When you swallow medicine or undergo a test, you do so in the belief that it will be doing you some good. Yet for many of these things there is little – if any – evidence that they are worth doing.
HIGH-FIBRE DIET FOR IBS
For many years increasing the amount of bran in the diet was the main advice given to those with irritable bowel syndrome. Yet there was no evidence it worked.
‘In fact for many patients it made the symptoms worse. There was never any evidence that it would work – it just became a widespread belief,’ says Professor Chris Hawkey, a gastroenterologist at Nottingham University who is also chairman of CORE, the charity for those with diseases of the gut, liver and pancreas.
ASPIRIN FOR A FAULTY HEARTBEAT
Around one million people have atrial fibrillation, an irregular and often abnormally fast heartbeat. It can raise the risk of blood clots forming in the heart’s chambers, causing a stroke.
Even though research shows aspirin is not beneficial in atrial fibrillation patients, some are still given it, says cardiologist Klaus Witte. ‘Aspirin does have a marginal blood-thinning effect but this is probably ineffective in preventing the type of clot that causes a stroke in atrial fibrillation.’
These patients should instead be prescribed an anticoagulant – medicines to prevent clots – such as warfarin, or one of three newer drugs, apixaban (Eliquis), dabigatran (Pradaxa) or rivaroxaban (Xarelto).
Yet the results of a small survey last year by the Atrial Fibrillation Association suggested 200,000 patients are still being given aspirin.
FLOSSING YOUR TEETH
An emerging body of research suggests flossing makes no difference to oral or dental health, says Professor Damien Walmsley, scientific advisor to the British Dental Association.
A review last year in the Journal of Clinical Periodontology concluded: ‘The majority of available studies fail to demonstrate that flossing is generally effective in plaque removal and in reducing gingival (gum) inflammation.’
Professor Walmsley admits that he continues to floss anyway as it makes him ‘feel better’ and it helps to dislodge bits of food, but says: ‘If you are not flossing, don’t worry too much about it as there may be no need.’
Flossing may still be part of recommendations from your dentist because, as Professor Walmsley says, it can take a long time for a body of opinion to take on new findings and modify recommendations.
‘We still recommend floss because if used correctly, it’s unlikely to cause harm,’ he adds.
In contrast, the recommendation to brush your teeth twice a day is well supported by studies, he says, as it disrupts bacteria build-up and prevents sticky biofilms developing, which can lead to plaque and tooth decay.
ANTIBIOTICS FOR EARACHE
One in four children suffers an ear infection (otitis media) by the age of ten. Research carried out at Southampton University shows ear infections are the most common reason for children being prescribed antibiotics by their GPs.
In fact two in three ear infections are caused by viral infections, which antibiotics are powerless to treat, says Professor Tony Nerula, president of the ear, nose and throat specialists’ body ENT UK. Only about one in three is caused by bacteria.
A viral infection usually clears up on its own within 48 hours, and patients are advised simply to take paracetamol or ibuprofen.
‘The problem is GPs have no way of knowing if a virus or bacterium is the cause,’ says Professor Nerula.
‘So most issue a deferred prescription for antibiotics dated for a couple of days’ time. The parent is told to collect the prescription if the infection does not clear up by then.’
Conclusion: In fact there are many treatments that also have little or no evidence to support their use – but doctors may prescribe them because ‘you make a decision that sometimes it is worth a go
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