Evidence-based approaches

Yesterday Chris Roche and Rosalind Eyben set out their concerns over the results agenda. Today Chris Whitty (left), DFID’s Director of Research and Evidence and Chief Scientific Adviser and Stefan Dercon (right), its Chief Economist, respond.

It is common ground that “No-one really believes that it is feasible for external development assistance to consist purely of ‘technical’ interventions.” Neither would anyone argue that power, politics and ideology are not central to policy and indeed day-to-day decisions. Much of the rest of yesterday’s passionate blog by Rosalind Eyben and Chris Roche sets up a series of straw men, presenting a supposed case for evidence-based approaches that is far removed from reality and in places borders on the sinister, with its implication that this is some coming together of scientists in laboratories experimenting on Africans, 1930s colonialism, and money-pinching government truth-junkies. Whilst this may work as polemic, the logical and factual base of the blog is less strong.

Rosalind and Chris start with evidence-based medicine, so let’s start in the same place. One of us (CW) started training as the last senior doctors to oppose evidence-based medicine were nearing retirement. ‘My boy’ they would say, generally with a slightly patronising pat on the arm, ‘this evidence-based medicine fad won’t last. Every patient is different, every family situation is unique; how can you generalise from a mass of data to the complexity of the human situation.” Fortunately they lost that argument. As evidence-informed approaches supplanted expert opinion the likelihood of dying from a heart attack dropped by 40% over 10 years, and the research tools which achieved this (of which randomised trials are only one) are now being used to address the problems of health and poverty in Africa and Asia.