New guide for patients admits that best treatment is often no treatment at all
By Jeremy Laurance, Health Editor
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
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
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
"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.
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.
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
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.
Myth: Surgery, radiotherapy and hormone treatment are necessary to save
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
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
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.