Guest post by Dr Kathryn Oliver and Dr Warren Pearce to celebrate the publication of their new Open Access article ‘Three lessons from evidence-based medicine and policy‘ in Palgrave Communications,
Part of the Open Access series ‘politics of evidence based policymaking‘ (for which we still welcome submissions).
Evidence-based medicine (EBM) is often described as a ‘template’ for evidence-based policymaking (EBPM).
Critics of this idea would be 100% right if EBM lived up to its inaccurate caricature, in which there is an inflexible ‘hierarchy of evidence’ which dismisses too much useful knowledge and closes off the ability of practitioners to use their judgement.
In politics, this would be disastrous because there are many sources of legitimate knowledge and ‘the evidence’ cannot and should not become an alternative to political choice. And, of course, politicians must use their judgement, as – unlike medicine – there is no menu of possible answers to any problem.
Yet, modern forms of EBM – or, at least, sensible approaches to it – do not live up to this caricature. Instead, EBM began as a way to support individual decision-makers, and has evolved to reflect new ways of thinking about three main dilemmas. The answers to these dilemmas can help improve policymaking.
How to be more transparent
First, evidence-informed clinical practice guidelines lead the way in transparency. There’s a clear, transparent process to frame a problem, gather and assess evidence, and, through a deliberative discussion with relevant stakeholders, decide on clinical recommendations. Alongside other tools and processes, this demonstrates transparency which increases trust in the system.
How to balance research and practitioner knowledge
Second, dialogues in EBM help us understand how to balance research and practitioner knowledge. EBM has moved beyond the provision of research evidence, towards recognising and legitimising a negotiation between individual contexts, the expertise of decision-makers, and technical advice on interpreting research findings for different settings.
How to be more explicit about how you balance evidence, power, and values
Third, EBM helps us think about how to share power to co-produce policy and to think about how we combine evidence, values, and our ideas about who commands the most legitimate sources of power and accountability. We know that new structures for dialogue and decision-making can formalise and codify processes, but they do not necessarily lead to inclusion of a diverse set of voices. Power matters in dictating what knowledge is produced, for whom, and what is done with it. EBM has offered as many negative as positive lessons so far, particularly when sources of research expertise have been reluctant to let go enough to really co-produce knowledge or policy, but new studies and frameworks are at least keeping this debate alive.
Overall, our discussion of EBM challenges critics to identify its real-world application, not the old caricature. If so, it can help show us how one of the most active research agendas, on the relationship between high quality evidence and effective action, provides lessons for politics. In the main, the lesson is that our aim is not simply to maximise the use of evidence in policy, but to maximise the credibility of evidence and legitimacy of evidence advocates when so many other people have a legitimate claim to knowledge and authoritative action.