WHY RESEARCH

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WHY RESEARCH ??

• Alan M. Ducatman, MD, MSc
• Chair, Department of Community Medicine
• Professor, School of Medicine,
• West Virginia University

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ABOUT THIS TALK

• When you steal from one author, its
  plagiarism if you steal from many, its
  research.
• Wilson Mizner

(Wilson Mizner is also famous for a remark
that applies to mid-level administrators, Youre
a mouse studying to be a rat.)
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RESEARCH

• The scientist values research by the size
  of its core contribution to that huge, logically
  articulated structure of ideas which is already,
  though not yet half-built, the most glorious
  accomplishment of mankind.

Sir Brian Peter Medawar. The Art of the Soluble.
1967
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PHYSICAL SCIENCE BEAUTY

• It is impossible to follow the march of one
  of the great theories to see it unroll
  majestically its regular deductions starting from
  initial hypotheses, to see its consequences
  represent a multitude of experimental laws, down
  to the smallest detail, without being charmed by
  the beauty of such a constructionsuch a creation
  of the human mind is truly a work of art.

Pierce Maurice Marie Duhem La Theorie Physique.
Son objet, sa structure. 1906
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Scientific Method

• Science concerns itself with the why of things,
  but in a scrupulously rigorous manner.
• Concepts concerning scientific method were
  developed with the assistance of
  encarta.msn.com/find/

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Key Concept 1

• Objectivity
• the attempt to observe things as they are,
  without falsifying observations to accord with
  some preconceived world view.

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Key Concept 2

• Acceptability
• is judged in terms of the degree to which
  observations and experimentations can be
  reproduced.

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Key Concept s 3 4

• Inductive reasoning
• reasoning from specific observations and
  experiments to more general hypotheses and
  theories and
• Deductive reasoning
• reasoning from theories to account
  for specific experimental results.

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LEARNING AS EXPERIMENT

• Every man naturally persuades himself
  that he can keep his resolutions, nor is he
  convinced of his imbecility, but by length of
  time and frequency of experiment.

Samuel Johnson. Prayers and Meditations. 1770
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RESEARCHERS

• Among scientists are collectors, classifiers,
  and compulsive tidier-uppers, many are detectives
  by temperament and many are explorers some are
  artists and others artisans. There are
  poet-scientists and philosopher-scientists and
  even a few mystics.

Sir Brian Peter Medawar. The Art of the Soluble.
1967
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THE RIGHT TRAINING TOOLS

• Every experiment is like a weapon which must
  be used in its particular way a spear to
  thrust, a club to strike. Experimenting requires
  a man who knows when to thrust and when to
  strike, each according to need and fashion.

Phillipus Aureolus Paracelcus. Surgeons Book
(Chirurgische Burcher) 1605
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OPINION and TRUTHExperienced as Thought
Experiment

When men have realized that time has upset
many.fighting faiths, they may have come to
realizethat ultimate good desired is better
reached by free trade in ideas and that the
best truth is the power of thought to get itself
accepted in the competition of the market
That any rate is the theory of our constitution.
It is an Experiment, as all life is an
experiment.
Oliver Wendell Holmes, Jr. Abrams -vs- U.S. 1919
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Science has Many Separate Disciplines

• Disciplines differ greatly in terms of subject
  matter and the possible ways of studying that
  subject matter. No single path to discovery
  exists in science, and no one clear-cut
  description can be given that accounts for all
  the ways in which scientific truth is pursued.

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Population-Based Science

• A number of complexities not present in other
  fields.
• Challenges include
• - Ethics
• - Bias
• - Confounding
• - Minimal experimental control

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Selection Bias

• There are many variants of this.
• They all relate to representativeness of the
  population.

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Confounding and Bias in Social Science

• Agreement of a conclusion with an actual
  observation does not itself prove the correctness
  of the hypothesis from which the conclusion is
  derived. It simply renders the premise more
  plausible. The ultimate test of the validity of
  a scientific hypothesis is consistency with the
  totality of other aspects of the scientific
  framework. Associations need not be causal !!

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Another Kind of Bias - Personal

• Scientists, like other human beings, may
  individually be swayed by some prevailing
  worldview to look for certain experimental
  results rather than others, or to intuit some
  broad theory that they then seek to prove. The
  scientific community as a whole, however, judges
  the work of its members by the objectivity and
  rigor with which the work has been conducted in
  this way the scientific method prevails.

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Why Do Research ?

• Axiom 1
• What gets measured, gets done.
• Axiom 2
• What gets celebrated, gets done well.

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What Types of Things Do We Measure ?

• Precise (valid)
• Accurate (repeatable)
• Significant (important)
• Replicable (bench-marked)

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Research in Business Terms Leading, Trailing,
and Financial Measures

• Leading Measures define the problem and inputs
  precisely
• Trailing define the change impacts
• Financial assign costs, income or savings,
  realistically

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Simplified Metrics what did we do and what were
the impacts ?

• Leading Indicators
• Hypothesis
• Methods
• Costs
• Impacts
• Health, risks, services
• Productivity
• Product quality
• Perceptions/morale
• Cost/benefit

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Complicated Metrics Can Be Real Too what didnt
happen ?
() workforce perceptions
recruitment retention productivity
product quality customer perceptions

• (-)
• absenteeism
• accidents
• litigation
• labor management issues
• labor replacement
• property loss
• regulatory problems/costs

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Why Are Metrics Important ?

• New discovery
• Create change ( in policy)
• Convince others

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Constituency

• In academic settings, we tend to believe that the
  audience we seek is . . . our peers!
• That view is correct, and limited. We hold to
  professional standards because that is essential.
  In so doing, we may not reflect enough on how
  narrow is our constituency (the citation index is
  a relative scientific perspective, which still
  understates the problem because its relative.)

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Research Constituencies

• The culture of academic scholarship is to leave
  coherent messaging for the public to amateurs,
  and then to virulently critique amateur efforts
  to popularize ideas.

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Obscurity Utility

• In the academic world, it is enough for research
  to be interesting, unless funding is also needed.

James McPherson, Professor of History at
Princeton, has pointed out that the job market
problem faced by historians relates to
the obscurity of their work. (The key to
academic success is to write more and more
about less and less.) The question then becomes
how to attract attention?
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Who Funds Research ?

• There has been substantial growth in public
  funding of research. We tend to believe in our
  society that the government will pay for what
  they need, independent of their own efforts.
• This belief is quickly outgrown when there is
  real need.

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Health Care Research Economics

• The United States spends over 45 Billion
  annually on health care research and development
• Academic health science centers perform about 28
  of all health-related RD
• The dominant (and most prestigious) source of
  support is the federal government

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Sources of Research Fundingin Academic Health
Sciences Centers - 1997
From Bench to Bedside preserving the mission of
academic health centers. The Commonwealth
Fund Task Force May 1, 1999 growing
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Health Care Research Economic Problems

• Federal funding inadequately supports the direct
  or indirect costs of research
• Academic health science centers have made up for
  this problem with clinical cross-subsidies, which
  are no longer viable in a managed care
  environment. (Law of unintended consequences.)

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How Will We Fund Research ?

• If research is to thrive, researchers need to
  enroll citizens as active constituents in
  learning and discovery. For the public to
  persistently invest in research, researchers must
  make it clear that research serves the public.

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Constituency

• Former U.S. Secretary of Health and Human
  Services, Donna Shalala, addressed the American
  Association for the Advancement of Science in
  1996 if science is to thrive, every citizen
  must be an active constituent of science.

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The Importance of Biomedical Research

• It is an expression of the hope and generosity of
  people. Application of intelligence and
  resources can
• reduce suffering and disease
• extend life and its quality
• in the U.S. and around the globe
• Some of these hopes have been realized, with
  notable successes in infectious disease,
  cardiovascular disease prevention and treatment
  childhood cancer treatment, and certain adult
  cancer presentations and treatments

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Research as Public Good

• In economic terms, public goods are
• Non-excludable once produced, anyone
• can enjoy the benefits, without
• producer consent
• Non-rival consumption by one does
• not diminish the quality or quantity
• of consumption by all

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Indirect Benefits of Biomedical Research

• New products
• Improved economy
• technology transfer
• High-paying jobs
• Balance of trade
• Efficiency of workforce
• Prestige

Positive public opinion
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The Role of Hypothesis Testing

• If you dont know where you are going,
• chances are you will end-up somewhere.
• Attributed to Yogi Berra

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Why Measure Social Intervention Outcomes ?

• Defines Vision and Mission Statements in
  operational terms
• Supports continuous improvement
• Demonstrates the value of a program in business
  terms

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Evidence Profiles

• FOR AGAINST
• Definitive Some None Some
  Definitive
• Evidence-Based Medicine
• Alternative Medicine
• Quackery

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Perception Surveys - Inherently

• Valuable, provided
• 1. Instruments available
• 2. Key elements (domains) covered
• 3. Conduct and analysis are standard
• 4. Benchmarking is possible especially with
  comparisons to external validity

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EXPERIMENTATION, REASON FREEDOM

• The Newtorian principle of gravitation is
  now more firmly established, on the basis of
  reason, than it would be were the government to
  step-in, and to make an article of necessary
  faith, reason and experiment have been indulged,
  and error has fled before them.

Thomas Jefferson. Notes on the State of
Virginia. 1781-1785
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MEASURING THE MIND

• Psychology cannot experiment with men,
  and there is no apparatus for this purpose. So
  much the more carefully must we make use of
  mathematics

Johann Friedrich Herbart. Lehrbuch zur
Psychologic. 1816
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THE ROLE OF THEORY

• a theory is a policy rather than a creed
  its object is to connect or coordinate apparently
  diverse phenomena, and above all to suggest,
  stimulate, and direct experiment.

Sir Joseph John Thomson. The corpuscular theory
of matter. 1907
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NAÏVE QUESTIONS

• I love fools experiments. I am always making
  them.
• From Life and Letters of Charles Darwin. 1887

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The Philosophy of Experimentation

• True science teaches us to doubt
• We must never make experiments to confirm our
  ideas, but simply to control them.
• Science increases our power in proportion, as it
  lowers our pride.

Claude Bernard. From Bulletin of N.Y. Academy
of Science 1928 IV. pg 997
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Expertise

• An expert is one who knows more and more
  about less and less.

Nicholas Murray Butler. Commencement Address