This is (slightly modified) from a blog post by Marco Arment, writing about the entertainment industry:

Relying solely on yelling about what’s right isn’t a pragmatic approach to take. It’s unrealistic and naïve to expect everyone to do the “right” thing when the alternative is easier, faster and cheaper for so many of them. The pragmatic approach is to address the demand.

I came across this quote via Jonathan Rothwell’s blog post, and, in truth, I’m fairly ambivalent about the entertainment industry.

Yet the sentiment of the quote (perhaps better expressed in the full article) – the importance of marrying the “right” with the “pragmatic” – is applicable in so many areas of life, not least public health. And yet, it strikes me as an often forgotten, or perhaps often ignored, tenet.

It’s easy to say “lose weight”, “drink less”, or “stop smoking”, and we all know that such messages are right. But all have a multitude of maintaining habitual behaviours and causal factors, and maintaining the status quo is all-to-often “easier, faster and cheaper”. The secret of great public health interventions is to turn the “right” choice into the “pragmatic” choice – and, in truth, we’re not always great at doing that.

Marrying “right” with “pragmatic” can be hard, and requires seeing a problem from multiple points of view. It’s easier to concentrate on the “right”, but it rarely works. We all need to get better at making out solutions pragmatic, even if it means approaching problems in unfamiliar, unusual ways.

Here endeth the lesson.

Which of the following numbers represents the biggest risk of getting a disease? 1 in 100, 1 in 1000, or 1 in 10?

Almost 30% of Germans and 25% of Americans answered this question incorrectly in this study of statistical numeracy.

It’s an interesting reminder that healthcare professionals shouldn’t underestimate the statistical complexity of risk concepts: I think I’d previously have thought that these descriptions were fairly clear, but clearly they are not well understood.

This has been sat on my kitchen table for a few days now… and yet I’ve only just noticed the word in the cover image. Duh.

This morning, I was sent a list of seven papers in medical journals by a colleague. The titles looked intriguing, and I wanted to read further.

I have access to various journals via a number of means: the NHS provides me with access to a given selection via Athens, comprising about 1,500 journals; I personally pay the RSM to give me access to another 1,000 or so; and my BMA membership allows me to access perhaps 100 others. Clearly, the numbers are too large for me to retain details of which portal gives me access to which journal.

So, having found a given article, I then have to cycle through the three access methods, generally in the order outlined above, to find which works. That’s three sets of logins to three different sites (neither the BMA nor the RSM allows direct login from journals’ own sites). This is maddeningly frustrating, especially when I’m trying to glance through seven articles. Accessing each article can take, perhaps, five or ten minutes, which is sheer lunacy. I often don’t have that kind of time.

Now, let me share with you the process for just a couple of the seven papers I happened to be accessing this morning.

First was the Journal of Medical Ethics. I stuck the article title into Google (1 click). The second result was on a bmj.com domain. I often read things in JME, so I knew that I could access this via the BMJ domain with my NHS password. So I clicked the link (2 clicks), and ended up on the abstract page. I hunted for the “Full Text” link, which took me (3 clicks) to a login page. I clicked the “Login via Athens” button (4 clicks), which took me to an institutional login page. I clicked the “Login via Athens” link on this page (5 clicks), entered my username and password, and got redirected (6 clicks) back to the full article.

I make that six clicks and one login to get from my email to the article, for something I know how to access. Clearly, no-one in the field has heard of the three click rule.

Second on the list was a 2011 article from the Journal of the National Cancer Institute. Again, I copied and pasted the title into Google (1 click). The top result was from Oxford Journals, taking me to the abstract page (2 clicks). I clicked the “Full Text” link (3 clicks) to be taken to a log-in page. I clicked “Login via Athens” (4 clicks), and then “Sign in via Athens” (5 clicks) on the resulting page. I entered my NHS Athens details (6 clicks), and got redirected back to the journal’s login page, with no explanation as to why. Out of confusion, I clicked “Login via Athens” again (7 clicks), then “Sign in via Athens” (8 clicks), and again got redirected to the login page with no explanation as to why.

I assumed (correctly) that the NHS doesn’t pay for access to this journal. So I accessed the RSM website (9 clicks), and clicked “Library” (10 clicks), then “E-journals collection” (11 clicks). I logged in (12 clicks), and searched for “National Cancer Institute” (13 clicks). No results.

So I accessed the BMA website (14 clicks) and logged in (15 clicks). I went to “Library Services” (16 clicks), chose “E-resources” (17 clicks), and “Login now” under e-journals (18 clicks), despite having already logged on earlier. This gave a list of journals, on which JNCI didn’t feature.

At this point, I gave up. I could’ve requested the article from the BMJ or the RSM for a couple of quid, or emailed round to see if anyone else had access (e.g. via a university). But for an article I’m browsing for interest and to casually increase my own knowledge, it’s not worth the hassle or cost.

So now, I’m left more ignorant than I need be because of incompetence (the system is crazy), stinginess (my employer isn’t paying for access), and a touch of defeatism.

I struggle to see how conducting research and then hiding it from people is ethical – isn’t that precisely what skeptics constantly berate Big Pharma for doing? Granted, there’s are important ethical and practical differences between non-publication and sticking an article behind a crazily high pay-wall, but I’m sure there’s an extent to which people on the ground are less informed than would ideally be the case because of this broken system.

Why can’t somebody (perhaps the UK Access Management Federation) compile a composite list of journals I have from various sources, and provide some kind of auto-login toolbar or cookie that gets me straight from the abstract page to the full-text page without the faff, or morosely reports my lack of paid access if none of my providers subscribe?

And why can’t journals like PLoS and BMJ Open have more sensible publication fees for individual authors who, for want of a better metaphor, don’t want to hide their light under a bushel? Funded research should factor in the cost of publication in such journals into it’s funding; un-funded research should be admitted for a nominal fee (or, preferably, nothing).

Anyway, it strikes me that the whole system is pretty crazy – something I’ve thought frankly since I started reading medical journals almost a decade ago. And I needed a cathartic rant. Thanks for reading it.

The news reader announces a 30% chance of rain tomorrow. Thirty per cent of what? Most people in Berlin think that it will rain tomorrow 30% of the time. Others believe that it will rain tomorrow in 30% of the region. In New York the majority believe that it will rain on 30% of the days for which the prediction was made.

This is the (edited) opening of BMJ 2012;344:e245, a fascinating paper about single event probabilities by Gigerenza and Galesic. It’s only short, quite fun, and may convince you to change your practice. Well worth a read.

I’ve been meaning to visit the Wellcome Collection for quite some time – I’ve been received the Trust’s newsletters via post for years. I finally found half an hour to pop in this morning, and would highly recommend it (though 30 minutes is clearly not long enough!). Above is William Cobbing’s Palindrome, an artistic expression of the fact that the pelvis and the skull are thought to share a common evolutionary bony ancestor.

And below, since I just couldn’t choose which photo to use today, is the complete human genome in printed form. Not only is it an impressive display of human achievement, it also provides a slightly depressing reminder of the relative weediness of the Y chromosome!

Both of these exhibits are from the Medicine Now exhibition, which is permanent, free, and well worth a visit.

It’s seems unfortunate that Direct Holidays have chosen to advertise by seemingly making light of sunburn, the UK’s leading cause of skin cancer.

My concentration on revision is slipping as I get increasingly bored of it. I’ve just spent at least 30 seconds trying to puzzle out why you’d need to provide a “book room” for a focus group. I’m not usually so slow. It’s from this book, if you’re wondering.

The problem faced by public health campaigns in the UK is the tendency for people to react to being told what to do.

Benjamin Daniels, Confessions of a GP

Five reasons why this video (whilst it makes an important and valid wider point) irritates me:
1. It doesn’t acknowledge that both A (on the left) and B (on the right) are both, ultimately, working for profit rather than purely for the benefit of patients.
2. It doesn’t acknowledge that A likely employs salaried doctors like B, with similar issues.
3. It doesn’t acknowledge that since A opted out of providing out-of-hours care, B has stepped in to provide it. In fact, it’s B who’s illustrated at walking out at the end, just when B’s colleagues are kicking into action.
4. It suggests that non-partner doctors hold less professionalism, and are less concerned with patient welfare. Such doctors include many GPs, as well as virtually all secondary and tertiary care physicians and surgeons.
5. It doesn’t acknowledge a single advantage of the corporate model. A’s approach may well be preferable as a whole, but B’s approach is not without merit, and it’s idiotic to suggest that it is.