Harriet S.MeyerMD, Contributing EditorJonathan D.EldredgeMLS, PhD, Journal Review EditorRobertHoganMD, adviser for new media
by Nortin M. Hadler, 2nd ed, 433 pp, with illus, $75, ISBN 0-7817-1495-8, Philadelphia, Pa, Lippincott Williams & Wilkins, 1999.
When Archimedes elaborated the principle of the lever, he could rightly claim that if given a place to stand, he would move the world. Nortin Hadler makes no such hubristic claim in this second edition of his notable book, but if read by physicians, lawyers, lawmakers, and administrators in and out of the government, it would change the way we diagnose, treat, and even look at medicine as it pertains to the musculoskeletal system.
Like Francis Fukuyama, whose latest book, The Great Disruption, calls for "biologically informed approaches to psychology and anthropology," Hadler calls for that and more. The emperor of nosology wears no clothes; such terms as fibromyalgia and repetitive strain syndrome are meaningless descriptors based on flawed research, leading to much mischief and cost. Such terms can convince suffers that they are sick and disabled when instead they may be experiencing transient discomfort, bringing the might of government and tort law into play in the wrong arenas. With erudite historical perspective, Hadler deconstructs maladies now termed injuries. He shows how the appellation ruptured disc suggests cataclysmic events when the discal herniation may not be a major contributor to back symptoms. He shows how an industry of invasive surgery to the back and wrists grew out of unproven attributions, and how disability may grow out of disaffection and dissatisfaction. In other words, don't let the title fool you: this is a book of philosophy, with strong personal opinions unapologetically delivered by an author not afraid to speak in the first person and willing to back up assertions with documentation.
Musculoskeletal DisordersOccupational Musculoskeletal Disorders. JAMA. 2000;283(2):260-261. doi:10.1001/jama.283.2.260-JBK0112-2-1