Intended for healthcare professionals

Education And Debate

Democratisation of scientific advice

BMJ 2004; 329 doi: (Published 02 December 2004) Cite this as: BMJ 2004;329:1339
  1. Roland Bal (, assistant professor1,
  2. Wiebe E Bijker, professor of technology and society studies2,
  3. Ruud Hendriks, assistant professor of philosophy2
  1. 1 Department of Health Policy and Management, Erasmus University Medical Centre, PO Box 1738, 3000 DR Rotterdam, Netherlands,
  2. 2 Faculty of Arts and Culture, University of Maastricht, PO Box 616, 6200 MD Maastricht, Netherlands
  1. Correspondence to: R Bal
  • Accepted 20 September 2004

Dutch experience shows how scientific advisory bodies can cope with the growing political demands for transparency and lay participation without compromising their function


Scientific advisory councils in Western countries have become increasingly confronted with demands that are usually reserved for the political arena.1 2 Two such demands stand out: transparency and public participation. Although these seem legitimate demands, and have been taken up by governments in most democratic countries, it is unclear how they can be enacted or what their effects will be on the advisory process. Open and closed procedures are conventionally viewed as opposites.3 4 We argue that they have a dialectic relation and are not mutually exclusive, using the example of the Health Council of the Netherlands.

Need for transparency

Good arguments exist for democratising the advisory process. The first was raised as long ago as 1937, when Gulick noted that “history shows us that the common man is a better judge of his own needs in the long run than any cult of experts.”5 Normative and instrumental arguments have also been put forward.6 The normative argument holds that citizens have a democratic right to be involved in decisions that affect their lives. The instrumental reason, which is probably the most important to regulators, is that excluding citizens from the advisory process may hamper regulation. As the House of Lords select committee on science and technology notes in its influential third report on science and society: “framing the problem wrongly by excluding moral, social, ethical and other concerns invites hostility.”7

Role of the council

The Health Council of the Netherlands reports on the state of knowledge concerning health to the Dutch government and covers a broad area of health, food, and environmental policy. The council consists of around 200 members but works on the basis of ad hoc committees …

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