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Promoting critical thinking about treatment claims

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Home > Read or listen to the book > About

About

In This Section

  • About
    • About the book
      • About the authors
      • Download the book
      • Reviews
      • Translations
    • Why do we need fair tests of treatments?
    • What are fair tests of treatments?
    • What can be done to improve tests of treatments?
  • Background
    • Foreword by Ben Goldacre
      • References (Foreword)
    • Foreword by Nick Ross
    • Why Testing Treatments was written
    • Introduction
      • References (Introduction)
  • Why are fair tests of treatments needed?
    • New – but is it better?
      • Thalidomide
      • Vioxx
      • Avandia
      • Mechanical heart valves
      • Herceptin
      • References (Section 1)
    • 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
      • References (Section 2)
    • More is not necessarily better
      • Intensive treatments for breast cancer
        • Mutilating surgery
        • Bone marrow transplantation
      • Dare to think about doing less
      • References (Section 3)
    • Earlier is not necessarily better
      • Lessons from neuroblastoma screening
      • Weighing benefits and harms
        • Phenylketonuria screening: clearly beneficial
        • Abdominal aortic aneurysm screening: proceed with care
        • Breast cancer screening: well established but remains contentious
        • Prostate cancer screening: clear harms with uncertain benefits
        • Lung cancer screening: early but not early enough?
        • Genetic tests: sometimes useful, often dodgy
      • What screening aims to achieve and why evidence matters
      • Is anyone normal?
      • References (Section 4)
    • Dealing with uncertainty about the effects of treatments
      • Dramatic treatment effects: rare and readily recognizable
        • Laser treatment of portwine stains
        • Imatinib for chronic myeloid leukaemia
        • Mother’s kiss
        • A new treatment for strawberry birthmarks
      • Moderate treatments effects: usual and not so obvious
      • When practitioners disagree
        • Caffeine for breathing problems in premature babies
        • Antibiotics in pre-term labour
        • Breast cancer
      • Addressing uncertainties about the effects of treatments
      • Providing treatment as part of a fair test
      • References (Section 5)
  • What are fair tests of treatments?
    • Fair tests of treatments
      • Why are fair tests of treatments needed?
        • The beneficial effects of optimism and wishful thinking
        • The need to go beyond impressions
        • So what are fair tests?
      • Comparing like with like
        • Treatments with dramatic effects
        • Treatments with moderate but important effects
          • Comparing patients given treatments today with apparently similar patients given other treatments in the past for the same disease
          • Comparing apparently similar groups of patients who happen to have received different treatments in the same time period
          • Unbiased, prospective allocation to different treatments
          • Ways of using unbiased (random) allocation in treatment comparisons
          • Following up everyone in treatment comparisons
          • Dealing with departures from allocated treatments
          • Helping people to stick to allocated treatments
      • Fair measurement of treatment outcomes
      • Generating and investigating hunches about unanticipated adverse effects of treatments
      • References (Section 6)
    • Taking account of the play of chance
      • 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
      • References (Section 7)
    • Assessing all the relevant, reliable evidence
      • Is one study ever enough?
      • Systematic reviews of all the relevant, reliable evidence
        • Reducing biases in systematic reviews
        • Identifying all the relevant evidence for systematic reviews
        • Reducing the play of chance in systematic reviews
        • Recognizing vested interests and spin in systematic reviews
      • What can happen if all the relevant, reliable evidence is not assessed?
        • Avoidable harm to patients
        • Avoidable harm to people participating in research
        • Wasted resources in healthcare and research
      • Reports of new research should begin and end with systematic reviews
      • References (Section 8)
  • What can we do to improve tests of treatments?
    • 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
      • References (Section 9)
    • Research – good, bad and unnecessary
      • Good research
        • Stroke
        • Pre-eclampsia in pregnant women
        • HIV infection in children
      • Bad research
        • Psychiatric disorders
        • Epidural analgesia for women in labour
      • Unnecessary research
        • Respiratory distress in premature babies
        • Stroke
        • Aprotinin: effect on bleeding during and after surgery
      • Distorted research priorities
        • Questions that are important for patients
        • Who decides what gets studied?
      • References (Section 10)
    • 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
        • Patients’ organizations: independent voices or not?
        • Bridging the gap between patients and researchers
      • Working collaboratively bodes well for the future
      • References (Section 11)
    • So what makes for better healthcare?
      • What might the ideas in this website look like for you?
      • Shared decision making: a consultation for a common condition
      • Questions about translating research evidence into practice
        • 1: Isn’t anything worth trying when a patient has a life-threatening condition?
        • 2: Although patients might want to know if a treatment ‘works’, suppose they don’t want all the details?
        • 3: Statistics are confusing – should patients really have to look at the numbers?
        • 4: How can someone know that the research evidence applies to them?
        • 5: Won’t genetic testing – and ‘personalized medicine’ – mean doctors can work out the specific treatment needed in every individual and make all this unnecessary?
        • 6: If someone has a condition that is being studied in an ongoing clinical trial, how do they find out about this if their doctor doesn’t know about it?
        • 7: What’s the best way of telling if the evidence (on the web or elsewhere) is reliable?
        • 8: Are there reliable sources of information that can be recommended?
        • 9: How should people avoid being ‘labelled’ with an ‘illness’ and getting unnecessary treatments?
      • Where do we go from here?
      • References (Section 12)
    • Research for the right reasons: blueprint for a better future
      • Ask the right research questions
      • Design and conduct research properly
      • Publish all the results and make them accessible
      • Produce unbiased and useful research reports
      • Blueprint for a better future
      • Action plan – 10 things you can do
      • References (Section 13)

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