Does it do what it says on the tin?

aftershave and lotionsMiracle creams, body firming lotions and anti-wrinkle balms… and that’s just MY shelf of the bathroom cabinet.

I strongly suspect there is little or no scientific basis for the claims of the advertisers of these products. “Can topical vitamins really do THAT?” I wonder as I read the side of a jar.

This would not do in the field of healthcare delivery. Whether you are having a brace, a baby or a bypass, you would expect that the experts providing your care would be using techniques that they know are safe and effective.

And to know that, they have to look at the “evidence”.

Experimentation!

Evidence that techniques are effective is found by well designed scientific studies. These come in different forms… some are more “trustworthy” than others!

At the lower end of the spectrum is “anecdotal” evidence… someone’s say-so that is not backed up by independent examination. That “someone” may be a cosmetics advertiser who assures us of a “significant” reduction in wrinkles… has that claim been verified… and what does “significant” mean?

At the upper end, you may have the “randomised control trial” or “RCT” which involves rigorous attention to research principles such as the sample size, how the sample chosen, how the data is collected, how the results are analysed and interpreted.

Of course most research falls between these two extremes. The trick is to tease out what is “good” research and what is “not so good”.

The wisdom of pulling teeth

In dentistry, there is a good example of how well designed research has changed the way healthcare is provided.

Impacted wisdom teeth CAN cause pain, infection and their removal is sometimes the correct clinical decision.

Until relatively recently, the “prophylactic” removal of wisdom teeth was recommended. The idea was to remove wisdom teeth BEFORE they gave rise to problems.

However well designed research has shown that the prophylactic removal of wisdom teeth does NOT result in better outcomes. In fact, the surgical risk of damage to surrounding nerves in the jaw and postoperative infection outweighs any benefits.

So the PROPHYLACTIC removal of wisdom teeth is now NOT carried out in the NHS and many patients have been saved from undergoing a significant surgical procedure.

And as this was at one point the most common surgical operation in the UK, this presumably has allowed healthcare resources to be used more efficiently.

Does “evidence” affect my brace treatment?

It surely does. Cleveland Orthodontics is a specialist-led practice, and part of specialist training in the UK includes completion of a Master of Science research degree. This involves training in research methodology and the completion of a piece of research (my research project was on impacted teeth in individuals with cleft palate).

So what does this mean for our patients?

It means that we are trained to look at published research papers critically so that we choose the best techniques and make the appropriate clinical decisions based on the best evidence available.

Our clinicians regularly meeting to discuss current published clinical research.

The wires we use, the decision whether you need teeth taken out or not, even the decision whether you actually need a brace in the first place …all of these areas have been subject to clinical research.

Specialist orthodontic training allows us to ensure we provide the best care for you and your family based on the best available evidence.

Recommended reading

Check out Ben Goldacre’s online Guardian column “Bad Science” if you are interested in how “good” science should improve many aspects of modern living. www.badscience.net

freeimagesuksmall