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Clinical Preventive Medicine
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Richard N. Matzen and Richard S. Lang; eds. 1263 pages. St. Louis, Missouri: Mosby-Year Book; 1993. $85.00.
Over the past 20 years, much effort has gone into developing evidence-based guidelines for clinical preventive services. The Canadian Task Force on the Periodic Health Examination, established in 1976, uses explicit criteria to grade the level of evidence used in, and the corresponding strength of, recommendations for including specific interventions in periodic preventive health examinations. The U.S. Preventive Services Task Force, established in 1984, uses the same criteria (Guide to Preventive Services, Williams & Wilkins, 1989), and the two task forces have collaborated.
Clinical Preventive Medicine was still being written when the U.S. task force's Guide to Clinical Preventive Services was published. According to the editors, their book expands on some issues raised by the U.S. text, supplements others, and explores many areas that the U.S. book did not address. This is true. However, this book does not follow the trend established by the Canadian and U.S. task forces toward evidence-based recommendations. Throughout the book the authors draw conclusions and give recommendations, but they do not explain the methods used to reach the conclusions or formulate the recommendations. The book is therefore typical of most medical textbooks written by experts; unfortunately, experts often get it wrong. Without knowing what strategies were used to formulate problems; identify relevant evidence; and select, assess, and synthesize that evidence, it is hard to distinguish opinions from facts and to judge the strength of conclusions.
Clinicians often have problems managing scientific information and applying it. Partly because of this, there are important gaps between evidence of the effectiveness of clinical preventive services and what clinicians do. This book is not likely to narrow that gap. Some of the introductory chapters and a few of the later ones may give readers a broad overview of a topic, but for the most part, the little time clinicians have to read would be better spent on texts that have been systematically developed using explicit methods and that are kept up-to-date.
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