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  • Title: Documenting the evolution of fair tests
    Descriptive info: .. Enter Text Search:.. The.. James Lind Library.. has been created to help people understand fair tests of treatments in health care.. The principles of fair tests are explained in.. essays.. available in.. Arabic (ربي).. ,.. Chinese (中文).. English.. French (français).. Russian (русский язык).. Portuguese (Português).. and.. Spanish (español).. In addition, three.. books.. written for the public are available here for free download.. One of the books -.. Testing Treatments.. - is available in 2 editions and seven languages at.. www.. testingtreatments.. org.. To illustrate the evolution of fair tests of treatments, the.. also contains images of.. key passages.. from manuscripts, books, journal articles and other relevant material supplied mainly by the  ...   the.. People’s Epidemiology Library.. - was.. launched officially at the Royal College of Physicians of Edinburgh.. is dedicated to the patients and professionals who have contributed evidence about the effects of treatments in health care.. For a full description of the.. click here.. or here for.. Comments are welcome, and should be sent to.. feedback@jameslindlibrary.. what is a fair test.. contents.. browse records.. what's new.. building the Library.. about us.. This website has been created by.. The Library and Information Services Department.. of the.. The Royal College of Physicians of Edinburgh.. (CC) All James Lind Library content, except where otherwise noted, is licensed under a.. Creative Commons Attribution 3.. 0 Unported License..

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  • Title: Search
    Descriptive info: Home.. Contents.. jameslindlibrary.. Contents.. About Fair Tests.. Fair tests of treatments in health care.. Why fair tests are needed.. Why comparisons are essential.. Why comparisons must address genuine uncertainties.. Avoiding biased comparisons.. Differences between the people compared.. Differences in the way treatment outcomes are assessed.. Interpreting unbiased comparisons.. Differences between intended treatments and treatments actually received.. Taking account of the play of chance.. Identifying unanticipated effects of treatments.. Systematic reviews of all the relevant evidence.. Dealing with biased reporting of the available evidence.. Avoiding biased selection from the available evidence.. Reducing the play of chance using meta-analysis.. Up-to-date, systematic reviews of all relevant, reliable evidence.. :.. Commentaries on the  ...   Danish.. Dutch.. Egyptian.. Egyptian, Ancient.. English, Medieval.. Finnish.. Flemish.. French.. German.. Greek Ancient.. Hebrew, Ancient.. Hungarian.. Indian.. Indian, Ancient.. Indonesian.. Irish.. Israeli.. Italian.. Italian, Medieval.. Japanese.. Multinational.. Norwegian.. Persian, Medieval.. Polish.. Portuguese.. Russian.. South African.. Spanish.. Swedish.. Swiss.. Vietnamese.. Select records illustrating:.. Principles of testing.. Uncertainty.. Natural history.. Placebo effects.. Benefit: harm.. Need for comparison.. Dramatic effects.. Quantification.. Group data.. Tabulation.. Proportions/ratios.. Control of allocation bias.. N-of-1 crossover.. Crossover tests.. Cluster allocation.. Factorial design.. Adherence to Treatment.. Intention-to-treat analysis.. Control of observer bias.. Double Dummy.. Unanticipated effects/Adverse effects.. Play of chance.. Analysis bias.. Reporting bias.. Interpretation bias.. Sponsor bias.. Reporting standards.. Systematic review.. Meta-analysis.. Meta - epidemiology.. Surgery.. Comments welcome..

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  • Title: James Lind Library :: Fair tests of treatments in health care
    Descriptive info: Over the past half century, health care has had a substantial impact on people s chances of living longer and being free of serious health problems.. It has been estimated that health care has been responsible for between a third and a half of the increase in life expectancy and an average of five additional years free of chronic health problems (Bunker et al.. 1994).. Even so, the public could have obtained - and still could obtain - far better value for the very substantial resources invested in research intended to improve health.. Furthermore, some of the treatment disasters of the past could have been prevented, and others could be prevented in future.. The James Lind Library.. has been created to improve general understanding of fair tests of treatments in health care, and how these have evolved over time.. Misleading claims about the effects of treatments are common, so all of us should understand how valid claims about the effects of treatments are made.. Without this knowledge, we risk concluding that useless treatments are helpful, or that helpful treatments are useless.. Fair tests of treatment are tests that take steps to obtain reliable information about treatment effects by reducing the misleading influences of.. biases.. and the.. play of chance.. When the need for fair tests of treatments is ignored, people suffer and die unnecessarily.. The explanatory essays in.. have been written to promote wider understanding of why fair tests of treatments are needed, and what they have come to consist of.. You can access each essay by clicking on the underlined words, below, or you can select them from the.. screen.. If you want to  ...   all the relevant evidence.. Preparing systematic reviews of all the relevant evidence entails minimising the impact of.. biased reporting.. biased selection from the available evidence.. A statistical process called.. meta-analysis.. may help avoid being misled by the.. in systematic reviews.. Up-to-date systematic reviews.. of all relevant, reliable evidence are needed for fair tests of treatments in health care.. Even with up-to-date systematic reviews, however, it's important to be on the lookout for biases and spin.. These can result in separate reviews, which are supposedly addressing the same question, reaching conflicting conclusions.. In summary.. contains the following essays:.. Why fair tests are needed.. Why comparisons are essential.. Why comparisons must address genuine uncertainties.. Differences in the way treatment outcomes are assessed.. Interpreting unbiased comparisons.. Taking account of the play of chance.. Systematic reviews of all the relevant evidence.. Dealing with biased reporting of the available evidence.. Reducing the play of chance using meta-analysis.. Up-to-date, systematic reviews of all relevant, reliable evidence.. These explanatory essays draw on a wealth of illustrative material in the.. This can be accessed by clicking on the underlined links or images in the essays.. The text in these essays may be copied and used for non-commercial purposes on condition that explicit acknowledgement is made to.. The James Lind Library (www.. jameslindlibrary.. org).. A 100-page book.. Testing Treatments: better research for better health care.. was published by the British Library in 2006 (for reviews see here).. Translations have been or are being published in Spanish, Italian, Arabic, German, Chinese and Japanese.. The English text is now being made available without charge (under a.. 0 Unported Licence).. Download.. References.. Cite As:.. Editorial commentary (2007)..

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  • Title: Testing Treatments: better research for better health care
    Descriptive info: Free downloads of books.. How do we know whether a particular drug, therapy or operation really works, and how well? How reliable is the evidence? Are clinical trials truly unbiased? And is current research focused on the real needs of patients? Such timely and pressing questions are raised and addressed in this probing enquiry into modern clinical research, with far-reaching implications for daily medical practice and patient care.. Aimed at both patients and professionals,.. builds a lively and thought provoking argument for better, more reliable, more relevant research, with unbiased or fair trials, and explains how patients can work with doctors to achieve this vital goal.. Freely downloadable texts of the 2006 and 2011 editions of.. , together with reviews and translations of the first edition, are available at.. is also available for sale in paperback and eBook versions at.. Pinter and Martin.. In addition,.. TT.. Interactive.. is being developed to allow more flexible access to the text of the book, and to link to other resources that help to explain and illustrate the principles and messages contained in the book.. Consumers are often confronted with decisions about their health.. These decisions can be challenging: how should one think through all the issues and how should one decide what evidence is believable? Help is now available  ...   full-text PDFs.. Smart Health Choices.. can be found.. for sale via Alibris.. Every day we are bombarded by television ads, public service announcements, and media reports warning of dire risks to our health and offering solutions to help us lower those risks.. But many of these messages are incomplete, misleading, or exaggerated, leaving the average person misinformed and confused.. Know Your Chances.. is a lively, accessible, and carefully researched book that can help people sort through this daily barrage by teaching them how to interpret the numbers behind the messages.. In clear and simple steps, the authors - all of them physicians and professors at Dartmouth Medical School, New Hampshire, USA - take the mystery out of medical statistics.. By learning to understand medical statistics and knowing what questions to ask, readers will be able to see through the hype and find out what - if any - credible information remains.. The book's easy-to-understand charts will help ordinary people put their health concerns into perspective.. This short, reader-friendly volume will foster communication between patients and doctors and provide the basic critical-thinking skills needed to navigate today's confusing health landscape.. Full text of Know your chances now available for free.. download free full-text PDF.. Know your chance.. s can be found.. for sale via University of California Press..

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  • Title: James Lind Library ::
    Descriptive info: Articles.. Adams CE (2004).. William Halse Rivers (1864-1922).. Adams CE (2009).. James Crichton Browne and controlled evaluation of drug treatment for mental illness.. Agnew RAL (2008).. John Forbes FRS (1787-1861).. Armitage P (2002).. Randomisation and alternation: a note on Diehl et al.. Armitage P (2009).. A note on the statistical analysis of the 1948 MRC streptomycin trial.. Armitage P (2013).. The evolution of ways of deciding when clinical trials should stop recruiting.. Bastian H (2004).. Down and almost out in Scotland: George Orwell, tuberculosis and getting streptomycin in 1948.. Bastian H (2007).. Lucy Wills (1888-1964), the life and research of an adventurous independent woman.. Birbeck E (2011).. The Royal Hospital Haslar: from Lind to the 21st century.. Booth CC (2002).. John Haygarth FRS (1740-1827).. Boren SA (2006).. Max Pinner (1891-1948).. Boren SA, Diaz M, Neuhauser D (2006).. James Burns Amberson (1890-1979).. Boylston AW (2008).. William Watson s use of controlled clinical experiments in 1767.. Zabdiel Boylston (1679/80-1766).. Boylston AW (2010).. Thomas Nettleton and the dawn of quantitative assessments of the effects of medical interventions.. Boylston AW (2011).. Observation and experimentation in developing the Suttonian Method of inoculation.. Boylston AW (2012).. John Haygarth’s 18th century ‘Rules of Prevention’ for eradicating smallpox.. The origins of inoculation.. The origins of vaccination: no inoculation, no vaccination.. Boylston AW, Williams AE (2008).. Zabdiel Boylston’s evaluation of inoculation against smallpox.. Bracken MB (2008).. Why animal studies are often poor predictors of human reactions to exposure.. Bryder L (2010).. The Medical Research Council and clinical trial methodologies before the 1940s: the failure to develop a ‘scientific’ approach.. Burch D (2009).. Astley Paston Cooper (1768–1841): anatomist, radical, and surgeon.. Campbell MJ (2012).. Doing clinical trials large enough to achieve adequate reductions in uncertainties about treatment effects.. Chalmers I (2010).. Joseph Asbury Bell (1904-1968).. Joseph Asbury Bell and the birth of randomized trials.. Chalmers I (2006).. Archie Cochrane (1909-1988).. Why the 1948 MRC trial of streptomycin used treatment allocation based on random numbers.. Chalmers I (2013).. UK Medical Research Council and multicentre clinical trials: from a damning report to international recognition.. Chalmers I, Clarke M (2002).. J Guy Scadding and the move from alternation to randomization.. Chalmers I, Dukan E, Podolsky SH, Davey Smith G (2011).. The advent of fair treatment allocation schedules in clinical trials during the 19th and early 20th centuries.. Chalmers I, Toth B (2009).. 19th century controlled trials to test whether belladonna prevents scarlet fever.. Chalmers J (2005).. Sir George Chalmers, (c 1720-1791), portraitist of James Lind.. Clarke M (2004).. The 1944 patulin trial of the British Medical Research Council: an example of how concerted common purpose can get reliable answers to important questions very quickly.. Cochrane AL, Blythe M (2004).. Sickness in Salonica.. Cockerill A, Goble PJ (2012).. Thomas Graham Balfour, pioneering medical statistician and stern disciplinarian.. Cook H (2010).. Testing the effects of Jesuit’s bark in the Chinese Emperor’s court.. Cox DR (2009).. Randomization for concealment.. Craft A (2006).. James Stansfeld (1917-1998).. Crofton J (2004).. The MRC randomized trial of streptomycin and its legacy: a view from the clinical front line.. Crofton J (2005).. Marc Daniels (1907-1953).. Crofton J (2006).. John Crofton (1912-2009).. Crofton J (2007).. Reginald Bignall (1913-2000).. Davey Smith G (2006).. Capitalising on Mendelian randomization to assess the effects of treatments.. Dean ME (2003).. An innocent deception : placebo controls in the St Petersburg homeopathy trial, 1829-30.. The homeopathic mustard gas trials of 1941–42.. Dean ME (2009).. Comparative evaluation of homeopathy and allopathy within the Parisian hospital system, 1849-51.. Diaz M, Neuhauser D (2004).. Lessons from using randomization to assess gold treatment for tuberculosis.. Dickersin K, Chalmers I (2010).. Recognising, investigating and dealing with incomplete and biased reporting of clinical research: from Francis Bacon to the World Health Organisation.. Doll R (2003).. Controlled trials testing two or more treatments simultaneously.. Donaldson IML (2004).. Ambroise Paré’s accounts of new methods for treating gunshot wounds and burns.. Donaldson IML (2005).. Mesmer’s 1780 proposal for a controlled trial to test his method of treatment using ‘Animal Magnetism’.. Donaldson IML (2008).. Lavoisier s comments on the art of drawing conclusions from experiments.. Donaldson IML (2013).. Francis Bacon’s comments on the power of negative observations in his Novum Organum, first published in 1620.. Doyle D (2011).. Thomas John MacLagan (1838-1903).. Thomas MacLagan’s 1876 demonstration of the dramatic effects of salicin in rheumatic fever.. Edwards M (2010).. Dora Colebrook and the evaluation of light therapy.. Elwood P (2004).. The first randomized trial of aspirin for heart attack and the advent of systematic overviews of trials.. Erill S (2008).. Louis Lasagna (1923-2003).. Farewell V, Johnson A (2010).. Hilda Woods (1892-1971).. The first British textbook of medical statistics.. William Thomas Russell (1888-1953).. Farewell V, Johnson A (2011).. The origins of Austin Bradford Hill’s classic textbook of medical statistics.. Ferroni E, Jefferson T, Gachelin G (2011).. Angelo Celli and research on the prevention of malaria in Italy a century ago.. Fox DM (2011).. Systematic reviews and health policy: the influence of a project on perinatal care since 1988.. Furberg CD (2009).. How should one analyse and interpret clinical trials in which patients don’t take the treatments assigned to them?.. Gachelin G (2013).. The interaction of scientific evidence and politics in debates about preventing malaria in 1925.. Gartlehner G, Stepper K (2011).. Julius Wagner-Jauregg: pyrotherapy, Simultanmethode, and ‘racial hygiene’.. Gluud C (2008).. Povl Heiberg (1868-1963).. Gluud C (2010).. Danish contributions to the evaluation of serum therapy for diphtheria in the 1890s.. Gluud C, Hilden J (2008).. Povl Heiberg’s 1897 methodological study on the statistical method as an  ...   GM Bullowa (1879-1943).. Neuhauser D, Diaz M (2007).. Russell LaFayette Cecil (1881-1965).. Use of rotation to allocate patients to homeopathic or regular medical services in Cook County Hospital, Chicago, 1882.. Neuhauser D, Diaz M, Chalmers I (2007).. A puzzling omission in a great medical textbook edited by a pioneer of controlled trials.. Nunn JF (2008).. A treatment that has stood the test of time for over three and a half millennia.. O Rourke K (2006).. A historical perspective on meta-analysis: dealing quantitatively with varying study results.. Olsen SF (2002).. The People s League of Health trial.. Opinel A, Gachelin G (2010).. French 19th century contributions to the development of treatments for diphtheria.. Passmore R (2001).. William Cullen (1710-1790).. Pazzini A (1958).. Angelo Celli (1857-1914).. Peters L (2006).. James Lind’s descendants.. Peters L, Hepner J (2009).. George Chalmers’ portrait of James Lind, 1783-2008: a reconstruction.. Petrosino A (2004).. Charles Frederick [Fred] Mosteller (1916-2006).. Podolsky SH (2008).. Jesse Bullowa, specific treatment for pneumonia, and the development of the controlled clinical trial.. Podolsky SH, Davey Smith G (2011).. Park’s story and Winters’ tale: alternate allocation clinical trials in turn of the Century America.. Pollock JI (2003).. A controlled trial using a factorial design reported in 1946.. Biographical information on Clifford Wilson (1906-1997) and Martin Pollock (1914-1999).. Clifford Wilson (1906-1997) and Martin Pollock (1914-1999).. Pollock JI (2005).. Two controlled trials of supplementary feeding of British school children in the 1920s.. Pormann PE (2013).. Qualifying and quantifying medical uncertainty in 10th century Baghdad: Abu Bakr al-Razi.. Reid CM (2008).. Donald Darnley Reid (1914-1977).. Rennie D, Chalmers I (2009).. Exposing the dangers to patients of medical reviews and textbooks that ignore scientific principles.. Rodeck CH (2004).. Geoffrey William Theobald (1896–1977).. Rolls R (2003).. Caleb Hillier Parry (1755-1822).. Sackett DL (2008).. A 1955 clinical trial report that changed my career.. Scadding JG (2002).. Reflections on my studies of the effects of sulphonamide drugs in bacillary dysentery in Egypt, 1943-1944.. Senn SJ (2003).. Cushny and Peebles and optical isomers, 1905.. Shannon H (2008).. A statistical note on Karl Pearson’s 1904 meta-analysis.. Sidebottom E (2012).. Roger Bacon and the beginnings of experimental science in Britain.. Silverman WA (2003).. Personal reflections on lessons learned from randomized trials involving newborn infants, 1951 to 1967.. Silverman WA, Chalmers I (2002).. Casting and drawing lots: a time-honoured way of dealing with uncertainty and for ensuring fairness.. Sinclair L (2007).. Recognising, treating and understanding pernicious anaemia.. Slater SD (2010).. The discovery of thyroid replacement therapy.. Solis C (2011).. Bartolomé Hidalgo de Agüero’s 16th century, evidence-based challenge to the orthodox management of wounds.. Spain P, Kadan-Lottick N (2010).. Observations of unprecedented remissions following novel treatment for acute leukemia in children in 1948.. Spanager L (2005).. Jansen’s 1910 use of a single blind experiment to assess the effects of radioactive water on rheumatic diseases.. Spanager L (2010).. Hans Ditlev Jansen (1875–1933).. Stjernswärd J (2009).. Meta-analysis as a manifestation of bondförnuft (‘peasant sense’).. Stjernswärd J (2013).. Personal reflections on contributions to pain relief, palliative care and global cancer control.. Stolberg M (2006).. Inventing the randomized double-blind trial: The Nürnberg salt test of 1835.. Stoll S (2004).. Paul Martini s Methodology of therapeutic investigation.. Stoll S (2010).. Paul Franz Xavier Martini (1889-1964).. Stylianou C, Kelnar C (2008).. The introduction of successful treatment of diabetes mellitus with insulin.. Sugiyama Y, Seita A (2013).. Kanehiro Takaki and the control of beriberi in the Japanese Navy.. Sutton G (2004).. James Lind aboard Salisbury.. Tansey EM (2006).. Philip Montagu D’Arcy Hart (1900-2006).. Thacker SB (2009).. How I came to write papers for clinicians in the late 1980s about improving the quality of reviews.. Tibi S (2005).. Al-Razi and Islamic medicine in the 9th Century.. Tröhler U (2003).. Adolf Bingel (1879-1953).. Charles MacLean (c.. 1766-1824).. Edward Alanson (1747-1823).. Edward Alanson 1782: responsibility in surgical innovation.. James Lind and scurvy: 1747 to 1795.. James Lind and the evaluation of clinical practice.. James Lind at Haslar Hospital 1758-1774: a methodological theorist.. John Clark (1744-1805).. John Clark 1780 1792: learning from properly kept records.. MacLean 1818: comparing like with like and recognising ethical double standards in therapeutic experimentation.. Withering s 1785 appeal for caution when reporting on a new medicine.. Tröhler U (2007).. An early 18th century proposal for improving medicine by tabulating and analysing practice.. Tröhler U (2010).. Adolf Bingel’s blinded, controlled comparison of different anti-diphtheritic sera in 1918.. Emil Theodor Kocher (1841-1917).. Johann Friedrich de Quervain (1868-1940).. The introduction of numerical methods to assess the effects of medical interventions during the 18th century: a brief history.. Towards endocrinology: Theodor Kocher’s 1883 account of the unexpected effects of total ablation of the thyroid.. Tröhler U (2013).. William Cheselden s 1740 presentation of data on age-specific mortality after lithotomy.. Tsiompanou E, Marketos SG† (2012).. Hippocrates: timeless still.. Vandenbroucke JP (2003).. Aspirin: an unanticipated beneficial effect.. Thalidomide: an unanticipated adverse effect.. The contribution of William Fletcher s 1907 report to finding a cause and cure for beriberi.. Vandenbroucke JP (2012).. Adolphe Vorderman s 1897 study on beriberi: an example of scrupulous efforts to avoid bias.. Vessey MP (2006).. Learning how to control biases in studies to identify adverse effects of drugs.. Volmink J (2005).. The willow as a Hottentot (Khoikhoi) remedy for rheumatic fever.. Weingarten S (2003).. Food in Daniel 1:1-16: the first controlled experiment?.. Wessely S (2009).. Surgery for the treatment of psychiatric illness: the need to test untested theories.. Wickenden JVS (2011).. The strange disappearances of James Lind.. Williams KJ (2009).. The introduction of ‘chemotherapy’ using arsphenamine - the first magic bullet..

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  • Title: Whats New
    Descriptive info: What's New.. James Lind Newsletter:.. January 2010.. May 2009.. Autumn 2008.. Some commentaries from the.. are reprinted in a monthly section in the.. Journal of the Royal Society of Medicine.. If you wish to receive emails when new material is added, please let us know through:..

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  • Title: Building the James Lind Library
    Descriptive info: Building the.. What are the objectives of.. ?.. has been created to increase general knowledge about how fair tests can help us to distinguish helpful from harmful effects of treatments.. What are the origins of.. was built on the foundations of a website called.. Controlled Trials from History.. This was launched by the.. Library of the Royal College of Physicians of Edinburgh.. in 1998, to mark the 50th anniversary of the publication of the British Medical Research Council s celebrated randomized trial of streptomycin for pulmonary tuberculosis (.. MRC 1948.. ).. The website was redesigned and relaunched in 2003 as The James Lind Library to mark the 250th anniversary of the publication of James Lind s.. Treatise of the Scurvy.. Lind was a Fellow and Treasurer of the Royal College of Physicians of Edinburgh, and his Treatise contained a systematic review of what had been written about scurvy, and an account of a controlled trial showing that oranges and lemons were dramatically better than the other supposed treatments for the disease.. In 2003,.. '.. Scientific American.. awarded.. a 2003 Sci/Tech Web Award.. Judges representing the journal considered 1000 websites across all of science, and selected 50 for awards.. Five of these were in the 'Medicine' category.. was the only one of these five sites to have been created outside the United States.. What s  ...   records relate to tests of measures intended to prevent healthy people becoming patients.. We select records for inclusion in the.. both to illustrate the evolution of.. principles of fair tests of treatments.. , and to illustrate the application of these principles, in practice.. We include records to illustrate the application of principles, up to the point at which the principles appear to have become widely accepted.. For example, by the 1960s, there was wide acceptance of the need to generate comparison groups using alternation or random allocation - so that like would be compared with like.. Biases in assessing treatment outcomes had also been recognised, and the steps needed to reduce these, sometimes by using placebos.. By the end of the 20th century, people had realised how important it is to assess treatment effects using systematic reviews of all the relevant evidence, published and unpublished.. At the beginning of the 21st century, there is increasing awareness of various biases associated with commercial sponsorship of tests of treatments.. It is clear that the.. continue to evolve, and we try to reflect this continuing evolution in.. Can you help us improve.. ?.. Although we do not attempt to be comprehensive, we are constantly assessing additional material for possible inclusion in the.. We welcome suggestions for additional candidate records, and other comments.. Let us know about these through..

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  • Title: Who is responsible for the James Lind Library?
    Descriptive info: Contributors to the.. Editor:.. Iain Chalmers, James Lind Initiative, Oxford, UK.. Associate Editors:.. Iain Milne,.. Library, Royal College of Physicians of Edinburgh.. , UK.. Alfredo Morabia.. CBNS, Queens College, City University of New York.. , USA.. Ulrich Tröhler,.. Institute of Social and Preventive Medicine (ISPM), University of Bern.. , Switzerland.. Jan Vandenbroucke,.. Department of Clinical Epidemiology, Leiden University Hospital.. , The Netherlands.. Document supply:.. Estela Dukan, Library Services and Digitisation, Royal College of Physicians of Edinburgh, UK.. Document preparation:.. Patricia Atkinson, James Lind Initiative, Oxford, UK.. Alfredo Morabia, Ulrich Tröhler, Iain Milne, Iain Chalmers, Estela Dukan, George Tait, Jan Vandenbroucke.. Institutional support for the editorial team:.. Sibbald Library,.. Royal College of Physicians of Edinburgh, UK.. ;.. National Institute for Health Research, England;.. Medical Research Council.. Institute of Social and Preventive Medicine (ISPM) at the University of Bern.. Donors to James Lind Library Fund:.. Current Controlled Trials Ltd.. Institute of Naval Medicine.. Worshipful Company of Barbers.. Editorial Advisers.. Iain Donaldson, Royal College of Physicians, Edinburgh, UK.. Harry Marks, Johns Hopkins University, Baltimore, USA.. Emilie Savage-Smith, University of Oxford, Oxford, UK.. Tilli Tansey, Wellcome Trust Centre for the History of Medicine, London, UK.. Authors of explanatory essays, commentaries and biographies:.. Clive Adams, Robin Agnew, Lene Andersen, Peter Armitage, Hilda Bastian, Max Blythe, Christopher Booth, Sue Boren, Arthur W Boylston, Michael B Bracken, Linda Bryder, John Bunker, Druin Burch, Iain Chalmers, John Chalmers, Mike Clarke, Archie Cochrane, Harold Cook, David Cox, Alan Craft, John Crofton, Michael Emmans Dean, Mireya Diaz, Kay Dickersin, Benjamin Djulbegovic, Richard Doll, Iain Donaldson, Allan Donner, Derek Doyle, Martin Edwards, Peter Elwood, Sergio Erill, Vern Farewell, Eliana Ferroni, Curt Furberg, Gabriel Gachelin, Christian Gluud, Yang Gong, Peter Gøtzsche, David Grimes, Gordon Guyatt, John Hampton, Elina Hemminki, Lorna Hepner, Jørgen Hilden, Stuart Houston, Asbjørn Hróbjartsson, Edward Huth, Frank Hytten, Tom Jefferson, Milos Jenicek, Hershel Jick, Tony Johnson, Peter Joosse, Nina Kadan-Lottick, Ted Kaptchuk, Christopher Kelnar, Catherine Kerr, Neil Klar, Michael Radcliffe Lee, Irvine Loudon, Micheline Louis-Courvoisier, Ilana Löwy, Andreas-Holger Maehle, Howard Mann, Harry M Marks, Klim McPherson, John Middleton, Iain Milne, Wendy Moore,  ...   John Forrester, Patrick Forsyth, Janet Foster, Andrea Gareffi ,Paul Glasziou, Steve Goodman, Brian Greenwood, Gordon H Guyatt, Bec Hanley, Selma Harb, Jim Hartley, Philip and Ruth D Arcy Hart, David Harvie, Barbara J Hawgood, Larry Hedges, Harry Hemingway, J Hepner, Andrew Herxheimer, Jini Hetherington, Edmund Hey, Tony Holbrook, Tony Hope, Eddy Houwaert, Richard Hughes, Helen Hulson, Roderick Hunt, Geir Jacobsen, Ian Jenkins, Tony Johnson, Christopher Kelnar, Barbara Kirkham, Masamichi Kitagawa, Jos Kleijnen, Bruce Kupelnick, Ken-Wen Ma, Claudia Langenberg, Christopher Maher, Maureen Malowany, Harry Marks, Geraldine Macdonald, John Middleton, Tatjana Mikhailova, Frederick Mosteller, Ann Oakley, Sjúrður Fróði Olsen, Nancy Owens, Andy Oxman, Iris Pasternack, Alex Peck, Linda Peters, Royal London Hospital, Sophie Petit-Zeman, Mark Petticrew, Tim Powell, Patricia Priest, Michael Rawlins, Lucy Reid, Albert Rinsler, Ze ev Rosenkranz, Karl Sabbagh, Emilie Savage-Smith, John Scadding, Mabel Scadding, Camilla Seymour, Julia Sheppard, John Simes, Wyon Stansfeld, Charilaos Stylianou, Libo Tao, Duncan Thomas, Hazel Thornton, Leigh-Ann Topfer, Bridget Trahair, Geoffrey Venning, Ekaterina Vikhlyaeva, Patricia Want, Chris Watkins, Geoff Watts, Micky Weingarten, The Wellcome Library, Sarah White, Jane Wickenden, John Williams, Charlie Xue.. Translations of the.. screen and the explanatory essays were arranged and administered by.. Luis Gabriel Cuervo and America Valdes at the Pan American Health Organisation, and Betty Galliano and Federico Carroli at Ocean Translations (for Spanish, Portuguese and French).. Hoomen Momen and Jing Wang at the World Health Organization in Geneva (for Chinese and Russian).. Najeeb Al-Shorbaji, formerly at the East Mediterranean Regional Office of the World Health Organisation, now Director, Knowledge Management and Sharing, World Health Organisation, Geneva (for Arabic).. The translators were:.. for Arabic: Ahmad Kamel, Kassem Sara, Gada Al Sherbini, and Atef Zayed.. for Chinese: Qingdong Qi and Wenping Li.. for French: Translations team of the Pan American Health Organization (PAHO/AMRO).. for Portuguese: Marco Neves, Joana Taborda, Vera Almeida, Rodrigo Gonçalves, and Inês Passos.. for Russian: Boleslav Bairach and Roustem Rizvanov.. for Spanish: Sandra Paván y Silvina Cantarella, Luciana Ramos, and Hernán Moreno.. The editors are very grateful to these many contributors to the.. Note:.. was launched in 2003, superseding.. (1998 2002)..

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  • Title: Search
    Descriptive info: Search Results..

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  • Title: James Lind Library :: Why fair tests are needed
    Descriptive info: Trying to do more good than harm.. Why do we need fair tests of treatments in health care? Have not doctors, for centuries, done their best for their patients? Sadly, there are many examples of doctors and other health professionals harming their patients because treatment decisions were not informed by what we consider now to be reliable evidence about the effects of treatments.. With hindsight, health professionals in most if not all spheres of health care have harmed their patients inadvertently, sometimes on a very wide scale (.. click here for examples.. Indeed, patients themselves have sometimes harmed other patients when, on the basis of untested theories and limited personal experiences, they have encouraged the use of treatments that have turned out to be harmful.. The question is not whether we must blame these people, but whether the harmful effects of inadequately tested treatments can be reduced.. They can, to a great extent.. Acknowledging that treatments can sometimes do more harm than good is a prerequisite for reducing unintended harm (Gregory 1772;.. Haygarth 1800.. ; Fordyce 1802;.. Behring 1893.. We then need to be more ready to admit uncertanties about treatment effects, and to promote tests of treatments to adequately reduce reduce uncertainties.. Such tests are fair tests.. Why theories about the effects of treatments must be tested in practice.. People have often been harmed because treatments have been based only on theories about how disease should be treated, without testing how the theories played out in practice.. For example, for centuries people believed the theory that illnesses were caused by humoral imbalances , and patients were bled and purged, made to vomit and take snuff, in the belief that this would end the supposed imbalances still, as long ago as the 17th century, a lone Flemish doctor was impertinent enough to challenge the medical authorities of the time to assess the validity of their theories by proposing a fair test of the results of their unpleasant treatments (.. Van Helmont 1662.. By the beginning of the 19th century, British military surgeons had begun to show the harmful effects of bloodletting for treating "fevers" (Robertson 1804;.. Hamilton 1816.. A few decades later, the practice was also challenged by a Parisian physician (.. Louis 1835.. Yet at the beginning of the 20th century, orthodox practitioners in Boston, USA, who were not using bloodletting to treat pneumonia were still being judged negligent (Silverman 1980).. Indeed, Sir William Osler, one of the most influential medical authorities in the world, who was generally cautious about recommending unproven treatments, advised his readers that: during the last decades we have certainly bled too little.. Pneumonia is one of the diseases in which a timely venesection [bleeding] may save life.. To be of service it should be done early.. In a full-blooded, healthy man with a high fever and bounding pulse the abstraction of from twenty to thirty ounces of blood is in every way beneficial (Osler 1892).. Although the need to test the validity of theories in practice was recognized by some people at least a millennium ago (.. Ibn Hindu 10th-11th century.. ), this important principle is still too often ignored.. For instance, based on untested theory, Benjamin Spock, the influential American child health expert, informed the readers of his best selling book.. Baby and Child Care.. that a disadvantage of babies sleeping on their backs was that, if they vomited, they would be more likely to choke.. Dr Spock therefore advised his millions of readers to encourage babies to sleep on their tummies (Spock 1966).. We now know that this advice, apparently rational in theory, led to the cot deaths of tens of thousands of infants (Gilbert et al.. 2004).. The use of drugs to prevent heart rhythm abnormalities in people having heart attacks provides another example of the dangers of applying untested theory in practice.. Because heart rhythm abnormalities are associated with an increased risk of early death after heart attack, the theory was that these drugs  ...   the effects of.. For example, in the 1950s, theory and poorly controlled tests yielding unreliable evidence suggested that giving a synthetic sex hormone, diethylstilboestrol (DES), to pregnant women who had previously had miscarriages and stillbirths would increase the likelihood of a successful outcome of later pregnancies.. Although fair tests had suggested that DES was useless, theory and the unreliable evidence, together with aggressive marketing, led to DES being prescribed to millions of pregnant women over the next few decades.. The consequences were disastrous: some of the daughters of women who had been prescribed DES developed cancers of the vagina, and other children had other health problems, including malformations of their reproductive organs and infertility (Apfel and Fisher 1984).. Problems resulting from inadequate tests of treatments continue to occur.. Again, as a result of unreliable evidence and aggressive marketing, millions of women were persuaded to use hormone replacement therapy (HRT), not only because it could reduce unpleasant menopausal symptoms, but also because it was claimed that it would reduce their chances of having heart attacks and strokes.. When these claims were assessed in fair tests the results showed that, far from reducing the risks of heart attacks and strokes, HRT increases the risks of these life-threatening conditions, as well as having other undesirable effects (McPherson 2004).. These examples of the need for fair tests of treatments are a few of many that illustrate how treatments can do more harm than good.. Improved general knowledge about fair tests of treatments is needed so that - laced with a healthy dose of scepticism we can all assess claims about the effects of treatments more critically.. That way, we will all become more able to judge which treatments are likely to do more good than harm.. The principles of fair tests of treatments have been evolving for centuries - and they continue to evolve.. Apfel RJ, Fisher SM (1984).. To do no harm: DES and the dilemmas of modern medicine.. New Haven, Ct: Yale University Press.. Behring, Boer, Kossel H (1893).. Zur Behandlung diphtheriekranker Menschen mit Diphtherieheilserum.. Deutsche Medicinische Wochenschrift 17:389-393.. Fibrinolytic Therapy Trialists’ Collaborative Group (1994).. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients.. Lancet 1994;343:311-322.. Fordyce G (1802)..  A second dissertation on fever.. London: J Johnson.. Gilbert R, Salanti G, Harden M, See S (2005).. Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002.. International Journal of Epidemiology 34:874-87.. Gregory J (1772).. Lectures on the duties and qualifications of a physician.. London: Strahan and Cadell.. Hamilton AL (1816).. Dissertatio Medica Inauguralis De Synocho Castrensi (Inaugural medical dissertation on camp fever).. Edinburgh: J Ballantyne.. Haygarth J (1800).. Of the imagination, as a cause and as a cure of disorders of the body: exemplified by fictitious tractors, and epidemical convulsions.. Bath: R.. Crutwell.. Ibn Hindu (10th-11th century CE; 4th-5th century AH).. Miftah al-tibb wa-minhaj al-tullab [The key to the science of medicine and the students guide].. Louis PCA (1835).. Recherches sur les effets de la saignée dans quelques maladies inflammatoires et sur l action de l émétique et des vésicatoires dans la pneumonie.. Paris: Librairie de l Académie royale de médecine.. McPherson K (2004).. Where are we now with hormone replacement therapy? BMJ 328:357-358.. Moore TJ (1995).. Deadly Medicine.. New York: Simon and Schuster.. Osler W (1892).. Principles and Practice of Medicine.. London: Appleton, p 530.. Robertson R (1804).. Observations on the diseases incident to seamen, 2nd edn.. Vol.. 1, London: for the author.. Silverman W (1980).. In: Chalmers I, McIlwaine G (eds).. Perinatal Audit and Surveillance.. London: Royal College of Obstetricians and Gynaecologists, 1980:110.. Spock B (1966).. 165th printing.. New York: Pocket Books, pp 163-164.. van Helmont JB (1662).. Oriatrike, or physick refined: the common errors therein refuted and the whole are reformed and rectified [translated by J Chandler].. Lodowick-Loyd: London, p 526..

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  • Title: James Lind Library :: Why comparisons are essential
    Descriptive info: Is a treatment better than nature and time?.. Patients and healthcare professionals hope that treatments will be helpful.. These optimistic expectations can have a very positive effect on everybody s satisfaction with health care, as the British doctor Richard Asher noted in one of his essays for doctors:.. If you can believe fervently in your treatment, even though controlled tests show that it is quite useless, then your results are much better, your patients are much better, and your income is much better too.. I believe this accounts for the remarkable success of some of the less gifted, but more credulous members of our profession, and also for the violent dislike of statistics and controlled tests which fashionable and successful doctors are accustomed to display.. (Asher 1972).. People often recover from illness without any specific treatment: nature and time are great healers.. As Oliver Wendell Holmes suggested in the 19th century when there were very few useful treatments (.. Holmes 1861.. ), "I firmly believe that if the whole materia medica,.. as now used,.. could be sunk to the bottom of the sea, it would be all the better for mankind - and all the worse for the fishes.. ".. The progress and outcome of illness if left untreated must obviously be taken into account when treatments are being tested: treatment may improve or it may worsen outcomes.. Writers over the centuries have drawn attention to the need to be sceptical about claims that the effects of treatments can improve on the effects of nature.. Put another way, If you leave a dose of flu to nature, you ll probably get over it in a week; but if you go to the doctor, you ll recover in a mere seven days.. In the knowledge that much illness is self-limiting, doctors sometimes prescribe inert treatments in the hope that their patients will derive psychological benefit the so-called placebo effect.. Patients who believe that a treatment will help to relieve their symptoms - even though the treatment, in fact, has no physical effects - may well feel better.. Doctors have recognized the importance of using placebos for centuries (.. list relevant records.. For example, William Cullen referred to his use of a placebo as long ago as 1772 (.. Cullen 1772.. ), and references to placebos increased during the 19th century (Cummings 1805;.. Ministry of Internal Affairs 1832.. Forbes 1846.. Because Austin Flint believed that orthodox drug treatment was usurping the credit due to nature , he gave thirteen patients with rheumatism a placeboic remedy consisting of a highly dilute extract of the bark of the quassia tree.. The result was that the favourable progress of the cases was such as to secure for the remedy generally the entire confidence of the patients (.. Flint 1863.. At Guy's Hospital in London, William Withey Gull came to similar conclusions after treating 21 rheumatic fever patients "for the most part with mint water" (.. Sutton 1865.. At the beginning of the 20th century William Rivers discussed psychologically-mediated effects of treatments in detail (.. Rivers 1908.. The need for comparisons.. Just as the healing power of nature and the placebo effect have been recognized for centuries, so also has the need for comparisons to assess the effects of treatments over and above natural and psychologically-mediated effects.. Sometimes treatment comparisons are made in people s minds: they have an impression that they or others are responding differently to a new treatment compared with previous responses to treatments.. For example, Ambroise Paré, a French military surgeon, concluded that treatment of battle wounds with boiling oil (as was common practice) was likely to be harmful.. He concluded this when the supply of oil ran out and his patients recovered more quickly than usual (.. Paré 1575.. Most of the time, impressions like this need to be followed up by formal investigations, perhaps initially by analysis of healthcare records.. Such impressions may then lead to carefully conducted comparisons.. The danger arises when impressions alone are used as a guide to treatment recommendations and decisions.. Dramatic effects and moderate effects of treatments.. Treatment comparisons based on impressions, or relatively restricted analyses, only provide reliable information in the rare circumstances when treatment effects are dramatic (.. click here to list relevant records..  ...   so-called crossover test (.. Martini 1932.. An early example of a crossover test was reported in 1786 by Dr Caleb Parry in Bath, England.. He wanted to find out whether there was any reason to pay for expensive, imported Turkish rhubarb as a purgative for treating his patients, rather than using rhubarb grown locally in England.. So he crossed-over the type of rhubarb given to each individual patient at different times and then compared the symptoms each patient experienced while eating each type of rhubarb (.. Parry 1786.. (He didn't find any advantage of the expensive rhubarb!).. Treatment comparisons within individual patients have their place when there condition returns after stopping treatment.. There are many circumstances in which this doesn't apply.. For example, it is usually impossible to compare different surgical operations in this way, or treatments given for progressive conditions.. Comparing groups of patients given different treatments concurrently.. Treatments are usually tested by comparing groups of people who receive different treatments.. A comparison of two treatments will be unfair if relatively well people have received one treatment and relatively ill people have received the other, so the experiences of similar groups of people who receive different treatments over the same period of time must be compared.. Al-Razi recognized this more than a thousand years ago when, wishing to reach a conclusion about how to treat patients with signs of early meningitis, he treated one group of patients and intentionally withheld treatment from a comparison group (.. al-Razi 9th century.. Comparisons with nature or with other treatments are needed for fair tests of treatments.. If these comparisons are to be fair, they must.. address genuine uncertainties.. , avoid.. , and.. be interpreted carefully.. al-Razi (10th century CE; 4th Century AH).. Kitab al-Hawi fi al-tibb [The comprehensive book of medicine].. Asher R (1972).. Talking sense.. London: Pitman Medical.. Banting FG, Best CH, Collip JB, Campbell WR, Fletcher AA (1922).. Pancreatic extracts in the treatment of diabetes mellitus.. Canadian Medical Association Journal 12:141-146.. Colebrook L, Purdie AW (1937).. Treatment of 106 cases of puerperal fever by sulphanilamide.. Lancet 2:1237-1242 1291-1294.. Cullen W (1772).. Clinical lectures.. Edinburgh, February-April, 218-9.. Cummings R (1805).. Medical and Physical Journal, page 6.. Druker BJ, Talpaz M, Resta DJ, Peng B, Buchdunger E, Ford JM, Lydon NB, Kantarjian H, Capdeville R, Ohno-Jones S, Sawyers CL (2001).. Efficacy and safety of a specific inhibitor of the BCR-ABL tyrosine kinase in chronic myeloid leukemia.. New England Journal of Medicine 344:1031-1037.. Flint A (1863).. A contribution toward the natural history of articular rheumatism; consisting of a report of thirteen cases treated solely with palliative measures.. American Journal of the Medical Sciences 46:17-36.. Forbes J (1846).. Homeopathy, allopathy and young physic.. British and Foreign Medical Review 21:225-265.. Holmes OW (1861).. Currents and countercurrents in medical science.. In: Works, 1861 Vol ix, p 185.. Martini P (1932).. Methodenlehre der Therapeutischen Untersuchung.. Berlin: Springer.. McLean-Tooke APC, Bethune CA, Fay AC, Spickett GP (2003).. Adrenaline in the treatment of anaphylaxis: what is the evidence? BMJ 327:1332-1335.. Medical Research Council (1948).. Streptomycin treatment of tuberculous meningitis.. Lancet 1:582-596.. Ministry of Internal Affairs (1823).. [Conclusion of the Medical Council regarding homeopathic treatment].. Zhurnal Ministerstva Vnutrennih del, 3:49–63.. Minot GR, Murphy WP (1926).. Treatment of pernicious anaemia by a special diet.. JAMA 87:470-476.. Paré A (1575).. Les oeuvres de M.. Ambroise Paré conseiller, et premier chirugien du Roy avec les figures portraicts tant de l‘Anatomie que des instruments de Chirugie, de plusieurs Monstres.. Paris: Gabriel Buon.. Parry CH (1786).. Experiments relative to the medical effects of Turkey Rhubarb, and of the English Rhubarbs, No.. I and No.. II made on patients of the Pauper Charity.. Letters and Papers of the Bath Society III: 431-453.. Rivers WHR (1908).. The influence of alcohol and other drugs on fatigue.. London:Edward Arnold.. Roux E, Martin L, Chaillou A (1894).. Trois cent cas de diphthérie traité par le serum antidiphthérique..  Annales de l’Institut Pasteur 8:640-661.. Schleisner PA (1849).. Island fra et lægevidenskabeligt Synspunkt.. København: Boghandler Iversen.. Sutton HG (1865).. Cases of rheumatic fever, treated for the most part by mint water.. Collected from the clinical books of Dr Gull, with some remarks on the natural history of that disease.. Guy s Hospital Report 11:392-428.. The medicinal use of opium in ninth-century Baghdad.. Leiden: Brill..

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