Questions that are important for patients

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Researchers in Bristol decided to pose a fundamental question:  ‘To what extent are questions of importance to patients with osteoarthritis of the knee and the clinicians looking after them reflected in the research on this condition?’ [17]

They began by convening four focus groups – of patients, rheumatologists, physiotherapists, and general practitioners, respectively. These groups were unanimous in making clear that they did not want any more trials sponsored by pharmaceutical companies comparing yet another non-steroidal anti-inflammatory drug (the group of drugs that includes, for example, ibuprofen) against a placebo.

Instead of drug trials, patients wanted rigorous evaluation of physiotherapy and surgery, and assessment of the educational and coping strategies that might help patients to manage this chronic, disabling, and often painful condition more successfully. Of course, these forms of treatment and management offer much less scope than drugs for commercial exploitation, and so are often ignored.

How many other fields of therapeutic research would, if evaluated in this way, reveal similar mismatches between the questions about treatment effects that matter to patients and clinicians, and those that researchers are addressing? Regrettably, mismatch appears to be the rule rather than the exception. [18, 19, 20, 21]

Minor changes in drug formulation rarely lead to the drugs having substantially new, more useful effects, yet these types of studies dominate research into treatments not only for arthritis but also for other chronic disorders. What a waste of resources!

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