Maintaining trust in science and increasing research literacy

This month, British Science Week took place from 8–17 March 2024. A ten-day celebration of science, technology, engineering and maths (STEM), it provides a platform for STEM events and activities; ultimately, I imagine, to not only celebrate these subjects, but inspire future scientists and promote public understanding and appreciation of science as a whole.

Pharmacists, of course, ought to know only too well the inherent value of science — or need only to look back at the emergence of, and response to, the COVID-19 pandemic to remind ourselves of the importance of science in our everyday practice, and even wider than that, the role that science played in restoring world order. Indeed, data published in 2023 showed that COVID-19 increased public trust in science — at least in the British sample that was surveyed. I am sure then that others too will find it reassuring to know that the latest iteration of an annual survey that consulted more than 32,000 people across 28 countries showed scientists to be among those most trusted to tell the truth. The authors of an even larger study on the topic, however, go on to warn us, in a pre-print of their paper, “we cannot discount the concern that lack of trust in scientists by even a small minority may affect considerations of scientific evidence in policymaking”. This is a point I have been pondering this week.

While many factors will influence people’s trust in science, I was alarmed to see several examples of papers published in their final format that contained remnants of text (within the body of the published manuscripts) that were seemingly lifted directly from response boxes of generative artificial intelligence (AI) tools. I won’t draw attention to the papers in question here (they involved another publisher) but there is a question to be asked about the downstream impact that such glaring flaws in authoring, peer review and publication processes will have on trust in scientists in allowing papers to be constructed in this way and for such errors to go unchecked before reaching the public domain. I am particularly keen to help increase pharmacy professionals’ research literacy, so my focus this month is on studies that use a mainstay of the scientific method: the experimental design.

The first paper, published in the Journal of Pharmaceutical Health Services Research, is a randomised, controlled, interventional study, examining adherence to medication in patients with glaucoma. Randomised, because 190 patients with open-angle glaucoma recruited to the study were assigned at random to one of the study groups; interventional, because the study set out to assess the impact of an educational intervention on specific outcome measures; and controlled, because as well as the intervention group (i.e. those assigned to a group receiving the education), a group of participants were assigned to ‘usual care’ to enable a comparison of specific measurement with the intervention group in a before-and-after design. The outcome measures were adherence to medication, eye drop administration technique and knowledge about glaucoma, which were assessed at baseline (i.e. at the start of the study, before any intervention/usual care) and at a follow up.

The authors hypothesised that adherence to medication would be significantly improved as a result of delivering their educational intervention. I found very little information on the intervention itself other than it involved the provision of an educational booklet, which included information on administration technique, and individual discussions with those in the intervention group while they waited in the clinic. In case readers are questioning the rationale for such a study, the authors argue that non-adherence is a problem in the treatment of glaucoma, with only a minority of patients showing good adherence, which in any case declines over time. It could be considered fortunate for the patients (but perhaps not for the study) that, at baseline, 62.1% of the participants were found to be fully adherent to their glaucoma medications. This is a relatively high rate of adherence and might be expected to limit the impact that an intervention could have. Nonetheless, the authors found the intervention to significantly improve patients’ adherence to their eye drops as well as their administration technique, compared to the control. This is good to know and provides further evidence that one way of having a positive impact on patients is, indeed, to quote a phrase, ‘education, education, education’.

The second paper I read is published in the International Journal of Pharmacy Practice, entitled “Impact of uricosurics on mortality outcomes in patients with COVID-19: a systematic review and meta-analysis of randomised controlled trials”. Compared to the first paper above, this study was a systematic review (of randomised, controlled trials), because it sought to systematically search the available literature and retrieve all papers relevant to the study; and meta-analysis, because it sought to use a credible method to statistically combine the individual results contained within the pool of relevant studies to answer the research hypothesis. In this case, the research hypothesis was that use of medication with uricosuric properties (i.e. those that increase the excretion of uric acid), compared to other interventions, could increase ‘mortality events’ among patients with COVID-19 and hyperuricaemia. Overall, the authors report that while uricosurics in general have no significant impact on such outcomes, a subgroup analysis found ascorbic acid (vitamin C) to reduce the risk of mortality in patients with COVID-19. I must say that this is not the first time that vitamin C has been investigated as a potential treatment in COVID-19, and I would have thought that the recent large-scale report of two harmonised, randomised clinical trials, which found that vitamin C has “low probability of improving organ support-free days and hospital survival” in hospitalised patients with COVID-19, would have to be considered too. Nonetheless, the authors of the current study recommend further trials.

Returning to pharmacy and our efforts during the COVID-19 pandemic, one positive point of learning is that the vast network of pharmacies staffed by a scientifically-trained workforce ought to be an invaluable resource in dealing with future health emergencies, not only from a delivery-of-care perspective, but also for future research endeavours. This is certainly acknowledged within the interventional PANORAMIC study, where pharmacy teams have been encouraged to help recruitment of volunteers from underserved and diverse backgrounds. I salute all these efforts to increase our involvement in research.