Monday, 17 August 2015

Crystal clear knowledge for decision making

By Cristina Roure 
Excellent health care is one in which patients, professionals and managers apply the best available knowledge in decision making. Only well-informed agents can take the most appropriate decisions for an effective, safe and efficient health system. We often think that the big problem of the system is the lack of money, and only devoting more resources will solve the problems, but lack of knowledge is much more worrying than it may seem at first glance.

Sir Muir Gray, Chief Knowledge Officer of the National Health Service (NHS), uses an analogy that I find very spot on: "It takes knowledge as crystal clear as the water we drink if we want to take the right decisions." But the current reality is very different because we drink from contaminated sources of knowledge.

See below the list of impurities or the seven deadly sins as presented by Gerd Gigerenzer and Muir Gray in the book "Better Doctors, Better Patients, Better Decisions"  (see quote at the end of post):
  1. The bias in the biomedical research sponsorship that prioritizes corporate profits above questions relevant for patients.
  2. Lack of transparency in the publication of research results by researchers, with the participation of the great biomedical journals.
  3. The bias in information and publicity provided to professionals by the industry.
  4. The bias in the health and health care information and publicity that reaches citizens through the media.
  5. Conflicts of interest, not only of healthcare professionals but also of the other players in the chain: researchers, expert groups, etc.
  6. The practice of defensive medicine.
  7. Deficits in statistical competence or the "innumeracy" of health care professionals, managers and citizens, which is exploited to distort the perception of the benefits and risks.
As a result of this pollution of knowledge sources, resources are wasted on unnecessary (and often unsafe) tests and treatments, on research projects little or no relevant or on the implementation of health programs that do not add value to people’s health, to give just three examples. Muir Gray makes a very instructive comparison when he says that the first revolution in improving the health of populations came from the work of epidemiologists who fought infectious diseases like cholera by treating the drinking water and improving environmental hygiene, and similarly we now need a new revolution to treat the knowledge sources as the water was successfully treated: filtering it and channelling it to reach managers, professionals and citizens’ taps, suitable to be drank safely in an environment of shared decision making.

Health care systems should be developed in networks and systems based on relevant and quality knowledge in which the patient is the protagonist. The responsibility of filtering, channel and distributing knowledge can not be left to individuals. According to Muir Gray "Ignorance is like cholera in the sense that it cannot be controlled individually and requires society’s organizational efforts to combat."

In this video, posted on NHS Health Choices, a website aimed at the general public, Muir Gray talks about the importance of clean and accurate information to help physicians and people to make the most appropriate decisions.


Gigerenzer G, Muir Gray JA. Launching the century of the patient in: "Better Doctors, Better Patients, Better Decisions. Envisioning Health Care 2020". Cambridge Massachussets, 2011.

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