Prove It: The wrinkles of Evidence-Based Policymaking

Can you prove it?

Great article on the growing role that evidence plays in policymaking. Does evidence change minds? Are we shifting as a society and increasing the public demand to know, or are the ‘sellers’ – policymakers, marketers, companies, governments etc., simply responding to a growing call for (and availability of) proof? As the article starts off, historically, policymakers have seen evidence as a marketing gimmick rather than burden of proof.

“There was, [he] argued, a need to examine more thoroughly the evidence on which the proposed legislation was based. “We are looking at publishing the evidence,” replied the Minister, but “in the end, you pick the evidence which backs your argument.”

The idea of evidence-based policymaking vs. policy-based evidencemaking is an interesting one. An added wrinkle is the notion of making policy based on values – what if the evidence disagrees with what you want the law to enforce? Interesting example with everyone’s favorite topic, marijuana:

“Another, and opposite, problem was that the much vaunted commitment to the evidence only went so far. Coaker’s gaffe was just one example. It was a Labour Home Secretary, Alan Johnson, who in 2009 provoked one of the biggest science policy controversies of recent times by sacking an independent expert, Professor David Nutt, from the Advisory Council on the Misuse of Drugs. Nutt’s position was voluntary and unpaid, his job to provide frank and objective policy advice based on his scientific knowledge. Yet when the Professor criticised the government’s decision to recategorise cannabis from a Class C to a Class B drug, and argued that drug classifications should be based solely on the evidence of the harms they cause, the Home Secretary had him removed from the advisory council. Opinion polls indicate strong public opposition to any relaxation of the drug laws, including the downgrading of cannabis. Opponents of decriminalisation insist that heavy penalties are needed, in order to “send a message” that the use of drugs is morally wrong. New Labour’s putative commitment to “what works” was trumped in this case by the need to stay in line with public opinion.”

The piece goes on to discuss the role that ‘evidence’ played in restructuring the UK’s health care delivery system. This was/is a huge deal in the UK – in terms of the level of change they’ve introduced, think Obamacare x 10. When billions of pounds/dollars of government restructuring is at stake, the ‘evidence’ you’re basing it on suddenly comes under more scrutiny.

The role of evidence-based medicine is also at the root of NICE, one of the NHS’ lauded successes in controlling health care costs. In the US, the same idea is affectionately demonized as Death Paneling and Rationing. In the US, our policy is based on values – people have the right to demand as much care as they want. IN the UK, their policy is based on evidence – determine what’s effective based on looking at patients who received the treatment vs. didn’t, how they fared post-treatment, what their demographic and health profile consists of, and dozens of other factors.  Without taking a strong side (both have their pros and cons), suffice it to say, the policymaking framework is quite different.

Final thoughts:

1. I think that generally, the overavailability of evidence is a problem. If you can find some study to back up anything you want, then what’s the point? In grad school epidemiology we learned about the futility of this, using examples about things like the effect of drinking coffee on prostate cancer risks. There seems to be a new study every day. Which one do you trust? On a broader scale, with institutions sponsoring studies that are politically driven, how can policy be truly objective just because it’s based on research?
2. After reading this I haven’t come to a conclusion on whether it’s good that society is trending towards a veneer of accountability based on ‘evidence’ or whether this is just the evolution of marketing. In the TV series Mad Men, there’s a slow shift over the four seasons towards using study-based data to change advertising methods. If that’s a microcosm of what we’re seeing on the broader policymaking front, then consider me a more sober, non-smoking non-lascivious version of Don Draper.

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