Essays on Early Language: 1, Language - Is it what makes us human?

The next few blogposts: 'Essays in Early Language' explore some foundational questions   that help us to understand the nature of communication difficulties in modern society.  These questions may often be overlooked, or taken as a given without much analysis, but they are key to understanding the importance of language in human communication, what can go wrong and the implications for individuals if things do go wrong. 

Whilst I have been meaning to post the essays for some time, I was inspired to share the first of these in response to a discussion on Twitter about the claim that "Language is what makes us human".  This is a claim that has been made about language in the past, perhaps most audaciously by Pinker (1994).  It is a debatable claim, for example, I have also heard friends describe the use of fire as being our most fundamentally human characteristic, and one could cite the complex communication systems of other species in defence of the argument that we are not so unique after all, although this factor is robustly defended by Tomasello (2008). Even considering these arguments, there is no denying that language is pretty special, and worthy of being a major player amongst fundamental human characteristics.  In my PhD research I examined Language Learning Impairment and its impact on individuals.  The starting point was to address the question of exactly how important the ability to communicate using language is for individuals. Is it merely a desirable practical skill, or is it at the very core of what it means to be human?

This first essay; 'Language - is it what makes us human?' tackles this question by considering how necessary language is for humans for healthy living and functioning in society. Rather than debating the question of whether language is the one characteristic that stands out from others (such as use of fire) as defining the human organism, however, the argument is made that, although individuals who's language skills are impaired are certainly not any less human, that language is a fundamental human ability that significantly affects our ability to fully participate in many aspects of social life and be humans together.

The argument for the fundamental need for language in modern society in this essay is made considering three factors.  First, through a consideration of the origins of language and its use amongst humans universally.  Second, a case is made for the increased demand for language skills in modern society, highlighting further the fundamental need for language competence.  Third and final, the recognition of language as a basic human need in law and international policy is examined. Communication needs are considered within the context of the United Nations Declaration of Human Rights, and examples of national interpretations are illustrated through UK based policy and law. 

Origins and universality of language

Evolution of language in humans

As primates, human beings are biologically adapted for social life (Joffe, 1997; Tomasello, 2007).  In his summary of social adaptation, Winston (2002) reported that the ability to function within groups has enabled humans to increase their capacity for passing on learned skills and knowledge, and for engaging in group activities including finding food and tool use, and that the primary skill that enables these functions is the ability to communicate.  As part of this biological adaptation for social and cultural life, humans have a highly developed communication system, the most complex feature of which, by far, is language.  

The question of how humans evolved to use language and whether language structure itself is a biologically evolved adaptation, or a learned cultural process emerging from other social adaptations continues to be debated (Bickerton, 1992; Fitch, Hauser, & Chomsky, 2005; Pinker, 1994; Pinker, 2002; Sampson, 1997; Tomasello, 2008) and will not be covered in detail in this essay. For the purposes of understanding to what degree language is important to our species it is only necessary to state that it is widely agreed that human language is in some degree related to and dependent on our biological and evolutionary makeup (Sampson, 1997). Human language enables us to request and offer help, inform and share intentions and experiences (Tomasello, 2008).  Not only is the ability to communicate using language beneficial to humans for all these reasons, it is in fact expected between conspecifics, and humans who do not understand or cooperate according to the underlying purposes of human communication (including cooperation, altruism) may find themselves ostracised from society if they are not supported (Tomasello, 2008).

Universality of language

Human language use is universal (Pinker, 1994).  Whilst across the world we all speak different languages, all normally developing humans acquire some form of spoken or signed language. Even individuals raised without a linguistic model (for example deaf children born to non-signing parents, or slaves removed from their own linguistic environment and therefore only using pidgin versions of a language) have been reported to generate full linguistic competence within a single generation (Bickerton, 1992; Pinker, 1994).  Whilst there are limitations in these early anthropological studies (Pinker, 1994; Sampson, 1997), it appears that for all cultures worldwide language use is a robust human skill and full linguistic competence develops quickly between individuals, even in adverse circumstances.  Language use appears therefore to be a fundamental feature of what it means to be human.

Increased demands for language use in the modern world

Reduction of manual labour

It has been proposed that in the twenty-first century the ability to communicate has become an even more vital skill for participation in the developed world.  Several authors have highlighted that as society has moved towards advances in technology, the demand for traditional manual labour has decreased, (Hart & Risley, 1995; Law, Reilley, & Snow, 2013; Ruben, 2000).  As Law et al. (2013) stated; “the more sophisticated, the better educated and the more automated or digitalised the society becomes, the greater the shift from the blue collar manual employment towards white collar ‘communication’ focused jobs” (p. 488).  Ruben (2000) carried out a survey of employment in the USA which found that labour that would be considered to be manual had reduced from 80% of the workforce in 1900 to 37% of the workforce in 2000.  He also postulated that even the work that is considered to be blue collar manual labour in 2000 would require employees to have certain cognitive skills, for example in process management or logistics.  These skills rely to a degree on language abilities.

The need for language in a digitalised society

It is also noteworthy that the increasing dependence on the Internet for participation in society places demands on an individual’s communication skills.  Livingstone (2002) highlights three different kinds of interactions that take place on the internet; user to user interactions, that is, computer aided interactions such as email, text and chat environments, user to document, such as access to information through hyperlinks and user to system, such as takes place in gaming environments.  The internet is now used for so many aspects of life; participation in social life for forming friendships and relationships (e.g. McKenna, Green, & Gleason, 2002), access to information for the purposes of health (e.g. Norman & Skinner, 2006), education (e.g. Wright, 2010), employment (e.g. Kuhn & Skuterud, 2000) and for leisure (e.g Sanchez-Navarro & Aranda, 2012).  The ability to interact in these three ways using the internet is now considered to be a basic skill (Skills for Life Network, 2015).  There is even some evidence of an attempt to measure social status in part according to level of social networking on the internet (Savage et al., 2013).  It is proposed in this essay that the ability to take full advantage of all aspects of a digitalised society is largely dependent on an individual’s communication and language skills, and that those with speech, language and communication needs are further disadvantaged.

Global recognition of communication as a human right

Given the importance of these highly developed communication skills through language in the evolution of humans and the universality of language use, it is not surprising, therefore, that the ability to communicate effectively (and arguably, thus, to use language) is considered globally to be vital to an individual’s health and wellbeing and is recognised internationally to be a basic human need. 

Declaration of communication rights and human rights

In 2014 the International Communication Project published a universal declaration of communication rights (International Communication Project, 2014).  This declaration was developed by its member organisations across the globe, that is, the speech and language therapy professional bodies of the UK, Canada, Ireland, USA, Australia and New Zealand.  This declaration is not representative of the world as a whole as it represents only the interested profession of English speaking developed world.  It also does not have the legal gravitas of the Universal declaration of Human Rights (United Nations, 1948) which was agreed by fifty member states and now forms the basis of human rights law.  The communication rights declaration does, however, highlight that the ability to communicate affects significant aspects of life that are referenced in the United Nations Declaration of Human Rights (1948).  For example, the declaration of communication rights states that barriers to communication affect an individual’s ability to relate to and interact with others (thus affecting their right to realise social and cultural rights and develop their personality, as outlined in Article 22), to learn (affecting their right to an education as stated in Article 26) and to access the justice system (affecting their right to equal protection before the law as stated in Article 7).   Furthermore, the World Health Organisation (WHO) recognises the importance of communication as vital for health literacy.  The WHO defines ‘communication and interpersonal skills’ as one of five areas of life skills globally relevant and necessary for health promotion and the protection of human rights across the world (World Health Organisation, 1999).

The rights of children

The importance of communication is also recognised internationally concerning the rights of children.  The United Nations Convention on the rights of the Child (1989), signed by all member States (excluding the USA and Somalia) acknowledges the rights of children to be able to express their views (Article 12, p.5).    Furthermore, Article 13 (p.5) states that “the child shall have the right to the freedom of expression; this right shall include the freedom to seek, receive and impart information and ideas of all kinds.... either orally, in writing or in print...”.

Recognition of communication as a human right in the UK.

The international recognition of the importance of communication is reflected in UK policy and law.  Numerous reviews and white papers highlight the importance of communication to support child development and wellbeing. Just as in the case for the UN declaration of human rights, barriers to communication would also affect a child’s ability to achieve the five outcomes which are identified in the government green paper ‘Every Child Matters’ (2004) and underpinned in the Children Act 2004.  These outcomes are ‘be healthy’, ‘stay safe’, ‘enjoy and achieve’, ‘make a positive contribution’ and ‘achieve economic wellbeing’.  In the green paper the role of speech and language therapy as a priority in meeting a child’s educational and social outcomes is cited as an example of good practice (p. 19 Department for Education and Skills, 2004). The Children Act specifies the need for the Children’s Commissioner to ‘consult with’ and ‘communicate with’ children regarding the discharge of his/her function (Part 1, section 4, page 2, 2004).  Furthermore, the Act also stipulates that the Children’s Commissioner take steps to accommodate the needs of children who do not have adequate means to make their views known (Part 1, section 4, page 2, 2004).

The Bercow Review

In 2008, mindful of the importance of communication for health and wellbeing the UK government carried out a review of services for children with speech, language and communication needs (SLCN) (Department for Children Schools and Families, 2008).  The evidence gathering process of this review was comprehensive and included a range of enquiry methods.  Whilst the methods of sampling were not reported, the consultation questionnaire received 2000 responses, which considerably exceeds the usual requirements for a 95% confidence interval in findings for the population of the UK (Raosoft, 2014).  Consultation groups were held with a variety of interested parties, including a range of people affected by SLCN and services and professionals employed to support children and young people with SLCN.  Consultations were convened in a diverse selection of geographical locations, but did not include Wales, Scotland or Northern Ireland (so therefore may only be representative of views in England).  The review also commissioned research from a range of UK academics with expertise in SLCN.  It may be concluded, therefore, that the findings of this review are representative of interested parties concerned with SLCN, particularly in England.  The review confirmed international opinion that communication is an essential life skill, stating, “the centrality of communication is not simply a personal statement of value. It is a formal, public and multilateral declaration...[and] is a fundamental human right.” (p. 16).

Summary

The use of language, therefore, is universal; it is the direct or indirect result of biological adaptations in humans to facilitate highly complex levels of cooperation necessary for advanced social life.  Language competence has been proposed as even more essential for participation in a technologically advanced society.  It is recognised internationally at a governmental and legal level to be a fundamental life skill, necessary for health, education as well as for emotional and economic wellbeing, and the protection of human rights.  Indeed, it has of itself been described as a human right (Department for Children Schools and Families, 2008; International Communication Project, 2014).   

The centrality of language to human life was summed up succinctly by Tammet (2014): “there is almost nothing we can do to a human being worse than take away their language and their ability to communicate and... relate to other human beings through language"  (you can listen to Tammet here, the quote is spoken at 04:42 minutes).  The question of whether it is language or some other factor which is the one defining feature of being human may not be answerable.  As stated above, the need for language, however, could be argued as a fundamental factor that enables us to be humans together.

The material from these essays has been adapted from my PhD thesis due to be electronically available from the University of Surrey repository.

References:

Bickerton, D. (1992). Language and Species. Chicago: University of Chicago Press.

Children Act 2004,  (2004).

Department for Children Schools and Families. (2003). Every Child Matters. London: Crown Copyright
Fitch, W. T., Hauser, M. D., & Chomsky, N. (2005). The evolution of the language faculty: Clarifications and implications. Cognition, 97(2), 179-210.  

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American Children. Baltimore MD: Paul H Brookes Publishing Co.

International Communication Project. (2014). The Universal Declaration of Communication Rights. Retrieved from

Joffe, T. H. (1997). Social pressures have selected for an extended juvenile period in primates. Journal of Human Evolution, 32(6), 593-605.  Retrieved from http://www.sciencedirect.com/science/article/pii/S0047248497901408

Kuhn, P., & Skuterud, M. (2000). Job Search Methods: Internet versus Traditional. Monthly Lab. Rev., 123(3), 3-11.

Law, J., Reilley, S., & Snow, P. C. (2013). Child speech, language and communication need re-examined in a public health context: a new direction for the speech and language therapy profession. Int J Lang Commun Disord, 48(5), 486-496. doi:10.1111/1460-6984.12027

Livingstone, S. (2002). Young People and New Media: Childhood and the Changing Media Environment. London: Sage.

McKenna, K., Green, A., & Gleason, M. (2002). Relationship Formation on the Internet: What’s the Big Attraction? Journal of Social Issues, 58(1), 9-31.

Norman, C. D., & Skinner, H. A. (2006). eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res, 8(2), e9. doi:10.2196/jmir.8.2.e9

Pinker, S. (1994). The Language Instinct. London: Penguin.
Pinker, S. (2003). Language as an adaptation to the cognitive niche. In M. H. Christiansen & S. Kirby (Eds.), Language evolution. (pp. 16-37). New York, NY, US: Oxford University Press.

Raosoft. (2014). Sample size calculator.   Retrieved from http://www.raosoft.com/samplesize.html

Ruben, R. J. (2000). Redefining the survival of the fittest: communication disorders in the 21st century. Laryngoscope, 110(2 Pt 1), 241-245. doi:10.1097/00005537-200002010-00010

Sampson, G. (1997). Educating Eve; The 'Language Instinct' debate. London: Cassell.

Sanchez-Navarro, J., & Aranda, D. (2012). Messenger and social network sites as tools for sociability, leisure and informal learning for Spanish young people. European Journal of Communication, 28(1), 67-75. doi:10.1177/0267323111432411

Savage, M., Devine, F., Cunningham, N., Taylor, M., Li, Y., Hjellbrekke, J., . . . Miles, A. (2013). A New Model of Social Class? Findings from the BBC's Great British Class Survey Experiment. Sociology, 47(2), 219-250. doi:10.1177/0038038513481128

Skills for Life Network. (2015). About us.   Retrieved from http://www.skillsforlifenetwork.com/article/about-us/2174

Tammet, D. (2014). Are drugs the answer to language learning? - Highlights from a debate hosted by the Guardian and British Academy.   Retrieved from http://www.theguardian.com/education/video/2014/jul/24/are-drugs-the-answer-to-language-learning-video-highlights

The United Nations General Assembly. (1989). Convention on the Rights of the Child Retrieved from

Tomasello, M. (2007). The Human Adaptation for Culture: Public Lecture. London School of Economics.

Tomasello, M. (2008). Origins of Human Communication. Cambridge, MA: MIT Press.

United Nations. (1948). The Universal Declaration of Human Rights.   Retrieved from http://www.un.org/en/documents/udhr/index.shtml

Winston, R. (2002). Human Instinct. London: Bantam Press.

World Health Organisation. (1999). Partners in Life Skills Education; Conclusions from a United Nations Inter-Agency Meeting. Retrieved from

Wright, N. (2010). e-Learning and implications for New Zealand schools: a literature review. Retrieved from Hamilton:

Are speech and language therapists too "nice" for robust peer review on the internet?

This is a sensitive post that explores the issues around debates that take place on social media. Whereas with other blogs I have attempted to source third party information, due to the sensitive nature of the story told, parts of this blog will remain anonymous.  Some readers will be aware of specific events I have referred to from Twitter, but as the role of this blog is to explore the themes and principles necessary to learn about professional development through social media, individual names and tweets will not be repeated here.

Social media has burst into the professional arena over the past few years and is increasingly being used to network with colleagues, share information and reflect on practice.  In my last blog "Healthy skepticism in clinical practice" I recommended Twitter as a forum to share critical thinking in order to develop robust practice.   The past few days, however, have been rather heated in the Twittersphere with allegations of cyberbullying and individuals being requested not to use certain professional networking hashtags as a result of their previous tweets.

The twitterstorm originated from one user challenging a speech and language therapist who had hosted a guest post about psychological astrology on a professional blog.  Requests were made to remove this post with the argument that it did not adhere to the principles of evidence based practice.  A lively discussion followed on twitter which extended to discussion around evidence based practice and blogging in general.  Shortly after this, however, the originator found themselves the subject of allegations of cyberbullying from several users of the professional hashtag.  Allegations included using an inappropriate tone in tweets, "obsession with EBP", and fostering negativity on the hashtag.  The originator was asked by these users to stop requesting that fad therapy posts be removed, stop asking for evidence for interventions and to stop using the professional hashtag.  Whilst there may be differences in opinion over the hows and whys of the discussion that had taken place, was it necessary to jump to public allegations of cyberbullying?  And was it appropriate to request another user to stop tweeting and to veto them from a professional network hashtag?

This incident has raised a few issues that as a profession we need to explore. Discussed in more detail below they are: a; the nature of pre peer review publication, b; conduct on social media concerning peer review and c; professional standards in the world of social media.

The nature of pre peer review publication
Before the emergence of social media most professionals communicated through peer reviewed journals or edited professional magazines.  These media give should give the reader confidence that the reports and views of the author have been reviewed and given approval for publication by other professionals in the field. (That assumption has recently been in dispute in one case, as described by Bishop, but largely holds true).  Whilst professional magazines (such as the RCSLT's Bulletin) are not peer reviewed, the editorial process provides some protection to the reader against outlandish or rogue opinions.  Magazines also often give an opportunity for readers to respond to articles through a letters page.

Things on the internet are different.  Individuals may freely publish articles on blogs without any peer review.  Opinions can also be tweeted without checks and balances on twitter and can reach thousands of people very quickly.  This has benefits and disadvantages.  One of the benefits of these forms of media is the democratisation of opinions.  You don't have to be an established figure or authority to have a voice, and anyone can comment on information.  Another benefit is the speed and degree to which information can be shared amongst professionals.  Through tweets and blogs news gets out very quickly and can be disseminated widely.  I believe I am better informed in my area of practice (early language development) than I would be if I were not on Twitter and did not read other professionals' blogs.   Social media also gives an international perspective for things, so as a UK speech and language therapist I am learning from professionals in different countries and different health economies. In her keynote speech to the RCSLT 2014 conference, Caroline Bowen proposed that Twitter was useful for generation and dissemination of news, engaging in discussion, asking and answering questions, inspiring, encouraging and supporting others, participating in professional learning networks, and connecting and collaborating with groups. Disadvantages of social media, however, include the ease in which cod science and quackery can be distributed and the unpleasant interactions that can result from this unregulated environment (both of which I have alluded to above).

Two blogposts with guidance for academics on Twitter and Blogging have been written by Dorothy Bishop.  This guidance may be equally applied to clinical professions, such as speech and language therapy.  Bishop also discusses the role of blogging in post publication peer review here. The value of peer critique on social media extends beyond post publication review of peer reviewed journal articles. I would argue it is not only of huge benefit to our profession but is essential in the presence of pre-peer reviewed publications, such as professional blogs and websites.  It is the post publication review (via comments on a blog, tweets and shares) that takes place within social media that helps the wider community interpret and understand the validity of what is published.  Put simply, if you blog or tweet, you need to be open to critique of what you are saying.  If we seek to stifle or subdue opinion, that is to the detriment of our profession.

Conduct on social media concerning peer review:
Given the unregulated environment of social media, and its relative youth in terms of a medium for human communication it is not surprising that things go wrong.  There are many examples in Twitter of where things have got nasty and personal.  Trolling on Twitter happens and we need to be aware of it. There are steps you can take to protect yourself from this, including blocking and reporting offensive tweeters.  The extreme reaction to this is not to be on Twitter, or not to tweet what you really think.  Whilst I always advocate 'thinking before tweeting' and not being offensive or personal, it would be such a shame if our desire to always be 'nice' or 'positive' resulted in a muting of the debate.   Our profession could consider a code of conduct when communicating with others on Twitter.  There are several questions that such a code might address.  First, what is the right way to critically appraise someone else's work?  How might someone whistle blow if professional misconduct is observed on social media?  How should we decide what is the appropriate use of a hashtag?  I would argue that it would not be appropriate to dictate who can or cannot use hashtags as that goes against the democratic nature of social media.  It seems reasonable, however, to have explicit agreed rules over how a hashtag may be used.  #WeSpeechies, for example has a rule that the hashtag is not used for promotion or advertising of commercial goods and services.

Professional standards in the world of social media:
Another issue that this incident raised is the extent to which we are free to publish or post what we like on a professional blog or website.  A clinical standard which all speech and language therapy professional bodies now expect, for example, is adherence to the principles of evidence based practice.  Our clinical practice falls along a continuum regarding levels of underpinning evidence and I would doubt anyone would advocate too strict a policy regarding what level of evidence is required for services.  It could be argued, however, that it is not appropriate for our profession to promote services that would be considered 'rogue' or 'outlandish', however, or services where there has been clear evidence of non-effectiveness.  Given that many speech and language therapy professionals now use the internet to promote services, I suggest that our profession would benefit from professional standards on blogging and other publication on the internet.

Update 6th March:
Thank you to those of you who responded to a request for information regarding current guidelines. In the UK the RCSLT does not have its own standards, but refers all enquiries to the HCPC which has guidelines on social media here. Speech Pathology Australia have guidelines here and please see Caroline Bowen's comment below for guidance on use of the #WeSpeechies hashtag. If you are aware of any other professional bodies across the world with guidelines or standards for publishing on the internet, please do get in touch with me and I'll update this blogpost.

Conclusion - are we too nice?
The internet is the 'wild west' of our professional practice.  Currently unregulated and with no code of conduct it appears that anything goes.  This can be refreshing and liberating but it also has its consequences.  While we do develop our practice in this arena, however, I challenge the reader to consider the priorities. When working towards a better, more clinically robust service for the benefit of our clients (who I would hope should always be the priority), let's not close down discussions for fear of not being 'nice' enough.  We need to be robust and stand up to critique, especially those of us who publish on the internet.  Try to be nice on the internet, but not too nice not to keep the debate open for the benefit of everyone.

3rd March 2015 PS: Further to my request for information on guidelines from different professional bodies I have received comments from readers with information.  I am waiting to hear from others, after which I will update this blogpost.  In the meantime please do read the comments below where you will find more information on professional guidelines for social media and internet use.

Healthy skepticism in clinical practice.

I’m a bit of a stargazer, so I was exited to learn that we would be able to see the International Space Station passing over the UK last Christmas.  My family and I stood outside in the cold and watched in wonder as what looked like a bright star majestically passed directly over our house.  A couple of days later another astronomy tweet did the rounds claiming that on January 4^th 2015 we would all experience some weightlessness due to an unusual planetary alignment in our solar system. Thanks to Phil Plait – astronomer and blogger, this claim was debunked shortly afterwards as being completely false (Plait, 2014).  This saved me from the social embarrassment of jumping up and down on January the 4^th yelling to the kids “can you feel it?” for no good reason! Aside from astronomy, however, Plait’s blog caused me to reflect on the importance of healthy skepticism within our profession.

What is skepticism?

A skeptic questions the truth or value of a claim.  Not to be confused with religious skepticism, scientific skepticism is fundamental to the advancement of knowledge.  A skeptic will endeavor to base beliefs on the accumulation of evidence and is prepared to modify beliefs in the light of new scientific findings.  It is also not the same as intelligence, Plait noted that intelligent people are sometimes taken in by false beliefs.  This is more likely if the belief is either widely held or championed by an authority figure.

In the workplace, effective skeptical practice does not stop with questions but seeks evidence to either support or reject assumptions.  This may result in a conclusion of ‘we don’t know yet’, but that is better than a false assumption that we do know.   

Why is skepticism important for speech and language therapists?

We might consider that a skeptical approach to our work is not so important, because we are already underpinned by evidence-based-practice.  Alternatively we may believe that we are already skeptical enough.  A skeptical approach to work, however, is needed more than ever for the following reasons:

1.  Professional integrity

A huge amount of information is now available at the click of a mouse.  I recently carried out  a google search using the search term ‘speech therapy’ and it yielded over 18.5 million results.  Not only is the quantity of this information overwhelming, much of it will not be reliable and clients may find a vast range of cod science and quackery surrounding their clinical need.  As a protected profession we are trusted as experts and our message should be reliable. New trends that overlap with our therapy practice emerge regularly that claim efficacy but are not grounded in adequate or reliable evidence (examples in my field of practice include brain gym and baby signing).  Some advice even extends to the ridiculous, with one speech therapy blog hosting a guest blogger promoting astrology for children with communication needs!  Whilst most practice does not extend into the realms of the ridiculous in this way, we do need to be aware of the grounds on which claims of efficacy are made.   As we know, no evidence of effectiveness is not the same as evidence of non-effectiveness and therapists are entitled to be open-minded about new initiatives.  We should, however, be aware of the level to which different approaches are evidence-based, and in turn be honest with clients about this.

2.  Myths and legends. 

We may be tempted to believe that we are no longer subjected to myths and legends as in times past, however, there are still many stories that abound concerning communication and language that need to be debunked.  Recent mainstream news articles in the UK have blamed forward-facing buggies and ipads for damaging child development.  Neither claim is underpinned by any evidence (for an analysis of the iPads article see this Guardian post, and for forward facing buggies read my blog here).  Whilst as a profession, we generally follow principles of evidence-based-practice it can be tempting to run with stories such as these because in doing so we can promote our own messages (for example, a carer-facing buggy promotes face to face interaction).  I believe we have a duty, however, to be more robust with our professional advice instead of dressing up our messages up in popular opinion.

3.  Conflicts of interest. 

Sources of evidence that we are presented with may be influenced by bias due to conflicts of interest.  These may be financial but may also be for other reasons.  For example, ‘investigator allegiance’ refers to a particular intervention being championed by one person, who may be seeking to enhance their own reputation (Bernstein-Ratner, 2006).   This, as well as other conflicts of interest may lead to a bias towards positive results in the literature, known as a positive publication bias. Aware of this bias, there is now an expectation that negative findings of evaluation studies or trials are published but this still does not routinely happen.  Ben Goldacre highlighted this issue very clearly in the case of drug trials in this talk.  We need to be aware that a similar bias may also occur in our own field of practice concerning trials of interventions.  As a profession, we need to keep up with these results too, so we are aware of what is likely not to work for clients as well as what is likely to work.  Loff (2011) highlighted that if evidence suggesting an intervention does not work is not shared then ineffective practice can continue, grow in popularity and become part of the folklore of the profession. As I stated earlier, myths that are widespread are more likely to be believed.

What should we be skeptical about?

Skepticism should not just be limited to questions concerning effective therapy approaches. Our profession can benefit if we question all aspects of our practice, from theory underpinning our decisions through to discharge planning.  We should even question assumptions about evidence-based practice itself.   As we all bring different perspectives, collective and constructive skepticism can help to move the profession forward.

How can we exercise healthy skepticism?

We can’t all be experts on everything, so it is important to be skeptical collectively.  Make the most of specialists and regularly update care pathways in line with recent evidence.  Clinical researchers are skeptics in practice, so if there is a research active clinician or a researcher in residence in your team, use them to inform the questions you ask and the way you go about answering your questions.  They should be aware of the most up to date guidelines that are in place to inform the quality and clinical relevance of evaluation studies and trials. 

As well as researchers, use the tools now available to support evidence based practice decision making, including the What Works Website, SpeechBite and the Evidence-Based Clinical Decision making tool (Joffe and Pagnamenta, 2014). How about a regular “What’s the evidence?” feature in the non peer reviewed professional magazines, such as the RCSLT's Bulletin, where different contributors write an analytical article on the current evidence for a particular therapy?

Another great source for collective skepticism and a way to keep in touch with evidence based practice is to maintain an active Twitter account.  As well as my Twitter account @clarrysmith there are many ,champions for evidence based practice in the Twittersphere.  These include, but are by no means limited to @vjoffe, @SusanEbbels, @deevybee, @lilacCourt, @avrilnicoll, @speech_woman and @BronwynHemsley, as well as professional networking and organisational Twitter handles, including The Cochrane Library, WeSpeechies and EBPChampion.  Twitter also enables me to maintain an international perspective.  As well as my own professional body, the RCSLT, I am also able to follow other speech and language therapy professional bodies such as ASHA and SpeechPathAus.  I appreciate I am probably preaching to the converted here, if you have read this blog then it may be because you're already on Twitter.  If you benefit from Twitter in the way that I do, however, why not share this blog or your message with your colleagues via email and spread the word.  The more clinicians we can network with via Twitter, the greater our collective wisdom.

Reflective practice and clinical supervision are opportunities for disciplined skeptical thinking.  Reflective practice is a great opportunity to question your own practice and assumptions.  Within group supervision healthy skeptical conversations can be encouraged at work.

Skepticism can be seen as a negative trait but if harnessed constructively, it can help us to grow as a profession.  As we experience more commissioning of services, a team that enables open and constructive skepticism supports staff in developing robust services that they are proud to deliver.

References:

BERNSTEIN-RATNER, N. 2006. Evidence-based practice: an examination of its ramifications for the practice of speech-language pathology. Lang Speech Hear Serv Sch, 37, 257-67.

JOFFE, V. & PAGNAMENTA, E. 2014. Evidence-based clinical decision making. RCSLT Bulletin. London: RCSLT.

LOF, G. L. 2011. Science-based practice and the speech-language pathologist. Int J Speech Lang Pathol, 13, 189-96.

PLAIT, P. 2014. No, a planetary allignment on 4th January 2015 won't decrease gravity. Bad Astronomy [Online]. Available from: http://www.slate.com/blogs/bad_astronomy/2014/12/24/zero_g_day_nope.html [Accessed December 2014 2014].