9º World Congress on Health Information and Libraries

Salvador, Bahia - Brazil, September, 20 to 23 - 2005


4th Regional Coordination Meeting of the VHL

September, 19 to 20 - 2005


Evidence and democracy in health-related decision-making (panel 2)

Decisions related to health, involve and affect individuals, communities and societies. Scientific knowledge is an accumulative process that evolves continuously bringing evidences to support decision making process. Is there a contradiction between evidence-based policies and public participation in the decision making process?

 Countless agencies and networks are striving to provide decision makers with evidence to inform their policies. However, the way the evidence is researched and used still has a long way to go, as demonstrated by the chilling account of Iain Chalmers, editor at the James Lind Library, United Kingdom, both academia and industry have consistently ignored important questions for health services and users. Collusion between health practitioners and the industry for financial reasons has reached scandalous proportions. Even more fundamental is that scientists should, but don’t, cumulate information scientifically. In light of this, how can knowledge be generalized?
As early as 1884, Lord Raleigh, Nobel prize for Physics, already stressed the importance of explanation as well as discovery –new facts must be not only presented, but their relation to old ones must also be pointed out. A fundamental question regarding new discoveries is “What does it mean anyway?”. Setting new studies in context has to be taken seriously, but how seriously is it taken in scientific publications?
Out of 26 studies examined in 1997, 19 showed no apparent systematic attempt to set new results in context with previous trials; only 2 did. New surveys in 2001 and 2005 revealed no improvement in the matter. Chalmers gave numerous examples of “scientific” findings and recommendations that in reality led to the death of thousands of people. A systematic review of risks could have prevented most of them.
In an attempt to start redressing this disastrous situation, the British medical journal The Lancet now requires its contributors to provide a clear summary of previous research findings and to explain how their trial’s findings affect this summary. However, academia still seems not to be taking it seriously and Chalmers stresses that “the public should be very angry about it”.
For Rodrigo Salinas, member of the Chilean National Council for Health Research, a major challenge for policies based on evidence is combining evidence information with social participation in a way that validates the process of prioritization. Political will is not enough; the appropriate technical basis must also be called for. A further challenge is organizing a regional system that will allow joining efforts in countries with similar demand for information and analysis.
Anca Dumitrescu, director of the WHO Regional Office for Europe’s Division of Information, defined evidence as “findings from research whenever possible, and other knowledge that may serve as a useful basis for decision makers in public health and health care”. The WHO’s HEN program strives to provide policy makers with answers to specific questions within their political agendas. Evidence is then graded on the strength of findings in scientific studies, according to number and quality. The HEN network is composed of 35 government agencies and other public institutions, the European Commision, and all UN agencies with a mandate in health.