Intended for healthcare professionals

Rapid response to:

Views & Reviews From the Frontline

Bad medicine: rheumatoid arthritis

BMJ 2011; 343 doi: (Published 05 October 2011) Cite this as: BMJ 2011;343:d6357

Rapid Response:

Re: Emotive Responses

Dr Spence writes:

"I rather resent this type of emotive response"

Well, perhaps he shouldn't accuse the vast majority of
rheumatologists of "bad medicine", who rely on "subjective" diagnostic
methods (like, er... clinical examination), imply that new guidelines
exist to make our profession "a profitable business", or go out of his way
to inform rheumatologists that "...immunosuppressive treatments require
regular monitoring and are associated with serious harms". I have the
utmost respect for GPs, who do a job that I would find extremely
difficult; but is it any wonder that vastly experienced specialists get
rather annoyed when a non-specialist strides into the public arena and
tells them that a good chunk of their work is "intellectually bankrupt"?

"If you can diagnosis RA with normal inflammatory makers and negative
RF, this simply doesn't seem credible"

When I was a first year medical student, giving beta-blockers to a
patient with heart failure didn't seem very credible either.
Fortunately, those with the relevant expertise (and evidence) knew better
than me.

"Do you really believe there is no risk of overdiagnosis?"

Of course I don't believe this, and it's disingenuous to ask.
Giving large dose cefalosporins to a child with meningitis before lumbar
puncture carries a risk. The real question is - is the risk worth it?
Spence doesn't even attempt to provide an answer. Rheumatologists do,
every day, in their clinics, and have provided their evidence in these
rapid responses. I know who I'd rather entrust my health to.

Competing interests: No competing interests

14 October 2011
Jamie S Robertson
ST3 Rheumatology
NHS Tayside