Blog: Evidence Based Medicine

Charles Kingsland

Posted by Charles Kingsland

22 April 2016

Hardly a day goes by without some newspaper claiming some medical breakthrough and we, the readers devour the story thinking we've finally cured cancer, found a failsafe way to lose weight or discovered a cream that will make us all look 20 years younger. It’s got to be true because it’s in the Newspaper or better still on News at Ten.

You know the stories, there will be one today. Most of us will believe what we read and think fantastic and some Doctor will be adorned with the title, 'Pioneer' or 'Leading Surgeon'

The more inquisitive amongst us will ponder for a while and then think ‘hang on a minute, is this really true?

Well there is an answer to that question that very few patients ask.

In my 30 years as a Doctor it never ceases to amaze me that very few patients ever ask me the most important question any patient can ask their caring practitioner and that is; 'What evidence Doctor can you show me to prove that what you are telling me is going to do me any good?'

In my area of expertise, the treatment of infertility, the specialty is absolutely full to the brim of stuff that has no evidence base whatsoever and we still use it. Not that this is necessarily bad. It only becomes bad if the following happens. Firstly, if the patient is not fully informed of the risks and benefits of the treatment that he or she is being prescribed and secondly if the Doctor is intent on harming the patient.

Once the patient is clear of the risks and benefits and everyone is confident that harm is being avoided then decisions about therapy can be made.

Another misnomer that patients sometimes fail to understand, myself included when Im a patient (quite recently actually) is that a Doctors contract with a patient does not include having to make them better, it’s not to make them worse!

The first line in the Hippocratic oath that Doctors all sign up to when we qualify is 'First do no harm.' Most of the time, Doctors do make patients better, sometimes a lot better but that's a bonus.

So, the next time you have go to see your Doctor or read an article in a newspaper about some great new earth shattering medical breakthrough, ask the question; 'Thanks for that Doctor but what evidence………?'

I’ll give you an example; If a couple come to see me who have been trying for a baby for a number of years unsuccessfully until now, there are a number of boring things I can tell them that are unequivocally proven to be of benefit, namely, don't smoke, get to your appropriate weight and for the female, take your folic acid AND have sexual intercourse properly. Frustratingly, evidence based treatment is cheap and just not sexy so patients don't like it.

Spend a fortune on dietary supplements, some new stuff to improve your sperm count which happens to be reassuringly expensive, so it must be good………….. (tumbleweed blowing across the page…) Sounds great in theory but no proof its going to do you any good. At least you’ve spent a lot of money, and it’s been on News at Ten and discussed on loose Women so it must be good and it won't harm you though, or will it?

 

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Charles Kingsland

Author: Charles Kingsland

Professor Kingsland is joint Founder and Senior Consultant of The Hewitt Fertility Centre and Professor of Reproductive Medicine at Edge Hill University.