From evidence to policy making - 23 November 2017
How to keep people alive and in the best possible health?
Whether you are a methodologist, a physician or a statistician, you would like to find your work useful and beneficial. The field in which we would like to make the most impact by using GRADE methodology is medicine, and the goal of medicine is to keep people alive and in the best possible health for as long as possible. To achieve this goal, we conduct systematic reviews and develop guidelines, and use available tools to verify the available data and to tailor recommendations to patient preferences and local conditions. Evidence Prime is developing software that partly automates and accelerates systematic reviews and guidelines development. The purpose of well-documented, evidence-based policy is to enable patients to benefit from the latest advances in scientific research. How to efficiently and effectively implement this knowledge within the health care system is not an easy question. Unfortunately, in few countries, even well-developed ones, there is a system of “early information”. This is not just because the health-care machine has a lot of inertia; the problem goes much deeper, and also higher up at the administrative level.
To use the analogy of the human body: The head has to hear and understand what the scientists have to say. Then the heart must initiate the action by pumping blood into the arteries. Then the limbs start moving. Before making changes to medical policy, first the decision makers need to understand the evidence and need to want to make the changes.
For those in the world of Evidence-Based Medicine, usually scientists and methodologists, the basis for a sound decision is the selection of evidence. The most widely supported sources of evidence are randomized controlled trials and systematic reviews.
Practicing doctors are often not involved in evaluating evidence, and many would not have the resources to carry out critical analyses of the available scientific data. Policy makers are in a similar situation. To use another analogy: The owner of a building company does not need to be able to perform construction calculations – they can commission this to a qualified engineer. It is sufficient that the owner is aware that for the safety of the inhabitants and for his own security, reliable calculations have a fundamental value.
Do we need evidence-based policy making? Of course, but not built on the principle that every politician involved in public-health should have an in-depth knowledge of how to prepare a systematic review. We can argue, however, that their decisions should rely on analyses made by established institutions such as the Cochrane Collaboration, or by an advisory body using a validated methodology to evaluate evidence – nowadays the GRADE approach is the standard methodology.
In the policy-making literature, attention is drawn to the dissemination of already well-structured recommendations based on “good methodology”, while no less work is needed to convince decision makers that the quality of the evidence is also relevant. The bitter truth is that the “scientific evidence” nowadays means nothing more than “evidence of scientists”. The age of reason seems, at least in a broader context, to be a thing of the past. Being a servant of EVIDENCE is not today anything obvious, it looks rather like a declaration to which part of the world I want to belong. Do you still remember Homo Sapiens Manifesto and GRADE planet action? It was just about recalling reason.
The human touch
We promote 2 conclusion for scientists intending influence the policy: 1) to develop scientific competence in the government and 2) to acknowledge that politicians, like the rest of society, often make decisions under the influence of emotions. Therefore, in our dialogue with stakeholders we – scientists or methodologists – should use also examples from the world of emotion and personal values. After all, verification and grading of evidence, and specifically the GRADE approach, is also a process based on values.
A basic virtue, or attribute if you prefer, that guides scientists, is the resistance of outside influence and manipulation. At the same time, any manner of persuasion that can help steer politicians toward an evidence-based approach to decision making is worth considering. In the sphere of values, politicians’ decision-making or lack of decision-making is still based on a question of values. Building credibility in this area is of common interest to politics and science – something worth exploring and consolidating, ultimately in the greater social interests of all.