“Stand aside Doctor, I’m a Politician / Journalist / etc..”

Healthcare decisions need to be based ‘primarily’, on sound scientific and clinical evidence. Unfortunately, this evidence is all to often ignored.

“It’s often difficult to make someone understand something when their income depends on their not understanding it.” – Mark Fendrick

If we don’t have ‘evidence based medicine’, you may recognise the alternatives. BMJ

• Eminence based – experience, is worth any amount of evidence. “making the same mistakes with increasing confidence over an impressive number of years.”
• Vehemence based – speak loudly and with authority.
• Eloquence based – the carnation, silk tie, ‘silver’ tongue and verbal eloquence.
• Providence based – when in doubt do nothing. If the practitioner has no idea what to do, the decision may be best left in the hands of the Almighty.
• Nervousness based – defensive approach ‘do everything to avoid litigation and hope it works’

Professor N Waugh (2006) added:

• Propaganda based – the drug company says.
• Pressure based – people want.

Clinical and Cost effectiveness 

The requirement for proof of clinical effectiveness ‘should’ be a no brainer. Then the only difficulty should be when having to make decisions based on the cost effectiveness of a range of clinically effective interventions.

Is it, a disgrace that millions are wasted on Clinically and Cost ‘ineffective’ interventions? Then, there’s no money to ensure interventions which do work, are received by all those who would benefit!

Why? Because of the alternatives to Evidence Based Medicine?

Dr Jonnie McCrea

What should Healthcare learn from Farmers?

I had a dear friend, who had been farming in Ireland since he was a boy in the 1930’s. He was one of the first in the country to have a tractor and when NASA was going to land on the moon, they joked he was involved as he was wanting to buy land for farming, on the moon.

Some years ago I was teaching ‘evidence based practice’ to healthcare professionals and on one of my holidays was up visiting him. He wanted to understand what my job was. He was horrified to learn that much within medicine was based on received wisdom or quite simply tradition and especially that there was often reluctance, by health professionals, to change their clinical practice. His comment was:

“Farming is always changing, it has to”

What really got him going was the lack of evidence for the clinical effectiveness and cost effectiveness of so much of what healthcare professionals were doing. The analogy was quite clear:

“If someone came to the farm trying to sell me something and they had no proof that it worked, I’d run them of the farm” 

Yet, many of our health professions continue to attend courses, learn how to do treatments, spend time doing it, and then years later some ‘heretic’ finally does some research which shows it was all nothing more than smoke and mirrors. Do they blush, resign, demand their money back from those who sold them these courses? No! They just quietly move on, like dumb beasts, to the next fad of pseudo-science. Over 130 years ago the charge was made against a certain healthcare profession that:

“it is content to spin theories before the imagination of its believers, and to amuse the patient while the disease runs its own course” – BMJ 1879 October 4th, p 579.

Little has changed in the attitude of some health care professionals in over 100 years. His opinion of doctors and “the whole lot of them”, didn’t improve much:

“I knew they were no good. I’d be better going to the vet!”

Year after year the scientists, those who know what they are talking about, say:

Do the things we have proof for. Stop doing the things for which we have no evidence of clinical or cost effectiveness.

But, nobody listens. They’re all too busy!! 

So, what would a farmer do? 

• Keep up to date with relevant research, attend scientific meetings.
• Continually evaluate current practice.
• Discard ineffective or inefficient practices immediately.
• Have ‘ruthless’ scientific rigour and integrity

I know one farmer who did this!

Dr Jonnie McCrea

With thanks to my dear friend, who I miss chatting to, so very much!

Health fraud – More integrity in a tin of Baked Beans?

For many decades the profile of ‘Evidence Based Practice’ has been raised in the Medical, Nursing and Allied Health Professions. Now, directives to use ‘evidence based practice’ are more prevalent in professional guidance documents and clinical guidelines. There have also been greater constraints imposed on the advertising, for example, of health and beauty products. Yet ‘Health fraud’ remains an issue and we should always be cautious.

More integrity in a tin of Baked Beans

“You buy a tin of beans and it says ‘Baked Beans’ on the label. What do you expect to find when you open it?”

Yet, when purchasing health products we frequently have to place our trust in the sales person or the healthcare professional.

“But, will it do what it says on the tin?”

U.S. Food and Drug Admnistration

For many years now the U.S. Food and Drug Administration has hosted a web page specifically dealing with ‘Health Fraud’. Some of the ‘Tip-offs‘ they suggest to help you identify a Health Fraud are:

• One Product Does It All
• Personal Testimonials
• Quick Fixes
• ‘Natural’
• Time-Tested or New-Found Treatment
• Paranoid Accusations
• Meaningless Medical Jargon

Professional regulation

The professional and regulatory bodies of the health professions, such as the British Medical Association (BMA) and General Medical Council (GMC) for doctors, have the role of helping to ensure the highest standards of their members. Indeed this regulation helps to give us the high level of confidence we have in our health care professionals.

We are all aware of cases over the years where such bodies have had to investigate malpractice. In 2010, as reported in the ‘TheTelegraph‘, the GMC struck off Dr Robert Trossel for providing unproven Stem Cell and other treatments to patients with Multiple Sclerosis. The chairman of the GMC fitness to practise panel stated:

”You have exploited vulnerable patients and their families… You have given false hope and made unsubstantiated and exaggerated claims to patients suffering from degenerative and devastating illnesses… Your conduct has unquestionably done lasting harm, if not physically, then mentally and financially, to these patients and also to their families and supporters.”

So what can the lay person do?

Faced with ill health or serious disease we can be in a vulnerable and desperate position. We should challenge those selling us products, bearing in mind the guidance of the US FDA, discuss concerns with local trading standards, be aware of the bodies which regulate Healthcare Professionals, discuss the evidence supporting treatments with your GP and look up reputable websites such as ‘NHS Evidence‘ and ‘The Cochrane Library‘.

And finally, learn from the cases where things have gone wrong.

Dr Jonnie McCrea