I feel that my previous post was a bit like weak academia,
but what I hope to do with this one is illustrate how some elements of the model I proposed for
understanding policymaking might be useful.
One of the debates I mentioned in my last post was about the
role of the alcohol industry in policymaking.
This has been
in the news, as a result of a
report by Jim McCambridge, Ben Hawkins and Chris Holden which argued that
the alcohol industry misrepresented research evidence in its submissions to the
Scottish Government’s 2008 alcohol policy consultation, which included
proposals for minimum unit pricing (MUP).
A lively debate followed (I found John Holmes on Twitter particularly
interesting), and in one case strayed into a semantic discussion
of the nature of ‘evidence’.*
The headline of a blog on the Guardian website presented the
wider debate in stark terms: “Should
those with a vested interest comment on minimum alcohol pricing?” This headline is itself a misrepresentation
of the clear summary of the research Suzi Gage that followed. The specific suggestion of the researchers is
that ‘industry actors’ shouldn’t be involved in ‘the interpretation of research
evidence’.
Thinking back to my previous post, this specific wording by
McCambridge and colleagues really amounts to a claim that the alcohol industry
isn’t the expert in what I posited as the second stage of thinking about
policy: ‘what works’. The gripe of
McCambridge and colleagues is that the industry downplays strong evidence and
promotes weak evidence or unevidenced conjecture in its place.
There is a statement in the article that ‘policy making is
not a purely rational process, informed only by evidence. It is by definition political and thus
subject to a wide range of influences’.
I would take issue with this.
Policy cannot be solely informed by evidence, because evidence without
aims is meaningless. The decision on
what these aims might be is certainly political, but that does not mean that it
is by definition ‘not … purely rational’ – or more precisely that this somehow
contrasts categorically with discussions of evidence.
What’s happening here is a prime case of the sort of problem L Susan Stebbing (the
original thinker-to-some-purpose) was concerned to highlight.
It seems to me almost self-evident that the alcohol industry
should be permitted to express its views on government policy, rendering the Guardian blog headline a bit of a straw
man. What’s at issue is quite how this
should happen. If we understand the
injunction from McCambridge and colleagues as being that the alcohol industry
shouldn’t get too involved in the ‘what works’ part of the policymaking process,
this doesn’t rule out it contributing to the more fundamental question of ‘what
is the problem’ (and what would be legitimate actions to address this).
This really hit home with me last November, when I was
attending the DrugScope
conference and felt that, regardless of my personal position, I could
probably make the industry’s case better than Mark Baird was doing. This is partly about not being so confrontational
with those coming from a public health perspective, but it’s also about
shifting the debate to ground where there is genuine uncertainty – and in fact there
can never be certainty, because in this sense the decision is a political and
moral one, rather than being simply about effectiveness.
The industry has a perfect right to sit at the policymaking
table, but only as a stakeholder if it is being the industry. If it’s trying to
be a commentator on research evidence, you’re probably better off asking
someone else (like McCambridge, or any number of other people). The industry might commission
research – but then you’d want to ask the actual researchers about the
detail of that, rather than an industry representative such as Mark Baird (particularly
given his slightly unusual definition of what constitutes ‘evidence’).
So, if I’m recommending shifting the debate to an earlier,
more fundamental stage in that policymaking cycle, why, and what difference
would that make?
Well, my first point is that all this industry
‘misrepresentation’ of research evidence isn’t a genuine debate about efficacy
or effectiveness. It seems fair to
assume that the industry will continue to oppose intervention, even if in my
view some
explanations of why this is so (the shareholder imperative) are potentially
a little simplistic in terms of their understanding of modern capitalism.** Evidence can’t really change the industry’s
position on intervention, because it’s based on economics and politics.
This applies not just to the alcohol industry’s position on
alcohol policy, but to the issue itself in general. The public health evidence can show that an
intervention like MUP might reduce health harms across a population, or perhaps
for a specific group; what it can’t show is whether this is a desirable aim, or
(assuming health understood in these terms is a ‘good’ we want to promote as a
society) how this balances against other potential ‘goods’ such as the pleasure
of intoxication or the principles of liberty and autonomy.
L Susan Stebbing would probably argue that the industry
should just come out and make this position clear, for reasons of transparency
and so that we can have a constructive dialogue and genuine debate. I’m tempted to think that, as well as this –
in policymaking or public health circles perhaps – being open in this way would
actually improve the industry’s standing.
Personally, I’m not sure that MUP would actually be an
infringement of individuals’ (or corporations’) rights, but these sorts of
arguments can’t be entirely undermined by predicted public health
benefits. When McCambridge says (in the
radio link on the BBC
article) that MUP would ‘benefit’ society at the expense of the industry, he’s
assuming a particular view of the ‘good life’ and a particular conception of
‘society’ as opposed to ‘industry’. These
assumptions are not incontrovertible truths; they are particular ways of
understanding the world.
If, in the mind of the public (or policymakers specifically),
liberty and the pleasures of intoxication and taste trump living longer, that’s
it – the argument is over no matter how effective a potential intervention
might be. And this would be without questioning
the reliability or validity of the public health evidence.
In a sense, this is what McCambridge and colleagues are
saying – as I quoted above, what they actually say is that ‘industry actors’
shouldn’t be involved in ‘the interpretation of research evidence’, and taking
my model this would mean the industry wouldn’t have much of a role in the second
stage – the ‘what works’ stage – but it might feed into the first: defining the
problem.
However, I’m not sure how this could work out in
practice. I can’t really see the
industry changing tack and being more open about their interests and
objections. (This is at a time when unfavourable
comparisons with the tobacco industry are being made by McCambridge and
colleagues.) On the other hand, this
doesn’t matter so much if we have policymakers and a wider public who are able
to see the issues for what they are and consider them critically.
This idea of a public more willing and able to engage critically
with public policy issues and cut through the rhetoric is at the core of L
Susan Stebbing’s book, alongside the hope that politicians and other
policymakers themselves might be clearer in their thinking and rhetoric. Given that today, almost 75 years after it was
first published, the arguments of Thinking
to Some Purpose still seem directly relevant, it’s easy to be defeatist
about the nature of public debate. For
the moment, though, I’m happy just to keep trying to follow Stebbing’s advice
that ‘we should develop in ourselves a habit of sceptical inquiry’.
* Holmes also cited several other similar articles or
findings. One that’s quite informative
is the discussion in response to this article in the
BMJ. I’m particularly interested in Don
Shenker’s analogy with the car industry, where marketing a car on the basis of
its safety record was apparently ‘anathema’ in the 1960s and 1970s. (The discussion, under the tab ‘Read
Responses’, seems to be free to non-subscribers.)
** On this front I immediately think of JK Galbraith’s idea
of the technostructure,
but there’s plenty of other work that critiques this sort of modelling of industry
actors.