Reviewed By:
Barry Goldlist, MD, FRCPC, FACP
Director, Division of Geriatric Medicine,
University of Toronto

Health, Illness, and Medicine in
Canada 3rd Edition
Juanne Nancarrow Clarke
Oxford University Press Canada 2000

I am unsure of the origins of this text, but it reads as though it was adapted from a course on the sociology of health, illness, and medicine. This might explain the clarity of the language and the fact that enough background about sociology and its jargon is given to make the text completely accessible for a neophyte such as myself. In her writing, Professor Clarke, a professor of sociology at Wilfred Laurier University, shows herself to be a gifted teacher.

The book is divided into three parts. The first part, "Sociological Perspectives" explains ways of thinking and studying about health, illness and medicine from the perspective of sociology. The four central sociological perspectives, structural functionalism, conflict theory, symbolic interactionism and feminist theory, are clearly explained with examples given. Structural functionalism and conflict theory are useful in studying and understanding large societal 'systems', which is to say social and political groups (including interest groups), and private and government-run institutions and corporations. Symbolic interactionism, with its stress on individuals and their interactions, is useful for understanding the more intimate interaction between a patient and her doctor (or between a patient and any other practitioner). Feminist theory can be a useful tool for analyzing both 'systemic issues' and individual interactions. This part also explains, and clearly illustrates, the tools that each sociological perspective uses. A physician might object to some of the concepts expressed. For example, epidemiology is called "the study of the causes and distribution of diseases" and AIDS research is given as an example. I would argue that "correlation" would be a better word than "cause" to help explain epidemiology. In my opinion, epidemiology suggested a virus as the cause of AIDS, and basic laboratory research proved it. The comment that silicone breast implants are associated with numerous health problems is based on a quote from a 1993 paper; unfortunately, the author seems to be ignoring the overwhelming and more recent epidemiological data that shows that there is no correlation. This might reflect a lack of editorial updating of this edition.

The second part of the book examines the sociology of health and illness and includes chapters on disease and death, environmental disease, social inequity, on visiting the doctor, and on the experience of being ill. All are excellent. The sections on health and inequality may be particularly sobering for less experienced physicians, some of who are from relatively privileged backgrounds.

The third part of this book is the section, which may be of greatest interest to doctors&emdash;the sociology of medicine. Chapters on related topics include discussions of the development of medical and scientific knowledge, the 'medicalization' of society, that is, the institutionalization of the practice and teaching of medicine (in the forms of hospitals and university departments), and the development of private and government organizations and structures to regulate and support the delivery of medical care. These are chapters on nursing and midwives, alternative medicine, and the medical industrial complex. As a physician, I am always concerned that medicine seems to be held to a higher degree of accountability than are some of its 'competitors'. I feel this has occurred in this book to some degree. Moreover, there are certain internal inconsistencies. We are informed at the beginning of the text that the major determinants of health are non-medical (although in some cases, as with clean water, medi-cal science played a crucial role in terms of identifying them as determinants of health). Then in chapter 11, we are informed that remunerating doctors on a capitation basis will provide an incentive for doctors to keep people healthy. Does the author feel the determinants of health are medical or non-medical? Chapter 13 examines the relationships between the male medical profession and the female nursing profession. This chapter would have been stronger had the approach been a comparative one; the provision of some examples or analysis of the relations between female doctors (half the current graduates) and nurses, who are still overwhelmingly women, would have been helpful. However, the biggest flaw in this section, is that the sole focus is on a sociological perspective. This area, in my opinion, requires a combined historical and sociological approach. Doctors, nurses, and health care are part of a much larger social picture, and understanding the development of modern medicine cannot be done without understanding the broader historical context.

Despite the few issues I have mentioned, I consider this to be an excellent text. It is clearly written and contains information relevant to the practice of medicine. It is worthwhile reading for all doctors, particularly those in primary care.

Reviewed By:
Barry Goldlist, MD, FRCPC, FACP
Director, Division of Geriatric Medicine,
University of Toronto

Adding Value to Long-Term Care
An Administrator's Guide to Improving Staff Performance, Patient Experiences, and Financial Health
D. Lazer and T.L. Schwartz Cassell
Elder Clinical Resources LLC 2000

This text is clearly meant for administrators of long-term care (LTC) facilities, and not for the physicians who take care of the residents in these facilities. The basic tenet of the book, that placement in LTC facilities can be a positive experience, is to be applauded. Placement should not be considered a "failure", but rather the appropriate choice in certain circumstances. This book is a "how to" manual for creating an optimal environment, an approach that will ensure high quality resident care.

Unfortunately, this book will not help most Canadian LTC administrators. The approach they suggest--ensuring an appropriate physical environment, multidisciplinary resident assessment, programming that ensures family involvement, and continuous quality improvement--is hardly ground breaking. It is the standard approach in most Canadian LTC facilities. The best part of this text is the section on how to make use of U.S. funding sources (e.g. Medicaid) in order to achieve these goals. Unfortunately, this advice is not applicable in Canada, and will not help Canadian facilities.

There are several appendices at the end of the text that are useful for monitoring the LTC environment, but once again they are hardly innovative by Canadian standards.

One of the appendices is on how to use simulation to teach caregivers about physical changes associated with aging. This is clearly a useful section, but it is interesting how little clinical information is available in the text itself. For example, the most common reason for institutionalization is a dementing disorder, and one would think that administrators, many without clinical backgrounds, would benefit from understanding the nature of dementia and its causes. The short section on this topic in this book, is incomplete and seriously out of date. Although excellent references are given, I feel the book would be strengthened by a more comprehensive approach.

In summary, this book addresses a worthy and important topic. However, its areas of greatest strength are relevant only to LTC administration in the United States, and will not help Canadian LTC administrators. Most of the other approaches and tools are easily available from provincial LTC associations, and are specifically designed for the Canadian health care environment. Despite its excellent intentions, I really cannot recommend this book to Canadian readers.

Reviewed By:
Barry Goldlist, MD, FRCPC, FACP

Handbook of Psychiatry in Palliative Medicine
Edited by: Harvey M. Chochinov and William Breitbart
Oxford University Press, 2000
ISBN # 0-19-509299-6

This multi-authored text 'grew out' of the editor's contribution to the most recent edition of The Oxford Textbook of Palliative Medicine. The authors are well-respected leaders in the field, and do not reside or practice in any one geographic area. Ten of the contributors are from Canada. This broad representation of authors ensures that the information in the book is based on views which are not parochial, but are rather widely acceptable. The textbook covers more than just psychiatric issues. There is a very good chapter summarizing the principles of physical symptom management in the terminally ill, and there are sections dealing with family and staff issues, and ethical and spiritual issues, which are also appropriate in a general textbook of palliative care.

The chapters specifically pertaining to psychiatric care are all very good, particularly the one on diagnosis and management of depression in palliative care. There is also an extensive section on psychotherapeutic interventions and palliative care. Some of these chapters contain very helpful case examples, which can aid the non-psychiatrist in particular.

In summary, this text is well written and thorough, and covers many important aspects of palliative care. Health specialists involved in palliative care are the most likely target of this book, as most physicians involved in palliative care would probably prefer to purchase a more general text, such as The Oxford Textbook of Palliative Medicine. However, any palliative care service or hospice would benefit from having this book available as a reference.

"NEURODEGENERATIVE DEMENTIAS"

McGraw-Hill, 2000
Edited by G.M. Clark and J.Q. Trojanowski

Reviewed by Barry J. Goldlist, MD, FRCPC, FACP

The text from McGraw-Hill, "Neurodegenerative Dementias" is clearly aimed at a very specialized audience--neurologists with a strong interest in dementia and neurodegenerative disorders. I suspect it will satisfy its target audience. It is remarkably up-to-date for such a multi-authored volume. For example, the chapter on Treatment Strategies in Alzheimer's Disease by Rachelle Doody has references from 1999. For the non-neurologist interested in dementia there are many valuable chapters. The book starts superbly with four chapters on normal aging. Although not meant to be comprehensive, these chapters are clear and address all the key issues. The chapters on Alzheimer's Disease which form the core of this text are excellent. The presentations on amyloid deposition and the tau-based neurofibrillary tangles explain difficult concepts clearly. The chapter on treatment strategies, the key chapter for clinicians, is quite comprehensive. Although current therapy is discussed in a restrained manner, the implied possibilities for the future certainly inspire optimism.

HURST'S THE HEART, Ninth Edition

Alexander RW, Schlant RC, Fuster V (editors)
McGraw-Hill, New York, 1998

Reviewed by Barry J. Goldlist, MD, FRCPC, FACP

The latest edition of Hurst's The Heart is a massive tome, comprised of 2602 pages of text, and an index of 96 pages. Clearly this is not a book that is meant to be read at once from cover to cover! My first task was to check the list of authors. There are 181 contributors, and they are truly an outstanding group. However, as is common in American texts, only six of these are from outside the USA (one from Belgium, Germany, South Africa and Canada, and two from the United Kingdom). This could be a weakness as the pattern of delivery of cardiac care, especially advanced cardiac care, may differ from country to country. The table of contents mirrors the goals of the text, which are to provide a comprehensive reference source. However, there are a number of topics that could have been added. Part 1, "Basic Foundations of Cardiology", could have included a chapter on how to interpret the burgeoning cardiovascular literature. Although the principles of critical appraisal span all disciplines, the specifics (e.g. methodological pitfalls, appropriate outcome measures, meaning of clinical significance) vary widely from specialty to specialty. Issues concerning coronary artery disease in women are incorporated into various chapters. Considering the huge challenges this area creates for clinicians, it would have been preferable to have a separate chapter on the topic. There is a chapter entitled "Geriatric Considerations in Cardiovascular Therapy", but it focuses exclusively on pharmacology. Topics such as altered presentation, difficulties in diagnosis, and under-treatment are not addressed.

The book itself is well designed. The typeface is clear and crisp, and there are large numbers of excellent and appropriate illustrations. The use of charts to highlight important information is excellent. As in all multi-authored texts, the quality varies somewhat from chapter to chapter, but generally the content is excellent. The chapter on history, physical examination and cardiac auscultation is superb. The chapter on diagnosis and management of heart failure exhibits the major difficulty that textbooks face. It is very well written, but there is nothing in the references more recent than 1997, and thus the authors do not mention the survival benefits of spironolactone, and are less "bullish" on beta-blockers than they would have been today because more evidence has been accumulated.

In summary, this is an excellent text that covers virtually all aspects of cardiovascular disease, and is a first rate reference. However, the fast pace of change in cardiovascular medicine means that clinicians will have to use additional more current sources of information when they manage individual patients.

"DIAGNOSIS AND MANAGEMENT OF DEMENTIA A MANUAL FOR MEMORY DISORDERS TEAMS"

Oxford University Press, New York, 1999
Edited by G.K. Wilcock, R.S. Bucks and K. Rockwood

Reviewed by Barry J. Goldlist, MD, FRCPC, FACP

Dementia, and Alzheimer's disease in particular, have become "hot" areas. After almost a century of therapeutic nihilism and clinical despair, we have now at least a glimpse of light at the end of the tunnel. Currently, modestly effective therapies are available for Alzheimer's Disease, and the future is promising. With growing understanding of AD, and with increasing expectations from patients and families, physicians will have to become better informed. This book is a manual on how to establish a multidisciplinary memory disorders service. One of the editors is the eminent Canadian Geriatrician, Ken Rockwood, from Dalhousie University. This book is superb. The important contributions from all disciplines, e.g. neurology, psychiatry, neuropsychology etc, are clearly explained. The first chapter by Beattie et al., is an excellent resource for those wishing to start their own clinic. Although not meant to be a clinical text, the sections on the diagnostic process are excellent summaries, and certainly highlight what a primary care physician should know about distinguishing the various dementias. Although primary care physicians are not the main targets of this book, they will get some practical information about diagnosing the common types of dementia, and a good understanding of the complexity of the diagnosis and management of dementing disorders. For those intending to establish a memory disorders team, this is a must read. For those already in the "memory business" there is still much practical information to be gleaned from this book.

Reviewed by: Barry J Goldlist, MD, FRCPC, FACP

CLINICAL CARDIOLOGY IN THE ELDERY
2nd EDITION
Chesler, Eliot M.D., Editor

Futura Publishing Company, Inc
Armonk, New York, 1999
ISBN #0-87993-421-2

Why produce a textbook on geriatric cardiology? The obvious answer is the incredible growth of the elderly population and the tremendous increase in the prevalence of cardiac disease (clearly and elegantly described in chapter one of this text by McLaughlin and Cassel). However, as a practising Geriatrician, I think there is another important reason to produce such a volume. There is ample evidence in the literature that effective treatments for cardiac disease (e.g. ASA, beta-blockers, and thrombolytic agents) are underused in the elderly. Any publication that might change this is indeed welcome.

Like any multi-authored text, there is some variability from chapter to chapter, and some authors do not use enough tables or charts, thus making their chapters intimidatingly dense. As well, the inevitable delay between writing a chapter and the publication date of the book means that few chapters have any references past 1997. Nevertheless this is an excellent text. It is not likely that any reader would read this text cover to cover. Rather the reader would use the book to review particular topics or answer specific clinical questions. The chapter on 'Physiology of the Aging Heart' is tremendously helpful to a practicing physician. The chapter on 'Management of Lipid Disorders' clearly summarizes the current literature and notes where data is insufficient for firm recommendations (primary prevention in the elderly), and gives practical management advice to the physician. The chapter on 'Congestive Heart Failure' unfortunately was written before the role of beta blockers and spironolactone were clearly established, but does review vasodilators, diuretics, and digoxin very clearly.

In summary, this is an ambitious, and for the most part, very successful textbook. It would be particularly useful for Geriatricians, Internists and Cardiologists. However, primary care providers with large numbers of elderly patients in their practice could also profit from purchasing this book.

Reviewed By:
Barry J Goldlist, MD, FRCPC, FACP

In health care in the 1990's, the major changes from the health care professional's point of view concern restructuring of the delivery system. In the United States, managed care has had tremendous growth, and in many parts of Canada restructuring of the hospital system has been dramatic.

However, I think it is likely that the recipients of health care are more interested in another fundamental change, the 'empowering' of patients. This has been manifested by scientific meetings that include disease sufferers and advocates (HIV, breast cancer), an explosion of self help groups and publications, and an almost ubiquitous interest in complementary medicine.

The MemoryMinder is a personal health journal that allows people to track numerous aspects of health in a systematic manner. Each double page (covers one day) has space for the following: (1) Date, (2) Weather, (3) Morning and afternoon weight, temperature, and blood pressure, (4) Blood sugars, (5) Hours slept at night, (6) Naps and time spent napping, (7) Drugs/medications, (8) Vitamins/herbs, (9) Physical activity, (10) Pain/discomfort/ skin changes (with diagram and rating scale), (11) General feeling, (12) Today's conditions and symptoms (organized anatomically), (13) Today's diet, and (14) Comments

Theoretically this will allow users of the journal to assist their doctors, discover patterns in their own health, and remain more focussed on their dietary and physical activity goals.

I think more limited journals, e.g. for tracking diabetes mellitus, that are easier to complete, would be more usable for the average patient. Of course, there is nothing to prevent patients from only filling out the portions they are particularly concerned about.

In summary, the MemoryMinder is an interesting concept, but I am unsure whether it will be helpful in actual clinical practice.

The Memory Minder Personal Health Journal is available from MemoryMinder Journals by writing PO Box 23108 Eugene, Oregon 97402-0425, calling 1-541-342-2300 or on the Web at www.memoryminder.com

Reviewed By:
Barry J Goldlist, MD, FRCPC, FACP
Old, Female, and Rural
Editor: B. Jan McCulloch, Ph.D.
Haworth Press, Inc.
Binghamton, New York, 1998
ISBN 0789006715

This book, Old, Female, and Rural, has been co-published simultaneously as Journal of Women & Aging, volume 10, number 4, 1998. It consists of four research articles with a critical review. The topics covered include use of health care, economic realities, and family relationships. As well, the initial article gives a case study of a 90-year-old woman living in rural Minnesota.

Although the book seems overly specialized, much of the information is relevant to older women wherever they live. Even when the information is particular to the rural setting, comparisons to the urban setting are made which also convey very useful information to health care providers in cities.

The first article, the case study, particularly impressed me. The interviewee's view that use of formal support services implies a failure of informal supports also applies to many of my patients. The article on the economic circumstances of older women is not at all surprising, but the high prevalence of poverty in this group is nonetheless disturbing.

In summary, this book is clearly a 'niche' publication. It is a valuable publication for health care providers in rural areas, and provides interesting information for those of us practicing in urban areas. Although it is based on American demographics and research, I suspect that the general principles hold for Canada as well.

Alzheimer's Disease--Current Treatment and Future Prospects
Author: William M. Brown
Publisher: Financial Times, Pharmaceuticals/FT Pharmaceuticals
ISBN: 1 86067 355 4
Price: £ 475/US $740
Pages: 155

Reviewed by: Barry J Goldlist, MD, FRCPC, FACP
When I first saw the advertisement for Alzheimer's Disease--Current Treatment and Future Prospects I was intrigued by the price, $740 US. I did not realize until the book arrived for review that the target audience was not physicians or neuroscientists, but the financial community. The book, even with the references and glossary, is only 155 pages long. All the information contained in the book is already available (although scattered) in the public domain.

The book is basically a synopsis on neurodegenerative diseases, predominatly Alzheimer's disease, and the current and upcoming treatments. The author is a neuroscientist, but more importantly, a clear and concise writer. I have rarely seen medical information transmitted so clearly. The content is up-to-date (although there is no mention of chromosome 12 and a possible relationship to Alzheimer's disease) and the description of possible therapies and their mechanisms is exhaustive. A neuroscientist might not learn anything new, but a practising physician in the area, such as myself, would learn about new drugs in the pipeline.

The most obvious lesson I learned is that the economics of practising medicine and the economics of business are quite different. At $740 US there is not enough value for a physician, but I suspect there is for an astute business person. Certainly that person will receive a beautifully written, concise, yet thorough review of market opportunities relating to the treatment of Alzheimer's disease. Further information regarding this book can be obtained by calling +44 (0) 171 896 2184.