Speaking at the European Congress for Integrative Medicine (ECIM) in November 2021, our Chair, Dr Michael Dixon, debated how much evidence should drive health policy in modern healthcare. Here, Dr Dixon expands on that debate…
“I am sure that everyone will agree that evidence should drive health policy – after all what is the point of research if it doesn’t change things? But in the real world today, I would contend that evidence is neither a sufficient nor even a necessary determinant of health policy. Here, I want to examine why this is so and what we can do about it.
“When the integrative community provides evidence, there is an inbuilt inertia in the system towards accepting it and historical or vested interests will often block it. I cite the example that our NHS guidelines for back pain recommend acupuncture – but note that acupuncture is available in practice in only a very few areas of the country.
“If our health system commissions a new treatment then – given limited resources – it needs to decommission another and it is very slow and loath to do this. New evidence also needs public and political support and often to engage the support and imagination of the media as well as those who might benefit from it. That is the modern vernacular.
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“I will give you an example. A few of us pioneered the idea of social prescription in England four or five years ago. It is now national policy and implemented in every part of the country but not because of the evidence – which is still insufficient in the view of many academics.
“It is national policy because of the strength and reach of patient stories, because all levels of our health service and the politicians can see its logic and because a powerful though radical group of clinicians have engaged closely with politicians, managers and patients within the NHS to make it happen.
“So as a research community, how can we make sure our research hits the target? Firstly, it needs to be practical and grounded and answering the questions that those engaged in health policy need answering. That is prospective comparative research that answers questions such as how do painkillers and acupuncture compare in the treatment of headaches? And which don’t end with the let-out clause – “further research is required”.
“If possible, research should be rooted – even commissioned – by the very people, clinicians, managers and politicians for whom the answers are relevant so that everyone has ownership of the answers and therefore an investment in their implementation.
“Of course, research must be objective but if we are to make our mark in future, I would suggest that it also needs to be connected to its communities, prepared to include the N = 1 stories, engage with the pressing current issues and be relevant to the prevailing social and political climate. In short it needs to combine its objectivity with muddying its face with the realities of where it hopes to change things.
“In conclusion – if you ask me does evidence matter then I would have to say – not enough. If you ask me is evidence enough? Then my answer is – not on its own.”