An equation for decision making on public health interventions
Lots of chat from fellow science bloggers (see here, here, here and here) about fluoridation following the recent Hamilton City Council decision. Naturally most of the posts focus on the science and the logic (or otherwise) of the arguments around fluoridation. I have no knowledge about fluoridation per se and have nothing to add to the science. What I did think was necessary was to posit an equation which gives the debate and many others like it (folic acid, vaccinations etc etc etc) a wider context.
My simplistic equation points out that any decision on a public health intervention involves far more than scientists and far more than science. Obviously, financial costs ranging from what it may cost to provide an intervention, to the impact of less ongoing health associated costs and greater productivity in those benefiting from the intervention are an essential part of the decision making. I would love a health economist to weigh in and give us a better idea of what an equation may look like. Questions of rights and responsibilities are harder to quantify, but no less important than the scientific and economic ones. Indeed, I think they are the most important as how we deal with them defines who we are as a society. In the case of folic acid, for example, this means balancing the rights of the unborn child against the rights of the mother and of the rest of society. While not a complete parallel to the abortion debate, it is familiar territory. At its heart is how society cares for the most vulnerable, whilst also acknowledging the rights of others to make choices for themselves. The final part of the equation involves the decision makers, spare some sympathy for the politicians here as they grapple with the complexities of science, economics and ethics. This year is local body election year, and next year we have a general election. My challenge is that if you care enough about these issues to read a blog post, spend a little more time getting to know the candidates and try to figure out if they are up to making complex decisions on your behalf. If so, give them your vote.
Just heard Julia Lane – an expat Kiwi and science economist speaking on Radio NZ about science and the economy. She’s in Christchurch for a debate “Is Science Good for the Economy?” which can be heard tomorrow night as part of the ice fest – see here.
A few nice points she made (my paraphrasing).
- There is a challenge for governments in that returns from basic research are long, complex, and often in unexpected directions. This is often different from government priorities which are focused on short term benefits.
- The principle reason for governments to invest in science is for the public good. If there are high returns expected, then this is a place for the private sector not the government. So called “failure” or “dry holes” as she called them are examples of public good. If a private company invests in science that does not work as they hoped, they have no reason to tell the world. Government funded science will tell the world, thereby enabling all businesses to make better decisions about where not to invest $.
- The reasons for government investment should be (in this order) 1) Formation of more science knowledge, 2) social gains (eg cleaner streams), 3) work force effect (trained in science people entering businesses etc), and 4) economic
- A current concern is that there is too much emphasis on bean counting (eg science judged on number of publications, patents etc – Take note HRC, Marsden, PBRF (my comment)).
- Better funding models seem to be ones that fund individuals and groups rather than projects. She mentioned the Howard Hughes Medical Institute which has done this very successfully and talked of ANU and Uni Melb who have upped their game doing this.
- Nice phrase was that “Science involves creation, transmission and adoption of knowledge through networks of human beings.” She thinks science funding should emphasise the people and networks. An example is TNF alpha which was discovered in the 70’s by Dr Lloyd Olds at Sloan Kettering. A trace study (no reference, sorry) showed that whilst Dr Olds never produced a drug based on TNF alpha, his networks using the knowledge he gained developed billions of dollars worth which have helped millions of people.