ABOUT THIS EPISODE

Australia's shadow assistant treasurer Dr Andrew Leigh is a proponent of evidence-based policy through the use of random trials. He's written a book, Randomistas, on why random testing can provide data for policies that work. He's in New Zealand for a lecture on how random trials can help reduce crime and inequality.
English
United States

TRANSCRIPT

00:00:00good morning wallace chapman and thanks for joining us here on a sunday morning or is it national now later this hour australian comedian cow baron did pan as ever and he's hitting our wife shows this month but now another australian doctor anjali is a former economics professor at
00:00:15the australian national university of former london lawyer and has a ph d from harvard these days he's an australian politician of the shadow assistant treasurer and while his political ideology fluid for awhile with tiny billie's third way he prefers these days to talk about a special duty to
00:00:31look out of the most disadvantage he's in new zealand this week as part of the presbyterian support northern speaker siri's on improving child well being he's an author and has made us booker's a random easter's her looking at how randomized tests carry out every day to find out
00:00:47what works what doesn't thie tests are done by supermarkets search engines online dating sites and also by a political parties who use randomized trials to try to win elections his book tells the stories of researchers have fight to have the findings from the research implemented dr andrew leigh's
00:01:05taken time from his peck shit joe welcome thanks well it's great to be with you tell me how did your interest in randomized trials actually start well it came originally when i was doing a peerage date haven't university and working with a range of people who were just
00:01:22as passionate as i was about addressing social disadvantage but had far fewer prejudices about which programs worked in which didn't and it made me reflect on my own philosophy and social policy i think i've been very attracted to solution nhs and much less scientific and critical then for
00:01:40example a medical researcher who was trying to cure cancer not realizing that actually no matter how idealistic you are lots of things that sound good turn out not to work so well in practice one great example is scared straight program that puts troubled youths in jail for a
00:01:57day in order to scare them onto the straight and narrow but actually turned out in rigorous randomized trials to increase offending rights we'll talk a little bit about that problem and others in a minute but actually you've okey what i've been reading about random mrs heretical research has
00:02:12changed our world you start the book with a very interesting story air about scurvy so one commodore george anson in the terrible problems he had with scooby tell us a bit about this well indeed your your odds of dying of scurvy during the sixteen hundreds and seventeen hundreds
00:02:32what way higher than your odds of of dying in battle even during the seven years war it was it was scurvy that was doing most of the killing rather than a cannon and there were many solutions that were suggested most of them turned out to be hocus pocus
00:02:46but one young naval doctor by the name of james lind decided that he would do a simple randomized trial he took twelve patients is similar as he could put them into piers and then for each of the piers tried six different solution sea water vinegar the various remedies
00:03:03that it had been suggested and then of course oranges and lemons we know citrus is the way in which you ward off scurvy and this is the citrus patient silas we're straight back on duty within a few days everyone else was still lying in there in their hammocks
00:03:18with their connective tissue slowly separating as scurvy does to you so that randomized trial really underpin the way in which the british navy managed to get on top of scurvy i hated the french navy if you want teo no what why the battle of waterloo turned out the
00:03:32way it is part of the answer is the british navy was fighting a scurvy ravaged flight it was their profound absolutely you know the accounts of what scurvy does to you or just terrifying that some of the sailors found that old battle wound it's twenty years earlier would
00:03:49begin to open up you couldn't eat is europe now that slowly swelled sometimes boats would go down because they weren't enough men to keep their guard and keep them going and the surviving men were too weak to swim ashore but all you have to do is just put
00:04:04enough oranges and lemons on the on the ship and bob's your uncle and yet you're able to take on the world so that was what the british did the simplest remedy to the most horrific disease quite as quite an extraordinary on the story and so here we had
00:04:17a remarkable experience experiment by a young surgeon who said what if we do this you know we take a randomised trial and we give half the half the members you know cem cem citrus did did his randomized trial catch on how long did it take for the british
00:04:34navy to actually catch on to this trial well it did take longer than you than than you'd like well and part of the problem was that rather than simply saying oranges and lemons work and i'm not precisely sure why lind instead came up with this sort of quiet
00:04:49wacky set of theories as to a store why oranges and lemons work till the tile in the in the book about a man by the name of william stark who sixteen years after linde published his results decided that he would do an experiment on himself to work out
00:05:06how different food's affected scurvy so he gave himself scurvy after a couple of months on britain water and then started supplementing his diet with olive oil milk goose and beef and and he was going to come to fresh fruit and vegetables but he had to make his way
00:05:21through bacon and cheese first and unfortunately perished in the attempt eso stark celfin scurvy experimentation is a reminder that good evidence doesn't just need to be produced it also needs to be properly disseminated you're ever kiss off randomized trials for those of us who you know might not
00:05:39know what they are do you want to tell us a little bit about how they worked what actually die yeah so look one easy way to think about this is imagine we wanted to know whether getting an extra hour of sleep like she a happier we might take
00:05:51one hundred people toss a coin fifty people have heads fifty people have tails we asked the heads group to sleep an extra night and then if they reported being happier would conclude that a little more snooze helps you lose the blows that's in a principle which is applied
00:06:05to new pharmaceuticals calcutta new drug approved in most advanced countries without putting it through this kind of a randomised trial on the beauty of tossing a coin is you get to groups which are otherwise comparable and if you observe differences then you know it's got to be the
00:06:21intervention rather than something else going on in the world and so you say that when it comes to for example you took a medicine there but you know when it comes to designing randomized trial safer social policy the vast majority of programs designed to help the most vulnerable
00:06:39i grounded and grey beard beliefs not empirical evidence so that instead of rigorous evaluation we ask the hippo what's the hippo the hippo was the highest paid personal in person's opinion a cz one person said if we have if we have donald let's go with that if its
00:07:00opinion we're going forward might as well use mine some of this grand misters are those who are don't lose their passion for the problem but a scientific and critical in in finding out what books do you really think that's what happens the highest paid opinion counts that that
00:07:16that that the the big recon and accompany an organization an institution has weight over evidence okay absolutely and people have seen the movie moneyball will say ah great example in which data can overwhelm dre being wisdom on the sports field better use of data is one of the
00:07:35great revolutions of our age the best businesses are getting on top of this netflix has been refining its algorithm for which movie to show you show you next based on randomized trials google picked the color of its search bar based on randomized trial in which they tried forty
00:07:51different shades of blue in order to find the favorite one on that added millions of dollars to their their their bottom line cole said market in australia has a loyalty program called fly byes one of the hundred cards are a control group who don't get the marketing and
00:08:05that allows the coals board to assist the efficacy of the marketing programs so great companies are doing it from the challenges for great governments to step up and do it just assign you talk a lot about both in the book and speeches given randomized trial so that's the
00:08:19sort of trialing this is the way we approach crime and you highlight restart of justice experiments is being an example off an evidence based approach to crime that heads worked and if you mention new zealand and you walk among other countries what has restarted justice talks about why
00:08:37we tackle crime in so far as using randomized trials were started justice is the idea that if we bring the offender and the perpetrator together to discuss what the perpetrators should do to repair the harm that i've caused then we not only do right by the victim but
00:08:56we can also reduce the chance that the perpetrator re offense there's been a serious of randomized trials of this approach which seemed to suggest that you get a significant crime reduction one study in in london city has suggested that the benefits of crime reduction were worth to the
00:09:12community fourteen times the cost of running the randomized running the restorative justice process but you also get victims who i feel less inclined to take revenge this is something that native americans indigenous australians maddie and new new zealand have recognised for a long time if you want victim
00:09:32and offender to go back teo living together restorative justice khun work not for not for every case but for many instances this is a big issue in new zealand now dr lee we had last week on the show severe gluckman talking about him spearheading this new report really
00:09:47saying very similar things what you're saying is that we need we need maur darter enlist dog when it comes to our extraordinary incarceration rates and how we approach our prison rights you'd agree with that absolutely both new zealand or australia have about one in five hundred adults behind
00:10:06bars as we spoke in the united states it's it's biggest still as more african americans under criminal supervision now than there were slaves in eighteen fifty so this is a huge need to get mohr evidence into criminal justice policy what's striking about australia and new zealand over the
00:10:23last couple of decades is that most categories of crime have fallen and yet incarceration has risen so thinking about one of the good evidence based policies not just that i feel good and i got but actually he'll produce crime and incarceration is absolutely critical issue here that this
00:10:41does fly in the face of all got perhaps andrew you know that sees being tough on crime works that they need people who you know i commit a crime you didn't need to be punished and punished a decent time put him in prison today dean tell us more
00:10:58about this other experiment the scared straight program yes oh well scared strike is another attempt at reducing juvenile delinquency the idea being that if you put your troubled troubled young men in prison for a day they'll be scared onto the under the strike narrow it emerged actually from
00:11:18nineteen seventy eight documentary which which proposed such an idea and then in a kind of life imitates art since many american states took it up local the evaluation seems suggest that a cut crime but once the random misters got in we got good call the evidence it turned
00:11:34out it was actually increasing crime perhaps because young men realized that jail actually wasn't as bad as that as that thought so if you're interested in keeping the streets safe then scared strike is the opposite way way to do it and i suppose to people who say that
00:11:49criminal justice policy should be based on the gut i'd say that i'd rather my kids were were safe i'd rather we brought down incarceration right rather than rather than and the crime right rather than put in place policies that simply are shown by the evidence not to work
00:12:03right and the scared straight scared straight program quite a famous program by time the randomized trials came along it was pretty entrenched very entrenched wasn't it so this would have been quite a quite a surprise to some people absolutely and you know there there was even a documentary
00:12:23in about a decade a gallery called beyond scared strike which yet again tried to perpetrate the myth that scared strike worked on dh provoked quite a backlash from the experts who had known for decades that this was aa program which wasn't just a failure it was actually ineffective
00:12:40it was actually increasing the odds that they these kids worked hard got a child probably no surprise to people who spend a bit of a bit of time in jail than being in jail been around jails that being in jail changes your friendship quotes so yeah it's a
00:12:53crime university so you want to think quite carefully about the use of incarceration in order teo to reduce offending rights i'm speaking with a dr andrew lee all about using evidence to guide policy making all areas new books called random easter's howl radical research has changed our world
00:13:10here for some speeches in new zealand and in the late nineties this is quite interesting you talk about a really radical solution to the hero and epidemic in australia and this is moved in new south wales premier bob carr said that he would trial very controversial idea tell
00:13:29us about it yeah so when bob carr had lost his brother to in heroin overdose australia was with suffering a huge heroin epidemic in the light nineteen ninety seven hundred fifty thousand people shooting up regularly and he was interested in whether or not some approach apart from traditional
00:13:49criminal justice sentencing might be affected they put in place after a drug summit the idea of a drug court in which drug offenders would be put through a supervised rehab program with jail is as a sanction if they didn't comply and turns out that drug courts work even
00:14:06if you place no value on the well being of drug offenders if all you care about is the impact on crime in the community you should support support drug courts because they appear teo to reduce offending right significantly they pass a cost benefit study and it was interesting
00:14:22that there was a retrospective on the drug drug court awhile back with the new cell piles director of public prosecutions nicholas cadre admitted that the evidence had turned him around that he'd been a skeptic and was now a strong supporter of drug courts again evidence based policy in
00:14:39action reducing crime and reducing incarceration what interesting my dear drug courts to address the critics the state government would have had to have some pretty damn strong evidence off their thickness else it would have been politically very damaging i could imagine absolutely and their evidence was was the
00:14:58following if you look at a hundred offenders who released put him through a traditional criminal justice process you get sixty two drug offenses for every hundred offenders put him through the drug court you get eight offenses for every one hundred offenders s o you get a massive drop
00:15:13in in offending once you deal with the fact that these people who have an addiction problem and locking him up in the cell doesn't necessarily solve that addiction problem so it works yeah yeah it's it's it's been replicated now on a range of other jurisdictions in australia and
00:15:29you know i think has a lot to teach other kind of other countries we're also learning from some of the experiments that are being done in criminal justice in places like a why looking at the impact off improving certainty around parole parole khun khun b quite sort of
00:15:45ad hoc and capricious and some of the randomized trials they're suggesting that if you can make the system more certain then that has a bigger impact on crime reduction then if you just focus on the length of the sentence now when we most people will listen to the
00:16:00sport will be thinking of randomized trials they will their mind will immediately go to the medical field why'd they andrew you know in that scenes you talked about something quite what amazing you talk about this thing called a placebo surgery also known as sham surgery so this's use
00:16:17when researchers rectory uncertain whether or not an operation helps patients explain it a bit for us yes sham surgery was shocking to me when i first heard about the idea that you would actually cut somebody open not perform an operation and so than that a cup again but
00:16:36the reason that it was done was because we didn't have good evidence that many of their surgeries worked when we began doing these sham surgeries when when doctors began doing them they discovered that in many cases the outcomes we're no better from from rhea ll surgery than from
00:16:50shams it's really so for example for example of classic says study in recent years is knee surgery performed for a tauron meniscus it's so called menace ectomy it's performed millions of times around the around the world every year but the outcomes for middle age patients of menace inktomi's
00:17:07don't seem any better than share and sham surgery and one of the challenges here is the placebo effect in surgery is really big so if i give you a tablet then sugar tablet the chances are you'll feel a little bit better if i give you a saltwater injection
00:17:22then that'll it'll produce an even bigger placebo effect but if i have an expert in the white coats slice you open in the placebo effect of that is bigger than the injection and certainly beginning with sugar tablet so you need the randomized trial too actually i drew out
00:17:37the placebo effect and see what the true effect of the surgery so let me get a strike in terms of methodology you'd actually have surgeons bring in the patient i'd go under there would literally can't a person opens servant back together again and that do nothing that's right
00:17:52and patients of course have to consent to this beforehand controversial biddies but but you've got informed consent and you've got ethics board's over the other diver saying it and ultimately the ethics boards regard this is being appropriate to do because being cut open and sewn back up again
00:18:08silas infection risk for example eh so if you really not sure that the surgery surgery works then then you may well be better off today in the control group than than to be in the treatment group we're learning a lot from they said these sham surgery randomized trials
00:18:24and its suggesting that in many cases we might want to look a non surgical interventions that's good for for the taxpayer because we're paying for fewer surgeries on it's also good for the patient so were then able to be to be moved in tow physical rehabilitation therapy some
00:18:41other strategy which could be more effective and of course much cheaper for the community much of held public received information now dr lee is through you know opinion columns op ed pieces thought pieces friends opinions on the facebook and less through you know this is what leavitt and
00:19:00sees or in the area of a crime they call a penal populism quite and quite is this a big problem for the likes of yourself who want to sheet home that the idea that we need proof before we commit to a particular policy we need proof or even
00:19:15before we need to talk about inequality or certain social outcomes for a while so i mean i certainly think that there are some people who just want to shoot from the gut there's that lovely roast of george w bush that was was done awhile back saying that that
00:19:34he goes straight from the gut because there's more nerves and they got from the brain how do i know that not because my brain tells me because my gut tells me but if you look at the successful firms they're the ones that recognize that they know is they
00:19:46need to pull together evidence it shouldn't be that surprising given that nine out of ten drugs that look promising in the lab don't producer produced results through clinical trials one out of five google experiments works for out of five are enough ineffective on the education field the american
00:20:03what works clearinghouse finds that only one out of town one of the ten education interventions works once you start to realize we're in uncertain world i think you much more inclined to go with data and certainly my hosts presbyterian support northern who brought me out from australia to
00:20:19do this lecture series i've been impressed by how much they is a charitable foundation are interested in solutions and scientific and critical about the approaches to get there so i think there's a lot of good people both in government and in the community sector in new zealand thinking
00:20:35in this way dr andrew lee speaking in new zealand speeches drawn from his new book a random easter's how medical research has changed our world andrew good to have you on the show thanks so much for ascribed to jet

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