How do we prioritise the priorities?
Evidence-based medicine aims to put best evidence into practice. Another less-publicised application EBM and epidemiology is the shedding light on the best use of resources or the “biggest” health and public health issues. The National Institute for Health and Clinical Excellence (NICE) aims to judge which treatments and technologies are most “cost-effective” in order to advise policymakers of the treatments which give most “bang-for-buck”.
We are bombarded with priorities, goals and commitments. The United Nations’ Millennium Development Goals are an example of how different stakeholders can be galvanised towards a common set of targets, which may be as important as achieving the goals. Research priorities have begun to be set in the same way. The Grand Challenges in Global Health have highlighted the areas of greatest need in global health research. These are high profile initiatives with scientific financial backing from key players including the Gates Foundation and the Wellcome Trust. Both journals and funders have continual “calls for proposals”, whether it is the Lancet’s latest call for health research in China, or the strategic goals of the Wellcome Trust.
How good are these goals at picking the right priorities? At first glance, they may be wide open to multiple biases and conflicts of interest depending on the interests, both financial and scientific, of stakeholders and the goal-setters. The Delphi method tries to avoid this problem by using the “collective intelligence” of many experts in several questionnaire-led rounds. For example, this method has been used to set the Grand Challenges in Mental Health.
At the World Congress of Epidemiology last week, during a keynote speech by Ivor Rudan, I learned about the Child Health and Nutrition Research Initiative, or CHNRI method, designed to suggest the “best bets” for health research priorities on the basis of evidence and several stages of scoring of different options.
There will inevitably be some wastage in research funding but it is surely a good sign that institutions, whether local or global, want to channel resources towards areas of greatest need and potentially greatest benefit, and that we are developing better tools to set these priorities.