You’d think that a humble anaesthetist would be happy. A really big study on anaesthesia and awareness gets released in the media and gets people talking. About time. No more of people asking to “See the Doctor” when you go for the preoperative review. Less Sudoku jokes. Except then I read this coverage in The Guardian.
Shock. Horror. Calamity. People are sometimes aware when they should be super unconscious during surgery.
Except that reporting is sort of baloney. The report has been messed up by another example of “I” disease, where a very clever research team have let it be about them and not the problem of interest. It’s a problem in other branches of medicine. You can usually spot it when a medico uses the word “I” too much when discussing a story that should be about a patient.Why the snarl?
There’s a particular section of that report that really did it. It’s around the point where the lead author quoted comes up with this:
He said: “For a long time it has been a discussion on the periphery. This is real. We need to understand it and tackle it.”
I get it. You run a big and impressive study. You want to get word out there. It’s a chance to say something. It’s hard not to try and make it sound that little bit more seductive. After all, you wouldn’t want to get trumped by surfing dogs on the news. It’s so tempting to make sure the release sounds that little bit more sensational.
Then you end up with a whole lot of misrepresentation.
The thing is, awareness is not at all a peripheral topic in anaesthesia. Generations of anaesthetists have sweated over it. It is a core part of what anaesthetists offer patients when they deliver general anaesthesia. It’s a topic that has been researched extensively (both the protocol and summary paper under discussion have more than 40 references at the back, though not every one is specific to awareness). There are a variety of monitors that have been trialled as a means of preventing awareness. Sounds like the sort of behaviour of those trying to ignore the whole thing, right? (It’s even inspired blog posts from obscure people.)
Read that report and you’d think the profession hadn’t realised this was a thing that was a thing. After the opening we hear about a string of things that have been “recognised officially for the first time”. Apparently patients can be aware (not news). Some patients are traumatised and some are not (not news). Having medicine on board that prevents you moving increases your risk (not news). Drug errors are implicated (not news).
It’s hardly the first time there’s been a bit of the sensational in a bit of coverage on something related to anaesthesia. It certainly isn’t as extreme as this special effort from 2005, where one of the commonly used co-agents was fingered as somewhere between cyanide and arsenic. A few years later the follow-up study showed that all the earlier stuff claimed was actually not an issue.
Excellent. The self-correcting virtuous circle of research strikes again, right? Slight pity about the impact on all the doctors and patients in between times of course.
Why the mankini?
So why try to dress it up as something memorable? Maybe they were misrepresented and really just wanted to stress that it is a problem that needs addressing (it is). Maybe they wanted to be able to say “I” just a few extra times.
The thing is there’s lots of interesting stuff in the study they could have focussed on. They sampled a period including nearly 3 million anaesthetics, utilising 296 local site co-ordinators with a 100% response rate. That’s a pretty astonishing effort and makes it about as big as you could hope for when it comes to sample size.
They chose to include only self-reported cases of possible awareness which is a slightly different method to that frequently used in other awareness research. Often an interview technique is used where patients are specifically quizzed over a bit of time which might well influence people’s recall of events. This may partly explain the overall lower reported incidence of awareness here, which for this study is around 1 in 20 000 anaesthetics (down from the oft quoted 1-2 per 1000). Even on a pessimistic interpretation, you’d only have a rate of about 1 in 6000 anaesthetics.
They confirmed that having an anaesthetic to deliver a baby or for heart surgery can still be considered high risk situations, but kids having surgery were a lower risk group using this study methodology. All of these things are worth a chat. So why make it sound like no researchers came before and anaesthetists didn’t really give a damn?
It’s not just sleepy doctors
Maybe there are bigger issues here. A recent excellent piece on the risks of blowing your own trumpet in research appeared over at The Conversation. It covers a bit on BICEP 2 and improbably fast neutrinos (there’s a whole series on Understanding Research at The Conversation which is well worth a read). It makes the very fair point that a bit of circumspection can save a lot of confusion for all. A bit more reserve might have other benefits.
The temptations to claim big results are obvious. In an environment where funding is hard to come by and it is easy to feel your work is invisible there is a push on at many levels to make a big splash whenever possible. The problem is that framing all research findings as bold new discoveries is a disservice to the public we’re trying to inform. Surely the story of research is one of small revelations not sudden bolts of lightning. Isn’t it more honest to let the public know that research tends to be a lot of work to reveal sometimes obscure details in a complex picture?
Then maybe when we try to explain that new knowledge takes decades to fully understand, or that making the step from first insight to clever thing that changes your life is actually thousands of shuffles it would make more sense. The argument that science needs a long-term strategic plan with consistent commitment from supporters would be more obvious. The need to have lots of different people looking at a puzzle from a variety of angles would be far easier to explain too.
Whether it’s a case of “I” disease, or a desire to bring sexy back to (or even just to) your patch of research it might just be time to communicate a bit more honestly. If there is a time and place to put on a mankini, I’m pretty sure it doesn’t involve researchers.*
* In the spirit of logical consistency, it should probably be said that the time and place for a mankini cannot involve researchers because there is no time and place that should involve a mankini.