••Summer 2004/Vol. 8, No. 3

Book Reviews

Conn's Current Therapy, 2004 | pdf >> by Robert E Rakel, MD, and Edward T Bope, MD, editors Book review by Charles Hamori, MD

In my nearly ten years as a practicing internist, I had yet to discover Conn's Current Therapy, now edited by Rakel and Bope. The textbook was originally published in 1949 and is updated yearly. The preface states that the purpose of the book is "to provide the practicing physician with the most up-to-date information on recent advances in therapy in an easy-to-read format." That sounds fine in theory, so I decided I would take the book for a test drive to see how it performs in actual practice.

The first patient to whom I applied Conn's was a young woman with melanoma. I had spent hours in the library researching the literature on melanoma, but Conn's was right on point as to treatment: Because the tumor was deep and the sentinel node positive, lymphadenectomy was required. After surgery, the patient had terrible nausea and vomiting--two more subjects for which appropriate management was superbly discussed in Conn's. The next issue I researched was adjuvant therapy, a topic that Conn's discussed in a somewhat limited way. To be sure, the book does include some detail on the standard treatment (high-dose interferon), but opinion differs considerably as to the utility of this treatment. I was therefore disappointed that the book presented only scant discussion of the multiple clinical trials being conducted on an ongoing basis among patients with this increasingly common type of cancer.

The second subject I reviewed in depth was subclinical hypothyroidism, a condition which I encounter several times per day in my preventive medicine practice. Conn's mentions that this disorder is common--present in 15% of women and 9% of men older than 55 years. To my chagrin, however, this statistic was mentioned only in passing without any clear discussion of the risks versus benefits of treatment. Moreover, no firm treatment recommendation was offered.

I then moved on to hypertension, a condition which any primary care practitioner sees about ten times per day. True to the book's preface, this section was well written and up-to-date. Everything the practicing physician needs to know--and then some--is contained in this section, which at 17 pages is somewhat long. By contrast, the section on hypertension in Harrison's Principles of Internal Medicine¹ consists of 14 similarly dense pages.

Last, I checked the chapter on obesity. As we all know, this condition is a growing health problem. The discussion was concise, readable, and very useful to my practice. Types of intervention ranging from psychology to exercise to very-low-calorie diets to medications to surgery were all succinctly discussed. At five and a half pages, this section was both readable and perfect for quick review between patient appointments.

My major criticism of the book is that most of its chapters contain no bibliographic references. In this era of evidence-based medicine, this omission is a considerable shortcoming. Although we do not necessarily look up primary references for every patient, we sometimes must--especially in atypical cases. Then, when we read a textbook that lacks references, we must search elsewhere, a far less efficient procedure. Fortunately, the author of the obesity chapter provided an extensive bibliography, a feature that only added to the strength of that section.

Overall, I found Conn's Current Therapy to be a very useful book: The table of contents is clear; the chapters are for the most part well written and concise; the topics covered are useful ones for practicing physicians; and the information seems quite up to date. Some gaps do exist, however, so Conn's would probably not be the only book you would take to a desert island--but it could serve as a helpful adjunct to other major texts.

Reference

1. Braunwald E, Fauci AS, Kasper DL, Hauser SL, Longo DL, Jameson JL, editors. Harrison's principles of internal medicine. 15th ed. New York: McGraw-Hill; 2001.

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