First, Do No Harm: The Blind Duchess

One of the great strengths of the evidence movement in education has been its bipartisan nature. Democrats and Republicans, liberals and conservatives have equal reasons to want to know what works, and to try to ensure that government funds will be spent primarily on programs and practices known to work from rigorous experiments. Politics plays a legitimate role in determining how evidence is put to use and what values should underpin policies in education, but whatever one’s politics, everyone should agree that it’s essential to know what works.

Yet while it’s easy to conclude that we should promote what does work, it’s not so easy to decide what to do in areas in which there is insufficient evidence. We want to gradually replace programs and practices not known to work with those that do have strong evidence, but what do we do while the evidence base is growing?

I recently took a tour of Chatsworth, a huge, ornate great house that since the 1600s has been the family seat of the Dukes of Devonshire, one of the wealthiest families in England. Our guide told us about a famous duchess, Georgiana (a distant ancestor of Lady Diana). In the late 1700s, Georgiana suffered from irritated eyes. Her physician had her bathe her eyes in a mixture of milk and vinegar, and then applied leeches. As a consequence, she went blind.

The duchess’ physician ignored the first principle of medicine, stated in the Hippocratic Oath that every doctor swears: “First, do no harm.” I think it is safe to assume that the Duchess of Devonshire could have had any doctor in Europe, and that the one she chose was considered one of the best. Yet even a duke or duchess or a king or queen could not obtain the kind of routine medical care we take for granted today. But what their doctors could at least do was to take care to avoid making things worse. Recall that around the same time, King George III suffered from insanity, perhaps caused by his physicians, and George Washington was killed by his leech-using doctors.

Today, in education, we face a different set of problems, but we must start with the Hippocratic principle: First, do no harm. But for us, doing no harm is less than straightforward.

In educational practice, we have a growing but still modest number of proven interventions. As I’ve noted previously, our Evidence for ESSA website contains approximately 100 reading and math programs for grades K-12 that meet current ESSA evidence standards. That’s impressive, but it is still a smaller number of proven programs than we’d like, especially in secondary schools and in mathematics. We are now working on the category of science, which has fewer proven programs, and we know that writing will have fewer still.

In all of education research, there are very few programs known to do actual harm, so we don’t really have to worry too much about the Duchess of Devonshire’s problem. What we have instead is a growing number of proven and promising programs and a very large number of programs that have not been evaluated at all, or not well enough to meet current standards, or with mixed outcomes.

For educators, “First, do no harm” may be taken to mean, “use programs proven to be effective when they exist, but stick with promising approaches until better ones have been validated.” That is, in areas in which there are many programs with strong, positive evidence of effectiveness, select one of these and implement it with care. But in areas in which few programs exist, use the best available, rather than insisting on perfect evidence.

One example of what I am talking about is after-school programs. Under federal funding called 21st Century Community Learning Centers (21st CCLC), after-school programs have been widespread. Several years ago, an evaluation of 21st CCLC found few benefits for student achievement, and there are few if any proven models in broad scale use. So how should the federal government respond?

I would argue that the principle of “First, do no harm” would support continuing but significantly modifying 21st CCLC or other after-school funding. Federal support for after school programs might be reformed to focus on development and evaluation of programs that improve achievement outcomes. In this way, federal dollars continue to support a popular and perhaps useful service, but more importantly they support R&D to find out which forms of that service produce the desired outcomes. The same approach might be applied to career and technical education and many other areas in which there is substantial federal, state, or local investment, but little evidence of what works. In each case, funds currently supporting popular but unproven services could be shifted to supporting development, evaluation, and dissemination of proven, effective strategies designed to meet the activity’s goal.

Instead of potentially harming students or taking away funding altogether, such a strategy could open up new areas of inquiry that would be sure to eventually create and validate effective programs where they do not exist today.

In education, “First, do no harm” should not justify abandonment of whole areas of education services that lack a sufficient selection of proven approaches. Instead, it means supplementing service dollars with R&D dollars to find out what works. We cannot justify the kinds of treatment the Duchess of Devonshire received for her irritated eye, but we also cannot justify using her case to give up on the search for effective treatments.

This blog is sponsored by the Laura and John Arnold Foundation

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