What are fair tests of treatments?
Not all is created equal: some tests of s are more reliable than others. Sometimes tests of treatments can be […]
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Linguistic strategies for improving informed consent in clinical trials among low health literacy patients
Evidence-based guidance on how to improve informed consent processes for patients being invited to participate in clinical research.
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Informed Health Choices Primary School Resources
A textbook and a teachers’ guide for 10 to 12-year-olds. The textbook includes a comic, exercises and classroom activities.
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Know Your Chances
This book has been shown in two randomized trials to improve peoples' understanding of risk in the context of health care choices.
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What can be done to improve tests of treatments?
We can all play a part in ensuring that treatment decisions are based on fair tests of treatments. This will […]
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Building evidence into education
Ben Goldacre explains why appropriate infrastructure is need to do clinical trials of sufficient rigour and size to yield reliable results.
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Anecdotes are great – if they convey data accurately
Ben Goldacre gives examples of how conclusions based on anecdotes and biased research can be damagingly misleading.
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Studies of studies show that we get things wrong
Ben Goldacre gives examples of how conclusions based on anecdotes and biased research can be damagingly misleading.
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Weasels Are on the Loose
Weaseling is the use of certain words to weaken a claim, so that the author can say something without actually saying it and avoid criticism
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Taking account of the play of chance
Differences in outcome events in treatment comparisons may reflect only the play of chance. Increased numbers of events reduces this problem
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Quantifying uncertainty in treatment comparisons
Small studies in which few outcome events occur are usually not informative and the results are sometimes seriously misleading.
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Bringing it all together for the benefit of patients and the public
Improving reports of research and up-to-date systematic reviews of reliable studies are essential foundations of effective health care.
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10 Components of effective clinical epidemiology: How to get started
PDF & Podcast of 1-hr talk by Carl Heneghan (Centre for Evidence-Based Medicine, Oxford) on effective clinical epidemiology.
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Explaining the unbiased creation of treatment comparison groups and blinded outcome assessment
A class were given coloured sweets and asked to design an experiment to find out whether red sweets helped children to think more quickly.
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5 reasons why you might not get the best healthcare
Five reasons why patients may not always get the best care available.
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Tamiflu: securing access to medical research data
A campaign by researchers has shown that Roche spun the research on Tamiflu to meet their commercial ends.
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The need to compare like-with-like in treatment comparisons
Allocation bias results when trials fail to ensure that, apart from the treatments being compared, ‘like will be compared with like'.
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Why avoiding differences between treatments allocated and treatments received is important
Knowledge of which treatments have been received by which study participants can affect adherence to assigned treatments and result in bias.
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The need to avoid differences in the way treatment outcomes are assessed
Biased treatment outcome assessment can result if people know which participants have received which treatments.
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Avoiding biased selection from the available evidence
Systematic reviews are used to identify, evaluate and summarize all the evidence relevant to addressing a particular question.
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Preparing and maintaining systematic reviews of all the relevant evidence
Unbiased, up-to-date systematic reviews of all the relevant, reliable evidence are needed to inform practice and policy.
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Dealing with biased reporting of the available evidence
Biased reporting of research occurs when the direction or statistical significance of results influences how research is reported.
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Using the results of up-to-date systematic reviews of research
Trustworthy evidence from research is necessary, but not sufficient, to improve the quality of health care.
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Why treatment comparisons must be fair
Fair treatment comparisons avoid biases and reduce the effects of the play of chance.
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Avoiding biased treatment comparisons
Biases in tests of treatments are those factors that can lead to conclusions that are systematically different from the truth.
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Bias introduced after looking at study results
Biases can be introduced when knowledge of the results of studies influences analysis and reporting decisions.
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Reducing biases in judging unanticipated effects of treatments
As with anticipated effects of treatments, biases and the play of chance must be reduced in assessing suspected unanticipated effects.
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Recognizing researcher/sponsor biases and fraud
The vested interests of researchers and organizations tend to be reflected in reports of treatment research in which they are involved.
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Video games and health improvement: a literature review of randomized controlled trials
This is a critical appraisal of a non-systematic review of randomized trials of video games for improving health.
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Why comparisons must address genuine uncertainties
Too much research is done when there are no genuine uncertainties about treatment effects. This is unethical, unscientific, and wasteful.
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Why treatment comparisons are essential
Formal comparisons are required to assess treatment effects and to take account of the natural course of health problems.
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Why treatment uncertainties should be addressed
Ignoring uncertainties about the effects of treatments has led to avoidable suffering and deaths.
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Making Sense of Screening
Screening tests can cause harm. This guide helps you to make sense of claims about screening for health conditions.
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Testing Treatments
Testing Treatments is a book to help the public understand why fair tests of treatments are needed, what they are, and how to use them.
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Does it work?
People with vested interests may use misleading statistics to support claims about the efects of new treatments.
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How do you know which healthcare research you can trust?
A detailed guide to study design, with learning objectives, explaining some sources of bias in health studies.
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Smart Health Choices: making sense of health advice
The Smart Health Choices e-book explains how to make informed health decisions.
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How to read articles about healthcare
This article 'How to read health news behind the headlines', by Dr Alicia White, explains how to assess health claims in the media.
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Can measurements show if a treatment works?
An article discussing errors to avoid when testing treatments.
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The basic principles of Evidence Based Medicine
A webpage explaining the foundations of systematic reviews.
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Animal and Lab studies
A webpage explaining how results from animal studies may not be transferable to humans.
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Commercialism
A webpage about commercialism and conflicts of interest in health research.
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Be careful with composites
Kevin Lomangino's article discusses the limitations of composite outcomes and surrogate markers.
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In defence of systematic reviews of small trials
An article discussing the strengths and weaknesses of systematic reviews of small trials.
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Reducing the play of chance using meta-analysis
Combining data from similar studies (meta-analysis) can help to provide statistically more reliable estimates of treatment effects.
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Absolute versus relative risk – making sense of media stories
This blog by Sarah Williams should help people who want to understand risk in the context of health and medical stories in the press.
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Association is not the same as causation. Let’s say that again: association is not the same as causation!
This article explains how to tell when correlation or association has been confused with causation.
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Fair tests of treatments: a quick guide for journalists
When deadlines are pressing, how can journalists tell whether to believe claims about the effects of a new treatment or breakthrough?
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Evidence Based Medicine Matters: Examples of where EBM has benefitted patients
Booklet containing 15 examples submitted by Royal Colleges where Evidence-Based Medicine has benefited clinical practice.
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Shared Decision-Making
This resource from the Health Foundation shows how shared decision-making can be made to work in a typical consultation.
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Communicating with patients on evidence
This discussion paper from the US Institute of Medicine provides guidance on communicating evidence to patients.
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Surgery for the treatment of psychiatric illness: the need to test untested theories
Simon Wessely describes the untested theory of autointoxication, which arose in the 1890s and caused substantial harm to patients.
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What did James Lind do in 1747?
A 2 minute Video clip of a BBC documentary recreating James Lind's celebrated experiment to test treatments for scurvy.
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Foreword by Nick Ross
This book is good for our health. It shines light on the mysteries of how life and death decisions are […]
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On being sucked into a maelstrom
In 2006, a patient in the UK, who happened to be medically trained, found herself swept along by the Herceptin […]
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A tragic epidemic of blindness in babies
‘In the period immediately after World War II, many new treatments were introduced to improve the outlook for prematurely-born babies. […]
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Anecdotes are anecdotes
‘Our brains seem to be hard-wired for anecdotes, and we learn most easily through compelling stories; but I am aghast […]
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Shared decision making: a consultation for a common condition
Doctor: Well, you have moderate osteoarthritis of the knees, which is common as people get older. It’s often referred to […]
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A new treatment for strawberry birthmarks
Treatments with dramatic effects are occasionally discovered by accident. Take the example of a condition that occurs in infants called […]
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Mother’s kiss
Low-tech approaches can have dramatic effects too. Young children sometimes place small objects – plastic toys or beads, for example […]
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Imatinib for chronic myeloid leukaemia
Impressive results have also been seen in patients given imatinib for chronic myeloid leukaemia [4], [5]. Before imatinib was introduced […]
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Laser treatment of portwine stains
The birthmarks known as portwine stains are caused by permanent and malformed dilated blood vessels in the skin. Commonly occurring […]
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Breast cancer
The treatment of breast cancer provides another example of professional uncertainty. There is considerable variability in the use of surgery, […]
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Antibiotics in pre-term labour
Fair tests of treatments with hoped-for beneficial effects, and which are assumed to be harmless, can show that neither is […]
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Caffeine for breathing problems in premature babies
Large variations in the treatments used for a particular condition provide clear evidence of professional uncertainty about the relative merits […]
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Genetic tests: sometimes useful, often dodgy
Not so long ago ‘genetic testing’ was more or less confined to generally rare, single-gene disorders – for example, the […]
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Lung cancer screening: early but not early enough?
Screening may detect disease earlier, but not always early enoughto make a difference (see Figure). Some cancers, for example lung […]
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Prostate cancer screening: clear harms with uncertain benefits
Prostate cancer is the second most common cancer in men worldwide,14 and broadly falls into two types. Some men have […]
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Breast cancer screening: well established but remains contentious
Since routine breast screening with mammography is well established in many countries one could well assume that mammographic screening must […]
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Abdominal aortic aneurysm screening: proceed with care
At the other end of the age spectrum, abdominal aortic aneurysm screening can also be beneficial. The aorta is the […]
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Phenylketonuria screening: clearly beneficial
Newborn babies are routinely screened for an inherited disease called phenylketonuria (PKU). Babies with PKU are unable to process phenylalanine, […]
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New – but is it better?
Key points Testing new is necessary because new treatments are as likely to be worse as they are to be […]
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Foreword by Ben Goldacre
Medicine shouldn’t be about authority, and the most important question anyone can ask on any claim is simple: ‘how do […]
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Action plan – 10 things you can do
Identify questions about the effects of treatment that are important to you. Learn to recognize uncertainty; speak up; ask questions; […]
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Blueprint for a better future
Medical research could be done for the right reasons and could be done and reported well. Taken individually, none of […]
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Produce unbiased and useful research reports
Even when studies are published, they often omit important elements that enable readers to assess and apply the findings. One […]
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Publish all the results and make them accessible
Selective reporting of the results of research can lead to serious biases. Some ‘negative’ studies are never published when the […]
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Design and conduct research properly
Stimulated by surveys revealing the poor quality of many reports of clinical trials, reporting standards have been developed and applied. […]
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Ask the right research questions
Sometimes doctors do not know which treatment is likely to be best for their patients because the available options have […]
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Research for the right reasons: blueprint for a better future
Key points: Ask the right questions Design and conduct research properly Publish all the results and make them accessible Produce […]
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Shared decision-making
‘Shared decision-making has been defined as “the process of involving patients in clinical decisions”. The ethos is one where professionals […]
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Where do we go from here?
These issues – about individual concerns and values, about understanding statistics and how they apply to individuals, and about the […]
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9: How should people avoid being ‘labelled’ with an ‘illness’ and getting unnecessary treatments?
Medicine has made amazing advances: vaccines and antibiotics for preventing and treating infections; joint replacements; cataract surgery; and treatment of […]
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8: Are there reliable sources of information that can be recommended?
There is no single information source for all diseases and treatments. To apply the principles in this book, readers may […]
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7: What’s the best way of telling if the evidence (on the web or elsewhere) is reliable?
What should people look out for? Unfortunately there is no completely reliable simple marker for reliable information. If you are […]
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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?
Fewer than one in 100 people seeing a doctor will be enrolled in a clinical trial. The proportion varies widely […]
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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?
Although the idea of being able to work out the specific treatment needed in every individual is undoubtedly attractive, and […]
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Don’t be fooled by eye-catching statistics
Let’s say the risk of having a heart attack in your fifties is 50 per cent higher if you have […]
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4: How can someone know that the research evidence applies to them?
All decisions rely on previous experience of some kind – individual or collective. Fair tests of treatments such as randomized […]
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3: Statistics are confusing – should patients really have to look at the numbers?
The way that numbers are presented can be very daunting – or even downright misleading. But if you really do […]
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2: Although patients might want to know if a treatment ‘works’, suppose they don’t want all the details?
It is important to strike a balance between information overload and depriving people of enough information to help them make […]
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1: Isn’t anything worth trying when a patient has a life-threatening condition?
It can be tempting to want to try the latest ‘wonder-drug’, or follow the example of some high-profile celebrity who […]
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What might the ideas in this website look like for you?
Although no two consultations are identical, the guiding principles for how to arrive at the best possible decision, as set […]
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So what makes for better healthcare?
Key points The “best” depends on your situation and needs. Your doctor should understand these, not just your . Sometimes […]
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Mutilating surgery
Until the middle of the 20th century, surgery was the main treatment for breast cancer. This was based on the […]
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Involving citizens to improve healthcare
‘The confluence of interest between advocacy groups, those who sell treatments, and those who prescribe them makes for a potent […]
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Pester power and new drugs
‘New drugs by their very nature are incomplete products, as full information about their safety, effectiveness and impact on costs […]
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Lay people help to rethink AIDS
‘Credibility struggles in the AIDS arena have been multilateral: they have involved an unusually wide range of players. And the […]
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A key partnership
‘People-focused research in the NHS simply cannot be delivered without the involvement of patients and the public. No matter how […]
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Patients’ choice: David and Goliath
‘Who has the power to see that research questions actually address the greatest needs of patients in all their misery […]
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Working collaboratively bodes well for the future
There are numerous ways in which patients and the public can become involved in testing treatments. As we have already […]
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Bridging the gap between patients and researchers
We drew attention above to problems that can result from patients becoming involved in testing treatments, and ways in which […]
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Patients’ organizations: independent voices or not?
Another less well known conflict of interest exists in the relationship between patients’ organizations and the pharmaceutical industry. Most patients’ […]
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How patients can jeopardize fair tests of treatments
In this sub-section: Introduction (this page) Patients’ organizations: independent voices or not? Bridging the gap between patients and researchers Introduction […]
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Involving patients in research
How has this involvement of patients in research come about? In a previous section we showed, for example, how the […]
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How can patients and the public help to improve research?
The formerly closed world of medicine is increasingly opening its doors to admit fresh ideas and former ‘outsiders’, and paternalism […]
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Getting the right research done is everybody’s business
Key points Patients and researchers working together can help to identify and reduce Input from patients can lead to better […]
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Psoriasis patients poorly served by research
‘Few trials involved comparison of different options or looked at long-term management. The duration of studies is unconvincingly brief in […]
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All it takes is to find the gene
‘It’s . . . hoped that the genetic revolution will cure every problem known to man. We will be able […]
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Dodgy, devious and duped?
Writing a light-hearted article for a Christmas edition of the British Medical Journal, two researchers created a spoof company called […]
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Doctors and drug companies
‘No one knows the total amount provided by drug companies to physicians, but I estimate from the annual reports of […]
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Impact of “me-too” drugs in Canada
‘In British Columbia most (80%) of the increase in drug expenditure between 1996 and 2003 was explained by the use […]
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My experience of Magpie
‘I was really pleased to be part of such an important trial. I developed swelling at 32 weeks which grew […]
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Who decides what gets studied?
Clearly this situation is unsatisfactory, so how has it come about? One reason is that what gets studied by researchers […]
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Questions that are important for patients
Researchers in Bristol decided to pose a fundamental question: ‘To what extent are questions of importance to patients with osteoarthritis […]
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Aprotinin: effect on bleeding during and after surgery
Research funders, academic institutions, researchers, research ethics committees, and scientific journals are all complicit in unnecessary research. As we explained […]
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Stroke
Another example of unnecessary research, yet again because the results of preceding studies had not been gathered together and analyzed, […]
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Respiratory distress in premature babies
Some research falls in between good and bad – it is plainly unnecessary. An example of such research concerns premature […]
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Epidural analgesia for women in labour
The importance of assessing outcomes that matter to patients is clearly illustrated – in a very negative fashion – by […]
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Psychiatric disorders
Regrettably, research is not always well done or relevant. Take the example of a distressing condition known as tardive dyskinesia. […]
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HIV infection in children
The results of good research are also making a real difference to children infected with HIV (human immunodeficiency virus), the […]
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Pre-eclampsia in pregnant women
Another outstanding example of good research concerns pregnant women. Worldwide, about 600,000 women die each year of pregnancy-related complications. Most […]
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Stroke
Stroke is a leading cause of death and long-term disability. The death rate is between one in six and two […]
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