April 18, 1986

The Effectiveness of Medical Care: Validating Clinical Wisdom

Author Affiliations

Rose F. Kennedy Center Albert Einstein College of Medicine Bronx, NY


by Barbara Starfield et al (Johns Hopkins Series in Contemporary Medicine and Public Health, Samuel H. Boyer IV et al, eds), 168 pp, $27.50, Baltimore, Johns Hopkins University Press, 1985.

JAMA. 1986;255(15):2087. doi:10.1001/jama.1986.03370150129047

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This is a succinct, well-written collection of critical reviews of the effectiveness of medical care in the management of 16 common pediatric health problems. The authors stress the importance of documenting the evidence of medical care benefits, a task that is particularly critical in our current era of health care rationing, since lack of such data may be used to justify the further withdrawal of beneficial services.

The book does not aim to be comprehensive, although the conditions described here are fairly representative of the major issues in child health in the United States today. The chapters are organized into three sections, depending on the point at which medical care is perceived to be most effective: (1) decrease in incidence (eg, neonatal mortality), (2) early detection in the premorbid stage (eg, lead poisoning), and (3) reduction in complications of sequelae (eg, bacterial meningitis).

Most of the chapters are thorough reviews