Excerpt

This book aims to help consumers and practitioners develop the skills to assess health advice – and hopefully to make decisions that will improve the quality of their care. For some people, making better-informed decisions could be life saving. We hope that it will be useful if you are struggling to come to terms with an illness or injury, and the best ways of managing it. Or you may simply want to lead a healthier life, and may be wondering how to make sense of the often conflicting flood of health information that deluges us every day, through the media, and from our friends and health practitioners.

Contents

• Dedication
• About the authors
• Before you read this book
• Acknowledgements
• Disclaimer
• I. Health advice can be harmful
  • 1. This book could save your life
  • 2. Be sceptical
    • If it works on a rat, it will work on you
    • Here’s how it works
    • Blind you with science
    • Personal testimony and celebrity endorsement
    • References
  • 3. Bad evidence
    • Basic research – testing ideas
    • Applied research – does it work on people?
    • Common pitfalls to avoid when assessing research
    • References
  • 4. Don’t always rely on the experts
    • Why the experts disagree
    • Practitioners may not take account of their patients’ preferences
    • References
• II. Your body, your choice
  • 5. Smart health choice essentials
    • 1 What will happen if I wait and watch?
    • 2 What are my test or treatment options?
    • 3 What are the benefits and harms of these options?
    • 4 How do the benefits and harms weigh up for me?
    • 5 Do I have enough information to make a choice?
    • An evidence-based guideline or systematic review could provide the answers to your questions
    • Applying the five questions: two scenarios
    • References
  • 6. Choosing a practitioner or a hospital
    • Judging a practitioner’s decision-making expertise
    • Judging a practitioner’s technical expertise
    • Finding a practice or hospital that suits your needs
    • Choosing not to choose
    • References
• III. Stories and studies
  • 7. An education in shopping
    • In the shopping centre ...
    • How believable are the claims? ...
    • About the trial ...
    • Some things get better on their own ...
    • The placebo effect ...
    • And other study flaws ...
    • Personal experiences can be important ...
    • Let’s get sceptical ...
    • From detergents to treatment for acne ...
    • Randomised and blinded ...
    • Do the benefits outweigh the harms? ...
    • So does it really work? ...
    • Reference
  • 8. The weakness of one
    • The danger of the anecdote
    • Only survivors speak!
    • More problems with anecdotes
    • But anecdotes can be useful in some situations
    • N of 1 trials
    • A broad range of stories
    • References
  • 9. The power of many
    • The power of probabilities
    • Probabilities – what do they tell us?
    • Putting probabilities to work
    • Using probabilities to balance benefits and harms
    • References
• IV. Evaluating the evidence
  • 10. Judging which tests and treatments really work
    • Is there an evidence-based practice guideline or systematic review of randomised trials?
    • Is the evidence relevant?
    • Is the evidence reliable?
    • An example: judging whether you should switch to a Mediterranean diet rather than a low-fat diet if you are at higher risk of heart disease
    • References
  • 11. What makes you sick?
    • How to know when a relationship is causal?
    • Reference
• V. Improving your healthcare
  • 12. Finding the best evidence
    • Evidence from your practitioner
    • Evidence from companies providing products and services
    • Evidence from organisations
    • Surfing the internet yourself
    • Media reports
    • For heavy duty research
    • References
  • 13. Doing your bit
    • Lobbying for more responsible information
    • Being part of a trial
    • Legal issues
    • References
  • 14. How to apply the evidence to you and your situation
    • Think critically
    • Ask key questions
    • Think about all the benefits and harms
    • Consider how the benefits and harms weigh up for you
• VI. Testing your skill
  • 15. Making sense of health advice
    • Example 1 Making sense of a study
    • Example 2 Should a woman in her 40s have screening mammography?
    • Example 3 Product information – Blackmores Hyperiforte 1800 (St John’s wort)
    • Example 4 Keyhole or open surgery for a hernia? Which is best for me?
    • Example 5 Do mobile phones cause brain cancer?
    • References
  • 16. Is this a useful diagnostic test?
    • Sensitivity and specificity of a diagnostic test
    • Pre-test and post-test probability
    • References
  • 17. Decision thresholds
  • 18. Relative risk, relative and absolute risk reduction, number needed to treat and confidence intervals
    • Relative and absolute risks
    • Confidence intervals
• Useful sources of health advice
• Glossary
• After you read this book

Cartoons by Ron Tandberg

Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made.