Lost in Translation: The Promise and Problems of the Globalization of Research

Abstract

The purpose of this article is to consider the promise and problems of the globalization of research for nurses and other healthcare professionals. Over the past decade, there has been an impressive increase in research activity in many regions of the world, such as in several of the Asian countries. This increasing capacity to conduct research and create innovations has great promise for shared health, prosperity, and well-being, but it also has some significant problems and limitations that are often not reported. One area of research that has drawn considerable international research attention is aging and longevity. In the United States, there is much to learn from the work of international colleagues in terms of clinical application; it is unclear how generalizable the findings are or, in other words, what may be lost in translation.

Keywords

aging globalization research

The purpose of this article is to consider the promise and problems of the globalization of research for nursing and other healthcare professionals. Over the past decade, there has been an impressive increase in research activity in many regions of the world as well as an increased amount of international research. In several of the Asian countries, for example, there has been an increase in research funding and activity, such that in 2017, scientists in South Korea published approximately 65,000 research articles, in Japan 89,000, and in China 414,000 (Noorden, 2018). While this growing body of research has contributed much to the advancement of science and technology, it is unclear what the impact on these studies is on global health and healthcare practice, in the home countries and across national and regional borders. In other words, it is unclear what can and cannot be translated into practice from international research. The author in this article suggests that the translating of research across countries and regions to healthcare needs to be done with caution and conservatively. Not all data, research findings, and recommendations can be implemented outside of the country of origin, just as it may not apply to diverse groups within countries. There are also problems with the translation of research, theory, and clinical recommendations, concepts, and theories.

The author discusses here research on international and local aspects of aging and longevity, because it is one area that potentially has much to benefit from the globalization of research. Because the number of older adults around the world is increasing, these topics require greater attention. There is also variation across countries and regions that affect aging; some groups or subgroups appear to do particularly well in terms of longer lifespans or low disease burden. These differences are very interesting from a global public health perspective and spark considerable interest in various antiaging and healthy-aging practices, but can studies of the differences be adopted outside the places where they are found?

One example is Lawson’s (2011) book about life in Campodimele, Italy, which is titled A Year in the Village of Eternity. He reported that the average life expectancy for both men and women in Campodimele, Italy, is 95 and that the population has much lower levels of heart disease, obesity, and cancer than other places. But he also describes how many people there raise their own goats and eat cheese made from their milk or eat locally grown vegetables, a lifestyle that is not an option for the majority of the world population. Yet these observations raise interesting research questions about lifestyle and diet and suggest these practices can be linked to health and longevity and should be considered elsewhere. The question remains, What is lost in translation? Later in this paper, the merit of some elements of lifestyles and diet are more closely examined.

Globalization of Research

Globalization of research in science and healthcare is part of a much bigger process taking place worldwide. Google and other internet tools can search billions of pieces of information and various types of media, from almost anywhere in the world, in seconds. Artificial intelligence can collect and uncover patterns in huge amounts of information. But even machine-based collection, organization, and analysis of data are not without biases—for example, when Google Translate converts Spanish into English, references to women get converted to “he said” and “he wrote” (Zou & Schiebinger, 2018, p. 324). Such biases can affect decision-making because computers amplify such errors and present them as if they were unbiased. In addition, not everything is accessible or retrievable; there are both random and nonrandom access to data limitations and misinterpretation of concepts, findings, and recommendations. Translation software while impressive is not without errors and biases.

In addition, it is important to consider that “bad statistics may well be worse than no statistics, since they rigidify the deep channels of our false flows of thought” (Hill, 1984, p. 493). In various places, there are groups and persons who want to suppress certain information; for example, in the United States, because of pressure from the White House, the Centers for Disease Control and Prevention had for 8 years been restricted in publishing data on gun-related injuries reported in emergency departments (EDs). There is also fake information used by some groups, countries, and companies to influence campaigns designed to mislead and create discord. In other situations, some groups and leaders have exaggerated numbers to make their political point or argue for greater budget allocations (Sadiq, 2005).

There is even less accurate information available about phenomena that are outside of the official or legal transactions in many countries. Such limitations in data collection and access also vary across states and regions within countries. Unavailable and unreliable data combined in international studies make the results of these studies difficult to interpret and generalize. Depending on cultural and political issues, stigmatized behaviors and conditions continue to be underreported even by the most nonjudgmental clinicians and careful researchers, while on the other hand, efforts to destigmatize behaviors or be more inclusive can lead to underreporting and the minimization of unhealthy behaviors and practices.

There are geographic, cultural, and value differences in various countries that raise interesting questions and comparisons, but inconsistency in the reporting and data collecting makes comparisons difficult. For example, longer hours of sunlight or variation in local diets, as mentioned above, can be correlated with various health outcomes and longevity, but even if these associations are causal, it is unclear if they would be equally beneficial if adopted elsewhere. Studies of regional health challenges do produce important data and studies, the results of which have considerable interest worldwide. For example, the Severe Acute Respiratory Syndrome (SARS) that reached Hong Kong from China, parasite research in Malaysia, and using CRISPR gene editing to improve crop yields in South Korea are research projects that are both locally critical and have worldwide potential, if they can be translated and replicated in other places (Cyranoski, Law, Ong, Phillips, & Zastrow, 2018). There are also innovations in eldercare in various places, such as Holland, with a designated village (Hogeweyk) designed to maximize the freedom and dignity of persons with dementia (Hogeweyk, 2018).

Likewise, there are countries that have national health registries or studies with very large datasets that many countries cannot match, but can the data and resulting finding be generalized or can the data be included in international meta-analyses? For example, there is one study in China that involves 33,000 babies in Guangzhou (Cyranoski, 2018). These data have attracted considerable global attention in part because they include information about the infant’s microbiome, which is a major area of research interest at this time. But one initial finding from this study revealed how different the lives of these participant families are from families in other parts of the world. In one study using the data of the large study, researchers found that incense burning in the home was associated with an increase in hypertension in expectant mothers (He et al., 2018). While this may be common in Southern China, it is not as common elsewhere. In other words, while digital language translation continues to improve, as does the access to large datasets, the differences across borders and cultural, language, linguistic, and literacy need to be considered as well as other communication and translation limitations. Nurses and healthcare, as well as the general public, have to consider that such cross-regional research findings can create clinical errors if adopted uncritically.

Considering what can be described as the three “Ls” (language, linguistics, and literacy), differences continue to create barriers to national and international surveys and other data collection methods; research concepts and findings likewise differ from place to place. Linguistics reflects regional differences in the use of words and phrases, such as English in England, the United States, and Australia, not to mention racial, class, cultural, and generational differences in the same country and area. In addition to the risks of losing the meaning in translation, there are philosophical, conceptual, and ethical issues to be considered when seeking to adopt data, findings, concepts, and recommendations from countries that may have different human subjects protections. Ethical issues also need to be raised, in that some researchers have intentionally or unintentionally taken advantage of lax institutional review board (IRB) standards or enforcement in various places of the world.

Some places have allowed the exploitation of subjects, particularly in places where healthcare services are inaccessible or unaffordable, making people more amenable to consenting to research that would be impossible in other countries, making use of these data or findings ethically questionable.

Research on Aging and Longevity

Research on aging and longevity provides a case in point about some of the promises and problems in seeking to translate international research to local practice. While aging is inevitable and universal for all material and living creatures, the rate of aging varies remarkably in different places and with locations. Roizen and Oz (2007), for example, are popular authors and health information communicators with a large following. They have distinguished chronological age from what they refer to as RealAge. They define RealAge as “biological age based on your lifestyle and behaviors” (Roizen & Oz, 2007, p. 4). Such a conception helps persons to consider the effect of some of their decisions and suggests there are things to be done that cannot only slow the aging process but reverse some age-related changes. How old a person feels or perceives him- or herself is an important predictor of remaining healthy and active. Contributing to the experience of aging is how persons are treated and perceived by others in their family, work place, social groups, culture, country, and world, but it also follows from their values and beliefs. The meaning of aging and the experience of the impact of the changes associated with aging arises in space and time (De Juan Pardo, Russo, & Roque Sanchez, 2018), which is always changing and unpredictable (Parse, 2014).

Social, natural and human-built environment, climate, access to services, healthy foods, and water quality all play a role in the experience of aging and must be considered when interpreting international research on aging and longevity. For example, one recent study of nearly 4,000 “superelderly” (persons age 105 and older) in Italy (Barbi, Lagona, Marsili, Vaupel, & Wachter, 2018) suggested to some that there are no natural limits to how long humans can live or that there is a relative mortality plateau for those who can survive to such advanced age. Ken Wachter, a mathematical demographer, suggested such debates are fueled by studies from “bad records and statistics” (Dolgin, 2018, p. 15).

Beyond the universally recognized importance of remaining physically active and maintaining a healthy weight, to what degree do specific elements of diet and eating habits, activities, and behaviors and other life choices contribute to slowing the rate of the aging process? For example, the consumption of green tea, which is more common in Asia, has been associated with a number of health benefits and therefore healthy aging and longevity in other countries as well. Green tea is described as being high in phenolic compounds, which are catechins, more so than black tea, and these compounds are seen as antioxidants, antimutagenic, and anticarcinogenic (Chacko, Thambi, Kuttan, & Nishigaki, 2010). While consumption of large amounts of green tea is not without health risks, primarily from the caffeine and aluminum it contains, and their effect on iron availability, based on observational epidemiological studies and some intervention trials, drinking green tea is widely recommended for persons without advanced heart disease and pregnant or breastfeeding women. A Cochrane review reported that “black and green tea have a beneficial effect on lipid levels and blood pressure, but these results were based on only a small number of trials that were at risk of bias” (Hartley et al., 2013, p. 2). This review included five studies done in the United States; the rest were done in the Netherlands, Japan, Australia, China, and Poland. Of the five studies that included green tea, four also involved exercise, and the primary outcome of the fifth was photoaging skin. An earlier Cochrane review found insufficient and conflicting evidence for the effectiveness of green tea consumption in the prevention of cancer (Boehm et al., 2009). Because it is likely that people who drink green tea in the United States also exercise more than the general population and eat other green foods, it is difficult to determine the effect of green tea consumption.

Similar issues can be raised from other adopted practices. One small study done in persons living in the Unites States has shown that the long-term practice of Tai Chi and meditation with exercise was associated with better executive function, an important cognitive skill associated with successful aging, than in persons who did not practice these specific exercises (Hawkins, Manselle, & Woolacott, 2014). While this cross-sectional study only suggested an associated between the practice of Tai Chi and meditation and executive function, it was nevertheless a positive finding. Authors of another small study of an intensive balance-focused and Tai Chi exercise program suggested that these programs could be useful to improve functional fitness and reduce fall risk (Zhao, Chung, & Tong, 2017). The sample of this study was older adults attending a community center in Hong Kong. The average body mass index (BMI) of the sample was 23.9, and the participants were on three or fewer types of medications, and 77% of them reported daily regular exercise. In addition, the authors suggested that these types of exercises were “appealing and feasible” for the sample and by inference suggested that they would be to older adults elsewhere (Zhao et al., 2017, p. 491).

Clearly the same older population in the United States is heavier, has more chronic conditions, takes more medications, and gets less regular exercise. It is unclear if such exercises would be equally appealing in other cultures and places. Despite these apparent limitations, the authors and the journal that published the paper suggested such programs could be equally effective in other countries, and they suggested the finding could be broadly generalizable. One solution to these potential problems translating findings and practices internationally is to test them elsewhere. High levels of stress and ways of dealing with stress have been linked to healthy aging by various authors and researchers. Stress and ways of dealing with stress are also things that vary in different places and countries.

One area of health, aging, and longevity research that has generated a lot of popular and scientific research attention and claims of health benefits has been taking omega-3 fatty acids, or encapsulated fish oil supplements. Extensive claims have been made regarding the health benefits of these supplements, even overeating wild or farm-raised fish and plant sources of omega-3 fatty acids, both in the United States and elsewhere. Cardiovascular, nervous system, eye, and joint benefits from the ingestion of omega-3 fatty acids have been widely reported. Most studies suggest that mechanism of action of the fish oils is related to their action as mediators of inflammation, but the dose necessary to reduce harmful inflammation is unclear, and the associated eating enough fish to reach such a dose may increase a person’s mercury levels to an unsafe level (Greenberg, 2018).

One study of the quality of omega-3 fish oil supplements commercially available in New Zealand found that “best-before date, cost, country of origin, and exclusivity were all poor markers of supplement quality” (Albert et al., 2015, p. 7928). Despite nearly 30,000 studies involving omega-3 fatty acid fish oils, their benefit to cardiovascular health has not been demonstrated (Greenberg, 2018). Greenberg also pointed out that the presence of omega-6 fatty acids, which is in many commercially processed foods, can interfere with the potential benefits of omega-3 fatty acids. He pointed out that people who have little access to fish but who do eat a balanced diet with green leafy vegetables are healthier than adults who eat eight or more ounces of a variety of seafood per week, which is recommended by the U.S. Federal Government’s Dietary Guidelines for Americans 2015–2020 (National Centers for Complementary and Integrative Medicine, 2018). Greenberg (2018) also is concerned that the commercial “reduction” of small fish to make fish oil supplements for people and feed for animals is devastating the oceans, reducing the amount of preferred food of the world’s larger fish and sea mammals, which humans also eat and enjoy.

The most recent study is a systematic assessment of effects of omega-3 fats from 79 randomized control trials (112,059 participants) done by the Cochrane Groups suggesting that increasing omega-3 fatty acids from oily fish (long chain omega 3), which included eicosapentaenoic acid [EPA] and docosahexaenoic acid [DHA]) as well emega-3 from plants (alpha–linolenic acid [ALA]), has little or no effect on mortality or cardiovascular health (evidence mainly from supplement trials) (Abdelhamid et al., 2018). The Cochrane reviewers used the International Clinical Trials Registry and declare they have no language restrictions.

Conclusion

Gabriel Marcel (1951), having watched most of the world he knew ruined during the Second World War, warned against superficial optimism and a false sense of unity that minimizes human differences and fails to honor human dignity. His concern with technology and science was that reducing things to numbers and measurable outcomes fails to appreciate human freedom and complexity. Technology and science are playing an increasingly important role in the modern world, transforming civilizations to become more dominated by artificial rules, methods, interventions, and technical skills, and too willing to reduce human beings and nature to standardized outcomes used to attain predetermined goals. Scientific research and innovation are all-encompassing phenomena that can improve the human condition, but it can also lead to immense destruction and loss of life, as evident in the Second World War.

The increasing capacity of countries to conduct research and create innovations has great promise for shared health, prosperity, and well-being, but it also has some significant limitations and problems, particularly if adopted prematurely. Addressing local health threats that have the potential to spread globally clearly has promise and opportunity to improve global health and avoid global disasters like the Spanish Flu epidemic. But specific activities and diets that may promote health and slow aging in one part of the world may not be that useful elsewhere or generalizable internationally, as are the application of healthcare and nursing interventions internationally. The readers of nursing and other research findings, the news, social media, and most certainly fake news need to view critically as well as look for replication in various places. That is not to say persons in the West cannot learn from and adopt practices from elsewhere or appreciate the findings of truly international multisite research. But it is far too easy for many people and groups to exaggerate health and antiaging claims and be too impressed by advanced aged “supervisors” who attribute their health and longevity to specific diet items or lifestyle differences as the cause of such success. Differences in the three “Ls” (language, linguistics, and literacy) are important barriers to safe and effective healthcare and to global science and health research. Computers and software advances provide great opportunity to do effective and translatable global research, but researchers and the general population need to remain very critical of what they are being fed (figuratively and literally) from international projects.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the authorship and/or publication of this review.

Funding

The author received no financial support for the authorship and/or publication of this review.

ORCID iD

Steven L. Baumann

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