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Not given to questioning too much

Impertinent questions

Does it seem to you that we live in a very strange world, beleaguered by the inexplicable? Do you find yourself berating the TV, newspaper, or even respectable medical journals? If so, join the club: you are not alone.

The problem involves media correspondents who always have to give two sides of an argument, even if one is bonkers, and the whole peer-review process of medical journals that seems to let far too much nonsense through. It all comes down to not questioning too much.

An example comes this month from the world of acupuncture. Yet another paper shows acupuncture to be no different from something that is vaguely similar to, but completely unlike, acupuncture (a control). This time we can work out that both are the same as doing nothing, yet the paper claims it as proof positive that acupuncture is a good thing.

When we have good evidence about alternative medicine it is a bit worrying. A look at Ayurvedic herbal remedies shows that a good proportion contain dangerously high levels of lead, mercury, or arsenic, enough to cause real problems. How long have we known this? Since the mid-70s, yet without any moves to regulation. You can buy them in many countries, completely unregulated, because they are dietary supplements. Makes you wonder about paying taxes for all those regulatory authorities, doesn't it?

Impertinent questions

Bronowski believed that asking an impertinent question put us on the way to a pertinent answer. Pertinent answers require straight thinking. A few good examples of straight thinking to balance the less than straight.

Perhaps the best is a systematic review of antidepressants for bipolar depression. One definition of evidence-based medicine is to apply the best evidence from systematic research to the treatment of individual patients, and this review is a near-perfect blend of evidence, clinical experience, and care. Excellent teaching material. Another good example is emerging evidence about impaired fasting glycaemia, its consequences, and what to do about it. Another, asking questions about how treatments work for our diverse peoples, has been worth waiting for.

It is the failure to ask questions, pertinent or impertinent, that makes us fulminate. It is one thing to be patient, but some poet or another cautioned about bewaring the fury of a patient man.

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