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Books, Journals, New Media
August 23/30, 2000

Fiction

Author Affiliations
 

Books, Journals, New Media Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA; David H. Morse, MS, University of Southern California, Norris Medical Library, Journal Review Editor; adviser for new media, Robert Hogan, MD, San Diego.

JAMA. 2000;284(8):1029. doi:10.1001/jama.284.8.1029

EthicsFrom Chance to Choice: Genetics and Justice

by Allen Buchanan, Dan W. Brock, Norman Daniels, and Daniel Wikler, 398 pp, $29.95, ISBN 0-521-66001-7, New York, NY, Cambridge University Press, 2000.
GeneticsA Passion for DNA: Genes, Genomes, and Society
by James D. Watson, 250 pp, $25, ISBN 0-87969-581-1, Cold Spring Harbor, NY, Cold Spring Harbor Laboratory Press, 2000 (essays).
The Second Creation: Dolly and the Age of Biological Control
by Ian Wilmut, Keith Campbell, and Colin Tudge, 333 pp, $27, ISBN 0-374-14123-1, New York, NY, Farrar, Straus & Giroux, 2000 (book for popular audiences by the team that cloned "Dolly").
Health SystemsArthur Andersen Guide to Navigating Intermediate Sanctions: Compliance and Documentation Guidelines for Health Care and Other Tax-Exempt Organizations
by Diane Cornwell, Anne M. McGeorge, Jeffrey D. Frank, and Vincent J. Crowley, 128 pp, 3-ring binder with tabs, includes diskette containing charts, $159.95, ISBN 0-7879-5214-1, paper, ISBN 0-7879-5038-6, San Francisco, Calif, Jossey-Bass Publishers, 2000.
Customer Service in Health Care: A Grassroots Approach to Creating a Culture of Service Excellence
by Kristin Baird, 162 pp, paper, $34.95, ISBN 1-55648-269-8, San Francisco, Calif, Jossey-Bass Publishers, 2000.
Health Care in the New Millennium: Vision, Values, and Leadership
by Ian Morrison, 260 pp, $39.95, ISBN 0-7879-5115-3, San Francisco, Calif, Jossey-Bass Publishers, 2000.
Health Data Quest: How to Find and Use Data for Performance Improvement
by Jill Lenk Schilp and Roy E. Gilbreath, 230 pp, $45.95, ISBN 0-7879-4155-7, San Francisco, Calif, Jossey-Bass Publishers, 2000.
Informing American Health Care Policy: The Dynamics of Medical Expenditure and Insurance Surveys, 1977-1996
edited by Alan C. Monheit, Renate Wilson, and Ross H. Arnett, III, 242 pp, $44.95, ISBN 0-7879-4599-4, San Francisco, Calif, Jossey-Bass Publishers, 1999.
Medical Staff Peer Review: Motivation and Performance in the Era of Managed Care
by Daniel A. Lang, 292 pp, paper, $34.95, ISBN 1-55648-266-3, Chicago, Ill, American Hospital Association Press, 1999.
Next Generation Physician-Health System Partnerships
by Craig E. Holm, 195 pp, paper, $49, ISBN 1-56793-124-3, Chicago, Ill, Health Administration Press, 2000.
Shrinking Time for Health Administrators: Father-Daughter Psychiatrists Discuss Time Management
by Walter E. Barton and Gail M. Barton, 98 pp, paper, $9, ISBN 0-8059-4509-1, Pittsburgh, Pa, Dorrance Publishing, 1999.
Winning in the Women's Health Care Marketplace: A Comprehensive Plan for Health Care Strategists
by Genie James, 271 pp, $44.95, ISBN 0-7879-4444-0, San Francisco, Calif, Jossey-Bass Publishers, 2000.
Infectious DiseaseHigh-Yield Microbiology and Infectious Diseases
by Louise B. Hawley, 190 pp, soft cover, $15.95, ISBN 0-683-30277-9, Philadelphia, Pa, Lippincott Williams & Wilkins, 2000.
Infection Highlights 1999-2000
edited by Mark H. Wilcox (Fast Facts), 87 pp, paper, $19.95, ISBN 1-899541-19-5, San Francisco, Calif, Health Press, 2000.
OphthalmologyPenetrating Keratoplasty: Diagnosis and Treatment of Postoperative Complications
by Maria Severin and Karl Ulrich Bartz-Schmidt, 145 pp, with illus, $84, ISBN 3-540-66491-2, New York, NY, Springer-Verlag, 2000.
Principles and Practice of Ophthalmology
edited by Daniel M. Albert and Frederick A. Jakobiec, 2nd ed, one CD-ROM, requires 640 × 840 monitor, 256 colors, 16 MB RAM, 6 MB free space, 2 × CD drive, Win 95, 98, 2000, or NT, 486 SX or Mac 68040, System 7.6.1, $950, ISBN 0-7216-8614-1, Philadelphia, Pa, WB Saunders, 2000.
OrthopedicsThe Elbow and Its Disorders
by Bernard F. Morrey, 3rd ed, 933 pp, with illus, $225, ISBN 0-7216-7752-5, Philadelphia, Pa, WB Saunders, 2000.
Interfaces in Total Hip Arthroplasty
edited by Ian D. Learmonth, 167 pp, with illus, $106, ISBN 1-85233-205-0, New York, NY, Springer-Verlag, 2000.
Manual of Cable Osteosyntheses: History, Technical Basis, Biomechanics of the Tension Band Principle, and Instructions for Operation
by Reiner Labitzke, 187 pp, with illus, $119, ISBN 3-540-66508-0, New York, NY, Springer-Verlag, 2000.
Review of Orthopaedics
by Mark D. Miller and Mark R. Brinker, 3rd ed, 622 pp, with illus, paper, $59, ISBN 0-7216-8153-0, Philadelphia, Pa, WB Saunders, 2000.
Surgical Reconstruction of the Upper Extremity
by James H. Herndon, 1055 pp, with illus, $225, ISBN 0-8385-9304-6, Stamford, Conn, Appleton & Lange, 2000.
Pharmacology-TherapeuticsAtypical Antipsychotics
edited by B. A. Ellenbroek and A. R. Cools (Milestones in Drug Therapy), 236 pp, $139, ISBN 3-7643-5948-X, New York, NY, Springer-Verlag, 2000.
Bipolar Medications: Mechanisms of Action
edited by Husseini K. Manji, Charles L. Bowden, and Robert H. Belmaker, 440 pp, $58.50, ISBN 0-88048-927-8, Washington, DC, American Psychiatric Press, 2000.
IDI: Instant Drug Index
by Patricia Aloisi, 210 pp, spiral-bound, $29.95, ISBN 0-632-04523-X, Malden, Mass, Blackweill Science, 2000 (lists of drugs and relevant body systems).
Pharmacology: Drug Actions and Reactions
by Ruth R. Levine, 6th ed, 573 pp, paper, $51.45, ISBN 1-85070-497-X, New York, NY, Parthenon Publishing, 2000.
PsychiatryAmerican Psychiatric Association Practice Guidelines for the Treatment of Psychiatric Disorders: Compendium 2000
738 pp, $64.95, ISBN 0-89042-312-1, paper, $49.95, ISBN 0-89042-315-6, Washington, DC, American Psychiatric Press, 2000.
Complementary and Alternative Medicine and Psychiatry
edited by Philip R. Muskin (Review of Psychiatry, vol 19, No. 1), 275 pp, paper, $28.50, ISBN 0-88048-174-9, Washington, DC, American Psychiatric Press, 2000.
Concise Guide to Consultation-Liaison Psychiatry
by James R. Rundell and Michael G. Wise, 3rd ed, 350 pp, paper, $22.95, ISBN 0-88048-394-6, Washington, DC, American Psychiatric Press, 2000.
A Cry Unheard: New Insights into the Medical Consequences of Loneliness
by James J. Lynch, 345 pp, $26.95, ISBN 1-890862-11-8, Baltimore, Md, Bancroft Press, 2000.
Current Diagnosis and Treatment in Psychiatry
edited by Michael H. Ebert, Peter T. Loosen, and Barry Nurcombe, 640 pp, paper, $54.95, ISBN 0-8385-1462-6, New York, NY, McGraw-Hill, 2000.
Elements of Clinical Research in Psychiatry
by James E. Mitchell, Ross D. Crosby, Stephen A. Wonderlich, and David E. Adson, 207 pp, $34.50, ISBN 0-88048-802-6, Washington, DC, American Psychiatric Press, 2000.
Ethnicity and Psychopharmacology
edited by Pedro Ruiz (Review of Psychiatry, vol 19, No. 4), 139 pp, paper, $28.50, ISBN 0-88048-274-5, Washington, DC, American Psychiatric Press, 2000.
Handbook of Psychiatry in Palliative Medicine
edited by Harvey Max Chochinov, 435 pp, $79.50, ISBN 0-19-509299-6, New York, NY, Oxford University Press, 2000.
Pain: What Psychiatrists Need to Know
edited by Mary Jane Massie (Review of Psychiatry, vol 19, No. 2), 188 pp, paper, $28.50, ISBN 0-88048-173-0, Washington, DC, American Psychiatric Press, 2000.
Practice Guideline for the Treatment of Patients With Major Depressive Disorder
edited by American Psychiatric Association, 2nd ed, 87 pp, paper, $24.50, ISBN 0-89042-316-4, Washington, DC, American Psychiatric Press, 2000.
Psychodynamic Psychiatry in Clinical Practice
by Glen O. Gabbard, 3rd ed, 597 pp, $79.95, ISBN 1-58562-002-5, Washington, DC, American Psychiatric Press, 2000.
Psychotherapy for Personality Disorders
edited by John G. Gunderson and Glen O. Gabbard (Review of Psychiatry, vol 19, No. 3), 167 pp, paper, $28.50, ISBN 0-88048-273-7, Washington, DC, American Psychiatric Press, 2000.
What's Normal: Narratives of Mental and Emotional Disorders
edited by Carol Donley and Sheryl Buckley (Literature and Medicine), 355 pp, paper, $26, ISBN 0-87338-653-1, Kent, Ohio, Kent State University Press, 2000 (literary anthology).
Public HealthFeeding the World: A Challenge for the Twenty-First Century
by Vaclav Smil, 360 pp, $32.95, ISBN 0-262-19432-5, Cambridge, Mass, MIT Press, 2000.
Health and Welfare for Families in the 21st Century
edited by Helen M. Wallace (The Jones & Bartlett Series in Nursing), 616 pp, paper, $46.95, ISBN 0-7637-0867-4, Sudbury, Mass, Jones & Bartlett Publishers, 1999.
ReferenceDorland's Illustrated Medical Dictionary
by Douglas M. Anderson, 2088 pp, with illus, $46.95, ISBN 0-7216-6254-4, Philadelphia, Pa, WB Saunders, 2000.
The Medical Abacus: Review of Clinical Formulas and How to Use Them
by David Rifkind, 69 pp, paper, $21.95, ISBN 1-85070-023-0, New York, NY, Parthenon Publishing, 2000.
UrologyVoiding Dysfunction: Diagnosis and Treatment
edited by Rodney A. Appell (Current Clinical Urology), 341 pp, with illus, $99.50, ISBN 0-896-03659-6, Totowa, NJ, Humana Press, 2000.

by Allen Buchanan, Dan W. Brock, Norman Daniels, and Daniel Wikler, 398 pp, $29.95, ISBN 0-521-66001-7, New York, NY, Cambridge University Press, 2000.

by James D. Watson, 250 pp, $25, ISBN 0-87969-581-1, Cold Spring Harbor, NY, Cold Spring Harbor Laboratory Press, 2000 (essays).

by Ian Wilmut, Keith Campbell, and Colin Tudge, 333 pp, $27, ISBN 0-374-14123-1, New York, NY, Farrar, Straus & Giroux, 2000 (book for popular audiences by the team that cloned "Dolly").

by Diane Cornwell, Anne M. McGeorge, Jeffrey D. Frank, and Vincent J. Crowley, 128 pp, 3-ring binder with tabs, includes diskette containing charts, $159.95, ISBN 0-7879-5214-1, paper, ISBN 0-7879-5038-6, San Francisco, Calif, Jossey-Bass Publishers, 2000.

by Kristin Baird, 162 pp, paper, $34.95, ISBN 1-55648-269-8, San Francisco, Calif, Jossey-Bass Publishers, 2000.

by Ian Morrison, 260 pp, $39.95, ISBN 0-7879-5115-3, San Francisco, Calif, Jossey-Bass Publishers, 2000.

by Jill Lenk Schilp and Roy E. Gilbreath, 230 pp, $45.95, ISBN 0-7879-4155-7, San Francisco, Calif, Jossey-Bass Publishers, 2000.

edited by Alan C. Monheit, Renate Wilson, and Ross H. Arnett, III, 242 pp, $44.95, ISBN 0-7879-4599-4, San Francisco, Calif, Jossey-Bass Publishers, 1999.

by Daniel A. Lang, 292 pp, paper, $34.95, ISBN 1-55648-266-3, Chicago, Ill, American Hospital Association Press, 1999.

by Craig E. Holm, 195 pp, paper, $49, ISBN 1-56793-124-3, Chicago, Ill, Health Administration Press, 2000.

by Walter E. Barton and Gail M. Barton, 98 pp, paper, $9, ISBN 0-8059-4509-1, Pittsburgh, Pa, Dorrance Publishing, 1999.

by Genie James, 271 pp, $44.95, ISBN 0-7879-4444-0, San Francisco, Calif, Jossey-Bass Publishers, 2000.

by Louise B. Hawley, 190 pp, soft cover, $15.95, ISBN 0-683-30277-9, Philadelphia, Pa, Lippincott Williams & Wilkins, 2000.

edited by Mark H. Wilcox (Fast Facts), 87 pp, paper, $19.95, ISBN 1-899541-19-5, San Francisco, Calif, Health Press, 2000.

by Maria Severin and Karl Ulrich Bartz-Schmidt, 145 pp, with illus, $84, ISBN 3-540-66491-2, New York, NY, Springer-Verlag, 2000.

edited by Daniel M. Albert and Frederick A. Jakobiec, 2nd ed, one CD-ROM, requires 640 × 840 monitor, 256 colors, 16 MB RAM, 6 MB free space, 2 × CD drive, Win 95, 98, 2000, or NT, 486 SX or Mac 68040, System 7.6.1, $950, ISBN 0-7216-8614-1, Philadelphia, Pa, WB Saunders, 2000.

by Bernard F. Morrey, 3rd ed, 933 pp, with illus, $225, ISBN 0-7216-7752-5, Philadelphia, Pa, WB Saunders, 2000.

edited by Ian D. Learmonth, 167 pp, with illus, $106, ISBN 1-85233-205-0, New York, NY, Springer-Verlag, 2000.

by Reiner Labitzke, 187 pp, with illus, $119, ISBN 3-540-66508-0, New York, NY, Springer-Verlag, 2000.

by Mark D. Miller and Mark R. Brinker, 3rd ed, 622 pp, with illus, paper, $59, ISBN 0-7216-8153-0, Philadelphia, Pa, WB Saunders, 2000.

by James H. Herndon, 1055 pp, with illus, $225, ISBN 0-8385-9304-6, Stamford, Conn, Appleton & Lange, 2000.

edited by B. A. Ellenbroek and A. R. Cools (Milestones in Drug Therapy), 236 pp, $139, ISBN 3-7643-5948-X, New York, NY, Springer-Verlag, 2000.

edited by Husseini K. Manji, Charles L. Bowden, and Robert H. Belmaker, 440 pp, $58.50, ISBN 0-88048-927-8, Washington, DC, American Psychiatric Press, 2000.

by Patricia Aloisi, 210 pp, spiral-bound, $29.95, ISBN 0-632-04523-X, Malden, Mass, Blackweill Science, 2000 (lists of drugs and relevant body systems).

by Ruth R. Levine, 6th ed, 573 pp, paper, $51.45, ISBN 1-85070-497-X, New York, NY, Parthenon Publishing, 2000.

738 pp, $64.95, ISBN 0-89042-312-1, paper, $49.95, ISBN 0-89042-315-6, Washington, DC, American Psychiatric Press, 2000.

edited by Philip R. Muskin (Review of Psychiatry, vol 19, No. 1), 275 pp, paper, $28.50, ISBN 0-88048-174-9, Washington, DC, American Psychiatric Press, 2000.

by James R. Rundell and Michael G. Wise, 3rd ed, 350 pp, paper, $22.95, ISBN 0-88048-394-6, Washington, DC, American Psychiatric Press, 2000.

by James J. Lynch, 345 pp, $26.95, ISBN 1-890862-11-8, Baltimore, Md, Bancroft Press, 2000.

edited by Michael H. Ebert, Peter T. Loosen, and Barry Nurcombe, 640 pp, paper, $54.95, ISBN 0-8385-1462-6, New York, NY, McGraw-Hill, 2000.

by James E. Mitchell, Ross D. Crosby, Stephen A. Wonderlich, and David E. Adson, 207 pp, $34.50, ISBN 0-88048-802-6, Washington, DC, American Psychiatric Press, 2000.

edited by Pedro Ruiz (Review of Psychiatry, vol 19, No. 4), 139 pp, paper, $28.50, ISBN 0-88048-274-5, Washington, DC, American Psychiatric Press, 2000.

edited by Harvey Max Chochinov, 435 pp, $79.50, ISBN 0-19-509299-6, New York, NY, Oxford University Press, 2000.

edited by Mary Jane Massie (Review of Psychiatry, vol 19, No. 2), 188 pp, paper, $28.50, ISBN 0-88048-173-0, Washington, DC, American Psychiatric Press, 2000.

edited by American Psychiatric Association, 2nd ed, 87 pp, paper, $24.50, ISBN 0-89042-316-4, Washington, DC, American Psychiatric Press, 2000.

by Glen O. Gabbard, 3rd ed, 597 pp, $79.95, ISBN 1-58562-002-5, Washington, DC, American Psychiatric Press, 2000.

edited by John G. Gunderson and Glen O. Gabbard (Review of Psychiatry, vol 19, No. 3), 167 pp, paper, $28.50, ISBN 0-88048-273-7, Washington, DC, American Psychiatric Press, 2000.

edited by Carol Donley and Sheryl Buckley (Literature and Medicine), 355 pp, paper, $26, ISBN 0-87338-653-1, Kent, Ohio, Kent State University Press, 2000 (literary anthology).

by Vaclav Smil, 360 pp, $32.95, ISBN 0-262-19432-5, Cambridge, Mass, MIT Press, 2000.

edited by Helen M. Wallace (The Jones & Bartlett Series in Nursing), 616 pp, paper, $46.95, ISBN 0-7637-0867-4, Sudbury, Mass, Jones & Bartlett Publishers, 1999.

by Douglas M. Anderson, 2088 pp, with illus, $46.95, ISBN 0-7216-6254-4, Philadelphia, Pa, WB Saunders, 2000.

by David Rifkind, 69 pp, paper, $21.95, ISBN 1-85070-023-0, New York, NY, Parthenon Publishing, 2000.

edited by Rodney A. Appell (Current Clinical Urology), 341 pp, with illus, $99.50, ISBN 0-896-03659-6, Totowa, NJ, Humana Press, 2000.

Fiction

Shou

by Deborah Shlian and Joel N. Shlian, 419 pp, paper $17.95, ISBN 158348759, iUniverse.com, Lincoln, Neb, ToExcel, 1999.

Shou is a powerful and compelling drama by two family physicians, who practiced medicine together and now write together. This, their third and most ambitious novel to date, is set in China, Korea, Hong Kong, and the United States. It chronicles the journey of Lili Quan, a young Chinese-American physician, as she fulfills her mother's dying wish for her to return home.

A medical mystery, international thriller, and bittersweet love story, most of Shou is set in the tumultuous weeks surrounding the Tianamen massacre in 1989. While greedy and ambitious men vie for the most earth-shattering discovery since the atom bomb, Lili, a passionate idealist, meets and falls in love with Chi-Wen Zhou, a victim of the Cultural Revolution and a romantic Taoist. Their relationship blossoms, plunging them into the midst of the international intrigue surrounding this startling medical discovery. Their diverse cultural backgrounds and unique perspectives form a fascinating backdrop for understanding the turmoil of recent Chinese history.

Shou opens in May 1949, as Mao Zedong and his People's Liberation Army are poised to enter Shanghai and alter China forever. For most Chinese, who have suffered for so long under numerous oppressive regimes, Communism offers new hope. For Dr Ni-Fu Cheng, a British-trained doctor and researcher, it is neither better nor worse than other political systems. He believes that only modern science will enable the Chinese people to truly compete with the outside world. This belief, coupled with his unwavering love for his country, forces him to remain in China even as he sends his daughter, his only living relative, to the United States. On the verge of a spectacular medical discovery that could also change China, he never fears for his own safety. He will soon have the ultimate solution to unlocking the secret of longevity, the ability to increase the human life span well beyond the allotted three score years and ten. He names this discovery "Shou," after a Chinese symbol for longevity.

Forty years later, now a wiser and tempered 75 years, Cheng has finally found and perfected his secret. But he is now less certain that his discovery will be the greatest gift to humankind. His beloved China is in upheaval, as young students begin to question the corrupting leadership of the old. Able to work in complete secrecy at the Xi'an Institute while Mao lived, Cheng is suddenly caught by the new medical director. A loyal party member, the new director immediately reports to his three superiors, all octogenarians who helped Mao bring communism to China. Now they fear that the new reform policies threaten their power. A potion to "cheat" death might give them the time they need to suppress those who question their authority and motives, and they will go to any lengths to force the secret from Dr Cheng—including plotting to lure his physician-granddaughter, Lili, to China.

This book is clearly a stretch beyond the Shlians' two previous medical mystery thrillers. In Shou, the authors venture outside the confines of an enjoyable, easy read and explore such weighty themes as the implications of prolonging life on earth: overpopulation, generational conflicts, the impact on world resources, ethical and moral dilemmas inherent in this kind of clinical research, and the globalization of the pharmaceutical industry. These are all issues of importance to physicians as we move into the next millennium.

The Shlians have obviously done considerable research. Their book is loaded with historical, political, and medical facts. In 419 pages, the authors weave a complicated yet thoroughly engaging plot. At its heart lies Lili Quan. Born in San Francisco, Lili is Chinese but she can not reconcile her cultural and ethnic heritage with her identification as an American. Becoming a physician is her way of defining herself outside of other labels. It is only when Lili travels to China that she completes her search and confronts her denial of her heritage, finding her grandfather, her past, love and, ultimately, acceptance of herself.

Taken as history alone, this is a fascinating book. By the end of Shou, the reader begins to understand China, as well as contemplating some of life's biggest questions. Because of its medical focus in this interesting setting, physicians especially will enjoy this book.

Brain Pioneers

Minds Behind the Brain: A History of Brain Pioneers and Their Discoveries

by Stanley Finger, 364 pp, $35, ISBN 0-19-508571-X, New York, NY, Oxford University Press, 2000.

Whereas many history books trace scientific movements and the development of theory or institutions, the people behind the science, their personal lives, ambitions, and biases, are often left aside. As a result, reading scientific history can lose the link to human history, and for general readers as well as scientists the investment and lessons learned remain abstract.

To counteract this phenomenon, Stanley Finger has composed a series of biographical sketches in Minds Behind the Brain. He has selected approximately 15 neuroscientists, anatomists, physiologists, chemists, and clinicians whose contributions to modern science remain vital and whose biographical details have direct bearing on the evolution of their thoughts and contributions. The individuals include Hippocrates and Galen; Vesalius and Descartes; Willis; the great thinkers on cortical localization theory, including Gall, Broca, Ferrier, and Hitzig; and the celebrated 19th-century clinicians and experimentalists Charcot, Ramon y Cajal, and Sherrington. The 20th century is represented by Adrian, Loewi and Dale, Sperry, and the one woman in the book, Rita Levi-Montalcini.

The choice is admittedly subjective, but each biographical study justifies the exploration of the person behind the science. In an accessible, 15-to-20 page essay, each chapter covers a scientist's life and career in the context of both the social and scientific milieu of the epoch. Finger's breadth of historical and medical knowledge and keen rendering of personality traits lifts these scientists out of the past and brings them into the present with vibrancy and clarity. Extensive portraits, drawings, and scientific iconography accompany the text and enrich the reading. The antique color of the paper and attention to detail in the book design add to the pleasure of reading.

The work is based on secondary sources, so research scholars are not likely to learn any new information or unearth new documents through this work. This book is not original research but, rather, synthesis and interpretation. It serves as the natural companion to Finger's earlier work, Origins of Neuroscience, in which people were largely relegated to second place against the monuments of scientific theory and the evolution of experimentation. Here, the people come forward and serve as the vehicle for a clearer understanding and perspective on science. Whereas Albert Camus and other philosophers argued against the utility of knowing a man's life to understand his work, this book admirably demonstrates the added perspective on scientific history gleaned when we understand the person as well as the science.

Brain Policy

Brain Policy: How the New Neuroscience Will Change Our Lives and Our Politics

by Robert H. Blank, 199 pp, $60, ISBN 0-87840-712-X, paper, $21.95, ISBN 0-87840-713-8, Washington, DC, Georgetown University Press, 1999.

The brain is the substrate for the person. As science delves deeper into the basic biology of the brain, we are learning to alter the brain's fundamental processes in our quest to cure neurological diseases. These alterations, in turn, will affect personhood. Since many of our laws and policies are aimed at protecting personhood and the rights of individuals, interventions that affect the brain have ramifications for policy.

We live in a time in which this resonance between neuroscience and policy is of increasing importance. In the past few decades, neuroscience has emerged as a final frontier. The US population is aging, resulting in a rising incidence of neurological diseases, especially the neurodegenerative diseases and stroke. Never before have individuals been surviving longer with major alterations in their personhood, such as paralysis, aphasia, dementia, and movement disorders. At the same time, despite the profound impact of these diseases and our ever-increasing ability to intervene in their natural history, there is considerable confusion in the realm of policy.

In Brain Policy Robert Blank points out many of the challenges–and opportunities–that await us in our attempt to orchestrate policy that is practical yet sensitive to the ongoing advances in the neurosciences. The challenges are protean and interrelated. Blank notes that there does not exist a body analogous to the US Food and Drug Administration to regulate neurosurgical procedures. Who should decide whether a new procedure is ethical? What kinds of studies will be required? Informed consent for such studies in patients with alterations in their personhood is particularly difficult. Outcome assessment for many neurological disorders is still a young and inexact science. At the same time that extreme care and caution need to be exercised to accurately determine the worth of emerging technological advances, there is a strong impetus on the part of technology companies to introduce their innovations rapidly. Who will ultimately pay for these technologies? The reimbursement system is leveraging perhaps undue influence on the availability of many new technologies by taking on the task of assessing outcomes and "regulating" their use by determining compensation. Is this right?

A particular frontier that epitomizes the challenges of our technological advance as a species and how we regulate this growth is the intersection of molecular genetics and neuroscience. The manipulation of the most fundamental instructions of life may have a profound effect on human behavior. Blank explores the potential issues that will arise if, for example, genetic therapies can alter such behaviors as violence, addiction, and sexuality. That behavior can be so significantly altered may change our society's notions of responsibility and perhaps even free will. The implications of these kinds of neurological interventions will almost certainly require sweeping policy advances. This is precisely Blank's point: tomorrow's policy issues might be largely predicated on a deep understanding of neuroscience, and there is a need to start wrestling with these issues now.

Pediatric Emergency Medicine

Textbook of Pediatric Emergency Medicine

edited by Gary R. Fleisher and Stephen Ludwig, 4th ed, 2030 pp, with illus, $179, ISBN 0-683-30609-X, Philadelphia, Pa, Lippincott Williams & Wilkins, 1999.

With the publication of the fourth edition of their Textbook of Pediatric Emergency Medicine, editors Gary Fleisher and Stephen Ludwig have once again created an outstanding reference for any health care provider who cares for the acutely ill or injured child. It has been seven years since the publication of the third edition, and the numerous changes that have occurred since then are well reflected in this new edition.

There are several new chapters, including "Cyanosis," "Oral Lesions," and "Neonatal Problems." The last is a particularly useful addition given the recent trend to discharge the postpartum mother and her newborn infant from the hospital as early as possible. As the authors note, "Discharge often occurs before the parents have received adequate instruction in care and before they have established a level of comfort and rapport with their baby . . . [E]ven experienced parents may feel inadequate in determining whether their newborn is ill or has a significant defect." Such discomfort is no less real for the physician who is not a pediatrician and usually has limited experience who must evaluate these new infants. The authors' overview of color changes; skin findings; head, neck, and mouth problems; chest, back, and abdominal findings; and orthopedic and neurologic concerns (eg, differentiating neonatal seizures from "jitteriness") is a valuable resource.

Another outstanding new chapter, reflective of the times, is "Approach to the Care of the Technology Dependent Child." Nothing strikes fear into the otherwise calm heart of an emergency physician more than a chronically ill child with multiple medical problems who presents to the emergency department attached to highly specialized devices with which the physician has little or no experience and may have never even seen before. Parents of such children are often quite sophisticated and know much more about the child's medical problems than the average physician does. The chapter authors correctly point out that this can be a tremendous advantage if the physician works with the family and relies on them for important information. This chapter offers useful information on everything from cerebrospinal fluid shunts and tracheostomy tubes to indwelling venous access devices and gastrointestinal and genitourinary diversion. It also reminds the physician not to assume that there are complications simply because devices are present. The child with a cerebrospinal fluid shunt who presents with vomiting may certainly have a shunt malfunction but may also have nothing more than gastroenteritis.

Not all new chapters are equally successful. The editors state in their preface that the chapter "Myocardial Infarction" has been added to "prepare us for the rare occurrence of this event in childhood and for the occasional parents and grandparents who show up in pediatric emergency departments, clutching their chests in pain" [italics mine]. Unfortunately, nowhere in the chapter is there any mention of the pediatric patient at all. Since myocardial infarction is such a rare event in children, it might have been useful to add information on which children are at risk for heart attacks. Physicians also need to know the following: Are signs, symptoms, and electrocardiographic findings different in the pediatric population? Is the recommended therapy any different? Are there any data on the use of thrombolytics in children? The information on treating adults can be found in any standard emergency medicine textbook and offers little of value in this context.

I was particularly pleased to see the effort made, in the neonatal chapter as well as in a few others, to include relevant information about different ethnic and racial groups. For example, the authors note that neonatal jaundice may be a normal variant in individuals of Pacific Rim and Native American ethnicity and that the parents' coloring should be compared with the baby's. Similarly, in their discussion of Mongolian spots, they note that these pigmented lesions are quite common in African-American, Hispanic, Native American, and East Asian infants, while being relatively rare in whites. Given the changing demographics of the population in the United States, it is critical that new textbooks go beyond the previous bias toward framing everything in terms of white patients, so as to better address the cultural, social, and medical issues that reflect the wide diversity of patients now seen in all parts of the health care system. While this textbook avoids this bias in some chapters, in some sections, for example, "Psychosocial Emergencies," attention to ethnic diversity is notably absent.

Although much material in this textbook is available in standard pediatric texts, there is a wealth of information that simply cannot be found elsewhere. Textbook of Pediatric Emergency Medicine would be a useful addition not just to any emergency department, but for any physician who cares for sick children.

"ER"

The ABC of the ER

by Vincent Hanlon, one audio CD and 56 pp book, $20, Lethbridge, Canada, Night Shift Productions, http://www.abc-er.com, 2000.

For anyone interested in an inside look at the "emergency room," this booklet and CD provide many insights and nuances. It will interest emergency medical technicians, nurses, aids, clerks, and physicians as well as television viewers.

The writer, an emergency department physician, poet, and playwright, succinctly portrays common emergency department scenarios, eloquently performed by actors. The recorded stories take you inside the minds and hearts of the patients, nurses, and physicians. Each vignette has a letter of the alphabet as its starting point, eg, "D is for Dead," "F is for Falls," "K is for Knocked Out," "N is for Night Shift," "U is for Uncertainty." A photograph accompanies each story, adding to the narrative and evoking memories for the practitioner.

The vignettes are not essays on medical conditions, but rather they speak to many facets of emergency department life—skills, emotions, attitudes, the physical, and the spiritual. I shared The ABC of the ER with colleagues. A physician remarked, "I did not learn anything new in medicine but found it entertaining and well done." A night nurse commented, "Once you pick it up, you do not want to put the book [or CD] down. The material flows. The CD is hilarious with the different voices as well as the songs/skits. The subject matter is well written and can be understood by all. It encompasses all aspects of ER life from the MD to the nurse to the clerk and even the patient at times. I loved it."

My life experience in family practice for 30 years and emergency medicine for the past 12 years does not make me an art critic. From my vantage point, this is a fun piece of literature, and for those interested in life within the "ER," the CD and photographs will offer an enjoyable and enlightening experience for listening and sharing with friends and colleagues in all walks of life.

Psychiatry

American Psychiatric Press Reference Library 2.0

one CD-ROM, requirements: 256 color VGA, 4 × CD-ROM drive, Windows 3.1 or higher, DOS 5.1 or higher, 486/66 MHz PC, 16 MB RAM, 10 MB hard disk space, or Macintosh System 7.0 or higher, 16 MB RAM, 10 MB hard disk space, $395, ISBN 0-88048-953-7, Washington, DC, American Psychiatric Publishing Group, 1999.

The American Psychiatric Press Reference Library 2.0 provides on one CD the texts of the DSM-IV, the third edition of The American Psychiatric Press Textbook of Neuropsychiatry (1997), the second edition of The American Psychiatric Press Textbook of Psychiatry (1994), the first edition of The American Psychiatric Press Textbook of Psychopharmacology (1995), Schatzberg, Cole, and DeBattista's Manual of Clinical Psychopharmacology, volumes 12 through 16 of Review of Psychiatry, Gabbard's Treatments of Psychiatric Disorders, and 10 practice guidelines (eating disorders, major depressive disorders in adults, psychiatric evaluation of adults, Alzheimer and late-life dementias, bipolar disorder, panic disorder, delirium, nicotine dependence, schizophrenia, and substance use disorders). All this is provided at an extremely reasonable price compared with the total cost of the individual books. This collection would be invaluable to any psychiatric training program, anyone studying for board examinations, and most practicing clinicians.

The electronic library is not without its problems, however. To keep the CD compatible with Windows 3.1, the minimum PC requirements are literally ancient (DOS 5.1, Windows 3.1, a 486 PC running at 66 MHz, 16 MB of RAM, 10 MB of hard disk space). Consequently, a system file failed during installation on my Pentium 150 with 64 MB of RAM and Windows 98. A call to technical support, whose number is listed on the package, was answered in two rings and Steve, the technician, gave the correct solution promptly, e-mailing it to me as well. It was necessary to copy 550 MB of data to my hard disk, delete the offending file, install the program from the hard disk, and edit my registry to correctly make the CD the reference point for the data files. This may be a bit beyond the average psychiatric user. Other problems included printouts that did not use the full-page width (at least on my Epson 600), independent of the page width on screen and a single absent illustration. I did not test the program on a Macintosh.

The program is extremely rapid, finding results for most searches in a second or so. Boolean searches are supported, bookmarks can be placed for rapid return, and user specific annotation capability is provided. The program can be installed on a network, but I did not test this configuration. Although the Help file indicates that an online update feature is available, it was not in evidence in the version I reviewed.

The initial display presents the user with a search form and a screen with a table of contents on the left and the document chosen on the right. I found it most helpful to set the screen to show only retrieved documents and the results list. This allows full width viewing of the retrieved document and is easier on presbyopic eyes. All settings are easily changed on a very clear command menu.

The program had difficulty searching for brand names of common psychiatric medications, a weakness that could be easily corrected with an expanded index file in the next edition. The information is current through 1998.

This CD is a remarkably useful academic and clinical tool. If you have the technical capability to deal with potential installation difficulties (or have access to someone who does), I would recommend it without hesitation. It is certainly a remarkable value.

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