Clinical Epidemiology: The Architecture of Clinical Research

obtain yes/no answers at alpha = 0.05, whereas this formulation is almost useless to the policy maker, who is more interested in the amount of improvement that can be expected in different segments ofsociety and the translation of that into demographic and economic terms. Third, the book is revealing to those who imagine that even the best-designed studies really answer the original questions definitively. A controversial suggestion made in one of the discussions is that the investigators in a clinical trial should be prohibited from drawing the policy-related conclusions from their research! Obviously, there are arguments against, as well as for, this position. Immunizations still emerge as the prototype of medically based preventive medicine, with frequently impressive cost-benefit data. Even here, however, these ratios are quite different when a disease is rare than when it is common, so that these relationships tend to change over time, and the ratios are much more favorable for some immunizations than for others. The essays I found most interesting and helpful were those on the economic aspects of prevention by Bengt Jonsson, immunization programs by Jeffrey Koplan, screening programs by T.W. Meade, multiple risk factor intervention programs by Ingvar Hjermann, tobacco-related diseases by Richard Peto, and the role of controlled trials by Goeffrey Rose. Depending on background, others might find some of the other essays more profitable, but all are solid contributions. The book is strongly recommended to anyone interested in the area of preventive medicine, especially in its application to the chronic diseases.