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The Use and Abuse of Medicine
mund Doering, "The Role of the Primary-Care Physician in the Diagnosis and Management of Anorexia Nervosa," is outstanding in emphasizing the importance of the primary care physician in facilitating prompt psychiatric intervention. Four chapters outlining the hematologic, gastrointestinal, gynecologic, and cardiac findings in anorexia nervosa provide valuable data for the clinician. "Failure to Thrive," by John B. Reinhart, is an interesting chapter, but the connection, if any, to anorexia nervosa is not specified. K. Miller Kovach's "The Assessment of Nutritional Status in Anorexia Nervosa" provides information useful for a thorough anthropometric evaluation of the patient. The treatment section of the book is somewhat disappointing, in that the necessity of distinguishing between symptoms of malnutrition and underlying personality trends is not discussed, nor is the weight restoration program described in detail; and although group therapy is said to be effective, objective data supporting this conclusion was not provided. The chapters on hypnotherapy and biofeedback are interesting and innovative, but inclusion of the article on total parenteral nutrition by Chiulli and colleagues is unfortunate since this treatment modality has a very high incidence of severe and lethal complications and is rarely, if ever, necessary. The chapter on the psychology of anorexia nervosa by Bliss reviews some of the crucial psychological issues but not in sufficient depth. In summary, the quality of the chapters varies significantly (and JANUARY 1984' VOL 25 • NO I
the diagnostic criteria for anorexia nervosa are repeated redundantly), but the clear delineation of presenting physical findings and laboratory tests makes the book valuable. Dr. Doering's chapter, already cited, emphasizing both the inclusionary and exclusionary diagnostic criteria in the framework of motivating patients and their families to seek psychiatric treatment, should be required reading for physicians who screen patients for anorexia nervosa. Pauline S. Powers, M.D. University of South Florida
The Use and Abuse of Medicine Edited by Manen W. de Vries, Robert L. Berg, Mack Lipkin, Jr., New York, Praegar Publishers, 1982,296 pp, $37.50.
• This book grew out of a conference in Rochester, New York, dealing with the proper role of medicine in both Western and developing cultures. The critiques are interdisciplinary and include contributions from anthropology theorists, sociologists, and physicians. "Medicalization" is used as a pejorative term to indicate corruption, aggrandizement, and incompetent medical practice. The contributions describe how various medical systems are used and abused, with emphasis on the pernicious effect of Western medicine, especially in the developing countries of the world, There are intriguing examples given, in reference to such conditions as couvade and leprosy, in which the Western model is
claimed to have caused chaos in treatment. The most fascinating chapter deals with the alienation of the physician, by Dr. John-Henry Pfifferling. He describes in detail the ritualistic training given the medical student, who must accommodate to a decreased allowance of idealism and empathy and problem solving. The process of medical school graduation requires mastery of a body of information that minimizes or denies significance of metaphysical intuitions. There is a sacrifice of humanism, idealism, and perhaps curiosity. When the graduate becomes a house staff member, he evolves a value system in which he is the master of all facts in this new technology. The new physicians are evaluated by a faculty of peers for their analytic astuteness in pathophysiology and biochemistry but not in their ability to use relevant cultural and social factors. Dr. Pfifferling concludes that the current mode of medical training brutalizes and dehumanizes the medical profession and contributes to marital disharmony, suicide, alcoholism, and depression among physicians. The authors' thesis that the physician should look into himself is self-evident. But the general thesis that the chaos in medicine has contributed to the chaos in an industrialized society is not proven by the fascinating examples given. The "medicalization" criticism outlined by the authors is not a preoccupation with illness but rather a reaction to depersonalized care. Louis L. Lunsky, M.D. Culver City, Calif. 75
the diagnostic criteria for anorexia nervosa are repeated redundantly), but the clear delineation of presenting physical findings and laboratory tests makes the book valuable. Dr. Doering's chapter, already cited, emphasizing both the inclusionary and exclusionary diagnostic criteria in the framework of motivating patients and their families to seek psychiatric treatment, should be required reading for physicians who screen patients for anorexia nervosa. Pauline S. Powers, M.D. University of South Florida
The Use and Abuse of Medicine Edited by Manen W. de Vries, Robert L. Berg, Mack Lipkin, Jr., New York, Praegar Publishers, 1982,296 pp, $37.50.
• This book grew out of a conference in Rochester, New York, dealing with the proper role of medicine in both Western and developing cultures. The critiques are interdisciplinary and include contributions from anthropology theorists, sociologists, and physicians. "Medicalization" is used as a pejorative term to indicate corruption, aggrandizement, and incompetent medical practice. The contributions describe how various medical systems are used and abused, with emphasis on the pernicious effect of Western medicine, especially in the developing countries of the world, There are intriguing examples given, in reference to such conditions as couvade and leprosy, in which the Western model is
claimed to have caused chaos in treatment. The most fascinating chapter deals with the alienation of the physician, by Dr. John-Henry Pfifferling. He describes in detail the ritualistic training given the medical student, who must accommodate to a decreased allowance of idealism and empathy and problem solving. The process of medical school graduation requires mastery of a body of information that minimizes or denies significance of metaphysical intuitions. There is a sacrifice of humanism, idealism, and perhaps curiosity. When the graduate becomes a house staff member, he evolves a value system in which he is the master of all facts in this new technology. The new physicians are evaluated by a faculty of peers for their analytic astuteness in pathophysiology and biochemistry but not in their ability to use relevant cultural and social factors. Dr. Pfifferling concludes that the current mode of medical training brutalizes and dehumanizes the medical profession and contributes to marital disharmony, suicide, alcoholism, and depression among physicians. The authors' thesis that the physician should look into himself is self-evident. But the general thesis that the chaos in medicine has contributed to the chaos in an industrialized society is not proven by the fascinating examples given. The "medicalization" criticism outlined by the authors is not a preoccupation with illness but rather a reaction to depersonalized care. Louis L. Lunsky, M.D. Culver City, Calif. 75