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Over the last twenty or so years, it has become standard to require policy makers to base their recommendations on evidence. That is now uncontroversial to the point of triviality--of course, policy should be based on the facts. But are the methods that policy makers rely on to gather and analyze evidence the right ones? In Evidence-Based Policy, Nancy Cartwright, an eminent scholar, and Jeremy Hardie, who has had a long and successful career in both business and the economy, explain that the dominant methods which are in use now--broadly speaking, methods that imitate standard practices in medicine like randomized control trials--do not work. They fail, Cartwright and Hardie contend, because they do not enhance our ability to predict if policies will be effective. The prevailing methods fall short not just because social science, which operates within the domain of real-world politics and deals with people, differs so much from the natural science milieu of the lab. Rather, there are principled reasons why the advice for crafting and implementing policy now on offer will lead to bad results. Current guides in use tend to rank scientific methods according to the degree of trustworthiness of the evidence they produce. That is valuable in certain respects, but such approaches offer little advice about how to think about putting such evidence to use. Evidence-Based Policy focuses on showing policymakers how to effectively use evidence, explaining what types of information are most necessary for making reliable policy, and offers lessons on how to organize that information.
How partisanship, polarization, and medical authority stand in the way of evidence-based medicine The U.S. medical system is touted as the most advanced in the world, yet many common treatments are not based on sound science. Unhealthy Politics sheds new light on why the government's response to this troubling situation has been so inadequate, and why efforts to improve the evidence base of U.S. medicine continue to cause so much political controversy. This critically important book paints a portrait of a medical industry with vast influence over which procedures and treatments get adopted, and a public burdened by the rising costs of health care yet fearful of going against "doctor's orders." Now with a new preface by the authors, Unhealthy Politics offers vital insights into the limits of science, expertise, and professionalism in American politics.
The Politics of Evidence Based Policymaking identifies how to work with policymakers to maximize the use of scientific evidence. Policymakers cannot consider all evidence relevant to policy problems. They use two shortcuts: ‘rational’ ways to gather enough evidence, and ‘irrational’ decision-making, drawing on emotions, beliefs, and habits. Most scientific studies focus on the former. They identify uncertainty when policymakers have incomplete evidence, and try to solve it by improving the supply of information. They do not respond to ambiguity, or the potential for policymakers to understand problems in very different ways. A good strategy requires advocates to be persuasive: forming coalitions with like-minded actors, and accompanying evidence with simple stories to exploit the emotional or ideological biases of policymakers.
Healthcare decision makers in search of reliable information that compares health interventions increasingly turn to systematic reviews for the best summary of the evidence. Systematic reviews identify, select, assess, and synthesize the findings of similar but separate studies, and can help clarify what is known and not known about the potential benefits and harms of drugs, devices, and other healthcare services. Systematic reviews can be helpful for clinicians who want to integrate research findings into their daily practices, for patients to make well-informed choices about their own care, for professional medical societies and other organizations that develop clinical practice guidelines. Too often systematic reviews are of uncertain or poor quality. There are no universally accepted standards for developing systematic reviews leading to variability in how conflicts of interest and biases are handled, how evidence is appraised, and the overall scientific rigor of the process. In Finding What Works in Health Care the Institute of Medicine (IOM) recommends 21 standards for developing high-quality systematic reviews of comparative effectiveness research. The standards address the entire systematic review process from the initial steps of formulating the topic and building the review team to producing a detailed final report that synthesizes what the evidence shows and where knowledge gaps remain. Finding What Works in Health Care also proposes a framework for improving the quality of the science underpinning systematic reviews. This book will serve as a vital resource for both sponsors and producers of systematic reviews of comparative effectiveness research.
Drawing on the work of the Roundtable on Evidence-Based Medicine, the 2007 IOM Annual Meeting assessed some of the rapidly occurring changes in health care related to new diagnostic and treatment tools, emerging genetic insights, the developments in information technology, and healthcare costs, and discussed the need for a stronger focus on evidence to ensure that the promise of scientific discovery and technological innovation is efficiently captured to provide the right care for the right patient at the right time. As new discoveries continue to expand the universe of medical interventions, treatments, and methods of care, the need for a more systematic approach to evidence development and application becomes increasingly critical. Without better information about the effectiveness of different treatment options, the resulting uncertainty can lead to the delivery of services that may be unnecessary, unproven, or even harmful. Improving the evidence-base for medicine holds great potential to increase the quality and efficiency of medical care. The Annual Meeting, held on October 8, 2007, brought together many of the nation's leading authorities on various aspects of the issues - both challenges and opportunities - to present their perspectives and engage in discussion with the IOM membership.
This book this book provides an overview of research and ideas in relation to evidence-informed policy and practice (EIPP) in education. The chapters all share a single overarching purpose: providing insight into how EIPP in education can be achieved. The result is a powerful account of Brown’s recent work.
Evidence-based medicine (EBM) is, simply, the conscientious and judicious use of medical research ("evidence") in clinical practice (Sackett et al. 2000:1). EBM emerged as a solution to various identified uncertainties in clinical practice as a programme for intervention at the level of individual medical judgments. Drawing on textual methods of analysis, my dissertation investigates how uncertainty is dealt with in two specific cases: multiple sclerosis and breast cancer. First, I ask if the principles of evidence-based medicine have the potential to reduce uncertainty by producing practice guidelines for rule-guided, procedural medical judgments. Then, I ask if there are other social relations that influence the production or translation of research and medical knowledge into concrete practices. I argue that the effects produced by the strategies of EBM have the potential to be deresponsibilizing, and that evidence is created within a political economy. I conclude by considering the Grey Zone of clinical practice and the ethic of responsibility, and then highlight the political implications for evidence-based policymaking and the sociology of medicine.
This book investigates the causes and consequences of congressional attacks on the US Supreme Court, arguing that the extent of public support for judicial independence constitutes the practical limit of judicial independence. First, the book presents a historical overview of Court-curbing proposals in Congress. Then, building on interviews with Supreme Court justices, members of Congress, and judicial and legislative staffers, the book theorizes that congressional attacks are driven by public discontent with the Court. From this theoretical model, predictions are derived about the decision to engage in Court-curbing and judicial responsiveness to Court-curbing activity in Congress. The Limits of Judicial Independence draws on illustrative archival evidence, systematic analysis of an original dataset of Court-curbing proposals introduced in Congress from 1877 onward and judicial decisions.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.