Tag: Steven Johnson

knowledge translationpublic healthscience & technologysocial media

The Fourth Estate of Health and Medicine

Who Will Hold Evidence To Account?

Journalists occupy an important, yet often unacknowledged, role in the health system by providing a dispassionate account of the system’s strengths, weaknesses, and opportunities to the public. It is through journalists that much of the research we scientists and practitioners produce gets communicated to the audiences likely to use them. This fourth estate is also a  place where hard questions can be asked and answered, holding governments, business and the health system itself to account because journalists operate apart from this space, unlike scientists and clinicians. We are at risk of losing this and it’s time to consider what that means for our collective health and wellbeing.

Disrupted Media

The news business is going through a massive upheaval, part of a larger overall disruption in media. Many newspapers are reducing the size of their print offerings, publishing less frequently or ceasing operations altogether.

This reduction in the capacity and size of the fourth estate begs two simple questions: Who will hold health scientists, clinicians, pharmaceutical companies, health product manufacturers, and policy makers to account? and who will tell the stories of science, health and medicine in public?

While we have some activist academics doing great work on influencing broader audiences like policy makers, they are exceptions not the norm. Stanton Glantz, a major tobacco control champion from UCSF who taken to blogging as a means of communicating to professionals and the public directly, is one of these such people. But Stan is atypical and holds a tenured position at a major university, something he’s acknowledged protected him when pursuing issues of evidence withholding from the tobacco companies in the 1990’s and beyond. Many faculty (particularly younger ones) are not this secure and even fewer independently funded scientists are. Academia is changing and not in ways that favour security and stability, which has implications for the kind of stories that get told.

Journalists have traditionally relied on protection from their publisher or producer under the name of journalistic freedom (the fourth estate) as a key pillar of their profession. It’s hard to imagine the Watergate scandal coming to light had Bob Woodward, Carl Bernstein and the other reporters working for the Washington Post, Time Magazine and New York Times not had the resources, stability and support provided by their newspapers . But what happens when these resources are no longer available or there are no institutions to support journalists in serving as watchdogs to hold people or institutions to account for what they do and don’t do?

Are ‘Monkeys in Coats’ A Healthy Story?

It’s been suggested that the Internet will take care of this. Citizen journalists, armed with camera-laden handsets connected to social media will fill the news gap. For example, it was citizens, not journalists, who first captured the story of Darwin the monkey, dressed in a shearling coat, walking around an Ikea parking lot in Toronto that went viral on a global scale on December 10, 2012. This is great for those interested in simian fashions and retail adventures, but the reason it was captured was because the story was obvious and in the face (or at the ankles) of those who told it. (For those of you not familiar with Toronto, coat-wearing monkeys are not typically seen at shopping centres or anywhere around town for that matter.)

Health and medicine is not the same as monkeys wearing coats (no matter what kind of joke you want to make). There is nuance, debate and reason that requires sustained attention and focus that someone with an iPhone and Twitter account is less likely to convey. Reasoned arguments for citizen journalism’s potential suggest it can complement the work of traditional journalism, not replace it. Yet, is this belief in one form (citizen journalism) undermining support for the other (traditional journalism) and serving as a fix that ultimately fails? If free-and-easy content is available, how likely are publishers willing to pay for professional work? Particularly if the choice of stories of one group (e.g., monkeys in coats) are more likely to garner the kind of attention that drives advertising than that of another (e.g., health care financing). Only one of these stories will impact our collective health.

Why does this matter? Trained journalists are required to be good communicators to a broad audience, scientists are not. Clinicians are slightly better, but decades of research has shown it is still highly problematic across areas of practice. This will not be solved overnight, if at all. Scientists and clinicians have told me they are already burdened with enough job expectations and adding knowledge translation skills to that list is asking too much.

As I have argued previously, there is a valued place for synthetics in research: those are who are good at taking ideas and weaving them together into an accessible narrative. Journalists are ideally suited to play or support this role. They do the job that many scientists can’t or won’t do and have better to tools, skills and strategies to do it. They write in a style that is suited to broad audiences in a way that suit those audiences’ needs, not what funders, disciplinary traditions, universities, or scientific peers demand (without evidence that those methods of communication are effective). There are reasons why journalists assess the reach of their work in the thousands and social scientists in the dozens (by citations in their field of practice).

Going Deeper to See Clearer

Although we have more information about health available to us than ever before, this may not be healthy for patients. The potential for those uninformed about medical diagnostics, evidence, and the nature of health itself to make poor choices based on incomplete, incorrect or overwhelming information is high. Further, without the kind of dispassionate examination of evidence in a synthetic manner that is tied to the way in which that evidence is expressed in the world through public opinion, policy making and healthcare practices, we lose a major accountability mechanism and means of informing public discourse.

In October I co-delivered a workshop on health evidence for students at the University of Toronto with the 2012 Hancock Lecturer and journalist Julia Belluz. Julia writes the Science-ish blog for Macleans Magazine and is an Associate Editor with the Medical Post. Julia`s lecture was on the role that social media plays in our health system and how its power to leverage the attention of the masses — for good and ill — is shaping the public understanding of health and medicine often in the absence of evidence for effects of conditions, processes, and practice. The lecture is summarized online on Science-ish beginning here.

Reading through the lecture notes one sees a depth of study that would be unlikely to be found anywhere within the formal health system. The reasons are that it blends evidence with commentary, observation with carefully selected sources, and takes a perspective that seeks to inform a wide, not narrow audience in both practical and intellectually stimulating ways. Taken together, this is a collection of activities that are not within the scope of practice for scientists and practitioners. There are reasons why the greatest contributors to public discourse on many scientific issues has come from journalists, not the scientists who generate the research. They tell the story better.

Malcolm Gladwell, Steven Johnson, Mitch Waldrop, Julia Belluz, Andre Picard and others are a big part of the reasons most of the those who vote to support funding of science, who donate to research-related causes, and fight for policies to keep us healthy know of the research that backs those ideas up.

Imperfect as journalism is, it serves the public when done with integrity. It’s worth spending some time considering what can be done to support the fourth estate so it supports us.

Photo credit: DBduo Photography on Flickr used under Creative Commons Licence.

complexityinnovationknowledge translationpsychology

Jonah Lehrer and the Crisis of Knowledge Synthesis

Jonah Lehrer - Pop!Tech 2009 - Camden, ME
Jonah Lehrer is/was as big as it gets in science writing and two weeks ago proved the adage that the higher one climbs the farther the fall after admitting to some false content in his stories. This is bad news for him, but may be much worse for all of us interested in making science and innovation knowledge accessible for reasons that have as much to do with the audience as it does the message and messenger. 

Jonah Lehrer was one of our most prolific and widely read science writers until he admitted fudging some quotes about Bob Dylan in his new book, Imagine, which looks at the process of discovery, creativity and innovation. The discovery by fellow journalist (and fervent Bob Dylan fan) Michael Moynihan set off a wave of reflections and investigations of Lehrer’s work revealing passages in the book (and other pieces) that had been reused from his other writings without proper self-attribution and sparking questions about the integrity of the author’s entire body of work. The “fall of Jonah Lehrer” was big news at a time when the London Olympics were dominating most of the media’s attention.

This case is a testament to the wide appeal that Lehrer’s work had beyond the usual ‘science geeks’ while illustrating the power of the internet to enable the kind of curation and investigation to support on and offline fact checking. But what it spoke to most for me is the role

The Writer and his Craft

Much digital type has been spent on the Lehrer incident. Search Google and you’ll find dozens of commentaries looking at how things transpired and how Lehrer ironically succumbed to the cognitive biases he wrote about.

Roxane Gay, writing in Salon, took a gendered approach to the issue and questioned whether our fascination is less with the science and more about the ‘young male genius’. Lehrer’s youth was something she saw as critical to amplifying the fascination with his work. She writes:

When young people display remarkable intelligence or creativity, we are instantly enamored. We want or need geniuses to show us the power and potential of the human mind and we’re so eager to find new people to bestow this title upon that the term and the concept have become quite diluted.

I agree with her on the point about our desire to over-inflate the accomplishments of youth (as if we are *amazed* that any of them could possibly do anything brilliant, which is as offensive to them and it is to older people), although a careful look at Lehrer’s articles and much of the press around his work suggests that he was much less a focus of the attention than his ideas.

John McQuaid‘s take on the affair in Forbes speaks to a larger issue:

Call it “Gladwellization.” It’s not just lucrative, but powerful: your ideas (or rather, the ideas you’ve turned into compelling anecdotes for a popular audience) can influence everything from editorial choices across the publishing world to corporate management and branding strategies.

But with this comes mounting demands to produce, and to recycle. You have to be prolific, churning out longer pieces that give your insights some ballast, and brilliant, bite-sized items. And yet you can’t be too new either: people want to hear what you’re already famous for. In this cauldron of congratulation and pressure for more and more, it’s not hard to see how standards might erode, how the “ideas” might become more important than doing the necessary due diligence to make sure they sync with reality.

‘Snappy Science’ and Synthesis

Innovation is about ‘new’ and there are good reasons why its a challenge to get the message out that this ‘new’ can be adapted, small, and unsexy and still make a large difference in the long run instead of big, bold and transformative right away. We are in an age of selling “snappy science” and it says more about the media and audiences than the authors and scientists producing the original work.

This snappy, bite-sized science might sell books and make for great TED talks, but it is a misrepresentation of what we actually know and do as scientists. Rarely does a single finding lead to a solution, rather it is an amalgam of discoveries small and large brought together that gets us to closer to answers. Synthesis is the driver of change and synthesis is what journalists do particularly well. Malcolm Gladwell, Steven Johnson and Jonah Lehrer are among the best synthesizers out there and I would imagine (no pun intended) that they contribute to more to public and professional understanding of social innovation than all of the original-sourced scientific knowledge on the subject combined.

When I hear Malcolm Gladwell cited as an original source in serious discussions with colleagues on scientific matters, I realize we have a problem…and an opportunity. Gladwell’s writings popularized the concept of tipping points, but his work is based on a wealth of scientific data on complex systems. They are not his original ideas, but they are his syntheses and (sometimes) his interpretations. This is important work and I am not taking anything from anyone who makes science data digestible and accessible, but it is not the original science.

That Jonah Lehrer is as well known as he is tells me that there is an appetite for science and I’ll freely admit to using his work (and that of the other authors I’ve mentioned) to inform what I do in a general sense. It is good work, however I also acknowledge that I have the scientific training to know how to go beyond the initial articles to critically appraise the information, place it in context, and I have the resources to go to the original sources in academic journals. Most people (professionals and lay people) do not. This access is going to decrease as resources shrink.

It is for this reason that synthetic work is so important. My Twitter feed often is filled with references to such synthetic work, rather than original works of research because I aim to fill role that is somewhere between journalism and the science of design, systems and psychology. I am not a pure science blogger, nor am I speaking to the lay public, but rather other professionals seeking to enrich their knowledge base. That is a role I’ve created for myself, largely because there is a high demand and low supply.

We have a need for synthesis and a demand for it, but little acknowledgement of the value of this role in professional scientific circles. Yet, when we leave journalists to do the work for us, we allow a different system to take charge. John McQuaid ended his article with this caution:

 Book publishers don’t do fact-checks, so there’s no fail-safe, just the conscience of the writer. Reach that point, and all is lost.

Filling the gap, meeting a need and shooting the messenger

Journalists like Johnson, Gladwell and Lehrer fill a gap, which is why I am saddened by the loss of one of them and angry at what has transpired. While there is no doubt that Lehrer made mistakes, they were of a rather minor nature in the grand scheme of things. Synthetic work is designed to provide a big picture overview, not guide microscopic decisions. I would like people to read Lehrer and learn about the creative process and the role of neuroscience in making our lives better, to appreciate systems thinking and decision making because of Malcolm Gladwell, and see innovation, emergence and discovery in new ways because of writers like Steven Johnson.

Yet, when we seek more and more from these authors, we might get less and less. This is what happened to Jonah Lehrer. As more people found themselves drawn to his work, the pressure grew for doing more, faster and getting that ‘snappy science’ out the door. GOOD magazine in the ‘tyranny of the big idea‘ goes further:

The problem is that it’s unreasonable to expect that every new piece of media should upend conventional wisdom or deliver a profound new insight. To think that Jonah Lehrer could expose an amazing new facet of human psychology every week, in 1,000-odd words no less, is ludicrous. There are only so many compelling, counterintuitive, true ideas out there.

But the demand for them doesn’t abate. That’s why you see so many science writers talking about the same handful of studies (the Stanford prison experimentthe rubber hand illusionDunbar’s numberthe marshmallow test) over and over. That’s why you see pop economists who should know better creating flimsy and irresponsible contrarian arguments about climate change for shock value. That’s why you get influential bloggers confessing they’re only 30 percent convinced of their own arguments but “you gotta write something.” That’s why the#slatepitches meme hits home.

Search Censemaking and you’ll find many of these topics not just because they are punchy, but because they are useful.

I hope we haven’t lost Jonah Lehrer as a voice just as I hope more people stop putting writers like him on a pedestal, where they don’t belong (nor do the scientists who produce the research). Synthesis is about bringing ideas together to produce innovative insights that often lead to bigger conversations about how to socially innovate. Synthesis is bigger than science, but dependent on it. It means paying attention to parts and wholes together and is the epitome of systems thinking in knowledge work.

It also means taking responsibility as knowledge producers and consumers and be wary of shooting the messengers while asking more from the messages they deliver.

Unless we are prepared to give people time to search, appraise and synthesize research on their own — and train them to make informed choices — the role of synthesizers – professional, journalistic, or otherwise – will become more important than ever.

Photo from Wikimedia Commons and is used under licence.

behaviour changeeducation & learninghealth promotioninnovationpublic health

How Serious Are We About Learning?

How Serious Are We About Learning?

When journalist and book author Daniel Pink tweeted the above image the other day it provoked thinking about what real learning means and what it takes to achieve it. We produce enormous amounts of knowledge, yet struggle to put it into use, but we also teach much and learn little because the systems we’ve designed for education and experience don’t match our expressed interest and rhetoric around learning. 

In my graduate course on behaviour change I would ask students on the first day why they were taking the class in the first place. Aside from the few students for whom the course was required everyone else was doing it by choice because there were many others to choose from. So why would they choose this one?

The answers would vary, but inevitably I’d hear over and again that students love learning and wanted to understand more about behaviour change, because they were interested in change and some would even say they were good at it and wanted to help others do it.

These are all well-meaning and said in a spirit that I think was honest and true. Except the reality is that it is likely a big, huge lie and one that we all share in its telling.

I would counter with two things:

  1. Loving the idea of learning something new is different than actually seeking out learning opportunities and that most of us love the former, but are not so enthused about the latter;
  2. The only people who regularly welcome change are babies with soiled diapers.

To illustrate the first point I simply ask people to consider the last conference they went to where there were options on what sessions to attend. How many of the sessions did they attend that featured content that confirmed or gently extended what they already knew versus content that was new? If you’re a health promoter doing community engagement work, sessions on Bayesian modelling for epidemics might offer far more learning than a session on working with diversity in communities (particularly if that is what you already do). Even more, how often do people go to sessions from people they know or have already seen speak? Chances are, many.

One could argue that there are subtleties that a conference presentation might offer on a familiar topic that are worth attending and while I would say that has merit, most learning that has impact is uncomfortable at some level. It extends our thinking, challenges our beliefs, or re-arranges our worldview — in ways small and large.

Wanting knowledge and living learning

Many people will say “I love change”, but that is usually in the context that everyone else is changing, not them. When I was the boss and said “things must change” it was very different than when my staff or my boss would say “things must change“. As a behaviour change educator and intervener, I need to be mindful of my own ironies and resistance to change. So should we all.

The same thing goes for knowledge. Academics are famous for ending studies with “more research is needed”. We never seem to have enough knowledge. There are two problems with this idea.

The first is that, in dynamic and evolving environments, we will never have  perfect knowledge that fits like a glove, because the contexts are always novel. This isn’t to say that evidence isn’t useful, but ‘good enough’ knowledge might be a more reasonable demand than ‘best evidence’ in many of the situations where complexity is high and so is change. That’s why data gathering techniques like developmental evaluation aren’t attractive to those who need certainty.

But there is another problem with the knowledge quest and that is one of integration. In our efforts to seek more knowledge, are we integrating what we are learning from what we already have? Are we savouring the data we collect, the articles we read, the Tweets and blogs that get forwarded are way?

We quest for more, but should we quest for better?

A newly published paper synthesized research on event horizons on memory and found that shifts in activities around an event — boundaries — can prompt forgetting and recall. We remember transitions between activities, but they also prompt forgetting depending on the mindfulness associated with the act. When we are deluging ourselves with more data, more media, more everything, we are increasing the potential remember rate, but due to the volume of content, I would surmise that we are increasing the forget rate much more. Simply reflect on your high school or undergraduate education and ask yourself if you remember more than you forgot about what you learned.

We are so busy with our search for new knowledge that we interrupt opportunities to learn from what we have.

Serious learning means non-doing

Returning to the tweet from Dan Pink, it’s worthwhile considering what it means to learn and the systems we have in place to facilitate learning. The tweet links to a discussion of how German companies give their employees five days of off-site continuing education each year. This concept of Bildungsurlaub is a leave designed to allow employees to stretch their thinking and integrate something new. Not only is off-site learning important, but the time associated with integrating material is critical.

A read of the literature on innovation and research shows consistently how time off, quiet time, slow time and down time all contribute to discovery. Robert Scott Root-Bernstein’s brilliant Discovering, Jonah Lehrer’s Imagine, or Steven Johnson’s Where Good Ideas Come From are all books that dive deep into creative production and show that great discoveries and innovations come from having time (with limits) to integrate material to learn. Freedom to create, explore and sit and mindfully reflect are all united concepts in the pursuit of good learning. Not everything requires this, but big concepts and bold ideas do from mathematics to science to social science and philosophy.

Yet, at an organizational and systems level, where is the support for this? Even university faculty (the tenured ones at least) who have generous vacations and sabbaticals are finding themselves crunched for time between the fight for one of the ever-fewer grants, increasing numbers of students and teaching demands, and the added push to ensure knowledge is translated. The image of faculty sitting and reading and thinking is truly an imagination. Most of my colleagues in academia do little of this, because they are out of time.

In the corporate and non-profit world this is worse. Every hour and day is to be accounted for. The idea of sending people off to learn and to think seems anathema to productivity, yet research shows incredible powers associated with taking a break and doing less and not more.

Getting serious about learning

To illustrate the scope of the problem, the University of Toronto holds one of the finest academic library systems in the world and has over 11.5 million books and 5.7 million microform materials. It is one university (of many) in one city. Add in the local Toronto public library system, the network of universities and other libraries it is connected to, local and global bookstores and all the content freely available online that is not part of this system and I challenge anyone working in social innovation or public health to say with conviction that there is a lack of knowledge out there on any important topic. Yes, we don’t know it all, but we don’t do nearly enough with what we do know because there is so much.

We will not read it all nor can we hope to synthesize it all, but we can do much with what we have. Just looking at my own personal library of physical books (not including all I have in the digital realm between books and papers) it’s easy to see that I have more than enough knowledge to tackle most of what I am facing in my work. Most of us do. But do we have the wisdom to use it? Do we have the systems — organizations and personal — that allow us to take the time and soak this in, share our ideas with others, and be mindful of the world around us enough to learn, not just consume?

When we spend as much time creating those spaces, places and systems, then we can answer “yes” to the question of whether we’re serious about learning.

Enough knowledge here?