[My Thoughts] Attacks on Science: The Risks to Evidence-Based Policy
After our very first meeting in our HPS 221 class with the course title, “Political Dynamics of Health Policy Process”, we were tasked by our professor to read in advance our assignment. The title of the article was, “Attacks on Science: The Risks to Evidence-Based Policy”
First, let me walk you through the paper via the questions posted:
The Grab (Why is this article useful, important and/or unique?)
My answer to this question is partly subjective. First, it is important because evidence-based researches and studies are now being called upon to serve the nation by contributing to policy-making.
Second, there is an increasing debate about the so-called “obsession to measures,” to which some believe, myself included, is not the only way. In fact, it is only one of the tools that may solve health disparities.
In the Philippine context, there is an increasing attention given to research and development, which is concretized by the growing funds invested into research through government research agencies such as the Philippine Council for Health Research and Development (PCHRD) attached to the Department of Science and Technology (DOST).
Aside from this, the Global Forum on Research and Innovation for Health 2015 will be hosted here in the country on August 24-27, 2015 by the Council on Health Research and Development (COHRED) in partnership with the Department of Health (DoH) and PCHRD-DOST. The theme of the forum is, “People at the Center of Health Research and Innovation”. Official hashtag of the forum is #RI4H15 and the twitter handle is @COHRED_Forum.
While this may be positive, on the other side, the question really is: does the current environment in the Philippines truly conducive for research? And who shall benefit the research? Is it truly people? Will they be involved and have the capacity to even do research? Do we empower them with the use of research? Will research serve the needs of the people?
I hope this will be answered by my exclusive article on this research forum.
In the meantime, let’s go back to the article.
The Big Problem (primary problem that needs to be addressed)
For HealthActivist (on how I understood the author), the big problem is that the integrity of evidence-based practice, the scientific research process and even its data are put into risk due to the unnecessary pressures applied by those with vested interest especially the policy-makers themselves. In simple terms, science or evidence-based studies are being used to justify policy. And this is being done in various ways through economic manipulation, delays, hidden identities by those with vested interests, and harassment (these are mostly done by the corporations but the author included as well emotional, ideologic and political “advocacy” groups)
The Unique Solution (describe the ways in which the author proposes to address the problem)
The following are the proposed solutions from the author:
- Increase awareness and institutional responses.
- Respond to honest scientific challenges as opposed to those issued due to vested interest.
- Build and diversify partnerships.
- Provide policies re transparency of funding sources and publication of results.
- Balance of neutral funding
- Guidelines to protect integrity of the research process
- Rules of publication of research results
- Financial disclosure, recusal
- Know when science ends and policy-making begins
The Next Steps (a. Describe b. Alternative Recommendations/Solutions to the Problem and c. Missing or what other things are needed in the article?)
A. The First Step
The author’s proposal, which she identified in the article, was mostly about “setting the stage” or putting up policies to protect, preserve and ensure the integrity of the evidence-based process. They are steps toward the right direction. However, they are not enough to preserve or even ensure the credibility of the evidence-based process including the data.
B. The Next Steps
For HealthActivist, what should be done next after “setting the stage” is to build a conducive environment for research by creating public support for it. How? By establishing “evidence-base/science as a tool to serve the genuine needs of the people. It may also help if each country develops its national health research agenda and separate these from industry-sponsored researches. And the delineation should be very clear. Policies, like the ones mentioned in the article must be established and strictly observed and implemented.
The last step is to institutionalize this support through additional rules specifically on communicating the results of research (for policy-making) to the general public (through targeted/key people).
C. What is missing in the article: My critical thoughts
Let me explain further the next steps I have identified.
First, how to establish support? This is exactly the reason why I insist on defining “evidence-based”.
According to Agency for Health Care Research and Quality (AHRQ), evidence-based practice (EBP) means…
Another resource pointed to the most common definition of EBP by Dr. David Sackett (1996)
As you can see, most of the definitions I got are applied to clinical trials or mostly quantitative studies. However during one of the meetings with our research team, I asked what do we mean when we say “evidence-based” and I developed this definition in my mind based on their answers:
It is a body of evidence that includes both quantitative and qualitative processed information interspersed with each other to produce a logical answer to a certain concept or phenomena. The body of evidence also includes as well other factors such as context and the people’s perspectives about those being investigated.
Also, I don’t believe in EBP’s being cast in stones because this should be constantly reviewed for its effectiveness. This is a challenge in disseminating and implementing EBPs especially in clinical interventions. There is an estimated 17-year gap between the initial research establishing an effective practice and its introduction to general use (Balas & Boren 2000).
Now, back to my point of why the need to define EBP. Because decreasing risks to EBP for policy will only happen if people understand and are not alienated by it. Once they understand EBP especially those emotional and ideologic advocacy groups (identified by the author to also influence policy) from the very beginning, they can be turned into avid supporters of EBPs and may question the science not because of their vested interest but because they have legitimate scientific concerns (to which the author suggest that the scientific community should be able to respond appropriately). These critics turned advocacy groups and EBP supporters could help push forward the use of the practice in policy. They could also be powerful allies against big corporations. In this way, we have reduced the number of critics of the EBP.
On the question of “obsession to measures” as if they are the only solutions, this dissipates as well because EBPs already incorporate people’s contexts and perspectives into the evidence. This means that the body of evidence encompasses all the other components necessary to make informed decision-making in health.
Lastly, we must not portray the medical and scientific community as “THE ONLY GROUP” to trust. Let us break this exclusive elite kind of group because it does not help EBP to prosper and it will always be met with risks and pressures from all sides if this will be the case.
It was very clear in the given article that the scientific/medical community is vulnerable to risks of being economically manipulated by big corporations such as the case of the 1993 federal report that linked secondhand smoke to lung cancer. In the early days of the anti-smoking advocacy, tobacco corporations hired and paid scientists handsomely to write “for hire” materials to counter the report, which appeared in supposedly credible journals such as the likes of the Journal of the American Medical Association, the Journal of the National Cancer Institute, Risk Analysis, the Journal of Regulatory Toxicology and Pharmacology, and the Wall Street Journal.
This of course puts into question the credibility of the scientific/medical community amongst advocacy groups (who are ordinary people, consumers, support groups and patients as well). In addition, it also questions the rigour of the EBPs and even the “peer-review” process.
The people expect no less than credibility and integrity of motivation of the sources of their health information and the scientific/medical community has the obligation to give this to them. After all, science and technology is there to serve the people/humanity and not corporations. EBP and science as well is not for the exclusive use of a so-called, “expert/elite group”.
EBP and science should not be unassailable. The people should be able to question science but they must learn and know how to be critical and to think.
Once the integrity and credibility of EBP is built in the eyes of the people, the risks and pressures can be easily dealt with and the support it needed from the people (more people) will be there.
To end this, I would like to emphasize the need and importance of health literacy/health communication to further people’s understanding of science and this is the role of the scientific/medical community especially those serving the public health arena. And they should do it no matter how hard it is. This is where the need for a health communication agenda lies (democratizing health information).