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DPT: A shot in the dark
health care providers are not to be trusted. To the author’s credit, she has arranged the material in a pleasing format. The book features large print with key words and phrases highlighted in bold face type. Important points are offset with a dot ( . ). Her writing style, for the most part, is simple and informal. The few illustrations that accompany the text serve to enhance the written material. In general, I would recommend this book to those expectant parents or pregnant adolescents with little or no knowledge of pregnancy. I would refer, however, those clients who have a more sophisticated level of knowledge or who would benefit from a more in-depth discussion of these topics to other resources DPT: A Shot in the Dark. By Harris L. Coulter and Barbara Loe Fisher. San Diego: Harcourt, Brace, Jovanovich, 1985. 431 pages. $19.95, hardcover. Reviewed
by: Martha K. Swartz, RNC, Professor, Yale University School of Nursing, New Haven, CT. MS, PNP, Assistant
With the controversy that has arisen in recent years regarding the large scale administration of the diptheria-pertussis-tetanus (DPT) vaccine to children, parents are in need of a volume that clearly and logically documents the cost-benefit analysis of the vaccine, enables them to make informed choices, and outlines current policy, recommendations, and needs for further research. Unfortunately, the effort by Coulter and Fisher falls short of these criteria. The jumbled text consists largely of detailed, anecdotal accounts by families whose children suffered vaccine side effects. These presentations alternate with a largely biased, poorly referenced discussion of the development, efficacy, and current recommendations regarding the vaccine. In no sense does this reviewer wish to minimize the sometimes traumatic, heart-wrenching experiences of parents who have watched their children suffer from apparent vaccine side effects-to say nothing of families whose children have suffered and died from the effects of whooping cough. Yet, in this text, a discussion of the cost-benefit analysis of the vaccine that would enable parents to make an informed choice is not adequately presented. While figures are given that document the incidence of Journal of Nurse-Midwifery
?? Vol.
side effects and coincident deaths, little mention is made of the pertussis epidemics that occurred in the late 1970s in some parts of the world as a result of a sharp decrease in vaccine administration. In particular, in 1977 and 1978, Great Britain and Japan reported a total of 113,000 cases of pertussis with 69 deaths. Nor is adequate attention given to current thought regarding other hypothetical causes of death in young children. For example, the authors (whose qualifications one is not aware of) do much to further the argument that there may be a relationship between the administration of the DPT vaccine and sudden infant death syndrome (SIDS). Yet, a report recently issued by the National Institute of Child Health and Human Development concluded that there is no relationship between SIDS and the DPT immunization. This finding was based on a study in which only 40% of SIDS infants had received DPT vaccines. Buried in the text near the end of the book are some salient points for parents including the need to provide a good history to the child’s practitioner, to notify the pediatrician or practitioner of any side effects, and to be aware of their legal rights to waive the vaccine. The authors underscore the importance of informing parents of all possible vaccine-related side effects. This vital communication is a hallmark of sound pediatric practice. The authors also advocate the need to develop a purer vaccine (particularly with regards to the pertussis organism) and for the provision of compensation should any injury result from the administration of the vaccine. Again, these are directions that are supported by pediatricians and practitioners as evidenced by the National Childhood Vaccine Injury Compensation Act, sponsored by the American Academy of Pediatrics, which is currently before Congress. At the very best, this volume is important in that it does inform the public that a controversy over the DPT vaccine does exist and that it is important for parents to be well informed. Unfortunately, the degree to which the authors present clear, scientifically based information regarding benefits, risks, contraindications, clinical research, and national policy does not adequately meet the needs of children and their families. The Psychiatric Implications of Menstruation. Edited by Judith Gold, MD.
31, No. 6, November/December
1986
Washington, Press, Inc., hardcover.
D.C.: American Psychiatric 1985. 102 pages. $15.95,
Reviewed
by: Linda Denise Oakley, RN, Professor, PsychiatricMental Health Nursing, Yale School of Nursing, New Haven, CT.
PhD, Assistant
The “Progress in Psychiatry” series is a product of the APA annual meeting program; this edition collects seven papers on premenstrual changes, menstrual disorders, pregnancy, infertility, and menopause. The specified intent of presenting the papers is to publish diverse medical viewpoints regarding problems associated with menstruation. The books primay contribution is the presentation of stimulating ideas on many hypothesized associations between women’s lives and female biology. The papers on pregnancy, infertility, and menopause offer brief clinical case studies and symptomatology reviews. Pregnancy loss and infertility are discussed as biologic events that can affect women emotionally, particularly when pregnancy loss causes a sudden change in the women’s serum estrogen and progesterone levels. Significant levels of guilt and reassurance needs are also expenenced by some women. The authors warn that a belief that female identity is based upon a woman’s capacity to reproduce is an unnecessary source of this guilt and insecurity. The discussion on menopause covers the topic in brief detail, with exploration of the social and physiologic aging events that occur simultaneously. The importance of the influence of societal expectations of aging upon women is given close attention. The central focus considered here is the distinction between health problems attributable to aging and specific clinical health problems associated with menopause. The greatest contribution of the book is the range of questions addressed to the scientific debate on the diagnosis and treatment of premenstrual stress (PMS). No agreements or conclusions are offered. Instead, impressive intellect is exhibited in the general observations that there now exist more PMS treatments than there are valid and reliable explanations of PMS. The consensus of the opinions expressed is that PMS treatment conclusions are premature at this time: A warning based on considerable research evidence. The unknown influ-
303
by: Martha K. Swartz, RNC, Professor, Yale University School of Nursing, New Haven, CT. MS, PNP, Assistant
With the controversy that has arisen in recent years regarding the large scale administration of the diptheria-pertussis-tetanus (DPT) vaccine to children, parents are in need of a volume that clearly and logically documents the cost-benefit analysis of the vaccine, enables them to make informed choices, and outlines current policy, recommendations, and needs for further research. Unfortunately, the effort by Coulter and Fisher falls short of these criteria. The jumbled text consists largely of detailed, anecdotal accounts by families whose children suffered vaccine side effects. These presentations alternate with a largely biased, poorly referenced discussion of the development, efficacy, and current recommendations regarding the vaccine. In no sense does this reviewer wish to minimize the sometimes traumatic, heart-wrenching experiences of parents who have watched their children suffer from apparent vaccine side effects-to say nothing of families whose children have suffered and died from the effects of whooping cough. Yet, in this text, a discussion of the cost-benefit analysis of the vaccine that would enable parents to make an informed choice is not adequately presented. While figures are given that document the incidence of Journal of Nurse-Midwifery
?? Vol.
side effects and coincident deaths, little mention is made of the pertussis epidemics that occurred in the late 1970s in some parts of the world as a result of a sharp decrease in vaccine administration. In particular, in 1977 and 1978, Great Britain and Japan reported a total of 113,000 cases of pertussis with 69 deaths. Nor is adequate attention given to current thought regarding other hypothetical causes of death in young children. For example, the authors (whose qualifications one is not aware of) do much to further the argument that there may be a relationship between the administration of the DPT vaccine and sudden infant death syndrome (SIDS). Yet, a report recently issued by the National Institute of Child Health and Human Development concluded that there is no relationship between SIDS and the DPT immunization. This finding was based on a study in which only 40% of SIDS infants had received DPT vaccines. Buried in the text near the end of the book are some salient points for parents including the need to provide a good history to the child’s practitioner, to notify the pediatrician or practitioner of any side effects, and to be aware of their legal rights to waive the vaccine. The authors underscore the importance of informing parents of all possible vaccine-related side effects. This vital communication is a hallmark of sound pediatric practice. The authors also advocate the need to develop a purer vaccine (particularly with regards to the pertussis organism) and for the provision of compensation should any injury result from the administration of the vaccine. Again, these are directions that are supported by pediatricians and practitioners as evidenced by the National Childhood Vaccine Injury Compensation Act, sponsored by the American Academy of Pediatrics, which is currently before Congress. At the very best, this volume is important in that it does inform the public that a controversy over the DPT vaccine does exist and that it is important for parents to be well informed. Unfortunately, the degree to which the authors present clear, scientifically based information regarding benefits, risks, contraindications, clinical research, and national policy does not adequately meet the needs of children and their families. The Psychiatric Implications of Menstruation. Edited by Judith Gold, MD.
31, No. 6, November/December
1986
Washington, Press, Inc., hardcover.
D.C.: American Psychiatric 1985. 102 pages. $15.95,
Reviewed
by: Linda Denise Oakley, RN, Professor, PsychiatricMental Health Nursing, Yale School of Nursing, New Haven, CT.
PhD, Assistant
The “Progress in Psychiatry” series is a product of the APA annual meeting program; this edition collects seven papers on premenstrual changes, menstrual disorders, pregnancy, infertility, and menopause. The specified intent of presenting the papers is to publish diverse medical viewpoints regarding problems associated with menstruation. The books primay contribution is the presentation of stimulating ideas on many hypothesized associations between women’s lives and female biology. The papers on pregnancy, infertility, and menopause offer brief clinical case studies and symptomatology reviews. Pregnancy loss and infertility are discussed as biologic events that can affect women emotionally, particularly when pregnancy loss causes a sudden change in the women’s serum estrogen and progesterone levels. Significant levels of guilt and reassurance needs are also expenenced by some women. The authors warn that a belief that female identity is based upon a woman’s capacity to reproduce is an unnecessary source of this guilt and insecurity. The discussion on menopause covers the topic in brief detail, with exploration of the social and physiologic aging events that occur simultaneously. The importance of the influence of societal expectations of aging upon women is given close attention. The central focus considered here is the distinction between health problems attributable to aging and specific clinical health problems associated with menopause. The greatest contribution of the book is the range of questions addressed to the scientific debate on the diagnosis and treatment of premenstrual stress (PMS). No agreements or conclusions are offered. Instead, impressive intellect is exhibited in the general observations that there now exist more PMS treatments than there are valid and reliable explanations of PMS. The consensus of the opinions expressed is that PMS treatment conclusions are premature at this time: A warning based on considerable research evidence. The unknown influ-
303