Scientific evidence alone is not sufficient basis for health policy
Veterans Affairs and Stanford University Medical Centers, VAPAHCS, 152-MPD, 795 Willow Road, Menlo Park, CA 94025, USA.BMJ (online) (Impact Factor: 17.45). 02/2012; 344(feb27 1):e1316. DOI: 10.1136/bmj.e1316
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- "In public health, evidence-informed decision making with respect to policy and practice has been gaining momentum (Armstrong et al, 2007). Although policy makers and health professionals are expected to base their decisions on scientific evidence (Coleman and Nicholl, 2001; Humphreys and Piot, 2012; Muir Gray, 2004), applying scientific evidence is not straightforward (Dobbins et al, 2002; Oxman et al, 2009). This may partly be due to shortcomings in the process of knowledge translation, which is the translation of research evidence into policy or practice (McKibbon et al, 2010). "
ABSTRACT: One of the barriers regarding evidence-informed decision making is the gap between the needs of policy makers and the ways researchers present evidence. This pilot study evaluates the barriers and facilitators to the implementation of a tool to enhance transparent and unambiguous communication on scientific evidence by knowledge workers.Therefore, mixed methods (qualitative and quantitative) were applied.The results indicate that to promote successful implementation of such a tool, efforts should be undertaken to provide time and guidance on how to adapt routines and on how to apply the tool to various products.
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- "The role of science is, however, to inform, not to dictate policy decisions. Humphreys and Piot  recently argued that scientific evidence alone is not a sufficient basis for health policy and that other factors (such as democratic and human rights considerations) should be taken into consideration in health policy. "
ABSTRACT: We review the various aspects of health technology assessment in osteoporosis, including epidemiology and burden of disease, and assessment of the cost-effectiveness of recent advances in the treatment of osteoporosis and the prevention of fracture, in the context of the allocation of health-care resources by decision makers in osteoporosis. This article was prepared on the basis of a symposium held by the Belgian Bone Club and the discussions surrounding that meeting and is based on a review and critical appraisal of the literature. Epidemiological studies confirm the immense burden of osteoporotic fractures for patients and society, with lifetime risks of any fracture of the hip, spine, and forearm of around 40 % for women and 13 % for men. The economic impact is also large; for example, Europe's six largest countries spent 31 billion on osteoporotic fractures in 2010. Moreover, the burden is expected to increase in the future with demographic changes and increasing life expectancy. Recent advances in the management of osteoporosis include novel treatments, better fracture-risk assessment notably via fracture risk algorithms, and improved adherence to medication. Economic evaluation can inform decision makers in health care on the cost-effectiveness of the various interventions. Cost-effectiveness analyses suggest that the recent advances in the prevention and treatment of osteoporosis may constitute an efficient basis for the allocation of scarce health-care resources. In summary, health technology assessment is increasingly used in the field of osteoporosis and could be very useful to help decision makers efficiently allocate health-care resources.
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- "For example, it has recently been suggested that individual-level recommendations should be evidence-based, but policy-level guidance should be evidence-informed. The rationale for this would be that the contribution of aspects not related to the background evidence, including acceptability of policy options by stakeholders, implementation feasibility and equity, may be substantial . Economic consequences may also play a key role: in Europe, one of the less visible consequences of the financial crisis has been for much increased involvement of the European Union in running national health systems with close supervision of national budgets . "
ABSTRACT: A new resolution on mental, neurological and substance use disorders was adopted in January 2012 by the World Health Organization (WHO) Executive Board. The resolution urges WHO and Member States to collaborate in the development of a comprehensive mental health action plan, to be submitted for discussion and approval to the WHO World Health Assembly. This commentary aims at rising awareness on the risk that this resolution may not fulfil its potential. Lack of political awareness and visibility of the resolution is a first major issue. Theoretically, Member States should be aware of the resolution and support its implementation at their respective national level, but in practice political commitment may not be high enough, and technical and financial resources made available may be limited. A second challenge is that the resolution suggests to work with Member States and technical agencies to promote academic exchange through which to contribute to policy-making in mental health. It is not straightforward, however, how such a statement may be effectively translated into action. A third key methodological aspect is how scientific evidence and factors other than scientific evidence will be handled. This seems particularly relevant in the field of mental health, where value-based decisions together with resource and feasibility considerations may be unavoidable. We argue that WHO and Member States should work together to increase the visibility of the resolution, ensuring that Ministries of Health and other relevant components of the health systems are aware of the resolution and its implications. As the resolution urges for academic exchange, WHO should develop a plan for an explicit, inclusive and open call for support and collaboration, so that partners willing to contribute are not kept out from the process. The production of an action plan for mental disorders should be based on scientifically sound methodology. Such a methodology should be transparently described, for example in a WHO process document, to make it clear how individual-level recommendations and policy-level guidance are developed. WHO should establish and maintain an open forum of experts, scientists, health officials and user groups worldwide to interact and agree on values, preferences, feasibility, acceptability, implementability, equity and economic issues that should inform the action plan.