Book Review: Testing Treatments

Testing Treatments by Imogen Evans, Hazel Thornton, Iain Chalmers & Paul Glasziou asks the crucial question, how can we ensure that medical research effectively meets the needs of patients? It is a crucial question because all over the world, resources are wasted on poor quality research, research that only meets the needs of drug companies, and on unproven, disproven, or unnecessary treatment.

The authors state that medical research is ‘everybody’s business’ (p.114) and suggest that if patients, doctors and researchers worked as a team, the testing of treatments could be more effective, precise and useful. The BMJ famously bans the phrase ‘more research is needed,’ and Evans et al, who comment ‘do less… but focus the research on the needs of patients’ (p114) clearly agree.

A useful complement to Ben Goldacre’s Bad Science and Simon Singh’s Trick or Treatment, Testing Treatments clearly lays out the principles of robust research, defining what makes a fair test, and explaining the importance of setting a study within the context of existing research. In itself, these principles do not sound particularly challenging, but the authors go on to show how the waters are muddied by vested interests, patient pester power, paternalistic clinicians, and inexcusable poor practice.

Finally, they set out a strong blueprint for a better future, asking for patients to be treated as equal partners, both as individuals requiring treatment, and as groups participating in research.

The manifesto is laudable, but for this to work, people need to read this book and get on board; and not just other academics. There is an obvious effort to make the style of the book accessible to the wider public, and indeed it is, as I read it in two days despite the company of a bored five year old. I found the slight dumbing-down of some of the terminology (words like ‘menstrual’ and ‘cardiac’ explained in parentheses) slightly patronising; and the over-simplified diagrams lacked much meaning. Boxed quotations are scattered over almost every pages, which breaks up the flow of the text without adding very much in terms of content. However the chapters are very clearly laid out and richly illustrated with anecdotes and examples. It was impressive that the entire chapter on statistics managed to avoid using the word ‘statistics.’

I would definitely recommend this book to my colleagues and to some of my more sciencey friends, but this is why I feel that it will mainly preach to the converted. Those paternalistic GPs who are certain of their infallibility, those focus groups desperate to prolong precious life, those politicians in the pockets of big pharma: they should be forced to read it!

I took away from Testing Treatments, a much enhanced understanding of the arguments against routine screening, and an appreciation of the need for greater regulation and better-informed consent for treatment outside the context of clinical trials. I enjoyed reading what could potentially have been a heavy-going book, but was in fact, as Ben Goldacre says in the foreword, ‘interesting and clever.’ (p.xii)

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