Intended for healthcare professionals

Feature Essay

Defending evidence informed policy making from ideological attack

BMJ 2018; 362 doi: (Published 10 September 2018) Cite this as: BMJ 2018;362:k3827

Re: Defending evidence informed policy making from ideological attack

Bonnell C, Reiksin R, Mays N, et al
BMJ 2018;362:k387
The authors make some contentious claims.

“The world faces a new era of greater hostility to experts and evidence.”
Wrong. The world is not hostile to ALL experts. It is certainly hostile to ideas purveyed by policy makers who claim that they are going by expert advice.
We have been bitten by such policy makers.
The essayists quote Mr Tony Blair with approval. The politician who cited various expert researchers who alleged that Iraq was in possession of weapons capable of attacking Cyprus. I would regard Mr Blair and his ilk in the same way as I regard second hand car salesmen ( I have been bitten by such a salesman once. Never again will I buy a second hand car. )

“The rise of ideological thinking”.
The authors traduce populist thinking. Liberal democracies, they say, are declining and authoritarian regimes are multiplying.....mainstream parties adopting populist policies in.................and the UK.
“Populism” has become a term of political abuse and the Essayists use it in this sense.
They forget that DEMOCRACY is government of the people, for the people, by the people. Democracies are not declining. If the voters choose a government according to THEIR OWN preferences, so be it. If you do not like their choice - tough.
Liberal? It is a useless term.
The Australian Liberal Party is anything but liberal - if we use the term to imply political agendas of the English liberal party of the 1900s. Jo Grimmond was the last true Liberal politician in England.
To me, populism is another word for democracy.

BREXIT - I do not like it. Nor do I condemn the majority of electors who voted for it.
For all we know, if our very own democracy had taken heed of the concerns of the poor, the unemployed, of the areas which became deindustrialised, bringing manufactured goods from half way round the globe, the have-nots and the no-hopers might have voted to stay in an EU. Our political Brexiteers shouted about bloated Brussels, but never stopped it from becoming bloated. They could have stopped it - they had equal part in causing bloating. But the REMAINERS never told the voters that our very own British Elite in Brussels bloated themselves - at our expense.

Do the essayists remember (from their childhood) the saying “carrying coal to Newcastle”?
After Mrs Thatcher smashed the NUM and so many mines, we actually started importing coal from Poland, in ships that unloaded in ....Newcastle-upon-Tyne. Evidence did show that in the short term, Mrs Thatcher’s policy saved money. The Great British Public supported the policy. I deplored it. But I swallowed the democratic poison.

The authors seem to approve of the “currently popular policy of conditional payments to promote healthy behaviours”
But, subject to popular vote - through their elected representatives, I would suggest legal measures such as limiting availability of some “ foods”, such as desserts in dessert parlours (close down these parlours), some “drinks” such as “ alcohol” cut down opening hours, stop sales of alcohol everywhere except pubs).

The authors want evaluation. So do I. But evaluation of health policies takes longer than a year or two. It could take a generation. By the end of that time, many of the “subjects” will be dead. Those who introduced or promoted the policies will have moved on - or died.

In brief, I will follow the experts if I believe them. That is my ideology.

Competing interests: No competing interests

14 September 2018
JK Anand
Retired doctor
Free spirit