1987.) Rodolfo Low. 182 pp. An. Owl Book. Henry Holt and Com- pany, Inc., New YorklFitzhenry and Whiteside Ltd., Markham,. Ont. 1989. $7.95. ISBN 0-8050-.
BOOKS * LIVRES
Somewhat patchy Transdermal Estrogen Replacement for Menopausal Women. Edited by George F.B. Birdwood. 51 pp. Illust. Hans Huber Publishers, Toronto. 1989. $16 (US). ISBN
0-920887-36-8 I nterest in estrogen replacement therapy has been growing rapidly in recent years. More women are seeking medical advice about menopausal complaints or simply requesting prescriptions of estrogen for hormonal replacement. This monograph provides a short overview of transdermal estrogen replacement therapy for menopausal women. The 10 papers, which place particular emphasis on transdermal administration, were originally presented at two symposia, Benefits of Transdermal Estrogen Substitution and Recent Advances in the Management of the Menopause, held during the Fifth International Congress on the Menopause, in Sorrento, Italy, in 1987. As the editor says in the introduction, "This combination of reports . . . provides an up-to-date review of transdermal estrogen therapy, in relation to other forms of administration. Its value to clinicians should be enhanced by the concluding papers, from an experienced clinic sister and a menopausal patient, which serve to set the scientific contributions in a human context." The monograph is well illustrated with graphs and is easy to read. Each paper is preceded by a question, which is answered in the text in a simple manner. The questions include What is the most suitable preparation? What -
For prescribing information see page 897
dosage of estrogen should be given? How long should estrogen therapy be continued? Should it be accompanied by cyclic progesterone therapy? What are the benefits and side effects to be expected from short-term and long-term estrogen replacement therapy? and What is the role of estrogen in the prevention of diseases such as osteoporosis and heart disease? Any physician or nurse involved in the care of postmenopausal patients will find that this monograph provides the answers to many questions they are confronted with in day-to-day practice. Although the book is somewhat superficial and patchy, I feel confident in recommending it for the practising physician. B. Norman Barwin, MD, FRCOG B 1-770 Broadview Ave. Ottawa, Ont.
Reject the book, not the theory Victory over Migraine. (First published in hardcover as Migraine in 1987.) Rodolfo Low. 182 pp. An Owl Book. Henry Holt and Company, Inc., New YorklFitzhenry and Whiteside Ltd., Markham, Ont. 1989. $7.95. ISBN 0-80500927-2 T n here is every reason for a scientifically oriented physician to reject this book. It claims to present a simple method for the relief of a common and often intractable problem for which allopaths like me usually offer drugs. The author is a chemist and the "President of a leading
University" but not a physician. The chatty prose is appropriate for a lay audience. However, the scientific rigour of the clinical experiments would not be acceptable to most journals, although the author does cite four papers that he has had published in Tribuna Medica (Colombia), a publication of which I am ignorant. The author, for years a migraineur, eliminated sugars from his diet and lost his migraines. He conducted some tests, not well described here, from which he concluded that "only refined sugar stimulated the pancreas of predisposed individuals to produce too much insulin". A diet including six meals a day rich in natural carbohydrates and containing no refined sugar, alcohol or certain chemicals is his prescription. A scattering of anecdotal reports of glucose tolerance tests and of satisfactory patient outcomes after adoption of this diet demonstrates the author's conviction that this is the necessary and adequate method of managing the problem of migraine. So should we reject the book? Perhaps, but not the theory. Certainly there are patients with vascular headaches whose attacks are precipitated by hypoglycemia, and I am quite prepared to advise dietary therapy for people who consult me about their migraines. However, it is preferable to give patients some responsibility for determining their own precipitants and for learning to avoid them. I am sorry that the style of this book may cast doubt on the premise that many factors, including hypoglycemia, are relevant in the pathogenesis of such headaches. It is also unfortunate that CAN MED ASSOC J 1990; 142 (8)
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the author, who is forward in pointing out that he heads a major university, has presented his results in a manner unacceptable to those who counsel people with headaches that intrude unacceptably into the smooth running of their lives. The theory propounded here has face validity. It would be appropriate and not too difficult to subject it to the same kind of controlled analysis used to examine other putative therapies. Sadly, no such examination is described in this popular presentation. William E. Pryse-Phillips, MD, FRCPC Chief Division of Neurology Health Sciences Centre St. John's, Nfld.
Educating health services managers Health Services Management. A Book of Cases. 3rd ed. Edited by Anthony R. Kovner and Duncan Neuhauser. 252 pp. Illust. Health Administration Press, division of the Foundation of the American College of Healthcare Executives, Ann Arbor, Mich. 1989. $20 (US). ISBN 0-910701-41-5
T n he case method of teaching is common in a number of disciplines as a means of applying theories and concepts to real-world circumstances. It is most common in those fields in which the interplay of variables is so complex that traditional didactic methods are inadequate. Health services management is such a field. The interplay of clinical, organizational, ethical, political and economic factors creates a situation in which traditional modes of education may lead to a fragmented understanding of management. Such approaches may also give students a false sense of security and yield 848
(AN MED ASSOC J 1990; 142 (8)
solutions to problems that do not professional integration, adaptation and accountability. The conconsider context or timeliness. In educating health services text is the US health care system, managers Shortell' suggested the which limits the applicability to need to develop methods for deal- the Canadian system somewhat. ing with hidden problems: However, the underlying themes are pertinent to Canadian managers. Cases and problem assignments . . . need to be developed in accounting, finance, economics, marketing, and quantitative methods courses. They need to illustrate that what appear to be answers at a given point in time may unravel when additional variables are introduced or specific assumptions are added or deleted.
He went on to suggest that the hard tools of management (accounting, finance and other quantitative methods) are imprecise and represent only one set of inputs in making complex decisions. Others have noted that although business schools have successfully trained technocrats, they have in large part failed to educate managers. Many educational programs have failed to bridge the gap between theory and practice. In health services management there is a dual challenge of educating people to function within highly complex and unstable environments while providing the technocratic skills required to manage. In a sense, we are educating in the art and science of management, and educators require continual interaction with the field to do this effectively. In response to this challenge, educational programs are increasingly using such mechanisms as field placements, guest lecturers and cases to supplement didactic classroom presentations. In some instances practitioners and academics have collaborated to develop case materials in health care administration.2 This book presents 15 cases that deal with a wide range of health services management issues, such as the role of the manager, control, organization design,
Although targeted to health services management students, this book is also appropriate for two other audiences: people in other health care fields, including nurses and physicians, and the clinician-manager. This casebook may also be of interest to physicians who are not managers but are affected by management decisions: it illustrates the range of complex and hidden problems facing managers in the health services sector. Bruce J. Fried, PhD Department of Health Administration Faculty of Medicine University of Toronto Toronto, Ont.
References 1. Shortell SM: Dealing with hidden problems: a challenge to management educa-
tion. J Health Adm Educ 1985; 3: 1-6 2. Curry L, Fried BJ: Joint case writing: maintaining the validity and relevance of training in health care administration. J Health Adm Educ 1989; 7: 274294
Physical causes of low back pain New Perspectives on Low Back Pain. Edited by John W. Frymoyer and Stephen L. Gordon. 406 pp. Illust. American Academy of Orthopaedic Surgeons, Park Ridge, Ill. 1989. Price not stated. ISBN 0-89203-029-1 F a or those who aleady possess an intimate knowledge of the lumbar spine this book is an excellent reference text. It delineates recent advances, beginning with a comprehensive review
