Where's the evidence? : debates in modern medicine

The essays in Where's the Evidence? focus on problems ignored. This book is a unique collection of critical andw controversial essays on intractable ethical issues and evidence-based problems in modern medicine. Most, but notr therapeutic disasters. Although it is impossible to prevent all missteps in medicine, the author argues, a hedging strategy using concurrent controls when new therapies are introduced always reduces the number of patients killed or injured. It is dangerous to use treatments widely, he warns, before they are subject to rigorous comparative trials. Additionally, the author points out, questions have emerged about how to wield medicine's new capabilities wisely. How do we draw the line,' he asks 'between "knowing" (the acquisition of new medical information) and "doing" (the application of that new knowledge). What are the long- term consequences (moral, social, economic, and biological) of responding to a demand that medicine always do everything that can be done?' This book now issued in paperback is a collection of critical and controversial essays discussing intractable ethical issues and evidence-based problems in modern medicine. The essays together with responses were published over a ten-year period in the journal Paediatric and Perinatal Medicine. Most of the examples, but not all are taken from perinatal medicine, the field in which the author has worked for many years. The essays are thought provoking and will be of great interest to those involved in the ongoing evidence-based medicine debate. (See selected reviews)

• Foreword by David L. Sackett
• Preface
• List of Respondents
• Introduction
• 1. Selective ethics
• 2. Does a difference make a difference
• 3. Prescription for disaster
• 4. Therapeutic mystique
• 5. Humane limits
• 6. Intruding in private tragedies
• 7. The glut of information
• 8. Betting on specified horses
• 9. Begin with 'if...'
• 10. Archie's scepticism
• 11. Arbitrary vs discretionary decisions
• 12. Bioengineering
• 13. '...disavowing the tree'
• 14. Diffusing responsibility Weil's reply
• 15. Hawthorne effects
• 16. Power plays
• 17. Unbridled enthusiasm
• 18. Caring and curing
• 19. On the edge
• 20. Informing and consenting Weil's reply
• 21. Lifesavers
• 22. Belief and disbelief
• 23. Preferences
• 24. Bradford Hill's doubts
• 25. More-informative abstracts
• 26. Pain control in neonates
• 27. Miraculous cures
• 28. Observer bias
• 29. The gamekeeper's brouhaha
• 30. Champing at the bit
• 31. Piecemeal skirmishes
• 32. Resolution of dilemma's Sinclair and Fowlie's reply Watts and Saigal's reply
• 33. 'Fixing' human reproduction
• 34. Justice defined as fairness
• 35. 'Methods-based' reviews
• 36. Non-replication of the replicable
• 37. Who defines 'futility' Goldworth and Benitz's reply
• 38. Fitting targets in holes
• 39. Medical 'manners' on trial
• 40. Sanction of whose beliefs and values?
• 41. Mindness existence
• 42. Interventions on an unprecedented scale
• 43. Preoccupation with 'autonomy'
• 44. A 'win' in medical Russian Roulette Lantos' reply
• Citations
• Bibliography
• Index