Neurology for the 21st century? | |
Analytic neurology. Examining the evidence for clinical practice. Michael Benatar. Amsterdam: Butterworth Heinemann, 2003 (xvi + 328 pp). ISBN 0 7506 7440 7. |
The analysis of neurological
practice 20 years ago relied on individual experience and the study of experts. Computerised databases offered aids to clinical decision-making, but at that time the majority of diagnoses belonged in the “because I say so” category. The assumption was that the expert should expect to get it right, and be trusted to do so. The title of this book thus promised new vistas of understanding for the clinician of the 21st century.
The focus of the book is on therapeutics, and its shortcomings reflect issues surrounding the use of evidence-based medicine. There is no discussion of how to use sets of probabilistic data. Unless clinicians understand the basic principles of clinical decision-making, where patients’ values need to be combined with options of various probabilistic outcomes, the value of the data is significantly limited. While these concepts are intuitively used by experienced clinicians, they are not generally recognised by funding bodies. These bodies routinely criticise clinicians for not relying on what is conceived of as evidence. It is a pity that the book does not contain a discussion of the principles of literature appraisal. Given that some of the information is inevitably outdated by the time it reaches print, such a discussion would help the reader to update the readings from this volume and make the volume more useful. Analytic neurology will be helpful to the novice — practising neurologists are expected to keep up to date through journals and the Internet. To live up to its promise as an analytic view consistent with practice in the new millennium, this kind of book will need to go beyond describing the evidence for therapeutic options and provide a conceptual framework for the use of this evidence in clinical practice. John I Balla
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