Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-25T05:08:18.786Z Has data issue: false hasContentIssue false
  • English
  • Français

EVIDENCE, VALUES, AND DECISION MAKING

Published online by Cambridge University Press:  28 April 2014

Michael D. Rawlins
Michael D. Rawlins*
Affiliation:
Royal Society of Medicine
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The evidence supporting the use of new, or established, interventions may be derived from either (or both) experimental or observational study designs. Although a rigorous examination of the evidence base for clinical and cost-effectiveness is essential, it is never sufficient, and those undertaking a health technology assessment (HTA) also have to exercise judgments.

Methods: The basis for this discussion is largely from the author's experience as chairman of the national Institute for Health and Clinical Excellence (NICE).

Results: The judgments necessary for HTA to make are twofold. Scientific judgments relate to the interpretation of the science. Social value judgments are concerned with the ethical principles, preferences, culture, and aspirations of society.

Conclusions: How scientific and social value judgments might be most appropriately captured is a challenge for all HTA agencies. Although competent HTA bodies should be able to exercise scientific judgments they have no legitimacy to impose their own social values. These must ultimately be informed by the general public.

Keywords

clinical effectivenesscost effectivenessscientific judgementssocial value judgements
Type
Policies
Information
International Journal of Technology Assessment in Health Care , Volume 30 , Issue 2 , April 2014 , pp. 233 - 238
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Rawlins, MD. Therapeutics, evidence and decision-making. London: Hodder; 2011.CrossRefGoogle Scholar
2. Rawlins, MD. De Testimonio: On the evidence for decisions about the use of therapeutic interventions. Lancet. 2008; 372:2152–2161.CrossRefGoogle ScholarPubMed
3. Kesselheim, AS, Solomon, DH. Incentives for drug development — The curious case of colchicine. N Engl J Med. 2010;362:2045–2047.CrossRefGoogle ScholarPubMed
4. Smeeth, L, Cook, C, Fombonne, E, et al. MMR vaccination and pervasive developmental disorders: A case-control study. Lancet. 2004;364:963–969.CrossRefGoogle ScholarPubMed
5. Glasziou, P, Chalmers, I, Rawlins, MD, McCullough, P. When are randomized trials unnecessary? Picking signal from noise. BMJ. 2007;334:349–351.CrossRefGoogle ScholarPubMed
6. WHO Commission on Macroeconomics and Health. Macroeconomics and health: Investing in health for economic development. Geneva: World Health Organization; 2001.Google Scholar
7. Rawlins, MD. Pharmacopolitics and deliberative democracy. Clin Med. 2005;5:471–475.CrossRefGoogle ScholarPubMed
8. Beauchamp, TL, Childress, JF. Principles of biomedical ethics. Oxford: Oxford University Press; 2001.Google Scholar
9. Littlejohns, P, Rawlins, MD, eds. Patients, the public and priorities in healthcare. Oxford: Radcliffe Press; 2009.Google Scholar
10. National Institute for Heath and Care Excellence. Citizens Council Report. The use of incentives to improve health. London: National Institute for Health and Care Excellence; 2011. www.nice.org.uk/aboutnice/howwework/citizenscouncil/reports.jsp?domedia=1&mid=10860C6D-19B9-E0B5-D46FA5607685FB05 (accessed April 16, 2014).Google Scholar
11. Rawlins, MD, Culyer, AJ. National Institute for Clinical Excellence and its value judgments. BMJ. 2004;329:224–227.CrossRefGoogle ScholarPubMed
12. National Institute for Heath and Care Excellence. Social value judgements: Principles for the development of NICE guidance. London: National Institute for Health and Care Excellence; 2008. http://www.nice.org.uk/media/C18/30/SVJ2PUBLICATION2008.pdf (accessed April 16, 2014).Google Scholar
13. Rawlins, M, Barnett, D, Stevens, A. Pharmacoeconomics: NICE's approach to decision-making. Br J Clin Pharmacol. 2010;70:346–349.CrossRefGoogle ScholarPubMed
14. Gilchrist, A. The life of William Blake. London: Bodley Head; 1907.Google Scholar
15. Harbour, R, Miller, JA. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323:334–336.CrossRefGoogle ScholarPubMed
Supplementary material: File

Rawlins Supplementary Material

Table 1

Download Rawlins Supplementary Material(File)
File 60.8 KB