The British Journal of Psychiatry (2005) 186: 83
© 2005 The Royal College of Psychiatrists
Clinical Trials in Psychiatry
Richard Gray
Professor of Medical Statistics and Director, University of Birmingham
Clinical Trials Unit, Park Grange, 1 Somerset Road, Birmingham B15 2RR,
UK
By Brian S. Everitt & Simon Wessely Oxford: Oxford University Press.
2004. 189 pp. £ 27.50 (pb). ISBN 0 19 852642 3
Everitt & Wessely are to be congratulated on producing an excellent
guide to help overcome the snags in clinical trial research. Clearly written
and in an engrossing style, the book is likely to become a classic textbook on
clinical trials, and not just in psychiatry. The authors’ enthusiasm and
grasp of clinical trial research make for a gripping and insightful read.
The first chapter deals with the bleak history of non-evidence-based
treatment of mental illness. The ‘slow march from dogmatic, even
mystical, certainty to proper scientific uncertainty’ is painfully
described. Exorcism, bleeding, vomiting, purging, spinning on a pivot, removal
of teeth and tonsils all came into fashion, were taken up and then dropped.
Chapter 2, describing the slow move from expert opinion to the development of
the clinical trial, is liberally interspersed with illuminating case histories
and quotations: ‘the plural of anecdote is not evidence’. Chapters
3 and 4 cover the design and special problems of trials in psychiatry. As
shown by the typical Cochrane review, previous trials have generally been of
poor methodological quality, too small and have used the wrong outcome
measures. Everitt & Wessely note the overemphasis on symptoms and
recommend patient-rated functional outcome measures. For maximum relevance,
trials should be pragmatic, and set as close to real-life clinical practice as
possible. Chapters on statistical analysis and systematic reviews are aimed
also at non-statisticians and avoid being overtechnical. The final chapter
covers the arguments for, and against, clinical trials in an objective and
balanced way. Appendices on practical issues are informative and
well-referenced.
The book is well set out, with a summary at the end of each chapter. It is
excellently researched with many recent references. It should be essential
reading for anyone involved in clinical trials in psychiatry, whether a
researcher or a user of research evidence. I would also recommend it to a much
wider readership – it is one of the very best books that has been
written on clinical trials.
