Reporting in The New York Times, Gina Kolata offers a compelling lede:
The findings of a large federal study on bypass surgeries and stents call into question the medical care provided to tens of thousands of heart disease patients with blocked coronary arteries, scientists reported at the annual meeting of the American Heart Association on Saturday.
The new study found that patients who received drug therapy alone did not experience more heart attacks or die more often than those who also received bypass surgery or stents, tiny wire cages used to open narrowed arteries.
And Julie Steenhuysen adds an interesting detail to this new major study: “At least two prior studies determined that artery-clearing and stenting or bypass surgery in addition to medical treatment does not significantly lower the risk of heart attacks or death compared with non-invasive medical approaches alone.”
But these details may prove to be the most important ones of all: “Over $8 billion worth of coronary stents will be sold annually by 2025, according to a new research report by Global Market Insights, Inc. The increase over the years will be created by an increase in artery diseases coupled with a growing demand for minimally invasive surgeries,” explains Stephen Mraz.
So now let’s do the math. If heart doctors shift to what the new research shows, “The nation could save more than $775 million a year by not giving stents to the 31,000 patients who get the devices even though they have no chest pain, Dr. Hochman said,” reports Kolata.
Better and less intrusive patient care, lower overall medical costs for a U.S. healthcare system already overburdened—what is there to keep the medical profession from embracing compelling scientific research?
Well, the market of course.
Lower costs come from fewer heart surgeries, meaning heart surgeons lose income—and possibly patients.
Keep in mind that while the medical profession decades ago emphasized best practice in prescribing antibiotics (only when bacterial infections are detected), many doctors found that following best practice led to dissatisfied patients, who flexed their consumer muscles by finding doctors who would usurp best practice and prescribe the requested antibiotics even when they weren’t warranted.
The new research on stents and heart disease treatment is a cautionary tale involving research, the media, and the market—a cautionary tale that should inform the current call for the “science of reading,” especially as that impacts children with dyslexia.
That several studies now show the use of stents should be reduced or at least delayed, but that doctors have resisted that evidence calls out for us to ask an important question about scientific research: In whose interest is the research being applied?
At the International Literacy Association 2019 conference, P. David Pearson, University of California, Berkeley, lays out in about 11 minutes a compelling unpacking of What Research Really Says About Teaching Reading–and Why That Still Matters.
In this framing talk before a panel discussion, Pearson confronts the role of media in misinforming the public about research, challenges advocates of “scientific research” who fluctuate between endorsing research and following “common sense,” and calls for not ignoring “scientific research” but expanding the types of research relied upon to make teaching and learning decisions (recognizing a broad spectrum of evidence-based research that trumps ideology or assumptions).
One of the most compelling examples offered by Pearson is how the media framed research on reading after the report from controversial National Reading Panel (NRP), at the center of No Child Left Behind’s mandate for scientific research. The headline Pearson highlights is “Systematic, explicit, synthetic phonics improves reading achievement.”
Yet, the specific study being cited actually was far more complicated, and less endorsing of systematic phonics; along with “many other elements…, a small but robust effect for a subset of the population is found on a measure that requires kids to read a lists of pseudowords.”
Pearson adds that even if we accept the larger NRP report as valid (and several scholars do not), the report calls for systematic phonics for K-1 students, not older struggling readers. Yet, as Pearson explains, many calling for the “science of reading” push for systematic phonics programs throughout grades well beyond grade 1.
So there exists several traps in calling for scientific research in education, and more narrowly, in the teaching of reading.
As another example, consider Timothy Shanahan’s response to the effectiveness of dyslexia fonts:
Over the past decade or so, three new fonts have appeared (Open Dyslexia, Dyslexie, and Read Regular), all claiming—without any empirical evidence—to somehow aid dyslexic readers.
Since then there have been 8 studies into the value of these fonts.
Most of the studies found no improvement in reading rate, accuracy, or eye fixations (Duranovic, et al., 2018; Kuster, et al., 2018; Rello & Baeza-Yates, 2013; Wery & Diliberto, 2017). The studies even found that dyslexics—children and adults—preferred reading standard fonts to the special ones (Harley, et al., 2016; Kuster, et al., 2018; Wery & Diliberto, 2017).
Only one study reported a benefit of any kind—the dyslexic students in this study read faster (Marinus, et al., 2016). This benefit apparently came, not from the font design, but from the spacing within and between words. The researchers increased the spacings in the standard fonts and the same effect was seen. Masulli (2018) likewise found that larger spacings improved the reading speed of dyslexics—but that effect was apparent with non-dyslexic readers, as well.
Reading faster is a good thing, of course, as long as reading comprehension is maintained. Unfortunately, these studies didn’t look at that.
The use of dyslexia fonts, then, are driven by the market—consumer demand being met by businesses—but not supported by evidence; neither the claims of the businesses nor the outcomes from implementing the fonts are justified by “scientific evidence.”
Just as Hooked on Phonics flourished in two different iterations (the first felled by court rulings that exposed the lack of research backing market claims), many reading and phonics programs in education are buoyed by ideology and the market but not by research.
But the traps around programs and “scientific” are extremely complex from two different angles.
First, as noted in several examples above, teaching and learning are likely not served well within a market dynamic whereby parents and students are the consumers and teachers and the schools serve the inexpert demands of those consumers.
Yes, parents and students have a right to express their need, but they most often lack the expertise to demand how that need should be met.
Parents of children with reading problems or dyslexia should be demanding that their children be served better and appropriately. But calling for specific policy and practice is outside the purview of those “consumers.” (This is the same dynamic in patients seeking doctors who prescribe antibiotics when they are not needed, creating a health hazard for themselves and others when medical best practice is usurped by market demand.)
The second trap, however, is “scientific” itself. As I have detailed, experimental and quasi-experimental research (what we mean by “scientific,” as Pearson discusses) draws causal relationships that can be generalized. By definition, then, generalizable research doesn’t address outliers or real-world situations where several factors impact the effectiveness of teaching and learning.
The “scientific” trap positions a parent of a child struggling to read, diagnosed with dyslexia, into a problematic corner if that child finds success with dyslexia fonts, a practice not supported by research.
Teaching and teachers must be guided by evidence, both the evidence of a wide range of research and the evidence drawn from the individual students in any classroom.
To teach is to quilt together what a teacher knows about the field, reading for example, and then to match instruction to where any student is and where any student wishes to go.
This, ironically, is the philosophy behind balanced literacy, the approach demonized (usually with false claims and without evidence) by those calling for the “science of reading.”
Each time advocacy for systematic intensive phonics for all students gains momentum, I ask the key question: In whose interest is the research being applied?
Go back to the new research on stents, a true life-and-death matter, and think about that question when you read the media demand the “science of reading.”
For Further Consideration