Screening scepticism - A seminar with Dr. James Coyne

We are not sceptical enough as researchers, academics and scientists. Dr. James Coyne introduced himself as a sceptic: scrutinising the quality of evidence in research with a critical eye. Coyne's work mainly focuses on the lack of a solid evidence base for clinical screening and, as a result, access to treatment. Firstly. it was noted that clinical guidelines are notoriously biased to their own provision of services. I personally believe that official guidelines should not be taken as gospel, and be viewed critically, in the same way we view our research. Unfortunately, the world of academia is highly politicized. The way to tackle this is through awareness, scepticism and a critical outlook upon not only the evidence provided by others, but also of your own research. 

As an example, Coyne disputed the notion of distress as the 6th vital sign, often measured as a distress thermometer. However, unlike the other vital signs such as blood pressure for example, distress has a strong psychosocial component. Therefore, is it valid to measure distress in the same way we would with biological symptoms? Of course not. Measures like these seem to disrupt clinical conversations and restrict the patients from expressing their true concerns and feelings. The facts seem to be that, even when distress was 'diagnosed' using these methods, a referral to services was unlikely to improve patient outcomes. Individuals who are already highly distressed are either already receiving services or simply do not want them, preferring to self-manage or use their own social networks for support. The weak link in clinical diagnosis is not detection but completion of referral for those individuals who actually want to access services. 

The notion that doctors are 'not paid to solve problems' but are 'paid to do procedures' is misguided to say the least. 

I entered this seminar, already a firm believer in being critical, but I left wanting to be a true sceptic.