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Where’s the evidence? Debates in modern medicine
  1. Paramjit S Gill
  1. Department of Primary Care and General Practice, University of Birmingham, UK

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    W A Silverman. (Pp 259; £18.95). Oxford University Press, 1999, reprinted 2000 (paperback). ISBN 0-926-3088-1.

    Don’t be put off by the title. This is not a textbook on evidence based medicine (EBM) and statistics but about issues that evidence based health raises when patients present with problems that can be difficult to manage.

    It is a collection of very short essays that were first published in the journal Paediatric and Perinatal Epidemiology. They were written between 1987 and 1997, well before establishment of EBM into the health culture, and were published under a nom de plume: Malcontent! It is a pleasure to read these as Silverman gives his poignant views that are richly peppered with quotes and anecdotes. In addition there are additional views on the original essay added to reflect the authors changing views on the subject—and even commentaries from those who disagree with him!

    These essays raise ethical issues such as what to do when a patient says “do something” for their intractable pain and no effective treatment is available. How do we deal with uncertainty? The value and implementation of randomised trials for patient care is also touched upon such as the recruitment of participants; value of placebo controlled trials and generalisability of the results. All of these essays are illustrated with examples taken from the author’s specialty of intensive neonatal care though the principles are applicable to all us all frontline clinicians. Indeed they are also relevant to health managers and society at large.

    I am not surprised that this book won the 1999 BMA Medical Book Award and recommend it to you all.

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