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EXPERT OPINION
WHERE’S YOUR EVIDENCE?
and only a further 21% are likely to be beneficial. This translates into 50-80% of all healthcare activity, not being evidence based or beneficial (the percentage depends on specialty as the more common treatments tend to have a stronger evidence base). Evidence based medicine (EBM) is
fairly sure we’ve solved the crime. In situations like this we tend to arrest the person in the house next door.” He extracts the handcuffs and continues: “It’s a marvelous approach and it really works; in 99% of cases the crime is never repeated. Thank goodness for the first- hand experience and common sense of police officers!” Virtually speechless you manage: “But, where’s your evidence?” It’s nice to know that working in the healthcare industry we don’t come across absurd situations where people’s lives are affected simply because of a lack of good evidence. Or do we? Many of us would agree that
T
contemporary medicine is a modern miracle. We have diagnostic techniques that could not have even been imagined a generation ago. Many interventions that were highly invasive, have been replaced by drug therapies or surgical methods that are less traumatic. The treatment of heart disease has been revolutionized, organ transplants which were ground- breaking are routine and many diseases have been virtually eradicated. This is all true, but many might
be surprised to hear that only13% of treatments have good evidence,
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he doorbell rings. It’s the police: “The house next to yours was burgled last night and we are
defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. Its advocates are vociferous in their criticisms of the various quacks and charlatans that peddle their snake oils at the edges of what we think of as conventional medicine. But they are also very critical of many of those who operate in the mainstream of professional healthcare. Pharmaceutical companies, academics and practitioners are accused of a multitude of failures from being complacent (not keeping up with research and well proven practice) to being downright dishonest (covering up poor research outcomes to preserve reputations and commercial interests). There have been very well publicized
scandals in the history of modern medicine, such as the thalidomide cases of the 1950s and 60s, but it is our day-to-day experience of current medical and research practice which probably worries us most at a personal level. Does my doctor know what the best available evidence is for treating my condition? Why does my best friend know about new treatments for my condition but my doctor does not? When my doctor tells me that the drug they have prescribed works effectively for half of all patients, what does that mean to me? When I read in the newspaper about a new study saying that a lot of salt in my diet is not bad for me at all, how can I be sure that there aren’t a number of other studies that indicate that it is? There are some learned and vocal
advocates for EBM – a great many of them doctors, but I would suggest that only patients really have the power to conduct a revolution in this area. There is no question that patients have more opportunity to
do this than ever before. The internet provides more information than any medical school library had only 10 years ago. The internet does not just provide information. It supports communities; even those who are suffering from the most unusual disorders can find fellow sufferers and compare symptoms, treatments and outcomes. Muir Gray, a UK doctor and champion
for better patient information makes the point: “Many patients are better educated than the clinician. Furthermore, the patient may have one problem, whereas the clinician has to deal with hundreds.” How can we harness this to create better medicine? Governments spend a great deal of effort and money on promoting EBM to clinicians, but they need to do more to include patients in this strategy. But how? They can create websites which allow non-clinicians to find information about conditions that interest them and which guide them to other reliable sources of information. They can fund and foster programmes which help patient groups get started and become sustainable. Many patient- operated help forums exist in English but there are fewer in Arabic. The strength of patient groups comes from a passion to find answers to their personal health problems. Governments should seek ways to support such movements but at a distance – perhaps enabling networks, sharing professional skills in IT and communications as well as giving impartial advice. But they must resist the temptation to control these communities directly once they are started. Patients can do that for themselves. ■
AH
MORE INFO: Philip Leonard is a Director with Ernst & Young and the Sector Leader for Healthcare Advisory Services in the Middle East & North Africa. He can be contacted by email:
philip.leonard@bh.ey.com
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