Andrew Kay

Evidence-based medicine matters to me because evidence matters to me.

Bob Gerics

The first definition of medicine in my dictionary here at my desk says, “The science of diagnosing, treating or preventing disease or bodily injury.” That is how we should think of “medicine.” If someone is talking about medicine, “evidence-based” should be a given. That means homeopathy and other non-scientific approaches should not be considered medicine. Pursuing non-science based approaches to physical problems and postponing real medical approaches is dangerous as some conditions worsen with delay of proper treatment. Too much time, money, energy and hopes are wasted on unproven approaches. Also, giving credence to the “logic” that is used to support many “alternative medicines” promotes a lack of critical thinking. A capacity for critical thinking (along with compassion) is one of the strongest attributes of our species.

Brian Parkin

Alternative medicine kills more people than it cures. My evidence for this statement? It cures no one, being totally ineffective, apart from the placebo effect, and people die as a result of rejecting evidence based medicine in favour of it. My wife suffers from Sickle Cell Disease, and is taking Hydroxyurea, which is the next best thing to a cure. Although developed for Leukaemia sufferers, it has been found to increase the production of foetal haemoglobin in sickle cell sufferers, the result being the cessation of major crises. Alternative medicine, of course, has nothing to offer for the condition.

Bryan Howard

At a time when the price of pharmaceuticals is rising and the sophistication, precision (and price) of diagnostic equipment increasing, the cost of providing medical care rises steadily; and this is against a background of an aging population. When resources come under pressure, it is essential that they are deployed to best effect, and the only way of ensuring that this takes place is to require an audit to be kept of inputs and outputs to the care and treatment of our citizens. In effect, this will demonstrate the efficiency and effectiveness of medical care provision, allowing informed decisions to be made about the allocation and deployment of resources. Furthermore, the collection of information about the effectiveness of medical interventions enables not only the dissemination of best practice but also the identification of issues, investigation of which may advance medical science further, thereby enhancing practices. This is not to argue that all medical practice must always be evidence based. There will always be sceptics who challenge perceived wisdom, and thy too may demonstrate inconsistencies and muddled thinking by more traditional practitioners.

Christine Drakeley

As an MS sufferer it is important to me that all medicines that are prescribed for my use have been tested, and based on evidence to say that they are worthwhile. It matters to me all the time, but especially when something new, or different to me is suggested. For example I have recently developed a trapped nerve situation, and my GP has suggested that my current use of diclofenac should be changed because my system has got too used to the medicine I have had for several years, and my new consultant has suggested a different medication to help the bladder and bowel situation. Both of these medications, new to me, have evidence of testing and seem to be working well.

Christine James

We feel that safety is paramount and we would always weigh up the pros and cons of new drugs, i.e. known side effects and risks. From what we understood at the MS Life conference, it would seem that new research could well be developing treatments that have greater risks attached than previously. Therefore it is important that as much evidence can be collated with regard to effectiveness and risks. I personally am trying to follow a diet for my husband, as recommended by Jan de Vries, although it is difficult to stick rigidly to it, especially with the gluton free element. I feel that if it has helped others then it's worth a try, especially as it shouldn't have the side-effects that certain drugs could have.

David Elliott

I have a scientific background, but no experience in the medical (or even pseudo-medical field). My interest is really in the cost-effective use of necessarily limited resources as exemplified (on a good day) by NICE and the kind of kicking it gets when it decides that a particular treatment is not cost-effective despite several anecdotes that it might be helpful in some cases. What is required, as well as evidence based practice, is massive public education on this issue. People simply cannot understand why, especially when it comes to them and their loved ones, decisions have to be made that are best for the population as a whole. Statistics and probability are another huge area of public misunderstanding which needs addressing in order that people can understand why some decisions are the right ones. For example, very few people understand, even now after widespread debate over a number of years, why giving their child the MMR vaccine is the right thing to do for the public well-being as well as for their own child.

David Flint

Evidence-based medicine makes a radical demand. It demands that medical treatments should work. That they should make patients better. It applies to treatments from all sources - orthodox and complementary - and to all kinds of treatments - from placebos to major surgery. Asking for money for unproven treatments - except in trials to test their value - is little different from fraud. The test of evidence is our best protection against it.

David Hyams

I have been employed in the pharmaceutical industry for over 20 years. Before that, I was an analytical chemist. Even as child I wanted to know how things worked - that’s why I became a scientist. My whole philosophy is based on “show me the evidence” and I can’t even begin to understand how anyone can take a medicine of any kind without knowing that many years of hard work have gone into proving that it is both effective and safe. Arthur C Clarke famously said “Any sufficiently advanced technology is indistinguishable from magic.” Among the general population, so few people understand or have an interest in science these days that, to the public at large, we are now living in that age of that advanced technology. Since scientists and science are generally mistrusted, true scientific claims and scientific-sounding mumbo jumbo have equal value. Any attempt to redress the balance must be worthwhile. Sadly, I feel that any such initiatives only preach to the converted and are doomed to failure. That doesn’t mean we should stop trying!

David Smith

It’s critically important that people are not harmed by short-term or long-term side effects of medicines unless they have agreed to take a known risk based on sound advice based on sound evidence. However, where side effects are known and anecdotal evidence of effectiveness is yet to be proved the decision becomes less clear e.g. when one’s GP, neuro-physio’ and consultant urologist encourage one to take a drug which is going through yet another trial. In an advancing condition e.g. secondary phase multiple sclerosis, it is important to continually weigh up the odds. That’s why evidence applies all the time.

Derek Marcus

I know placebo can have some positive effect, but find it difficult to understand why so many people fall for the con of alternative so-called 'therapies'. I suppose it parallels religious belief in having faith in something for which there is no evidence. The question is whether those that sell alternative products and services should be allowed to con the public and stopped by legislation, or whether the public needs better education to be wiser about these matters. Licensing and having 'professional' regulation bodies just gives them the credence they don't deserve.

Ethan Larson

My problem with homeopathy isn't that it's a treatment with an unknown mechanism of delivery. Homeopathy's method is very well understood by current science, and there is no way it can have any effect beyond that of the placebo effect. Further investigation into homeopathy would be akin to further research to find out if the Earth is flat. We already know it's useless; let's move on and not waste any more resources on it.

Iain Crosbie

Safety is obviously important as some of the stronger multiple sclerosis treatments in the pipeline are potentially harmful. The example is Mitaxantrone with heart disease risk and Tysabri with progressive multifocal leukoencephalopathy risks. It is important to be fully aware of these before beginning treatment or even deciding which treatments are safe or unsafe for which people. As far as effectiveness is concerned the benchmark in research is an randomised controlled trial. This is a good standard to have though my caveat is that as Professor Alasdair Coles said in his presentation at MSLIFE 2008 "Placebo has a marked effect in MS". My experience is that although Cannabanoids have no clear evidence base they certainly work for me. My gripping sensation around my abdomen is quelled by the use of Sativex. In most cases in my experience, people affected by MS will try things and see if they work and if they do, they do. If not, then discontinue them. Evidence base is powerful but cannot be the only deciding factor. I would first go to the research to find information then also some of the MS user forums to get experiences too. So it matters, but not all the time. Oh and it helps to have a friendly GP for odd prescription items!
So it matters, but not all the time.

Janet Meenaghan

Evidence-based medicine matters to me because without it, I simply wouldn't be here. My mum developed Type 1 diabetes in 1946 when she was just 15. Evidence-based medicine had by that time discovered, trialled and tested the use of insulin for diabetes and this effectively kept my mum alive into adulthood. She went to college, worked full-time, got married, had children and grandchildren - all of these aspects of normal life possible only because evidence-based medicine had developed an effective and safe solution for diabetes sufferers. I was born in 1963 and my sister in 1964 - we and our own children are truly thankful that medicine has moved out of the dark ages, that it is underpinned by proper scientific testing and that rigorous standards apply for the introduction of all new treatments.

Jenny Henderson

It definitely matters to me that the safety and/or effectiveness of medicines is based on evidence.

It would not matter to me if I was seriously ill and a doctor wished to try a medicine on me in the hope that it helped. This has happened to me with tablets from the USA not licensed in England, but seemed to be the only thing that might help my condition. They worked!

As a person with multiple sclerosis, it appears that the medical profession regard any health problem to be related to the MS and as such, surgery is never considered. However, I am living proof that life can be made more tolerable by using surgery to overcome problems, particularly relating to the bladder and bowel.

John Dean

My support of evidence-based medicine is part of a broader interest I have in understanding and (where I can) resisting pseudoscience and just straight nonsense. As a reader of Ben Goldacre in the Guardian and James Randi's website, I am only too aware of the large number of con artists and deluded snake oil peddlers out there, who can get in the way of people getting the treatment they need. I followed the MMR debate closely and was able very early on to come to the conclusion that the risks of not having my children take the jab hugely outweighed the risk of having it. Subsequent events have confirmed this was the right choice, including recent evidence of the beginning of measles outbreaks. I am paticularly concerned about the spread of homeopathic preparations to retailers such as Boots, where they are prominently displayed.

John Hawcock

As a some-time recpient of medical care though, I am glad the concept of constantly testing interventions exists. Modern medicine may not be perfect but it has made a sinificant contribution to both the quantity and quality of life.

Laurence Smaje

Science is the overwhelming success and defining feature of modern culture. It progresses by being open to repetition and refutation, if repetition by others competent in the technique do not confirm the previous findings or if further experiments provide contrary evidence. In other words, deeper understanding comes from more and better evidence. What is true of science in general is true of medicine too. One cannot use authority or votes to determine the truth or otherwise of statements purporting to provide explanations for phenomena or for the success of therapeutic interventions.

Linda Oatley

It’s imperative to me that my medications are based on scientific evidence. I couldn’t conceive of taking any medication for this condition that hadn’t been thoroughly tested. I will / do however take various supplements from time to time knowing that a large proportion of the population take them safely. Scientific evidence matters for the obvious reason that untested & un-prescribed medication is potentially very dangerous. I am risk averse when it comes to my health. The only exception in the world of multiple sclerosis, possibly, is hyperbaric oxygen therapy; from my own experience I have found no benefit or negative reaction, however there is strong anecdotal evidence that it helps with incontinence & fatigue for example.

Nickie Hallam

This is the only way of coming close to informed choice about benefits and risks. There is too much out there that claims to help, but is based on hearsay or even blind faith!

Paul Bull

What is of interest to me about it is that the people who are in charge of my medical care, including myself, embrace the philosophy of evidence-based medicine in any therapeutic advice offered. In that way I can have confidence in the risks involved being reasonably well known and chances of me experiencing serious harm minimised.

Peter Telford

My children are growing up knowing and enjoying their grandparents - I only ever knew my maternal grandmother. The longevity and quality of life that has been won through EBM does not get more human than proud, smiling grandparents and giggling children. I would like more children to know where they came from.

Rita Baillie

This matters to me because over the last 20 years I have been encouraged to try so many expensive drugs or treatments. I could have spent a bomb and it would have all been wasted! I would have done better to have a good holiday. There is no cure for MS. There are some very limited treatments for specific symptoms. These may not be for everybody. It is hope that makes us grab at straws! Remember our frailties. We need facts not dreams.

Ross W Sargent

I find it very sobering to reflect that at any other time in human history I would have been dead by the age of fifteen, a victim of Crohn's Disease. It is also very likely I could have died at an even earlier age but for vaccination against diseases which had been childhood killers for centuries. It is evidence-based medicine that has made this possible and nothing else. All the "ancient" medical systems that were all we had for thousands of years would have been worthless to me and yet we have people today peddling Ayurvedic medicine or acupuncture who never tire of saying how old these treatments are, as if this in some way proved their efficacy. At heart most so-called Complementary Alternative Medicine, no matter how dressed up in pseudoscience, is only Vitalism - the old belief that some kind of spirit or energy animates living matter and that by enabling or unblocking such energies one can influence a patient's health. Alternative treatments, whether homeopathy or Chinese "Traditional" medicine or Hopi ear-candling should meet the same standards expected for conventional treatments - if they don't they should not be called medicine, even when qualified by such weasel words as alternative, complementary or traditional.

Sally Gordon Boyd

If I or a member of my family is ill I want honest advice from a doctor. A single practitioner cannot be aware of the risks and benefits of all medicines, or even of the medicines he or she prescribes. They need to have some standard by which to compare, and information which is more extensive than their personal experience or a patient’s anecdotal evidence. EBM is an attempt to provide this. I know that not all trials are reliable and if possible I would want a medicine which has been widely tried, maybe with meta analysis. A single trial, although most useful for advertising a medicine, is not very convincing unless it can be reproduced. I am looking for a high standard of randomised controlled trial, with adequate numbers and which has been reproduced. All medicines have side effects and I want to hear about them and be in a position to make an informed choice. I support efforts to control and oversee the quality of trials, such as the Cochrane Collaboration and the James Lind Alliance. I believe it is imperative that all results, negative as well as positive, of registered trials are published and accessible.

Sally Leevers

It always matters - I wouldn't take a medicine without first investigating both safety and effectiveness.

Sandra Quincey

A few years ago I was helping a young student who had very severe psoriasis (I am a teacher aide) and she took out a tiny bottle of liquid and said that some drops were to be put under her tongue. I asked to see the bottle and was horrified to see that not only was it useless homeopathic rubbish, but it had been sold to her by the local chemist for about $20 and she and her family were on welfare and every dollar counted. I watched her develop horrible bleeding cracks on her hands and arms and she was in constant pain and I wanted to tear his own skin off of that money grabbing chemist. Fair enough if an adult chooses to buy such stuff but this young person went to them for help and they did nothing but take her money and give her nothing back. I see large sections of our chemist shops now being devoted to homeopathic junk and a homeopathic adviser on the staff. I try to avoid shops like that and not give them any of my money but it is getting harder.

Steve Clapman

Doctors have existed for hundreds of years, but it’s only with the advent of double blind studies, placebo effect etc. that they have started to save lives. Before that, trepanning, bloodletting, the four humors etc. would kill you. Complementary medicine at best does nothing, and at worst convinces people to stop their cancer medicine or anti-malarial drugs.

the Lord Plumb of Coleshill D. L.

Having served as a non-executive Director of a Pharmaceutical Group for a number of years, I appreciated the thoroughness and care taken in the research and production of medicine for animals and humans. Now aged 83, I have been able to enjoy good health and appetite, free from indigestion and high cholesterol taking my daily tablet of simvastatin and lansoprazole. This means I am living proof of evidence based medicine and Sense about Science.

Tom Parker

Without testing, without evidence, we might as well be giving people dirt off the ground as a 'cure' for their ills. Without measurement, how can we tell what works and what doesn't? Whose ambiguous piece of anecdotal unrepeatable folk tale should we judge as the best? As someone put it (and I think I'm now badly paraphrasing), "it's not science if you can't find numbers for it". In a way, this is what separates humanity from the rest of the animal kingdom - our ability to figure out things, pass them on to others, and then build upon what others have found out to continue finding out more about the universe. Without that, we wouldn't be here today. Most of us (myself included) would be long dead without the scientific process, and I'd quite like to continue living for a long while yet to come, so I will reject any form of non-EBM that tries to get pushed in my direction.