thor concludes that this is still a gray area andone that remains poorly understood. In fact,the first positive reports on infectious causeof cancers linked parasites, liver flukes, andSchistosoma with specific human cancers.Ironically, the Danish scientist JohannesA.G.Fibiger won the Nobel Prize for Physiologyor Medicine in 1926 for his investigations in-criminating the nematode Ganglyonemaneoplasticum in rat tumors, although his re-sults have not been confirmed independently.

Globalization, coupled with increases inhuman migration, means that more and morehumans will be competing for space and re-sources with wild populations of animals thatharbor infectious agents. Such encountershave the potential to result in hitherto un-known human diseases, including cancers.This book will serve as a useful reference inunderstanding some of these infectious agentsand their role in development of cancer.

Rajkumar SasidharanYale University School of MedicineMolecular Biophysics andBiochemistry Department

Stress in Health and Disease. Editedby Bengt B. Arnetz and Rolf Ekman.Weinheim: Wiley-VCH, 2006; 434 pp.US $230 Hardcover. ISBN: 978-3527312214.

The concept of stress, as it applies to thehuman experience of feeling worn out, pres-sured to keep up with the frenetic pace ofmodern society, and “emotionally uneasy”(as one author in this book phrased it), is sopervasive in today’s culture that it wouldseem impossible to produce a living humanadult who has avoided the experience com-pletely.We lament about being stressed, bragabout being stressed, attempt to fix and treatour stress, and (in some perverse effort tocover all our bases) stress that we are toostressed out. Yet, as it is with entities that areby their very nature primarily conceptualizedas a human perceptual experience (i.e., “I feelstressed”), a neat and tidy definition of stress,particularly one that explains its underlyingpathophysiology, has been elusive.

Now more than ever, as physicians andhealth care workers in every area of medi-cine are confronted with patients experienc-ing “stress” that affects, if not their actualbodily health, then at the very least theirsense of well-being, it is imperative that webegin to understand this entity in a more co-herent manner. This is the goal of a newmulti-disciplinary compilation on the sub-ject edited by Bengt B. Arnetz and RolfEkman. It is one of the first books attempt-ing to address every possible dimension ofstress — historical, cultural, biological, so-ciological, evolutionary, and clinical — re-lated to both health and pathology. As such,it emphasizes the need for new, innovativeparadigms born of trans-disciplinary collab-oration.

In this vein, the work succeeds to pulltogether many different voices and perspec-tives from a host of predominantly Swedish,Norwegian, and American clinicians andscientists. For example, the book opens withan insightful historical exploration of stressthat charts the concept’s birth (at least in themodern sense) to the early 19th century,when dramatic urban growth and changes inthe speed of business, travel, and communi-cation contributed to a sense of “nervous en-ergy” depletion that caused “mental strain.”Thus, stress is not simply a biological orpsychological phenomenon.

Each chapter is authored by a differentset of authorities and remains fairly specificto their area of expertise, often directly re-flecting their own research findings. Thesechapters explore stress through many differ-ent lenses, including that of business andmanagement, biology, evolution, a psy-chosocial paradigm, and so on. The biolog-ical chapters cover many expected baseswith adequate depth, including autonomicactivation, the cortisol response and otherendocrine outcomes, central nervous systeminvolvement, inflammation and immunefunction, and metabolic effects. In addition,the psychosocial chapters add more dimen-sion by exploring anti-stress interventions(e.g., social support), the role of sleep andfatigue, the potential link to medically unex-plained syndromes, and connections to

53Book reviews

mood findings (e.g., depression), chronicpain, addiction, and the neurobiology offear. Surprisingly, a cohesive exploration ofpost-traumatic stress disorder is not present,though many chapters used related findingsto emphasize a point. However, trauma inearly childhood and trauma related to naturalcatastrophes are explored in greater detail.

A benefit to compilation works such asthis is the chance for perspectives from mul-tiple disciplines to intermingle and spark di-alogue. In fact, it is a striking testament tohow little we really know about stress thateach chapter seems to present us with an en-tirely new paradigm. To this end, I almostwished that other authors had been allowedto provide a short commentary after theother chapters, thereby jumpstarting some ofthe interesting conversations this multi-dis-ciplinary approach will hopefully engender.

Adrawback is that the quality of writingcan vary greatly, particularly when dealingwith nebulous concepts.Although in generalthe writing in the book remains lucid, somechapters falter more than others. For exam-ple, the vague observation that the “desyn-chronization in the [autonomic nervoussystem], if sustained, taxes the nervous sys-tem and bodily organs, impeding the effi-cient synchronization and flow ofinformation throughout the psychophysio-logic systems” provides little additionalelaboration. In fact, it is interesting to notethat the language is even reminiscent of theolder ideas about “strained” nervous systemsfrom the turn of the century.

One strength of the book is that eachchapter is divided into organized segmentswith clear titles that also are provided in theContents section, easily enabling one to scanfor areas of particular interest. Searching forindividual references in the body of eachchapter is more difficult, however, becausethe reference sections are short and not allclaims are directly referenced in the text.

Stress in Health and Disease may notgive us all the answers, but it serves as ancrucial jumping-off point for the develop-ment of future research and paradigms thatwill help elucidate what stress is, the mech-anisms by which it affects our health, and

how we can mitigate its harmful effects andharness its good ones. For this reason, it isan excellent resource for clinicians and re-searchers who wish to pursue some of theseanswers in their own work, or simply forthose whose interests intersect with thetopic. After all, one thing the reader can besure of upon completion of the book is thatnearly every system in the body may be af-fected by stress. But try not to stress toomuch about it, okay?

Margaret ReynoldsYale University School of Medicine

Neuroscience. By Dale Purves. Fourthedition. Sunderland, Massachusetts:Sinauer Associates Inc.; 2008, 810 pp.US $102.95 Hardcover. ISBN: 978-0878936977.

Is it too bold to say that the ultimateutility of a neuroscience textbook can bemeasured by its ability to explain the basalganglia? Perhaps. If we were to accept suchcriteria, the fourth edition of Dale Purves’Neuroscience would stand as one the finestand most economical texts in the field.While Kandel’s Principles of Neural Sci-ence is the tome that sits on the desks ofmost neuroscientists-in-training, Purves’Neurosciencemay safely serve as the under-graduate’s introduction to neuroscience.Medical students wishing to appreciate theneurophysiology of clinical phenomena —a component often lost in clinical neu-roanatomy textbooks — may also usePurves. Be forewarned, however, thatPurves’ Neuroscience lacks the clinical de-tail, radiographs, and case presentations thatgive books such as Neuroanatomy ThroughClinical Cases (Blumenfeld, Sinauer Asso-ciates) and Clinical Neuroanatomy (Wax-man, McGraw-Hill Medical) their weight.Medical students using Purves as their pri-mary text would benefit by supplementingwith Neuroanatomy Made Ridiculously Sim-ple, the widely used, wonderfully useful,minimalist manual to clinical neuroanatomy.

Purves divides the 31 chapters of thisfourth edition into five units: Neural Sig-

54 Book reviews