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A Guide to Treatments That Work Edited by Peter E. Nathan and Jack M. Gorman. Oxford: Oxford University Press. 1998. 624 pp. £55.00 (hb). ISBN 0-19-510227-4

Published online by Cambridge University Press:  02 January 2018

John Geddes*
Affiliation:
University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
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Abstract

Type
Columns
Copyright
Copyright © 2000 The Royal College of Psychiatrists 

The aim of this book is succinctly stated by the title. It consists of a series of reviews of pharmacological and psychosocial treatments of a wide range of mental disorders. As it marks an acceptance that the treatment of mental health problems should be based on the best available research evidence, this book may become a landmark in the development of evidence-based mental health care. The reviews summarise the available evidence for specific interventions, with evidence from randomised-controlled trials considered to be the most reliable way for establishing the efficacy of all treatment (including psychological treatments).

The importance of this book is probably more as an indication that a paradigm has shifted and less as a reliable collection of reviews of the effectiveness of mental health care interventions. Methodologically, it is quite limited. Many of the reviews are written by clinical experts, but it is difficult to tell how systematic they are. Although the treatment recommendations are classified according to their level of evidence, few of the reviews include a description of the search strategies that were undertaken to identify the primary studies. The reviews tend to be narrative and there are no attempts to quantitatively review or metaanalyse individual study results when appropriate. A further problem is that although these reviews may have been reasonably recent at the time the book went to press, they are already out of date. This applies particularly to the chapters on drug treatment for Alzheimer's disease and schizophrenia, areas where there have been considerable advances of the past couple of years. Clinicians requiring up-to-date information must look elsewhere, for example in the Cochrane Library or Evidence-Based Mental Health. But in some ways, although clearly relevant to the clinician, these are minor quibbles. The importance and interest of this book are in the wealth of clinical expertise contained within its pages and in the fascinating political processes surrounding its production that are reflected in Seligman's extraordinary Foreword and Afterword. These attempt to forestall the misuse of the reviews by managed care organisations whose first goal is to cut costs. Clinicians attempting to implement evidence-based practice will be familiar with these dangers, though will appreciate that they should not invalidate attempts to provide the most effective care for their patients.

References

EDITED BY SIDNEY CROWN and ALAN LEE

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