems of self-regulation of marketing and the growing failure of such self-regulation, the frequency and nature of alcohol marketing we found in televised football highlights a mismatch between what the code of conduct is designed to restrict and what is actually shown. The alcohol marketing we found in English football was almost entirely frequently repeated exposure to simple branding and logos. In contrast, the code of conduct focuses on what alcohol should not be associated with.

According to the code, alcohol marketing should not “in any direct or indirect way…suggest any association with bravado, or with violent, aggressive, dangerous or anti-social behaviours…illicit drugs…sexual activity or sexual success…[or] that consumption of the drink can lead to social success or popularity”.

The impact of marketing is related to both exposure and power. Power refers to the creative content of marketing -- how memorable a single exposure is and how well it appeals to particular individuals. Power can be difficult to quantify, but is why Don Draper gets paid so well. Exposure is simply about how often you see the marketing. There is no simple formula linking impact, exposure and marketing. But clearly if you can’t have one, you would be well advised to go all out for the other.

The UK’s alcohol marketing code of conduct seems to focus entirely on marketing power. It restricts the creative content of the sort of narrative advertisements shown in the commercial breaks between programming. It has absolutely no impact on exposure.

It is difficult to say if restrictions on alcohol marketing power triggered increases in exposure, or if industry lobbied for restrictions on power rather than exposure because they know something about the relative influence of each on impact. Or perhaps there is no simple either:or. But what we are left with is a code of conduct that appears to have little bearing to the nature of the huge volume of alcohol marketing seen in televised football (and, I would wager, elsewhere).

Stronger restrictions on alcohol marketing in sport, and elsewhere, are never going to be a magic bullet that will solve the problem the UK currently seems to have with alcohol. But as part of a suite of approaches limiting advertising, affordability and accessibility it would make an important contribution.

This post was originally posted on the OUPBlog

Finagle’s law, Murphy’s law or Sod’s law?

Posted by Balsam Ahmad

I am finally writing a post for the Fuse blog. It is not the happy one I anticipated, but rather a reflection on one of the worst nightmares for a PhD student. That is a corrupted word file of a PhD thesis minutes before turning it into the final PDF that I was hoping to send to Print Services in the library.

I still remember the day vividly as if it was yesterday. The day that was supposed to be the beginning of the end of a PhD project that took me such a long time to complete. What happened proved to me the accuracy of three laws I knew about, Finagle's Law of Dynamic Negatives, Murphy’s Law and Sod’s Law. Finagle’s Law says “ Anything that can go wrong, will—at the worst possible moment”. This is similar to Murphy’s Law that most of us know “Whatever can go wrong, will go wrong” and what an ‘unlucky sod’ I was. According to Wikipedia ‘"Toast will always land butter side down" is often given as an example of Sod's Law in action’ and ‘being "mocked by fate"’ is another enactment of it.

Now I just want to tell the story for it has many learning points that are maybe of use to other PhD students. Even if there are none, the story in itself is interestingly spooky.

On the 30th of September, I had a plan to integrate the revisions that were approved by my PhD external examiners into my thesis and update it so that it was ready to print. I anticipated this work would take 5-6 hours, which I had planned out of my work for this purpose. Everything was going well and I was pleasantly surprised that even my Endnote file with more than 360 references, which caused me a lot of anguish at times, was behaving nicely. I even remember pinching myself in disbelief that I could finally see an end in sight. After 6 hours of meticulously working through the PhD file correcting typos, mistakes and tidying the formatting and referencing, the disaster struck. In my final attempt to save and update the document everything froze and my whole 400 page PhD thesis turned into one page of footnotes. The strange thing was that it had the same large size as the original PhD file.

I was in utter shock as my whole thesis dwarfed in a matter of seconds literally just before I turned it into the final pdf to send to print. I tried to stay calm though and searched for temporary saved files and for backups. Nothing appeared on my personal folder on the university network drive. I tried retrieving earlier versions but nothing worked. It was 8 pm then and I was anxious that if I stayed at work any longer, I would miss my children’s bedtime so I carried myself home feeling very tearful. I found sharing my status on twitter that evening quite helpful as the messages of sympathy and advice from colleagues poured in.

The Twitter support network kicks in

I spent the next two days emailing and meeting various people in IT and support services across the university. A whole team of 3-4 people worked relentlessly to find backups and recover my thesis file. At the end of the day on the 2nd of October I got the following message from someone in support services:

“Unfortunately we have not been able to recover the content in Word. It is there, but not visible and we don’t know why. You may just have to revert to a previous version of your thesis…let me know how you get on and if one of my colleagues comes up with a miracle we’ll send you a message. So sorry we can’t help you at this time.”

Having lost any hope for retrieving my document I realised that I had to redo the work. It took me a few evenings to complete but worse was having to complete the work whilst feeling so terrified that the same thing would happen again.

So reflecting back now, these are the lessons learnt that I want to share with you:

1. Never trust 100% that saving your work on a network drive is entirely safe. Try to save throughout on a flash drive or a different medium as well.

2. Email yourself with a copy even mid-way through your work. Do not wait until the end.

3. Take regular breaks and never work when tired.

But, like a fairy tale, the story has a happy ending. On the 1st of November I submitted two copies of my thesis to the Graduate School of the Faculty of Medical Sciences. Fingers crossed I will graduate from the PhD program in December this year!

Proof that there is a happy ending to this fairy tale

A thousand words

Posted by Linda Penn

I am invited to speak at a conference next week (6th November). This conference is “Organised and provided by Diabetes UK Northern and Yorkshire Region, the University of York and the University of Huddersfield in collaboration with healthcare professionals representing their diabetes services from around the region”.

I know this invitation is a huge privilege and I am aware of the responsibility to properly present work which involves many people. I might analyse the data, sometimes I conduct interview studies as well, and I might draft the research papers with input from statisticians and co-authors, but I never really feel that I do the real work.

The ‘real work’ is done by the intervention delivery staff. Thus I am anxious to do them credit and I was thinking about this when my son (who is a painter) sent me a text about prints. This prompted me to request intervention photos. Problem solved. The data is of course of paramount importance, but my guess is that people will mostly remember the pictures.

Recruitment etiquette

Posted by Lorraine McSweeney

Throughout my short experience of the research world, one of the most frequent laments I’ve encountered from fellow researchers and presenting academics is the difficulties surrounding recruitment. Issues include disseminating the study information to the relevant populations, encouraging people to ‘sign up’, attendance/participation and retention. However, have you ever stopped to consider whether your etiquette may be partly to blame?

Trying to be a supportive colleague I frequently ‘advertise’, hand out leaflets or inform by word of mouth any studies which I think certain individuals would be suitable for, or interested in participating. However, without wishing to admonish researchers who are pressed for time or who are inundated with several thousand interested participants (we wish); do you reply to enquiries? Yes, that simple act of returning a phone call or an email! One of the frustrations reported back to me (including a study I applied for personally) was the rudeness of not receiving a reply or even an acknowledgement.  Perhaps the person applying is not suitable for your study but please could you recognise their interest, courage and time taken to apply? 

After all it is only good manners and you never know the interested party might apply for another study for which they are suitable.

Computer says no...

Posted by Martin White

What happens when you bring together informed citizens, academics and a range of professionals, in mixed teams of 12 for a two-day simulation experiment to decide how to reduce the gap in life expectancy at age 55 between social classes by 50% in ten years? Well, quite a lot of things (more of which later), although none of which included fully achieving this objective. Nevertheless, that was the aim of Newcastle University’s ‘Healthy Life Simulation’, which had its first formal outing on 27-28th September 2013. 

The ‘game’ was developed “to bring fresh energy to finding new ways to tackle the unacceptable unfairness that currently exists in the time people can expect to live without debilitating illness”. Although an initiative of Newcastle University’s Biomedical Research Centre in Ageing and Chronic Diseases, some members of Fuse were asked to advise on the simulation model content and participate in the exercise as members of the ‘White Team’. This is the group in a traditional ‘war game’ that makes up the rules and provides expert advice to one or more of the competing teams. When they feel like it. Or not. Or changes the rules or context, when they feel like throwing a spanner in the works. It is a highly responsible job – but one in which you can also have a fair amount of fun.

Many of us in public health and related disciplines in the North East have participated over recent years in ‘accelerated solutions environment events’. Whilst not using the same adversarial approach as a ‘war game’, these offer the same kind of opportunity for concentrated, multidisciplinary, goal-oriented, group work on a future scenario. Hence, the overall dynamics of the healthy life simulation, including some excellent incidental learning and the warm glow of team building, came as no surprise. What I found more revealing, however, was the effect of direct competition. This of course brought out the best and worst in participants.

Socio-economic inequality is familiar to readers of this Blog. Everyone knows how wide the gap is in the North East and elsewhere in the UK. Or so you would have thought. Some of the lay participants were genuinely surprised at some of the data presented on inequalities, and many participants expressed disbelief at the relative lack of evidence to support their favoured strategies. So, the exercise may have had more value for the lay participants than professionals. Nevertheless, participating professionals also remarked that, being faced with the challenge of achieving an ambitious public health goal in a team did bring fresh energy to the challenge. And the learning was not just about the logic needed to address the challenge (i.e. playing the simulation effectively to identify the best options), but also about how the art of persuasion was needed to carry the team with you.

Many familiar themes emerged throughout and were prominent in the final plenary discussion. The health and well-being arena, now firmly located in local government, continues to suffer from the perennial challenges of long timescales but short-term funding, a mismatch between who pays and who benefits (local authority spends on prevention, NHS secondary care gains through reduced burden), and a preference for innovation despite a lack of evidence and evaluation. None of which helps us towards more evidence-informed public health at a local level.

So, what did I learn? For me it was a privilege to meet some extraordinary and committed individuals from entirely different fields who shared their expertise to develop and run the simulation. And to hear the inspirational stories of community members from the poorest areas of Newcastle, who deal first hand with the life expectancy gap from day to day, and are committed to bringing about change. I also learned much about how innovation, research and development are managed quite differently in the commercial sector. For example, there is a more hard-nosed approach to success and failure, and thus a willingness to disinvest in all but the best innovations, funnelling R&D towards sure-fire investments. All of which has got me thinking about our current model for translation. I think there are important implications for Fuse and for public health more generally. But developing a new model, even conceptually, may take a while. There are so many ways in which commerce is fundamentally different from the public sector. But, we desperately need new ideas, so this is a challenge worth pursuing. I hope I can report some progress on this front in due course.

How to finish your PhD on time

Posted by Lynne Forrest

So, with a few minutes to spare, I submitted my PhD thesis within the three-year deadline. But, don’t worry, this isn’t going to be some smug blog on how I successfully managed to do this. No, the writing-up period was a total nightmare that involved 90-hour working weeks and then staying up all night to send the thesis off for binding at 4.30am on the day of submission. There has to be a better way.

"Piled Higher and Deeper" by Jorge Cham; www.phdcomics.com

These are my rules for successfully submitting on time, all of which, on reflection, are pretty-much common sense but yet, somehow, I (mostly) failed to do:

Go on a course to ‘how to manage large documents’ if your institution offers it. 

I’ve been using Word for years so was pretty blasé and thought I didn’t require this. But, a bit too late, I realised there was a lot of functionality that I had never used. With two days to go I had to learn how to create a Table of Contents automatically, as well as a Table of Tables and Figures, so that I didn’t have to manually update page numbering each time I moved text and tables. Really useful, but I should have done it far earlier.

Don’t leave the document-formatting until the last minute. 

It takes far longer than you think to do all this and I left it to the final fortnight. I had dozens of tables that I then interspersed within the text, some of which were landscape and thus required the insertion of section breaks and different, customised margins to the portrait text. Once the custom margins were inserted tables had to be re-sized to fit. Tables split over pages needed headings repeated. All of this is tedious and very, very time-consuming.

Don’t go on holiday shortly before your submission date. 

Save your holidays until post-submission. It’s really no fun trying to get a dodgy wi-fi connection as everyone else enjoys themselves, and thesis drafts do not make for relaxing poolside reading.

Don’t go to a conference 2 weeks before your submission date. 

I’d barely returned from holiday when I went off to SSM2013. I’d seriously thought of cancelling but luckily my presentation was written well in advance and actually the conference turned out to be really revitalising during a real low-point in my write-up. So maybe not such a bad thing to do after all if you can handle the stress…

Write the literature review and methods early on – in the first year if possible. 

At the beginning of the PhD it feels like you have plenty of time but you really don’t. So get on with the stuff you can do as soon as possible. Then it just requires some last minute tweaking and updating in the last few months. I did actually do this one!

Focus single-mindedly on the write-up. 

My husband lost his job shortly before the end of my write-up. I coped with this by ignoring it and ploughing on. Personal-life crises will inevitably happen and sometimes you just have to be ruthlessly single-minded and concentrate on getting finished. You can have the meltdown once you submit.

Know when to stop. 

I think the best piece of advice I received was being told that your thesis does not have to be perfect, it just has to be good enough to pass. If I’d had a few more weeks my thesis could definitely have been better but I also think there are diminishing returns here. The more time you have the more you revise and re-edit. If you’ve made the changes recommended by your supervisors and they say it’s fine then just STOP. (However, I haven’t had my viva yet so we’ll need to see how this one pans out…)


Ultimately I finished on time because I was given a non-negotiable deadline. If I didn’t submit on time I would lose the three month funding available to write-up papers. This was such a good opportunity that drifting on was not an option. I’d have preferred to have done it without putting in ridiculous hours, never seeing friends or family and doing nothing but working in the final weeks, but it’s done.

It is possible so good luck!

Thoughts on a research tangent…

Guest post by Heather Ohly (Fuse loves guest posts too)

As an academic and Registered Nutritionist (RNutr), I get really annoyed with so-called professionals who give diet advice to members of the public that is not grounded in science. I’m not the only one. High profile writers like Ben Goldacre have been very critical of them, unfortunately tarring all ‘nutritionists’ with the same brush. My work includes nutrition (and public health) research, guidance, education and consultancy, all of which I aim to ensure are evidence-based.

Anyway, I decided that if I was to continue harping on about evidence-based nutrition, I really ought to learn how to do systematic reviews. This is the gold standard method used to review high quality scientific evidence. It follows a structure approach to identify, select, appraise and synthesize evidence relevant to a research question.

My opportunity came with a six month post at the European Centre for Environment and Human Health, University of Exeter Medical School. The subject…Attention Restoration Theory, or in layman’s terms the effect of nature on our ability to concentrate or focus on a task…environmental psychology!

The great thing about systematic reviews is that the process is always fundamentally the same and you don’t need to be an expert in the field to do a good job. That is what I said in my interview, hoping it to be true! I have learned that, although it can be tricky to understand the terminology and research methods of different disciplines, a critical eye and an understanding of research principles are the most important skills. I would almost go as far as to say there are some advantages to not being an expert, since you do not have any conflict of interest or prior beliefs about the outcome of the review.

Working on this review has encouraged me to think about my own discipline from different perspectives and to step outside my comfort zone. It has been great working with an interdisciplinary team to shed new light on a subject that, while not my area of expertise, is really interesting. I hope that my next systematic review will be about nutrition or public health, and I know I will do a better job having done one on something completely different.

For my holidays, I went to....

Posted by Jean Adams

This blog is supposed to be about doing public health research. In essence, work-y stuff. Sometimes it is a bit tangential. But, you-know, it can be hard keeping up the work prattle week in, week out. So this post is about my holidays. Feel free to nod off whilst I work through my slides at an excruciatingly slow rate. But please try and snap back to life for the last paragraph, where there’s a work-y punch line.

This year, rather on a whim, we spent our summer holidays mostly doing the GR54 (GR=Grand Randonnee, French long-distance footpath). We did the GR20 a few years ago. I was cruising around outdoor-y websites trying to think of a summer holiday thing to do that satisfied partner’s ‘somewhere sunny’ requirement with my ‘somewhere hilly with something to do’ requirement and read that the GR20 in Corsica was the hardest trek in Europe. Jeez, I thought, how hard can a trek be? I mean, doesn’t ‘trek’ just mean ‘long walk’ done by people who use those telescopic trekking pole thingies?

Day 10 - walking out from Refuge de la Muzelle (photo: Martin White)

So off we trundled to Corsica, took the train to our start point, bundled out of our hotel at about 0930 – pretty early for a holiday day, I reckon – and nearly died on the trek up to the first hut which we finally arrived at sometime approaching 1900. Yep. Pretty hard.

When I say we ‘did’ the GR20. I mean we did the northern 9 days of the full 15 day trip. But I’ve heard it’s the harder section (yes, I’m competitive outside work too)...

After a rather humbling first day, we grew to love the GR20. Corsica’s mountains are fab – rugged, fragrant, warm, pretty empty when we went. So when someone suggested that we do the GR54 around the Ecrins massif in the French Alps (touted as the hardest trek on mainland Europe), it sounded like it might be just right.

Over 10 days, we walked 176km, ascended (and descended) more than 12,800m, and consumed more tartes aux myrtilles and cafe crème than was probably sensible. We stayed in little private hostels and mountain huts and carried as few pairs of clean pants as we thought we could get away with (one on, one being handwashed/dried, one for emergencies). French mountain huts are, by the way, an outstanding example of just how well the French do everything hospitality - there is often no, or minimal, electricity and luke-warm showers if you’re lucky, but dinner will include a choice of wine and a cheese course.

I find this sort of thing all very restful. There is nothing to do apart from get up, pack your bag (no need to choose what to wear if following a strict underwear rotation system), follow the signs for seven hours, and then let someone else cook you a mammoth meal. Sure ‘follow the signs’ can be quite physically demanding. But there is little active thought required. Ponder over what the shepherd’s do in the winter, consider the tenacity of the little rock flowers blooming at 2500m, try and bag the best mures sauvage before your partner does.

The GR54 was not busy in late August. We met people on the trail every day, but not loads of them. We met a few other GR54-ers in the huts, but they were all following different schedules from us so there was none of that becoming part of mass group thing you sometimes get on popular multi-day routes. We chatted routes, and huts, and schedules, and weather with people. But one of my absolute favourite things about trekking is that we never once chatted work.

At work I am Jean Adams, Senior Lecturer in Public Health at IHS/Fuse/Newcastle. This label precedes almost everything I do. It, inevitably, colours what others think of both me and what I say, do and write. On the trail I am almost entirely anonymous. No-one cares what I do. Mostly they don’t care what I’m called either. But if they do, I have long since given up on trying to convince French people that a girl might be called Jean. All I am is Jeanne l’Ecossaise.

When is a sermon a knowledge translation message?

Posted by Avril Rhodes

I used to think I moved in two different worlds, especially on Sunday mornings, at that wobbly moment contemplating my sermon one final time before delivery, in the relative privacy of the vestry. Straightening my surplice (from J Wippell & Co who, by coincidence, make clerical and academic robes for some Universities) – and nothing could seem further from Fuse-land. 

Is it all preaching to the converted? 

Not so. Sermons get written, re-written, researched, laced with contemporary references and re-checked, and then they get delivered to the converted. Seminars get written, re-written, researched, laced with contemporary references and re-checked, and then they get delivered to those who know the topic already. Churches are probably the last place to find the non-Christian enquirer. Seminar rooms are probably the last place to find the non-academic enquirer. And yet we still invest time and effort in both, for good reasons of feeding our minds, and indeed souls. But it’s not outreach and we know it in both cases. 

So, we work on ‘church in the local’ (hiring a room in the pub to have a good open debate without the theological jargon) or Café Fuse (a very similar idea coming soon). We aim to join lots of local community groups (in the parish), or gain entry to meetings of key decision makers (in local government) to persuade those gracious enough to receive us on the other side of the table that it is worth asking Fuse. In both worlds we look hard for opportunities to exhibit and present ourselves, in one case a stand at the wedding fair, and in another a stall at a health conference. 

We do all of this because a direct conversation outside our usual environment beats the institution, a joint project trumps a single track approach, and, above all, we’re both in the field of behaviour change at population level with a long time horizon, as Jesus said in the now lost Gospel of St John (Snow). Medieval buildings with stained glass windows that people last visited years ago (I refer to the older University as well as ecclesiastical buildings) are not necessarily the right place for the message – much as we might preserve them and their crusty occupants as national treasures.

Last Saturday, I went to a conference entitled, “How to share your faith” (led by Bishop John Pritchard, one of those Bishops who writes in a very accessible style, despite being Bishop of Oxford which surely is a job title that’s a passport to academic gatherings) – and it’s given me pause for thought. What would be the equivalent day for knowledge translation and public health? 

Oh, stop your whining.

Posted by Jean Adams

I used to loath those consultants who told us medical students that 36 continuous hours on the ward and 100 hour working weeks never did them any harm, so the junior doctors of today should just stop their whining.

Sure stupidly long working hours might not have done the junior docs of the 1980s any lasting harm. But it certainly did their patients some harm and I’ve heard lots of stories of the short term damage such ridiculous working practices did to health and sanity. Really I thought those days were over, but apparently not.

Now that I have some responsibilities for earlier career staff and students, I am wary of becoming those loathsome consultants. For quite a while I would tell people who worked with me, quite truthfully, "well I don’t work at the weekend, so I don’t see why you should have to". This was sometimes accompanied by "I don’t think you get paid enough to work more than you’re paid to". 

I still try really hard not to work at the weekend. But I’m not as good at is as I used to be. I increasingly find myself turning on my laptop in the evening because there’s just a little job (more often jobs) that I have to do before the meeting(s) tomorrow to avoid being totally unprepared.

I think I sometimes work too many hours. Not all the time. But some weeks, and I don’t get a chance to slack off the other weeks to make up for it. My contract helpfully doesn’t specify how many hours I should work – just that I should get my job done – so it’s hard to be sure about this. I just sometimes get the feeling that there is too much work in my life. But I get paid well, I knew that this was coming when I signed up for the job, and there are certainly other people who work more than I do.

What bothers me is that my increasing working hours seem to be accompanied by decreasing sympathy for other people’s work:life balance. I still say that stuff about working the hours you’re paid for and if you can’t fit it in, we need to think about getting some help, but somehow it doesn’t feel so convincing. Genuinely, it isn’t that convincing – I am getting worse and worse at convincing myself to work that way.

The very worst thing is that I am starting to resent the people who I think aren’t pulling their weight. The people who say they’re too busy to help out, who I know aren’t as busy as me. Jeez. Who am I to judge whether other people are too busy to help out? When did I stop thinking that ‘too busy’ can mean all sorts of things that has nothing to do with working at the weekend?

Tell me I haven’t become one of those loathsome consultants.

Stealing the spotlight from hot chocolate research and the royal baby

Posted by Katie Haighton

It seems there’s always a bit of interesting research in the news; so why isn’t it mine? I thought the media might pick up on my extremely important and immensely interesting research by osmosis with all those keen journalists reading my really enthralling academic papers published in scholastic journals; but for some reason it’s just never really happened. Why not, I wonder, when the media run stories about drinking hot chocolate to prevent Alzheimer’s disease? Well, that’s because I’ve never actively gone about publicising my own work, so when my latest academic paper was accepted for publication I contacted our press office and asked if they would do a press release; and they said yes!

Photo of me looking very serious on TV

Ok, so it wasn’t quite that simple. We had to come up with a key message that would attract the attention of the press while making sure we mentioned everyone involved and gave everyone an opportunity to provide a quote (mainly so they could get their name in the newspaper!). We needed to time the press release so that it coincided with the publication of our academic paper but also so that it didn’t arrive at the same time as the far more interesting and important royal baby! And then I was told that I needed to be available too! Now this is where I would usually, and quite willingly, hand the fame to someone else. It’s one thing writing about your research but quite another answering a barrage of questions, live, in front of hundreds, possibly thousands, of other people. However I’ve come to understand how important it is for us academics to leave our ivory towers and make our research accessible to others, so this time I bit the bullet and made myself available for interviews.

In the end the royal baby arrived in plenty of time for the press to give the birth full coverage before our paper was finally published and our press release went out. That first day I spoke to the press office regularly as we worried about whether there was going to be a delay in publication of our paper and if we’d included everyone we should and I was beginning to think I’d not have very much to do until the interviews came flooding in. My first interview was for a local radio station and was a recorded piece which would go out the following day – I think your first interview is never your best but it got me warmed up for three more which came in that afternoon and time to prepare for live interviews for the following morning.

It was a bit of a shock to me that I’d have to be up and ready for my first interview before 7am but in the end it wasn’t difficult as I couldn’t sleep anyway! As I brewed my tea that morning (maybe I should have had hot chocolate instead!) I Googled my research and was pleased to see there was already a healthy coverage in the media.  Then the first radio station rang to say my story had been moved to the headline and so could I go live early? The next 48 hours were a whirlwind of TV and radio interviews as my research made national newspaper headlines and even went international. Yes, apparently I actually do carry out really important and immensely interesting research! In the end I spoke about my work to many journalists over a number of hours and on most occasions they only used a 15 second sound bite to illustrate their own take on my work however I’m happy that my research has been recognized by others and that my academic paper has been read by many. Most importantly of all, however, is that my Mum can finally say that she’s seen me on the telly!

Read the full paper: Wilson GB, Kaner EFS, Crosland A, Ling J, McCabe K; Haighton CA. 2013. A qualitative study of alcohol, health and identities among UK adults in later life. PLOS ONE, 8(8)

On potty training a black swan. Confession time.

Posted by Heather Yoeli

Few of my writings have generated as much feedback as the January blogpost about my daughter’s refusal to use either potty or toilet. To those who have asked whether she is now potty trained… yes (phew – and thanks for asking). To those who have asked whether their advice to me at the time was helpful… no (sorry – but thanks for trying). Neither the iconic Poo Goes to Pooland, nor its beautifully-illustrated Hebrew counterpart, nor decorating the potty with Peppa Pig stickers, nor chocolate buttons, nor anything else at all helped. She simply decided that she was going to poo in the toilet, her nappy mat applied for its state pension, and all was well. In retrospect, I can now see that, whether for physiological or developmental or her own personal reasons, she simply hadn’t been ready before.

Black Swan, by Robyn Carter

Within public health, we try to look at all aspects of health and wellbeing and development at a population or community or global level, rather than as it affects individuals. We therefore know the pitfalls of trying to create individualised targets merely from statistical norms. And so, in trying to get my daughter potty trained before the arbitrary age of 3 before which potty training is ‘supposed’ to happen, I was inflicting upon her tiny posterior a premise that is scientifically a bit dodgy. I do sometimes wonder whether there’s a preponderance of pushy parenting coming from public health and academic types. Both public health and academia as a whole are competitive fields, and it tends to be those who are by nature a little bit competitive who enjoy public health academia. Or maybe I’m making excuses for myself. Maybe it’s just me. (Hint: do leave a comment…)

Nevertheless, a new challenge awaits. My son had just turned two, and with it has gained the delightful habit of undoing his trousers whilst shouting wet wet wet at the cat. Unless he begins to show signs of any development delays or health challenges requiring of extra help, I aim to tackle his whole potty training experience without attempting a single literature search for valid and robust current public health data on the age at which children achieve full bladder and bowel control. However crap (or damp) things become, it’ll be an interesting challenge…

Aim high, or just get it out there and move on?

Posted by Jean Adams

So shall we talk impact factors?

Every peer-reviewed journal that has been around for a few years has an impact factor. It’s a number (calculated to three decimal places!) that reflects the average number of times papers published in the journal are cited by other papers in peer-reviewed journals.

In an unthinking world, there is an assumption that the higher the impact factor of a particular journal, the ‘better’ the journal is. From there, it’s easy to start to think that the papers published in journals with higher impact factors describe ‘better’ research and that the people who write papers published in journals with higher impact factors are ‘better’ researchers.

It's just much easier to judge who's 'best' in some areas than others

Of course you can see that such a simple metric is never going to be a particularly accurate reflection of the quality of either the research or the people writing the research. Lots of people have written lots of things about how bad a job impact factors do of assessing quality. They’re even pretty poor at predicting the number of citations any particular paper will get. And who said that citations are a good marker of how good a paper (or the research it describes) is anyway?

I know all of this. I understand it. Yet I still care about impact factors. I still want to submit my papers to journals with high impact factors and it frustrates me when my papers get rejected by the ‘best’ journals and I have to do the long, boring job of trying the next ‘best’ journal, then the next ‘best’, and then the next ‘best’. Which is not to say that every paper I’ve ever published has been rejected by The Lancet (certainly none have been published there). But that I do want the best possible for each of my little paperlings.

Lately I’ve been doing quite a lot thinking about this, wondering why I am so obsessed by playing the impact factor game that I know to be such a highly suspect marker of skill – as much ludo as chess. I guess some of it is vanity – if that’s what people are going to think makes me ‘good’, then I’ll do it because I definitely want them to think I’m ‘good’ (although, why do I care what those people who place such value in such a suspect number care?). Some of it is pure competitiveness – if it’s hard to do that, then I’m going to do it.

But I guess right at the very bottom of it all is the REF. The big ol’, not quite sure that we think that’s a particularly good marker of quality either, REF. I have to have four papers that are ‘good enough’ for the REF or to be submitted as an individual; I definitely want to be submitted (see above re vanity and competitiveness, but let’s also add in it’s sort of my job); and in the absence of other markers of quality, we seem to be relying pretty heavily on impact factors to decide what papers are ‘good enough’. Not entirely. But quite a bit.

Whilst many of the people I work with are similarly fairly obsessed by the impact factor game. Not all of them are. Some people, who I have lots of respect for, reckon it’s a bit fat waste of time (and morale) to try your paper in a high impact factor journal, get it bounced, reformat it for the next one, get it bounced blah blah blah. They laugh and say ‘oh just get it out and move on’. Maybe it isn’t a coincidence that these tend to be the sort of people who have loads of ‘good enough for the REF’ papers anyway. But I am starting to wonder if what I need to be doing is not constantly ‘aiming high’, but developing a better sense of what papers are worth ‘aiming high’ for.

How to establish a reputational yardstick

Posted by Heather Yoeli

As anyone who has been around any university research department recently will probably have realised, the general atmosphere within academic circles is, erm, interesting. The deadline for submissions towards the next REF is swiftly approaching, and preparations are escalating towards a level of intensity last seen amongst those who trusted Harold Camping’s prediction that the world would end on May 21 2011. I do hope that none of my colleagues will take offence at such an analogy. But the 2014 REF does remind me of Harold Camping in that its rules, like the reasoning behind his prophecies, appear to the novice eye as rather convoluted.

Harold Camping predicts the end of the world

Basically, the REF’s main website explains itself as follows;

The REF will be undertaken by the four UK higher education funding bodies. The exercise will be managed by the REF team based at HEFCE and overseen by the REF Steering Group, consisting of representatives of the four funding bodies.

The primary purpose of the REF is to produce assessment outcomes for each submission made by institutions:

· The funding bodies intend to use the assessment outcomes to inform the selective allocation of their research funding to HEIs, with effect from 2015-16.

· The assessment provides accountability for public investment in research and produces evidence of the benefits of this investment.

· The assessment outcomes provide benchmarking information and establish reputational yardsticks.

The REF is a process of expert review.

Is it just me, or is that not entirely clear? I mean, I can sort of surmise that it’s something to do with telling universities how good their research is and might involve some cash prizes, but I’m not sure that the phrase ‘establish reputational yardsticks’ is one I’d use in everyday conversation. In the public health context, I think a reputational yardstick probably has something to do with the apparent REF buzzword of impact – that is, making our research relevant beyond academia and beneficial to the wellbeing of society and doing much of what we’re doing anyway with what we call knowledge exchange – but still, it’s a rather clumsy phrase. I would hate to trip over a reputational yardstick in the corridor.

My worry for the 2014 REF is that, as much is it will have achieved a great deal in encouraging universities and their researcher staff to work hard and to do their very best, its so-called impact may be limited by the way in which few people who are not themselves university researchers really understand enough about the REF itself. In my own completely unqualified opinion, the HEFCE might want to consider how to give the next REF a reputational yardstick as something just a little less impenetrably confusing.

Summer holidays

Wow. It's been a long year so far, hasn't it?

The blog's been working hard. But it isn't all work and no play. No way. A little while ago, the blog scraped all it's birthday and Christmas money together and bought a VW camper-wreck on ebay. Everyone laughed. Predictably. What was a blog going to do with camper-wreck? When was the last time it did up a van? Did it know anything about engines anyway?

Well everyone can start laughing on the other sides of their faces. Because the blog has been spending evenings and weekends in the garage. With a little help from some YouTube videos and a lot of trial and error the camper-wreck has been transformed into a camper-palace.

So now the blog is off on a road-trip. The sun's out and the open road beckons.

See y'all in September.

Rannoch Moor, by Joe Dunckley