GPs and the caveman approach to evidence
From http://www.cectic.com under Creative Commons Attribution license
“I don’t have to be able to read papers, I have a pharmacist to do that for me.”
A quote from a GP at a training event I attended earlier this year. This is cast iron, copper-bottomed muppetry of the highest order.
It was at a Substance Misuse training event run by the Royal College of General Practitioners. The Part 2 certificate involves attending 3 one day meetings and completing a portfolio of work. There is a fair bit of reading of original papers involved in the course and one of the parts of the portfolio is to critically appraise in further detail one of those papers.
Appraising the evidence should be a fundamental skill for doctors. Of course, the sheer volume of information out there means that most practising GPs very reasonably rely on others to condense and summarise this into some useful and accessible form. But I have absolutely no time for this GP who felt deeply aggrieved, angry in fact, that he had to read some original papers. This was a course to develop the skills of GPs in a specialist area and a GP practising in a specialist area certainly needs to be able to consider and modify their clinical practice as research is made available.
However, it is more important than that – I don’t expect GPs to refer to original papers very often in the course of their working week but the basic ability to discern good science from bullshit is a basic skill that any doctor should have. Rose Shapiro in Suckers: How Alternative Medicine Makes Fools of Us All quotes:
…despite their scientific medical training more than half of British GPs now offer alternative medicine, either provided by themselves or referral.
Maybe what the GP workforce really needs is some further fine-tuning of their bullshit detectors.
Well lets take ‘evidence’ for the statins.
The NHS spends over £1 billion on them, if we add together the actual cost of the drugs, plus blood tests/manpower, etc.
Yet the cholesterol hypothesis hardly bears scrutiny – hell, there isn’t even such a thing as a “cholesterol level” [since cholesterol is transported in lipoproteins and cannot be directly measured].
And even there was such a thing as a cholesterol level [which there isn't], then why does the so called “target” or threshold, presently 5 or something like that, keeps being reduced ?
Take a look at Kendricks “The Cholesterol Con” – if doctors can’t get a handle on glaring anomolies in research evidence for statins [particularly amongst women] then one has to wonder what else they are failing to understand, or at least adopt a healthy cynicism toward [did somebody mention SSRIs] ?
The problem is that, having read a paper as best I can, I do not often find ‘glaring anomolies’ (anomalies?). In reality it is extremely difficult to tease out problems with research papers.
I’m trying to ignore the ‘one has to wonder what else they are failing to understand’ bit.
I have to admit I was thinking more towards the woo end of the market when highlighting deficiencies GPs have when appraising evidence but it is a good point re statins.
At the risk of sounding like I am trying to please everyone I also think Amrchair Daddy has a point. Some of these massive trials can be pretty tricksy to critique without investing a lot of time and effort (and Big Pharma can be very efficient at subtle manipulations) – I wouldn’t expect GPs to get too far with this.
I also agree I would like to see much more healthy cynicism but QOF targets don’t help develop that.
Perhaps we can all agree that Big Pharma and CAM need watching very carefully.
I will put Kendrick on my reading list.