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

HISTORY OF MEDICINE:
A SCANDALOUSLY SHORT INTRODUCTION
Jacalyn Duffin
University of Toronto Press, 1999
Toronto, Buffalo, London
ISBN 0802079121

Why would anybody other than a medical historian (or an aging doctor such as myself) be interested in a book on the history of medicine? Jacalyn Duffin gives us all the answer in the final chapter of this book (How to Research a Question in Medical History) when she writes: "No medical subject--be it a person, a practice, an institution, a technology, or an idea-- can be fully explored without also studying its political, social, economic, and cultural environment." In this introductory text (compiled from medical student lectures at Queen's University) one gets a clear view of how medicine reflects society, and how health care providers are influenced by non-medical factors in society at large. Although this is not a textbook of Canadian medical history, it is written by a Canadian for a Canadian audience. This is particularly valuable as many of us who are wondering where the Canadian health care system is heading, can get at least an overview from this text of how our current system developed.

The text is organized by topic (e.g. History of Anatomy) rather than as a continuous chronology. This makes the reading much simpler for a relatively uninformed reader, as only one concept at a time is explored. As well, chapters can be read in any order, depending on the reader's particular interests. The exceptional nature of this book is probably based on the relatively rare characteristics of the author: she is a practicing physician (haematologist) as well as a formally trained historian. As a result the book covers both important historical trends as well as the difficulties facing individual practitioners as they try and alleviate human suffering.

My favourite chapter was entitled "Science of Suffering: History of Pathology." The reader is given a clear understanding of how the concept of 'disease' developed, and both the strengths and weaknesses of this diagnostic labelling. The chapter on blood (Why is Blood Special?) literally 'pulses' with excitement and enthusiasm, obviously reflecting the author's particular interests as well as the historical importance of the topic.

Throughout this text, there is a refreshing absence of both medical jargon and dense academic prose, making reading the book an enjoyable process. My one quibble is that Professor Duffin's elegant descriptions of the importance of a population approach to health fails to ask one question that always intrigues me. Does the focus on a population health approach have within it the inevitable potential to put differential values on human life? Was the eugenics movement a result of a 'population health' perspective? In Canada, with universal medicare and no private practice option (as occurs in the United Kingdom), might someone with an 'unimportant' disease eventually be 'uncovered' by medicare? Does focusing on the greater good inevitably result in inhumane or unfair treatment to some? Perhaps a topic for a second edition.

So once again who should read this book? Clearly it is a must read for medical students and doctors interested in medical history. However, it would be a shame to limit this fine text to that small audience. This book can be enjoyed by anybody interested in understanding health care or who is just interested in medical history. It deserves a wide audience.

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 Goldlist, MD, FRCPC, FACP

FÉLIX D'HERELLE AND THE ORIGINS OF MOLECULAR BIOLOGY

William C Summers
Yale University Press
New Haven and London
1999
ISBN 0300071272

This textbook is a combination book, partly the biography of an exceptional individual and partly a history of scientific discovery. The author, William Summers, is eminently qualified to write such a text, being a physician, scientist, and historian at Yale University.

D'Herelle is a renowned Canadian Scientist about whom I was totally ignorant. Born in Montreal, he traveled and lived in numerous areas around the world, although France became his eventual home. He never gave up his Canadian citizenship, however. D'Herelle was born to a wealthy family in Montreal, and after high school he traveled extensively, thanks to a gift from his mother. He never found time to return to formal schooling, but he learned enormous amounts in his chosen field, microbiology. His seminal scientific discovery was the description of bacteriophages, and their possible application in human infectious diseases. For this he received numerous awards, and at one time was a research professor at Yale University despite his own lack of formal education. Dr. Summers clearly delineates the process of scientific discovery, and the subsequent controversies over the nature of this new discovery (was it really a living organism or an enzyme?), and the determination of scientific priority. There is a fair amount of technical description, but Dr. Summers is a clear and logical writer who is able to guide the reader through the scientific process.

This book is an incredible work of scholarship, with extensive use of primary source documents. However, because the main thrust of this book is one of scientific discovery, we get very little analysis of d'Herelle's personality. I would have been interested in some speculation on how his lack of formal education might have influenced his often-stormy relationships with other scientists. Also, why was such a distinguished scientist so poorly treated at the Pasteur Institute, his spiritual home? There would be much to learn from a biography of this highly complex individual. Meanwhile, this is an excellent book that helps us understand the nature of scientific enquiry while saluting an outstanding scientist, who just happens to be Canadian.

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.