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NHS Handbook criticises evidence based medicine

Professor Hunter, writing in the latest issue of the NHS Handbook, expresses concern that evidence based medicine is "being oversold as a panacea for the problems of rationing and alleged underfunding in the NHS." This view, he says, smacks of "certainty and neatness, neither of which can readily be applied to medicine."

Evidence based medicine cannot be isolated, says Professor Hunter: "Unless we understand how doctors use evidence and how they presently make decisions it is unlikely that simply providing information to them on how to do things differently, or not at all, will succeed. A balance needs to be struck between the needs of an individual patient and of a local population."

Overall, writes Professor Hunter, "the issue is not whether an intervention is effective or not but rather how effective it is and to what degree of probability."

In a separate section of the same handbook Dr Tawfique Daneshmend, consultant physician and gastroenterologist, argues that all doctors believe that they practise evidence based medicine. He says: "The current vogue for evidence based medicine is no more than good traditional scientific clinical medicine under the latest fashionable guise, genuflecting to the modern healthcare gods of cost effectiveness and cost containment."

Dr David Sackett, editor of the journal Evidence-Based Medicine, said that neither author seemed to understand what evidence based medicine was really about. He said that far from being a panacea for rationing, evidence based medicine, in seeking the best care for the individual patient, could increase the cost of care.

Dr Sackett said evidence based medicine had two elements to it: "First there is the best external evidence. Second there is the individual clinical judgment of the clinician in deciding whether that evidence applies at all and, if so, how it has to be tailored to the individual patient." --CLAUDIA COURT, BMJ

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