Health research

Since my first semester as a lecturer, I have been working with medical students. Rather rapidly, my work shifted towards guiding them to conduct research, and this for several reasons.

  1. That’s what I thought I could teach them the most accurately
  2. Since they have to write a research thesis I thought it would be valuable
  3. I am convinced that studying medicine without understanding the research process is a flawed approach

Guiding students to the conduct of research when they have little or no research background is a challenge. I say guiding because I refuse to be teaching them from a theoretical standpoint the steps of research. Learning to conduct research, I feel, is alike learning a craft: you learn by doing.

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Over the past year teaching and researching at the School of Medicine at the Universidad San Francisco de Quito, Ecuador, I have encountered amazingly inspired and knowledgeable students. I found in many a genuine eagerness to take part in research and for a number of reasons, opportunities were seldom offered.
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With recent-ish news of the reinvention of space race with front runner Elon Musk, interest in the world beyond our blue planet has made a come back. The paradigm traveling alongside is no longer tinted with Cold War and atomic annihilation of human life , but rather environmental apocalypse and annihilation of human life. To a certain extent, colonizing another planet is a way to prepare for the collapse of society and in that regard, Elon Musk is the ultimate prepper!

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Several times, prospective PhD students have asked my opinion about whether they should start a PhD or not. I’d like to share one aspect – among many other – which supports commitment into a PHD: improved productivity.

Why am I writing a PhD? Throughout my now fairly long life as a PhD candidate (I am now five and a half years into it), I gave the answers I thought best: it teaches me to be responsible of a large scale project all by myself, I learn how to use new research methods and, among many other reasons, I learn about how I function as a human being – Oh, and I contribute to research, I was going to forget that one!

While they are true, these responses only answers part of the question. Why do I write a PhD? Not the part about motivations, but rather the so what part.

Here is something about me – about most of us: I procrastinate, i.e. I postpone to tomorrow what could be done today. And since primary school, we are taught that procrastination is evil. Just look up online the thousand pseudo solutions to fight procrastination.

9gag (source: 9gag)

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I recently gave a presentation to doctors of the Hospital de Los Valles, Universidad San Francisco de Quito USFQ, Ecuador about Delphi panels and I thought I’d translate it into a blog post to keep a trace, but also because I am sure some have asked themselves the question. Indeed, many have encountered the term “Delphi” without really digging into what it means. This post aims to be brief and straight to the point and answer the following questions:

– What is a Delphi panel?
– What are Delphi panels applications in health?
– What is the position of Delphi panels within health evidence?

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Imagine sitting in the chair of a venture capitalist: you have two candidates, one with an average idea with strong evidence that there is a need for the product and another with a very innovative project but who did not give too much thought into the evidence. It is likely that the candidate with strong evidence will get the funding. What could the innovative project candidate have done to more effectively make their case?

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Working in health and more precisely around pharmaceutical products is a complex situation due to the highly controversial actions of the pharmaceutical industry. To sketch things in a slightly over simplistic manner, researchers have to choose side: either you are a pure academic sociologist and generally oppose the capitalist pharmaceutical industry or you collaborate with the industry and take for granted a certain number of assumptions.

I feel I sit between both chairs. On the one hand my research lab displays a sociological orientation working independently from the pharmaceutical industry and my supervisors are not known for their support to the pharma world. On the other hand, my sponsoring institution is a consultancy working directly for the industry. This potential issue had not arisen so far, but since I have started working on theoretical concepts of medicalisation and pharmaceuticalisation, I see the topic has become hotter.


The efficacy of pharmaceutical treatments is in many ways the centre of disagreement. In his book ‘Limits to Medicine, Medical nemesis: the Expropriation of Health, Illich unwillingly exposed the dilemma. (Illich I. 1976) He argued that many treatments, especially newer ones harm society more than they help. However, he admitted that a number of pharmaceutical discoveries were in fact fundamentally positive, citing infections like malaria or syphilis for which medical treatments were found to be efficacious. To me, by entering the field of comparative health research he puts his argumentation at risk of being falsified due to advancing knowledge and contradictory evidence.

 After having worked in health economics for over three years I understand that measuring efficacy of medical treatments is not a straight forward black or white science. It is necessarily embedded in theoretical assumptions, methodological biases and limitations of a number of sorts. Treatments initially appearing as efficacious in a particular indication can be demonstrated harmful ten years down the line and/or can be proven efficacious later in another indication following complementary investigations. Because of the pharmaceutical industry’s financial interests, the controversy will remain between those defending the product and those opposing it.

When I first entered the medical field of osteoporosis and knew only very partially the existing literature, I started with the reading of pro-pharmaceutical industry publications (including the report I mentioned in a previous post, Hernlund et al. 2013). As most observers, I was sensitive to the argument of a tremendous treatment gap: older people were denied efficacious treatments. So my initial research question was formulated as follow: there are fully recognised efficacious treatments available to treat a well known harmful and costly disease: why are treatment uptake rates low and now declining? This was the argumentation I supported at one of my first conference presentations, the SMi Safe Geriatric Medicine Summit in 2013 in London.

 As I went on reading I understood the other side of the controversy alongside the limitations associated with the efficacious characteristics of treatments against osteoporosis as well as the concepts of disease mongering (pejorative way of describing the role of the pharmaceutical industry in the increasing place of health in life). I also acknowledge that I don’t have the knowledge nor the willpower to engage in this endless and highly technical debate. It is for this reason that I have decided to take an almost anthropological stand at the situation and avoid the question of efficacy.

 When anthropologists study the role of shamans or sorcerers in societies (technological or traditional societies – yes there are still such practices in Western countries nowadays!), they do not argue the effectiveness of the spiritual procedure; either because the researcher considers in a slightly cynic way that such beliefs are kinda retarded or because he/she voluntarily chooses a neutral position. Adopting such a position in our modern societies on the topic of pharmaceuticals suggests that I put medicines at the same level as an exorcist procedure. Because I work in an environment completely devoted to the assessment of pharmaceuticals’ effectiveness, it makes it delicate to adopt an external position. Sorry for the comparison, it is as if I was anthropologically questioning the usage of exorcism as I simultaneously worked as priest assistant! It is complex, yet surely not impossible.

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