Medical Treatment Without Evidence. Doing More Harm Than Good?
In Taking the Medicine Burch argues many medical treatments, old and new, have no evidence they work. Good intentions are undermined when bad science meets blind faith.
Taking the Medicine, a Short History of Medicine’s Beautiful Idea, and our Difficulty Swallowing It is a book that can be treated in two ways. Most simply, it is history of medicine and particularly of drug development over mankind’s history. Behind the history there is a critique of the quality of the science and evidence that justifies treatment whether long established practice or the result of modern pharmaceutical development.
History of Drugs and Their Development
Druin Burch sets out a history of medicine from the earliest days of folk remedies to modern synthetic drugs and shows how the improvement in chemistry techniques provided new treatments. He explores the development of the coal-tar industry into becoming dye manufacturers and eventually the modern commercial pharmaceutical company.
However he shows that just like many of the traditional remedies modern drugs are given to patients on the basis of the doctor’s trust in their efficacy and with little evidence that the benefits outweigh the harm. Unlike many doctors he asks the question “How well do they work?” Repeatedly the evidence for the benefits of most treatments is little better than it was centuries ago and is based on opinion, blind faith and perhaps not a little misplaced arrogance. Often the “evidence” is anecdotal.
Regulation and Testing of Medicines, Drugs and Other Medical Treatments
Although the techniques that would support evidence based medicine go back more than a century Burch shows their use is still not universal. Indeed the regulatory framework introduced in the last 50 years has only made marginal difference as commercial pressures encourage drug companies, and others, to work around the intent of the regulations. Doctors use “off label” prescribing in the belief, or hope, that what they are doing is better than nothing – but Burch points to evidence that is often not the case.
Much of the “scientific” evidence is shown by Taking the Medicine to come from studies which appear to be poor science and are designed to prove benefits quickly for commercial reasons rather than identify harm. Such studies have often not been rigorous or follow proper scientific method. Where proper statistically based studies have been undertaken they have often shown small, but important, benefits that could not be detected in clinical practice and do not justify doctors’ confidence in the intervention. Even worse many studies have shown that the treatment or approach is actually counterproductive.
Evidence Based Medicine or Opinion, Belief and Trust?
Burch points to growing pressure for evidence based medicine but there is still an uphill battle against commercial interests and doctors’ mistrust or lack of understanding of rigorous statistical methods and their perception . Many doctors believe it gets in the way of the moral necessity to use the “best” treatment (in their opinion) for their patients.
Ethical Treatment, Poor Science and Weak Evidence
This book is robust in its criticism but does not sensationalise the issue. It sets out the issues clearly and challenges the assumptions and attitudes of the medical profession and the pharmaceutical industry. The author acknowledges the ethical and moral basis that underpins why many doctors take the stand they do and recognises that they generally operate from the best of intentions.
In a very readable form it throws out a challenge that medicine should be more strongly based on evidence and good science rather than the belief and dogma that has driven medicine for most of its history. The tools and science are now there to be more rigorous in evaluating medical treatments and making regulation more effective.
Druin Burch is casting light on the poor quality of much medical science and the failure to adopt proper scientific method in their studies . Much as Gary Taubes has done with the science of nutrition and public health in . Whether the reason is commercial greed, professional self-interest or motivated by ethical and altruistic purposes it does the public and the patient no favours as it hides the truth and prevents better outcomes.
The author, Druin Burch is a hospital doctor in Oxford, United Kingdom. He has also written a biography, Digging Up the Dead, of the Victorian surgeon Astley Poston Cooper.
With a similar sceptical approach but relating to diet, obesity and lifestyle diseases is
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