Evidence Based Medicine

Seeing is not necessarily believing

Cartoon RatI had a post half-written, and then life got in the way (as it does). Then this happened…

The Independent and the Telegraph (among others) report that a giant rat has been found near a children’s playground in Hackney. The article has a picture of the monster rodent being held up by the chap who found it. The Telegraph speculates that this might be a cane rat – which apparently do grow to huge size – and that they might be breeding in London’s sewers. [Scream!]

And then, the Guardian also reports on the giant rat, which, it seems, is not as giant as all that. It’s all to do with your perspective, according to the chap the Guardian journalists spoke to. The Guardian article also features a “giant orange fox”, photographed in their very own offices, in case of doubt. Basically, if you hold out an object such as a rat (to take an example totally not at random) in front of you on a stick and get your mate to take a photo from the right angle, it looks as though the common-or-garden rat you’ve got is actually a huge monster rat.

As the Guardian (rather smugly) says, this is why you shouldn’t believe everything you read on the internet.

Journalistic standards have obviously sunk; one expects this kind of thing from red-top tabloids, but not from the Independent and the Telegraph (as far as I can tell, The Times has preserved a dignified – or lucky – silence). One might speculate that the growth of web 2.0, and the ability of everyone and his brother to stick news up on the internet has meant that real journalists have to make sure they get their news in quick while it’s still news, and before they get scooped by some bloke on Facebook. More expert people than I have written about this problem – journalists, even from ‘reputable’ news sources, leap on a rumour and report it as fact, or with minor hedging-words like ‘reportedly’ or ‘claiming’ – and thus people are deceived.

And that’s being charitable, and putting the misinformation down to carelessness, and not self-interest and malice. The overall standard of reporting on certain hot-button topics like immigration, Europe and human rights can’t be put down to just journalistic ignorance. If it was ignorance, surely there ought to be a few reasonably intelligent journalists out there who would learn from prior mistakes and get better at it. But reporting standards have been awful for years, so it must be on purpose. Adam Wagner, a human rights barrister, got so fed up with the poor standard of human rights reporting by journalists that he founded Rightsinfo, which exists to give people the real facts. With pretty graphics.

I find it depressing, personally. Journalists are very keen to jump up and down about their journalistic privileges being infringed – but they seem to forget that their privileges as regards information gathering and dissemination are in exchange for being the source of information the public relies on. If they are not doing their job properly by giving us reliable information, why should they have privileges?

Of course, I might be wrong. The Independent and the Telegraph might have it right: after all, Sherlock Holmes knew about this stuff. The Giant Rats of Sumatra are obviously alive and well and living in Hackney…


The end is nigh? Homeopathy on the NHS in Glasgow

Fairy Gold

Fairy Gold

A judicial review challenge to Glasgow Health Authority’s decision to stop funding referrals to a homeopathic clinic has failed. You can read the judgement here.

This is a considerable relief to those of us who support evidence based medicine – that is, who believe that the NHS should spend its limited resources on treatments that have good evidence that they actually work, or at least probably work.

I’ve been the person trawling through the research papers, trying to figure out whether a particular treatment is beneficial or not. I’ve written the final report for the formulary committee, so that they can decide whether the evidence is good enough, or not, to commit patients’ health, and NHS money, to. It’s therefore a continual astonishment to me that “alternative” treatments seem to get a free pass.

There is no good evidence that homeopathy works. Any non-alternative treatment that had as little going for it as homeopathy would have been ditched years ago. Yes, I can understand that homeopathy was popular in the 19th century, when it actually was a good option. When the alternative is medicines containing mercury or arsenic, then little sugar pills start to look really good. I’d pick the sugar pill over the mercury chloride myself. But modern medicine has moved on.

Nowadays, we’ve got beyond the stage of “Just don’t kill the patient, eh?” Nowadays, we actually aim to make people better, and a lot of time we even achieve it. And, since the NHS is paid for by the taxpayer, we also try to do it in a cost-efficient manner.

Why is it that “alternative” treatments get held to a lower standard than mainstream medicine? Why is it that all you have to do is tell some kind of mystical cock-and-bull story, and suddenly you don’t have to jump through all the hoops that the boring old scientists do?

But what really gets my goat about homeopathy is that it is based on a fundamental error. The chap who started all this – a Dr Hahnemann – noticed that preparations of cinchona bark cured malaria. He further noted that taking cinchona bark induced malaria-like symptoms in himself. He therefore came up with the theory – not unnaturally, given the state of medicine at the time – that a thing that induced symptoms in large quantities would cure them in small quantities. Thus homeopathy.

Unfortunately for Hahnemann, and the theory of homeopathy, the reason cinchona bark cures malaria is because it contains quinine. Which is still one of the main drugs for treating malaria. Cinchona bark cures malaria not because of any homeopathic principles but because it’s chock-full of a powerful drug that kills the malaria parasite.

So, despite the fact that the entire theory of homeopathy is based on a massive (though understandable at the time) error, it’s still surviving. I wonder if it’s because most people want to believe in the magic, the fairy-dust? Maybe the people holding the budget want to believe in little sugar pills because, compared to monoclonal antibodies, they’re cheap. If we could all just take a little sugar pill and get better, or if the fairy tale about the gold at the end of the rainbow were real, the NHS would not have the financial woes that it does.

But the NHS does not waste time searching for fairy gold, and it should not waste money on homeopathy. This judgement represents one more step taken in the fight against waste and inefficiency.

Good work, NHS Lothian.