MD

If you want to get in shape, or in better shape, following these highly effective 20-30 minute bodyweight exercise routines will get you results. Each exercise is precisely explained and paired with quirky hand-drawn illustrations. No gym membership, no equipment, no commute, no excuses -- TBK Fitness is no nonsense bodyweight conditioning for everyone. Why do you think the military uses such routines? Because they work. Whether you're an athlete or a couch potato, there is plenty in here to challenge you.

Dr. Katz's dietary recommendations also make sense. He advocates a hunter-gatherer type diet consisting of fruits, veggies, nuts & seeds and high quality lean meats/fish. While somewhat difficult to implement if you're vegetarian, the book contains an abundance of well researched and baked-up dietary information. Much of which may surprise or even shock you, considering all the misinformation we're fed by the media.

Dr. Katz has been very forthcoming in making himself available to answer my questions and for that (and this book) I thank him.

Highly recommended.

I first learned about him through his website at tbkfitness.org, and after applying his fitness and diet program to myself (with great success!), I give him my full endorsement. Not only is his program both effective and inventive, he also speaks to his readers in a no-nonsense, clear and succinct style, and respects their intelligence, providing them with the rationale behind the TBK lifestyle and explaining with great deftness the biology behind the body's interaction with the foods that we consume and its response to various activities (or lack of activity, as the case may be). In addition, he provides you with references to tons of research journals, so you can check up on his arguments yourself (in fact, he encourages you to write to him with questions). He's well-read, well-informed, and with his strong scientific background, has a true understanding of what's good for your body. I urge everyone out there seeking a change in lifestyle - an improvement in fitness level, health, and/or looks - to read this book.

The doctor/author is clearly knowledgeable and brilliant with regard to fitness and health. I read his book before it became so incredibly popular and have been more than pleased with the results I have obtained by following his simple yet well-reasoned principles. I feel younger and more fit and have gained insight into preventative care of myself and my loved ones. I highly recommend this wonderful book. And thank you, Dr. Katz.

Bell's ninth novel is a stunning accomplishment; alternating between the explosive language of Baltimore's drug culture with the meditative qualities of Tae Kwon Do, he examines race relations, hope and compassion, and most specifically, the moral dilemma of doing and not just saying. The novel takes places in modern day Baltimore, both in the suburbs of upper middle class, as well as the inner city urban homes.

Mike Devlin seemingly has it all, a successful psychiatric practice, a nice home in one of the wealthier suburbs, a loving wife and a daughter getting ready to go off to the college of her choice in a year. He is also a black belt in Tae Kwon Do, and as the top student in his Master's school, Devlin is sent to start a new branch. This branch is set up in the inner city of Baltimore. It is here that the rest of our cast is introduced.

We meet many inner city youth at his school: Trig, Gyp, Kool-Whip, Freon, Sharmane, Tamara, Buster, D-Trak, Clayvon, Stuttz, amongst others. Here we see the opposite life to Devlin's; those with nearly nothing. Living in projects, one or maybe no parents, and children way before they were ready.

There are virtually no minor characters in this novel besides maybe some of Devlin's patients. They are used to foreshadow some events and to allow the reader the possibility that Devlin is not satisfied with his current life. Over half of the dope dealers and those residing in the projects are fully realized. We understand what they do, how they do it, and sadly, why they do it.

Bell is one of the few authors out there seriously writing about race issues. It's as if he needs to do so, as if his writing about the problem will help him come to some conclusions. In lesser writer's hands, this set up could lead to a very cliché book. In the hands of Bell it becomes anything but. His use of language is true; as the story alternates between various narrators (including an omniscient third person narrator), the language takes on the structure and vocabulary expected.

To the outsider, as Devlin gets more involved in his school, he begins acting strangely. To some it would appear as some sort of a mid-life crisis. Even his wife, an ex-social worker with some professional acumen, feels he is sliding down a tunnel of depression and warns him he won't drag her along. He even struggles himself at times to come to words for what he is doing, but before his final actions he comes to a realization.

He is not succumbing to the notion that one individual can't make a difference. He is following the words of his Master and doing what he says, not just saying it. He is getting involved in lives, trying to make a difference. For an hour a day, he is fairly successful. It is the other 23 that put him to the test.

There is plenty of action throughout the novel; both in and out of the Tae Kwon Do school. Bell does a great job of describing hand to hand combat. His writing allows the reader to visualize each action, almost well enough to believe he or she is learning Tae Kwon Do, banging along with the characters, or watching Devlin's patients describe their lives.

You won't soon forget Devlin, his daughter Michelle, Trig or any of the other characters in this book; their efforts, actions and plight will stick with readers for awhile. Amazingly enough, Bell published this book in between volumes I and II of his Haitian trilogy. With ten novels in print now, and two short story collections, Madison Smartt Bell has enough to keep you busy reading for a long time. Take advantage.

I'm not much of a reader. As a matter of fact, I used to avoid books like the plague. Ten Indians is a book that I had to read during summer school last year in college, and I am glad that I did. The author did a wonderful job of grabbing my attention and keeping it throughout the entire novel. Basically, this review goes for all you non-readers out there, if you have to read a book, read this one.

Madison Smartt Bell does a masterful job of contrasting inner city and middle-class life through speech, thought, and experience. A good read...compares favorably with Richard Price's "Clockers"

An interesting book, probably unique in its kind. Dr Crippen is an intensive care specialist from Pittsburgh, Pennsylvania who in 1996 started an international internet discussion group (CCM-L) to deal with many issues involving critically ill patients. More than 1,000 members have enrolled. This is exceptional in the sense that for the first time health care professionals and providers from all over the world were able to interact and exchange information and opinions in such a direct, facile, almost immediate way.

A fundamental problem - As the population ages and life may be "artificially" extended with the use of sophisticated and often expensive technical support, ICU availability and costs have become an issue of growing public importance and concern. Dr Crippen created three hypothetical patients and asked critical care providers from all over the globe to offer their comments on their management. The result is this remarkable book which is surprisingly easy to read despite the use of specialized terminology. Different perspectives based on different cultures and socioeconomic backgrounds emerge as the reader proceeds. A physician from South Africa describes the huge demand for ICU beds and the limited availability. Physicians from India and Russia underline the importance of the patient's social and financial status and what impact this may have on future decisions related to hers/his critical care. A physician from the Netherlands describes the universal coverage health system available in his country and how the decision for further care rests primarily on the physician's medical judgment. A physician from Israel tries to achieve a balance between religious constraints and futile care. And at the end of the book, non-physician critical care providers contribute with vivid descriptions of pertinent cases and with their perception of futility. Among them, a hospital chaplain describes how she helps her patients deal with the fear of the incoming inevitable death by bringing them closer to a picture of a God who is love, mercy and compassion instead of fear, punishment and revenge.

It is evident throughout the book that one of the major issues shaping critical care costs and distribution in the USA is unlimited patient autonomy and overzealous litigation. Increased physician mistrust on behalf of the patients is stated as a major cause of this phenomenon. Whereas many physicians outside USA would assume a role conceived as paternalistic for the USA standards, patients in the USA are often offered a menu of available option regarding their future critical care treatment ("Mr. Jones, in case your breathing worsens do you want us to proceed with mechanical ventilation? In the event your heart stops, do you want us to start chest compressions?" and so on... )

Under the editing of Dr's Crippen, Kilcullen and Kelly a balance and an answer is sought. It is not an easy task but the team involved is one of the best international teams available. I highly recommend this book. It underlines once again the concept that a good question is often more important than the answer.

From Dr. Hoyt's chapter "Globalization of Critical Care"
"There is only one way to explain the birth of this book. That is CCM-L..., an electronic bulletin board that is devoted to critical care medicine), and Dr. David Crippen, one of the book's editors. An avowed nonconformist and refugee from the 1960's, Dr. Crippen has connected intensive care unit (ICU) physicians from around the world by means of the Internet. He has singlehandedly, without commercial sponsorship, woven a network of international intensivists. Nothing like this has ever occurred before. All readers of this book are being treated to a unique experience."

I might add a historical irony. One of Dr. Crippen's ancestors was Dr. Hawley Harvey Crippen. This man was the first criminal to be arrested in 1910 via the use of wireless technology. The earlier Dr. Crippen had murdered and disposed of his wife, then sought escape by going on an ocean liner with his mistress (disguised as his 12 yr. old son). The Captain grew suspicious (he saw the "father and son" holding hands and appearing amorous) and wired back to shore. This then led to a spectacular arrest as a member of Scotland Yard traveled on a faster ship and arrived in time to board and arrest Dr. Hawley Crippen. The papers at the time had a field day and this case was part of the "inspiration" for the Alfred Hitchcock film "Rear Window" starring James Stewart, Gene Kelly, and Raymond Burr. Now at the turn of another century we have yet another Dr. Crippen again making history via the use of a new "wireless" technology-- the internet. And the issue of death is involved. But instead of the sensational and criminal death of one person, we have the issue of death and dying in ICU's all over the world.
The four issues interwoven and discussed throughout the book are 1) patient autonomy, 2) beneficence (providing benefit), 3) nonmaleficence (doing no harm), and 4) distributive justice. Does patient autonomy imply not only the right to refuse treatment, but also to insist upon whatever aggressive therapies they may desire (and may have looked up on the internet)? Could we provide more benefit by trying to ease suffering during the end of life as opposed to prolonging life by a matter of days to weeks? To what extent do patients, on the surface appearing calm and sedated, actually suffer as we apply futile resuscitation efforts in their last days? If we are to formally apply some legal formula for the just distribution of critical care resources, is this a decision best left for medical professionals? Or is it a political and ethical decision for the public at large? Those looking for easy and short answers to these questions will be disappointed with this book. Many of the chapter's authors take divergent viewpoints.
What I found interesting was how several authors pointed to a historical trend in the USA. In the old fee-for-service era, when all provided technology and service was very lucractively billed, it was the families whom were going to court to have futile life support terminated. Now, in the new era DRG's, capitation & shrinking reimbursement, it is the hospitals and MD's whom are seeking to legally no longer provide futile care. This seems to imply that there has always been an economic foundation as to the determination of what constitutes "futile care". If we are discussing the compassionate and just application of medical technology and service then "futile care" may be seen as one thing. If we are talking about the provision of billable medical services then "futile care" may be seen as quite something else.
If this book has any one failing in my opinion it is that the issue of Palliative Care isn't addressed adequately. I feel this issue warranted a full chapter at least. While "palliative care" was mentioned in passing by several contributors, a more in depth look at the international differences would have been quite revealing. In many countries Palliative Care is it's own specialty. "Doing everything" is usually meant to do everything in regards to prolonging life, not doing everything to ensure a good death-per many of our default biases. Indeed a recent SCCM pamphlet I received in the mail, titled "ICU, Issues and Answers" and meant for family members of ICU patients, answers the question ""What is meant by 'doing everything' with the following.
"'Doing everything' implies tht any and all appropriate therapies will be utilized in order to preserve life." The pamphlet goes on to describe how MD's aren't required to offer therapies that would be medically ineffective. But what if we expanded our definition of "doing everything" to include effective and compassionate end of life care. That care may not be "critical" in the technological sense, but certainly it is "intensive" from the standpoint of patient need and clinician time, energy, and professionalism.

One chapter is by an RT and is titled "Advanced Medical Technology and End of Life, A Respiratory Care Practitioner's Perspective by David Walker, MA RRT. Mr. Walker eloquently describes a "day in the life" of a Respiratory Therapist.
Another chapter is titled "End of Life Care in the Intensive Care Unit" by Gabriele Ford CCRN. Ms Ford paints a rather disturbing picture of what it is like to oversee the provision of futile care.

This is one of the most interesting and riveting books I've read in a while. It is a book which deserves to be both read over again as well as passed around. No ready-made solutions pop out of the book, but I assure you that your cerebral matter will be quite stimulated.

For all the information packed into this book, it reads like a rich and compelling narrative rather than a stuffy textbook. Care plans for three critically ill patients are debated by a diverse panel of experts from around the globe. The debate is lively and energetic, engaging and candid. Geared for anyone with an interest in healthcare, it goes beyond clinical medicine to consider ethics, the law, and the three individuals behind the Three Patients.

Most orthopaedic surgeons are aware of Hoppenfeld's Anatomical Exposures text...this is the other one, which is just as important and helpful for the general or specialist orthopod. For residents who often are in a quandary regarding routine followup and rehabilitation goals with regards to patients, this paperback proves invaluable. Chief residents who often run clinics will find this as an excellent tool for evaluating the progress of their patients postop. Another excellent text with self explanatory illustrations and photographs.

An excellent,a great work by professor Hoppenfeld and his team. The best book worldwidelly on his field as offer advices and protocols on rehabilitation of fractures day by day,week by week,both for Orthopedic surgeons and for Physical therapists they work together.Me,i'm a Physical therapist for over 22years and i'm working in the Physical Therapy Department of Social Security Institute (I.K.A) of Greece in the city of Thessaloniki. This book is "a diamond" for every medical library.I really feel very lucky to have this book in my hands.

Iam a orthopedial surgeon with all most 25 years on my practice, and I 'd like every resident may read it, it is a critical review of the fractures that gives a line for the junior or senior surgeon, the autor is a rarelly formative teacher, that has help me and others to find easy the job, with his anterior books, and this new one is extremelly good,since I receipt it I readed it in two days, and now Iam checking my knowledge with it. Its is a new AMAZON SUCCESS and Dr. Hoppenfeld gift to the medicine...

This is an impressive collection of high quality ultrasound images with succinct explanations of their interpretation. The images are presented in context of clinical relevance and acquisition technique. Chapters are well divided by exam type and are clearly written with focus on communicating high yield facts.

A must read book for the practicing sologists and budding students in this field. A rare insight into magic of sound waves. The book is a masterly pictorial presentation with befitting write up.

This is a must buy book for any one who is a practicing sonologist. This has information that can be used at all times. The question answer formatt is simple to understand. Images are of excellent quality. This book is very reasonably priced.

Although I am a paediatric cardiologist, I have never really understood paediatric heart sounds. I was born into the subject in 1980 with an ultrasound machine attached to my right wrist and could not wait to dispense with the guesswork that auscultation seemed to entail. Now I wear my stethoscope only for decoration or to add a touch of old fashioned authenticity for suspicious parents. The title of this publication seems quaint for the 1990s, at a time when technology has taken over from the stethoscope and a child with a complex heart malformation can be evaluated and surgically treated without the bell ever touching the chest.

Bereft of his portable echo machine, Lehrer has put together a package that is ideal for both undergraduates and postgraduates in paediatric training. The reasoning behind children's heart sounds and murmurs is laid out clearly and Lehrer is obviously a skilled, thoughtful, and experienced auscultator. I recommend especially the chapter on systolic murmurs to many of my consultant paediatric colleagues who remain unable to distinguish a classic innocent murmur from that of a ventricular septal defect. Many children arrive in our clinics having been referred for unnecessary echocardiograms. On several occasions I became concerned that the author had lost touch with modem terminology; endocardial cushion defects are not commonly described as such nowadays, being referred to as atrioventricular septal defects. Also, to talk of surgical pulmonary valvotomy, when the established treatment for pulmonary stenosis for nearly ten years has been a balloon valvuloplasty, seems strange. There is a brief, if slightly naive, overview of some major heart malformations, but this is perfectly suitable for undergraduates.

The tape provides good examples of the different types of heart sounds and murmurs found in children. I was surprised that one of the most common, that of pulmonary stenosis, was not included. However, familiarity with the limited nature of possible diagnoses should dispel the panic often felt by undergraduates and even, in some instances, postgraduates when asked to auscultate a child's heart.

LINDSEY ALLAN
Fetal Cardiology, Guy's Hospital, London SE1 9RT, UK

The Lancet 1992; 340:1147.

Reviews

UNDERSTANDING PEDIATRIC HEART SOUNDS By Steven Lehrer. 230 pp., illustrated, with accompanying audiocassette. Philadelphia, W.B. Saunders, 1992. ISBN 0 7216 2387 5.

One of the joys of pediatric cardiology is the formulation of a clinical impression based only on the history and cardiovascular examination, perhaps supplemented by an electrocardiogram and a chest x-ray. For cost effectiveness and efficient use of resources, screening and referrals must be based on these cornerstones of clinical assessment. It is therefore timely and appropriate to reiterate the importance of bedside clinical evaluation. Lehrer's book emphasizes that auscultation is a diagnostic skill that still has great influence in the investigation of the pediatric patient thought to have heart disease.

Understanding Pediatric Heart Sounds is a well written, succinct book combined with a 20 minute audiotape. It contains 15 chapters, the first 3 of which concern anatomy and physiology, physical principles of auscultation, and an overview of the history and physical examination in pediatric cardiology. A brief chapter explains the methods of phonocardiography and external pulse recordings. The remaining chapters extensively detail the auscultation of normal heart sounds, abnormal cardiac sounds, and murmurs. The differential diagnosis of murmurs and the murmurs characteristic of both common and complex entities are presented. The relatively brief audiotape includes normal and abnormal heart sounds, as well as examples of murmurs common in young patients. For maximal clarity, the use of a stethoscope placed near the speaker is recommended when listening to the tape.

The major strengths of this book are its crisp, clear cut, and readable style and its thorough descriptions of auscultatory findings and of the mechanisms of cardiac sounds and murmurs. The integration of the text with ample, high quality illustrations allows the reader to proceed at a brisk pace. The reference list includes many classic works, and the index is comprehensive. On the audiotape, the reproductions of heart sounds are excellent. On the other hand, many of the murmurs are of only fair quality and are not always representative of clinical findings in young patients. However, having tried many times to simulate or present common murmurs in an audio format, I have great empathy for authors who try to reproduce them accurately. We live in an age of incredible electronic sophistication, but our ability to record or produce heart murmurs has lagged well behind our skill at other endeavors. Learning the art of auscultation requires accurate information, tutelage, and repetition. The reader-listener might be better served by paying more attention to the easy to follow text and the well produced heart sounds and less to the simulated heart murmurs.

Although the style is consistent, chapter 5 may be somewhat confusing to both novice examiners and experienced practitioners. It presents a revision of traditional areas of auscultation. Instead of referring to the well known mitral and tricuspid areas, the author uses a format that includes left and right ventricular and left and right atrial areas, as well as the traditional aortic and pulmonary areas. Although it has some potential benefit for enhancing communication, this format has the drawback of substantial overlap between these regions. Furthermore, the author states subsequently that the cardiac structures in congenital heart disease may be "displaced from their usual locations." Instead of a concentrated focus on specified areas of auscultation, a description of murmurs in relation to well-known landmarks, such as the mid left sternal border, the lateral second left interspace, and the suprasternal area, might be more effective. The technique of inching, moving the stethoscope in small increments over the entire anterior chest and also over the back, is described briefly, but it deserves emphasis. Also, the technique of dissection, which involves concentrating on one portion of the cardiac cycle or one heart sound to the exclusion of others, is often beneficial but is not discussed in the text.

A few minor omissions include the low pitch of innocent carotid bruits, the left lateral displacement of the aortic closure sound in congenitally corrected transposition of the great vessels, and the diffuse nature of continuous murmurs in patients with tetralogy of Fallot with pulmonary atresia and pulmonary blood flow derived from aortopulmonary collateral vessels. The narrow split of the second sound in patients with pulmonary hypertension is shown in a figure but is not mentioned in the text. In addition, the auscultatory variations of murmurs due to ventricular septal defects should have received more extensive review.

Despite these minor criticisms, I found Lehrer's work refreshing, concise, and a pleasure to read. The author's clear style makes the book, and at least a good portion of the audiotape, eminently suitable for students, house staff, and practitioners who wish to enhance their listening skills for pediatric cardiovascular examination. I wholeheartedly agree with the author that auscultation should not become a lost art.

J. PETER HARRIS, M.D. University of Rochester Medical Center

New England Journal of Medicine 1992; 327:741-742.

-------------------------------------------------------------------------------- Pediatric Heart Sounds

Understanding Pediatric Heart Sounds, by Steven Lehrer, 230 pp, with illus, and one audiocassette, paper. ISBN 0 7216 2387 5, Philadelphia, Pa, WB Saunders Co, 1992.

This 230 page soft cover book, by Steven Lehrer, MD, is a comprehensive review of the literature related to heart sounds. The author writes simply and clearly. The book is almost an abbreviated text of pediatric cardiology and could be titled "Pediatric Cardiovascular Assessment and Diagnosis." Much of the material has been previously covered in such books as Pediatric Cardiology for Practitioners, by M. K. Park, and two books by J. K. Perloff, The Clinical Recognition of Congenital Heart Disease and Physical Examination of the Heart and Circulation.

The figures and tables are almost exclusively reproduced with acknowledgment from previous publications. Although little new information is included, the manner in which the author presents the material is outstanding and goes much beyond the understanding of pediatric heart sounds. The references at the end of each chapter are extensive and excellent for the student who desires to pursue the subjects in great detail.

The chapter on heart murmurs will be particularly helpful for a better understanding of the origins of such sounds. As pointed out by the author, functional benign heart murmurs are common in children, yet perplexing for the practitioner to identify. Most care givers feel uncomfortable with any murmur that is grade 3 in intensity and will refer the child to a pediatric cardiologist for assessment.

The glossary is very beneficial, as is the chapter "Transcript for the Supplemental Tape." The tape should be most useful to the sincere student of auscultation. With the faster heart rates of younger children, the use of one's stethoscope under the tutored wisdom of an experienced pediatric cardiologist is indispensable!

The first three chapters of this book will be most helpful to all medical students. Family practice and pediatric residents and pediatric cardiology fellows will find the book full of good information in summary form. For the practicing care giver, the book will be an excellent reference text for refresher information.

Antoni M. Diehl, MD JAMA December 16, 1992 Vol 268, No.23, p 3380.

-------------------------------------------------------------------------------- Understanding Pediatric Heart Sounds Steven Lehrer. Philadelphia: Saunders. 1992. Pp 230 + audio cassette. ISBN 0 7216 2387 5. Although I am a paediatric cardiologist, I have never really understood paediatric heart sounds. I was born into the subject in 1980 with an ultrasound machine attached to my right wrist and could not wait to dispense with the guesswork that auscultation seemed to entail. Now I wear my stethoscope only for decoration or to add a touch of old fashioned authenticity for suspicious parents. The title of this publication seems quaint for the 1990s, at a time when technology has taken over from the stethoscope and a child with a complex heart malformation can be evaluated and surgically treated without the bell ever touching the chest.

Bereft of his portable echo machine, Lehrer has put together a package that is ideal for both undergraduates and postgraduates in paediatric training. The reasoning behind children's heart sounds and murmurs is laid out clearly and Lehrer is obviously a skilled, thoughtful, and experienced auscultator. I recommend especially the chapter on systolic murmurs to many of my consultant paediatric colleagues who remain unable to distinguish a classic innocent murmur from that of a ventricular septal defect. Many children arrive in our clinics having been referred for unnecessary echocardiograms. On several

This package teaches how to examine the heart of a child, with a book and audio tape that reproduces heart sounds. The book reviews the anatomy and physiology of a child's heart as well as principles of sound, hearing, and the proper use of the stethoscope. It details methods for history taking, performing a physical examination, and auscultating the heart. "The author's clear style makes the book, and at least a good portion of the audiotape, eminently suitable for students, house staff, and practitioners who wish to enhance their listening skills for pediatric cardiovascular examination." New England Journal of Medicine

I have been in substance abuse counseling and AA on and off for a few years. Recently I began researching alternatives to the 12-step approach in secular organizations such as SOS and non-AA affiliated books such as "Rational Recovery." This was one of the books I chose to read and I'm very happy I did. Written by a medical doctor and experienced researcher, the book brings together a lot of information about alcoholism that I had picked up in bits and pieces from treatment into an understandable and inspiring model for recovery. The chapters -- entitled "Paradoxes and Contradictions", "The Lure of the Siren", "The Dry Drunk", "The Mystery of Craving", "On and Off the Wagon", "The Proper Frame of Mind", "Resisting Temptation", "Sobriety Scripts" and "The Sober Mind" -- cover in depth how and why alcoholics relapse, and present foundations for committed sobriety. He states the fundamental view of the book in the preface: "1. ...many alcoholics, under the proper circumstances, do manage to recover. 2. Those who recover do so by adopting certain characteristic ways of thinking and behaving. 3. The changes associated with recovery...tend to involve...all aspects of their lives." The book follows this premise with scientific background, real life examples, and insight into why AA and other approaches work or do not work for different individuals. I've been able to put into perspective the seriousness of my harmful drinking and understand what it means for me to make a true, lasting commitment to sobriety. Most importantly, I've gained insight into the worst aspect of alcoholism (for me), craving, through the latter chapters on how to avoid, curtail and resist it. The information in this book has given me valuable tools to continue with my sobriety.

I love this book. As a drunk, I recommend it to all my friends who need help quitting. The book talks a lot about the tricks we play on ourselves.

This book is a good "companion" book for someone who wants to stop drinking. It has chapters detailing the nature of cravings, practical solutions for resisting temptation, and what happens beyond sobriety. You can pick it up and put it down, after the first read through, and always find something useful if you need a little boost. The author's credentials and amount of research are exemplary.

This is one of the few nonfictional books that I have ever read that I have literally had a hard time putting it down. Dr. Altman not only wrote a book of significant importance about the need for self-experimentation, and the history of it...but he wrote it so well that I wanted to know what and who did the next group of experiments. It also explained a lot of procedures I learned about in medical school, but sometimes without the knowledge of the history behind it complete understanding is impossible. The author also explains quite clearly why we can't use just animals in experimentation, and gives numerous illustrations of physicians and scientists who...surprise!...actually think about others compassionately and are able to put themselves in the shoes of the patients. After undergoing an experimental cochlear implant which failed (in its early days), this book makes it a lot easier for me to explain to others why I undertook such a risk and didn't sue when it failed and made me ill. The book also makes clear the need for both patient and doctor awareness of informed consent...for all patients, including those who are disabled or those who lack a complete education. Dr. Altman wrote a book that should definitely be required reading by all medical personnel in ethics classes. Karen L. Sadler, Science Education, University of Pittsburgh, klsst23@pitt.edu

This book discusses a taboo in medical research--self-experimentation. The self-experimenters ranged from the oddball to the dedicated, experiments ranged from shots in the dark to well planed out Gives a glimpse into the courage of these men and women. I highly recommend this unusual and thrilling book.

This is a wonderful book about a nearly wholly ignored aspect of medical research - - doctors who are the cutting edge of experimentation. Hopefully it will be in paperback soon

Who's In Charge: Autonomy and Mental Disorder gives hope to persons who are severely disturbed and hope for the families who suffer along with them. The three case studies allow the reader to follow the patients' progress toward mental health. Dr. Appel's compassion for his patients stands alongside his training and experience as an indispensible component in his approach to healing. The book is clearly written for the layperson as well as the professional. It offers insights into the dynamics of family members who would not yet be considered mentally ill. As a pastor Who's in Charge has helped me identify autonomy as a key cause to family distress in our congregation.

Who's In Charge: Autonomy and Mood Disorder, provides a thought provoking challenge to traditional theories of the cause and treatment of a variety of mental and emotional disturbances. Authoritatively written, Who's In Charge draws on the author's considerable experience as a masterful clinician at one of the nation's premier mental health institutions, providing not only a clear theoretical base, but as well, three extensive case studies which demonstrate the author's therapeutic approach. Central to Dr. Appel's approach is the assertion that many individuals who struggle with mood and personality disorders have often been deprived of the fundamental experience of exercising self-management, thus never successfully differentiating from other figures of authority and influence. Through intentional affirmation of the patient's perceptions, Dr. Appel gently but firmly moves the non-autonomous patient toward a greater sense of self-reliance and trust, imparting both self-confidence and the courage necessary to re-cast relationships in a non-subordinate role.

Who's In Charge is bound to be a controversial offering because it dares to challenge the most fundamental assumptions of the mental health community. Nonetheless, it is a challenge that should be embraced and tested, as the efficacy of Dr. Appel's assertions will be found, not in the arena of theoretical speculation, but rather in the application of that theory to the needs of patients.

Being in charge of one's own behavior is central to the well-being of individuals. Dr. Appel spells out the critical importance of autonomy and reminds the reader of its course of development. He uses three case examples to illustrate the damaging effects that lack of autonomy can perpetuate and the remarkable shifts that can occur as it emerges. This book reflects the depth of Dr. Appel's training and experience as well as his skillful ability to translate complex theories into terms useful to both the skilled mental health provider and to the layperson interested in grasping concepts for successful, healthy living.

I liked this book a lot. While it is not the last work on most topics, it gives a very nice overview of LOTS of different things in urology. I think it is a very nice book for the urology resident or non-urology doc, as it gives a quick one or two page read on most topics in urology. It is also helpful as a jumping off point for the boards, since it hits on most major topics. I did a lot of making notes on the margins of this book, adding to the overview with more current info as well as crossing out things that I did not like or were a bit out of date. Even given that this is a very nice book that gives a lot of bang for your buck.

This Book is great for urologists or primary care physicians. You can quickly look up almost all common urologic diseases, and find out what you need to know.