Lecture 10 - Evidence and Policy in Health

Question 1

What are the 3 models of the research-policy interface?

Answer 1

1. Rational (Weiss, 1978)
2. Enlightenment (Walt, 1994)
3. Strategic (Weiss, 1999)

Question 2

Explain the rational approach to explaining the research-policy interface

Answer 2

(Weiss, 1978)

Research provides a library of information, of which policymakers will tap into when making decisions

Question 3

Explain the enlightenment model to understanding the research-policy interface

Answer 3

Walt, 1994

Research and policymaking take place alongside other social processes
Research provides new ways of conceptualising the worls
Effect of research and cumulative and complex

Question 4

Explain the strategic model of explaining the research-policy interface

Answer 4

Weiss, 1999

Research is ammunition to support predetermined positions or to delay decisions

Investigating power and interests can help explain why there is lots of evidence, how evidence is understood, why evidence is used/ignored/misused

Question 5

What are some factors that may influence the use of knowledge?

Answer 5

• knowledge is inherently contestable
• power and interest play a role in the use and interpretation of knowledge
• decision makers’ thinking is limited by bounded rationality
• cognitive psychology affects the way we understand evidence in political arenas

Question 6

What does evidence need to compete with to influence decision-making?

Answer 6

Power, politics, opinions, interests

Question 7

What is the 2 worlds approach to understanding the research-policy interface?

Answer 7

The conceptual separation between the realms of scentific research and policymaking

Each group has distinct goals, cultures and processes

The world of research: emphasises objectivity, rigour, and generalisability. Strive to generate knowledge through established methodologies and aim for unbias findings that contribute to broader scientific understanding.

The world of policy: prioritises effectiveness, expedienct and specific context. They seek solutions to address real-world problems, often under time constraints, and considering the political and social realities

Question 8

In the 2 Worlds approach, why is it important than there is interaction/dialogue between the groups?

Answer 8

1) Research findings can inform policy decisions: research evidence can provide valuable insights and evidence support for policymakers

2) Policy can guide research direction: understanding real-world challenges faced by policymakers can help direct research. questions towards issues with practical significance

3) Communication enhanced transparency and accountability of the research and policy processes

Question 9

Why is it difficult to bridge the “2 Worlds” together?

Answer 9

• differing languages and priorities; they each use distinct terminology and have different evaluation criteria for success
• time pressures: policymakers often need immediate solutions which research processes can be time-consuming
• political considerations: policy decisions may be influenced by political factors beyond the scope of purely scientific evidence

Question 10

What type of model is the 2 Worlds Approach to understanding the research-policy interface?

Answer 10

Rational or enlightenment view; there is a know-do gap that can be overcome

Question 11

What is the alternative to the 2 Worlds Approach?

Answer 11

A strategic approach

Question 12

What are the 2 biases with regards to EBP?

Answer 12

1) Technical bias: evidence advocates, concerns over non-use of evidence, piecemeal evidence, manipulated evidence or invalid use
2) Issue bias: policy scholars, concerns over the depoliticisation of the policy process, worries of skewing the policy agenda to those conducive to particular forms of evidence or where evidence has already been created. Also worried about naive rationality - that policies are driven by facts which is seperate by values (these are interrelated)

Question 13

What happened to drug industry research in the 1990s vs 2000s/today?

Answer 13

Early 1990s about 75% of drug industry research funds went to universities, but by 2000 it was 34%.

The rest went to private research companies or pharmaceutical companies own researchers.

Question 14

Explain Serwedda et al (1992) and Carswell et al (1989) findings about the risk factors for HIV in Uganda. Why were they different?

Answer 14

Serwadda et al 1992
- The number of sexual partners was a factor for HIV infection

Carswell et al 1989
- The number of sexual partners was not a factor for HIV infection

Difference was attributable to how the question was asked and how answers were coded

e.g. how many sex partners have you had in the last 5 years versus how many sex partners in total

Question 15

What were Fries and Krishnan’s (2004) findings?

Answer 15

Investigated potential bias in industry-sponsored clinical trials for rheumatology by analysing the abstracts accepted for the American College of Rheumatology 2001 meetings.

The study found that every single trial with the above characteristics had results that favored the sponsor’s product or intervention.

Studied abstracts accepted for the American College of Rheumatology 2001 meetings that reported RCTs, acknowledged industry sponsorships and had clinical endpoints

Based on this observation, Fries and Krishnan propose that design bias is the main reason for these results.
Design bias suggests that researchers might use extensive preliminary data, often favorable to the sponsor’s product, to design studies more likely to produce positive outcomes.

Question 16

What does it mean that policymakers can select evidence consciously or unconsciously?

Answer 16

Consciously - in line with their philosophies and goals

Unconciously - certain aruments make sense to them given their existing beliefs and mental frames

Question 17

Explain the case study of Thabo Mbeki on HIV/AIDs

Answer 17

• In South Africa, HIV/AIDS denialism had a significant impact on public health policy from 1999 to 2008, during the presidency of Thabo Mbeki
• In 2000, he organized a Presidential Advisory Panel regarding HIV/AIDS including several scientists who denied that HIV caused AIDS.
• In the following eight years of his presidency, Mbeki continued to support HIV/AIDS denialism, and instituted policies denying antiretroviral drugs to AIDS patients. The Mbeki government even withdrew support from clinics that started using AZT to prevent mother-to-child transmission of HIV. He also restricted the use of a pharmaceutical company’s donated supply of nevirapine, a drug that helps keep newborns from contracting HIV.
• Denied the link between HIV and AIDS; “A virus cannot cause a syndrome. A virus can cause a disease, and AIDS is not a disease, it is a syndrome” – 2000
• Larger approach was to challenge Western practice and dominance
• South Africa wanted to be an independent leader in Africa

Question 18

What did Thibodeau and Boroditsky (2011) find?

Answer 18

When crime in Addison, Texas was described as an infecting ‘virus’ more people supported reform as opposed to enforcement. When crime was described as a ‘beast’ more people supported enforcement.

Question 19

Why are knowledge translation efforts (to bridge the gap between research and application) often limited?

Answer 19

• politics is potrayed as a barrier to uptake
• don’t address why evidence might not be taken up
• don’t consider where bias comes from (technical vs issue bias)
• often train individuals in technical skills rather than institutionalising changes (making changes to the orgination itself) to govern the use of evidence

Question 20

What are the explicit normative principles that guide the good governance of evidence? (5)

Answer 20

1. Integrity: honest and unbiased handling of evidence throughout the process, free from manipulation or distortion
2. Accountability: clear responsibility for the quality and applicaiton of evidence
3. Contestability: openness to scrutiny and debate to ensure evidence is robust and conclusions are well-founded
4. Public representation: involving the public in decision-making processes that rely on evidence
5. Transparency: clear communication of the evidence used, it’s limitations and the reasoning behind policy choices

Question 21

What are some institutional changes that can happen to improve the governance of evidence?

Answer 21

• extablishing dedicated bodies for evidence-based decision-making
• training and equipping staff with the skills to critically evaluate and utilise evidence
• build robust data collection and analysis systems
• foster a culture of transparency and accountability within institutions

Question 22

What is partisan polarization and how did it manifest in US health policy?

Answer 22

Partisan polarization: increasing ideological and policy differences between political parties, particularly in the context of a two-party system

There’s a lack of strong scientific evidence on which treatments are most effective for various medical conditions.
This “medical evidence gap” creates uncertainty for patients, doctors, and insurance companies making healthcare decisions.

Comparative effectiveness research (CER): This research aims to compare different treatment options and determine which ones work best for specific conditions.
Experts from both political parties acknowledge CER’s importance in resolving the evidence gap and improving healthcare decision-making.

Despite initial agreement, CER became a politicized issue.

The debate over CER got entangled with the highly partisan issue of universal healthcare reform.
Opponents of universal healthcare reform might have portrayed CER as a way to implement “crude rationing schemes” where the government decides which treatments are available, limiting patient choice.
This framing associated CER with government interference in the doctor-patient relationship, raising concerns among some.

Even seemingly technical and non-partisan issues like CER can become political tools, hindering “pragmatic governance” and preventing solutions to real societal problems.