In This Section
- About the book
- Background
- 1 – New, but is it better?
- 2 – Hoped-for effects that don’t materialize
- 3 – More is not necessarily better
- 4 – 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 (Chapter 4)
- 5 – 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 (Chapter 5)
- 6 – 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
- Fair measurement of treatment outcomes
- Helping people to stick to allocated treatments
- Generating and investigating hunches about unanticipated adverse effects of treatments
- References (Chapter 6)
- 7 – Taking account of the play of chance
- 8 – 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 (Chapter 8)
- 9 – Regulating tests of treatments: help or hindrance?
- 10 – 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 (Chapter 10)
- 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
- Patients’ organizations: independent voices or not?
- Bridging the gap between patients and researchers
- Working collaboratively bodes well for the future
- References (Chapter 11)
- 12 – 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 (Chapter 12)
- 13 – Research for the right reasons: blueprint for a better future