Adrian Koster

Agronomist, Editor & Journalist

It is vital that all medicines for MS are evidence based, efficacious, safe with least side-effects, ethically produced and researched, also that there is an immediate end to the plethora of "off-label" prescriptions which the medical profession is apt to prescribe. MS medicines should be dedicated for MS and not side-lined from very many other medical conditions for which they were originally designed and researched.

The stringency of prescription crop protection agrochemicals/products is more rigidly adhered to than is often the case in MS medicine. A crop consultant has to match the crop disease to the registered limitations of the product and has to identify the crop disease or nutritional shortcoming to justify and write the prescription. In MS medicine there can be too much guessing and assumption so that unwanted, unintended side-effects may outweigh the prescription itself.

Chris Longridge

Journalist

The general public doesn't much care about evidence-based medicine. Most people don't care about medicine at all until they need some. And when that moment comes, they need to be able to trust that what they are told about their treatment is true. That what they are told isn't merely someone's opinion, nor an unscrupulous salesman's lies to the vulnerable, nor an optimistic amateur's wild speculation. They need to know that what they are told about their treatment is as true as can be realistically expected in an imperfect world. Evidence-based medicine is of no interest to the healthy and of fundamental importance to those same people when they become sick. It is what we all deserve, and it's up to our elected leaders to make sure that we receive it, because until the worst happens, none of us has time to care about it. That's what governments are for.

Dr*T

Editor, Thinking Is Dangerous

If you suffer from arthritis (which unfortunately I do), you'll almost certainly be aware of the barrage of companies ready to take your hard-earned cash in return for promised pain relief or even a cure. Modern medicine, although coming on leaps and bounds, is still a bit duff when it comes diseases like arthritis. Outwith mechanical intervention, pain management is about all there is, and even then, the painkillers can have side effects and long term effects that aren't much fun. Put yourself in that position - constant chronic pain, only slightly eased by medication - and suddenly old wives tales, exotic berries and other natural products seem to hold the answer. We can't hope for pill-pushers and nonsense therapy merchants to have much proof, because people buy the dream, not the evidence. We need medicine and knowledge that is evidence-based to be able to base our pain-management approach on treatments that have been shown to be effective. Otherwise, we're throwing our money at the moon. The Daily Mail has trumpeted rosehips, vegan diet, white wine and vitamin D as ways of reducing the pain or risk of arthritis, with little evidence to show, but shamefully didn't publish an important piece of research which came out in 2008 - a large randomized, placebo-controlled trial conducted at several sites across the USA - which showed that glucosamine and chondroitin are no better than placebo at pain reduction or slowing down osteoarthritis progression. This sort of study is what NICE base their recommendations on, meaning that the best possible treatments can be given to patients and that individuals benefit from the latest knowledge. Furthermore, our knowledge of the disease advances with every trial and by following Evidence Based Medicine, I hope my grandchildren will laugh at the silly, baseless treatments currently on the market in the same way we currently view leeches.

Sir Iain Chalmers

Editor, James Lind Library

As far as I am concerned there should be a single standard to judge evidence across the board – orthodox and complementary/alternative.

Evidence based medicine is important to me as a patient, because that’s where I come from now. I used to be a clinician, I used to be a researcher, but I’m none of those things now. I’m a patient. By demanding an expensive treatment that might have a modest advantage over some alternative treatment, I will probably reduce treatment options open to other people using the National Health Service. In a spirit of, if you like, social solidarity, I feel that, as our National Health Service will always have a limited budget, it is proper to be thinking about the costs of treatments, and not to be blinkeredly selfish in deciding that one must have a treatment regardless of its effectiveness and cost.

All of the relevant information needs to be made available to those who are judging whether drugs should be released for us to be given them. One of the things that annoys me about some ‘scientific establishment’ statements on complementary medicine is the failure to take sufficient account of psychologically mediated effects of care and the need for more research to understand how best to exploit them. Many, perhaps most patients know that these elements of health care are important, so it’s silly to pretend they aren’t out there and in needs of consideration.

Dr Irene Hames

Managing Editor, The Plant Journal

Patients place their trust in their doctors, and want to feel confident that they are receiving the best possible care and treatment. The practice of evidence-based medicine helps ensure this happens. It provides a framework whereby the best clinical and scientific evidence available is identified and appraised, and can then be translated into effective and safe everyday practice by doctors based on their own experience and, very importantly, knowledge of their individual patients. But just because research has been published this doesn’t necessarily mean it can be trusted, or that it represents a completely accurate picture. Studies may have been poorly designed or carried out. Some may subsequently be shown to be flawed, or even fraudulent. It is also widely recognised that there is bias in publication – for example, studies reporting positive results are more likely to be published than those with negative results, sponsors of work may be selective in what they put forward for publication, holding back unfavourable studies or misrepresenting findings by exaggerating the benefits and minimising the risks. The path from getting results to final publication and dissemination is a long and complex one. It is open to abuse and unethical practices, such as ‘ghost management’. Here people and companies not directly involved with the work manage its handling and publication, with the primary aim of achieving an outcome other than just the advancement of human knowledge, for example the promotion of a product for commercial gain. Sometimes, influential people who have contributed nothing to the work may even be added as authors to bestow authority and increase dissemination. How can healthcare professionals find their way through all this? Daily they face the challenge of keeping up with medical advances as well as providing care for their patients. For many it would be impossible to keep track of the rapidly expanding medical and scientific literature, let alone feel confident in its critical appraisal as part of their evidence-based treatment strategies. Luckily there are resources available – such as the Cochrane Library and the databases of the Centre for Reviews and Dissemination - that they can turn to and use to inform their decision making in the health care they give their patients. These identify the highest quality research evidence available on healthcare-related issues and clinical interventions and treatments, and provide systematic reviews of that evidence. In these days of ever-increasing availability of information where anyone can put anything up online, they provide a gold standard that can be trusted.

Mandy Payne

Freelance Medical Writer

I’ve been into evidence ever since I was told as a small child that I shouldn’t pull a face because if the wind changed I’d get stuck like that. I’ve always been amazed at the way people cling on to preposterous ideas about health. You can smile to yourself when you hear nonsense about draughts, earwigs, going outside with wet hair... but when new mums reject the powerful link between cigarette smoking and risk of cot death because they once saw a TV programme that blamed it on the mattresses, or deprive their kids of life-saving vaccines for fear they’ll make them autistic, it’s not so funny. Medical writers like myself are hugely privileged in that we can speak directly to the experts to get as close as possible to the truth, or at least to the current nearest approximation of the truth. The general public have to rely on a hotch potch of hearsay, websites of dubious accuracy, and of course what we journalists churn out. So we’ve a massive responsibility to write as accurately as possible, especially when it goes against popular beliefs. We don’t always succeed. Over-simplifying for lay readers can introduce misinformation. And of course the experts don’t always agree with each other. Look at the debate in the BMJ recently*, about whether or not sunbathing causes cancer deaths. Most ordinary people think the link is cut and dried, and obediently slap on the cream and sunhats. But what if life in the shade is linked with a whole other spectrum of diseases? Evidence-based medicine means constantly having to question and adjust your beliefs about health – there’s no room for closed minds. As a woman I’m irritated when my girlfriends rush off for expensive all-round health checks “just to be sure” when there’s no evidence they actually do any good. And when the midwife gave me homeopathic arnica tablets during labour. I didn’t need a placebo against bruising, and I neither did I want to start wondering if anything else going on in the delivery room that day was unproven. As a consumer I don’t want to see shop windows displaying lists of serious diseases that can be “helped” by Chinese medicine/homeopathy/naturopathic diets etc. Or homeopathic remedies and supplements of unproven benefit lining the shelves of trusted big-name high-street pharmacies (OK, Boots). Among the hundreds of shoppers that will walk by every day, how many will know what is nonsense and what isn’t? As a parent I’m dismayed by misleading health information in my children’s schools. Sometimes it’s just well-intentioned groups taking a daft idea and running with it. Like saying that drinking more water improves kids’ test results, promoted in schools all over the UK on the shakiest of evidence. And I fume when healthy kids are excluded from school because of headlice. Here, even after schools are presented with the best scientific evidence, I still see ignorance and superstition win while children lose out. *BMJ Online First, 22 July 2008. BMJ 2008;337:a764

Professor Michael Wilson

Editor, The Journal of Horticultural Science & Biotechnology

Centuries ago, we had no choice but to seek solace (but little else) from the purveyors of “snake-oils”, magical remedies, and all manner of quackery, relics and pardons. Happily, after 200 years of sound scientific research, we are (and should continue to be) in a much better (and improving) situation – but only if the clear evidence of top-quality science-based medicine is supported.

As a professional scientist with 40 years of post-high school learning, research and broad experience, it saddens and irks me that so much credit and credibility is given to the “soft-minded” nonsense and profound ignorance that now pervades our media, our personal product advertising, and our safer, more secure and comfortable society. Without the genius and sound experimental evidence behind modern human medicine (physiology, biochemistry and pharmacology) many, including myself, would simply not be living today. Quite bluntly, I much prefer to believe in and benefit from the objective factual evidence of modern pharmacology than in the rantings and “provings” of what is now politely and mystically termed “alternative medicine”.

Paul Chrisp

Editor, Core Medical Publishing

EBM is at the heart of my business; I publish a medical journal Core Evidence (www.coremedicalpublishing.com) that provides doctors, pharmacists and healthcare commissioners with the evidence on the clinical and cost effectiveness of new drugs. This is crucially important to aid rational decision making, as the demands increase on limited healthcare resources from new, more expensive treatments, and an aging population who expect the best. Without EBM, money will be wasted, and the right patients may not get the right treatment at the right time.

Prue Leith

Author and Cook

I have a friend with severe manic depression so I've been asking around for advice. Everyone has an answer: meditation, hormone therapy, faith, exercise, routine, yoga, Chinese herbs, colonic irrigation, massage, acupuncture, talk therapy, medication. For none of these, except the last, is there any evidence-based research, and even for medication, there is pretty little.

Dr Richard Burnham

Freelance Writer

CAM proponents like to use the word 'holistic'. It seems to me that EBM is what offers truly holistic support for the patient and his or her family. I had a brother and sister who died around 30 years ago in their 20s/30s. They were born with cystic fibrosis (CF), the most common genetically-transmitted condition amongst people of western European descent. Although they died young, they were amongst the earliest CF patients to survive to adulthood. This was entirely due to increasing scientific knowledge of the disease. Research, including detailed understanding of the genetic mutations and their effects, now offers not only treatment with dietary supplements and antibiotics, but also early diagnosis, physiotherapy, high-dependency or intensive care where required and even lung transplants. There is genetic counselling for carriers or suspected carriers of the gene. Perhaps one day gene therapy may remove the threat of the disease. I’m sure that CF sufferers are not the only people who have been given the chance of leading fuller lives by advances in scientific medicine.

Richard Horton

Editor, The Lancet

Progress to reduce disadvantage, inequality, and poor health in society depends on generating the best and most reliable evidence. This is the task of modern medical and public-health science, and it is a task that those who work in these fields do incredibly successfully. Yet there is a terrible schizm between the production of reliable knowledge and its application. Partly, this is the fault of scientists for failing to appreciate the critical part they play in social change. But partly too it is the fault of policy makers who too often choose to ignore evidence and make decisions based on instinct or ideology. Our collective task – and this is a mission The Lancet is passionate about – is to bring scientists and policymakers together to deliver the benefits of science to those who need them most: the individuals and communities that we, as doctors, serve before anyone else.

Dr Susanne Ludgate

Clinical Director, Devices, Medicines and Healthcare products Regulatory Agency

Evidence-based medicine is vitally important to ensure patients are given the optimal treatment for their particular condition and circumstances.