How do we know whether a particular treatment really works? How reliable is the evidence? And how do we ensure that research into medical treatments best meets the needs of patients? These are just a few of the questions addressed in a lively and informative way in Testing Treatments. Brimming with vivid examples, Testing Treatments will inspire both patients and professionals.

Building on the success of the first edition, Testing Treatments has now been extensively revised and updated. The second edition includes a thought-provoking account of screening, explaining how early diagnosis is not always better, and a new chapter exploring how over-regulation of research can work against the best interests of patients. Another new chapter shows how robust evidence from research can shape the practice of healthcare in ways that allow treatment decisions to be reached jointly by patients and clinicians.

Testing Treatments urges everyone to get involved in improving current research and future treatment, and outlines practical steps that patients and doctors can take together.

Contents

• About the authors
• Acknowledgements
• Foreword by Ben Goldacre
• Foreword to the first edition by Nick Ross
• Preface
• Introduction
• 1. New – but is it better?
  • WHY FAIR TESTS OF TREATMENTS ARE NECESSARY
  • UNEXPECTED BAD EFFECTS
  • TOO GOOD TO BE TRUE
• 2. Hoped-for effects that don’t materialize
  • ADVICE ON BABIES’ SLEEPING POSITION
  • DRUGS TO CORRECT HEART RHYTHM ABNORMALITIES IN PATIENTS HAVING A HEART ATTACK
  • DIETHYLSTILBOESTROL
  • HORMONE REPLACEMENT THERAPY (HRT)
  • EVENING PRIMROSE OIL FOR ECZEMA
• 3. More is not necessarily better
  • INTENSIVE TREATMENTS FOR BREAST CANCER
  • DARE TO THINK ABOUT DOING LESS
• 4. Earlier is not necessarily better
  • LESSONS FROM NEUROBLASTOMA SCREENING
  • WEIGHING BENEFITS AND HARMS
  • IS ANYONE NORMAL?
• 5. Dealing with uncertainty about the effects of treatments
  • DRAMATIC TREATMENT EFFECTS: RARE AND READILY RECOGNIZABLE
  • MODERATE TREATMENT EFFECTS: USUAL AND NOT SO OBVIOUS
  • WHEN PRACTITIONERS DISAGREE
  • ADDRESSING UNCERTAINTIES ABOUT THE EFFECTS OF TREATMENTS
  • PROVIDING TREATMENT AS PART OF A FAIR TEST
• 6. Fair tests of treatments
  • WHY ARE FAIR TESTS OF TREATMENTS NEEDED?
  • COMPARING LIKE WITH LIKE
• 7. Taking account of the play of chance
  • THE PLAY OF CHANCE AND THE LAW OF LARGE NUMBERS
  • ASSESSING THE ROLE THAT CHANCE MAY HAVE PLAYED IN FAIR TESTS
  • WHAT DOES A ‘SIGNIFICANT DIFFERENCE’ BETWEEN TREATMENTS MEAN?
  • OBTAINING LARGE ENOUGH NUMBERS IN FAIR TESTS OF TREATMENTS
• 8. Assessing all the relevant, reliable evidence
  • IS ONE STUDY EVER ENOUGH?
  • SYSTEMATIC REVIEWS OF ALL THE RELEVANT, RELIABLE EVIDENCE
  • WHAT CAN HAPPEN IF ALL THE RELEVANT, RELIABLE EVIDENCE IS NOT ASSESSED?
  • REPORTS OF NEW RESEARCH SHOULD BEGIN AND END WITH SYSTEMATIC REVIEWS
• 9. Regulating tests of treatments: help or hindrance?
  • DO REGULATORY SYSTEMS FOR TESTING TREATMENTS GET IT RIGHT?
  • INFORMATION AND CONSENT
  • WHAT REGULATORY SYSTEMS DO NOT DO
• 10. Research – good, bad and unnecessary
  • GOOD RESEARCH
  • BAD RESEARCH
  • UNNECESSARY RESEARCH
  • DISTORTED RESEARCH PRIORITIES
• 11. Getting the right research done is everybody’s business
  • HOW CAN PATIENTS AND THE PUBLIC HELP TO IMPROVE RESEARCH?
  • INVOLVING PATIENTS IN RESEARCH
  • HOW PATIENTS CAN JEOPARDIZE FAIR TESTS OF TREATMENTS
  • WORKING COLLABORATIVELY BODES WELL FOR THE FUTURE
• 12. So what makes for better healthcare?
  • WHAT MIGHT THE IDEAS IN THIS BOOK LOOK LIKE FOR YOU?
  • SHARED DECISION-MAKING: A CONSULTATION FOR A COMMON CONDITION
  • QUESTIONS ABOUT TRANSLATING RESEARCH EVIDENCE INTO PRACTICE
  • WHERE DO WE GO FROM HERE?
• 13. Research for the right reasons: blueprint for a better future
  • BLUEPRINT FOR A BETTER FUTURE
• References
• Additional resources
• List of Vignettes
• List of Key Points

Foreword © 2011 Ben Goldacre