Correlation, Association and Causation…Is It Time for a Review?

correlationWhen I returned to higher education for my Master’s Degree, my end point was to become credentialed so I could begin my dream job as an inpatient nurse practitioner. This was a new role in 1993 and I will admit that as a single woman who  could afford only one year away from the paycheck, I was committed to getting in and out of my Master’s courses at Boston College quickly and efficiently. In particular, I had no aptitude or desire to become a researcher. My mind was clear that I would go through the “hoops” of the beginning research course (mandatory) and then “never do research again.”  I can hear your laughter now….

So, on day one of my Master’s year, I entered Research 101 for Nurses; thoroughly prepared to hate it, pretty sure I might not pass it, and very clear that it was not pertinent to my clinical life. (Yes, one can be quite naïve, even at age 35). Amazingly, I entered a classroom taught by the most wonderful teacher of my entire academic life (I’m including grade school here too). I’ve long forgotten her name but I’ll never forget her. She taught me to love and appreciate the science of science. For 18 rapid weeks, she taught a basic exercise. Each week we were given a nursing research paper to read and then in each class, we reviewed it and discussed the paper’s merits. She, of course, chose increasingly complex papers with a variety of study designs and writing skills. Some papers were good, some terrible, some stated what they did not find, some overstated conclusions….you get the idea. Our class thrived! It sounds so naïve to admit, but we were empowered to realize that just because the researchers said it, it might not be true…because of design flaw, overreaching results, and other errors, glaring and subtle.

Our professor also taught us to appreciate that while we may not be researchers, we were intelligent…and that research should not be sloppy, unreadable, or beyond our understanding. It was up to the writer to tell us what their question was, what was known about it, explain the study design, tell us how they did it, discuss their results against their question and draw some conclusions based on what they found. She demystified the process and actually taught us to critically analyze what we read….or as my Mother said, “Don’t automatically believe everything you read”. The fact that the reader of research had a responsibility in the process changed us from observers to participants. An amazing teacher with an amazing gift.

So, research became very relevant in my clinical role and subsequent professional life….if, for no other reason, than for me to critically read research and analyze its credibility. Since entering the field of obesity care, this analysis has become increasingly important. I’m not sure if is the weight bias/discrimination inherent in the specialty or the infancy of our understanding of the causes and biology of obesity…but often the “studies” that “prove” some aspect of obesity do not pass the rigor that I was taught in Research 101. Popular press articles and studies presented at conferences and professional journals that conclude association or correlation are often misinterpreted as evidence of causation.

With the flood of open access predatory publications, this issue has moved to the forefront in my mind. These journals, with their non-existent or shoddy peer reviews processes, lack of editing and oversight, and an emphasis of meeting the needs of authors, not readers, are publishing flawed articles. On a continuum these papers range from  poorly done, uninspired studies that couldn’t find a legitimate publication home, to deeply deceptive junk science reporting results that have the potential for real patient harm.

So, my thought is that it may be timely to review basic research principles at conferences, journals, and classrooms….sincerely. It has been a long time for many of us since Research 101. With so much information bombarding us daily through so many mediums, it is easy to just skim the headlines or read the conclusion of the paper. An emphasis on critical analysis of research (or what is presented as research) might remind us and our readers to take a moment to read the fine print.

 

One thought on “Correlation, Association and Causation…Is It Time for a Review?

  1. To facilitate reprinting of this editorial, we have retained the copyright as authors. If you would like to reprint it in your journal, please email us at the addresses below and we’ll be happy to grant permission.

    Jean Proehl – jean.proehl@gmail.com Anne Manton – apmatc@comcast.net Susan Alexander – sa00010@uah.edu

    Happy Thanksgiving!

    Jean

    *Jean A. Proehl, RN, MN, CEN, CPEN, TCRN, FAEN, FAAN*

    *Emergency Clinical Nurse Specialist, Proehl PRN, LLC |www.ProehlPRN.com * *Editor, Advanced Emergency Nursing Journal |www.AENJournal.com *

Leave a Reply