Evidence-Based Medicine and the Search for a Science of Clinical Care

Daly J. 290 pages. Berkeley, CA: Univ California Pr; 2005. $65.00. ISBN 0520243161. Order at www.ucpress.edu. Field of medicine: Evidence-based medicine and clinical epidemiology. Format: Hardcover book. Audience: Teachers, students, and evidence-based medicine practitioners. Purpose: To provide a comprehensive history of the origins and development of evidence-based medicine and its permeation into clinical practice. Content: The author details the emergence of evidence-based medicine as a scientific method for clinical decision making and traces the intellectual contributions of its leaders. She articulates the rationale for evidence-based medicine but also challenges its tenets by enumerating the history and work of its many detractors. The author discusses the ascendance of the randomized, controlled trial and the elevation of meta-analyses as the preeminent science of clinical care, along with the limitations of applying clinical trial data to complex patient care decisions. The book challenges evidence-based medicine's focus, direction, and reach in clinical care, patient participation, research, medical economics, and public policy. Highlights: The author's interviews with the central figures of evidence-based medicine provide an intimate view of its development and insights into the creativity and vision of its leaders. The author provides an insightful critique of the discipline, including an analysis of personal relevance, her exploration of the dissemination of evidence-based medicine in her home country of South Africa. She describes a medical education system reliant on authority as the construct for teaching clinical decision making and a culture in which politics subvert evidence, highlighting the global challenges facing evidence-based medicine's proponents and public policymakers. For practicing physicians, the book provides a balanced perspective of evidence-based medicine's role in patient care. Far from confirming a new paradigm for medical decision making, the author acknowledges the strengths and achievements of evidence-based medicine but sets an agenda for the continuing refinement and search for the science of clinical care. Limitations: Some of the individual histories are quite long and, in some instances, are repeated in other chapters. Related readings: Goodman's Ethics and Evidence-Based Medicine: Fallibility and Responsibility in Clinical Science (Cambridge Univ Pr, 2003) also reviews the history of evidence-based medicine and its related ethical dilemmas. Evidence-Based Practice: A Critical Approach (Blackwell Science, 2000), edited by Trinder with Reynolds, critically reviews evidence-based practice with consideration of alternative approaches. Reviewer: John M. Byrne, DO, Loma Linda University, School of Medicine, VA Loma Linda Healthcare System (14A), 11201 Benton Street, Loma Linda, California.