Should medical treatments need to be scientifically proven?

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’.

11 Responses to Should medical treatments need to be scientifically proven?

  1. Regina Wilshire 9 March 2007 at 6:28 pm #

    One must attend in medical practice not primarily to plausible theories but to experience combined with reason.

    – Hippocrates

  2. Bo Nielsen, M.D. 9 March 2007 at 6:48 pm #

    Dear dr. Briffa

    Thank you for a very informative newsletter.

    As I am teaching medical professionals in Denmark about Orthomolecular medicine, I would highly appreciate if you could be so kind as to provide me with the exact reference to the “15%”:

    “The actual percentage of treatments classified as proven ‘beneficial’, according to the British Medical Journal’s Clinical Evidence webite is actually 15 per cent”.

    Yours sincerely
    Bo Nielsen, M.D.

  3. Dr John Briffa 9 March 2007 at 7:22 pm #

    Hello Bo, here’s a link to the source of the 15 per cent claim:

    http://www.clinicalevidence.com/ceweb/about/knowledge.jsp

  4. Brian Abbott 9 March 2007 at 10:44 pm #

    PREGNANT WOMEM ARE SOMETIMES SUPPOSED TO HAVE NEED TO EAT AT UNUSUAL TIMES AND IN UNUSUAL AMOUNTS. I KNOW ONE OF MY CHILDREN COULDN’T BE PREVENTED FROM TRYING TO EAT DIRT FROM THE GARDEN.
    I SUSPECT THAT LIKE OTHER ANIMALS WE SOMETIMES INSTINCTIVELY KNOW THAT WE ARE SHORT OF A MINERAL AND TRY TO OBTAIN IT BY THESE MEANS. I SUSPECT THAT PERHAPS BY THE SAME PROCESS WE INSTINCTIVELY KNOW ABOUT OUR HEALTH AND SOME OF THE THINGS WE SHOULD DO WHEN IT ISN’T RIGHT. PERHAPS IT’S BECAUSE WE HAVE LEARNED TO IGNORE THESE IMPULSES THAT MODERN MAN FREQUENTLY SUFFERS DISEASES NOW, ESPECIALLY CHRONIC DISEASES THAT WERE UNCOMMON EVEN 150 YEARS AGO. OF COURSE MANY ILLNESSES MAY NEED MEDICAL TREATMEMT-SURGERY FOR INSTANCE, BUT I SUSPECT THAT IF WE COULD SOMEHOW REGAIN AND BECOME AWARE OF OUR NATURAL INSTINCTS REGARDING OUR HEALTH WE MIOGHT BE A LOT MORE HEALTHY AND LESS NEEDFUL OF CONSULTING A MEDICAL DOCTOR.

  5. Janet Alton MNIMH 11 March 2007 at 4:28 pm #

    Cindy Engel’s book “Wild Health: How animals keep themselves well and what we can learn from them” (Weidenfeld & Nicholson, 2002) is a fascinating account of how animals seek out medicinal plants or mineral-containing rocks whenever they need them. And yes, if we only listen to our bodies, we can still do this too. An American herbalist colleague of mine practises this instinctive skill to this day, taking his patients out for a walk in the woods and letting them choose their own remedies, by what plants they are drawn to in the peace and silence. Weird New Age mystic rubbish? I don’t think so – it’s a rediscovery of what we always knew, if we would only drop the ‘rational’, ‘scientific’ pose for a minute, listen to our own bodies, and re-establish our connection with the rest of nature (at least some of the time; I’m certainly not totally against ‘science’, I hasten to add – it’s just not the ONLY way to look at things).

  6. Chris cashin 11 March 2007 at 10:53 pm #

    oh brilliant so now u are suggesting eating earth and behaving like animals ! How safe is that! That is why quack practises need some control! One thing is for sure when you are ill you will go for real doctors !

  7. Sara Neill 13 April 2007 at 6:36 pm #

    Oh, Chris dear, do please keep your comments flowing. Your prejudices give me a really good laugh – which I need after the damage doctors have done to me.

    And John, have you a figure for the proportion of illness in the U.K. that is iatragenic?

    Sara

  8. Chris 14 April 2007 at 6:39 pm #

    well that intriques me what damage – actually doctors are generally useless at anything to do with nutrition. I am constantly wagging a finger at them – i work at 2 surgeries. Actually i am completly fed up with this web site – so many experts. I luv the self taught who have never actually seen a real person! Can i ask what u do – or is that not allowed. The internet is creating a type of syndrome – i dont have a word for it yet but I am sure there is one!

  9. Sara Neill 16 April 2007 at 2:53 pm #

    Ah, but you see, I am not an expert, nor do I pretend to be. I am a “real” person. One whose career has been destroyed and life very much damaged by medical so-called “experts” who think they know everything and are always right. People like you, Chris. My fault, I should have become critical much sooner, but I thought doctors knew what they were doing.

    Have YOU a figure for the proportion of iatrogenic illness in this country? You didn’t answer that question so I do rather wonder if you even know what iatrogenic means? As I understand it, the fourth highest cause of death in the UK is prescription drugs. If that’s deaths, who knows how many illnesses are attributable to them? By definition, those drugs will have been prescribed by medical professionals. Experts, even. And for people, real or otherwise.

    The refreshing thing about Briffa is that he engages with people: politely, cogently, logically, and is willing to admit he can be wrong. It seems he offends you because he would like others to recognise they might be fallible, too – though it is hard to tell since you seem to read what you expect to read and not what he has actually written.

    I’m sure you deal with your patients/clients rather more tolerantly and rationally than you appear to here, or they’d never come back! My experience (and it is experience and therefore merely anecdotal – if lengthy) is that far too many medical men and women put ego before impartiality, so they end up ranting about how good they are instead of keeping an open mind and looking round for anything useful that might help the often desperate people who come to them for help. I confess I’m rather glad I don’t live in Wales. The self-described “best surgeon in Kent” was more than enough for me.

    But don’t give up. Read the saner entries on this blog carefully and you might come to understand – maybe even to value – intelligent questioning and impartiality one day.

    You are quite right about blogging. It does seem to be a venue for vacuous, safely-anonymous animosity, doesn’t it?.

    But I, as I said, do enjoy a giggle, so keep it up. Humour is so life-enhancing.

    Toodle-pip!

    Sara

  10. Chris 17 April 2007 at 3:38 pm #

    oh dear – how patronising was that. All i can see on here is hero worship!

    So what is wrong with living in Wales I found that comment rather offensive!- we are a friendly nation and i am sure my own patients would vouch for that. Actually that is really why this site has irritated me so much – people read a study but see it in isolation and then how do you apply it. Most dietitians and properly qualified nutritonists are good at what they do because they have the underlying knowledge that can turn these studies into real life. When all these studies are published in quick succesion constantlyt contradicting each other one has to question in the end what they are achieving. I see it daily – it is switching people off !
    I am passionate about nutrition and so sick of experts coming up with unrealistic ideas!

    Iechyd da – good health

  11. Chris 17 April 2007 at 3:46 pm #

    oh and ps Wales is actually streets ahaed of england in terms of promoting a healthy lifestyle – the WAG is actaully doing alot of very innovative work particularly in deprived areas – i guess even the english have them!

    I have been overseeing a project in a poor valley area and it is transforming the local community. we have increased the numbers of non smokers , got all ages doing exercise, introduced local food coops so over 100 families are now buying fruit and veg. and fresh local meat every week. These sort of projects are not rocket science but this is vital to engage local populations – small inroads will bring huge health gainsin years to come and the assembly has had the foresight to do this. Showing people how to cook and shop is farmore useful to them than the latest superfood study.
    But if you think this kind of info is unimportant then that is up to you – I think perhaps a reality check is needed by all

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