- 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.
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- 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.
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- 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.
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- 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.
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- On back pain it recommends sufferers should avoid lying
in bed and instead continue with their normal activities, taking painkillers
if necessary.
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- 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.
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- 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.
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- The removal of impacted wisdom teeth - a routine operation
for decades - is needless, unless there is evidence of infection, it says.
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- It also examines a dozen common operations and diagnostic
tests, weighing up the risks and benefits of each.
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- 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.
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- "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.
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- "I think conveying uncertainty is important. We
need to say when we just don't know. "
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- 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.
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- "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.
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- The guide has separate sections for patients and doctors,
but both can be accessed by anyone - so patients can read the advice for
doctors.
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- 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.
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- "It is about trying to tell the truth," she
said.
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- Rosie Winterton, health minister, said: "We know
that patients would like more information to support them in making decisions
about their healthcare.
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- "This is an important step in providing patients
with the resources they need to make informed choices."
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- Curing medical myths
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- CONDITION
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- Anorexia 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.
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- Anxiety 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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- OPERATION
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- Adenoidectomy 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.
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- Grommets 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.
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- Tonsillectomy 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.
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- © 2004 Independent Digital (UK) Ltd http://news.independent.co.uk/uk/health/story.jsp?story=508899
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