We, thumb the people of the UK are fully entitled to Evidence Based Medicine (EBM) on the NHS.
Believe it or not I say that and I stand by it. In fact I will go further and say that EBM should be the only litmus test for all NHS interventions to which the UK public are fully entitled. EBM, unlike ‘plausibility’ (which relies on the uncertain field of philosophy) can be scientifically calibrated, thus qualifying it to be the acid test for any medical intervention. In that little word, ‘any’ lies the crux of this post.
If EBM is to be the golden standard, then any intervention available on the NHS must pass the test. The UK public would then not be entitled to any medical intervention which does not pass the clearly stated level of EBM stipulated by the NHS regulators. That sounds logical enough doesn’t it? But let me tell you what will happen if EBM was genuinely and honestly applied in this way.
Many forms of complementary and alternative medicine would fail the test for their use in specific conditions. However the damage to CAM would be miniscule compared to the hurricane of destruction that would be encountered by ‘conventional’ NHS interventions that would fail the EBM test. All doctors would be required to check the level of evidence for any (that word again) treatment prescribed. In the spirit of the age, they would be coerced into informing many patients that certain drugs which they thought were helping them, could no longer be prescribed because they didn’t pass the EBM acid test. Pandemonium in GP surgeries would ensue. But GPs could show patients the relevant pages in the BMJ’s book Clinical Evidence that would reveal the evidence for any specific treatment of any disease or symptom. As my Pie Man shows, a great deal of ‘orthodox’ interventions do not come out of the EBM test very well to say the least! The quality of life of patients, doctors and the financial health of Big Pharma will take a huge hit from Hurricane EBM – but with apologies to Keats:
Evidence is truth, truth evidence, – that is all
Ye know on earth, and all ye need to know.
Fortunately there is an alternative to this: Doctors should tell patients of any treatment (whether it is ‘orthodox’, ‘conventional’ or ‘plausible’ is utterly irrelevant because EBM is the only calibrated test) that lacks the requisite badge of honour from the EBM-trained regulators. After that individual doctors could feel free to give their own opinions based on long personal experience, information from drug reps (yes I know it happens – why do you think the job of ‘drug rep’ exists?), knowledge of whole person medicine including any form of CAM they are interested in, and most importantly knowledge of that particular patient’s physical and psychological health. Indeed the doctor might suggest that the patient eats a healthy diet he has tried on himself, takes up yoga or Tai Chi from a teacher he knows, or consult a local homeopath, osteopath or acupuncturist. However he will make clear that these are his personal recommendations and that the patient can take them or leave them. The patient would thus be entitled only to treatments that have the requisite EBM pedigree but after being told whether any treatment passes the acid test, would be ‘allowed’ to opt for their doctor’s personal recommendation – if they wanted to. Patients could choose to register with GPs who prescribe EBM-rated treatments exclusively though I doubt may would choose this option. Doctors would remain accountable for all their actions of course but patients would be fully informed about what the evidence says about any proposed treatment.
And that dear reader, is what I call patient choice.