Evidence-Based Medicine Matters

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