To Subgroup or Not to Subgroup?
Far from being ‘stamp collecting’, as Ernest Rutherford is said to have claimed, classifying things is central to the scientific enterprise – imagine biology without the Linnaean taxonomy (multi-dimensional classification) of plants, animals and minerals (now plants, animals, fungi, protists, chromists, archaea and eubacteria kingdoms). Or medicine without its nosology. Classification has been the basis […]
Science Denial and the Importance of Engaging the Public with Science
A recent paper in JAMA, concerning science denial, tackles a problem of immense importance.[1] For us scientists, science denial negates our reason for being. Far more important though, is the effect on society. We need to think only of the vaccination fiasco. The JAMA paper used the difficulties that people with certain neurological conditions have […]
Use of Causal Diagrams to Inform the Analysis of Observational Studies
Observational studies usually involve some sort of multi-variable analysis. To make sense of the association between an explanatory variable (E) and an outcome (O), it is necessary to control for confounders – age for example in clinical studies. A confounder (C) is a variable that is associated with both E and O. Indeed it is […]
Speaking to Hearts Before Minds: Increasing Influenza Vaccine Uptake During COVID-19
In 2019, the UK health secretary Matt Hancock said that he is “open” to making vaccines compulsory, and Labour MP Paul Sweeney argued that failure to vaccinate children should be a “criminal offence”. But mandates are difficult to enforce, and punishments diminish public trust. In addition, people still opt out of mandatory policies, and effectiveness […]
The Land War in the Fight Against COVID-19
Gone are the days of thinking there is a quick fix to the COVID-19 pandemic. Another country-wide lockdown would reduce COVID-19 infection, but at the same time would damage the economy and pose a threat to other long-term health conditions, with disproportionate effects on the more disadvantaged groups in society. The Great Barrington Declaration – […]
When Waiting is Not Enough
Healthcare is emerging from the immediate crisis response of COVID-19 into a hugely uncertain environment. One of the very few things of which we can be sure is significantly longer waiting times for elective procedures. The Health Foundation recently published a report drawn from pre-COVID data,[1] which starkly portrayed the challenges around the 18 weeks […]
Recognising the rising tide in service delivery and health systems research
With rising demands and finite resources, health systems worldwide are under constant financial pressure. The US has been at the extreme end of high spending, with health expenditure consisting of 17% of its GDP in 2017 – compared with 9.8% for the UK and 8.7% for the average of the OECD countries (OECD).[1] Therefore, the […]
Changing the Message to Change the Response – Psychological Framing Effects During COVID-19
The way in which a government communicates can shape people’s responses. Psychological and behavioural research reveals that the same objective information can elicit different responses when presented in different ways, an effect called ‘framing’.[1] For example, one study compared describing blood donations as either a way to “prevent a death” or “save a life”.[2] While […]
Walking Through the Digital Door: Video Consultations During COVID-19 and Beyond
The “NHS Long-Term Plan” (2019) is a five-year plan describing how NHS services should be redesigned for the next decade. This plan includes making better use of digital technologies, such as video consultations. While video consultations have potential advantages for patients and hospital systems,[1] they may make patients uncomfortable. If patients do not walk through […]
The Holy Grail of Quality Measurement
Writing in JAMA, Austin and Kachalia argue for automation of quality measurements.[1] We ourselves have argued that the proliferation of routine quality measures is getting out of hand.[2] The authors argue, as we have argued, that using quality measures to incentivise organisations is a blunt tool, subject to gaming. Far better, is to use quality […]
Leadership, Heroism and Heroic Leadership
Some years ago, two outstanding academic leaders, Peter Pronovost and Lord Ara Darzi, wrote an article in which they argued for an end of heroism in medicine.[1] I responded in the pages of our previous CLAHRC WM News Blog along the lines of, be careful what you wish for.[2] I was reminded of this interchange […]
Policy Makers Should Use Evidence, But What Should They Do In an Evidence Vacuum?
There are two points of view concerning the obligations of policy makers when there is no direct evidence to guide them: It is wrong to take any action or intervene unless there is evidence to support your decision. A lack of evidence is neutral; it neither allows a decision-maker to intervene, nor does it sanction […]
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