In the AMA, Policy Follows Science: A Case History of Tobacco

In the evolution of health policy we can trace a cycle beginning with need, followed by a perception of that need, leading to questions (see Fig 1). The questions result in the challenge of thinking and research, generating data, which become information and are distributed. Over time, new knowledge may lead to changed attitudes. As some individuals change, they work to change the policies and practices of their institutions so they will reflect the new knowledge. Those whose attitudes have not changed will resist policy changes, and a struggle follows. If the force of the new knowledge and attitudes is strong enough, new policies will result. These will be followed by the implementation of new procedures, their subsequent evaluation, and further questions. The process cycles endlessly as humans and systems cycle. Subsequently changing human behavior on a large scale is perhaps the most difficult change, and it may happen slowly