Share The Wealth by Chris Gupta
March 08, 2005

Best Treatment Is Often No Treatment At All

....""The big 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."...

The following post extracted from Pankaj Seth's (ND) incredible site is a great complement the earlier post "THE TOP 10 MEDICAL MYTHS'. As usual the article has been embellished with appropriate links. In addition to the medical archive section Punkaj' s excellent site is a treat to visit and provides an educational introduction to Ayurveda and Health.

See also: Drugs do not work - in most cases

Chris Gupta
New British Medical Journal guide for patients admits that best treatment is often no treatment at all
Jeremy Laurance, Health Editor - The Independent UK: 06 April, 2004

The biggest myths of modern medicine were challenged in a new guide for patients launched yesterday that sets out the best treatment for 60 of the commonest medical conditions.

Instead of claiming miracles, the guide admits that often the best treatment is no treatment. Devised by the British Medical Journal (BMJ), it is based on evidence from thousands of research studies and is being made available through the NHS Direct website, the advice service for patients.

Treatments are ranked according to effectiveness and the pros and cons of surgery are explained. In some cases the guide says it can't recommend any treatment because there is no good evidence that anything works.

Prostate cancer is the commonest male cancer and one of the fastest growing, affecting 27,000 men a year, but surgery to remove it may cause more harm than good, according to the guide. Men who opt for "watchful waiting" live just as long, it says.

On back pain it recommends sufferers should avoid lying in bed and instead continue with their normal activities, taking painkillers if necessary.

It does not recommend tranquillisers as a treatment for anxiety - except for short term use. It also says that there is no evidence that any of the treatments tried for anorexia, which is a serious illness caused by a variety of different factors, work.

Mastectomy for breast cancer does not extend women's lives any more than the smaller operation of removing the lump and keeping the breast intact.

The removal of impacted wisdom teeth - a routine operation for decades - is needless, unless there is evidence of infection, it says.

It also examines a dozen common operations and diagnostic tests, weighing up the risks and benefits of each.

Luisa Dillner, editor of BMJ Best Treatments, said the guide was designed to give patients the same information as their doctors based on the most up to date information available.

"The big 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.

"I think conveying uncertainty is important. We need to say when we just don't know. "

The BMJ already publishes a guide for doctors, called Clinical Evidence, which assembles the best research to give up to date advice on the treatments that work.

"We thought it made sense to give patients the information that doctors get. We found in our research that patients said they wanted to read what their doctor read, not what their doctor thought they should read," Dr Dillner said.

The guide has separate sections for patients and doctors, but both can be accessed by anyone - so patients can read the advice for doctors.

The BMJ is paid a licence fee for use of the material but has complete editorial control, avoiding charges that the advice is subject to political interference. Dr Dillner said it was not designed to deter people from seeking treatment but it was about looking squarely at the evidence rather than relying on custom and practice.

"It is about trying to tell the truth," she said.

Rosie Winterton, health minister, said: "We know that patients would like more information to support them in making decisions about their healthcare.

"This is an important step in providing patients with the resources they need to make informed choices."

Curing medical myths



Myth: Treatable with a combination of drugs and therapy.
BMJ advice There are no drugs that can cure anorexia and there is no strong research evidence that any treatments work well.


Myth: Tranquillisers can cure anxiety.
BMJ advice There are no quick fixes. Talking treatments (cognitive therapy) and certain drugs (some antidepressants) may help but doctors don't know which is best.

Back pain

Myth: Best cure is rest.
BMJ advice Staying in bed doesn't help, it won't make the pain any better and could be harmful. Staying active is the best remedy.

Breast cancer

Myth: Mastectomy (removal of the breast) is the safest option to prevent return of the cancer.
BMJ advice Breast-conserving surgery (only the lump is removed) is just as effective for locally-advanced disease with the same 10-year survival rate.

Heart failure

Myth: Exercise can be dangerous where the heart is failing and may precipitate a heart attack
BMJ advice A moderate amount of exercise is beneficial. Drug treatments, such as ACE inhibitors and beta blockers, work.

Prostate cancer

Myth: Surgery, radiotherapy and hormone treatment are necessary to save life.
BMJ advice Where the cancer has not spread, patients who do nothing but "watchful waiting", with regular check-ups, are likely to live just as long.

Wisdom teeth

Myth: When they don't come through the gum properly (impacted) dentists often recommend removal.
BMJ advice If they are not causing problems taking them out is likely to do more harm than good.



Removal of adenoids at the back of the nasal cavity.
Myth: The only way to improve breathing and prevent ear infections in children.
BMJ advice The problems will usually clear up of their own accord, as the child grows. The operation works best in children who still have persistent problems aged five or more.


Small tubes inserted in the ear drum to drain fluid from the middle ear.
Myth: Cure for glue ear.
BMJ advice Most children grow out of glue ear. There is no good evidence demonstrating that fitting grommets is better than doing without.


Removal of tonsils at the back of the throat.
Myth: The cure for repeated sore throats and ear infections.
BMJ advice Taking antibiotics may be just as good. There is no good evidence to show that the operation reduces throat infections.


posted by Chris Gupta on Tuesday March 8 2005
updated on Saturday September 24 2005

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