Evaluating facts and facting evaluations: On the fact‐value relationship in HTA

Abstract

Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of “fake facts” and “truth production.” Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values.” Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTA's own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values,” which we call “factuation.” We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this “factuation” is key to making HTA valuable to both individual decision makers and society as a whole.

Treating real people: Science and humanity

“…In an important paper that resonates with the conclusions of both Wieringa et al and Mayes et al, Bjorn Hofmann and colleagues discuss the relationship between fact and value in health technology assessment (HTA) . Explaining the crucial role that philosophy (in particular ethics) plays in addressing the relationship between facts and values in HTA, they defend an Aristotelian “middle way” between the traditional positivist account of “evaluating facts” and the social‐constructivist account of “facting values”, which they label “factuation”.…”

“…We are delighted to report that, in the year following these comments, we have received a vast amount of correspondence and submissions from some of the most insightful and influential commentators in health research and practice, taking this “great debate” forward in just the way we had hoped. This thematic edition of the Journal of Evaluation in Clinical Practice (the largest single edition of the JECP in its 24‐year history) includes over 50 papers, reviews, and reports of conferences that reflect the attention being given across the board—by practitioners, guideline developers, systematic reviewers, and philosophers—to the relationship between evidence, science, context, bias, truth, value, and methodology, with the quintessentially pragmatic goal to develop accounts of these concepts to assist decision‐making in practice. It includes specific sections consisting of papers delivered to major conferences on diagnostic categories (focussing on both their limitations and their overuse), clinical guidelines, and mechanisms in medicine .…”

Principles for deliberative processes in health technology assessment

“…It was also noted that the traditional boundary between "assessment" and "appraisal" is perhaps not as clear-cut as has traditionally been assumed, and the terms are often used interchangeably. This distinction assumes that there is a clear separation between facts and values within HTA in processes where these elements are considered to be collected and analyzed separately from one another and are then "integrated" through an appraisal process, for example, deliberation (15). The ITO model, and the feedback loops between the activities, helped to show why this traditional distinction is problematic and highlighted the need for principles to cover the entirety of the deliberative process (leaving open the question of whether and how these principles might apply to other aspects of the HTA process).…”

Hvordan vurdere etiske aspekter ved modernehelse- og velferdsteknologi?

“…I tråd med utviklingstrendene beskrevet ovenfor, synes helseteknologivurderingsfeltet å bevege seg fra å se teknologi som et verdinøytralt middel for et eksternt mål, og til at teknologi kan ha utilsiktede konsekvenser, legge føringer for handlinger, vaere verdiladet og kan formes sosialt. Man har begynt å innse at alle aspekter av helseteknologivurdering er verdiladet (Hofmann, Bond, & Sandman, 2018). Å se teknologi som en aktør (aktant) (Williams-Jones & Graham, 2003), har man ikke vaert helt moden for så langt, men det skjer store endringer på feltet.…”