Medicine And Books

Mechanisms of Disease: An Introduction to Clinical Science

BMJ 1997; 315 doi: (Published 22 November 1997) Cite this as: BMJ 1997;315:1387
  1. E R Chilvers, Wellcome Senior Research Fellow in Clinical Science
  1. Respiratory Medicine Unit, University of Edinburgh

    Ed S Tomlinson, A M Heagerty, A P Weetman: Cambridge University Press, £19.95, pp 513 ISBN 0 521 46738 1

    Progress towards establishing a truly integrated medical curriculum in Britain that provides students with an adequate scientific base to support bedside clinical teaching and, more importantly, the capacity to continue to learn has been painfully slow. While the need for such an approach to learning—in which understanding the basis of disease replaces the more traditional didactic approach—has long been recognised, the lack of appropriate books has been a major stumbling block.

    Mechanisms of Disease goes a long way to filling this gap by laying out the scientific basis and the clinical features of several carefully chosen disorders that cover a wide range of disease types—from autoimmune thyroid disease, through Alzheimer's disease, to colorectal carcinoma. The ambition of each chapter is to provide a “state of the art” review of scientific knowledge in a particular area followed by a detailed review of a single exemplar disease.

    In all but a few chapters this approach works well, and this book should be received enthusiastically by medical students. It will almost certainly be of enormous value to the large number of MRCP candidates struggling to get to grips with the new world of molecular medicine and molecular based treatments. It is refreshing to get away from accounts of diseases that begin with the obligatory trawl through incidence; associations with age, sex, and HLA type; geographical variations; etc. Reading this book, I found it hard to resist comparing it to the first edition of Davidson's Principles and Practice of Medicine, which in its time was also ahead of the field and shared many of the same ambitions; while Davidson's has evolved into a more traditional student text, I hope the editors of the current book resist such a temptation.

    One surprising aspect of the book, however, is its unfashionable production style, with lack of colour and large unwieldy tables; in the days of CD ROM and computer-aided learning packages, this gives the book an old fashioned feel. There is also repetition in the earlier chapters, but I suppose this is hard to avoid in the first edition of a multiauthor book.

    Having been baffled and irritated in my own preclinical years by an overbearing mass of largely unmemorable and sterile “foundational” science that only in retrospect made any sense, I find this book a refreshing and innovative attempt to allow clinical scientists access and input to medical students at an early stage and provide a true understanding of the cause rather than effect of disease. A brave new book for a brave new world; better production and illustrations might well sweep this text to the top of most students' book list.

    Rating: ***

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