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 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....The essays are pithy, scholarly, lucid, iconoclastic, and suffused with the author's humanity and humor."--Rob Schechter, Amazon

"[Silverman] encourages us to respond by questioning the evidence that informs our decisions, by distinguishing between the values we need when acquiring knowledge and those we need when applying it, and by recognizing that all medical previleges are granted to us by our patients. This book...offers succour to those of us who fear that most of the world's troubles are caused by people who have the courage of their convictions and yearn to hear from those like Silverman who have the courage of their doubts."--British Journal of General Practice

"This is an extraordinary book....[these] essays should be savored, dipped into and returned to rather than read consecutively from cover to cover, thought about, argued with, and reread."--The New England Journal of Medicine

"We can only be grateful that the distilled wisdom of a great man is at least in part encapsulated within 200 pages of highly readable prose....a unique collation of topics that are always thought provoking,usually challenging and sometimes downright aggravating."--Paediatric and Perinatal Epidemiology

"Where's the evidence? is a collection of 45 short, thoughtful and challenging essays in which Silverman continues to hold up a mirror to medical practitioners."--Journal of the Royal College of Physicians of London

Foreword by David L. Sackett

Preface

List of Respondents

Introduction

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

12. Bioengineering

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

21. Lifesavers

22. Belief and disbelief

23. Preferences

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

Citations

Bibliography

Index