Field of medicine: General medicine, health care policy, and ethics.

Format: Softcover book.

Audience: Health care providers, administrators, policymakers, ethicists, and analysts.

Purpose: To describe and advocate a health care policy that applies cost-effectiveness analysis to the everyday practice of medicine. The framework is meant to guide both individual clinical decision making and the allocation of societal resources.

Content: Using a series of essays originally published in The Journal of the American Medical Association, Eddy lays out the challenge of clinical decision making in an era of limited resources. Within the context of today's turbulent medical marketplace, Eddy combines theoretical discussions of physician behavior, patient preferences, practice guidelines, and rationing with concrete examples of these concepts, such as screening for colorectal cancer and the Oregon Medicaid Plan. Concepts are further clarified by Eddy's hypothetical discussions with his father, a skeptic of Eddy's theory of cost-effectiveness analysis.

Highlights: This book is a thoughtful, lucid articulation of the utilitarian, evidence-based approach to clinical decision making and resource allocation. Eddy shows great understanding of the challenges facing clinicians who are committed to providing quality care, but he logically and relentlessly emphasizes maximizing the health of the public in an era of limited resources. He succeeds in combining elements of clinical medicine, decision analysis, economics, statistics, and professional ethics into a readable, coherent argument.

Limitations: Because each essay originally stood alone, the book is repetitious at times.

Context: This is an insightful introduction to the application of cost-effectiveness analysis to clinical decision making at both the individual and societal levels. It should become a classic in the field.

Reviewer: Marshall H. Chin, MD, MPH, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

Commentary: A reader exploring the formation of clinical health care policy should supplement this book with articles that discuss nonutilitarian theories of distributive justice and political and organizational barriers to change.