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Computer Assisted Medical Learning 1: Clinical Anatomy
664 of the book. These results emphasise the importance of time preference in health choices-for example, people typically prefer the benefits of smoking now and discount the costs of lung cancer in the future and he notes that unless this psychology is understood, health promotion policies may fail. In part II Fuchs analyses the behaviour of physicians. In particular he emphasises the role of doctors as resource allocators and analyses how in some market situations they appear to induce demands (and hence create incomes) for their and other health professional services. A British reader of this work will inevitably ask questions such as Why is surgical activity increasing, for whom, and for what benefit in terms of additional life years and quality of life? As in the US, these questions remain largely unasked and unanswered. The final part of the book analyses various aspects of health policy. Here Fuchs exhibits a healthy scepticism about market mechanisms, indicating that every revolution carries in it the seeds of its eventual destruction, and a belief in the need for the State to take an active redistribution role. He explains this role in terms of the relative decline of religion and the family-agencies which were previously paramount in redistributing access to health and health care.
Often economists are depicted as inhuman calculating machines dedicated to making the doctor bow to the economic unavoidability of costs. There is much more to health economics than this and in this volume Fuchs deploys a wide range of easy-to-understand skills, both of logic and statistics, to demonstrate with telling analytical power how economics can illuminate the nature of the health and health-care markets, public and private. Although the examples used in this work are American and there is all too little reference to the UK health economics literature, this collection of Fuchs’ lifetime work is essential reading for doctors and health researchers interested in evaluating the role of economics. Fuchs looks towards the day in which work such as his will be an essential ingredient in the training of doctors in medical school and across their life-cycle. Amen, and the sooner the better for those concerned with the welfare of the patient. University of York Centre for Health Econormcs, York Y01 5DD
ALAN MAYNARD
who differ enormously in their skill, honesty, materia medica, and mode of operating. Meanwhile, western medicine is acclaimed, often copied, and its products widely dispensed in small numbers. Whether the burgeoning small guilds and societies of individualistic traditional practitioners which are now emerging could ever constitute the core of a united profession is highly questionable. But the distinction between African and western medicine is likely to become even more unclear as each borrows liberally from the other. Pluralism is undoubtedly here to stay. Department of Community Medicine, Usher Institute, Warrender Park Road, Edmburgh EH9 1DW
UNA MACLEAN
Software Computer Assisted Medical Learning 1: Clinical Anatomy J. Pegington and D. Ellis. London: Chapman and Hall. 1985. 6 disk package for Apple II +, IIe, and IIc. £ 195 +VAT. IN what direction should medical teaching be going? In anatomy, is the vast tome (Gray, Cunningham, and so on) out of date? In this computer package, six disks cover: the head; the neck and upper limb; thorax and vertebral column; the abdomen, pelvis, and perineum; the lower limb; and game and file options. On each disk there is a series of questions (some based on fairly sketchy line diagrams) demanding a yes or no answer with a "pass" option. After the usual computer raspberry for a wrong answer or chime for a correct answer, the teaching starts. The best feature of this set is the clear and practical discussion that follows each question, outlining its importance and adding related information. Despite this the system is a method of testing progress rather than learning. For the student of anatomy, particularly the primary FRCS candidate, there is no alternative to the hard slog through the textbooks, gross dissection, inspection of prepared specimens, and study of the skeleton. To be fair, the authors emphasise this in the accompanying text. But the program could make a sensible and
profitable break from intensive study. The questions are the usual mixture of the straightforward, the difficult, and the abstruse, with an admixture of traps to encourage the careful reading required in answering multiple-choice questionnaire papers, and the perverse to introduce new ideas. As a result I was not happy with a few of the answers.
There is Edited by Murray Last and G. L. Chavundukas. Manchester: Manchester University Press. 1986. Pp 293. 29.95.
THE contributions
to
this volume all
concern a
not
enough anatomy given to get a student through an
exam, but the final score—one point for each correct answer and one
The Professionalisation of African Medicine
remarkable
development of recent years: namely, the way in which practitioners of traditional medicine in Africa are organising to protect and further their interests. Once regarded as exotic, ignorant, quasimagical operators, they are fast becoming a force to reckon with and are pressing for official recognition within countries which can never hope to supply rural areas with modem doctors and nurses. It is noteworthy that one of the editors of the book combines an academic chair in Zimbabwe with the presidency of his country’s national association of healers. Traditional practitioners already provide basic care for most of the population in many developing countries, where public policy and modem doctors’ personal career plans combine to neglect people on the periphery. In 1978, the World Health Organisation recommended that it would be better to accept reality and involve suitably trained local healers in primary health care plans. Nevertheless, stereotypes and misconceptions abound, leading some policy makers to reject the existing "dangerous" local practitioners out of hand. In some countries their activities are illegal. Other governments speak of some kind of recognition. Advocates of traditional practice praise its holistic approach, the accumulated knowledge of herbs, and the manifest psychological power of diviner priests. Across the vast continent there are innumerable variants on these themes and a range of practitioners
deducted for each error-will give a good indication of how the work is going. Anyone with a score of 75"" or more ought to pass the primary Fellowship in anatomy. How easy is it to use the set, how do I rate it, and who should buy it? The accompanying text is excellent-a model of its kind-and, even for the inexperienced, setting up and running the programs should be easy. The spirit of the system, "user friendly", can grate with its constant joking and punning: "some juicy spinal roots coming up" or "just fishing for a rib". The final disk is another story. It is for devotees of Space Invaders and those into computer programming. The set is not cheap. If an hour is allowed per disk, the cost is £ 39 per hour’s tuition. And ready access to an Apple II is essential. Picture this reviewer in the micro-computer lab working away at an Apple with the lid off and all its pips exposed. Anyone who has this access could find the system invaluable, but I doubt if many individuals will find it worth [,195, which otherwise could go towards a "cram" course. In that course, or in an anatomy department, with assistance from a teacher, it should prove most useful. That I suggest is the area most appopriate for this form of teaching, and where I intend my set to go. A final warning: don’t judge the set by the sampler diskavailable free. If you regard Space Invaders as noisy time-wasters, you will not even get through it. Subdepartment of Paediatnc Surgery, Children’s Hospital, Sheffield S10 2TH
J. A. S. DICKSON
Often economists are depicted as inhuman calculating machines dedicated to making the doctor bow to the economic unavoidability of costs. There is much more to health economics than this and in this volume Fuchs deploys a wide range of easy-to-understand skills, both of logic and statistics, to demonstrate with telling analytical power how economics can illuminate the nature of the health and health-care markets, public and private. Although the examples used in this work are American and there is all too little reference to the UK health economics literature, this collection of Fuchs’ lifetime work is essential reading for doctors and health researchers interested in evaluating the role of economics. Fuchs looks towards the day in which work such as his will be an essential ingredient in the training of doctors in medical school and across their life-cycle. Amen, and the sooner the better for those concerned with the welfare of the patient. University of York Centre for Health Econormcs, York Y01 5DD
ALAN MAYNARD
who differ enormously in their skill, honesty, materia medica, and mode of operating. Meanwhile, western medicine is acclaimed, often copied, and its products widely dispensed in small numbers. Whether the burgeoning small guilds and societies of individualistic traditional practitioners which are now emerging could ever constitute the core of a united profession is highly questionable. But the distinction between African and western medicine is likely to become even more unclear as each borrows liberally from the other. Pluralism is undoubtedly here to stay. Department of Community Medicine, Usher Institute, Warrender Park Road, Edmburgh EH9 1DW
UNA MACLEAN
Software Computer Assisted Medical Learning 1: Clinical Anatomy J. Pegington and D. Ellis. London: Chapman and Hall. 1985. 6 disk package for Apple II +, IIe, and IIc. £ 195 +VAT. IN what direction should medical teaching be going? In anatomy, is the vast tome (Gray, Cunningham, and so on) out of date? In this computer package, six disks cover: the head; the neck and upper limb; thorax and vertebral column; the abdomen, pelvis, and perineum; the lower limb; and game and file options. On each disk there is a series of questions (some based on fairly sketchy line diagrams) demanding a yes or no answer with a "pass" option. After the usual computer raspberry for a wrong answer or chime for a correct answer, the teaching starts. The best feature of this set is the clear and practical discussion that follows each question, outlining its importance and adding related information. Despite this the system is a method of testing progress rather than learning. For the student of anatomy, particularly the primary FRCS candidate, there is no alternative to the hard slog through the textbooks, gross dissection, inspection of prepared specimens, and study of the skeleton. To be fair, the authors emphasise this in the accompanying text. But the program could make a sensible and
profitable break from intensive study. The questions are the usual mixture of the straightforward, the difficult, and the abstruse, with an admixture of traps to encourage the careful reading required in answering multiple-choice questionnaire papers, and the perverse to introduce new ideas. As a result I was not happy with a few of the answers.
There is Edited by Murray Last and G. L. Chavundukas. Manchester: Manchester University Press. 1986. Pp 293. 29.95.
THE contributions
to
this volume all
concern a
not
enough anatomy given to get a student through an
exam, but the final score—one point for each correct answer and one
The Professionalisation of African Medicine
remarkable
development of recent years: namely, the way in which practitioners of traditional medicine in Africa are organising to protect and further their interests. Once regarded as exotic, ignorant, quasimagical operators, they are fast becoming a force to reckon with and are pressing for official recognition within countries which can never hope to supply rural areas with modem doctors and nurses. It is noteworthy that one of the editors of the book combines an academic chair in Zimbabwe with the presidency of his country’s national association of healers. Traditional practitioners already provide basic care for most of the population in many developing countries, where public policy and modem doctors’ personal career plans combine to neglect people on the periphery. In 1978, the World Health Organisation recommended that it would be better to accept reality and involve suitably trained local healers in primary health care plans. Nevertheless, stereotypes and misconceptions abound, leading some policy makers to reject the existing "dangerous" local practitioners out of hand. In some countries their activities are illegal. Other governments speak of some kind of recognition. Advocates of traditional practice praise its holistic approach, the accumulated knowledge of herbs, and the manifest psychological power of diviner priests. Across the vast continent there are innumerable variants on these themes and a range of practitioners
deducted for each error-will give a good indication of how the work is going. Anyone with a score of 75"" or more ought to pass the primary Fellowship in anatomy. How easy is it to use the set, how do I rate it, and who should buy it? The accompanying text is excellent-a model of its kind-and, even for the inexperienced, setting up and running the programs should be easy. The spirit of the system, "user friendly", can grate with its constant joking and punning: "some juicy spinal roots coming up" or "just fishing for a rib". The final disk is another story. It is for devotees of Space Invaders and those into computer programming. The set is not cheap. If an hour is allowed per disk, the cost is £ 39 per hour’s tuition. And ready access to an Apple II is essential. Picture this reviewer in the micro-computer lab working away at an Apple with the lid off and all its pips exposed. Anyone who has this access could find the system invaluable, but I doubt if many individuals will find it worth [,195, which otherwise could go towards a "cram" course. In that course, or in an anatomy department, with assistance from a teacher, it should prove most useful. That I suggest is the area most appopriate for this form of teaching, and where I intend my set to go. A final warning: don’t judge the set by the sampler diskavailable free. If you regard Space Invaders as noisy time-wasters, you will not even get through it. Subdepartment of Paediatnc Surgery, Children’s Hospital, Sheffield S10 2TH
J. A. S. DICKSON