Friday 16 March 2018

Knowledge mobilisation: relationship guidance for ‘stubborn’ practitioners and ‘smug’ scientists

Posted by Peter van der Graaf, AskFuse Research Manager, Teesside University

Last week, I presented at the UK Knowledge Mobilisation Forum in Bristol, which is an annual event for all those with a passion for ensuring that knowledge makes a positive difference to society. The Forum brings together practitioners, researchers, students, administrators and public representatives who are engaged in the art and science of sharing knowledge and ensuring that it can be used.

Getting creative sticking to ‘unconference’ principles
One of the key note speaker, Dez Holmes who is the Director of Research in Practice with 20 years of experience in championing evidence-informed practice in social care, vented her frustration about a question she was often asked by people interested in knowledge mobilisation (KMb): where can I access training in this? Her response: you can’t! Knowledge sharing is personal and therefore a social skill that you can only develop by practising it.

The skills needed to practice KMb are everyday skills, such as listening, emotional intelligence and persuasion. Reciprocity and mutual respect are crucial in relationships and therefore in knowledge mobilisation. Knowledge mobilisers use these skills to make knowledge relatable and therefore relevant to people’s lives. Dez used a Japanese word to sum up these skills: ‘ikigai’ (meaning “reason for being”): if we can’t relate knowledge to people’s sense of self they won’t be inclined to use it.

Acknowledging feelings in knowledge mobilisation is therefore important, not least because implementation barriers for knowledge are often personal. Dez quoted the common misperception between practitioners and academics that are at the heart of the so-called knowledge-to-action gap: “scientist blame the stubbornness of practitioners for insisting on doing it their way, believing they know their patients best, while practitioners lamented the smugness of scientists who believe that if they publish it practitioners will use it”. These misperceptions signify emotions at work in the knowledge gap that need to be addressed before we can start mobilising knowledge.

A great example of on the job knowledge mobilisation learning was captured in a story told by Vicky Ward, Associate Professor in Knowledge Mobilisation at Leeds University and one of the organisers of the Forum, who reflected on her research about knowledge sharing between professionals in social care. The story, titled ‘Dealing with the carousal of knowledge’, illustrates how practitioners continuously added new and different types of knowledge to their team meetings but never really made use of this knowledge until Vicky started asking some ‘constructively clue less’ questions. These questions helped them to recognise the emotions they attached to the client cases that they were discussing and enabled them to discover patterns in their carousel of knowledge. Identifying patterns allowed the professionals to select knowledge that was most useful for each case and made this knowledge transferable.

The conference format itself acknowledged the relational and context-specific work involved in knowledge mobilisation: participants were encouraged to hone their skills in randomised coffee trials, open space discussions, interactive poster sessions, market stalls, short presentations and practical, interactive workshops. The programme was deliberately based on ‘unconference’ principles, which means that it focused on offering opportunities for conversations, creativity and collaborative learning, with much of the direction being driven by the participants instead of the conference organisers. In this sense, the conference was a training ground for knowledge mobilisers to practice and learn new skills.

Friday 9 March 2018

How industry-funded organisations mislead the public on alcohol & cancer

Guest post by Dr Nason Maani Hessari, Research Fellow, London School of Hygiene and Tropical Medicine

When it comes to the risk of cancer associated with alcohol consumption, there is a significant disconnect between scientific evidence and public opinion.

The evidence of the independent link between alcohol consumption and cancer is clear, as emphasised by recent comprehensive reviews by the UK Committee on Carcinogenicity* (Committee on Carcinogenicity of chemicals in food, 2015), and the International Agency for Research on Cancer (IARC, 2012). Drinking alcohol can cause a range of cancers, including oral cavity, pharynx (cavity behind the nose and mouth), larynx (voice box), oesophagus (gullet), colorectal (bowel and colon), breast and liver cancer. Furthermore, the risk of developing cancers of the mouth, throat and breast increases with any amount consumed on a regular basis (Department of Health, 2016). However, public awareness of this link remains low, with a 2016 survey reporting only 12.9% of respondents identifying cancer as a potential consequence of drinking too much alcohol (Buykx et al., 2016).

What does this have to do with the alcohol industry? Well, in the UK and many other countries, alcohol-industry funded organisations, called Social Aspects Public Relations Organisations (SAPROs), present themselves as sources of health information to the public, particularly around ‘responsible drinking’, underage drinking and drink driving (Maani Hessari and Petticrew, 2017). These organisations have been criticised for their inherent conflict of interest, as they are linked to large multinational alcohol producers, for whom a large proportion of profits come from harmful drinking (Casswell et al., 2016). The industry has a track record of focusing on education and individual responsibility, while lobbying against population-level measures to reduce alcohol-related harm (Babor and Robaina, 2013), even though these are evidence-based (Burton et al., 2017), and form the basis of the WHO Global Alcohol Strategy, in which alcohol producers participated (World Health Organisation, 2010).

Considering the role of the alcohol industry in providing information to consumers, we decided to examine the extent to which the industry fully and accurately communicated the scientific evidence on alcohol and cancer. To do this, we systematically examined the content of 27 industry-funded organisations or websites. In each case, we analysed how information regarding alcohol and cancer was presented, and whether the statements they made about cancer risk were in agreement with the scientific evidence, as presented in the Committee on Carcinogenicity (COC) and IARC reviews.

We found that most alcohol industry SAPROs appeared to misrepresent evidence by denying, distorting or distracting from links to cancer, particularly breast cancer (Petticrew et al., 2017, Petticrew et al., 2018). A full list of examples can be found in our paper and the supplementary information, but as an example of denial, consider this:
“Moderate wine intake may actually reduce the risk of oesophagus, thyroid, lung, kidney and colorectal cancers as well as Non-Hodgkin’s Lymphoma…Concerning breast cancer, there may also be a protective role for wine.” [Wine Information Council].
When some risk was acknowledged, it was often presented alongside a range of other confounders, thus undermining the evidence that there is an independent relationship. For example:
“Alcohol has been identified as a known human carcinogen by IARC, along with over 1,000 others, including solvents and chemical compounds, certain drugs, viral infection, solar radiation from exposure to sunlight, and processed meat.” [International Alliance for Responsible Drinking]
Or in another instance:
“Not all heavy drinkers get cancer, as multiple risk factors are involved in the development of cancers including genetics and family history of cancer, age, environmental factors, and behavioural variables, as well as social determinants of health.” [Australia: Drinkwise].
It is not clear how the consumer is meant to interpret this information. The use of such descriptions to describe risk of cancer from smoking would in essence be both equally correct, and equally misleading. In fact, this type of language is highly reminiscent of arguments used by the tobacco industry, which emphasise the complex causes of lung cancer and coronary heart disease, in order to help deny the scientific evidence and identify other independent risk factors for smoking-related diseases to deflect focus from their products (Petticrew and Lee, 2011).

Since the publication of our findings (Petticrew et al., 2017, Petticrew et al., 2018), additional examples of alcohol industry representatives openly disputing the link between alcohol and cancer continue to emerge. For example, a recent study in the Yukon, Canada, examining the effects of adding a cancer warning label to alcohol (as one of three potential labelling options) has been suspended due to industry pressure.

Perhaps even more striking: as part of the ongoing debate in Ireland regarding the Public Health Alcohol Bill (PHAB), when a physician noted on live TV that alcohol was a carcinogen, a leading alcohol industry spokesperson countered inaccurately that alcohol was in fact, not a carcinogen, and that there were “…as many studies, medical studies, as there are on the ‘pro’ side…” (clip below).

It has been argued that greater public awareness, particularly of the risk of breast cancer, poses a significant threat to the alcohol industry (Connor, 2017). In response to other threats to profits, there is evidence that the industry has attempted to engage in “denialism” (Katikireddi and Hilton, 2015), and it appears this may also be the case for cancer, particularly breast cancer.

Currently, the alcohol industry remains involved in developing alcohol policy in many countries, and in disseminating health information to the public, including school children. Our research findings, which build on existing evidence regarding the activities of SAPROs (Babor and Robaina, 2013, McCambridge et al., 2014, Moodie et al., 2013), should be cause for a re-evaluation of such arrangements. The World Health Organisation has previously stated that ‘In the view of the WHO, the alcohol industry has no role in the formulation of alcohol policies, which must be protected from distortion by commercial or vested interests.’(Chan, 2013). The clear and obvious similarities to tobacco industry tactics that we report, which reflect the inherent conflict of interest, serve as a reminder that policies are but one aspect at risk of industry distortion.

All views expressed are those of the author.


BABOR, T. F. & ROBAINA, K. 2013. Public health, academic medicine, and the alcohol industry's corporate social responsibility activities. Am J Public Health, 103, 206-14.

BURTON, R., HENN, C., LAVOIE, D., O'CONNOR, R., PERKINS, C., SWEENEY, K., GREAVES, F., FERGUSON, B., BEYNON, C., BELLONI, A., MUSTO, V., MARSDEN, J. & SHERON, N. 2017. A rapid evidence review of the effectiveness and cost-effectiveness of alcohol control policies: an English perspective. Lancet, 389, 1558-1580.

BUYKX, P., LI, J., GAVENS, L., HOOPER, L., LOVATT, M., GOMES DE MATOS, E., MEIER, P. & HOLMES, J. 2016. Public awareness of the link between alcohol and cancer in England in 2015: a population-based survey. BMC Public Health, 16, 1194.

CASSWELL, S., CALLINAN, S., CHAIYASONG, S., CUONG, P. V., KAZANTSEVA, E., BAYANDORJ, T., HUCKLE, T., PARKER, K., RAILTON, R. & WALL, M. 2016. How the alcohol industry relies on harmful use of alcohol and works to protect its profits. Drug Alcohol Rev, 35, 661-664.

CHAN, M. 2013. WHO's response to article on doctors and the alcohol industry. Bmj, 346, f2647.


CONNOR, J. 2017. Alcohol consumption as a cause of cancer. Addiction, 112, 222-228.

DEPARTMENT OF HEALTH 2016. UK Chief Medical Officers' Alcohol Guidelines Review - Summary of the proposed new guidelines.

IARC 2012. Personal habits and indoor combustions. IARC monographs on the evaluation of carcinogenic risks to humans.

KATIKIREDDI, S. V. & HILTON, S. 2015. How did policy actors use mass media to influence the Scottish alcohol minimum unit pricing debate? Comparative analysis of newspapers, evidence submissions and interviews. Drugs (Abingdon Engl), 22, 125-134.

MAANI HESSARI, N. & PETTICREW, M. 2017. What does the alcohol industry mean by 'Responsible drinking'? A comparative analysis. J Public Health (Oxf), 1-8.

MCCAMBRIDGE, J., KYPRI, K., MILLER, P., HAWKINS, B. & HASTINGS, G. 2014. Be aware of Drinkaware. Addiction, 109, 519-24.

MOODIE, R., STUCKLER, D., MONTEIRO, C., SHERON, N., NEAL, B., THAMARANGSI, T., LINCOLN, P. & CASSWELL, S. 2013. Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. Lancet, 381, 670-9.

PETTICREW, M., MAANI HESSARI, N., KNAI, C. & WEIDERPASS, E. 2017. How alcohol industry organisations mislead the public about alcohol and cancer. Drug Alcohol Rev.

PETTICREW, M., MAANI HESSARI, N., KNAI, C. & WEIDERPASS, E. 2018. The strategies of alcohol industry SAPROs: Inaccurate information, misleading language and the use of confounders to downplay and misrepresent the risk of cancer. Drug Alcohol Rev.

PETTICREW, M. P. & LEE, K. 2011. The "father of stress" meets "big tobacco": Hans Selye and the tobacco industry. Am J Public Health, 101, 411-8.

WORLD HEALTH ORGANISATION 2010. Global Strategy to Reduce the Harmful Use of Alcohol.

*Carcinogen is any substance or agent that promotes the formation of cancer

Image: ‘Spilling wine’ (3375802661_fc4ff615ba_z) by Gunnar Grimnes via, copyright © 2009: