Current Events, Tech & Innovation
Evidence-Based Betrayal: Bias in Healthcare Research
October 27, 2020
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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.”
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:
*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.
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:
These questions still float around my mind to this day; I—we all—need to be more vigilant.
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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