Reply to discussion of ‘Empirical vs natural weighting in random effects meta‐analysis’

Three discussion papers raise interesting points, but at the end of the day, we continue to recommend that past meta‐analyses which have influenced public policy or clinical paradigms be reanalyzed by unweighted methods. For all future meta‐analyses that employ either (a) fixed effects where concomitant treatment and/or eligibility are diverse or (b) classical random effects weighted methods, unweighted methods should serve as the primary analysis. Other analyses would be reasonable as secondary approaches. Two commentaries suggest that weights are only random to the extent of estimation errors in the between study and within study variance components. We shall demonstrate that even if these components are known, there is still considerable random variability in the weights. In fact, methods that try to weight the estimates inversely proportional to the variance have a number of undesirable properties, including bias, incorrect standard errors, inconsistency (including coverage of confidence intervals), and counter‐intuitive properties that the expectation of the estimator changes both with the number of studies sampled and with constant multiples of sample size across all studies. These adverse properties do not exist for the unweighted approach. From the numerical example of phenylephrine 10 mg, despite the arguments of Waksman, the proper conclusion is that the collection of studies does not constitute evidence‐based support for efficacy in terms of lowering nasal airway resistance. In the final section, we present two compelling examples where questionable inferences were made, with potential major public implications. Copyright © 2010 John Wiley & Sons, Ltd.     

From ‘holding pen’ to ‘a space to breathe’: affective landscapes in a newly‐integrated sexual health clinic

This paper examines the role of affective landscapes in the formation of attendees’ experiences at a re‐provisioned, integrated sexual and reproductive healthcare facility. The ‘One‐Stop Shop’ (OSS) is an example of the organisational shift towards integrated services occurring across the UK, bringing together in one clinic the historically discreet services of genitourinary medicine, HIV medicine and Family Planning. An ethnographically‐informed study of new spaces of care and changed organisation, this paper focuses on the experiences of 29 attendees as they made their way along the clinic's care pathways. Drawing on concepts of affect and atmosphere to augment the analytic lens of ‘therapeutic landscapes’, this paper demonstrates how various spaces of the clinic influenced attendees’ experiences. A cramped, featureless ‘holding pen’, the foyer served to exacerbate pre‐existing anxieties while creating new fears. The main waiting room, an organisational sorting space, both soothed and aggravated attendees’ concerns. Serving as an architectural feature to connect the old Victorian hospital with the new clinical extension, the atrium was experienced as a space to breathe, with an affective atmosphere that challenged the assumed unpleasantness of sexual health clinics. This paper demonstrates how affective landscapes of the clinic shape attendee experiences in a novel setting.     

‘Bourdieu’, medical elites and ‘social class’: a qualitative study of ‘desert island’ doctors

Sociologists of professions draw on Weberian theories of closure. However they have tended to ignore Bourdieu's work, which rejects Weberian notions of class and status groups as distinct ideal types and sees these concepts as inextricably linked. Bourdieu emphasises the importance of a class‐based habitus which generates orientations, inclinations and dispositions that organise practices and the perception of practice. For Bourdieu, because individuals perceive one another primarily through the status that attaches to their practices (through a symbolic veil of honour) they fail to perceive the real basis of these practices: the forms of capital that underlie the different habitus and enable their realisation. This article draws on interviews with 17 elite doctors appearing on a national (UK) radio show during which they choose eight discs to take to a desert island. According to Bourdieu, ‘nothing more clearly affirms one's “class”, nothing more infallibly classifies, than one's taste in music’. An analysis of the doctors' musical tastes and their mode of acquisition (largely, for these elites, via their family and education at independent schools), as well as other insights into their cultural capital reveals the importance of linking class and status when exploring professional status and prestige.