2018 Annual Sowerby Lecture
13 November 2018 - 19:30-21:00
Reflections on why I want what I want from research and researchers — as a patient
Lecture: Sir Iain Chalmers
Theatre 2, New Hunt’s House, KCL Guy’s Campus
A quarter of a century ago, I decided to ask myself what I wanted—as a patient—from health research and researchers. In a BMJ paper I stated that I wanted decisions about my health care to be informed by ‘reliable evidence’. I also noted that people are bound to vary in what they regard as ‘reliable evidence’, and that a leap of faith would anyway always be needed in judging what the effects of health care options would be for me, as an individual. But I also made clear that, for me, ‘reliable evidence’ would usually mean evidence derived from systematic reviews of carefully controlled evaluative research, assembled with an awareness of the ways in which biases and the play of chance can play us false.
I suggested in the paper that there had been too little support for the kind of applied health research that I felt I needed to inform my health care choices. And I gave examples of the damaging consequences that can result from insufficient attention to reducing the effects of biases and the play of chance.
My lecture will revisit the themes I addressed 25 years ago and reflect on why—as a patient—I still want what I wanted from research and researchers quarter of a century ago.
About the Speaker:
Iain Chalmers was founding director of the National Perinatal Epidemiology Unit (www.npeu.ox.ac.uk) between 1978 and 1992, and founding director of the UK Cochrane Centre (www.uk.cochrane.org) between 1992 and 2002. Since 2003, he has coordinated the James Lind Initiative, which developed the James Lind Alliance between 2004 and 2013 (www.jla.nihr.ac.uk). Iain edits The James Lind Library (www.jameslindlibrary.org) and Testing Treatments international English (www.en.testingtreatments.org); he co-organised with Paul Glasziou the 2014 Lancet series on reducing waste and adding value in biomedical research (www.rewardalliance.net); and he is a co-investigator with Andy Oxman and colleagues in Norway and East Africa of the Informed Health Choices Project (www.informedhealthchoices.org).
Annual Sowerby Lecture -- All Welcome
26 November 2015 - 18:30-20:00
“If I had to live like you, I think I’d kill myself”: Explaining the Disability Paradox
Lecture: Havi Carel, Professor of Philosophy, University of Bristol
Comment: Brian Hurwitz, Professor of Medicine and the Arts, King’s College London
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The ‘disability paradox’ identifies a significant difference in how ill and disabled people rate their wellbeing, compared with healthy people asked to imagine how happy they would be if they were unwell. Ill and disabled people’s wellbeing rating is only slightly lower than that of healthy people. However, healthy people rate their hypothetical wellbeing as much lower when asked to imagine themselves as ‘hypothetical patients’. There are three possible explanations: either patients misreport their wellbeing due to adaptation, or healthy people mis-imagine ill-health, or both.
In this paper I examine these explanations and suggest that it is healthy people who misimagine ill-health. I also claim that it is impossible to claim that ill people are misreporting their wellbeing due to adaptaion without this having general consequences for any subjective wellbeing measurements. I also claim that the phenomenon of adaptation to illness raises important questions for health economics, and that the psycho-social mechanisms involved in adaptation can be illuminated by a phenomenological analysis.
2016 Annual Sowerby Lecture
24 November 2016 - 19:30-21:00
Medical Nihilism: Should we trust medical research?
Many prominent physicians and journalists have expressed arguments supporting medical nihilism, which is the view that we should have little confidence in the effectiveness of novel medical interventions. In this talk I assess the case for medical nihilism. Salient arguments are based on the frequency of failed medical interventions, the extent of misleading and discordant evidence in clinical research, the sketchy theoretical framework on which many medical interventions are based, and the malleability of even the very best empirical methods employed in clinical research. To evaluate medical nihilism with care I articulate the general argument in formal terms. If we attend more broadly to our evidence, malleable methods, and background theories, and reason with our best inductive framework, then I argue that our confidence in the effectiveness of most medical interventions ought to be low.
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2017 Annual Sowerby Lecture
9 November 2017 - 19:30-21:00
Mental Health and Justice: Classical and Romantic perspectives
Lecture: Gareth Owen – King’s College London, Institute of Psychiatry, Psychology and Neuroscience
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Psychiatry has long attracted interpretations from cool, detached perspectives valuing objectivity (Kraepelin, Freud, Beck) to hotter, embodied perspectives valuing subjectivity (Reil, Laing, Foucault).
These two perspectives (‘classical’ and ‘romantic’) are now expressing themselves in psychiatry’s meeting point with law with different approaches taken to the decision-making of the mentally ill. A recent ‘classical’ achievement in this area is the Mental Capacity Act (2005) which lays out a test of decision-making capacity within a legal framework that has been described as “a masterpiece of legal clarity”. A recent romantic achievement has been the UN Convention on the Rights of Persons with Disabilities which emphatically asserts a social model of mental illness in which society, not the brain, is the true source of disabilities.
This lecture will probe the subjectivity of some disorders of mind and brain. What, for example, is it like to be a decision-maker under conditions of brain injury unaware of one’s deficits or a person with affective disorder fluctuating between experiences of the future as intensely dark and intensely bright? And how should others respond? It aims to use these forms of human experience to challenge the single mindedness of both classical and romantic perspectives and draw out implications for psychiatry as a branch of medicine interacting with law and society.
About the Speaker:
Dr Gareth Owen leads the Wellcome Trust funded Mental Health and Justice Project – a collaborative research endeavour spanning psychiatry, law, ethics, neuroscience and social science/public policy. The project takes an interdisciplinary approach to the core dilemma of respecting vs. protecting the decision-making of people with mental disabilities or disorders. He did undergrad studies in physics, philosophy and medicine and post grad psychiatry training at the Maudsley.