Medicine Politics Science

Fear of the frame, part II: A cultural divide

I remain confused.

Yes, I know that people who don’t like me very much or at least don’t like the message that I lay down here day in, day out, week in, week out probably aren’t surprised at this startling admission, but I don’t mean it in a general fashion (although no doubt those aforementioned people will take it that way). No, in 10 days or so since I first weighed in about it, I remain confused at the vociferously hostile reaction that Chris Mooney‘s and Matthew Nisbet‘s recent article in Science, Framing Science, and their follow up article published on Sunday in the Washington Post. Since then, as Bora has pointed out, a certain spin about Mooney’s and Nisbet’s message about how scientists need to frame their work in ways that will resonate with the public has arisen, specifically that “framing = spin,” with Larry Moran in particular characterizing framing as “a fancy word for spin,” a comment that I found particularly ironic, given that that comment is a particularly good example of “spinning.” At least, that’s how I “spin it.”

Yes, I’m being a bit sarcastic, but that’s OK. My sarcasm is quite mild compared to what I’ve seen in the anti-framing contingent; so I hope you’ll forgive me. It’s just a mild taste of my Respectful Insolence™ applied to bloggers that I respect but who, to my frustration, maintain a persistent blind spot when it comes to this particular issue. This led me to think about why this might be, given that it’s patently obvious to me that as scientists we frame our data and message all the time and my puzzlement as to why there is such hostility to Mooney and Nisbet’s mostly quite reasonable suggestion that we as scientists should do a better job at framing discussions of our work for the consumption of the lay public. After all, when bloggers I respect (although frequently disagree with on some issues) are so incensed over something, I can do one of two things: either dismiss them as wrong (which would be the surgeon thing to do, à la Dr. Egnor) or reexamine my view on the topic. I chose to do the latter, and doing so led me to an idea about why there might be such a violent disagreement over this issue.

I’ve concluded that a lot of issues underlying this kerfuffle may be the difference between the “pure” scientists and science teachers (like PZ and Larry Moran, for example), who are not dependent upon selling their science for the continued livelihood of their careers, and scientists like me, who are, not to mention nonscientist journalists and communications faculty (like Mooney and Nisbet), for whom communication is their career. As I’ve mentioned before, writing grants and giving scientific talks force scientists to “frame” their data all the time, to maximize their persuasive powers in the service of convincing their audience that their science is valid. Indeed, just presenting data in different formats involves framing, as Bora detailed so well. PZ and Moran, for example, appear no longer to have to sell their ideas to external granting agencies or suffer a severe hit to their careers, as far as I can tell. I do not have that luxury. If I lose my grants and go without funding for more than a year or so (which is all the buffer I have left in my startup funds), I will lose my lab. Period. This provides an enormous incentive for me to frame my work in such a way that I can convince other scientists of its correctness and value.

Perhaps I can make this clearer with a couple of concrete examples. Instead of just talking about writing grants in general, I’ll discuss a specific grant mechanism, the Department of Defense Congressionally Directed Medical Research Programs, specifically the Breast Cancer Research Program Idea Award. This is a grant program that exists to reward innovative, high risk projects. Right there, that tells a scientist that “framing” his work as a natural stepwise extension of previous work in his lab (as one would do when trying to apply for an NIH R01 or to renew one’s R01) would not be very likely to be successful. The “audience” (namely the Army reviewers) are looking for innovation and impact. A second aspect of these grants is that there are breast cancer survivors and advocates on the committees and study sections deciding which grant proposals are funded. Consequently, one has to “frame” one’s proposed study with that additional audience in mind. These advocates will tend to be less interested in obscure, albeit scientifically interesting minutiae of mechanisms of cancer progression, unless it can be framed in such a way as to convince them that it will make concrete progress at laying the groundwork for a better cancer treatment.

There are multiple components of a D.O.D. Idea Award application, but the most relevant for the issue of framing are the public abstract, innovation statement, and impact statement. Here’s what the Army says about the Public Abstract:

Public Abstract: One-page limit. Start on a new page. The public abstract is an important component of the proposal review process because it addresses issues of particular interest to the consumer advocate community.

  • Describe the scientific objective and rationale for the proposal in a manner readily understandable by non-scientists.
    • Do not duplicate the technical abstract.
  • Describe the ultimate applicability of the research.
    • What types of patients will it help and how will it help them?
    • What are the potential clinical applications, benefits, and risks?
    • What is the projected time it may take to achieve a consumer-related outcome?
  • If the research is too basic for clinical applicability, describe the interim outcomes.
  • What types of contributions will this study make to advance breast cancer research?
  • How will the research enhance this or other studies being conducted?

There you have it, your frame. It’s a rather difficult and unforgiving frame as well. You have one page (0.5″ margins, 12 pt. Times New Roman type) to represent your science accurately in language that an interested lay audience can understand in such a way that the audience will be excited enough about it to fund your project to the tune of $300,000 over three years. I would submit to you that you would have to be quite good at framing your work to describe your work accurately in such a short span and in such a way to get this audience interested enough in it to recommend it for funding. But that’s not all. Let’s look at the Impact Statement and Innovation Statement, which are both even more difficult:

Impact Statement: One-half-page limit. The Impact Statement must be submitted as a single PDF file named “Impact.pdf,” in accordance with the formatting guidelines specified in Appendix 4. State explicitly how the proposed work will have an impact on breast cancer research or patient care. Describe how the combination of innovation and the expected results of the proposal will contribute to the goals of eradicating the disease and advancing methods, concepts, prevention, diagnosis, or treatment of the disease or quality of life for patients.


Innovation Statement: One-half-page limit. The Innovation Statement must be submitted as a single PDF file named “Innovation.pdf,” in accordance with the formatting guidelines specified in Appendix 4. Summarize how the proposal is innovative. The following examples of ways in which proposals may be innovative, although not all-inclusive, are intended to help PIs frame the innovative features of their proposals:

  • Study concept – Investigation of a novel idea and/or research question.
  • Research method or technology – Use of novel research methods or new technologies, including technology development, to address a research question.
  • Clinical interventions – Use of a novel method or technology for preventing, detecting, diagnosing, or treatment.
  • Existing methods or technologies – Application or adaptation of existing methods or technologies for novel research or clinical purposes, or for research or clinical purposes that differ fundamentally from those originally intended.

Oh, my goodness, did I actually see the dreaded f-word in these instructions? And, between these two statements, you only have one page to accomplish all this framing. (Of course, it is the dreaded military-industrial complex, I guess, so I would guess that the Army would require all sorts of Orwellian “framing” in its applications.) Do you think this sort of framing is “spinning” or “lying” or “dumbing down” your science, charges that have been leveled at the word “framing”? What about the fact that you only have six pages to describe a three year project and expand the “frame” in such a way to convince those who were interested based on your Public and Lay Abstracts and Innovation Statement to think it might be worth funding? Do you think this additional, albeit somewhat different, framing is “lying” or “spinning” and thus not to be done by a scientist? Too bad for you, I guess. No grant money for you. Good luck keeping your lab funded, because all grant applications, federal or private, require a high degree of framing, based on the purpose of the granting agency and the constraints in space and form placed on the application. Longer grant applications allow one to discuss more of the science, but there are grant applications out there that are only one page long (I know; I’ve applied for a couple such grants). You’re deluding yourself if you think you can write a successful application that short without some serious framing. Longer applications, such as NIH applications, allow more leeway for detailed discussions of data and science, but pointing out that “it is the job of the applicant to convince the reviewer” and that reviewers “may not fully understand the significance of the research area without a clear, compelling argument presented in the application.” Given that many reviewers will not be familiar with the specific issues involved, it will be up to the applicant to frame those issues for them.

Thus, I ask again: If it’s acceptable to frame science in such a way that will convince granting agencies to fund that science, why is it not acceptable to frame science for a different audience, the public? Or are both not OK? And if both are not OK, then how does a scientist convince his fellow scientists and lay people controlling the purse strings at private foundations that his work is worthy of funding otherwise? As an example, a typical reviewer for an NIH study section has to read in detail and review around 10 grants, each of which is 25 pages long, often with an additional 50 pages or so of other supporting documentation (budgets, BioSketches, etc.). Salesmanship within the bounds of scientific accuracy is, like it or not, essential to catch the reviewer’s attention and inspire him remember and support the grant. Lastly on this issue, I’ll point out that framing data and the science this way can help an investigator hone his science and intentions to a fine edge. To write such a grant, it’s necessary to distill the supporting data and the aims of the project down to their bare essences, casting aside all extraneous sidelines that do anything to distract from your core hypothesis and plan. It’s also necessary to review all the literature related to your project and distill it, too, down to its essence and describe correctly but in a way that supports your rationale and hypothesis while recognizing controversy. All in all, as painful as it is, when looked at properly, the framing that is necessary to write a grant can actually be a powerful tool to help an investigator clarify his understanding, ideas, and research plan. Admittedly, the downside of this process is something called “grantsmanship,” where certain buzzwords, catch phrases, and strategies are used to frame the application, but, by and large, grantsmanship is nothing more than knowing how to persuade other scientists and knowing how to budget.

Being the long-winded type that you all know that I am, I can’t resist one last example, which may explain why physician-scientists appear not to be nearly as afraid of or hostile to the frame as our esteemed colleagues, such as PZ, Larry, or ERV. This came in response to a comment that framing is “condescending, offensive, and naive.” My retort to that is that it is naive to think that framing isn’t necessary. It seems to rely on the idealistic belief that people will just “understand” if you put the facts out there enough times or that the “facts will speak for themselves.” They won’t, because any presentation of the “facts” will require choosing which facts and in what context to present them, in other words, a “frame.”

Be that as it may, I have to wonder why someone would would consider framing necessarily “condescending” or “offensive”? I suppose that there are cases where it could indeed be all of those things, but it is not inherently so. And, in fact, it is essential for what I do. Consider this example, which I as a surgeon encounter all the time. A woman is diagnosed with breast cancer, and I need to explain the scientific rationale behind my proposed course of surgical treatment. Let’s say that she is a high school dropout (I have a high percentage of charity care patients in my practice), and hasn’t had any science or biology education beyond the seventh or eighth grade. Moreover, let’s assume that she doesn’t read about science; she’s too busy working a crappy, low-wage job with no health insurance to support her family. What is more “condescending,” simply to tell her this operation is what needs to be done, with no attempt to explain the scientific rationale behind the surgery and the evidence supporting its efficacy, which, given her lack of education, will certainly require considerable simplification of the facts and scientific research behind it, or to “frame” this information for her so that she understands it as well as her educational background allows?

I remain puzzled why “framing” my rationale so that the patient understands as well as her background allows her to my rationale for my proposed treatment might be so “offensive” or “condescending” in this situation. In fact, I would consider it far more condescending to revert to the paternalistic model of medicine and just tell this patient that she needs a lumpectomy and sentinel lymph node biopsy with a followup course of chemotherapy and radiation without bothering to attempt to explain why. If I were to do that, the end result would be that my well-educated patients would get an explanation of my rationale (because they wouldn’t accept treatment otherwise or would quickly find a new surgeon) while the less-educated would get a pat on the head and instructions just to trust me on this. In fact, in this case, there is an absolute ethical imperative to attempt to explain the scientific rationale for the procedure, along with its potential risks and benefits, to the best of my knowledge and to the best of my ability to frame the issues involved in such a way that the patient can understand. I may not always succeed (indeed, I can think of a few spectacular failures at doing this that I’ve had), but I at least have to try. Moreover, clinical trials themselves would be impossible, because it is also an ethical imperative for physicians to frame the scientific rationale behind the trial to potential research subjects so that they understand the potential risks, benefits, and uncertainties as well as possible.

Thinking about this issue in these terms, I have to admit a grudging respect for PZ and Larry’s purity of vision when it comes to science, even as I remain puzzled and exasperated by it (particularly given the way Larry, for example, persists in enthusiastically repeating the execrable and historically inaccurateNeville Chamberlain atheist” and “Neville Chamberlain school of evolutionists” spin, which shows that he’s quite willing to spin to his heart’s content when it suits his purposes, although I’m sure he doesn’t see it that way). Sadly, in my position, I can’t maintain such a rigorous level of intellectual purity when it comes to selling my work. Science is a human endeavor, which means that all the foibles of humans and their modes of communications necessarily enter into any discourse about science, be it between a grant applicant and the study section evaluating the grant, a speaker at a scientific conference and the audience, a physician and his patient, or a scientist and the public. Perhaps one of them can explain to me why, if it isn’t “spin” or “lying” to frame one’s science for a grant application or to patients in a clinical trial, it is “spin” or “lying” to do so when explaining complex science to the public. I realize that framing can be used for good or bad, but tell me why it is inherently such a bad thing, a characterization that seems to be the “spin” being placed on it.

I really want to know. And, please. frame it in simple terms for me. After all, I’m just a dumb surgeon.

By Orac

Orac is the nom de blog of a humble surgeon/scientist who has an ego just big enough to delude himself that someone, somewhere might actually give a rodent's posterior about his copious verbal meanderings, but just barely small enough to admit to himself that few probably will. That surgeon is otherwise known as David Gorski.

That this particular surgeon has chosen his nom de blog based on a rather cranky and arrogant computer shaped like a clear box of blinking lights that he originally encountered when he became a fan of a 35 year old British SF television show whose special effects were renowned for their BBC/Doctor Who-style low budget look, but whose stories nonetheless resulted in some of the best, most innovative science fiction ever televised, should tell you nearly all that you need to know about Orac. (That, and the length of the preceding sentence.)

DISCLAIMER:: The various written meanderings here are the opinions of Orac and Orac alone, written on his own time. They should never be construed as representing the opinions of any other person or entity, especially Orac's cancer center, department of surgery, medical school, or university. Also note that Orac is nonpartisan; he is more than willing to criticize the statements of anyone, regardless of of political leanings, if that anyone advocates pseudoscience or quackery. Finally, medical commentary is not to be construed in any way as medical advice.

To contact Orac: [email protected]

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