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Evans I, Thornton H, Chalmers I, et al. Testing Treatments: Better Research for Better Healthcare. 2nd edition. London: Pinter & Martin; 2011.

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Testing Treatments: Better Research for Better Healthcare. 2nd edition.

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List of Key Points

  1. New – but is it better?
    • Testing new treatments is necessary because new treatments are as likely to be worse as they are to be better than existing treatments
    • Biased (unfair) tests of treatments can lead to patients suffering and dying
    • The fact that a treatment has been licensed doesn’t ensure that it is safe
    • Side-effects of treatments often take time to appear
    • Beneficial effects of treatments are often overplayed, and harmful effects downplayed
  2. Hoped-for effects that don’t materialize
    • Neither theory nor professional opinion is a reliable guide to safe, effective treatments
    • Just because a treatment is ‘established’ does not mean it does more good than harm
    • Even if patients do not suffer from inadequately tested treatments, using them can waste individual and community resources
  3. More is not necessarily better
    • More intensive treatment is not necessarily beneficial, and can sometimes do more harm than good
  4. Earlier is not necessarily better
    • Earlier diagnosis does not necessarily lead to better outcomes; sometimes it makes matters worse
    • Screening programmes should only be introduced on the basis of sound evidence about their effects
    • Not introducing a screening programme can be the best choice
    • People invited for screening need balanced information
    • The benefits of screening are often oversold
    • The harms of screening are often downplayed or ignored
    • Good communication about the benefits, harms, and risks of screening is essential
  5. Dealing with uncertainty about the effects of treatments
    • Dramatic effects of treatments are rare
    • Uncertainties about the effects of treatments are very common
    • Small differences in the effects of different treatments are usual, and it is important to detect these reliably
    • When nobody knows the answer to an important uncertainty about the effects of a treatment, steps need to be taken to reduce the uncertainty
    • Much more could be done to help patients contribute to reducing uncertainties about the effects of treatments
  6. Fair tests of treatment
    • Fair tests of treatments are needed because we will otherwise sometimes conclude that treatments are useful when they are not, and vice versa
    • Comparisons are fundamental to all fair tests of treatments
    • When treatments are compared (or a treatment is compared with no treatment) the principle of comparing ‘like with like’ is essential
    • Attempts must be made to limit bias in assessing treatment outcomes
  7. Taking account of the play of chance
    • Account must be taken of ‘the play of chance’ by assessing the confidence that can be placed in the quality and quantity of evidence available
  8. Assessing all the relevant, reliable evidence
    • A single study rarely provides enough evidence to guide treatment choices in healthcare
    • Assessments of the relative merits of alternative treatments should be based on systematic reviews of all the relevant, reliable evidence
    • As in individual studies testing treatments, steps must be taken to reduce the misleading influences of biases and the play of chance
    • Failure to take account of the findings of systematic reviews has resulted in avoidable harm to patients, and wasted resources in healthcare and research
  9. Regulating tests of treatments: help or hindrance?
    • Regulation of research is unnecessarily complex
    • Current systems of research regulation discourage fair tests of treatments that would make for better healthcare
    • Despite the onerous regulatory requirements placed on researchers, regulatory systems do little to ensure that proposed studies are genuinely needed
    • Research regulation does little to monitor and follow-up approved research
  10. Research – good, bad, and unnecessary
    • Unnecessary research is a waste of time, effort, money, and other resources; it is also unethical and potentially harmful to patients
    • New research should only proceed if an up-to-date review of earlier research shows that it is necessary, and after it has been registered
    • Evidence from new research should be used to update the previous review of all the relevant evidence
    • Much research is of poor quality and done for questionable reasons
    • There are perverse influences on the research agenda, from both industry and academia
    • Questions that matter to patients are often not addressed
  11. Getting the right research done is everybody’s business
    • Patients and researchers working together can help to identify and reduce treatment uncertainties
    • Input from patients can lead to better research
    • Patients sometimes inadvertently jeopardize fair tests of treatments
    • Relationships between patients’ organizations and the pharmaceutical industry can result in distorted information about treatment effects
    • To contribute effectively, patients need better general knowledge about research and readier access to impartial information
    • There is no one ‘right way’ of achieving collaborative participation in research
    • Patient participation should be appropriate for the specific research purpose
    • Methods of involving patients are continually evolving
Copyright © 2011 Imogen Evans, Hazel Thornton, Iain Chalmers and Paul Glasziou.
Bookshelf ID: NBK66189


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