Yes, because evidence is the only way medicine gets better. Yes, because people have sometimes died, or had risky procedures, or endured more suffering, because of the application of opinion-based, fashion-set meandering through all the medical interventions that imagination has to offer. Yes, because time, money and effort is wasted when people are given non evidence based treatments by healthcare practitioners.
Nevertheless, the careers section of the British Medical Journal website devotes some uncritical space to careers advice about osteopathy. The doctor describing his decision to pursue a qualification in the discipline – he now combines medicine with osteopathy – says that since the UK National Institute for Health and Clinical Excellence recommend it, it should be done.
But this isn’t, I don’t think, good enough: mainly because the evidence for treating back pain, which is the specific Nice recommendation he refers to, is complicated by the fact that the great bulk of back pain will get better no matter what doctors do or don’t do.
More importantly, a systematic review of systematic reviews of spinal manipulation a review of systematic suggests that ”Collectively these data do not demonstrate that spinal manipulation is an effective intervention for any condition. Given the possibility of adverse effects, this review does not suggest that spinal manipulation is a recommendable treatment.”
There remains the concept that doing more in medicine is always better. In truth, doing can be far more evidence based.
Margaret McCartney
Clive Cookson
Andrew Jack