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Cardiovascular Disease, Methods and Protocols: V.2. Molecular Medicine
Qing K. Wang, (Editor), Totowa, N.J.: Humana Press, 2006, 376 pp., illus., index, $125.00. ISBM: 1-58829-892-2. The menace of cardiovascular disease has challenged and inspired many of the brightest physiologists of several centuries. Such giants of physiology as Carl Ludwig, Thomas Lewis, Carl Wiggers, and Silvio Weidmann dedicated their entire careers to this field. Yet, at the turn of the 21st century, despite all the titanic efforts of so many, we realize that cardiovascular disease will remain the major cause of human mortality well into the future. Perhaps it is time to step back and ask ourselves a tough question: where do we stand and where should we go from here? The book by Qing K. Wang presents an excellent opportunity to reflect on this theme. The history of cardiovascular physiology swings like a pendulum between reductionist and integrative approaches. In the first case, investigators attempt to dissect complex phenomena and rigorously quantify simplified models of a physiological system. This approach yields breakthroughs in technology development and an understanding of the system’s individual components. However, eventually a reductionist model fails to grasp the systemic complexity of the studied phenomenon and becomes overwhelmed by the sheer number of complex quantitative relationships involved in the system. Subsequently, the pendulum swings to the integrative approach, which reestablishes the systemic view. It synthesizes the wealth of knowledge accumulated by reductionists of the preceding period and identifies new feedbacks and regulatory networks. However it too eventually fails because of its inherent qualitative nature. The second half of the 19th century was the era of Ludwig’s integration, which was followed by the reductionist views of Starling. The pendulum again swung towards the integrative approach at the turn of the 20th century with the work of Wiggers, who dominated American physiology for nearly half a century. The discovery of ion channels has led to the dominance of the reductionist paradigm for the past half century and led to the channelopathy hypothesis of cardiac arrhythmias, which is arguably the most distinguished showcase of the reductionist approach linking a physiological mechanism to disease from gene to bedside. Wang presents numerous excellent chapters with state-of-the art accounts of powerful technologies applied to cardiovascular disease, including microarray, genomics and proteomics approaches, studies of ion channel biophysics in heterologous expression systems, and protein structure/function studies with X-ray crystallography and NMR spectroscopy. Experts on their respective fields, authors of the chapters did a superb job in presenting the strengths and limitations of the techniques. However, this triumph of reductionism has also signaled the end of the pendulum cycle. While, in some cases single molecular abnormalities have been linked to arrhythmias in a particular population of patients, these cases offered no treatment. And limited progress has been made to address such gigantic problems as atrial fibrillation and heart failure. Despite the efforts of several generations, no effective antiarrhythmia drugs have resulted. Many physiologists sense that a new synthesis is needed to integrate the wealth of knowledge accumulated by the reductionists. It appears that the period of paradigm shift is approximately 50 years, and the time has come to reestablish the synthetic complexity of the cardiovascular system using integrative approaches. One of the major obstacles in advancing our understanding of the mechanisms of cardiovascular disease is a lack of comprehensive technologies to address the structure-function relationship at the tissue, organ and physiological system levels. In order to comprehend the complexity of the remodeling processes leading to diseases of the heart, one needs to investigate the mechanisms of excitation, contraction, autonomic control, and their molecular basis in the same heart. Wang presents masterfully written chapters with an impressive array of novel approaches to integration in cardiovascular physiology rooted in the most advanced technologies learned by reductionists of previous generations: transgenic animal models, various animal models of hypertension, heart failure, atherosclerosis and arrhythmia, biophotonics techniques to study genetics and electrophysiology, in vivo and in vitro gene transfer methodology, and stem cell techniques. Max Planck is quoted as saying that “science advances funeral by funeral.” Every shift from reductionism to integration or back has been a painful process of renewal in physiology filled with drama. Recently, Eugene Braunwald, who published his reflections on the Founding Editor of Circulation Research Carl J. Wiggers, described a century old competitive rivalry between the reductionism of Ernest H. Starling and integration of Carl J. Wiggers. Cardiovascular Disease: Methods and Protocols by Qing K. Wang presents an opportunity for a peaceful transition to a systemic integrative approach that will build upon the breakthroughs of previous decades of reductionism. Igor R. Efimov Washington Univ. in St. Louis, MO |
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Physiology Case Studies in Pharmacy Laurie Kelly McCorry, PhD Washington, DC: American Pharmacists Association, 2006. 208 pp., index, $35.00 ISBN: 1-58212-089-7. Physiology Case Studies in Pharmacy is a collection of 82 cases distributed in nine “systems.” Each case is accompanied by a varying number of open-ended questions. An Appendix contains brief descriptions of a large number of diagnostic tests (and normal values where appropriate). There is also a Glossary with brief definitions of physiological and clinical terms. Answers to the questions are not found in the book. An Email address is provided, not very prominently, for requesting answers from the publisher (which arrives as a large pdf file). The case descriptions are very brief, most consisting of no more than a dozen lines of text with a few being as long as 20 lines of text. Most problems contain relatively little data. The questions that follow each case description are almost all open-ended (not multiple-choice), and they range in difficulty from requests for definitions of terms to explanations of the results of diagnostic tests. It appears that the preponderance of questions is at a very low level of difficulty, with only a few questions requiring the application of significant problem solving skills. Many of the questions, while germane to the general topic area of the case, seem to have been included only as probes of the students’ knowledge of basic physiology. The answers that are provided to the questions also tend to be very brief, ranging from one to two sentence definitions of a term or the identification of a structure (Question 10, page 19–identification of Wernicke’s area as the locus of language comprehension) to 15-20 lines of text describing a complex mechanism (all of E-C coupling in skeletal muscle in 133 words–Question 12, page 57). There is a hand full of answers containing something in addition to text: a graph, a chemical equation, or a calculation. While the answers seem to be factually correct, it is not clear how much help they would be to students who do not understand the physiology involved. Acquiring an understanding of E-C coupling requires reading more than 130 words! Who would benefit from using this book? The title identifies pharmacy students as the intended audience. In the Preface the author offers some clues about what this book is about: it “. . . provides an opportunity for integrative thinking,” offers an “. . . early introduction to the case-based nature of their future careers,” and the cases provide “. . . a review of basic physiologic principles.” The author clearly sees this book as a supplement to the assigned textbook. How well does the book meet these objectives? I admit that I have only a limited knowledge of the needs of pharmacy students. Nevertheless, I would have to say that the author has failed to provide a book that meets those objectives. The fundamental problem is that the cases are very impoverished, usually providing little more than a description of patient symptoms. The questions accompanying each case are too often limited to requests for names or definitions. Thus, the cases and their questions do a poor job of providing opportunities for integration and real application of knowledge of physiological mechanisms. What this book does provide is a possible resource for self-assessment. Students should be able to use their ability to answer the questions as a guide to what they know, and more importantly, what they don’t yet know. Joel Michael Rush Medical College, Chicago, IL |
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Handbook of Psychophysiology. John T. Cacioppo, Louis G. Tassinary, and Garry G. Berntson, (Editors). New York, NY: Cambridge Univ. Press, 2007, 898 pp., illus., index, $175.00. ISBN: 978-0-521-84471-0. |
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[Index] [ACDP
2006 Survey Results] [Fellowship Report: From Laboratory to Legislation] [APS News]
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