Wednesday, May 30, 2012

Book Review: Between the Lines

Every year for the past several years, I have served as a faculty group leader for a course in "Evidence-Based Medicine" taught to first and second-year medical students. The course aims to provide students with basic tools to navigate the medical literature that we hope they will retain during their training and use to answer clinical questions long after they enter practice. Unfortunately, the course is a low priority for students in their preclinical years, and many of the epidemiology and statistics concepts we teach are far more advanced than what they will need to know as physicians.
It was a pleasure, then, to read Dr. Marya Zilberberg's Between the Lines: Finding the Truth in Medical Literature, a rare book that bridges the gulf between medical publications and the real world of practicing clinicians. Zilberberg, a physician and noted health services researcher who blogs at Healthcare, etc., distills her expertise from two decades of teaching evidence-based medicine into a concise text that is accessible not only to medical students and other health professionals, but to journalists and educated laypersons who want to look past the latest sensational headlines to uncover what we actually know about sickness and health. The book's conversational tone makes the reader feel as if Zilberberg herself is in the room giving a one-on-one tutoring session.

The book is divided into two parts: "Context" and "Evaluation." The first part was my favorite, containing a collection of short essays with provocative titles such as "Beware of What Seems Too Good to Be True" and "Assume a Spherical Cow." Here Zilberberg exposes the faulty reasoning behind certain health care beliefs shared by much of the general public and a good number of clinicians, as well. For example, a screening test that is touted as being highly sensitive for the condition it detects still may not be worth undergoing, depending on how common (or uncommon) the disease is and how many false positive results it generates.

The second part follows a more standard format for a book on the medical literature, moving logically through a traditional hierarchy of study designs and threats to the interpretation of study results. Zilberberg's writing is clear and straightfoward, and key points are helpfully highlighted in accompanying figures and tables. I recommend this book highly to all students of evidence-based medicine, regardless of occupation or professional degree.