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Don't let your practice become an evidence-free zone

GPs must apply the same standards of evidence to the complementary therapists they allow to practice from their premises and the complementary therapies they themselves offer as they do conventional treatments.

GPs must apply the same standards of evidence to the complementary therapists they allow to practice from their premises and the complementary therapies they themselves offer as they do conventional treatments.

Doctors in the UK have an obligation to practice evidence-based medicine; the GMC's ‘Good Medical Practice' document makes this quite clear: "you must provide effective treatments based on the best available evidence". The GMC also reprimands doctors who do not behave accordingly. In 2004, I was an expert witness in a case where 2 GPs were brought before the GMC for this very reason.

They had treated and advised a breast cancer patient. Instead of conventional treatments they had recommended several alternatives, including Laetrile, the infamous (i.e. disproven and dangerous) remedy from apricot kernels. The GMC panel ruled that, providing misleading information about a treatment for which there is no good evidence, is irresponsible and not in the best interest of patients. The two GPs were found guilty of serious professional misconduct.

At the time, I thought this ruling might mark an important sea of change in attitude towards evidence in British medicine. I had hoped that, in future, clinicians would have to pay much more than a mere lip service to evidence-based medicine. I was confident that this would work in favour of those forms of complementary therapy for which good evidence exists while, at the same time, stimulating research in many areas where uncertainty prevails.

For instance, I thought that doctors would now be obliged to inform a depressed patient that a good therapeutic option is St John's wort. I also hoped that doctors would tell their patients that other treatments, for instance chiropractic for conditions other than back pain, are not supported by good evidence. In other words, I had expected that the known facts about complementary medicine would now become part of GPs' working knowledge.

I fear I was wrong.

Today many GPs offer complementary therapies to their patients and many have complementary practitioners on their premises. Sadly, however, I do not have the impression that evidence has anything to do with their decision to do so.

Let me give you an example. My own GP surgery has recently started offering osteopathy. The osteopath has an office in the surgery and there is a flyer at reception informing patients that he can effectively treat a wide range of conditions. One of these, whiplash injury, caught my eye. I had just been an expert for the ‘Advertising Standards Agency' on the very same subject. The ruling was that there is insufficient evidence and therefore there should be no advertising claiming otherwise.

I decided to write a polite letter to the osteopath asking him whether he could send me any evidence for his claim. There was no reply and I forgot all about it. About a year later, I had to see my GP again and found the same flyer still on display. So I wrote another letter, this time with a copy to the principal GP of the practice. A couple of weeks later, the flyer had been changed and is now devoid of unsubstantiated claims.

All this makes me wonder: how many GP practices across the country might find themselves in similar situations? How long will complementary medicine remain an evidence-free zone? And why do so many GPs apply double standards?

Professor Edzard Ernst Recent posts

Natural doesn't mean safe. And CAM is neither 06 April 09

So-called 'integrated medicine' is disturbing nonsense 30 March 09

Why 'belief' in complementary medicine is misguided 23 March 09

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