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Book reviews

Evidence-based Pharmacy. Phil Wiffen. Radcliffe Medical Press, Abingdon, 2001. 182pp £19.95 ISBN 1-85775-384-4

When it comes to what an 'evidence-based' approach means to any particular professional group, general texts can sometimes be less than wholly helpful because authors write from their particular point of view. That may not always coincide with the interests of another profession. Examples may be unhelpful or unfamiliar, and concepts cast into moulds that are alien to us.

What is needed is for an author who is 'one of us' to get their brains around evidence based approaches, and to rehearse them in ways that are familiar and relevant. Phil Wiffen has done this for pharmacists. As well as being involved with NHS pharmacy practice in the UK, he is also intimately involved with the Cochrane Collaboration.

That's why his book works. Much of what it contains will be familiar to those of us trying to be evidence-based. For newcomers, the way he tells the story will be a revelation. As well as the standard stuff well told, there's oodles of things a pharmacist might want to know, whether it's pharmacy journals, personal bibliographic software, essential drugs or web addresses, it's all there.

Someone who has been there, done that, and got the T-shirt takes us by the hand and keeps us safe in the jungle. It not only makes us feel and be better, but keeps us from making ludicrous mistakes because of ignorance. Given the increasing importance of pharmacists in helping decide prescribing policy, the book comes none too soon.


Risk matters in healthcare. Communicating, explaining and managing risk. Kay Mohanna & Ruth Chambers. Radcliffe Medical Press, Abingdon, 2001. 114pp ISBN 1-85775-456-5

'If anyone ever asked me for the number-needed-to-treat that would be a real indication to refer them to outpatients'. That comment is from a GP discussing risk and how to communicate them, one part of an interesting book examining risks and communication and planning in a sensible and accessible way.

We all take risks. If you drive, you have about a 1 in 20,000 chance of dying in any given year, and that is a risk most of us presumably accept. The risk of dying in a train crash is about 1 in 200,000, but it gets headlines. Bandolier always enjoyed the health and safety talk that began with the declaration: it's the employer's responsibility to keep employees safe at work so they can go hang-gliding at the weekend.

The trouble is that risks look different, feel different, and probably are different from different perspectives. To risk is the most irregular of irregular verbs. There will probably never be any absolutely absolute and comprehensive way of describing it, but from where we are now this book makes a super stab at it.

It takes us through risks and communication, through changing the culture and managing risks in primary care. It's about how we develop our personal and organisational attitudes. Difficult, though, this, because what we are doing is to stop things that happen rarely from happening at all, and it's awfully difficult to measure that. The intellectual and organisational challenge is to understand in the first place what risk and risk management is all about.

The book may be worth having for a few pages at the end with lists of risk estimates for various medical procedures and conditions. Makes you think!
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