Debunking medical myths
I am sure most, if not all, of us can think of something that we have learned as medical students or subsequently as doctors that has either been disproved or reversed. This brings home how much medical practice is changing. Many treatments or interventions that we previously used have now either been changed or disregarded. Meanwhile newer treatments and methods of diagnosis are coming to our attention and becoming established.
In this competitive environment it is easy to be seduced by new therapies and management plans and high-tech investigative tools. But these innovations are often expensive and have to be justified by evidence - we not only have to prove clinical effectiveness but, dare I say it, cost effectiveness of a novel treatment. The latter is not always easy.
So we have the difficult situation of wanting to introduce new therapies, diagnostic tools and care pathways but at the same time we have to assess them rigorously and independently. Even when a final conclusion has been made, that information has to be disseminated to front-line clinicians, which can be difficult as these people are bombarded with data and information every single day.
In light of this, I enjoyed reading an article recently published in the univadis GP News service which reported that "epidural steroid injections commonly used to treat low back pain may be of no benefit" (click here). However, that is not the last word on the matter as the article goes on to state that the authors "call for larger studies with longer follow-up to test the benefits of steroid injections further". An example like this certainly gives food for thought.
Of course, front-line clinicians cannot appraise all the data on every topic for themselves and so we have to rely on trusted experts who have the skills and time to analyse and then publish their findings and recommendations. This can be a costly exercise that requires dedicated funding - difficult enough even in times when money is plentiful.
Even so, it is imperative that all therapies, diagnostic tools and clinical pathways are continually assessed, which can lead to the best possible knowledge being squeezed out of the mass of information that is being created every day. At the same time, avoiding use of ineffective treatments is not only good practice, it also saves money.
So as well as being aware of the best possible evidence from trusted sources, front-line clinicians must always be willing to question, read and listen to keep aware of new trends, and be prepared to put them into practice when the evidence is convincing.
Dr Harry Brown, editor-in-chief univadis
By Dr Harry Brown