Thursday, July 26, 2012

Ask for evidence, always

The excellent Sense About Science have a campaign: Ask For Evidence. As they say: "Evidence matters in many of the decisions we make - as patients, consumers, voters and citizens. If you want to know whether a claim made in a policy, newspaper article, advert or product is backed by scientific evidence, ask the people making the claim to provide it. "

Evidence matters, and it's really important to know on what basis claims are made. One of the supporters of this campaign is Dr Christian Jessen, television presenter:
“Asking for evidence is vital to ensure quality control in science, and to stop vulnerable patients from being exploited. Believing without question has no place in science and medicine.”
A noble sentiment, but sadly Dr Jessen has fallen short of this.

Dr Margaret McCartney  wrote a good article for the Daily Mail (I know!) on the dangers of unnecessary medical screening (the references for her claims are listed on her website).

Dr Jessen tweeted these (here and here):

You can see how people responded on twitter here. What struck me from that conversation was that, quite reasonably, Dr McCartney asked Dr Jessen to back up his tweet by asking "What evidence do you want to pull me up on?" Dr Jessen entirely ignored her tweets, then later said that he had blocked her, saying that "She appears to have issues with me!", which evidently wasn't the case. This isn't a very evidence based approach - all that was being asked for was the evidence to back up the claims he had made. The closest he got is this tweet:

Is this backed up in the article? No.

Examples of what screening is good:

What patients need to remember is that the pros  of screening should outweigh  the cons.
So, for example, newborn babies have a heel prick test a few days after birth to check for several rare diseases.
These need early treatment — like thyroid abnormalities — which can make a huge difference to the well-being of the child.
So the UK National Screening Committee recommends that these tests are routinely provided and fully funded on the NHS.
And people with diabetes are recommended regular eye tests to avoid complications from  the disease.

The article finishes with what patients should be doing:
Potential patients need to know what they’re getting into — well before they get into the costly screening scanner.
Dr Christian Jessen works for DoctorCall, a company which offers people the potentially needless and harmful screening Dr McCartney was writing about. Indeed, this company also offers acupuncture, which, it has been shown, does not work.

The article didn't leave me worried. But Dr Jessen's tweets did. Dr Gregory House says of full body scans (in the episode "Role model", the title of which gave me a wry smile, given the subject matter of this post) that they are useless because "you could probably scan every one of us and find fifty doo-dads that look like cancer". It worries me when a fictional TV doctor does better than a real TV doctor.

Believing without question has no place in science or medicine.

Always ask for evidence, and watch out when someone's not forthcoming with it.

1 comment:

  1. You only have to watch "Embarrassing bodies" to see evidence for exams and tests is not a big feature of their message. I was surprised to see them promote breast self-exams and testicular exams, neither is recommended in Australia and I understand that is also the case in the UK. They also fail to mention that all cancer screening is an option, nothing more, all tests have risks and hopefully, some benefits. It annoys me when we get "should" and "must" messages....which ignores informed consent and the individual..our risk profiles and how we all feel about the nature and amount of risk we carry in our lives. We should be given risk information and details of "actual"benefits...if there is something controversial, we should hear about it, like over-diagnosis in breast screening.
    I also recall this doctor and his on-screen colleague promoting Tampap, the HPV self-test kit, available to UK women, but from memory they told women that a negative reading means you still need pap tests...which is, of course, nonsense, HPV negative women are not currently at risk and can't benefit from pap's risk for no benefit. It does nothing more than promote harmful excess if you still advise HPV negative women to have pap tests.

    I respect Dr McCartney, she is one of the very few doctors prepared to treat women as competent adults - we have very few here in Australia. The attitude has always been...conceal real information from women, anything that might put them "off screening", feed them a screening story, fiddled-with stats or a scare campaign and count them like ignorant sheep to achieve a govt set target. It's a disgraceful way to treat women; that attitude must be challenged and of course, women have to deal with all of the negative consequences that flow from excess, over-treatment and over-diagnosis. I wish we had a Dr McCartney....of course, many of these issues also involve men with full body scanning etc, but here men are treated very differently, risk information for prostate screening came out quickly and doctors were reminded to obtain informed consent. Women are6 still waiting for this same respectful treatment. Keep writing and talking, Dr McCartney!


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