From The New England Journal of Medicine
The field of neurology was long infamous for a lack of therapeutic options. But those sere days have passed into history, and the field is now vibrant with new treatments and with hope even for patients with the worst neurodegenerative diseases and tumors. The most skeptical doubters will be impressed by this two-volume set, which emphasizes treatment. The numbers themselves are noteworthy: 15 section editors (all of them famous and highly respected), 345 contributing authors, two volumes, 271 chapters with 2874 pages of text, and a 70-page index. A useful addendum is the ring binder with a compendium of tables and figures, somewhat larger than pocket-sized but still convenient. The first section of the first volume deals with basic principles, molecular therapies, clinical trials, placebos, evidence-based medicine, ethical issues related to treatment and trials, and domestic violence. These topics would not ordinarily be found in a clinical textbook. There follows a long series of discussions of specific conditions, starting with pain and the management of pain and headaches of different types. The rest of the two volumes comprise sections that cover all conceivable neurologic diseases or symptoms, in the format of a comprehensive textbook of neurology, with perhaps more attention to therapy than is found in most such textbooks. The production of these volumes is neat and clear, with most of the book in black and white but with blue headers that are helpful. There are tables galore but not many photographs of patients or other images. The breadth of the content is so vast that I was surprised to find no chapter on ethical issues or practical considerations related to end-of-life care. Nevertheless, this book is surely a worthy effort that can serve as a reference source for individual neurologists or for groups. The book will be most useful to trainees in neurology, candidates for board certification, and practitioners. Internists may find useful information in the 100 pages devoted to intensive care neurology or the almost 300 pages on neurologic complications of systemic illness. But I wonder about the book's future. Volume I weighs 8 lb, volume II 10 lb. They are not very portable. Cost is another consideration. And it will be difficult to ride herd on 345 authors to keep the text up to date. I checked 10 chapters at random, and none had references that are more recent than 2000. I turned to our residents to learn their views about jumbo books in general. They told me that, when confronted with a clinical problem, they often seek a review of the subject in a large neurology textbook as the first step, which they follow with an online search of the contemporary literature. Will readers ignore the challenges of handling king-sized volumes? Or will they just go straight to less comprehensive but more physically manageable textbooks or, perhaps more likely, go directly to online data bases and smaller but renewable textbooks? Or will readers seek reprint-like pdf versions on the Web when they want published papers or reviews of new treatments? Time will tell. In the meantime, we neurologists thank Dr. Noseworthy and his illustrious team for bringing neurologic therapeutics to the fore.
Lewis P. Rowland, M.D.Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.