1 read a story about WC Fields. Apparently a friend called to see him when he was dying and was surprised to see the hard-drinking, misanthropic comedian intently absorbed in the Bible. The friend asked him if he was seeing the error of his ways but Fields put him straight 'I'm just looking for the loopholes'. Perhaps t shouldn't admit it in a respected journal like this, so please don't mention it to the serious folk from the Front Pages, but I seem to be increasingly approaching academic papers and evidence-based medicine with the same philosophy. Maybe I'm just changing into a Luddite as the years go by but something about the relentless trend to medicalise and intervene grates with actual day-to-day experience as a GP. The world, of acronymed, international multicentre trials is often completely at odds with the world I come across on an everyday basis. Their model of the world resembles some teeming ant hill where we all scurry around in predetermined, stereotyped simplistic ways. Their conclusions may apply for large populations but individuals are different, complex, often fascinating or frustrating and unpredictable. 1 am less and less convinced that large trials translate smoothly into appropriate care for individual patients.
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