The kinds of attention that scholarly articles receive often tell interesting stories. In the “Interactions” weekly series of blog posts, we look at how intertwining conversations and differing views of the general public, scientists, medical professionals, and science communicators contribute to the overall impact of a scholarly article.
Science in the making
Science is shared online for many reasons, and in the short-term, exciting, novel findings are what typically seep into the public’s consciousness. And yet, a number of long-term, ongoing online discussions concern so-called “science-making”, a subject that can encompass everything from publication processes to research ethics to the scientific method. In medicine, science-making discussions are immensely valuable for scientists and clinicians, because such introspection helps to improve the way that evidence is collected and subsequently interpreted in the clinic. For the general public, following discussions about science-making is educational. Understanding the processes, strengths, and limitations of scientific inquiry can help non-scientists to assess whether medical claims are sensationalised in the media, while also informing better treatment choices for personal medical care. In spite of the benefits for including the general public in conversations about how science is done (rather than simply what has been found), much of the science-making debate is often only known by academics. An exception to this comes from an article published in 2003 in BMJ, which dealt with limitations in randomised controlled clinical trials as the “gold standard” for how clinicians evaluate the effectiveness of medical treatments. By examining an utterly ridiculous problem (whether or not parachutes were effective at preventing death or major trauma from falls) in the format of a systematic review, the sarcastic article made a case for common sense, igniting a much wider discussion about evidence-based medicine.
Tackling a serious topic with humour
The BMJ article, written by Smith and Pell, was comically titled “Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials”.
With a nod to Jane Austen’s Pride and Prejudice, the authors posed the overarching problem:
“It is a truth universally acknowledged that a medical intervention justified by observational data must be in want of verification through a randomised controlled trial.”
Encapsulated in the dry, sarcastic humour was the argument against the medical community’s obsession with evidence-based medicine. By concluding that parachute use has never been shown in human clinical trials to prevent death or major injury, the authors criticised the over-reliance of clinicians upon the results of double-blind, randomised, placebo-controlled trials, especially if observational data would actually be convincing enough. In the parachute example, the obvious fact that parachutes save lives should suffice, and clinical trials to determine efficacy are certainly unnecessary. (Randomised controlled trials widely are regarded by clinicians as the highest form of medical evidence, and are designed to evaluate the effectiveness of an active treatment against a placebo. The evidence of “evidence-based” medicine refers specifically to what is indicated by randomised controlled trials.)
A scathing but hilarious conclusion in a summary section of the article stated:
“Individuals that insist that all interventions need to be validated by a randomised controlled trial need to come down to earth with a bump.”
Discussing evidence-based medicine outside the clinic
The thought-provoking BMJ article prompted 42 reader letters. The reactions from academics were highly polarised, and while many appreciated the joke, others proclaimed their disdain for the article’s content. In contrast, online reactions were almost uniformly favourable. With the help of social media, as well as blog coverage, the article shot out of scholarly and medical circles to reach a broader audience. Certainly, it didn’t hurt to use humour as a means for capturing the interest of the general public. According to Altmetric data of the BMJ article collected from 2011 onwards, 60% of those who tweeted the article are members of the general public, whereas only 10% are clinicians. Online users widely praised the cleverness of the satire, as well as the importance of the arguments:
— Mark Bernstein (@eastgate) November 6, 2011
— Shannon P (@shannolater) September 13, 2011
Notably, in addition to the social media attention, various science blog posts also explored the issues raised by the article in detail, and also what may or may not need to be validated by evidence-based medicine, citing real-world examples of bariatric surgery for type 2 diabetes, obesity, and homeopathy. Making the salient points of the BMJ article accessible through excellent science communication, the blog Not Totally Rad discussed the parachute example while also contrasting evidence-based medicine with “science-based medicine”.
The online popularity of the article certainly shows that the logical arguments and euphemistic phrases of formal scientific writing are highly conducive for satire. But more importantly, the wide appeal of the article beyond academia demonstrates that humour can be a powerful tool that allows researchers and clinicians to raise the public’s involvement within important issues in science-making.