How can we all best use evidence?

The Academy of Medical Sciences is undertaking a project to examine how we can all best use evidence to judge the potential benefits and harms of medicines.

Status

Launched

The Academy issued a call for written evidence to gather external input into this project. The call is now closed (close: Monday 21 September 2015), however we are still accepting late submissions. If you would still like to respond, please contact the secretariat.

Over the past few years, questions have been raised in both the general and scientific media about the evidence underlying decisions about treatment options (for example the use of statins and Tamiflu). The validity of the different ways of collecting and analysing evidence has been part of this debate. At the same time, broader discussion of issues such as overmedicalisation (or the reliance on prescribing drugs over lifestyle changes) and conflicts of interest in the way that evidence collection is funded and/or analysed has led to wider questions surrounding trust in academic researchers, clinicians, the media and the pharmaceutical industry .

To explore these issues further, the Academy of Medical Sciences is undertaking a project to examine how we can all best use evidence to judge the potential benefits and harms of medicines. The workstream is chaired by Professor Sir John Tooke FMedSci, and led by an oversight group that will steer the overall direction of the project. Please visit our ‘Oversight group’ tab for further details. The group is expected to publish a report of its findings in early 2017.

The project will consider elements relating to:

  • The strengths and limitations of different sources of evidence used to evaluate the risks and benefits of medicines. For more information, please visit our policy project page dedicated to this topic. 
  • The ways in which conflicts of interest impact on the validity (or perception of validity) of evidence. For more information, please visit our policy project page on this topic. 
  • The communication of evidence to support discussion and decision-making. For more information, please visit our policy project page on this topic.
  • The perceptions and perspectives of society on scientific evidence (including in the context of shared decision making between patients and their clinicians). For more information, please visit our policy project page on this topic. 

The workstream will not seek to replicate the work performed by the Medicines and Healthcare products Regulatory Agency and the National Institute of Health and Care Excellence. The remit of this project requires expertise from outside of the Academy, and we will therefore engage widely via a call for evidence, workshops, and further dialogue with a broad range of stakeholders including patients, citizens and healthcare professionals. The full terms of reference and details of the call for evidence are listed under separate tabs.

We have collated the evidence we have received to date in a repository on our website so that it can be viewed and accessed by anyone who is interested in this topic. The repository will be continually updated as the project progresses.

This is an independent project that has the support of the Chief Medical Officer. Arthritis Research UK, the British Heart Foundation (through a Strategic Funding Award), the British Pharmacological Society, the British Society for Immunology, the Medical Research Council, the Naji Foundation and the National Institute of Health Research Health Technology Assessment Programme have kindly provided financial contributions towards this work.

 www.arthritisresearchuk.org

    www.bhf.org.uk

  www.bps.ac.uk

 www.immunology.org

  www.mrc.ac.uk

 najifoundation.org

   www.nihr.ac.uk

This workstream will examine the evaluation of scientific evidence for medicines and how this evidence can be best interpreted and assimilated. In doing so, this workstream will explore:

  • How the different perspectives, perceptions and interrelationship of key stakeholders impact on the evaluation of evidence. This will form the basis of dialogue activities throughout the project.
  • The strengths and limitations of evidence that originates from different sources (including case reports; observational or large databases; randomised clinical trials; meta-analyses; evolving and novel trial designs; and citizen science) to evaluate risks (adverse events) and benefits (efficacy and effectiveness) of medicines. This will be examined by a sub-group study launched in summer 2015.
  • How interests (including different models/sources of funding for the collection and analysis of data on risks and benefits) impact on the validity, and perception of the validity, of evidence. This will be informed by a workshop in autumn 2015.
  • The implications of the study's findings for the communication and public trust in evidence, including the availability of the evidence around the risks and benefits of medicines. This will be informed by a workshop in spring 2016.

The combined report will draw on examples of dilemmas in current therapeutic practice but will not seek to address all such areas of contention, nor to replicate the work performed by the Medicines and Healthcare products Regulatory Agency and the National Institute of Health and Care Excellence. The remit of this project requires expertise from outside of the Academy, and we will therefore engage widely via a call for evidence, workshops, and further dialogue with a broad range of stakeholders including patients, citizens and healthcare professionals.

Chair

Professor Sir John Tooke FMedSci (Chair of the Oversight Group) is Co-Chair of the Centre for the Advancement of Sustainable Medical Innovation, a joint initiative between Oxford University and University College London (UCL). His research interests relate to the pathogenesis of diabetic complications and their management, and the development of academic health science systems. He was Vice Provost (Health) at UCL until July 2015 and Academic Director of UCL Partners, and in the past has served as Chair of the Medical Schools Council. He is a Non-Executive Director of Bupa and Executive Chairman of Academic Health Solutions, a company that offers advice to international governments, universities and other agencies on the development of Academic Health Science systems. He has served as President of the Academy of Medical Sciences for four years until December 2015. He was in receipt of a National Institute of Health Research grant for the UCL Hospitals Biomedical Research Centre. He serves on the International Advisory Boards for both the Qatar Academic Health System and the National University of Singapore Medical School. 

Members

Professor Dorothy Bishop FRS FBA FMedSci is a Wellcome Trust Principal Research Fellow and Professor of Developmental Neuropsychology at the University of Oxford, where she heads a programme of research into children’s communication impairments. Her main interests are in the nature and causes of developmental language impairments, with a particular focus on psycholinguistics, neurobiology and genetics. She is a supernumerary fellow of St John’s College Oxford. She has honorary degrees from the Universities of Lund, Western Australia, and Newcastle upon Tyne.  As well as publishing in conventional academic outlets, she writes a popular blog with personal reactions to scientific and academic matters. She is in receipt of a Wellcome Trust Programme Grant and is Director of Scholars Mews Residents.  

Mr Michael Blastland is a writer and broadcaster. Now freelance, he devised the More or Less programme and continues to present The Human Zoo, both on Radio 4, and The Inquiry, on BBC World Service. He also recently produced and co-wrote with Andrew Dilnot for Radio 4 two series of A History of Britain in Numbers. He presents and advises widely about data, statistics and risk, and also about journalism and communication. This has included work for the Said Business School Executive Leadership programme, at the BBC’s College of Journalism, and for business, the public sector and in academia. He has written three books - the first about autism, the second about making sense of numbers in the news, and most recently a book about risk, co-authored with Professor David Spiegelhalter. He has received payment for conference presentations on the representation of risk by Biogen Idec Limited and by the Association of the British Pharmaceutical Industry. A member of his family is a Non-Executive Director of the Hillingdon Hospitals NHS Foundation Trust.

Professor Sarah Cunningham-Burley: Biography and interests to be added shortly.

Professor Jane Dacre is President of the Royal College of Physicians (RCP), an Honorary Consultant Physician and Rheumatologist at the Whittington Hospital in North London, Professor of Medical Education and was former Director of University College London Medical School. She was also the Medical Director of the Membership of the Royal Colleges of Physicians of the United Kingdom (MRCP(UK)) examination until December 2013 and prior to that Academic Vice-President of the RCP. She was a General Medical Council (GMC) Council Member, chaired the GMC Education and Training Committee (2008-2012) and leads a research programme in medical education focussing on assessment. Professor Dacre has been instrumental in the development, implementation and evaluation of assessment systems in medicine. She is a Trustee of the RCP.  

Mr Simon Denegri is National Director for Patients and the Public in Research at the National Institute for Health Research (NIHR), and Chair of INVOLVE – the national advisory group for the promotion and support of public involvement in research funded by NIHR. He was Chief Executive of the Association of Medical Research Charities (AMRC) from 2006 until 2011 and, prior to this, Director of Corporate Communications at the Royal College of Physicians from 2003. He also worked in corporate communications for Procter & Gamble in the United States from 1997 to 2000. He has a long-standing personal and professional interest in the needs and priorities of people with dementia and their carers, and currently chairs the Lay Champions Group for the national portal on dementia research that is to be launched this year. He is a member of the NIHR Advisory and Strategy Boards, and a Board member of the UK Clinical Research Collaboration (UKCRC), Farr Institute and care.data programme respectively. He also writes a blog about the public and health research. He is Chair of the UK Clinical Trials Gateway Project Board, the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames International Expert Advisory Board, and the Patient and Public Involvement Strategic Group at the North Thames Genomic Medicine Centre. He is a member of a number of Advisory Boards and Groups (Clinical Practice Research Datalink, BMJ, WEB-RADR, Open Trials, Engineering and Physical Sciences Research Council (EPSRC) MeDe Innovation, EU Joint Programme on Neurodegenerative Disease Research). He is also a member of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, COMET Patient and Public Involvement and Engagement Working Group, the Canadian Institutes for Health Research Adjunction Panel for Support for Patient Orientated Research Units, and sits on the editorial boards of the International Journal for Engagement and Involvement and Research for All.

Professor Sir Gordon Duff FRSE FMedSci: Biography and interests to be added shortly.

Professor Rob Horne: Biographies and interests to be added shortly.

Professor Peter Johnson FMedSci is Professor of Medical Oncology at the University of Southampton and Chief Clinician for Cancer Research UK. He is responsible for bringing together a broad multidisciplinary group of basic, translational and clinical researchers, and linking the research of the academic unit to the extensive clinical practice in cancer treatment in the Southampton Cancer Centre. His research interests are in applied immunology and immunotherapy, lymphoma biology and clinical trials. He is Chief Investigator for lymphoma trials ranging from first in man novel antibody therapeutics to international randomised studies, and for the Cancer Research UK Stratified Medicine Programme.  He was Chair of the UK National Cancer Research Institute Lymphoma Group from 2005-2011 and has been a member of national trials committees for the Medical Research Council, Cancer Research UK and Leukaemia and Lymphoma Research. He has received grants from Bloodwise, Cancer Research UK, Eisai and Janssen for his scientific work, and is a Director of Cancer Research UK. He has carried out advisory work for Boehringer Ingelheim, Bristol-Myers Squibb, Epizyme, and Pfizer.

Professor Martin Marshall CBE is Professor of Healthcare Improvement at University College London and leads Improvement Science London, an initiative to promote and embed the science of improvement across both the health service and academic sectors. Previously he was Director of Research and Development at the Health Foundation, Deputy Chief Medical Officer and Director General in the Department of Health, and a clinical academic at the University of Manchester. He has been a General Practitioner for 27 years, now serving an inner city community in Newham, East London. He is a Fellow of the Royal College of General Practitioners (RCGP), Royal College of Physicians and Faculty of Public Health Medicine, and was a Non-Executive Director of the Care Quality Commission until 2012.  He was awarded a CBE in the Queen’s Birthday Honours for Services to Health Care. He is a member of the RCGP’s Council, Tower Hamlets Clinical Commissioning Group Primary Care Commissioning Board, and the Newham Health and Wellbeing Board. He is also an External Examiner at Imperial College London.

Professor Theresa Marteau FMedSci is Director of the Behaviour and Health Research Unit in the Clinical School at the University of Cambridge, Director of Studies in Psychological and Behavioural Sciences at Christ’s College, Cambridge, and a National Institute for Health Research Senior Investigator. Her research focuses on: the development and evaluation of interventions to change behaviour (principally diet, physical activity, tobacco and alcohol consumption) to improve population health and reduce health inequalities, with a particular focus on targeting non conscious processes; risk perception and communication particularly of biomarker-derived risks, and their weak links with behaviour change; and acceptability to public and policy makers of government intervention to change behaviour. She is a member of the Academy of Medical Sciences’ Council, the International Scientific Advisory Board of the French National Cancer Institute, the Scientific Advisory Panel of the Behavioural Insights Team (Cabinet Office and Nesta), and of the Chief Medical Officer’s Alcohol Guidelines Working party. She is a Fellow of the Academy of Social Sciences and the Royal College of Physicians of Edinburgh, and is an Associate Fellow at the Cambridge Centre for Science and Policy. She has funding from the Department of Health Policy Research Programme.  

Professor Jonathan Montgomery is Chair of the Health Research Authority and of the Nuffield Council on Bioethics and is Professor of Health Care Law at University College London. His research work concerns health care law and bioethics governance systems. His previous national Chair roles include the Advisory Committee on Clinical Excellence Awards (2005-14) and the Human Genetics Commission (2009-12). He has been involved in the preparation of ethical guidance in a number of areas of health practice and is currently chairing a task and finish group for the General Medical Council overseeing the revision of its guidance on confidentiality. He is an Honorary Fellow of the Royal College of Paediatrics and Child Health. In his role of Chair of the Nuffield Council on Bioethics, he is in receipt of grants from the Nuffield Foundation, Medical Research Council and Wellcome Trust, which co-fund the organisation.

Baroness Onora O’Neill CH CBE HonFRS FBA FMedSci combines writing on political philosophy and ethics with a range of public activities. She was Principal of Newnham College, Cambridge from 1992-2006, President of the British Academy from 2005-2009, chaired the Nuffield Foundation from 1998-2010 and has been a crossbench member of the House of Lords since 2000 (Baroness O’Neill of Bengarve). She currently chairs the UK’s Equality and Human Rights Commission and is on the Boards of the Medical Research Council (MRC) and of the Banking Standards Review. She lectures and writes on justice and ethics, accountability and trust, justice and borders, as well as on the future of universities, the quality of legislation and the ethics of communication. She is Emeritus Professor of Philosophy at the University of Cambridge. She chairs the University of London’s Institute of Philosophy Advisory Board, is a Council Member for the Royal Institute of Philosophy and the Foundation for Science & Technology, a Trustee of the American University of Sharjah, and a member of the Demos Advisory Group. She is a member of the University of London/British Academy Panel advising on an inquiry into the future of Public Service Broadcasting, and was a member of the Royal United Services Institute Independent Surveillance Review, the Nurse Review Reference Group and is on the Committee for the appointment of the next British Judge on the European Court of Human Rights.          

Dr Imran Rafi is a General Practitioner Principal and Senior Lecturer in Primary Care Education at St George's, University of London. He is Chair of the Royal College of General Practitioners (RCGP) Clinical Innovation and Research Centre (CIRC), providing leadership to oversee the clinical priority programme, contributing to programmes that support research and promote quality improvements in general practice. He is a collaborator with the 3D research study, a NIHR funded, University of Bristol led randomised controlled trial. CIRC receive the bulk of their funding from other charities and foundations, NHS England, Public Health England, Department of Health and the European Commission. Historically CIRC have received unrestricted educational grants from Pfizer, Novartis and Grunenthal Pharma.

Dr Rafi has an interest in genetics and has been a member of the Health Education England Genome Advisory Board and the Human Genome Strategy Group Service working group. He was a founder member of the Primary Care Genetics Society and the World Organisation of Family Doctors specialist interest group in primary care genetics, as well as the Society for Academic Primary Care specialist group on primary care genetics. He is currently funded by the HEE on the Masters Medical Genomics course at the University of Cambridge. He is a member of the RCGP and of the Royal College of Physicians. He is a member of the RCGP and a fellow of the Royal College of Physicians.

Professor Sir Michael Rutter CBE FRS FBA FMedSci is Professor of Developmental Psychopathology at the Social Genetic and Developmental Psychiatry (SGDP) Research Centre at the Institute of Psychiatry, Psychology and Neuroscience, King’s College London. His research interests include the use of natural experiments and animal models to test hypotheses about causation; the use of epidemiological longitudinal studies for the same purpose; gene-environment interplay; and studies of psychosocial risk. He founded the SGDP in 1994 and was its first honorary director. He retired from his administrative posts in 1998 but remains active in research and teaching. His textbook on child and adolescent psychiatry remains distinctive in attention to both conceptual and statistical issues, as well as the integration of science and clinical work. He is Governor of the Coram Foundation and Chair of the Scientific Advisory Group for the Canadian Institute for Advanced Research programme on Children and Brain Development.

Ms Suzie Shepherd is outgoing Lay Chair of the Royal College of Physicians (RCP) Patient and Carer Network, a Member of the RCP Future Hospital Commission Implementation Group, a full Member of RCP Council, and sits on the Clinical Standards Accreditation Board at a national level. In these roles she works to influence health and public health policy and organisational development within healthcare. Prior to retiring, Ms Shepherd worked for the NHS as a Senior Dental Nurse and, in her role as Improving Working Lives Lead for Leeds Community and Mental Health Trust, supported staff through service reconfigurations, modernisation and redesign. Drawing on her experiences as a patient, carer, parent and a former member of NHS staff, she has maintained a key interest in ensuring that the lay patient and carer voice is heard during times of service change and development. She is Director of Leeds Occupational Health Advisory Service and Vice-Chair of the Clinical Services Accreditation Alliance (CSAA). She is a lay member of a number of national, regional and local Boards and Committees, including at the RCP.

Professor Sir David Spiegelhalter OBE FRS is Winton Professor for the Public Understanding of Risk, and Professor of Biostatistics, at the University of Cambridge. His background is in medical statistics, particularly the use of Bayesian methods in clinical trials, health technology assessment and drug safety. He leads a small team, attempting to improve the way in which the quantitative aspects of risk and uncertainty are discussed in society. In collaboration with the Millennium Mathematics Project, he is developing an exciting treatment of probability and risk for mathematics education. He advises organisations and government agencies on risk communication, and is a regular commentator on current risk issues. He is a Fellow of Churchill College Cambridge, an Honorary Fellow of the Institute for Risk Management, an Honorary Fellow of the Royal College of Physicians, and a Fellow of the Royal Society. He was awarded an OBE in 2006 and knighted in 2014, both for services to medical statistics.

In 2013, Professor Spiegelhalter received an honorarium for a talk on the public perception of risk at a meeting supported by Pfizer.

Dr Julian Treadwell is a practicing General Practitioner based in Wiltshire. He is Vice-Chair of the Royal College of General Practitioners (RCGP) Standing Group on Overdiagnosis and a member of the editorial board of the Drug and Therapeutics Bulletin. He has an interest in evidence informed prescribing and shared decision-making and has worked with the National Institute for Health and Care Excellence and RCGP in this area. He is a member of the RCGP and of the British Medical Association.

Professor Patrick Vallance FMedSci is President of Pharmaceuticals R&D at GlaxoSmithKline (GSK), where he is responsible for ensuring that GSK maintains a flow of new medicines through the R&D pipeline from early discovery through to approval. He is a member of the Corporate Executive Team and, prior to his appointment, was Senior Vice President, Medicines Discovery and Development. Prior to joining GSK, he was a clinical academic and led the Division of Medicine at University College London. He has been on the Board of the UK Office for Strategic Co-ordination of Health Research (OSCHR) since 2009. He is an Honorary Fellow at both University College London and Imperial College London, a Non-Executive Director and Board member for UK Biobank, a Non-Executive Board member for Genome Research Laboratory, and is a Member of the Dementia Discovery Fund which is managed by SV Life Sciences. He is also a GlaxoSmithKline shareholder.

The remit of this project requires expertise from outside of the Academy. As such, we issued a call for evidence as part of our process for gathering external input. The call is now closed (close: Monday 21 September 2015), however we are still accepting late submissions. If you would still like to respond, please contact the secretariat. The call for evidence questions are available to download from the right hand side of this page as a Word document to complete

The questions set out in the call for evidence aim to gather views on:

  • The strengths and limitations of evidence to evaluate the risks and benefits of medicines.
  • Effective ways of communicating evidence to various stakeholders.
  • Conflicts of interest.
  • Ideas for dialogue around the evaluation of scientific evidence.

The submissions we receive will feed into our initial sub-project on ‘Methods of evaluating evidence’, and inform other elements of the workstream, namely:

A number of the Academy's other projects relate to this workstream, including the following:

The workstream will aim to engage with these related activities throughout the course of the project.

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