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Pedaloing into an evidence-free future



Evidence based medicine. Yeah, remember that? Just a stupid fad, wasn’t it, using science and stuff to decide on the treatments we should use? After all, as the great Stewart Lee says, you can prove anything with facts.

And yet some supposedly reputable bodies still seem to think that EBM should be taken seriously. The RCGP states in its own curriculum – which, believe me, I’ve read from cover to cover, otherwise how would I know this? – that trainees should base their treatment and referral decisions on best available evidence. The GMC echoes this by saying that we should provide effective treatments based on the best available evidence.

And even that paragon of reason and common sense, the CQC, explains, rather repetitively, that, ‘By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.’

So how stupid they must all feel now. Because, in the brave new world of personal health budgets – a world, filled, as we know, with iRobots, summerhouses and pedalos – the laws of EBM no longer apply, overwhelmed by the therapeutic smell of aromatherapy and horse dung.

In fact, the RCGP must feel particularly embarrassed. Because it’s our own esteemed college that has introduced us to this new concept of evidence-free medicine, despite its worthy curriculum-based pronouncements on EBM. I quote from ‘Personal Health Budgets: Guide for GPs’ published by the RCGP, ‘People may want to use their budgets for treatments where there is no clinical evidence to support their use. This should not automatically prevent approval as, despite not being supported by clinical trials, a selected treatment may work for an individual.’

And it expands on this, in case you were at all confused, by explaining that, ‘We will need to consider appropriate treatments or services on a case-by-case basis, thinking holistically about the individual and what may or may not work for them. Allow people to try things, setting clear review dates to help assess whether something is working.’

Admittedly, they wrote this three years ago. I’ve simply sat on it while awaiting an important enough moment to give it due prominence. And now seems as good a time as any, given that personal health budgets are finally getting the publicity they richly deserve.

Because this is exactly how the college should be promoting primary care. As a place where we accept that vacuum cleaners, Wii Fit consoles and singing lessons might not have the most robust evidence base, but then nor did parachutes, and look how they turned out? So hey, let’s give them a go, they might work for you, let me know if your fibromyalgia’s feeling any better in a week or two, that’s good enough for me, even if it does mean we can afford less of the boringly conventional stuff like statins or hip replacements.

Thank you RCGP. Let’s pedalo together into this fearless, fantastical future. In fact, I’m already in the queue for my own personal health budget, with which I hope to fund some stress-relieving sexual favours from Monica Belluci. I don’t know about the evidence, but I’m sure it’ll work for me.

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield