Man is an intelligence, not served by, but in servitude to his organs (Aldous Huxley)

In Evidence-Based Medicine on February 7, 2009 by Hanna Tagged: , , ,

The FT has a GP columnist , Margaret McCartney, slap bang in the middle of the usual glossy weekend magazine (albeit I think it’s generally more intelligent than the average-compare it with the Guardian’s offering as I do which is only worth buying for the Guide which you can’t read online). This week she’s talking about the Biobank project which is a long term study currently recruiting 500 000 people aged between 40-69 in which the participants will be screened, their health being assessed long-term in a bid to gather information about why some people are more likely than others to develop illness and disease. It is hoped that the large sample size will allow the intertwining nature of genetic and environmental factors to be examined and may allow us to prevent death and disability in the future; an issue that becomes more pressing we age, our lives increasingly being cut short not through preventable illness but from less predictable and debilitating diseases such as dementia. McCartney says this is all very well (the study has Department of Health and Wellcome funding amongst others, has been planned since 2000 and only rolled out after a pilot) but what will we do with the information? She fears further pharmacological intervention: ‘Aggressive use of medication can treat risk factors in some people, for example those with high blood pressure. But more often, patients on medication won’t see great benefit but will have to endure side effects.’ And we all know what the risk factors are for many diseases such as cardiovascular and respiratory problems. Although this study is not exactly population screening it does ring an alarm bell in my mind as well: that this sort of study is interesting and noble but is much like a sociology textbook and tells us the bleedingly obvious and unsexy message that we should all lose weight, cut down on stress yadda yadda. The public health preventative measures that would yield results without having to wait for all these people to get old and die are so obvious it takes distractions in the way of including the public and coming up with a novel way of utilising all the data the NHS collects to give clout to such a message. McCartney fears that as a GP it is not just public health infrastructure that is needed but social interventions too as illness is caused by loneliness, poverty and social exclusion, woolly terms that show how complex tackling illness really is. A pill won’t solve these problems either although health and social care professionals then have to wade against a tide of ill-informed debate and hippyism (my own term I admit) to fight for evidence based medicine and evidence based public policy, a job I don’t envy. Long term studies can justify plugging away at such matters such as in smoking and cancer or can stop futile efforts. The middle ground is clinical judgement.


One Response to “Man is an intelligence, not served by, but in servitude to his organs (Aldous Huxley)”

  1. Hi Hanna. Hippyism, I like it. The trouble with these massive studies collecting reams of data for thousands of people, hundreds of conditions and hundreds of possible causative factors, is that it’s difficult to know what to do with the huge amount of data it will inevitably generate. Of course you are going to find lots of associations here there and everywhere, but what’s real and what isn’t. Hypothesis generating, yes, but can it provide proof of cause and effect?

    But it can be good to investigate the ‘bleeding obvious’. As your link to the ‘stop futile efforts’ shows, the bleeding obvious can sometimes be downright dangerous.

    Not that I get it myself, but the Times magazine on a Saturday can be an interesting read…

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