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).

One of the comforting myths about the powerful drugs used in modern medicine is that they are prescribed on the basis of good scientific evidence. Proper randomised clinical trials, we are regularly assured, compare them with a placebo and the results can tell us which are safe and effective.
However this is an illusion. For nearly thirty years drug experts have known that there was a major flaw in this assumption, which doctors and the agencies set up to regulate drugs have chosen largely to ignore. (Read more…)