In the UK the Health Technology Assessment programme (HTA) is part of the National Institute for Health Research (NIHR). It produces independent research information about the effectiveness, costs and broader impact of healthcare treatments and tests for those who plan, provide or receive care.
The British Medical Journal (BMJ) says the following, from its Clinical Evidence project -
Clinical Evidence aims to help people make informed decisions about which treatments to use. It can also show where more research is needed. For clinicians and patients we wish to highlight treatments that work and for which the benefits outweigh the harms, especially those treatments that may currently be underused. We also wish to highlight treatments that do not work or for which the harms outweigh the benefits. For the research community our intention is to highlight gaps in the evidence, where there are currently no good RCTs or no RCTs that look at groups of people or at important patient outcomes.
So what can Clinical Evidence tell us about the state of our current knowledge? Figure 1 illustrates the percentage of treatments falling into each category. Dividing treatments into categories is never easy hence our reliance on our large team of experienced information specialists, editors, peer reviewers and expert authors. Categorisation always involves a degree of subjective judgement and is sometimes controversial. We do it because users tell us it is helpful, but judged by its own rules the categorisation is certainly of unknown effectiveness and may well have trade offs between benefits and harms. However, the figures above suggest that the research community has a large task ahead and that most decisions about treatments still rest on the individual judgements of clinicians and patients.We are continuing to make use of what is ‘unknown’ in Clinical Evidence by feeding back to the UK NHS Health Technology Assessment Programme (HTA) with a view to help inform the commissioning of primary research. Every six months we evaluate Clinical Evidence interventions categorised as ‘unknown effectiveness’ and submit those fitting the appropriate criteria to the HTA.
BMJ Clinical Evidence published this report, with intervention effectiveness shown to be quite a concern because of the high level of ineffectiveness and unknowns. Source: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jspBackground, 2006:
For those of you unfortunate enough to read any articles or see any television reports featuring Professor Jonathan Waxman, a natural products-hating oncologist from Imperial College, London, indulge yourself in some soothing words from Dr Damien Downing.
On seeing Professor Waxman's 'personal view' issued in the pages of the British Medical Journal yesterday (BMJ 2006; 333:1129), Damien immediately responded via the BMJ's Rapid Response pages and posted the following response:
Professor Waxman employs and perpetuates a crucial medical myth - that, in contrast to complementary therapies, conventional therapies are all evidence-based, on sound science. But the BMJ's website Clinical Evidence reports that, of the 2404 treatments they have surveyed, only 15% are rated as beneficial, while 47% are of unknown effectiveness1. In his own speciality, indeed, chemotherapy for cancer was found in a 2004 systematic review of studies in the USA and Australia2 to improve overall 5-year survival chances by less than 2.5%. Interestingly, the review of dietary interventions he cites3 derived an odds ratio for the effect of a healthy diet, with or without dietary supplements, of 0.90 - which appears to make them probably 4 times as effective as chemotherapy. Different end-points, granted, and a big confidence interval, but nevertheless "absence of evidence is not evidence of absence".
Talk of "vile and cynical exploitation" could with equal justification be applied to the cancer industry, into which billions has been poured in recent decades, to very little effect. Surely Professor Waxman should be careful not to become, as discussed in the same issue of BMJ, "a lapdog to drug firms"?
1 http://www.clinical evidence. com/ceweb/ about/knowledge. jsp
2 Morgan G, Ward R, Barton M. The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies. Clin Oncol (R Coll Radiol), 2004; 16(8): 549-60.
3 Davies AA, Davey Smith G, et al.. Nutritional interventions and outcome in patients with cancer or preinvasive lesions: systematic review. J Natl Cancer Inst 2006; 14: 961-73.
It's clear from Professor Waxman's response that a threat is perceived not only from dietary/food supplements used by millions to support their health, he has also taken a sideswipe at organic food, produced by a branch of agriculture supported by increasing numbers of consumers that is threatening Big Food and agri-business. The irony, of course, is that those most interested in reducing the burden on the healthcare system and spending time in doctor's waiting rooms are those that will be more likely to consume both organic foods and high quality food supplements. Market research has demonstrated that most users of food supplements do not use these products to counter poor diet, but rather use them to add nutrients that they believe are missing as a result of modern agriculture and food products.
The increasingly vocal hatred expressed by key opinion leaders within the orthodox medical community has to be an expression of the threat that they perceive from the millions of people around the world who continue to use products derived from nature as key components of their healthcare regime.
You'll appreciate that this is no time for anyone to put their head in the sand!
Please feel free to forward this as widely as you can to anyone who you feel may be interested.
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