How to communicate and use science
Introduction to the course “Finding and Implementing Scientific Evidence”, 10th – 12th of April 2019, National and University Library of Iceland, Reykjavik, Iceland
Jani Ruotsalainen, Managing Editor, Cochrane Work Review Group
Apparently we live in the time of post-truth and alternative facts. However, we do not have to take this lying down. What the occupational safety and health community can offer is a viable alternative, meaning real facts. There are two things that are critical in this: what to do when faced with outright lies, or opinions parading as facts, and what to offer in their place. In other words, what is our strongest information and how do we convey it to the people who really need it?
The key to both issues is bias. Alternative facts consciously ignore biases and their effects. Somehow a personal gut feeling just Trumps scientific reasoning. The best thing we believers in science can do is to accept the existence of biases and to try and minimize their effects in what we do. One tried and tested way to do this is by means of systematic review. It is a means of abstracting a higher level of truth from multiple scientific studies that each examine a similar issue, thus overcoming the credibility issues of single studies. For example, we have all seen the media one day promoting a study finding coffee to be healthy. The next day can another study can say the opposite. To the average person this can be confusing and frustrating. It is impossible for him or her to make sense of the bigger picture: how valid and reliable are all these findings and how can you combine them? This is where systematic reviews step in to save the day.
Whilst synthesizing the results of individual studies and formulating overall conclusions, the author of a systematic review explicitly displays the biases affecting both the existing research (what others have done) and the process of synthesis (what the review author does to combine the results of the studies in one conclusion). The next step, that is, implementing evidence to practice (i.e. the meat and bones of this course) involves another form of synthesis that brings together said evidence with clinical experience and knowledge of the context, meaning client values and preferences. The process of using these three ingredients is broadly known as evidence-based medicine. This is also how we define OSH expertise: as a combination of epidemiology (finding and understanding scientific evidence), clinical skills or topic expertise (the stuff taught at school) and a “bedside manner” that is sensitive to the client’s actual needs. It is important to note that all three components have equal value. This is because focusing only on clinical skills makes “eminence-based medicine”, focusing only on evidence makes “cookbook medicine” and focusing only on client preferences makes an anti-vaccine movement, for example. These three examples are all cases of bias in extremis. The smartest approach is to accept that each component has bias and to know that these can all be addressed.
With this course we want to help people bolster their own expertise with the best available scientific evidence and to enable them to require that others do likewise in situations where expertise is outsourced. The course will consist of lively discussions and interactive learning methods that will challenge both the lecturers and the participants, whilst still being fun.