Call to address mistrust of evidence base in medication decisions

A SURVEY conducted on behalf of the Academy of Medical Sciences (AMS) has found that only 37 per cent of the public trust evidence derived from medical research when deciding to take or refuse medication, as compared to 65 per cent who trust the experiences of friends and family.

Clinical trials funded by the pharmaceutical industry are particularly mistrusted with 82 per cent of GPs and 67 per cent British adults believing these are often biased to produce a positive outcome.

These findings are highlighted in a new AMS report on the use of scientific evidence to judge the potential benefits and harms of medicines. The report summarises data from surveys of 1,013 GPs and 2,041 British adults, as well as information from public and expert workshops.

The report states that poor quality evidence about medicines and the misrepresentation of evidence can lead to under or over-medication and thus prevent the full realisation of the health gains from medical innovation.

The authors write: "Recent high-profile media debates about the use of statins to prevent cardiovascular disease, of Tamiflu to treat flu and of the HPV vaccine to prevent cervical cancer have opened up public debate about medical and scientific claims. These debates have queried whether the underpinning evidence for the use of licensed medicines is robust, relevant to the patient population and trustworthy, or has been communicated accurately in an accessible and usable way."

Among recommendations in the report are longer GP consultations to allow adequate time for shared decision-making about treatment options and lifestyle changes, particularly in the context of multimorbidity. There is also a call for improved content and readability of patient information leaflets, offering a balanced appraisal of the benefits and harms of medicines.

The AMS recommends more involvement of patients, carers and the public in research, and greater understanding of research methods and the use of statistics among healthcare professionals. It also supports enhanced dissemination of and access to research findings, including wider publication of rigorous results “regardless of outcome”, and developing frameworks for declaring and managing interests.

The report calls for NHS Choices to become the central repository of information on the benefits and harms of medicines – making direct reference to underlying evidence (with updates as further evidence emerges) and providing relevant, robust and evidence-based decision aids that can be used by both patients and healthcare professionals.

Professor Helen Stokes-Lampard, Chair of the RCGP, commented: "We know that information about health can be a minefield for patients, particularly given how rapidly this information can change, and the massive volume of potentially contradictory information available to patients online.

"GPs are highly trained to have full and frank discussions with our patients - taking into account their unique circumstances - about how to achieve the best possible outcome for their health. As such, we would welcome patients becoming more involved in making informed decisions about their health and treatment plan, as recommended in this report.

"However, GPs are delivering care to over 1m patients every day, within the constraints of the standard 10-minute consultation, which is increasingly unfit for purpose, and does not lend itself to the type of in-depth conversations necessary to explain what are often complicated health matters.

"Ultimately, we need the Government to implement the pledges in NHS England’s GP Forward View as a matter of urgency, including £2.4bn extra a year and 5,000 additional GPs and 5,000 practice team members, so that patients can be given more time with their family doctor to ensure they get the care they need."

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