Evidence-Based Betrayal: Bias in Healthcare Research
One of the first terms I remember learning in nursing school was “evidence-based.” Right before I took my very first set of vital signs, my first clinical instructor said, “Everything in modern, western medicine is evidence-based; before you perform any nursing task, think about the evidence.”
I loved the concept; it made me feel safe. I felt that as long as I knew how to find the evidence, I’d be okay as a new nurse. For example...
The order says I should weigh my patient daily, but when during the day?
Well, the evidence says you should weigh patients at the same time every day for the most accurate representation of fluctuations.
Why are patients given baths with antiseptic wipes immediately before surgery?
Well, research has shown it decreases postoperative infection rates by such-and-such percent.
As I grew as a nurse and began teaching students myself, I found myself echoing the sentiment of my first clinical instructor. In fact, I spend hours teaching my students how and where to find credible, evidence-based information when unsure.
“You’re not expected to remember everything as a nurse, you’re expected to know who to ask and where to find everything” is what I tell every group of students I meet on the very first day.
Aside from day-to-day nursing tasks, evidence-based research helps us provide culturally competent care to the various demographics of people we serve in the United States. Our healthcare textbooks explain how western medicine is viewed from various points of view and offers strategies to help provide inclusive care.
While research cannot replace listening to each patient’s specific needs, it truly helps us as providers understand how best to approach providing care based on commonly known cultural norms.
Okay, so research is an awesome tool for healthcare providers. Got it. But is there a downside? Let’s start by defining what qualifies as “research.”
What Is Research?
Research is the systematic investigation into and study of materials and sources in order to establish facts and reach new conclusions, according to Oxford Dictionary. Just as the definition states, research is a system within which there is protocol in place to ensure the conclusions we draw from given information are safe and dependable.
The research process essentially* goes as follows:
- Someone determines there is a problem that needs to be solved or a question that needs an answer. This person is a researcher.
- The researcher reviews current literature to determine if their question has already been answered by prior research, and if there is anything to add to what has already been researched.
- This researcher then determines the most appropriate methods to study this problem or question to yield the answer they are looking for.
- The researcher then investigates this problem or question using the appropriate methods determined in Step 3 and collects data.
- The researcher concludes the investigation, sorts the data, determines if the findings are statistically significant (aka are these findings by chance or not) and draws a conclusion about the problem/question based on the study data.
- The researcher then compiles all of these steps into a scholarly article and submits the article to a related publisher (like an esteemed medical journal) to be published.
- The publisher’s review board extensively reviews the question asked, the study methods, and data findings to determine if the conclusion drawn by the researcher is truly backed by their data and adds to the scientific and/or medical communities.
- The review board approves the researcher’s submission, and the researcher’s study will now be published.
*This list is highly condensed and does not detail all steps in modern medical research, but you get the idea.
Now that the research has been published, the healthcare community reviews the data and decides whether to incorporate the findings of this study into their established standard of care.
With such an involved process, many of us in healthcare trust what is published and feel comfortable incorporating the latest findings into our care for patients. We are even more comfortable when the research is published in a world-renowned, long-standing, respected medical publication. After all, if anything is wrong, it should have been caught during some portion of the lengthy review, right?
Now enter #medkini and #medracism.
The Height of #medkini and #medracism
During summer 2020, two published articles were, very publicly, shamed for implicit bias, sexism, racism, and classism among others.
The now-retracted article behind the hashtag #medkini, titled “Prevalence of unprofessional social media content among young vascular surgeons,” was scrutinized for shaming woman healthcare providers who share “unprofessional” photos in bikinis and Halloween costumes on their personal social media pages.
The article disproportionately discussed the social media content of female vascular surgeons, and the study was conducted by a majority male group.
The other now-retracted article is behind the #medracism hashtag. “Poverty & Culture” was called out for egregious racism and classism due to the author’s claim that poverty in certain populations is due to cultural differences as opposed to systemic racism. The author stated, “Fifty years after civil rights, their main problem is no longer racial discrimination by other people but rather that they face an individualist culture that they are unprepared for.”
The article completely ignores the impact of systemic failures on the populations he frequently writes about. The author of “Poverty & Culture” is even considered an “expert” on the topic of welfare and is frequently consulted by lawmakers for his opinion on related legislation.
Both articles made it through the rigorous peer-review process, were published in well-known academic journals, and were only questioned after a massive virtual shaming. And both articles “scientifically” confirmed sexist and racist notions to be fact, respectively.
This led me to ask:
- How many articles have we missed!?
- How many times have medical and nursing students been assigned reading like the above-mentioned articles?
- How many patients have been treated poorly based on “evidence?”
- How can such a rigorous system be so terribly flawed!?
- And how can I trust research that has betrayed me and the patients I care for?
These questions still float around my mind to this day; I—we all—need to be more vigilant.
Where Do We Go From Here?
Change MUST come to the field of research. Peer review boards MUST be more diverse and inclusive. Publishers MUST be held accountable for the content printed in their journals. Lastly, we as healthcare providers MUST continue to call out these biased articles and demand retractions.
If we are to continue to trust the research-based, fact-checked system that we have all become so accustomed to putting all of our faith into, we must all do our part. We must all acknowledge the power of the published pen and habitually dissect and analyze the facts published works claim to prove.
We must continue to hold publishers accountable for the words they print. And researchers, you need to continuously check your bias when conducting research, ensure your teams are diversely staffed, offer varied perspectives, and understand the power of the studies you conduct.
Remember: Your work will be used to educate the next generation of providers.
I will admit prior to #medkini & #medracism, I would quickly skim articles to find what I needed without making sure methods were unbiased. However, now when doing my own research or when teaching my students about researching evidence now, I will be sure to include further checking for bias.
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