Oxford Handbook of Clinical Medicine 6th ed
There has seldom been a better time to be ill, one might think, on reviewing all the changes and developments since our last edition. From Angina to Zollingerâ€"Ellison syndrome, the new developments, all detailed in this volume, seem universally bright or brighteningâ€"and overall death rates from the big killers such as coronary heart disease are declining faster than ever before. This superficial view hides darker forces which paint a more sombre picture. The pandemic of HIV has grown a pace or two or three. Diabetes is doubling its grip, and global warming is introducing new diseases to areas where local inhabitants have little immunityâ€"these effects are described in Chapters 9 and 14. Once-trusted antibiotics are becoming useless in the face of pathogen development (p262); airlines are spreading completely new diseases around the worldâ€"eg SARS. Diseases caused by medicine have never been more common. Crucially, the world is no wealthier than when we first began to write on these topics.
While this book will doubtless prove indispensable in choosing correctly between self-destruction and passive extinction, some readers will point out that this received wisdom is wisdom subverted. Is SARS really an example of the darker prophesies being fulfilled? New diseases have always been appearing; what may be new about this epidemic was that is was caught early (albeit provisionally)â€"by the rapid dissemination of knowledge via electronic media. Often the people in white coats were waiting for the disease before it arrived. Information spread faster than the diseaseâ€"and the organism's genome was sequenced almost as soon as it was identified. Similarly, with HIV, not all the news is bad. Rich countries are learning, painfully slowly, to share their expensive drugs with poorer populations. There is no alternative to altruismâ€"even if one takes a purely selfish view of one's own interests. Altruism pays! (If the rich prosper only at the expense of others, the net result is not sustainable wealthâ€"revolution, or something unknown, is more likely.)
These, and many other developments described in this book point to just what can be achieved by dialogue and teamwork. This edition sees a new beginning (our Prologue) in which we flesh out what teamwork really means by giving an example of when it all goes wrong. Evidence-based medicine is a prime example of teamwork going rightâ€"usually. The funding organizations, the investigators, the statisticians, and the clinicians work together to provide the best possible treatment for the patient. We detail more fruits of this collaboration than in all other editions. We are using a new disc sign, with a number below ([diskette]1) to direct readers to the correct location on the web page of our references and their internet-enabled links at www.oup.com/uk/medicine/handbooks. Scholars among our readers may want to print these out to carry with them with our text to provide chapter and verse during tricky ward-rounds. Those who miss immediate access to our sources may remind themselves of Hagel's view in his Aesthetics that the purer the form, the less space it requiresâ€"and this economy of space has been one of our principal aims.[diskette]2
Further changes include a short section on essential drugs; a new section on Clinical Skills; more ECGs; and many new algorithms to reflect current practiceâ€"as well as new topics from the all-encompassing (Patient-centred care) to rare minutiae (such as all the different types of multiple endocrine neoplasia and their nefarious genetic associations). There are new mnemonicsâ€"not too intrusive, and not too rude (usually). Much re-organization is in evidence (eg Diabetes mellitus). But the most important changes are the hardest to spotâ€"thousands of small changes in the bodies of paragraphs. This incrementalism, accumulating like coral, amounts to whole new formations which, in this edition, take on a life of their own, set against backgrounds of rich tropical coloursâ€"a holiday for the eye, for which we thank the ever-creative staff at the Press.
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Oxford Handbook of Clinical Medicine 6th ed
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