Spectacular treatment disasters in recent years have made it clear that informal "let's-try-it-and-see" methods of testing new proposals are more risky now than ever before, and have led many to call for a halt to experimentation in clinical medicine. In this easy-tp-read, philosophical guide to human experimentation, William Silverman pleads for wider use of randomized clinical trials, citing many examples that show how careful trials can overturn preconceived or ill-conceived notions of a therapy's effectiveness and lead to a clearer understanding (...) of clinical anomalies. Because it gives careful guidance on setting up trials and avoiding conceptual pitfalls, this book will be of great interest to all epidemiologists and clinical statisticians, and to a wide varitey of clinicians, pharmacologists, and nurses. Since it requires no medical or statistical knowledge, it will also appeal to ethicists, lawyers, and the general public. (shrink)

Neonatal pediatrics has made stunning and completely unprecedented progress in recent years. Nonetheless, an increasing number of voices now ask, Where is this field of medicine going? Is it, dare one ask, even headed in the right direction? These are reasonable questions, but first we need to know where this subspecialty of pediatrics has been. The current phenomenon is all the more remarkable because it differs so completely from the past.

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. (shrink)