Evidence Expert is Expert of Nothing

There is a new kind of fundamentalism creeping its way onto the medical scene, it is Evidence Based Medicine Fundamentalism. NICE are a centralised organisation that demonstrate this kind of fundamentalism very well indeed with their never ending protocols and guidelines. In fact NICE have recently been in the news with their frankly stupid osteoporosis guidelines, they continue to restrict the prescribing power of specialists while empowering the incompetent PCTs. Numerous specialists have come out against NICE on this issue and the National Osteoporosis Society has gathered thousands of signatures in a petition against NICE's proposals.

This is hardly the first time that NICE has tried to enforce their flawed interpretation of scientific evidence upon the whole medical community. NICE has become a political rationing machine and is undermining good medical practice based on the scientific evidence. On many occasions NICE is dictating its guidelines to top specialists in that particular field, when these guidelines have been crafted by people who are very far from being experts in this field. In this way moronic centralised totalitarianism is replacing local excellence.

The man photographed is Professor Paul Galsziou, a Professor of Evidence Based Medicine, and the reason that he is being mentioned alongside the fundamentalists of NICE is a recent piece that he wrote in the BMJ. Prof Glasziou, a GP by trade, elected to treat a radial head fracture without seeking advice from the local specialists because he thought that a quick literature search would be good enough:

"I went to the Clinical Queries section of PubMed Central (which is bookmarked on my Firefox toolbar) and used the narrow version of the "therapy" filter (which filters for randomised trials). I entered search terms to describe the condition "fracture and radial and head," which brought up seven studies. Two of these studies were not trials and three were not relevant (two looked at different types of internal fixation, and one looked at different methods of reduction), which left two that were relevant. I used the most recent study (2002)1 because it was more relevant to this patient's problem and I had access to the full text. I had access only to the abstract of the second trial,2 but this seemed to be consistent with the findings of the first trial. My search took only a few minutes."

So here we have it, he performed a quick literature search and only read one paper in full; he then felt adequately prepared to have a crack at treating his patient. Professor Glasziou is demonstrating the NICE tendency towards Evidence Based fundamentalism here, shown by his rather naive and arguably dangerous assumption that anyone can manage specialist problems that they have minimal or no experience of by performing a quickie Internet search. This consultant plastic and hand surgeon sums up rather well how low Professor Glasziou has sunk.

There are so many flaws in Professor Glasziou's approach that it is hard to know where to start, whether it be his assumption that the radiology report is correct or his belief that clinical experience of a specialty is unimportant compared to the 'evidence'. Anyone working in a particular specialty will tell you that you need years of experience of that specialty before you can go about understanding the evidence, let alone managing individual cases based on the evidence. Unfortunately for the standard of medicine in this country, the government is intent on cutting costs by shunting work away from the properly trained to the inadequately trained, and the likes of Prof Glasziou will back them up with his flawed take on the evidence. As one consultant respondent commented:

"There is a very pernicious process at work indeed when a family specialist feels able to write an article in the BMJ about fracture immobilisation. That process involves, along with generic referrals, practice-based commissioning, exceptional treatment panels and much more, the total dumbing down of British medicine."