D Books

I could not put this book down. I found it to be extremely helpful and therapeutic.

This book gave me clarity and peace after suffering from 2 miscarriages. I refer to it often when I need some guidance and explanation. A must for all women who have experienced one or more miscarriages.

After his wife miscarried four pregnancies, author Jon Cohen poured effort into assembling a comprehensive, accurate, and user-friendly repository of information on miscarriage. Now in a new paperback edition that corrects a few errors found in the original, Coming to Term: Uncovering the Truth About Miscarriage explores the latest research and findings on the phenomenon, debunks myths and hype, and shines a spotlight on real problems that could be making the occurrence worse in today's world - such as federally unacceptable nitrate levels (which fluctuate seasonally, often influenced by agriculture and animal waste disposal) found in some American wells. Cohen also explores a diverse array of medical treatments, from drugs to surrogate parent contracts to "touchy-feely" emotional therapy methods that can offer surprisingly positive results. Steeped in compassion as well as wisdom and solid information, Coming to Term is highly recommended.

this is definitely the best book that I've found on the subject of miscarriage. I have had three miscarriages and one child and have been told many differing opinions from doctors. When I suffered my last miscarriage at 37, a doctor told me that I had only a 40% chance of having another successful pregnancy. As with any medical condition, you have to be your own advocate, and this book is the best starting place that I've found to make the journey.

Since my last miscarriage, I saw a doctor that suggested IVIG. the procedure would cost me $9000. I consulted another doctor in the book, who gave me a better explanation of my situation and now I feel comfortable trying to move forward without expensive interventions.

When you experience several miscarriages you are faced with a maze. I found this book essential in figuring out the best way for my husband and I to proceed.

There are several reasons why this book does not deserve its present "five star" rating which are explained in this detailed review. The primary criticism is that the author demonstrates a lack of understanding of the scientific literature. He also shows a lack of scientific insight, and fails to recognize how immune issues can play a role in reproductive failure. He also uses a (now widely considered) flawed study to support his central arguments. Finally, he criticizes reproductive immunologists for their use of anecdotal evidence, yet relies on heavily anecdotal evidence to support his own views. In more detail, here are the weaknesses in this book:

On IVIG treatment for recurrent miscarriage

Cohen chooses to elaborate on the negative sides of the IVIG argument, yet fails to elaborate on the positive arguments, a disservice to the reading, investigating audience trying to understand all sides of IVIG issue.
For example, he agrees that elevated natural killer cell levels can be associated with miscarriage. On page 95, he says: "...studies suggest that women who repeatedly miscarry chromosomally normal babies produce higher level of natural killer cells." Cohen also agrees that IVIG may suppress natural killer cells. Page 95: "Some experiments show that IVIG suppresses natural killer cells" Yet, despite his acceptance of an NK miscarriage connection, he still chooses to scare patients away from lifesaving IVIG treatment that many clinics offer. On page 95 Cohen says "IVIG inadvertently infected people with hepatitis C" and "no amount of screening can test for a pathogen that science has yet to discover." Also, Cohen fails to mention the fact that modern IVIG preparations are screened for all known viruses, past and present. And fails to emphasize that IVIG is completely FDA-approved and thousands of patients are using it routinely with no ill effect for dozens of common autoimmune diseases. For a professional reporter supposedly reporting all sides of an issue, Cohen's investigation seems surprisingly one-sided.
Finally, Cohen seems to criticize the mental state of any patient choosing the IVIG option. At the end of page 95, he states: "untried options can have an intoxicating effect, leading them (women) to throw caution to the wind." I think Cohen's personal bias against reproductive immunology is clear. His ability to report on IVIG with logic and impartiality is sacrificed.

Th1:Th2 theory

On page 79, Cohen states that Th1:Th2 (immunological rejection) theory is a "hugely controversial hypothesis." However, most people who read scientific reproductive journals today would wonder how Cohen arrived at this understanding of the miscarriage literature. If he had a proper grasp of current theory he would not see that the Th1:Th2 theory is not only not "hugely controversial," but it is actually one of the freshest and most accepted new research developments in reproductive immunology medicine today.
How does Cohen arrive at his "Th1:Th2 is controversial" conclusion? In the book, Cohen cites only one single Th1:Th2 review study by Laird SM et al. (he apparently ignores the rest of the rest of the supporting studies in the literature) Yet, interestingly, upon reading carefully, this study actually seems to support Th1:Th2 relevance to miscarriage. It states: "Immunological rejection of the fetus due to recognition of paternal antigens by the maternal immune system, resulting in abnormal immune cells and cytokine production, is postulated to be one cause of unexplained pregnancy loss...there is some evidence for an alteration in the ratio of Th1 and Th2 cytokines produced by peripheral blood monocytes."
Note the phrases: "evidence for an alteration in the ratio of Th1 and Th2 cytokines" may be the "cause of unexplained pregnancy loss." So Cohen's strongest study against Th1: Th2 theory actually seems like it does not bolster his argument much at all?

Antiphospholipid Antibody (APA) Issues

On page 96, Cohen implies that APA positive recurrent miscarriage patients are like a "Black Swans" meaning that, although these patients exist, they are not as common as people might think like (they are rare and over-sensationalized). Again, it appears Cohen is "off the mark" here too. In fact, any layperson who does a cursory Pub-Med search through the literature would find that APA miscarriage patients are actually very common in the recurrent miscarriage population. In fact, one study shows that APA positive patients are present in almost a third of ladies who suffer unexplained recurrent abortion. See study by Cubillos J et al, Incidence of autoantibodies in the infertile population." Obstet Gynecol. 1997 Sep;90 (3):364-9 which states: "In the group of patients with a history of miscarriage, 38.2% (p < 0.05) (tested positive) for APL."
In addition to failing to state the truth about APA frequency, Cohen fails to address the fact that very few centers do the proper APA testing. This may account for why so many APA patients are missed in many infertility clinics. Few local laboratories test for all 6 classes of APA, causing many APA positive patients to be missed: See study by Coulam CB et al: Antiphospholipid antibodies associated with implantation failure after IVF/ET. J Assist Reprod Genet. 1997 Nov;14 (10):603-8. Study quote: "A complete APA panel using seven isotypes is necessary for diagnosing implantation failure associated with RAFS. If only anticardiolipin antibody is measured, 4% (13/312) of the positive APAs are detected, and 81% (56/69) of women with implantation failure associated with RAFS will have the diagnosis missed." Cohen never addresses any of this.

Endometriosis

On page 44, Cohen asserts that no miscarriage/endometriosis connection exists.
Cohen's words: "...controlled, randomized prospective trials later convincingly showed that no such connection exists." However, the truth is, there are dozens of studies in the literature citing the connection between endometriosis to immune issues early pregnancy loss. Does Cohen simply not know these studies exist? Or just he just over-look these studies, instead? Doesn't Cohen ever wonder about the "coincidence" that endometriosis is closely tied to immune issues and is also connected to recurrent pregnancy loss? Has he ever thought that there may possibly be a connection between endometriosis and miscarriage? Once again, Cohen seems naive to the literature and totally naïve to the larger interrelated implications that individual, so-called "unrelated" studies can present. Not only do Cohen's assertions about endometriosis seem naïve, but his assertions seem weak as well. His arguments are based on one single study: Vercammen EE et al: Endometriosis and recurrent pregnancy loss. Semin Reprod Med. 2000;18(4):363-8.
Upon reading the fine print of the study, you find that the argument against the recurrent miscarriage/endometriosis connection is not even that strong to begin with. The authors (countering what Cohen might imply) actually suggest that endometriosis is associated with implantation failure...yes... the very study Cohen uses as his argument against such a connection makes such a connection! See study quote: "...some studies have shown that the decreased number and quality of oocytes, the fertilization rate, and the implantation rate per embryo may be reduced in women with endometriosis"

The Polycystic Ovary Syndrome Issue

On page 114, Cohen states "The largest studies to date of pregnant women with PCOS estimate miscarriage rates of 40 percent and 60 percent." Yet, Cohen misses the connection between PCOS miscarriages and immune issues completely. There is one important immune-PCOS study that he omits entirely by Jakubowicz DJ et al: Reduced serum glycodelin and insulin-like growth factor-binding protein-1 in women with polycystic ovary syndrome during first trimester of pregnancy. J. Clin Endocrinol Metab. 2004 Feb;89 (2):833-9. Study quote: "These findings are significant in that they may provide a mechanism for first-trimester miscarriage in PCOS. Because glycodelin inhibits mixed lymphocyte reaction and natural killer cell activity, impaired production of glycodelin presumably allows a maternal immune response against the embryo." Cohen misses the PCOS immune connection completely.

Incompetent Cervix

Cohen's lack of understanding of the miscarriage literature comes through again in discussions about incompetent cervix as well. On page 138, he states "factors that cause the cervix to weaken largely remain a mystery." Yet he also says "some studies have shown links to other uterine anomalies, exposure to DES, and even antiphospholipid antibodies"
Why doesn't Cohen dig deeper here? If indeed he says incompetent cervix is linked to APAS, DES and uterine anomalies, how has he missed the fact that cervical incompetence is also associated with Th1:Th2 cytokine imbalance and that Th1: Th2 cytokine imbalances is associated with incompetent cervix? Doesn't he want to solve this cervical incompetence (as he puts it) "mystery"?
See supporting incompetent cervix studies that Cohen completely misses in his book:

1. Mohapeloa H et al HLA-DR typing of women with recurrent late spontaneous abortion and unsuccessful cervical cerclage. Hum Reprod. 1998 Apr;13(4):1079-82.
"The results suggest that HLA-DR-associated immunological factors might play a part in recurrent late spontaneous abortions and extremely preterm births under a cervical incompetence-like picture, at least in the subset of cases not treatable by cervical cerclage."

2. Lee KY et al: Interleukin-6, but not relaxin, predicts outcome of rescue cerclage in women with cervical incompetence. Am J Obstet Gynecol. 2004 Sep;191(3):784-9.
"Amniotic fluid interleukin-6 is increased in patients with cervical incompetence, which suggests that subclinical inflammation may contribute to cervical incompetence. Further, an elevated interleukin-6 level predicts a cerclage short-latency interval between cerclage and delivery. In contrast with interleukin-6, amniotic fluid relaxin does not appear to contribute to cervical incompetence-induced cervical dilation."

DES immune connection

Also, Cohen misses the fact that families who have used DES to prevent miscarriage may indeed have a higher incidence of immune issues (causing the miscarriages) that this "family tendency" to immune issues may be why "DES daughters" have more miscarriages, not the fact that they have been exposed to the DES in the womb? This possibility is never even considered, brought up or discussed in the book. Cohen, again, fails to address the possible immune connections in families who have used DES, leaving the total DES discussion more confused, not less.

Environment

On page 172, Cohen seems to agree that a few environmental factors may affect pregnancy outcome in certain instances: Nitrates in well water (page 172), and Bisphenol A in plastics (page 173). Nonetheless, Cohen seems uninterested in following up with these studies, he instead still prefers to dismiss the environmental idea overall. On page 174: "... miscarriages, as far as science can now determine, rarely occur because of what a woman eats or drinks, where she lives and works, and what air she breathes."
In fact, Cohen uses a (frankly, ridiculous) description as an example of pregnancy environmental durability: he describes how his grandmother jumped repeatedly off a chair in an attempt to induce a miscarriage. (page 174) This anecdote is (somehow?) used to support the idea that "the uterus, amniotic sac, and the placenta marvelously work together to prevent harm." Quite frankly, this is an embarrassing example of the typically non-scientific arguments that Cohen uses to support his journalistic angles.

Infection

Similarly, Cohen uses faulty logic when he discusses infectious agents. He admits that certain infections possibly may increase the incidence of miscarriage: page 166: "Infection may cause miscarriage "...rubella, syphilis, genital herpes, mumps, toxoplasmosis, malaria, possibly gardenerella." Yet, despite conceding this, Cohen still manages to glide over the infection/immune problem connection. (page 166: "...a few pathogens may account for a small percentage of miscarriages, although their sporadic nature means they play no important role in recurrent loss.")
In addition to pushing the infection miscarriage connection "under the table", Cohen never mentions how infectious agents may possibly stimulate the immune system to cause immune related miscarriage? In fact, the infection- immune connection is never even addressed at all? This is a glaring fault in Cohen's research, especially considering the fact there are several studies implicating the immune system as the ultimate cause of infection-related miscarriage. In fact, Dr Attila Toth of New York City has devoted whole career to this infection/miscarriage issue. Yet apparently Cohen knows nothing of Dr. Toth's research? Or if he does, Cohen chooses not to discuss it? A few infection -immune studies that Cohen misses:

1. Korbel DS et al: Natural killer cells and innate immunity to protozoan pathogens. Int J Parasitol. 2004 Dec;34(13-14):1517-28.
"Natural killer (NK) cells are lymphoid cells that mediate significant cytotoxic activity and produce high levels of pro-inflammatory cytokines in response to infection."... "NK derived interferon-gamma (IFN-gamma) production is also essential for control of several protozoal infections including toxoplasmosis, trypanosomiasis, leishmaniasis and malaria."

2. Ashkar AA et al: "Interleukin-15 and natural killer and NKT cells play a critical role in innate protection against genital herpes simplex virus type 2 infection." J Virol. 2003 Sep;77(18):10168-71. "This study demonstrates that IL-15 and NK-NKT cells are critical for innate protection against genital HSV-2."

3. Jensen JR et al: Fluctuations in natural killer cell activity in early syphilis. Br J Vener Dis. 1983 Feb;59(1):30-2. "In primary syphilis natural killer cell activity was increased, especially in patients lacking circulating lipoidal antibodies."

Luteal phase defect and progesterone

In addition to missing the infection-immune connection completely, Cohen also seems to miss the hormonal-immune connection as well. Though he says that an association may exist between luteal phase defect and miscarriage, Cohen misses (yet again) the possible immune relationship that may exist between these two issues. On page 99, Cohen states: "If the lining becomes inhospitable too early, as happens with what's called a deficient luteal phase, the embryo will not burrow, leading to a miscarriage, or it will not borrow currently, causing preeclampsia later in pregnancy"
No discussion is made about the fact that patients with poor luteal phases often have low progesterone in the latter half of the cycle...or the fact that progesterone has been shown to have an immunosuppressive effect. This immune factor may contribute at least in part to progesterone supplement's immune healing effect in recurrent miscarriage patients. See more studies that Cohen apparently misses in his book:

1. Szekeres-Bartho J. Immunological relationship between the mother and the fetus. Int Rev Immunol. 2002 Nov-Dec;21(6):471-95. "Another protective mechanism operating in favor of pregnancy is progesterone-dependent immunomodulation. Due to stimulation by fetally derived antigens, pregnancy lymphocytes develop progesterone receptors and in the presence of progesterone produce a mediator (PIBF) that, through altering the cytokine balance, inhibits NK activity and exerts an antiabortive effect in mice."

2. Laskarin G, Tokmadzic VS, Strbo N, Bogovic T, Szekeres-Bartho J, Randic L, Podack ER, Rukavina D.Progesterone induced blocking factor (PIBF) mediates progesterone induced suppression of decidual lymphocyte cytotoxicity. Am J Reprod Immunol. 2002 Oct;48(4):201-9. "The results indicate possible role for PIBF, as a mediator of progesterone in regulation of Decidual Lymphocyte cytolytic activity at the maternal-foetal (M-F) interface."

Preeclampsia

Lastly, on page 99, Cohen successfully makes the connection that patients who suffer from luteal phase defect may also suffer from preeclampsia at a higher rate. However (yet again) he totally misses the possible connection that exists between preeclampsia and immune issues (even more surprising considering the number of studies supporting the preeclampsia- immune connection that exist out there). How can Cohen miss this? Again and again it seems Cohen is totally unable to put the complex pieces of the miscarriage puzzle together. Again and again he fails to see the immune connection, failing to see how it can clarify so much of the "muddy water" that exists in this recurrent miscarriage field today. Here are some more immune/reproductive studies that Cohen completely misses:

1.Saito S, Sakai M. Th1/Th2 balance in preeclampsia. J Reprod Immunol. 2003 Aug;59(2):161-73. "Th1 predominant immunity is closely related to inflammation, endothelial dysfunction and poor placentation."

2. Makhseed M, Raghupathy R, El-Shazly S, Azizieh F, Al-Harmi JA, Al-Azemi MM. Pro-inflammatory maternal cytokine profile in preterm delivery. Am J Reprod Immunol. 2003 May;49(5):308-18.
"These data are suggestive of a maternal type 1 cytokine bias in preterm delivery".

3. Simhan HN, Krohn MA, Zeevi A, Daftary A, Harger G, Caritis SN. Tumor necrosis factor-alpha promoter gene polymorphism -308 and chorioamnionitis. Obstet Gynecol. 2003 Jul;102(1):162-6.
"Carriage of the TNFA2 allele is associated with a more than three-fold increased risk of clinical chorioamnionitis, even when accounting for important clinical and microbiologic risk factors."

4. Kaplan D. Fetal wastage in patients with rheumatoid arthritis. J Rheumatol. 1986 Oct;13(5):875-7.
"Ninety-six women with rheumatoid arthritis (RA) were found to have an abortion ratio higher than that of a comparison group (p = 0.005). This was true even before the onset of their RA (p = 0.007)"

5. Sergent F, Verspyck E, Marpeau L. [Crohn's disease and pregnancy. About 34 cases. Review of the literature] Gynecol Obstet Fertil. 2003 Jan;31(1):20-8.
"When the disease (Crohn's) is active, the risk of abortion and prematurity increases."

3. Cohen's flawed anti LIT arguments

Gullible patients

On page 58 Cohen begins: "Many couples plug their ears and firmly believe that because of the treatment, they have babies - and no amount of scientific data can shake the power of that conviction." From the beginning of the book, Cohen seems step off on the wrong foot about a typical reproductive immunology patient's psychological nature. He apparently accusing anyone who choose new or controversial treatments (like LIT or IVIG) to be emotionally gullible, unwilling (or unable?) to make sound scientific decisions. In fact, in my personal experience (through my many years watching these types of treatment programs) I have found that reproductive immunology (RI) patients are probably some of the most clear thinking, well read, well researched medical patients out there, able to pull apart any study to find its strengths, weaknesses and its flaws. Certainly most RI patients are not types to ignore solid scientific data. Already Cohen seems "off base" about the patient population he is writing about.

The REMIS LIT study by Carol Ober

Regarding the Carol Ober REMIS study Cohen states on page 69: "Because of the lack of benefit, we recommend against this intervention (LIT) as a treatment for unexplained recurrent miscarriage' concluded the researchers." It is already known that the REMIS study "proving" LIT ineffective was flawed in many ways. Dr. Beer outlined these flaws in detail in his Letter to the Editor sent to the Lancet. Among the REMIS study flaws that Dr. Beer cites are:

1. Failure to recruit an adequate number of study patients.

2. Failure to induce immune responses. Only 26% of women who received lymphocyte immunization developed HLA antibody response. (The immunization must have been prepared and/or given incorrectly to elicit this low response.)

3. 21 of 59 abortuses received genetic study. All (total 11) abnormal fetuses were from treatment group but this data was not reflected in the outcome analysis.

4. A higher proportion of treatment group had a previous live birth (P=0.054). Yet a previous meta-analysis had shown that lymphocyte immunization more effective in women with primary abortions. This was not discussed or considered in the REMIS study.

I know Cohen, through his LIT research, must have read the miscarriage support sites and Dr Beer's Lancet letter (available online to anybody), yet he makes no mention of this letter or any of its arguments in his LIT chapter. Why does he seem to avoid addressing this issue? This reporting bias not only does injustice the LIT, but also to those trying to find the truth about this LIT medicine. And frankly makes one wonder about how "impartial" Cohen's journalistic intentions really are.

Poor patient selection

Many of Dr. Beer's criticisms of the REMIS study similarly apply to other LIT studies. A common flaw found in negative outcome LIT studies is the failure to test subject's LAD (blocking antibody) levels before and after the LIT injections. As a result, researchers never really know if LIT patient:

1. Really needs LIT
2. Has achieved a proper LIT response before conception is attempted

In addition to these flaws, some LIT studies fail to use fresh donor cells (such as the REMIS study), making LIT less effective. Other studies fail to follow the timing and dose requirements that Dr. Beer recommends (i.e. some studies only do LIT once preconception, some studies do not wait the 3- 4 weeks necessary for the proper immune response take place). Lastly, those who understand reproductive immunology understand that LIT should be not be used as the sole immune treatment. Other immune problems need to be identified and independently treated as well (e.g. APA issues, ANA issues, cytokine imbalance, etc). Essentially, patients need a full immune work-up before doctors decide how LIT will fit into their total immune protocol. See Christiansen et al: Evidence-based investigations and treatments of recurrent pregnancy loss. Fertility and Sterility, Volume 83, Issue 4, April 2005, pages 821-839. Study quote: "Current meta-analyses evaluating the efficacy of treatments of RPL are generally pooling very heterogeneous patient populations and treatments. It is recommended that future meta-analyses look at subsets of patients and treatment protocols that are more combinable."

Cohen criticizes the use of anecdotal evidence yet uses anecodotal evidence himself

On page 74 Cohen criticizes the LIT studies as being flawed saying, "the fuzzy scientific rationale behind theories often makes it difficult to select patients who indeed may benefit from a treatment." Yet at the end of the same chapter, on page 82, he uses the example of a solitary successful pregnancy (Jess') that succeeded without LIT use, saying this success "casts further doubts about whether the value of lymphocyte immune therapy"
So Cohen uses one solitary pregnancy success to "further cast doubts" on the value of LIT? He admits the success is anecdotal, yet still uses it as an emotional tool to bash LIT at the end of his chapter. Again Cohen seems to push non-scientific thinking here. How are readers supposed to respect the author as a scientifically unbiased journalist when so much emphasis is placed on the emotional power of the single success story, to pull the emotions of the reader at the end?
Also, it should be noted, if Cohen had any true understanding of LIT, he would recognize that blocking antibodies built of from Jess's previous successful pregnancy would have alone explained her second pregnancy success without LIT. Yet this possibility is not even touched upon in the chapter because Cohen apparently does not understand the LIT science (either "does not understand" the issue or chooses to skip over the issue altogether?) In either case, from a reproductive immunologist's point of view, this LIT chapter ends on a very weak note.

The Tender Loving Care (TLC) argument

Last but not least, we must talk about the author's focus on "Tender Loving Care" (TLC) Cohen's "beloved" argument that he seems to like to use to dilute the validity of many miscarriage studies in the book. Throughout the book, it is evident that Cohen has been rather "sucked in" by the Tender Loving Care argument, the idea that offering extensive psychological support and emotional support to a patient can significantly increase a patient's likelihood of pregnancy success.
On page 175, Cohen calls the Liddell TLC study, "a study with spectacular powers." In a RESOLVE Interview Cohen calls Dr. Lesley Regan's 1997 TLC study "an amazing study. I learned more from it than maybe any single paper (and I have read maybe1000). I highly recommend it." Essentially Cohen has three studies to back his TLC argument:


1. Liddell HS et al: Recurrent miscarriage--outcome after supportive care in early pregnancy. : Aust N Z J Obstet Gynaecol. 1991 Nov;31(4):320-2.
86% success with TLC (38/44)
33% success without TLC (3/9)

2. Clifford K et al: Future pregnancy outcome in unexplained recurrent first trimester miscarriage. Hum Reprod. 1997 Feb;12(2):387-9.
74% success with TLC (118/160)
49% success no TLC (20/41)

3. Stray-Pedersen B et al: Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol. 1984 Jan 15;148(2):140-6.
86% success TLC (no actual pregnancy numbers given in this abstract)
33% with no TLC

At first glance, these success numbers seem surprising, even shocking and impressive considering the "vague", "touchy-feely" nature of the TLC subject matter. But looking deeper in the methodology of these studies, we find the statistics are probably more deceiving and more flawed than we know. First, all the patients in each of these studies were "self selected" to receive TLC from the clinic. Populations were not randomized at all, which, of course, is a Big Red Flag to anyone trying to get meaningful scientific results. So you have to ask yourself, given the fact these TLC populations are "self selected", what reasons could cause one patient to "select" to discontinue medical care while another patient chooses to continue it? Could it be that patients whose pregnancies succeed may be more inclined to stay with the clinic, while those that are having negative experiences tend to drop out of a program with higher frequency? This is not TLC are we are measuring here. It could be a measurement of an interesting tendency to "hide" and "grieve" in human nature.
Also, another point to note about these TLC studies: in not one of these TLC studies is the actual "Tender Loving Care" procedure exactly outlined. What does this TLC actually involve physically? There may be factors involved in these TLC pregnancy successes apart from the TLC itself, factors we could never pick up on because they are not outlined for us? This description deficiency is yet another red flag with these studies.

Dr. Beer's success due to TLC?

Last, but not least, it appears that Cohen sees Dr Beer's program through "TLC tinted glasses" as well. See Cohen's quote on page 82: "I suspect that he (Dr. Beer) does offer tender-loving care, and that its benefits may confuse the results his patients experience with experimental treatments." In making this statement, Cohen clearly reveals his lack of familiarity with the day to day running of Dr. Beer's program. One thing most of Beer patients know, only a small percentage of Dr. Beer's registered patients actually ever meet Dr. Beer in person. Most of Dr. Beer's consults are conducted by phone or by email. In fact, Dr. Beer only meets about 5% of his registered patients "in person" at all. Many of these patient meetings are "one time only" personal meetings with later consults being done over the phone or through email. Certainly, Dr. Beer does not have ongoing basis face to face relationship with most of his patients, unless one considers emails "TLC." All in all, Cohen puts these TLC studies on a pedestal in a way he rarely does with other studies in the book. Cohen's later words about the TLC studies are even more revealing:
Page 179: "Just as scientific research can never prove that love exists, I suspect it can never arrive at rock solid evidence that expert care prevents miscarriage or helps people come to terms with their reproductive fate. But as one researcher said to me, If you witness a talking dog, you do not need a control group to believe it. In three different recurrent miscarriage clinics around the world, I have seen the equivalent of a talking dog"
How can you argue with someone who has decided that controlled studies are no longer necessary to prove a theory valid? This is the same man who says we should dismiss LIT because the studies are flawed? A man who believes that TLC is as obvious because it is like a "talking dog"? It scares me, frankly, that Cohen is writing a book we are supposed to take seriously, that the world is supposed to take seriously, when he openly admits to using a "talking dog" type of reasoning.

Finally, Cohen's most heartfelt speech in his book, making the strongest veiled attacks on any miscarriage patient's decision to use immune therapy are found on page 129: "Women and men who want babies, especially those who have tried and failed, would benefit if they recognized how intense desires can lead them to take unnecessary risks. It bears repeating again and again and again. Most women who miscarry even three or four times, will carry to term if they become pregnant again...they (millions of women) may logically end up in the delivery room praising an intervention that, years later, they will come to curse." What does this mean, praising an intervention "in the delivery room" that, years later, "they will come to curse"? Does this mean, even after delivering our "Beer babies" using immunotherapy, we will feel we made the wrong decision to do LIT and IVIG? Please! I just hope that others can see through the facade of this book the way that I do.

As I hold and play with my "Beer babies" each day, after suffering devastating losses, I feel blessed that I myself, at least I have put the scientific connections together. That I, myself, at least, have seen the patterns, seen the immune connections, as a result, understand the bigger miscarriage picture in a much more complete way.
Pity those who read this book and come away feeling more confused about immune therapies than they were before. Pity them. Pity Cohen for bringing this situation about. However, in the big picture, I am not worried. I honestly feel that so much progress has been made in this reproductive immunology field the last few years, that the blind, anecdotally-based musings of a sensationalist reporter will do nothing to hurt the field over the long term. The foundation of the RI science is far too reaching, far too strong to ever be marred by the non-scientific ponderings that are really so biased that most (if not all) true scientists will see right through them upon reading this very dangerously naïve and misleading book.

-An informed RI Advocate and Dr Beer patient

If this classic work on the formulation of basic Christian doctrines teaches its reader anything, it is that Christian men and women once worried incessantly and carefully about matters that we moderns and post-moderns too quickly dismiss as quibbles. One can consider this obsessive and even perverse, yet it stands in stark contrast to an approach to Christian theology that is perhaps best described as careless.

A read through Kelly's more than five hundred pages of classic exposition of the processes that led to definitions of Christology, canonicity, Trinity, and the like is a warning shot across the bow of a generation that would be well served by worrying just a bit more about things that matter very deeply.

Kelly's survey comprises four 'parts'. Part I: Prolegomena surveys the trends and material witnesses that formed the basis of Christian deliberation in the first five centuries. Part II: The Pre-Nicene Theology names that Council (325 A.D.) as a watershed, probing deeply into the incipient doctrines that would be crystallized and canonized by subsquent colloquys. Part III: From Nicea To Chalcedon follows the afterwinds of Nicea through to one of the essential Councils. Part IV: Epilogue projects into Chalcedon's future the lines of thought that were developing at the time and picks up a few miscellanies.

Because Kelly's work (see also his Early Christian Creeds stands as a reference point for historical theologians, a deeper survey of his eighteen chapters is in order. The author's first chapter sets forth an apology for his choice of doctrinal development from the close of the first century through to the middle of the first ('The Background', pp. 3-28). On the one hand, it makes sense to begin outside the parameters of the New Testament. On the other, the creative surge of the first five centuries gave way to 'formalism and scholasticism in the sixth.' Kelly's heuristic rubric utilizes a vertical and a horizontal dividing line. The vertical distinguishes the different temperaments of East and West. The horizontal recognizes a concrete passage with the reconciliation of Church and State under Constantine, a development of which Nicea is the emblem. When Kelly surveys the matrix of the post-apostolic era in terms of Judaism, religious trends in the Roman Empire, Graeco-Roman philosophy, Neo-Platonism, and gnosticism, one becomes aware how ahead of his time the author stood in 1960. His perception of a highly traditional Judaism clothed in the language of Hellenism but with a Palestinian soul and his delineation of gnosticism as a habit of thought rather than an organized religion would only later come to represent scholarly consensus.

Chapter II ('Tradition and Scripture', pp. 29-51) examines the interrelationship of scripture and tradition at a time when there was no fixed canonical 'New Testament'. Kelly judiciously treats the combination of oral and written apostolic material that must have oriented the nascent church and the problems forced upon the community by the gnostic utilization of scripture for ends that were not aligned with apostolic teaching. 'The Bible as interpreted by the Church' that became the Christian norm, an affirmation and confidence that would require considerable qualification in due course.

When these scriptures eventually crystallize into a 'New Testament', Kelly judges the composite to have included the deuterocanonical books on the theory of an 'elastic' Hellenistic attitude towards the sacred writings (Chapter III, 'The Holy Scriptures, pp. 52-79). Irenaeus is the first to have used the term 'New Testament' and to lay the uniquely Christian scriptures as equal in authority alongside the Hebrew canon, now by implication called the 'Old Testament'. Sectarian tendencies often led to and/or were generated by a disdainful attitude towards the latter, an historical datum that ought to weigh heavily on the conscience of Christians today. Kelly is particularly helpful when he addresses the Christian hermeneutic that found in the Christ event a fulfillment of scriptural anticipation and even promise. Here he brings to the discussion the differing Alexandrine (alt., Alexandrian) and Antiochene temperaments that were to exist in tension and even contradiction most notably, more than ever in the context of christological controversy.

Kelly initiates his survey of Pre-Nicene theology (Part II of the book) with a chapter on 'The Divine Triad' (pp. 83-108). The word 'triad' is presumably chosen in order not to prejudice the slow and tortuous process that ended in the choice of 'trinitarian' language. The author rightly recognizes that the early conversation's monotheistic assumption was a legacy of the Bible and Judaism rather than philosophy. The secondary nature of the philosophers is evidenced in, say, Justin's conviction that Plato and subsequent Greek thinkers had access to Moses. Yet this visceral monotheism was complicated by Christian conviction, for as Kelly writes: 'Before considering formal writers, the reader should notice how deeply the conception of a plurality of divine Persons was imprinted on the apostolic tradition and the popular faith.' How to reconcile both convictions? Kelly presents the apostolic fathers as witnesses to the tradition rather than interpreters of it. The beginnings of an 'angelic christology' are present in Hermas.

Such conceptual innocence ended with the apologists, who began to develop a language for 'describing eternal distinctions within the Deity'. Yet this new attention to the nuances of plurality do not compromise their fundamental conviction: '(the) Logos was one in essence with the Father, inseparable in HIs fundamental being from Him as much after His Generation as prior to it.' Monotheism was not in doubt, though it's expression in the light of the Christ event and New Testament reflection on it was to require considerable time to reach its mature form. Shades of what would become known as 'economic Trinitarianism' were visible in Irenaeus' writing, though not to the detriment of this pre-Nicene giant's ability to recognize 'the mysterious three-in-oneness of the inner life of the Godhead'.

By the time his gaze falls upon the third century, Kelly is prepared to employ the word 'Trinitarianism' (chapter V, 'Third-Century Trinitarianism', pp. 109-137). This is as it should be, for attention now fixes with regularity upon the distinctions within the Godhead that urge new vocabulary and sophistication if they are to be adequately described. From North Africa, Tertullian framed the question in terms of two diametrically opposed approaches, the first asking about the Three-in-One in his eternal existence, the second inquiring into his self-revelation in creation and redemption. A purely analytical approach would have severed the tendons of monotheistic conviction, but Tertullian of course was alive to that danger and too wedded to the biblical materials to fall victim to it. Tertullian was prepared to designate the Son a persona and to use the term trinitas to describe the Godhead. To speak of distinction between the personae was to discern a distinctio or dispositio but emphatically not a separatio.

Outside of what history would judge to be orthodox, dynamic and modalistic monarchianism was to seek to preserve the deity's unity by ascribing the appearance of plurality to presentation and appearance alone. He is distinct, according to this view, in his operations but not in his existence. Meanwhile, Clement and Origen in the East were temperamentally more inclined to focus on the distinctions than the unity of the triadic God. The three persons were each a 'distinct hypostasis from all eternity, not just ... in the economy'. Clearly this view militates against modalistic tendencies. Kelly lingers over the persistently subordinationist tendencies in Origen's synthesis, a legacy that was to prove both fruitful and complicated.

Chapter VI, 'The Beginnings of Christology', begins with the observation that the primitive confession 'Jesus is Lord' contained the recognition that Jesus Christ was divine as well as human, an affirmation that by its very nature would require the unpacking of its complex implications (pp. 138-162). Christology proceeds along the lines of the 'double premiss of apostolic Christianity, viz. that Christ as a Person was indivisibly one, and tht He was simultaneously fully divine and fully human ... (T)he task of theology (was) to show how its two aspects could be held together in synthesis.' Unilateral solutions to the christological conundrum were not lacking: Ebionism denied the divinity of Christ altogether. Adoptionism, too, considered Jesus to be merely a man. On the other extreme, Docetism (and its cousin, Gnosticism) denied the humanity of Jesus Christ, placing all its christological eggs in the basket of his divinity. The latter attempted to preserve the notion of divine impassibility by rendering the human aspect of the Christ a mere appearance.

One of the considerable achievements of this chapter is that Kelly reminds us how close Gnosticism came to winning the day. 'Orthodoxy' conquered in the end by holding fast to the reality of Jesus' two natures according to the primitive apostolic confession, even when the ambiguities inherent in this stance must have seemed inconvenient and troubling. Tertullian was the first theologian seriously to address the relationship that must exist between the two natures, divine and human. He laid down the important premise that both nature must have remained unchanged. As the chapter title suggests, these searchings represent but the beginnings of Christology. Yet they establish the logical parameters and habits of mind that were to endure into the mature phase of the discussion.

Kelly introduces soteriology as that topic about which 'no final and universally accepted definition of the manner of its achievement has been formulated to this day', a rather startling observation in a book that tends to treat creedal consences reached in the first five chapters with something akin to reverence (chapter vii, 'Man and his Redemption', pp. 163-188). By the time of the Apologists, the relationship of Adam and his sin (as the second Adam and his righteousness, Pauline language all of it) to the rest of the human race has become the soteriological locus of attention. Irenaeus--building upon and moving beyond the work of Justin--changed everything by offering a theory of 'recapitulation' that sought to bring the biblical materials into a coherent soteriological system that did more than simply choose a preferred biblical vocabulary of salvation and ignore the rest. Origin saw humanity being offered a 'new start' in the second exemplary Adam of the biblical drama. The theologians Kelly canvas largely emphasized the example of Jesus, mankind's mystical union with the Christ, or even a species of penal substitution without reaching the kind of detailed synthesis that was to become the gift of the Councils when other areas of theology came under their treatment.

When he comes to the topic of ecclesiology, Kelly notes the poles of particularity and universality that came early to the communal instincts of the Christian movement, together with the emergence in second century between a catholic church that maintained the apostolic faith over against multiple heterodoxies, which did not (chapter VIII, 'The Christian Community', pp. 189-220). Fairly early in its life the Church was forced to declare its mind with regard to the orthodox 'sacraments' and the effect of these (or not) that ensued upon their enactment by non-orthodox parties.

Eventually, Christian reflection upon Christ's deity passed the Nicean watershed and attention became focused on new concerns. The road from Nicea to Chalcedon entailed intricate consideration of the two natures of Christ. The 'Christological controversy', it turns out, was not to end in Nicean harmony. Part III of Kelly's work takes up this next stage of Christology in the making.

The Nicene Crisis was set off by Arius' reduction of Christ's status to that of a demigod, in keeping with his insistence that the Father alone is the eternal God in the fullest sense of the phrase (chapter IX, 'The Nicene Crisis', pp. 223-251). Arianism was condemned at Nicea in 325 in an enduring creed that establishes Christ's co-equality and co-eternity with the Father. Talk of Jesus as a creature would henceforth be considered heresy. Yet the creed's statement hardly specifies the manner in which its Christ can be fully human. In terms of Christology, Nicea represents a penultimate consensus. It is worthwhile to linger over Kelly's treatment of Athanasius, the young Egyptian who represents the 'moderate' position of the Nicene party. Athanasius was able to maintain in tension the deity and humanity of Christ in a way that foreshadows the Chalcedonian achievement. Kelly notes the 'battle royal' that the extant literature portrays with regard to the conflict of Sabellians and Arians. Orthodoxy, in the person of Athanasius and the company of the Nicene party, was to steer a course between such extremes and such articulate extremists. Passion, one might surmise, is not enough to generate orthodox belief.

Chapter XI ('Fourth-Century Christology', pp. 280-309) is the book's pivotal chapter. This is so in part because of the critical christological analysis that came to the fore in that century and in part because Kelly's survey of the 'Word-Flesh' (associated with Alexandria) and 'Word-Man' (associated with Antioch) christologies is masterful in its clarity. Nicea did not only settle problems. It created new ones by the brevity of its claims regarding the Son's deity. Critically, Appollinarianism forced the Church to reckon with the two natures of Christ--human and divine--and to struggle in the direction of articulating their relationship. Even so moderate and intuitively acute moderate Alexandrian as Athanasius was unable finally to provide a satisfying description of 'the structure of the Godhead'. Kelly is surely correct to observe that it would fall to the Antiochenes to bring dogma into vital contact with the historical Jesus. They found 'the Alexandrian truncation of Christ's humanity unacceptable and set about developing the vocabulary that would serve the Chalcedonian project of accounting for Christ's two natures. Though Nestorianism lingered over the horizon, Kelly achieves a sympathetic reading of some fathers who would eventually be derided as 'Nestorians before Nestorius' because of their concrete convictions regarding Christ's humanity. This is surely accurate historiography. This chapter augments the reader's comprehension of how orthodoxy was increasingly becoming the ability to hold in tension the christological paradox without caving in the urge to allow the Son's deity or, conversely, his humanity to practically erase the reality of the other.

Between the years 428 and 451, there occurs what Kelly calls 'the decisive period for Christology, viz. the short span between the outbreak of the Nestorian controversy in 428 and the council of Chalcedon in 451' (chapter XII, 'The Christological Settlement', pp. 310-343). In preparing his reader to understand the collision between the 'Word-Flesh' and 'Word-Man' christologies that shaped the anteroom to Chalcedon, the author alerts him to the prevalence of personalities and politics in what would be mistakenly apprehended as a merely abstract and conceptual controversy. Indeed it turns out that Nestorius himself might not have been a 'Nestorian', though it was convenient for his adversaries to concur with the notion that he subscribed to a view of Christ's two natures as essentially distinct and ununited. If this quintessentially Antiochene figure was willfully misunderstood as dividing the two natures, so was Cyril--his erstwhile Alexandrian opponent--somewhat recklessly said to have united the two natures in a way that denied Christ's humanity.

Curiously, the controversy was in part fueled not by a discrete attempt to define the relationship of Christ's 'two natures', but rather by the question of how Christians should refer to Mary. Cyril, the Alexandrian, preferred theotokos ('God-bearing') while the Antiochenes preferred anthropotokos ('man-bearing') or at most christotokos ('Christ-bearing'). Nestorius suspected that theotokos denied Christ real humanity. Cyril saw in Nestorius' preference for anthropotokos a virtual adoptionism via the denial of Christ's real deity.

It is worthwhile to hear Kelly's own appraisal of Cyril's strength, one that emerges from his focus on the 'structure of the Godhead' not in terms of the need to explain the two natures but rather by an almost chronological scheme that attempted to explain the Son's status before and after the incarnation:


Cyril thus envisaged the Incarnate as the divine Word living one earth as very man. Here lay the strength of his position from the religious and soteriological standpoints; the Jesus of history was God Himself in human flesh, living and dying and rising again for men. Understood in this light, his horror of Nestorius's rejection of Theotokos is comprehensible.

Kelly tells us that it was when Cyril came to accept that it was possible to make a distinction between the two natures that did not imply a separation, the Alexandrian bishop found it possible to accomodate a settlement with the moderate Antiochenes, yet not before becoming rather lavish with the anathemas he pronounced upon his eventual partners-in-compromise.

Personalities and politics also shaped the lay of the land subsequent to the Chalcedonian Definition. Dyophysites (on the extreme 'Antiochene' side) and Monophysites (on the 'Alexandrian')--quotes now seem appropriate in the wake of the Definition--continued to denounce the work of Chalcedon. It would fall to future councils to reassert the substance of the Definition with allegedly increased clarity.

Christian faith necessarily stewards and negotiates reflexes with regard to human nature and the human condition that are profoundly optimistic, on the one hand, and deeply pessimistic on the other. It was the fourth and fifth centuries when this paradox came to the fore in Christian thinking (chapter XIII, 'Fallen Man and God's Grace', pp. 344-374). The dominance of the Bible's creation narratives and the Pauline wrestling with the relationship of Adam and his sin to humanity in general supplied the prevalent motifs.

In the West, Ambrose, Ambrosiaster, and Augustine worked towards a theory of original sin that presumed the race's moral solidarity. Mankind was at least contaminated and possibly even culpable in Adam's sin. Augustine's view of the human race as a 'lump of sin' incapable of helping itself without assertive divine interference ran counter to Pelagius' uber-optimistic conviction that human 'free will' could not be obstructed in any real way and was indeed the pivot upon which a person's destiny hinged. Augustine's logic leads inexorably in the direction of a doctrine of predestination, since human intervention is the sine qua non of any redemptive outcome. Augustine, notoriously for both supporters and detractors, followed that logic to its end, arguing that God elected certain individual from eternity past to know the benefits of faith and redemption, passing over other less fortunate souls who nonetheless have no claim upon their Creator for having overlooked them in his salvific movements.

Pelagianism was, in the end, condemned. The evidence suggests that Augustinianism enjoyed a fate somewhat less than universal approbation. On balance, its penetration of the divine and human wills worked more faithfully with the biblical materials than its rather humanistic alternative, though sectors of the church remained and remain reticent about pushing its logic further than the biblical materials themselves appear to warrant. All orthodox positions underscore that salvation is a 'gift', though different sectors parse the implications of this affirmation in diverse fashion.

At the beginning of his chapter on soteriology, Kelly warns his reader that it was not until the twelfth century that the effective of Christ's redemption would receive anything near the definition that the christological controversies demanded of the church's first five centuries (chapter XIV, 'Christ's Saving Work', pp. 375-400). Instead one finds apparently unrelated theories that Kelly argues can and should be viewed as complementary. The notion of recapitulation--presented by the apostle Paul and developed by Irenaeus--is in Kelly's approach the thread that unites the evident disparity. In discussing physical, mystical, and realistic theories of redemption, the author is particularly attentive to how 'ransom' notions work themselves out in terms of who pays the price, who receives the price, and how exactly the liberation of the ransomed is made effective. Augustine steps for the bearer of a mind capable of uniting the diverse forms of conversation about redemption into the closest thing to a unified theory of redemption that the church of the first millennium would produce.

In all of this struggling to know its mind, the Church had necessarily to establish its own identity. Who merited full inclusion in the great conversation, and on what basis? To whom was full fellowship to be extended and from whom withheld? Though the answers to these questions were for some time held to be implicit, they would be articulated with relationship with the Constantinopolitan Creed in terms of four adjectives: 'one', 'holy', 'Catholic', and 'apostolic' (chapter XV, 'Christ's Mystical Body', pp. 401-421). Because these terms are as much theological as sociological, the proper relationship of the human assembly known as the church--in all its far-flung corners--to Christ himself would come in for intense discussion. This reviewer finds Kelly to be a particularly useful guide with regard to Rome's emergence to preeminence, a prerogative whose merits were not always and entirely clear to all parties.

In chapter XVI ('The Later Doctrine of the Sacraments', pp. 422-455), Kelly portrays the church wrestling with the role of the priest, of the medium, and of the believing recipient in the gradually emerging collection of sacraments. True to form, Kelly wisely indicates the role of the restoration (or not) of Christians who had lapsed under persecution in driving forward the definition of the sacraments, by what criteria they can be assumed to function, and upon whom they should be conferred.

Somewhat unexpectedly, the author's 'Part Four'--entitled 'Epilogue'--contains just two chapters, one on 'The Christian Hope' (chapter XVII, pp. 439-489) and the other on 'Mary and the Saints' (chapter XVIII, pp. 490-499). Several turns of phrase in these two chapters encourage the view that these subjects fall into an 'epilogue' as much because the author was able to come to them only lately as because they are afterthoughts in the development of early Christian dogma.

In his consideration of eschatology, Kelly surveys the twin elements of the apostolic teaching that forever consign Christian thought to managing the tension between the once-and-for-all 'nowness' of a new kingdom, on the one hand, and the expectation of a spectacular consummation at the end of ordinary time, as another. Along other lines, the early church struggled with the nature of resurrection. Was it chiefly a corporate experience or, rather, did it represent the endpoint of individual human existence and its entrance or even release into the world to come? Is the nature of the resurrected body identical with that of what we know in this world's experience or, alternatively, is resurrection metaphorical of the eternality of the soul or is the human body as we know it susceptible to a transformation that requires continuity with present experience in the light of an intensified or glorified extension of it?

Does prophetic and apostolic expectation merge with the famous twentieth chapter of John's revelation in a way that constructs a chiliastic or millenarian hope, or is this vision rather to be construed as a picturesque representation of the church's experience in this age.

Finally, is the blessing of the life to come representative of a perfect contemplation of God or will we yet see through a glass darkly, even if (much) less darkly?

From the perspective of this reviewer, none of these considerations ought from either a historical or a theological viewpoint be consigned to marginal status, and so it is advisable to read this chapter of Kelley's work without undue attention to its label.

Finally, the author takes account of the natural preoccupation of the early church with honoring the mother of its Lord. Defining the nature and duration of her virginity may seem a colossally unfathomable preoccupation to moderns but was arguably a natural sidebar to the reverential instinct. Signs of a cult of Mary are evident, if just, by the third century. Yet the orthodox Church's respect for the person some would both describe and address as theotokos was restrained by the gospel's own witness to her need for correction by her beloved son.

It is difficult to assess a work like this in a few words. One attempt to do so finds recourse to the word 'classic' to characterize the enduring power of Kelly's synopsis of a body of material that easily overwhelms a lesser student. This reviewer has no hesitation in doing so.

Early Christian Doctrines is perhaps the finest such synopsis to see the light in the last century. That it is read still by historians and theology students is testament not to some preternatural ability to anticipate academic development since its first publication, but rather to a uniquely masterful statement of what we knew not so long ago that somehow still stands as an adequate point of departure a half century hence.

Kelly's treatment of the first few centuries is an outstanding work and a rightfully a standard in the field but THIS PRINTING IS TRASHY (hence 4 stars rather than 5). The paper is of ultra low grade quality and the binding is pretty crummy also. You are much better off buying the more recent printing by Prince Press.

`Early Christian Doctrines' by J. N. D. Kelly was my textbook for a course of the same name in 1964, over 40 years ago, when our Philosophy Department thought it could not assemble a large enough class for Medieval Philosophy. The joke was on them, because the class came to but three students, two Philosophy majors (myself and a classmate) and a `heretic' who was clear about the fact that he was taking the class to support arguments for his specifically anti-Christian point of view. I am not really qualified to address this book as an historian, and I could address it as a general scholar and from a philosophical point of view (which I will to some extent), but I really wish to present the book to this third fellow in our class, and to the opposite camp, extreme Christian conservatives.

For starters, I am really impressed that this unassuming book is still in print and going strong. The fact that it has gone through a number of editions and revisions says a lot about the value of the book even before you crack the spine. From the point of view of the casual scholar who may not read scholarly books for a living, I find the book just a bit weak in its layout. To the inveterate reader of bibliographies (me, for example), I find a weak presentation of very brief and cryptic scholarese references in the back of each chapter, and no general bibliography at the end of the book. This is unfortunate to those who would like, for example, to find out more about the major players in the first five centuries of Christian doctrinal development. Most people have some notion of St. Augustine, but most people don't have a clue as to when and where in history Origen, Arius, Eusebius, and Irenaeus, among a cast of hundreds, lived, worked and wrote. The author is basically speaking to an audience who knows the careers of these figures well, at least as far as we can know them from this far remove.

But none of this really detracts from the overall value of the book to the average intelligent reader. The overall impression one gets very early on is the notion that for almost 200 years after Christ, the body of documents, the foundation of the modern New Testament, and even the exact composition of the Old Testament inherited from Judaism, was not firmly defined. This is in sharp contrast to, for example, the Koran, the foundation of Islam, which was written by a single individual within a single lifetime and, to my limited knowledge, has undergone very little modification. The problem faced here is how to reconcile the character of Christian doctrine as revealed by God when the plain physical fact is that it took 250 years to decide from a larger body of writings, which were `holy' and which were not! And that doesn't even start to get into the problem of translations from Greek and Hebrew to Western European languages! What I take from the author's very scholarly point of view of this issue is that this is not at all a difficult problem. Selection, translation, and interpretation may be difficult, but the nature of faith plus a bit of understanding makes it all quite understandable. The written documents are human artifacts and no matter how much divine inspiration had a hand in the conception, it was still a fallible human who put pen to papyrus or sheepskin and put thoughts into a poorly standardized natural language.

I will not deal with the problems of translation, as Kelly's book is not about archeology or philology. For this, check out `Things a Computer Scientist Rarely Talks About' by the distinguished computer scientist, Donald E. Knuth. Rather, Kelly's main interest is in the interpretation of these documents by the early church fathers.

For those fundamentalists who are inclined to take every word of their Bible translation at `face value', it may be surprising to discover that some of the most important makers of `Early Christian Doctrines' including the great St. Augustine, were very definitely interpreting New Testament writings to explain things which, on the face of it, seemed either bizarre or utterly simple. Some of the very earliest writings even went so far as to interpret some statements with allegorical meanings.

This being said, we should also be reassured that this interpretation was often done within very carefully prescribed limits, threading the needle between the excesses of Gnosticism and the oversimplifications of Arianism. I for one am really quite surprised to see that there was a quasi-Christian sect, the Gnostics, who had an interpretation which looked remarkably like the old Greek and Roman myths. But, even 1000 years before it was promulgated, the mainstream church fathers seemed to follow the principle of Occam's razor, paraphrased by Albert Einstein, which said that doctrines need to be just as complicated as need be, but no more complicated!

For those who thing the interpretation of 2000 - 4000 year old documents which became our Bible is an uninteresting pursuit fit only for scholars, you only need to look at the abomination to which Biblical literalism can be put in nominally political works such as Ann Coulter's book `Godless'.

My main object in reviewing this book was less scholarly than it was to bring this book's point of view into the radar of the average well-informed reader who needs to evaluate statements seemingly based on scripture.

Professor Kelly has served us well over the years!

I purchased this book because I was told by the most reliable scholars that is this is the classic must read! They were correct.

`Early Christian Doctrines' by J. N. D. Kelly was my textbook for a course of the same name in 1964, over 40 years ago, when our Philosophy Department thought it could not assemble a large enough class for Medieval Philosophy. The joke was on them, because the class came to but three students, two Philosophy majors (myself and a classmate) and a `heretic' who was clear about the fact that he was taking the class to support arguments for his specifically anti-Christian point of view. I am not really qualified to address this book as an historian, and I could address it as a general scholar and from a philosophical point of view (which I will to some extent), but I really wish to present the book to this third fellow in our class, and to the opposite camp, extreme Christian conservatives.

For starters, I am really impressed that this unassuming book is still in print and going strong. The fact that it has gone through a number of editions and revisions says a lot about the value of the book even before you crack the spine. From the point of view of the casual scholar who may not read scholarly books for a living, I find the book just a bit weak in its layout. To the inveterate reader of bibliographies (me, for example), I find a weak presentation of very brief and cryptic scholarese references in the back of each chapter, and no general bibliography at the end of the book. This is unfortunate to those who would like, for example, to find out more about the major players in the first five centuries of Christian doctrinal development. Most people have some notion of St. Augustine, but most people don't have a clue as to when and where in history Origen, Arius, Eusebius, and Irenaeus, among a cast of hundreds, lived, worked and wrote. The author is basically speaking to an audience who knows the careers of these figures well, at least as far as we can know them from this far remove.

But none of this really detracts from the overall value of the book to the average intelligent reader. The overall impression one gets very early on is the notion that for almost 200 years after Christ, the body of documents, the foundation of the modern New Testament, and even the exact composition of the Old Testament inherited from Judaism, was not firmly defined. This is in sharp contrast to, for example, the Koran, the foundation of Islam, which was written by a single individual within a single lifetime and, to my limited knowledge, has undergone very little modification. The problem faced here is how to reconcile the character of Christian doctrine as revealed by God when the plain physical fact is that it took 250 years to decide from a larger body of writings, which were `holy' and which were not! And that doesn't even start to get into the problem of translations from Greek and Hebrew to Western European languages! What I take from the author's very scholarly point of view of this issue is that this is not at all a difficult problem. Selection, translation, and interpretation may be difficult, but the nature of faith plus a bit of understanding makes it all quite understandable. The written documents are human artifacts and no matter how much divine inspiration had a hand in the conception, it was still a fallible human who put pen to papyrus or sheepskin and put thoughts into a poorly standardized natural language.

I will not deal with the problems of translation, as Kelly's book is not about archeology or philology. For this, check out `Things a Computer Scientist Rarely Talks About' by the distinguished computer scientist, Donald E. Knuth. Rather, Kelly's main interest is in the interpretation of these documents by the early church fathers.

For those fundamentalists who are inclined to take every word of their Bible translation at `face value', it may be surprising to discover that some of the most important makers of `Early Christian Doctrines' including the great St. Augustine, were very definitely interpreting New Testament writings to explain things which, on the face of it, seemed either bizarre or utterly simple. Some of the very earliest writings even went so far as to interpret some statements with allegorical meanings.

This being said, we should also be reassured that this interpretation was often done within very carefully prescribed limits, threading the needle between the excesses of Gnosticism and the oversimplifications of Arianism. I for one am really quite surprised to see that there was a quasi-Christian sect, the Gnostics, who had an interpretation which looked remarkably like the old Greek and Roman myths. But, even 1000 years before it was promulgated, the mainstream church fathers seemed to follow the principle of Occam's razor, paraphrased by Albert Einstein, which said that doctrines need to be just as complicated as need be, but no more complicated!

For those who thing the interpretation of 2000 - 4000 year old documents which became our Bible is an uninteresting pursuit fit only for scholars, you only need to look at the abomination to which Biblical literalism can be put in nominally political works such as Ann Coulter's book `Godless'.

My main object in reviewing this book was less scholarly than it was to bring this book's point of view into the radar of the average well-informed reader who needs to evaluate statements seemingly based on scripture.

Professor Kelly has served us well over the years!

I came across a copy of this book a few months after my mother's passing. Although I was familiar with various perspectives on the spiritual and transpersonal aspects of dying this book was my guide to understanding some of the subtleties of her physical and mental withdrawal. It provided me with some "aha!" insights.

This insightful book about the "psycho-spiritual" aspects of dying, draws upon the perspectives of several spiritual traditions, largely eastern. I found it to be a wonderful blend of Sogyal Rinpoche and Elizabeth Kubler-Ross.

The topic does not make for easy, light, quick reading, but it is not difficult to understand if one keeps an open mind, regardless of one's faith. The material can be as fluid, thought-provoking, or as complex as a reader perceives it to be.

It ought to be required reading for any medical student and professional, as a mind-opener, much as a world-religions glass educates people about different faiths; no conversion necessary. Many thanks to Ms. Singh for her valuable work!

E.A. Davis, author, Waiting for Wings: Accompanying a Parent to the Edge of Life

With profound wisdom and insight, Kathleen Dowling Singh offers a uniquely clear view of the arc of life, encouraging readers to open into the gifts of awareness made available through facing death. This book will open your eyes to truths about where we came from and where we're going, and help clarify the beauty of this journey of human existence. Her writing style is clear and incisive, as well as compassionate and poetic. I recommend this book to everyone who desires greater self-awareness and who enjoys expanding their consciousness.

I have read many books on the dying as I work with hospices and have to say, this is one of the best books I have read yet. It not only gives the experience of the person dying, but also with those surrounding and accompanying the person on this "journey".
Very complete and well written book.

Kathleen Dowling Singh presents excellent descriptions of many healings that are possible in the process of dying. While her transpersonal orientation is apparently inspired by Sufi (mystic Muslim) traditions, her writing is relevant universally. As she notes, "I am an ordinary person working with ordinary people dying ordinary deaths." ( p. 3).

Singh specifies that this book is for people who have a space of time towards the end of their life - or are close to someone in this situation - and can contemplate what lies ahead. It is not for people who are already in the process of transition. At this stage, one's business is simply to get on with what is happening, not to distance oneself from it through analyzing it.

I found Singh's discussion on qualities of the Nearing Death Experience to be helpful handles on aspects of the deathing process. These include the qualities of relaxation, withdrawal, radiance, interiority, silence, the sacred, transcendence, knowing, intensity, merging, and experienced perfection.

Taking a more structured perspective, Singh considers stages of releasing of controls over psychophysical functions (Karnofsky scale - Appendix II) and relates them to stages in the process of dying which she finds conceptually helpful, including chaos, surrender and transcendence.

Singh's discussion brings an atmosphere of peace, acceptance and healing to what is often in our society a time fraught with anxieties, fears and distress. An example of this attitude is evident in the following observation:

"The AIDS community has called its disease `Accelerated Individual Discovery of Self' and has referred to the pandemic as `enlightenment at gunpoint.' This phrase applies equally to any one of us who is dying." (p. 15)

I strongly recommend this book to anyone who is involved in the dying process or just interested in understanding it in greater depth, from a healing perspective.

Assuming the Platonic narrative is an important aid to those who are dying over an extended gentle period Singh incorporates much of the vocabulary -- from pop-psychology and philosophy -- to build a coherent picture that must certainly soothe us as we die. Here, at the point where Aristotle would challenge us to recognize our soul ends with the body and accept that our soul was past tense -- a narrative sure to depress those who enjoyed life and wish for eternity -- reiterating the Platonic narrative using current idioms is a great service to our dying process. The reassurance that this interpretation of the narrative is persuasive depends on accepting Singh's expereinces which we cannot duplicate. Indeed, those who have had such experience, being present at many deaths, have told me they did not share such experience. But it is a safe argument since we cannot test it. It is beleivable to those who wish to beleive it and that may be enough.

I took the book to the beach and couldn't put it down. I was riveted from the very first sentence. The author led us with such skill to the character Reb Michael Klimrod that you are hooked immediately.

Paul-Loup Sulitzer is a master storyteller. His skill and thought provoking insight into this complex character gave us an entirely different prospective into this tragic time. He lifts your soul and fires your imagination with imagery that has you holding your breath in anticipation of what comes next. This book will make you stop whining about your life and look outside yourself to the possibilities available. I'm not a person that likes to read a book more than once but with The Green King I find myself reading it once a year and feeling like it is the first time every time.

Do you have a teen that feels life is boring or that you know needs to be challenged? This book has the power to bring on a change in thinking. I read several novels weekly but this is a book you will want to read slowly and savor every word.

Movie Makers Take Notice - the world needs a thought provoking movie and this is it!

The green King is without any doubt one of the best tales ever told, about the life of a person with so much to give to the world, and so much to do and explore.For me it was amazing from the beginning, the tall blonde boy with the anger and pain of the concetration camp to the nearly end, Reb the one of the richest man alive fighting for a good cause. Read it love it, please someone do a movie about this extraordinary Man.

i read The Green King in its Russian translation 12 years ago and it remains my most favorite book... i still keep it and it is much beaten up by now... i can definetely say that the power of this Sulitzer musterpiece was a major factor in shaping my adolesent character... now i am grown up and unfortunately find it impossible to have a strong figure in my life who i would want to be like, but there is something in The Green King that will make you either rediscover the feeling or help find it for a first time....

I found a copy of the hardback English translation at a "friends of the library" sale. The tale of Reb Michael Klimrod is an improbable one, although riveting. With the start of the book with Klimrod rescued from Mauthausen concentration camps during the war, he survives amid a sea of bodies, pulling on some inner strength and self-image that allows himself to function in horrendous circumstances without letting it attack his spirit. He then goes on an adventure to find what happened to his family and their wealth, makes connections in cigarette black market trade that finance his eventual stalking down of the Nazi who tortured, filmed and killed his father.

From that tale of vengeance the book propels us into the Amazon, where Klimrod again survives a hostile environment and develops a bond with the natives in Amazonia. After emerging from there, he heads to New York where he again flourishes in the hostile environment of big business, using powers of persuasion and an incredible memory to create a number of businesses in a short amount of time and surround himself with loyal followers that become known as "the Black Dogs."

Klimrod falls in love with the unstable Charmian whose ups & downs captivate him. The scene on the boat where she actually shoots him is a profound chapter on the power of love.

Having amassed billions, Reb turns his attentions to Amazonia, creating a culture in the heart of the jungle. The secrecy and silent attraction of others to Reb make him an enigmatic lead character, one that holds our interest until the end. The ending at the United Nations where Reb, the unknown billionaire, is going to try to "come out" against boarders and nations is foiled and the novels seems to dissipate as much as climax. Denise Raab Jacobs' translation from the French reads and flows well. All in all, this is a memorable story, one that grabs you in the first few pages and takes you in numerous unpredictable directions. Enjoy!

The Green King is my all-time favorite book. I read it for the first time when on vacation in Aruba in '85 and have read it at least three times since. I found a first print in hardcover and it is the jewel of my book collection.

Reb Michael Klimrod's journey from a nazi death camp to the richest man in the world without anyone knowing him is remarkable. The detail that Sulitzer maintains in his book of the men that kept this secret is breath taking; the web of financial companies and transactions is exhilarating. This is a great book for anyone that enjoys high finance and a desire to fulfill a dream. 5 Stars are not enough for this book.

Bored to death after reading many other so called vampire books out there, I researched on-line for the next vampire thrill. I stumbled upon a website and Desires Unleashed (1st book) was mentioned on the blogs. Caught my curiosity and purchased it. Fell in love with it regardless of the misspellings. It's lustful (not in a girly/Fabio way) it's sinful, and it's so erotic. All in a vampire-lish way. It's animalistic, it's raw. I even purchased another one for a friend. DN Simmons has a cult following now these days and I am one of them. Bought the second book, The Guilty Innocent, and I am presently reading it for the second time. I am totally hooked. I want more. These books are addictive. Can't wait for Royal Flush!!!!

Great book! Better editing than the first book, so that was good. Awesome storyline! Sergio, who is my favorite character kicked butt in this book! D.N.'s writing style is improving with each book it seems and I'm really enjoying this series.

I'd totally recommend reading the KOTDC.

I have 3 of the books in this series, and I found it refreshing compared to some have I've read.

The books are fast paced, the plot(yes there is a plot) moves smoothly.

The descriptions of Chicago takes me back to when I lived there, I can see the places she describes, and only an exceptional writer can do that.

Yes, the supernaturals are beautiful, what supernaturals in what series are not. There are sex scenes in the books, what supernatural novel being written now does not, yet the sex is believable, well writtten and there is no "F**ck me while I'm tight" being screamed at every encounter, and sex is not the energizer bunny powering up everyone within a 10 mile radius. Yes some of the characters are homosexual, and no I do not remember reading that all of them were submissive, they are well written characters. Characters who some can relate to, characters that although are supernatural have problems of life and love and resolve them in the way you woule expect supernaturals to do so.


Yes, there are typos, but once informed of this, Ms. Simmons has promised to correct them in the next release of these books. I applaud and commend her, she is a self-published author, she did not have proofreaders, editors, a husband or reading group to help her along.

I'd gladly pay 25 bucks for her next novel.

There have been authors and then there have been authors.
As a love leter to D.N.Simmons, first let me say, "Do Your Thang!"
The Guilty Innocent, gave me the best ride of my book reading life, I love that although Natasha is the one telling the story, that Natasha is not the story.
I love that the vampires aren't campy or have fallen head over heels for her simply because Natasha is the one telling the story.
I love that there are other strong women in this series, who aren't a threat to her and if they are she says it and so be it.
I could pull a recap of what another reveiewer said and tell you the story, but I have a better idea for you, buy the book, it's worth the price.

This book has me laughing from cover to cover, but I loved the ACTION! I mean there was bullets flying, people dying, it was awesome. And the ending of this book just blew me away, one of the sexiest scenes I've EVER read in this type of novel and done so well.

I like that D.N. isn't vulgar about her sex scenes and each character, you can't help but respect because they're written so well. I love D.N.'s supernaturals, unlike many other books, I like that they have a loyalty to each other that really stands out and they don't angst, whine and cry about everything. They do what's gotta be done and kick butt in the process. D.N.'s a great writer and I can see that she's improving her writing style in this book because it really shows. I can't wait for the third book, it can't get to me fast enough. The forum/website said it's coming in August and that's almost too far away.

This book is very thorough and gives an in depth look into the most recent research surrounding manic depressive disorder and depression. Starting with the history surrounding mental illness, moving along to diagnosis, prognosis, course of the illness', physiological, biochemical and anatomical changes that occur along with up to date research in it's genetic component, this book gives great insight into mood disorders.

This month's long-awaited second edition recently hit the streets, and is well worth the wait. At more than 1,200 pages and with an impressive list of collaborators shedding light on all manner of matters melancholic and manic, the book represents a virtual Manhattan Project on mood disorders.

With our recovery riding on being as smart, if not smarter, than our treating professionals, it pays for patients to read what their clinicians are reading, especially a work of this magnitude. Don't let clinician-speak intimidate you. The authors went to great lengths to organize their subject matter into a meaningful and comprehensive whole, with clear transitions from one topic to the next. A few pages into the text, and one quickly becomes habituated to the polysyllables. Then it's clear sailing.

At $99, sales resistance is understandable. My two cents: You cannot afford NOT to have this book. Each day you struggle with this illness costs you money, already. The cost-benefit is a no-brainer. Stop paying your cable bill, if you have to, and make what could prove to be the best investment of your life.

Although a huge book along with a hefty price tag, this is probably the most up to date information on bipolar disorder (manic depression) available today. It offers a wealth of information that is usable to the clinician as well as the patient. In fact, I think this should be required reading for any clinician who deal with people with this condition.

I strongly urge the purchase of this book esp. for the consumer as self knowledge will be such an asset when communicating with your doctor. This book covers most everything from the most basic to the most complex information to date on this vexing condition. Though I am constantly searching the internet for the most up to date information on bipolar disease, I find the authors of this book to be the leading authorities presently.

Studying and treating Bipolar Disorder is a difficult trend. Since Kraepelin lessons became available in his book, perhaps "Manic Depressive Illness" is the first to try the almost impossible mission to launch new lights on the matter. And with an amazing approach full of eruditism as well as simplicity and warmth. Untill nowadays, extremely accurate, complete, precise and comprehensive. In little words: in all aspects, amazing!

I bought this book because someone I know has just been diagnosed with "Soft Bipolar" disorder. This is a "shadow" form of bipolar disorder. While I've dealt with people with bipolar disorder before ( I'm a retired minister), I never heard of "soft bipolar" or "bipolar spectrum" disorder before. This book is the classic text on Bipolar disorder. The only problem is that it is a little old ( about 10 to 15 years old) and discoveries about "soft bipolar" disorder are just coming into the literature now. If you are depressed or diagnosed as depressed, as the person close to me was, you might have soft bipolar disorder. It is much more common than you think. The problem with it is that it needs different medications than regular unipolar disorder does. As an example, if you take one of the SSRI's (such as Prozac or Zoloft) and have soft bipolar, the chances are very good that you will end up with hypomania, which is a mild form of mania. It feels good for a long time--just like alcohol. But at some point in time, it will begin to backfire on you as it did on my friend. She kept getting more and more hyper and angry. Finally, her therapist decided to try out this diagnosis on her. He switched medicines, and it made her mood much more stable. This book would also be excellent for someone who wants to know about bipolar I disorder--manic depressive disorder. The problem with the book is that it is very technical, but everything is there even if it could use a little updating.

....on today's society. A woman who blames herself for all the shortcomings in her marriage, a man whose indiscretions destroy his marriage and scar for life his family, a teenage daughter who is disrespectful and deceitful, a mother who doesn't have the backbone to discipline her daughter or the inclination to even parent her. All that wrapped around the girl-meets-guy, girl-dumps-guy, girl-gets-guy-back storyline, laced with acceptance of immorality and distorted Christian views. Disappointing.

Wonderful story and mystery, realistic characters. Thank You Ms Richards

What a great book, and having lived in Dupont Circle several years ago, the images painted of Georgetown, DC, Booeymonger's, etc brought back vivid and accurate images. I'll bet I can even guess the name of the restaurant from which Pavel brought curry, rice and daal to Faith's home! Enjoyed every page immensely!

I loved the characters, the plot, and the mysteries. I feel like I've just been to Georgetown for a brief holiday. This book is going on my "favorite books" shelf. Thank you, Emilie Richards, for a wonderful read.

I haven't written a review in a while but I was so excited to have found a new author (to me)whose writing I really loved, I couldn't let the opportunity pass to offer encouragement to Ms.Richards to keep writing and to readers who are wondering whether to delve into this latest novel.
I thoroughly enjoyed the character development and sublte mystery in this novel. The issues addressed by the author were sensitively probed with an expert understanding and depth of
prose. There was no gratuitous sex or distasteful language. The author writes with feeling about a family in trouble; their needs, secrets and the people who enter into their lives to help.
You finish the read realizing that everyone has a story and truth and love and doing the right thing is the only way to live a life. Wrongs can be set right and forgiveness is possible.
I found the insight particularly helpful since the author worked in the counseling profession and knows the nuances of charter human beings are capable of displaying and the deep reasons for their actions. Read it! It's like being in therapy without even knowing it!!

I thought I knew the woods. "Reading the Forested Landscape" allows you to see what is in front of you, but not seen. I will never look at a woods in the same way again. Tom Wessels does a masterful job of showing you how to "read" the landscape. The book is a "detective novel" of information. I will read it again and visit the woodlands and do a bit of detective work. Great fun.

...makes more sense after reading this book. The chapters give an introductory look at what you see when you walk through a forest and what it means to the ecosystem and to you if you're just curious or you are in wildlife management.

Before I read this book, I knew the woods had stories to tell; now, I can begin to understand them. This book is a forensic reference demystifying the clues the forest has to reveal. Each chapter describes, in depth, a particular setting and the clues found there. The drawings, unfortunately, are not as good or helpful as the writing. I would have preferred photographs, but it's only a small drawback.

See that tree? - that stone wall? - How about that mound of earth in the woods? Never noticed them before? Well this book will help you to discover all kinds of 'hidden' clues that help us to understand how the land was used in the past and what forces helped to make it the way it is today.

This is a wonderful book to read and then put into practice as you ramble around the wonderful landscapes of New England.

I have grown up in new england and studied the biological sciences for 20 years and Tom Wessel knowledge and wonderful insight to the natural world is amazing. the book is a wonderful read and I highly recommend it to anyone who enjoys the outdoors and natures beauty.

I took the Microsoft exam 70-216 for network infrastructure today and all I can say is AMAZING! How did the writers know what was on the exam? There is so much obscure stuff on the exam that no other book I read covered the questons on the exam. But this one did. So much of the test was troubleshooting the network, so I guess a TCP/IP troubleshooting book would be the right one. But the similarity of this book to the test is amazing.

This book was good to read too and I am using it at my job and fixing some of the problems we've had with WINS and VPN based on what I learned. Great book and best study guide for the test.