Why Testing Treatments was written
The first edition of Testing Treatments, published in 2006, was inspired by a question: ‘How do you ensure that research into medical treatments best meets the needs of patients?’
Our collective experience – collective at that point meaning Imogen Evans, a medical doctor and former researcher and journalist, Hazel Thornton, a patient and independent lay advocate for quality in research and healthcare, and Iain Chalmers, a health services researcher – was that research often failed to address this key issue. Moreover, we were keenly aware that many medical treatments, both new and old, were not based on sound evidence. So we set out to write a book to promote more critical public assessment of the effects of treatments by encouraging patient-professional dialogue.
We were heartened by the level of interest shown in Testing Treatments – both in the original British Library imprint and when we made the text freely available online at www.jameslindlibrary.org – and that it appealed to both lay and professional readers. The first edition of Testing Treatments has been used as a teaching aid in many countries, and several full translations are available for free download from en.testingtreatments.org.
From the outset we thought of Testing Treatments as work in progress; there will almost always be uncertainties about the effects of treatments, whether new or old, and therefore a continuing need for all treatments to be tested properly. To do this it is essential to visit and re-visit the evidence; to review existing evidence critically and systematically before embarking on new research, and similarly to interpret new results in the light of up-to-date systematic reviews.
Embarking on the second edition of Testing Treatments, we three became four, with the addition of Paul Glasziou, a general practitioner and researcher with a commitment to taking account of high-quality research evidence in everyday clinical practice. We have a new publisher – Pinter & Martin, who reprinted the first edition in 2010 – and the new text is available free on line, as before, from en.testingtreatments.org.
While our basic premise remains the same, the original text has been extensively revised and updated. For example, we have expanded coverage of the benefits and harms of screening in a separate section entitled Earlier is not necessarily better. And in Regulating tests of treatments: help or hindrance? we describe how research can become over-policed to the detriment of patients. In the penultimate section we ask: ‘So what makes for better healthcare?’ and show how the lines of evidence can be drawn together in ways that can make a real difference to all of us. We close with our blueprint for a better future and an action plan.
We hope our book will point the way to wider understanding of how treatments can and should be tested fairly and how everyone can play a part in making this happen. This is not a ‘best treatments guide’ to the effects of individual therapies. Rather, we highlight issues that are fundamental to ensuring that research is soundly based, properly done, able to distinguish harmful from helpful treatments, and designed to answer questions that matter to patients, the public, and health professionals.
Imogen Evans, Hazel Thornton,
Iain Chalmers, Paul Glasziou
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