588440 research-article2015
SJP0010.1177/1403494815588440E. HemminkiExperimental research in public health
Scandinavian Journal of Public Health, 2015; 43: 445–446
editorial
Experimental research in public health
Elina Hemminki
A wider use of experimental research in public health, particularly in health services research, would be a useful addition to the research portfolio. Our knowledge of environmental (social and biological) factors influencing health is largely based on observational studies and practice experience. However, in order to determine causality, experimental research is usually the strongest method, especially in health services research. Decisions to intervene or organize services are not usually random, but depend on the outcomes of interest; unexpected effects are many and other changes in the environment are likely. Unlike observational research, experimental research approaches are still to find their place and even their name. In English, terms have been used such as randomized health services study, randomized routine procedures, health services-based trials, community trials, randomized social experiments and trials for policy. I have recently seen observational studies concluding that regularly eating eggs is not harmful, using postmenopausal hormone therapy reduces mortality and using testosterone drugs on ageing men is useful and safe. The long-term effects of nutrition are difficult, even though not impossible, to study experimentally, so the impact of egg-eating habits may still be based on observational studies. But it is inappropriate to draw causal conclusions of observational studies on exposures given intentionally, and by definition, selectively. Postmenopausal hormone therapy is a good example: most observational studies show that women using it have a better health prospect than those not using, but this result is usually not supported by experimental studies. Both self-selection and selection by physicians of healthier and more health conscious women to use hormone therapy is a likely explanation of the discrepancy. The reasons to opt for observational rather than experimental studies include study feasibility, costs
and attitudinal reasons. It is much easier to observe than to ask institutions or individuals to change their way of doing things. Experiments are easier when a new free-standing exposure, say a new vaccination or screening method, is taken into practice. But, if the intervention is complex requiring support from various actors, administrative challenges may be discouraging. This particularly concerns young researchers, who have tight timetables and need to produce results in a fixed time period, not allowing time for lengthy negotiations. Furthermore, they are often not in a good position to negotiate with actors outside research circles. The administrative challenges of experimental research also concern clinical research with complex interventions. The development, particularly in the USA, to integrate research closely with patient care (‘learning health care’) is a promising development, both in terms of administrative simplicity, costs and attitudes. However, public health does not have similar wealthy structures as the caring health services, and imbedding public health research in services is more difficult. The preventive health services need a clearer structure and mandate. In the Nordic countries there is too little noncommercial funding available for health research. Health research has become a luxury product, as one researcher put it. How to increase funds and guarantee its fair distribution to various research fields, are pressing questions, which I will not cover here. But another method to help balance the needs and the availability of research money is to reduce costs by making research less expensive. In experimental public health research, there are many ways in which this could be done: by integrating research into practice, by utilizing readily collected outcome data and by proportioning research regulation. Some of this can be done by researchers themselves, but research regulation requires a new look by various gate-keepers.
© 2015 the Nordic Societies of Public Health DOI: 10.1177/1403494815588440
Downloaded from sjp.sagepub.com by guest on November 14, 2015
446 Editorial Within clinical medicine there is a lively discussion and even action in some countries to modernize ethics requirements, particularly informed consent and guaranteeing data confidentiality. In the Nordic countries, the data protection laws and practices have mostly been research-friendly, but future EU regulations may worsen the situation. Informed consent needs a thorough discussion on why, how and when it should be required in public health intervention research.
The practical difficulties and costs may thus far have contributed to resistance among some researchers towards experimental research, even in situations when it would be a good approach. Methodological puritanism and rigidity may have contributed to this resistance. Further causes are competition for research money and rivalry between different schools and approaches. Such obstacles are difficult to abolish, but good examples of useful experimental research and support from public health community may help.
Downloaded from sjp.sagepub.com by guest on November 14, 2015
SJP0010.1177/1403494815588440E. HemminkiExperimental research in public health
Scandinavian Journal of Public Health, 2015; 43: 445–446
editorial
Experimental research in public health
Elina Hemminki
A wider use of experimental research in public health, particularly in health services research, would be a useful addition to the research portfolio. Our knowledge of environmental (social and biological) factors influencing health is largely based on observational studies and practice experience. However, in order to determine causality, experimental research is usually the strongest method, especially in health services research. Decisions to intervene or organize services are not usually random, but depend on the outcomes of interest; unexpected effects are many and other changes in the environment are likely. Unlike observational research, experimental research approaches are still to find their place and even their name. In English, terms have been used such as randomized health services study, randomized routine procedures, health services-based trials, community trials, randomized social experiments and trials for policy. I have recently seen observational studies concluding that regularly eating eggs is not harmful, using postmenopausal hormone therapy reduces mortality and using testosterone drugs on ageing men is useful and safe. The long-term effects of nutrition are difficult, even though not impossible, to study experimentally, so the impact of egg-eating habits may still be based on observational studies. But it is inappropriate to draw causal conclusions of observational studies on exposures given intentionally, and by definition, selectively. Postmenopausal hormone therapy is a good example: most observational studies show that women using it have a better health prospect than those not using, but this result is usually not supported by experimental studies. Both self-selection and selection by physicians of healthier and more health conscious women to use hormone therapy is a likely explanation of the discrepancy. The reasons to opt for observational rather than experimental studies include study feasibility, costs
and attitudinal reasons. It is much easier to observe than to ask institutions or individuals to change their way of doing things. Experiments are easier when a new free-standing exposure, say a new vaccination or screening method, is taken into practice. But, if the intervention is complex requiring support from various actors, administrative challenges may be discouraging. This particularly concerns young researchers, who have tight timetables and need to produce results in a fixed time period, not allowing time for lengthy negotiations. Furthermore, they are often not in a good position to negotiate with actors outside research circles. The administrative challenges of experimental research also concern clinical research with complex interventions. The development, particularly in the USA, to integrate research closely with patient care (‘learning health care’) is a promising development, both in terms of administrative simplicity, costs and attitudes. However, public health does not have similar wealthy structures as the caring health services, and imbedding public health research in services is more difficult. The preventive health services need a clearer structure and mandate. In the Nordic countries there is too little noncommercial funding available for health research. Health research has become a luxury product, as one researcher put it. How to increase funds and guarantee its fair distribution to various research fields, are pressing questions, which I will not cover here. But another method to help balance the needs and the availability of research money is to reduce costs by making research less expensive. In experimental public health research, there are many ways in which this could be done: by integrating research into practice, by utilizing readily collected outcome data and by proportioning research regulation. Some of this can be done by researchers themselves, but research regulation requires a new look by various gate-keepers.
© 2015 the Nordic Societies of Public Health DOI: 10.1177/1403494815588440
Downloaded from sjp.sagepub.com by guest on November 14, 2015
446 Editorial Within clinical medicine there is a lively discussion and even action in some countries to modernize ethics requirements, particularly informed consent and guaranteeing data confidentiality. In the Nordic countries, the data protection laws and practices have mostly been research-friendly, but future EU regulations may worsen the situation. Informed consent needs a thorough discussion on why, how and when it should be required in public health intervention research.
The practical difficulties and costs may thus far have contributed to resistance among some researchers towards experimental research, even in situations when it would be a good approach. Methodological puritanism and rigidity may have contributed to this resistance. Further causes are competition for research money and rivalry between different schools and approaches. Such obstacles are difficult to abolish, but good examples of useful experimental research and support from public health community may help.
Downloaded from sjp.sagepub.com by guest on November 14, 2015
