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.
VALVULAR HEART DISEASE. Second Edition. Catherine Otto, M.D. W.B. Saunders.
Reviewed by Steven Blumlein, M.D.
Associate Professor Of Medicine
University Of California, San Francisco
Catherine Otto's
Valvular Heart Disease is an in depth text that provides a thorough and up- to-date review of this common cardiac disorder.
Valvular is divided into three segments. The book begins by reviewing the prevalence and clinical outcomes for specific valvular lesions and their pathology. This is followed by a detailed evaluation of valvular disease by-way of echocardiography and cardiac catheterization, as well as nuclear CT and MRI scans. The rest of this section is primarily devoted to a review of the pathophysiology of valve disease, exploring the most common medical and surgical approaches available to the physician. The middle chapters of the text then examine the specific lesions of the aortic and mitral valves and the wide array of surgical, catheter-based and medical treatments available to best treat the patient who presents with heart valve abnormalities. Finally, the book closes with a discussion of right-sided valve disease, valve prostheses, endocarditis, pediatric valve disease and the affect of valvular disease on pregnancy. Even though the text is full of information, doctors will find it easy to digest because of the concise way in which Otto presents her data. The material is further enhanced by the ample references which high-light each of the chapters; also note the 16 excellent colors plates showing echocardiographic examples of valvular pathology that preface Chapter One.
Valvular is appropriate for use as a general cardiology reference text, or as a teaching guide in the classroom for anyone studying valvular disease, including medical students and attending cardiologists. Students of this area of medicine should take specific note of the numerous examples of ultrasound images that depict heart valve lesions in various stages, as it is these excellent illustrations that set this text apart from other books dedicated to this form of disease. In short,
Valvular would be a valuable addition to any cardiologist's library, and I am personally pleased to have it available as a reference guide in my own practice.
Steven Blumlein, M.D., F.A.C.C., is an Associate Clinical Professor at the University of California, San Francisco and a founding member of the California Pacific Cardiovascular Medical Group. Dr. Blumlein, who has been in private practice since 1984, was educated at he Medical College of Wisconsin. He then went on to study Internal Medicine at the University of Southern California in Los Angeles and Cardiology at the University of California, San Francisco. Contact him at sblumlein@cpcmg.com
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RECOMMENDATIONS FOR THE PHYSICIAN
For The Ophthalmologist/Optometrist
UVEITIS: FUNDAMENTALS AND CLINICAL PRACTICE. 3rd Edition. Robert B. Nussenblatt and Scott M. Whitcup. W.B. Saunders. Uveitis is a common affliction in which the ocular structures of the eye become inflamed and then painful, altering sight. Uveitis -- now in its 3rd edition -- is a balanced and well-written handbook covering this disorder, offering keys to diagnosis, patient management, surgery options and long-term care. In depth in its scope, this manual is designed for Ophthalmologists and Optometrists rather than the general practitioner. Includes detailed examination of Anterior Uveitis, Sarcoidosis, Retinal Vasculitis and White Dot Syndrome. The new edition also features examination of the newest diagnostic techniques, as well as valuable clinical comment on the impact of AIDS and immunosuppression on the eye. Well illustrated throughout -- with 75 full color plates that aid the physician in office diagnosis. In addition to its obvious value to the Ophthalmologist/Optometrist, Uveitis would be appropriate for use as a teaching text in the classroom. Also recommended as a reference for medical school libraries.
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ON THE HUMAN EYE
ALSO FOR THE OPHTHALMOLOGIST
The following texts will be of specific interest to all eye specialists, and augment Nussenblatt’s treatise nicely:
DISEASES OF THE MACULA. Jack J. Kanski and Stanislaw A. Milewski. Mosby. Manual focused on afflictions of the macula (the macula is a component of the retina that governs the details of central vision). Macular degeneration is a common disease that affects the elderly, and it is often responsible for the loss of sight among older individuals. Diseases offers detailed comment on the eye and factors that can exacerbate macular failure (such as vascular disorders of the retina). Kanski and Milewski have done a wonderful job in organizing the text and in covering a vast amount of information. Moreover, Diseases becomes note worthy not only for its expert analysis of eye disease, but also because of its use of the case study format: by using case studies (together with color plates), the practicing physician is able to immediately recognize the signs and symptoms of macula failure and begin appropriate treatment. On this level, the book would be an excellent teaching text, allowing the young ophthalmologist to quickly familiarize himself with a condition that presents itself frequently among geriatric patients.
SYSTEMIC DISEASES AND THE EYE. Jack J. Kanski. Mosby. Another title written by Kanski worth mention is Systemic, which looks at disease through the myriad webs of the human eye. Many times, doctors are tipped off to a body in the midst of disease by what is revealed by a simple eye examination: "It is surprising how many systemic diseases have potential ocular manifestations or associations," writes Kanski. "In some cases ocular manifestations are common and potentially serious, e.g. in diabetes, whilst in others they are uncommon and innocuous, e.g. in gout. The purpose of this book is twofold. The first is to remind practising ophthalmologists of the many diverse physical signs of systemic conditions that may affect the eye. The second is to acquaint the non-ophthalmologist with potential ocular manifestations of systemic disease." Readers will note some subtle differences between UK and American spelling, but these stumbling points do not impact the over-all value of the book. Even though Systemic is an older title (first published in 2001), its value to clinicians cannot be overstated: In the end, this manual is as much for the primary care physician as it is for the eye specialist. Well written and well illustrated, with the color plates simplifying symptom identification and diagnosis.
OPHTHALMOLOGY. Second Edition. Myron Yanoff and Jay S. Duker. Mosby. This is the literal bible of Ophthalmology, and contains detailed analysis of the human eye and the most common diseases that affect its health. The book includes over two thousand illustrations and plates that aid both in treatment and in diagnosis. So, what sets this manual apart? Its breadth! The ground Yanoff, Duker and their contributors cover here is mind boggling -- everything from cutting edge surgical techniques to new data on Uveitis, Cataracts and revolutionary approaches to non-penetrating glaucoma surgery. Yanoff and Duker have also done an admirable job in editing their book -- keeping things simple so that the practicing doctor can quickly refer to this manual in the office, answering questions without pause or delay. This material is also available in an E-Edition. E-Edition presents the full text of the book, including all images, plus weekly up dates which are monitored by Hanoff and Duker before being posted on the web. Physicians who purchase this package are at a real advantage in that they have access to the latest advancements in treatment and can apply that knowledge immediately. More than anything, this on-line version speaks to patient care: information readily available to the doctor means the patient reaps an immediate benefit. It only takes a cursory look to realize that the E-Edition of Ophthalmology speaks to the best aspects of the internet -- immediate access to reference material is vital to doctors and this book lights the way for other publishers and authors as they explore the changing face of how the world exchanges data. Among the numerous note-worthy aspects of the on-line package is in the drug reference data base: information on drugs is presented here in an easy-to-use format and should make prescribing medicine to patients safer as doctors are now able to investigate options thoroughly before writing a prescription. Moreover, all the material here is fully downloadable to PowerPoint, a feature that allows the physician to educate his patients in the course of treatment - augmenting and promoting effective long term care. E-Edition is ground breaking in both scope and quality, an on-line resource that encourages patient and doctor interaction while presenting the latest available data. A model for on-line textbooks everywhere. In either form Ophthalmology is a reference text that should be included in all Health Science libraries; also a "can’t miss" teaching text, for this book covers the full spectrum of eye disease and treatments in a readily accessible format.
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For The Gastrointestinal Surgeon/Interist/General Surgeon
MAYO CLINIC GASTROINTESTINAL SURGERY. Keith A. Kelly. Michael G. Sarr. Ronald A. Hinder. And 50 Additional Contributors. W.B. Saunders. This text is the authority on surgical approaches to diseases of the gastrointestinal tract. However, physicians and students are advised that Mayo Clinic is not meant to be a scientific analysis of disease, but rather a practical guide for surgeons on how to repair the body in the midst of gastrointestinal distress. Absolute in its scope, Mayo Clinic examines the gastrointestinal tract from the esophagus to the anal canal, offering keys to diagnosis, indications for surgery and surgical options for every major gastrointestinal disease. The text covers advancements in procedure for hepatic resection, liver and pancreatic transplantation; also discussion of Heller myotomy and colectomy. Probable surgical outcomes are also addressed. Well-illustrated (note the 845 plates) and meticulously written, the authors have come together nicely to discuss an array of complicated procedures in a concise and direct way, thus creating the most comprehensive surgical guide we’ve seen on the gastrointestinal tract. Recommended for all surgeons of this discipline; also would be appropriate for radiologists who specialize in the GI tract. Recommended for health science libraries as a reference text and for the classroom as a surgical teaching guide.
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For The Internal Medicine Resident
THE JOHN’S HOPKINS INTERNAL MEDICINE BOARD REVIEW. Redonda Miller. Stephen Sisson. Bimal Ashar (All From The Faculty at Johns Hopkins). Mosby. This should be viewed as the "Bible" for all physicians seeking to gain certification or recertification in Internal Medicine. As the consummate medical "study guide," it presents the information that is likely to appear on the Internal Medicine exam in logical and concise terms. Like the guides that help fledgling attorneys prepare for state Bar exams, Board Review is meant to allow its reader to become familiar with how exam questions will be put together and how the student should approach study of the material so it is retained long-term -- and not just to pass a test. To this end, the authors have taken pains to create sample questions and provide their answers; moreover, they carefully explain why each answer is correct. By doing this, Miller, Sisson and Ashar promote a deeper understanding of the material in an effort to prepare young doctors for the challenges of private practice. Topics covered include cardiology, infectious disease, pulmonary and critical care medicine, gastroenterology/liver disease, nephrology, endocrinology, rheumatology, hematology, oncology, neurology and various miscellaneous topics (including dermatology and bioterrorism). Absolutely imperative for any resident preparing to take the board certification exam. Also recommended to health science libraries as a general reference text.
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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.
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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.
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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.
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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.
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LAW AND RELATED LEGAL TOPICS
ORGANIZED CRIME. Howard Abadinsky. Thomson/Wadsworth. Since its inception, the population at large has been intrigued by the idea of the Mafia and organized crime groups. And from "The Untouchables," to "The Godfather" to "The Sopranos," writers and film directors have sought to capture the ‘real life’ scenes of how the mob operates -- winning Emmies and Oscars along the way.
However, Organized, now in its seventh edition, does all these efforts one better -- for this is a text examining the real deal, no lead actors or script doctors, just facts and analysis on how syndicates of criminals come together to thrive and get rich. Organized, written by Howard Abadinsky, examines the concept of criminal enterprise from the idea of structure, analyzing changes within organized criminal associations and how by being willing to change with the times these groups are able to maintain power and control. Meticulously written and careful to honor every detail, Organized takes us through the concept of crime step-by-step, showing students what "organized crime" is and then breaking down its historical ‘life.’ First, Abadinsky explores organized crime in the United States (including wonderful chapters on the New York and Chicago factions, before moving into the very specialized world of African American criminal movements). From that, Abadinsky takes us through the ethnicity of crime, from major Italian movements through the Asian gangs, finally breaking down the business of crime and how money is made and stolen goods turned into cash. In the final chapters, the ways law enforcement has dealt with organized groups of criminals is examined, including a review of the United States statutes that serve as the controlling law in this area.
This comprehensive textbook has many new and interesting angles, but what’s most intriguing is the material on outlaw biker groups. Much of this information is new, and it will hold a searching student spellbound as the myths of "Angels" is dissected line by line. Moreover, Abadinsky’s style of writing is friendly and journalistic -- he’s like a newspaper columnist writing a long feature: rather than driving students away with a coarse and dry sociological "study," he instead draws us in with by cutting into the reasons of a mythical phenomenon, opening us up to the question of why so many men have chosen this as their life’s work. Appropriate undergraduate text in criminology and sociology courses; also worthwhile text to be used in Administration of Justice courses at the undergraduate level. Recommended as a general reference in all college level libraries.
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INTRODUCTION TO CRIMINOLOGY. Brendan Maguire. Polly F. Radosh. West/Wadsworth. Excellent and revolutionary text in that it is more than an over-view of the theories and types of criminology. Instead, Maguire and Radosh force the student to first develop and then employ critical thinking skills in order to understand why crime occurs (and why they have developed their own personal perceptions about it):
"Marxist criminology explains crime as a product of capitalist social relations. The powerful in society (capitalists) determine what behaviors are defined as criminal and otherwise control the workings of the criminal justice system. The Marxist theory of crime further suggests that most crimes committed by the powerless are in response to social exploitation and repression."
(Page-249)
I especially liked the way these authors didn’t shy away from issues such as police brutality: by choosing to identify the fact that dirty cops exist they immediately force each student to study the issues of crime from all angles and perspectives. And it is this fact that’s unique in the world of academic writing: rather then take the easy out and tell the student what to think, Maguire and Radosh force students to learn the issues and then think for themselves. This break away from ‘formula’ should signal other textbook writers to open up their minds and examine new approaches. Highly recommended as a classroom text in both Criminal Justice and Administration of Justice courses (future police officers need to read and absorb this kind of material before being graduated from an academy). Also recommended as a general reference text in all academic libraries.
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FORENSIC PSYCHOLOGY. Lawrence S. Wrightsman. Wadsworth. This text, written by Lawrence Wrightsman (a recognized authority in the field) examines the place of the Forensic Psychologist in American culture -- including the myriad roles the Forensic Psychologist plays in the US judicial system. Most of us are familiar with such psychologists testifying at high-profile murder trials, discussing the reasons as to why somebody might have committed a crime (also known as criminal profiling).
However, the work Forensic Psychologists do within the legal system goes far beyond this. The Forensic Psychologist will also act as a trial consultant in a variety of ways, perhaps most importantly in family court settings, making recommendations with regard to child custody/child visitation in the wake of divorce. Forensic Psychologists are also often called to testify in court in rape and battered women cases, describing to a jury the mental anguish victims endure. In short, Forensic Psychologists are asked to describe the inner-workings of the criminal mind in cogent and accessible ways.
Accordingly, Wrightsman has written a detailed and thorough text that avoids the tendency to lecture, instead clearly and concisely imparting information to students -- almost as if he was in court "testifying" to a jury. In preparing the student for professional service, Wrightsman (who teaches at the University of Kansas) takes time to describe job opportunities in the arena of forensic psychology, examining the various requirements of the field so that students can make informed decisions. Recommended as a classroom text, and as a general reference text at the college level.
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FIGHT YOUR TICKET IN CALIFORNIA. David W. Brown. 10th California Edition. Nolo Press.
BEAT YOUR TICKET (Go To Court And Win). David W. Brown. 3rd National Edition. Nolo Press.
This is one of The Electric Review’s consumer picks of the year, and a book every driver should own. Fight, written by Monterey, California attorney David Brown, has been published to educate you about protecting your rights (in California and beyond) from unjust traffic tickets.
In California, law enforcement offices through out the state have been besmeared in recent years with allegations of writing tickets to fill quotas and for engaging in racial profiling. And as much as we’d like to believe these things don’t happen, they most certainly do. However, as bleak as all this sounds, David Brown’s book offers a detailed analysis on just how to effectively defend yourself in court proceedings and protect your driving record:
"Finally, realize that police and prosecutors often have significant influence over the selection and retention of judges. A judge who rules too often against the prosecution may find himself running for re-election without the crucial endorsement of the police and prosecutor’s associations, and perhaps even being challenged by a former prosecutor for being ‘soft on crime.’ "
(From Beat Your Ticket at 3/8)
These are complicated times, and traffic tickets are no longer just an annoyance. Now, they have the power to follow you for years and increase insurance premiums for decades. Thus, Fight Your Ticket is required reading if your operate a motor vehicle in these United States. In his book, Brown advises that drivers should never just pay a ticket without first examining the situation completely. In Fight, Brown describes how to read and assess whether you should fight it out in court or request traffic school. Fight also includes a tremendous amount of detail regarding applicable Vehicle Code sections and the elements prosecutors much satisfy in order to win a conviction (all meant to help successfully prepare you for trial).
Fight, published by Nolo Press (Nolo has been publishing self-help legal books since 1971) is about protecting your rights as a citizen and as a driver. Even though driving is a privilege, it doesn’t mean you relinquish all idea of your Due Process rights just because a cop says you erred on the road. Trust me -- in these times (post George Bush Patriot Act), you can’t afford not to have a copy of this book at hand. Also recommended for all libraries as general reference text.
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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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