Last Tuesday evening I attended a debate organised by the Guild of Health Writers. The debate centred on the motion that ‘A treatment should have to be scientifically proven to be available on the NHS. The motion had two proposers and two opposers. The proposers were Dr Evan Harris (LibDem MP) and Dr Jonathan Ledermann (leader of University College London’s cancer trials and reader in medical oncology). The debate was organised by the Guild of Health Writers, of which I am a member.
Their support of the motion seemed to rest on a lot of language about medicine being a ‘scientific’ endeavour. Dr Harris appeared to have a withering (and seemingly ill-informed) attitude to natural medicine. Dr Ledderman, on the other hand, banged the drum for the importance of subjecting potential treatments to ‘randomised controlled trials’ (RCTs) ” generally considered taken by those in the scientific community as the only rigorous way to evaluate a treatment.
Before the debate, about two thirds of the room confessed to being ‘for’ the motion. But when questions were opened up to the floor, it became apparent quite quickly that those keen to speak were generally questioning the wisdom of not just the notion, but conventional medicine generally.
I decided to ask a couple of questions of my own. I first of all asked the Drs Harris and Ledermann to hazard as guess as to the percentage of conventional medical care has been proven ‘beneficial’. Dr Ledderman said nothing but, to his credit, Dr Harris plumped for 5 per cent. My suspicion is that even though both Drs Ledermann and Harris were there to speak up for the concept of ‘evidence-based’ medicine, neither one of them had done their homework in order to ascertain how much of medicine is actually evidence-based.
The actual percentage of treatments classified as proven ‘beneficial’, according to the British Medical Journal’s Clinical Evidence webite is actually 15 per cent. So, my question was a simple one: What are we going to do about the other 85 per cent? I suggested that according to the logic of Drs Ledderman and Harris, we doctors should pack up and go home now.
Dr Ledermann’s response was that in the education of doctors involves teaching them to critically appraise the science and come to their own conclusions about what works and what doesn’t. I said that that didn’t answer my question. My point is what happens then when we as doctors become aware that most of what we do is not based in scientific ‘evidence’? As I I was at pains to point out, for all Drs Ledermann’s and Harris’ posturing and rhetoric about medicine being scientifically based, it really is nothing of the sort.
Personally, I don’t have a problem with this, I just think we should be honest about it and not attempt as a profession to delude the public by making out that medicine is something that it is not.
But I don’t believe we have to chuck the baby out with the bath water. I do think scientific study has something to offer, which is one of the reasons I regularly quote it on this site and elsewhere.
However, I think we doctors should more readily accept and be honest about the fact that only a small portion of conventional medical care is ‘proven’. And the fact that something is not proven does not render it invalid. I mean, hip replacement hasn’t been subjected to a RCT, but that doesn’t mean we should stop orthopaedic surgeons doing them, should we? The same, by the way, can be asked of practically any surgical procedure. And are we going to stop a doctor administering potentially life-saving drugs to a critically ill patient just because they haven’t been subjected to RCTs either?
The concept that only scientifically proven medical treatments should be available on the NHS is ridiculous. If nothing else, it conveniently ignores that, for the most part, what we doctors do is simply not scientifically ‘validated’.