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When evidence-based medicine evaporates

Copperfield is concerned over a new scheme offering support to families that have previously suffered a cot death.

Copperfield is concerned over a new scheme offering support to families that have previously suffered a cot death.

Just so we lose the raving anecdotalists from the very outset, let's just agree that – whether by natural inclination or by being beaten with sticks – we all practice EBM these days. OK? Good.

So how evidence-based, do you suppose, would an intervention offered to new parents who've previously suffered a cot death have to be? An intervention which could involve any or all of the following: weekly home visits by a health visitor; apnoea monitors; symptom diaries; room temperature monitoring; weekly, sometimes daily, weighing?

Wow, you'd think. With that level of intensity and with such high stakes, and going back to the original, EBM question, you'd have to say, ‘Very.' In which case, you're in for a surprise.

The CONI scheme (that's ‘Care Of Next Infant'), which has just hit my area big time – and is probably heading your way if it isn't there already – is a programme to offer support to families that have previously suffered a cot death.

The thing is, and I almost hate to say this given that it's obviously well-intentioned, there doesn't seem to be any good evidence that it prevents subsequent cot-death. Indeed, as the blurb almost disarmingly puts it, ‘It must however be noted that the procedures recommended are based on user reaction only and have not been subjected to scientific controlled evaluation.'

So, we don't know if it works, but people like it. Hang on. In the name of EBM, and logic, and rational use of funds, and patient and hospital protection, I spend large parts of my day denying the punters things they'd like, such as antibiotics, sick notes and unnecessary MRI scans. How is it that this principle evaporates just because we're dealing with something as emotive as cot death?

And if it does, why stop with apnoea monitors, health visitor visits, temperature monitoring, symptoms diaries and weighing? Why not get a professor of paediatrics to phone every half hour just to confirm that everything's still OK?

I can already hear the fluff-heads and SIDS charity tub thumpers saying, ‘Can't do any harm, though, can it?' I beg to differ. Up to a third of parents find the scheme ‘Worrying at times'. Besides, are the families subjected to this interventional blitzing actually made aware that there's no evidence of benefit outside of being impressed that everyone's so blitizingly interventionist? If not, they're being deceived – benignly, perhaps, but deceived nonetheless.

Ironic that the do-gooders imply apnoea in the new baby can be prevented by smothering the family. CONI? Phoney, more like.

Copperfield

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