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Book Reviews

The extraordinary voyage of Pytheas the Greek. Barry Cunliffe, Allen Lane, The Penguin Press, 2001. ISBN 0-713-99509-2. pp 182, £12.99.

This book is not about evidence-based medicine, nor even about medicine, but it is about evidence. It is a remarkable tour-de-force by Barry Cunliffe, the renowned Oxford archaeologist, at the height of his intellectual powers and experience, writing about a topic that clearly excites him.

The Pytheas in question was a native of the Greek colony of Massalia (Marseilles), who made a remarkable journey around the Atlantic fringes 2,300 years ago. He wrote about it in a book, long since lost. He apparently visited Britain (the subtitle of the book is the 'man who discovered Britain', though that is a rather classical view), and even travelled as far as Iceland and Denmark.

Exploration outside the Mediterranean was not unknown, and could be quite extensive. The Pharaoh Necho II in about 600 BC arranged for some Phoenician ships to circumnavigate Africa, and several hundred years later Carthaginians penetrated the Atlantic as far as the Sargasso Sea. But the tin isles, and the source of amber, remained something of a mystery.

Tin and amber were motives. The deciding factor was the closure of the straits of Gibraltar by the Carthaginians, and a prolonged state of armed neutrality with western Greek expansion in the Mediterranean.

Cunliffe sets out to recreate Pytheas' book, ' On the Ocean ', from fragments quoted by other writers in later centuries, and vituperous arguments between those who thought Pytheas a great man, and those who considered him a charlatan. What makes this book useful is the way Cunliffe deals with evidence, from textual analysis, agreements or disagreements between texts and archaeology, and even mathematics.

If you love history, this book is a must for its history alone. If you are not a historian, you'll love it for its sense of enquiry and fun. Whatever, you'll learn a little something about using evidence appropriately.

Getting health economics into practice. Edited by David Kernick. Radcliffe Medical Press, 2002. ISBN 1-85775-575-8. pp358, £ not known.

There is lots in this book that is good, but it is curiously unsatisfying. It's not a 'curate's egg' problem of being good in parts, because there is nothing bad about any of it. Perhaps the sense of unease comes from what is missing or what is not dealt with in as exciting a way as it could be.

Some examples. The prologue is entitled - better to be vaguely right than precisely wrong. Nice stuff from John Maynard Keynes. But Keynes didn't run a PCT. What technique might I use if I did run a PCT. Operational research is one such. Invented in Oxford by Watson Watt for the better use of radar, it won the war and helped make US industry great. It can be complicated, but is often simple, and helps incorporate economics and efficacy in decision-making. Not mentioned in this book.

Again, programme budgeting and marginal analysis (PBMA) can be really exciting, and especially innovative in healthcare. It might be seen as an ideal technique for healthcare decision-making, and there is talk of ministers becoming interested. Here it is dealt with only from the literature. This isn't very encouraging, but very little good management is published because journals simply are not interested. At least there is an appendix of studies we can get our hands on, some of them very good.

Perhaps that is the problem. Slightly too hands off for the folk to whom it is directed, those involved in planning, commissioning and delivering healthcare. Maybe the fault is in the discipline itself, a bit pointy-headed academic and airy-fairy, when what is needed is a robust sleeves-rolled-up, no-nonsense handbook about how to make things better. A sort of Haynes Manual for the NHS.

Since we won't ever get that, we have to make do with what we can get. This book will help. It covers most of the bases, is mostly written in a lively style, and had large doses of reality. Individual chapters, like Chris Newdick's chapter on patients' rights, rationing, and the law are simply terrific. But I'd like to see an accompanying volume on real problems where evidence, economics and management have all been used to make a difference, so that we can all have the same performance as the best.

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