Ben Goldacre & patterns of public policy

In 2014, Research ethics on March 31, 2014 at 8:49 am

“The patterns of public policy … are determined not only by such final decisions as votes in legislatures, … but also by the fact that some subjects and proposals emerge in the first place and others are never seriously considered.” John Kingdon

Hazel Biggs and I enjoyed Ben Goldacre’s recent discussion of ‘Medicine and Money’, part of the Nuffield Theatre’s inaugural Fulcrum Southampton: A point of balance between science and art, held over three days on 21-23 March 2014. His fast-paced impassioned talk focused, unsurprisingly, on the problems regarding the non-reporting of clinical trial data and what this means for medicine, money/government spending, patients, i.e., ‘us’ public in general. When considering exactly what this might mean, and the apathy that sometimes results – it’s not about ‘me’, has little or nothing to do with ‘me’, why is this really a problem etc – he flagged up the ‘dead babies’ problem. That is, the (potential) natal fatalities that have resulted as a result of the precautionary non-use of medicine, due to a lack of knowledge regarding side-effects of use on pregnant women (as clinical trial data was not published), when using the substances in question may have saved many lives. (This write up is inevitably ‘couched’ as – in law – causation would need to be proved: once a Tort lawyer …).

Interestingly, Ben Goldacre tweeted this message last Friday afternoon:

ben goldacre (@bengoldacre) 28/03/2014 15:43
Fab briefing by Parliamentary Office Sci Tech @POST_UK on withheld clinical trials bit.ly/1h0kJIP #alltrials Unimaginable 2 yrs ago

The POSTNOTE referred to is a briefing paper on issues around increasing transparency of clinical trial data. It’s the last part of the tweet that grabbed my attention: ‘unimaginable 2 yrs ago’. It reminded me of John Kingdon’s seminal text on pre-decision public policy processes, in which he provides a compelling and authoritative account of the messy world of public policy formation. His starting point is the question: ‘what makes an idea’s time come?’ He identified two categories of potential factors that may influence agenda setting and consideration of alternatives, namely i) participants, and ii) processes. These categories are further refined into i) participants inside and those outside of Government, and ii) problem recognition, policies/the generation of policy proposals and politics/political events. At crucial points problems, policies and politics meet, are coupled together, and according to Kingdon, it is at these junctures that the ‘greatest policy changes’ emerge.

It may be too early to determine whether or not the activities of those participants outside (see especially All Trials) and inside Government – during this month’s Southampton talk Ben Goldacre credited Dr Sarah Wollaston MP for her pivotal role in bringing this issue to the (agenda) table – together with ‘events’ such as the MHRA reportedly ‘shredding’ documents pertaining to the efficacy of Prozac, after 15 years on file, will inevitably lead to a sustained policy change. But, if anything, this seems more likely now than ever.

Caroline Jones

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