Anyone who works in evidence-based medicine in wants to see it being influential at the level of policy-making. We are often frustrated however, as a mixture of factors such as media scares, pressure group tactics and political shennanigans seem to trump evidence every time. A recent paper in the Millbank Quarterly by Jewell and Bero looks at the utilisation of research at the level of state government in the USA based on 28 structured interviews of state-level medical policymakers. It paints a slighty worrying picture; for example they quote one official who said that, in assessing the effectiveness of a new medical procedure, “I just did exactly what … everyone … is hoping I’m not. I talked to my brother-in-law and I Googled it.”
The article goes into some detail about the administrative and legislative barries to effective use of evidence for policy making, along with other issues such as accesibility to evidence, the tendency of pharmaceutical companies to attack the whole idea of EBM when it doesn’t suit them, and the power of the andecdote, before giving some approaches that may offer some chance of success. These include:
1) use evidence that is able to concretize impact: i.e. packaged to “incite and persuade”. It was argued that general health arguments tended to be less effective than those that asserted and clearly described particular benefits or harms, ideally at the level of the indvidual (or particular patient groups).
2) link research to costs and benefits: One policymaker showed how he could use evidence for the effectiveness of a infant home nurse visitation program to show that future social costs would be averted by eliminating the current need to expand prison capacity; i.e. “We were debating another prison, and how … we [were] going to pay for [it], and here I come along with something that’s going to prevent
that sort of thing. And with good research to prove it.”
3) reframe policy issues with the available evidence: An example is given about an attempt to pass legislation to allow radiological technologists (rather than only MDs and RNs) to inject contrast medium. While there was no evidence concerning how safe radiological technologists are as a group, there was evidence that the dyes being used had become much safer: “For some reason, none of the groups advocating for the bill had made that point … people were interested to know. ‘You mean this stuff … occasionally used to cause allergic reactions but the new stuff doesn’t? Oh that’s important.’”
The article discusses more issues, such as training and collaborative behaviour. Take a look if you have time. It’s nicely written and will at least help us evidence-heads to understand better the challenges facing the poor saps who have to actually make policy, very often “on the hoof” and with little support.