Hey academics -- Hands off health policy!

Policymakers, rather than academics, should dictate decisions about health priorities, the regional director of the Ghana Health Service, Irene Akua Agyepong, told the Global Ministerial Forum on Research for Health conference in Bamako, Mali, this week, according to scidev.net.

Academics don't always know what research is most relevant to a specific country or region, and should stick to determining how projects -- not which projects -- are conducted, she said.

Is Agyepong demeaning the role of academics in the scientific debate, particularly in the developing world?

Elie Dolgin, Associate Editor, The Scientist

Setting priorities in policies due to budgetary considerations can be left up to policymakers, but the effort ABSOLUTELY has to go hand in hand with factual science. Otherwise you end up with inane policy makers as found in the Bush Administration’s efforts to suppress and misrepresent scientific evidence on global warming, stem cells, prenatal care, abortion, medical insurance, welfare, education, sex ed, “no child left behind”, euthanasia, energy conservation, criminal rehabilitation, etc., etc., just to name a very small few.

The ivory tower is quite real. Researchers have their own axes to grind, and so-called science isn't always real science. Fads, fantasy and being as out of touch with reality as Blanche Dubois in A Streetcar Named Desire, are all things that "scientists" are known for.

One of the worse examples of this was Jeffery Sachs and "Shock Treatment" in Russia.

We scientists have our sacred cows, and our politically correct ideas. Our ideas are usually products of our Western upbringing, and those ideas are often completely wrong when applied outside of our world.

But, with that in mind, it is ridiculous to suggest that scientists, who are often the most knowledgable people around on some topic, should not participate. But they should participate while listening. That doesn't mean accepting, or not arguing, it just means listening and evaluating.

I'm fascinated by the assertion that Western scientific ideas are often completely wrong when applied outside "our world".

I'd like to invite readers to submit examples of scientific ideas that are applicable in developed countries but not in, say, Africa.

Hello! Leaving health policy to legislators is the very thing we can no longer afford. Keep in mind that the majority of legislators, and the new administration in D.C. are lawyers by profession. So, as I have know lawyers, unless they are actively in patent practice, just don't have a lot of techinical savvy. I am just finishing a study of the Healthcare Delivery System in the U.S., and it has several objectives to its being reinvented. FIrst, it needs a makeover since it is so inefficient, costly and casually structured from decades of just letting the medical community do what is has always done. Secondly, systems are for healthcare delivery are the domain of engineers- not scientists. The science of going to the moon was small compared to the systems development efforts by the engineers. Third, a good systems concept must overcome the ineffective nature of the present healthcare system; i.e. for example, discontinue the practice of prescribing antibiotics for symptoms that clearly indicate a viral infection. (This one reaches into the arena of bio-science). Fourth, our current acute based delivery (you gotta know your sick before you see a doctor) must convert to a chronic care system (preventive healthcare) if we shall ever see a real improvement in both the cost effectiveness and efficacy of healthcare in the U.S.
Ladies and gentleman of the most wonderful science community on this planet; please encourage the applied science of systems engineering to tackle the problems of our failed healthcare delivery system, and furthermore, when the engineers ask you how and why a part of medical/biological science is necessary to the improvement of healthcare quality and cost effectiveness, be ready to defend your response in a most adament and honest manner.

JON199271 wrote:I'm fascinated by the assertion that Western scientific ideas are often completely wrong when applied outside "our world".

I'd like to invite readers to submit examples of scientific ideas that are applicable in developed countries but not in, say, Africa.

Afaict nobody said such a thing.

Indeed, Robert, they did not. But, I suspect he is referring to me. I will use a couple of examples, one from outside of bioscience, and two that will be controversial from inside.

1. In the 1990's economists from Harvard and company, with Jeffrey Sachs as their leading spokesman, sold the former USSR on "shock treatment" as the proper way to transition to a market economy. They had no criteria for success, no measures specified to track, no methods specified in their papers they wrote, no conclusions that were not cherry-picked, and mostly, to this day they simply don't like to talk about it. Fact is, millions died because of it. Public health and medical care was nearly destroyed for huge segments of the population. One can read "Collision and Collusion" by Wedel, to help understand the way this worked in Eastern Europe. Curiously, there was an inverse relationship between the health of the economy 10 years later and the amount of western aid and advice the nation got.

2. In Africa today we press for certain methods of HIV control, and denigrate the use by certain cultures of vigilantes that beat and kill violators of sexual rules. And yet, those regions where such methods are used have had some of the lowest rates in Africa.

3. Also in Africa, scientists are pressing for use of antivirals to treat HIV to prevent transmission to infants. And yet, Africa has an extraordinary problem with AIDS orphans that was at the 14 million level in the early 2000's and was predicted to hit 18 million by 2010. Since these orphans are left to their own devices, they are the core that warlords and warlord wannabes use as cannon fodder for their horrors. So, looked at wholistically, to save infant lives without providing properly for the care and socialization of the child is to set up conditions for blowback from those orphans. It sets things up so that it's like lighting a match in the hills above Santa Barbara. If a wind comes up, the result is terrible.

These kinds of things are what the politician meant when he said that scientists should not set governmental policy.

Science has its uses, but scientists are all too often extremely narrow-minded, laser focused on their own little area. Scientists also tend to bring their cultural prejudices, which can be liberal or conservative, to their work, without ever thinking about them. Academia has its own little shibboleths that are blinding as those of any religion. It is not enough to be right within your own little area. For policy to work, it must be right for the system as a whole.

This discussion indicates the problem - it's not either policymakers or scientists - it has to be BOTH that are involved!

Yes, scientists can be narrowly focused and have their own agenda towards their own interests research-wise, but so can policymakers! How many times have they cut the science and health budget, not because the research wouldn't be worth it, but because they didn't understand its necessity or consequences.

Policy without factual basis is just as bad as policy focused on a narrow focus. The big picture should always be visible.

As for localized vs. global problems, it depends on the economic, cultural, and government issues in the area being addressed. AIDS is a great example of how American policy (education and condom use) does NOT translate to the epicenter, Africa. Societal taboos, government denial, and a fear of Western medicine does not make it that easy there. More policy decisions have to be made as far as education and training, and providing the materials necessary for testing and counseling services for families and patients. But this issue isn't about academics vs. policymakers, it's about people of all types not realizing the differences between cultures.