EDITOR'S NOTE: For a comprehensive library resource that brings the best general and academic reference sites together in one place, go to:
www.libraryspot.com
THE TEXTBOOK DEBATE
During the past several months, many an article has hit the mainstream press rebuking textbook companies for charging too much and for issuing needless editions. Some students and professors believe that there is no point to such new editions, except as a means to generate additional revenue for publishers. However, after careful examination of myriad titles in many scientific (and general academic) disciplines, I must heartily disagree.
The reasons for my opposition to the media status quo is based upon the fact that research in the medical sciences is constantly advancing therapies and the way that illness and concepts of treatment are approached (this is also true in the fields of law, paralegal study, psychology and civic engineering). Keep in mind that once research studies are completed, authors and publishers must immediately revise current texts in order to incorporate new information and bring students and teachers up-to-date.
Yes, these books are massively expensive. Yes, they are economically burdensome for many students to purchase. But remember that they are also expensive to produce: many of the medical texts I saw were over 500 pages in length and included hundreds of color plates. And all this requires significant dollars to create. Add to this the extra costs of editing and binding these tomes and you will begin to understand the factors at work which drive prices upward. Unfortunately, it is an expensive proposition going to college today. And that expense only increases when a student decides to embark on a career in medicine. However, the whole point behind medical school is to learn about the body’s systems thoroughly and to investigate the most current research data available. Thus the need for these constantly evolving editions.
But is there a more efficient way of providing this data to the student? Perhaps. Perhaps publishers might begin to examine the production of small supplemental editions that might augment existing texts as a way to mitigate some of the cost to the student. Still, consumers of this material must also accept the fact that the internet has changed the dynamics of the way books are bought and sold. Accordingly, publishers in all genres are finding it more difficult to cut a profit during the last decade -- hamstrung by the economics of trying to cover costs without completely pricing their audience out of the market. Basically, publishers can only drop prices so far before the margin falls into the negative.
Obviously, these are tough times. Both individuals and corporations alike are struggling as the country teeters on the edge of a full scale depression. Yet, publishers can only be blamed for the price of a college education so much. The bottom line is that it costs money to build these books, and this is compounded by the fact that scientific data changes by the day. With each of these factors intersecting and interlinking at the same time, it is not likely that the situation will get better soon. ~John Aiello
The following recommendations speak to books with strong reference or professional content, and each have high value to both collegiate and public libraries alike.
CONN’S CURRENT THERAPY. 2004. Edited by Robert E. Rakel. Edward T. Bope. W.B. Saunders. This comprehensive text charts the latest therapeutic treatments for a variety of maladies affecting each of the body’s organ systems. The volume condenses the preferred techniques of over 300 leading physicians from across the world in treating myriad diseases ranging from sleep apnea to menopause -- and everything in between. Each contributor providing medical analysis is a recognized authority in their field, offering careful and thoughtful commentary on how to best confront and manage disease and illness in the front lines of a doctor’s office.
However, this isn’t just the same "take two aspirin and get extra rest" guidebook; instead, the writers cover much new ground here, taking the time to comment on the challenges that confront medicine in 21st century America (namely the very real threat of bioterrorism). Included in this coverage is new information on Anthrax and the steps the medical professional should take if presented with a patient exhibiting signs of this deadly affliction. In a day and age when the country is bombarded with weekly "terror alerts" these chapters seem invaluable. There is also some interesting information on herbal remedies, again showing how much modern medicine has changed (25 years ago, would any of us have imagined this kind of data in a doctor’s reference?).
As previously noted, Conn’s is a manual meant for the general practitioner and for the internist -- a quick and easy guide to patient management and symptom control. Also would prove valuable to nurses and physician’s assistants who are in close contact with patients. Would further aid advanced medical students as a practical teaching tool, illuminating treatment options and therapies for many common problems. Absolutely imperative for medical school libraries and for the university library shelf as a general medical reference.
Order from Amazon.com or go to http://www.us.elsevierhealth.com
RECOMMENDATIONS FOR THE PHYSICIAN
For The Endocrinologist
DAVIDSON’S DIABETES MELLITUS. 5th Edition. Anne Peters Harmel. Ruchi Mathur. Saunders. This text is meant for the practicing physician and the internist, focusing on the care of patients with Diabetes Mellitus. Davidson’s provides the most up-to-date information available on how to treat a patient in the throes of glucose intolerance. Davidson’s is in depth in its examination of the impact of diet on maintaining satisfactory glucose levels; also explores the most recent drug advancements and ways that medicines can be combined for more efficient long-term maintenance of the diabetic. Harmel and Mathur have done a comprehensive job putting this volume together, investigating many "routine" issues that plague the Diabetes Mellitus patient (such as how to avoid infection through proper hygiene and the importance of keeping weight under control to avoid spikes in blood sugar). Another "fresh" aspect of this text is how it deals with the psychological impact of disease and the affect Diabetes Mellitus has on sexual desire and sexual function. This is a sound and valuable manual for the use of the general physician; it would also prove useful for nurse practitioners who administer blood glucose testing and who review maintenance therapies directly with patients. Appropriate for University libraries and for public sector libraries as a health reference text.
Order from Amazon.com or go to http://www.us.elsevierhealth.com
For The Allergist/Ear, Nose and Throat Specialist
MILGROM: PRACTICAL ALLERGY. Etan Milgrom. Richard P. Usatine. Ricardo A. Tan. Sheldon Spector. Mosby. As spring quickly approaches, it’s once again time for the focus of Ear, Nose and Throat specialists and family practitioners to switch from the flu to allergy. And Etan Milgrom’s Practical Allergy provides a natural starting point. Milgrom offers practical guidance on the diagnosis and treatment of the most common allergic afflictions, along with recommendations for long-term management. The primary care physician referring to this guide will further be assisted by the color plates/illustrations that provide visual direction in terms of identifying common allergic conditions. Fine chapters on Asthma and Allergic Rhinitis (in Core Topics Section), Patch Testing (Procedures/Practice section), and food allergies (Appendix) provide the allergist with up-to-date information on this often debilitating problem that affects millions of people across the world. Milgrom also provides an additional section on Patient Education included on a CD-ROM. This material can easily be printed out and given to patients, thus allowing them to become directly involved with their own care. This section is of particular value to nurse practitioners and physician’s assistants who administer tests, as they now have a means to educate the people whom they are treating. Highly recommended for both allergy specialists and primary care physicians as a "one-stop" guide to treating allergy. Also recommended for University medical school libraries as a core reference with valuable information on identifying various allergic disorders.
Order from Amazon.com or go to http://www.us.elsevierhealth.com
For The Hematologist/Immunologists
IMMUNE HEMOLYTIC ANEMIAS (Second Edition). Lawrence D. Petz. With George Garratty. Churchill Livingstone. This second edition of the Petz/Garratty manual serves as the authority on the identification and treatment of blood disorders. Immune, first released in 1980, has been revised and now includes background and diagnostic information on all immune hemolytic anemias, a condition in which the body’s immune system begins to prematurely destroy red blood cells. Petz and Garratty examine this phenomenon in detail, breaking down the probable causes for the condition and ways the physician can administer effective treatment. The expanded second edition also presents new information on anemia in bone marrow transplantation recipients, as well as examination on differential diagnosis in lymphoma. In short, Immune is a high-level text written for hematologists, immunologists and pathologists who confront blood disorders on a daily basis -- this in depth analysis and thorough ‘dissection’ of the ways anemia impacts the myriad systems of the human body. It should be noted that primary care physicians, unless specifically dealing with anemia as a sub-specialty, will most likely not use this material enough to warrant inclusion of Immune in an office library. However, this expanded edition is highly recommended for all medical school libraries as a reference text. Further, the text is a natural candidate for use by instructors in the fields of hematology and immunology, as Petz and Garratty have done a masterful job in delineating these afflictions in a logical, well-written and thoughtful manner.
Order from Amazon.com or go to http://www.us.elsevierhealth.com
For The Neurologist/Oncologist
BATCHELOR: LYMPHOMA & THE NERVOUS SYSTEM. Tracy Batchelor. Butterworth Heinemann. Tracy Batchelor (Assistant Professor of Neurology at Harvard Medical School) presents, in collaboration with 20 expert contributors, a first-rate guide on the diagnosis and treatment of lymphoma of the nervous system. This manual covers all primary implications of the disease, offering valuable discussion on symptom identification, epidemiology and neuroimaging. The text contains a wealth of information, as Batchelor breaks down this complex disorder into comprehensive chapters outlining the mine fields that the practicing physician is likely to encounter in the lymphoma patient. In depth chapters analyze diagnosis and management of both AIDS and non-AIDS associated primary central nervous system lymphoma, as well as Hodgkin’s lymphoma. Options for treatment are discussed in practical terms, as Batchelor remains careful to identify the complications inherent with radical cancer therapies. Although this text is written for the per se lymphoma specialist, there is nonetheless a chapter for the non-oncologist/primary care physician, offering insight into basic case management. Batchelor’s Lymphoma is simply the authority on the subject - an absolute requirement for oncologists across the globe. Also highly recommended as a reference manual for all medical school libraries. Would further be a useful teaching text for the advanced Neurology/Oncology student. However, the primary focus of this guide is to provide guidance to the practicing physician.
Order from Amazon.com or go to http://www.us.elsevierhealth.com
CANCER OF THE HEAD AND NECK. Edited by Eugene N. Myers, James Y. Suen, Jeffrey Myers and Ehab Hanna. 4th Edition. W.B. Saunders. This is the definitive text on cancerous diseases of the head and neck, offering comprehensive information on diagnosis and treatment. Treatment options cover both surgical and non-surgical therapies, with fine illustrations that further enhance detail and presentation. This revised edition contains new information on nasopharangeal cancer, and also provides comment on immunotherapy regarding the assessment and treatment of head and neck cancer. Fine illustrations throughout and a well-edited narrative by the top physicians in the field (in addition to the four primary editors, Cancer contains contributions from 53 other leaders in the sub-specialty). Highly specialized text for oncologists, head and neck surgeons and otolaryngologists. Should be included in all medical school libraries as a reference text. Would also be a first choice as a teaching text in advanced classes exploring diseases of the head and neck.
Order from Amazon.com or go to http://www.us.elsevierhealth.com
SNAPSHOT ON MEDICINE
THE DOCTOR’S PERSPECTIVE
By John Aiello
I.
Northern California is fortunate to have available to it some of the best medical care in the country, including Stanford Medical Center, St. Francis Hospital, U.C. Davis Medical Center, California Pacific Medical Center, and the esteemed University of California, San Francisco Medical Center. UCSF, located atop Parnassus Avenue on the edge of the city’s famed Haight-Ashbury district, is world renowned for many of its departments, including the cutting edge care in cardiology research and treatment it offers.
UCSF’s cardiology staff is comprised of many of the most accomplished doctors in the United States. These doctors all work in what is commonly referred to as a "teaching hospital " -- a facility where physicians double as instructors, teaching the practice of medicine to interns, nurses and fellows while simultaneously treating patients in a state-of-the-art medical center.
Cardiologist Kanu Chatterjee has been a Professor of Medicine at the University since 1975. Reserved, with a deliberate and poetic nature, Chatterjee is known through out the world as a physician of supreme skill and compassion, carefully balancing the quality of his patients’ lives against treatment options. No matter what situation he is confronted with, Chatterjee never seems to lose sight of the fact that his patients are each individuals and not just "case studies;" because of this absolute dedication to his profession, Chatterjee’s opinion is routinely sought by patients and colleagues from across the globe.
Chatterjee, who was born and educated in India, has written over 300 articles and 95 book chapters on the treatment of heart disease. He has received countless awards during his distinguished 40 year career, and serves on the review boards for many professional journals. Further, his thoughtful and respectful demeanor in the classroom has influenced multiple generations of physicians who continue to spread his unique vision as a healer through the work of their own careers.
During the last 15 years Chatterjee, along with fellow cardiologists Teresa De Marco, William Grossman, and the recently retired William Parmley, has also been active in promoting the work of the "Foundation for Cardiac Research." This non-profit organization is committed to furthering treatment options for various forms of heart disease, with a specific emphasis on congestive heart failure and vascular maladies.
The mission of the Foundation, and the impact it has had on Bay Area and surrounding communities, is seen first hand during the one hour television special, "A Change of Heart." The program, produced by Foundation Board Member William Criswell, is currently slated to be rebroadcast on ABC affiliates throughout the northern portion of the state in February; it tracks the treatment of several heart patients from UCSF, recording their reflections in the face of serious illness. The documentary is of note because it exemplifies the hands-on approach Chatterjee, Parmeley and De Marco take towards their patients -- not only prescribing pills and administering clinical tests -- but also helping to guide them past the emotional peaks and valleys that accompany this struggle between life and death.
This interview with Doctor Chatterjee was conducted at his offices on the UCSF campus in April of 2003.
Tell me a bit about your background.
I was born in India, in an area that is now known as Banglasdesh. I attended Medical College in Calcutta, and graduated in 1956, and then served as House Physician at Burnpur Hospital in India from 1957 through 1963. After that, I was trained at various hospitals in London, where I remained until 1971. That’s when I came to the United States to become the Clinical Director of the Myocardial Infarction Research Unit at Cedars-Sinai Medical Center in Los Angeles. I stayed there until 1975, and then came to work at UCSF with William Parmley.
How does the practice of medicine differ in India and Europe from the practice of medicine in America?
Well, there have been quite a lot of changes since I graduated medical school in India. At that time, in the 1950s, medicine was based on a clinical approach, and there just weren’t that many treatments available for most diseases. There also were very few diagnostic tests a doctor could use. But things have changed a great deal since that time, and now many of the same advanced treatments we commonly use here in the United States are used in India and in other similar countries. The main difference is the institutions offering these services are limited in number -- there simply aren’t a lot of these facilities around.
I imagine in your nearly 30 years at UCSF, you have witnessed many changes here as well...
Oh yes! Many many changes. For example, in 1975 when I came here, there were only 4 beds in the Intensive Care cardiac unit. Now in less than 3 decades, we have more than 50 beds in critical care units throughout the hospital. This is an important change, in that it has increased the number of patients we’re able to help.
Obviously, this part of California is rich with many fine hospitals. What distinguishes UCSF?
I am very proud of this hospital and the things we have been able to do here. The Medical Center has regularly been ranked in the top 10 nationally, and this year it is ranked number 6 among all medical schools in the nation. I think there are many reasons for our high ranking, the biggest of which is our commitment to patient care. What we try to do here is blend medical research and the teaching of young doctors with excellent patient care. We are dedicated to this mission.
Of all the sub-specialties in medicine, why did you chose to pursue a career in cardiology?
Well, this goes back to my beginnings. As a student in medical school, I was very interested in cardiac physiology and in physical diagnosis. And there are actually only two sub-specialties -- cardiology and neurology-- that allow you to make a diagnosis with your stethoscope. Aside from these reasons, my father died of a disorder known as "heart block," before pacemakers were available. And this event increased my interest in the field in that it made me want to look at what could be done and what could not be done in cardiology.
Aside from your work as a physician, you have also been quite active in the role of the Foundation for Cardiac Research during the past 15 years.
Yes, I am very grateful to the Foundation. Since it was founded in the late 1980s, it has provided vital support to the University, supporting research into heart disease and new approaches for treatment. The wonderful thing about the Foundation is that it supports fellows and junior faculty as well as faculty -- it is literally supporting all the research being done in the field of cardiology at UCSF.
In what direction do you see cardiology treatment moving in the next ten years?
I think in the coming years we will begin to use research as a means to preventative medicine; this will most certainly be at the forefront of our thinking. Currently, we have made remarkable advances in treating the consequences of heart disease -- an example is angioplasty and stent treatment -- to substantially increase both the quality and the length of a patient’s life. I think in the future we are not only going to be looking at how to better treat heart disease, but we will also begin developing a multi-pronged attack to prevent it. The ultimate goal is prevention.
Your work schedule is almost legendary in medical circles, I’m talking about the way you’re able to treat patients and teach and then serve as a guest lecturer at hospitals all over the world. Where does your boundless energy come from and what keeps bringing you back for more?
I really do enjoy the whole aspect of the practice of medicine, and especially the practice of cardiology. I can think of no other profession that brings you so close to the patient. As a cardiologist, you are bound to have close contact with your patient and their family, you’re not just looking into the microscope as is the case with some other sub-specialties. I truly find it a blessing and a privilege to come into emotional contact with my patients and become involved in their ultimate well-being. I am also driven to pass on knowledge to other doctors. I shall never forget a conference I once chaired: of the six presenters, four were former students of mine. I was so proud of that. I can only think of one thing that can compare to that kind of a feeling, and that’s seeing a patient get better. (pauses) I guess the energy I have comes from my passion for my work. If I didn’t like it I wouldn’t do it. It’s just second nature now, after so many years it’s a part of me, of who I am, of my existence. My schedule is tough on my wife Docey though -- she doesn’t see me much and this is frustrating for her. I am certainly grateful she has tolerated me and my schedule for so long. (laughs)
Looking forward, can you ever imagine a time when heart disease will actually be eradicated, or is it simply a natural part of our life & death process which will always exist in some form?
Well, there have been many great achievements in the treatment of heart disease during the past 20 or so years. We have been able to better treat patients after heart attack through agioplasty and stent procedures, with the rate of mortality markedly declining. And we have also made advances on prevention by better controlling cholesterol and high blood pressure with some new and more efficient medications (like the "statin" drugs used to treat elevated cholesterol levels) . However, I don’t think the problem will ever be eradicated in its entirety. But I think as life span increases, we will be able to delay the onset of heart disease. It has been projected that by the year 2050 the normal life span will be between 80 and 85, with a percentage of the population surpassing 100 years of age. The key to all of this is in better understanding the aging process and in perhaps being able to modify the aging process by regulating or delaying cell death. If this can be done, then heart disease will be delayed as part of the aging process itself.
II.
Doctor Teresa De Marco, a Professor of Clinical Medicine and the Director of the UCSF Heart Failure and Pulmonary Hypertension Program, immigrated to the United States from Italy in 1967, earning degrees from UC Berkeley and the UC Irvine School of Medicine.
Since joining the UCSF faculty in 1989, De Marco has worked closely with Doctor Chatterjee, and her efforts have been at the forefront of the treatment of heart failure. De Marco’s major contribution in this area has been in "resynchronization therapy," which uses a sophisticated form of pacemaker to improve the function of a failing heart. As the Medical Director of the Cardiac Transplantation Program at UCSF, De Marco’s research ultimately documented the fact that nerves are actually able to regenerate in a transplanted human heart, a discovery that radically improves the long-range outlook for transplant patients.
This interview with Doctor De Marco was conducted last April.
Several of your patients are featured prominently in the "Change of Heart" documentary that is set to be rebroadcast throughout the northern portion of the state in February 2004. One of these patients, Lonnie Smith of San Jose, has captured the thoughts of many as he continues to transcend his illness. Looking back, what impressed you most about Lonnie?
Lonnie was very tenacious, very determined to get well. When I first met him in the ICU, he was in bad shape. He was deathly ill. His body was full of fluid and he was in severe heart failure; the lack of blood flow was also effecting other organs, like his kidneys and liver. When I began treating him, we immediately became focused on increasing the blood flow (in his body) and reducing the fluid that had built up. Once we had Lonnie feeling and breathing better, we started to look at other procedures that would keep him feeling better. Unfortunately, because his heart was in such bad shape, we were forced to go to the next step, and we started looking at transplantation. The transplant we ended up doing allowed us to truly increase Lonnie’s quality of life.
How many transplants are done at UCSF per year?
Up until 1998, we did between 12 and 15 procedures each year. In 1998, this slowed down because we had a couple of our surgeons leave. However, Dr. Chuck Hoopes, formerly of Duke University, joined our staff this year. And with the addition of Dr. Hoopes as a surgeon, our goal is to once again do between 12 and 15 transplant procedures per year. Looking at the Bay Area as a whole, between 60 and 80 heart transplants are done amongst 3 programs, including Stanford University, UCSF and California Pacific Medical Center. In Sacramento, Sutter Medical Center also does some transplant procedures.
And how many transplant patients do you continue to follow today Dr. De Marco?
About 80 or 85.
What is the success rate and the probable life expectancy for the typical transplant patient?
The one year survival rate is 90%. At five years, it’s 70%; and at 10 years, it’s 50%. The longest living transplant patient that I am aware of has survived 21 years. The goal of the procedure is to improve a patient’s quality of life. Usually after transplant, one has increased exercise tolerance and can engage in the normal activities of life. But it’s important to remember that a transplant is an "end of the line" treatment to be used for heart disease patients who are out of alternatives. Heart transplant is not a cure, but instead a treatment to be considered when the patient is out of options.
What are the major obstacles facing a transplant patient?
During the first month following transplant, the primary trouble we run into tends to be with either infection, rejection of the donor heart, or technical problems with the procedure itself. These problems are sometimes long-term concerns as well, but rejection becomes less likely over time as the patient’s body becomes more tolerant of the donor heart. The main long term problem for transplant recipients is with coronary artery disease. After 5 years, 50% of transplant patients show evidence of coronary artery disease, with a progressive narrowing of blood vessels. We treat these events with angioplasty or by-pass surgery, but these procedures tend not to work well, and eventually we have to look at retransplantation. Another major long-term concern is with cancer. Patients are at an increased risk for some cancers because their immune systems have been suppressed as a result of transplantation.
Can you envision a time when cardiac medications will be so advanced as to make heart transplant procedures obsolete?
It’s happening right now. With the institution of medications like beta-blockers we have been able to forestall the need for transplant and in some cases avoid it altogether. However, I think we have actually reached a plateau with drugs, and will now start to look at other treatment options -- like resynchronization therapy -- to more effectively treat patients and avoid transplantation.
You have also remained active in the Foundation For Cardiac Research. What do you see as the primary role of the Foundation?
The Foundation’s role is to evaluate promising new areas of research that cardiologists can pursue. Funding for cardiac research is difficult to obtain, and the Foundation’s ability to fund research projects plays an important role in furthering a doctor’s ability to better treat patients.
And what would you cite as the most important advancements in cardiology treatment during the past decade?
One of the most important things to happen along these lines is the advent of "Thrombolytics" -- or so-called "clot-busting" drugs -- that actually work to dissolve a clot within an artery when someone is having a heart attack. In addition, doctors can also intervene through angioplasty and stent procedures: in short, we now have several different ways in which we can actually abort a heart attack and prevent heart muscle from dying. And by salvaging heart muscle, we avoid tissue death and prevent heart failure from developing.
For more information on the Division of Cardiology at UCSF, go to: ucsf.edu or www.foundationforcardiacresearch.org
CHATTERJEE IN PRINT
HEART FAILURE: SCIENTIFIC PRINCIPLES AND CLINICAL PRACTICE.
Phillip A. Poole-Wilson; Wilson S. Colucci; Barry M. Massie; Kanu Chatterjee; Andrew J.S. Coats. Churchill-Livingstone. This first rate clinical text explores the medical implications of heart failure, written and edited by many of the leading cardiologists in the United States. The book is focused on clinical concepts, approaching the disease from the researcher's point of view. Accordingly, the presentation is tailored to medical students and the general practitioner or internist, offering insightful commentary on the mechanics of heart failure and ways the medical professional might approach diagnosis and treatment. Doctor Chatterjee's chapter, written in collaboration with Doctors Tony Chou and Stuart Hutchison, explores ways the physician can manage patients who are in acute heart failure. This is a major reference text meant to expand the over-all understanding of this category of coronary disease. Fine illustrations also. Invaluable to all college libraries and especially to university students with biology and physiology majors.
~John Aiello
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