ESHS/HSS Annual Meeting

Evidence and consensus: Healthcare systems, clinical data and the reception of the antenatal steroid trial, 1969 to 1993

• In Event: The Politics, Epistemology and Ethics of Medical Evidence, ca. 1960–ca. 2000

English Abstract

Between 1969 and 1974, two New Zealand clinicians, Graham Liggins and Ross Howie, completed a double-blind randomised clinical trial in which 1218 women at risk of premature birth received steroids to help the maturation of the newborn lung. The positive results of the trial promised an effective, cheap and simple treatment for premature babies. The trial attracted huge international attention, worldwide replications, and rapid clinical uptake. But they also raised questions about risks, benefits and validity of evidence that resonated strongly in the aftermath of thalidomide and DES scandals.
My talk compares the reception of the trial in two settings. In the United Kingdom, researchers developing evidence-based medicine welcomed the trial enthusiastically. In the United States, where the National Institutes of Health pioneered consensus-based approaches to settle disputes over evidence, the reception was muted. Not even a big US-based multi-centre trial in the late 1970s resolved the controversy, which would only be settled in 1993 (in favour of the use of steroids).
The UK and US shared worsening economies in the 1970s, in which politicians and administrators alike queried the ‘value for money’ of publicly funded research. But in the UK, discussions over evidence took place against debates around equitable distribution of resources within the UK’s NHS. In contrast, in the US the foregrounding of an individual patient-oriented, expert-led approach was linked to its largely private healthcare system. A discussion on how the debate over antenatal steroids was settled in the early 1990s provides insights into both to the changing political and economic contexts as well as changes to evidence-based medicine.

Author

• Tatjana Buklijas, University of Auckland