This semester I’ll be blogging along with Karoline Mortensen’s Introduction to Health Systems (UMD’s HLSA 601). The syllabus is here (PDF). This first post will serve as an index to all subsequent ones. Below the following index are a few comments about one of the first week’s readings.
- Introduction [this post]
- Health care spending growth, debt, and you [9/10/12]
- Heterogeneity [9/17/12]
- Romney and HIPAA [9/24/12]
- Priceless: Chapter 15 [10/8/12]
- Health insurance and outcomes [10/15/12]
- How specialization can be bad [10/30/12]
- Preventive care and vaccine safety [11/5/12]
- Should doctors in training work less and sleep more? [11/5/12]
- Cost control by administrative headache [11/26/12]
Comments on How Public Health Policy is Created, by Alfred Sommer (American Journal of Epidemiology, 2001)
The paper by Sommer is both short and ungated. I recommend you read it. Though there’s plenty to agree with, I want to push back on this sentence in the third paragraph:
In an ideal world, health policy would be formulated in a rational, linear process, moving from data collection, to interpretation, to scientific consensus.
This is a popular sentiment among researchers. I may have expressed the same some time ago. But I now think it’s wrong.
In a TIE guest post, Keith Humphreys commented on his paper Scientific evidence alone is not sufficient basis for health policy, coauthored by Peter Piot (BMJ, 2012). Keith wrote,
What we do with scientific evidence is always a political and moral judgment. We don’t provide health care to the sick because the evidence forces us to. We provide health care to the sick because such activity is in keeping with our values. Likewise, we might choose to morally oppose certain policies (e.g., capital punishment) even if there is solid scientific evidence of benefit (e.g., if it is ever shown conclusively that capital punishment reduces crime). It would be dishonest to hide behind the evidence and say, for example, that science made us put a helpless human being to death; that moral judgment falls on all of our heads.
Despite where it starts, Sommer’s paper seems to wind up agreeing with Humphreys and Piot. The final sentence is,
Health policy involves far more issues than epidemiologists and other scientists know or care about.
Agreed. So it is not clear in what sense a rational, data-driven world guided by scientific consensus would be ideal. More than that, it is not so clear how such a world could exist. Decisions are informed by data but not made by them.