Domhnall MacAuley: Public health summer school

Domhnall MacauleyDoes your research really matter? Most VIP introductions are bland and unchallenging. Not this time. When (Professor Sir) Peter Gregson, vice chancellor at Queen’s University Belfast, introduced the joint summer school of the UK Clinical Research Collaboration’s centres of public health and Health Research Board (Ireland), he pointed out how universities often fail to show the greater community why their research is important. Universities need to be able to justify research, especially in the current economic environment. Frank Kee (CoEfPHNI) continued, saying their international advisory committee endorsed their research output but wanted them to think more about added value – how did it actually benefit the community. There is a chasm between research and its impact and he encouraged young researchers to think about the meaning of what they do.

Is it relevant? Drinking and smoking are major public health problems in the developed world. Given a choice, I would choose drinking as a research field. There is so much known about smoking, it is difficult to see new research opportunities. But alcohol research is relatively uncharted. Stephanie O’Neill (FUSE) proposed a new model when exploring how young people drink. I loved the category she described as “pragmatic hedonism” – those who seek adventure, pleasure, and hedonism, but within limits. “I know when I am drunk and gotta stop and then I need to go home.” In her work, parental advice had no influence. In smoking behaviour, however, James White (DECIPHer) found that a mother’s smoking increases the risk of girls but not boys smoking. But, the most important protective factor was family connectiveness – an old fashioned family value.

Will people believe it? Graham Moore (DECIPHer) discussed an evaluation of exercise referral schemes – a topic that fascinates me. When he pointed out that exercise referral schemes were  introduced ahead of the evidence, I squirmed. In the past, I had been very active in promoting a national exercise referral scheme. It didn’t work. Graham pointed out that when research evidence became available, these generic schemes were not as effective as expected, but that it was difficult to disentangle what might work for whom and in what circumstances. NICE now recommends that referral schemes should only be endorsed as part of controlled research studies. But have you tried telling this to the evangelical wing of the physical activity movement? Though fully committed to the public health message on the benefits of exercise, I now avoid participation in expert groups, committees, and advisory bodies. If you question the evidence base, the “believers” gang up and life becomes very uncomfortable. So, I now decline such invitations, I will leave that to Graham.

How will we inform? Ssshhh, don’t tell anyone, but academic journals don’t really get to the right people. Those who read academic journals are academics. Eimear Barrett and Helen McAneney (CoEfPHNI) looked at  new forms of  communication and how the cyber infrastructure has  spawned new forms of research: Infodemiology and infoveillance. And, I also learned the difference between complicated and complex interventions from Mark Pettigrew (London School of Hygiene and Tropical Medicine). A complicated intervention is detailed but predictable. A complex intervention is unpredictable and may have unintended consequences. Lots more new words. Epidemiology with epistemology.

Domhnall MacAuley is primary care editor, BMJ

  • Firstly, about making research relevant to current problems in the world & giving it a chance of paying off: in Australia most universities ask that these issues be dealt with in proposals now. It's also easier to get research approved that has an outside/business stakeholder involved. However these criteria only apply in the sciences, or close “relatives”. About exercise and getting anyone without a natural inclination to do it for health: I don't think it's possible to get most people to exercise unless you supply them with a free friendly, neighbourhood task master/coach, or parents bring up kids to think that it's a natural part of daily life! So many programs have been done and hardly any of us have ever done regular, healthful exercise. Plus, we're getting too old to derive any benefit! I'd love to try a community health research project/PhD on the neighbourhood coach idea, but it's unlikely in the current economic climate. Now- alcohol research- at least you wouldn't be short of sponsorship!