What makes evidence‐based policy making such a useful myth? The case of NICE guidance on bariatric surgery in the United Kingdom

Abstract

There is widespread skepticism among policy scholars and practitioners about the move to rationalize policy making: The naive vision of “evidence‐based policy” is often contrasted with the reality of “policy‐based evidence.” Yet, the language of evidence‐based policy making (EBPM) continues to dominate policy debate about complex and contested issues. In this paper, I explore this apparent paradox by looking at what makes EBPM such a useful myth for all sorts of policy actors. I do so with reference to the pioneering work of the National Institute for Health and Care Excellence (NICE), focusing specifically on its work in relation to bariatric surgery, a suite of controversial and drastic weight loss procedures. I show that the myth of EBPM has political, pragmatic, and procedural utility in practice, allowing the organization to set and administer guidelines on this uncertain, complex, and contested treatment in ways that sustain buy‐in and enable ongoing contestation.

Evidence and morality in harm-reduction debates: can we use value-neutral arguments to achieve value-driven goals?

“…Participants believed that evidence-based policy was the only rational and just principle on which to base drug policy, and as such they were all nominally committed to it. As Boswell (2018) argued, evidence-based policy is the 'secular faith' that binds stakeholders together, and a very useful myth to uphold and frame to deploy. However, participants' accounts suggest a propensity for some stakeholders to associate moralism with views which are opposed to those they themselves hold.…”

“…Among other outcomes, the rise of scientific over religious organisation of beliefs (Gieryn, 1983) contributed to shifting the moral domain away from the community and toward the individual in the west. Within this process, which affected both western liberals and conservatives (Haidt, 2013), liberals are PALGRAVE COMMUNICATIONS | DOI: 10.1057/s41599-018-0119-3 ARTICLE PALGRAVE COMMUNICATIONS | (2018) 4:62 | DOI: 10.1057/s41599-018-0119-3 | www.nature.com/palcomms certainly further attached to science as 'secular faith' (Boswell, 2018;Zampini, 2016), and to individual freedom as foundational in their value system (Haidt, 2013). The liberal to conservative spectrum is complex, and is characterised by varied, internally contradictory, and periodically changing positions, which do not easily align with either individualised or community-based loci of moral values (expressed as the individualising-binding dichotomy [Graham, Haidt and Nosek, 2009]).…”

Policy‐Based Evidence Making in Local Government: The New South Wales’ Municipal Merger Program, 2011 to 2017

“…The scholarly discourse on policy‐based evidence making is less well developed than even its counterpart on the broader phenomenon of the externalisation of policy advice. Although progress has been made on the epistemological foundations of policy‐based evidence in public policymaking (see, for example, Jung et al ., ; Strassheim & Kettunen, ), outside of medical research and health policy (see, for instance, Boswell, ; Marmot, ) little effort has been directed at applying the insights which have been generated. Indeed, it would appear that only limited published research exists on policy‐based evidence making in the realm of the empirical analysis of Australian local government policy formulation.…”

The UK government’s imaginative use of evidence to make policy

“…It is used by some to support a greater role for scientific evidence in policy, and others to give legitimacy to existing policies (Cairney 2016a;Boswell 2009Boswell , 2017. Its comparator is 'policybased evidence' (PBE), invoked when critics of government policies argue that a policymaker decided what they wanted to do then 'cherry-picked' information to back it up.…”