997 Anti-Rheumatic Drugs
Reviews of Books
Clinics in Rheumatic Diseases. Vol. V, No. 2. Edited
Current Neurology Vol. II-Edited by RICHARD TYLER and DAVID M. DAWSON, lIarvard Medical School. Boston and London: Houghton Mifflin. 1979. Pp. 531. ;22.50.
THE first volume in this series on recent developments in clinical neurology and related basic sciences was welcomed when it appeared last year. Vol. II generally upholds the standard. It is again divided into eleven sections, although the last one (neurological aspects of medical disease) represents a change of format. Fifteen of the twenty-six chapters cover new subjects, the remaining eleven being updates of topics covered in vol. I. These "updates" are generally disappointing because many of them add very little worthwhile information. Of the new chapters, those on nerve root and peripheral nerve entrapment in the upper limb, on intracerebral haemorrhage, on myasthenic syndromes, on aphasia, and on metabolic encephalopathies are very well constructed. A chapter on the physiological basis of voluntary movement deals with this topic in an elementary fashion, and the one on amyotrophic lateral sclerosis is muddled and not at all helpful. The chapter on brain tumours is largely concerned with medical aspects of the management of malignant tumours, surgical aspects being neglected. In a stimulating essay D. A. Stumpf has produced a speculative, but all-embracing, classification of mitochondrial multi-system hypoxic brain injury and Wilson’s disease. The breadth of material covered in the volume is exceptional and this is in itself a tribute to the strength of American neurology.
Surfaces of Normal and Malignant Cells Edited R. O. HYNES, Massachusetts Institute of Chichester and New York: Wiley. 1979. Pp. 471.24.
Technology.
CELL-SURFACE structure and functions have long been considered important in the understanding of the biological properties of malignant cells. It is important, for example, to define cell-surface changes which accompany malignant transformation, and one would like to know whether cells which separate from a primary lesion to form secondary deposits at other sites in the body have specific surface characteristics. Much has been learned in recent years about the properties of malignant cells by the study of their behaviour when they are maintained in culture. This approach owes much to the classical observations of the late Sir Michael Abercrombie and his colleagues that contact inhibition, defined as the restraint of locomotion imposed by cell-to-cell contact, of normal cells is not operative against malignant cells. The reviews by Richard Hynes and his colleagues on various aspects of cell-surface structure and function are set against this background. The theme of the book is that since cell-surface characteristics can be defined biochemically they should allow more precise interpretations of the biological behaviour of normal and malignant cells. This is emphasised by several accounts of the chemical composition of cell-surface membrane components including proteins, glycoproteins, and glycolipids. The external morphology of normal and transformed cells is also reviewed, and there are accounts of the influence of cell-surface components, such as membrane enzymes and neoantigens, on mediation of host-immune responses. This admirable selection of informed reviews by specialists presenting up-to-date accounts of their fields of endeavour will be of considerable interest to research workers. But the various approaches for the study of malignant cells are not brought together, and one is left with the conclusion that the description of malignant cell characteristics, particularly metastatic potential, still eludes the researcher.
by
E. C.
HUSKISSON, St. Bartholomew’s Hospital, London. Eastbourne and Philadelphia: W. B. Saunders. 1979. Pp. 385. [10. THIS book, like others in the Clinics series, reflects the high standard of authorship and sound editing that we have come to expect. Twenty-five contributors from the U.K., Europe, and the U.S.A. have in nineteen chapters discussed many of the drugs currently used in the treatment of rheumatic diseases ; other drugs have either been covered in previous issues or will be dealt with later. Research workers and clinicians undertaking trials of antirheumatic agents will find this book an up-to-date and well-referenced guide. For many of the common anti-inflammatory drugs their pharmacology, mechanism of action, clinical uses, toxicity, and performance in clinical trials are brought together in a single chapter. Readers must make their own conclusions as to whether one drug has advantages over another. Unfortunately a system of "try it and see" is still the only way of finding out and, as the editor says, considerable skill is required to find the right drug for the right patient at the right time in the right disease. There are separate chapters on drugs which seem to have a specific action in rheumatoid arthritis-namely gold, penicillamine, and levamisole. Levamisole has begun to lose favour with clinicians because of the high frequency of idiosyncratic reactions, although a single weekly dose now seems much safer and just as effective as earlier regimens. Chapters on the treatment of systemic lupus erythematosus, gout, and Paget’s disease provide concise reviews of the management of these conditions. Although the article by the editor on the routine drug treatment of rheumatoid arthritis and other rheumatic diseases is the penultimate chapter, it is perhaps the one that should be read first. It gives a balanced view of current management which few rheumatologists will quibble with. This volume on anti-rheumatic drugs is more detailed than Drug Treatment of the Rheumatic Diseases (see Lancet July 28, 1979), which should appeal to both general practitioner and the rheumatologist ; the volume reviewed here is written primarily for the rheumatologist, but doctors and pharmacologists in the drug industry will also find it a valuable source of information. The Esophagus Handbook and Atlas of Endoscopy. M. SAVARY, University of Lausanne, and G. MILLER, Bürgerspital Solothurn. Translated by DUNCAN COLIN-JONES. Solothurn, Switzerland: Gassmann. 1978. Pp. 248. SFr 180 (English edition); SFr 285 (German and French editions).
THIs book is divided into three sections which deal with the normal oesophagus, and the diseased first section is subdivided into portions where indications and contraindications, failures, complications, preparation, instruments, and methods are discussed in detail. There is an attempt at a similarly comprehensive approach in the latter sections. The type is large, attractive, and varied, the black-and-white photographs and reproductions of radiographs are excellent, the line drawings are clear and helpful, and the tables and other diagrams are well-designed and easy to follow. In addition there are scores of colour photographs of endoscopic appearances. An ear, nose, and throat specialist and a gastroenterologist, both Swiss, have pooled their extensive experience and have attempted to present this in book form. The result is beautiful to look at, a delight to handle, but not entirely successful. The style tends towards the didactic, and there are few references. There is an attempt at comprehensiveness which, in a book of this size, leads to occasional oversimplification. The authors clearly believe in the benefits of classification, a useful approach but perhaps here overexploited. The text reads like a translation and the flavour is still that of a book originating from a Continental school of medicine (which is perhaps as it should be). Whatever the precise
oesophagoscopy, oesophagus. The
998 and would disappear if industrial production were organised on socialist lines. She is, of course, critical of the drug industry, but many of her criticisms were answered by W. Duncan Reekie and Michael Weber’s book (Profits, Politics and Drugs, see Lancet Aug. 25, 1979) published while hers was in the press. She both challenges the motives behind current DHSS policies and priorities, and criticises Ivan Illich’s sweeping dismissal of the benefits of modern medical technology. Altogether a stimulating book and a worthy contribution to current debates on the politics of health.
aims of the authors, and these are not clearly expressed in the this book does not meet the criteria for a successful textbook on diseases of the oesophagus. The strength of the book lies in its colour photographs. Here there is a wealth of material, beautifully reproduced. Whatever may be the pros and cons of fibre versus rigid oesophagoscopy (and this problem is not fully discussed), this book is proof that really excellent photographs can at present only be obtained through a rigid oesophagoscope. It is an expensive book; the potential reader must decide whether he wishes to spend a large sum on what is essentially an atlas.
preface,
Counseling Parents of Hearing-impaired Children
Man against Disease
DAVID LUTERMAN, Boston: Little Brown. London: Quest. 1979.
Pp.l93.$9.9S;/;6.70.
Preventive Medicine. By J. A. MUIR GRAY. Oxford: Oxford University Press. 1979. Pp. 192. 4.9$; /;2.50 (paperback).
THIS is
an
THOSE few individuals who are skilled in the diagnosis and care of hearing-impaired children are well aware of the impor-
excellent book. In less than 200 pages Dr Muir
of involving the parents, but whether personal experiof this often traumatic relationship can be put on paper for the benefit of others is questionable. Variations in family background and intelligence makes both the impact of advice on the parents and subsequent care of these unfortunate children very individual problems needing individual attention. This personal account by the director of a parent-centred nursery programme in a large North, American city is a hard read. The author’s sincerity cannot be doubted but the text is rambling, interspersed with snippets of conversation between parent and himself. In essence it is a psychological treatise written by an academic audiologist of the many ways in which parents of handicapped children living in North America can be helped to cope with the impact of this domestic misfortune. The patient seems to play little part in this dialogue and one is left wondering about the fate of children with uncooperative parents. Most parents in the programme are "middle-class" (whatever this means), and "lower-class" parents taking part are said to be seeking "class improvement". The seven chapter headings include "structural group experiences", "developing programmes of parents", and "parents in the group". By far the most interesting section is the one on the impact of deafness on the family, for this relates to deafness at all ages and in most social groups. However, it is hardly worth buying the book for the benefits of this one chapter. tance
Gray summarises much of the reflective wisdom that epidemiology and community medicine are offering to their colleague specialties. Indeed, such is its style and clarity that many laymen will easily understand all the main issues discussed. The book begins with a concise general look at the history of health prevention and then moves on to discuss the scope for prevention today. Then there is an excellent chapter on the opportunities for preventive medicine in underdeveloped countries, where the potential for saving health and life dwarfs that of the developed world. There follow two clear chapters on the promotion of child health and prevention of disease in adult life. Ways and means of applying our current knowledge, including legislation and health education, get good coverage, as do the main obstacles to prevention. The book closes with a discussion of the future of prevention. The book leaves the impression that, in some areas, we are making greater strides in prevention than we realise. For example, the incidence of roadtraffic accidents has been falling, the prevalence of cigarette smoking is decreasing, and we have reason to believe that a large proportion of malignancy may be due to environmental agents (though, as yet, we do not always know what these agents are). At a time when his specialty of community medicine is in "
low morale and poor a valuable contribution doctors can make to prevention. The fact that this book is clearly aimed at the general reader and that its title is Man (rather than Doctors) Against Disease reflects -the author’s view that prevention of ill-health is everyone’s job. This is an admirable book which really deserves to be widely read. an
embattled condition with
ences
a
recruitment, Dr Muir Gray has revealed what
Pathobiology Annual Vol. IX. Edited
The Political Economy of Health LESLEY DOYAL (with IMOGEN PENNELL), Polytechnic of North London. London: Pluto Press. 1979. Pp. 360. /;4.9S.
THIS is a cut above the usual polemical book on health and health services. It is readable and well researched. The author has mastered an impressive range of data: 297 pages of text are followed by more than 50 pages of references and notes. Many who do not share the author’s marxist viewpoint or agree with her conclusions will be grateful for her industry and for her ability to write clearly on subjects which other writers have often shrouded in the obscurity of unreadable prose. The book explores the nature of health and sickness, the development of medical technology, and the influence of social and economic factors on health in an advanced industrial society. It gives much attention to the relationship between medicine, medical ideology, and what is inevitably described as "the oppression of women". Similar emphasis is placed on the part played by western medicine in the oppression and exploitation of colonial peoples. Mrs Doyal argues that disease due to industriar pollution is more widespread than is generally realised. One can share her concern at the evidence pointing in this direction without sharing her belief that such disease is a capitalist plot
by H. L. IOACHIM. New York: Raven Press. 1979.
Pp. 402.$41.60.
,
Pathobiology Annuals can be relied on to present an eclectic choice of subjects, and the latest volume maintains this tradition. Could any single reader draw on sufficient background knowledge to appraise with equal accuracy the treatment of topics as diverse as raised intracranial pressure, the HLA system in human pathology, vitamin BI2’ the mechanisms of immunity in tuberculosis, and microglobulins? The subjects are invariably interesting and most of them seem to be reviewed adequately. The approach is inevitably selective, and the reader will disagree with the emphasis adopted by some contributors. The detailed bibliographies will be useful. New Editions Basis of Disease-2nd ed. By Stanley L. Robins and Ramzi S. Cotran. Philadelphia and Eastbourne: Saunders. 1979. Pp.
Pathologic
1598.$39.50; £ 21.50. Muscle Relaxants-2nd ed. By S. A. Feldman. Eastbourne: Saunders. 1979. Pp.240. cell.50. World Directory of Medical Schools-5th ed. Geneva: %X’orld Health Organisation. 1979. Pp.358. Sw.Fr. 30.00. Clinical Chemistry in Diagnosis & Treatment-3rd ed. By Joan F. Zilva & P. R. Pannall. London: Lloyd-Luke. 1979. Pp. 492. 7.00. Accident Surgery & Orthopcedics for Students-2nd ed. By J. K. Pearson and R. T. Austin. London: Lloyd-Luke. 1979. Pp. 441. 8.75.
Reviews of Books
Clinics in Rheumatic Diseases. Vol. V, No. 2. Edited
Current Neurology Vol. II-Edited by RICHARD TYLER and DAVID M. DAWSON, lIarvard Medical School. Boston and London: Houghton Mifflin. 1979. Pp. 531. ;22.50.
THE first volume in this series on recent developments in clinical neurology and related basic sciences was welcomed when it appeared last year. Vol. II generally upholds the standard. It is again divided into eleven sections, although the last one (neurological aspects of medical disease) represents a change of format. Fifteen of the twenty-six chapters cover new subjects, the remaining eleven being updates of topics covered in vol. I. These "updates" are generally disappointing because many of them add very little worthwhile information. Of the new chapters, those on nerve root and peripheral nerve entrapment in the upper limb, on intracerebral haemorrhage, on myasthenic syndromes, on aphasia, and on metabolic encephalopathies are very well constructed. A chapter on the physiological basis of voluntary movement deals with this topic in an elementary fashion, and the one on amyotrophic lateral sclerosis is muddled and not at all helpful. The chapter on brain tumours is largely concerned with medical aspects of the management of malignant tumours, surgical aspects being neglected. In a stimulating essay D. A. Stumpf has produced a speculative, but all-embracing, classification of mitochondrial multi-system hypoxic brain injury and Wilson’s disease. The breadth of material covered in the volume is exceptional and this is in itself a tribute to the strength of American neurology.
Surfaces of Normal and Malignant Cells Edited R. O. HYNES, Massachusetts Institute of Chichester and New York: Wiley. 1979. Pp. 471.24.
Technology.
CELL-SURFACE structure and functions have long been considered important in the understanding of the biological properties of malignant cells. It is important, for example, to define cell-surface changes which accompany malignant transformation, and one would like to know whether cells which separate from a primary lesion to form secondary deposits at other sites in the body have specific surface characteristics. Much has been learned in recent years about the properties of malignant cells by the study of their behaviour when they are maintained in culture. This approach owes much to the classical observations of the late Sir Michael Abercrombie and his colleagues that contact inhibition, defined as the restraint of locomotion imposed by cell-to-cell contact, of normal cells is not operative against malignant cells. The reviews by Richard Hynes and his colleagues on various aspects of cell-surface structure and function are set against this background. The theme of the book is that since cell-surface characteristics can be defined biochemically they should allow more precise interpretations of the biological behaviour of normal and malignant cells. This is emphasised by several accounts of the chemical composition of cell-surface membrane components including proteins, glycoproteins, and glycolipids. The external morphology of normal and transformed cells is also reviewed, and there are accounts of the influence of cell-surface components, such as membrane enzymes and neoantigens, on mediation of host-immune responses. This admirable selection of informed reviews by specialists presenting up-to-date accounts of their fields of endeavour will be of considerable interest to research workers. But the various approaches for the study of malignant cells are not brought together, and one is left with the conclusion that the description of malignant cell characteristics, particularly metastatic potential, still eludes the researcher.
by
E. C.
HUSKISSON, St. Bartholomew’s Hospital, London. Eastbourne and Philadelphia: W. B. Saunders. 1979. Pp. 385. [10. THIS book, like others in the Clinics series, reflects the high standard of authorship and sound editing that we have come to expect. Twenty-five contributors from the U.K., Europe, and the U.S.A. have in nineteen chapters discussed many of the drugs currently used in the treatment of rheumatic diseases ; other drugs have either been covered in previous issues or will be dealt with later. Research workers and clinicians undertaking trials of antirheumatic agents will find this book an up-to-date and well-referenced guide. For many of the common anti-inflammatory drugs their pharmacology, mechanism of action, clinical uses, toxicity, and performance in clinical trials are brought together in a single chapter. Readers must make their own conclusions as to whether one drug has advantages over another. Unfortunately a system of "try it and see" is still the only way of finding out and, as the editor says, considerable skill is required to find the right drug for the right patient at the right time in the right disease. There are separate chapters on drugs which seem to have a specific action in rheumatoid arthritis-namely gold, penicillamine, and levamisole. Levamisole has begun to lose favour with clinicians because of the high frequency of idiosyncratic reactions, although a single weekly dose now seems much safer and just as effective as earlier regimens. Chapters on the treatment of systemic lupus erythematosus, gout, and Paget’s disease provide concise reviews of the management of these conditions. Although the article by the editor on the routine drug treatment of rheumatoid arthritis and other rheumatic diseases is the penultimate chapter, it is perhaps the one that should be read first. It gives a balanced view of current management which few rheumatologists will quibble with. This volume on anti-rheumatic drugs is more detailed than Drug Treatment of the Rheumatic Diseases (see Lancet July 28, 1979), which should appeal to both general practitioner and the rheumatologist ; the volume reviewed here is written primarily for the rheumatologist, but doctors and pharmacologists in the drug industry will also find it a valuable source of information. The Esophagus Handbook and Atlas of Endoscopy. M. SAVARY, University of Lausanne, and G. MILLER, Bürgerspital Solothurn. Translated by DUNCAN COLIN-JONES. Solothurn, Switzerland: Gassmann. 1978. Pp. 248. SFr 180 (English edition); SFr 285 (German and French editions).
THIs book is divided into three sections which deal with the normal oesophagus, and the diseased first section is subdivided into portions where indications and contraindications, failures, complications, preparation, instruments, and methods are discussed in detail. There is an attempt at a similarly comprehensive approach in the latter sections. The type is large, attractive, and varied, the black-and-white photographs and reproductions of radiographs are excellent, the line drawings are clear and helpful, and the tables and other diagrams are well-designed and easy to follow. In addition there are scores of colour photographs of endoscopic appearances. An ear, nose, and throat specialist and a gastroenterologist, both Swiss, have pooled their extensive experience and have attempted to present this in book form. The result is beautiful to look at, a delight to handle, but not entirely successful. The style tends towards the didactic, and there are few references. There is an attempt at comprehensiveness which, in a book of this size, leads to occasional oversimplification. The authors clearly believe in the benefits of classification, a useful approach but perhaps here overexploited. The text reads like a translation and the flavour is still that of a book originating from a Continental school of medicine (which is perhaps as it should be). Whatever the precise
oesophagoscopy, oesophagus. The
998 and would disappear if industrial production were organised on socialist lines. She is, of course, critical of the drug industry, but many of her criticisms were answered by W. Duncan Reekie and Michael Weber’s book (Profits, Politics and Drugs, see Lancet Aug. 25, 1979) published while hers was in the press. She both challenges the motives behind current DHSS policies and priorities, and criticises Ivan Illich’s sweeping dismissal of the benefits of modern medical technology. Altogether a stimulating book and a worthy contribution to current debates on the politics of health.
aims of the authors, and these are not clearly expressed in the this book does not meet the criteria for a successful textbook on diseases of the oesophagus. The strength of the book lies in its colour photographs. Here there is a wealth of material, beautifully reproduced. Whatever may be the pros and cons of fibre versus rigid oesophagoscopy (and this problem is not fully discussed), this book is proof that really excellent photographs can at present only be obtained through a rigid oesophagoscope. It is an expensive book; the potential reader must decide whether he wishes to spend a large sum on what is essentially an atlas.
preface,
Counseling Parents of Hearing-impaired Children
Man against Disease
DAVID LUTERMAN, Boston: Little Brown. London: Quest. 1979.
Pp.l93.$9.9S;/;6.70.
Preventive Medicine. By J. A. MUIR GRAY. Oxford: Oxford University Press. 1979. Pp. 192. 4.9$; /;2.50 (paperback).
THIS is
an
THOSE few individuals who are skilled in the diagnosis and care of hearing-impaired children are well aware of the impor-
excellent book. In less than 200 pages Dr Muir
of involving the parents, but whether personal experiof this often traumatic relationship can be put on paper for the benefit of others is questionable. Variations in family background and intelligence makes both the impact of advice on the parents and subsequent care of these unfortunate children very individual problems needing individual attention. This personal account by the director of a parent-centred nursery programme in a large North, American city is a hard read. The author’s sincerity cannot be doubted but the text is rambling, interspersed with snippets of conversation between parent and himself. In essence it is a psychological treatise written by an academic audiologist of the many ways in which parents of handicapped children living in North America can be helped to cope with the impact of this domestic misfortune. The patient seems to play little part in this dialogue and one is left wondering about the fate of children with uncooperative parents. Most parents in the programme are "middle-class" (whatever this means), and "lower-class" parents taking part are said to be seeking "class improvement". The seven chapter headings include "structural group experiences", "developing programmes of parents", and "parents in the group". By far the most interesting section is the one on the impact of deafness on the family, for this relates to deafness at all ages and in most social groups. However, it is hardly worth buying the book for the benefits of this one chapter. tance
Gray summarises much of the reflective wisdom that epidemiology and community medicine are offering to their colleague specialties. Indeed, such is its style and clarity that many laymen will easily understand all the main issues discussed. The book begins with a concise general look at the history of health prevention and then moves on to discuss the scope for prevention today. Then there is an excellent chapter on the opportunities for preventive medicine in underdeveloped countries, where the potential for saving health and life dwarfs that of the developed world. There follow two clear chapters on the promotion of child health and prevention of disease in adult life. Ways and means of applying our current knowledge, including legislation and health education, get good coverage, as do the main obstacles to prevention. The book closes with a discussion of the future of prevention. The book leaves the impression that, in some areas, we are making greater strides in prevention than we realise. For example, the incidence of roadtraffic accidents has been falling, the prevalence of cigarette smoking is decreasing, and we have reason to believe that a large proportion of malignancy may be due to environmental agents (though, as yet, we do not always know what these agents are). At a time when his specialty of community medicine is in "
low morale and poor a valuable contribution doctors can make to prevention. The fact that this book is clearly aimed at the general reader and that its title is Man (rather than Doctors) Against Disease reflects -the author’s view that prevention of ill-health is everyone’s job. This is an admirable book which really deserves to be widely read. an
embattled condition with
ences
a
recruitment, Dr Muir Gray has revealed what
Pathobiology Annual Vol. IX. Edited
The Political Economy of Health LESLEY DOYAL (with IMOGEN PENNELL), Polytechnic of North London. London: Pluto Press. 1979. Pp. 360. /;4.9S.
THIS is a cut above the usual polemical book on health and health services. It is readable and well researched. The author has mastered an impressive range of data: 297 pages of text are followed by more than 50 pages of references and notes. Many who do not share the author’s marxist viewpoint or agree with her conclusions will be grateful for her industry and for her ability to write clearly on subjects which other writers have often shrouded in the obscurity of unreadable prose. The book explores the nature of health and sickness, the development of medical technology, and the influence of social and economic factors on health in an advanced industrial society. It gives much attention to the relationship between medicine, medical ideology, and what is inevitably described as "the oppression of women". Similar emphasis is placed on the part played by western medicine in the oppression and exploitation of colonial peoples. Mrs Doyal argues that disease due to industriar pollution is more widespread than is generally realised. One can share her concern at the evidence pointing in this direction without sharing her belief that such disease is a capitalist plot
by H. L. IOACHIM. New York: Raven Press. 1979.
Pp. 402.$41.60.
,
Pathobiology Annuals can be relied on to present an eclectic choice of subjects, and the latest volume maintains this tradition. Could any single reader draw on sufficient background knowledge to appraise with equal accuracy the treatment of topics as diverse as raised intracranial pressure, the HLA system in human pathology, vitamin BI2’ the mechanisms of immunity in tuberculosis, and microglobulins? The subjects are invariably interesting and most of them seem to be reviewed adequately. The approach is inevitably selective, and the reader will disagree with the emphasis adopted by some contributors. The detailed bibliographies will be useful. New Editions Basis of Disease-2nd ed. By Stanley L. Robins and Ramzi S. Cotran. Philadelphia and Eastbourne: Saunders. 1979. Pp.
Pathologic
1598.$39.50; £ 21.50. Muscle Relaxants-2nd ed. By S. A. Feldman. Eastbourne: Saunders. 1979. Pp.240. cell.50. World Directory of Medical Schools-5th ed. Geneva: %X’orld Health Organisation. 1979. Pp.358. Sw.Fr. 30.00. Clinical Chemistry in Diagnosis & Treatment-3rd ed. By Joan F. Zilva & P. R. Pannall. London: Lloyd-Luke. 1979. Pp. 492. 7.00. Accident Surgery & Orthopcedics for Students-2nd ed. By J. K. Pearson and R. T. Austin. London: Lloyd-Luke. 1979. Pp. 441. 8.75.
