I have a hospital appointment tomorrow, at which I shall have a non-evidence-based treatment.
This is something I find somewhat troubling. I’m a medical statistician: I should know about evidence for the efficacy of medical interventions. And yet even I find myself ignoring the lack of good evidence when it comes to my own health.
I have had pain in my hip for the last few months. It’s been diagnosed by one doctor as trochanteric bursitis and by another as gluteus medius tendinopathy. Either way, something in my hip is inflammed, and is taking longer than it should to settle down.
So tomorrow, I’m having a steroid injection. This seems to be the consensus among those treating me. My physiotherapist was very keen that I should have it. My GP thought it would be a good idea. The consultant sports physician I saw last week thought it was the obvious next step.
And yet there is no good evidence that steroid injections work. I found a couple of open label randomised trials which showed reasonably good short-term effects for steroid injections, albeit little evidence of benefit in the long term. Here’s one of them. The results look impressive on a cursory glance, but something that really sticks out at me is that the trials weren’t blinded. Pain is subjective, and I fear the results are entirely compatible with a placebo effect. Perhaps my literature searching skills are going the same way as my hip, but I really couldn’t find any double-blind trials.
So in other words, I have no confidence whatsoever that a steroid injection is effective for inflammation in the hip.
So why am I doing this? To be honest, I’m really not sure. I’m bored of the pain, and even more bored of not being able to go running, and I’m hoping something will help. I guess I like to think that the health professionals treating me know what they’re doing, though I really don’t see how they can know, given the lack of good evidence from double blind trials.
What this little episode has taught me is how powerful the desire is to have some sort of treatment when you’re ill. I have some pain in my hip, which is pretty insignificant in the grand scheme of things, and yet even I’m getting a treatment which I have no particular reason to think is effective. Just imagine how much more powerful that desire must be if you’re really ill, for example with cancer. I have no reason to doubt that the health professionals treating me are highly competent and well qualified professionals who have my best interests at heart. But it has made me think how easy it must be to follow advice from whichever doctor is treating you, even if that doctor might be less scrupulous.
This has made me even more sure than ever that the Saatchi bill is a really bad thing. If a medical statistician who thinks quite carefully about these things is prepared to undergo a non-evidence-based treatment for what is really quite a trivial condition, just think how much the average person with a serious disease is going to be at the mercy of anyone treating them. The last thing we want to do is give a free pass for quacks to push completely cranky treatments at anyone who will have them.
And that’s exactly what the Saatchi bill will facilitate.