Treatments with moderate but important effects

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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