Art

The science of science advice The European context: European

Science Advisory Network for HealthImproving Science Advice project (EuSANH

– ISA) Future perspectives

Progress average life expectancy in developed

countries: by about 25 years in 20th century(health related) quality of life >>

Remaining and new issuessocial gradients, ageing, mental health, food

and nutrition, lifestyle, environment, quality of care

infectious diseasesopportunities/risks new technologiesethical implications

Increasing knowledge implies new opportunities, but also higher responsibility

International dimension of problems and knowledge

Culture of justification, accountability, and transparency

Increased expectations/demands from the public: predictable effect, no-risk

Public interest groups Media pressure Time pressure Longterm impact shortterm policies

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1970 1975 1980 1985 1990 1995 2000 2005

Thomas Stearns Eliot (1888 – 1965):

Where is the life we have lost in living,Where is the wisdom we have lost in knowledge?Where is the knowledge we have lost in information?

(Chorus from the rock)

Science advice: recommendations for policy based on knowledge, considering also expert judgment, ethical and societal aspects,and ‘experience expertise’

Important study subject per se Priority, relevance, impact, evaluation Quality and reproducibility (ceteris

paribus, mutatis mutandis) International standard development Common methodological basis

(compare EBM, Cochrane, HTA)

OriginExternal (government agency, parliament,

researchers, professionals, public/patients) Internal

MotiveUncertainty over best policyPublic credibilityConflict resolution

As science itself, science advice can (should) only be convincing when based on solid methodology

- A clear question

- An appropriate working method

- expertise (quality and composition committee)

- evidence base (literature - quantitative, qualitative), investigations,

- analysis: SR/MA & appraisal, HTA, expert judgment, ethical analysis, context

- experience expertise, stakeholder involvement/consultation

- reaching conclusions/recommendations/options

Committee: the best experts in the field of interest

Multidisciplinarity, balance Authority committee chair Volunteer participation; no honorarium Independence and integrity, disclosure of

interests Skill and experience of the Staff Independent peer review (internal, external)

Adequacy of funding Timeliness (product differentiation) Relation to policy makers and politics (content

and progress) Communication/dissemination Implementability implementation Evaluation

Transparency

(IOM)

It is easy to lie with statistics.It is even easier to lie without them.

Frederick Mosteller

It is easy to make bad policy with science.It is even easier to make bad policy without

science. Harvey Fineberg

Policy makers Health professionals Public Business and civic leaders Patient interest groups Educators and researchers Others

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Science has longterm scope Good science has shown to be effective in

history Science advice

not to reproduce straightforward research results (e.g., RCTs on singular treatment effects)

should focus on more complex issues, uncertainties, disagreement

Science is international by definition Many public health problems are border

crossing In EU, with ever intensifying interactions

in addition to national approaches, increasing international dimensions

Complexity of problems Cumulation of knowledge Scarcity of expertise Limited resources Quality optimisation

international exchange, sharing, & collaboration easier when methods have commons basis

• ‘The commission in general and DG Sanco in particular attach high importance to the use of sound science to underpin its work, and strive therefore to ensure that its scientific advice is of the highest quality.’

• ‘… make the best use of external experts and benefit from the enormous reservoir in the Community and beyond.’

(Sanco DG Robert Madelin, 2004)

Combining (scarce) expertise, efforts and resources in the field of science advice: quality, effectiveness/efficiency, coverage

To promote evidence informed policy making at the national and European level

With the objective to improve the health of the population

Target groups: policy makers, professionals, other stakeholders, the public

• Statutory Advisory bodies• Permanent• Advising to government/parliament• Independent• Broad scope

• 13 MS currently involved

e.g., ageing, lifestyle issues diabetes, obesity, population screening, cost-effectiveness/benefit questions

Pan/epi-demicsair qualityfood safetyhealthcare

infrequent disorders/treatments extensive infrastructure for treatment (e.g., heart transplantation in young children)

comparative analysishealth system performancehealth disparities

Cultural and ethical diversity Socio-economic health differences Antibiotic resistence Organ donation Primary care orientation

Life expectancy women, at birth

EU-25France

HungaryPoland

UK

EU-15Italy

NetherlandsPortugalSweden

Exchanging/sharing scientific knowledge and expertise

Complementarity of working programmes

Sharing expertise in collaborative advisory committees

Joint advisory reports National governments European bodies

Level

of co-

opera-

tion

The Directorate General Research - launched an e-Network to make

scientific advice more available at the EU and national level: SINAPSE (Scientific Information for Policy Support in Europe).

- keen to support initiatives to strenghten science-based policy making

Variety of topics but also overlap Many reports not available in English Method:

Variety of methods: not always explicit justification

Evidence, expert judgment and experience Existing evidence and/or additional surveys Stakeholders and peer review not always

mentioned Recommendations for implementation need

more attention Procedures to safeguard independence not

always mentioned

EuSANH-ISAImproving Science Advice for Health in

Europe

To improve quality, effectiveness and efficiency of science advice for health across Europe

Current status in EuSANH member countries; thematic analysis of reports from each participant country.

Common ‘best practice’ methodology for science advice Communication and co-operation structure for the expanding

network, using the SINAPSE e-communication tool. Test the common methodology and the network by

developing in a case study for a European report. Internal and external diss emination of results

Globalize the evidence localize the decision (John M Eisenberg, Agency for healthcare research and quality US)

Health Aff (Millwood) 2002; 21: 166-8)

Proportionality and subsidiarity: what advice on national level, between individual states, or EU level ?

Cross-border scientific advice to bridge gaps in the field of science and health between science and policy to guide policy makers to anticipate rather than be

reluctant EuSANH to be a generally recognised source for

independent science advice for health in the European policy arena

Complementarity/collaboration other actors Compare USA: CDC,FDA <-> IOM

ECDC, EFSA, EMEA <-> EuSANH