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Evidence-based medicine

"What if we tried to practise medicine according to the best evidence, only to find that half of it was mssing?" asks Minerva, in today's BMJ. In fact, as she goes on to say, that is exactly our position. She lllustrates this by citing a Cochrane review of a treatment for venous leg ulcers using flavonoid supplements. A previous review had found some support for this although the trials were mostly not good quality. Now a better trial has come to light; it was conducted by the manufacturers and did not find evidence of better healing. it was left unpublished.

Advocates of unorthodox treatments are often criticised for not providing convincing evidence of efficacy, and this criticism is often justified. But what is usually glossed over is the fact that orthodox treatments are usually in not much better shape.

The previous week Minerva reported a Canadian randomised trial of naturopathy that was published in the Canadian Medical Journal. The "more orthodox facets" of this treatment were compared with usual care to reduce cardiovascular risk factors and body mass index. Naturopathy proved more effective, and the methodolocical failings were no greater than those that are found in many similar trials of orthodox treatments.

It's not that we don't need evience of effectiveness in medicine - we do - but it's a lot harder to come by than we often think.

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