Tuesday, November 1, 2011

[EQ] Testing Treatments - Better Research for Better Healthcare

Testing Treatments - Better Research for Better Healthcare

Imogen Evans, Hazel Thornton, Iain Chalmers and Paul Glasziou

British Library - second edition 2011

Available online as PDF file [226p.] at: Edition http://bit.ly/rMaZtX

“…………..‘There is no way to know when our observations about complex events in nature are complete. Our knowledge is finite, Karl Popper emphasised, but our ignorance is infinite. In medicine, we can never be certain about the consequences of our interventions, we can only narrow the area of uncertainty. This admission is not as pessimistic as it sounds: claims that resist repeated energetic challenges often turn out to be quite reliable. Such “working truths” are the building blocks for the reasonably solid structures that support our everyday actions at the bedside.’

William A. Silverman. Where’s the evidence?

Oxford: Oxford University Press, 1998, p165……….”


“…….Modern medicine has been hugely successful. It is hard to imagine what life must have been like without antibiotics. The development of other effective drugs has revolutionized the treatment of heart attacks and high blood pressure and has transformed the lives of many people with schizophrenia. Childhood immunization has made polio and diphtheria distant memories in most countries, and artificial joints have helped countless people to be less troubled by pain and disability.

Modern imaging techniques such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) have helped to ensure that patients

are accurately diagnosed and receive the right treatment. The diagnosis of many types of cancer used to spell a death sentence, whereas today patients regularly live with their cancers instead of dying from them. And HIV/AIDS has largely changed from a swift killer into a chronic (long-lasting) disease.


Of course many improvements in health have come about because of social and public health advances, such as piped clean water, sanitation, and better housing. But even sceptics would have difficulty dismissing the impressive impact of modern medical care. Over the past half century or so, better healthcare has made a major contribution to increased lifespan, and has improved the quality of life, especially for those with chronic conditions.1, 2 But the triumphs of modern medicine can easily lead us to overlook many of its ongoing problems. Even today, too much medical decision-making is based on poor evidence….”



Foreword to the first edition by Nick Ross

Foreword © 2011 Ben Goldacre



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

5 Dealing with uncertainty about the effects of treatments

6 Fair tests of treatments

7 Taking account of the play of chance

8 Assessing all the relevant, reliable evidence

9 Regulating tests of treatments: help or hindrance?

10 Research – good, bad, and unnecessary

11 Getting the right research done is everybody’s business

12 So what makes for better healthcare?

13 Research for the right reasons: blueprint for a better future


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