What is the world asking of me?
“What is the world asking of me?” was the question posed by Professor Colleen Aldous, who was recently inaugurated as a full professor, the highest accolade in an academic’s career.
Aldous, an accomplished scientist and esteemed academic, is determined to ensure that science is intermingled with humanitarian values and that these values are instilled in every student she supervises or teaches.
From an early age, Aldous – who was the first female in her family to attain a matric pass – recalled her family’s strong influence in instilling in her a love for education. A geneticist by profession, she developed a keen interest in science education (SE) and went on to graduate with a doctoral degree in SE from the University of Twente in The Netherlands.
Said Professor Richard Hift, former Dean of the School of Clinical Medicine and current HOD of Clinical and Professional Practice in the School of Clinical Medicine, when introducing Aldous to the audience: "Colleen is highly active in research and the career development of young researchers. She has been committed over the years to supervising PhDs who are clinically trained, including heads of clinical departments. She has published over 150 articles in peer-reviewed journals and has a strong interest in the field of evidence-based medicine (EBM). Further, in 2022, she mentored two young women to becoming associate professors."
Aldous began her scientific career with challenging many basic principles. She said: "EBM’s central tenet is to consider all available evidence when making treatment recommendations and decisions. The EBM pyramid, which arranges research design into a hierarchy, is the first place where EBM's interpretation has been distorted. 'Certainty of evidence' has inappropriately been replaced by 'quality of evidence', leading to a shift away from considering the totality of evidence to focusing exclusively on randomised controlled trials (RCTs) and higher levels. The replacement of the word 'certainty' with the word 'quality' in the figure, however, has led to the incorrect conclusion that reports in the RCT level and above are acceptable, while all observational studies and background information/expert opinions which are found only in the lower levels are improperly dismissed.
"By replacing certainty with quality, medical training and media discourse have ingrained in physicians and the public that, a priori, case series are of poor quality and RCTs are of high quality. This has been a serious misuse of EBM, especially during the COVID-19 pandemic. For example, RCTs 'proving' a drug does not work, and which were not well designed or executed, have been accepted as good quality because of their position in the pyramid model, not because of their true scientific quality. Conversely, well-run case series rendering more reliable results with more certainty than poorly executed RCTs have been ignored," said Aldous.
Aldous, together with an international team of scientists, has challenged the EBM pyramid by developing a T-EBM Wheel. She said: "The T-EBM Wheel represents everything the pyramid has represented, but without the hierarchy, and includes laboratory studies.
"My thinking as a scientist and member of a global society has developed more in the last two years since the COVID-19 pandemic than it did during my PhD years. My long-held beliefs and trust relationships I had with structures were challenged. As I heard more and more distortions of evidence-based medicine ideals and saw the synchronised manipulation of mainstream messages across the globe, the more I realised that if there was ever a time to be a truly independent and critical thinker, it is now. I believe we are at a critical time in human civilisation where discerning information will become one of the most important life skills everyone needs to develop to avoid being herded into fixed thought chambers.
"I don’t know how to change the world. My job is to contribute to evidence-based medicine while guiding novice researchers towards doctorateness. I can, however, ask that we review the way evidence-based medicine has come to be seen, correct its course where it has gone wrong and emphasise a values-based approach," said a passionate Aldous.
One of Aldous’ students, Michelle Baker, commented: ‘Congratulations Prof. I feel so privileged and safe to be working under your supervision."
Aldous also thanked people who played an important role in her journey. She thanked her parents who continue to read her works and provide feedback; her school teachers, including Mr Herselman, Mrs Beck and Mrs Dixon, who instilled the love of science and languages in her; her sons, Arn and Jac and their wives; Professor John Rogan who supervised her master’s and PhD degrees; Professor Brenda Wingfield who helped with her registration; Professor Jonathan Jansen for his teaching and generosity of spirit; Professor Fanie Botha who employed her at UKZN and her close personal friend and colleague; Professor Richard Hift for encouraging her to apply for her first promotion; as well as her best friend and best support, Mr David Manion.
"I am so thankful to all my students. I learn so much from you. Each of you means so much to me," she said.
Words: MaryAnn Francis