Happy New Year: The cargo cults of science.

A belated Happy New Year to scientists and those who are interested in science everywhere from us. I am afraid I still don’t get why the greeting is Happy New Years on this side of the Atlantic. Am I missing more than one of them? Anyhow, we apologize for not getting round to our usual fun post this holiday, but we have both been swamped by work and other commitments so the blog has had to take a back seat. Believe it or not this stuff takes quite a bit of work!

Nevertheless, there was lots of good humour abound at the end of 2014 and I was pleased to note another bumper crop of Ignoble awards for 2014. My favourite has to be  the Arctic Science Prize for Eigil Reimers and Sindre Eftestøl, for heir ground-breaking study testing how reindeer react to seeing humans who are disguised as polar bears. Absolutely brilliant, and I definitely want some advice on writing my next grant proposal from them.

After my last posting (and reaction) I was discussing with some colleagues how a good understanding of the philosophy of science and scientific practice still seems so elusive for many people, and how organizations spring-up everywhere that mimic the real thing to take advantage of this. I would characterize this as a failure of education, and sadly the results in modern society are actually quite profound. We see examples in extremist behaviour and positions (often resulting in violence), the search for overly simple solutions to complex problems, the adoption of magical practices by intelligent individuals, and of course, the usual mischaracterization of science as the antithesis to religion. You only have to look around the news or the web for examples everyday, with Oprah and Dr. Oz championing the latest magical nutritional fads, or homeopath’s claiming they can cure ebola.

I find one of the most fascinating aspect of all this the alternatives to scientific inquiry and dissemination that masquerade as science. Years ago as an undergraduate student I studied social anthropology, and was fascinated by the phenomenon of cargo-cults, which represents a useful metaphor here. The term cargo cult encompasses a diverse range of practices that occur in the wake of contact with the commercial networks of technologically superior colonizing societies. The name derives from the belief that various ritualistic acts will lead to a bestowing of material wealth of some sort (cargo).

The best known example is from World War II where contact with the Japanese and late Americans military in the pacific  brought about a considerable transformation of the indigenous peoples of Melanesia (Ton, 2009). At the end of the war, the military abandoned the airbases and stopped dropping cargo by parachute to their units. Those technological products that had been seen or been available to the Melanesian islanders through the colonizing armies, disappeared or became in sort supply. In response, charismatic leaders arose amongst remote Melanesian populations and developed cults that promised to restore on their followers deliveries of these goods (such as food, arms, radios, vehicles etc.) The leaders explained that the cargo was really gifts from the gods or ancestors, and in attempts to get cargo to fall by parachute or land in planes or ships again, islanders imitated the same practices they had seen the military personnel use. They mimicked the day-to-day activities and dress styles of US soldiers, such as performing parade ground drills with wooden or salvaged rifles, and in a form of sympathetic magic, many built life-size replicas of aeroplanes out of straw and built mock airstrips complete with wooden control towers to encourage aircraft to land (as shown in the picture below).

Cargo-Cult

 

 

 

 

 

 

 

 

Even though the cargo never arrived the leaders maintained their cults for years as the social benefits of belonging to the group persisted, and they provided hope for the elusive products in the future. Today the original cults have almost disappeared but some cargo cults are reportedly still active today (Raffaele, 2006).

The term “cargo cult” represents a useful metaphor to describe an attempt to recreate successful outcomes by replicating circumstances associated with those outcomes. However, the circumstances mimicked are either unrelated to the causes of outcomes or insufficient to produce them by themselves (in the former case, this is an instance of the post hoc ergo propter hoc fallacy). The metaphorical use of the term was popularized by physicist Richard Feynman at a 1974 Caltech commencement speech, which later became a chapter in his book Surely You’re Joking, Mr. Feynman!, where he coined the phrase “cargo cult science” to describe activity that had some of the trappings of real science (such as publication in scientific journals) but lacked a basis in honest experimentation.

The term seems to have fallen out of common use today, but I would suggest we are seeing boom times for cargo-cult science today and its time to resurrect it. Recent examples include journals that purport to be scientific but are not (see our recent post of predatory publishing), many CAM therapies, naturopaths, and the growth of the Integrative science movement.

Times are tough for real scientists, and I sometimes think it would be easier to join the masses of new-age practitioners rather than keep up the struggle for good quality scientific health care, and be characterized as the allopathic dinosaur (soon to be extinct) in the face of the new age of integrative healthcare. The trouble is, I just can’t bring myself to nod sagely next time someone suggests that “sciencing the art sheds light on the meaning of universal living experiences…” Nor can I sign-on for this sort of nonsense for an easy academic life, as I fear it’s patients who actually loose out here. What the heck, maybe I’ll just go and build an effigies of Dr. Oz and Dora Kunz on the roof and see what happens…

Onwards and upwards

Bernie

References

Feynman R. (1974) Surely You’re Joking, Mr. Feynman! Adventures of a Curious Character, Richard Feynman, Ralph Leighton (contributor), Edward Hutchings (editor), 1985, W W Norton, ISBN 0-393-01921-7

Raffaele, P. (2006). “In John They Trust”. Smithsonian (Smithsonian). Retrieved Nov 26, 2009.

Ton, O. (2009). “What happened to Cargo Cults? Material Religions in Melanesia and the West”. Social Analysis 53 (1): 93–4.

Are Nurses in British Columbia Licensed to Practice Magic?

Seasons greetings to all.

An Interesting Case

This year I decided to pursue a complaint against a practitioner with the College of Registered Nurses of British Columbia (CRNBC) for a nurse who was using their Registered Nurse (RN) title to market their own private Therapeutic Touch (TT) business. To those outside of the nursing profession this might seem a little confusing, but in other countries where I have worked as a nurse it is an established professional principle that you do not use your professional qualifications/status to promote your own for-profit activities outside of your role as an RN. The reasons for this are fairly self-evident. For example adding RN to your name gives you some professional credibility and it would be disingenuous to use it for personal gain, such as by selling something (be it real estate, car parts, vitamins or even personal life-style counselling). The CRNBC has its own standards governing use of title and even produced  guidance for practitioners with a case example to explain this. See: Can she Use her Title? where they note that having “RN” after your name may be seen as “…important in gaining the public trust and selling more product.”

Indeed, it was this very article that incited me to make the complaint as a test case, as I came across a TT practitioners website where the title of RN was explicitly used next to the practitioners name. I used the exact format and language in the guidance for the complaint and cited the relevant “Use of Professional Titles” standard and College Bylaws (sections 4 & 8)  in the complaint, and simply asked that the CRNBC to ask them not to use the RN title on the website. I had been in contact with this individual on other occasions and suggested that the use of RN was inappropriate to endorse this business activity and had a completely negative response, so a simple complaint to the CRNBC on appropriate use of title seemed an appropriate next step.

At this stage it is probably worth a quick recap on what the professional regulators function is. Basically, the regulation of nurses includes licensing, the creation of professional standards, enforcement of those standards, disciplinary measures and nursing education approval. Overall, the key principles that underpin the statutory professional regulation of nursing may be considered as: (a) maintaining the safety and quality of the care that patients receive from health professionals; (b) sustaining, improving and ensuring the professional standards of health professionals and identifying and addressing poor practice or bad behaviour; (c) providing systems and legislation that sustain the confidence of both the public and the healthcare professions through demonstrable impartiality; and (d) ensuring that the integrity of health professionals is sufficiently flexible to effectively meet the different health needs of the public and healthcare approaches can adapt to future changes and demands (Hewitt 2007; ICN 2014; Walsh 2012; WHO 2002). To ensure that regulatory standards are effective, the regulatory process itself also needs to be seen as impartial and independent from the government, the professionals themselves, employers, educators and all the other interest groups involved in healthcare (Hewitt 2007). I.e. the CRNBC should represent the interests of the public at large rather than the profession or government (this is an important point , which we will come back to). So, one would think that in terms of public protection this complaint would represent a fairly straightforward case of inappropriate use of title to support a commercial enterprise.

Another consideration here is that in this case the title was being used to help market a completely unscientific, non-evidence based and “unverifiable” practice (as indicated by the CRNBC’s own Bylaws, 2012; Section 8.04). We have discussed the merits of TT on this blog before, and it is of course, pure magic in the terms it is portrayed (remote healing using undetectable energies) with no-scientific evidence to support efficacy. A 1999 review of the physics of complementary therapies states that the existence of a “bio-field” or “bio-energetic field” directly contradicts principles of physics, chemistry, and biology (Stenger, 1999). A recent Cochrane systematic review found “no robust evidence that TT promotes healing of acute wounds (O’Mathúna et al, 2012). The American Cancer Society stated in 1999, “Available scientific evidence does not support any claims that TT can cure cancer or other diseases” (AMA, 2012).  Lastly we have the youngest person ever to get a paper published in the Journal of the American Medical Association ( the nine year old Emily Rosa) presenting a study that debunked the claims of TT practitioners in a simple study where twenty-one practitioners of therapeutic touch failed to detect her aura (Rosa et al, 2009). TT is then, complete mystical woo-woo, and fails to meet any test of scientific credibility in that 1) the underpinning theory is tautological nonsense, and b) practitioners can demonstrate no efficacy better than placebo. No respected university will touch TT practical training with a barge pole. Nevertheless, we should note it is a highly profitable enterprise  (the overheads are minimal) and many nurses do support it. The professional regulator would seem to have some responsibility to ensure practitioners are using evidence-based practices, so TT (based on current evidence) clearly falls outside that scope.

The Outcome

Anyhow, in the end the CRNBC disposition on this case earlier this year sided with the practitioner, and that they were perfectly entitled to use their RN credentials to market their TT business as they found that:

a) the regulations are not intended to apply to RNs providing education services. The CRNBC regarded this registrant as providing an educational service, as the website identified was aimed at a TT consultation service.In other words they viewed an educational service as not being a product (even though it was a commercial, for-profit enterprise)!

b)  Alternative and complementary therapies are considered within the realm of holistic nursing.

Given the CRNBC’s position on CAM in general, I was not unduly surprised with this outcome, but am concerned this represents a particularly troubling precedent as point a) represents a very narrow view of what a commercial product is, and also implies you can sell health education on anything (whether good or bad) and simply tag your RN credential to your marketing materials. Point b) is even more worrying as it represents an “anything goes” approach to the regulation of RN practice (as long as you don’t physically hurt anyone; it’s all good). This completely ignores the regulators responsibility to make sure practitioners don’t financially or emotionally exploit the public, and tarnish the reputation and credibility of the nursing profession.

Let’s examine a comparable example. If I want to promote my business as a tarot or astrology based health practitioner, and make good money selling my advice and education to the public who believe in this. Then I can tag on my RN credential to give it an air of professional respectability, better market my magical consultation services and improve my profits. Its all good!

In what universe does this approach protect the public rather than the profession? the finding does nothing to protect the public from exploitation, and gives carte blanche for RNs to practice magic. To illustrate this, I have just acquired a practising Witchdoctor (WD) certification from the Canadian Association of Witch Doctors (it was a tough program, and examination I can tell you)! So, with my new magical powers, apparently using my title in the following advertisement is well within my scope as an RN:

Loco Advert

Click here to see the full size Locomatic Energy Inc Advert

This advert covers the same ground as the website I made my original complaint against (well, apart from the cat, services being free and the windsurfing). The use of the RN title to support this sort of activity is clearly nonsense, and to be frank, supporting it is a travesty of regulatory practice and represents an example of where our professional regulatory body is failing miserably. Regulators traditionally err on the side of caution, remain impartial, and represent the public interest, not those of the professionals they regulate. In this case I would argue they clearly failed to meet their regulatory obligations in this respect.

Other nursing and health professional regulators I have observed seem to do a much better job in this area. The College and Association of Registered Nurses of Alberta (CARNA) Standards on CAM, 2011 notes:

“Registered nurses cannot use the title ‘RN’ or ‘NP’ in association with the endorsement or promotion of products or services. Endorsement of a product or service occurs when a nurse uses their credentials to lend credibility to a commercial product or service (CNO, 2009). The endorsement of a product or service without providing information about other options could mislead the public and may be considered a conflict of interest.”

Likewise the College of Nursing of Ontario, Professional Misconduct Regulations, 2014 states:

“It is not acceptable for a nurse to use her/his registration status to promote personal interests such as commercial products or services. Endorsement occurs when the nurse inappropriately uses her/his credentials to lend credibility to a commercial product, product line or service. The endorsement of a product line or service without providing information about other options has the potential to mislead the public and compromise trust.”

Both clearly indicate services (such as educational consultation) are to be treated the same as products in this respect. In the UK, The Nursing and Midwifery Council Code of Conduct 2014, is similarly clear, requiring practitioners to:

  • not abuse your privileged position for your own ends.
  • ensure that your professional judgement is not influenced by any commercial considerations.
  • uphold the reputation of your profession at all times.
  • ensure that the use of complementary or alternative therapies is safe and in the best interests of those in your care.

The College of Surgeons and Physicians of BC are also much clearer on how we should consider CAM in respect to public healthcare:

“Practitioners must not misrepresent the safety or efficacy of any therapy or procedure.”

“Complementary and alternative therapies differ from conventional medicines because they are generally unproven. When an alternative treatment undergoes rigorous testing, for example in a controlled and randomized trial, then the results dictate whether the alternative treatment becomes conventional treatment, whether the unorthodox becomes accepted, and whether the unproven becomes proven. Assertions, speculations, and testimonials do not substitute for scientific evidence.”

I did pursue this CRNBC disposition on this case with the BC Health professional Review Board (HPRB), but have dropped it, as there is really nothing they can do in such a case as the HPRB are focused on interpretation of process and the law and are very unlikely to intervene in what they see as “professional jurisdiction” unless there is clearly evident harm arising. Interestingly, it appears guidance published in CRNBC newsletters and advice has no real legal grounding anyhow, so can be completely different from interpretation of the actual standards by the disciplinary board. I worry that this doesn’t seem to reflect a coordinated organization. So, my next action is another formal approach to the CRNBC (I have raised this issue with them before) requesting they review their regulations and toughen them up in this respect.

Although TT is generally harmless, we should be reminded these are serious concerns here and these are not the trivial issues they are often taken as. Firstly, financially exploiting vulnerable people is a serious issue. Secondly, where the public are advised to consider alternatives to conventional evidence-based treatments, life-threatening results occur, as exemplified by the recent cases of the parents of two children with acute leukaemia seeking CAM remedies, and with people being advised to take homeopathic vaccines rather than actual vaccines. If we continue with this  approach to regulation and CAM practices, and allow them to be marketed with implied professional support, sooner or later deaths or injury will result from people In BC choosing CAM over medical alternatives on the advice of a nurse using their professional title to support their CAM practice. Effective regulation can help prevent this.

So, are nurses in BC licensed to practice magic? What do you think…

Bernie

References

American Cancer Society (2012) Therapeutic Touch.  Retrieved 20 October 2014.

Hewitt, P. 2007. Trust, Assurance and Safety – The Regulation of Health Professionals in the 21st Century. London: H.M. Stationary Office

International Council of Nurses (2014). Regulatory Board Governance Toolkit. Retrieved July 29, 2014. http://www.nurse.or.jp/nursing/international/icn/report/pdf/2014m/04-04.pdf.

O’Mathúna, D. N. P.; Ashford, R. L. (2012). O’Mathúna, Dónal P, ed. “Cochrane Database of Systematic Reviews”. Cochrane database of systematic reviews (Online) 6: CD002766

Rosa, Linda; Rosa, E; Sarner, L; Barrett, S (1998). “A Close Look at Therapeutic Touch”. JAMA 279 (13): 1005–10

Stenger, Victor (1999). “The Physics of ‘Alternative Medicine’ Bioenergetic Fields”. The Scientific Review of Alternative Medicine.

Walsh, P. 2012. “Health Professional Regulation.” AvMA Medical and Legal Journal 18(3): 3–4.

World Health Organization (WHO). 2002. Nursing and Midwifery: a Guide to Professional Regulation. Cairo: WHO Publications Eastern Mediterranean Regional Office.

Other Relevant Sources

1. The CRNBC has a self-identified mandate to “protect the public through the regulation of registered nurses and nurse practitioners: https://www.crnbc.ca/crnbc/Pages/Default.aspx

2. Registrants are required to use their title(s) in ways that comply with the: CRNBC Standards of Practice. See: https://www.crnbc.ca/Standards/Lists/StandardResources/343AppropriateUseofTitlesPracStd.pdf

3. CRNBC October 2013 case study “Can she use her RN title?” which was subsequently amended – current version is at: https://crnbc.ca/Standards/resourcescasestudies/beinganurse/selfemployment/Pages/marketing.aspx .

Creativity and Science: An overlooked relationship?

Hello again!

After a long break here is another blog. If you are our reader, you may have noticed something of a hiatus in regularity of the blog when it’s my turn. Bernie is obviously not working hard enough and seems to have bags of time. In the UK October/November tends to mark the deadline for all research bids, so I have been terrifically busy – begging.

Anyway, I have a book out this month on Creative Science so thought I might write about just that. Strange really that the two are often seen as being so distinct, for curiosity is a key scientific attitude as is a willingness to change ideas in light of evidence. Therefore, science is, by its very nature, twinned with creative thinking. Furthermore, Murphy (2005) suggests that learning science enhances the development of creative thinking skills, such as fluency, flexibility, originality of ideas and imagination.

It is interesting that Torrance (1965), an eminent creativity researcher, nearly 50 years ago put forward the following definition of creativity ‘As the process of becoming sensitive to problems, deficiencies, gaps in knowledge, missing elements, disharmonies, and so on; identifying the difficulty; searching for solutions, making guesses, or formulating hypotheses about the deficiencies; testing and retesting these hypotheses and possibly modifying and retesting them; and finally communicating the results.’ (p. 663-664) This definition, a scientific definition of creativity, met resistance, with objections that he had no right to use the term ‘creative’ outside such fields as art, music, and writing. He argued that his definition seemed to fit the creativity of both artists and writers as well as it did that of the creative scientist. p. 665 Fortunately, things have moved on from then and the notion that science and creativity may not be mutually exclusive is certainly plausible.

In his highly regarded TED talk (Robinson 2006), Sir Ken Robinson made a robust case for creativity in formal education stating that it should have equal status with literacy. He argued that all children have tremendous talent and have an extraordinary capacity for innovation. However, he declared unequivocally that children are ‘being educated out of creativity.’ To be creative, he asserted, you have to be prepared to be wrong, and that the current model of formal education leaves children frightened of being wrong. Unfortunately, this is particularly pertinent in science where there is often a perceived ‘right’ answer and this notion drives down creativity and divergent thinking. Scotland have rooted creativity firmly in their Curriculum for Excellence and it is seen as fundamental to the definition of what it means to be a ‘successful learner’ in the Scottish education system (Education Scotland 2013).  Unfortunately, the recent National Curriculum for England (2013) does not seem to be embracing creativity as much.

Why creativity is important

Science is exciting and engaging in many of the ways in which it is already explained and taught. Some teachers, or trainee graduates, particularly with science backgrounds will already hold a clear and functional view of what science is and what is important in terms of teaching it. You may have very clear ideas of what constitutes a scientific approach and quite strongly held views on what is really important for children to understand about ‘science methods.’ However, such interpretations can framework and even confine your approach to teaching.  The issue here of course is not everyone, even within the scientific community may share your view. We may be very different in terms of the subject we studied (such as physics, chemistry, biology) and the different skills and approaches that this imparts. Indeed, it is not uncommon for those with science degrees, training to be science specialists on initial teacher training courses, to express concerns about teaching areas of science that they “know nothing about!”

In teaching we can utilise all sorts of creative and imaginative methods and apply these to topics not normally associated with science curricular. Of course the obvious question is why should we bother to change? Well, the answer to this is twofold. Firstly, we want to reassure those who are new to science that they have a whole range of valuable skills that can really promote and encourage children to see science as a creative and relevant subject and secondly, to address a wider issue; that something is going wrong in science education for across many of the ‘high-income countries’ (including the UK) a distinctive downward trend in the numbers studying science has been recognised (Fensham, 2004). Yet, for those of us who work around children, it is plainly obvious that they are natural scientists in that they have an almost universal curiosity about the world around them. Young children are always asking the question “why?” Yet, somewhere along the line they appear to lose this curiosity and fascination.

Of course paradoxically in the last 20 years the advances in science and technology have bordered on the revolutionary, particularly in areas such as biomedicine and electronic communications. The technological tools that we have developed now allow us to explore not only adjacent planets but to view horizons that span from the edge of the known universe to sub-atomic space. Never before in our history have we understood so much about ourselves, or the physical world around us and never before have we had the means of communicating this understanding (as well as intriguing questions concerning that which we still do not understand) to such a wide and literate audience. The advances that we have made and the pace of such developments have been little less than spectacular.

It is also undoubtedly true that the planet is facing a seemingly worsening environmental decline and that there needs to be a profound change in the way we live that is based on sustainability. Science also has a profound role in providing the knowledge and skills that young people will need to face the problems that the future will certainly pose.

Given this, how can it be that young people are being put off science apparently by even as early as 7 – 8 years old? The only possible answer is somewhat worrying. Children do not tend to ‘do’ science at home and only rarely in ‘out of school’ settings. They come across it predominantly at school and therefore something is quite clearly going wrong at this point. Put plainly, children appear to be put off science at school.

How can we halt this decline? One way in which this may be achieved is to remove the artificial barriers that lead to the compartmentalization of science in teaching. We suggest a more holistic approach to science teaching; one that both blurs the distinction between approaches in arts and science and also one that sees science as an integral part of social, emotional and personal development. In a way we would like children not to be able to necessarily distinguish science from any other area of the curriculum. Going even further, sometimes barriers are not just theoretical, but made from bricks and mortar and in the same way we would wish to see artificial divides removed, we’d extend that wish to the classroom walls. Teaching in the environment, for the environment may be a well-worn phrase now, but it is still a valuable sentiment.

We would like to move science away from being a distinct subject to having a more integral role across the wider curriculum. A potential problem with this lies in the way in that science is sometimes perceived. How would you describe science? Logical? Precise? Analytical? Or creative, imaginative and inspiring? Most people would probably draw up a list close to the sentiments at least to the first set of words

 Challenges

Calls for new approaches to teaching science are of course not new, the famous Nuffield Science Teaching Project was developed in the 1960s and the Schools Council Integrated Science Project in the early 1970s.

We have over 50 years of pedagogic and curriculum development as a backdrop to the decline in numbers studying science. Given the amount of time, money and enthusiasm put into these projects to re-contextualize science and to change the approach to science teaching one wonders about the real impact of any suggested change in teaching approaches. Perhaps the difference here is that we only want to utilize the skills and develop the confidence of teachers in primary settings not to see science as something daunting and separate from everything else that goes on. In fact to see ways of teaching science that don’t necessarily depend on designing and carrying out experiments, that maybe are creative and artistic in the way that data are presented, that can lead to discussions about ‘bigger’ ideas and concepts, not being afraid to engage in potentially controversial areas. In reality of course, all the characteristics of good science!

What we are not suggesting here is a ‘new science’ but rather different ways of teaching and seeing the old one. Whenever there is an attempt to change the way we approach teaching science, we have to be very wary of slipping into what could be called pseudo-science. Pseudo-science is perhaps best described as something that purports to be scientific, looks scientific, even sounds scientific (in terms of the language it uses) but on close inspection it is not. It is a bit like a science ‘tribute band’ – it looks a bit similar from a distance, but doesn’t stand any degree of closer inspection. It normally lacks supporting evidence, employs non-scientific methods and cannot be reliably tested or verified. In this sense it is different from something that has come to be called ‘Bad Science’. Bad Science is just that, poorly designed, erroneous results, it is generally just poor practice. Any endeavor, however noble and well intentioned can be carried out badly, it sometimes happens and can be understood. Pseudo-science cannot.

Roger