Dr Alan Davies

Medical Director, GE Healthcare

Alison Lapper Pregnant, the 3-metre statue on the fourth plinth in London's Trafalgar Square up to late 2007 was, I thought, a wonderful celebration of life and womanhood. I was almost blind to her phocomelia. It also reminded me that the thalidomide tragedy drove the first Medicines Act and encouraged the tripartite approach of safety, efficacy and quality that underpins modern medical practice. But we realised later that this is not enough. It is not always about 'what can we do?' but is often, in medicine, when there are so many choices ' what should we do"? There are many reasons for choosing one particular treatment option over another. Scientific medicine requires that the evidence base increasingly helps us to make a decision that is grounded in fact and knowledge.

Dr Andrew Conway Morris

Anaesthetist

As a doctor, I find basing my decisions on the best available evidence gives me the confidence that I am doing my best for my patients. Although it does not replace the need to judge each patient as an individual, it removes a lot of the guesswork and 'practice by tradition' which typified medicine in the pre-scientific era. Working in intensive care and anaesthesia I have seen many treatments dropped when trials clearly show them to be of no benefit, the rigor of evidence-based medicine also helps limit fads for new but unproven treatments. However I would argue that the greatest benefit of evidence-based medicine is seen outside my field of practice, in the area of paediatric oncology. Survival rates for childhood leukaemias are now above 80% for the most common types, a major advance over the past 30 years. These advances would not have occured without rigorous testing of treatment regimes and adoption of the best possible therapies.

Bob Ellison

Senior Clinical Effectiveness and Audit Facilitator

EBM matters to me because it's proven medicine, using best evidence with documented and tested scientific proof for care of patients. It's not a treatment based on anecdotal hearsay or 'Aunty Flo's remedy'. It's the real thing properly tested and evidenced to work.

I work in Clinical Effectiveness/Clinical Governance and EBM and evidence-based Practice is the mainstay of credibility, effectiveness, efficacy and safety of patient care.

Dr Christopher Cates

GP

In my view, evidence alone will not make a good doctor, but I would ask how it is possible to be a good doctor without any reference to the evidence.

Dr Danielle Freedman

Consultant Chemical Pathologist and Associate Physician in Clinical Endocrinology

As somebody with a scientific background, I’m a great follower of evidence-based medicine, but I get extremely frustrated by the process, by which even when the evidence is overt, it may take many years before it’s implemented in every day practice. A couple of examples are: 1) the time it took for thrombolysis to be used in the treatment of myocardial infarction - the evidence was known about several years before it became accepted practice. 2) the use of a marker for congestive cardiac failure called BNP. The evidence came out from the Department of Health supporting it as a frontline marker for cardiac failure, but many laboratories in this country have not be funded to provide this lab test.

John Renish

Retired Healthcare Administrator

Evidence-based medicine is the only medicine that can assure us that it "works". Evidence-based medicine has the additional quality of offering quantifiable benefits and known risks and costs, enabling societies to make rational decisions among competitive treatments. There is no alternative medicine, only unproven medicine: if an alternative treatment's supporters can demonstrate its efficacy and safety, it automatically becomes part of orthodox medicine. During a long career in health care, I often encountered people who were ill or injured because of inattention to preventive measures or just plain ignorance. Since retiring, I have come to believe the latter cause is increasingly important in morbidity and mortality. That so many ordinary people - some of them intelligent - believe in dangerous nonsense is a public health tragedy.

Professor John Wattis

Professor of Old Age Psychiatry

Evidence-based medicine is a vital component of good clinical practice. The evidence base shows the importance of clinician-patient and wider social relationships and these must not be ignored. Nor should the importance of a creative synthesis of ideas in forming individual treatment plans be underestimated. The absence of evidence of effectiveness is not the same as evidence of absence of effectiveness. However, good clinical practice demands that we search for and develop evidence of efficacy and effectiveness and select treatment options according to the best evidence available. You will see from the above that I do not think a narrow "evidence-based" approach is adequate. We must embrace evidence about how we practice medicine as well as the narrower and more precise evidence about what treatment works in what groups of conditions; but without an evidence base clinical practice is like a rudderless ship adrift in an ocean and tossed this way and that by the currents of prevalent fashion!

Juliet Stevens

Medical Student

An evidence base is vital if one is to understand the benefit of one treatment over another. Medicine without an evidence base is, in the huge majority of cases, highly dubious in modern practice.

Ken Gillman

Retired Psychiatrist

My comment is simple, make sure we apply the sample sceptical and critical standards to 'big pharma' drugs as we should/do to alternative medicines. There are plenty of examples of psychotropics that have very poor evidence of efficacy.

Les Rose

Clinical Research Consultant, Pharmavision Consulting

The Medicines Act marked the end of the era of snake oil salesmen – or so we thought. The Act was triggered by an obvious need for evidence for the safety of medicines, but the necessity of evidence for efficacy was equally understood at the time. Informed decisions need evidence, whether the decision is in health care or anywhere else. Forty years later this is still not properly understood by many who should understand it – such as politicians, theologians, and even some eminent physicians seeking career advancement. Knowledge is power, and knowledge cannot exist without evidence.

Dr Michael Fitzpatrick

GP and author of Defeating Autism: A Damaging Delusion

Promoters of ‘unorthodox biomedical’ treatments in autism – including diets and supplements, detox regimes and drugs – often claim that their therapies are effective and safe. When asked to justify these claims they cite clinical experience and testimonials from satisfied customers. But the medical profession has learnt from systematic studies that many medications that doctors had been using for years were neither effective nor safe. Any number of experiences and anecdotes does not add up to scientific data.

Unorthodox practitioners insist that they do ‘what works’ rather than waiting for trials. But without trials how do we know what works – and what might cause harm? This crass empiricism takes us back to the dark ages of medical practice when therapeutics was guided by personal impressions and intuition – and patients suffered the consequences.

Dr Oliver Samuel

GP

Having practised as a GP with the murkiest of knowledge how effective what we did could be, I embraced the arrival of EBM - not only the statistical assessment of evidence, but above all else the ready availability of information on the web, Medline etc. This transformed my working life. So I was saddened by the increasing public acceptance of crackpot medicine just at the time we had begun to know what really did make a difference. Still we were at last able to tell the difference and advise out patients accordingly, even if the others were now able to advertise strongly their line of practice which lacked science but was able to attract support - rather the way tobacco does.

Dr Simon Baker

Vet

As a vet my primary concern is the welfare of animals. That welfare is not served well by the use of therapies, especially homeopathy, that are not merely unproven but disproven. I gathered a number of significant figures in the profession to request the Royal College of Veterinary Surgeons to make a clear statement that use of homeopathy can never be in an animal's best interest. The response from the then RCVS President was deeply depressing and quite misguided. We were asked to consider that our responsibility was to act in accordance with clients' wishes, which is of course the problem not the solution.

The Rt Hon the Lord Jenkin of Roding

Former Secretary of State for Health (1979 - 81) and Life Peer

I have little doubt that one of the most important techniques of evidence-based medicine, used to verify claims about new drugs and treatments, is the 'double blind clinical trial. Of course, nothing is without flaws, but such trials go a long way to eliminate any possibility of bias in assessing the results. When both the patient and his doctor do not know which patients are receiving, say, the drug to be tested and which are receiving a placebo, the results should avoid any suspicion of bias. However, there is some evidence that even administering a placebo can mislead a patient into thinking he is getting better, so the more objective the assessment can be, the better. A proper peer review of the process is also important to ensure that trials which do not support the claims made for a drug are disclosed, fully taken into account and not suppressed. Properly used, this technique is evidence-based medicine at its best.

Dr Tore Bye

Physician

As a physician I want to know that the treatments I prescribe or the preventive measures I recomend probably are effective and there are reasonable explanations for their effectiveness.

Dr William Lee

Psychiatrist

My patients deserve the best advice that knowledge has to offer. This means EBM, not flim-flam, conjecture, wishful thinking, hand waving and falsehood. This is their other choice.