I have just turned 60 and am due to retire at the end of this academic year. In anticipation of this rather sad situation I enrolled, two years ago, in a part time PhD in epidemiology at the School of Public Health at the Chinese University of Hong Kong. It is a research based degree and continues my life long interest in paediatric burns care. Primary prevention of paediatric burns has always been a major concern, and now I have an opportunity to look at it in more depth. One of my community service hats is that of chairman of the prevention committee of the International Society of Burns Injuries (ISBI). I am trying to promote an awareness of global prevention in burns that spans from primary, through secondary, tertiary, and quaternary prevention. In all aspects of prevention, data is needed both to record the past, but also to predict the future. I should digress for one moment to mention that after giving a presentation on the importance of data at an International Burns meeting held in China last year, a senior American burns surgeon could not resist criticising me for my use of the word data. I was using it as a collective noun, but he wanted me to talk about datum (singular) and data (plural).
At the ISBI we have been actively discussing the collection of burns data and how we might apply this to epidemiological studies and primary prevention of burns. Having worked in this field for over 30 years I have developed some intuitive discomfort with our traditional epidemiological approach which is basically to look at individual patients in increasing detail. Ultimately I have concluded that this approach is flawed as we are looking in increasing detail at the numerator, but overlooking the denominator when assessing risk.
So for my PhD I have decided to try something else which is to see if there is a relationship between the incidence of burns and other characteristics of the population from which those patients came. This is very amenable to a geographical information systems approach and being a highly visual person, as becomes a plastic surgeon, I am now fascinated by this evolving study. A very important part of the study, and a reason why it is so applicable to Hong Kong, is that we have a well defined population as a result of the very detailed census data produced by the Hong Kong government. I now have data on over 8000 burns patients that I can correlate with geographical distribution in terms of Gini coefficient, demographic changes, educational levels etc.
This is all very exciting, and I have already produced one or two preliminary maps that indicate areas for more in depth statistical analysis. But a report in the paper stopped me in my tracks. It now appears that for years, there has been widespread data fabrication by Hong Kong census field officers. Oh dear. I am still working out what the implication will be for my studies, but I realise that a considerable amount of the data on which we base our assessments, studies, and predictions is “reported” data and not “validated” data. So do I urge all researchers and policy makers who rely on data sets to continually question, are the data real? And if so, how real are they?
Andrew Burd is professor of plastic, reconstructive, and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.