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using a "comparative method." The taxonomic, ecological, and geographical distributions of sexual and asexual reproduction are closely examined in a series of pairwise comparisons of rival hypotheses. One alternative is eliminated by each comparison, until the one hypothesis that best explains the facts is left. The procedure is analogous to the operation of a taxonomic key. The chosen winner of the exercise is the "tangled bank" hypothesis, the title coming from Darwin's metaphor in the final chapter of The Origin of Species. According to the tangled bank hypothesis, the genetically diverse offspring of sexual parents succeed more frequently in a spatially complex environment in which a single genotype is best adapted in only a fraction of the total environment. Bell considers that his search for the advantage of sex comes to a successful conclusion with the elimination of all hypotheses other than the tangled bank. The reviewer remains unconvinced, however. The comparative method assumes that a single hypothesis is responsible for the persistence of sex in most eukaryotes, and that the "correct" hypothesis is among those considered. The tests are futile if either of these questionable assumptions is not valid. Moreover, many of the dichotomous tests that are applied have insufficient power for the tasks asked of them, either because they rest on inadequate facts or because they contain restrictive qualifications. The analysis often succeeds in ruling out one or more hypotheses in particular cases, but I believe it fails in the stated aim of identifying one grand and comprehensive advantage of sex. The final section stands apart from the rest of the book. Four phenomena associated with sex (automixis, recombination, the alternation of generations, and gamete dimorphism) are discussed. The topics were presumably chosen because the author has a particular interest in them, and the discussions break considerable new ground. No attempt is made to cover the full range of strategies associated with sexual reproduction. A number of recently fashionable topics , such as sex ratios and allocations, sexual selection, male-female dimorphism, and natural sex reversals are considered only in passing, if at all. The overall impression that I am left with is that we still have a very imperfect understanding of the natural history of sex. Perhaps a brilliant new insight will suddenly appear and clear much of the present confusion, although Bell clearly does not expect this. Ifwe do have to use the comparative method to uncover the selective value of sex and its associated features, we have a long and difficult road ahead. In the meantime, this book provides a thoughtful and penetrating account of the incidence of sexual reproduction, and it has many stimulating ideas for others to work on. David G. Lloyd Botany Department, University ofCanterbury Christchurch, New Zealand The Social Transformation ofAmerican Medicine. By Paul Starr. New York: Basic Books, 1982. Pp. 514. $24.95. Professionals have a limited sense of the history of dieir vocation. What often serves is self-satisfied if not self-serving ideology chronologizing the major turning points and cultural heroes and acclaiming the remarkable achievements that Perspectives in Biology and Medicine, 27, 1 ยท Autumn 1983 | 163 resulted in the profession's lofty status. Despite significant and distinguished scholarship in medical history, physicians typically are uninformed about the past and how it shaped their practice and thinking about what diey do. Much medical history is specialized, focuses on narrow trends, and is inaccessible to the general reader. In contrast, Paul Starr has produced a book so ambitious and broad in scope, bold in generalization, and well written that any reader can profit. The basic argument of die book is not particularly new, but the skillful intermixing of social and cultural analysis and an impressive synthesis of historical data give the volume special force. Prior to 1850 in America, healing was an entrepreneurial endeavor widi conflicting and competingstreams. These internal divisions, and resistance of the public and economic limitations, made consolidation of medical activities difficult. Between 1850 and 1930 the development of transportation, urbanization, the emergence of an expanded marketplace, and the science and technology of medicine itself radically changed the opportunities for the profession's development. Borrowing significantly from Freidson's classic study of the Profession of Medicine...


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