Wednesday, July 20, 2011

How to get a rosy cheeks naturally:Tips for getting pinkish cheeks using home remedies, how to have pinkish glow on the cheeks

Rosy cheeks are considered to be the epitome of beauty. No doubt rosy cheeks play an important role in upping your glam factor. I am sure that you all crave for the cheeks that bloom like a rose. Wanna get rosy cheeks naturally without an exorbitant use of blush? If your answer is yes, you have reached the right place .In this article you will find some very effective tips for getting rosy cheeks naturally.

                                                     Image courtesy of marin / FreeDigitalPhotos.net

 In order to get a rosy glow, why not just start by attacking your own kitchen larder? Vegetables, fruits and other ingredients available at home work wonder without burning a hole in your pocket.



Natural way to get rosy cheeks


Apply a paste of two mashed bananas on your face .Wash off after 20 minutes. This face pack is very helpful in giving you a red rosy glow.

 Boil  2-3 beetroots and mash them. To this , add 3 teaspoons of kaolin powder (it is easily available in your local chemist shop) and apply this mix on your face and neck .Leave it on 20 minutes. Use this home remedy to get a rosy effect.

Soak up masoor daal in unboiled milk for 30 minutes .Grind the mix into a smooth paste. Mix with kaolin powder .Dab on your face. Leave this mix for 20 minutes .And see how your skin glows like a rose.

To get a soft blush –like effect ,apply 2-3 teaspoons of gram flour with one spoon of milk cream,3 teaspoons of each wheat bran and curd. Slather this face pack on your skin for 15 minutes. Wash off after 15 minutes.

Apply the pulp of cucumber on your face to get that rosy effect you die for. Cucumber is an excellent skin lightening agent. It helps to fade dark circles also and acts as a great exfoliating agent.

Apply apple cider vinegar on your face to get rosy effects on your face.

You can make a face pack at home mixing grated cucumber ,lemon juice(1/4)cup,5 teaspoon of each honey and milk .To this ,add flour to get a thick paste consistency. Then refrigerate it for 5-6 hours. Then smear this mask on your face for 15-20 minutes to get rosy cheeks naturally.

Take 1/4 cup of amaranth juice with a pinch of turmeric to apply on your cheeks. This concoction acts as a natural bleach and helps in warding off wrinkles and dry skin .Apply with cotton balls on your face .In just 2-3 days , you will notice you are blooming like a rose.

You can also mix 1/4 cup of lemon juice with milk to massage on your face to facilitate blood circulation to get a pinkish glow.

Grind few almonds and apply with crushed rose petals, 5 teaspoons of each mint juice and honey. This mix will look like a cream that can be refrigerated for 5-6 days. This face mask will start showing results in just 1 week .This face mask is to be applied at bedtime.

To get rosy cheeks, you can apply orange peel powder with milk or cream on your face.

Nutrition-Your diet also plays an important role in giving you a glowing skin. Take a healthy diet which will reflect on your face instantly .Take fresh fruits, fruit juice ,fresh vegetables ,milk to get the desired glow on your face. Taking vitamin C and E help in giving rosy cheeks .So have a bite on plenty of citrus fruits and leafy vegetables.

Take exercise and lead a stress free life-Taking exercise will make you glow naturally because of blood circulation it imparts. Apart from that stay away from stress. Be happy and I am sure glow of happiness will make you look rosy naturally.

By now ,you are aware of many tips on getting rosy cheeks .So why wait dear ?Now is the time to putting these tips to practice .Follow these tips and wow the whole world with your rosy cheeks.

Check out  http://becomebeautifulnutan.blogspot.in/2013/09/81-fairness-tips-for-getting-fair-skin.html

http://becomebeautifulnutan.blogspot.in/2013/09/51-tips-for-treating-acne-on-face.html

How to look beautiful from head to toe



                                               Image courtesy of stockimages / FreeDigitalPhotos.net


 Glowing  face , silky hair ,smooth lips ,soft hands ,beautiful feet  almost  every  woman dies for  it all .If you wish to look stunning at all times ,here is a lowdown on  how you  look ravishing everyday  using ingredients available in every household.           




                      
For glowing face

Apply red sandal wood powder mixed   with rose water on your face .Leave it on for 20 minutes. Wash it off for getting   glowing complexion.

Massage coconut oil all over the body before taking shower .  Coconut oil massage will ensure moisturized and   hydrated skin.

Soak up 5-6 currants in water .Mash them and apply with lemon juice on the   face, leave this mix   on for 15 minutes   , then wash off. You will notice an incandescent glow in your face.
 Make  sure you slather your skin with sun block   with an SPF of   30 or above before you plan to head off   in the sun   .    Excessive exposure to the sun can play havoc on your skin in form of   premature aging   and skin darkening. The daily application of sunscreen is mandatory even if you are indoors.

Apply cucumber juice with raw milk to get fairer complexion naturally.


 For bidding farewell to pimples

Apply red sandal wood with cucumber juice on the area where you have pimples .Wash off after 30 minutes.

You can use leaves of neem with turmeric to stave off   acne   and   diminish the spots pimples leave behind.

Wash off your face with rose water in which a pinch of camphor is added .This will keep pimples at bay and keep skin oil-free.

Dab on besan (gram flour) with the cow milk and lemon on pimples.

Apply coconut milk with a pinch of saffron to   combat pimples effectively.

Those with pimple prone skin must steer clear of   oily foods. Never let your hair infested   with dandruff .Stay away from stress as much as possible.


For crowning glory

Massage your hair with 2 egg yolks and a teaspoon of olive oil. Leave this mix on for 15 minutes. Wash off with lukewarm water   to get that soft hair you would like to touch every time.

Soak up henna in an iron container overnight. To this, add coffee, eggs   , amla. Whisk all ingredients thoroughly before applying on   the hair. Application of this wonderful hair pack is a must every fortnight for sporting gorgeous hair.

To grant luster to your hair, use malt vinegar as a last rinse.


 For the   beauty of eyes

Always wear sunglasses before heading outdoors   . Take adequate sleep to avoid dark circles

Splash   water into the   eyes while taking bath. This act prevents formation of wrinkles around eyes and acts as a quick cool-off.

Slice a potato or cucumber in half   ; place this on the area   below your eyes to fade away dark circles.

Coconut oil massage around eyes will also help in diminishing dark circles.

 For removing facial hair

 Apply the mixture of turmeric ,curd and gram flour on your face.Let it dry.Rub it  off very gently.

Grind the leaves of dried turmeric .Apply with coconut oil on the face   and leave overnight. Wash off in the morning.

In order to get a flawless complexion

Apply honey with tomato on the face to fade blemishes.

Mash banana and apply on your face. Wash off after 20 minutes.

Dab on coconut water on your scars to lighten them naturally.

For beautiful lips

To prevent your lips from drying   , apply milk powder mixed with water. Wash off after some time.

Apply the juice of raw amla for beautiful lips.

Apply beetroot juice on the lips thrice a day. Get set   to see your naturally reddened lips. 

To prevent your lips from drying, apply the mix of rose water and buttermilk to the lips.



For banishing ugly black marks from the neck

If you notice the black lines   on your neck, then rub rock salt with lemon juice on affected area.

Pour fenugreek seed in curd to   scrub on your neck. Wash off after   leaving this mix for a few minutes.

For flaunting soft hands

 Slice the lemon in half. Mix with 2 spoons of sugar to scrub on your hands. Follow with moisturizer.

You can apply cornmeal on your hands after washing your hands to get soft hands.

Milk cream with   gram flour   also can do wonder for your hands .
                                  
For getting kissable feet

Apply a mix of rosewater and glycerin on feet for getting those soft feet you will be tempted to touch   again   and   again.

Apply olive oil on your cracked heels   ; leave it on overnight .You will be stunned to find your kissable feet.

Soak up you feet in warm water for 15-20 minutes everyday.  Make sure you do not forget to rub with pumice stone post   feet soak up, to clear away all the accumulated dirt your feet gather all day.

By now, you are aware of many beauty tips that will have you glowing skin   from head to toe.   Do your   skin a favour by adhering to a regular beauty care regimen.  Now is time to   putting these   tips to practice. Wait no more! And get set   to face the mirror   of beauty with a tinge of pride and happiness.

check out http://becomebeautifulnutan.blogspot.in/2014/01/101-tips-for-hair-care-home-remedies.html

Monday, July 4, 2011

21 Solution-Focused Techniques

© 2011, Coert Visser

Several informal surveys have given an impression of the relative popularity of different solution-focused techniques. The following 21 techniques seem to belong to the most well-known and popular solution-focused techniques: scaling questions, the past success question, the preferred future question, the platform question, the exception seeking question, reframing, indirect compliments, the miracle question, summarizing in the words of the client, the what-is-better question, normalizing, the usefulness question, the observation question, the perspective change question, the coping question, the continuation question, the prediction suggestion, leapfrogging, and mutualizing. Below is a description of these techniques.


1. The scaling question: The technique of scaling questions originated more or less coincidentally when a client, in a second session with Steve de Shazer, answered to his question how he was doing: “I’ve almost reached 10 already!” de Shazer began to play with the idea of using numbers to describe one’s situation. This started the development of the scaling question used in solution-focused therapy. Today, scaling questions have developed into the most well known and most frequently used solution-focused techniques. Scaling questions are relatively easy to use and extremely versatile. Nowadays, many therapists, coaches and managers use them. Even many people who know little about the solution-focused approach know the scaling question.

2. The past success question: The past success question is the question when things have already been better and what made that possible. By asking this question the client may remember when he has already been able to cope with a problem or to solve it. Remembering one or more past successes is likely to increase the confidence and hopefulness of the client and usually helps the clients find ideas to take a step forward. Some examples of past success questions are: “When have things already been a bit better?”, “Have you ever been able to solve such a problem before?”, and “Have ever experienced a situation which is a bit like the situation you want to achieve?”

3. The preferred future question: This is one of the most essential types of solution-focused questions. It is the question with which the coach invites the client to describe how he or she would like the situation to become. The coach or therapist encourages the client patiently and curiously to vividly describe the preferred future, (or the 'desired situation'). The preferred future gets described in terms of concrete, positive results. A few ways in which the question can be posed are: “What does your preferred future look like?”, “How do you want your situation to become?”, “What would you like instead of the problem?”, and “How will you notice things will have become better?” When asking the preferred future question it helps to encourage clients so that they can build an image of their preferred future step by step. Usually a good sign is when clients begin to describe in positive terms what they themselves will do differently in that situation. When this happens their motivation and willingness to try out steps forward usually increases.

4. The platform question: The platform question helps to see the client what is already there. Examples are: “What have you already achieved?”, “What is already there?”, and “What has helped to bring you to your current position?”. By focusing on what has already been achieved, people usually get a different, more positive perspective both on their current situation (“It is not all bad!”) and on their future. Once they start looking at the glass as half full instead of half empty, they become more hopeful that they will be able to achieve their change goals.

5. The exception-seeking question: In solution-focused change, an assumption is that the intensity of problems fluctuates constantly. There will always have been situations in which the problem was less intense and when things were better. These situations are identified and analyzed because they will often help to find ideas to solve the problem. An example of how exception-seeking questions may be asked is: “Are there times when the problem does not happen? When was this? What was different? How did you make that happen?”

6. Reframing: With reframing the professional gives a positive twist to the words or actions of the client. He or she sees the positive meaning or intention in or behind the words of the client and highlights that. Insoo Kim Berg once explained the concept of reframing nicely: "Reframing is simply an alternate, usually a positive interpretation of troublesome behavior that gives a positive meaning to the client's interaction with those in her environment. It suggests a new and different way of behaving, freeing the client to alter behavior and making it possible to bring about changes while "saving face". As a result, the client sees her situation differently, and may even find solutions in ways that she did not expect."

7. Indirect compliments: Complimenting indirectly means inviting the other person through a question to describe what was good about what he or she has done and what has worked well. An example of an indirect compliment is: “Wow, how did you manage to finish that task so quickly?"). You might also call such kinds of questions ‘affirming questions’. It is also possible to include the perspective of other people in indirect compliments. An example may be: “What do your colleagues appreciate in how you work?” An advantage of complimenting through questions is that you activate the other person. Also, there is less chance that he or she will feel embarrassed or will turn down the compliment ("It was nothing special"). Instead, you challenge the other person and make him or her reflect (“Actually, how did I do that.... let's see.....?”).

8. The miracle question: Another solution-focused classic is the miracle question. The miracle question is a sequence of questions which invite the client to vividly describe a day after which the problem has miraculously disappeared. It goes like this: "Suppose our meeting is over, you go home, do whatever you planned to do for the rest of the day. And then, sometime in the evening, you get tired and go to sleep. And in the middle of the night, when you are fast asleep, a miracle happens and all the problems that brought you here today are solved just like that. But since the miracle happened over night nobody is telling you that the miracle happened. When you wake up the next morning, how are you going to start discovering that the miracle happened? ... What else are you going to notice? What else?" The miracle question in fact is a special case of the desired situation question. It often leads to hope, energy and ideas for steps forward.

9. Summarizing in the client’s words: Solution-focused professionals frequently summarize what clients have said while sticking to their choice of words (this is called language matching). Advantages are that the client will feel taken seriously. Also, it helps them and gives them some time to think about what more they should tell. After a summary, it is often not even necessary for the coach to ask a question because clients already know how they would like to proceed. Peter De Jong and Insoo Kim Berg give six important functions of solution-focused summaries: 1) The summary reassures the client that the SF practitioner was listening carefully, 2) The summary reassures the SF practitioner that he has heard the client accurately, 3) By using the client's words in the summary the SF practitioner shows respect for the client's frame of reference, 4) The summary (if done descriptively and in a spirit of openness) has the effect of inviting the client to say more (correct, revise or add), 5) The summary has the effect of putting the client in control of how to describe their experiences, and 6) The summary assists the SF practitioner in formulating the next question based on what the client has just revealed.

10. The what-is-better question: This is also one of the most frequently used solution-focused techniques. The what-is-better-question is mainly asked in follow-up coaching or therapy sessions (second and later sessions) with clients. The advantage of this type of' question is that it helps the client to focus on which progress has been made in the past period and on what has worked well. This usually has a motivating effect, often leads to more awareness of what works and to useful ideas about further steps forward.
Some people who first hear about what-is-better-question are first a bit reluctant about using this slightly strange question. They think it's a bit awkward (”Isn't it more normal to just ask how things are going?") and they fear their client may think the question is strange, too. Well... to be honest, the question is a bit strange indeed. But the thing about is .... it works amazingly well. The value of the answers to the 'What's better?' question is enhanced when you, as a coach, ask probing questions. You keep asking until the situation is described so concretely that is easy to see what happened, what was good about it and how the person has managed to accomplish it. Much more important, however, than that the coach understands this is that the client see this concretely. The questions of the coach are a tool to accomplishing this. The interesting thing with the 'What's better?' question is that you repeat it often ("What else is better?"). Usually you don't just ask it 1, 2, or 3 times, but rather 6, 7, or 8 times. The surprising thing often is that client indeed manage to mention as many examples as that (encouragement by the coach is important of course). Also, coaches are often surprised to find out that sometimes the most interesting examples of what's better are not the first or the second ones that are mentioned. Sometimes, already 6 examples have been mentioned and then, suddenly, the client mentions a very important improvement, also to his or her own surprise (”Gee, I forgot that has happened but it is actually really important."). On a video tape I once saw a client who mentioned something like 35 things that were better. While the conversation proceeded his smile got bigger and bigger.
You may wonder: "But what do you do when the answer is 'Nothing is better!' or 'I have no idea'?" Coaches who want to ask the 'What's better?' question are sometimes worried that their client will answer like that or that they may even say: "What is better? Nothing's better. Everything has gotten worse!” Or that they may be irritated about the 'strangeness' of the question. In answer to this, I like to say two things. One is that although these things may indeed happen, in the majority of the cases they tend not to happen. Most clients do need a few seconds and some encouragement but then, they actually started mentioning improvements.

11. Normalizing: One of the nice things about the solution-focused approach is that it has many subtle and effective techniques. One of them is normalizing. Normalizing is used to depathologize people’s concerns and present them instead as normal life difficulties. It helps people to calm down about their problem. It helps them realize they're not abnormal for having this problem. Other people in their situation might respond the same. This is important, because if they felt angry and they'd also feel their anger was pathological, they'd have two problems, their anger and the fact that they behaved pathological. That their behavior would be pathological would be a surplus problem to the original problem (the thing they were angry about). Normalizing helps to prevent this surplus problem from happening. By saying something like: "Of course, you're angry, I understand. It's normal to be angry right now." You can help people to relax and to move on relatively quickly beyond their anger.

12. The usefulness question: A question which is used a lot in solution-focused coaching is the so-called usefulness question (sometimes referred to as the useful-question). The purpose of this question (of course) is to make conversations as useful as possible for those involved. Solution-focused coaches use usefulness questions at the beginning of conversations, during conversations and at the end of conversations. At the beginning, of conversations questions like these can be used: “How can we make this conversation as useful as possible?”, “What do you want to come out of this conversation?”, and “How would you notice afterwards that this conversation has been worth your time?” During the conversation, questions like these can be used: “So far, has this conversation been useful to you?”, (if yes) “What was useful?”, “How was it useful?”, (if no) “What are your ideas about how we can make the conversation more useful?”, and “How can we make the remaining time as useful as possible?” At the end of the conversation, questions like these can be used: “Has this conversation been useful to you?”, and “How is what we talked about useful to you?”
By asking usefulness questions, it becomes easier for people to focus on what they want to come out of the sessions. By asking the question, they will remember their goals and linking the conversation to these goals. The question has an activating effect. By asking the question people will usually become actively involved in the conversation right away. The interesting thing is that the usefulness question can be applied just as well in one-on-one conversations as in group sessions.

13. Observation suggestions: When clients find it hard to identify examples of earlier successes or exceptions to the problem, observation suggestions can be applied. Here is an example of this intervention may be done: “Could you, between now and our next conversation, pay attention to situations in which things are a bit better? … When you notice that things are better, could pay close attention to what is different in that situation and to what you do different yourself? And could you make a note of what is different and what you do that helps so that we can talk about it, next time we meet?”. The observation task often has a surprisingly strong effect. The question makes them notice more consciously what goes right in their lives. Usually, this helps them become more optimistic and gain more confidence.

14. The perspective change question: A powerful and simple way to help people visualize how their situation will be different once their situation will have become better is the perspective change question. Essentially, this question is: ”How will other people notice things are better?” There are many different ways to phrase the question. Here are some examples: “How would our customers notice that we would have become more customer focused?”, “How will other colleagues notice that the conflict will be solved?”, “How would your manager notice this coaching is no longer necessary?”, and “How would our competitor notice that our company has become more competitive?” The perspective change question helps client to develop a broader view on themselves and their situation and to look more objectively so that they can build clearer goals.
Often, this type of question is also referred to as the relationship question. This name is especially relevant when the perspective of a significant other is used. When clients are asked to imagine how, for example, their partner would notice the difference the question usually strengthens the relationship with that person. By answering the question clients find it easier to view things from the perspective of the other person which helps to appreciate this perspective more. Also, clients come to appreciate the relationship with this person more.
Perspective change questions help clients to view themselves from a third-person perspective. There is some research indicates that doing this has a motivational impact.. When we picture ourselves acting in the third-person, performing the type of behavior we would like to perform, we see ourselves as an observer would. It helps to view ourselves as the kind of person who performs such behavior which increases the likelihood of engaging in that behavior.

15. The coping question: solution-focused professionals use a specific kind of question that works well when people are going through hard times and can barely find the energy to do something about their problems. This type of questions is called ‘the coping question.’. When normal strategies to solve problems don't seem to work anymore you can try this question. An example of a situation in which you can use the coping question is when your client says he or she is now at a zero on the scale (see the scaling question). The basic form of the question is: “How do manage to keep going?” But there are many other ways of phrasing the question. Here are some examples of coping questions:
  • What keeps you going under such difficult circumstances?
  • How do you manage to deal with such difficult situations each day?
  • What helps you to keep going even though things are really hard?
  • How can you explain to yourself how you have been able to do so well while the circumstances are so hard?
  • It is admirable how you have been able to keep on going under such difficult circumstances.... how did you do that?
  • How did you manage to cope before you gave up?
The coping question helps people in difficult situations to find new energy to keep on dealing with their problems. By using the coping question clients are helped to become aware that they in fact are managing, at least to some extent... This helps them to see that they are still able to do some things well and that their energy has not faded completely. By exploring how they do cope they can become more aware of what it is exactly that keeps them going. What is still so worthwhile for them to get out of bed each morning and to face the day? By becoming more aware of this you will see, nine times out of ten, that the motivation and hope of this person will strengthen almost immediately.

16. The continuation question: A solution-focused technique which often works well, both with individual and with organizational change is the continuation question. The question tries to identify that which does not have to change. Here some examples of how it may be phrased: “What happens in your situation that you want to continue to have happen?”, and “What doesn't have to change because it is already going well enough?” By asking this question you make clear that the client (or employee) does not have to change more than necessary and you acknowledge that there are things that are going well. Inviting clients to focus on what does not have to change has the following advantages: 1) they feel taken seriously and appreciated because the coach or therapist implies and acknowledges that there are things that are already going well, 2) after clients have made a list of things that do not have to change they usually find it easier to proceed to focus their attention to things that do need to change, 3) while they focus on what is already going well enough, clients usually get some ideas about what they might do to make progress.

17. The yes-set: The concept ‘yes-set’ refers to a technique with which the professional conducts the conversation in such a way that the client is tempted to say ‘yes’. One way of doing this by summarizing what the clients has said in the words of the client. Another way is to which the client can very easily say ‘yes’. A few examples of such questions are: ”Is it alright if I ask you a question?”, “Would you like your situation to become a bit better?” An effect of the yes-set is that clients become more suggestible and admissible. This helps them to focus more on the questions that are asked and to become imaginative in answering them. Some solution-focused professionals use the yes-set in a reversed way, too. When they notice in themselves a tendency to object to or reject something a client says they restore an openness to what client says by saying ‘yes’, or by thinking ‘yes’.

18. The prediction suggestion: A lesser known intervention in the solution-focused approach is the so-called prediction suggestion. In essence with the prediction task, the coach asks the client: "Each night, before going to bed, predict whether or not you will succeed in ............. (whatever it is the client wants to accomplish) the next day." Prediction suggestions are based on the idea that what you expect to happen is more likely to happen once the process leading up to it is in motion. While making clients set in motion the processes involved in having a better day. No matter what guess the predictor puts down, the idea that clients might have a good day is bound to cross their mind. Of course, having a good day is what they really want due to which a self-fulfilling prophecy might develop and this might prompt "better day behavior" the next day.

19. The overcoming the urge question: In the solution-focused approach it is seen as normal that people who try to change their behavior will sometimes feel the urge to fall back to old, less desired behaviors. Most people who to quit smoking will at some point feel the temptation to light another cigaret. Giving in to this urge can threaten the change process because it can negatively affect clients’ motivation to go on. A good skill to develop in change processes is the skill to overcome the urge to fall back into old behaviors. The way solution-focused practitioners may help their clients to discover and develop this skill is to suggest the following to them: "Pay attention to what you do when you overcome the temptation or urge to fall back". This type of observation task, the so-called ‘overcoming the urge question’, presupposes that clients will indeed be able to overcome their urge, at least in some situations. When they find out how they resist and overcome the temptation they can become more aware of this skill and further develop it.

20. The optimism question: The optimism question helps clients to identify reasons for optimism. Here are some ways of asking this question: "What makes you optimistic?”, “What indications do you have that you will be able to achieve ...?”, and “What small signs do see that indicate you will succeed in ....?”. Even in very difficult circumstances both clients and coaches or therapists are often surprised by the fact that still some reasons for optimism can be identified. When this happens, clients’ hopes are lifted. The optimism question makes use of the phenomenon that, often, what you focus on becomes more important. This is also the case with this question. It makes change easier by strengthening optimism.

21. Mutualizing: The solution-focused approach is often used in situations in which two partners have disagreements (conflict resolution, mediation, marital therapy, etc). One skill is particularly helpful in these kinds of situations in which people may differ in perceptions, interests and goals: mutualizing. Phil Ziegler explains the process of mutualizing as reframing issues or goals in a way that all parties can agree to. He gives an example of a mediation case: "If one parent says: 'I want the child living with me full time because that's what's best for my daughter. And the other says: ''I want our daughter living with me half time and half time with you because that would be best for her.' Then I would say, 'It's pretty clear to me that both of you want to develop a plan that will be best for your daughter--you disagree at this point about what plan would be best but you share the common goal of making the best plan for her. Can we all agree about that?'" Instead of emphasizing the different positions and goals the solution-focused practitioner mutualizes the preferred future.

Friday, July 1, 2011

Improving science

Science can be defined as the systematic enterprise that builds and organizes knowledge in the form of testable explanations and predictions about the world. Science is one of humanity's greatest inventions which has the potential of improving our lives and our societies. The core of the scientific process consists of scientists making observations, reading scientific literature, formulating questions, testing ideas through systematic studies, and sharing their findings. The system of science contains principles and sets of rules which help make science self-correcting and cumulative. Scientists are required to share not only their findings through publication but also provide detailed descriptions of their studies so that replication of their studies by other scientists becomes possible. A process of peer review functions as a filter to guarantee that only research that meets scientific standards is published in journals. Replication studies make it possible to test findings using the same methods but with different subjects and experimenters.


By building on robust findings and revising or discarding findings that fail to be replicated scientific theories are built over time. Here is a simplified description of the subsequent stages of knowledge development in science. In early stages, scientists observe associations between phenomena. Then, they are able to make predictions. Next, they gain insight in underlying causal mechanisms. Finally, they are able to control phenomena and to use scientific knowledge.

An example of science at its best is the theory of evolution. Roughly 150 years ago, Charles Darwin, after many years of careful observation and thought, produced a theory that still drives the contempory scientific agenda. Darwin's breakthrough insight was that in organisms whose environment changed nonrandomly and whose reproductive success in that environment depended on inherited traits, evolution became inevitable. Today, the theory of evolution has developed into an extremely well-tested macro theory consisting of a diverse set of micro theories which together yield invaluable technologies.

There is a difference between this idealized description of the scientific enterprise on the one hand and scientific practice on the other. While science as an idea is wonderful there are many aspects of scientific practice which require improvement. When we think about refining and improving the scientific process we usually focus on improving the core of the scientific process. For example, we may discuss whether or not the large scale use of significance testing in social science is justified or not. While important, this is not the only area in which improvement may be achieved. The effectiveness and efficiency of the scientific process is also importantly determined by several other factors, somewhat more in the periphery, which are easily overlooked. The scientific process can be seen as a chain of events. Strengthening the weakest links in this chain may yield the greatest improvements. The figure below is a simplified depiction of this 'chain'.



Here are some ideas about how each of these links in this chain affects the overall effectiveness and efficiency of scientific progress and some (sometimes implicit) suggestions for improvement:
  1. Research funding: in order to be able to do research scientists (usually) have to write grants to find financial resources. Decisions about grants for research are not only often made on scientific grounds alone. Three factors threaten scientific impartiality in grant allocation: 1) commercialization of science: an example is how most medical research is now funded by industry; 2) political agendas: political convictions may have an important influence on whether certain scientific research is funded or not (for instance stem cell research); 3) vested interests of conventional scientists: decisions about grants are usually made by well-known scientists who may be wedded to conventional ideas and approaches and may have an interest in these conventional ideas and practices.
  2. Original research: the quality of the methods and techniques used remains an essential determinant of scientific progress. Ongoing discussions about the proper design of studies and about the correct use of (statistical) analyses remain important.
  3. Peer review: in order to be published papers have to pass the process of peer review. While this is intended to provide a guarantee of scientific quality there is certainly room for improvement in peer review practice. Many instances of peer review failure have been identified which may have to do with limited or no access of the reviewers to the data and/or the details of the method or with bias by vested interest of the anonymous reviewers.  Open peer review has been suggested as a way to improve the transparency and accuracy of the peer review process. 
  4. Replication studies: replication studies play an essential role in the self-correcting nature of science. But in practice scientists are not eager to do replication studies, in particular when they think the results of the study were wrong. Also, journal editors typically prefer to publish groundbreaking new research and are often very reluctant to publish replication studies. Some even have an explicit policy of not publishing replication studies (source). Recently, Daryl Bem reported some very surprising results on so-called precognition. Here is an article about how replication studies were rejected by journals and about some solutions suggested by psychologist Richard Wiseman.
  5. Follow up studies: follow up studies play an important role in the cumulative, progressive character of science. By building on previous research, theories may be tested and refined and, gradually, theories may be developed which are massively supported by evidence. This paper discusses, among other things the critical and perhaps underestimated role that anomalies play in building better theory. 
  6. Further dissemination of scientific knowledge: Scientific knowledge may be spread through popularized science books, magazines, websites like Google scholar, Wikipedia and Youtube, television programs,  and education. An interesting and useful development is also how some universities have started to create chairs for the public understanding of science (for instance Oxford). There are now also peer reviewed scholar sites (scholarpedia.org). And there are more and more researchers uploading pdf files on their websites. Some universities are very generous in sharing their knowledge, too. Despite all these initiatives, there remains a substantial gap between scientific developments and the public's knowledge and understanding of it. Some worry that the gap growths. Even basic scientific knowlegde is unknown to large proportions of the population of many countries. Some people argue for a free open access to all publicly funded scientific knowledge for everyone. 
  7. Science education: education is a specific way of disseminating scientific knowledge and to teach students about scientific methods and making students scientifically literate. Scientific illiteracy of politicians, parents and school managers may pose serious threats to this process. For example, politicians may argue that equal attention should be paid in class to creationism and evolution theory ("teach both sides"), which, wrongly, suggests that there is, among scientists, a controversy about the evidence for evolution (actually, the evidence is overwhelming). Politicians may even go so far as to make libel laws which may practically prevent scientists to criticize claims made by sellers of alternative medicine or other approaches which are unsupported by scientific evidence.  
  8. Application of scientific knowledge: the availability and application of scientific knowledge would be facilitated by improving the practices described above. Scientific progress would happen faster and would benefit more people. 
The scientific enterprise is extremely important and we should continue to improve scientific practice.

Overdiagnosed: too much diagnosis is turning more and more of us into patients

The rationale for the increasing emphasis on diagnosis
In Overdiagnosed, H. Gilbert Welch (photo), with Lisa M. Schwartz, and Steven Woloshin, explains how the medical profession has an increasing tendency to make diagnosis which is not good for us. The rationale for more diagnosis seems good. When we diagnose more we are able to detect abnormalities, like cancer, high blood pressure, diabetes, high cholesterol, etc., earlier so that we can treat them earlier and prevent serious health problems. An example of this greater emphasis on diagnosis is the prevalence of disease awareness campaigns which encourage people to undergo medical screenings. Another example of increased tendency to diagnose is when doctors have patients tested for things about which they have no complaints.


When are abnormalities dangerous?
Although more diagnosis may sound good, according to the author it is actually, on balance, not when it leads to overdiagnosis. Overdiagnosis is the detection of abnormalities which are harmless. Overdiagnosis is likely to happen when diagnosis is done when there are no symptoms. What is important to know is that many asymptomatic people have abnormalities of some kind which are no threat for their health and which will never become a threat to their health. Some of these unharmful abnormalities may fall into innocent sounding categories like slight overweight, or pain in the knee, but some unharmful abnormalities involve terribly dangerous sounding words like stroke, cancer, high blood pressure, diabetes, high cholesterol, etc. While all these dangerous sounding words may involve abnormalities which indeed can kill you, in many cases abnormalities like these won't kill you or even harm you. For instance a study found that 10 percent of healthy participants had had strokes (silent strokes) without them being aware of it. Another example is that a large percentage of adults have some evidence of thyroid cancer. For most of them this will never become dangerous because cancers are often static or progress extremely slowly. Some abnormalities are dangerous, many abnormalities aren't. How does the medical profession decide when abnormalities should be considered pathological?

How lowering cutoffs creates new patients
Medical professionals consider an abnormality pathological when the value they find in a diagnosis is above a certain cutoff score. This cutoff score is not something which is purely scientifically established. The distinction between abnormal and normal can be rather arbitrary. The author explains that cutoffs are defined by panels of physicians and they involve not only scientific judgments but also personal values and opinions and financial interests. Cutoffs are also not fixed. They frequently change over time. The direction of this change has been to set cutoffs lower and lower. Due to this, the threshold to make a diagnosis has fallen and the number of individuals who are labeled sick has increased, often dramatically. The picture below (source) illustrates this with the -arbitrary- example of cholesterol level cutoffs.
As the picture shows, lowering the cutoff only slightly, creates a great number of new 'patients'.

What forces drive the lowering of cutoffs?
The author mentions at least three forces driving the lowering of cutoffs. First, there is the true belief by many that early detection is a good thing because it can prevent worse. Second, new technology enables medical professionals to screen more easily, cheaper and more refined. Third, finding more abnormalities and defining these abnormalities more and more as pathological enlarges the medical market which leads to financial benefits. The author explains that this third force is a dangerous one. He says the commercialization of medicine is a corrupting force. It may have been fine if medical care would have been a free market but it is nowhere close to being a free market. Sellers in the medical care market create demand for their wares by being in the position to decide whether or not you need to consume their products. Turning more people into patients is (like) expanding the market, something of which the whole medical-industrial complex financially benefits. Medical research is also negatively affected by commercialization. In order to do research researchers have to apply for grant money. Decisions about grants for research are not only often made by the commercial companies like the pharmaceutical industry (most medical research is now funded by industry) but also by other researchers who are wedded to conventional ideas and approaches. Sympathetic sounding disease awareness campaigns also increasingly involve paid advertising.

What is the problem with more diagnosis and lower diagnosis thresholds?
More diagnosis and lower thresholds lead to more treatments. A cycle of seeing more, finding more, and doing more emerges. People with small abnormalities will be treated more than was the case before. There are two problems with this. First, people with milder abnormalities stand to benefit less from treatment than those with severe abnormalities. A few may be helped but many will be overdiagnosed and some of them will be harmed and no one knows who. The following picture (source) shows the relationship between treatment benefit and level of abnormality.

Second, being diagnosed and being treated has some serious disadvantages. There are potential psychological (for example viewing oneself as a patient), practical (for example not being admitted to insurance), financial (for example spending more on healthcare) and medical harms (for example side effects, sometimes very serious, even life threatening) of being diagnosed and treated. When patients have seriously threatening abnormalities there is often little that can be done about these harms. In those cases treatment is necessary and its benefits outweigh the negative effects of being diagnosed and treated. But for patient with mild abnormalities chances are that negative effects of being diagnosed and treated outweigh its medical benefits.

If it ain't broken ...
This book is not a criticism against conventional health care. It does not advocate alternative healthcare. It is also not against diagnosis and treatment. On the contrary, the author is all for conventional healthcare and urges people with symptoms to talk to their doctor. It is diagnosis and treatment in the absense of symptoms the author warns against. Often, it is wise to remember: if it ain't broken, don't fix it.