Evidence-Based Medicine Matters

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.