To assess the evidence, you need to know it is there.
Properly conducted clinical trials provide the best evidence for whether drugs work and are safe. But about half have never been published, and trials with positive results – where the drug concerned is shown to be safe and effective – are more likely to be published than negative ones. Patients can be harmed – for example if a treatment found to be harmful in an invisible trial is then given to patients in a new one – or medicines used ineffectively or wastefully, as a result. Researchers can’t plan research properly because they don’t know what has gone before. The problems with this situation have been well documented for years, but things may now be going to change.
The new entry starts by saying, “Homeopathy is a ‘treatment’ based on the use of highly diluted substances” and is bracingly frank in the evidence section: “There is no evidence for the idea that substances that can induce certain symptoms can also help to treat them. There is no evidence for the idea that diluting and shaking substances in water can turn those substances into medicines”. The evidence appears to have triumphed.
Is the speed with which this entry was rewritten a record?
Bans on smoking in public places are linked with reductions in preterm births, says a study from Belgium published in the BMJ, which introduced smoke-free bans in three steps. Each time a ban was bought in, the risk of babies being born before 37 weeks fell. There were no downward trends in the period before the bans – and other factors such as ‘flu epidemics did not seem to explain the differences either. So, good news for the public health benefits of smoking bans as premature birth is an important health risk factor.
Mrs Blood, Dr Crook, Mrs Killer and Mrs Tipler – which would you choose to be your birth attendant?
These people all practised in Derbyshire early in the twentieth century. Dr Crook was a male GP, Frances Killer was a qualified, trained midwife, and Elizabeth Tipler was a ‘bona fide’ midwife – she had no training but was registered, and had some experience. Mrs Blood was one of a diminishing band of uncertified, untrained ‘handywomen’ who delivered babies and helped afterwards. Which had the best outcomes, for the mothers and babies they cared for? The answer is surprising and may also help explain why birth outcomes did not improve much at first after midwifery became a regulated profession in 1902. Continue reading →