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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.
EthicsFrom Chance to Choice: Genetics and Justice
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
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.
Minds Behind the Brain: A History of Brain Pioneers and Their Discoveries
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
Brain Policy: How the New Neuroscience Will Change Our Lives and Our
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
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.
The ABC of the ER
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
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
American Psychiatric Press Reference Library 2.0
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.
Fiction. JAMA. 2000;284(8):1029. doi:10.1001/jama.284.8.1029
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