Healthy Futures: Medical Regulation and Human Agency
Friday, 22 January 2010
Location: CRASSH

(a) Summary Abstract

Decisions relating to medical regulation are fraught with uncertainty, and have grave implications for public health. This meeting kicked off with a plenary talk from Sir Michael Rawlins, Chairman of NICE, which illustrated vividly the difficulties and responsibilities involved in weighing the consequences of action when one’s evidence base is far from complete. The presentations which followed drew together philosophers, epidemiologists, social scientists, statisticians and others, all of whom commented on various features of action under uncertainty, and the efficacy of tools designed to cope with uncertainty. Themes explored included the legitimacy of cost/benefit analysis, the realities of the policy-making process and the role of multidisciplinary work. 

b)  Conference Review

The goal of this meeting was to bring together a diverse group of theorists and practitioners, drawn from social and natural sciences, to address the question of how to respond to uncertainty in health care regulation. The problems underlying these questions have many dimensions. First, they include the practical issues of how, as a matter of fact, regulatory bodies are briefed on health matters, how they feel constrained in their decision making, and how their institutional structures have been shaped historically. Second, they encompass technical issues regarding the sorts of decision making tools which are available, including mathematical modelling techniques and decision-theoretic frameworks, as well as the quality of scientific information flowing into these processes. Third, they spill into more philosophical aspects, reflecting the ways in which costs and benefits should be balanced, the dangers of wholly utilitarian approaches, and the availability of workable alternatives to cost/benefit analysis.

The meeting was characterised by a good balance between abstract concerns (whether mathematical, sociological, biological or philosophical) and the investigation of practical case studies. The meeting was also extremely successful in fostering a genuinely interdisciplinary perspective on the problems addressed. Different approaches were allowed to shine a light on problems which all participants recognised, and discussion was productive, rather than reflective of disciplinary boundaries.

It is hard to state in any uncontroversial way what conclusions were reached by the meeting, but in rough terms most delegates seemed to endorse the measured use of quantitative decision-making tools, not so much as an arbiter of the correct decision, but rather as a disciplining tool which could enable the features of a decision problem to be clearly delineated, and which was often the lesser of many evils. There was, however, a strong reminder of the need to police the quality of data fed into these tools, and to explore their robustness for policy analysis. Finally, there was a sense that in some cases uncertainty might be so profound that these tools were no longer of value.



 

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