Perspectives in Biology and Medicine

gamma on collagen gene expression in the liver and on proliferation of hepatic cells are reviewed in detail. Discussion and the review of the literature on the regulation of procollagen and extracellular collagen synthesis in the liver by glucocorticoids and Prostaglandines are followed by a chapter on novel approaches of drug therapy in liver cirrhosis. This chapter discusses the rationale and mechanistic aspects of the use of drugs such as cholchicine, ursodeoxycholic acid, and methtrexate. Section IV is a general discussion and review of the literature on the function of extracellular matrix. This section is highlighted by chapters on diverse issues such as the role of the extracellular matrix in the development of tissue architecture , regulation of cell excitability, and the liver as a stem cell and lineage system. The final section of this book is entitled "Pathogenesis" and consists of two chapters, one on pathogenesis of hepatic fibrosis and the other on the extracellular matrix and metastasis. It is indeed an excellent note on which to conclude the book. The chapter on hepatic fibrosis is superbly analytical and concise at the same time. In the last chapter the importance of the extracellular matrix and its components in the metastatic process is discussed in detail, in conjunction with discussions of the interplay between extracellular matrix and various growth factors. In summary, this book is a timely review of the literature on the extracellular matrix and its importance in the biological processes involving cell development and differentiation in health and diseases. Readers with a general interest in the extracellular matrix will find the book useful, whereas those particularly focusing on the liver will find it indispensable. Mahboubeh Eghbali Department of Anesthesiology School of Medicine Yale University New Haven, Connecticut Empathy and the Practice ofMedicine: BeyondPUL· and the Scalpel. Edited by Howard M. Spiro, Mary G. McCrea Curen, Enid Peschel, and Deborah St. James. New Haven: Yale Univ. Press, 1994. Pp. 208. $20.00. Empathy and the Practice ofMedicine is predicated on two premises: (1) empathy is essential in optimal health care delivery, and (2) empathy can be taught. Howard M. Spiro, et al., compile essays by 17 authors to address the topic of empathy and the practice of medicine. The contributors know whereof they write. Over two-thirds are M.D.s, half Ph.D.s, and four have dual degrees. The editors select those who agree with their position: the highly technological climate in which health care is delivered must be balanced by caregivers with humanness and empathy. Spiro states: Medicine is . . . both science and narrative, both reason and intuition. Empathy may yet prove essential in the third millennium, when we have relegated computers to routine Perspectives in Biology and Medicine, 38, 1 ¦ Autumn 1994 | 145 diagnosis. Computed tomographic scans offer no compassion. . . . Only men and women are capable of empathy, (p. 14) There is but one lone voice of dissent, Richard L. Landau. In "And the Least of These Is Empathy," Landau cautions: "encouraging physicians to cultivate empathy in their relations with patients will undermine their ability to function as wise, understanding doctors, who give of themselves in guiding patients through life's concerns and illnesses" (p. 108). The first section, "The Practice of Empathy," is the most readable, the least didactic. John Stone, a physician/poet, is especially successful in "A Deep Dying," in which he describes his interaction with a senior colleague, Jim Schwartz, who died at age 65 after a long illness: "Jim agreed, somewhat reluctantly, to come to my class on ethics and tell the young medical students what it was like to be sick, what it was like to be a doctor who was sick, just tell his story" (p. 36). Stone testifies: "From his death and from his life, I have learned a great deal about empathy." As Stone relates his experience with his mentor, the author transmits his own lesson so that the present reader might benefit. In "Travels in the Valley of the Shadow," Joanne Lynn tells the stories of patients for whom she cared as a physician in a hospice program. In remembering the story of one 72-year-old nursing home resident, Lynn tells of how she "stood so...