Modern medicine has been hugely successful at reducing the impact of disease and increasing life expectancy.
In spite of this, too much medical decision making is based on insufficient evidence. As a result, doctors and other health professionals have sometimes harmed patients instead of helping them.
As recently as 2010, for example, the diabetes drug rosiglitazone (Avandia) was found to have caused serious cardiovascular events such as heart attacks and strokes in spite of being licensed for over 10 years.
How we can prevent these things from happening again is the theme of Testing Treatments interactive (TTi), a family of websites Minervation has produced with an international group of collaborators.
TTi is about how we tell whether one treatment is better than another. In other words, it’s about what constitutes a “fair test” of the effects of treatments.
TTi contains a wealth of similar examples:
- how Dr Spock’s untested advice on babies’ sleeping position inadvertently caused thousands of cot deaths
- how more intensive treatment for breast cancer isn’t always the best option
- how genetic testing is sometimes useful, but often dodgy
These are just a few of the examples. Patients, professionals and the public should be aware that we urgently need to improve the way we evaluate the effects of treatments.
But it’s not all bad news
TTi also puts forward positive proposals to improve the quality of this research.
These changes are essential if decisions about what treatments to use are to be based on fair tests of their effects. Not only will they save lives and prevent harm, they will reduce waste by identifying treatments that don’t work at an earlier stage.
Whether we are concerned with an individual patient in a consultation with a doctor, a health professional looking to incorporate research evidence in practice or the whole system of health research, Testing Treatments interactive offers practical advice on how to improve health care through better research.
Who is Testing Treatments interactive for?
Although written for the general public, patient representatives, students, teachers and people who are involved in writing about health care in particular will find this an indispensable resource for understanding how treatments should be evaluated.
Three main questions are addressed:
- Why do we need fair tests of treatments?
- What are fair tests of treatments?
- What can we do to improve tests of treatments?
How we built the site
The core of the site is a hypertext version of the second edition of the book Testing Treatments, by Iain Chalmers, Hazel Thornton, Imogen Evans and Paul Glasziou.
The core website has been cloned and translated into multiple languages. Each “sibling” site is supplementing the core material with interactive content from around the web in their own language.
To date, we have versions of TTi in Arabic, Chinese, English, French, German, Italian, Norwegian and Spanish.
Where are we now?
In 2013, we evaluated the effectiveness of the site with hands-on usability testing and are currently implementing a programme of improvements.
One of the things we learned was how difficult it is to communicate complicated methodological concepts to people whose interest is primarily in specific clinical topics or stories.
People generally don’t want to hear about statistical methods or research methodology. As one of our journalist reviewers put it:
Process is boring!
Therefore we have established an ongoing programme of user engagement with patient representatives, schools and journalists that will help us to understand better how to communicate this sometimes complex “process” content to people who need to know about it.
Look out for further developments in 2014, and by all means, visit the site and tell us what you think.