Book Review

Principles of Molecular Medicine

N Engl J Med 2007; 356:429-430January 25, 2007

Article

Principles of Molecular Medicine
Second edition. Edited by Marschall S. Runge and Cam Patterson. 1268 pp., illustrated. Totowa, NJ, Humana Press, 2006. $195. ISBN: 978-1-58829-202-5

Principles of Molecular Medicine was first published in 1998. When Michael Goossens reviewed the book in the Journal, he emphasized its value in integrating molecular biology and molecular genetics into medical education. Today, one can only concur with the importance of this goal, which is now prominent in specialty training programs and medical schools throughout the world. At the same time, the elucidation of the molecular aspects of disease has progressed impressively in all areas of medicine, making the task of compiling a state-of-the-art book difficult. In fact, although the title and the publisher of this second edition are the same as those of the first edition, in several ways this is a new book altogether: Marschall S. Runge and Cam Patterson have replaced editor J. Larry Jameson, many of the contributors have changed (whereas most of the section editors have remained), and many of the 130 chapters have been replaced.

This book shows clearly that insight into disease at the molecular level has penetrated areas that until now have been almost inaccessible; this is, in my view, its most valuable feature. It may not be a coincidence that the presentation of this progress is especially prominent in cardiology, the editors' specialty — the material on congenital heart disease and the long QT syndrome, for example, would have been unavailable only 10 years ago. Another plus is that the editors have aimed to emphasize areas other than genetics and cancer in which the study of pathophysiology has reached the molecular level. These areas include infectious diseases, inflammatory and degenerative diseases, muscle wasting, and heart failure.

In a book with more than 200 contributors, overlapping and heterogeneity are inevitable. However, it is disconcerting to find a chapter on iron overload in the gastroenterology section and another in the hematology section and to find a chapter on melanoma in both the oncology section and the dermatology section. Some chapters are more authoritative than others; some are not very readable and almost devoid of illustrations; and some chapters, while good on clinical aspects and management, contain little to justify their inclusion in a book on molecular medicine.

It would be pedantic to argue whether this is a textbook or a collection of review articles. Apart from three sections (“Genetics,” “Metabolic Disorders,” and “Oncology”), the book is organized by organ system, yet it does not aim to be comprehensive. For someone of my generation, it is surprising not to find anything about hemoglobinopathies in this book. This omission is distressing not just because they are the mother and father of all molecular diseases but also because of the remarkable new developments in this area (the α-thalassemia mental retardation syndrome, for example). Moreover, many of the classic metabolic disorders are simply skipped. The editors might have wished to outline their policy for selecting topics in the preface; perhaps some omissions are deliberate, because the respective topics are the backbone of The Metabolic and Molecular Basis of Inherited Disease (edited by C.R. Scriver et al. 8th ed. New York: McGraw-Hill, 2001), an encyclopedic text that the publishers of this book evidently did not intend to compete with. As for the spectacular discovery of the molecular basis of polycythemia vera (a JAK2 mutation), not yet 2 years old, it may have come too late to be included in the book.

Despite these limitations, this book succeeds in giving a remarkable, mostly up-to-date overview of molecular medicine such as has not been available between two covers hitherto. The book reflects appropriately the notion that today the ultimate level of understanding of any disease must be on the molecular level, and it illustrates how this development has already influenced clinical medicine extensively in terms of nosology, diagnosis, and therapeutic targets. In addition, chapter 88 gives a firsthand account of the first clinical results of gene therapy; there is reason to hope that if there is a future edition of the book, it will report on success in gene therapy, not only in immunodeficiency syndromes but also in other diseases.

Lucio Luzzatto, M.D.
Istituto Toscano Tumori, 50139 Florence, Italy
lucio.luzzatto@unige.it