Drug killing 10,000 in UK every year. How could you tell?

Evidence in wonderland

Even more arbitrary is the claim made to me by a senior anaesthetist that the guidelines weren’t really an issue in the UK because clinicians often didn’t follow them. But many of our drugs are licensed on the basis of approval in Europe. How do individual clinicians make an evidence based decision on which guidelines to follow and which to ignore? This is wonderland territory.

And it gets worse. The ESC has just put out a press release reassuring us that the guidelines no longer said to use the beta-blockers but to assess each patient on the basis of their individual needs and see if they were appropriate. Again this looks sensible and reassuring. But it is meaningless in the context of evidence based medicine and guidelines.

That’s because controlled trials and the guidelines they are used to establish are by definition not concerned with the individual – they deal with averages. So what was the sort of evidence that might help clinicians make their decision about whether a patient would benefit?

Hypothetical evidence

The original Devereaux trial that found that giving the drug raised the risk sufficiently to advise against it. But if you are going to say that clinicians should judge each case on its merits – what evidence do you use? There were plenty of hypothetical suggestions in the response to Francis’ paper.

Patients “might” be safer if the drug was started earlier than it had been in the trial. If a different drug were used, that “could” do better than the one used in the Devereaux trial. Patients with high risk of heart problems were excluded from the trial – it is “possible” that they would benefit from beta-blockers. All plausible but none actually based on the RCT evidence that doctors are supposed to be following when making these decisions.

Just think of the outrage if it was found that a recommended use of vitamin C was killing 10,000 people a year and that the main nutrition society had known that for five years and had being working as fast as possible to change the guidelines. And then imagine the response if, with the same amount of evidence based data the society recommended talking to your nutritionist to see if vitamin C was right for you. Yet that’s what evidence based medicine can look like.

 

 

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “10 Secrets of Healthy Ageing” was written with nutritionist Patrick Holford. He blogs at “Body of Evidence” – jeromeburne.com. 2015: Finalist for 'Blogger of the Year' award from Medical Journalists' Association.
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3 Comments

  • “They said they had decided not to use beta-blockers about ten years ago. But how could they have done that?” Just speculation, but could there already have been doubts about Poldermans’ integrity?

    • Editorial

      Well sure it is certainly a possibility but that is my point. Either you have a sort of informed free for all with experienced clinicians (and presumably some not so bright ones) saying don’t think this work is very sound, going to ignore these guidelines or, as we supposedly have.an evidence based system where people run proper trials, experts study them and on that basis draw up guidelines that everyone is supposed to follow. I may have missed something but my understanding is that that is supposedly the difference between the evidence free world of complementary medicine where people do make their own decisions without any proper evidence and real medicine where is all tied down and based on evidence. The point of the piece as to say that at times it looks as if the decision making process in proper medicine looks remarkably evidence free.

      I think that is inevitable, that you can’t legislate for every eventuality in biology, that you have to say we will take what we can from studies and then use our judgement to do what we think is best for individual patients. The point being that that is precisely what clinicians using CAM medicine also do.So could certain cheer leaders for “evidence based” medicine stop claiming the scientific high ground and acknowledge this reality.

  • They nearly killed my uncle with a drug for his Arthritis infection. He then got really bad lung/kidney damage and nearly died.

    I was also at 39 told I did not have a serious chest infection, “go home and stop whining”, (lol my words, Doc pretended he cared). I don’t run to surgery at every opportunity, had not had out of hrs doctor for 25 yrs, my mum worked IN This surgery for 15+ yrs so they KNEW I did not malinger etc. On trying the anti biotics, they did not work, I got unable to breathe, dragged myself to surgery with a friends Oxygen bottle as was unable to drive myself, walk 20 feet without a breathing attack. So he checked lung, temp and said nothing really wrong, go home relax take more anti biotics ( I was also being sick/trots & had not drunk for 3 days, eaten for 8 days). On returning home as was too weak to argue, I collapsed, and emergency ambulance was called, admitted to hospital told I had lung infections/pneumonia and had irreversible lung damage.

    Does anyone think I should sue my doctor, as was unable to climb stairs, when I was a 38-39yr old fit guy when this happened. Now I use a salt inhaler/silver colloidal water/High VIT C, Good natural Vits/Minerals and a decent diet, getting better quality food all the time as it IS Working. I’m getting less than 6-7 Chest infections every year, and don’t need 5-6 courses of steroid (prednisolone) and anti-biotics every month/6weeks.

    I was truly dying and none of the medical ppl really cared, they are so demoralised by the corruption/budget cuts, poisonous drugs they have given up, but still take the Cash.

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