Why we still have a long way to go before public health practice, let alone policy, is of a reasonable quality.
Sanitation, vaccines, control of various environmental factors that affect health, and much more have greatly improved our quality of life and our average lifespan. But while public health practice has come a long way, there are still numerous areas of improvement. Not only must public health practice improve in terms of communication with the public, but we must also work on improving how quickly scientific knowledge is used to update public health practice. Additionally, public health policy involving zoonotic disease (diseases which are contracted from animals) and protection of the health of livestock and pets, also requires serious attention.
The antivax movement, the push for homeopathy, and great deal of other pseudoscientific movements are hurting public health practice. While there’s still lot that we do not know about recent outbreaks of various diseases such as measles and whooping cough, medical science absolutely justifies the use of vaccines in the prevention of dangerous symptoms associated with these diseases. Meanwhile, the link between vaccines and autism has long since been debunked, and yet a large portion of the population still believes in it.
Furthermore, a number of people are choosing to forgo “traditional” medicine and instead use homeopathic treatment. Unfortunately, based on systematic review of available literature, there is no indication that homeopathy works any better than a placebo. There is also no scientific justification for a mechanism through which it should work. Homeopathy literally has every trace of active ingredient diluted out of the product, to the point where a person is just consuming a sugar pill. While the placebo effect can be a powerful medicine in and of itself, it is not a substitute for recognized gold standards of care.
Better science communication, and better education in philosophy, both should improve individual understanding of how science works and acceptance of standard medical treatments. However, there are still other issues. There are cases where our standard of care is outdated.
Living Systematic Review
One of the greatest concerns with public health practice is that it takes a very long time for new scientific evidence to become part of the public health practice. One estimate places the lag time between findings and implementation at 17 years.
Unfortunately, in order to alter public health practice, we need to have more than just a single investigation indicating efficacy. Public health practice relies heavily on systematic reviews. There are two options for systematic reviews. A systematic review can periodically be conducted to see if there’s additional information available. This option is the traditional route. Alternatively, a systematic review can be ongoing, where data is added at regular intervals and the conclusion is reevaluated.
This process is called a living systematic review. This option is fairly new. As of 2017, protocols for the process were still being developed. Elliott JH et al. 2017 discusses the importance of living systematic reviews (LVRs), and suggests that they may be most useful when there’s a lot of new research being done on a topic, when there’s still a lot that we don’t know about the topic, and when new information might change current protocol.
Unfortunately maintaining trust is going to be difficult even if we can update our protocols more quickly. Long standing recommendations being overturned can be problematic because people may wonder why it took so long for the medical community to realize their mistake. Meanwhile constantly changing recommendations to fit new data could establish a view that the medical community is fickle.
People may also become even more confused about what to do for proper health. While this issue isn’t as problematic for people who regularly see a doctor for checkups, some don’t, and current medical recommendations do not actually suggest that they are necessary. This lack of necessity is likely to change if public health policy is updated on a more regular basis though, so this factor needs to be taken into consideration.
Call to Research Format
Even with living systematic reviews, new research needs to be conducted and we need to communicate limitations of existing research. One of the issues that prevents public health policy, and science as a whole, from being as up to date as possible, and evolving at a fast enough pace, is a failure to communicate. I have written numerous papers on concerns about current medical science practices and limitations of our understanding. These papers are not research papers in the normal sense. They fellow what I call the “call to action format.”
Most of my focus has been on vaccines. I’ve written on the issue with understanding recent measles outbreaks, as well as our limited understanding of how asymptomatic infections influence Whooping Cough epidemics. While there is a lot that we know about vaccines and their efficacy, there seems to be a lot that we do not know. And these unknowns are not being discussed in enough detail or frequency to drive new research that can be used to fuel living systematic reviews.
The first half of the call to research format is similar to a systematic review, but it’s more focused. It looks for specific gaps in our understanding, and summarizes them. It might take into account personal observations by the author, as well as specific questions that they have come across. Questions may also be pulled from existing systematic reviews.
The second half of the paper is a discussion on potential theories on the matter, and studies that can be conducted. The discussion isn’t as detailed as a research proposal, but a single call to research paper could have many suggestions on types of research that can be performed. There should be at least enough detail that a person reading the paper could take the suggestion and turn it into a full research paper.