James Lind Library

The James Lind Library has been developed to illustrate the evolution of fair tests of treatments in health care. A new design of the website was launched on May 20th 2015, International Clinical Trials Day, the day in 1747 on which James Lind began his celebrated controlled trial comparing different treatments for scurvy.

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Launch of the redesigned James Lind Library
20th May 2015

The James Lind Library (JLL) – www.jameslindlibrary.org – was created to illustrate the evolution of fair comparisons of treatments, an evolution that began over a millennium ago and still continues today (Jefferson et al. 2014).

More than 1000 years ago a Persian physician, Abu Bakr Muhammad ibn ZakariyaʾAl-Razi (Rhazes), recognized that to come to a reliable conclusion about a treatment’s effects one needs to compare the outcomes of patients who have received the treatment with those of patients who haven’t. He wrote of his experience “For I once saved one group [of patients with meningitis] by it [blood letting], while I intentionally neglected [to bleed] another group. By doing that, I wished to reach a conclusion.”(Razi).

More than 750 years later, a Scottish naval surgeon, James Lind, recognised that, in making treatment comparisons, one needed to ensure that patients in the comparison groups are similar apart from the treatments being compared (Lind 1753). In a comparison of six purported treatments for scurvy began on 20 May 1747, he ensured that the sailors in the comparisons groups were at a similar stage of the disease, had the same basic diet, and were all nursed in the same part of his ship – HMS Salisbury.

Half a century after Lind had taken steps to ensure that the sailors in his six comparison groups were similar apart from the treatments they received, a British army surgeon, Alexander Lesassier Hamilton (1816), used alternate allocation of sick soldiers to treatment comparison groups to ensure that the patients allocated to them would be similar. A century later alternate allocation to treatment comparison groups was beginning to be adopted as a component of fair tests of treatments.

Not long after, a German doctor, Adolf Bingel recognised that fair treatment comparisons should entail, when possible, assessment of treatment outcomes without knowing to which treatment group patients have been allocated. He used this method of reducing measurement bias in his comparison of normal horse serum with activated horse serum in treating diphtheria (Bingel 1918).

Soon after, the American physician Jesse Bullowa in the Bulletin of the New York Academy of Medicine how statistical tests could be applied to assess how likely it was that any differences in treatment outcomes might simply reflect the play of chance (Bullowa 1928).

By 50 years ago, these fundamental principles of fair treatment comparisons had became widely accepted. Since then, other threats to fair treatment comparisons have been recognised – most studies have too few outcome events to be reliable (Peto 1978), there is biased under-reporting of research (Dickersin and Chalmers 2010), and bias is introduced by sponsors and researchers with vested interests (Lexchin et al. 2003).

In recognition of these and other contributions to the evolution of the principles underlying fair tests of treatments, the James Lind Library was initially launched in 1998 by the Sibbald Library of the Royal College of Physicians of Edinburgh as ‘Controlled Trials from History’. The event was chosen to mark the 50th anniversary of the Medical Research Council’s celebrated randomised trial of streptomycin for pulmonary tuberculosis (MRC 1948). The JLL was redesigned and relaunched in 2003 by the Sibbald Library to mark the 250th anniversary of James Lind’s controlled trial (Lind 1753).

In the JLL’s latest incarnation, a further redesign was launched under the aegis of the Centre for Evidence-Based Medicine (CEBM) at the University of Oxford on Clinical Trials Day (20 May) 2015. It was a well attended and appreciated event, organised by Ruth Davis, manager of the Centre, supported by Sian Harrison and Alice Thompson. The launch was chaired by the deputy director of the Centre, Kamal Mahtani, who spoke briefly about how important it was in clinical practice to ensure that treatments offered to patients had been tested using fair comparisons.

The five plenary presentations began with an overview of the evolution of fair treatment comparisons by Iain Chalmers, who concluded his presentation by dedicating it to Dave Sackett, founding director of the Centre of Evidence-Based Medicine, who had died the previous week (Oxman and Chalmers 2015).  In his presentation, Ben Goldacre noted that reporting bias had been recognised at least as long ago as the middle of the 17th century (Bacon 1645), and that it remains a serious problem today. Doug Altman introduced the audience to Donald Mainland, an unrecognised medical statistician genius (Mainland 1938) who was among the first to draw attention to the unsatisfactory quality of most reports of research – an issue that Doug and his colleagues have been addressing through the EQUATOR Network (www.equator-network.org).  Using the experiences of Ignaz Semmelweis (Loudon 2013) and Archie Cochrane (Cochrane and Blythe 2004), Jeremy Howick illustrated how material in the James Lind Library has been used by the Centre for Evidence-Based Medicine in its teaching on the history and philosophy of evidence-based health care.

In a concluding presentation, Douglas Badenoch, whose company Minervation has overseen the redesign of the JLL, introduced his and Paul Glasziou’s plans to add more material to the Library to illustrate the evolution of evidence-based health care over the past 30 years.  One of the examples he used was an early attempt by Sharon Straus, Ann Eisinga and Dave Sackett ‘to bring the library to the bedside’ through an ‘evidence cart’ (Straus et al. 2015).

Douglas ended the presentations by urging everyone present to make use of the James Lind Library and to send him and other members of the editorial team suggestions for improving it. If you would like to comment on the library or can help us improve it then please do get in touch.

al-Razi (10th century CE; 4th century AH). Kitab al-Hawi fi al-tibb [The comprehensive book of medicine].

Bacon F (1645). Franc Baconis de Verulamio / Summi Angliae Cancellarii /Novum organum scientiarum. Lugd. Bat: apud Adrianum Wiingaerde, et Franciscum Moiardum. Aphorism XLVI (pages 45-46).

Bingel A (1918). Über Behandlung der Diphtherie mit gewöhnlichem Pferdeserum [On the treatment of diphtheria with normal horse serum]. Deutsches Archiv für Klinische Medizin 125:284-332.

Bullowa JGM (1928). The control. Contribution to a symposium on the use of antipneumococcic refined serum in lobar pneumonia, 15 December 1927. Bulletin of the New York Academy of Sciences 4:339-343.

Cochrane AL, Blythe M (2004). Sickness in Salonica. JLL Bulletin: Commentaries on the history of treatment evaluation (http://www.jameslindlibrary.org/articles/sickness-in-salonica/)

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. JLL Bulletin: Commentaries on the history of treatment evaluation (http://www.jameslindlibrary.org/articles/recognising-investigating-and-dealing-with-incomplete-and-biased-reporting-of-clinical-research-from-francis-bacon-to-the-world-health-organisation/)

Jefferson T, Jones MA, Doshi P, Del Mar CB, Hama R, Thompson MJ, Spencer EA, Onakpoya I, Mahtani KR, Nunan D, Howick J, Heneghan CJ (2014). Neuraminidase inhibitors for preventing and treating influenza in healthy adults and children. Cochrane Database of Systematic Reviews 2014, Issue 4. Art. No.: CD008965. DOI:10.1002/14651858.CD008965.pub4.

Lesassier Hamilton A (1816). Dissertatio Medica Inauguralis De Synocho Castrensi [Inaugural medical dissertation on camp fever]. Edinburgh: J Ballantyne.

Lexchin J, Bero LA, Djulbegovic B, Clark O (2003). Pharmaceutical industry sponsorship and research outcome and quality: systematic review. BMJ 326:1167-70.

Lind J (1753). 2A treatise of the scurvy. In three parts. Containing an inquiry into the nature, causes and cure, of that disease. Together with a critical and chronological view of what has been published on the subject. Edinburgh: Printed by Sands, Murray and Cochran for A Kincaid and A Donaldson.

Loudon I (2013). Ignaz Phillip Semmelweis’ studies of death in childbirth. JLL Bulletin: Commentaries on the history of treatment evaluation. (http://www.jameslindlibrary.org/articles/ignaz-phillip-semmelweis-studies-of-death-in-childbirth/)

Mainland D (1938). The treatment of clinical and laboratory data: an introduction to statistical ideas and methods for medical and dental workers. Edinburgh: Oliver and Boyd.

Medical Research Council (1948). Streptomycin treatment of pulmonary tuberculosis: a Medical Research Council investigation. BMJ 2:769-782.

Oxman A, Chalmers I. Farewell and thanks to Dave Sackett, Cochrane’s first pilot. Cochrane Library http://www.cochranelibrary.com/editorial/10.1002/14651858.ED000099

Peto R (1978). Clinical trial methodology. Biomedicine 28 (special issue):24-36.

Straus S, Eisinga A, Sackett D† (2015). What drove the Evidence Cart? Bringing the library to the bedside. JLL Bulletin: Commentaries on the history of treatment evaluation (http://www.jameslindlibrary.org/articles/what-drove-the-evidence-cart-bringing-the-library-to-the-bedside/