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public policy

Everyone has an interest in exaggeration

Carl Heneghan
Last edited 7th April 2011

Think about health care communication to the public. Is it done well, does it lead to informed choice? Do you feel skeptical about the issue, and disillusioned with the current status of communication of health to a wider audience.

Today, at Kellogg College, at the University of Oxford a workshop on ‘Enhancing the Public Understanding of Health Research’ aimed to bring together folk with experience in developing and evaluating materials to help people become better users of health research. The question is, why isn’t the public informed? The two issues when we are faced with research findings, whether it be on TV, in the newspapers or in a scientific journal, are ‘Why should I believe these results,” and “What do they mean?”

Steve Woolshin and Lisa Schwarz authors of the ‘Know Your Chances’ book, talked enthusiastically, and with an array of examples, of the bigger picture and what is out there.

The issue that caught my eye was how invested we all are in exaggeration: manufacturers to sell products, academics to get their research published, journals to get their research cited and picked up by the news and for media to gain more advertising revenue. And so the cycle goes on.

For instance, Dannon's Activia, exaggerated health claims led to a US $21M fine, a further example is a study which suggests, ‘nutrient enhanced water drinks are ''''expensive lolly waters'''' with exaggerated health claims’. All sorts of exaggerations occur on a daily basis ‘Radiation health fears exaggerated, claims Oxford professor’. Just try googling ‘exaggerated health claims’.

My favourite is vitamin D which has reached rock-star status in recent years, as a potential cure for the prevention of everything.

The BBC even highlights medical journals are all part of the exaggeration phenomena: ‘Medical journals have been accused of hyping up the findings of the research that they publish.’

Am I prone to exaggeration, you bet I am! Obviously this is the best site worldwide to find the opinion on the evidence to trust.

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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