How to decide what to do, whatever the evidence.

7 Jun

At the recent Cyrenian’s conference on the potential for delivery of alcohol brief interventions in untested or unproven community settings, Dr. Andrew Tannahill’s presentation with the above title, may be of interest. Rather than an ‘evidence rules’ approach decision-making, his thesis (part of his work for NHS Health Scotland) advocates 10 principles to underpin an ethics-based approach to deciding how to improve population health and reduce health inequalities. The alternative motto of this approach, he claims is ‘ethics rule: evidence serves’.

Importantly, evidence remains an important part of the decision-making framework, but so does logic and theory about the probable and possible impact of any decision or intervention made. The 10 principles can be organised into 3 categories:

1. Four principles fundamental to main health outcomes and how the organisation goes about its
business: Do good, Do not harm, Fairness, Sustainability
2. Five principles to do with other outcomes and/or how the organisation goes about its business:
Respect, Empowerment, Social responsibility, Participation, Openness
3. Principle of Accountability – for consequences of decisions and actions, use of resources, value for
money, etc

Dr. Tannahill’s presentation goes through each of the principles and considers how it might be applied to the rollout of IBA in new or untested settings and is well worth a look.  You can also read his journal paper on the framework.

Personally, I find it offers an answer to concerns I have had about how to balance the need for evidence with the great need to do something effective about alcohol consumption.  A solely evidence based approach is not always possible – many, many aspects of what we do are not evidence-based, and it seems to me unlikely that we will ever have really robust, hard evidence for many ‘interventions’ by many practitioners.  Dr. Tannahil’s approach offers part of the answer.  A shorter answer may be that – if we choose to do new things – we have a responsibility to contribute to knowledge about them – by clearly describing why and how and what happened – and to be honest with ourselves and others about exactly what the level of evidence is.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s