Thursday, 23 September 2021

Forget ‘miracle cures’, medicine is a work in progress

AS I sat down to write this, my initial aim was to try to pinpoint the biggest advances in medicine over the past year. In doing so, I rather suspect I made a rod for my own back. It turns out that pinpointing specific advances that aren’t incredibly specialised and, frankly, mundane for the uninitiated is quite difficult.

Headlines from certain sections of the media pronouncing grand new breakthroughs every other day would have you believe that vast strides are frequently made overnight.

Talk of “miracle cures” and such is all too common and, while regular grand discoveries may not in reality be as frequent as they were perhaps a century ago, this is not to say that dramatic advances are not being made. Rather the process behind these advances is simply more gradual and far more intricate.

This led me to reflect upon one of the most interesting aspects of medicine and hopefully I can convey the numerous ways in which medicine and the way in which we practise it remain a work in progress.

Throughout the last century people felt justifiably reassured by the steady advance of medical know-how. In the 20th century there were some incredible breakthroughs in the organisation of medical care, the understanding of disease and the implementation of effective treatments. (Antibiotics,
public health, surgery, pharmaceuticals… the list is almost endless.) A lot of this will have been based on a new approach — evidence-based, which I will come to later.

Even now, however, even after all these advances, it is important to acknowledge that we don’t know everything and must constantly strive to improve and develop existing treatments as well as being on the lookout for new ones. Part of this will involve adapting to changes in demand, which may vary from one decade to another.

Thankfully, that is exactly what many people are working on in order to stay up to date and push the boundaries in order to make treatments more effective. Not only is medical research important, it is — for better or for worse — big business. As such, a phenomenal amount of money is invested in research every year.

In the UK alone, the Industrial Strategy Challenge Fund has set aside £146 million of government money over the next four years for life sciences. Add to that the countless charities working on medical research and the pharmaceutical companies and you can see how much activity there is in this field.

It is inevitable, therefore. that we see headlines almost daily about rumoured miracle treatments for this and that and warnings about things to avoid that at first glance seem perfectly innocuous, such as burnt toast causing cancer.

Our job is to sift through all of the research that is carried out (and there is a lot) and utilise the research that makes sense. Often this is done via panels that do that work for us and produce guidelines, though it must be said there is frequent disagreement among professionals about even these.

Needless to say, there is considerable variation in the quality of research and some of it must be taken with a pinch of salt.

If we consider the development of a new drug, for example, one of the most important aspects is whether or not it is effective. In order to answer this question, studies must be carried out to trial it on as many people as possible in order to iron out any statistical inconsistencies. The longer the trial goes on the better.

Add to that the complicated task of removing as much bias as possible from those carrying out the study and you will find that, of the thousands of studies carried out each year, very few have enough statistical power to draw totally reliable conclusions.

Unfortunately, even the most unfounded conclusions end up as headlines. Here’s an example. “Tattoos could give you cancer, new research suggests”. This was based on a study in which four out of six donors had ink particles in their lymph nodes after post-mortem. There was no information about whether the donors had cancer or not. And yet, for many, that headline is enough.

For this reason, we all have a responsibility to be wary about what we take from the news no matter where it is published. It is so easy to fall foul of misinformation — even health ministers are not immune.

It is important to add that some studies, although they do not come up with firm conclusions, add to the body of research out there. If people didn’t at least try to generate evidence, progress would be much slower.

For example, last summer a UK study hit the headlines following its claim that the age-old notion of finishing a course of antibiotics may be outdated. It suggested that doing this actually contributed to antibiotic resistance.

Quite rightly, the study did not sway official advice — to finish the course of antibiotics before the tablets run out even if you begin to feel better — because the way the study was carried out left too much scope for bias from the organisers.

It did, however, raise the question and will no doubt encourage further, more powerful studies that will give us a better idea of what we should be doing.

This is what I mean by an evidence-based approach. This approach has become the cornerstone of modern medicine and for good reason.

So, while it may not have given us a list of showstopping breakthroughs of late, it has given us a valuable and active research community that is perpetually in motion and coming up with improvements and suggestions, however large or small, all the time.

To finish, I must stress that development of medicine is not just about medications and treatments. It is vital that we are able to utilise these treatments in the best and most effective way possible.

Technological advances are becoming more prominent (for example, artificial pancreases for type 1 diabetics and drones delivering medical supplies) but with the current levels of demand and the well-documented pecuniary squeeze in mind, for me the biggest advance in 2017 has been the provision of locally available care.

As hospitals come under more strain, a big drive to treat more people in the community is afoot and in Henley, following a period of upheaval, we have seen the various services at Townlands increase.

Alongside outpatient services, there is occupational therapy and physiotherapy and the minor injuries unit is open every day (9am to 8pm) and is incredibly useful for things like deep cuts, eye injuries, broken bones, severe sprains, minor head injuries, minor burns and scalds.

There is also an intermediate care service available in the adjoining Chilterns Court care centre, where there are beds available for those who require respite care, and the excellent rapid access care unit, which continues to prove invaluable for treatments that previously could only be done in hospital.

Having services like these makes a huge difference and I must highlight how much of a positive these additions have been.

The more people are aware of the services available, the easier it is for the health services to spread the load. After all, if the strain on our health services becomes too difficult to sustain even at the most basic level, it may be even more difficult to make the clinical breakthroughs of the future a reality.

• Next time: Dr Chee Pavey on “Gut feeling: irritable bowel syndrome”.

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