Scientific uncertainty and the role of expert advice: the case of health checks for coronary heart disease prevention by general practitioners in the UK

This paper examines some of the ways in which scientific evidence influenced the development of the policy for the payment of general practitioners for coronary heart disease (CHD) prevention in the UK, in particular the introduction of 'health checks'. The specific policy events which are examined are the 1990 and 1993 contracts for health promotion by general practitioners. Data for this paper were provided by oral history interviews with key informants including general practitioners, public health doctors, civil servants and academics. The study shows the way in which complex scientific evidence interacted with other, professional and political, factors to produce a policy for which there was variable scientific evidence. The relationship between science and policy was complicated and tortuous but two aspects were particularly salient, the way in which scientific uncertainty influenced the content of the policy and the contribution of expert advice to policy making. The existence of social and technical uncertainty about the effectiveness of health checks allowed different players to hold different views depending on their professional affiliation or other agendas. The mechanisms by which scientific advice was given to policy makers were primarily by medical civil servants and through informal contacts and networks. There was no independent systematic formal system to assess and disseminate scientific advice to policy makers, for instance by an expert committee. These factors in turn allowed policy makers to ignore or misinterpret scientific evidence according to other policy imperatives.