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Book reviews

Evidence-based rheumatology. Editors Peter Tugwell and others. BMJ Books 2004. ISBN 0-7279-1446-4. £70 UK, $135 USA. 540pp.
The dictionary of health economics. Anthony J Culyer. Edward Elgar Publishing. ISBN 1-84376-208-0. £95, $160 USA. 390pp.


Evidence-based rheumatology. Editors Peter Tugwell and others. BMJ Books 2004. ISBN 0-7279-1446-4. £70 UK, $135 USA. 540pp.

This heavy book, which was published in 2004, has only recently swum into Bandolier's ken. We chose to review it because it has an interesting approach that some will adore, others will hate, and to which some will be indifferent. Moreover, there are electronic updates (www.evidbasedrheum.com) that make up for the inevitable delays between recency of information and publication.

It is for professionals, but has a significantly different approach in that it provides a series of summaries and decision aids for patients that address decision-making through the weight of evidence for the potential benefits and harms of interventions. It helps professionals share therapeutic decisions with patients.

Now that is incredibly difficult, because there is precious little evidence about how to do that at all, let alone well. But hey, someone has to start somewhere, and the authors deserve a big gold star just for attempting to do this across a range of rheumatological conditions. Many will find some of the decision aids and patient information fantastically useful on the back of the evidence we have. The book comes with CD, but for Windows only.

The approach is to use searches to try and answer questions (like, ' Are non-pharmacological modalities effective in rheumatoid arthritis '), finding systematic reviews, randomised trials, and observational studies. In that regard, it is a more in-depth version of Clinical Evidence . It tells the reader what information there is.

Some people will quibble at aspects of the book. The levels of evidence used, for instance, gives platinum or gold gradings where there are sample sizes of 50 per group. Whatever the statistical power, random play of chance can affect both the result and the extent of any benefit or harm. Some would be more comfortable if the bars were raised. Calculating NNTs from single trials with a few tens of patients will leave some readers uneasy. They might argue that if there is inadequate or insufficient evidence, there isn't any useful evidence.

The use of US measurement units without SI equivalents will mystify younger readers, and will be a turn off, and it is curious that the publishers couldn't be bothered to consider the global audience.

Bandolier's advice is to check the website. Go to a bookshop and peruse the book over a cup of coffee. Many of you will want to take it home; some others will have to stifle their screams till they get outside. It is unusual for a book to have that effect.


The dictionary of health economics. Anthony J Culyer. Edward Elgar Publishing. ISBN 1-84376-208-0. £95, $160 USA. 390pp.

It is just like it says on the tin – a dictionary, which starts with the ability to pay and ends with the z-test, and provides definitions for all of them. Some of those definitions are short, and some long. But that still leaves an awful lot of terms and definitions to fill 380 pages or so.

While you might be comfortable with prevalence before you opened the book, there are few readers who would want to stand up before an audience and give a short lecture on price discrimination. Actually, price discrimination looked really interesting, and the page or so devoted to it was too short: there is much more to this than meets the eye.

The book is stuffed with terms that few of us ever come across, like extra-welfarism, or friction cost, or indifference curve, or partial equilibrium. You are thinking, so what? But if you were to read the definitions of each of these terms, with minimal neuronal responsiveness (actually, we just made that up, it's a technical term for being awake), you would want to know more about it.

Take a moment out to think where we are, certainly in the UK, and probably with healthcare globally. The markets are taking over, and economics, and health economics in particular, is possibly the second most important influence on decisions, after politics and before or alongside effectiveness. We all should know more, and books like this are useful for the library bookshelf, to browse, and to stimulate.

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