Thursday 31 January 2013

Research ethics. Why handbooks and guidelines don’t help.

Posted by Heather Yoeli

If you had asked me, before I began my PhD, to define research ethics, I’d have told you that ethics is about morals and values, about how and why we conceptualise, construct or differentiate right and wrong and about what we do with our judgments or perceptions of right and wrong – and that research ethics is thereby about how we promote the personhood and dignity and human rights of our subjects, and about how we know that what we’re doing isn’t going to harm them. I was idealistic, principled, and, fresh from a Religious Studies degree, prone to expressing my every academic thought in an 85-word sentence, and prone to using too many commas. These days, I’d define research ethics more succinctly, and less naively: it’s about placating the insurance companies by assuring your host institution that you won’t do anything that’d get them sued, and it’s about following the rules.

Within health academia, the contemporary drive towards research ethics developed primarily in response to the horrific atrocities committed during the clinical and epidemiological ‘research’ undertaken by Nazi doctors in the World War II concentration camps. In 1947, the Nuremberg Code was published, and in 1964, the Helsinki Declaration, most recently updated in 2008. Both of these documents provide clear standards and principles designed for researchers to interpret and apply with regard to their own contexts and situations, but never a how-to guide to manage every conceivable scenario. In conceptual terms, this is known as teleological ethics: advocating doing what is right, however this is to be achieved. But many people criticise teleological methods for their inherent lack of common-sense safeguards. For example, it’s great that the Helsinki Declaration tells us (Section A5) that we have a particular duty to those underrepresented in research, but how far can I go and what can I do to find the underrepresented of Cowgate?

Josef Mengele: one of the leading Nazi doctors in the medical research programme at Auschwitz
Within the UK academic community, research governance has appropriated responsibility for ethics, ensuring that every university, NHS Trust and Local Authority produces a detailed handbook of rules mandating what researchers should do in absolutely any situation they may encounter. In conceptual terms, they provide a deontological ethic: stipulating that the rules are followed, because rules are rules and the organisational insurance provider has set their premium on the understanding that the rules will be followed.

The problem, however, with such a deontological minutiae of rules is that it reduces research ethics to a vast set of forms to be completed and a prescribed sequence of actions to be completed. By depriving researchers of the capacity to think for themselves about what might be right or fair or appropriate in their own particular study, such handbooks prevent researchers from using their creativity to respond innovatively to the most vulnerable of participants.

Throughout the history of research, ethics has been an evolving, changing discipline, always discussing responding to the new challenges it is posed. A few years back we were considering whether it was ethical to accept typewritten student essays (in case somebody else had written it) and a few years before that we were considering whether it was ethical to accept women into medical schools (because the academic pressure might disrupt their menstrual cycles). Today we’re considering gene therapy and social networking, and the lesson from the history of ethics is that the generation below us will see no problem whatsoever with mitochondrial gene transplants or Facebooking study participants – assuming, of course, that mitochondrial disease and social media still exist. But when all of our ‘ethics’ comes distilled in a university or NHS-approved directive of ordinances simply to follow, and when we know that we’ll never get our proposal agreed without doing exactly what we’re told, it can be hard to innovate, or even to think. For example, I know that I should anonymise all data (Northumbria University Research Ethics and Governance Handbook, p.20), but am I not permitted to make an exception for the participant who says she will consent to participation only if I agree her real name when quoting from our conversations in my PhD thesis?

Or, to put it more succinctly, we’re all spending too little time thinking about how we can do the very best for our research participants because we’re all wasting too much energy poring through the rulebooks and filling in the forms.

Am I right? And if so, what does it mean that I’m right? And if I’m wrong, what do you mean? Discuss.

Tuesday 29 January 2013

On potty training a black swan. Exploring the limits of the evidence base in public health

Posted by Heather Yoeli

In recent years public health has been trying to make itself more evidence-based, which is probably why policy making, commissioning and service providing organisations seem to be listening to and funding research centres such as Fuse at the moment. Evidence is an epistemology, a theory of knowledge. Evidence is the main epistemology which science believes in.

The primacy of evidence was first asserted by the eighteenth century philosophers Locke and Hume, who created empiricism as the theory that our only way of knowing anything is to see, hear, smell, touch or taste it. Empiricism has developed into the methodology of twentieth century scientific research by Popper, with the aid of a few black swans along the way. The processes and protocols for creating evidence bases from scientific research continue to evolve, with new mechanisms for ensuring rigour, validity and trustworthiness of peer review developing in response to new challenges.

At this present moment, however, one of the greatest challenges in my life is in trying to persuade my daughter (as many twee American parenting websites would put it) ‘to go potty in the bathroom’. As a research scientist I have sought help from the evidence-based publication Poo Goes to Pooland. Poo Goes to Pooland was written out of the doctoral research of local psychologist Tamsin Black, and is the of Poo, who is lonely and unhappy in a child’s bottom and wants to go home his mummy in Pooland, and about how Pooland is down the toilet and we can all send our poos there too. For clever empiricists, however, Poo Goes to Pooland has one inherent problem, and my daughter noticed it before me, asking ‘but Mummy how do we know that Pooland is down the toilet? How do we know that Pooland isn’t on the floor or in my knickers? Can you not pwove it?’ I can’t pwove it. She’s right. And she’s too bright to be fobbed off by my attempts to show her Poo’s Mummy peeping out from behind the U-bend, either…

And so, the need to locate Pooland reveals the limits of empiricism and the drawbacks of evidence-based methodology. I have therefore been attempting to use some alternative epistemologies to persuade her;

1. The rationalist method (Descartes, Leibniz etc): We can’t prove that Pooland is down the toilet but we can theorise that it’s there. Thousands of toddlers have successfully used Poo Goes to Pooland to teach them to poo in the toilet, so Pooland must be down there somewhere.

2. The psychoanalytic method (Jung, Klein etc): It’s a category error to demand proof. Poo Goes to Pooland is a story, a piece of literature. Pooland is a metaphor created to teach us where to poo, not a real place.

3. The ontological method (Anselm, Heidegger etc): We don’t need to prove it as such. Few of the millions of people who believe in God value any attempt to verify his existence, because even by believing something to be there we can create its existence for ourselves. Pooland is.

There are alternatives, then, to the empiricist epistemology of the evidence base. But I can report that none of them are working either; my daughter is still not going potty in the bathroom.

There are, of course, evidence-based alternatives to the Poo Goes to Pooland method. And even within evidence-based potty training practice, evidence bases can produce many approaches;

4. The medical approach: Stop thinking about Pooland for just a minute. Is there something making it sore for you to poo on the toilet?

5. The behavioural approach: It doesn’t matter where Pooland is. Just sit calmly on the toilet reading The Lorax until you poo and you’ll get a Peppa Pig sticker on your chart.

6. The hermeneutic approach: Let’s talk about Pooland, shall we? Let’s chat about poo and toilets for a bit…

So far, none of these are working either. And then, as is usually the case in most areas of public health, epistemologies get tangled up with ideologies and politics;

7. The communist/kibbutz method: All of you together, arrange your potties into a neat line and sit and poo together. Nobody moves until everyone poos. (Just to clarify, I haven’t tried this)

8. The authoritarian method: You will poo where I tell you because I am your parent. End of. (Again, to clarify, I’m not going there.)

9. The attachment-parenting approach: If we keep breastfeeding, co-sleeping and home-educating you for long enough and relax, you’ll poo in the toilet eventually, even if it takes a few more years.

So… it’s all providing a brilliant introduction to epistemology; fascinating insight into the range of ways we can think about what we know, and daughter is having a fantastic time intellectually out-manoeuvring me. But she’s still not going potty in the bathroom, so all further ideas (and/or donations of Ecover) are most welcome.

Thursday 24 January 2013

Ignoring the ‘experts’ and sticking with the hard to follow guidance as a mom

Posted by Liane Azevedo

Being a Mom has changed my research interests. Now, every time I see something related to physical activity, diet or even sleeping behaviour in early childhood it grabs my attention.

However, I must confess that it is not always easy to follow the public health recommendations that are set for moms on how we should raise our children. More important, I think, is to fight against the pressure that you receive from family, friends and sometimes complete strangers to follow their guidance.

For me this started with breastfeeding. Being born in Brazil where breastfeeding is the rule rather than exception, I have never considered any other option. However, I must say this hasn’t been an easy process. I faced several challenges including mastitis, bleeding, and the fact that my son woke every hour during the night to breastfeed. As soon as I mentioned these problems to other people the first advice I received was, “Give him a bottle.” But I don't want to give him a bottle. Then you’re told that your milk must be weak, which is why he is waking up every hour and so on... (Note: my son was born on the 50th percentile and after 4 months he was on the 90th just with breastfeeding). 

Pieter de Hooch: Mother nursing her child, c1674 
People appear to want to impart their ‘expertise’ on every phase of his development. They say: “Why did you let your child feed himself? Now he is a fussy eater and look at the mess he does! Look at my son he is 2 and I still feed him and he is not a fussy eater”. Then when it comes to sleep they suggest the use of techniques such as ’control crying’, in which you let your child cry until he/she settles down. Being a very soft mom (I know I will pay for this later in his teenage years), I can’t cope with this idea. Luckily, I found some scientific evidence to support my decision (you can always find what you want to, when you search for it). According to this paper “Leaving an infant unattended and in distress, advocated by many clinicians, is not the only efficacious method by which sleep consolidation can be achieved and may not be either necessary, ethical or biologically sound.” It basically says that crying is the way a child communicates with its parents and by ignoring it, you will be blocking this communication. So, that will do as justification for me.

This all reminds me of a presentation I saw recently at the North East Physical Activity Forum, with the intriguing title: “Why we should shut up about the long-term benefits of physical activity”. Although the presenter didn’t give any scientific evidence to her comments, the main message was that long-term benefits of physical activity cannot persuade people to start physical activity. So, we should advocate the short-term benefits such as “have more energy”, “sleep better”, “meet people”, and “reduce anxieties, worries and depression”. I don’t necessarily agree with her comments, probably because I work in this field and the long-term benefits strike me more than the short ones. But this might be worth investigating. However, if I decided to look for the short term-benefits on how to raise my child, I would probably be doing everything against the recommendations. Don’t breastfeed, let him cry himself to sleep, and leave him in front of the TV so you can have your own time. I’ve learnt that sometimes you need to stick with hard to follow guidance to see the benefits which, might take a while to show but, are much more important than the immediate comfort that you would probably get from not following them.

Tuesday 22 January 2013

Why blog?

Posted by Jean Adams

It seems an odd thing to write a blog post about the value of blogging. I mean, if you’re reading this blog, it suggests you place some sort of value on the medium. Or maybe, you don’t really but you came to my presentation today on blogging and felt some vague compulsion/interest in following up the link on the handout just this once, seeing as it was such a funky little handout.

What is a blog? What’s it for?

If this really is your first visit to a blog, let me tell you a bit about it and show you around. 

Blogs (a contraction of web logs) are web-sites, or parts of web-sites, that are designed to be regularly updated with new content, including text, images, audio and video content. Entries, or ‘posts’, are presented in reverse chronological order with the most recent first. By providing a facility for readers to comment, and writers to respond to readers’ comments, blogs provide a forum for interactive discussion. Blogs can be single or multi-author and about anything and everything.

This page is mostly text. But we try to include either still or video images with every post. If you scroll down a bit, you’ll find previous posts. And even older ones if you scroll right to the bottom and click ‘older posts’.

Don't say  I didn't prepare - the natty little handout you would have got if you'd come to my presentation
You can see that posts are written by a variety of different people – this is a multi-author blog. Anyone affiliated with Fuse can post and we also accept guest posts from people not affiliated. At the bottom of each post, there’s a little note highlighting either that there are currently ‘no comments’ or maybe ’23 comments’. We haven’t quite cracked the ‘interactive discussion’ bit here, but if you’d like to help overcome that you just need to click on the ‘no comments’ link and let rip. This is the internet, so we use links within posts to source material, or more information on various concepts, rather than a list of references at the bottom of posts.

To the right of the main text, you can see some other stuff introducing the blog and what it’s about, listing previous posts, and bigging up our besties. There's also some Twitter and social network sharing stuff there. We publicise the blog primarily through Twitter. If you're new to blogs, a good way to find out about new posts is to follow me (@jeanmadams) or @fuse_online on Twitter.

The majority of mainstream science communication follows a formal, and often highly structured, format. In contrast, blogs allow scientists and researchers to be both authoritative and informal. In blogs the personality of a researcher can shine through in a way that it rarely does in peer-reviewed publications and traditional science journalism. For this reason, science blogs have been proposed as “one way to demythologize science”.

Fuse is a Public Health Research Centre of Excellence that brings together academics and researchers from five universities in the North East of England. One of Fuse’s key aims is to engage with those working in public health policy and practice across the region (policy and practice ‘partners’) to conduct research with and for these groups, and to ensure translation of research findings into policy and practice.

We set up the Fuse Blog because, although awareness of Fuse seemed high locally, understanding of what exactly it does and how, appeared limited. We were also concerned about a feeling that Fuse researchers were perceived by policy and practice partners as a bit far removed from the real world, up in their ivory towers. Finally, we wanted a method to build some sort of community across a research centre that is located in five different universities at some geographical distance from each other.

To achieve these things, posts tend to be about the day-to-day realities of doing public health research, written in a way that hopefully makes us look human. But we also sometimes post what might be considered lay summaries of our research findings and accessible discussions of recent research developments.

Why should I bother blogging?

I asked my Twitter followers why they blogged. These are some of the responses I got:

I think that the reasons that a researcher might want to blog can be broken into three areas: personal, professional and organisational.

From a personal point of view, I quite enjoy blogging. Like Bronia, I like having an opportunity to write about the things that matter to be but that I can’t put in academic papers. It can be quite cathartic. I also like the people that I’ve met – both in person, and virtually – through blogging. I’m quite a shy person underneath, so this medium suits me well.

Professionally, Sherry and Lynne cover some of the important points. Blogging is a form of engagement that allows researchers to speak to people they often can’t access through traditional dissemination routes, about things those routes don’t generally cover. On the blog, I am Jean. It’s fine for Jean to discuss the everyday realities of doing public health research and to chat about her research. Most other public places I go in a professional capacity, I am Dr Adams. From her you get cautious interpretation of her latest peer-reviewed findings.

This sort of engagement ticks boxes in terms of communicating the method of science. But it is also considered a moral duty by some: if the public fund our research through government agencies, don’t we have a duty to tell them about it in a way they might understand?

As Lynne says, blogging is also a good way to get into writing – a skill that every researcher needs. It’s quick (we normally say 5-800words for a post, but this one is rapidly breaking the rules, but I’m the editor, so that’s fine) and it doesn’t have to be perfect (I seem to have identified a number of post-publication typos...).

Organisationally, the most important thing that the Fuse blog might have done is make us a bit more democratic. Our posts tend to be written by early career researchers who often don’t speak up in other forums. As one professor eloquently put it, the blog gives a voice to those who are too often voiceless in our organisation.

In turn, this gives a good impression of Fuse to the outside world: we’re the sort of organisation who aren’t afraid to let our early career staff and students speak out and we support them to do that. The blog also means we have a constantly updated web presence. It says: we are flourishing.

But…what about all the bad stuff?

Obviously you should be aware of the risks of anything before you start. Simon Wren-Lewis from Oxford University offers sound responses to many of the risks you might think blogging has, from not having enough time, to not having anything to say. With a multi-author blog like the Fuse blog we easily absorb many of these. Matt Might from the University of Utah also offers some good tips on low-effort blog post strategies – if you’re going to write a presentation for a departmental seminar on blogging, write a blog post about it.

With a central editor (me) who scrutinises all posts before they go live we also add an additional layer of checking to the ‘read it again in the morning’ strategy used by Wren-Lewis. We err on the side of caution and if there’s anything I think you might live to regret posting, I’ll talk to you about it. But that rarely happens – researchers live and breathe confidentiality and professionalism.

No…I meant: what will people think?

Well, what do you think? Do you think that researchers and academics writing about their day-to-day working lives in non-peer-reviewed publications is ‘vulgar’? Do you think Athene Donald, professor of physics at Cambridge University and Fellow of the Royal Society is ‘showing off’ in her blog? Do you think Trish Greenhalgh, professor of primary health care at Queen Mary, who contributes to many multi-author blogs has ‘too much time on her hands’? Most people probably think the same way you do.

If you’ve written a post or want to chat about ideas for posts, get in touch.

Thursday 17 January 2013

Thesis looming

Guest post by Sadie Boniface

I knew it was coming. I am envisaging months of isolation. I remember the long hours I spent at the Robinson Library when I wrote my Masters dissertation (supervised by Martin and Jean). But that was only for two months, and I have budgeted nine for this. A word limit of 15,000 cannot be compared with one of 100,000.

Yes, I am on the cusp of starting what every PhD student dreads: the writing-up phase.

I will survive
In preparation, I did a swift ‘audit’ of all the work I’ve done so far towards my PhD, which is on under-reporting of alcohol consumption in England. This includes my upgrade report and presentation, conference papers, journal articles (at various stages of completion), along with personal notes and musings. This has boosted my confidence. I didn’t quite realise it before, but I have done lots of work already. My thesis is going to write itself! As my opposite desk neighbour and I keep saying to each other: ‘it’s going to be fine’.

Doing this allowed me to put together a chapter outline. ‘Excellent!’ I thought once I had finished, pleased to see a structure I can dissect into manageable chunks. Eight chapters, each with all their relevant little sub-sections. And my supervisor said the outline was good. This is going to be easy.

Despite my deliberate optimism, truthfully, I know it won’t be easy (and perhaps that’s why I’m procrastinating by writing my first blog post). Writing up has a reputation for being difficult. Google “PhD write up” and the three of the top ten hits are about how to survive the writing-up process. Books have whole chapters dedicated to it. The focus is on coping and perseverance. When I speak to fellow students in my Department who are in the writing up phase they seem numb. The thesis takes over. It is almost as if pulling together the threads of the previous two-to-five years - to weave the tapestry that is the thesis – is best done robotically, not by hand.

Due to make this transition to automaton myself, I am anxious about how I am going to manage. I experience a definite slump in productivity when I am working on the same thing day after day. Without a doubt the part of my PhD I have enjoyed the most so far has been the process of collecting data for two of my four studies. I really like getting out and speaking to members of the public. Without this interaction, I expect time to pass more slowly. It’s looking like a long nine months.

This is partly why* I have taken on additional commitments. I am tutoring schoolchildren with the aim of widening access to top universities, and I will also soon be helping to collect data for a large new study. I hope that the extra experience I’m getting will make me more employable. I’m also hopeful that this time away from working on my thesis will give me space to reflect, allowing me to come back to it with ‘new eyes’. Ultimately, I expect these breaks to improve my writing.

Juggling writing up with other (unrelated) work is going to be a challenge. I’m not sure when or how I’ll know if I’ve got the balance right. My PhD is undoubtedly my priority, but perhaps it will be a mistake not to focus my attention fully on my thesis. I am determined to hand in by the time my funding runs out. Whether I will or not, only time will tell. With luck, I might be able to spare an afternoon to share my experience of the writing up process on this blog in a few months’ time.

If you are doing a PhD, do you have similar fears about writing up? If you have a PhD, how did you ‘survive’ the write up? What tips would you give to PhD students to help them write their theses?

*another contributor is the unfortunate fact that my MRC doctoral training grant studentship stipend has been frozen since 2010!

Tuesday 15 January 2013

Winter is coming? Surviving the final months of a PhD

Posted by Amy O'Donnell

At the end of 2012, I officially stopped being a full-time funded PhD student, and re-entered the world of the tax-paying worker (staying here at Newcastle University – thanks for having me!). In theory, of course, this means I should be about to submit my leather bound, gold embossed thesis to some lucky examiners. Sadly, I’m not quite there (although, come April, a couple of eminent academics should beware of the ominous thud through their letterbox).

Apparently, these final months of frantic write-up will be quite the endurance test: the tough hardship of George R.R. Martin’s never-ending winter compared to those halcyon summer days of first and second year studentdom. I’ve been warned that I will basically have to give my children up for adoption, withdraw from polite society and hole myself up in some ivory tower for the interim (which is starting to feel like a pledge to the Night’s Watch but I’ll put the poorly-disguised Game of Thrones references aside for a moment).
 Sorry, one more totally undisguised Game of Thrones reference
In some ways, these warnings are starting to come true. I can’t remember the last weekend I didn’t do at least a day’s work and my school runs are down to the absolute bare minimum (I almost forgot Children in Need costumes!!!). I am constantly thinking about deadlines, drafts and discussion sections (sometimes way too early in the morning for my liking). And yet, I’m not even remotely hating any of this. Far from it. I can honestly say I’m loving my PhD more than ever and, if anything, dreading the whole adventure coming to an end. It’s all finally (mostly) making sense, and of all the elements that comprise the mysterious business of research, writing is definitely my favourite. I’ve also been getting ‘out there’ more, including being lucky enough to enjoy a fantastic conference trip to Barcelona, emboldened by a sense of possibly having something to say at long last.

Of course, the ‘party’ is far from over. About 30,000 words away from being over to be precise, and I intend to enjoy everyone one of them. Returning to Game of Thrones, I read somewhere that there are around 1,500,000 words in the five tomes of the Song of Ice and Fire series so far, and I’ve read and enjoyed most of them. Much like the PhD, all its left me with is a desperate need to see how things finish. So on that note, I’ll leave the final word to the marvellous George R.R. Martin:

“Some battles are won with swords and spears, others with quills and ravens.”

Thursday 10 January 2013

Some top tips on publishing from some editors of top journals

Posted by Jean Adams

I was recently asked to take part in a panel discussion on publishing for the UK Society of Behavioural Medicine's Early Career Network.

Also on the panel were: Professors Paul Aveyard (senior editor of Addiction, and an editor of the Cochrane Tobacco Addiction Review Group), Ronan O'Carroll (associate editor of Health Psychology and British Journal of Health Psychology, member of the editorial boards of Psychology & HealthBritish Journal of Clinical Psychology and Journal of Behavioral Medicine) and David French (associate editor of British Journal of Health Psychology and Psychology & Health, member of the editorial board of Annals of Behavioral Medicine).

I was the token non-male, non-professor on a panel of rather eminent male professors. So whilst they poured forth of their wisdom on publishing, I took notes. With their permission, I've tried to summarise some of the top tips on publishing research of some of the top UK editors of behavioural medicine journals.
Calvin & Hobbes on writing

1. The best way to write a paper is to write a paper. Stop procrastinating and get something, anything, down on paper. Don't expect your first draft to be any good. Writing is mostly about editing and re-editing.

2. Know what your paper is about before you start. One suggestion was to write a structured abstract first to force yourself to condense your work and thoughts into 2-300 clear words.

3. Be clear about the "so what" factor. The editors were particularly scathing about wishy-washy, discussion section stalwarts such as "more research is needed". They wanted to see clear statements about the implications of results and suggestions for exactly what further research is needed.

4. Make sure your work is internally consistent. Don't be afraid to revert to the old skool approach of saying what you're going to do (aims and methods), doing it (results), and then saying you've done it (discussion). This structure of covertly repeating yourself helps keep everyone focused.

5. Learn to deal with rejection. Someone pointed out that the best journals reject more than 80% of the stuff they're sent. Even the next tier of merely 'good' journals still reject at least 50% of submissions. So everyone (even eminent professors) have papers rejected on a fairly regular basis. Don't take it personally and be open with your colleagues about the experience. Focus on what you might be able to learn from any feedback you receive and get on with getting your manuscript ready for the next submission

6. Seek constructive criticism from colleagues before submitting. Don't just find someone who'll say your paper is lovely. Find someone who'll give you substantive comments on how you could improve it.

7. Don't annoy the reviewers. Reviewers are busy researchers and academics - just like you. Bad writing, poor grammar, and non-standard formatting all have the potential to put them in a bad mood with almost inevitable negative effects on the review they write about your manuscript.

8. Focus on what's generalisable about your work and don't get bogged down in local details. There was a strong feeling that to be published in an international journal, work has to be internationally relevant. If you performed your work in Huddersfield, make clear that this setting was merely an exemplar for proving a more widely applicable point.

9. There were fairly mixed feelings on the importance of cover letters. There was much more clarity on the importance of getting the response to reviewers letter right. Ensuring this letter is polite was seen as crucial. One editor admitted that he often writes a fairly sweary first draft of this to vent his rage, before editing to make it more presentable.

10. Don't be a slave to the impact factor. Whilst high impact papers are definitely considered important, one editor also stressed the importance of a journal's standing within its field. So a fairly low impact factor journal that is the best within its field is likely to be considered better than a similar impact factor journal that is mid-ranked in its field. Others felt that, especially for an early career researcher, being able to show that you can write and publish by having a reasonable number of publications on your CV, is arguably more important than having a few papers in very high ranking journals.

11. Don't be afraid to take a punt. Everyone agreed that editors and reviewers can be unpredictable. It is a system based on opinion, so one person might have a very different opinion of your paper than another. Don't automatically think your paper is only worthy of the Journal of Universal Rejection if JAMA turn you down. There are many options in between and another very good journal might still be interested, even if JAMA isn't.

12. Consider making informal per-submission enquiries. This was not something that anyone in the room had substantial experience of, but one member of the panel had once emailed a senior editor with a structured abstract to ask if he would consider the paper for his journal. The answer was no, but at least the response was provided quickly and without any messing around with reformatting references and completing online submission forms.

Tuesday 8 January 2013

My Big Fat-and-Caffeinated New Year’s Resolution

Posted by Heather Yoeli

I need a coffee. I can’t write without coffee. Happy New Year. May 2013 be a year of love and blessings and decaffeination for you and all those whom you love. And please excuse the very inept deployment of the subjunctive in the previous sentence. I need a coffee, you see...

I’m sure I’m not the only one within Fuse to have made a New Year’s Resolution. I imagine that I’m not the only one within Fuse to have made a health-related behaviour-changing type New Year’s Resolution either. I am (deep breath) going to make fewer – alrightalright NO - trips to the friendly new espresso machine located at the local garage and I am (even deeper breath) going to put the money saved towards one of those cringworthily excruciating-sounding Mummy-and-Tot Dance Classes, through which I will instil in my progeny an enthusiasm (grit teeth) for exercise. And I’m wondering what New Year’s Resolutions others might have, and how forthcoming they might be in sharing them with a blog…

My vice. This is a caffeine molecule, apparently. Chemistry was never my strongest suit, so I’ll take its word for it.
Within most areas of health, healthcare and health sciences, there exists an ethos which says that professionals and researchers should distance themselves from their area of practice or study. If, for example, you’re a doctor or a PhD student with diabetes or bipolar disorder, it’s nobody else’s business at all and they can piss off if they ask you anything about it. You don’t go there because to do so would be unprofessional or self-indulgent or irrelevant or burdensome to others, in essence a transgression of Western society’s Cartesian boundary of subject/object, body/mind, Self/Other. In other words, our personal lives need neither to be affected by nor to affect anything we do to pay the bills. It’s all a stress-management technique or a coping mechanism or a survival strategy, and one with which few would disagree.

Within public health, however, ethical challenges emerge from attempts to uphold such distinctions. Even those of us who subscribe to the most deterministic and we’re-all-merely-victims-of-our-social-environment woolly leftie-isms would concede that we all exercise some level of choice regarding our health behaviour: we decide, for example, how much (if any) chardonnay we drink, how frequently (if ever) we disinfect our chopping boards and whether (if female) we turn up for smear test appointments. Merely by virtue of possessing some level of personal autonomy and merely by living in a country offering virtually universal health services, we are all patients (or service users, clients or consumers) of public health. And some of the choices we make with regard to our health will be visible or apparent to those with whom we’re working.

Within qualitative service evaluation literature produced on public health interventions in the Cowgate community, smoking is a case in point. Davies (1998) does not mince her words:

… some families spend a third of their income on cigarettes. The smoking message is one that the midwives repeat over and over again, and everyone, including social workers, seems to ignore it... 

Stacy (1988) puts it a little more discreetly:

Staff should decide whether to make reduction in smoking one of the objectives in their health promotion work.

In other words, if we can’t give up smoking why should they want to?

And if I’m wasting £2.30 a day on un-recycled paper cups of over-caffeinated beverages funding a monolithic rainforest-destroying global multinational, how can I think with any integrity about questions of ethics and sustainability with public health? I’m really [expletive redacted after long tea-fuelled discussion with editor] going to have to do this. Aren’t it?

So, before I put the kettle on for camomile tea in a vain attempt to assuage the shakings and cravings of my coffee withdrawal, would anyone else like to share what they’re resolving to do to address their own un-public health-worthy little vices? What’s your New Year’s Resolution, and why?