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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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Introduction

Don’t be too certain

  • Xenophanes, 6th century BCE.
  • Charlie (‘Peanuts’) Brown, 20th century CE.
  • Susser M. Causal thinking in the health sciences. Oxford: Oxford University Press, 1983.

1. New – but is it better?

Anecdotes are anecdotes

  • Ross N. Foreword. In: Ernst E, ed. Healing, hype, or harm? A critical analysis of complementary or alternative medicine. Exeter: Societas, 2008:vi-vii.

A tragic epidemic of blindness in babies

  • Silverman WA. Human experimentation: a guided step into the unknown. Oxford: Oxford University Press, 1985:vii-viii.

On being sucked into a maelstrom

  • Cooper J. Herceptin (rapid response). BMJ.Posted 29 November 2006 at www​.bmj.com.

2. Hoped-for effects that don’t materialize

No wonder she was confused

  • Huntingford CA. Confusion over benefits of hormone replacement therapy. Lancet. 2004;363:332. [PubMed: 14751720]

3. More is not necessarily better

We do things because

  • Parmar MS. We do things because (rapid response). BMJ. Posted 1 March 2004 at www​.bmj.com.

Drastic treatment is not always the best

  • Brewin T in Rees G, ed. The friendly professional: selected writings of Thurstan Brewin. Bognor Regis: Eurocommunica, 1996.

The classic (Halsted) radical mastectomy/Extended radical mastectomies

  • Adapted from Lerner BH. The breast cancer wars: hope, fear and the pursuit of a cure in twentieth-century America. New York: Oxford University Press, 2003. [PubMed: 11949674]

Random allocation – a simple explanation

  • Harrison J. Presentation to Consumers’ Advisory Group for Clinical Trials, 1995.

The struggle for unbiased evidence

  • Adapted from Kolata G, Eichenwald K. Health business thrives on unproven treatment, leaving science behind. New York Times Special Report, 2 October 1999. [PubMed: 11647705]

4. Earlier is not necessarily better

From person to patient

  • Cochrane AL, Holland WW. Validation of screening procedures. British Medical Bulletin. 1971;27:3–8. [PubMed: 5100948]

Don’t assume early detection is worthwhile

  • Morris JK. Screening for neuroblastoma in children. Journal of Medical Screening. 2002;9:56. [PubMed: 12133921]

Overdiagnosing prostate cancer

  • Chapman S, Barratt A, Stockler M. Let sleeping dogs lie? What men should know before getting tested for prostate cancer. Sydney: Sydney University Press, 2010: p25.

Discoverer of PSA speaks out

  • Ablin RJ. The great prostate mistake. New York Times, 10 March 2010.

Selling screening

  • Woloshin S, Schwartz LM. Numbers needed to decide. Journal of the National Cancer Institute. 2009;101:1163–5. [PubMed: 19671771]

Don’t play poker with your genes

  • Sense About Science. Making sense of testing: a guide to why scans and other health tests for well people aren’t always a good idea. London: Sense About Science 2008, p7. Available from www​.senseaboutscience.org.

The screening circus

  • Warlow C. The new religion: screening at your parish church. BMJ 2009;338:b1940.

5. Dealing with uncertainty about the effects of treatments

Stepwise progress doesn’t hit the headlines

  • Goldacre B. Bad Science. London: Fourth Estate, 2008, p219.

Facing up to uncertainties: a matter of life and death

  • Chalmers I. Addressing uncertainties about the effects of treatments offered to NHS patients: whose responsibility? Journal of the Royal Society of Medicine. 2007;100:440. [PMC free article: PMC1997270] [PubMed: 17911116]

Addressing uncertainty is professional

  • From: Medical Research Council response to Royal College of Physicians consultation on medical professionalism. 2005.

Doctors talking about guesswork in prescribing

  • Adapted from Petit-Zeman S. Doctor, what’s wrong? Making the NHS human again. London: Routledge, 2005, pp79-80.

Can patients cope with uncertainty?

6. Fair tests of treatment

Mistaking the cure

  • James Stuart, King of Great Britaine, France and Ireland. A counterblaste to tobacco. In: The workes of the most high and mightie prince, James. Published by James, Bishop of Winton, and Deane of his Majesties Chappel Royall. London: printed by Robert Barker and John Bill, printers to the Kings most excellent Majestie,1616: pp 214-222.

Believing is seeing

  • Asher R. Talking sense (Lettsomian lecture, 16 Feb, 1959). Transactions of the Medical Society of London, vol LXXV, 1958-59. Reproduced in: Jones, FA, ed. Richard Asher talking sense. London: Pitman Medical, 1972.

The Yellow Card Scheme

  • Bowser A. A patient’s view of the Yellow Card Scheme. In: Medicines & Medical Devices Regulation: what you need to know. London: MHRA, 2008. Available at www​.mhra.gov.uk.

7. Taking account of the play of chance

What does ‘statistically significant’ mean?

8. Assessing all the relevant, reliable evidence

Why did you start?

  • Robinson KA, Goodman SN. A systematic examination of the citation of prior research in reports of randomized, controlled trials. Annals of Internal Medicine. 2011;154:50–55. [PubMed: 21200038]

Synthesizing information from research

  • Rayleigh, Lord. In: Report of the fifty-fourth meeting of the British Association for the Advancement of Science; held at Montreal in August and September 1884. London: John Murray, 1884: pp3-23.

The importance of systematic reviews

Marketing-based medicine

  • Spielmans GI, Parry PI. From Evidence-based Medicine to Marketing-based Medicine: Evidence from Internal Industry Documents. Journal of Bioethical Inquiry. 2010;7(1):13–29. Available online: http://tinyurl​.com/Spielmans.

Science is cumulative but scientists don’t accumulate evidence scientifically

  • Goldacre B. Bad Science: How pools of blood trials could save lives. The Guardian, 10 May 2008, p16.

Could checking the evidence first have prevented a death?

  • Perkins E. Johns Hopkins Tragedy. Information Today 2001;18:51–54.

Instructions to authors to put research results in context by the editors of the medical journal The Lancet

  • Clark S, Horton R. Putting research in context – revisited. Lancet. 2010;376:10–11. [PubMed: 20609979]

9. Regulating tests of treatments: help or hindrance?

Who says medical research is bad for your health?

  • Hope T. Medical ethics: a very short introduction. Oxford: Oxford University Press, 2004, p99.

In an ideal world

Biased ethics

  • Lantos J. Ethical issues – how can we distinguish clinical research from innovative therapy? American Journal of Pediatric Hematology/Oncology. 1994;16:72–75. [PubMed: 8311175]

Rethinking informed consent

  • Manson NC, O’Neill O. Rethinking informed consent in bioethics. Cambridge: Cambridge University Press, 2007, p200.

A commonsense approach to informed consent in good medical practice

  • Gill R. How to seek consent and gain understanding. BMJ. 2010;341:c4000. [PubMed: 20736270]

Academic nicety – or sensible choice?

  • Harrison J. Testing times for clinical research. Lancet. 2006;368:909–910.

What research regulation should do

10. Research – good, bad, and unnecessary

My experience of Magpie

  • MRC News Release. Magnesium sulphate halves risk of eclampsia and can save lives of pregnant women. London: MRC, 31 May 2002.

Impact of ‘me-too’ drugs in Canada

Doctors and drug companies

  • Angell M. Drug companies & doctors: a story of corruption. New York Review of Books. 2009:15.

Dodgy, devious, and duped?

All it takes is to find the gene

  • Iannucci A. The Audacity of Hype. London: Little, Brown, 2009, pp270-1.

Psoriasis patients poorly served by research

  • Jobling R. Therapeutic research into psoriasis: patients’ perspectives, priorities and interests. In: Rawlins M, Littlejohns P, eds. Delivering quality in the NHS 2005. Abingdon: Radcliffe Publishing Ltd, pp53-6.

11. Getting the right research done is everybody’s business

Patients’ choice: David and Goliath

  • Refractor. Patients’ choice. David and Goliath. Lancet. 2001;358:768.

A key partnership

  • Professor Dame Sally Davies. Foreword to Staley K. Exploring impact: public involvement in NHS, public health and social care research. Eastleigh: INVOLVE, 2009.

Lay people help to rethink AIDS

  • Epstein S. Impure science: AIDS, activism and the politics of knowledge. London: University of California Press, 1996. [PubMed: 11619509]

Pester power and new drugs

  • Wilson PM, Booth AM, Eastwood A. Deconstructing media coverage of trastuzumab (Herceptin): an analysis of national newspaper coverage. Journal of the Royal Society of Medicine. 2008;101:125–132. [PMC free article: PMC2270248] [PubMed: 18344469]

Involving citizens to improve healthcare

12. So what makes for better healthcare?

Shared decision-making

  • Adapted from Thornton H. Evidence-based healthcare. What roles for patients? In: Edwards A, Elwyn G, eds. Shared decision-making in health care. Achieving evidence-based patient choice. Second edition. Oxford: Oxford University Press, 2009, p39.

Don’t be fooled by eye-catching statistics

  • Goldacre B. Bad Science. London: Fourth Estate, 2008, pp239-40.

Who has diabetes?

  • Welch HG, Schwartz LM, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. Boston: Beacon Press, 2011, pp17-18.
Copyright © 2011 Imogen Evans, Hazel Thornton, Iain Chalmers and Paul Glasziou.
Bookshelf ID: NBK66193