Skip to main content

Main menu

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers

User menu

  • Subscriptions
  • Alerts
  • Log in

Search

  • Advanced search
British Journal of General Practice
Intended for Healthcare Professionals
  • RCGP
    • BJGP for RCGP members
    • BJGP Open
    • RCGP eLearning
    • InnovAIT Journal
    • Jobs and careers
  • Subscriptions
  • Alerts
  • Log in
  • Follow bjgp on Twitter
  • Visit bjgp on Facebook
  • Blog
  • Listen to BJGP podcast
  • Subscribe BJGP on YouTube
British Journal of General Practice
Intended for Healthcare Professionals

Advanced Search

  • HOME
  • ONLINE FIRST
  • CURRENT ISSUE
  • ALL ISSUES
  • AUTHORS & REVIEWERS
  • SUBSCRIBE
  • BJGP LIFE
  • MORE
    • About BJGP
    • Conference
    • Advertising
    • eLetters
    • Alerts
    • Video
    • Audio
    • Librarian information
    • Resilience
    • COVID-19 Clinical Solutions
Life & Times

The Age of Hubris

Saul Miller
British Journal of General Practice 2020; 70 (693): 194. DOI: https://doi.org/10.3399/bjgp20X709217
Saul Miller
Wooler, Northumberland.
Roles: GP
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info
  • eLetters
  • PDF
Loading
Figure

Apps don’t help parents of sick kids.1

A recent systematic review of research relating to apps and their use in helping parents of ill children found an absence of evidence of benefit but evidence of user dissatisfaction.

We are in the midst of the Information Age, but I suspect that a combination of outcomes is something we are all familiar with, whether users of such apps or not. Wikipedia identifies the development of the transistor as the fundamental facilitator to the ending of the earlier Industrial Age,2 shifting us to an economy primarily based on information technology; that economy includes plenty of failed promises still.

I contend that this is in fact the Age of Hubris. It is salutary to think how little we still know.

Ignorance comes in several guises. There is stuff we know that turns out to be otherwise. There is stuff we know that turns out we just don’t, and no one else does either. There are the known unknowns, the stuff we actually know we don’t understand. And there are the unknown unknowns, as made famous by Donald Rumsfeld: ‘The message is that there are no “knowns”. There are things we know that we know. There are known unknowns. That is to say there are things that we now know we don’t know. But there are also unknown unknowns. There are things we do not know we don’t know.’3

Those parents of sick children who try to use an app to determine their best course of action probably fall into the first category — they thought it would be helpful but learn that it is not. They are not the only ones to be prone to having to change their view though. Fresh challenges to existing beliefs come up all the time. For example, a recent cohort study using a database based on UK GP records identified that macrolide prescribing in pregnancy was associated with an increased risk of malformations.4

A recent US safety assessment of commonly used active ingredients from sunscreens falls into the second group — we all assume they’re safe but it turns out nobody knows if they genuinely are.5 The research in question found all six compounds tested show higher than recommended plasma levels even after a single application. Although they report no significant toxicity, this was not a long-term follow-up study.

A core purpose of science is to explore the known unknowns and to help us reduce the blindspots so that we can then explore those too. A piece of research that won an Ig Nobel Prize in 2018 explored a known unknown — why most users of new electronic consumer products don’t RTFM (read the field manual).6 It identified that children were least likely to do so, and that most users use only a subset of the features of their products. The probable cause? Over-featuring and being forced to consult manuals appear to cause negative emotional experiences.

France’s recent decision to remove state funding for dementia drugs suggests its government has decided to move the topic of how to promote cognition in dementia back into the category of known unknowns.7 I applaud this, thinking there are quite a few medicines we peddle that have only marginal benefit at best and whose use promotes the illusion of knowing how to help.

In terms of unknown unknowns, my practice faces a Care Quality Commission (CQC) inspection next week. A recent study reported that the quality indicators used by CQC to measure UK general practices have very little correlation with the inspection ratings practices receive.8 So it appears the basis for the rating we will receive is as unknowable as the outcome of our visit.

If this really is the Information Age, we’re still some way off its zenith.

  • © British Journal of General Practice 2020

REFERENCES

  1. 1.↵
    1. Donovan E,
    2. Wilcox CR,
    3. Patel S,
    4. et al.
    Digital interventions for parents of acutely ill children and their treatment-seeking behaviour: a systematic reviewBr J Gen Pract2020https://doi.org/10.3399/bjgp20X708209.
  2. 2.↵
    1. Wikipedia
    Information Age2020https://en.wikipedia.org/wiki/Information_Age (accessed 3 Mar 2020).
  3. 3.↵
    1. Department of Defense news briefing (12 February 2002) as quoted by Donald Rumsfeld
    2019https://en.wikiquote.org/wiki/Donald_Rumsfeld (accessed 3 Mar 2020).
  4. 4.↵
    1. Heng F,
    2. Ruth G,
    3. O’Callaghan F,
    4. Leah L
    Associations between macrolide antibiotics prescribing during pregnancy and adverse child outcomes in the UK: population based cohort studyBMJ2020368m331
    OpenUrlAbstract/FREE Full Text
  5. 5.↵
    1. Matta MK,
    2. Florian J,
    3. Zusterzeel R,
    4. et al.
    Effect of sunscreen application on plasma concentration of sunscreen active ingredients: a randomized clinical trialJAMA20203233256267
    OpenUrl
  6. 6.↵
    1. Blackler AL,
    2. Gomez R,
    3. Popovic V,
    4. Thompson HM
    Life is too short to RTFM: how users relate to documentation and excess features in consumer productsInteracting with Computers20162812746
    OpenUrlCrossRef
  7. 7.↵
    1. Walsh S,
    2. King E,
    3. Brayne C
    France removes state funding for dementia drugsBMJ2019367l6930
    OpenUrlFREE Full Text
  8. 8.↵
    1. Allen T,
    2. Walshe K,
    3. Proudlove N,
    4. Sutton M
    Using quality indicators to predict inspection ratings: cross-sectional study of general practices in EnglandBr J Gen Pract2019https://doi.org/10.3399/bjgp19X707141.
Back to top
Previous ArticleNext Article

In this issue

British Journal of General Practice: 70 (693)
British Journal of General Practice
Vol. 70, Issue 693
April 2020
  • Table of Contents
  • Index by author
Download PDF
Download PowerPoint
Article Alerts
Or,
sign in or create an account with your email address
Email Article

Thank you for recommending British Journal of General Practice.

NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
The Age of Hubris
(Your Name) has forwarded a page to you from British Journal of General Practice
(Your Name) thought you would like to see this page from British Journal of General Practice.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
The Age of Hubris
Saul Miller
British Journal of General Practice 2020; 70 (693): 194. DOI: 10.3399/bjgp20X709217

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

Share
The Age of Hubris
Saul Miller
British Journal of General Practice 2020; 70 (693): 194. DOI: 10.3399/bjgp20X709217
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
  • Mendeley logo Mendeley

Jump to section

  • Top
  • Article
    • REFERENCES
  • Figures & Data
  • Info
  • eLetters
  • PDF

More in this TOC Section

  • It’s The Sun Wot Won It
  • The WHO’s definition of health: a baby to be retrieved from the bathwater?
  • Books: The Only Book I’ll Ever Write: When The Doctor Becomes The Patient
Show more Life & Times

Related Articles

Cited By...

Intended for Healthcare Professionals

BJGP Life

BJGP Open

 

@BJGPjournal's Likes on Twitter

 
 

British Journal of General Practice

NAVIGATE

  • Home
  • Current Issue
  • All Issues
  • Online First
  • Authors & reviewers

RCGP

  • BJGP for RCGP members
  • BJGP Open
  • RCGP eLearning
  • InnovAiT Journal
  • Jobs and careers

MY ACCOUNT

  • RCGP members' login
  • Subscriber login
  • Activate subscription
  • Terms and conditions

NEWS AND UPDATES

  • About BJGP
  • Alerts
  • RSS feeds
  • Facebook
  • Twitter

AUTHORS & REVIEWERS

  • Submit an article
  • Writing for BJGP: research
  • Writing for BJGP: other sections
  • BJGP editorial process & policies
  • BJGP ethical guidelines
  • Peer review for BJGP

CUSTOMER SERVICES

  • Advertising
  • Contact subscription agent
  • Copyright
  • Librarian information

CONTRIBUTE

  • BJGP Life
  • eLetters
  • Feedback

CONTACT US

BJGP Journal Office
RCGP
30 Euston Square
London NW1 2FB
Tel: +44 (0)20 3188 7400
Email: journal@rcgp.org.uk

British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners
© 2023 British Journal of General Practice

Print ISSN: 0960-1643
Online ISSN: 1478-5242