Evidence-based medicine used to seem quite simple to me, until this week. My mother-in-law, at 78, has decided to stop taking her enalapril on the grounds that she was “getting hooked on it”.
I’ve just taken her BP, and it’s 208/118. Mine is now 220/100 because I’ve just spent half an hour trying to describe the evidence for long-term blood pressure control in the elderly.
All in all it’s been a trying week - someone told me recently that we are happiest during our twenties, and then not again until we hit 60. That would explain a lot, as I’m slap-bang in the middle of the “happiness trough”; and it would also explain my mother-in-law’s permanent state of euphoria.
All she requires for happiness is a pot of Yorkshire tea and Corrie on the box. Perhaps a complete lack of insight really is the only way to achieve happiness. To this end I’ve decided to try a little experiment - henceforth I’m only going to read celebrity news, concentrating on Katie Price and Peter Andre’s ongoing life-choices (so there’s plenty of material), and see if I’m any happier after a couple of weeks.
Meanwhile, at work, life is being enhanced by a heated argument involving clinical autonomy and the evidence-base for wearing surgical facemasks. Theatre management is attempting to enforce a universal facemask rule - but we have some surgeons who adamantly refuse to do so (particularly, and in my opinion somewhat bizarrely, the gynaecologists) and obviously all the anaesthetists take it as a personal affront.
Of course the evidence for facemasks reducing infections is sketchy to say the least, although it has been demonstrated that wearing them reduces bacterial growth on agar plates placed near the op site.
But it turns out evidence isn’t what it used to be. For a start, it changes radically from one year to the next - one moment it’s dangerous to drink alcohol, the next it’s good for you, then we’re being told that the calorie limits we’ve all used for years are too low (although frankly who cares, since everyone ignores them anyway).
If we can’t even agree on things for which there is copious evidence like evolution or global warming, then what chance is there for something as nebulous as wearing a facemask?
Basically we’ve got to wear masks because the trust thinks it’s good for discipline, and, in conjunction with other things, it may (or may not) help to reduce infections. In the anti-mask camp, the following convincing arguments have been advanced: A. they’re itchy B. they’re hot C. they make people sneeze, and D. we don’t like being told what to do by a set of jumped-up managers who probably wouldn’t even recognise a Chi squared test. Talking of which, where are the double-blind randomised controlled trials which we demand for anything we don’t want to do?
I only wish that I had so few things to worry about that I could be upset about wearing a face mask. Really, on the scale of life’s tragedies, it doesn’t really float my boat.
On the way home, I notice the headline in the paper “Peter left me for Nanny” Katie Price exclusive. Now that really is something worth getting worked up about.
Tags: Evidence-based medicine
