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Peter C. Gøtzsche
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Henrik R. Wulff
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Rational Diagnosis and Treatment: Evidence-Based Clinical Decision-Making 4th Edition

by Peter C. Gotzsche (Author)
4.7 4.7 out of 5 stars 5 ratings
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Now in its fourth edition, Rational Diagnosis and Treatment: Evidence-Based Clinical Decision-Making is a unique book to look at evidence-based medicine and the difficulty of applying evidence from group studies to individual patients.

The book analyses the successive stages of the decision process and deals with topics such as the examination of the patient, the reliability of clinical data, the logic of diagnosis, the fallacies of uncontrolled therapeutic experience and the need for randomised clinical trials and meta-analyses. It is the main theme of the book that, whenever possible, clinical decisions must be based on the evidence from clinical research, but the authors also explain the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient.

For this new edition, the sections on placebo and meta-analysis and on alternative medicine have been thoroughly updated, and there is more focus on insufficient reporting of harms of interventions. The sections on different research designs describe advantages and limitations, and the increased medicalisation and the effects of cancer screening on health people are noted. A section on academic freedom when clinicians collaborate with industry and ghost authors is added.

This essential reference work integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice; distinguishing between data, sets of data, knowledge and wisdom, and their application. Such an intellectually challenging book is ideal for both medical students and doctors who require theoretical and practical clinical skills to help ensure that they apply theory in practice.

Previous page
  1. ISBN-10
    0470515031
  2. ISBN-13
    978-0470515037
  3. Edition
    4th
  4. Publisher
    Wiley-Interscience
  5. Publication date
    January 1, 2008
  6. Language
    English
  7. Dimensions
    6.25 x 0.75 x 9.25 inches
  8. Print length
    229 pages
  9. See all details
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Editorial Reviews

Review

"An extremely interesting and intellectually stimulating book ... .I would recommend this book, particularly to medical students and junior doctors." (Evidence Based Medicine, December 2008)

From the Inside Flap

This fourth edition of Peter Gotzsche’s ‘Rational Diagnosis and Treatment’ argues that clinical decision-making should be built from first principles. By asking relevant questions, such as ‘how reliable are various sorts of data?’,  ‘how has the disease classification evolved over time, and is it logical?’, fewer mistakes will be made by the practising physician and trainee. 

This beautifully written book integrates the science and statistical approach of evidence-based medicine with the art and humanism of medical practice.  It stresses that, whenever possible, clinical decisions must be based on the best evidence from clinical research; but also highlights the pitfalls of such research and the problems involved in applying evidence from groups of patients to the individual patient.

Such an intellectually challenging book is ideal for medical students, practitioners and doctors who require theoretical and practical clinical skills to help ensure that they apply theory to their practice, to achieve the best possible outcomes.

  • How does the diagnostic process narrow down options, and what are the pitfalls in diagnostic reasoning?
  • How do randomness, the spontaneous course of the disease, the placebo effect, luck and clinical trials come together?
  • What is the nature of reasoning?
  • What is the true value of the published literature?
  • How do commercial interests distort our perceptions about drugs?
  • Should people get screened for cancer and other diseases?

New edition contains:

  • Updated sections on placebo and meta-analysis
  • Sections on different research designs, focusing on advantages and limitations
  • Notes on increased medicalisation and the effects of cancer screening on healthy people
  • Updated section on alternative medicine
  • Greater focus on insufficient reporting of harms of interventions
  • Additional text on academic freedom.

Product details

  • Publisher ‏ : ‎ Wiley-Interscience; 4th edition (January 1, 2008)
  • Language ‏ : ‎ English
  • Hardcover ‏ : ‎ 229 pages
  • ISBN-10 ‏ : ‎ 0470515031
  • ISBN-13 ‏ : ‎ 978-0470515037
  • Item Weight ‏ : ‎ 1.06 pounds
  • Dimensions ‏ : ‎ 6.25 x 0.75 x 9.25 inches
  • Customer Reviews:
    4.7 4.7 out of 5 stars 5 ratings

About the authors

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  1. Peter C. Gøtzsche

    Peter C. Gøtzsche
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    Peter C. Gøtzsche, DrMedSci, MD, MSc

    Professor Peter C Gøtzsche graduated as a Master of Science in biology and chemistry in 1974 and as a physician 1984. He is a specialist in internal medicine; worked with clinical trials and regulatory affairs in the drug industry 1975-1983, and at hospitals in Copenhagen 1984-95. Co-founded the Cochrane Collaboration (the founder is Sir Iain Chalmers), and established the Nordic Cochrane Centre in 1993. Became professor of Clinical Research Design and Analysis in 2010 at the University of Copenhagen and has been a member of the Cochrane Governing Board twice. Co-founded Council for Evidence-based Psychiatry in the UK in 2014 and International Institute for Psychiatric Drug Withdrawal in Sweden in 2016. Founded the Institute for Scientific Freedom in 2019. Currently works as researcher, lecturer, author and independent consultant, e.g. in lawsuits. Visiting professor, University of Newcastle.

    Peter’s greatest contribution to public health was when he, in 2010, opened the archives of clinical study reports in the European Medicines Agency after a 3-year long battle that involved a complaint to the European Ombudsman. EMA was solely concerned with protecting the drug industry’s interests while ignoring those of the patients. The Ombudsman ruled there was no commercially confident information in the study reports.

    Peter has published more than 75 papers in "the big five" (BMJ, Lancet, JAMA, Annals of Internal Medicine and New England Journal of Medicine) and his scientific works have been cited about 50,000 times (his H-index is 70 according to Web of Science, April 2019, which means that 70 papers have been cited at least 70 times). Peter is author of several books. The most recent ones are:

    • Mental health survival kit and withdrawal from psychiatric drugs (2020, will appear in other languages).

    • Vaccines: truth, lies and controversy (2020, will appear in at least 7 languages).

    • Survival in an overmedicated world: Find the evidence yourself (2019) (will appear in 7 languages).

    • Death of a whistleblower and Cochrane’s moral collapse (2019).

    • Deadly psychiatry and organised denial (2015) (in 9 languages).

    • Deadly medicines and organised crime: How big pharma has corrupted health care (2013) (Winner, British Medical Association’s Annual Book Award, Basis of Medicine in 2014; in 16 languages).

    • Mammography screening: truth, lies and controversy (2012) (Winner of the Prescrire Prize 2012).

    • Rational diagnosis and treatment: evidence-based clinical decision-making (2007).

    Peter has given numerous interviews. One, about organised crime in the drug industry, has been seen about 350,000 times on YouTube: https://www.youtube.com/watch?v=dozpAshvtsA. Peter was in The Daily Show in New York on 16 Sept 2014 where he played the role of Deep Throat revealing secrets about big pharma. A documentary film about Peter’s reform work in psychiatry, Diagnosing Psychiatry, appeared in 2017.

    Peter has an interest in statistics and research methodology. He has co-authored CONSORT for randomised trials (www.consort-statement.org), STROBE for observational studies (www.strobe-statement.org), PRISMA for systematic reviews and meta-analyses (www.prisma-statement.org), and SPIRIT for trial protocols (www.spirit-statement.org). Peter was an editor in the Cochrane Methodology Review Group 1997-2014.

    Peter is Protector for the Hearing Voices Network in Denmark.

    Peter’s websites: scientificfreedom.dk and deadlymedicines.dk.

    Twitter: @PGtzsche1

    Email: pcg@scientificfreedom.dk

    See more on the author's page
  2. Henrik R. Wulff

    Henrik R. Wulff
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    Discover more of the author’s books, see similar authors, read author blogs and more

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Customer reviews

4.7 out of 5 stars
4.7 out of 5
5 global ratings

Top review from the United States

Eric J. Cassell
5.0 out of 5 stars About decision-making. Written years ago but still clear and ...
Reviewed in the United States on May 31, 2015
Verified Purchase
About decision-making. Written years ago but still clear and understandable. Wise man and wisdom more important than technical stuff you can read anywhere.
2 people found this helpful
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Top reviews from other countries

Hugh van der Mandele
5.0 out of 5 stars A brilliant introduction to systematic thinking
Reviewed in the United Kingdom on April 28, 2016
Verified Purchase
Though the subject is medical, this book is of great interest to anyone (including me, an economist) interested in scientific methodology and philosophy. Amazingly well written and researched.
2 people found this helpful
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