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health policy

Evidence 2010

Carl Heneghan
Last edited 15th June 2010

Right now, you would have to have been asleep to not realize implementing cost-effective change based on evidence is the key challenge for health systems around the world. beciause this its the most pressing problem we decided to bring together a conference of the evidence creators and evidence users to define the processes for implementing best clinical practice and forging efficient and cost-effective solutions for healthcare.

We would like you to join us at Evidence 2010, the leading evidence-based healthcare event at the forefront of EBM debate and innovation.

The conference is a collaboration between the BMJ and the Centre for Evidence Based Medicine CEBM.

The aims of the conference are to:

* Improve evidence-based decision making and provide practical, evidence-based ideas that can be implemented in practice
* Foster effective innovation
* Guide efficient commissioning
* Provide education and training to improve evidence-based healthcare.

We've got some great speakers lined up including:
Jim Easton, Sir Iain Chalmers, Sir Muir Gray Victor Montori,
Paul Glasziou, Mike Clarke, Sharon Straus,
Giordano Perez Gaxiola, Steven Woloshin, Fiona Godlee, Bill Summerskill, Helen Lester, Rubin Minhas, Amanda Burls, Dan Lasserson, Dyfrig Hughes, Tony Rudd, Tim Ringrose, Tom Jefferson, Ann McPherson, and Fiona Fox
Oh and not to mention Ben Goldacre Bad Science.Net

Look forward to seeing you there, Carl

A confidentiality agreement, also known as a non disclosure agreement is a legally binding contract between two parties who wish to share information with one another, but wish to restrict access to others. Basically keep it a secret. They are used by companies when they are undertaking a potential business relationship. Some of these agreements are signed with employees or paid consultants, restricting the use of material and confidential information. In some circumstances the existence of such an agreement cannot be disclosed at all.

Some of you may have never even heard of such agreements or considered them important. However, in the last few years I’ve had numerous organizations approach me, mainly with regard to monitoring and diagnostic technologies. And even before talking, they want you to sign one of these confidentiality agreements or NDAs (non- disclosure agreement) as they are known in the trade.

To this, I have a perfectly simple answer. ‘If you want perfect confidentiality, then let’s not meet. Otherwise, if you want to keep it confidential then don’t mention it, but I won’t be signing any agreement now or in the future.’

So, when this week we find out from Fiona Godlee at the Council of Europe that:
‘Also worrying is the existence of a secret "emergency committee" which took key decisions relating to the pandemic: first the decision to downgrade the definition of pandemic in May 2009, and then to announce the pandemic one month later, triggering pre-established vaccine contracts around the world.’

Deborah Cohen’s investigative work on the WHO and the pandemic flu "conspiracies"
‘And why does the composition of the emergency committee from which Chan sought guidance remain a secret known only to those within WHO? We are left wondering whether major public health organisations are able to effectively manage the conflicts of interest that are inherent in medical science.’

Recently I gave a talk, and realized I was the only person not being paid in the room, and in doing so, was the only person who hadn’t signed up to a 5 year NDA.

Therefore, it is highly likely anyone who has a conflict of interest has signed an NDA previously, and has a major bias. As of now this should be added to journal submissions as part of the conflict of interest statement and be disclosed by public committee that set our health policies – In fact, if you’ve signed one of these you shouldn’t be allowed on the committees in the first place.

What is Evidence Based Policy?

Carl Heneghan
Last edited 30th May 2010

In defining Evidence-Based Policy my first thoughts were to think of the original definition of EBM by Sackett.

Evidence-Based Medicine is the ‘conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients,’ and its practice requires ‘integrating individual clinical expertise with the best available external clinical evidence from systematic research.’

In this article, individual clinical expertise is referred to as ‘the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice.’

In contrast Evidence-Based Policy is public policy informed by rigorously established objective evidence. See the contrast, where is the requirement for expertise? Whilst Governments ‘must produce policies that really deal with problems, that are forward-looking and shaped by evidence rather than a response to short-term pressures; that tackle causes not symptoms.’ theyre is no mention of expertise.

Whist in EBM Increased expertise can be observed in many ways, such as effective and efficient diagnosis and in understanding patients’ values and circumstances to make the right clinical decisions, in Evidence-Based Policy there is no such reliance on expertise. In fact, who are the experts practising such Evidence-Based Policy? Never mind whose values should be taken into account when implementing such policies.

Therefore, to move the field forward my new definition for Evidence-Based Policy would be: public policy informed by rigorously established evidence that takes into account healthcare expertise and understands the public values and circumstances affected.

Now, where are the experts?

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