Systematic Reviews in Health Care: A Practical Guide. (Book Reviews).

Authors: P. Glasziou, L. Irwig, C. Bain, and G. Colditz

Publisher: Cambridge University Press, 2001

The practice of medicine is rapidly shifting from an art to a science. Evidence-based medicine is rapidly gaining ground. But how strong is the evidence? Does the evidence presented apply to a particular clinician's patient population? Can the clinician reasonably extrapolate the findings of a study to the patient in the office? Clinicians have to face these vexing questions every day. They receive a large number of publications and review articles (many unsolicited), and they often see several pharmaceutical company representatives every day. Each encounter can last only a few minutes. During that time representatives try to present evidence that the medication promoted is better than the competition. Clinicians listen halfheartedly, are often distracted, and just glance at the glossy brochures presented. This fleeting furtive glance, however, is often sufficient for a well-conceived and eye-catching chart or diagram to be imprinted in the clinician's mind and to influence prescribing habits.

Over the past few years there has been a proliferation of clinical studies. An entirely new vocabulary has emerged: retrospective studies, observational studies, case-control studies, prospective randomized clinical trials, and meta-analyses are but a few examples. The sheer volume of medical journals (over 22,000), the need for physicians employed by academic institutions to publish, and the ease with which one's mind can be swayed when presented with "statistically significant results" make clinicians particularly vulnerable to information overload and at times misinformation. Clinicians are so busy with their clinical work that they have neither the time nor the inclination to thoroughly appraise studies they come across. Besides, they often do not understand the statistical jargon used and cannot appreciate all the nuances of the statistical analysis. So many clinicians rely on review articles, the opinion of "specialists," and the pharmaceutical industry to provide them with the "bottom line" findings of studies. Unfortunately, for a number of reasons, this information is not always objectively presented.

Clinicians should be able to independently analyze and appraise various studies they come across and place them in the larger context of their own knowledge base and personal experience. In approximately 100 pages, Glasziou and colleagues provide the means of achieving this difficult task. The contents of the book accurately reflect the title, Systematic Reviews in Health Care: A Practical Guide. The book is very well written and extremely easy to read. It is a true practical guide through the maze of clinical studies. Complex issues are presented in a clear, concise, logical, and easy-to-follow manner. The book is well divided, and the customer-friendly layout and presentation make it very easy to find the needed section or paragraph long after the book has been read. I believe this book should be essential reading for all practicing clinicians and should be prominently displayed in every medical library.