Testing Treatments: Better research for better healthcare

Read Testing Treatments: Better research for better healthcare!

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Do higher doses of vitamin C prevent colds? Are there any benefits from antioxidants? Does marijuana help treat chronic pain? The answers to these and similar questions are not really difficult to obtain. If someone has not already investigated a particular question or announced its answer then we too can try and find the answer. In order to do this, we need to choose subjects that are as similar to one another as possible, randomly sort them in large enough groups of which one will be subjected to a treatment whose effectiveness we are interested in, one will receive placebo (drug without active ingredients), and one will not receive any treatment. This type of research is called a randomized controlled trial. Research so designed does not seem overly complicated, but it is carried out very rarely, and is often of poor quality, which prevents it from being published in good scientific journals. Sometimes such research is even completely unnecessary as the authors did not systematically review the literature and notice that the evidence already exists. All of the above leads to recommendation of treatment for which there is a lack of evidence that supports its  effectiveness.

But it isn’t just operations and pills that can be dangerous; so can medical advice. In the 1950s, a book by Dr. Benjamin Spock titled Baby and Child Care was published in the US. For fifteen years, Dr. Spock, in numerous editions of that extremely popular book, told parents that babies should sleep on their stomach, because of seemingly irrefutable logic - according to Dr. Spock, if the child slept on its back, it could swallow its vomit or spit and suffocate. He also claimed children have a tendency to always turn their heads to one side, which could cause abnormal moulding of the head. Because of his advice, parents dutifully put their children to sleep on their stomachs, and it became a routine practice in families and hospitals. Soon afterwards suspicions were raised that sleeping on the belly was actually associated with a higher incidence of Sudden Infant Death Syndrome. Unfortunately, it took 40 years for serious research to be conducted to confirm the tragic consequences of that advice. After numerous public campaigns that followed and called for parents to abandon putting the children to sleep on their bellies, the number of sudden infant deaths dramatically declined.

It is these kinds of experiences that the book Testing Treatments is about. The book was translated into Croatian by Professor Livia Puljak of the University of Split School of Medicine, with the support of Cochrane Croatia and a grant for the  ‘Popularization of Science’ awarded by the Ministry of Science, Education and Sports. The first English language edition of the book appeared in 2006 and has achieved great success. Since then thousands of copies have been sold, the book has been translated into six languages, and a second edition was published in 2011. One of the conditions for all translations, including the Croatian translation, is that the book be made available free of charge from the following website http://hr.testingtreatments.org/

Testing Treatments carries an important message – by choosing therapies for which there is real evidence of effectiveness, health care can save a lot of money. The reluctance to conduct detailed analysis is deeply embedded in our nature so no matter how educated we are, we tend to make decisions on the fly. When we add personal interests amongst those who make health care decisions, the reasons why we do not have better health become much clearer. When was the last time you heard someone making a health policy decision based on a serious evaluation of the evidence? It’s no wonder then that decisions are made to which no one adheres (remember the smoking ban), or those which last several months (remember working in shifts) or those about campaigns that do not do what they should (healthy breakfast campaign).

For doctors the really interesting part of the book is the one that deals with the methodology of clinical trials and the ways to objectively examine treatment options and avoid bias. The authors describe, very concisely, why over-regulation of research can be harmful, and they give examples of good, bad and unnecessary research. In their assessment, they don’t spare the pharmaceutical industry or academia, nor patient organizations, and they provide strong recommendations on how to simplify the regulation of research and how to develop a system that will not discourage re-testing of drug and treatment effectiveness. They also highlight studies that are truly valuable to the patient, and those which provide answers to questions that are daily asked of doctors, but on which patients do not get satisfactory answers.

The book also talks about the complexity of the problem of screening - methods for early detection of diseases - which in some cases do not achieve the desired results, but stigmatise healthy people as those that are sick. Making decisions about screening too easily and implementing them when they are not needed can cause great harm to the health system as well as to the health of individuals. Simply copying other people's experiences is not necessarily good and so the question arises why is there no hard data on the effectiveness of screening carried out in our region.

Testing treatments is not an attack on medicine. Throughout the book the authors express genuine respect for the achievements of modern medicine, but warn us that the adoption of new methods must also take into account the possible harmful consequences, or simply - the ineffectiveness of some drugs. So the most important question anyone can ask is, "How do you know?", and answer this question by taking into account all principles of evidence-based medicine. This book invites us to engage in the struggle for better treatments ourselves, by giving us practical advice on how this can be achieved, and by encouraging us to think critically. Simply saidTesting treatments is good for our health”.