Using the Results from Rigorous Multisite Evaluations to Inform Local Policy Decisions

Evidence‐based policy at the local level requires predicting the impact of an intervention to inform whether it should be adopted. Increasingly, local policymakers have access to published research evaluating the effectiveness of policy interventions from national research clearinghouses that review and disseminate evidence from program evaluations. Through these evaluations, local policymakers have a wealth of evidence describing what works, but not necessarily where. Multisite evaluations may produce unbiased estimates of the average impact of an intervention in the study sample and still produce inaccurate predictions of the impact for localities outside the sample for two reasons: (1) the impact of the intervention may vary across localities, and (2) the evaluation estimate is subject to sampling error. Unfortunately, there is relatively little evidence on how much the impacts of policy interventions vary from one locality to another and almost no evidence on the implications of this variation for the accuracy with which the local impact of adopting an intervention can be predicted using findings from an evaluation in other localities. In this paper, we present a set of methods for quantifying the accuracy of the local predictions that can be obtained using the results of multisite randomized trials and for assessing the likelihood that prediction errors will lead to errors in local policy decisions. We demonstrate these methods using three evaluations of educational interventions, providing the first empirical evidence of the ability to use multisite evaluations to predict impacts in individual localities—i.e., the ability of “evidence‐based policy” to improve local policy.     

Understanding “corruption” in regulatory agencies: The case of food inspection in Saudi Arabia

Corruption is a relatively neglected topic in studies of regulatory agencies. The label is applied to a wide range of deviations from behavioral standards ultimately derived from Weber's account of the ideals of Prussian bureaucracy. This paper draws on a study of the work of Saudi Food Inspectors to argue that it is unhelpful to reduce a complex phenomenon to simple allegations of malpractice that can be managed by disciplinary sanctions. Our data show that irregular behavior by street‐level agents may be deeply embedded in the expectations that members of a society have of one another. It is less a matter of personal gain than of maintaining one's recognition as a fellow citizen. Such behavior is not easily changed through sanctions directed at individual inspectors. Our study does not exclude the possibility that irregular behavior can be motivated by personal gain, and properly managed by criminal or similar penalties. However, it does propose that research should be more sensitive to the contexts within which irregular behavior occurs rather than treating “corruption” as a uniform and homogenous phenomenon.     

Asperger's disorder and the criminal law

Asperger's Disorder has the potential to be relevant to many aspects of the functioning of the criminal justice system. However, its mere presence does not excuse or justify all offending. The inquiry into its potential relevance to criminal offending and sentencing must be both contextual and informed by suitably qualified expert evidence. This column reviews court decisions in respect of offences of physical violence, sexual violence, arson, stalking/harassing and computer offences across a range of jurisdictions to evaluate how courts have latterly incorporated Asperger's Disorder into decisions about criminal responsibility and culpability.     

Death by homeopathy: issues for civil, criminal and coronial law and for health service policy

Homoeopathy has a significant clinical history, tracing its roots back to Hippocrates and more latterly to Dr Christian (Samuel) Hahnemann (1755-1843), a Saxon physician. In the last 30 years it has ridden a wave of resurgent interest and practice associated with disillusionment with orthodox medicine and the emergence of complementary therapies. However, recent years have seen a series of meta-analyses that have suggested that the therapeutic claims of homeopathy lack scientific justification. A 2010 report of the Science and Technology Committee of the United Kingdom House of Commons recommended that it cease to be a beneficiary of NHS funding because of its lack of scientific credibility. In Australia the National Health and Medical Research Council is expected to publish a statement on the ethics of health practitioners' use of homoeopathy in 2013. In India, England, New South Wales and Western Australia civil, criminal and coronial decisions have reached deeply troubling conclusions about homoeopaths and the risk that they pose for counter-therapeutic outcomes, including the causing of deaths. The legal decisions, in conjunction with the recent analyses of homoeopathy's claims, are such as to raise confronting health care and legal issues relating to matters as diverse as consumer protection and criminal liability. They suggest that the profession is not suitable for formal registration and regulation lest such a status lend to it a legitimacy that it does not warrant.     

Umbilical cord blood banking: beyond the public-private divide

Umbilical cord blood is a source of haematopoietic progenitor cells, which are used to treat a range of malignant, genetic, metabolic and immune disorders. Until recently, cord blood was either collected through donations to publicly funded cord blood banks for use in allogeneic transplantation, or stored in commercial cord blood banks for use in autologous transplantation. The line between public and private cord blood banking is being blurred by the emergence of "hybrid" models that combine aspects of both the public and private systems. The authors describe these hybrid models and argue that their emergence is explained by both market forces and public sector policy They propose that the future of the sector will depend heavily on several key developments that will differentially affect public, private and hybrid banking models.     

Racially conditional donation: the example of umbilical cord blood

While direction of donated tissue to family members has long been accepted, direction to members of specific racial groups has been opposed, on the basis that it is discriminatory and contrary to the ethos the institution of organ donation seeks to promote. It has, however, recently been proposed that racially conditional donation may provide a useful--and ethically acceptable--way to address the social inequalities and injustices experienced by certain cultural groups. This article examines the ethical, legal and cultural arguments for and against racially conditional donation, concluding that the practice is more likely to undermine the values of equity and justice than to promote them and that it may also lead to other unfavourable personal and social outcomes.