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Independents' Day

I'm weak at the knees at this new research

Copperfield

Makes you wonder whose side those researchers they have these days are on, doesn’t it? Particularly when they come up with findings that suggest that not only do cortisone injections for osteoarthritic knees not work, they may make matters worse. It was there, in the BMJ. Yeah, I know. But still.

It also makes you wonder where common sense has gone in medicine. I give loads of knee injections, and most of my patients swear by it. Some even swear during it.

Besides, they’ve made the schoolboy error of taking a very patient-centric view. There are two sides to any intervention, and by stupidly focusing solely on patient benefit, they have completely overlooked the benefits to the GP. Specifically:

By focusing solely on patient benefit, they’ve completely overlooked the benefits to the GP

1 These are really easy consultations, as they don’t require any intellectual activity whatsoever.

2 The injection gives the illusion that we are actually doing something, which makes a nice change from the delusion that we are actually doing something (eg: dishing out statins to patients who won’t take them to prevent something that wouldn’t have happened anyway).

3 We get paid for doing them.

Take this away from us, and what do we have to offer patients?

Research (that again) suggests that standard oral analgesics are ineffective/potentially dangerous, waits for physio are beyond average life expectancy, and TKRs are only available to those who are paragons of health virtue and most of these patients aren’t (try weighing them) otherwise they probably wouldn’t have such bad OA in the first place.

It’s EBM gone mad and they’re just spoiling it for the rest of us. Why don’t they do something useful instead, and meta-analyse the hell out of the Government’s suggestion that we should be visiting residential homes every week?

That workload can only increase, on account of a lot of untreated arthritis. In the meantime, let’s give those so-called researchers an injection of common sense. Or doesn’t it work?

Dr Tony Copperfield is a GP in Essex. Read more of Copperfield’s blogs at http://www.pulsetoday.co.uk/views/copperfield or follow him on Twitter @doccopperfield

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Readers' comments (10)

  • Ivan Benett

    Very amusing I’m sure. Indeed there has never been evidence of long term benefit from intra-articular steroid injections.
    However, there IS overwhelming evidence that statins reduce MI, stroke and death in people with coronary disease, cerebrovascular disease and peripheral vascular disease.
    Whilst these populist articles can be entertaining, and I hope I’m not a kill joy, I do think that they should restrain themselves from spreading falsehoods.
    You can’t on one hand promote EBM, then ignore the evidence you don’t like.

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  • When you look at numbers needed to treat especially at q-risk of 10% many of those given statins were never going to die of a heart attack or stroke and the statins did nothing. Problem is our ability to pick out those that would have benefitted.

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  • Who would you rather have as your own GP - Tony or Ivan?
    Give me Tony every time

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  • Definitely Tony

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  • Tony any day

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  • An apple a day

    I'd rather have Tony as my GP too!

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  • I'm sorry Ivan - but its Tony for me. By the way. Your evidence base doesn't have any evidence base. Why don't big pharma publish ALL their -ve studies too?

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  • Look at Malcolm Kendrick's latest blog about placebos, specifically the placebos used in the major stain trials. Amazingly, the adverse event percentage for the statin in question was almost exactly the same as that of the placebo, in every trial. So what, you may say - the interesting thing is that the rate of adverse events varies from single figure percentages in some to over 80% in the meteor trial. Isn't it handy that the placebo adverse event rate always mirrors the statin adverse event rate, almost as if they'd been chosen with side effects in mind? The drug companies will not release the details of the placebos used either.

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  • Definitely Tony! Sorry Ivan but you are a kill joy. We read Tony's articles for a laugh. GPs are not stupid and we know when to and when not to use statins.

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  • Just Your Average Joe

    i would rather have a steroid injection for my knee than a statin - statin made me aches like a 90 year old, tried all and dose variations.

    Don't care if It saves a MI in 20yrs time as can't live in pain for next 20 years, plus my knee hurts!

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