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Evidence-based medicine prophets are going too far

The undermining of a profession through doubt and innuendo has far-reaching and unexpected consequences. So it is with the revisionist philosophy of evidence-based medicine and its prophets at NICE and the MHRA.

Last week NICE delivered a damning verdict on the traditional management of diarrhoea and vomiting in primary care while the MHRA sowed panic among mothers with grizzly infants by banning use of Bonjela in the under-16s. And yet the statistical evidence for both these edicts was very flimsy indeed.

For example, NICE said there were 150,000 cases of diarrhoea and vomiting per annum in England, 37,000 of which resulted in hospital admission. No GP would recognise that ratio of one admission to every four cases.

The incidence seems unrealistically low, but on closer scrutiny the reference paper actually counts the number of rotavirus cases.

How many GPs check for rotavirus in this most common of childhood complaints, which invariably runs a short and benign course requiring minimum input from the medical profession?

And is it really so important to deride use of carbonated drinks? Most contain 5-10% sugar and no sodium. Is that really, for the short time required, so bad for the toddler? Do we need to recommend commercial oral-replacement solutions?

It's a similar situation with proprietary gels containing salicylate for teething. The MHRA recommendation was based on three cases, which could have been Reye's syndrome but were not. This is the same Reye's syndrome of which 52 cases were reported in five, yes five, years in the 1990s.

So GPs who in good faith have given desperate mothers some realistic support for two minor conditions are now accused of infanticide by the more informed of those same mothers. Once again, anxiety levels in this increasingly hysterical population of ours have been racked up. The bond of trust between family and family doctor has been weakened.

One day we will look back and wonder whether this was what we wanted when our laudable aim was to promote 'good practice'.

From Dr Jim Sherifi, Sudbury, Suffolk

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