The James Lind Alliance

The James Lind Alliance (JLA) is named after a pioneer of clinical trials, James Lind. Two hundred and fifty years ago, there were many conflicting ideas and unanswered questions about how to treat the deadly disease scurvy. James Lind – a Scottish naval surgeon – decided to confront this uncertainty by treating his patients within a clinical trial comparing six of the proposed remedies. His trial showed that oranges and lemons were dramatically better than the other supposed treatments.

The JLA has been established to help identify and confront uncertainties about the effects of treatments considered important by patients and clinicians. The JLA will promote two principles: first, that addressing uncertainties about the effects of treatments should become accepted as a much more routine part of clinical practice; and second, that patients and clinicians should work together to agree which, among those uncertainties, matter most and thus deserve priority attention.

Specifically, the JLA will facilitate the identification of research priorities shared by patients and clinicians, hence its strapline – ‘tackling treatment uncertainties together’. This approach to identifying research priorities remains very rare. Most funding bodies consult professionals when they decide which areas of research to support, and sometimes patients and/or the public are involved in the design of particular projects.  But few actively seek to establish which areas both professionals and patients agree require further investigation.

The JLA wishes to promote such a joint approach for two reasons. First, identification of uncertainties about the effects of treatments deemed important both by patients and by clinicians is important in its own right, and second, because those who fund and support therapeutic research should take particular notice of these shared priorities.

The James Lind Alliance will:

• establish a network of affiliate organisations and individuals who support and wish actively to promote the principles set out above.
• help to develop a Database of Uncertainties about the Effects of Treatments (DUETs) containing questions about the effects of treatments being asked by patients and clinicians which cannot currently be answered confidently.
• foster the evolution of working partnerships of patients and clinicians, to identify and prioritise their shared uncertainties about the effects of treatments, and then to press for systematic reviews of existing evidence in areas where these are needed, or to influence priorities for additional research.
• provide a setting as free as possible from major biases (distorting factors) and competing interests, in which patients and clinicians can meet to identify and promote shared priorities for addressing uncertainties about the effects of treatments.

As used in JLA discourse and documents, ‘patients’ includes patients and those (such as carer groups/charitable groups) who advocate for those patients who are unable to do so for themselves; ‘clinicians’ implies all health and social service professionals (doctors, nurses, therapists and others who treat patients), not just those who are medically qualified; and ‘treatments’ implies all forms of therapeutic intervention for patients, including, for example, drugs, devices, surgical operations, psychological and physical therapies, educational strategies, and the ways treatments are delivered (for example, coordinated care in stroke units).

The evidence from question-answering services for patients and clinicians is that most of their questions are about the effects of treatments. This is why the JLA is focusing on treatments. At this stage in its development, the JLA will not attempt to deal with unanswered questions about the frequency, causes and diagnosis of health problems.

Regular meetings of the JLA will provide opportunities to review and evaluate the progress made by the JLA in meeting its objectives.

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