Intended for healthcare professionals


Scientific evidence alone is not sufficient basis for health policy

BMJ 2012; 344 doi: (Published 27 February 2012) Cite this as: BMJ 2012;344:e1316
  1. Keith Humphreys, professor1,
  2. Peter Piot, director2
  1. 1Veterans Affairs and Stanford University Medical Centers, VAPAHCS (152-MPD), 795 Willow Road, Menlo Park, CA 94025, USA
  2. 2London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. Correspondence to: K Humphreys Keith.Humphreys{at}
  • Accepted 17 January 2012

Keith Humphreys and Peter Piot argue that basing health policy solely on evidence is inherently contrary to the essence of policy development and even potentially dangerous

Articles recently published in Addiction1 2 3 4 5 6 have reignited debate about David Nutt’s 2009 conflict with the then UK home secretary, Alan Johnson. After Professor Nutt publicly accused the government of ignoring science when formulating drug policy (for example, by overestimating the dangers of ecstasy), he was sacked as UK drug policy adviser. As with other contentious issues such as heroin prescribing, needle exchange, and sex education, many scientists think that the lesson of the Nutt controversy is that we must take the politics out of health policy decisions and simply “do what the science says.” Based on experience as researchers and as policy makers at the White House and United Nations, we argue that although science should inform health policy, it cannot be the only consideration.

How science should inform health policy

Science can and must inform health policy decisions in several ways, including by identifying emerging problems. The discovery of new types of influenza virus, for example, or of smoking as a cause of cancer made policy makers aware of grave threats to health. The documentation of the first cases of AIDS and of the emerging epidemic of methamfetamine addiction in the western United States provided similar warnings.

Science can also be useful for telling policy makers which tools are likely to produce a desired effect. For example, when the Obama administration was looking for strategies to reduce substance use disorders, it relied on a large literature establishing the effectiveness of screening and brief intervention services within general healthcare. These services were ultimately included as an essential preventive service in the 2010 healthcare reform and the national drug control strategy.7 8 Similarly, the …

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