Dr Scadding and The James Lind Alliance: One

Dr Scadding and The James Lind Alliance: One

From April 2004


The James Lind Alliance

A coalition of organisations representing patients and clinicians collaborating to confront important uncertainties about the effects of treatments


The Royal Society of Medicine
The James Lind Library


Two hundred and fifty years ago there were many conflicting opinions about how to treat the deadly disease scurvy, and these disagreements were reflected in wide variations in practice. The Royal College of Physicians of London recommended dilute sulphuric acid; the Admiralty favoured vinegar; other proposed treatments ranged from burying patients up to their necks in the ground, through to patented concoctions made from secret recipes.

Faced with this confusing situation, James Lind, a Scottish naval surgeon, wondered how to treat patients dying from scurvy. He decided to confront his uncertainty by treating his patients within a controlled clinical trial comparing six of the proposed remedies, including those favoured by the Royal College of Physicians and the Admiralty. Lind’s controlled trial showed that oranges and lemons were dramatically better than those favoured by the authorities of the day, and the other supposed treatments with which he had compared them.

Important uncertainties about the effects of treatments exist today, and, as in Lind’s day, these are reflected in variations in clinical practice. These uncertainties must be confronted to help improve the quality of care provided for current and future patients using the National Health Service. The James Lind Alliance has been established to foster discussion among patients and clinicians (doctors, nurses, therapists, and others who treat patients) about these variations in practice, and to identify which uncertainties about the effects of treatments are sufficiently important that they should be addressed in clinical trials. The Alliance is being co-convened initially by INVOLVE (formerly Consumers in NHS Research), the Royal Society of Medicine, and The James Lind Library.

Exploratory meetings

An ongoing series of meetings will be held at the Royal Society of Medicine to help promote discussion about how important uncertainties about the effects of treatments can be identified and confronted. Each of these meetings will be co-convened by a partnership consisting of an organisation representing patients and an organisation representing clinicians, both sharing an interest in a particular health problem or group of related problems. Every meeting will be facilitated by a chair from outside the field concerned, and will have the following elements:

  • Declarations of competing (financial) interests by all contributors
  • Presentation of data on variations in practice, suggesting collective uncertainty
  • Presentation of the results of systematic reviews relevant to practice variations
  • Discussion about how to confront important residual uncertainties
  • Agreement on an action plan by the organisations convening the meeting

Annual meeting of the James Lind Alliance

The James Lind Alliance will be formed from a gradually increasing number of partnerships between organisations representing patients and organisations representing clinicians, working together to confront important uncertainties about the effects of treatments. The first annual meeting of the Alliance will be held as part of the annual Clinical Excellence conference, on Wednesday 1 December 2004, at the International Convention Centre in Birmingham. The meeting will provide an opportunity for members of the Alliance to share experiences of progress and obstacles, and to identify common themes.

The annual meeting will also be used by members of the Alliance to inform representatives of the facilitating and regulatory organisations able to promote progress and help overcome obstacles experienced by the patient-clinician partnerships. These facilitators/regulators include:

  • the Department of Health
  • NHS Trusts and Strategic Health Authorities
  • organisations that fund research (particularly the MRC and the NHS Technology Assessment Programme
  • clinical researchers
  • academia, including the Higher Education Funding Council
  • information providers and educators (including the print, broadcast and electronic media)
  • the Medicines and Healthcare products Regulatory Agency
  • the research ethics committee system

INVOLVE, the Royal Society of Medicine, and The James Lind Library are coconvening the James Lind Alliance for an initial period of two years. If the Alliance has begun to fulfil its objectives by the end of 2006, Alliance members (pairs of organisations representing patients and clinicians) will then assume responsibility for the Alliance’s management and development.

Coalitions of patient and clinician organisations in the UK interested in developing the James Lind Alliance should write jointly to:

Patricia Atkinson
Administrator, James Lind Alliance Secretariat

Summertown Pavilion
Middle Way
Oxford OX2 7LG.

Email: patkinson@jameslindlibrary.org

Nick Partridge, Chair, INVOLVE (Consumers in NHS Research) www.invo.org.uk

John Scadding, Associate Dean, Royal Society of Medicine www.rsm.ac.uk 

Iain Chalmers, Editor, James Lind Library www.jameslindlibrary.org 

8 April 2004

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