ALLERGY\THE SCIENTIFIC EVIDENCE: DIFFERENT DOCTORS, DIFFERENT PATIENTS
A third factor that influences medical trials is the type of patients a particular doctor sees. To take one example, a consultant gastroenterologist working in a large hospital will see a wide range of patients with persistent diarrhoea, who have been referred by their family doctor. These patients will vary in all sorts of ways, including their own ideas about their illness. Some may think that particular foods cause their symptoms but most will have no clue at all why they are ill. An allergist, on the other hand, will not see many patients with diarrhoea, but those he does see will probably have been referred by their family doctor because they believe their symptoms are caused by ‘allergies’ to food. Experience shows that such patients have often tried some form of self-diagnosis, or alternative therapy, without success.
A proportion of the allergist’s patients may be people with psychosomatic problems, who have latched on to diet as an explanation for their symptoms because they find the label psychosomatic’ unacceptable. Despite their lack of success in identifying dietary triggers for their symptoms they are unwilling to give up. Of course, the first group of patients – those seen by the gastroenterologist – may well include some with psychosomatic problems, but they are probably fewer than in the group seen by the allergist.
When referring patients, family doctors take account of the consultant’s views, and, it must be said, their own personal preferences. A ‘difficult’ patient whose diarrhoea is accompanied by a patently neurotic personality is likely to be referred to a consultant whose main interest lies in psychosomatic causes. Another patient with much the same bowel symptoms, whom the family doctor believes to be mentally well-balanced, will probably be referred to a consultant who is more interested in physical causes. This again biases the ‘sample’ of patients that a particular consultant sees, and tends to reinforce medical prejudices.
Neither of these two groups of patients is a representative sample of everyone in the country with persistent diarrhoea. A survey which showed that a third of ‘apparently healthy’ people suffered some form of bowel disorder also discovered that the majority had not sought medical treatment. So the statistics produced by any medical study are not necessarily applicable to the population at large.
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