The best treatment for over 50 common medical conditions is no treatmentl. Sylvia Thompson reports
A new Internet-based guide devised by the British Medical Journal gives patient-friendly information on treatments offered for conditions as wide-ranging as back pain, heart failure, prostate cancer and sore throats. The BMJ Best Treatments website (www.besttreatments.co.uk), also available through the British National Health Service website (www.nhsdirect.co.uk) ranks treatments according to their effectiveness and discusses the pros and cons of surgery.
"The guide was designed to give patients the same information as their doctors based on the most up to date information available," Dr Luisa Dillner, editor of BMJ Best Treatments said at the guide's launch last week.
So, for instance for those diagnosed with prostate cancer which hasn't spread, the site suggests that best treatment may be to do nothing but 'watchful waiting' with regular check-ups. For impacted wisdom teeth, the advice is if they are not causing problems, taking them out is likely to do more harm than good. And, perhaps more controversially, it suggests that there is no good evidence to show that tonsillectomies (the removal of tonsils) reduces throat infections.
"The biggest myth about medicine is that people know what works. In fact, they do things for which there is no evidence. There is a tendency for doctors to exaggerate the benefits of what they do because they want to help," said Dr Dillner. "I think conveying uncertainty is important. We need to say when we just don't know," she added. The site is currently only available to UK residents .
The content is derived from the results of research studies sorted through by over 500 doctors for the sister site, www.clinicalevidence.com
Commenting on the suggestion that the best treatment for many conditions is no treatment at all, Dr Niall O'Cleirigh from the Irish College of General Practitioners told the Irish Times, "It is a very well established principle that the doctor is the tablet and advise from the doctor is itself the treatment. However, so many things have become medicalised and the thrust of life is to seek a cure.
"Medical professionals would prefer if patients took responsibility for their own health and accepted advise from doctors rather than seeking a prescription. In day to day practise, most GPs are seeing self-limiting conditions and people should be more accepting of advise rather than constantly seeking to be better immediately," he added.
Speaking about patient's use of the Internet for information on medical conditions, Dr O'Cleirigh added. "The basic principle of good medical research is that it is published in peer-reviewed medical journals which means that it has been scrutinised and validated. The same applies to websites. There is no way that the general public can know the value of information on websites unless it has been validated by significant national or international medical organisations."
The closest Irish equivalent of the Best Treatments site is www.irishhealth.com which includes clinics on health problems such as cholesterol, eczema and erection problems and an Ask the Doctor section alongside daily health news updates. However, the major difference here is that patients themselves have to judge the research findings even if the selected articles have been reviewed by a panel of healthcare professionals.
A spokesperson for the ICGP told the Irish Times that providing web-based information on treatment choices for medical conditions to both patients and doctors is one of its long term aims.