Heroes Not Zombies

Research studies routinely use different ways to present their conclusions. In particular they present “relative risk”, “absolute risk”, and/or “numbers needed to treat” information. Gigerenzer is brilliantly clear about this. He says

Gigerenzer shows how drugs companies and authorities routinely use Relative Risk to emphasise the potential benefits of their treatment while at the same time presenting the potential harms as Absolute Risks to minimize the impression of adverse potential.

This week in the BMJ, there is a study where researchers have looked at the use of relative and absolute risk reporting in studies which examine inequalities in health. Their argument is quite modest – that to fully understand any study BOTH relative and absolute risks should be reported. They say this is best practice. So, how often does it occur?

Almost never.

75% (258/344) of all articles reported only relative measures in the full text; among these, 46% (119/258) contained no information on absolute baseline risks that would facilitate calculation of absolute effect measures. 18% (61/344) of all articles reported only absolute measures in the full text, and 7% (25/344) reported both absolute and relative measure

But in fact, the literature is even more skewed than those conclusions suggest because

We found that nearly 90% of studies with quantitative estimates in the abstract presented only relative measures, and 75% of all articles reported only relative measures in the full text.

Why is the bias towards relative risk even greater in the abstract than in the full text? Because its the abstract which most people read, and it is probably the abstract which is used to write the PR headlines.

Does this matter? Yes it does. The authors argue that the choices of relative or absolute risk reporting influence policy making.

Makes you wonder how often the “evidence” is produced to fit the policy, rather than the policy being produced from the evidence…….and that applies across the board from the writing of guidelines and protocols, to decisions about health care spending, to individual doctors deciding what treatment to offer an individual patient.

The current set of concepts being used to organise health care prioritise a certain reductionist view and assume the ability to predict outcomes of actions – as if health and health care were linear systems (hint – they’re not! They are complex and non-linear). One of the consequences of this way of thinking is to break professional roles down to a series of tasks. Once a simple task is examined, it is usually possible to argue that only a little training and knowledge is required to carry out that task (just the skills and knowledge required for this particular task). What we lose sight of, is a person-level perspective, and hence a professional one.

Let’s consider one type of health care professional. A doctor. What is a doctor? What’s a doctor’s role? Actually,that’s not so easy to answer, but if you read “Tomorrow’s Doctors” by the General Medical Council, which is their attempt to describe what a doctor should be able to do, you’ll find a strong emphasis on leadership.

So, it was interesting to come across the concept of “humble leadership” which is beginning to attract attention.

In the midst of spectacular failures of the “superman” type of leader in the financial, corporate and political sectors, people are beginning to question the wisdom of seeking such charismatic but frequently arrogant individuals whose main strength seems to be the conviction of the rightness of their own decisions.

So what is a humble leader? Leadership humility…

generally involves how leaders tend to view themselves (more objectively), others (more appreciatively), and new information or ideas (more openly) 

And

The humble leader behaviors we identified (e.g. acknowledging mistakes, spotlighting follower strengths, modeling teachability) as well as the mechanisms (e.g. legitimization of uncertainty and personal development) were often described as directly challenging the more popular top-down conceptions of leadership.

As doctors are expected to be able to handle complexity and uncertainty, it would seem that humble leadership skills might be highly relevant. Wouldn’t you like your doctors to observe themselves more objectively, you and their colleagues appreciatively, and to be continuously open to new information and ideas?

Such a shift to humble leadership could completely change the doctor-patient relationship for the better. It is a much more appropriate way to deal with the reality of the complexity and uncertainty which is characteristic of human health and disease.

The researchers who are studying leadership humility identify two key characteristics or qualities – competence and sincerity.

Hard to argue with that!