Monday, May 31, 2010

At the end of April I was in Warsaw, to participate in a meeting of the European Science Advisory Network for Health (EuSANH). This is a network of national science advisory bodies working which in the field of health that promotes independent scientific advice and evidence-based health policy. We have been contributing by preparing reports on bodies fulfilling this role in the UK, including LSHTM’s on-call facility for the Department of Health, the Academy of Medical Sciences, and NICE (with thanks to those involved for providing the necessary information).

The meeting was combined with a conference discussing the role of scientific advice for policy, at which I gave a keynote lecture. I began by reflecting that the world is complex (helpfully illustrated by a diagram published in the New York Times the previous day in which the US Department of Defense sought to represent the challenges it faced using a diagram that had the appearance of an upturned bowl of multi-coloured spaghetti), before looking at the different stages of communicating information. One problem is that researchers too often take pride in the obscurity of their messages, viewing anything comprehensible as lacking intellectual rigour, although an alternative view (which I prefer) is that this is simply an opportunity to defend the status of their discipline. I was therefore delighted, when researching the lecture, to come across a paper from 1968 entitled “Are sociologists incomprehensible? An objective study”. It cited an earlier paper which argued that “A few sociologists write the best English they are capable of writing.... Others, however – and a vast majority – write in a language that has to be learned almost like Esperanto. It has a private vocabulary which, in addition to strictly sociological terms, includes new words for the commonest actions, feelings and circumstances. It has the beginnings of a new grammar and syntax, much inferior to English grammar in force and precisions. So far as it has any effect on standard English, the effect is largely pernicious. “ A more recent paper, reflecting on economics, said “We have all had the experience. You start a new job, be it academic or corporate. You walk into a presentation by a colleague. Before the third slide comes up on the screen, you find yourself totally lost in a morass of method, terminology, and tradition beyond your comprehension. You know the speaker is brilliant and you have full confidence in the conclusions; however, you find it impossible to follow the logic that takes the work from beginning to end.”Enough said!

However, much is being done to redress this situation and I argued that anyone seeking to make a difference should read the excellent series of articles recently published by John Lavis, Andy Oxman, Simon Lewin, and Atle Fretheim in Health Research Policy and Systems, which takes the reader through all the stages, from creating organisational structures that support the use of evidence, through identifying evidence needs and finding and assessing the evidence, to making evidence-based decisions.

Yet, no matter how hard researchers try, they need to confront the biases that exist in the minds of recipients of evidence. David Stuckler and I were thinking about this in the run up to the recent UK general election. At one stage, when it became clear that he was trailing in the public response to the televised debates between the party leaders (among those watching on TV, not those listening on radio, echoing an earlier debate between Nixon and Kennedy), Gordon Brown called for a focus on substance, not style. This was a complete waste of time. As we showed in a paper in the BMJ reviewing new research from neurosciences, once the electorate have come to a judgment on an individual, it doesn’t matter what they say. Research using fast magnetic resonance imaging shows that they automatically discount your messages, while ignoring obvious contradictions from politicians they admire. These biases influence how objective evidence on health policy is interpreted. An elegant American study published in late 2009 looked at how political allegiance shaped interpretation of evidence on the causes of diabetes, presenting news stories that were identical except for what they said was its main cause (not mentioned, genes, individual lifestyles, or social determinants, such as the obesogenic environments in which many of us live). Democrats and Independents reading the last of these were more likely than those whose news item mentioned no cause (controls) to agree that social determinants were important, while there was no effect among Republicans. However, while reading the explanation invoking social determinants made Democrats and Independents more likely than controls to support collective social responses, Republicans were less likely to.

Then there is the effect of the media. Ben Goldacre has drawn attention to some of the more bizarre stories in the British tabloid paper the Daily Mail, including its apparent campaign to place every object in the world in the categories of causes or cures for cancer, and in some cases both simultaneously (indeed, so numerous are its claims that there is a website specially for those who wish to keep up with them, helpfully listing them in alphabetical order). However, it has an equally vociferous campaign against what it calls the “nanny state”, in which most of us would include the spectrum of public health policies that have rendered death in childhood a rarity in Britain and have contributed to a steady gain in life expectancy. But does the media matter. Sadly, yes, as was shown in a study that tracked the roll-out of Fox News to cities on cable channels in the USA between 1996 and 2000. Its appearance in a city was associated with a significant electoral shift to the right.

Finally, there is the role of vested corporate interests. Marshalling vast financial resources, and using remarkably sophisticated marketing techniques, they have developed tremendous experience in influencing how we think. A now notorious example is the use of product placement in movies by tobacco companies.

So, in summary, if we as researchers are to have an impact on policy, then we need to get our own house in order, finding out what it is that policy makers want and giving it to them. But as citizens, we should also demand that our policy makers recognise their responsibilities to be aware of the biases they bring (and the forces that influence them) and at least try to be objective.