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On being eclectic

Difficult topics

Bandolier revels in eclecticism, finding material from different sources. So many questions to ask and such a lot to find. Questions come from readers (whiplash and soft collars, and probiotics for pouchitis in this issue), from topics covered previously (aspirin and cancer), from stuff found by accident (click to be sick?), and things that have interested us before and niggle (honey for wounds, and anaemia).

What constitutes evidence is another driver, because it varies so much. Most of us would usually tend to dismiss evidence from a few tiny trials, but when there is a very large effect from high quality, valid trials of long duration, tiny trials can still be compelling (pouchitis).

Difficult topics

It is rarely this easy, though. Take honey and wounds. We have a clutch of trials of limited quality, and even a systematic review, but despite some biological plausibility we tend to hang back. Yet there is power in case reports and case series. When a case of almost miraculous recovery is reported in impossible circumstances we should take notice. We should also ask why, given impressive results, good trials are not being done to convince us.

The answer is that there is little or no commercial interest - can any of us really expect to see our favourite supermarket sponsoring a trial? But when even a casual glance indicates possible big benefits to healthcare providers, it seems strange that none can get organised to investigate this for their own (and our) benefit.

Anaemia is another difficult topic. Bandolier has had an interest in this for a while, but it has taken time get a grip on it. Anaemia is clearly bad news, especially in sick older people. But the subject is so multifactorial that understanding it will take time.

And finally, a warning about the power of the press release is chilling.

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