Skip navigation

Book Reviews


Evidence-based medicine: how to practice and teach EBM. D Sackett, S Straus, WS Richardson, W Rosenberg, B Haynes. Churchill Livingstone pp 260 plus CD ROM. ISBN 0-443-06240-4.

This is the second edition of this marvellous book, one that has changed the lives of many of us. This second edition is more than the book, though, because it comes with a CD-ROM and associated website. Is it any good?

There is no question that for those of us who want either to do better ourselves, or to help others do better, this is THE book. In the 1960s there was a film adaptation of HG Well's 'The Time Machine'. In the last scene the hero returns and takes just three books off to the future to create a new society. This book would be one of the three.

It isn't just that the book walks us through ways of looking at diagnosis, treatment, prognosis, harm, guidelines, teaching and many other things besides. It's the way it does it: non threatening, non academic, not in any way superior. It is written by people who have been where you are now, who have felt the frustration or despair that you are feeling now, and who have found a way to help. Having this book is like having a friend at your elbow. Since Bandolier received a copy to review, it hasn't left our side.

What's changed since the first edition? Perhaps not so much the basic ideas, but the clarity with which they are conveyed. EBM is actually easy once you have some basic tools with which to think. But that's the point. You have to think, not just know, and that makes it different from the way much medical education has traditionally been taught. Even EBM practitioners get caught because they fall back into the old ways while teaching the new, or constructing new knowledge, like systematic reviews. That's why many of them are so bad and misleading.

Every healthcare organisation should think seriously about bulk purchase and distribution to its staff. Every healthcare professional who hasn't got a copy to hand should think carefully about their future. One way or another, get it.

Evidence based resource in anaesthesia and analgesia. M Tramèr. BMJ Books ( www.bmjbooks.com ) pp 220 ISBN 0-7279-1437-5.

The editor has managed to bring together contributions from an interesting group of people involved in preparing and thinking about systematic reviews. In a room together, one suspects there would be some free and frank exchanges about the nature of evidence, how to get it, how to appraise it, how to use it, and whether it matters in any case. Therein is its charm.

It is not a cookbook, nor is it a paean of praise for EBM. But it is a formidable collection of essays of interest to audiences wider than just anaesthesia. The first part looks at EBM and systematic reviews in a wider context. Neville Goodman's opening chapter is all about caution, and rehearses many of the arguments about EBM. If it does nothing else, it makes you think. Egger & Davey Smith do much the same by putting the potential and limitations of meta-analysis under their 'meta-scope'.

The second part is more about what evidence there is and what to do with it. Pain, nausea and vomiting and more specific topics are examined in detail. The chapter on allogenic blood transfusion borders on the exciting. Cleverly, the whole gamut of systematic reviews relevant to anaesthetists is brought together at the end.

Yes, this is an important resource. Bringing evidence and philosophy together for one discipline makes sense, and works. More please.

JA Senneff. Numb toes and aching soles: coping with peripheral neuropathy. MedPres, San Antonio, Texas. 300 pp. ISBN 0-9671107-2-6 (hardback); ISBN 0-9671107-1-8 (paperback).

John Senneff is a retired lawyer who has peripheral neuropathy. His story, recounted in the preface, is that of difficulty with diagnosis and more difficulty in finding a treatment that helped. The side comments about acupuncture at $75 a pop will ring bells for those used to examining evidence.

But an evidence-based book this isn't. It's written by a patient, for patients, and with a particularly north American bent. European readers will find some of the drug names unfamiliar. Those who want evidence with a capital E will find it hard going at first.

But persevere. The book has enormous scope and is up to date (COX-2 inhibitors are discussed, for instance). Most of the medical treatments likely to be effective are there, together with some interesting and pertinent comments on adverse effects and from patients who use some of many treatments mentioned in the book. There are interesting thoughts from the patient perspective: 'clinical trials, or the lack thereof, do not mean a lot when your feet are hurting and you are getting relief from magnet shoe inserts - or you think you are'.

The paperback costs about $20 (by phone 1-888 633-9898 in the US). It is probably worth that for the chapter on coping alone. Practical tips from others who suffer brought together. No tirade, lots of caution about treatments, conventional and others. It wouldn't do researchers any harm to spend a few minutes with the book either.

previous story in this issue