The most recent Nobel prize for Economic Sciences was awarded to Banerjee, Duflo and Kremer. The ARC WM Director is a fan. These researchers have a long history of excellent randomised trials of social policy and economic interventions. One poorly recognised feature of the trails landscape is that trials do not only answer individual questions one by one, but can be synthesised across many interventions to learn more general scientific questions and develop theories that are broader than can be studied by any particular RCT.

ARC WM researchers have used this concept to compare the same treatment across different conditions, thereby discovering, for example, that adjuvant chemotherapy is effective across all cancers.[1] Similarly, trials of different methods to improve adherence with treatments for diabetes, have shown what works for whom where.[2] Synthesising evidence across a large range of individual economies or cities has come up with an important finding – that the gap in productivity between the highest and lowest performing institutions is much wider in low- then in high-income economies. It is easy to create one or two beacons of excellence, but much harder to ensure more pervasive high performance. This general rule likely applies also in the healthcare industry.

Richard Lilford, ARC WM Director

References:

1. Bowater RJ, et al. Efficacy of adjuvant chemotherapy after surgery when considered over all cancer types: a synthesis of meta-analyses. Ann Surg Oncol. 2012; 19(11): 3343-50.
2. Tricco AC, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet. 2012; 379: 2252-61.