Category: Preventive Medicine

Why is Research Less Respected Today?

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The scientific method, and the discoveries in science and technology that have resulted from its use, have revolutionized the world. Why does it seem to be less respected today?

By Mark D, Harris

Research brought the world scientific and technological advances that have changed the lives of men and women forever. During the period characterized by the philosophy of modernism, from roughly 1750 to 1950, conventional wisdom expected that science would solve all the problems of mankind, both material and moral/ethical. Scientific and social research, which would lead to technological supremacy over the physical world and enlightened policies in every society, would usher in a utopia. World War II, the Holocaust, and the atomic bomb shattered these hopes, demonstrating that science and technology, and the research behind it, can destroy as easily as they can save. Though we prate about following “science,” in the past 70 years, research has lost respect.[1]

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Study Discussion – Gender Disparities in Internal Medicine Residency Awards

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How do we, as a society, determine how to acknowledge and reward people? Do we do it on the basis of excellence, or on the basis of equity? Can we combine the two goals? How?  

By Mark D, Harris

In the March 2021 issue of The American Journal of Medicine, seven physicians, whose first names suggest that they are all female, wrote “Investigating Gender Disparities in Internal Medicine Residency Awards.”[1] The authors began by recounting gender disparities in salary, academic rank, grant funding, and awards. They performed a multi-institutional study based on survey data from academic internal medicine residency programs starting in 2009 and extending through 2019. These physicians’ initial findings are in Table 1:[2]

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Social Distancing, Public Health, and the Bible

Leprosy lesion on chest
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Social distancing is an important public health measure to slow or stop the spread of many diseases. God’s instructions to the Hebrews in the Bible were primarily for holiness, but also had important health benefits.

By Mark D. Harris

I was at the auto parts store last week buying brake pads to replace the old ones in my daughter’s Prius. An elderly woman walked in, donning a mask and gloves, and carefully staying at least six feet away from others. When a clerk approached her and when other customers walked by, she retreated. I walked the long way down a separate aisle to get around her, trying to provide the space that she needed. Given her increased level of risk, and the fact that she didn’t seem grumpy, I appreciated her caution.

Social distancing, putting space between people who may infect each other with a disease, is the major way that individuals and governments throughout the world are trying to deal with the COVID-19 pandemic. It has worked many times in history, such as in the Spanish Flu pandemic of 1918, a far deadlier disaster than the current plague. The nation, and indeed much of the world, has been staying at home, or at least away from others, for over six weeks. Public health experts have used many other interventions for infection control as well. This article will discuss social distancing and other public health actions against infectious disease.

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How to Do No Harm

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How leaders can minimize harm in health care, in other industries, and in all areas of life.

By Mark D. Harris

“How can we change this process to prevent this error from happening again?” the senior ward nurse asked the group. It is a common question, one that I have heard thousands of times from experienced and dedicated health care professionals of all stripes.

I have worked in health care for many years, serving in positions from volunteer to emergency medical technician to senior attending physician to chief of staff at a hospital to chief medical officer of a large network. In every position, “do no harm” is a fundamental theme. This famous statement from the writings of Hippocrates encapsulates quality improvement, patient safety, access to care, and many other goals in modern medicine.

“Do no harm” can be thought of as eliminating risks that could lead to a bad outcome, such as injury or death. Occupational and Environmental Medicine physicians learn that there are four ways to decrease risk in the workplace and in the environment:

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Checklist for Evaluating Articles in the Medical Literature

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Clinicians face mountains of medical literature, and no one can keep up. Much of it is trash. Doctors and other health care professionals must know how to evaluate medical literature to provide the best possible care to their patients; but few know how. Here is some help:

Title and General

1.    Is the title appropriate?

2.    Are the authors appropriately identified?

3.    Does information on conflict of interest or other disclaimers appear in the article?

Abstract

1.    Does the abstract entice the reader to read the article?

2.    Does the abstract correctly summarize the study and its findings?

Objective

1.    Objective(s)

2.    Study type – observational (cross sectional, case control, cohort) or experimental (randomized controlled trial, vaccine trial)

3.    Are the objectives reasonable and worthwhile?

4.    Strengths and limitations of the objective and study type

5.    How could these affect the results or conclusions (biased, generalizable)?

Methods

Study design

1.    Study design –

2.    How conducted?

3.    Who conducted?

4.    Methods appropriate for objective?

5.    Strengths and limitations

6.    How could these affect the results or conclusions (internal and external validity)?

Study population

1.    Who are the study subjects?

2.    How selected?

3.    Who selected?

4.    Strengths and limitations –

5.    How could these affect the results or conclusions (biased, generalizable)?

Study maneuver

1.    What treatments/interventions planned?

2.    How administered?

3.    Who will provide the maneuvers (where and when)?

4.    Are these appropriate for the study objectives?

5.    Strengths and limitations of planned maneuver –

6.    How could these affect the results or conclusions (biased, generalizable)?

Study observations/measures and data to be collected

1.    What observations/data collection is planned (On whom, where and when; are they consistent)?

2.    How will they be made or collected (by what method, are they standardized, are observers blinded)?

3.    Who will make the observations and collect the data, where and when?

4.    Are these appropriate for the study objectives?

5.    What are the strengths and limitations of the planned observations (exclusion, masked or unmasked, sources of bias, likely to be reliable, valid)?

6.    How could these affect the results or conclusions (biased, generalizable)?

Analysis

1.    What is the planned data analysis (what methods will be used, how will the data be grouped, what tests will be used for each analysis planned, what will be considered statistically significant)?  Are assumptions based on prior studies?

2.    How will the data be analyzed?

3.    Who will conduct the analysis?

4.    Is the planned analysis appropriate for the study objective and the type and level of data collected (parametric or non-parametric tests, one-sided vs. two-sided tests of significance, stratification when appropriate)?

5.    What are the strengths and limitations of the planned analysis (what is the power of the planned data collection/analysis)?

6.    How could these affect the results or conclusions (failure to detect a true difference)?

Results

1.    What results/observations are presented/not presented (are all the findings presented for all subjects)?

2.    How were the results obtained (what analysis was used, was the planned analysis completed)?

3.    How were the results which are presented/excluded determined and why (data insufficient, poor response, not significant)?

4.    Are the results appropriate for study objectives, planned observations and analysis?  Are they correctly performed and interpreted, internally consistent and valid (arithmetic errors, what is considered statistically significant, appropriate comparisons)?

5.    What are the strengths and limitations of the analysis results (statistical vs. biologic/clinical significance, statistical power)?

6.    How could these affect the results or conclusions?

Discussion and Conclusions

1.    What are the conclusions?

2.    How or on what basis were they made (are they justified by the results and analysis, is that analysis sufficient to determine whether significant differences may be due to incomparability of groups or methodological considerations)?

3.    Are the above limitations under all other sections adequately addressed in this section?

4.    How do they affect the conclusions?  Is this adequately assessed?

5.    What are the strengths and limitations of the conclusions?

6.    What recommendations do the authors have for future study?