Cause-Effect? Why bother when conjecture will do

Deaths from heart attacks have halved in the UK in the past decade. This is the conclusion by researchers from the Public Health Department of Oxford University.

Researchers have looked at the data and found that fewer people are having heart attacks and more people are surviving heart attacks. Dr Kate Smolina concludes that this a great success story for the NHS.

Dr Mike Rayner then goes on to discuss why that might be so. Coronary care in the NHS seems to have improved.

He then describes things that may have made a difference, such as a reduction in smoking. He guesses that a reduction in saturated fat intake and an increase in fruit consumption (mostly as juice) may have made a difference.

Professor Goldacre thinks that drugs for high cholesterol and high blood pressure may have made a difference. Goldacre also details improvements in cardiac care, such as faster transportation to hospital after a heart attack may have made a difference.

So we have a report that gives us a simple fact: deaths from heart attacks have halved in the UK in the past decade.

It then discusses what may or may not have contributed to this change.

What gets reported in the UK press?

Deaths have halved because NHS doctors have been prescribing statins.

Never let facts get in the way of cosy beliefs and comfortable prejudices.

Can we learn to be creative?

This is a question often posed when I tell people what I teach. It implies that some of us are creative and others are not, which I dispute.

I believe that we are all creative in different ways. However it's possible to build creative muscle by regular practice.

Some choose mindfulness and a meditation practice to still the mind and promote more immediate responses to life, rather than conditioned behaviour based on thoughts of past and future.

Others practice a form of exercise that stimulates different pathways and a better sense of balance. Qi Gong shifts thinking and energy.

Creative writing is popular as a way of opening up the imagination. Some write non stop for 10 minutes a day, without editing their output. Others follow a range of exercises.

Will Hewett set himself the challenge of singing for 15 minutes a day for a year. He planned to boost his creativity and help himself to be more outgoing:



Will's dual purpose fits the results I've observed in many people who follow a daily practice. Confidence, balance and internal calm are some of the qualities that seem to flow from time spent with the self on some purposeful activity, that seems to have no material payoff.

The Big Con

Her Majesty's Opposition are scornful of David Cameron this week, because he has not slashed Stephen Hester's bonus.

When the Royal Bank of Scotland was saved from collapse by government investment, Hester was brought in to bring the bank back to solvency so that it could be resold and public money returned to the Treasury. HMO, who were then Her Majesty's Labour Government, designed the contract, by which Hester received a relatively modest salary, but a substantial bonus awarded for meeting specific targets. The aim was to motivate Hester to perform, rather than sit back and draw a comfortable salary. He has exceeded those targets, behaved with great honesty and openness, thereby restoring some trust in the banking industry.

I sincerely hope that the Labour Front Bench, Gordon Brown's former bag carriers, are not now suffering from early onset dementia affecting their short term memory. That would be a tragedy indeed.

David Cameron made a firm statement about excessive bonuses paid to directors when companies were failing. He criticised bonuses collected for poor performance. Stephen Hester has performed well in difficult circumstances and is entitled to receive his bonus.

I hope the Prime Minister was referring to examples such as Conygar, a small property investment company. There was uproar at the recent AGM when directors awarded themselves substantial bonuses.

Was this as a result of diligent acquisition, development and sale of properties?

No.

The directors had merely sold and bought shares in the company, which, on paper, gave the impression of expansion and increased profitability. In effect they were rewarding themselves for churn, that old trick of financial advisers and investment fund managers (as well as some fiddling with the figures).

One of the problems was that the majority of shareholders were large institutions, many of whom seemed to have some link to the remuneration committee or were indifferent to the decision. One representative shrugged and likened these directors to Premier League footballers accustomed to garnering astronomical salaries. The majority of action to block the bonuses was taken by small investors. There seem to be 3 large institutional shareholders and only one of these, Aviva, voted against the remuneration package. Cameron needs to consider the cosy old boy network of boardrooms and institutional shareholders to prevent future abuse.

Perhaps more effort needs to be made to out those institutions that collude with bad practice and to publicise the efforts of companies like Aviva in upholding probity.

Perhaps Eds Milliband & Balls believe that the British public are stupid and have no idea what Labour did whilst in government, nor how to distinguish between rewards for performance and naked greed.

The Big Con is not the reward given to Stephen Hester for his excellent performance, but lowdown dirty dealings in an AIM company boardroom remuneration committee (and other similar examples.)

Charlatan

I had an interesting conversation with a young Polish cardiologist recently. He was friendly and open to discussing views on health, without resorting to the 'Me expert, you idiot' approach of yesteryear.

I talked about some of the things I've learned about preventing heart problems and mentioned the work of Dr William Davis. The cardiologist turned to his computer, typed in Dr William Davis in the PubMed search engine and found no results. He then told me that Dr Davis must be one of those American charlatans, who are just trying to make money out of empty assertions and selling snake oil. I explained that Dr Davis has had stunning results by recommending diet and lifestyle changes in order to reduce coronary arterial plaque. The cardiologist dismissed this telling me he could claim numerous positive results and that this would prove nothing. He told me that he would need to see peer reviewed articles to convince him that Dr Davis had anything valuable to contribute to the field.

I then asked for his views on the lipid hypothesis and the idea that saturated fats contribute to heart disease. He told me that there is evidence that they do, took my email address and promised to send me links to peer reviewed articles substantiating this fact. That was at the end of November 2011 and to date I've heard nothing.

Later I typed the young cardiologist's name into PubMed and found zero results, despite the fact that this doctor routinely prescribes heart drugs and surgery to deal with various symptoms. I also checked on my GP colleagues, with whom I've worked for 20 years, and found no peer reviewed papers by any of them. I've witnessed and heard from patients testimony to their efficacy in dealing with a wide range of medical conditions. I doubt if patients need peer reviewed articles to show that their doctors aren't charlatans.

Dr Davis relies on the results of scans to show his patients' calcium scores. It's possible to challenge the cause-effect relationship between diet and heart disease that he proposes, but his results are impressive.



Dr Davis is generous with his knowledge and shares his experience freely on his blogs and in interviews. He does have a heart disease prevention programme with a membership and also sells 2 books. I don't think this automatically discounts his work.

In a previous post I mentioned the difficulty of getting research published in peer reviewed journals if it challenges orthodoxy or a sticky metaphor. Lynn Margulis persisted and made a difference to how we understand the process of evolution. The way that the Helicobacter was brought to public attention so that research was financed and appropriate antibiotics developed for the treatment of stomach ulcers is another example of this trend.

Commentators are challenging how pharmaceutical companies chase gold mine drugs and jump to conclusions about cause-effect relationships rather than correlations to research treatment for serious conditions. Some claims for drugs have been undermined by research or more detailed analysis of the initial findings on which claims for the drug were based. 'Why Science is Failing Us' is a provocative article in this vein.

$29 Billion Introduction from 29billion on Vimeo.

Another angle in this debate focuses on the trend towards senior researchers to claim credit for all breakthroughs (and to quash evidence that young juniors have found something new.) Peter Lawrence claims that the heart of research is sick. He describes the push for publication in a few high profile journals so that your papers are cited by colleagues. This means that small, obscure areas of research are overlooked and that papers on planned genetic research are favoured, an area which seems to be reaching some dead ends. The outlook for UK scientific research is depressing.

I think it's absurd to assert that a doctor can only treat people if he/she has published research in a peer reviewed journal on the subject. The history of medicine has been built on doctors and surgeons applying the results of other people's research. Some members of the field indicate that the true charlatans may be those who change the paramaters of their research AFTER the results are in or those who conceal or understate side effects and statistically insignificant results by manipulating the data.

Framework for Problem Solving

My students sometimes trip over course terminology. We define Frameworks as metaphors for creative problem solving on B822. I encourage students to do a bit of method acting and imagine the role that they inhabit when problem solving.

I think everyone tackles problems from an individual mindset or belief about how the world works and what enables problems to be solved. This view determines their choices about how to approach problems and what techniques to use.

Most people seem to be unconscious about their Framework and sort of assume that the world actually works the way they believe it does. When my students are asked to make their Framework conscious and explicit, some of them choose to change the metaphor or analogy slightly to be make it more effective and include other people.

Years ago I did a lot of consultancy and training for the rail industry. Though British Rail was derided in the media, I met a few superb managers and lots of hard working people doing their best to maintain a transport system that functioned well.

Some managers led their teams through bomb threats and sabotage by the IRA and showed great skill in outwitting the terrorists. Others took tedious, bureaucratic quality systems and boiled them down to a useful, practical essence that their staff could understand and implement with enthusiasm. As a result railway staff, who had been dismissed as old codgers, now became a powerful force for positive change.

The unconscious Framework guiding this problem solving seemed to be 'Problem Solver as Football Coach' and BR had some budding Sir Alex Fergusons in their midst.

During the early incarnations of the Crossrail project, some managers tackled the issue of 'one man train operation' with some success. They subverted the bureaucratic meetings of labour relations and drew on personal contacts and relationships based on trust to persuade unions to adopt a different work pattern. The implicit Framework seemed to be 'Problem Solver as Networker'.

During and after privatisation, a lot of fuss was made about the new broom sweeping through the rail industry, with the appointment of senior managers from the commercial sector. The cynical view (in common with privatised electricity companies) was that failed managers from the oil industry found a safe haven in deregulated transport and utility companies.

I didn't work with the newly appointed titans of the rail industry, but certainly witnessed interactions between them and their staff as well as external consultants. They seemed to share a tendency to view people as problems. The Framework that comes to mind when I recall this era is 'Problem solver as Neanderthal'. These high testosterone managers seemed to have a very small toolkit for problem solving and most often used a large rock to try and crush the problem (or verbally bludgeoning their people.) This might work in the short term, but did nothing for long term cooperation and motivation.

In recent consultancy work in organisations that have driven down the demographic of supervisors and managers, I am seeing youngsters managing people who are older and more experienced than them. I witness a lot of 'Problem Solver as Dalek', where some of the youngsters seem scared and rigid, expecting their staff to carry out work exactly as they used to do it. Part of my task is to help them let go of their robotic approach so that they relax and set goals, freeing staff to find their own way of reaching them. Increasingly strident and fixed commands and reproaches cut no ice with people who believe they could do the same job better, faster and with less friction.

Dr Who may be brainy and have centuries of wisdom on which to draw, but he does involve his team in finding ways to get the job done.

Sticky Metaphors

I encourage my students to include metaphors and analogies in creative problem solving. One of the reasons is that a good metaphor can be sticky and stay in the minds of colleagues much longer than wordy powerpoint presentations or reams of data.

One example of how this works in society is the notion, now shared by most primary school aged kids, that saturated fat clogs our arteries (like chip fat poured down the drain) and makes us fat. If this were so, then it should follow that all our cars would become clogged by the oil we regularly pour in their engines.

Here's an eminent endocrinologist, Dr Robert Lustig, explaining what actually causes obesity:



If you stop someone on the street and ask them to explain evolution, they're likely to describe it as survival of the fittest an evocative description of how random mutation works in evolution championed by biologists such as Richard Dawkins.

The biologist Lynn Margulis died in November. It took nearly a decade and 15 rejections before the Journal of Theoretical Biology published her paper presenting the process known as symbiogenesis, by which organisms cooperate in development rather than always competing. One of the examples she cited was mitochondria, which are organelles within cells that generate most of the chemical energy needed by the cell. Mitochondria have many properties characteristic of bacteria (including reproduction by binary fission) and their DNA resembles that of bacteria.

One example in the human body is the appendix, which was thought to be a vestigial organ from the days when we ate rabbit food. Bill Parker, Professor of surgery and Duke University School of Medicine, is undertaking research that indicates the appendix may be a reserve of beneficial bacteria for the gut (symbiosis in action.)

Sticky metaphors can block fresh thinking and become orthodoxy that resists new research presenting contrary evidence.

In creative problem solving, sticky metaphors can lure colleagues away from rigid thinking to consider the status quo from a new, more dynamic angle that leads to critical thinking and action. In a previous post I mentioned the power of animal metaphors in describing the state of the company. The animal can help us talk about company problems without personalising them.

During a creative problem solving workshop a comic analogy (such as the above Gary Larson cartoon) may arise that seems to have no benefit or use in the process. If it persists, I encourage the group to revisit it and consider how it might contribute to the challenge at hand.

If it sticks, run with it.