In 2019, I committed to a weekly blog post on Tuesdays. Since then, I have almost always achieved that. This week will be a little bit of an update on my plans with this blog and then a rant about academic writing.
I am spending a lot of time creating an index post for the Theory of Money series. This involves me reading each post and figuring out how to summarize it in a single paragraph, which is not easy. I hope to have that ready by next week so it can be my next Tuesday post.
After that, I will get back to healthcare. Like I was saying before I started the Theory of Money series, I have been wanting for quite a while to start over reading different foundational healthcare economics and policy writings and sharing what I’m learning from them.
This will help me build a database in my reference manager of all the topics that interest me, so I’ll have ready access to lots of articles that support anything I’m writing about. And I hope it will be instructional for you guys as well.
But I don’t think doing that will solve my primary ongoing challenge related to referencing primary sources in a lot of my posts: Much of what I write about does not lend itself to citing studies.
If, for example, I’m talking about the different levers that determine profit, what am I supposed to cite? A Business 101 textbook? Or if I’m writing about my synthesis of the different building blocks that make up every payment reform program (shared savings, quality-contingent bonuses, etc.), what am I supposed to cite as evidence for that? How about when I write about the evolution of pharmacy benefit managers? There aren’t any academic works that talk about that, or if they do it’s based on the same information I’m using–educated inference and some interviews.
I had a medical student reach out once, asking for more evidence on a post I wrote, and I had to just send her the names of my favourite writers and thinkers on healthcare and tell her that they were my inspiration but that the synthesis was my own.
This sort of writing is looked down upon in academic circles, even when it’s information that is not amenable to citations. So what is a rational person to do? Just find something, anything, to cite anyway. I see this whenever I get notified that my Rewarding Value Instead of Volume article gets cited. I’ll go and read the section of the paper that cited my article, and I’ve never actually felt like my article was supporting what they were saying.
Here are a the most common citation-adding tricks I have seen academic writers use in my field to give their writing the illusion of academic rigor:
1. Throw in a citation to something that is at least somewhat relevant, even though you haven’t read it and it doesn’t actually support what you’re saying. Nobody will notice unless they actually go and read the whole article you cited. You think reviewers are going to question those citations? Maybe only rarely.
2. Say a whole bunch of unproven stuff, but then make it look like it’s evidence based by finding an example of hard evidence that’s at least obliquely related to a small part of what you just said.
3. Similar to the last one, say a bunch of unproven stuff and then find a random evidence-based statistic that at least establishes the truth of a peripheral aspect of your argument.
4. Possibly the most comical one, this is a two-step tactic. Step 1: Publish a paper with lots of citations and make sure to mix in some of your unproven or not-amenable-to-citations ideas. Step 2: Publish another paper, write those same unproven or not-amenable-to-citations ideas, and then cite your first paper as evidence of them. Mark Pauly, one of my favourite healthcare thinkers, does this all the time–and I absolutely can’t blame him because so often he’s writing about the same not-amenable-to-citation ideas that I do.
There are many others. This article does an awesome job of going through this issue in much more depth, and it lists 13 different tactics.
So what’s my point?
I am annoyed at the state of scientific writing with its overemphasis on citations. It dilutes the usefulness of any citation. It encourages deception about the reliability of things written. And it underappreciates any not-amenable-to-citation ideas (unless bogus citations are padded around it), including many of the things I write about.
Moving forward, as I acquire more and more legitimate citations, I will start including them. And for things that are not amenable to citations, I’m not going to add bogus ones.
Clear Thinking on Healthcare 