BEWARE of claims that have a bad basis
Many claims about the effects of treatments are not trustworthy. Often this is because the reason (the basis) for the claim is not trustworthy. You should be careful when you hear claims that are:
• Too good to be true
• Based on faulty logic
• Based on trust alone
People often think about the benefits of treatments and ignore possible harms. But few treatments that work are 100% safe.
Most claims that a treatment will make you 100% better or that it works for everyone turn out to be wrong.
We can rarely, if ever, be 100% certain about the effects of treatments.
People who are sick often get better without a treatment. Sometimes a treatment does not help and may even make things worse.
Treatments that should work in theory often do not work in practice.
Just because using a treatment is associated with people getting better or worse, that doesn’t mean that the treatment made them better or worse.
More data is not necessarily better data, whatever the source.
Unless a treatment is compared to something else, it is not possible to know what would happen without it.
Without a comparison, it is difficult to say that a treatment is the reason something happened.
If one treatment comparison (study) shows that people who got one treatment did better or worse than people who got something else, it does not mean that is the final answer.
Just because a treatment has been used for a long time or by many people, it does not mean that it helps or that it is safe.
Just because a treatment is new, expensive, or brand-named does not mean that it is better or safer than other treatments.
Earlier detection of ‘disease’ is not necessarily better.
It is rarely possible to know in advance who will benefit, who will not, and who will be harmed by using a treatment.
Someone with an interest in getting people to use a treatment, such as making money, may exaggerate benefits and ignore possible harmful effects.
If someone got better after using a treatment it does not necessarily mean that the treatment made them better.
Just because a treatment claim is made by an expert or authority, you cannot be sure that it is trustworthy.
“Peer-reviewed” and published studies may not be fair comparisons.
THINK 'FAIR' – and check the evidence from treatment comparisons
Evidence from comparisons of treatments can fool you. You should think carefully about the evidence that is used to support claims about the effects of treatments. Look out for:
• Unfair comparisons of treatments
• Uncareful summaries of comparisons
• How treatment effects are described
Look out for treatment comparisons where the comparison groups were not alike.
Look out for comparisons of treatments between studies that are different.
Look out for treatment comparisons where the comparison groups were cared for differently.
Look out for treatment comparisons where people knew which treatment they received and knowing that could have changed how they felt or behaved.
Look out for treatment comparisons where what happened was measured differently in the comparison groups.
Look out for treatment comparisons where what happened was not measured in lots of people.
Look out for outcomes that were not assessed reliably in treatment comparisons.
Look out for treatment comparisons where people’s outcomes were not counted in the group to which they were assigned.
Look out for summaries of studies comparing treatments that were not done systematically.
Look out for unpublished results of fair comparisons.
Look out for treatment comparisons that are sensitive to assumptions that are made.
Look out for treatment effects that are described just using words.
Look out for treatment effects that are described as relative effects.
Look out for treatment effects that are described as average differences.
Look out for treatment effects that are based on small studies with few people.
Look out for results that are reported for a selected group of people within a study or systematic review.
Look out for results that are reported using p-values instead of confidence intervals.
Look out for results that are reported as “statistically significant” or “not statistically significant”.
Look out for a "lack of evidence" being described as evidence of "no difference".
TAKE CARE – and make good choices
Good treatment choices depend on thinking carefully about what to do. Think carefully about:
• What your problem is and what your options are
• Whether the evidence is relevant to your problem and options
• Whether the advantages are better than the disadvantages
Always ask yourself whether the treatment outcomes that are important to you have been checked in fair comparisons.
Always ask yourself if the treatment comparisons included only people (or animals) that are very different from you.
Always ask yourself if the treatments evaluated in fair comparisons are relevant.
Always ask yourself if fair comparisons of treatments were conducted in circumstances that are relevant.
Always ask yourself whether the possible advantages of a treatment outweigh the disadvantages of the treatment.
Always ask yourself how sure you are that the possible advantages of a treatment are better than the possible disadvantages of the treatment.