TREATMENTS - BETTER RESEARCH
BETTER HEALTHCARE -
This book is
good for our health. It shines light on the mysteries of how life and
death decisions are made. It shows how those judgements are often badly
flawed and it sets a challenge for doctors across the globe to mend
Yet it accomplishes this without unnecessary scares; and it warmly
admires much of what modern medicine has achieved. Its ambitions are
always to improve medical practice, not disparage it.
My own first insight into entrenched sloppiness in medicine came in the
1980s when I was invited to be a lay member of a consensus panel set up
to judge best practice in the treatment of breast cancer. I was shocked
(and you may be too when you read more about this issue in Chapter 2).
We took evidence from leading researchers and clinicians and discovered
that some of the most eminent consultants worked on hunch or downright
prejudice and that a woman's chance of survival, and of being
surgically disfigured, greatly depended on who treated her and what
those prejudices were. One surgeon favoured heroic mutilation, another
preferred simple lump removal, a third opted for aggressive
radiotherapy, and so on. It was as though the age of scientific
appraisal had passed them by.
Indeed, it often had, and for many doctors it still does. Although
things have improved, many gifted, sincere and skillful medical
practitioners are surprisingly ignorant about what constitutes good
scientific evidence. They do what they do because that is what they
were taught in medical school, or because it is what other doctors do,
or because in their experience it works. But personal experience,
though beguiling, is often terribly misleading – as this book shows,
with brutal clarity.
Some doctors say it is naive to apply scientific rigour to the
treatment of individual patients. Medicine, they assert, is both a
science and an art. But, noble as that sounds, it is a contradiction in
terms. Of course medical knowledge is finite and with any individual
the complexities are almost infinite, so there is always an element of
uncertainty. In practice, good
medicine routinely requires good guesswork. But too often in the past
many medical professionals have blurred the distinction between
guessing and good evidence. Sometimes they even proclaim certainty when
there is really considerable doubt. They eschew reliable data because
they are not sure how to assess them.
This book explains the difference between personal experience and more
complex, but better ways of distinguishing what works from what does
not and what is safe from what is not. Insofar as it can, it avoids
technical terms, and promotes plain English expressions like ‘fair
tests’. It warns that science, like everything else in human affairs,
is prone to error and bias (through mistakes, vanity or – especially
pernicious in medicine – the demands of commerce); but it reminds us
that, even so, it is the meticulous approach of science that has
created almost all of the most conspicuous advances in human knowledge.
Doctors (and media-types, like me) should stop disparaging clinical
research as ‘trials on human guinea-pigs’; on the contrary there is a
moral imperative for all practitioners to promote fair tests to their
patients and for patients to participate.
This is an important book for anyone concerned about their own or their
family's health, or the politics of health. Patients are often seen as
the recipients of health care, rather than participants. The task ahead
is as much for us, the lay public in whose name medicine is practiced
and from whose purse medical practitioners are paid, as for doctors and
researchers. If we are passive consumers of medicine we will never
drive up standards. If we prefer simplistic answers we will get pseudo
science. If we do not promote the rigorous testing of treatments we
will get pointless and sometimes dangerous treatment along with the
stuff that really works.
This book contains a manifesto for improving things, and patients are
at its heart. But it is an important book for doctors, medical
students, and researchers too – all would benefit from its lessons. In
an ideal world, it would be compulsory reading for every journalist,
and available to every patient, because if doctors are inadequate at
weighing up scientific evidence, in general we, whose very mortality
depends on this, are worse.
One thing I promise: if this subject of testing treatments is new to
you, once you have read this book you will never feel quite the same
about your doctor's advice again.
TV and radio presenter and journalist
16 November 2005