by Link Swanson
This paper describes how scientists have explained the effects of psychedelic drugs over the course of the 19th, 20th, and 21st centuries. The paper finds common ideas shared between all the theories, and looks at how they explain the diversity of subjective effects, healing power, and ability to mimic aspects of psychosis associated with psychedelic drugs.
by Maia Szalavitz
This article reports on software used throughout the US to help doctors and pharmacists to evaluate the risk of addiction in patients. How this software calculates its risk scores is opaque, but it has significant influence over prescribing decisions and this can lead to patients being denied medication that is essential for them to manage their pain.
by Candice Brathwaite
The author shares her personal account of becoming a mother in London as a Black British woman, including how she nearly died from postpartum sepsis and how she navigates racism and cultural expectations of motherhood. Her story is interspersed with national statistics about inequalities in maternal and neonatal healthcare in the UK, including the shocking statistic that Black women are four times more likely to die during pregnancy, childbirth and in the first six weeks following childbirth than White women.
by Markus Strasser
The author describes his attempt to build tools to help industry extract knowledge from the biomedical literature. He concludes that these kinds of tools are not useful to industry for several reasons, including that the most useful knowledge is in people rather than in papers.
Related: Some good discussion of the article on Hacker News.
by Shayla Love
Researchers have found that Chinese people tend to express psychological distress through their bodies – which is known as somatization. The article describes some of this research, and how it links to cultural differences between China and Western countries.
by Alice Evans
Southern and North-Eastern Indian women do better on many measures than women in North and North-West India. The article considers a variety of explanations for this including types of crops grown, conquest, colonialism, and poverty.
by Musa al-Gharbi
This paper argues that although social scientists have looked at how their fields have been shaped by Western empires, they haven’t looked much at how social science functioned in other empires. It then describes the work of four Muslim scholars working in the Islamic Commonwealth period to understand how they approached social science and their links to imperial power.
Related: An interview with al-Gharbi on this article and his other work.
by Hasok Chang
This paper describes an undergraduate class run by the author on the history of science where undergraduates did original research on a common theme. Each year of the class would build on the research of the previous year’s class, enabling the undergraduates to build on each other’s work and reach a publishable standard.
Related: An Element of Controversy: The Life of Chlorine in Science, Medicine, Technology and War – the academic book published from this work.
Thanks for reading!
We’re always looking for interesting reading materials so get in touch if you have any to share.
We are also currently looking for a health funding design intern.
Develop your skills and gain experience while helping to create a more open, just and responsible philanthropic sector.
The Good Problems Team at Science Practice helps science and innovation funders to identify and act on promising opportunities to tackle pressing global and local challenges.
We’re looking for an intern to join our team for 3 months in early 2022 (remote position). We are looking for curious and passionate people able to bring a combination of lived, academic and/or practical experience in one or more of the following disciplines:
If you are interested in building a better understanding of how funding priorities are set and helping to make this process a more open and participatory one, we want to hear from you.
We are a dedicated team of five with skills ranging from design and research to social entrepreneurship, strategy and community building. Our portfolio includes over 50 innovation programmes designed in collaboration with funders such as the Wellcome Trust, the Humanitarian Innovation Fund, Impact on Urban Health, and Nesta.
We are currently supporting funders to scope and design programmes that:
As an intern, you will work as part of our team to support the development and design of these programmes. This will likely include organising and taking part in interviews with stakeholders who have different perspectives and levels of power, developing and testing new programme models, designing and facilitating workshops, and carrying out complementary desk research. You will be mentored by one of our team members who you will report to for the duration of the internship. We will make sure that the projects you are involved in match your interests and skills as closely as possible, and that they offer a relevant learning experience for you.
This role is suitable for someone at the beginning of their career interested in exploring different aspects of working with large funders and developing programmes.
We are advertising this internship as a 3-month opportunity to start in mid–late January 2022, with the possibility to convert to a permanent role beyond this. For this internship, we are looking for applicants able to commit at least 4 days/week over this period.
In order to apply for this internship, you should have the right to work in the UK or be eligible to apply to work in the UK through an authorised immigration scheme for work placements.
We value diversity at our company. This is core to our work as developing a robust understanding of problems and how to tackle them requires a diversity of thought, experience, and perspectives. We welcome applications from all backgrounds and abilities, and encourage applications from those who identify as members of frequently excluded groups.
Throughout our recruitment process as well as once part of our team, we are happy to consider any reasonable adjustments that employees may need in order to be successful.
To apply, please submit your details via this form.
The deadline for applications is 10am on Monday, 17 January 2022 (extended from 10 January).
We will review applications on a rolling basis.
The application process will consist of two interviews – one with our team lead to discuss the role and your experience, and (if shortlisted) one with the wider team to explore in more detail your interest in the position and relevant experience.
We look forward to hearing from you! 🙌
No agencies, please.
We will soon be working on a project to explore priorities in pain research. To prepare for this, we wanted to get an overview of pain from the point of view of biomedical science, social science, and lived experience.
In this post, we’re sharing the most useful resources we came across and what we learned from them in case they might be useful for others interested in learning about this topic.
Textbooks are great for getting an accessible overview. We looked at a few and found this one most easy to engage with at this early scoping stage: Pain: A Textbook for Health Professionals. There is also Wall & Melzack’s Textbook of Pain which looked too detailed for getting started, and An Introduction to Pain and its Relation to Nervous System Disorders which was too advanced, although may become useful as we get deeper into the project.
We used a mix of YouTube videos and a textbook to familiarise ourselves with key concepts and processes.
The Science of Pain (and its Management) covers some of the basics of what pain is, types of pain, and types of drug treatments.
Armando Hasudungan creates videos with hand-drawn diagrams that are easy to learn from. His videos on nociceptors and pain physiology are useful starting points for pain specifically, and he has other videos on neurology such as Neurology - Divisions of the Nervous System.
Dr Matt & Dr Mike have an Introduction to Pain which is dense with clear, introductory information on biological mechanisms of pain and how pain drugs work.
Modern Brain and Pain Science and Implications for Care is an entertaining talk that describes a range of experiments in pain science, particularly on the psychological aspects of pain.
Finally, Section 1 (‘What is pain?’) of Pain: A Textbook for Health Professionals goes deeper on pain psychology, neuroanatomy, and neurophysiology.
We got interested in the role of central sensitisation in pain as it may explain how pain can become chronic. Central sensitisation “refers to the amplification of pain by central nervous system mechanisms.”1
We found this video to be an accessible starting point: Dr. Sletten Discussing Central Sensitization Syndrome (CSS). Then Chronic Pain and Sensitisation provides more detail on the biological mechanisms.
The neurobiology of central sensitization gives a detailed overview of the phenomenon. It was particularly interesting to learn about the overlap between different chronic pain conditions, many of which have been grouped under the term Chronic Overlapping Pain Conditions (COPCs), including fibromyalgia, irritable bowel syndrome, chronic fatigue syndrome, headache, endometriosis, and low back pain. It may be that all of these conditions have central sensitisation as an important cause. The article says that “many pain experts have suggested that COPCs are best understood as a single lifelong disease that merely tends to manifest in different bodily regions over time”.
The paper also makes a useful division between central sensitisation that is driven by ongoing input from pain sensors, and central sensitisation that has no such ongoing input. Which of these a patient has affects which kinds of treatment are likely to work.
We wanted to find out more about opioids given their importance in managing pain and the challenges around the opioid crisis in the US.
A couple of resources helped us get oriented on biological mechanisms. Opioids and Opiates gives a brief introduction to the mechanisms by which opioids work and Opioids describes types of opioids, mechanisms, and adverse effects.
The Opioid Crisis: Past Present and Future is a short talk explaining the causes of the US opioid crisis and potential solutions. It outlines how well-intentioned goals such as listening to patients and taking pain seriously intersected with pharmaceutical company influence and financial incentives to create a problem of overprescription.
However, it’s important to realise that the swing away from opioids since then has caused significant problems in the US. Two articles in Wired describe the challenges that American chronic pain patients have in accessing opioids in the wake of the opioid crisis. In A Drug Addiction Risk Algorithm and Its Grim Toll on Chronic Pain Sufferers, they investigate software used throughout the US to help doctors and pharmacists to evaluate the risk of addiction in patients. How this software calculates its risk scores is opaque, but it has significant influence over prescribing decisions and this can lead to patients being denied medication that is essential for managing their pain.
[T]he most troubling thing, according to researchers, is simply how opaque and unaccountable these quasi-medical tools are. None of the algorithms that are widely used to guide physicians’ clinical decisions—including NarxCare—have been validated as safe and effective by peer-reviewed research.
In The Unseen Victims of the Opioid Crisis Are Starting to Rebel, Wired documents a movement of people with chronic pain campaigning for access to the opioids that they need.
The campaign to keep opioids away from people who abuse them has ended up punishing the people who use them legitimately—even torturing them to the point of suicide. Now they are pushing back, mobilizing as best they can into a burgeoning movement. “Don’t Punish Pain” rallies are taking place in cities nationwide on May 22, and pain patients are organizing a protest at the Centers for Disease Control and Prevention in Atlanta on June 21.
We also wanted to learn more about what it is like to live with chronic pain. Chapter 2 of Pain: A Textbook for Health Professionals gave a useful overview. It describes three ways that chronic pain affects people’s lives:
The search for restoration – people go through a long and frustrating process of trying to find a diagnosis and cure.
Loss – having chronic pain often leads to many difficult losses, such as loss of work, relationships, social roles, and valuable identities.
Stigma – people with chronic pain are often treated with suspicion by healthcare professionals and others in society.
The chapter also contains many quotes from people with chronic pain, which are valuable for understanding their experience. This is an excerpt from a quote by Ron:
I’m pretty stuffed I suppose, stuffed in many ways. The consequences of it are, I’ve lost my career, I’m a lousy father in the sense of my ability to handle the kids for more than an hour at a time, there’s no football, running on beaches, the ability to socialise, all those sorts of things I can’t do because movement aggravates pain, any movement aggravates muscle and joint pain. The fatigue denies me any ability to keep my brain alive, so going out to dinner and talking to someone is generally just not on.
We also discovered the healthtalk.org website which collects people’s experience of health conditions through video interviews. They have a section on chronic pain which covers people’s experiences of pain management, medication, and the impact of chronic pain on their lives. This site is particularly valuable as they use rigorous qualitative methods to develop their resources. This means, for example, that they work to represent a wide range of experiences of a condition.2
It was also useful to look at social media to understand more about people’s lives. There are many videos on YouTube where people with chronic pain talk about their experience. For example, this interview with someone with fibromyalgia or this Q&A by someone with trigeminal neuralgia and anesthesia dolorosa.
It’s also useful to read the comments on YouTube videos about chronic pain, as often people with lived experience will share their views. There are often many critical comments on videos of talks by researchers and doctors, which are useful for understanding some of the frustrations that people with lived experience can have with the medical system. Searching Twitter for chronic pain also brings up a lot of discussion.
“To make sure that a wide range of experiences and views are included we use a method called purposive (or maximum variation) sampling (Coyne, 1997). We carry on collecting interviews until we are convinced that we have represented the main experiences and views of people within the UK” – Health Experiences Research Group ↩
We – the team at Science Practice – read a lot, from a fairly broad set of sources and with interests covering science, tech, philanthropy, social innovation, and the intersections between these. Our thinking is inspired by what we read, you may see this percolate through into our work. So, each month, we are going to share a handful of articles or other links that we’ve found particularly valuable, and why – in case this helps you too.
by Jessica Horn (2020)
How an NGO called AIR is working with African women who have experienced trauma, and how they have developed alternative ways of working with trauma compared with Western psychology.
Related: video interviews with their staff.
Why we’re interested: Western psychology can be unhelpful outside of its cultural context, and we wanted to understand how a different model could work.
by Tom Kalil (2017) - Found via 80,000 Hours
Tom Kalil worked as a senior advisor on science and technology policy at the White House under Clinton and Obama. In this paper he gives practical advice on how to get things done in large organisations.
Related: Podcast interview with him on having an impact in government.
Why we’re interested: we often work and collaborate with large organisations, and so it’s useful to have a practical understanding of how change happens.
by Bent Flyvbjerg (2016)
This paper responds to common criticisms of case studies, such as that they can’t be generalised from, to show that case studies are a crucial part of any social science discipline.
Related: Making Social Science Matter by Flybjerg, which analyses why social sciences haven’t succeeded as well as natural sciences, and how they could matter more in the future.
Why we’re interested: questions about what kinds of evidence are valuable repeatedly arise in our work, and we also are commissioned to write case studies as part of our work, so we wanted to better understand their value and the thinking that goes into writing a good case study.
by David Manheim (2020) - found via his excellent twitter account
Manheim describes how, as technological development increases, the fragility of technological systems will increase to a point at which a shock that can produce collapse is unavoidable.
Related: The Vulnerable World Hypothesis by Nick Bostrom, which Manheim’s paper builds on.
Why we’re interested: we’re interested in discovering problems that aren’t widely known, and this is an example of that.
by Jeffrey Funk (2021) - found via Nintil’s links
Funk argues that too many recent startups lack profitability, and examines the causes of this, tracing it to a lack of breakthrough technologies to exploit.
Why we’re interested: we want to better understand how innovation happens.
Thanks for reading!
We’re always looking for interesting reading materials so get in touch if you have any to share – we might feature it next month!
Last year, Wellcome’s Public Engagement, Population Health, and Epidemics teams worked with Science Practice to establish a first-of-its-kind lab for investigating the impact of public engagement on clinical trial research outcomes.
Public engagement has great potential to support better research outcomes on clinical trials – for instance, by improving recruitment and retention, or by mitigating ethical and operational risks. However, its benefits are not being experienced as consistently, meaningfully, or widely as they could be because public engagement is not yet seen as essential for conducting clinical trials.
While there are ethical arguments for it, there may also be a case for requiring public engagement on clinical trials based on its instrumental contributions. From speaking with researchers about their experiences, Wellcome learned that public engagement can support a trial’s overall success by improving how it works with people. For example, some research centres work with community advisors or use public engagement to support informed consent. However, for the most part, funders like Wellcome as well as publishers, regulators, and researchers themselves lack formal evidence on whether and how public engagement impacts research outcomes.
Wellcome wanted the Clinical Trials Engagement Lab to respond to this evidence gap, and partnered with Science Practice to help imagine what the lab could look like, find researchers who could build on this vision and lead it, and develop an application and review process to help a funding committee select between several possible leadership candidates.
Given that launching a lab was a much more specific ‘ask’ than those posed by Wellcome’s existing grant funding opportunities, we realised that setting it up would require a different approach. We needed to invite grantees in to understand the very nature of the opportunity – and to work alongside us to figure out the right response. In the interest of sharing what worked, here are five practices for more open, collaborative grant-making that we’re taking away from this project.
Rather than posting a request for proposals on an existing platform, we took a directed approach to connecting with potential grant applicants. Open calls put the ‘reach-out’ responsibility on applicants, leaving them to judge for themselves whether or not they fit the grantee profile, if they even learn of the opportunity in the first place. But when funders instead take a recruitment-led approach, they assume responsibility for identifying potential grantees and promoting the funding opportunity. Opting to recruit saved us time. It helped us widen the pool of qualified applicants beyond those we’d expect to hear from if we posted an open call, and headed off the possibility that too few would come forward – a risk given the specificity of our expectations. It also gave us a chance to iteratively tailor our search criteria to identify a more diverse range of individuals and teams, and to allow the profile of an ideal candidate to emerge over time through conversations between Wellcome and the grant candidates. Long before it was time to make a funding decision, working like this helped set the tone for the more open funder-grantee relationship needed to enable applicants to propose their own vision for the lab.
Some grant opportunities leave it up to researchers to specify a project focus and methodology. In this case, to align with Wellcome’s wider strategy, we defined the ambition in advance – set up a lab to help fill an identified evidence gap – but were actively seeking researchers’ suggestions for how this should be achieved. With this request, we needed to put in extra time and effort to ensure we successfully communicated our vision to applicants so that they could confidently propose suitable approaches. Going beyond a typical application onboarding process, we guided them through a lengthier, more in-depth alignment phase. We gave applicants full transparency over what motivated this work and what Wellcome was looking for by sharing a theory of change, detailed description of the problem and opportunity, and potential forms the lab could take. On calls with each grant applicant, we were clear about what thinking had been done to shape the vision for the lab, and what needed further development, refinement, and leadership from them. Briefing applicants in this way helped position them as collaborators – a role they needed in order to take on Wellcome’s initial vision, develop it, and suggest how to deliver it. During the initial expression of interest phase and later, during the formal application process, we regularly checked in with applicants to offer clarification, reviews, and feedback on their initial ideas to ensure they aligned with the funder’s goals. We also shared and invited continuous contributions to an open Q&A document collecting questions from all potential grantees. This helped to avoid one group having access to information others didn’t, and ensured helpful strategic insights were shared across the applicant cohort. This approach fostered ongoing dialogue between funder and researchers, balancing Wellcome’s vision with the applicants’ own ideas.
It’s not so unusual anymore, but we held an initial ‘pitching’ round before asking for longer, more involved full-length proposals. Sometimes, funders open calls for expressions of interest to fulfill a similar purpose. In this case, asking for short and pithy pitches gave us an opportunity to invite more groups to apply because we felt comfortable asking them for a relatively small investment of time and effort, and also confident in our reviewers’ corresponding capacity. Importantly, the pitching step also offered applicants a chance to get to know Wellcome as a funder – its funding requirements, and the ambition for this funding opportunity – so that they could decide if they were interested in the prospect of working more closely with Wellcome, and therefore whether they wanted to develop their thinking into a longer proposal. We chose the pitch format to emphasise that Wellcome didn’t have preconceptions for the proposals it was looking for, but was instead on the lookout for original ideas drawing on researchers’ expertise. The format for this pitch was intentionally left open so applicants could build on their conversations with us and readily express their key thoughts however made sense to them.
Holding a pitching round also gave us an opportunity to preview candidates and invite the most promising ones to the full proposal stage. With this increased visibility over the different approaches applicants were working on, we noticed complementarity between some of the teams and ideas, and saw potential for partnership between them. To pass this opportunity on to the applicants, we gave each team a chance to ‘opt in’ to share their contact information with the others. Some applicant teams took this as a chance to make themselves known to the others while using this information to further refine and differentiate their proposals.
While it was Wellcome who initially came up with the idea to start a Clinical Trials Engagement Lab, they were very keen for applicants to bring their own vision and approach to leading it. At the same time, they wanted to retain visibility over the lab’s progress because even emergent findings could inform Wellcome’s ongoing conversations around public engagement policies and practices in funding and publishing circles. To support Wellcome’s leadership and influence in both public engagement and clinical trials research, the evidence and insights would need to be of sufficient quality and relevance to unlock further action. Given this interest, Wellcome wanted more visibility over preliminary insights and interim results and more opportunities to interact with the lab’s experts than a traditional grant-making relationship might provide. They were considering funding this work through a contracting process, but this arrangement would have been unusual for the applicants, most of whom were situated within research institutions where grants are the norm. Instead, they chose a third alternative: the milestone grant. Milestone grants are awarded as grants but work somewhat like contracts in that funding is attached to different milestones that the funder and grantee agree upon ahead of time. This option gives funders built-in opportunities for collaborative involvement and visibility over preliminary findings, while giving grantees more autonomy within the set milestone periods.
In situations like this, when a funder has identified a problem and developed a vision of addressing it, reaching out to experts who can figure out how to go about this can be daunting. There may be uncertainties about who to approach, how to reach them, what to communicate, and how to share control over the vision and its delivery. Adopting funding practices like the ones we’ve highlighted above can help by shifting the power dynamic between funder and grantees toward something more open, collaborative, and aligned.
To the funders out there: Have you applied any of these practices in your own work? Reach out to share your experience – we’d love to hear about it.