"Notes From the Field"
In a new play, Anna Deavere Smith explores the relation between education and criminal justice. In her review, Kate Taylor notes that the playwright was raised in Baltimore, the daughter of a teacher who became a principal, and was influenced by "women who believed strongly in the power of education to lift children out of poverty." The Pulitzer Prize recipient for "Fires in the Mirror" feels that the "school to prison pipeline" incorrectly ascribes responsibility for the development of children too narrowly to schools; thus, the current version of a performance in which Deavere Smith delivers the words of nineteen characters, dropped the subtitle "Doing Time in Education". Trauma experienced by children and teenagers may impair their ability to self-regulate and influence their behavior at school. Restrictions on how school personnel may respond to disobedient and disruptive students may leave educators reliant on police officers to enforce rules. When difficulties at home or in the neighborhood spill over onto campuses and into classrooms, collaboration between communities and schools may provide the best means to improve the futures of children.
Learning to Read
More than four decades after San Antonio v Rodriguez, school funding litigation is again present in a federal court. Geoffrey Stone discusses the constitutionality of inequality of education opportunity in a New York Times op-ed. Specifically, the issue of the right to a learning environment that fosters literacy. Stone poses a simple question for elected officials: what would you do if your children were assigned to a school whose capacity to teach the basics was suspect?
Alleviating Childhood Poverty
In an election cycle that has focused on almost anything but policy, the potential for “Giving Every Child a Monthly Check for An Even Start” is explored by Eduardo Porter in the Economic Scene column of the New York Times. Twenty percent of American children live in poverty. Of industrialized nations, only Brazil has a higher percentage. Finland, whose educational system is often seen as a model for other nations, confronts only one-fifth the concentration of children in such challenging circumstances. While Hillary Clinton advocates an increase in the child tax credit, others recommend providing direct financial support, a position favored by Senator Clinton’s predecessor from New York, Daniel Patrick Moynihan.
In a New York Times Op-Ed column “Rethinking College Admissions”, Frank Bruni examines Turning the Tide: Inspiring Good for Others and the Common Good through College Admissions, a report from the Making Caring Common project at the Harvard Graduate School of Education. The author team, led by Richard Weissbourd, and a diverse array of individuals who endorse their conclusions, describe how the college admissions process may be used as a lever to alter the civic (“ethical” and “intellectual”) engagement of high school students. In combination with such a stimulus, the report recommends changes in the manner by which admissions staffs evaluate the contributions of their applicants, factoring in variation related to social class, race, and culture.
Admission criteria provide an opportunity to increase equity in entering classes in a number of dimensions. Marketing and recruiting represent challenges for many institutions. The Coalition for Access, Affordability, and Success, a collective of more than eighty colleges and universities, has created a platform of online tools intended to compensate for insufficient support and guidance for students in many secondary schools. The platform will be accessible in the spring of 2016, and is intended to be utilized beginning in the freshman year of high school.
Observations v Experiments
An article on page one of the Wall Street Journal, Analytical Trend Troubles Scientists, contrasts observational studies with RCTs. John Ioannidis has identified potential limitations on making inferences from observational studies, including the immense literature linking biomarkers with disease. Dr. Ioannidis, Director of the Stanford Prevention Research Center, estimates that successful replication of observational studies may be one-quarter the rate of replication of RCTs. S. Stanley Young, Assistant Director for Bioinformatics at the National Institute of Statistical Sciences, estimates the replication rate for observational studies may be only one-quarter to half-one as large as the Ioannidis estimate. If either estimate is accurate, the utility of such studies as the basis for policy decisions may be called into question.
Targeting Interventions: The Critical Nature of Diagnostics
Personalized medicine is often pointed to as the leading edge of clinical care. Advances in targeted therapies require two components: an intervention and a diagnostic which determines suitability for specific patients. In the December 28 issue of the Journal of the American Medical Association, Michael Holmes and colleagues present an analysis of a genetic testing program with the response to a Plavix (clopidogrel, prescribed to prevent blood clots, had the second highest monetary value of any drug in 2010) which found no relation between the genotypic variation under study and cardiovascular events. Thirty-two studies were analyzed, six of which were RCTs. In this case, the utility of the diagnostic, whose use was stimulated by an FDA “boxed warning”, for the entire subset of patients with the genetic variation, may be limited. Further differentiation in the patient subgroups (e.g. those with a previous interventional cardiovascular procedure such as stenting), may be required to most efficiently target this intervention.
In the editorial, Pharmacogenomics and Clopidogrel: Irrational Exuberance?, in the same issue, Steve Nissan describes the two year debate which followed the FDA warning and the opposition of the American Heart Association & American College of Cardiology to routine genetic testing in this case. Nissan cites the potential influence of publication bias in smaller scale studies identified by Holmes et al. and limitations due to lack of access to patient-level data. He concludes that "a large randomized controlled trial is necessary to adequately test the clopidrogel pharmacogenomic hypothesis…the pharmacogenomics approach to drug therapy must undergo the same rigorous testing for efficacy and cost-effectiveness that is required for other therapies."
The National Academy of Sciences recently released the report Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease. The product of the Committee on the Framework for Developing a New Taxonomy of Disease, co-chaired by Susan Desmond-Hellman and Charles Sawyers, the project aims to enhance the links between the laboratory bench and the clinical environment, with the potential for bi-directional improvement in data transmission to optimize treatment efficacy. The "New Taxonomy" refers to disease classification with a basis in molecular biology, including genetic sequencing. Underlying this systematic framework, the document describes an "Information Commons" and "Knowledge Network" which require coordination across diverse medical settings.
Repeat After Me
Science magazine devotes a section of the December 2, 2011 issue to "Data Replication and Reproducibility" in a variety of fields.
As the papers presented under the section heading "Data Replication: The Scientific Gold Standard" make clear, the standard is frequently not met, at times potentially due to the complexity of the experiments, including a large number of independent variables. Related issues include: (a) the influence of publication bias in favor of positive outcomes, and (b) the capacity to reproduce outcomes utilizing data made publically available through the publication process. On the latter topic, see a recent letter by John Ioannidis and colleagues to Nature Genetics on the "Replication of Genetic Association Studies".
Missing Prior Research
The New York Times notes a study published in the Annals of Internal Medicine. Karen A. Robinson and Steven N. Goodman of Johns Hopkins assessed the extent to which reports of RCTs cite prior trials which analyzed the same interventions. They identified 227 meta-analyses and examined the 1,523 trials included in these analyses. Robinson and Goodman find that these trials, published over 41 years, cited less than one-quarter of the relevant prior trials. The median number of prior cited trials was 2; 23% of the 1,101 RCTs that could possibly have cited 5 or more prior trials cited none, and an additional 23% cited only 1 prior trial. The authors argue that the "potential implications" of their findings "include ethically unjustifiable trials, wasted resources, incorrect conclusions, and unnecessary risks for trial participants."
In a "Annals of Science" essay in the New Yorker Jonah Lehrer chronicles the decline effect in the replication of experimental results. Lehrer describes the exacerbating impacts of selective reporting and publication bias in favor of novel and significant outcomes. Jonathan Schooler notes that "[researchers have] the tools to be much more transparent about our experiments...[recommending] the establishment of an open-source database, in which researchers are required to outline their planned investigations and document all their results.