on 22 November 2011
Testing Treatments asks the crucial question, how can we ensure that medical research effectively meets the needs of patients? It is a crucial question because all over the world, resources are wasted on poor quality research, research that only meets the needs of drug companies, and on unproven, disproven, or unnecessary treatment.
A useful complement to Ben Goldacre's Bad Science and Simon Singh's Trick or Treatment, Testing Treatments clearly lays out the principles of robust research, defining what makes a fair test, and explaining the importance of setting a study within the context of existing research. In itself, these principles do not sound particularly challenging, but the authors go on to show how the waters are muddied by vested interests, patient pester power, paternalistic clinicians, and inexcusable poor practice.
Finally, they set out a strong blueprint for a better future, asking for patients to be treated as equal partners, both as individuals requiring treatment, and as groups participating in research.
This is a readable work of great importance, with easily accessible language and interesting examples throughout the text.
on 12 December 2011
Medical research is one of those areas where everyone thinks they know a little. Images of lab rats, miraculous cures and money grabbing pharmaceutical companies compete with the day to day reality of patients and doctors trying to tackle illness. A new edition has been published of a book that tries to shed a bit of light on to the subject.
The book is aimed at the informed patient and explains how new medical treatments are researched, and how that relates to the experience of the patient being treated. The book strikes a tone that is halfway between academic text and pop science, and might seem intimidating to some, but the regular summaries of key points and personal stories mean that the reader will soon find themselves gripped.
The book takes a long view over history, covering scurvy treatments in 1747 right up to cancer trials of the present day, advocating a partnership approach between patient and doctor, and includes calls to action for professionals, patients and policy makers to ensure that questions are asked and information is shared. The reader is encouraged to look sceptically at the need for treatments and screening, and to try to see through marketing and media hype.
Ben Goldacre provided the forward to this edition, and the book continues in the spirit of his work - accessible without being over simplistic. I would have liked to have more detail, but I'm not sure how that could have been achieved without losing the ease of understanding. There is an extensive list of further reading and references at the back of the book for the reader who would like to know more, and I didn't personally feel that the scientific knowledge was shied away from in the text. Perhaps a scientist would disagree, but I went away feeling that I knew much more about the subject and that I would be a more informed patient.
on 2 March 2012
This punchy and eminently readable book, by two doctors and a healthcare-research campaigner, takes a critical look at how treatments are assessed - and how so often the way they are evaluated falls short of the ideal.
The essence of good treatment evaluation boils down to the `fair test', the clinical trial that compares different treatments in a way that avoids bias, takes account of the play of chance and assesses all relevant, reliable evidence.
It might be supposed that clinical trials are based on well-constructed research protocols and done with due safeguards for unbiased reporting, but that doesn't always happen. All too often it is a question of profit-driven rather than evidence-based evaluation - pharmaceutical companies want to put their results in the best possible light, because their profit depends on it. One ploy is to withhold negative results from publication, but even independent researchers may neglect to write up their reports if the results are disappointing. Astonishingly, at least half of all clinical trials are never fully reported, which makes the collection of all relevant material for an assessment a daunting task.
The authors want to draw patients into helping to make decisions about their own treatment, and to this end the book tells them how to judge whether claims for treatments are trustworthy. "Getting the right research done", the authors conclude, "is everybody's business".
The book is filled with examples of good, bad and unnecessary research; injudicious use of screening ("early diagnosis is not always better"); the proliferation of "me too" drugs (new, expensive medicines that offer no advantage over older, similar ones); and the misuse of statistics. It is also liberally sprinkled with apt and sometimes pithy quotations - from thoughts on certainty and opinion (from Charlie `Peanuts' Brown) to observations on the overdiagnosis of prostate cancer. And it is beautifully written.
on 14 February 2012
Urgent and focussed... a vital book, in both senses of the word!
`Testing Treatments' is a broad-ranging work, important reading for patients, tax-payers, clinicians, researchers and research funders. It is packed with evidence of unrepeated studies, unsafe results, biased results, results which aren't properly followed up, or made available. These authors really know their subject.
You will recognise many of the culprits from media reports, but still others will shock you.
This book brings an awareness to consumers and patients that they are part, and can be a much bigger part, of the system by which a treatment is used and reported. Some treatments are researched, and go on sale as, ultimately, effective or ineffective drugs; others become a tragic name associated with a devastating side-effect.
It gives consumers a whole raft of questions to ask, to create a mechanism whereby supply will become driven by the demand of the informed patient, rather than the will, whim or interest of the drug company.
Testing Treatments is a valuable tool for anyone placing their faith in a health-shop remedy, a diagnostic procedure, or drug prescribed by a GP or consultant physician. There are a wealth of references, and the most comprehensive list of additional resources for general and specific information about current research, even about further training in the skills of assessing research evidence.
Many assumptions you might have made about your GP prescribing on the basis of up-to-date research results, or that any diagnostic test must be valuable, or that the evidence of one study alone is enough, will be swept aside in this eye-opening work.
There is a lot of statistical and medical information, but there are also key-points summaries, a `blue-print' for a better future and an action plan of things you can do. This is a vital book, in both senses of the word...read it, you will be riveted!
on 15 April 2012
if you have an opinion on the state of healthcare today you owe it to yourself (and everyone you have debates with) to read this book.
The second edition has been updated.
I thought with a chronic condition i knew all about the big bad pharmacos queering the pitch for getting useful work done in the world of healthcare.
I now have a fuller picture of what makes useful research.
Not, as a patient blindly demanding new research into novel non-pharmaceutical treatments but requesting consistent reporting and analysis of what's gone before in order to pave the way for any new research to be able to provide meaningful results.
Asking questions before, during and after the process of bringing a treatment to where it can be made best use of surprisingly doesn't happen as often as you'd have thought and would seem to be one of the first things that needs to change.
We need regulation in the right places
Gathering of scientific data needs to and should be a cumulative exercise.
until then we'll continue wasting lives and money.
I'd heard Iain Chalmers on the radio and he sounded like a commonsense-filled, eloquent and compassionate man who helped develop Cochrane Reviews; Systematic, objective analyses of existing robust research.
...If I've understood right.
I'm not a medical professional of any sort (as you may be able to tell) but I've had my fair share of being talked at and talking to a variety of medical professionals.
I feel this book has given me an insight into the research process: it's not a black & white panto enterprise with dastardly pharma v. innocent Snow-white & Cindarella victims with no voice having unspeakable things done to them in the name of 'progress' but a far greyer affair.
I've found this book to be fascinating, eloquent and compassionate.
glad i got it.
My letters to and requests of healthcare practitioners and decision makers will take a far more useful shape now, i hope.
Medical research has saved countless lives and made immense contributions to human welfare. But it could be done better and it could be done fairer.
How do you know if a new treatment is effective? Is it treatment or is it trickery? The question can only be answered if the evidence used to support the claims of the benefits of a new treatment has been reached by means of a fair test.
If you are holding a trial, then you must take two groups and make sure they are like for like. The Scottish naval surgeon James Lind did just this when he demonstrated in 1747 that oranges and lemons were more effective than any of the five other treatments then prescribed for the treatment of scurvy (including sulphuric acid). He took two groups of patients, both at the same stage of the disease. He could have biased the test by giving citrus fruits to sailors at the point of death, and beyond saving, but given sulphuric acid to those less ill. That would have been an unfair test. It would have suggested that sulphuric acid was the effective treatment when it was anything but. But both groups were at the same stage of the illness in Lind's test. That's a fair test. Although we have come a long way in terms of the sophistication of the methodology, the basics are the same and as relevant as ever. You make sure that nobody knows who is getting what treatment, and that you follow up people for a proper amount of time afterwards, to see how they have turned out, because outcomes vary over time. If you stop monitoring too soon, you may miss negative outcomes that emerge over a longer period of time (again biasing results).
There are a variety of vested interests, working at cross-purposes to the application of fair tests in medical research. Pharmaceutical corporations push to peddle an expensive new treatment, which only has a marginal benefit over an established, older one. Benefits may be played up while harmful side effects may be played down. Patient groups lobby for the release of a drug before its effectiveness is known. Clinicians and practitioners develop dogmatic habits themselves, insisting on particular courses of treatment, whatever the evidence says (100 years had to pass before most practitioners finally accepted that radical mastectomy made no difference to long-term breast cancer survival rates).
Because of the vagaries of chance, and the attendant risk of drawing premature conclusions from too few examples, you need a meta-analysis: a compendium and summary of the outcomes of all similar trials. It's a useful tool to determine whether a new treatment is effective and indeed whether there is any need to test for it at all. Superfluous trials which have wasted time, money and sometimes lives could have been avoided had the proper meta-analyses been done.
The authors conclude with a series of proposals to tighten up clinical research, to increase the likelihood that claims about new treatments, whether positive or negative, can be said to have been made as a result of a fair test. But this is not just an academic exercise and the authors want to equip, you, the reader, with an understanding of what a fair test is. Because we could all do with understanding more about what constitutes a fair test. That goes for practitioners but it also goes for the rest of us, as we are all likely to be patients at some point in our lives. Therefore read this book.
on 12 July 2012
This book is ideal for the lay person who wants to understand the basics about clinical trials and evidence based medicine. Even better, this book is available as a PDF free from the testingtreatments.org website. It is explained in very clear language and gives plenty of historical examples where poor research has led to increased human suffering and wasted research.
on 15 December 2011
physicians are flooded with informationas about better medicine, often promising best and modern care. This matches with the intentions of physicians and doctors, so it will easily be believed.
To believe is not to know. Very often the new drug is an unknown and dangerous drug. "Testing treatments" enables you to find out whether a diagnostic or therapeutic treatment is really helpful or just popped out of the merketing department of a Pharma multi.
Better knowledge promotes better healthcare. It brings back professionalism to physicians and is a pleasure to read. Buy, read and follow....
on 23 February 2012
A very accessible book that gives easy to grasp explanations of what can be quite complex research methods, although something is lost in the simplification of the descriptions. The book raised very interesting questions for me regarding the use of screening and its implications. As someone who works within public health it was an interesting perspective.
A very useful book for anyone to read to give a greater understanding of how new treatments are evaluated and works against the inherent assumption that `new' = `best'.
The book presents a challenge to the way in which our healthcare is currently conducted. I think after reading this book it would definitely make you a more informed patient and would equip[ you with some very interesting questions to present to your healthcare practitioner.
Overall a very engaging read which has encouraged me to look at the authors other publication - `Bad Science'.
on 17 May 2012
This is a well written book that cleverly combines evidence based practice and popular science. It explains things in a very simple way using examples and introduces the reader, without pain, to statistics and how these can be used to support and argue for both good and bad reasons.
I have decided to use this book as an pre-reading text for my second year Operating Department Practitioner students this year and hope that this will aid them in understanding of Randomised Controlled Trails and Systematic Reviews. I think it also explains some of the issues with the difficult relationship of health care, drug (medical companies)manufacturers and the media!
I would have liked to see the authors opinions and analysis of the evidence of qualitative research as well as the quantative side, but this may have been outside the remit of this book.