There is a possibility that some of the above mentioned statements that seem
contradictory at first glance will perhaps hold true in peaceful co-existence at
second glance. Yet it will be undeniable that some confusion will be part of the
researcher or clinician, interested patient, health care planner,9 medical auditor2
or journal editor, 15 who wants to know what is the prevailing professional view and
the state of the art of the diagnosis and therapy of this disease. All of these - except
for the researcher- do not have enough time, funds and energy to spend several years in collecting and analysing data for their question and fill in possible white
areas in our map of knowledge. Most likely they will take refuge in reviewing
existing data from the literature, and will try to sift and sort the differently qualified
evidence and to combine equivalent data and weigh it against opposite facts.
Well, this (and nothing more) is the purpose of the present thesis. Be it that an
attempt has been made towards a rational and rationalising way of analysis and
synthesis of the research question. This approach, in the past decades borrowed
from the military and the econometric and the psychometric domains, can be applied to medical problems as well and is then called
"medical decision analysis" (in Dutch medische besliskunde ). The result is not an
accurate description of all aspects of diagnosis and treatment ofLDH, but rather
a crude representation of the major choices that have to be made in the course of
"managing a patient" with this disease. Advocates of this method, emphasizing
that decision makers cannot wait and have to adhere to existing data sources, claim
that the re~uired data usually can be found in the literature. This claim has waned,
however. Another movement, that of meta-analysis6 is indeed exploiting the
literature, but indicates that the gold is buried very deep