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Thursday 11 June 2009

The time to switch to evidence-based medicine is now

The NHS is facing a massive shortfall. So what else is new? It can simply join the pile, along with education, local government, transport, the UK economy in general...

The answer was merely touched upon in the report, but it was there nonetheless. Privatisation - even part-privatisation - is not the answer (just look at the mess they made of the railways (privatisation without competition is corporate monopoly). The answer (or at least a good part of it) is cutting funding for non-essential services.

The article touched on two prime examples, homeopathy and IVF. There are two separate, but very good reason why these ought to be first on the lists of cuts.

There is no evidence-based for homeopathy working. The two basic principles, in case you are unaware, are that firstly you give a compound designed for the symptoms, rather than the pathogen, and you give the smallest possible amount of that compound. This means that, for example, a cold can be treated in many different ways depending on whether the sufferer has 'just a sniffle', a blocked nose and sore throat, a chesty cough or a nasty head-cold - even if they are all caused by the same strain of the rhinovirus, and you will only give them a very dilute compound (measured in parts per million, ppm, rather than a percentage).

Now, this may sound like it's never going to work to you and me, but that's not good enough - it may work. So, it needs to be tested. This means a double-blind randomised controlled trial, ie one group of patients getting active homeopathy drugs, and one getting placebo instead. If it is proved to work, then it need to be tested against the current standard therapy to see if it is more effective, or more effective per unit cost. This trial should, like all other drugs trials, be funded by the company making these pills, not the NHS. If it is proven to work, great! Bring it in, I'll eat my words, and we can stop using the current expensive treatments. Until that day, homeopathy has no place in our hospitals.

The second area for cutbacks - IVF. To me, this is a lifestyle choice, not a health condition. We'd not advocate performing breast augmentation, collagen lip enhancement or hair replacement on the NHS, so why IVF? Fair enough, some people cannot conceive naturally, and all they want in the world is to have a child. This is very upsetting for them, but why should the rest of us forgo our herceptin, insulin and salbutamol for them to bring another child into an already overpopulated country? The horrible fact is that some people are probably infertile for a reason. Now, I'm not one to utilise Darwinian theory to advocate eugenics and Fascism, but it is a fact that IVF produces a higher incidence of genetic disorders and malformations than natural conceptions, disorders which then need to be treated by the NHS, costing us again. Whilst I believe that the mark of a society is the ability of the whole to look after it's weaker members, rather than allowing them to die off, we should not be actively encouraging nature where it simply does not wish to co-operate.

The problem is that by not funding IVF, we give up the right to control it, and when it goes into private practice, who know is the prospective parents will stop at simply growing eggs? Will they select for blue eyes, brown hair or height? Will they ever be able to select for a musical ear, a sporting body or a scientist's brain? And what about if they can select against Down's Syndrome, Muscular Dystrophy and Haemophilia, or even protect against diabetes mellitus, breast cancer or heart disease? Will stopping public money for IVF create a private-sector elite?

So what to do? We need to keep pouring money into the (if not bottomless certainly very deep) pit that is the National Health Service, whilst simultaneously looking for ways to plug the leaks throughout the system. One of the better ways would be a fully evidence-based approach to drugs in the NHS, to block the sink that is homeopathy, acupuncture and all the other new-age unproven methods. Banning 'personal choice' treatments may be more controversial, but do remember the old saying; "As long as you've got your health, that's all that matters".

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