Generally we don’t trust utopias. If they don’t remain fantasies but emerge into the real world, we expect them either to rapidly descent into rigid authoritarian hells or to disintegrate into factions and unproductive chaos.
evidence based medicine
How much longer can the charity Diabetes UK continue to provide advice on diet to the UK’s 3.9 million people with type 2 diabetes that is based on the discredited Seven Countries Study carried out by Ancel Keys back in the 1940s? The urgency of this question cannot be overstated.
It’s generally agreed that the NHS is not in good health but there’s no clear diagnosis. There are plenty of suggestions – lack of funding, uncompassionate nurses or box-ticking managers. But I want to suggest another one: the crisis in evidence based medicine (EBM).
It’s no secret that there are serious problems with the practice of scientific evidence based medicine (EBM). It’s obviously a good idea to have a system for ensuring treatments are safe and effective. But as a defence against dangerous or poor drugs, the working of our current one makes the pre-crash banking regulation look rigorous.
Here’s a radical idea. Why not use drugs for cases where they are appropriate, safe and effective. And don’t use them when they aren’t. Wild eh! It’s an idea that could save the NHS billions. Three clinicians I know are thinking along exactly these lines.
We are being doctored to death. GPs’ surgeries and public health bodies routinely warn of hazards lurking all around us. They tell us sunshine is bad. Drinking alcohol is bad. Cholesterol is bad. Saturated fat is bad. Being overweight is bad.
Last month two new cholesterol lowering drugs stepped into the limelight at AHA’s (American Heart Association) annual conference. Neither is likely to make it to market until the end of next year but soon after that they are likely to be coming to a doctor’s surgery near you.
A new, as yet unpublished, study shows that the elderly are very likely to seriously lack vitamin D, raising their risk of broken bones. What’s more care homes rarely offer supplements. Making the situation even worse are the cocktails of prescription drugs that many of these patients swallow daily.
Regular readers of the “Statin Wars” soap that we’ve been following here for several months will be eager to know the result of the survey sent to members of the British Cardiovascular Society (BCS) last month. (Read More…)
For years anyone involved in any kind of non-drug therapies has faced accusations that without the support of randomised clinical trials (RCTs) they lack an evidence base and so their work is worthless, quite possibly dangerous and even fraudulent.
That might be reasonable if the RCT was an accurate and reliable method for gathering an evidence base for all forms of treatment. (Read More…)