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Show Journal of Neuro- Ophthalmology 21( 3): 233- 234, 2001. © 2001 Lippincott Williams & Wilkins, Inc., Philadelphia Books Reviews Handbook of Ocular Immunology, by RJ. W. de Keizer, M. Jager, A. Kijlstra. Aeolus Press, The Netherlands, 1998. This is a multi- authored book reviewing basic immunology and clinical aspects of ocular immunology. The book is designed to appeal to residents and practicing ophthalmologists, although the overall tone is academic and strongly oriented toward the basic mechanisms of immunologic disease rather than emphasizing clinical management. The first six chapters of the book deal with immunology, immunopathology, and immunoregulation with strong emphasis on these processes in the eye. There is an extensive review of the literature. The remaining 16 chapters focus on various aspects of specific immunologic diseases of the eye and orbit, including a chapter on uveal melanoma. Both infectious as well as purely inflammatory conditions are discussed. The treatment of some topics is done in significant depth, whereas others topics are treated in a more sketchy manner. For example, Herpes simplex keratitis is discussed in three pages, whereas in another chapter 19 pages are devoted to corneal melting syndromes such as Mooren's ulcer. The discussion of immunology of the eye is excellent and makes this book a good choice for ophthalmologists in training as well as those interested in ocular research. The bibliographies at the end of each chapter provide a good balance for those wishing to search for more details about the scientific studies. The chapter on orbital inflammatory disease is particularly good in its clinical relevance, as are the chapters on toxoplasmosis and Sjogren's syndrome. The authors of this book have chosen to underempha-size treatment and management decisions. Although the immunology underlying the disease process is important, the book is of less use to clinicians because therapy is not dealt with evenly. There is no chapter on therapeutic options for immunologic or infectious disease in which mechanisms of action and toxicity can be discussed. The chapter on sarcoidosis, for example, contains one paragraph on the treatment of ocular sarcoidosis and does not tell the practitioner anything that he or she already did not know. The chapter on ophthalmic manifestations of AIDS discusses cytomegalovirus retinitis but does not discuss the various advantages of the therapeutic options that are available. Intravenous ganciclovir and foscarnet are discussed. Cidofovir and ganciclovir implants are mentioned in passing, but there is no discussion of Vit-ravene or oral ganciclovir. In addition, there are no chapters on inflammatory disease of the optic nerve or on Barrett Katz, MB, MBA immunologic disease, such as myasthenia gravis, which affects ocular structures, so the neuro- ophthalmic community will be disappointed. This text can be useful for residents and research-oriented ophthalmologists as well as non- ophthalmologists who are interested in immunologic effects in the eye. The book deals well the ACAID immune privilege phenomena in the eye, and this will be of interest to nonocular immunologists. The introduction suggests that the clinician- reader will find this book to be useful- it is very useful in its discussion of immunologic mechanism of ocular disease. It is not likely that a clinician would turn to this book for the diagnosis, treatment, or management of an inflammatory ocular disease. The introduction makes it clear that the authors understand that current immunologic theory and knowledge " has not, as of yet, led to major transformations and improvements in the treatment of ocular inflammatory disease." Alan Palestine, MD Washington, DC Time to Heal, by Kemmeth Ludmerer. Oxford University Press, 1999. This is a scholarly and detailed historical description of medical education in the United States in the twentieth century. It chronicles American medical education from the turn of the century to the era of managed care. This book will do for the twenty- first century what the Flexner Report did for the twentieth century. It will become the definitive academic work on medical education and medical schools for the next several decades. Detailed and annotated, it reads like good novel. The book is divided into three sections. The first section is Fulfilling the Social Contract: Medical Education as a Public Trust and the Capture of Public Confidence. Here it relates the movement from proprietary to university- based training in medicine, chronicles the impact of major philanthropists on structuring medical education, and traces the relationship of the medical school to its association with larger universities. Dr. Ludmerer outlines the growth and rise of the formal teaching hospital and defines the contract between society and postgraduate medical education. This section outlines the practical apprenticeship of seeing, teaching, and doing and shows us how the system that we take for granted came to be. 234 BOOKS IN BRIEF The second section is entitled Medical Education in the Era of the Multiversity: The Growth of Research and Service in a Period of Abundance. It relates the golden years of medical education, the ascendancy of research, the expansion of clinical demands on faculty, the maturation of the graduate medical education curriculum, and the changing roles and behavior of medical students. The last section is entitled " Breaking the Social Contract: The Erosion of University Values, the Decline of Public Spiritedness and the Beginning of the Second Revolution in Medical Education." It characterizes the impact on graduate medical education of Medicare, Medicaid, civil rights changes, and the enormous financial pressure under which academic health centers have been placed. It ends in a provocative chapter entitled " A Second Revolutionary Period." Dr. Ludmerer characterizes this as a time of the erosion of the clinical learning environment, the diminishing of faculty scholarship, and the reemergence of the proprietary system of medical schools in which the faculty's financial aids take priority over education and research. This is a balanced, meticulously researched literary history of American medicine and its educational upheavals. It is wonderfully written, easy to read, and, although not answering the questions, raises them. It is a wonderful description of the world in which we work and indeed the world in which we live. The only deficiency of the text is that the reader misses more specific goals and directions about where medical education should be going; having done all the research involved and thought about the issues so compellingly, one wants to ask Dr. Ludmerer for some advice here. Understandably, this was not the intent of his treatise; nonetheless, it is a summary that would complement. All of us who are doctors, all of who work in academic health centers, and all of us who are involved with students and residents will find this an interesting narrative of medical education in the twentieth century. It will undoubtedly be the foremost document upon which twenty- first century education will be structured. Dr. Ludmerer is a respected medical educator, as well as a professor of medicine at the Washington University School of Medicine. His book will provide the background for making educated choices about the future of medical education in the coming years. Read it. Barrett Katz, MB, MBA The George Washington University Washington, DC / Neuro- Ophthalmol, Vol. 21, No. 3, 2001 |
