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Evidence isn’t always the answer

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Mark Robinson

 

THERE is a rising clamour for everything to be ‘evidence-based’. Professor Cairns makes some very good points in his blog The rise of anti-science and there is almost a routine ‘don’t do it’ from the so-called evidence experts.

It seems strange that the NHS has a history of acting without evidence. Complete organisational changes in the NHS, costing many millions of pounds, have not been based on a shred of evidence, but on a vision of how things might work better.

Pharmacists, like GPs, often have to work in a world of uncertainty and draw from patient feedback and their personal experience. I have to say that there is seldom the perfect evidence base to support individual situations that we face in practice.

In fact, it is common for the evidence base to be absent, fragmented, not appropriate to an individual situation or not fit with the person standing in front of you. It is a problem with clinical trials, which work within safer populations to primary endpoints, to jump over the licensing hurdle and get the product to market. But, so often the patients that we see have comorbidities.

It is also not uncommon for the evidence base to cast doubts on the effectiveness of a treatment – for example the effectiveness of paracetamol in osteoarthritis or mebeverine in irritable bowel syndrome (IBS) – but a balance of safety and efficacy would suggest that these treatments remain appropriate choices and first line in every guidance.

Professor Cairns is absolutely right that pharmacists should trust their scientific background and understanding, bring together available elements of evidence, and then make a decision appropriate to the circumstances. Pharmacists are asked to help people with their healthcare needs, and that help needs to be scientifically sound, evidence informed, patient centric and pragmatic.

Within the NHS there is a growing need for community pharmacists to manage and treat more patients with more conditions, forming a triage for the overworked general practice system. Undoubtedly, they will work in situations of greater uncertainty and take on greater personal responsibility. But it isn’t a problem – it is what we do every day.

Mark Robinson is director of Connect2Pharma

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