See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/246064291

Aging with Grace: What the Nun Study Teaches Us About Leading Longer,
Healthier and More Meaningful Lives.: David Snowdon. New York: Bantam
Press, 2001, pp. 256, $24.95 (HB) ISBN:...

Article  in  International Journal of Epidemiology · August 2002

DOI: 10.1093/ije/31.4.879

CITATIONS READS

2 2,857

1 author:

Carol Brayne
University of Cambridge
1,106 PUBLICATIONS   107,539 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

European Prevention of Alzheimer's Dementia (EPAD) Ethical, Legal and Social Implications View project

Stroke Riskometer View project

All content following this page was uploaded by Carol Brayne on 12 October 2016.

The user has requested enhancement of the downloaded file.

© International Epidemiological Association 2002 Printed in Great Britain International Journal of Epidemiology 2002;31:877–881

Book Reviews

Diseases of Globalization, Socioeconomic Transitions and than suggested. The focus is largely on changing trends in NCD
Health. McMurray C, Smith R. London: Earthscan, 2001, although some mention of infectious disease is made. Overall,
pp. 200, £45.00 (HB) ISBN: 1-85383-710-5; £16.95 (PB) ISBN: while changing trends in health and disease are reported for the
1-85383-711-3. three countries, these are not convincingly proven as the result
of globalization.
The impacts of globalization on human health are diverse Despite analytical fuzziness, there are important messages
and multi-faceted, and empirical evidence that sheds light on that arise from the book. First, the task of sorting out the com-
these complex linkages is highly welcome. This book seeks to plex linkages between globalization and health will be a tough
fill part of the existing knowledge gap by presenting the results analytical challenge. Multiple forces and determinants are at
of research on the health effects of global changes on three play and will require rigorous conceptualization and empirical
‘societies in transition‘: Mongolia, the Marshall Islands and evidence to demonstrate their relationships. Second, the need
Uzbekistan. The authors argue that the three case studies to link micro and macro level analysis will be central to this
illustrate the manner in which political change and economic task. The attempt in this book to bring the analysis down to the
modernization have impacted on health and well-being, as well societal and even individual level is an important contribution.
as demonstrating broader trends reflected throughout the world. Third, the importance of using qualitative and quantitative data
The first three chapters of the book set out some key issues is illustrated. The authors make use, in particular, of focus
that form the backdrop of the book—the dual forces of expansion groups, interviews and other methods to assess how global
and marginalization, shifting boundaries and changing values, changes are influencing social and cultural contexts within which
the demographic and health transition, and the epidemiological healthy lifestyles are achieved or not. Given these contribu-
transition from infectious to non-communicable disease tions, the aim of the book is clearly laudable—to lend greater
burdens (NCD). It goes on to explore different approaches to empirical evidence to the health impacts of globalization.
development as historical and ideological precedents for current
globalization processes. This is followed by an introductory
overview of the determinants of health, distinguishing between
Reference
1 For a discussion of the distinct definitions of these terms see Scholte
genetic, external and sociological factors. All three chapters are
JA. Globalization: A Critical Introduction. London: Macmillan, 2000.
brief and introductory. Bettcher D, Lee K. Glossary on globalisation and public health.
The main challenge of determining cause and effect among J Epidemiol Community Health 2002;56:8–17.
these issues, approaches and determinants of health form the
bulk of the remainder of the book. And it is here that the book’s KELLEY LEE
failure to set out sufficiently clear definitions and framework
for analysis becomes apparent. For example, the book begins
with the statement that ‘modernization is leading to changing Economic Evaluation in Health Care: Merging theory
patterns of health’. This is indeed historically true but a con- with practise. M Drummond, A McGuire (eds). New York:
flation of globalization with modernization is neither helpful Oxford University Press, 2001, pp. 286, £26.50 (PB). ISBN:
nor accurate. Neither is the underdeveloped definition of 0-19-263176-4; £ 52.50 (HB) ISBN: 0-19-163177-2.
globalization offered: ‘various processes that undermine local
autonomy, such as international flows of capital and investments, This book updates and complements the highly successful
and the promotion of Western values and lifestyles through Methods for Economic Evalutions1 that myriads of health
global media transmissions. States and individuals have become economists affectionately refer to as ‘the blue book’. This book
interconnected under the general rubric of “globalization”’ (p. 1). has become a standard textbook of economic evaluation and
While this definition touches on some elements of globalization, has proved to be an invaluable tool for everybody working in
as identified by other authors, it fails to be distinct from such the field because of its outstanding methodological clarity and
terms as liberalization and westernization.1 This simply causes didactic qualities. The original work was a landmark publication
confusion and, importantly, analytical imprecision. Indeed, the and set high standards for any future volume.
essential characteristic of globalization, as forces that circumvent After reading this new (red covered) book, I predict that
and even ignore territorial space, is not described. Curiously, people will mention it in the same breath. It is carefully written
while most definitions of globalization point to the erosion of by internationally acclaimed experts and summarizes recent
national borders and the emergence of new patterns of health theoretical and methodological advances of economic evalu-
that cut across state boundaries, the authors choose to under- ation. It also illustrates the rapid scientific development as well
take three country case studies. The book title is also slightly as the sub-specialization into single distinctive disciplines within
misleading as the subject of the book is more narrowly focussed the field. Rather than being an introductory textbook, this edition

877
878 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

is aimed at an advanced level; readers with prior knowledge of The Epidemiology of Diabetes Mellitus: An International
the subject will appreciate the profound discussions of all- Perspective. J-M Ekoé, P Zimmet, R Williams (eds). Chichester:
important aspects of economic evaluation in health care. John Wiley, 2001, pp. 437, £120. ISBN: 0-471-97448-X.
The book is divided into 11 chapters, building a bridge, as the
subtitle of this book suggests, from more theoretical discussions Once considered primarily as a risk factor for heart disease,
to relevant practical aspects of economic evaluations. Clearly, the diabetes has now become a high profile public health concern
first three chapters of this edition fall into the first category. in its own right, due to the escalating epidemic of diabetes in
The authors discuss the theoretical underpinnings of these older people, and the emergence of type 2 diabetes in children.
techniques that lie within welfare economics and the suggested The number of people with diabetes worldwide is set to
alternative ‘extra-welfarisms’. In addition, chapters 2 and 3 double in the next 20 years, as a result of increasing obesity
illustrate the far-reaching implications on outcome measure- and longevity. While some of this increase will be observed in
ment and valuation depending upon which viewpoint an Europe and North America, it is clear that the bulk of the
analyst is willing to adopt while carrying out a policy analysis. epidemic will be observed in non-European origin populations, in
Subsequent chapters deal with costing in economic evaluation countries undergoing rapid westernization. If anything, the
(chapter 4), take into account the increasing number of European origin populations are the anomaly, being substantially
economic evaluations conducted alongside clinical trials protected from type 2 diabetes compared to other world popu-
(chapter 6) and explain the progress being made on dealing lations. This is reflected in our current understanding of the
with uncertainty in economic evaluations (chapter 8). The epidemiology of diabetes, derived mainly from the study of non-
ongoing controversy about productivity costs (or indirect costs) European populations, such as the Pima Indians and Naruans.
is scrutinized and summarized in chapter 5. But it is clear that diabetes risks, manifestations, natural history
Issues on modelling in economic evaluations are superbly and even the criteria for the definition of diabetes itself, may
dealt with in chapter 7 and it is one of the best condensed vary considerably by population.
resources on this topic I have found in the literature to date. These considerations are being addressed by epidemiological
Remaining chapters are devoted to statistical issues in the studies of diabetes and its complications in several different
analysis of health care resource utilization and costs data populations, but despite the greater burden of diabetes in non-
(chapter 9), discounting (chapter 10) and transferability of European populations, the majority of participants in trials of
economic evaluation results to other settings (chapter 11). pharmacological agents are of European origin: little attempt
I would have liked to see a chapter about the actual use of is made to consider whether intervention efficacy, and thresholds
economic evaluations to inform resource allocation decisions. for treatment can, and should, be identical in all patient groups.
Issues that might be addressed in such a chapter could include: The Epidemiology of Diabetes Mellitus: An International Perspective
‘Have the results of economic evaluations made a difference in is a long overdue, and welcome response to these population
practice, and how?’ and ‘Why are decision makers still reluctant differences. Epidemiological study has made a major contribution
to use these techniques?’ or ‘In which way do they incorporate to our understanding of diabetes and its complications.
economic concerns into their decisions?’ Undoubtedly, decision Observations of international variations, and in particular
making in health care is a multidisciplinary affair that must migrant studies, have for decades furthered our knowledge of the
incorporate many different values and perspectives from patients, aetiology of diabetes. Recent epidemiological developments, such
health professionals, health policy makers, the general public as the changing definition of diabetes, and also the ultimate
etc. Economic evaluation can make this more transparent and promise of interventions which can now reduce the risk of
provide a normative view as to how these decisions should be diabetes itself, are all intelligently and comprehensively dealt
made. There is scope for further research to identify possible with here.
barriers for the application of economic evaluation results and However, despite the emphasis on the international aspects of
the best format to present these to relevant decision makers. disease, the population groupings are handled in a curious
As long as methodological issues such as how to measure and manner, using a combination of geography, race and ethnicity.
value health benefits in economic evaluations (chapter 3) or The chapters on non-Caucasian populations, for example,
productivity costs (chapter 5) are unresolved, I doubt whether include people from middle and south-east Asia, who are, at
the strengths of economic analyses in health care are fully least in part, of Caucasian descent. A book chapter on each of
appreciated by decision makers. Nevertheless, decision makers these diverse populations presents a challenge to the authors, as
need an understanding of the underlying principles and the it requires inclusion of material on the differing aetiology of
controversies around them. In illustrating and discussing them, diabetes, and a discussion of all the long-term complications of
the book clearly succeeds. This is a book to keep and refer to; diabetes, including risks and risk factors for microvascular
both health economists and health policy makers will undoubt- and macrovascular complications, and of neuropathy at the
edly benefit from reading and having this book on their shelf. very least. The contribution on African Americans rises well to
the challenge, but not all sections are as comprehensive.
Welcome chapters for a book of this kind include a review of
Reference the health economics of diabetes, and an emphasis on the
1 Drummond MF, O’Brien B, Stoddart GL, Torrance GW. Methods
evidence for prevention of both type 1 and type 2 diabetes. Even
for the economic evaluation of health care programmes, (2nd edn). Oxford,
New York: Oxford University Press, 1997. more usefully, for both the established and neophyte epidemi-
ologist, there is a chapter on the theoretical and practical aspects
INGOLF GRIEBSCH of field surveys for diabetes. Included are such vital but seldom
University of Bristol addressed areas as questionnaire development, sampling,
 BOOK REVIEWS 879

investigations, and also practical issues such as ethics, funding, conducting the study by those he was seeking to study, and how
staff recruitment, and even the importance of a reliable electricity the study evolved over time with the active involvement of the
supply to the survey site. The key environmental risk factors for nuns themselves. The style and presentation of the text, with
diabetes are known to be lack of physical activity and poor illustrations, provide a marked contrast to the dry and imper-
diet. An excellent chapter summarizes the tools available for sonal style of scientific papers that should make it accessible and
the assessment of physical activity, and discusses their pros interesting to a wide audience.
and cons, but disappointingly, this has no counterpart for dietary The content of the book maps the Nun Study from its first,
assessment. rather limited, ideas to the much more detailed study with
No book could be wholly comprehensive for such a complex which we are familiar. It reads somewhat as a breathless diary,
disease as diabetes, but there are some striking omissions. Little attempting to inject the pace and urgency of cutting edge lab-
is made of the work demonstrating that early life influences, oratory medicine, rather than the slower, more laborious, pace
including poor growth in utero and childhood growth velocities, of much epidemiology. This does work, as the book is short and
appear to be important in determining the risk of diabetes, and easy to read, although it results in a more superficial account
its associated vascular complications. Some discussion of the than can satisfy the truly curious. There are several important
inflammatory/infectious aspects of aetiology, and endothelial issues raised in the book beyond the possible recommendations
dysfunction, particularly the role of nitric oxide, and other aspects for healthy ageing. Longitudinal studies in closed communities
of vascular biology, which are now of increasing relevance even have to be based on a relationship between the researched and
to epidemiological studies unravelling the aetiology of the the researcher, and this leads to loss of objectivity. In this study
vascular complications of diabetes, might also have been antici- it would have been impossible to conduct the study in any
pated. Finally, apart from a detailed discussion of interventions other way, but this may have had some impact on findings. The
designed to reduce the risk of diabetes per se, and a discussion of value of carefully stored records is again emphasized by the
the UK Prospective Diabetes Study (UKPDS), there is no section serendipitous finding of written records by new novices, which
on interventions designed to reduce the risk of diabetes-related were then linked to later patterns of cognitive ageing. The
vascular complications, even though epidemiology has been at descriptions of development and progression of dementia, both
the forefront of some of these studies, and many have reported gentle and aggressive, show that the process does not have to be
only recently, quite substantially changing the way we treat stigmatizing, nor always distressing in the context of a caring,
diabetes. The section on retinopathy, for example, while dis- supported and loving community. The description of the brain
cussing the impact of the Diabetes Control and Complications donation programme within the study from first cautious steps
Trial on the perceived value of tight glycaemic control in to enthusiastic acceptance and participation (in principle before
retinopathy risk in type 1 diabetes, bemoans the lack of similar death and with actual donation after death) by the majority of
data in type 2 diabetes, despite a whole chapter on the UKPDS. the community is welcome. In the UK in the aftermath of
A common feature of most medical texts is that they are out events at Alder Hey this is an encouraging endorsement of the
of date even on publication. This is no exception. The Diabetes contribution of post-mortem studies to the greater understand-
Prevention Project, one of the largest and most definitive studies ing of ageing and dementia.
of the prevention of diabetes in high-risk groups, was reported The titles of the chapters (as well as the book itself) are all
too late for inclusion here. carefully chosen, giving a flavour of the relentlessly positive
This book is a welcome and innovative addition to the style of writing (‘the road to good counsel’, ‘the last nun stand-
lamentably few texts available on the subject, and in particular ing’, ‘grey matters’, ‘amazing brains’, ‘the heart of the matter’,
it is essential reading for those interested in the public health ‘our daily bread’). At a time when the study is still in progress
and economic aspects of a condition soon to be of epidemic the relationship of the author to the community is complex,
proportions worldwide. and a book of this kind can only present an upbeat message.
Nothing could or should jeopardize the ongoing work, and the
NISH CHATURVEDI value of the study. Perhaps it really is all this positive, but it does
leave this reader with the feeling that not all the story has been
told.
Who should read this book? Non-clinical colleagues involved
in the conduct of dementia studies enjoyed it immensely and
Aging with Grace: What the Nun Study Teaches Us About recommended it to researchers and clinical students for its
Leading Longer, Healthier and More Meaningful insight into the need for communication skills. Most people
Lives. David Snowdon. New York: Bantam Press, 2001, pp. 256, interested in dementia and the ageing process would enjoy
$24.95 (HB) ISBN: 0-553-80163-5. reading it, without necessarily learning much new, since the
findings from the study are already well known. Nor is it a book
This book seeks to tell us what a study based on a religious order which provides detailed design, set-up and conduct of this
of nuns in the US can tell us ‘about leading longer, healthier study, but this is not its intention. Those wishing to conduct any
and more meaningful lives’. It is the story of a research project kind of longitudinal study with biological tissue retrieval would
now known internationally as the Nun Study (searchable on be well advised to read the book for insight into how to go
the web). The scientific findings from this study have been about the process with a population sample.
powerful and widely publicized for some years. This book sets
these scientific findings into the context of setting up and carry- CAROL BRAYNE
ing out the study. It is a description of the education of the scientist
880 INTERNATIONAL JOURNAL OF EPIDEMIOLOGY

Stroke Services. Policy and Practice across Europe. C Wolfe, immediate and direct interest to the providers and planners
C McKevitt, A Rudd (eds). Abingdon, UK: Radcliffe Medical of stroke services within and throughout Europe. However, the
Press, 2002, pp. 144, £24.95. ISBN: 1-85775-455-7. principles and generic tools are also highly relevant to other
disciplines (e.g. stroke clinicians, public health physicians, and
This book is a wonderful example of how the sciences of epidemiologists), to other diseases (particularly chronic diseases),
epidemiology and health services research can be integrated and to other regions of the world (particularly multicultural,
and applied practically to the understanding and management developed countries).
of a major public heath problem (in this case, stroke) in a large,
multicultural region of the world (in this case, Europe). GRAEME J HANKEY
The central theme is the rationale, design, results and implica-
tions (for health care providers, planners and policy makers)
of the European Union Biomed Concerted Action studies of
stroke. The 23 authors of this 144-page, 9-chapter book are all Imperial Bodies: The Physical Experience of the Raj
collaborators in this project (geriatricians, neurologists, public c.1800–1974. EM Collingham. London: Polity Press, 2001,
health physicians, health care researchers), amongst whom pp. xiii + 273, £50.00 (HB) ISBN: 0-7456-2369-7.
Wolfe, McKevitt and Rudd are the editors and co-ordinators.
The book begins by presenting the previously published Sociological theories of embodiment—the role the body plays in
evidence for the substantial variation in outcomes of stroke our experience and in the expression of our beliefs and values—
(morbidity and mortality) among different countries through- bring together a number of things which previously had
out the world and asking why is this so, and particularly, why is appeared disparate: food, sport, ceremony, houses, intimate
this so in the different countries in Europe? This is the prompt relationships, power—and health and hygiene. Despite an early
to begin a study which is dedicated to documenting the out- tendency to opaque generalizations, this line of work has begun
come of stroke care in various European centres, and the likely to yield an assortment of sharp, detailed insights, perhaps most
important modifiable determinants of outcome (e.g. differences tellingly from historians, whose appetite for unfamiliar
in structure and process, besides age, culture and socioeconomic particulars makes them especially apt for this approach.
status). This book is a good example of these attractive qualities. After
The second and third chapters are a marvellous account of a short introduction in which Bourdieu and Foucault, and to
the principles of developing a data set for the Biomed studies, a lesser extent Elias, wreak some havoc with the author’s
and the relevance and important characteristics of population- normally lucid style, the book progresses to a description of
based registers. I wish I had read such a sound and clearly written bodily experience and bodily language in three periods of
source of these principles and characteristics 15 years ago (before Indian history, from about 1800 to the Mutiny in 1857, from
embarking on my own epidemiological studies) which are 1858 to 1939, and from World War II to independence in 1947.
widely applicable to many kinds of health services research. The first period begins with the image of the ‘nabob’, whose
The next four chapters focus on measuring the structure, physical and social style was relatively open to Indian influence,
process and outcome (including subjective outcomes of patients) and who sought to rule in an Indian idiom. The growth of
of stroke care; and how and why they may vary throughout evangelicalism and of utilitarian liberalism in Britain, however,
Europe. Such factors which may influence outcome after stroke brought an emphasis on moral responsibility for bringing the
include the number of stroke patients (incidence), the type benefits of progress, and this encouraged a degree of closure,
of stroke patients (incidence of stroke subtypes, prevalence of distancing officials to protect their impartiality and rectitude.
causal risk factors and prognostic factors, and co-morbidities), The shock of the Mutiny added momentum to this movement;
the interventions (access, appropriateness and quality of care), it became an axiom that in this vast population the British could
which and how outcome is measured, and the random play of in the end rule only by prestige, and closure became essential,
chance. The potential hazards that are inherent in the inter- creating the ‘sahib’ who expressed prestige through his body in
pretation of comparisons of outcomes among centres by league ceremony and in social relations, giving rise to an emphasis on
tables (even those that adjust for many or all of the above the physical separation of racial bodies. It was precisely this
factors [e.g. casemix]), are highlighted appropriately. ceremonial structure at which Ghandi struck, with his use of
Chapter eight outlines a method of measuring the costs of the Indian body in its greatest simplicity, and the success of his
stroke care across European centres, and exploring the reasons tactics was evidenced in the effort of officials to start
for cost differences. overcoming the barriers which had been set up. But it was too
The concluding chapter is an honest and humble account of late: defeat by the Japanese, and the arrival in India of
the positive and negative outcomes of the studies, the lessons thousands of unschooled British and American bodies in the
learned, and the opportunities for, and areas in need of, future form of troops, demolished the last of the spell.
research. The part played by public health in this colonial world is only
The editors and authors of this book are to be congratulated one strand, but an extremely interesting one. East India Company
for their insight, energy, collaboration and commitment to surgeons relied on environmental theories that suggested that
undertaking and fulfilling such an ambitious and important bodies bred in northern climes would degenerate in the tropics.
project, as described in this book. It is well designed, edited and They advised use of moderate and abstinent Indian practices,
indexed; easy to navigate; and consequently a pleasure to such as vegetarianism, to adapt the body, but Indian practices
read. The references are up-to-date and relevant to the subject. of conspicuous consumption, combined with Georgian meat-
Moreover, the methods and results are novel and will be of eating habits which surgeons warned against, proved more
 BOOK REVIEWS 881

compatible with the style of a nabob. By the 1820s, evidence of there are four appendices at the end of the book. In each of
degeneration (the Portuguese providing handy examples) led to these chapters the underlying theory of a model is presented
concerted efforts to change the environment instead. Hill and the application of this model illustrated using examples. Next,
stations were identified as more temperate, and became refuges a print out from a computer package is discussed and methods
in the hot season; elsewhere the classic scheme of the canton- for checking statistical assumptions are described. Towards the
ment was devised, with wide, airy streets carefully separated end of each chapter there are checklists for reporting the results
from the noise and heat of the cities; children were sent home; and for reading published analyses. Finally ‘frequently asked
terms of duty were interspersed with periods of home leave. questions’ are answered and multiple-choice questions included
Personal defences against the environment were spawned, to test knowledge and understanding. The appendices cover expo-
which became part of Anglo-Indian ceremonial—the sola topee nentials and logarithms, maximum likelihood and significance
on the head against the sun being prototypical. All this became tests, bootstrapping and Bayesian methods.
part of the movement towards separating Anglo-Indian from There were a number of things we liked about this book. It
Indian bodies; and the diffusion of the germ theory of disease in is short and fairly readable (for a statistics textbook!). The
the later 19th century only intensified the trend. consistent layout of the chapters worked well and each chapter
One area of social life remains paradoxical in this story—life is short enough to be easily tackled at one sitting. For those who
inside the bungalow, where separation from Indians in the form require extended explanations references to more detailed texts
of servants was less practised than in Britain. Anglo-Indian are included throughout. There were some features of the book
children thus absorbed the physical experience of India to an we were less impressed with. On occasions the explanatory text
extent that is unexpected from accounts of public life, and relied too heavily on mathematical language and equations for
affectionate relationships with ayahs and bearers were often our liking. In addition in some sections we thought it would
astonishingly strong. Collingham, with a historian’s relish for have been good to have diagrammatic or tabular summaries of
the deviant particular, brings out this paradox, and discusses it the text. We liked the inclusion of questions at the end of most
aptly in terms of the contradictions of paternalism. chapters, but wondered if short-answer questions might have
It is probably the strongest test of this portrait of the British been even better. Also, we felt that more detailed explanations
colonial world that it should be recognizable to a reader who of the answers were required and preferably on the next page
encountered that world outside India. African colonialism never rather than at the back of the text. We thought a glossary of
developed to the rigidity of the Indian version, but as one who frequently used terms for the reader to refer to would also have
absorbed its physical experience in the way that only a child can been useful. As neither of us had read ‘Statistics at Square One’1
do, I found this book more illuminating than any previous post- we did not find the frequent references to it helpful.
colonial history, both because it sees the world that children Both of us felt the book represented quite a leap forward in
saw—which is not far from the world that an observant doctor understanding from basic statistics and that this would be
sees—and because it goes further in accounting for it and challenging for someone just starting to use these techniques
explaining its unique mix of lovable and repellent features than and not familiar with computer packages and their print outs.
anything else I have read. We were not convinced that descriptions of bootstrapping and
techniques such as ordinal regression necessarily needed to be
RORY WILLIAMS included. We would also have liked to see more about the prac-
tical use of these techniques, including when to use them, how
to build and select appropriate models, and how to translate
Statistics at Square Two: Understanding Modern Statistical computer print outs into results tables suitable for publication.
Applications in Medicine. MJ Campbell. London: BMJ Overall we found this book a readable and useful intermedi-
Books, 2001, pp. 144, £12.95. ISBN: 0-7279-1394-8. ate text. If the book were revised we would prefer to see the
next edition focus a little less on the mathematical understand-
Two of us reviewed this book. One of us is a final year medical ing and a little more on the practical use of regression models in
student with a basic understanding of statistics and one of us is data analysis.
an epidemiologist (hopefully) more experienced in the use and
interpretation of more advanced statistical methods. The stated
aim of the book is to explain some of the more complex Reference
1 Swinscow TDV. Statistics at Square One, 9th Ed. (Revised by MJ
statistical models now used in medical research. It leads on from
Statistics at Square One.1 The book is short—144 pages. There is Campbell.) London: BMJ Books, 1996.
an introductory chapter revising basic statistical concepts. The
following five chapters describe different statistical methods and REBECCA ROBERTS AND ANDY NESS

View publication stats