As Voltaire said, "The art of medicine consists in amusing the patient while nature cures the disease." Or, in modern parlance: most drugs work in only 30 percent or 50 percent of people. Because patients so often get better or worse on their own, no matter what we do, clinical experience is a poor judge of what does and does not work. Clinicians want to relieve suffering. They find it difficult to do nothing (the aphorism "Don't just do something, stand there!" seems ludicrous).

Reasons for using ineffective or harmful treatments:

• Clinical experience
• Over-reliance on a surrogate outcome
• Natural history of the illness
• Ritual and mystique
• A need to do something
• No one asks the question
• Patients' expectations (real or assumed)

The editorial poses the following question and dilemma:

"What hope is there for not using treatments and tests that don't work? Medicine is not just a science--it is a human activity. It entails ritual, custom and the expectations of doctors, patients, and society. To safeguard against ineffective or harmful health care we need doctors who want to do the best they can for their patients, who are willing to continually question their own managements, and who have readily available sources of information about what does work."

Let us hope that the traditional medical community is waking up to the truth expressed in the above paragraph. My fear is that the brainwashing of the drug-based paradigm is still far more powerful than the common sense approach of natural medicine that addresses the cause of disease.

British Medical Journal February 28, 2004;328:474-475 Full Text Medical Journal