The best medicine

Alas, this is my last column for the FT. My aim was to help readers make more sense of medicine, since there is so much controversy and hype obscuring the real problems.

My first piece, seven years ago, was about the overselling of screening tests and the underestimation of harm. Since then, there has been a slight increase in media coverage about the dangers of false positives from such tests, but much of it has been sensationalist. Worse still, there has been little official recognition of the problem and even less unbiased material made available to patients. Unfortunately, this column has not been a randomised controlled trial, so one can have very little idea if it has done any good – and one might not know if there have been harms done, either. Naturally, I hope for the opposite, but since one of my themes has been the problem of good intentions still causing harm, I can hardly escape it.

For there are also the unknown unknowns – the things I really didn’t anticipate; the lady, for example, who told me that after reading a series of my columns she felt more confident than ever that homeopathy was the best medicine. (I re-read those columns and I still don’t understand why.) Nor do I think that my relationship with the pharmaceutical industry has improved: I’m still getting invitations to “chats about new drugs” over luxury dinners. As for the politics of healthcare, the lure of GP commissioning fills me with dread. I’ve seen no evidence at all that it will result in better services, and I have a horror of a bigger wedge being inserted between primary and secondary care, none of which is good for patients.

There are two real insights that writing this column has given me. The first is that the more evidence-based medicine I read, the more I wonder. It is no longer ethically acceptable to use non-evidence-based medicine, and quite right too. But the more reading I do of the very papers on which we base our evidence, the more gaps and flaws appear. I have reached a hopeful mix of pragmatic, evidence-based, professionally applied workmanship, held together by patients who talk to me about their priorities and concerns.

The other insight is from readers, for which I am profoundly grateful. A few years ago I wrote a piece decrying the use of battle terminology (“my war against cancer”) in illness. To do so was not only damaging, I wrote, but simply wrong. I had a number of replies from people who were dying and who had been distressed or troubled with the same analogy. I kept in touch with most of them and found the e-mails we exchanged thoroughly enlightening. Their friendship was the best thing this column has given me, and I will remember each one. So thank you – and on with writing the book.

Margaret McCartney is a GP in Glasgow

margaret.mccartney@ft.com