How a Citizen Science Project Overturned NHS Advice That Stood for Decades

In the last week alone, more than 10 million people have visited the NHS Choices website. Often viewed as the public go-to place for a wide-range of health information, it is somewhere many of us turn to when feeling under the weather or looking for advice.

In the last week alone, more than 10 million people have visited the NHS Choices website. Often viewed as the public go-to place for a wide-range of health information, it is somewhere many of us turn to when feeling under the weather or looking for advice.

We probably take for granted the scientific accuracy of the content - but with such a vast array of information widely used across the UK, you might not expect a small group of parents to be the ones presenting the evidence to change long-standing NHS recommendations.

In a tale they have billed as "David vs Goliath", a group of citizen scientists has successfully challenged NHS Choices advice, overturning the recommendation to avoid using biological detergents on all baby items. The Nappy Science Gang, a project funded by the Wellcome Trust and Royal Society of Chemistry, is made up of 800 parents, who range from seasoned research scientists to science enthusiasts.

Formed by public engagement specialist Sophia Collins in late 2014 - through a frustration at the lack of clear, evidence-based information about reusable nappies - the group has persistently asked questions around the contradictory advice on washing nappies.

"One question we kept coming up with was 'why shouldn't we use bio powder'? Experts agree bio cleans better. Most countries in the world don't even have such a thing as non-bio powder," says Collins.

"There are studies showing that bio doesn't cause any more skin problems than non-bio. Yet every time the question was asked, it all kept coming back to the fact that the NHS recommends using non-bio on all baby items."

After one of the group's science advisors, detergent expert Mark Smith wrote to the NHS asking on what evidence this was based - NHS Choices investigated concluded there was no evidence.

"Ultimately, a group of citizen science mums has changed the policy of an organisation so big it's the fifth biggest employer in the world. Just by persistently asking questions," adds Collins.

In their email exchange the NHS quoted Professor Hywel Williams, Professor of Dermato-Epidemiology and Co-Director of the Centre of Evidence-Based Dermatology at the University of Nottingham.

He said: "I know of no good evidence that supports avoidance of biological washing powders or fabric conditioners and use of non-bio instead. Modern washing machines are so efficient that they are very unlikely to leave behind traces of enzymes or soap that can act as irritants...it might be a legacy from a long time ago when they first came out, but it has left a legacy of a very strong ritual in the British population."

Collins expected it would take months of lobbying and was thrilled by how "quickly and thoroughly" the NHS had reacted to a lack of evidence. The NHS concluded their response saying: "Comments like yours are extremely useful to us, and help us to ensure that all of our advice is evidence-based and reflects best practice."

Just goes to show persistence, courage and good science engagement get brilliant results, every time.

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