Marking and the downshifting of science

Calling out around the world, are you ready for a brand new beat?

Well the summers here and the time is right for… marking bloody student degree projects!

Yes, the summer for me (and Bernie) has once again bought the delightful mixture of bright sunny days, wine in the barmy evenings and cricket on the radio. This idle is only disrupted by the deafening thud of student’s degree projects hitting my study floor. As I write I am actually surrounded by piles of them. One quite small pile is where I’ve put those I’ve marked. Another much, much bigger pile (that has already fallen over sideways and now cuts me off from the door) comprises those yet to be marked and then two still unopened boxes contain the ones I need to double mark for colleagues.

In part my misery at my marking is just the shear weight of numbers, but another aspect, and I hate to say this, is reading pretty much the same stuff every year. Students tend to look at previous projects, pick out the best ones and re-do them with slight changes to variables or parameters. So rather than looking for the effect of one nutrient on plant growth, they’ll look at another. Instead of looking at the relative effectiveness of ‘commercial’ against ‘green’ washing powders, they’ll check ‘commercial’ and ‘green’ washing up liquid… and so on and on and on…

This approach is hardly the type that promotes the exciting projects that will attract students into science, but it’s not uncommon.

Even at the very highest level of science research the data flatters to deceive. In an editorial piece Charlton and Andras (2008) point out that although numbers studying science for research based degrees is up, but they have identified a so-called trend of ‘down shifting’ in UK science, a trend away from so called ‘revolutionary science’ (that which is paradigm shifting) to ‘normal science’; that which is an “incremental extrapolation of existing paradigms” (Charlton and Andras, 2008: p 466). There is certainly very strong evidence in my field of this taking place.

If we are not careful, graduate projects will become little more than practical sessions, where the project is evaluated not on its originality, but on the accuracy with which the generated data fits the published results. We stop looking at the anomalies, the negatives, the outliers and stay safely in the mainstream, constantly verifying that the Sun goes around the Earth.

It won’t be the funding cuts that kill UK science (though they’ll kick it unconscious) it will be that sort of mind set and the teaching that promotes it.

Sorry it’s a short blog, but I’ve got to get back to my marking. Two more and I’ll treat myself to the cricket, red wine and this rather lovely English summer evening.

Roger

Reference:

Charlton, B.G. & Andras, P. (2008) ‘Down-shifting’ among top UK scientists – The decline of ‘revolutionary science’ and the rise of ‘normal science’ in the UK compared with the USA. Medical Hypotheses, 70(3) 465-472.

Cultural Safety and Science; are they compatible?

There has been a lot of interest around here on the subject of “cultural safety” lately, and it appears to be a growing trend in nursing. However, I remain rather confused about the idea, as it seems to me to be a position that supports epistemological relativism.

I certainly understand and support the notion of cultural competence; i.e. making sure that healthcare practitioners are are aware of and consider individual patients and clients different cultural needs. This is supremely important in making sure we do not perform any practices that are against a clients beliefs and wishes. For, example there was an awful case here a few tears back when a nurse shaved a elderly Sikh gentleman’s beard off. Practices for the handing of deceased patients are another area where nurses must be aware of the cultural wishes and practices for the patient and their family.

However, “cultural safety” appears to be something quite different, and raises some interesting questions in terms of public healthcare. Cultural Safety is a concept originally developed in New Zealand by nurses working with Māori people and goes beyond the traditional concept of cultural sensitivity and competence (accepting diversity and difference) to analyzing power imbalances, institutional discrimination, colonization and relationships with colonizers (Williams 1999, Doutrich et al, 2012). This seems to be based upon a postmodern deconstruction of healthcare systems to identify how they have failed to meet the needs of marginalized people.

So far, so good, as most healthcare professionals would readily recognize how indigenous peoples usually got (and continue to get) a raw deal in terms of public healthcare provision. Indeed, as a macro scale critique of public healthcare policy and population health it has many merits. However, the problem for me arises when we start to look at these ideas in terms of micro-level patient care. If culture is broadly defined as the beliefs and practices common to any particular group of people, then this includes beliefs about health and medicine. If we then extend the analysis to an argument that public healthcare should make all minorities feel “safe” within the healthcare system by supporting their own cultural healthcare practices and beliefs, then more complex questions arise as to how we could achieve this without abandoning evidence based practice (EBP), and accepting epistemological relativism. The feasibility of providing this in a publicly funded healthcare system is  something I would see as an issue for this approach.

The people most able or equipped to provide a “culturally safe” atmosphere are certainly people from the same culture as the patient, but as a multicultural society the ability to practically provide such an environment with centralized resources would be difficult.

Then there is also then raises the question of which minority groups should we apply this to? Does the theoretical framework only apply to  indigenous peoples, or also ethnic minorities, religious minorities, LGBT? Colonization is certainly not the only form of oppression we could use here.

However, my main qualms, remain on the philosophical grounds. Let us say for the sake of argument we accept the premise of trying to maintain a “culturally safe” atmosphere for a specific minority within public healthcare. What happens when that group request a healthcare practice that to them is a cultural norm, but to professional healthcare givers is a harmful and controversial practice? In terms of EBP our guidance would be clear and we would support practices that are supported by the best evidence at the time. But would denying the therapies requested not be in opposition to the principles of “cultural safety?”

Let us explore this in the context of the example of the well publicized case of “Dr”. Wu in the UK (no relationship to the Steely Dan song I am aware of). Ying Wu, a qualified traditional Chinese medical doctor operating in Chelmsford in the UK in 2010 was prosecuted for prescribing medicines that led to severe organ damage for one of her patients. For several years Ying Wu prescribed high doses of extracts from the Aristolochia plant to treat acne to a 58-year-old woman, reassuring her that the pills were “as safe as Coca-Cola.” Following this the patient lost both kidneys, developed urinary tract cancer, and had a heart attack as a result. Judge Jeremy Roberts gave Wu a two-year conditional discharge, saying Wu did not know the pills were dangerous and because the practice of traditional Chinese medicine was unregulated in the UK. Clearly this is an extreme example, but it does raise the theoretical question, if a Chinese patient and their family request to use Aristolochia ( a known liver toxin) as a treatment, what should the nurse do:  A) Allow them to administer it (supporting “cultural safety” but not physiological safety), or B) deny the request (possibly becoming a cultural imperialist)?

To be clear, I am not trying to make slippery slope or staw-man arguments here, but the work in this area seems rather vague about how the principles of “cultural safety” apply to practical patient care and clinical decision making. Nevertheless, if we adopt the “cultural safety” rationale, the same principles can be applied to justify a wide range of cultural practices from vaccination to faith healing or even female genital mutilation, depending upon the specific cultural context of the practice (and considering who is the oppressed and who the oppressor). How do we discriminate between cultural practices? Is cultural safety subordinate to physiological safety, and if so how can it ever work?

In short, I feel it is probably impossible to provide public healthcare, on the basis of “cultural safety” without resorting to epistemological relativism,  as there is always going to be some group who feel their beliefs have been marginalized. This has been acknowledged by researchers in this field themselves:

“Some uncertainties remain for us regarding theoretical pluralism and how to reconcile some of the fundamental differences between critical perspectives when bringing them together” (Reimer-Kirkham et al, 2009)

Another factor most of these ideas seem to treat culture as a static phenomena, and fail to address the issue that culture is dynamic. Culture changes and evolves with each generation (I only need to look at my kids cellphone use to see that) and what one generation regard as safe, another will not.

The notion of “cultural safety” seems to create more issues than it resolves as far as I can see, and I fear may be doomed to become another postmodern academic theoretical exercise. But maybe I have missed something, and as always comments and contrary opinions welcome!

Bernie

References

Doutrich, D., Arcus, K., Dekker, L., Spuck, J., & Pollock-Robinson, C. (2012). Cultural safety in new zealand and the united states: Looking at a way forward together. Journal of Transcultural Nursing, 23(2), 143-150.

Reimer-Kirkham, S., Varcoe, C., Browne, A. J., Lynam, M. J., Khan, K. B., & McDonald, H. (2009). Critical inquiry and knowledge translation: Exploring compatibilities and tensions. Nursing Philosophy, 10(3), 152-166.

Williams, R. (1999). Cultural safety–what does it mean for our work practice? Australian & New Zealand Journal of Public Health, 23(2), 213-214.

 

 

 

 

 

 

Tales from a Public Bar

For nearly thirty years now I have met up, two or three times a year, with a bunch of friends for a ‘social’ weekend of fun and frolics. At our last meet up we agreed, under the influence of drink, that our social gatherings always involved drinking in pubs and that it might be a good idea to do something different. As a result, this weekend I found myself, although desperately underprepared, running a half marathon. I say underprepared because I thought we’d never do it and only started pounding the back lanes of Devon about four/five weeks ago when we registered!

Anyway, the route took us over an area known as Salisbury Plain and ended at Stonehenge (yes that one). Given we’ve had monsoon conditions in the UK recently (what a friend has described as the wettest drought since records began) it was quite a surprise to find the grey constant cloud cover had been replaced by a bright sunny summers day. These rather pleasant conditions appeared to turn into searing desert heat five miles out!

Well, we finished it (just) but obviously, as we were dehydrated, we headed off to the city of Salisbury ….err…yes, to the pub (see first paragraph).

The pub we ended up in was very pleasant and turned out to be the preferred drinking place for Wessex Archaeology. This is the regional archaeology unit that conducts archaeological digs and research both locally and nationally. As a result the place was full of archaeologists and we got talking to one guy in particular. When he found out that I was a scientist the conversation took an interesting turn. It went something like this:

Arch: “For thousands and thousands of years there was no separation between natural law and science. They were seen as the same thing. Only by the 19th Century do you get that separation.”

Me: “Not sure if Galileo would agree with you”

Arch: “O.K. but generally speaking there was no separation, there weren’t ‘scientists’ as such in ancient Egypt”

Me: “Mmm…so who designed the pyramids? They may not have seen themselves as scientists, but they were.”

Arch: “No, they were engineers, not scientists. I agree, we’ve engineered solutions since the dawn of time. Engineering got us to the Moon, not science. The idea that science helps us understand the world around us and asks questions about existence and reality is very recent – and actually philosophy does that much better.”

Me: “But the Greeks wondered about the nature of reality and world around us, they did all sorts of experiments – not related to engineered solutions.”

Arch: “Well, they were natural philosophers”

Me: “Yeah, but come on that’s just another name for it.”

Arch: “I’m not so sure. Actually, I wonder what the world would look like if we’d spent the money we’ve spent on science on philosophy instead?”

Me: “Bloody awful! The difference between science and philosophy is that science delivers. I’d rather have antibiotics than Focault”

Arch: “Yeah, but what did the Moon missions deliver? Teflon. If they’d spent the money on building a perfect replica shark, they’d have got the same results!”

Me: “Hang on, you said the Moon landings weren’t science! But that aside, they delivered far more – even, well especially, philosophically. That Earth Rise photograph kick started the whole environmental movement, you know that whole Blue Planet thing?”

Arch: “Yes, but that wasn’t the aim”

Me: “But science doesn’t work in a linear way. We only have Penicillin because Flemming couldn’t be bothered to wash up!”

Arch: “Billions of dollars for a photo and a frying pan!”

Me: “But it was aspirational – the Stonehenge of a our time.”

Arch: “No, no, that’s just my point! Stonehenge is a good example of something that connects us to the natural and the spiritual. Not sure if a Saturn 5 rocket does!”

Well, the conversation continued on and off for the rest of the afternoon, but I became increasingly incoherent the more we ‘rehydrated’.

I know this is a curious blog, but I wonder if anyone out there might like to comment on these questions? Does science really contribute to our understanding of reality anymore than philosophy does? Can the practice of science add to our emotional (I use that term to avoid words such as spiritual), aspirational side? If that archaeologist is right, have we lost or gained in separating science from art and philosophy?

I’d be very interested in what you think?

Cheers!

Roger