The Logic of Medicine By Edmond A. Murphy (review)

BOOK REVIEWS The Logic ofMedicine. By Edmond A. Murphy. 2nd ed. Baltimore and London: Johns Hopkins UP, 1997. Pp. 416. $55 (cloth), $25.95 (paper). It is indeed a pleasure to review the second edition of Murphy's The Logic ofMediane , almost exactly 20 years after I reviewed the first edition. This greatly expanded version (increased by almost 50 percent) covers largely the same ground as the original version, but many of the discussions are enlarged with new examples and there are a few new topics in the second edition, including a section on modeling and a more detailed discussion of measurement. In general, the continuity present in the first edition is maintained in the newer version (although this was not the strong suit of the original text) . The strengui of the book is the elegant discussions of topics that form the interface between biostatistics and philosophy of science. The examples are plentiful, challenging, and thoughtful. One cannot help but to be amazed by Professor Murphy 's breadth and depth of knowledge. Examples from classical literature, physiology , basic biology, genetics, statistics, logic, and the philosophy of science abound. In fact, the range of topics is so broad that the overall structure of the discussion is somewhat difficult to appreciate and to follow, although each individual example is comprehensible. The book could be a text for a course on the philosophy of the science of medicine , although it would be difficult to use it as the sole or even the primary source. The discussions are very broad and assume a great deal ofthe reader. Besides having to be reasonably literate, it would be well to have a passing knowledge of the subject before tackling Murphy's treatment. The examples at the end of each chapter are more helpful and interesting than I anticipated, but placing all the references at the end is less well suited to the text. In addition, Murphy's style is challenging. There is no mistaking it—this is not an easy read. One is reminded of Alvin Feinstein, whose penchant for inventing his own language occasionally obscures the insights that he makes. There are several other books [1-3] that cover similar territory and could serve as an introduction, before taking on this more difficult treatment. However, there is much to be gained if one has the time and patience to wade through more than 500 pages of technical discussion. While the topics are heavily weighted toward statistics and statistical genetics, the discussions are blessedly almost devoid of formalization. There was a time when it was believed that the introduction of the principles of logic and philosophy would lead pari pasu to better medical care through more cogent, concise, and correct medical thinking. This material is no more commonly found in medical curricula now than it ever was. Either the idea that we could teach medical students—or anyone else—how to think didn't catch hold or it was abandoned, perhaps in the onslaught of new molecular biological knowledge or 144 Booh Reviews the tsunami of modern information processing. For whatever reason, it is probably time to abandon this approach and focus on introducing these concepts in clinical epidemiology, biostatistics, and health services research course material. For those individuals with an interest in the fundamental concepts at the root of statistics, biostatistics, and clinical inference, this treatise contains a vast amount of fertile soil to cultivate and nourish those interests. REFERENCES 1.Wulff, H.R. Rational Diagnosis and Treatment. London: Blackwell Scientific, 1976. 2.Sox, H.C; Blatt, M.A.; Higgins, M.C; and Marton, ?.?. MedicalDecision Making. Boston: Butterworth, 1988. 3.Albert, D.A.; Munson, R.; and Resnik, M.D. Reasoning in Medicine. Baltimore , London: Johns Hopkins UP, 1988. Daniel Albert University ofPennsylvania The Ovary ofEve: Egg and Sperm and Preformation. By Clara Pinto-Correia . With a forward by Stephen Jay Gould. Chicago: U of Chicago P, 1997. Pp. 396. $29.95. The history of preformation is one which has been well-told over the past half century. A number ofmajor studies, including my own Sexuality: An Illustrated History (New York: John Wiley, 1989), had documented the rise (and fall) of the belief that all ofthe...