Pain and Profit: The Politics of Malpractice By Sylvia Law and Steve Polan (review)

encumbered by translation into verbal text. These photomicrographs are a strong asset to the total purpose of this book. The author, David Ashley, a student of Winston Evans's, has tried to carry forward the strong embryologie flavor of the two original editions of this book. Evans's contributions to tumor pathology were from the dual vantage point of a trained embryologist and pathologist. This adds an extra dimension to pure morphology, which often explains variations in structural characteristics which would otherwise remain unexplained. The greatest deficiency of this well-conceived, well-presented, double-volume text is the lack of emphasis on the most recent literature, both in the text and in the bibliographic listings at the finish of each chapter. The overall balance is well maintained between tumors of different tissue origin. Due to the author's preference , the reproductive-tract neoplasms probably get a little more thorough handling, while tumors ofthe lymphohematopoetic system are relatively slighted in this presentation. If you have not already guessed, I am a long-time booster of R. Winston Evans's embryologie-morphologie analysis of human tumors, and I find the current David Ashley authored third edition a worthwhile addition to the library of any scientist who needs to interpret the vagaries of human tumor behavior. Francis H. Straus II Department ofPathology University of Chicago Pain and Profit: The Politics ofMalpractice. By Sylvia Law and Steve Polan. New York: Harper & Row, 1978. Pp. 306+xiv. $12.95. Law and Polan examine the inauspicious contributions of doctors, lawyers, and insurers to the medical malpractice mess. It should, therefore, interest these professionals greatly. The reader who hopes for some objectivity about the causes of the crisis and the alleged inability of physicians to obtain insurance coverage may, however, be disappointed. Doctors come off as the number one villains. In three major sections, the authors examine exhaustively the medical, legal, and insurance systems. References abound, and the authors demonstrate respectable scholarship, but their conclusions, particularly about physicians, are peculiarly naive and at times unnecessarily harsh. Can Law and Polan honestly believe that "malpractice actions do not arise until substandard practice produces a patient sufficiently angry to seek legal redress and injured so seriously a lawyer is willing to take the case"? Maldistribution of medical services in this country, they say, is a major cause of malpractice. The economic background of medical students, who, say the authors , come from families with incomes in excess of $22,000 and therefore lack incentive to seek forgiveness of government loans for their medical education by practicing in underserved areas, is a primary factor. Rather unkindly, the authors say that these students do not have a commitment to service. The pattern of financing makes it possible for young doctors to choose oversupplied spe312 J Book Reviews cialties and geographic areas. The authors attribute the frequency of malpractice in large measure to too many doctors with itchy fingers lying in wait for hapless patients. Unsurprisingly, the authors conclude that many patients receive no care or care that is below any reasonable standard. Overspecialization deprives patients of that sacred cow—primary care—another cause the authors cite for malpractice . They minimize the idea that internists and pediatricians can and do provide such care. Using an illustration of malpractice bordering on mayhem and the refusal of medical societies to discipline recognized malpractitioners, the authors focus on the strange case of two physician-brothers whose aberrant behavior, medical malfeasance, and drug addiction ended with their suicide. Their second example is Gonzales v. Nork (Case no. 228566, Superior Court, California, November 19, 1973), described by the presiding judge as making the court a Grand Guignol of medical horrors. To cite the reprehensible behavior of these wrongdoers to illustrate why the public sues physicians is like using the former Attorney General John Mitchell to exemplify the entire legal profession. Lawyers come off pretty well in Pain and Profit. Only professional prejudice or naivete could engender the authors' statement that the contingent fee system in America provides a powerful and efficient economic incentive to encourage lawyers to take only cases which involve serious injury. Could the authors, who are themselves lawyers, be unaware of those dubious practitioners with whom...