Evidence of Streeting credibility

Copperfield welcomes the health secretary’s lean towards evidence based medicine following his comments about prostate screening programmes

I’m not sure how this opening sentence is going to go, because it contains a combination of words I never thought I’d use, but: the other day the health secretary said something sensible which I completely agree with. There, I’ve said it.

Specifically, regarding the almost exclusively media-based tub-thumping about starting a prostate screening programme, he said we should be cautious about being swept along by campaigns and petitions and that decisions should be evidence-based and evidence-led.

That’s exactly what I’d have said! Yay for Wesidence Based Medicine!! OK, he did also say he was in favour of a prostate screening programme. But that’s like saying we’re in favour of unicorns, or eternal life, or Portsmouth not getting relegated. We all want those things but we all realise they may not happen.

So it sounds like the pendulum for dictating health policy might be swinging back in the direction of evidence based medicine. Yippee. I’m so old that I can remember when EBM wasn’t even a thing and we simply practiced according to experience, opinion and wind direction.

Then EBM became all the rage and we realised that maybe medicine would be better if we started using some facts. But when that revealed that pretty much everything we knew was wrong and that most treatments don’t work, the dial moved back to the fantasy approach. Particularly as politicians clicked that health strategy based on public clamour might ingratiate them with voters – remember mandatory training in women’s health and Davina McCall Centres?

So happy days! EBM is back with a bang, and I do prefer it that way. Not that it’s perfect. Most evidence is rubbish, as we know, and selectively cited. Specialists banging their particular drum can miss the big picture, hence evidence-based CV management meaning everyone lives long enough to end up in renal failure, care homes, or both. And, frankly, some EBM junkies are so obsessed and evangelical that you wouldn’t want to be in a locked room with one.

The main disadvantage, though, is that the EBM renaissance might flush opinion based medicine down the pan. That would be tragic and wrong. We all know that anyone presenting with TATT has nothing physically wrong with them, that no patient should be on more than six drugs, and that anyone with a chesty cough and wheeze carrying the Daily Mail needs treating not with antibiotics, nor with steroids, but with contempt. No more research required.

There is a way forward, though. The statement, ‘in my opinion, evidence medicine is the correct way to practise’ is self-evidently true, so clearly I can be both opinion and evidence based simultaneously. In other words, I can have my cake and eat it. Also, there is no evidence that cake is bad.

Dr Tony Copperfield is a GP in Essex.