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A Challenge for Evidence-Based Policy

Abstract

Evidence-based policy has support in many areas of government and in public affairs more generally. In this paper we outline what evidence-based policy is, then we discuss its strengths and weaknesses. In particular, we argue that it faces a serious challenge to provide a plausible, over-arching account of evidence. We contrast evidence-based policy with evidence-based medicine, especially the role of evidence in assessing the effectiveness of medicines. The evidence required for policy decisions does not easily lend itself to randomized controlled trials (the “gold standard” in evidence-based medicine), nor, for that matter, being listed in a single all-purpose hierarchy.

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Notes

  1. Head (2010) provides a good overview (with an extensive reference list). Davies et al. (2000a) is an earlier, comprehensive treatment of evidence-based policy. Like this literature, this paper focuses on the role and merits of specific forms of evidence for informing policy. An example of some of the broader discussions regarding the role of science and values in policy can be found in Douglas (2009).

  2. EBM puts forward a number of hierarchies for different medical questions. We follow the literature on this topic and focus on the hierarchy provided for therapeutic decisions.

  3. As Worrall (2002) notes, randomization does not ensure all possible confounding factors are equally balanced between the experimental groups. Confounding due to an unlucky consequence of random allocation is, however, a different type of error to the selection bias that can occur in observational studies.

  4. Macintyre et al. (2001) provide examples from health policy where decisions that have ignored relevant empirical evidence have led to harm.

  5. Incremental or mixed incremental-rational models of the policy process emphasize the incremental and disjointed nature of policy progress. While evidence and arguments about evidence play a more diffuse role in these models, evidence (broadly construed) remains central (Nutley and Webb 2000, p. 28).

  6. Rawlins (2008) provides a good overview of some of the criticisms that have been raised from within medicine. For philosophical discussion, see Bluhm (2005), Cartwright (2007), Clarke et al. (2013, 2014), Grossman and Mackenzie (2005), La Caze (2008, 2009), Osimani (2014), and Worrall (2007). Cartwright (2009) and Roush (2009) discuss the use of randomized studies in policy and Montuschi (2009) discusses some of the broader problems of evidence in policy.

  7. The importance of attending to the human elements of health are emphasised by proponents of narrative medicine. See Greenhalgh (2012) for a discussion on the importance of avoiding the reduction medical decision-making to “mathematical estimates of the change of benefit and the risk of harm derived from high-quality research” (Greenhalgh 2012, p. 94).

  8. See for example, Macintyre et al. (2001) and Society for Prevention Research (2004), and for a more general discussion, see Davies et al. (2000a).

  9. Davies et al. (2000b) and Head (2008) discuss the difficulties of conducting randomized studies in some areas of public policy.

  10. See also Cartwright and Hardie (2012).

  11. See Steel (2004) for a discussion of social mechanisms.

  12. See, for example, the recent policy decision by the Australian Government’s Biosecurity Australia to allow the importation of Cavendish bananas from the Philippines. The relevant import risk analysis report and policy decisions are available from the Australian Government’s Department of Agriculture Fisheries and Forestry website devoted to the matter: http://www.daff.gov.au/ba/ira/final-plant/banana-philippines.

  13. Lindenmayer et al. (2012) provides examples of how carbon-trading policy can have unwanted downstream effects if the game-theoretic structure of the problem is not appreciated and Colyvan et al. (2011) discuss the importance of games against nature and adaptive management in conservation management decisions.

  14. This might not be so different from some areas of medicine where organisms are known to have responded to continued treatment in ways not anticipated by initial randomized controlled trials. Think, for example, of the way antibiotic-resistant Staphylococci evolved in response to clinical interventions of sequential narrow spectrum antibiotics. While game theory is usually, and most obviously, applicable to sentient and rational agents, many non-sentient systems behave as though they were agents responding in the game in question. See Skyrms (2004) for more on the evolution of cooperation in non-sentient cases via evolutionary game theory. Examples such as the antibiotic-resistant Staphylococci suggest that faith in randomized-controlled trials, even in medicine, is problematic.

  15. This advice is exemplified in Cartwright and Hardie (2012).

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Acknowledgments

An early version of this paper was presented at the 2009 Sydney-Tilburg Philosophy of Science Conference: ‘Evidence, Science, and Public Policy’ held at The University of Sydney, 26–28 March 2009. We’d like to thank the audience at that conference for fruitful discussion and several very helpful suggestions. We are also grateful to the referees of this journal for helpful suggestions.

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Correspondence to Adam La Caze.

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La Caze, A., Colyvan, M. A Challenge for Evidence-Based Policy. Axiomathes 27, 1–13 (2017). https://doi.org/10.1007/s10516-016-9291-5

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Keywords

  • Evidence
  • Evidence-based policy
  • Evidence-based medicine
  • Randomized controlled trials
  • Public policy