Better research for better healthcare

Better research for better healthcareThe ill-fated TGN1412 phase I study and Prince Charles versus the medical establishment over complementary therapies recently pushed evidence-based medicine and clinical trials into prominence.For a society with poor vocabulary about probability, risk and uncertainty, and which increasingly blurs boundaries between well and ill, moving the debates forward, and in unity, will be tough.Prince Charles called for orthodox medicine to learn from alternative, telling the World Health Assembly in Geneva 'The proper mix of proven complementary, traditional and modern remedies, which emphasizes the active participation of the patient, can help to create a powerful healing force in the world'.Which begs the question 'What's the proof?'.In parallel, 13 eminent doctors wrote to acute and primary care trusts urging them to review practices with regard to 'ways in which unproven or disproved treatments are being encouraged for general use in the NHS'. 1 About half of all general practitioners refer patients to alternative practitioners, and should stop if it is pointless.As clinical scientist Leslie Rose said, the letter was to 'instill equal vigour in gathering evidence for every treatment prescribed to NHS patients', adding that a business plan for refurbishing the Royal London Homoeopathic Hospitalwhich cost £20m to set up-put no emphasis on evidence.£20m can buy a lot of what works, and such support begs questions about government consistency in calling for hard evidence for healthcare.The hospital's Dr Peter Fisher described the letter as an attempt to introduce 'medical apartheid' into the National Health Service, and Terry Cullen, of the British Complementary Medicine Association, said: 'There is so much anecdotal evidence that thousands of people gain benefit from using complementary medicines.We shouldn't dismiss that'.He is right: which is where a major problem arisesconfusing treating illness with 'gaining benefit', and indeed anecdote with evidence.The World Health Organization defines health as 'a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity'. 2. But the NHS has enough to do without being charged-in both senses-with creating this nirvana.Hoards of sensible, bright people swear by various blends of snake oil for multiple malaises, from back pain to itchy skin to mild melancholy.And maybe it is more powerful.But we need hard evidence that we can cure cancer, bypass a heart or silence schizophrenic voices with homeopathy, reiki, reflexology or aromatherapy.That is not to say they