Getting Doctors to Listen: Ethics and Outcomes Data in Context Edited by Philip J. Boyle (review)

basic principles of rabbinic interpretation. I knew that Jews may not injure or kill themselves except when faced wiür the alternatives of idolatry, murder or adultery/ incest, but I did not think through the extension of that reasoning to the popular conundrums that typically begin "Two men in the desert have water for only one to survive". In this circumstance (and any others like it), when the knowledge of the problem is first known, the person who has possession of the "lifesaver" keeps it, because you cannot save the life of another if you are dead. On the importance of the physician and public health measures to the survival of the community, the Babylonian Talmud is quoted where it states that, among other things, a Jewish scholar may not live in a city without public baths, toilet facilities, a surgeon, a ritual slaughterer and (an addition from Rabbi Akiba) several kinds of fruit that are beneficial for eyesight. To my surprise, body piercing, tattooing and cosmetic surgery are approved if the intent is to enhance and not harm the self and if no idolatrous religious connection may be made from the action. And in Chapter 1 2 "The Non-Medical Aspects of Medical Care" five classical criteria for triage of scarce resources are offered whose interpretations are as fitting for today's complex social problems as theywere when they were first written. An exhaustive list of topics also includes ethical wills, advance directives, cloning, assisted suicide, genetic counseling and mental health with detailed sources and references listed by page for each chapter. The writing is fluid, learned and compassionate always pointing back to the texts and traditions as they have evolved and are currently being interpreted by contemporary rabbis. This book is distinct from some religious books on life and death ethics in that it names dissenting denominations and/or rabbis and offers the dissenting interpretations respectfully together with what Dr. Dorff believes. What is clear is that, while no single denomination within Judaism can speak for any other on these important issues that arise before conception and go beyond death, there is common ground on many issues, especially those that address the suffering and welfare of others. Anyone who addresses the human condition from within the Jewish tradition will find much to think about in this book. Audrey Gordon University ofIllinois at Chicago Getting Doctors to Listen: Ethics and Outcomes Data in Context. Edited by Philip J. Boyle. Georgetown: Georgetown UP, 1998. Pp. 248. $45. Who could quarrel with the aims of the outcomes researchers? For too long, they argue, medical practice has been grounded on the sandy soil of personal prejudice, local custom, and untested professional dogma. As a result, most health professionals don't know, in a rigorous way, whether their treatments actually do patients any good. The diagnosis: by the best standards ofclinical science, physicians don't really know what works. Medicine is, to put it charitably, visually impaired. This impairment manifests itself in several notable forms. One is the performance of unnecessary or even frankly counterproductive procedures, such as the epidemic of tonsillectomy that afflicted many U.S. children several decades ago. Another is diminished quality of care, which occurs when suboptimal treatments are routinely 148 Book Reviews employed, such as antacids for peptic ulcer disease. Another is increased cost, as when an abdominal abscess is drained via laparotomy instead of percutaneous placement of a drainage catheter. The prescription for these woes: rigorous scientific study of medical outcomes to determine what actually works best. If the improvement of medical practice through outcomes research may be conceptualized as a two-step process, GettingDoctors to Listen grew out of a concern with the second step: not figuring out what works, but getting doctors to put it into practice. The Agency for Health Care Policy and Research funded a two-year study at the Hastings Center to explore the hypothesis of the former Director of the Hastings Center, Daniel Callahan, that the implementation of outcomes data and practice guidelines might be hindered by practicing physicians' moral resistance. The study aimed to identify the sources of that resistance, in hopes that addressing them would improve acceptance of outcomes...