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Testing Treatments: Better Research for Better Healthcare
~ How do we know whether a particular drug, therapy or operation really works, and how well? How reliable is the clinical evidence? Such timely and pressing questions are raised and resolved in this probing inquiry into modern clinical research, with far-reaching implications for daily medical practice and patient care. What emerges from this study is the surprising truth that clinical research is neither as unbiased, nor as relevant as patients have every right to expect, but that everyone – patients, doctors and researchers – can do much to change current practice and achieve better healthcare. Aimed at both patients and professionals, Testing Treatments builds a lively and thought-provoking argument for better, more reliable, more relevant research, with unbiased or ‘fair’ trials, and explains how patients can work with doctors to achieve this vital goal. Expertly and thoroughly researched, the fast-moving commentary explores a vast range of revealing case-studies, enlivened throughout by entertaining anecdotes and vivid eyewitness accounts drawn from the direct experience of patients, practitioners and researchers. Often startling, at times unsettling, but never pessimistic, Testing Treatments remains essentially pragmatic and constructive in tone, urging everyone to take an active part in changing conditions, and describing what practical steps doctors and patients can together take to improve current research and future treatment. ~
224 pages, Paperback
First published April 12, 2006
32 people are currently reading
873 people want to read
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Displaying 1 - 19 of 19 reviews
September 19, 2018
If I was to consider the book to be addressed to people within the health care sector, my rating would drop slightly. But as a book aimed to the general public, it does a good job in giving an adequate overview as well as most of the necessary basic knowledge regarding medical research and treatments, how it’s set and how physicians and surgeons proceed with both.
It did emphasize the important of unbiased experiments and encouraged patients to seek them and be part of them in nearly all of his chapters. I liked that - the idea that improving the available medical practice is not only our responsibility but the patients’ too; a better healthcare is everyone’s responsibility and every single person must understand how he or she can do their role and then proceed to doing it well with no hesitation !
Additionally, the way he emphasized and repeatedly highlighted the significance of systematic reviews is admirable. I come from an institution where we have to do a research of some sort in our 3rd year, and most students opt for systematic reviews cuz they are “easy” and “doable in a week with the rest of the block taken as a lovely vacation.” Well, it depends on your standards but having such a mentality growing around here did distort the importance of systematic reviews in the mind of many students. Now, this important consolidation of evidence isn’t appreciated as much due to that association and most students would opt for the fun original researches to get new evidence, adding up to the growing pile of unused new knowledge !
Again, this, to me, was a good overview to concepts and prices of knowledge I’m mostly familiar with. But, that doesn’t mean it won’t do a good educating role to those with interest from the general public.
(As one of the reviewers said, I doubt that people who aren’t in the medical field and interested in medical research would pick this book up, making this book a simple revision for the rest of us. But let’s hope so! At least young medics would see it as a nice welcome, enriched with knowledge, to the world of research !)
It did emphasize the important of unbiased experiments and encouraged patients to seek them and be part of them in nearly all of his chapters. I liked that - the idea that improving the available medical practice is not only our responsibility but the patients’ too; a better healthcare is everyone’s responsibility and every single person must understand how he or she can do their role and then proceed to doing it well with no hesitation !
Additionally, the way he emphasized and repeatedly highlighted the significance of systematic reviews is admirable. I come from an institution where we have to do a research of some sort in our 3rd year, and most students opt for systematic reviews cuz they are “easy” and “doable in a week with the rest of the block taken as a lovely vacation.” Well, it depends on your standards but having such a mentality growing around here did distort the importance of systematic reviews in the mind of many students. Now, this important consolidation of evidence isn’t appreciated as much due to that association and most students would opt for the fun original researches to get new evidence, adding up to the growing pile of unused new knowledge !
Again, this, to me, was a good overview to concepts and prices of knowledge I’m mostly familiar with. But, that doesn’t mean it won’t do a good educating role to those with interest from the general public.
(As one of the reviewers said, I doubt that people who aren’t in the medical field and interested in medical research would pick this book up, making this book a simple revision for the rest of us. But let’s hope so! At least young medics would see it as a nice welcome, enriched with knowledge, to the world of research !)
January 5, 2011
It's a solid read with a fantastic take-away lesson, and likely deserves a higher rating if one were to read it without background. However, I suspect anybody taking the time to seek it out and read it is coming into the work with a respectable foundation of the issues it addresses.
October 22, 2021
ينسى العديد من ممارسي الطب التقليدي -الأطباء- أن أهم ما يربطهم مع مرضاهم هو عملية وصف الأدوية، وأنها تحتل مركز مهم في هذا النموذج. لذلك تجد تركيز العديد من اختبارات التخصص ومزاولة المهنة والعديد من سياسات الجودة في الممارسة الصحية يتمركز حول التعرف على الأدوية، فعاليتها، أثارها الضارة وغير ذلك...
لكن في نفس الوقت ينسى الكثير أن هناك خطوات مهمة بقدر أهمية تلك الخطوات العملية، تسبقها في الحدوث؛ وهي اختبارات فعالية الأدوية في علاج أمراض بعينها، مقارنتها مع الأدوية السابقة، تفوقها في علاج أمراض مستعصية، التأكد من سلامتها وغير ذلك... وأن الدراسات والبحوث في الأدوية سواءاً كانت مخببرية أو سريرية مليئة بالاشكالات.
ينطلق هذا الكتاب من هذه المسلمة الأخيرة، نحو تشكيل نموذج أفضل للبحث العلمي في اختبارات الأدوية. وذلك من خلال سرد متنوع لأغلب مشاكل هذه البحوث من بين ذلك: تضارب المصالح بين شركات الأودية والبحوث العلمية، ضعف قراءة الاحصاءات وتحليلها، التحيّزات في البحوث، البيروقراطية وتعقيد شروط البحوث العلمية، استقطاب المرضى للمشاركة في البحوث العلمية وغير ذلك من الاشكالات
ما يميز هذا الكتاب أنه لا يسرد هذه الاشكالات بشكل نظري فقط، ولكنه يسردها بأمثلة عديدة عابرة للزمان والمكان تبدأ من بداية تجارب الأطباء مع الأدوية واختبارها في المرضى حتى وقتنا الحالي...
كتاب مهم لكن طبيب، باحث، مريض، متخصص في السياسات الصحية وغيرهم الكثير.
لكن في نفس الوقت ينسى الكثير أن هناك خطوات مهمة بقدر أهمية تلك الخطوات العملية، تسبقها في الحدوث؛ وهي اختبارات فعالية الأدوية في علاج أمراض بعينها، مقارنتها مع الأدوية السابقة، تفوقها في علاج أمراض مستعصية، التأكد من سلامتها وغير ذلك... وأن الدراسات والبحوث في الأدوية سواءاً كانت مخببرية أو سريرية مليئة بالاشكالات.
ينطلق هذا الكتاب من هذه المسلمة الأخيرة، نحو تشكيل نموذج أفضل للبحث العلمي في اختبارات الأدوية. وذلك من خلال سرد متنوع لأغلب مشاكل هذه البحوث من بين ذلك: تضارب المصالح بين شركات الأودية والبحوث العلمية، ضعف قراءة الاحصاءات وتحليلها، التحيّزات في البحوث، البيروقراطية وتعقيد شروط البحوث العلمية، استقطاب المرضى للمشاركة في البحوث العلمية وغير ذلك من الاشكالات
ما يميز هذا الكتاب أنه لا يسرد هذه الاشكالات بشكل نظري فقط، ولكنه يسردها بأمثلة عديدة عابرة للزمان والمكان تبدأ من بداية تجارب الأطباء مع الأدوية واختبارها في المرضى حتى وقتنا الحالي...
كتاب مهم لكن طبيب، باحث، مريض، متخصص في السياسات الصحية وغيرهم الكثير.
December 29, 2012
Excellent overview of issues from patient's perspective as well as of issues within the medical profession relating to testing of treatments and how to encourage learning from mistakes in a systematic way. Recommended if you ever think about health issues/practice.
January 1, 2012
Well done. I think some of the rave reviews are of the type - "I think YOU could learn a lot from it".
Currently reading
June 6, 2018.
December 29, 2021
Testing Treatments should be mandatory reading for anyone who has, or ever will need, to access healthcare (so ... everyone). In remarkably simple terms it describes firstly how dangerous it is to inadequately assess the values of new and old treatments; second, it briefly but intelligibly outlines the basics of randomised controlled trials as a means of achieving the hallowed 'fair test' of an intervention; and third it describes how everyone, from regulators to clinicians to researchers to patients, can be brought along in a whole-system, evidence-based drive to improve public health.
The book launches immediately into a series of small case studies where myriad failures to evaluate treatments has failed patients and the public more broadly. We hear about Avandia, a drug that had been approved in the 2000s to treat complications of type 2 diabetes. It was licensed with "limited evidence of its effectiveness and no evidence about its effect on the risk of heart attacks and strokes". In 2004, the World Health Organisation began to investigate these risks and by 2010 it was withdrawn because of the drug's impact on these risks. All of which was made possible by the poor practices in trial design and reporting of results this book so expertly tears apart.
This is just one of many such examples that the authors rightly cast in chillingly human terms. We hear time and again about the toll failures exact. Often these stem from incredibly reasonable assumptions. Those who have heart attacks, for example, often develop heart rhythm abnormalities - arrhythmias.
Shockingly, though, as the authors go on: "the drugs continued to be used – and continued to kill people – for nearly a decade. At the peak of their use in the late 1980s, one estimate is that they caused tens of thousands of premature deaths every year in the USA alone". In this case, the price in lives wasn't even a result of a lack of knowledge but of a failure to use existing knowledge.
Other examples amply illustrate the risks of other seemingly benign or even positive things, including patient advocacy groups. Herceptin in 2006 was a widely promoted drug, including by advocacy groups, for early treatment of breast cancer. But it had only been licensed for a small subset of late-stage cancer patients and there were concerns about adverse heart effects. Testing Treatments merely draws attention to this issue; a Cochrane (a major player in evidence-based medicine) review was published after this book in 2012. It concluded that Herceptin did have benefits to HER2-positive women but at much increased risk of heart disease. None of which information was available at the time when significant public money was being spent giving this drug to women in lieu of alternatives or active monitoring approaches.
The second part of the book explains with good examples why randomisation is important, the impacts of bias and so forth. The final part draws all the information together in a series of discussions on the roles of patients in research, of regulators and ideas for how things can be improved in future.
The reason I think this book is so valuable, far beyond its pleas to (say) academics or doctors, is in what it can teach the lay reader. In particular, this book can and should inculcate a great dissatisfaction in how medicine is delivered in the UK. As the book points out, patients are routinely 'experimented on' with treatments about which nothing rigorous is known: it's called going to your GP and having a punt on some medication or other for your difficult-to-treat condition for which evidence is wanting (think things like anxiety, or irritable bowel syndrome). The hoops your GP has to jump through are minimal: does the patient knowingly consent? Yes? Then great, let's get on with it.
The clinician hoping to use their patient's experience for the greater good in the form of a trial, meanwhile, has to jump through innumerable hoops - meaning they often will abandon doing so - losing that knowledge - at the literal expense of all taxpayers and the medical expense of the world.
This should infuriate readers, particularly in the UK where we have socialised medicine - meaning we all pay for everyone's care. In such a system - which is rightly popular - who wouldn't want to maximise the benefit of all this expense and ensure we all get the most effective treatments available? Some experience sharing data during the COVID outbreak by another luminary in the field - Ben Goldacre (who wrote a forward to this book) - demonstrates the art of the possible, but sharing data about patients should be easy and routine in the UK. And how do you sell this apparent loss of privacy politically? First, it can be delivered in a sophisticated privacy preserving manner using new tools like homomorphic encryption; second and more importantly, it should all be framed as a means to safeguard the NHS, as it buckles under the growing number of elderly patients with multiple conditions, through making sure every penny is spent on things we know work.
The only problem in all this is: how to get the people who need to read this book to read it? The authors have gallantly sacrificed their own financial gain and made it available for free - see here. But as they themselves admit, more must be done to educate people from school age up in understanding evidence. It seems like the lessons learned in this book are far more important than so much of what goes into the biology or general science syllabus. Only in such general education will the public support slower but much more impactful measures, like automatically enrolling people into clinical trials when using unproven drugs or interventions, and eschew the easy but bogus knee jerk of clamouring for every new, un-tested and potentially more damaging 'revolution in care' that the press, social media influencers and industry deign to hype up.
The book launches immediately into a series of small case studies where myriad failures to evaluate treatments has failed patients and the public more broadly. We hear about Avandia, a drug that had been approved in the 2000s to treat complications of type 2 diabetes. It was licensed with "limited evidence of its effectiveness and no evidence about its effect on the risk of heart attacks and strokes". In 2004, the World Health Organisation began to investigate these risks and by 2010 it was withdrawn because of the drug's impact on these risks. All of which was made possible by the poor practices in trial design and reporting of results this book so expertly tears apart.
This is just one of many such examples that the authors rightly cast in chillingly human terms. We hear time and again about the toll failures exact. Often these stem from incredibly reasonable assumptions. Those who have heart attacks, for example, often develop heart rhythm abnormalities - arrhythmias.
Since there are drugs that suppress these arrhythmias, it seemed logical to suppose that these drugs would also reduce the risk of dying after a heart attack. In fact, the drugs had exactly the opposite effect ... When the accumulated evidence from trials was first reviewed systematically in 1983, there was no evidence that these drugs reduced death rates.
Shockingly, though, as the authors go on: "the drugs continued to be used – and continued to kill people – for nearly a decade. At the peak of their use in the late 1980s, one estimate is that they caused tens of thousands of premature deaths every year in the USA alone". In this case, the price in lives wasn't even a result of a lack of knowledge but of a failure to use existing knowledge.
Other examples amply illustrate the risks of other seemingly benign or even positive things, including patient advocacy groups. Herceptin in 2006 was a widely promoted drug, including by advocacy groups, for early treatment of breast cancer. But it had only been licensed for a small subset of late-stage cancer patients and there were concerns about adverse heart effects. Testing Treatments merely draws attention to this issue; a Cochrane (a major player in evidence-based medicine) review was published after this book in 2012. It concluded that Herceptin did have benefits to HER2-positive women but at much increased risk of heart disease. None of which information was available at the time when significant public money was being spent giving this drug to women in lieu of alternatives or active monitoring approaches.
The second part of the book explains with good examples why randomisation is important, the impacts of bias and so forth. The final part draws all the information together in a series of discussions on the roles of patients in research, of regulators and ideas for how things can be improved in future.
The reason I think this book is so valuable, far beyond its pleas to (say) academics or doctors, is in what it can teach the lay reader. In particular, this book can and should inculcate a great dissatisfaction in how medicine is delivered in the UK. As the book points out, patients are routinely 'experimented on' with treatments about which nothing rigorous is known: it's called going to your GP and having a punt on some medication or other for your difficult-to-treat condition for which evidence is wanting (think things like anxiety, or irritable bowel syndrome). The hoops your GP has to jump through are minimal: does the patient knowingly consent? Yes? Then great, let's get on with it.
The clinician hoping to use their patient's experience for the greater good in the form of a trial, meanwhile, has to jump through innumerable hoops - meaning they often will abandon doing so - losing that knowledge - at the literal expense of all taxpayers and the medical expense of the world.
This should infuriate readers, particularly in the UK where we have socialised medicine - meaning we all pay for everyone's care. In such a system - which is rightly popular - who wouldn't want to maximise the benefit of all this expense and ensure we all get the most effective treatments available? Some experience sharing data during the COVID outbreak by another luminary in the field - Ben Goldacre (who wrote a forward to this book) - demonstrates the art of the possible, but sharing data about patients should be easy and routine in the UK. And how do you sell this apparent loss of privacy politically? First, it can be delivered in a sophisticated privacy preserving manner using new tools like homomorphic encryption; second and more importantly, it should all be framed as a means to safeguard the NHS, as it buckles under the growing number of elderly patients with multiple conditions, through making sure every penny is spent on things we know work.
The only problem in all this is: how to get the people who need to read this book to read it? The authors have gallantly sacrificed their own financial gain and made it available for free - see here. But as they themselves admit, more must be done to educate people from school age up in understanding evidence. It seems like the lessons learned in this book are far more important than so much of what goes into the biology or general science syllabus. Only in such general education will the public support slower but much more impactful measures, like automatically enrolling people into clinical trials when using unproven drugs or interventions, and eschew the easy but bogus knee jerk of clamouring for every new, un-tested and potentially more damaging 'revolution in care' that the press, social media influencers and industry deign to hype up.
Read
November 11, 2016Excellent, (reasonably) plain language explanation of overdiagnosis, medical uncertainty, patient involvement in research, and fair, randomized clinical trials. Takes on some really hairy topics like lead-time bias. Gets a little preachy in the research regulation chapter and the figures could be better explained but except for those small issues, this is informative and useful. And it's a free pdf download.
Thanks, Julia Belluz of vox.com for the recommendation.
Thanks, Julia Belluz of vox.com for the recommendation.
Want to read
March 16, 2010Recommended as further reading by Ben Goldacre in Bad Science.
December 14, 2016
Everyone must read this book. In it you'll find out many of the things you've always wondered (or should have wondered) about modern medicine. The books authors ensure that it is very well written and easy to understand even if you know nothing about medicine or medical research. You'll walk away from Testing Treatments knowing how to think about the esoteric monolith that is Medicine.
October 14, 2012
This is a great book. Is a book full of facts, good examples and references. It may not be the kind of "fun to read" that characterizes similar books like the ones of Goldacre, but is indeed a great reference to talk, think and act against bad practices in the health industry.
May 1, 2013
Something everybody should read, know and understand. It's not complicated and it explains essential concepts in medical research which every patient should know.
September 7, 2014
Everybody should read this...
April 4, 2015
Well written and easy to read. As Shane implied, no new knowledge and no surprises.
September 13, 2016
Good recommendations supported by somewhat anecdotal stories. Still, it gives a framework to question treatments and evidence, and how to be a better patient
July 14, 2024
As others have said, this book would be useful to non-medical people in understanding the need and the approach of research to determine effective treatments. That said, as an academic physician, I enjoyed and gained perspective on a number of the insights brought forward. I was particularly struck by the framing of the “double standards on consent to treatment.”
November 10, 2020
A very important book; something everyone should read. It discusses how healthcare treatments are and aren’t tested, current and potential problems with research, how this impacts on patients and healthcare and how we can work to make this better for everyone.
April 22, 2024
Brilliant book for those interested in evidence-based medicine. It is clearly written and very informative. Demonstrates both the potential pitfalls in, and the opportunities for, evidence-based medicine. Great book.
January 31, 2024
Great as an introduction to the basic ins and outs of clinical trials.
Displaying 1 - 19 of 19 reviews