Dr Benedict Michael is a NIHR Doctoral Research Fellow (DRF). He trained in Medicine in Liverpool, and has helped set up the NHS Northwest Neurological Infectious Diseases Research Network and Brain Infections UK and is a main author for the ABN/BIA National Encephalitis Guideline. Here, he shares his take on our recent guest speaker Mark Henderson’s ‘Geek Manifesto’:
I recently attended an interesting talk hosted by the Merseyside Skeptics Society and given by Mark Henderson, author of the “Geek Manifesto”, and one main thing struck me: Why are so many of the greatest proponents of evidence-based approaches not scientists?! As a physician, NIHR PhD Fellow, author of over 20 peer-reviewed scientific publications and active author in the Cochrane Collaboration, arguably the most widely respected evidence-based institution, I can claim at least some interest in this!
Although I commend Mark’s efforts, the non-scientific authors and proponents, if I can call them that (and by which I mean authors not regularly engaged in peer-reviewed scientific research publications and nothing pejorative), are not always in line with the scientific community.
In fact, many scientists and doctors oppose a fully evidence-based approach to guiding policy and practice, and some have gone so far as to raise the alarm against a cryptofacist evidence-based hegemony in which they find their practice constrained.
Now before you grab the pitch forks and tie me to a stake, let me explain. The drugs we can prescribe and to whom we can prescribe them are typically determined by our local Primary Care Trust, who generally make their decisions based on what national bodies, typically the National Institute for Health and Clinical Excellence (NICE) say (often their hand is even forced by these decisions); NICE in turn make their decisions based on the available best evidence, the most robust of which being, of course, the much praised gold standard of a Randomised Controlled Trial (RCT) and herein lies the problem. Large scale, multi-centre, multi-national, well-powered, well-stratified, confounder-matched, placebo-controlled, double-blind studies, with adequate follow-up and monitoring are expensive, cripplingly expensive. So, who can afford to undertake them? Pharma. Big Pharma.
Now I’m not against this sort of research, provided appropriate monitoring, outcome measures, openness of data and academic scrutiny of the data and published work is undertaken. But it does inevitably result in their being ‘better’ evidence for new flashy expensive drugs than the bog-standard old drugs that we all know work and have a wealth of collective clinical experience in using. Pharma aren’t stupid. When medicine turned to a heavily – and some would say blinkered – unrelenting dependence on evidence, Pharma answered.
So, should Mark’s Geek revolution come and policy makers and politicians make all their decisions on the ‘best’ evidence, do we have any doubt that big business and vested interests will step in to provide those studies that provide that data?
I welcome Mark’s efforts and look forward to reading his book I’ve just purchased, but if we truly want to see more evidence-based approaches in policy and politics, we need to not be blind to the lessons we should learn from evidence-based approaches in medicine.
Dr Benedict Michael is a NIHR Doctoral Research Fellow (DRF). He trained in Medicine in Liverpool, and has helped set up the NHS Northwest Neurological Infectious Diseases Research Network and Brain Infections UK and is a main author for the ABN/BIA National Encephalitis Guideline. He obtained an NIHR Academic Clinical Fellowship in 2008 and was awarded an NIHR Doctoral Research Fellowship in 2010.
He currently works between the Walton Centre for Neurology, the Health Protection Agency, Imperial College and the Institute for Infection and Global Health at the University of Liverpool. His research interests include: Neuro-immunological responses, particularly to infection, the clinical management of central nervous system infections and epileptology.
He works closely with the Encephalitis Society, the Meningitis Research Foundation, the International Encephalitis Working Group and the National Patient Safety Agency to promote public and patient involvement in research and clinical practice development