LabLit.com

Buy The Honest Look for the Kindle

Essay

Super-bugged

Why won't politicians listen to scientists?

Bill Hanage 8 July 2007

www.lablit.com/article/276

Menacing: policy makers who disregard the facts

How is it that the country's leading medical journal can make a forceful point, for the attention of politicians, and then be wholly ignored by the parliamentary organisation responsible for disseminating this science?

This is just a guess, but it is an informed one. If you are reading this, you probably do science in some way, or admire it from the sidelines. You read New Scientist or Nature (at least the easy bits in 'News and Views')) and your only objection to Salman Rushdie's knighthood is that it wasn't given to Ben Goldacre instead. To summarise, you care about science and society.

It can be a shock, but one has to understand that the rest of the world really does not agree. Partially it's education, partially it's because the role of the media is to sell papers, and nobody ever did that by promoting informed debate. There is, however, at least one sort of person who you might be forgiven for hoping would take some interest in science, and that is politicians. After all, they have to make the decisions, over nuclear policy, stem cell research, vaccination (whether against MMR or HPV/cervical cancer), climate change, flu and so on. But the majority of this tribe does not have a scientific background. Fair enough, no reason especially why they should. But how can they find out enough to make an informed decision?

I mean, it's a busy business being a full-time politician. In between such diverse distractions as illegal wars, who gets which peerage, how much did you get paid and somehow finding time to comment on the entirely fictional travails of a character in a soap opera, one has to promote oneself to Gordon, David, Ming or whoever is representing you at your level of the political firmament. Because after all, you can't do anything unless they pluck you out for greatness, no matter how brilliant you are.

This has been recognised by Westminster. And so the government funds the Parliamentary Office of Science and Technology, POST, which operates out of a building where they are squeezed cheek by jowl with various upper house members, and the walls are painted that special colour which Dulux would call 'Whitehall' (if they stocked, it which they don't because who the hell would buy it?). POST has a brief to "inform parliamentary debate" through a number of routes, both formal and informal. One of these is the production of POSTnotes: short briefing papers on a topic of importance. There are quite a lot of these, available online. These are sent to parliamentarians who can then read them or put them in the round wicker filing cabinet on the floor as they see appropriate. A lot of them make interesting reading. And they are a testament to the skill of POST's relatively small staff in covering the whole length and breadth of science.

What is interesting though, is what happens when science and policy clash. When what a party wants to do does not square with the science. There are many good examples. Think of the Tory government and BSE (a wonderful example of absence of evidence being equated with evidence of absence) or the current US administration and, well, just about anything.

In July 2005, a POSTnote was published on healthcare-associated infections. Superbugs. These were at the time a political problem. MRSA rates in the UK were and remain very high. The government's pledge to cut them by half was about as feasible as farming clouds.

The debate was, however, entirely centred around hospital cleanliness. There were several reasons why this was the case. Union officials had noticed that MRSA had gone up as numbers of cleaners went down, and tried to forge a link in order to help their members. Also, we can perceive cleanliness, and it can make people think that things are getting better when they aren't really. So it is easier for a politician to promise that, than to promise any actual effect. The Tory party used this in its election campaign. Every day I had to walk past a huge sign demanding 'I mean, how hard is it to keep a hospital clean?'.

The sad point is that hospital cleanliness, directly, has very little to do with MRSA, C. difficile or any of the other members of the heathcare-associated bestiary. Hand hygiene? Yes. (Though it is worth noting that the alcohol-based rubs now ubiquitous on wards are not equally useful against all bugs. Spore-forming organisms such as C. difficile tend to laugh them off as about as threatening as a refreshing shower.) That hospital cleanliness per se was not itself a factor was well known to epidemiologists and infection control experts at the time. I myself and others attempted to draw attention to it. There was even an editorial in the Lancet entitled 'MRSA: how politicians are missing the point'. This was published in April 2005. In July 2005, the POSTnote was published. How much did it mention these common misunderstandings about infection control? Not at all. Not once. Not even in a footnote.

Now how is it that the country's leading medical journal can make a forceful point, for the attention of politicians, and then be wholly ignored by the parliamentary organisation responsible for disseminating science to those politicians? Not being a member of POST, I cannot say. Robert Winston, who is the vice-chair of POST's board, might be able to shed some light, especially as he clearly appreciates the absurdity of the situation, as shown by an entry in entry in Hansard (his contribution is at the bottom).

Now, let me make clear that this is just a suggestion, but I can well understand why POST might shy away from commenting on something like infection control. After all, in the middle of an election campaign, were they seriously going to prepare something suggesting that one party's policy was founded on a fundamental misunderstanding the science? That looks like taking sides. And science is meant to be independent, unbiased, above all that.

Which is the problem, because while all those things are true, it does not stop the progress of politics being as venal and conniving as it ever was. We have to be able to state sometimes that a policy is not just wrong as a matter of opinion, but as a matter of evidence. There have been suggestions that the new administration is going to be more 'serious' than the previous one; less concerned with presentation and more with the hard facts. That may be so, but forgive me if I do not hold my breath: evidence tells me that however much I might wish the contrary, to do so would be very, indeed terminally, bad for my health.