Education And Debate

Controversies in Management: Department of Health shoots itself in the hip Why the report of the Advisory Group on Osteoporosis undermines evidence based purchasing

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7026.296 (Published 03 February 1996) Cite this as: BMJ 1996;312:296
  1. Trevor A Sheldon, professor and directora,
  2. Angela Raffle, consultant in public health medicineb,
  3. Iain Watt, consultant clinical radiologistc
  1. a NHS Centre for Reviews and Dissemination, University of York, York YO1 5DD
  2. b Avon Health, Bristol BS2 8EE
  3. c Directorate of Clinical Radiology, Bristol Royal Infirmary, Bristol BS2 8HW
  1. Correspondence to: Professor Sheldon.

    The report of the Advisory Group on Osteoporosis represents a step back in the way the Department of Health develops policy on health technologies.1 It ignores the mechanisms which have been established to provide research input into decision making,2 it fails to review the evidence in a systematic way,3 and it recommends clinical policies which are not justified by the available evidence. We can see why the current arrangements within the Department of Health for considering issues related to screening have been described as “wasteful and confusing; they blur responsibility and invite conflict.”4

    Ploy to avoid considering costs and benefits

    The advisory group was asked to “establish what information about osteoporosis is available, what research is being conducted and what further work needs to be done, and to report to ministers.” In making recommendations about the use of bone densitometry and about the number of machines the report goes well beyond this brief.

    What is wrong with the advisory group's recommendations? Few would disagree that the 50% or so of hip fractures in older women associated with low bone density are a major cause of suffering and a cost to the NHS. Nor would many disagree that bone …

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