Canadian Nursing Association Resolution to Promote Science Based Nursing and Autonomy Fails

Hi all,

To publicize the fact that nurses are losing professional ground to magical healthcare practitioners here in BC, and that since 2009 nurses have been legally required to take orders from naturopaths, I submitted a resolution to the Canadian Nurses Association as an individual member to protect the autonomy of nursing in future.

I had previously raised this issue with the CRNBC and also with the ARNBC but neither were interested in pursuing it, (CRNBC is solely focused on regulation rather than looking out for the profession now) and it probably isn’t a key priority for ARNBC at the moment due to the ongoing legal battle with the BCNU.

The resolution simply suggested that the CNA advocate that registered nurses (RNs) in Canada not be subject to legislation that requires them to take direction/orders from other health care professions that do not have a superior level of both academic and clinical preparation (that must include Canadian publicly accredited university graduate level academic qualifications, and substantial hospital-based education and training in their field).The full resolution is available here.

This was considered at today’s annual meeting, and after a short debate (4 mins and 35 seconds) it was narrowly rejected by the members. I am not particularly surprised, but am rather saddened that the profession has not taken a simple action that would help strengthen the professional status of nursing in Canada, and protect nurses from further professional exploitation.

The arguments that went against it were mainly from BC (no surprise there) and were:

  1. It isn’t a problem as nurses can always refuse to act agains orders given, and
  2. Strong language about using “Canadian” accredited qualifications and “superior levels of qualification” does not recognize the autonomy of other professions and international qualifications.

Vote

  • Yes: 77
  • No: 78
  • Abstain: 0

The point about international qualifications is reasonable. and could easily be included with an amendment such as “or equivalent” but the spirit of the resolution was clear enough, so a shame it didn’t pass with an amendment. Got support from the North West Territories though (yea, go NWT)!

Nurses continue to be at the mercy of political trends that leave new CAM practitioners who gain regulatory status the ability to identify themselves as better qualified than nurses though quackademic credentials. So, far from moving away from the role of “physicians handmaidens” and promoting advanced practice and professional autonomy nurses will continue to be seen as fair game in the Canadian healthcare system to become subservient to any complementary and alternative practitioners who can care to call themselves “doctorally prepared” (through whatever means or credential).

So I guess I am to tell my students, you are “autonomous practitioners” in theory, but in the healthcare system at large you are recognized as subservient to anyone who holds a piece of paper that is recognized by the provincial government as some sort of health professional and wants to employ you. It is rather hard to promote a positive role for nursing when practitioners who actually practice magical healthcare and have US based quackademic qualifications are regulated above Canadian nurses. Maybe I’ll get ahead of the game and just set up a course in magical healthcare for nurses for our next undergraduate curriculum revision.

Sad times indeed, and I do wonder what the status of the RN will actually become over the next few years. Looks like reversion to a technical role in support of other health professionals is well on the cards, with the odd restricted role for specialist advanced practice (where the system is under-resourced). So, what happened to the CNAs stated aim to “strengthen nursing and the Canadian health system?”

Bernie

 

 

The Last Hurrah! A farewell to the Science Blog, and the perils of data diving…

Greetings all,

It is with a sad note that Roger and I announce this will be our last real science blog for the foreseeable future. We are rather tied up these days with many other projects and have decided to call it a day as many other higher-profile blogs cover the same ground (and probably better so: see the side bar for examples). We have had a good run though, over the last five years, and as most blogs last less than 6 months we have done pretty well and hope we have made a useful contribution. A couple of our blogs actually got developed into published academic papers,  and in any case we certainly had some fun on the way, and so achieved our objectives. Hopefully we have given readers some interesting food for thought with our rants on this and that over the years.

The pursuit of high quality science and critical thinking that drove us to create this blog is still something we both feel strongly about, but on the less positive side, it still seems we still have a long way to go. We both come from newer university backgrounds, but our experiences suggest that the move to mass higher-education (HE) has not had the desired effect of raising scientific and artistic literacy in the population overall, but seems to have created an even more polarized educational environment. Today HE has become more of a commercially focused enterprise and science has become the catch-all phrase for any sort of inquiry that will help market a programme/course/text or product. I would place a bet that the vast majority of new graduates in my discipline have not been taught the common logical fallacies, and that more than 60% of newly qualified health care professionals in practice don’t really understand what P-values represent (see Lies, Damned Lies and Statistics if you have any nagging doubts yourself – you may be surprised). LIkewise in Science Education many newly qualified teachers still don’t seem to understand some fundamental scientific concepts.

Another example of the increasing indifference I see in scientific inquiry came to me recently when I was reviewing a set of grant applications (something I am asked to do from time to time). The ideas for the projects submitted were all excellent, and reflected innovative and practical areas needing investigation that could all provide really useful health/social outcomes. However, the approaches and methods selected to investigate the phenomena chosen seemed to indicate that the researchers were generally unconcerned with the best way to design their studies. Primarily, most researchers in the ones I reviewed couldn’t differentiate whether an inductive or deductive approach would be best to answer their particular question of interest. Several had adopted inductive methods to answer a deductive question (or the converse), some posed a deductive hypothesis and then proposed an inductive study to answer it. Several had included both inductive and deductive investigations in one study, with a mass of statistical tests in a  catch-all “lets find out everything at once” approach.

Designing complex and multi-outcome studies is certainly possible and can produce some excellent scientific work when done well, but it is a tricky business at the best of times, and as anyone who has undertaken scientific work will attest, the more complexity you add in to your study the more likely you will introduce confounding variables and have less certainty in your outcomes. In the worst cases this represents the fundamental research problem of trying to find your hypothesis in your data (also known as data diving, data fishing, data dredging, data snooping, or equation fitting).

Inductive vs. Deductive Research and Hypothesis Development

We have covered inductive thinking  and the problem of induction before on the blog (our prize is still there to be claimed)! However, a brief exploration of why it is useful to differentiate inductive/deductive approaches in scientific thinking, and how they relate to hypothesis development is worth revisiting here.  If we consider that a hypothesis is a proposed explanation of a phenomenon, it should only really come into play when we have established an explanation that we want to test, not when we are still coming up with multiple possible explanations. The following summary of the hypothetic-deductive model of scientific method may help when thinking about categorizing a line of inquiry and questions:

  1. Inductive Inquiry: Observations leads to pattern recognition, which leads to explanatory theory/theories generation, resulting in hypotheses (plural)
  2. Deductive Inquiry: A selected theory (singular) to be tested leads to hypothesis generation, leads to testing/observation, results in confirmation/refutation of theory

They both work together in a cycle of scientific inquiry, but in inductive inquiry you don’t have the hypothesis at the start (otherwise why bother – you would move straight to the deductive/testing part).

The Problems with Data Diving

Data diving/dredging seems to becoming increasingly popular in research. Probably because as we develop ever increasingly large databases and can mine them with powerful computers that can process complex statistical algorithms quickly and efficiently. It involves testing huge numbers of hypotheses about a single data set by exhaustively searching for combinations of variables that might show a correlation. The problem with it is that in proper statistical analysis we test a hypothesis with evidence (data) that was not used in constructing the hypothesis. This is critical because every data set contains some patterns entirely due to chance. In his book Bad Science, Ben Goldacre gives a nice example, in that if you randomly machine gun the side of a barn, and then go and inspect it afterwards, you might start to notice patterns in the holes that would make you think there was some sort of effect there and you could construct a hypothesis to explain it. For example possibly there was a micro-gravitational field to the left top corner of the barn making the bullets cluster there. Of course, there could have been, but every data set contains some patterns that arise entirely due to chance, so if the hypothesis is not tested on a different data set from the same population, it is impossible to determine if the patterns found are chance patterns. Another example would be if you toss a coin five times, with a result of 3 heads and 2 tails, might lead one to hypothesize that the coin favours heads by 3/5 to 2/5. As this hypothesis has been tested on the existing data set, it is confirmed! In reality, of course, the confirmation is meaningless. There are other issues with data diving too, and there is a very good wikipedia article on it here which gives many excellent examples of the main problems.

Farewell for Now…

So, it will be interesting how scientific thinking and practice develops over the next decade or so. Our sense is scientific progress will continue apace and we will eventually see the demise of postmodern nominalist and victimary thinking, as the generation of ever expanding descriptive theory has to be matched by practical outcomes and application. Science is in essence a useful way of understanding the world in that it helps us successfully predict and control events, rather than simply describe them. The volume of data on the internet is expanding at a phenomenal rate. The size of the digital universe, in terms of data being generated, is forecast by IDC to grow to a staggering 44 zettabytes by 2020, and so it will become even more important to be able to discriminate the actual information that represents of practical value to us. New and creative developments in scientific methodology and information technologies will accelerate this progress. However, we are not so sure of the future of the established university down the road in an age where knowledge and expertise are so widely disseminated.

We may of course feel the need to post the odd rant or rave on science (or other associated matters) as the mood takes us in future,  but for now we are signing off. So that’s it from us, no more typo infested and grammatically erroneous  missives for now! We wish all those who have read and contributed to the blog over the years all the best of luck.

Onwards and upwards.

Regards

Roger and Bernie

February 2014

 Reference

Goldacre B.  2008 Bad Science, Fourth Estate, London

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.