TESTING
TREATMENTS - BETTER RESEARCH
FOR BETTER HEALTHCARE
CHAPTER II - Excerpt
USED BUT INADEQUATELY TESTED
In Chapter 1 we
learned that some new treatments have had harmful effects that were
unexpected; the hoped-for effects of others failed to materialise; and
some predictions that treatments would not work were proved wrong. This
chapter highlights how commonly used treatments may not have been
tested adequately. How can this happen? The therapies
advocated for breast cancer – which are often in the news – provide
some especially valuable lessons.
WHEN MORE IS NOT NECESSARILY BETTER
Throughout the 20th century and even into the 21st, women with breast
cancer have endured some exceedingly brutal and distressing treatments.
These treatments – both surgical and medical – far exceeded what was
actually required to tackle the disease. But they were also
unquestionably
popular with some patients as well as their doctors. Patients were
convinced that the more radical or toxic the therapy, the more likely
the disease would be conquered. It took courageous doctors and
outspoken patient advocates many years to begin to turn the tide of
misbelief. They not only had to produce reliable evidence to banish the
myth that ‘more is better’, but also suffer the ridicule of their peers
and the resistance of eminent practitioners. Even today, fear, coupled
with the belief that more must be better, drives treatment choices.
This prompts some patients and their doctors to opt for ‘traditional’
mutilating and painful treatments, for which there is no evidence of
benefit over simpler approaches. How can this be?
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DRASTIC TREATMENT IS NOT ALWAYS THE BEST
‘It is very
easy for those of us treating cancer to imagine that better results are
due to a more
drastic treatment. Randomized trials comparing drastic treatment
with less
drastic treatment are vital in order to protect patients from needless risk and the early or late side
effects of unnecessarily aggressive treatment. The comparison is ethical
because those who are denied possible benefit are also shielded from possible
unnecessary harm – and nobody knows which it will turn out to be in the end.’
Rees G, ed. The friendly professional: selected writings of Thurstan
Brewin.
Bognor Regis: Eurocommunica, 1996.
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