Why there is – thank goodness – no such thing as “evidence-based health policy”

The following is a guest post by Keith Humphreys.  Keith is a Professor of Psychiatry at Stanford University and blogs at the Reality-Based Community.  He has worked with state, federal and international policy makers to improve public policies related to addiction and its treatment.

During my time at the White House and Peter Piot’s at the United Nations, we both heard many activists and academics say that we health policy makers should just “do what the science says”. Policy debates should be free of politics, moral concerns, values, and ideologies, they argued. Instead they believed that health policy (e.g., how to provide health care to the uninsured) could and should be based solely on cold, hard facts. And then they would lay down some facts and tell us what health policy allegedly followed logically from them.

Peter and I point out the logical and ethical problems with this conceptualization of “evidence-based policy” in BMJ (nee British Medical Journal, partly gated). There is no doubt that science can be extraordinarily useful for informing health policy, for example by evaluating new interventions, developing life-saving medications and identifying new threats to health (e.g., Peter co-discovered the Ebola virus).

But 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.

To drive home the distinction between scientific evidence and its application, consider the strong scientific evidence that risk for addiction is highest in adolescence. It is just as evidence-informed to respond to these data by targeting alcohol and cigarette advertising at adolescents (as some companies have done) as it is to respond to these data by targeting addiction prevention programs at adolescents (as health professionals do). The problem with addiction-promoting companies isn’t their lack of reliance on scientific evidence, but their lack of decency.

More generally, being good at science doesn’t mean being good at running society (if you don’t believe us, you really ought to sit in on a faculty meeting). That’s why scientists, including me and Peter, get one vote just like everyone else. We scientists of course have the right to push for our values and politics as individual citizens like everyone else, but we cannot claim the mantle of science when we venture beyond our data to our opinions about how other people should live.

In short, evidence-informed policy is a worthy goal, but value-free evidence-based policy is a wrongheaded concept, and to the extent it allows political agendas to hide behind scientific credentials, it can also be dangerous.

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