by Imogen Evans, Hazel Thornton, and Iain Chalmers
This is very important book and it should appeal to everyone who wants to join the revolution to reform clinical research, to ensure that it really does serve the interests of patients. It is the best available introduction to the methods, uses, and value of fair testing.
Patients are often seen as the recipients of healthcare, rather than participants. This book shines light on the mysteries of how life and death decisions are made. It shows how those judgements are often badly flawed and it sets a challenge for doctors across the globe to mend their ways.
Aimed at both patients and professionals, Testing Treatments builds a lively and thought provoking argument for better, more reliable and more relevant research with unbiased or 'fair' trials, and explains how patients can work with doctors to achieve this vital goal. Testing Treatments urges readers to take an active part in changing conditions and describes what practical steps doctors and patients can take together to improve current research and future treatments that best serve the interests of patients.
"If we are passive consumers of medicine we will never drive up standards. If we prefer simplistic answers we will get pseudo science. If we do not promote the rigorous testing of treatments we will get pointless and sometimes dangerous treatment along with the stuff that really works."
~ Nick Ross
Introduction from Authors:
"Although we describe the harm that some inadequately tested treatments have caused, it is certainly not our intention to undermine patients’ trust in their health professionals. Our aim is to improve communication and boost confidence. But this will only happen if patients can help their doctors critically assess treatment options. We hope that you, the reader, will emerge from this book sharing some of our passion for the subject and go on to ask awkward questions about treatments, identify gaps in medical knowledge, and get involved in research to find answers for the benefit of everybody."
"Only when the public finally grasps how little reliable knowledge exists will it have the motivation to become actively involved in prioritising the research agenda. Ultimately improvement in clinical care and patients’ outcomes will come from conducting the right kind of research, research that is of importance in the real world, as advocated in the recently established James Lind Alliance. Acknowledging uncertainties and informing patients about them is a key strategy for improving healthcare and lifting the fog from the practice of medicine."
~Djulbegovic B. Lifting the fog of uncertainty from the practice of medicine. British Medical Journal 2004;329:1419-20.
Another chilling example of a medical treatment that did more harm than good is thalidomide. This sleeping pill was introduced in the late 1950s as a safer alternative to the barbiturates that were regularly prescribed at that time; unlike barbiturates, overdoses of thalidomide did not lead to coma. Thalidomide was especially recommended for pregnant...
When More is Not Necessarilt Better - Even today, fear, coupled with the belief that more must be better, drives treatment choices. This prompts some patients and their doctors to opt for ‘traditional’ mutilating and painful treatments, for which there is no evidence of benefit over simpler approaches. How can this be?
Researchers who do not review past tests of treatments before embarking on new studies may not realise that uncertainties about treatment effects have already been convincingly addressed. This means that some patients are taking part in research unnecessarily and being denied treatment that can help them.
Biased (unfair) studies can lead to avoidable illness and premature deaths.
Neither theory nor professional opinion by itself is a reliable guide to safe, effective treatments.
Systematic reviews of studies are essential for designing and understanding both human and animal experiments.
Patients can draw attention to unexpected effects of treatments.
More intensive treatment is not necessarily beneficial.
Looking for disease in apparently healthy people can do more harm than good.
Comparisons are the key to all fair tests of treatments; they are essential for judging whether or not a treatment causes a certain effect.
The old adage that Nature is a great healer happens to be true – people often recover from illness without any specific treatment at all.
Unless attention is paid to biases and the play of chance, it is easy to conclude that some treatments are useful when they are not, and vice versa.
Systematic reviews of all the relevant evidence should be the basis for assessing treatment effects.
