Thursday 28 February 2013

The day the media circus came to town

Posted by Jean Adams

Is it more scary when Monty Don slags off your research on Twitter, or when a professor who you respect a lot asks you nicely to be a bit more careful with your not-quite-what-it-was-designed-for use of his carefully developed tool (also on Twitter)? How about both on one day?

What seems like a long time ago now, an MSc student emailed to ask if I’d be interested in chatting about an idea he had for a dissertation project.

His idea was simple: compare the nutritional quality of ready meals to celebrity chef meals. I don’t think the student (now graduate) in question would mind me saying that he’s not unfamiliar with a ready meal, or currently maintaining his weight within the recommended BMI range. Slightly fed up with being told his ready meal habit was bad for him, he was interested in finding out just how bad and whether it was any worse than the alternative that seemed to be in his face whenever he was eating his ready meals – something served up by Nigella, Jamie or Hugh.

In contrast, I and my co-supervisor were backing the celeb chefs. I don’t think I’ve ever eaten a ready meal, and it is possible that I have an affinity for glossy recipe books that has resulted in a collection that outgrew the kitchen bookcase some time ago. Scientists are neutral (not). We might be able to collect and analyse the data objectively, but it was clear what results each member of the research team was hoping to find.

The project was perfect for an MSc dissertation: clear research question, data collection primarily via the web, fairly straightforward analysis, no ethics permission required. We joked in supervision that the BMJ would love it.

And so it came to pass that the student collected and analysed his data, perhaps stretched the use of front of pack labelling for a good gimmicky visual a bit too far, got a good mark, and toddled off back to his real job promising to send us a draft of a paper sometime. Often those manuscripts never materialise. But lo! This one did. I wasn’t absolutely convinced that the BMJ really would love it, but we’d said they would and it seemed a shame not to try. They say ‘no’ pretty quickly.

I was mildly offended when the BMJ’s response to our rather serious and important piece of work was that it was “quirky” enough for their Christmas edition. Sure it was fun and sure I wasn’t quite convinced that it was good enough piece of work to be considered normal BMJ material. But there is a serious point here: lots of public health advice suggests that people should cook from scratch and implies this is better for you than eating ready meals. If you don’t know how to cook from scratch, then it isn’t a wild assumption to suggest that you might learn from the most prominent cooks around – celebrity TV chefs. A nutritional comparison of the two doesn’t seem outrageous.

Presumably you know what our findings were? We found that, on a number of nutritional metrics, ready meals did better than celebrity chef meals, but neither of them did very well. The ready meals were less unhealthy than the celeb chef meals, but it would probably not be right to say the ready meals were healthier than the celeb chef meals.

I knew what was going to happen. I didn’t have any idea how to stop it happening. Perhaps there was none.

The BMJ went to town promoting our paper. The media loved it. We got on the Today programme headlines, the paper was covered by loads of newspapers and not just in the UK, all three of us spent most of publication day doing interviews with just about everyone and their dog. But however much we tried, it was very difficult to get the message across that neither group of meals were particularly good for you – we were definitely not saying that ready meals are the way to go. But that’s the message that everyone seemed to hear.

Ho hum. What can you do? The media circus would move on. No-one would remember. And presumably any colleagues who would, might take the time to read the paper (or at least the abstract), and not just go on what was in the newspapers?

I can understand why people went for the “ready meals healthier than celeb chefs” headline and why that then prompted all the various responses it did. But I was most bothered by Monty Don’s response. And not just because I’ve always thought he seemed like a nice, and thoughtful, guy.

Do lots of people think scientists should only do, and publish, studies that come up with the ‘right’ results? That we should make sure the measures we use are designed to come up with those ‘right’ results? What about Ben Goldacre and the All Trials campaign for open data and publication of all trial results – not just positive ones? How does that match with this attitude? Or maybe I’m assuming that Monty is more representative of ‘the public’ than he really is.

Tuesday 26 February 2013


Posted by Heather Yoeli, and Claire

Monday morning, 9.34am. I’m with an interviewee between the consent forms and our list of questions and I’m just about to turn my mobile off and Dictaphone on… and my mobile is beeping. It’s Claire*. Claire has been able to get up and out this morning, and would I be free to meet her for a camomile tea somewhere across town any time before 10? I’m so pleased to get her text that I’m tempted to abandon the interview and just leg it to meet her. It’s such a rarity these days that Claire is well enough to get out for camomile or for anything much at all.

Public health generally aligns its priorities along utilitarian grounds: that is, we seek to deploy our resources to do as much as possible to improve the health of as many people as possible. Mortality rates are easier to quantify than morbidity rates and certainly, this leads to inevitable and perhaps perennial debates around how we define and measure health, challenges to health and health improvement. In the broadest terms, however, this means that we tend to prioritise the illnesses, lifestyle factors and ecological challenges which cause the most death and ill health to the greatest number of people: in terms of illnesses, this means coronary heart disease, cancer, diabetes, stroke and chronic lung disease; in terms of lifestyle factors, this means smoking, alcohol, obesity and physical activity; and in terms of ecological challenges, this means socioeconomic, political and environmental inequalities. This means that public health is very good, for example, at designing evidence-based cardiac rehab programmes to teach older people who have had a heart attack how to use the gym. This also means that public health is less able to address the needs of people with rarer illnesses and more unusual lifestyles. People like Claire, for instance.

Broken hug, by JuggleGlass
Claire has been a friend for many years; she is a lawyer, a cellist, a socialist, a lover of horses, and is deeply committed to her Roman Catholic faith. Claire has also lived with severe anorexia nervosa since her teens and though she is now too ill to maintain her professional role as a solicitor in family law, she manages through mindboggling determination nevertheless to use her legal experience as a specialist advisor to a local community advocacy group, giving more to society than most healthy and employed people. Most women who develop anorexia in their teens will recover by their mid-20s and most women who don’t recover by their mid-30s will die before they reach Claire’s age. Therefore, Claire does not 'fit' into any of the accepted categories or pathways within healthcare systems, and health improvement doesn’t feature in any of the care she does receive. Claire is an anomaly to public health systems, a mystery to doctors and an awkwardness to social workers. As Claire’s health needs move from the psychiatric to the palliative and from the medical to the social, her difficulties in finding the care she needs continue; she cannot secure funding for the hospice respite which might help yet has been offered the short-term meals-on-wheels service which... well, the pathos of it all made her laugh, at least. And so, by both her friendship and the tenacity with which she holds to life, Claire demonstrates and encourages me never to lose sight of the tiniest hidden minorities who slip between the gaps of all public health statistics and services. Claire has taught me that, although we may always prioritise the many, we should never forget the few.

I’d imagine that I’m not the only one here to have, or to have had, a ‘Claire’ in their lives; someone who has inspired or challenged their way of thinking about public health. Would anyone like to blog about their ‘Claire’?

* Claire is not her real name. However, this post was written with her permission.

Thursday 21 February 2013

The Fuse sandpit spa trip

Posted by Jean Adams

Quite often I have what I think is a great idea and I get all excited about it. I tell someone and they say “yes that is interesting”, whilst looking over my shoulder, and then walk off to do something more important. Occasionally the idea resurrects itself and is enacted without attribution. That’s okay: maybe someone else thought of it independently from me. Or maybe someone heard me talk about it, dismissed it, and then it came back to them as a seemingly new idea three weeks later when they were in the bath. But it’s not that common when I say “wow, I’ve just had this great idea” and someone says “that is an excellent idea, why don’t you write 500w outlining it, and we’ll discuss it at the next meeting of the Tedious Bureaucracy Executive Sub-committee”. Even rarer when the TBESC resolves to act upon my idea.

Sandcastle by Joe DSilva
So, you see, I haven’t had much opportunity to learn that when you have a great idea and someone else likes it, you then get charged with executing the idea.* I think I sort of thought I was just here to have great ideas – which is obviously a very poor reflection of what I do all day, but perhaps a very good reflection of what I wish I did all day.

On the Saturday before May Day 2012, I was climbing hills. I remember this because we climbed Ben Cruachan and it was my 142nd Munro – which is half way around the 283 Munros there were that day.** As we romped down the broad shoulder of Stob Diamh, Cruachan’s sister peak, back to the car park and tea shop in the warm May sun, I suddenly had this brilliant idea. Why not run a residential grant writing workshop for Fuse’s early career researchers (ECRs)? It would be a cross between those UK GRADschool development workshops that everyone raves about, and an EPSRC sandpit which everyone seems to come home from exhausted but £0.5m better off. 

We would get real people working in real-life public health to come up with research problems, get our ECRs to work with them to develop research solutions, and intersperse the whole affair with little seminars on career building, grant writing, and advanced research methods. It would be experiential learning personified. We could maybe even fund the best research idea? No? Ok, maybe that would be a teeny step too far. On reflection, this was probably not entirely my idea. But it’s a good story, no?

The only Fuse committee I am on is the Fuse Communications Group. I don’t think it has a particular remit for capacity building or career development, but I took my idea there because it was the only place I had to take it. I wrote my 500w. People seemed to like it. The idea got escalated to some other acronym and Fuse agreed to pay for the whole adventure (with the Strategic Health Authority later taking on more than half of the costs).

And then someone said, “so Jean, how do you want to organise this”? Truly? I didn’t want to organise it. Why would I want to do that? I just wanted to go off and climb some more hills and have some more ideas. But, you know, the person who asked was kind enough to say “okay, we could do it together”.

So we did. Janet and Avril and Mark and Terry and Sue and me, but mostly the others and not really me at all, co-ordinated calendars, visited venues, cajoled people into taking on all the various different roles required, told hotels that ‘limited’ wifi was not wifi enough for the 21st century, organised games, prepared delegate packs and almost drowned in organisational paper work.

On Monday 25th February, 30 Fuse early career researchers will join seven senior researchers, and three local public health practitioners in the beautiful surroundings of Linden Hall Hotel. The practitioners will present contemporary public health problems that require research solutions. The ECRs will work in groups with the practitioners to design relevant research projects. Each group will be guided by a senior ‘mentor’. Over three days the groups will write and submit full research proposals. These will then be considered by a board of Fuse members and associates in open session. Each member of the team who submit the application judged most appropriate for funding will win £500 to spend career development opportunities. There will be seminars on research methods and what funders are looking for in grant applications, a pub quiz, indoor cricket and a chance to hear about how one senior professor got where they are today. Perhaps there might also be some time to spend in the spa.

I hope it all runs smoothly – we certainly seem to have enough paperwork to suggest it will. I hope everyone enjoys it. But, more importantly, I hope they learn something useful from it.

Thanks Janet for liking my idea.

*Although, note that is exactly what happened with the “wow, let’s have a Fuse blog” idea.

**The Ordinance Survey continuously re-surveys the Scottish hills and between it and the Scottish Mountaineering Club the decision on how many Munros there are seems to vary on an annual basis. As I write, there are only 282 Munros.

Tuesday 19 February 2013

This blog needs a meme

Posted by Heather Yoeli

We’ve been discussing on here for a while how we’d like to make this blog a more interactive. So… does anyone fancy a little quiz? Ten years or so ago, endless mini self-created interview questionnaires were bouncing around Blogspot and MySpace and LiveJournal as a sort of forerunner to LOLcats, bronies, Ridiculously Photogenic Guy and other such memes. But I always quite liked the quizzy type format as a fun way to get to know people.

Iiiiiiiiiiiiiiiiiit's quiz time
The premise of this quizlet is that, whereas we all love public health research (well, I do anyway) we tend to spend a lot of our time focusing on single aspects of specific research projects, and public health is a broad and exciting field and we (or is it just me?) sometimes wonder what colour the grass is on the other side. So, here are three questions. You can answer them as a comment to this blogpost, or you can submit your own blogpost based on them. You can add questions too, and nominate people you’d like to answer them.

OK: the questions…

1. In an entirely hypothetical scenario in which time, money and skill were no object and you could research absolutely anything at all, what would you choose?

2. If you could poach a piece of research from one of your colleagues, which and whose would you pick and why?

3. If you could study and/or work at any university in the world, where would you go?

Right. Shall I go first?

1. In an entirely hypothetical scenario in which time, money and skill were no object and you could research absolutely anything at all, what would you choose?

I would seek to render the anopheles mosquito completely extinct, thereby eradicating malaria. Malaria is one of the most under-resourced and under-researched challenges to global public health, affecting as many as quarter of a billion people across the world each year and killing up to a million, most of them children in sub-Saharan Africa. I have no idea how one would even begin to approach such a task, and am aware that there are cleverer people than I already out there working on it. But thinking entirely hypothetically, that’s what I’d do.

2. If you could poach a piece of research from one of your colleagues, which and whose would you pick and why?I’d pinch Monique Lhussier’s PhD. Monique starts out looking like a rather mainstream qualitative interviewer thinking about quality of life in multiple sclerosis, and then she starts watches Pinocchio. She makes intriguing observations about the whole concept of quality of life within a postmodern framework, considering one of the many paradigms or constructs which public health tends never to question. Monique clearly has significantly more brain cells than I do, but I’m nevertheless wondering if I could slip a few quotes from Bart Simpson into my thesis.

3. If you could study and/or work at any university in the world, where would you go?
Somewhere hot and sunny and dry. Many many things attracted me to Northumbria, but the weather was not one of them…

Now, over to you. Please join in.

Tuesday 12 February 2013

Doing something about inequalities in health

Posted by Jean Adams

I was at a meeting in Edinburgh at the end of last year on inequalities in health. It was one of those events full of eminent (and emeritus) professors where I felt slightly out of my intellectual depth. I didn't trust myself to say much. But I tried to listen well.

We need to pro-actively engage with the media - like CJ Cregg did everyday
One of the things about health inequalities is that we all sort of know what the solution is. When I told my dad I was going to do a PhD on why poorer people tend to die younger than richer people, he said "well isn't it just because they don't have as much money?". This confused me. What I was interested in was the physiology - how does poverty "get under the skin?". I don't think the money thing had even crossed my mind.

Now, ten years later, I increasingly agree with my dad. Who cares about the physiology? Sure we could know more about the detailed biological processes going on, but what difference would it make to what we might do about inequalities? The solution remains that to change health inequalities to any substantial extent, we have to change the social structure. Reduce income inequalities, redistribute wealth.

You don't need to be a professor to work that out.

The problem seems to be that we (who? the academic community?) think any sort of drastic wealth redistribution is unattainable, or maybe just too difficult to attain. So we think of other little things we might be able to do to alleviate the problem, rather than tackle the cause. You know, target cancer screening programmes better, that sort of thing.

What would it take to get wealth redistribution? Political will. What would it take to get political will? Public pressure. What would it take to get public pressure? Media agitation. Just like everything else.

One of the things that I was slightly surprised we ended up talking about in Edinburgh was engaging with the media. Sure, I like a bit of science communication. But it's not something that has come up in any of my previous conversations about health inequalities. In fact in previous discussions about science communication, the conversation has rather stopped dead whenever I’ve mentioned inequalities.

The phenomenon of inequalities in health is not inherently media friendly. There are no breakthroughs to report on. No big shiny gadgets to take pictures of. Poorer people get sicker more and die younger. As one participant at the Edinburgh meeting pointed out, if there's a report documenting the extent of inequalities it might get a bit of coverage, but it will be presented as if this is some big, new finding. The coverage won’t go much beyond the data to explore what the cause or solution might be. Then there will likely be a few years of editorial 'fatigue' when it feels like that story has been done recently. Once everyone's forgotten, a new report might spark more interest, but again the coverage will be superficial. And the cycle will repeat.

Other participants described instances of reporters looking for a human angle on inequalities stories traipsing off to the most deprived parts of Glasgow and asking the people they met there why their health was so rubbish.

Mainstream media coverage doesn’t have to be like this. But it will be unless those of us within the public health academic and practice communities interested in inequalities in health get a bit more media-savvy. We need to pro-actively generate informed media debate ourselves. One fairly easy approach is to pitch articles to online outlets such as Comment is Free and newspaper blogs that are desperate for informed and timely content on policy issues.

We also need to be ready to publicly comment on anything to do with inequalities even before we are asked. One researcher, very experienced in media work, described how they prepare written commentary on new reports and statements on inequalities issues the day before they are released. It is fairly easy to guess in advance what the content of any new report will be and so respond appropriately – with final tweaks made on the day once they’ve had a chance to read the details. By staying a step ahead of events, it is possible to guide journalists and debate away from simple reporting to more in-depth consideration of what could be done to alleviate the problem.

Which is obviously all rather more easily said than done. We are, after all, full-time researchers, not part-time journalists. But maybe we could hold each others’ hands a bit and take it step by step and see how it goes? It seems we might have much more to gain, than to lose, from trying.

So who wants in with me on a Comment is Free post on what we need to do about health inequalities in the UK today? Ready to be pitched to coincide with the next big report.

Thursday 7 February 2013

The PhD ‘Journey’

Posted by Lynne Forrest

Now that I’m in the final year of my PhD (and possibly because I’ve been forced to watch too much bad Saturday evening television) I’ve been reflecting, in true X-factor-contestant style, over my PhD 'journey'. None of it has exactly turned out as planned…

Ryan's tearful journey
Looking back, the first year now seems fabulously self-indulgent. It mostly consisted of deciding on a research topic and then doing lots of reading, whilst eventually consolidating this reading into an early literature review. I also went on a couple of training courses and planned my ethics application and data analysis. This was a great opportunity to get immersed in the literature and I wished I enjoyed it more instead of being anxious to get some data and crack on with the analysis.

My project plan assumed I would get through ethics and obtain the cancer registry data I required, early in my second year. However, in case this didn’t happen, I had a back up plan. I would conduct a systematic review of inequalities in receipt of lung cancer treatment, to provide an evidence basis for my analysis and fill in a few months until the data arrived. In fact, as it turned out, I didn’t get all the data I required until my 3rd year.

So, in hindsight, my advice would be to assume that everything will take much longer than you originally think and to always have a contingency plan. And not to worry because sometimes the contingency plan actually works out to better than the original…

The systematic review turned out to be a far more major undertaking than I’d anticipated, in terms of scope, volume and time, but did ensure that I had some results in my second year, which meant I was able to submit abstracts for a couple of conferences. I was lucky enough to win a prize for best pre-doctoral abstract and the chance to present in a plenary session at SSM2012. From this, a professor in the audience contacted me to discuss my research and I’ve now been invited to speak at a clinical conference. So, although I still find conference presentations terrifying, I’m now convinced of the value of conferences as networking opportunities.

My supervisors encouraged me to write as I went along and I think this is excellent advice. I wrote up my systematic review as a paper and, although it was turned down by The Lancet (boo!), it was  accepted by PLoS Medicine, another high-ranking general medical journal. So, a piece of work I initially undertook as a fill-in exercise has somehow turned out fantastically well….

However, the pressure is now on to keep up the momentum. In my third year I need to complete the data analysis, write up, submit my thesis and get through the viva. I also need to start thinking about what I’m going to do when it’s all over. In eight months time my PhD funding will run out, and so I need to start planning ahead now. I want to stay in academia and so am thinking about a fellowship. Hopefully by the time I come to apply I will have more publications, as good, first-author publications do seem to be one of the major deciding factors for entry into academia. My plenary presentation, prize and PLoS paper should all look good on the CV. But nothing is certain, there are many others all fighting for the same prize and the fellowship process does seem to be something of a lottery.

So, anyone out there want to offer me a job?

Tuesday 5 February 2013

Learning leadership

Posted by Jean Adams 

Sometimes you have to do things you don’t want to do. I didn’t want to go on a leadership course. I have been on leadership and management courses before. They do Myers Briggs, tell you the difference between urgent and important, show you some schematic models of management and send you home. If you’re lucky, there are nice cakes at coffee time.

But, you now. Another fellowship application, another training and development plan. Apart from the knowledge-based things I wanted to learn, I couldn’t think of much. But someone else before me showed my their previously successful form and they had ‘leadership’, so I thought it might be the sort of thing that funders like.

This current leadership course seems a little different from the last few. To begin with, there was an application process. It was made clear I wouldn’t automatically get a place. I had to complete an application form, take part in an hour long telephone interview, and submit a reflective self-enquiry (exactly what it sounds like). As you might be able to tell from the fellowship bit, I do a good line in convincing people that I am totally, passionately, and unfailingly dedicated to whatever it might be that I am trying to achieve today. I felt bad after the interview that I had done such a good job at talking leadership bollocks nonsense. Even worse when I got a place on the back of it.

Ashridge Business School, Hertfordshire
The course involves four residential stays at a Victorian gothic mansion in Hampshire, plus a whole bunch of other stuff. For goodness sake, do you know how long it takes to get from rural Northumberland to Hampshire (6 hours door-to-door)? I wasn’t awed when I finally arrived in the grand entrance hall. I was grumpy about the length of the journey, infuriated by the assumption that I need luxury to learn, and starting to calculate the monetary and opportunity cost of putting up 21 mid-career academics in this place for 48 hours. And the timetable started at 4pm and didn’t finish until 10pm. By bedtime I was tired and grumpy.

After being invited to record our overnight reflections in our leadership journals (yes, really), day two proper started with an hour creating a pictorial representation of our current leadership context. I was still a bit grumpy. But then I saw the table of art supplies laid out and my making streak took over. What a lovely way to spend a Wednesday morning – making a picture representing my university department with all the art supplies I could ever want. Sometimes I get paid to do the most amazing things.

My current leadership context: no you can't have an interpretation
After coffee we each presented our creation. After lunch we were invited to spend some time walking the grounds with another person we were interested in talking more to. Then, inevitably, Myers-Briggs. Again. By the time I phoned home on the end of day two I was feeling more positive about the whole experience. I’d had an interesting and fun, if long day. What had I learnt? Genuinely? Nothing much. I’d met some interesting and bright people. Perhaps I’d met the crème-de-la-crème of mid-career health researchers in the UK today. I’d established that we share many common experiences, without sharing much in the way of research topic commonality. Maybe I was on my way to making some friends. But I’m not sure I’d learnt anything.

Day three was almost entirely devoted to breaking into groups of seven and sharing our ‘stories’ with our groups. The stories of how we got to where we are today. The stories of the defining moments in our lives. Sometimes, the difficult, traumatic, deeply personal stories. The stories that have perhaps never been articulated before – certainly not to colleagues, but often not to friends either. There were tears – of laughter as well as pain. By the end of 48 hours we had arrived at the very unusual place of knowing each other well enough to share our stories. But not well enough to be scared of sharing our stories. I think the last time I experience this was at summer camp in my teens. It feels very special when you are in the middle of it.

We had learnt almost nothing in the way of leadership. Apparently that will come.