Medicine is moving away from reliance on the proclamations of authorities to the use of numerical methods to estimate the size of effects of its interventions. But a rumbling note of uneasiness underlines present-day medical progress: the more we know, The more questions we encounter about what to do with the hard-won information.
The essays in Where's the Evidence examine the dilemmas that have arisen as the result of medicine's unprecedented increase in technical powers. How do doctors draw the line between "knowing" (the acquisition of new medical information) and doing" (the application of that new knowledge)? What are the long-term consequences of responding to the demand that physicians always do everything that can be done? Is medicine's primary aim to increase the length of life? Or is it to reduce the amount of pain and suffering? And who is empowered to choose when these ends are mutually exclusive? This engaging collection of essays will be of interest to professionals interested in the evidence-based medicine debate, including epidemiologists, neonatologists, those involved in clinical trials and health policy, medical ethicists, medical students, and trainees.
`This is an extraordinary book!...Bill Silverman, brings to bear on contemporary medical issues the logic of science, an abiding concern for the welfare of infants, and a vigorous defense of the rights of their parents. His essays should be savored, dipped into and returned to rather than read consecutively from cover to cover, thought about, argued with, and reread.'
Professor Leon Rosenberg, Department of Social Medicine, Harvard, New England Journal of Medicine (November 1998)
`This book reminds me of Alastair Cooke's classic radio broadcasts "Letter from America". Like Cooke, Bill Silverman has the ability to select a topic that you didn't know you were concerned about, capture your interest with an intriguing introduction, and then hold your attention with an avuncular, reflective, and civilised commentary...A feast of quotations, a sense of humour, and pointed but gentle challenges to conventional wisdom.'
Professor Tony Dixon, Family Medicine Unit, University of Hong Kong, British Medical Journal (December 1998)
`These essays were written over the past decade for the medical audience, but their subject matter and the range of materials Silverman brings to the discussions make them useful, and important reading for a much larger public. As a collection of key issues in the development and application of medical knowledge, the present volume provides a wealth of case studies which could be probed by scholars in fields such as anthropology, sociology, public policy
Suzanne Calpestri, Librarian The George and Mary Foster Anthropology Library, University of California, Berkeley
`As the parent of a child born prematurely who was damaged by modern medicine, I greatly appreciate Dr Silverman's honesty, clarity and anger.. I urge all who work with premature babies to read this book carefully. Most parents of such babies already know what Dr Silverman has discovered.'
Ron Londner Miami, Florida
`This compilation... deserves the widest possible readership within and beyond the medical community. As a pioneer in neonatology and controlled clinical trials, the author brings unparalleled experience to these pieces.'
Robert Schlechter, MD Berkeley, California
`This collection is a tribute to a wise and thoughtful physician of great distinction. We can all benefit from reading these reflections.'
James McCormick, Journal of the Irish College of Physicians and Surgeons
`'...fascinating book...Dr David Sackett, who wrote the foreword said "I stayed up all night reading this book. "I suspect that other readers will too.''
William Feldman, Annals of the Royal College of Physicians and Surgeons of Canada, vol.32, no.1, Feb.1999
`'Where's the evidence? published by Oxford University Press, contains 45 essays which first appeared in Paediatric and Epidemiology, brought up to date with current comments and annotation, some by the author and some by other experts. To open a page and start reading is to be enthralled...Silverman takes up difficult problems. He does not always solve them, but he does offer challenging and sometimes unconvential points of view...Do obtain a copy, dip
into it, and enjoy yourself while you stretch your mind.''
Avrum Katcher, American Academy of Paediatrics Senior Bulletin August 1999.
Foreword by David L. Sackett
List of Respondents
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
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
22: Belief and disbelief
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