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Clinical Evidence, Issue 1.
  1. Thomas Whitehead
  1. Specialist Registrar, Thoracic Medicine, Central Middlesex Hospital, London NW 10 7NS, UK

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    In today's climate of practising evidence-based medicine (EBM), a concise guide to the best available evidence for effective health care is welcome. With dimensions nearly identical to the British National Formulary, Clinical Evidence would fit into the pocket of a white coat or onto the consulting room desk. It claims to provide a more “friendly” access to EBM than other sources such as the Cochrane Library or EBM journals, and is targeted at practising clinicians. With dense text and very few figures or tables, this is a book for reference rather than prolonged reading. However, it is well formatted and indexed, making it quick to find information on a particular subject. Each section begins with a useful summary of the condition addressed and of the key messages relevant to EBM. Specific conditions are dealt with in the context of questions, such as “Is tonsillectomy effective in severe tonsillitis in children and adults?” rather than systematic reviews, making the information more accessible.

    Cardiovascular disease receives considerable attention, appropriate to the potential impact of EBM in this field. I found this section particularly useful, addressing areas such as treatment of hypercholesterolaemia in different patient groups and the evidence for the choice of antihypertensive agent. Such information, easily accessible during a clinic or on a ward round, will allow a more rational approach to treatment for busy clinicians, particularly in areas outside their specialist field.

    The scope of the book is perhaps over-ambitious, covering fields of medicine as diverse as impacted wisdom teeth and constipation in childhood to secondary prevention of stroke. As such, it may appeal more to general practitioners than to hospital doctors for whom only a small proportion of the book will be relevant.

    It is inevitable that such a compact volume omits many subjects. For instance, the section on neurological disorders deals with epilepsy but not the controversial area of treatment for multiple sclerosis. The compendium does not claim to be comprehensive, however; it is the first of a mammoth ongoing task to be updated and expanded every six months. The challenge will be to do this without increasing the size of the text, and this could be achieved by reducing the attention given to individual trials and reviews. These frequent updates will allow Clinical Evidence to overcome the greatest enemy of a printed text dealing with EBM—obsolescence.


    • Edited by Fiona Godlee. (Pp 598, illustrated; £45.00). London: BMJ Publishing Group, 1999. ISBN 0 7279 1364 6.