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Commentary

Evidence Based Health Policy Against Fads
Anders Sandberg, Center for the New Europe, 5-18-06

In this blog post on the CNE health website, Sanders makes a very interesting observation about the persistence of management fads, and how it may afflict the growing movement for "evidence–based medicine":

Management and education are plagued with new organisational practices introduced with fanfare that supposedly will improve things. But there is seldom any information on whether they work, and when the old fads are discarded in favor of new it is still not clear that the old ones were worse than the new ones.

Why does this happen? Jonathan Bendor, Bernardo A. Huberman and Fang Wu propose an intriguingly simple explanation in their paper Management Fads, Pedagogies, and other Soft Technologies. Often it is hard to evaluate the efficacy of the new technique, so we rely on the judgement of others—a dozen Fortune 500 companies can't be that wrong, can they? In their mathematical model they demonstrate that unless people solely listen to each other and ignore evidence they will eventually adopt good practices and abandon bad. But if the evidence is not clear and people easily rely on others, this convergence can take extremely long time. Worse, if better evidence arrives after a bad practice has started to spread it may still not be enough to change the adoption pattern. There are too many people who have invested in it and others think they know something they don't.

Medicine itself is trying to get to the bottom of the problem using evidence based medicine, a good idea but at least initially itself a movement with no evidence for efficacy. And as one moves into health policy things turn even more faddish. Neil Blumberg's The Costs and Consequences of Management Fads and Politically Driven Regulatory Oversight: The Case of Blood Transfusion (Archives of Pathology and Laboratory Medicine: Vol. 123, No. 7, pp. 580–584), for example, describes how the AIDS scare led to costly, inefficient changes in the control of blood banking. The most worrying effect is that the medical–technical people have been removed from leadership positions in favor of lawyers, business administrators, bureaucrats, and public relations experts—a group even less able to handle emerging medical problems.



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