Reviewed by Frank Aiello

Sociologist Otto Frank has observed that Western medical treatment involves a compromise between care and efficiency by creating the illusion of involvement. However, this illusion is now showing signs of severe strain as the costs of technology and health services, particularly in America, reach an unconscionable level.

Simply put, few will be able to afford the benefits of scientific medicine or obtain entry into arrogant and greedy healthcare systems which often treat patients as little more than an opportunity to bill an insurance company. Somewhere, in the quest for medical research and research dollars, the physician’s commitment to caring for patients has been lost.

In Medicine and Care, Milton J. Lewis notes that outspoken critics such as Thomas McKeown, Archibald Cochrane, Daniel Callahan and Eric Cassell have argued that high-cost, high-technology medicine is resulting in diminishing returns and an unsustainable system:

“It was a health care system with acute separated from chronic patients, home care form hospital care, and preventative measures from curative services. .. In the United States, Daniel Callahan and Eric Cassell were also calling for medicine to rediscover the lost art of caring. Callahan, on the grounds of humanity and economic sustainability, claimed that the health system had to cease giving primacy to high-technology medicine that aimed to cure all diseases and, in a godlike way, forestall death.” [p. 61]

Lewis further notes that in the mid 1990s, attention was focused on providing palliative care (especially after the publication of a report by the Institute of Medicine of the National Academy of Science, entitled, Approaching Death.And Lewis writes:

“[The report] identified four broad deficiencies in the care of people with incurable conditions: too may suffered from the failure of caregivers to offer effective palliative and supportive care; from caregivers who pursued aggressive treatment known to be ineffectual and even harmful to the dying patient; from regulations and other issues that frustrated the administration of adequate pain control; from fragmented organization that complicated the coordination of care; from Medicare hospice benefits requirements that could not be reconciled with the progression of many terminal illnesses that lack the steady progression of incurable cancer; from fee structures that induced overuse of procedural services but underuse of patient management and supportive services; from deficiencies in the education of health professionals that meant they did not know how to adequately care for dying patients; and finally from insufficient research (biomedical, clinical, epidemiological, and health services) into end-of-life care.” [p. 117]

Palliative care is defined by the author as the alleviation or mitigation of suffering, while palliative medicine is recognized as the management of patients in the throes of far-advanced diseases for whom the focus of care is enhancing quality of life. However, in present-day America, both the government and the healthcare industry appear to staunchly resist the focus on palliative care in favor of generating revenue of the massive medical industry:

“Under Medicare, home care programs did best, but for cost reasons, they used nursing homes for inpatient purposes. These homes, however lacked proper pain control services . . . Physicians tended to resist involvement in hospice programs, often referring only for the home support they offered...Medicare regulations sharpened physician opposition by requiring that patients be classified as terminal before admission to the hospice and the recommendations of the hospice team take precedence over the physician’s.

“Hospices were often in competition for referrals with area hospitals, nursing homes and home health agencies in a period when health care as a whole was facing financial cutbacks resulting form the government’s wish to contain expenditures...Educated, middle-class people disproportionately used the hospice programs. Neither ethnic minorities nor rural patients had adequate access to them…

“Two decades after the first hospices came into being in the United States, conventional health care structures were apparently more able to co-opt hospice than hospice was able to change traditional medical care.” [pp. 138-139]

Lewis writes in a clear and straight-forward manner and does not skirt difficult topic areas, choosing instead to open the eyes of his readers to the fact that sometimes the best medicine is resisting scientific intervention and providing comfort until the hour of death.

In addition to the illuminating information on palliative care and ways that physicians might integrate it into patient-plans, Medicine and Care also contains excellent chapters on the public debate involving pain control and euthanasia and the current state of the ‘right-to die’ movement (which grabbed international headlines recently in the Terri Schiavo case).

Readers and students should pay careful attention: The issues raised Lewis are not going away anytime soon.

Recommended as a primary text in courses that address new approaches to caring for the terminally ill. Further recommended to Health Science libraries as a general reference text – an in depth exploration of medical, sociological and philosophical issues focused on how to help people die in peace and with dignity. ~The Editor.

Now in its 3rd edition, this text from Oxford is recognized for its readability and clear-honed pitch, as the authors delve deeply into the mechanical specifics of how drugs take action on the human body.

As inferred by its title, Medicinal Chemistry focuses on molecular and biochemical principles, looking to unlock some of the mystery of how narcotics work, analyzing the mechanics of drug action on a broad and incisive molecular plane.

The text begins with a strong overview of the primary principles of medical chemistry, before graduating into exploration of the properties of drug molecules and the characteristics of drug receptors (in turn deftly outlining" drug receptor interactions"). Finally, through analysis of these receptors, the reader will be able to draw a discernible link between how disease stalks a human cell and how science might design better chemical compounds that hold the power to isolate pathogens (and then eradicate them from the host).

Nogrady’s and Weaver’s third edition is noted for updated information on myriad areas of study. However, the revised chapter on the immune system is of major importance: As Public Health offices in cities across the world struggle to prepare for a possible outbreak of Avian flu, a more acute understanding of how to use drugs to forestall the spread of viral and bacterial disease is desperately needed. To this end, the data Norgrady and Weaver share is vital, as scientists fight against the clock to build medications which have more striking power against pathogens (but don’t alter the overall balance of the body). Sections on specific drug classes (including medicines for antihypertensive, antiviral, and anticancer drugs) have also seen vast revision, with recent advances in pharmacological research smartly noted.

Aside from its organization (linear in fashion, building from one topic section to the next so as to create an ordered course of study), the value of this manuscript is in its greater social importance: When researchers come to understand the exact way each different drug class acts on human cell structure, they will then be able to design better medicines with fewer side effects and a more complete ability to counter-act disease. This will result in better medicines at more cost-effective pricing, in turn boosting the world-wide economy.

HUMAN BRAIN ANATOMY IN COMPUTERIZED IMAGES. Second Edition. Hanna Damasio. Oxford University Press. Oxford’s place as an academic publisher is personified by this medical science selection: In short, this book is about understanding the makeup of the human brain, a cell-by-cell scientific dissection of our quest for knowledge, this academic testament to our insatiable need to perfect an understanding of the human mind. Here, Damasio presents a compilation of normal brain scans that have been created through the expert anlayis of three-dimensional magnetic resonance images. This title is noteworthy because of the sharp and concrete detail with which it allows the reader to peer into the dimensions of the brain and then assess the varied depths of its neurological landscape.

TEXTBOOK OF PALLIATIVE NURSING. Second Edition. Betty R. Ferrell and Nessa Coyle. Oxford University Press. In medicine’s ultimate journey to cure disease, it sometimes overlooks an obvious issue: What do we do when the patient can’t be cured? How do we gently usher them into death in a dignified and humane manner? In this text, Betty Ferrell (City of Hope National Medical Center)and Nessa Coyle (Memorial Sloan-Kettering Cancer Center) do an exemplary job answering these questions for us in their well-conceived and important nursing manual. Palliative Nursing (now in its second edition) offers concrete direction for hospice and palliative care nurses who are charged with comforting patients in the throes of dying. This title is worthy of firm consideration by both instructors and practicing nurses because it integrates scientific principles (how do we adequately and effectively manage pain) with personal and private topics (how do we help one embark on the journey into the next state) in both compassionate and human terms. Upon completion of this book, the reader is left with a deeper understanding that medicine can only go so far. And when that point is reached and the doctor has taken the patient to the end of the road, it becomes the sole responsibility of the care-giver to be able to alleviate the fear and denial the terminal patient is often struggling against. Simply, no nurse who cares for the terminally ill should be without access to this text.

Recommended as a teaching guide in advanced nursing courses that confront palliative care topics. Required for all hospice care centers as an ‘on-the-job’ resource. Finally, recommended to all Health Science libraries as a general reference text.

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This text by Dr. Prat (Chairman of Pathology University of Barcelona) is unique in both scope and construction -- a manual built for use by the practicing pathologist in the course of patient evaluation, it outlines the anatomy and pathology of the ovary in complete terms.

Pathology begins by surveying the basics of the ovary -- including anatomy and histology. From here, we move into a detailed analysis of the diseases that most commonly strike this region of the body. Well-detailed exploration of all forms of malignancy found in the ovarian system is presented, including discussion of the general features of ovarian cancers (and hereditary factorswhich also influence predisposition to the disease). In addition, readers will find outstanding chapters on Steroid Cell tumors and various Endocrine Syndromes as related to the incidence of ovarian cancer. Over 500 color plates come together to provide quick diagnostic reference points for the clinician, further assisting in swift diagnosis.

The key element to this text is in the fact that it has been written with a keen and practical eye - with an eye focused on the way that pathologists think and work, the information is presented so as to allow it to be accessed in the course of the treatment room. In short, Pathology is not reserved for research or theoretical discussion, but instead, it is also at home in the hands of the doctor who is in the midst of trying to diagnose a patient who presents with ovarian abnormalities.

Prat, known throughout the world as a leading voice on the subject, wrote this text alone and without co-authors. Accordingly, he achieves a continuity in style and presentation here that is sometimes lacking in other medical science texts. It is this trait (coupled with the fact that the book will beimmediately meaningful to the practicing physician) which makes Pathology the authoritative reference in the field.

Recommended to all Health Science libraries as a general reference text. Further recommended to all Gynecologists and Gynecologic Pathologists.

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THE SHOULDER. Charles A. Rockwood Jr. Frederick A. Matsen III. Michael A. Wirth. Steven B. Lippitt. Saunders.

This text marks the primary reference available to the medical community on afflictions of the shoulder, collecting the work of 60 authorities in the field and examining the topic in full detail.

The text begins with an over-view of the anatomy of the shoulder (both gross and developmental). From here, the authors move through exploration of how clinicians can most effectively examine and diagnose patients. A complete discussion of the primary problems that surface during examination is included, with fine chapters on rotator cuff injuries, fractures of the clavicle, fractures of the scapula and nerve abnormalities. Finally, the reader will note that material on tumors and related malignant conditions common to the region has also been included - giving the physician a complete summary of everything that is likely to be encountered in this area of the body. In addition, discussion on all treatment options presently available to the patient is provided.

This third edition contains the latest data available to the clinician regarding both diagnosis and treatment. The authors have done a splendid job in chronicling their subject, directing their audience on every aspect of the shoulder practice:

Employing a comprehensive approach in their style, The Shoulder presents information on anatomy, physical examination, x-ray examination, primary symptoms/causes of disease, as well as the most up-to-date treatment options available. And it is here that the meat of the text is realized: Rockwood (Department of Orthopaedics, University of Texas Health Science Center) and co-authors have done an excellent job in discussing how to proceed with treatment according to the individual needs of the patient.

Cutting edge data on arthroscopic procedures establish the far-reaching advancements that have taken place in the field, and further evidence how this area of medicine has evolved. Obviously, the way that physicians evaluate and treat disorders of the shoulder has changed drastically during the last decade, and this selection gathers the most relevant analysis from the top scholars in the field in one place. In light of this fact, The Shoulder is likely to be the only reference text physicians will use on a daily basis in the course of their practice.

Recommended to all health Science libraries as a general reference text in the area of orthopedics. Further recommended as an in-office reference for all orthopedic specialists reflecting the most current research on the subject. Would also prove useful for sports medicine specialists and physical therapists who work with patients suffering from shoulder injury/disease.

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Of Related Importance

Campbell’s Operative enjoys an esteemed reputation in surgical circles -- for this biblical reference is all-inclusive and contains the most recent data available on invasive orthopedic procedures. Here, Dr. Canale (Campbell Clinic University of Tennessee) and his co-writers analyze over 1,800 surgical procedures in full and comprehensive detail. These four-volumes feature an amazing 9,000 illustrations and graphics which are designed to direct the surgeon through the often delicate intricacies of these procedures. There is literally something for a reviewer to expand on within very page of this text, but the thing that stands out is in the fact that the writers offer multiple treatment approaches for many of the conditions: the lesson here is that the treating physician should tailor therapy to the individual patient and not fall into a routine when presented with typical clinical problems. Also, there is new research and analysis of hip fractures, which will prove especially meaningful to doctors with vast geriatric practices. In addition, the data on elbow and wrist arthroscopy offers sound alternatives for physicians whose focus is sports medicine and injury (or injury related to repetitive motion). Note: The CD-ROM is an added bonus, as it features video clips of ten procedures that are detailed in the text -- creating a hands-on lecture on video thus allowing the practicing surgeon to absorb this information into the deepness of the mind for long-lasting retention.

SKELETAL TRAUMA. 3rd Edition: Basic Science, Management, and Reconstruction. In 2 Volumes. Bruce D. Browner. Jesse B. Jupiter. Alan M. Levine and Peter G. Trafton. Saunders.

In keeping with Campbell’s Operative, Skeletal focuses on advancements in treatment of bone injury. Here, the authors have come up with the definitive specialty text that outlines in comprehensive detail the matters of skeletal trauma. As noted, the focus here is comprehensive, and information on myriad conditions is presented, including cutting-edge material on trauma reconstruction, infection, and management of limb-length discrepancies. 93 contributing writers look into the skeleton of the human body with an eye towards treating common and not-so-common problems. Accordingly, there is a wealth of information on how to confront foot injuries, as well as analysis on total hip-replacement and direction on deformity correction. In light of the myriad subject matter collected here, this text will prove valuable to the many layers of the medical community who routinely encounter skeletal trauma - from Radiologists and Emergency Room personnel to Orthopedic Surgeons (and Physical Therapists responsible for post-op care).

SHOULDER ARTHROSCOPY. Gary M Gartsman. Saunders.

Like the Rockwood title reviewed above, Gartsman (University of Texas Health Science Center) has developed a text that covers the burgeoning arena of arthroscopic surgery of the shoulder in bright detail. Gartsman, widely considered an expert in the field, offers analysis of both complex and simple procedures, with especially relevant material on rotator cuff injuries, as well as treatment options for osteoarthritis (a huge problem in many female geriatric patients). Nearly 1,000 images augment Gartsman’s treatise -- offering the surgeon a visual demonstration as he makes his way through the material. Additionally, the video portion of the CD-ROM provides a step-by-step road map advising the surgeon on how to proceed through an arthroscopic procedure. A wealth of information is presented in a clear and practical package, making this required reading for all Orthopedic Surgeons who treat afflictions of the shoulder.

Each selection is recommended tohealth Science libraries for their value as general reference texts. Further recommended asin-office references for all orthopedic specialists reflecting the most current research on the subject. Would also prove useful for sports medicine specialists and physical therapists who work with patients suffering from skeletal injury/disease. Finally, recommended to Emergency Room physicians for relevant direction on assessing and treating traumatic injuries of the human skeleton.

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Now in its 7th edition, Alcamo’s Fundamentals of Microbiology marks the consummate teaching text in the discipline, reviewing each of its major components. The text begins with a broad overview, exploring how Microbiology came to be recognized as an independent area of study.

From here, the reader will be able to examine the basic concepts of chemistry in relation to Microbiology. With the foundation now built for deeper study, the reader will be engaged in an analysis of bacteria and how it constructs the various diseases that impact the human species; this includes a well-researched chapter on airborne bacterial disease. Further, information on micro-organisms (the virus and the fungi) is presented, in addition to thorough discussion on resistance and immune-related disorders.

Because of the way it’s written, Alcamo’s makes complex material accessible to the student reader. Microbiology is one of the most complex areas of study in all the medical sciences, and Pommerville (Professor of Biology at Glendale Community College) does an admirable job in keeping Alcamo’s readable.

Too many times science writers tend to become taken with their knowledge of the subject material, losing sight of the fact that the young reader cannot "keep up." However, this problem does not befall Alcamo’s. Instead, the time has been taken to present introductory notes to the student on how to use a textbook. As "basic" as this may sound, do not over-look its importance: instead of jumping into the core of the course material, Pommerville moves into it slowly, allowing the student to absorb the basics that must be learned before advancement in the subject area can be achieved.

There is also a continual impetus here to teach "science as a process of knowing" - a concept which is vital as the student begins to explore the idea of Microbiology in conjunction with the modern practice of medicine. In short, this book has been written for application within the profession rather than mere theoretical study, and it achieves its mission admirably.

Recommended to all Health Science libraries as a general reference text - the material here is presented in a clear and concise manner, with the idea to inspire the student to more in depth study. Further recommended as a classroom text in all Allied Health subjects, and in all nursing programs which explore Microbiology theories.

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GRAY’S ANATOMY E-DITION. The Anatomical Basis Of The Clinical Practice. 39th Edition. Edited by Susan Standring. Churchill-Livingstone/Elsevier.

There is a reason this text has been around for nearly 150 years -- it is simply the best at what it does - surveying the scope of the human anatomy so that the health care community can use it as a resource in the daily course of patient treatment.

Gray’s offers so much to its audience that it is impossible for a reviewer to touch on all its significant attributes. However, wrapped up here in its brand new format, the design has been updated to better reflect how doctors practice medicine. The idea here is practicality, and E-Edition is organized according to body region rather than organ system, making it easier for physicians to use in the examining room. This 39th edition is also careful to reflect the changing course of medicine, with inclusion of data on the inner ear, pelvic floor and endoscopic imaging (among so many other relatively new interests of concentration).

To last for a century and a half, you have to be very good at what you do. And that’s why we have to recommend Gray’s - it is abundantly good at everything it does. And it’s best selling point is that it is bold enough to keep up with the times. This E-Edition (the package contains the text, plus the CD-ROM, plus the on-line access) is quite a bold undertaking - bringing Gray’s amazing breadth of knowledge to the age of technology.

Remember, the many generations that grew up on Gray’s were use to seeing it in its stodgy book form, unaccustomed to seeing it spruced up on computer disk, unaccustomed to seeing the text come springing to electronic life. But by issuing this text in a companion electronic edition, Elsevier has given doctors the chance to obtain continuing web site updates on the subject matter in the comfort of their own offices. Further, these doctors can also use the CD-ROM in conjunction with the text to gain even more from the elaborate images/illustrations. Obviously, our new generation of physicians who have grown up on computers will relish the E-Edition because it has kept up with the way medicine is moving throughthe 21st century.

Even though its 150 years old, Gray’s has been careful to stay current with the changes in medicine, maintaining its place as the elder master of every doctor’s medical library.

Recommended to all physicians as an in-office reference manual. Recommended as a class text in all anatomy courses at both the medical schooland general college level. Recommended to all Health Science libraries as a general reference text. The best anatomy text for the last century.

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PHOTOAGING. Edited by Darrell S. Rigel. Robert A. Weiss. Henry W. Lim. Jeffrey S. Dover. Marcel Dekker.

This collection of treatises by some of the leading voices in Dermatological Science examine the effects of the sun on the aging process of skin, looking at the phenomenon in connection with the various treatments clinicians can use to combat symptoms and pathology.

The authors, led by Darrell Rigel (a Professor of Dermatology at New York University School of Medicine) do an exceptional job looking at photoaging in comprehensive terms, beginning their text by exploring the reasons why skin ages in the first place. From here, we are led into a discussion of the effects of UV rays on the human body. It is believed that long-term exposure to UV is at the root of photoaging, and the authors do a fine job is dissecting this topic, instructing the physician on what to look for in the patient who presents with sun-compromised skin (further speaking to how clinicians should approach the study of the effects of UV on the skin).

In addition, a full analysis of all available treatments doctors can use to help restore damaged skin is included (along with achapter reviewing the particular legal issuespertinent tophysicians who treat patients with photoaged skin).

The comprehensive nature of this text gives it immediate, broad-based reference value to physician, student and researcher. The best aspect of Photoaging is that it deals with the whole of the subject in a detailed and well-organized format. Although it will be of deep value to practicing Dermatologists, the book does a good job in addressing the subject in terms that will be meaningful to the internist and primary care physician as well.

All available treatment options have been examined, with vital chapters on Chemical Peels, Ablative Laser Resurfacing and Fat Transplantation. However, the most timely chapter expands on the use of Botulinum Toxin A in Photoaging, as Bo-Tox is being used more frequently across the country to combat sagging skin. Since patients are likely to be coming to their doctors requesting Bo-Tox treatments more and more in the future, doctors need to have a full understanding of what this course of therapy entails.

Moreover, the authors have also taken the time to address the fact that differences in patient skin require the doctor to tailor treatments to individual needs and genetics - in short, this is not a "one size fits all" area of medicine, and these authors do a laudable job in bringing the point across.

Recommended to all Health Science libraries as a general reference text. Further recommended to all Dermatologists and internists as an in-office reference presenting cutting-edge research and discussion on the effects of photoaging on human skin.

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By formatting the text in this step-by-step manner, the authors work to build a sound and solid foundation which lets the reader absorb the finer points of oculofacial surgery. Accordingly, this is where the meat of the text is found: Chen, Khan and McCord provide vital counsel in all phases of reconsturctive surgery, touching on the latest advancements in technique and treatment.

Physicians who access Color Atlas will receive expert instruction on Botox application and laser surgery, as well as laser resurfacing procedures to be used in conjunction with drug therapy. There is also an in depth chapter on Asian blepharoplasty with cross-sectional line drawings that note the differences between the Asian and Caucasian upper eyelid structure - a segment that allows the surgeon to study the intricate nature of this facial region in detail before scalpel ever touches skin. Well-used illustrations abound, including line-drawings and color frames which address anatomy as well as surgical methods.

In Color Atlas, Chen and his co-authors have provided a deeply layered text: this book will be looked on as "the authority" in the realm of Oculofacial Surgery for decades to come.

Recommended as in office reference for plastic surgeons, ophthalmologists and head/neck surgeons. Also recommended to all Health Science libraries as a general reference text. Finally, Color Atlas would be a sensible choice as a teaching text in any course addressing oculofacial surgical techniques.

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Note: Campbell’s is also available in CD-ROM applicable to both Windows and Macintosh systems. The CD contains the full text of the four volume set, additional images, plus the second edition of the Campbell’s Urology Study Guide (see our review of the Study Guide in the Library Advisory on the Industry News Page).

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