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Docket: 1-5524 Initial: JN

15524 December 1/98 CMAJ /Page 1405 Customer: CMAJ Dec 1/98

Books and other media

Livres et autres documents

Therapeutic Choices The Athletic Musician: ments about musicians’ injuries, and
a Guide to Playing much of the research on risk factors
2nd ed. Editor-in-chief, J. Gray. 886 pp. Illust.
Canadian Pharmacists Association. 1998. ISBN
Without Pain for occupational musculoskeletal dis-
orders is either ignored or misinter-
Barbara Paull, Christine Harrison. 175 pp. Illust. preted. The authors frequently make
Scarecrow Press, Lanham, Md. 1997. US$27. statements such as “study after study
Overall rating: Excellent ISBN 0-8108-3356-5 shows” without providing any refer-
Strengths: Comprehensive; clear dia-
grams, algorithms and tables; ences. No research support is pro-
easy to use Overall rating: Poor vided for pronouncements such as
Weaknesses: Unnecessary length Strengths: “Never do sit-ups in any shape or
Audience: Medical students, residents, • Addresses important subject
prescribing physicians • Appropriate for the lay reader form.” Although the exercise proto-
• Warnings for musicians not to play in pain col is presented as injury-prevention
Weaknesses: for musicians, research demonstrat-
• Information and recommendations reflect

T he second edition of this popu-

lar text is more than just an up-
date. It has 11 new topics, including
authors’ opinions and experience rather
than an evidence-based approach to injury
ing its effectiveness is not evident.
Similarly, in promoting their “er-
gonomically designed playing chair”
• Many inaccurate or misleading statements
chronic fatigue syndrome, HIV in- not supported by research the authors offer testimonials and
fection and croup. However, because • Though presented as a book for all musi- state: “All that remains to be done is
cians, the focus is on shoulder impinge-
of its length, it cannot be considered ment syndrome and string players to persuade healthy musicians to try
a quick pocket reference book. • Many common playing-related injuries are this [chair] and learn how to use it as
either not clearly defined or not even men-
Therapeutic Choices helps practi- tioned
a strong dose of injury-prevention
tioners choose the most appropriate • Anatomy for brass players embouchure medicine.” The authors provide no
treatment for their patients. A wide problems is not presented evaluation of the effectiveness of the
• Lack of warnings for the reader (especially
variety of topics makes it relevant to the injured reader) to consult a physician, chair.
various disciplines. A simple cost in- or any health professional other than an The few research studies that are
orthopedic physiotherapist before engag-
dicator is helpful when considering ing in the athletic protocol, which empha-
cited suggest a biased selection rather
this aspect in the choice of medica- sizes neck and back extension stretches than a comprehensive literature re-
tions. Each chapter is standardized Audience: Musicians, especially string view. For example, according to the
players with shoulder im-
under the headings of Goals of Ther- pingement syndrome best prevalence studies, playing-re-
apy, Investigations, and Therapeutic lated injuries affect approximately
Choices (Nonpharmacological and 43% of professional musicians;1 how-
Pharmacological). Occasionally, this
rigid approach makes for inclusion of
material that is either well known or
T his book was written by a phys-
iotherapist (Paull) and her vio-
linist patient (Harrison), who began
ever, the authors cite only studies re-
porting injury prevalence of 57% to
87%. By ignoring the methodologi-
easily accessible elsewhere. teaching injury prevention work- cal problems of the few cited studies
The algorithms and other dia- shops after their experience with as well as ignoring more rigorous
grams and tables are excellent. The Harrison’s shoulder problem. It ad- studies, the authors misrepresent and
index is particularly helpful for dresses an important topic, anatomy overstate a problem that is significant
cross-referencing trade names with is described clearly with simple dia- even without exaggeration. Similarly,
approved names. This book is rec- grams, and the recommendations the authors’ warning against taking
ommended for students and resi- not to play in pain are appropriate. anti-inflammatory medications is ac-
dents, and for physicians, both gen- Although this book appears to be companied by statistics on hospital-
eralists and specialty based. intended for all musicians, the focus ization and death that were reported
is on one type of shoulder impinge- at one conference presentation. Their
Peter John Kirk, MB, ChB ment syndrome. Few other playing- cautions to “sit as seldom as possible”
Professor and Head
related injuries are defined or even are based on one 1976 study.
Department of Family Medicine
Leo Luciani, MD
mentioned, and facial anatomy (ap- The authors advise readers who
Resident in Family Medicine plicable to woodwind and brass play- are injured that this book does not
University of Manitoba ers) is not covered. replace their own orthopedic phys-
Winnipeg, Man. There are several inaccurate state- iotherapist, and readers who experi-

CMAJ • DEC. 1, 1998; 159 (11) 1405

Docket: 1-5524 Initial: JN
15524 December 1/98 CMAJ /Page 1406 Customer: CMAJ Dec 1/98

Livres et autres documents

ence pain while performing the rec- and health law documents; least not for readers outside the
well written historical intro-
ommended stretches or exercises are ductions United States.
urged to consult an orthopedic Weaknesses: US audience; most docu-
mentation not necessarily Sandra J. Taylor, PhD
physiotherapist. However, there are applicable to Canadians
no cautions for the reader (injured Audience: Anyone with an academic
Bioethicist and
interest in bioethics and Director of Ethics Education
or uninjured) to consult a physician
health law School of Medicine
(or any health professional other Faculty of Health Sciences
than an orthopedic physiotherapist) Queen’s University
before engaging in the exercise pro-
tocol. The lack of appropriate warn-
ings and the authors’ emphasis on
J onsen, Veatch and Walters, well
known and respected US
bioethicists, have done an excellent
Kingston, Ont.

back extension stretches are cause job in compiling many of the piv-
for concern. otal documents in bioethics and
Although Harrison’s detailed ac- health law of the last few decades. Running With the Caribou
count of her injury experience illus- (As bioethics is a very new disci-
trates some frustrations other musi- pline, this really does constitute an Pete Sarsfield. 210 pp. Turnstone Press, Win-
cians encounter when consulting historical approach.) nipeg. 1997. $16.95. ISBN 0-88801-215-2
health professionals, both she and The five sections cover research
Paull make several unnecessary on humans, death and dying, human Overall rating: Good
derogatory comments regarding di- genetics, human reproduction and Strengths: Well written, humorous, per-
agnostic tests and treatments used the changing health care system. Weaknesses: None
by health professionals other than Each begins with an historical intro- Audience: All medical practitioners and
orthopedic physiotherapists. duction by one of the editors, fol- libraries
In sum, this book presents the au- lowed by documents (e.g., the well
thors’ opinions and experience rather
than a comprehensive evidence-based
approach to injury prevention.
known Belmont Report).
The editors promise to “Bring[s]
together in a single volume the core
I n Running With the Caribou Pete
Sarsfield sketches a broad picture
of his 25 years as a community health
legislative documents, court briefs, physician in northern communities in
Christine Zaza, ARCT, BMus, MSc, and reports by professional organiza- Ontario, Manitoba, Labrador and the
PhD tions, public bodies, and governments North West Territories. Part medical
National Cancer Institute of Canada
around the world.” Unfortunately, log, part personal quest, part travel-
Postdoctoral Fellow
University of Western Ontario “the world” does not include any- ogue, this book takes you on a jour-
London, Ont. thing north of the 49th parallel. ney you will be pleased you made.
Director, Canadian Network There are only a few documents Sarsfield allows us into his Canada:
for Health in the Arts from countries other than the United the northern landscape, native peo-
States. Although the literature is in- ples, friends, family, his travels, and
1. Zaza C. Playing-related musculoskeletal
teresting and informative, much of it, the provision of health care in the
disorders in musicians: a systematic review particularly the law, is not applicable north. One gets the sense that most
of incidence and prevalence. CMAJ in Canada. Indeed, relevant ethical of his time has been spent in an air-
and legal Canadian documents con- plane, train or bus, but in many cases,
cerning all areas discussed in the getting to the frontier is the best part
book do exist, and these documents of the story. He has made excursions
may be more important for Canadian to Hong Kong, Sweden and to Nevis,
readers interested in our own social where his Canadian medical training
Source Book in Bioethics: a
policies and norms. is called “destructively irrelevant” to
Documentary History This is not to say that Canadians that small nation.
Edited by Albert R. Jonsen, Robert M. Veatch,
cannot benefit from the insights of His writing style is subtle, eco-
LeRoy Walters. 510 pp. Georgetown U Pr. these respected bioethicists and from nomical and elegant. He wonders
1998. US$95. ISBN 0-87840-683-2 the reproduced documents. How- about medical specialists who have
ever, particularly at $95 (US), I do “chosen to avoid most ordinary hu-
not think it will become nor do I man contact by becoming unusually
Overall rating: Excellent, for US readers;
good, for others think it ought to become “a standard adept in one tiny area of people’s
Strengths: Good source of US bioethics text for courses in bioethics” . . . at problems.” Waiting for the Pope in

1406 JAMC • 1er DÉC. 1998; 159 (11)