One of the biggest obstacles to understanding scientific papers is the language they are written in, on occasions the suspicion is that bad studies are deliberately obscured by the use of an elitist language masquerading as a formal intellectual style of presentation. Nowhere has this been more apparent than in the cannabis / mental health debate where an established formal language makes these papers almost totally inaccessible to the lay reader – that’s most of us. Rather too often mutton is dressed as lamb by the pompous use of formal business style of writing which can mask personal opinions as some kind of highly respected academic statement of fact. The whole drugs debate is littered with writers who excel at this, some of whom this blog has mentioned in the past.
Now of course a formal language is necessary for academic studies as (at least in theory) it makes meaning clear and precise. However, much is often made of these studies not least by the media who either deliberately or otherwise misrepresent research, often presenting tentative results as solid proof. Providing a plain language summary would go a long way to preventing a misrepresentation of the authors work and in allowing the public to be better informed.
So it was a pleasent surprise to see a paper this week on the use of heroin maintenance for addicts entitled “Heroin maintenance for chronic heroin-dependent individuals” by Marica Ferri, Marina Davoli and Carlo A. Perucci, you can see the abstract here which contains a not only the usual sections such as Background, Objectives, Results and Conclusions, but also one headed “Plain language summary”. Yes, on this occasion the authors seem to have tried to present their findings in English which can actually be understood, this could be a first!
Sadly they didn’t do very well in places, coming out with:
The available evidence suggests a small added value of heroin prescription for long-term, treatment-refractory opioid users.
This can hardly be called “plain language”. What “treatment-refractory opioid users” means is heroin addicts who have been through standard methadone maintenance and other therapies and have continued to use street heroin – “refractory” in this sense means “resistant to treatment”. So what they are trying hard to say in plain English is that for the really hopeless cases of people determined to use heroin, letting them use heroin under properly supervised and regulated conditions is the probably the best option.
The thing is of course, if you really do use plain English it makes it all so much easier to understand and the conclusions they come to seem like the blindingly obvious if that’s what they actually are. Anyway once we have the results of studies like this available in plain English we can all start debating the issues in a meaningful and informed way and that can only be a good thing.
Of course, having set out to explain things clearly it invites questions. They write:
Adverse events were consistently more frequent in the heroin group.
But the abstract doesn’t explain this further, although of course the full paper might. Here it’s just stated as a fact and because of this the authors recommend
Heroin prescription should remain as a last resort treatment for people who currently or have previously failed maintenance treatment.
Another problem with plain language writing here because they don’t mean “failed maintenance treatment”, rather they mean people who have failed substitution treatment with methadone. Now of course we are talking about the most intractable cases here, these are people who are determined for whatever reason to use heroin and so have a long tradition – of that’s the right word – of chaotic street use where “adverse reactions” are quite commonplace, so the increased “adverse reactions” in a properly regulated environment are going to be less than happens onthe street. In any case the conclusions seem to be that for the most problematic people who refuse or are utterly unable (for whatever reason) to go along with prohibition’s aims of preventing heroin use, the best option is to give them it. This would seem to back up a lot of the current thinking about heroin maintenance which is, of course, opposed strongly by prohibition supporters.
The problem with this is a prohibition supporting critic would probably point to the incentive to fail all other treatments because the ultimate reward would be a supply of the thing the addicts crave most, thus undermining the enforcement of prohibition and it is difficult to argue with that logic, if logic it is. Ultimately if this study is being presented in a way which attempts to make heroin maintenance acceptable within the strict drug war prohibition regime, it’s going to face that criticism. That this might be the case is shown in the language used:
Drug users who were provided with heroin prescribed with flexible doses of methadone used fewer illicit substances and reduced the probability of their being imprisoned.
There is something rather odd about this statement. It doesn’t say the study group used less drugs, just that they used less “illicit substances”, so a reduction of cannabis use at the expense of increased alcohol consumption would presumably have counted as a good thing? Reducing the probability of being imprisoned of course is directly related to the workings of prohibition so keeping them away from the black market trade and all that entails is obviously going to reduce their likelihood of prison time. Presenting the results in plain language makes it easy to focus on points like this, which is not being pedantic.
The authors conclusions that heroin maintenance should be restricted to the hard core addicts only after everything else has failed is open to debate, after all it isn’t usually the case in life that something which shows benefits to the most intractable cases wouldn’t also have benefits to everyone involved. But this paper is to be welcomed because it does help move the debate forward and because they have tried to explain things to the wider audience.
Presenting their findings in plain language is a good first step to allowing a wider debate, it’s just a pity they didn’t quite manage it in places. But it’s to be hoped that plain language summaries will become a regular feature of all scientific studies in the not too distant future.
