RCTs – The Holy Grail of Arts in Health?

Mike White, Senior Research Fellow in Arts and Health in the Centre for Medical Humanities at Durham University, writes: On a humid June day in London, I attended a ‘hothouse’ seminar arranged by the Public Engagement Foundation for the purpose of developing a methodological framework for arts and health research. A keynote by Prof. Dame Sally Macintyre on ‘Complex interventions and knowing what works’ primed me to expect a consideration of mixed methods evaluation, even participatory action research, but we actually got a re-tread of the familiar reductionist argument for Randomised Control Trials as the only reliable method of collecting evidence. This was expounded in a blow-by-blow demolition of arts and health practititioners’ reasoned objections and hesitations to applying one-size experimental design in arts interventions in non-clinical settings.

For me, the keynote set the day off in the wrong direction. It assumed that all of us in the room, drawn from an impressively wide spectrum of research and practice, were agreed that the express purpose of arts in healthcare is to produce measurable therapeutic benefits. The research agenda is vast as there is now a broad spectrum of practice and it is still innovative and curious. We must not stifle that emergent vision and potential by only seeking a proven evidence base for arts in health that is narrowly defined through ‘control’ based interventions . It reduces the whole arts and health field to being some kind of ancillary treatment in healthcare. For the rest of the day our round-table conversations struggled with the task at hand to produce one rather formulaic research framework taking its cue from Dame Sally’s presentation. Thankfully by the end, one table from our brainy brood had produced an outline sketch for RCT-type research that at least acknowledged our concerns about including qualitative evidence, and so our saved faces beamed.

To adapt an aphorism of Oscar Wilde, there seems little point in knowing the price of arts interventions in a medical model of healthcare if we do not also appreciate their value in addressing inequalities through a social model of preventive health – which is where so much of the potential of arts in health lies. We are not interested only in cause and effect with a few variables; rather we thrive on the complexity of intractably difficult things to explain through experimental design, like for example humour, subversion, and how it actually feels to do arts in health. A rather absurd thought comes into my mind of constructing an RCT around a lantern procession, with the ‘control’ group bumbling around in the dark.

Dame Sally did not make a single reference to ‘qualitative’ evidence. Yet as I see this week at an international conference in Bristol, the emergence of small cross-national collaborations brings a renewed significance to narrative-based research because of the need to respect and reconcile differing cultural nuances in the application of creativity to health promotion. Finding common ground here precedes the challenge of identifying the relative medical and cost benefits across different systems of health education and welfare. The ‘healthy living’ stories we generate and exchange are the basis for international practice in arts in community health.

The Public Engagement Foundation (PEF) seems genuinely committed to the search for evidence that will make the case for funding, and rigorous evidence gleaned from RCTs of course has a crucial function in convincing health economists and those holding the Treasury Green Book. It seems to me unhelpful, however, to pre-determine a common research design for a very diverse field; rather like sending us off on the Enterprise with a Cosmos Tours brochure.

What I took away from the London seminar is that our diversity is actually our strength; our work is based on decades of research-guided practice and is not the ‘fluff’ that PEF claims is how it is regarded in policy circles. Nor should PEF claim to be ‘running’ the newly-formed national network for arts and health researchers; rather it provides through ESRC funding a secretariat for a wobbly round table of theoretical and ideological positions on appropriate research designs. We are in the early Middle Ages of arts in health, an age of romance and heretical discoveries, and we will assert our cosmology in the lists and not through a grail quest.

About Centre for Medical Humanities

Centre for Medical Humanities
This entry was posted in Arts in Health and tagged , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s