TESTING
TREATMENTS - BETTER RESEARCH
FOR BETTER HEALTHCARE - EXCERPT
CHAPTER I - Page 3
NEW – BUT NO BETTER
OR EVEN WORSE
So, carefully
designed fair tests are necessary to identify the effects reliably (see
Chapter 3). Without a fair – unbiased – evaluation, the risk is that
useless or even harmful treatments
are deemed helpful or, conversely, that helpful treatments are
dismissed as useless. Untested theories about treatments effects,
however convincing they may sound, are not enough. Some theories have
predicted that treatments would work, but actual evidence has revealed
otherwise;
other theories have confidently predicted that treatments would not
work when, in fact, tests showed that they did.
There is nothing new in this: in the 18th century James Lind used a
fair test to compare six of the remedies then being used to treat
scurvy, a disease that was killing vast numbers of sailors during long
voyages. He showed that (vitamin-C-containing) oranges and lemons were
a very effective cure. In essence, Lind conducted what is now called a
controlled trial.
In 1747, while serving as a ship’s surgeon aboard HM 4th Rate Ship
Salisbury, James Lind assembled 12 of his patients at similar stages of
the illness, accommodated them in the same part of the ship, and
ensured that they had the same basic diet. This was crucial – it
creating a ‘level playing field’ (see Chapter 3, and Chapter 4, box on
page 59). Lind then allocated two sailors to receive each of six
treatments that were then in use for scurvy – cider, sulphuric acid,
vinegar, seawater, nutmeg, or two oranges and a lemon. The fruit won
hands down, and the Admiralty later ordered that lemon juice be
supplied to all ships, with the result that the deadly disease had
disappeared from the Royal Navy by the end of the 18th century. Of the
treatments Lind compared, the Royal College of Physicians favoured
sulphuric acid while the Admiralty favoured vinegar – Lind’s fair test
showed that both these authorities were wrong. And medical authority
is not infrequently wrong (see below, and Chapters 2, 5, and 6).
Similar uncertainties about the effects of treatments are often
highlighted today when doctors and other clinicians differ about the
best approach for a particular condition (see Chapter 4). In addressing
these uncertainties the public as well as doctors have an important
part to play. It
is in the overwhelming interest of patients as well as professionals
that research on treatments should be rigorous. Just as doctors must be
assured that their treatment recommendations are based on sound
evidence, so patients need to demand that this happens. Only by
creating this critical partnership can the public have confidence in
all that modern medicine has to offer (see Chapter 7).
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