A fine example of post truth and alternative facts appeared in the Guardian on Monday. Defining any diet that made a medical claim as a fad, the article consigned them all to the bin.
evidence based medicine
Have you heard about the NHS trust that recently introduced an incredibly brutal, and possibly illegal, form of drug rationing to save money? Patients suffering post -operative pain will get half the dose normally required to keep them comfortable, kidney dialysis will be done twice a week rather than three and all diabetics will get the same amount of daily insulin regardless of their blood sugar levels.
Trust me I’m a doctor has become a knowing, cynical catch-phrase but the underlying truth is that we do need to trust our doctors, not only because trusted doctors exert a beneficial healing effect but also because we are entrusting them with something precious – our health.
Independent investigation reveals NICE approved treatment only a fraction as effective as experts claim it is.46
Would any doctor continue to prescribe a drug which they had been told would benefit 20 per cent of patients with a specific illness, once the truth was revealed to be around 7 per cent, only one percent better than no treatment at all? You’d have to hope not and that concerned and angry doctors would then shout loudly that they had been lied to and that patients had endured years of pointless treatment.
Why are menopausal women still getting a form of HRT that’s clearly linked to cancer? There is an alternative3
So, women who take HRT to help with symptoms of the menopause have a three times greater risk of developing breast cancer, according to a paper in the British Journal of Cancer published a couple of weeks ago. That’s certainly alarming news if you are approaching or going through menopause but it should really not come as a great surprise. The issue of HRT and cancer has been rumbling away for over a decade.
A small but remarkable trial of the effects that a change of lifestyle can have on diabetes and obesity has just been published in the relatively obscure SAMJ (South African Medical Journal).
The results are impressive and the implications ground breaking. The starting point is that the official ‘evidence based’, low fat, calories-in equals calories-out approach isn’t working.
Here’s a really bad idea. Send a dozen nutritionists to work alongside regular doctors in a Medecins Sans Frontières team providing emergency treatment to the wounded in a war zone. It’s a bad idea because they would lack any relevant skills. They might help speed up recovery but in the operating theatre they’d be be worse than useless as the wounded come in.
The complicated and confusing debate about statins – are they worth taking or not; are they safe or do they have nasty side effect? – has suddenly plunged into anarchic and uncharted territory by the claims of a new rival drug.
There can be few people who think that putting an increasing number of children on SSRI anti-depressants is really a good idea but then reflect that it’s just one of those things. Cash strapped NHS; time-poor GPs; waiting lists of months for therapy; drugs cheap; they may help some.
Evidence based medicine doesn’t protect patients – it just prevents them getting unpatentable treatments8
Leafing through the New Year papers I was struck by the similarity between the housing crisis the diabetes and obesity epidemics. In one case rapidly inflating prices pushing virtually all properties out of reach of anyone on an average wage, in the other a relentless expansion of supermarket shelving devoted to refined carbohydrates, driving an inexorable inflation of the nation’s waistlines.