Jeremy Howick is Module Co-ordinator for The History and Philosophy in Evidence-Based Healthcare. He is a Senior Researcher at the Nuffield Department of Primary Care Health Sciences, and Director of the Oxford Empathy Programme.
What was your earliest ambition?
To be a fireman.
Who has been your biggest inspiration?
Sir Iain Chalmers without a doubt. Sir Iain revolutionised the way I think about research. He taught me to use real examples in my philosophical investigations, and to insist on rigorous systematic reviews. He is also extremely generous with his time.
Why did you get into EBM?
During my stint as an international rower, I was subjected to random drug tests whereby I had to provide urine samples. In these circumstances athletes are instructed by their coaches to be very careful about anything they ingested because some athletes had tested positive for taking routine cough or allergy medication. I developed an allergy for the cat my mother bought for her sister. I visited the doctor who diagnosed me with a cat allergy and prescribed a nasal spray, which contained ‘corticosteroid’. Since ‘corticosteroid’ contained the word ‘steroid’, it scared me – would I test positive for nasal spray? I contacted Rowing Canada to find out but they were taking their time to reply. In the meantime I was suffering. My allergies were making me miserable, I couldn’t sleep, and the quality of my training deteriorated. As a last resort I visited a herbal doctor. I thought it would be hogwash and quackery. The herbal doctor suggested that I keep my head and neck warm, and that I drank ginger tea. It worked! But how did he really know that it was really effective? Or was it just a ‘placebo’? Or had my allergies disappeared simultaneously? How would you tell whether it was a placebo anyway? You can’t make a substance that looks, smells, and tastes like ginger tea but that is not ginger tea. Moreover, because you can’t patent ginger tea, people are less likely to be interested in researching whether it is effective. This experience took me on a journey.
What do you feel has made the most difference in EBM?
The insistence of doing systematic reviews, and the current AllTrials campaign.
Describe your approach to research in three words.
Question. Scepticism. Work.
What do you like most about teaching?
The rewards I get when I see students understand something new or change the way they think. I also like when students disagree with the arguments I’ve made in my publications.
What has been your most innovative piece of teaching?
Developing a system whereby students can act as peer reviewers for their own work. This teaches them to see through the lens of an editor/grader and greatly improves the way they write. The method I developed won an award. I’ve also developed a course on the History and Philosophy of Evidence-Based Healthcare, which is the only one in the world.
When are you having the most fun at work?
When I’m doing research I love, in a good supportive group.
If you weren’t a doctor/teacher what would you be doing instead?
I think I would be a teacher, but teaching something else. Perhaps motivational speaking.
What do you find hardest when teaching?
Teaching is all about preparation. I prepare at least 5 hours for each hour of teaching. That is the hardest bit.
If you were given £1 million for research, what would you do?
I would do a de-prescribing study. We would randomize a group of people who take more than 10 pills into two groups: one that has some of the pills taken away, while the other one carries on taking numerous pills. I suspect it would prove that taking some of the pills away improves health and reduces mortality.
What one resource should every EBM enthusiast read?
Evidence-Based Medicine Working Group. A new approach to teaching the practice of medicine.
For more interviews in this series, please click here.