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The two articles on evidence-based medicine versus complementary medicine, published in the January 2004 JRSM1,2, would perhaps be more convincing if they did not ignore the numerous drugs which we are happy to peddle and the benefits of which, while `evidence-based', are all too obviously either doubtful or negative. As I survive into retirement I have to listen more and more to the experiences of friends and relations who are on various tablets. Many are on six or more different compounds, often given to counteract the side-effects of the others. Some are more or less disabled by their pills. As a purely social acquaintance one cannot be too inquisitive about the exact identities of the substances involved, but ordinary conversation often raises doubts about what has been prescribed and what for.
An example might be provided by a close relation, aged 74, who was found at a routine examination to have a marginally raised blood pressure. He was given medication for this, and as a consequence suffered from dizziness, which prevented him from driving a car. He went back to the surgery, where he saw another doctor, who put him on another medicine for the dizziness. This gave him a dry mouth and indigestion, so he went back to the surgery again, where yet another doctor diagnosed depression and put him on an SSRI. Following this he became confused and inarticulate and even more depressed. His wife and daughters began to think about funeral arrangements. Fortunately he went back to the surgery again, where he saw the practice principal, a woman on the verge of retirement and still applying a measure of commonsense, who decided that there never had been any hypertension and took him off all medication. He is now symptom-free and alert and drives his car all over the county where he lives.
This is an anecdote. Does that mean we must ignore it? How many such anecdotes constitute evidence? How can there be a controlled trial of old folk who are on too many pills? Which drug company will subsidize such a trial?
My first experience as a house physician was in 1955 with Donald Hunter, then senior physician to the London Hospital. He used to say that we were leaving the period of dangerous surgery and entering that of dangerous medicine. He seems to have been right.