Knowledge translation as not using knowledge

Using knowledge well might mean not using it at all.

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We have a duty to use knowledge to address challenges facing society. We also, as I argued in my last post, have a duty to think through the consequences of knowledge use. 

This project of using knowledge well has been the core aim of the rapidly burgeoning fields of KERTI (knowledge exchange, research translation and implementation). KERTI can be viewed as a kind of social movement. It is driven by a collective sense that we are not making the best use of what we know in order to improve the world around us. KERTI functions as a kind of 'call to action' to champion certain ways of creating and implementing new knowledge.

One possible reason for the rise of KERTI relates to the reduction in permanent employment opportunities in research. This, coupled with increasing costs of scientific research and competition over scarce resources, creates pressures to show benefit for one's research over unrealistically short time frames. In this light, KERTI can be thought of as a symptom of systemic problems in research governance and funding.

On a more optimistic note, KERTI can be viewed as part of the specialisation process, a result of the  expansion of academic knowledge and practices that creates an opportunity for people to hone their skills in helping knowledge to be used well, creating specialist knowledge of its own kind in the process.

While I support initiatives to make better use of knowledge and count myself a member of the KERTI movement, I also find it a curious prognostication. Let me explain why:

Patience

KERTI is a fairly recent activity in the history of science. Plato, Aristotle, Newton, Einstein, Darwin, the Curies and Galileo didn't have dedicated KERTI teams at their disposal (well, maybe Socrates did). Still, their innovations found a way into the scientific doctrine. Did this take time? Yes. Did their ideas face resistance? Yes. Still, the ideas have come to occupy fairly central roles in modern scientific understandings. My broad position on this is to take a realist approach: if enough awareness is raised in relation to an idea that is true and useful, political processes and players will have a limited ability to suppress it in the long term. In this way, I am attributing some agency to the quality of an idea and relying on an intrinsic pragmatism in humans. The qualifier of 'awareness' is important because I am not discounting certain impediments to an idea getting a fair airing. For example, the articulation of ideas by men has been more likely to achieve the prominence necessary to become established. But, even here, this is an issue of who gets credit for an idea rather than whether the idea itself takes hold. If the idea is both true and useful, it will be 'discovered' by more than one person. 

This is a tough criterion on knowledge, though - a kind of post-hoc survival of the fittest argument - and one that is more easily applied to the really big ideas that anchor our understanding of the world, rather than the middling level, context dependent ideas that most of us engage with in the specialities we contribute to.

It is commonly cited that effective 'translation' of innovations takes approximately 17 years. (As the authors of this paper highlight, there are good reasons for viewing this figure with some scepticism. Still, I think we can take this figure as a rough approximation i.e., the usual rate of uptake of an innovation is a matter of years or decades rather than days, weeks, months or centuries). Statistics like this are often given in the context of suggesting how difficult and/or time consuming it is for good ideas to make it into practical application. But how long should an innovation take to be applied? How can we say that 17 years is too long to wait? Maybe it's not enough? Perhaps it depends on the specific innovation?

Of course, we do not want to delay beneficial interventions from serving beneficial goals. But let's say, for example, there exists a life saving medication that could have saved millions of lives over the 17 year period it takes to go through clinical trials, safety certifications and registration processes. Have those millions of people been harmed? Well, not necessarily. Until we have knowledge of the efficacy of a treatment and that its benefits will outweigh possible harms, we cannot say that these people are actually being harmed in missing out on a treatment. Really, until we have this kind of information, the treatment can't be said to exist. What exists, instead, is the promise of the treatment. A tantalising promise, perhaps, but a promise nonetheless.

If the argument is that the intervention is needed to avoid almost certain catastrophe and no alternative exists, then the argument for implementation might shift in favour of fast-tracking implementation. However, even in the case of fast-tracking Ebola vaccine development, checks and balances cannot be altogether cast aside. These tests are part of what defines the result as a treatment, properly speaking. This gestures to a larger point: effective implementation of knowledge requires decisions not to implement, or to delay implementation, while due diligence is undertaken.

Democracy

My second critique is what I will call the technocrats dilemma. This is the problem faced when implementing contentious solutions to contentious problems e.g., harm reductionist approaches to illicit drug use or efforts to mitigate climate change. These are issues where research evidence can be counter intuitive or unpleasant and thus social, psychological and political pressures turn against the ideas being presented. It is incredibly frustrating when political-ideological or social-psychological forces undermine researchers' dedicated and well thought out elucidations of problems and solutions - when you really 'know' what the issue or solution is but are rendered impotent in your attempts to convince others. KERTI presents itself as a potential solution to this problem. Sometimes researchers think that opposition to scientific research betrays lack of understanding that could be overcome by education (what's called the 'deficit approach'). Others believe that, given appropriately democratic preconditions for knowledge production, consensus solutions can be found (this approach goes by various labels like 'participatory action research' or 'co-design'/'co-creation').

Sometimes the problem is lack of understanding or lack of engagement with stakeholders early on, but sometimes different views exist that are irreconcilable; allowing alternative views to co-exist, even when that means that the weight of opinion goes against us sometimes, is the price we pay for democracy.

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These issues raise questions about what can be controlled and what should be controlled with respect to knowledge use. They also highlight how knowledge use cannot be disentangled from ethical considerations and the political and economic contexts in which we operate. These limitations on our control set limits as to our responsibility. However, they do not absolve us of the imperative to act dutifully. This discussion also underpins a point that is often not really articulated by KERTI practitioners: using knowledge well doesn't mean implementing knowledge indiscriminately. In some circumstances, using knowledge well might mean not using knowledge at all.

Thanks to JERE.be @JERECartoons for this image.