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Roach, O'Neale J.; Mosby, London, 2003, 263 pp., ISBN 0-7234-3297-X, $29.95

This is a book for medical student review of the metabolism and nutrition part of a basic science course within the medical curriculum, but which is integrated with the related clinical topics. It is stated that this “crash course” will speed you through your exams, and the text is claimed to represent a perfect set of course notes written by students for students (under the supervision of a senior member of faculty). There are a number of other books in the series including Anatomy; Gastrointestinal System; Muscles, Bones and Skin; etc., as well as clinical titles including Pediatrics; Surgery; Obst & Gynae; etc.; the back cover has, in large letters, the reassuring advice “DON'T PANIC.” It is also stated that in addition to acting as a review aid, the books could act as a supplement to course textbooks. Students purchasing all 22 books in the series would have spent quite a lot of money. The question is will they do this and will they do it in addition to buying the regular course textbooks? I suppose they might buy the ones related to the exams where they felt weakest. Or will they skip the major texts and only look at these “notes”? Medical students have always taken the route to the most “efficient” way of studying in order to pass the exam: this series obviously panders to this tendency.

Having said that, this book does present a reasonable survey of the area of metabolism and nutrition and has a considerable amount of clinically relevant information. The balance has to be struck between the learned professors lecturing to medical students on their own specialities, leaving no rare disease undescribed, and the medical students who have to cope with all the subjects in the course and are not going to absorb the fine details. Hence some of the Boxes in the book say things like “Porphyrias are very rare. You will seldom see or be asked about them. Fig XX summarizes all you will ever need to know about them.” Clinicians often say this sort of thing to medical students (usually about the preclinical sections) and one can see the instant appeal of the book. From the patient's point of view, the message may be “Try not to get a rare disease!”, and from the educator's point of view it might be to educate the students so that they know sufficiently to know what they don't know and when to ask for help. This is perhaps cynical, but we should never forget that there is too much information for any one person to remember and students and practicing medics have to devise ways of coping with the present and future flood of biomedical information.

The book is not trivial. There are 11 chapters divided among two sections: I, Metabolic Processes and Nutrition and II, Clinical Assessment of Metabolic Diseases. There is also a third section that gives exam practice: multiple choice questions, short answer questions (both of these with answers), and some essay question titles. The chapters in the first part are: Overview of Metabolism; Carbohydrate and Energy Metabolism; Production of NADPH; Lipid Metabolism and Transport; Protein Metabolism; Purines, Pyrimidines and Heme; Glucose Hemostasis; and Nutrition.

As an illustration of the approach taken, glycolysis is dealt with in about eight (smallish) pages, including glucose entry into cells, trapping, energy yield, aerobic and anaerobic, shuttles, regulation, pyruvate kinase deficiency, and hormonal regulation, with eight figures and three tables. (There are almost no chemical formulae, although there are some later on in the book under “ATP, porphyrins, cholesterol and nucleic acid bases,” for example.) For someone who knows most of this, I found the writing concise and precise, and the book would be good for review. I found it less easy to decide if it would be good for students coming to this for the first time without the benefit of a major textbook.

As an illustration of one of the “learning aids” in the book, a mnemonic is provided for remembering the intermediates of the tricarboxylic acid (TCA) cycle: A Certificate In Kama Sutra Should Further My Orgasm. (It's a bit more difficult if you use oxoglutarate instead of α-ketoglutarate, but anyway this should appeal to medical students.) As the book points out, the TCA cycle is a source of biosynthetic precursors as well as of exam questions. The medical relevance of things is well emphasized, although I thought there was too much on glycogen storage diseases, for example. But the text is good on fructose and galactose metabolism (as well as sorbitol), and on ethanol catabolism. Later on in the book there is a chapter on glucose homeostatsis, dealing with fed and starved states, gluconeogenesis, hormonal control, ketogenesis, exercise including long-distance running, diabetes, and its complications. (“Every examination you will ever have in medicine will have a question on diabetes. Know the effects of an increased glucagon/insulin ratio—the rest is easy and can be worked out.”)

Chapter ends have a list of short questions designed to aid understanding: thus in the Haem Metabolism chapter there are 16 one-line questions, including:

  • Describe the main functions of the salvage pathways

  • What use do xanthine oxidase inhibitors have?

  • Why is it important to ask about porphyrias during preoperative assessment for surgery?

  • What is the effect of lead poisoning on heme synthesis?

One might agree that these sorts of questions are not trivial and are medically relevant

Part II of the book is entitled “Clinical assessment of metabolic disease” and has three chapters: Common Presentations of Metabolic Disease; History and Examination; and Further Investigations. The first is about the symptoms of a number of common conditions, and the second includes a section on communication skills. This latter is important in the medical curriculum in the United Kingdom; the General Medical Council (GMC) has recommended that equal attention be paid to knowledge, skills, and attitudes when training medics, and the communication skills come into both skills and attitudes. The last chapter (Further Investigations) deals briefly with hematology, clinical chemistry, histology, imaging, enzyme assays, the glucose tolerance test (which is actually rarely done), and the assessment of nutritional status. As mentioned, Part III of the book is the self-assessment section.

In the above I have tried to impart some of the flavor of the book. Overall I felt that quite a lot had been packed into 263 pages, not only with very few errors or typos, but more importantly with a great deal of good sense about why medics have to do some biochemistry!