BOOK REVIEWS
The ACP Evidence-Based Guide to Medicine (NCCAM),4 “Complemen-
Complementary & Alternative
Medicine
Edited by Bradly P. Jacobs, MD, MPH, and
Katherine Gundling, MD. 452 pp, $69.95.
ISBN: 978-1-934465-04-2. Philadelphia, Pa:
ACP Press; 2009.
D ecades ago, undergraduate stu-
dents majoring in pharmacy were
required to take a 1-year course in phar-
macognosy, a scientific branch of
learning devoted to studying plants that
have pharmacologic activity. Included in
this requirement was a weekly 4-hour
laboratory component in which students
examined such plants both grossly and
in microscopic detail. I was one of those
undergraduate students. However, after
I moved into my graduate program to
specialize in pharmacology, I paid little
attention to pharmacognosy.
Over the years, undergraduate
exposure to pharmacognosy was trun-
cated to one semester, and ultimately
the subject became an elective as those
in control of curricula deemed this dis-
cipline to be anachronistic. As I con-
tinued my career in medical research,
some of my classmates went on to
become osteopathic physicians. None
of us paid much attention in our respec-
tive careers to the almost defunct disci-
pline of pharmacognosy.
During the past 15 years, however,
many adults in the United States and
other countries have increased their use
of dietary supplements, including
herbal products.1,2 Many of us in the
healthcare professions now clearly rec-
ognize that many patients presenting
for office-based treatment or surgery
are using such items on a daily basis.3
Thus, I have now come full circle,
because today I give a required pre-
sentation on herbal products to second-
year osteopathic medical students.
As defined by the National Center
for Complementary and Alternative
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been published in peer-reviewed jour-
tary and alternative medicine [CAM]
is a group of diverse medical and
[healthcare] systems, practices, and
products that are not generally consid-
ered part of conventional medicine.”
These CAM systems include acupunc-
ture, Ayurvedic medicine, chiropractic,
homeopathy, naturopathic medicine,
traditional Chinese herbal medicine,
and various manual procedures.
Researchers have suggested that the
expanding use of CAM, often in the
absence of efficacy studies, may be
related to the high cost of conventional
medical care,5 the ineffectiveness of that
care for patients with some chronic con-
ditions and life-threatening illnesses,6
or the wellness movement—aiming, as
it does, to improve and enhance health
through “natural” means.1
However, are herbal products toxic?
Do they interact with medicines pre-
scribed by physicians? In regard to dietary
supplements, some of these products are
actually nothing more than placebos,
while others do exhibit clinical activity.
Certain kinds of dietary supplements are
more likely to produce toxicity or inter-
actions that can affect the activity of pre-
scription medications. The fact that dietary
supplements are sold on an over-the-
counter basis makes the problem of
detecting such interactions more difficult
than it is for prescription medications.
How can we know which supple-
ments are clinically useful and which are
merely acting as placebos? How can we
readily evaluate their potential toxic
effects, which range from minor events to
life-threatening interactions with routinely
prescribed drugs? Such evaluations are
difficult because the US Food and Drug
Administration does not require pre-
market clinical trials for dietary supple-
ments or “herbal remedies.”
Clinicians might evaluate the effi-
cacy and safety of dietary supplements
by routinely reviewing evidence-based,
postmarket clinical studies that have
nals. In fact, that is exactly what I do to
develop relevant information for my
lectures to osteopathic medical students.
However, for the busy osteopathic
physician, such extensive routine exam-
ination of published clinical data is usu-
ally not practical. Fortunately, assis-
tance for this important task can now be
obtained from The ACP [American Col-
lege of Physicians] Evidence-Based Guide to
Complementary & Alternative Medicine—
an excellent text that provides exten-
sive facts on the efficacy of not only
herbal products and other dietary sup-
plements, but also many of the CAM
systems noted above. This book is an
outstanding source to guide physicians
through such evaluations.
The ACP Evidence-Based Guide to
Complementary & Alternative Medicine is
edited by Bradly P. Jacobs, MD, MPH,
and Katherine Gundling, MD. Dr Jacobs
is founder and director of the Institute
for Healthy Aging at Cavallo Point in
Sausalito, Calif. Dr Gundling is asso-
ciate clinical professor of allergy and
immunology in the Department of
Medicine at the University of California-
San Francisco. More than 20 contribu-
tors, including the editors, authored
chapters in the book.
A total of 15 chapters are divided
into two sections. Part I, “Fundamentals
of Complementary and Alternative
Medicine,” consists of a chapter on
CAM definitions and patterns of use and
a chapter on the framework for
addressing CAM in clinical encounters.
Part II, “Evaluation of Complementary
and Alternative Medicine Systems and
Therapies,” is divided into 12 chapters on
CAM as it relates to specific medical con-
ditions. These conditions—in the order
presented in the book—are allergic dis-
orders, asthma, cancer, general medicine,
gastrointestinal health, coronary heart
disease, human immunodeficiency virus,
men’s health, women’s health, muscu-
loskeletal disorders, obesity and over-
Book Reviews

weight, and depression. The final chapter
in the book is devoted to drug-supple-
ment interactions.
The book’s introduction explains
medical research terminology, such as
“effect size” and “magnitude of the
effect.” This material may be chal-
lenging for readers with minimal
research backgrounds. However, two
tables at the end of the introduction
serve as guides for how data from effi-
cacy and safety evaluations are pre-
sented throughout the book. Thus,
understanding this material does not
require extensive knowledge of statis-
tical methodology.
The “summary evidence” tables in
each chapter contain dosing informa-
tion, when appropriate and available, as
well as effectiveness grades ranging
from A (high level of effectiveness) to
D (very low level of effectiveness). Clin-
ical recommendations and special com-
ments are also provided. I found these
tables extremely helpful for obtaining a
quick understanding of important clin-
ical pharmacologic data and other med-
ical information about CAM.
Several examples serve to indicate
the clinical value of this text. In
chapter 6, “General Medicine,” the
authors summarize results from a
recent Cochrane Database System Review
study of 10 randomized clinical trials
examining the effects of cranberry juice
and supplements on urinary tract infec-
tions. The reviewers concluded that
cranberry juice and related supplements
“are associated with a 35% reduction
in the frequency of urinary tract infec-
tions when compared to placebo.”
Chapter 10, “Men’s Health,” has study
information indicating that saw pal-
metto causes a “small but definite
shrinkage of the prostate gland, which
means that [saw palmetto] is not just
treating symptoms but may be used to
both prevent and alleviate BPH [benign
prostatic hypertrophy].” In chapter 11,
“Women’s Health,” the author reports
Book Reviews
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in the one-sentence section on “osteo-
pathic and chiropractic manipulation”
that there is “insufficient evidence to
support or refute the use of spinal
manipulation as an effective treatment
for dysmenorrhea.”
I recognize that osteopathic physi-
cians do not view osteopathic manipu-
lative treatment as a type of CAM. Nev-
ertheless, according to the NCCAM,4
types of CAM used in “manipulative
and body-based practices” include
“osteopathic manipulation” along with
“chiropractic manipulation,” “massage
therapy,” “Tui Na,” “rolfing,” and sev-
eral other kinds of interventions. And
yet, in reviewing The ACP Evidence-Based
Guide to Complementary & Alternative
Medicine, I found only a couple refer-
ences (dysmenorrhea, hot flashes) to the
use of “osteopathic manipulation” as
CAM in the treatment of patients.
The book ends with two appen-
dices. One appendix contains descrip-
tions and reviews of safety and efficacy
of the following “systems of practice”:
Ayurvedic medicine, homeopathy,
spinal manipulation, chiropractic, natur-
opathic medicine, and acupuncture and
oriental medicine. The other appendix
is a glossary of CAM terms.
In conclusion, I view The ACP
Evidence-Based Guide to Complemen-
tary & Alternative Medicine as an excel-
lent database of clinical pharmacologic
information, not only on herbal prod-
ucts but also on the efficacy of other
CAM treatments, including acupunc-
ture, traditional Chinese medicine, and
Ayurvedic medicine.
Frederick J. Goldstein, PhD
Professor of Clinical Pharmacology,
Philadelphia (Pa) College of Osteopathic
Medicine; Book Review Section Editor, JAOA—
The Journal of the American Osteopathic
Association, Chicago, Ill
References
1. The use of complementary and alternative medicine in
the United States. National Center for Complementary and
Alternative Medicine Web site. http://nccam.nih.gov/news/
BOOK REVIEWS
camstats/2007/camsurvey_fs1.htm. Accessed July 23, 2009.
2. Kelly JP, Kaufman DW, Kelley K, Rosenberg L, Anderson
TE, Mitchell AA. Recent trends in use of herbal and other
natural products. Arch Intern Med. 2005;165:281-286.
http://archinte.ama-assn.org/cgi/content/full/165/3/281.
Accessed July 23, 2009.
3. Marinac JS, Buchinger CL, Godfrey LA, Wooten JM,
Sun C, Willsie SK. Herbal products and dietary supple-
ments: a survey of use, attitudes, and knowledge among
older adults. J Am Osteopath Assoc. 2007;107:12-23.
http://www.jaoa.org/cgi/content/full/107/1/13. Accessed
June 24, 2009.
4. What is complementary and alternative medicine?
National Center for Complementary and Alternative
Medicine Web site. http://nccam.nih.gov/health
/whatiscam/. Accessed June 24, 2009.
5. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins
DR, Delbanco TL. Unconventional medicine in the United
States. Prevalence, costs, and patterns of use. N Engl
J Med. 1993;328:246-252. http://content.nejm.org/cgi /con-
tent/abstract/328/4/246. Accessed July 22, 2009.
6. Elder NC, Gillcrist A, Minz R. Use of alternative health
care by family practice patients. Arch Fam Med.
1997;6:181-184. http://archfami.ama-assn.org/cgi/content
/abstract/6/2/181. Accessed July 22, 2009.
The 5-Minute Osteopathic
Manipulative Medicine Consult
By Millicent King Channell, DO, MA, and
David C. Mason, DO. 314 pp, $52.95. ISBN-
10: 0-7817-7953-7, ISBN-13: 978-0-7817-7953-
1. Baltimore, Md: Wolters Kluwer/Lippin-
cott Williams & Wilkins; 2009.
O steopathic manipulative medicine
truly cannot be practiced by fol-
lowing a “cookbook approach,” and
the authors of The 5-Minute Osteopathic
Manipulative Medicine Consult are in
agreement. Millicent King Chan-
nell, DO, and David C. Mason, DO—
both of the Department of Osteopathic
Manipulative Medicine at the Univer-
sity of Medicine and Dentistry of
New Jersey-School of Osteopathic
Medicine in Stratford—emphasize this
fact in the opening lines of the preface.
However, to continue the metaphor,
even the most experienced chef gener-
ally relies on recipes as the foundation
for his or her art. Similarly, the authors
present “recipes” to serve as a founda-
tion for various osteopathic manipula-
tive treatment (OMT) techniques. These
recipes appear in a handy, easily trans-
portable pocket format, increasing the
JAOA • Vol 109 • No 8 • August 2009 • 401
 BOOK REVIEWS
usefulness of this resource for the busy
clinical practice.
In this book, the authors first set up
various clinical diagnoses, suggesting
a variety of physiologic findings that
would be expected in the motor, sym-
pathetic, and parasympathetic systems.
The book next provides a list of related
somatic dysfunctions common to such
patients. Subsequently, the authors sug-
gest relevant OMT techniques for 2-
minute, 5-minute, and extended treat-
ment times.
While all osteopathic physicians
have training in applying OMT—at least
during their first 2 years of osteopathic
medical school—not all DOs have had
supervised clinical experience with this
treatment modality. Given the nature
of clinical encounters for osteopathic
primary care and specialist physicians,
the amount of treatment time available
during patient visits for utilizing OMT
is typically rather limited. The reasons
most often given by osteopathic physi-
cians for not treating patients with OMT
are not enough time, lack of experience
with OMT, and poor (or no) financial
compensation for OMT.1,2 It is possible,
however, to perform OMT in just a few
minutes—with health benefits for the
patient and financial compensation for
the physician. An easily accessible OMT
reference, such as this volume, that can
be used to jog an osteopathic physician’s
memory would improve the likelihood
of OMT being used in patient care.
The 5-Minute Osteopathic Manipula-
tive Medicine Consult has a simple,
straightforward organization, covering
60 common clinical conditions. Among
these conditions are ankle sprain, carpal
tunnel syndrome, depression, fibro-
myalgia, hypertension, influenza, otitis
media, pregnancy, restless leg syndrome,
scoliosis, tachycardia, and urinary tract
infection. After the physiologic findings
and related somatic dysfunctions of each
condition are described, the authors pre-
sent three appendices with step-by-step
instructions for OMT techniques
(appendix 1), specialized tests (appen-
402 • JAOA • Vol 109 • No 8 • August 2009
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dix 2), and summary charts (appendix 3).
Also included are recommendations for
International Classification of Diseases,
Ninth Revision (ICD-9) codes3 to use when
billing for osteopathic manipulative
medicine.
Appendix 1 presents OMT tech-
niques—via written descriptions, pho-
tographs, and diagrams—by body sec-
tion, including the head, the cervical,
thoracic, and lumbar sections, the
sacrum, and the upper and lower
extremities. Techniques addressed in
this appendix include auricular
drainage, counterstrain, Galbreath treat-
ment, high-velocity, low-ampli-
tude (HVLA), Muncie technique,
muscle energy, and myofascial release.
The specialized tests in appen-
dix 2—which is also organized by body
section—include the compression and
distraction (intervertebral foraminal
encroachment) tests and the Valsalva
test for the cervical spine; the hip drop
(sidebending) and straight leg raising
tests for the lumbar spine; the ASIS
(anterior superior iliac spine) compres-
sion test as well as the seated and
standing flexion tests for the pelvis; and
the Apley’s, Phalen’s, and Yergason’s
tests as well as the patellar grind and
valgus stress tests for the extremities.
The summary charts in appendix 3
address such items as cranial holds, der-
matomes, diagnoses, muscle motions,
nerve impingements, and reflexes.
As an example of the way that the
authors handle each clinical diagnosis,
the section on ankle sprain has a
detailed listing of sympathetic findings
(eg, “Increased tone-dilated arterioles
of the muscles,” T10-L2 myofascial ten-
derpoints, tissue texture changes over
transverse processes) and motor find-
ings (eg, L4-S2 common fibular nerve
impingement, inversion and eversion
strain). Regarding other somatic dys-
functions associated with ankle sprain,
the reader is directed to look for
pes planus (“flat foot”) and certain
tarsal, metatarsal, tibial, and fibular dys-
functions.
For OMT techniques in cases of
ankle sprain, the authors present
options for 2-minute (eg, counterstrain),
5-minute (eg, counterstrain, HVLA,
lymphatic drainage, myofascial release),
and extended (eg, articulatory, coun-
terstrain, HVLA) treatment. This listing
makes it clear that counterstrain—
which could easily be provided in less
than 2 minutes—is not the only manual
treatment option available. Regardless
of whether a radiograph was ordered,
a cast or splint applied, or a prescription
for an anti-inflammatory drug given,
the patient could still benefit from brief
application of OMT and leave the office,
clinic, or emergency department feeling
better.4
In the case of ankle sprain, the
authors note that the level of evalua-
tion and management coding for an
office visit by an established patient
(ie, 99213) could be supplemented with
a -25 modifier code, indicating that a
separately billable procedure—OMT—
was performed on the same day of ser-
vice. The authors also include the ICD-
9 code for lower extremity somatic
dysfunction (ie, 739.6) for use in patient
assessment and billing. However, they
fail to include the primary diagnosis
ICD-9 code for ankle sprain (ie, 845.00),
the prominent placement of which
(ie, heading) would make completion of
the billing form easier for the osteo-
pathic physician.
A few additional comments can be
made about the clinical diagnosis text.
Several of the clinical topics covered by
the authors, including headache and
hypertension, require more than one
ICD-9 number, depending on the con-
dition’s etiologic factors and symptoms.
The 5-minute and extended treatment
options mentioned by the authors
include some OMT techniques and
body regions not included among the 2-
minute options. However, almost any
OMT technique could be performed
within the 2-minute timeframe, and
(continued on page 464)
Book Reviews
 BOOK REVIEWS
(continued from page 402)
three or four OMT techniques could be
completed during a 5-minute treatment
session. The choice of techniques would
depend mostly on the skills of the osteo-
pathic physician and the comfort levels
of the patient with the treatment.
Additional clinical conditions could
have been added to the text without
significantly increasing the book’s com-
pact size. Some clinical concerns, such
as sensory and symptom relationships,
could have also been added to the text
to further flesh out complicated aspects
of certain diagnoses.
Although the relative brevity of The
5-Minute Osteopathic Manipulative
Medicine Consult prevents it from being
the final resource on this matter, the
book’s format—with nearly all of the
material on each clinical condition
appearing on facing pages—facilitates
quick scanning by the reader. The font
size, however, may be too small for
some readers. Most pages have plenty
of “empty” space in which the text
could have been enlarged for improved
readability. Regarding the graphics, the
diagrams and photographs featured in
the book’s OMT technique and spe-
cialized test sections are clear, simple,
and immediately comprehensible.
All things considered, The 5-Minute
Osteopathic Manipulative Medicine Con-
sult is a good effort and can be recom-
mended to osteopathic residents and
attending osteopathic physicians. Direc-
tors of residency training programs and
osteopathic medical educators who are
interested in incorporating OMT into
training should make this book required
reading—or they should consider pur-
chasing it for osteopathic residents.
Unfortunately, the available elec-
tronic version of this book (http://the
Point.lww.com/channell) may not be
quite as easy to use as the book itself.
When the reviewer attempted to access
this material online, access required reg-
istration with the publisher and then
entering a number from the scratch-off
464 • JAOA • Vol 109 • No 8 • August 2009
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area on the inside front cover of the
book. Once on the site, however, the
index at the left side of the Web page
was easily searchable. The illustrations,
text, and other items loaded quickly
and were easy to read. Readers should
be aware that the online material is not
available in a downloadable format,
however. Instead, it must be accessed
by signing on at the publisher’s Web site
each time one wants to view it. A
downloadable version that could be
placed on a personal digital assistant,
iPhone, or other electronic device would
be a great benefit to the busy osteo-
pathic physician, resident, and student.
In summary, The 5-Minute Osteo-
pathic Manipulative Medicine Consult is a
worthwhile book that, when properly
used, could increase the clinical appli-
cation of OMT. Expanded use of OMT
would benefit patients, osteopathic
physicians, and the osteopathic med-
ical profession at large. This is not a book
to read and place on the bookshelf.
Rather, it belongs in the pocket of the
laboratory coat or, at least, on the coun-
tertop in a nearby examination room.
Dennis J. Dowling, DO
Osteopathic Manipulative Medicine
Associates PC, Syosset, NY
References
1. Spaeth DG, Pheley AM. Evaluation of osteopathic
manipulative treatment training by practicing physicians
in Ohio. J Am Osteopath Assoc. 2002;102:145-150.
http://www.jaoa.org/cgi/reprint/102/3/145. Accessed
June 22, 2009.
2. Johnson SM, Kurtz ME. Conditions and diagnoses for
which osteopathic primary care physicians and specialists
use osteopathic manipulative treatment. J Am Osteopath
Assoc. 2002;102:527-540. http://www.jaoa.org/cgi/reprint
/102/10/527. Accessed June 22, 2009.
3. Centers for Medicare and Medicaid Services, National
Center for Health Statistics. ICD-9-CM Official Guidelines
for Coding and Reporting. Washington, DC:
US Government Printing Office; October 2008.
http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide0
8.pdf. Accessed June 22, 2009.
4. Eisenhart AW, Gaeta TJ, Yens DP. Osteopathic manip-
ulative treatment in the emergency department for
patients with acute ankle injuries. J Am Osteopath Assoc.
2003;103:417-421. http://www.jaoa.org/cgi/reprint/103
/9/417. Accessed June 22, 2009.
How Doctors Think
By Jerome Groopman, MD. 319 pp, $15.95.
ISBN: 978-0-618-61003-7. New York, NY:
Mariner Books; 2008.
C ombining 30 years of dedication to
internal medicine with a reputa-
tion as an accomplished essayist, Jerome
Groopman, MD, has produced a fasci-
nating tome exploring the minds and
thinking processes of physicians. How
Doctors Think, a New York Times best-
seller, was first published in 2007 and
republished in a paperback edition last
year with a new afterword.
Dr Groopman, chief of experimental
medicine at Beth Israel Deaconess Med-
ical Center in Boston, Mass, and occu-
pant of the Dina and Raphael Recanati
Chair of Medicine at Harvard Medical
School, begins How Doctors Think with
the proverbial introduction. However,
instead of the usual perfunctory segue
into the main topic, Dr Groopman’s
introduction is a 26-page, in-depth expo-
sition on how the practice of medicine is
in essence a study in communication.
The author intersperses his own
observations with interesting details
regarding the case of a female patient
who was misdiagnosed as having
anorexia nervosa with bulimia and irri-
table bowel syndrome. Dr Groopman
illustrates how faulty physician-patient
communication was responsible for the
incorrect diagnosis and how improved
communication (ie, open-ended ques-
tions and careful listening) resulted in a
correct diagnosis of celiac disease.
Throughout this fascinating
account, Dr Groopman uses phrases
that could well be classified as
Groopman aphorisms, including “Think
out of the box,” “Language is still the
bedrock of clinical practice,” and
“Freedom of patient speech is necessary
to get clues to diagnosis.” He summa-
rizes how physicians typically achieve
competency and improved patient skills
by noting, “Primarily, they [physicians]
recognize and remember their mistakes
Book Reviews

and misjudgments, and incorporate
those memories into their thinking.”
Following the introduction are
10 chapters that further establish
Dr Groopman’s thesis—offering lessons
for physicians, as well as advice for
patients, on improving communication
to achieve more effective treatment.
Rather than pointing fingers of accusa-
tion or pressing statistical assumptions,
he interviews highly accomplished,
competent medical specialists (some of
whom use pseudonyms) from across
the United States. These physicians
were willing to share with readers sig-
nificant mistakes they had made in
either diagnoses or treatment and to
examine and reflect on their thinking—
or lack of thinking—in those instances.
For example, in chapter 2, “Lessons
from the Heart,” Dr Groopman relates
the story of a healthy-looking, active
forest ranger who presented to a physi-
cian with a complaint of chest pain.
After physical examination, electrocar-
diogram, chest radiograph, and blood
tests all yielded normal results, the
physician told the patient, “I’m not wor-
ried at all about your chest pain. You
probably overexerted yourself in the
field and strained some muscle.” The
next evening, however, a colleague
informed the physician that the forest
ranger had returned to the emergency
department that morning with an acute
myocardial infarction. The physician,
noting that he was stunned by the news,
told Dr Groopman the following:
Clearly, I missed it [the ranger’s
unstable angina] ... And why did I
miss it? I didn’t miss it because of
any egregious behavior or negli-
gence. I missed it because my
thinking was overinfluenced by how
healthy this man looked ... Happily,
he didn’t die.
The physician then explained:
The unstable angina didn’t show on
the [electrocardiogram], because fifty
percent of such cases don’t ... His
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unstable angina did not show up on
the cardiac enzymes because there
wasn’t yet injury to the heart muscle,
and it didn’t show up on the chest
x-ray because the heart had not yet
begun to fail to pump blood, so there
was no fluid backup into the lungs.
Dr Groopman reports that the
physician concluded, “You have to be
prepared in your mind for the atypical
and not so quickly reassure yourself,
and your patient, that everything is
okay.” By presenting this and other
cases of physician error in a respectful,
collegial manner, Dr Groopman
strengthens his points about the impor-
tance of physicians improving their cog-
nitive and communication skills.
Each of the chapters in How Doctors
Think contains one or more such
intriguing accounts of misdiagnosed or
incorrectly treated patients. One of the
other strengths of this book is that these
cases are not written in formal clinical
language. Rather, Dr Groopman—who
is a staff writer for The New Yorker, a
frequent contributor to The New
Republic, The New York Times, and The
Washington Post, and the author of sev-
eral books—presents the cases in col-
orful, conversational language. His text
often includes discussions with, descrip-
tions of, and background information
on the physicians and patients involved
in the cases. For example, in chapter 4,
“Gatekeepers,” Dr Groopman writes
the following about a physician:
JudyAnn Bigby is a compact woman
with a round face, alert eyes, and a
lilting, almost musical voice that often
breaks into laughter. She was raised
in Hempstead, Long Island. When
she was a child, hers was one of the
first African-American families in
town ... Her father worked as a
mechanic for United Airlines and
only later in life did her mother, a
homemaker, return for a high school
equivalency degree.
Besides discussing examples of mis-
takes made by physicians, Dr Groop-
BOOK REVIEWS
man also covers various other areas of
concern related to the book’s subject
matter. Among these areas are the asso-
ciation among “Marketing, Money, and
Medical Decisions” (chapter 9), the
influence of aggressive pharmaceutical
company representatives, the error of
performing treatments by rote memory
even when those treatments are not
effective, and the overreliance on algo-
rithms and grids as “shortcuts around
the onerous process of assessing
each ... complex [case].”
In the book’s epilogue, Dr Groopman
concludes that while writing How Doctors
Think, he realized that in addition to the
usual sources of information available to
physicians (eg, textbooks, medical jour-
nals, colleagues), he has “another vital
partner who helps improve my
thinking ... my patient or her family
member or friend who seeks to know
what is in my mind, how I am thinking.”
Whether the reader agrees or dis-
agrees with Dr Groopman’s points, his
book provides interesting reading and
cogitation—as well as an excellent
opportunity for introspection for physi-
cians. I recommend this book for all
physicians, regardless of the type of
medicine they practice.
Arnold Melnick, DO, MSc, DHL (hon)
Professor of Pediatrics, Department of
Pediatrics, and Professor of Public Health, Public
Health Program, College of Osteopathic
Medicine; Executive Vice Chancellor and
Provost (ret), Health Professions Division, Nova
Southeastern University, Fort Lauderdale, Fla⽧
Editor’s Note: Dr Melnick writes the
monthly “To the Point” column on
medical communication for The DO
and is one of the American Osteopathic
Association’s Great Pioneers in Osteo-
pathic Medicine. For more information
regarding the Great Pioneers, please
see http://www.osteopathic.org/pdf/pub
_do0708pioneers.pdf.
JAOA • Vol 109 • No 8 • August 2009 • 465