A wild idea to improve science communication
As I discussed in my last post, science communication is really important. That’s especially true when it comes to healthcare, because the way we communicate medical science affects the decisions people make about their own health. As Ben Goldacre points out in his book Bad Science, there is almost no teaching in school science lessons about risk or other real-world science, yet something like half of the science stories in our national press are medical ones.
So what can we do about it? One obvious answer is teach these things in a useful and interesting way in schools, but that’ll take time. In the mean time, a colleague of mine had a great idea today: get the biomedical journals to help us by including a plain language summary. This isn’t a particularly new concept, and in fact the Cochrane Collaboration already does it on all of their systematic reviews (here‘s a recent example), but it’s a simple thing that might help increase public understanding of basic science.
Let’s look at an example to see how it might work. A good sample paper was published online in the New England Journal of Medicine (NEJM) on the 1st of October, entitled “Trastuzumab Emtansine for HER2-Positive Advanced Breast Cancer”. The story was widely reported (by The Daily Telegraph, Daily Mail, Daily Mirror, and Channel 4 News among others), and also covered by the ever-excellent Behind the Headlines. The abstract of the original research, as is usual, is publicly available both on the NEJM’s website, and at Pubmed. Abstracts are designed to give an overview of the important points of a journal article, and they’re great if you’re comfortable with the language used and are aware of their limitations.
But what if you’re not a doctor, scientist, pharmacist, or someone other wise used to reading stuff like this? A lot of the language and concepts used in abstracts is completely meaningless unless you have the necessary training and experience to interpret them. Taking the story above as an example, the abstract contains the following wonderful sentence:
Among 991 randomly assigned patients, median progression-free survival as assessed by independent review was 9.6 months with T-DM1 versus 6.4 months with lapatinib plus capecitabine (hazard ratio for progression or death from any cause, 0.65; 95% confidence interval [CI], 0.55 to 0.77; P<0.001), and median overall survival at the second interim analysis crossed the stopping boundary for efficacy (30.9 months vs. 25.1 months; hazard ratio for death from any cause, 0.68; 95% CI, 0.55 to 0.85; P<0.001).
Yes, that’s all one sentence. It contains 77 words (the recommended maximum sentence length to make text readable is 20-25 words), not to mention words and concepts that will be alien to most people. What’s a confidence interval? A hazard ratio? A stopping boundary for efficacy? For the intended audience that sentence is chock-full of useful information; for Joe Average it’s useless.
So what if journals started adding a bit? What if the usual structure was Background, Methods, Results, Conclusions, Plain language summary? We wouldn’t need the full abstract to be “translated”, just 2-3 sentences that give the reader the gist of the meaning. For the breast cancer story we’ve been concentrating on, I’d suggest something like the following:
This trial looked at a drug called T-DM1, which is designed to treat a type of breast cancer called HER-2 positive breast cancer. T-DM1 was compared to a combination of two drugs that are already available. It found that cancer progression was delayed by about three months in women who received T-DM1. These women also lived roughly six months longer.
That’s a first attempt and just an example; I’m sure people more skilled with words than I am could improve it vastly. But hopefully it illustrates the point; it takes relatively little effort to make the key points of a clinical trial much more accessible to the general public.
So what to do about it? Well, I plan to pick some key biomedical journals and just ask them nicely. I’d like you to join me, because we all know that a crowd of people making noise is more influential than one person alone. To make it easier I’ll make a list of contact details in an update to this post, as soon as I have time – hopefully this evening. If you have any suggestions for publications we should write to, leave a comment or send me a tweet (@Skanky_fish). If you have any ideas to improve this little scheme, please do likewise. It’s a very simple idea, and hopefully one that could make a small difference in the public understanding of medical science.