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Dr Jeremy Howick's research into philosophical issues concerning the nature of the evidence invoked in evidence-based medicine has led both to a revision of the standards for reporting trials, and to a redesign of the Oxford Centre for Evidence-Based Medicine `Levels of Evidence': one of the most widely used systems for ranking medical evidence, and thereby for deciding whether treatments are effective, in the world. His research into philosophical issues concerning the ethics of using placebos in clinical trials and in clinical practice has influenced practitioners as well as patients by helping to determine how treatments are developed and applied. Through his research in both of these areas he has enhanced public understanding of the use of placebos.
Research conducted by John Turnpenny shaped the recommendations of the House of Commons Environmental Audit Committee (EAC). In 2010, the EAC addressed the need to embed sustainable development across government policy-making. This followed the closure of the Royal Commission on Environmental Pollution (RCEP) and the end of funding for the Sustainable Development Commission (SDC). The EAC determined to change how it engaged with experts, while reaffirming and expanding its role in the overall scrutiny of government sustainability policy. Turnpenny's findings formed the basis of two of the thirteen headline recommendations in the EAC's 2011 report Embedding Sustainable Development Across Government. In addition his suggestions helped influence significant changes in the way that the EAC operates, and contributed to its wider impact among other policy actors.
The impact of this research has been achieved through developing evidence-based recommendations for personal advisers in Jobcentre Plus — the UK's one-stop service for administering state benefits and helping claimants into work. By opening the `black box' of adviser- claimant interviews for the first time, the study produced the following key impacts:
Beneficiaries were those claiming state benefits, Jobcentre Plus advisers and managers, and DWP and other Government policymakers.
Cardiovascular disease is a major worldwide health issue and cholesterol has long been recognised as an important risk factor. The Robertson Centre for Biostatistics (RCB), led by Prof. Ian Ford, has played a central role in establishing for the first time the benefits of statins in preventing first-time heart attacks in men, with subsequent major influence on medical practice and guidelines for patient care. Innovative record linkage techniques used by the RCB have identified the long-term benefits of treatment, confirmed safety, and quantified the economic benefits.
Patients in clinical trials tend to have a very high drop-out rate which compromises results. Research by Sarah Edwards provided the key ethical framework for limiting individual choice in designing research involving human subjects. Edwards' research, showing how such designs can legitimately limit individual choices to withdraw, was incorporated into guidelines in the UK, Canada and the US, and by international bodies such as the World Health Organisation. In the UK, the research was also used to develop guidelines for ethics committees approving controlled trials.
Clinical trials are costly to the pharmaceutical industry and public funding bodies, require major commitment from volunteer patients and take significant time to lead to patient benefit. Adaptive designs are one approach which seeks to improve the efficiency of such studies. Statistical research at Reading has led to novel methodology for the design and analysis of clinical drug trials within the framework of adaptive designs which has the potential to reduce the time taken for effective drugs to reach the market and thus benefit specific patient groups. To date the research has had impact in three major ways: i) it has been adopted by pharmaceutical companies as a means of improving the efficiency of their clinical trials, ii) the research has been cited in the regulatory guidance on adaptive clinical trial design, and iii) it has increased awareness by clinicians and other medical professionals of the potential benefit of the adaptive design methodology to their patient groups. Hence, the research has influenced industry, regulatory and health professionals with potential significant economic benefit and improved outcome for patients.
Patients are more likely to get the most effective healthcare, at affordable cost to the NHS, as a result of research methodology, developed by researchers at the University of Bristol, that allows the efficacy and cost-effectiveness of multiple treatment options to be compared, based on all the available evidence, much more efficiently than in the past. Since 2008, these methods have been used to inform Clinical Guidelines issued by the National Institute for Health and Care Excellence (NICE) and in submissions to NICE's Technology Appraisals. Guidance in NICE's Technology Appraisals is mandatory and therefore impacts directly on clinical practice. The methodology is used in decision making by NICE's equivalents in other countries including Canada, Germany, and South Korea, and by consultancy firms that conduct analyses for pharmaceutical companies.
Loughlin's research criticises the drive towards impersonal decision-making procedures across a range of professional practices, aiming to revive approaches placing the cultivation of the virtues, of sound judgement, at the centre of all practical discussion. It has empowered opponents of formalism in management and policy, and scientism in medical practice. This case study concerns Loughlin's identification of the limitations of Evidenced-Based Medicine (EBM), and development of an alternative, evidence-informed approach. Loughlin has communicated his research beyond a narrow academic audience, to a wide range of professional groups, triggering a growing recognition of the need for a humanist, person-centred alternative to EBM. Practitioners and patients alike benefit from the requirement to frame all debates about good practice with reference to the understanding that the parties to the clinical encounter are persons.
The National Institute for health Care Excellence (NICE) in England and Wales makes timely and equitable decisions regarding the use of health technologies (medical devices and pharmaceuticals) within the NHS in order to improve patient care. Such decisions are reliant on Health Technology Assessment (HTA) — the processes of evidence generation and synthesis, and the methods that underpin these. Methods pioneered and developed at Leicester over the last 15 years are now used routinely in HTA both by NICE and the pharmaceutical industry and healthcare consultancy companies who make submissions to NICE. Internationally, these methods are also now being adopted in the US by Agency for Healthcare Research and Quality (AHRQ), as well as in rapidly developing countries such as Brazil and Colombia.