Old folk at lunch

Friday, September 8, 2017

How bureaucracy destroys research in U.S. hospitals


I originally wrote this for one of my other blogs but I think it has a place here too

There is a long article here which gives a blow by blow account of a doctor trying to get permission to do a research study -- a study that seemed to need doing.  He spent years dealing with the bureaucracy only to be defeated by all the nitpicking in the end.  He was not able to do a perfectly reasonable study.

The article had a particular resonance to me because what he wanted to do -- a questionnaire survey -- was something I did many, many times in my research career.  And I never asked ANYBODY for permission.  I just did it.  So how come the difference?  Several possible reasons:

I did my research in the '70s and '80s.  Things may have tightened up more by now.

I also did my work mostly in Australia, a much less uptight country than the USA.  Many of my fellow academics, including the head of school, would have had a pretty good idea of what I was doing but trying to rein me in would have needed effort and they just could not be bothered with that

But perhaps the key factor was that I did not ask.  I did not set the bureaucratic machinery in motion. The bureaucracy just did not know of me. I was below their horizon.  I had not foolishly set their rumbling machinery into motion.  "Just do it" was an old piece of Hippie advice from the '60s and I was there in the '60s.

So with my experience I read with great horror what this guy experienced.  But he makes the correct point that bureaucracy does that.  The job of the bureaucracy is to say "No" to anything that might conceivably be dangerous in some conceivable world and it takes a lot to get around that.  And sometimes you can't.

And the end result?  I had 200+ academic journal articles published whereas this guy had none.  What a waste!

I think his final comments are worth reproducing:


"I sometimes worry that people misunderstand the case against bureaucracy. People imagine it’s Big Business complaining about the regulations preventing them from steamrolling over everyone else. That hasn’t been my experience. Big Business – heck, Big Anything – loves bureaucracy. They can hire a team of clerks and secretaries and middle managers to fill out all the necessary forms, and the rest of the company can be on their merry way. It’s everyone else who suffers. The amateurs, the entrepreneurs, the hobbyists, the people doing something as a labor of love. Wal-Mart is going to keep selling groceries no matter how much paperwork and inspections it takes; the poor immigrant family with the backyard vegetable garden might not.

Bureaucracy in science does the same thing: limit the field to big institutional actors with vested interests. No amount of hassle is going to prevent the Pfizer-Merck-Novartis Corporation from doing whatever study will raise their bottom line. But enough hassle will prevent a random psychiatrist at a small community hospital from pursuing his pet theory about bipolar diagnosis. The more hurdles we put up, the more the scientific conversation skews in favor of Pfizer-Merck-Novartis. And the less likely we are to hear little stuff, dissenting voices, and things that don’t make anybody any money.

There are so many privacy and confidentiality restrictions around the most harmless of datasets that research teams won’t share data with one another (let alone with unaffiliated citizen scientists) lest they break some arcane regulation or other. Closed access journals require people to pay thousands of dollars in subscription fees before they’re allowed to read the scientific literature; open-access journals just shift the burden by requiring scientists to pay thousands of dollars to publish their research. Big research institutions have whole departments to deal with these kinds of problems; unaffiliated people who just want to look into things on their own are out of luck.

SOURCE

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