Medicine's changing economics have already fundamentally, permanently altered the relationship between physician and patient, E. Haavi Morreim argues. Physicians must weigh a patient's interests against the legitimate, competing claims of other patients, of payers, of society as a whole, and sometimes even of the physician himself.

Focusing on actual situations in the clinical setting, Morreim explores the complex moral problems that current economic realities pose for the practicing physician. She redefines the moral obligations of both physicians and patients, traces the specific effects of these redefined obligations on clinical practice, and explores the implications for patients as individuals and for national health policy. Although the book focuses on health care in the United States, physicians everywhere are likely to face many of the same basic issues of clinical ethics, because every system of health care financing and distribution today is constrained by finite resources.

Once rarely discussed in medical circles, the relationship between spirituality and health has become an important topic in health care. This change is evidenced in courses on religion and medicine taught in most medical schools, articles in journals such as the New England Journal of Medicine, and conferences being held all over the country. Yet, much of the discussion of the role of religion and spirituality in health care keeps the critical distance of only being about spirituality. A Balm for Gilead goes further, offering a work of spirituality.

Sulmasy moves between the poetic and the speculative, addressing his subject in the tradition of great spiritual writers like Augustine and Bonaventure. He draws from philosophical and theological sources—specifically, Hebrew and Christian scripture—to illuminate how the art of healing is integrally tied to a sense of the divine and our ultimate interconnectedness. Health care professionals—and anyone else involved with the care of the sick and dying—will find this series of meditations both inspiring and instructive.

Sulmasy addresses the spiritual malaise that physicians, nurses, and other health care workers experience in their professional lives, and explores how these Christian healers can be inspired to persevere in the care of the sick. Drawing on the parable of the prodigal son, for instance, Sulmasy illustrates how some physicians have put financial gain ahead of their patients, and how genuine spirituality might change their hearts. He examines both enigmatic topics such as the relationship between sinfulness, sickness, and suffering and the spirituality of more routine topics such as preventive medicine. In one especially stirring and poignant meditation, he reflects on the spirituality of dying in the light of Christian hope.

A Balm for Gilead interweaves prayer and reflection, pointing the way to a twenty-first-century spirituality for health care professionals and their patients.

Scientific advances and economic forces have converged to create something unthinkable for much of human history: a robust market in human body products. Every year, countless Americans supply blood, sperm, and breast milk to “banks” that store these products for later use by strangers in routine medical procedures. These exchanges entail complicated questions. Which body products are donated and which sold? Who gives and who receives? And, in the end, who profits? In this eye-opening study, Kara Swanson traces the history of body banks from the nineteenth-century experiments that discovered therapeutic uses for body products to twenty-first-century websites that facilitate a thriving global exchange.

More than a metaphor, the “bank” has shaped ongoing controversies over body products as either marketable commodities or gifts donated to help others. A physician, Dr. Bernard Fantus, proposed a “bank” in 1937 to make blood available to all patients. Yet the bank metaphor labeled blood as something to be commercially bought and sold, not communally shared. As blood banks became a fixture of medicine after World War II, American doctors made them a front line in their war against socialized medicine. The profit-making connotations of the “bank” reinforced a market-based understanding of supply and distribution, with unexpected consequences for all body products, from human eggs to kidneys.

Ultimately, the bank metaphor straitjacketed legal codes and reinforced inequalities in medical care. By exploring its past, Banking on the Body charts the path to a more efficient and less exploitative distribution of the human body’s life-giving potential.

Felicia Knaul, an economist who has lived and worked for two decades in Latin America on health and social development, documents the personal and professional sides of her breast cancer experience. Beauty without the Breast contrasts her difficult but inspiring journey with that of the majority of women throughout the world who face not only the disease but stigma, discrimination, and lack of access to health care. This wrenching contrast is the cancer divide—an equity imperative in global health.

Knaul exposes barriers affecting women in low and middle-income countries and highlights the role of men, family, and community in responding to the challenge of breast cancer. She shares striking data about breast cancer, a leading killer of young women in developing countries, and narrates the process of applying this evidence and launching Tómatelo a Pecho (also the book title in Spanish)—a Mexico-based program promoting awareness and access to health care. The book concludes with letters from Dr. Julio Frenk, her husband and former Minister of Health of Mexico, written while they shared the trauma of diagnosis and treatment. With force and lucidity, the book narrates the journey of patient and family as they courageously navigate disease and survivorship.

Information on prenatal testing abounds, but few books are addressed to prospective parents in need of practical guidance. In this comprehensive and sensitive account, Elena Nightingale and Melissa Goodman offer remarkably clear answers to the set of bewildering questions generated by the concerns of parenthood.

Prospective parents are given the guidance needed to make informed choices about whether or not to undergo testing and, if they elect to do so, how best to use the results. As humans, we are recipients of a rich genetic heritage. Each human cell contains 46 chromosomes with a total of 50,000 to 100,000 genes distributed among them. Such richness carries immense possibilities for error when gene replication occurs; it is therefore not surprising that gene disorders such as Down syndrome, Huntington's disease, and neural tube defects pose a major public health problem. Rapid development of sophisticated new techniques has vastly increased our ability to diagnose genetic disorders during the prenatal period. For example, the amniotic fluid sampled in the middle trimester can be tested for such biochemical abnormalities as Tay-Sachs disease. The advent of more recent techniques, such as sampling the cells of the villi of the chorion (a procedure that can be carried out in the first trimester), employing gene probes, and using ultrasonographic detection, has advanced the diagnosis of genetic disorders faster than most researchers would have thought possible.

Nightingale and Goodman carefully explain the practicalities of this potentially confusing array of prenatal tests: how they are performed, what they reveal, and what their limitations are. The book concludes with a thoughtful consideration of the economic, ethical, and legal issues related to prenatal screening. Although primarily intended to assist prospective parents, this volume is also of interest to health care providers, public health officials, and policymakers who struggle with these difficult decisions.

Research with human subjects has long been controversial because of the conflicts that often arise between promoting scientific knowledge and protecting the rights and welfare of subjects. Twenty-five years ago the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research addressed these conflicts. The result was the Belmont Report: Ethical Principles and Guidance for Research Involving Human Subjects, a report that identified foundational principles for ethical research with human subjects: respect for persons, beneficence, and justice.

Since the publication of Belmont, these three principles have greatly influenced discussions of research with human subjects. While they are often regarded as the single-most influential set of guidelines for biomedical research and practice in the United States (and other parts of the world), not everyone agrees that they provide adequate guidance. Belmont Revisited brings together a stellar group of scholars in bioethics to revisit the findings of that original report. Their responses constitute a broad overview of the development of the Belmont Report and the extent of its influence, especially on governmental commissions, as well as an assessment of its virtues and shortcomings.

Belmont Revisited looks back to reexamine the creation and influence of the Belmont Report, and also looks forward to the future of research—with a strong call to rethink how institutions and investigators can conduct research more ethically.

”Every social mechanism appears to have a dual potential for good and evil. Prepayment for medical care is no exception. On the one hand, it provides assurance of necessary care as a safeguard to health, economic well-being, and peace of mind. On the other hand, it opens the way to wasteful and harmful care, to price inflation, and to concealed redistributions in socially undesirable directions. The problem is to devise a plan that allows us to reap the most advantages while we incur the fewest drawbacks.”

Benefits in Medical Care Programs is a comprehensive treatment of this problem. Dr. Donabedian begins with a clear and straight forward analysis of his own assumptions about the social mandate for medical care benefits, the objectives of medical care programs, and the magnitude and distribution of the unmet need that these programs are designed to alleviate. The problem of defining and measuring the need for care is considered within the con text of the data yielded by alternative definitions. The analysis then shifts to the impact of benefits on certain key features of the medical care system.

Program benefits are weighed against program objectives, and policy implications are drawn from this comparison. We are shown what can and cannot be accomplished through medical care benefits and what goals are served by specific aspects of existing or proposed plans. Although Dr. Donabedian counsels a fairly thorough reform of existing systems, he remains skeptical about the possibility of designing a perfect system, and he does not hesitate to point out that increased access to care "increases exposure to both what is good and what is bad in our system of medical care. . . The machinery of medical care has a sinister potential for those who fall into it in the wrong place at the wrong time.

Dr. Donabedian's previous book Aspects of Medical Care Administration has been called the "bible" of its field. Benefits in Medical Care Programs should prove equally invaluable.

In 1985 the media announced a new therapy for cancer. It was expensive, labor-intensive, and toxic--but, they said, it worked. How it worked is the story Ilana Löwy tells in Between Bench and Bedside, a compelling account of the clinical trials of interleukin-2 at a major French cancer hospital. Her book offers a remarkable insider's view of the culture of clinical experimentation in oncology--and of how this culture affects the development of new treatments for cancer.

Löwy, a historian of science who trained as an immunologist, makes the life of the laboratory and the hospital comprehensible and immediate. Before immersing us in the clinical drama, she fills in the history behind the action--a background of chemotherapy and radiation, controlled clinical trials, and the long line of immunological approaches that finally led to interleukin-2. The story then shifts to the introduction of interleukin-2 in a cancer ward. Löwy conveys the clinical investigation as a complex, multilayered phenomenon that defies the stereotypes of modern biomedicine. In this picture, the miracle-makers and arrogant, self-centered professionals of myth give way to moving images of real people negotiating the tensions between institutional and professional constraints, the search for a scientific breakthrough, and the obligation to alleviate the suffering of a patient. The result is a rare firsthand look at the multiple factors that shape real-life clinical experiments and the institutional tangle and emotional muddle that surround such trials--an invaluable view at a time when medicine is undergoing such great and confusing changes.

In Beyond a Western Bioethics, physicians Angeles Tan Alora and Josephine M. Lumitao join eight other contributors to provide a comprehensive exploration of bioethical issues outside of the dominant American and western European model. Using the Philippines as a case study, they address how a developing country's economy, religion, and culture affect the bioethical landscape for doctors, patients, families, and the society as a whole.

American principles of medical ethics assume the primacy of individual autonomy, the importance of truth-telling, and secular standards of justice and morality. In the Philippines, these standards are often at odds with a culture in which family relationships take precedence over individualism, and ideas of community, friendship, and religion can deeply influence personal behavior. Pervasive poverty further complicates the equation. Contributors move from a general discussion of the moral vision informing health care decisions in the Philippines to an exploration of a wide range of specific cases: family planning, care of the elderly, organ transplants, death and dying, medical research, AIDS care, doctor-patient relationships, informed consent, and the allocation of scarce health-care resources.

Written for both students and professionals, the book provides a much-needed perspective on how medical ethics are practiced in a developing nation, and it successfully challenges the wisdom of global bioethical standards that do not account for local cultural and economic differences.

In his latest book, David Bainbridge combines an otherworldly journey through the central nervous system with an accessible and entertaining account of how the brain's anatomy has often misled anatomists about its function. Bainbridge uses the structure of the brain to set his book apart from the many volumes that focus on brain function. He shows that for hundreds of years, natural philosophers have been interested in the gray matter inside our skulls, but all they had to go on was its structure. Almost every knob, protrusion, canal, and crease was named before anyone had an inkling of what it did--a kind of biological terra incognita with many weird and wonderful names: the zonules of Zinn, the obex ("the most Scrabble-friendly word in all of neuroanatomy"), the aqueduct of Sylvius, the tract of Goll.

This uniquely accessible approach lays out what is known about the brain (its structure), what we can hope to know (its function), and what we may never know (its evolution). Along the way Bainbridge tells lots of wonderful stories about the "two pounds of blancmange" within our skulls, and tells them all with wit and style.

This is an auto-narrated audiobook edition of this book.

There is little debate that health care in the United States is in need of reform. But where should those improvements begin? With insurers? Drug makers? The doctors themselves? In Big Med, David Dranove and Lawton Robert Burns argue that we’re overlooking the most ubiquitous cause of our costly and underperforming system: megaproviders, the expansive health care organizations that have become the face of American medicine. Your local hospital is likely part of one. Your doctors, too. And the megaproviders are bad news for your health and your wallet.

Drawing on decades of combined expertise in health care consolidation, Dranove and Burns trace Big Med’s emergence in the 1990s, followed by its swift rise amid false promises of scale economies and organizational collaboration. In the decades since, megaproviders have gobbled up market share and turned independent physicians into salaried employees of big bureaucracies, while delivering on none of their early promises. For patients this means higher costs and lesser care. Meanwhile, physicians report increasingly low morale, making it all but impossible for most systems to implement meaningful reforms.

In Big Med, Dranove and Burns combine their respective skills in economics and management to provide a nuanced explanation of how the provision of health care has been corrupted and submerged under consolidation. They offer practical recommendations for improving competition policies that would reform megaproviders to actually achieve the efficiencies and quality improvements they have long promised.
This is an essential read for understanding the current state of the health care system in America—and the steps urgently needed to create an environment of better care for all of us.

Congenital absence or closure of the bile ducts, biliary atresia, is a disease state of unknown etiology, controversial definition, and, until recently, no effective therapy. It is a condition of newborns, most commonly female newborns, and Western methods of treatment have achieved a survival rate no greater than seven percent.

Daniel Hays and Ken Kimura now make available a comprehensive study of radical methods developed in japan which have achieved dramatically more encouraging results over the last twenty-five years. Western and Japanese approaches are compared and contrasted with respect to differential diagnosis, methods of classification, surgical technique, results, complications, and long-range survival. The largely skeptical attitudes of Western surgeons are also examined with revealing insight. While the writing is always temperate, the facts themselves argue most eloquently for a closer appraisal of this option for treating an otherwise fatal disease.

Bioethics and the Human Goods offers students and general readers a brief introduction to bioethics from a “natural law” philosophical perspective. This perspective, which traces its origins to classical antiquity, has profoundly shaped Western ethics and law and is enjoying an exciting renaissance. While compatible with much in the ethical thought of the great religions, it is grounded in reason, not religion. In contrast to the currently dominant bioethical theories of utilitarianism and principlism, the natural law approach offers an understanding of human flourishing grounded in basic human goods, including life, health, friendship, and knowledge, and in the wrongness of intentionally turning against, or neglecting, these goods.

The book is divided into two sections: Foundations and Issues. Foundations sketches a natural law understanding of the important ethical principles of autonomy, non-maleficence, beneficence, and justice and explores different understandings of “personhood” and whether human embryos are persons. Issues applies a natural law perspective to some of the most controversial debates in contemporary bioethics at the beginning and end of life: research on human embryos, abortion, infanticide, euthanasia, the withdrawal of tube-feeding from patients in a “persistent vegetative state,” and the definition of death. The text is completed by appendices featuring personal statements by Alfonso Gómez-Lobo on the status of the human embryo and on the definition and determination of death.

Robotic exoskeletons that allow stroke survivors to regain use of their limbs, 3D-printed replacement body parts, and dozens of other innovations still in schematic design are revolutionizing the treatment of debilitating injuries and nervous system disorders. What all these technologies have in common is that they are modeled after engineering strategies found in nature—strategies developed by a vast array of organisms over eons of evolutionary trial and error.

Eugene Goldfield lays out many principles of engineering found in the natural world, with a focus on how evolutionary and developmental adaptations, such as sensory organs and spinal cords, function within complex organisms. He shows how the component parts of highly coordinated structures organize themselves into autonomous functional systems. For example, when people walk, spinal cord neurons generate coordinated signals that continuously reorganize patterns of muscle activations during the gait cycle. This self-organizing capacity is just one of many qualities that allow biological systems to be robust, adaptive, anticipatory, and self-repairing. To exploit the full potential of technologies designed to interact seamlessly with human bodies, properties like these must be better understood and harnessed at every level, from molecules to cells to organ systems.

Bioinspired Devices brings together insights from a wide range of fields. A member of the Wyss Institute for Biologically Inspired Engineering, Goldfield offers an insider’s view of cutting-edge research, and envisions a future in which synthetic and biological devices share energy sources and control, blurring the boundary between nature and medicine.

Biosecurity Dilemmas examines conflicting values and interests in the practice of “biosecurity,” the safeguarding of populations against infectious diseases through security policies. Biosecurity encompasses both the natural occurrence of deadly disease outbreaks and the use of biological weapons. Christian Enemark focuses on six dreaded diseases that governments and international organizations give high priority for research, regulation, surveillance, and rapid response: pandemic influenza, drug-resistant tuberculosis, smallpox, Ebola, plague, and anthrax. The book is organized around four ethical dilemmas that arise when fear causes these diseases to be framed in terms of national or international security: protect or proliferate, secure or stifle, remedy or overkill, and attention or neglect. For instance, will prioritizing research into defending against a rare event such as a bioterrorist attack divert funds away from research into commonly occurring diseases? Or will securitizing a particular disease actually stifle research progress owing to security classification measures? Enemark provides a comprehensive analysis of the ethics of securitizing disease and explores ideas and policy recommendations about biological arms control, global health security, and public health ethics.

Some of humankind's greatest tools have been forged in the research laboratory. Who could argue that medical advances like antibiotics, blood transfusions, and pacemakers have not improved the quality of people's lives? But with each new technological breakthrough there comes an array of consequences, at once predicted and unpredictable, beneficial and hazardous.

Outcry over recent developments in the reproductive and genetic sciences has revealed deep fissures in society's perception of biotechnical progress. Many are concerned that reckless technological development, driven by consumerist impulses and greedy entrepreneurialism, has the potential to radically shift the human condition—and not for the greater good. Biotechnology and the Human Good builds a case for a stewardship deeply rooted in Judeo-Christian theism to responsibly interpret and assess new technologies in a way that answers this concern.

The authors jointly recognize humans not as autonomous beings but as ones accountable to each other, to the world they live in, and to God. They argue that to question and critique how fields like cybernetics, nanotechnology, and genetics might affect our future is not anti-science, anti-industry, or anti-progress, but rather a way to promote human flourishing, common sense, and good stewardship.

A synthetic work drawing on the thought of a physician, ethicists, and a theologian, Biotechnology and the Human Good reminds us that although technology is a powerful and often awe-inspiring tool, it is what lies in the heart and soul of who wields this tool that truly makes the difference in our world.

The deprivations and cruelty of slavery have overshadowed our understanding of the institution's most human dimension: birth. We often don't realize that after the United States stopped importing slaves in 1808, births were more important than ever; slavery and the southern way of life could continue only through babies born in bondage.

In the antebellum South, slaveholders' interest in slave women was matched by physicians struggling to assert their own professional authority over childbirth, and the two began to work together to increase the number of infants born in the slave quarter. In unprecedented ways, doctors tried to manage the health of enslaved women from puberty through the reproductive years, attempting to foster pregnancy, cure infertility, and resolve gynecological problems, including cancer.

Black women, however, proved an unruly force, distrustful of both the slaveholders and their doctors. With their own healing traditions, emphasizing the power of roots and herbs and the critical roles of family and community, enslaved women struggled to take charge of their own health in a system that did not respect their social circumstances, customs, or values. Birthing a Slave depicts the competing approaches to reproductive health that evolved on plantations, as both black women and white men sought to enhance the health of enslaved mothers--in very different ways and for entirely different reasons.

Birthing a Slave is the first book to focus exclusively on the health care of enslaved women, and it argues convincingly for the critical role of reproductive medicine in the slave system of antebellum America.

Throughout the fourteenth century AD/eighth century H, waves of plague swept out of Central Asia and decimated populations from China to Iceland. So devastating was the Black Death across the Old World that some historians have compared its effects to those of a nuclear holocaust. As countries began to recover from the plague during the following century, sharp contrasts arose between the East, where societies slumped into long-term economic and social decline, and the West, where technological and social innovation set the stage for Europe's dominance into the twentieth century. Why were there such opposite outcomes from the same catastrophic event?

In contrast to previous studies that have looked to differences between Islam and Christianity for the solution to the puzzle, this pioneering work proposes that a country's system of landholding primarily determined how successfully it recovered from the calamity of the Black Death. Stuart Borsch compares the specific cases of Egypt and England, countries whose economies were based in agriculture and whose pre-plague levels of total and agrarian gross domestic product were roughly equivalent. Undertaking a thorough analysis of medieval economic data, he cogently explains why Egypt's centralized and urban landholding system was unable to adapt to massive depopulation, while England's localized and rural landholding system had fully recovered by the year 1500.

The major goal of developmental neurobiology is to understand how the nervous system is put together. A central theme that has emerged from research in this field over the last several decades is the crucial role of trophic interactions in neural assembly, and indeed throughout an animal's life. Trophic—which means nutritive—refers to long-term interdependencies between nerve cells and the cells they innervate.

The theory of trophic effects presented in this book offers an explanation of how the vertebrate nervous system is related to—and regulated by—the body it serves. The theory rationalizes the nervous system's accommodation, throughout life, to the changing size and form of the body it tenants, indicating the way connections between nerve cells change in response to stimuli as diverse as growth, injury, experience, and natural selection.

Dale Purves, a leading neurobiologist best known for his work on the formation and maintenance of synaptic connections, presents this theory within the historical setting of earlier ideas about neural organization—from Weiss's theory of functional reorganization to the chemoaffinity theory championed by Sperry. In addition to illuminating eighty years of work on trophic interactions, this book asks its own compelling questions: Are trophic interactions characteristic of all animals or only of those with complex nervous systems? Are trophic interactions related to learning? What does the trophic theory of neural connections imply about the currently fashionable view that the nervous system operates according to Darwinian principles?

Purves lays the theoretical foundation for practical exploration of trophic interactions as they apply to neural connections, a pursuit that will help us understand how our own nervous systems generate change. The ideas in this book not only enrich neurobiology but also convey the profound relevance of neuroscience to other fields of life science.

Whether classified as regulators of inflammation, metabolism, or other physiological functions, a distinctive set of molecules enables the human body to convey information from one cell to another. An in-depth primer on the molecular mediators that coordinate complex bodily processes, Body Messages provides fresh insight into how biologists first identified this special class of molecules and the consequences of their discovery for modern medicine.

Focusing on proteins that regulate inflammation and metabolism—including the cytokines and adipokines at the core of her own research—Giamila Fantuzzi examines the role body messages play in the physiology of health as well as in the pathology of various illnesses. Readers are introduced to different ways of conceptualizing biomedical research and to the advantages and pitfalls associated with identifying molecules beginning with function or structure. By bringing together areas of research usually studied separately, Fantuzzi stresses the importance of investigating the body as a whole and affirms the futility of trying to separate basic from clinical research. Drawing on firsthand interviews with researchers who made major contributions to the field, Body Messages illustrates that the paths leading to scientific discovery are rarely direct, nor are they always the only routes available.

In Body Parts, E. Richard Gold examines whether the body and materials derived from it—such as human organs and DNA—should be thought of as market commodities and subject to property law. Analyzing a series of court decisions concerning property rights, Gold explores whether the language and assumptions of property law can help society determine who has rights to human biological materials.

Gold observes that the commercial opportunities unleashed by advances in biotechnology present a challenge to the ways that society has traditionally valued the human body and human health. In a balanced discussion of both commercial and individual perspectives, Gold asserts the need to understand human biological materials within the context of human values, rather than economic interests.

This perceptive book will be welcomed by scholars and other professionals engaged in questions regarding bioethics, applied ethics, the philosophy of value, and property and intellectual property rights. Given the international aspects of both intellectual property law and biotechnology, this book will be of interest throughout the world and especially valuable in common-law (most English-speaking) countries.

Body, Society, and Nation tells the story of China’s unfolding modernity by exploring the changing ideas, practices, and systems related to health and body in late nineteenth- and twentieth-century Shanghai. The pursuit of good health loomed large in Chinese political, social, and economic life. Yet, “good health” had a range of associations beyond individual well-being. It was also an integral part of Chinese nation-building, a goal of charitable activities, a notable outcome of Western medical science, a marker of modern civilization, and a commercial catchphrase. With the advent of Western powers, Chinese notions about personal hygiene and the body gradually expanded. This transformation was complicated by indigenous medical ideas, preexisting institutions and social groups, and local cultures and customs.

This study explores the many ways that members of the various strata of Shanghai society experienced and understood multiple meanings of health and body within their everyday lives. Chieko Nakajima traces the institutions they established, the regulations they implemented, and the practices they brought to the city as part of efforts to promote health. In doing so, she explains how local practices and customs fashioned and constrained public health and, in turn, how hygienic modernity helped shape and develop local cultures and influenced people’s behavior.

Arousal is fundamental to all cognition. It is intuitively obvious, absolutely necessary, but what exactly is it? In Brain Arousal and Information Theory, Donald Pfaff presents a daring perspective on this long-standing puzzle. Pfaff argues that, beneath our mental functions and emotional dispositions, a primitive neuronal system governs arousal. Employing the simple but powerful framework of information theory, Pfaff revolutionizes our understanding of arousal systems in the brain.

Starting with a review of the neuroanatomical, neurophysiological, and neurochemical components of arousal, Pfaff asks us to look at the gene networks and neural pathways underlying the brain’s arousal systems much as a design engineer would contemplate information systems. This allows Pfaff to postulate that there is a bilaterally symmetric, bipolar system universal among mammals that readies the animal or the human being to respond to stimuli, initiate voluntary locomotion, and react to emotional challenges. Applying his hypothesis to heightened states of arousal—sex and fear—Pfaff shows us how his theory opens new scientific approaches to understanding the structure of brain arousal.

A major synthesis of disparate data by a preeminent neuroscientist, Brain Arousal and Information Theory challenges current thinking about cognition and behavior. Whether you subscribe to Pfaff’s theory or not, this book will stimulate debate about the nature of arousal itself.

Movement has long been considered the most obvious expression of brain activity and its correlative, mental activity. By studying movement, the neurophysiologist hopes to penetrate the interior of the living being and uncover the hidden source of action and its clues to the origin of life. We presume a role for the brain in movement—but should the brain be viewed simply as a machine that reacts to diverse stimuli, or is it an intelligent machine that organizes and controls not only itself but also the world around it?

Drawing upon the many disciplines that have contributed to brain research—anatomy, physiology, clinical neurology, psychology, psychiatry—Marc Jeannerod traces three centuries of ideas about movement and the brain. His critique of neural science takes into account the work of thinkers ranging from Descartes and Willis to Held, Hubel and Wiesel, Piaget and Chomsky. In his historical survey Jeannerod sees parallels between the influential neurological theories and dominating philosophical questions of the time: What is the nature of the soul? How does knowledge originate? What is the relation between the living organism and its milieu? Jeannerod's elegant arguments demonstrate that the “brain-movement problem” is the essential paradigm of the “brain-mind problem.” He advances a view of the neural organization of movement that has far-reaching implications for psychology and all neural sciences.

Neural grafting, virtual reality, gene therapy, psychotropic drugs As startling new treatments emerge for disorders of the brain, new concerns are arising along with them. In the first book to examine the implications of the full range of revolutionary interventions now possible in the human brain, Robert H. Blank warns that while these new techniques may promise medical wonders, they also raise profound political questions.

Our rapidly unfolding knowledge about the brain and the accompanying applications have three main policy dimensions: funding research initiatives, controlling individual use, and assessing social consequences. But underlying these aspects, Blank argues, are more disturbing issues that pose fundamental challenges to our conceptions of equality, autonomy, freedom, responsibility, and human nature itself.

Brain Policy makes the key facts from the technical literature readily accessible to social scientists and general readers and points out the implications for our society. Blank first explains the structure and function of the nervous system and current theories of brain operation; he then assesses the uses and potential abuses of various intervention techniques. He identifies the public policy issues raised by discoveries in the neurosciences and calls for intensified scrutiny of the advantages and disadvantages of new technologies.

Warning that the risks and dangers of the dramatic developments in neuroscience are potentially large, Blank offers a means of understanding these scientific advances and the philosophical and political issues they entail. This book will be of interest to social scientists, policy analysts, policy makers, bioethicists, scientists who want to see the bigger picture, and the informed reader with an interest in the implications of neuroscience for themselves and society.

The neuroscientist Alain Berthoz experimented on Russian astronauts in space to answer these questions: How does weightlessness affect motion? How are motion and three-dimensional space perceived? In this erudite and witty book, Berthoz describes how human beings on earth perceive and control bodily movement. Reviewing a wealth of research in neurophysiology and experimental psychology, he argues for a rethinking of the traditional separation between action and perception, and for the division of perception into five senses.

In Berthoz’s view, perception and cognition are inherently predictive, functioning to allow us to anticipate the consequences of current or potential actions. The brain acts like a simulator that is constantly inventing models to project onto the changing world, models that are corrected by steady, minute feedback from the world. We move in the direction we are looking, anticipate the trajectory of a falling ball, recover when we stumble, and continually update our own physical position, all thanks to this sense of movement.

This interpretation of perception and action allows Berthoz, in The Brain’s Sense of Movement, to focus on psychological phenomena largely ignored in standard texts: proprioception and kinaesthesis, the mechanisms that maintain balance and coordinate actions, and basic perceptual and memory processes involved in navigation.

In the late nineteenth century, medical educators intent on transforming American physicians into scientifically trained, elite professionals recognized the value of medical school design for their reform efforts. Between 1893 and 1940, nearly every medical college in the country rebuilt or substantially renovated its facility. In Building Schools, Making Doctors, Katherine Carroll reveals how the schools constructed during this fifty-year period did more than passively house a remodeled system of medical training; they actively participated in defining and promoting an innovative pedagogy, modern science, and the new physician.

Interdisciplinary and wide ranging, her study moves architecture from the periphery of medical education to the center, uncovering a network of medical educators, architects, and philanthropists who believed that the educational environment itself shaped how students learned and the type of physicians they became. Carroll offers the first comprehensive study of the science and pedagogy formulated by the buildings, the influence of the schools’ donors and architects, the impact of the structures on the urban landscape and the local community, and the facilities’ privileging of white men within the medical profession during this formative period for physicians and medical schools.