CLINICAL RESOURCE REVIEWS
Fishman’s Pulmonary Diseases and Disorders, 5th Edition
David H. Ingbar
School of Medicine, University of Minnesota, Minneapolis, Minnesota
Fishman’s Pulmonary Diseases and
Disorders, 5th ed. Editor-in-Chief: Michael
A. Grippi. Editors: Jack A. Elias, Jay A.
Fishman, Robert M. Kotloff, Allan I. Pack,
Robert M. Senior. Video Editor: Mark D.
Siegel. 278 contributing authors from 12
countries.New York: McGraw-Hill Medical;
2015. ISBN-13: 978-0071807289. ISBN-10:
0071807284
Purpose
Comprehensive coverage of pulmonary
medicine and the underlying basic and
applied science upon which clinical practice
is based.
Audience
Medical students, post-graduate trainees,
practicing clinicians, medical educators, and
clinical and translational researchers.
Formats
d Hardback: Two-vol set, 153 chapters,
approximately 2,400 pages, over 2,000
illustrations, 63 video or audio files, over
18,000 references. Video and audio files
are accessible by scanning quick response
(QR) codes embedded on the printed
pages.
d Full text available online through
AccessMedicine (McGraw-Hill); 153
chapters with the same content and full
complement of illustrations, video, audio
files, and references noted for the
hardback version. All illustrations are
downloadable as images or PowerPoint
slides. References include links to
PubMed and, for many, links to
Correspondence and requests for reprints should be addressed to David H. Ingbar, M.D., University of Minnesota PACCS Division, VCRC 350, MMC 276, 420
Delaware St. SE, Minneapolis, MN 55455. E-mail: ingba001@umn.edu
Ann Am Thorac Soc Vol 12, No 8, pp 1255–1256, Aug 2015
Copyright © 2015 by the American Thoracic Society
DOI: 10.1513/AnnalsATS.201506-336OT
Internet address: www.atsjournals.org
Clinical Resource Reviews
CrossRef. Available online access
through topic searches and cross-links to
the full content of AccessMedicine,
including drug monographs and quick
reference tools, as well as other major
textbooks (http://accessmedicine.
mhmedical.com/book.aspx?
bookID=1344).
Content
Reviewing a new edition of a longstanding,
classic, leading textbook is a daunting
challenge. The Fifth Edition of Fishman’s
Pulmonary Diseases and Disorders
published in April 2015 certainly poses this
type of challenge. The first edition
originated in 1980, and the most recent
fourth edition was published in 2008. For
the first two editions, Alfred Fishman
served as the sole editor; the new fifth
edition is the first since his death in 2010
and is dedicated to him. For this edition,
Michael Grippi has assumed the mantle of
Editor-in-Chief, assisted by five other
distinguished editors from the prior
edition—Jack Elias, Jay Fishman, Robert
Kotloff, Allan Pack, and Robert Senior—
and a video editor, Mark Siegel. Apart from
Dr. Senior, each has ties to the University
of Pennsylvania program and/or Alfred
Fishman.
This textbook includes contributions
from 278 authors, including many
contributors from outside the United States.
In general, most of the authors are
recognized senior and leading authorities in
their areas, but some of the contributors are
junior or not-yet well recognized. Not
surprisingly, many authors are derived from
the University of Pennsylvania and other
institutions associated with the editors, such
as Yale. It is organized into 18 “parts,”
including a small, initial, very interesting
part on the history of pulmonary medicine.
The extensive second part (350 pages) is
devoted to the genetic, cellular, structural,
and physiologic basis of normal lungs and
during injury and repair. The third part has
chapters on the clinical approach to the
patient (z40 pages) and imaging and
diagnostic procedures, including
pulmonary function testing and
bronchoscopy (190 pages).
Apart from Part 18, which is dedicated
to acute respiratory failure and critical care
(390 pages), the remaining 14 parts are
devoted to pulmonary diseases and sleep
medicine (57 pages). This two-volume
edition has “shrunk” somewhat since
the fourth edition, going from 2,948 pages
and 18 pounds to 2,400 pages and 16.3
pounds. The sixth edition of Murray and
Nadel’s Textbook of Respiratory Medicine
also released in April 2015 is a slim
2,064 pages and 13.6 pounds; it also
shed more than 300 pages and almost
4 pounds since the last edition. This
review is not based on a systematic
comparison of these two competing and,
to some extent, complementary, classic
textbooks.
The list price of the new Fishman’s text
is $450 and, presumably, this price includes
individual remote access to online content
via AccessMedicine and online updated
material for some period of time. However,
the latter components are not explicitly
stated on the McGraw-Hill website
description or described in the book. After
15 minutes on the phone with their
professional service customer service, there
remained uncertainty, and they promised
an e-mail response. Many institutions
have subscriptions to McGraw-Hill’s
AccessMedicine.
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Highlights
From my personal viewpoint, Fishman’s
textbook originally emphasized physiologic
principles and cell biology of pulmonary
medicine more than other, more disease-
and clinically oriented textbooks, including
Murray and Nadel. In general, Fishman’s
textbook has had less detail about diseases,
and instead has focused on a somewhat
more educational approach to presenting
material. Neither Fishman’s nor Murray
and Nadel’s textbooks have attempted to
comprehensively present critical care
medicine topics—they are no substitute for
one of the major textbooks of critical care.
Prior editions of Fishman’s have been
a good source to learn about a topic, rather
than finding as great a wealth and depth of
detailed information about specific diseases.
They also have been “graphics rich,” with
many illustrations and radiographs that
were very well reproduced. In the new
edition, this general approach and these
strengths have been continued and
amplified.
As one would expect in a large text,
the organization of the chapters varies, and
there is not a consistent pattern to the
figures and tables. In general, the chapters I
read were well organized, clearly written,
and had excellent supporting tables and
figures. The summary and overview
comments were reasonable and usually
not idiosyncratic or strongly biased. A
major strength is the superb graphics and
figures, particularly for the radiologic
images. There are embedded QR codes
that code for videos and other ancillary
content that can be accessed either via cell
phone or online. These videos—such as
CT scan image stacks—are excellent. A
minor drawback is that, on at least some
of them, one cannot stop or control the
image flow.
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CLINICAL RESOURCE REVIEWS
In addition to the excellent figures and
tables, a particular strength is the inclusion
of some relatively recent information, such
as the use of pirfenidone and nintedanib for
treatment of idiopathic pulmonary fibrosis.
In some areas, the linkage from basic science
to clinical illness is outstanding—such as the
genetic basis of lung cancer and approach
to personalized therapy. Compared with
other clinical texts, in a number of areas
there is greater depth of discussion of the
physiologic, cellular, and molecular aspects
underlying respiratory diseases.
Limitations
Not surprisingly in such a massive
undertaking, there also are some relative
weaknesses. There is inconsistency and
heterogeneity in the presentation of lung cell
biology. Why is there an entire chapter
devoted to T cells, but not to endothelium,
alveolar epithelium, or fibroblasts? Why is
there a chapter focused on reactive oxygen
species, but not on proteases in lung disease?
The discussion of lung cancer screening and
the benefits and pitfall is almost nonexistent,
even when searching the online content.
Perhaps the biggest question is: in the
age of the internet, what are the roles and
functions of major reference textbooks and
who should buy them? Clearly, this is not
the best place to look for the latest
information on new developments in
treatment or concepts. Producing a textbook
of this magnitude per force has a major lag
time from writing to actual publication
(April 15, 2015). It is impressive that
information about new idiopathic
pulmonary fibrosis treatments is included,
but other relatively recent advances are not
included. Using the American Thoracic
Society 2015 Clinical Year in Review
Syllabus as a reference point, most of the
AnnalsATS Volume 12 Number 8 | August 2015
major articles and advances from 2014 did
not make it into this text. That is likely
too high an expectation, but it points out the
inherent drawback of the printed textbook,
and highlights the need for the publishing
company to provide a clear plan for
online updates and access. Some form of
updating is essential for clinical relevance.
For example, the 2014 publications on
anti-IL5R (benralizumab) for asthma and
anti-IL5 (mepolizumab) for eosinophilic
asthma are not included. McGraw-Hill falls
short in providing clear information about
the plan for updating and accessing
information (and any cost) for potential
purchasers.
Summary
Although this textbook is very expense (like
its competitors), it provides considerable
value as an educational tool. While on our
pulmonary consult service, I did not find
that it had sufficient depth to answer
complex clinical questions. However, it was
an outstanding place for me to relearn in
subject areas where my current knowledge
was weak. It is also an excellent site to send
fellows and residents to read on a subject.
The radiologic and some of the basic
sections are outstanding syntheses of
information that is difficult to learn
efficiently from other sources. In spite of the
expense, this is an excellent book for
a pulmonary fellow or faculty member,
particularly if it is used to fill holes in
knowledge by reading relevant full chapters.
A key question to be answered is how the
online access and updating will occur, as this
is essential to maintaining the relevance of
the material. n
Author disclosures are available with the text
of this article at www.atsjournals.org.