Richard E. Neustadt (1919–2003)

I have a professional interest in the use of science to inform policy, giving me a nerdy predilection for this sort of thing - and I found it great! I was fascinated to see how the actions of a few people each with their own agenda managed to effectively 'put a gun to the President's head'. Lessons are drawn by the authors for how not to repeat the same mistakes again:

1) Build in regular reviews / decision nodes
2) Maintain awareness of implementation from the outset
3) Consider how perceptions outside (i.e. media) will influence the program
4) Maintain credibility
5) Question the `facts' and assumptions

It is also noteworthy that perhaps not all of the lessons to be learned from this episode have been so. Did / does the epidemiology of H5N1 really suggest that the AI panic of the last few years has been necessary and justified? Are we now in the position where the 'avian influenza industry' (and the vested interests within) is actually self-fulfilling? Not my assertions, but I do wonder (although we certainly have seen more restraint worldwide than the 'Swine Flu Affair' describes for 1976 USA.)

The book is actually the text of a report from Harvard staff commissioned by the incoming health Secretary, Joe Califano, as a 'lessons-learned enquiry lite'. The text is in some places complicated and not all the concepts are explained particularly well, unsurprising perhaps given that it was not intended for a lay non-US audience. Appendices include copies of key memoranda, timelines and cast of characters etc.

In summary, a really good read for anyone seeking to understand decision making in high places in momentous us times - perhaps not `The Villa, the Lake, the Meeting' or `13 days', but recommended.… (more)