Health Books

"Wonderful, wise words. It provides insight into the human side of serious illness and offers patients and families the hope and strength they need." Jimmie Holland, chairman Psychiatry, Memroial SLoan Kettering

"Filled with practical information for freinds and family, it should prove to be a great comfort..." Andrew von Eschenbach, director, the FDA


"...Provides hope and teaches us how to show compassion when it means the most." Steven Rosen, MD, director of the Lurie Cancer Center

This was the book I was searching for to help my best friend. It spoke to me because of the way the author told her personal story and gave ideas and suggestions. I felt like she was speaking to me.

She knew what I was feeling, knew I wanted to help and she gave me ways to do that. She helped me face the future right beside my friend.

when Life Becomes Precious was a godsend. It should be handed out to everyone at doctors' offices.

This truly is a fabulous resource! The information is quite straightforward and covers a wide array of areas/issues that are certain to be impacted by the news of a loved one being ill. The components of the book cover areas such as understanding your feelings, how our fears play out in the ordeal, how to have conversations regarding the illness and ramifications of the illness, how to find resourceful medical care and how to balance one's role in life given the situation.

I would highly recommend this book for people who are going through the challenge of a loved one being ill, as it applies to not only cancer patients - but all who have serious health issues.

Elise Needell Babcock's words are better than any I've read on dealing with cancer and family. Her advise is simple and extremely helpful.

My spouse had heart disease. At the same time, I was looking for a book for a friend with cancer. I found Precious and read it before giving it as a gift. I realized the suggestions applied to my family. I started using the author's ideas immediately and it helped us tremendously. I find myself quoting her often in my volunteer work at church (with patients) and with friends. One friend called and said she was having serious problem coping with her husband's diabetes. She read the book and called to tell me that after following the advice in Precious, she saw a dramatic change in the way her family communicated and supported each other. Another friend said she was in an argument with her daughter about the father's illness. The mother used the suggestions in the book to calm her daughter down. Later that evening, the daughter (in her 30s) came up to her mom and said, "Thank you. What you said and how you said it was wonderful!" This book should not even have cancer on the cover. It's practical, moving, upbeat and extremely helpful for patients and families coping with any medical challenge. J. Long, past president of a personnel agency

This book offers the very information people really need at the most difficult time in their life. Talking to other people about someone dying is usually a frustrating experience - they just don't understand. This writer does, and addresses issues only someone who has been through it understands. It's a great resource and a real lifeline for the living to the dying.

As an oncology chaplain at UCLA Medical Center, I am always looking for practical, helpful, and meaningful resources that I can use to help patients, their caregivers, and other health care professionals deal with the overwhelming challenges that serious illness can present. "Where Souls Meet" is one of the best resources I have read on this subject. It serves as a deeply moving and personal guide that will lead the reader through the journey that all of us, in one way or another, will someday travel.

AT A TIME WHEN PEOPLE CAN FEEL THERE IS NO HOPE, COMES A BEAUTIFUL RAY OF SUNSHINE. DILLON'S INSITE AND DIRECTION IS A BREATH OF FRESH AIR. AS A HOSPICE VOLUNTEER COORDINATOR, THIS BOOK HAS PUT NEW INSPIRATION INTO MY JOB. I HAVE A MUCH BETTER UNDERSTANDING AND INSITE INTO HOW TO HELP OUR VOLUNTEERS, OUR PATIENT'S AND FAMILIES DEAL WITH THE MOST DIFFICULT TIME OF THEIR LIFE. HAVING LOST CLOSE FAMILY AND FRIENDS PERSONALLY, WHERE SOLES MEET HAS HELPED ME RESOLVE PERSONAL ISSUES AND HAS GIVEN ME A PEACE IN MY HEART I HAVE NOT HAD BEFORE. I PLAN TO INCORPORATE THIS BOOK INTO OUR TRAINING CLASSES AND HAVE COPIES AVAILABLE FOR OUR PATIENTS. I HAD THE GREAT HONOR OF MEETING DILLON EARLIER THIS MONTH, AND I ENCOURAGE EVERYONE WHO HAS A CHANCE TO HEAR HIM IN CONCERT OR AT A SPEAKING ENGAGEMENT TO DO SO WITHOUT HESITATION.

This is a most excellant handbook that provides guidance and direction for family and caregivers of terminally ill people. It is the best and most thorough study that I have found on this subject. It clearly defines how to relate to a person who has been diagnosed with such an illness on the spiritual, emotional, and cognitive levels. It should be made a requirement for every hospice and healthcare worker who relates to terminally ill patients on a regular basis. Families with a terminally ill member will find the book most helpful. It will answer many of their questions and allow them to have a better informed understanding of the patient's emotional needs. It should be made available to all families who are caring for a terminally ill person. Besides focusing on our relational and vberbal behavior when relating to the terminally ill, it gives very practical suggestions. For example, appendice C gives suggestions on what to look for when hiring helpers for patient care. Appendice D has ideas and examples of how to make lists and charts for everyday monitoring.

Many times caregivers think only in terms of what they can offer the terminally ill patient. One chapter gives important lessons that the caregivers can learn from the terminally ill patient.

As a Certified Hospice Nurse and Hospice Administrator I have access to many tools to help both staff and loved ones through the grief journey. Where Souls Meet is both compelling and insightful. From introduction to appendix this book provides each reader with guidance and support through the most difficult time most of us will experience - the loss of a loved one. As we anticipate death, like life, we are faced with many challenges and obstacles. This book offers both inspiration and suggestions to help ease the fear. Dillon writes and shares with a level of emotion and realism that will help both caregivers and professionals alike. Share this book with a friend!

This book gives a lot of good advice and information on dealing with i.c. I was not formally diagnosed, but have a lot of the symptoms.
I have done a few things that were recommended and have gotten so much better. I would say that it was worth the money spent and it's good to learn from someone who has been there before.

This book has been a blessing to my life. Within a short period of time I was able to get off the antibiotics that I have been on for over 15 years. Ms Simone's insight and wisdom is a gift from God. I would highly recommend this book.

This book is a MUST for anyone that is suffering from IC. I was at the lowest (and in the most pain I'd ever been in) when I stumbled across this book. It literally has changed my life. I was in SEVERE pain and had just spent 6 days in the hospital and was still in pain and doing no better. After reading Along the Healing Path, I completely stopped ALL medicines, began drinking Marshmallow Root Tea (with Catnip and Raspberry Leaf) and acidophilus and within a few days I was COMPLETELY OUT OF PAIN!!! It was amazing! I have been suffering with IC since I was 16 (took two years to get diagnosed, which is so common for IC sufferers) and had recently been in a flare for over 6 months. I'd had three bladder distensions, several painful bladder distillations and was on 22 pills a day. My life was changed dramatically by this disease. I was unable to attend classes and work and felt like my whole world was collapsing. I cannot say ENOUGH about this book. Thank you, Catherine, for helping so many of us find our way out of pain!!!! You are amazing!!!!

I truly love this book. It makes so much sense to me that IC is not just a bladder disease but the result of a toxic body. I reaize how toxic my body has felt in the last few years and how now I can change that. My only wish is that she would have included information on diet. She has so much knowlwdge and I would love to hear how she feels diet plays a roll in healing. From all I have read, diet is a key factor in healing.

This is a great book that offers many alternatives in treating interstitial cystitis. It's very helpful! It gives many, many tips on how to recover from this awful disease. I also recommend her other books "To Wake in Tears" and "Awakening through the Tears."

This was a great value. I was going to purchase this at a well-known book store for $29.99, however decided to hold off and check on-line. I was extremely surprised at the price I was able to purchase it for. Excellent Value.

This gives the precise information we were looking forward to having at our finger tips. Good to have this type of informational book!

My daughter pointed out that the previous edition of this book we were using was from 1994, so I agreed an upgrade was called for. I was thrilled to find it was still in print and in a much newer version, while still retaining features I liked-such as the diagnosis guide and the chapters focusing on various body systems. This book is a great family resource, and easier to cull for information than the internet.

This book is the exact kind of medical guide which I like to refer too. It is user friendly. I would recommend this book to anyone who wants quick facts about illnesses'.

Speedy delivery of what promises to be a an excellent home reference for all personal medical information. Glad to have picked it out of the numerous offerings at Amazon.

The Andropause Mystery, Unraveling the Truths About the Male Menopause by Robert S. Tan M.D.

In this book, Robert Tan MD , an astute clinician and a board certified specialist in geriatric medicine, describes his professional experience, diagnosing and treating hormonal decline in aging males. Tan describes a turning point in his career when he stumbled upon a bedridden male with the typical signs and symptoms of low testosterone, namely muscle weakness, frailty, memory loss, and hair loss. Lab testing confirmed low testosterone levels. Testosterone for aging males was new in those days, so Tan had difficulty convincing the pharmacy to release the testosterone injections ( 200 mg twice a month). After three months of injections, the patient grew a beard, began walking again, and his memory and libido improved.

The experience motivated Tan to do a Medline search on the topic, and he found very little research in the area of Male Menopause, also called Andropause. This book was written to unravel the truths and dispel the myths about the Male Andropause and Testosterone replacement for the aging male.

Tan asks a few obvious questions. The medical system treats women for the hormonal decline of Menopause, so why aren't men treated for their similar hormonal decline of male Andropause? The medical system recognizes Menopause, but does not recognize Andropause.

Many physicians deny that Andropause really exists. Tan says sorry, but it does exist, and his patients are testimony to this truth. Andropause is a real syndrome, and he clearly explains that 30% of males over 65 have low testosterone levels with the associated muscle weakness, memory loss, and loss of libido. Tan also explains the reasons why the syndrome is ignored by conventional medicine. There is no curriculum in medical school or residency, and very little research in the library due to lack of funding, and lastly, unlike females who are more expressive and communicative about their night sweats and hot flashes, males tend to be stoic, and in denial of their Andropause symptoms.

Tan discusses the beneficial affects of testosterone on cognitive function, finding that many (but not all) demented nursing home males are restored to normal after testosterone treatments. He also discusses the effect of testosterone on mood, cardiac function, muscle strength, bone density, and lastly improvement in libido and erectile function. In one humorous story, Tan recounts a demented nursing home patient whose testosterone treatment had to be discontinued because of hypersexual effects. Apparently, the old fellow had approached several nurses with inappropriate requests.

Tan also discussed the incorrect belief that Testosterone treatment increases the risk of prostate cancer. Tan dispels this myth, stating that in his clinical experience, he has yet to see a case of prostate cancer induced by testosterone replacement. Nonetheless, Tan advocates routine prostate surveillance with serial PSA and DRE.

Chapter 7 discusses the nuts and bolts of testosterone replacement with diagnostic blood testing, available testosterone preparations and dosage schedules. Tan feels that testosterone replacement for males should become as routine as HRT for the female menopause.

Inconclusion, in a field with scant information, Tan's book fills a void. The book is an honest, courageous, down to earth, and occasionally humorous look at testosterone replacement for the aging male. Also recommended is The Testosterone Syndrome by Eugene Shippen MD.

Jeffrey Dach MD

What I thought I bought; a book about the aging process and the Andropause. What I got; mostly a book about testosterone replacement. This book was a let down.

The bravado of patriarchy and its reliance upon presenting males as strong, vibrant creatures able to take on the world when young, and equally powerful when old has always been a myth perpetuated as the alpha male syndrome.

However, the reality is that, like women, men undergo similar hormonal changes as a result of aging. While the outward appearance of men may remain somewhat similar, both personality and hormonal changes occur along with the physical changes in muscle power that young men discern readily in challenging the older male establishment for power and prominence.

Little discussed, or viewed as the natural aging phenomenon of men and the mellowed perspective in which he sees the world, and operates in it, typical male menopause has focused upon his desire to grativate toward younger women to extend his male prowess, or by making the wild changes of adopting fast cars, and more relaxed lifestyles in an attempt to capture his youth.

That males haven't come to grips with the similarities of aging among women ought to be a concern since so much of society is organized not around the vitality cycles of natural aging, but by the fantasies of aging men who deny their own mortality, and the consequences of aging. Taught to view women differently, men therefore find it more difficult to accept their own aging process because of the enormous differences in how men and women are cultured to be viewed by a male dominant society.

Because men died at somewhat younger ages throughout life, the lifecyle phenomenon of men has never been approached with the legitimacy or credibility that is a part of the natural consequence of being male.

That either men or women are taught to view the aging process as one that is devalued because of its physical changes rather than prized for its contribution to stable and sustainable populations is a social problem that has yet to be taken seriously. When country singers sing that "all my rowdy friends have settled down," they are recognizing this natural tendency of men to settle into a lifestyle that accepts their aging as natural, and normal rather than continuing to idolize the rowdy lifestyle that the constant pumping out of male testosterone helps to create.

The message, of course, is that, like women, men will not live forever, do suffer the consequences of aging, and must adapt age appropriate lifestyles that respects their aging, rather than condemns it. That attitude will work for both men and women to help define the expectations of being human, and mature as individuals, in planning their lives and knowing what to expect from their bodies, and what not to expect.

This book is really for the layperson. The book "Andropause Mystery" does describe evolving physical, sexual, psychological and mental challenges encountered by the aging male. It does explain hormone replacement for men and the potential problems. There is a nice chapter on the psychological impact of aging on sexuality. It is easy to read and understand, but I prefer "Aging Men's Health: A Case Based Approach" by the same author. No doubt, it is a textbook, but there is more depth and detail for the professional person.

I couldn't believe it! The controversy about hormones for women has begun, now men? The book and author was featured on NBC Nightly News on 7/31/02. Guess it must be an important topic to be on national news!

The author rescues a beautiful golden retriever on advice from his doctor to get a dog. The dog however has the ability to alert the author to impending cardiac episodes and in doing so, gives the author the freedom to work and go about his daily life. This book touches the readers soul and lets us know that maybe there is more to the human-animal bond than we know. The book also dicusses the "Americans with Disabilities Act" as it relates to service dogs. Anybody who has loved a dog will love this book.

I could not put this book down. Mike and Dakota's story as a team was inspiring and transcended this world. Their devotion to each other was amazing. You do not have to be an animal lover to learn from this book. My hope would be that after you read this book you will see how special animals are in our lives.

I Absolutely LOVED this book! MY sister in law bought for my husband --animal lover...Anyway she bought it for him but I read it first because the cover called my attention. I like dogs but was reluctant to get one because I though of all the work there is involved with taking care of animals..besides with a little one, school, and work a dog would be more work for me....But after reading this book, I know I want a dog..The magic between Mike and Dakota is so overwhelming --that it made me think that that is what we need in our lives..Yea it will be work to potty train and take care of ..but then again things in life that are worth anything sometimes require alot of work--..God Bless you Mike and Dakota and thanks!!!!

I enjoyed the book so much. Felt like I was right there with them and every time the author had an attack could visualize how much his Angel/dog helped him through it. They had a bond that is so hard to explain unless you have had an animal and then know what it means, they are not dogs, they are your family and in this case especially he was not only family but his life support and friend. I definitely would recommend this book to anyone, have since bought additional copies to give to my animal lover friends for gifts.

I recently lost my Golden Angel too, and while I was looking for a book to help
Me cope with my pain, I found this book. I am a very busy person and don't
Have much time to read, but this book took me 2 days. It is full of feelings and even humor. No matter what the situation is, our Golden's will manage to put a smile on our face. When you start reading this book, make sure you have a box of Kleenex
Near by. This book goes into my favorite book list, and I purchased a few more as
Christmas presents.

I LOVED this book. Lydia uses tons of references and provides the reader with varying opinions on acne. She readily admits that there isn't one universal cure for acne and her research is extensive. I recommend this book to all of my clients who suffer from acne. There is a comprehensive bibliography as well where you can find books with more in-depth information.

I enjoyed this book, but I think pictures would be useful to clarify the text.

I have had cystic acne since I was a teen. I'm now 42 and there are no signs of it going away. I see a dermatologist regularly. I have tried literally hundreds of skincare products.

I purchased this book, read it cover to cover, and changed my skincare routine in response. I am using products I already had - a mix of OTC and prescription items - I just didn't have a good plan for using them.

To my amazement, I have now gone six weeks without a cyst. This may be the longest cyst-free period in my adult life.

Lydia Preston, you are my hero.

UPDATE: Three months, no cysts. I could seriously cry!

After finding myself trying several OTC programs which didn't work, I stumbled across this book. I had no idea that I had been using BP all wrong! FYI, BP is not a spot treatment for pimples with white showing. I also had no idea that salicylic acid products had to be of a pH between 3 and 4 to be most effective. I wish the author would have tested more salicylic acid products for the appropriate pH. Only a couple of the ones she tested had the requisite pH. I would have much rather had a large list of products with the recommended pH than a large list of products without it. Also, I agree with a previous reviewer that pictures would be most helpful, especially in describing the formation of acne and what the different kinds of acne look like. Overall, I found that this book is a good introduction to the world of acne, but definitely not a place to stop learning.

Do you believe that if a product dries out your face, your skin will overcompensate by producing more oil? Do you think a special scrub can unplug your pores and help free you from blackheads? Or maybe you cherish the belief that you can sweat your pores clean of acne-causing dirt or toxins through vigorous exercise or steam treatments? If so, you need to read this book.

I have never realized how poorly I understood acne, and I am amazed how many myths I let myself absorb from "informative" commercials and advice given by well-intentioned editors of numerous women's magazines. I am immensely grateful to the author for teaching me what acne is - really and exactly - and for doing so in an accessible and friendly manner. Just the chapter "Understanding Acne" alone is worth the money I spent on this book, because it's hard to fight the condition without understanding it, and because it simply feels good to know for once what is going on with my skin.

When I was diagnosed in 2005, I was absolutely overwhelmed with fear, information, and decisions. This book is the only one I found that made sense to me. It is clear, concise, and very encouraging. Dr. Link's approach is from a place of genuine respect and regard, and he knows exactly what survivors need to know right away. Reading this book really helped me make the best treatment decisions for myself, with the best information available. The book teaches survivors (who for the most part are not medical professionals, but will unfortunately have to get to that level pretty quickly) how to read pathology reports, and helps you formulate the questions you need to have answered to make your choices. I recommend it to everyone I know who is newly diagnosed.

Very good basic guide for one suffering from breast cancer, one problem was that it was 8 years outdated. Would have been better had it been updated, new treatments are always being discovered. It was a good overview, though.

A book for those who are newly diagnosed with cancer. The book describes in detail the different stages of breast cancer. It also discusses how individuals should see doctors for a second opinion. Another great part about the book is the differences in opinion about how to manage breast cancer, and the different paths to take.

I bought this book when my mother was diagnosed with breast cancer. The first advice it gives was a breath of fresh air in the middle of a maelstrom. It simply said "you have time." It also gives great advice on second opinions. Besides this first advice the book is filled with general information written in easy to understand english. Some of the info applies some of it doesn't, everyones cancer is different. I greatly recomend this book to all those of us faced with this challenge. It provides you with the information doctors usually don't take the time to give you. A must read before your next doctors visit. One caveat: if you are looking for a feel good read this is not it... this is a serious book of medical information.

I just had this mailed to a friend who was recently diagnosed with very aggressive Breast Cancer. She is only 41. When I was 41 in 2000, I was also diagnosed. This book helped me so much! It is informative and easy to understand. It is not a dry read, like other books on this subject. Most importantly, it is not a downer. While this book is realistic it is also upbeat. I tried reading Dr. Susan Love's book and it was so depressing I could only read one chapter.

This was a required text while in school, but it is literally the bible and a must have in clinical practice!

I had a hard time finding this text. I had purchased it from many different carriers to find out that they were backordered.

I received this book with in 1 week of purchasing it. It was great. Nice new copy, shrink wrapped and all!

this is my bible. it does not have the up to date guidelines that are obviously constantly changing, but overall, it is great in clinic. when not sure, i pull it out and voila! i know how to test, when to have the pt return etc.

The book came in a timely fashion and was in excellent condition.

This has been an excellent reference book. It gives up to date/detailed information from gathering the health history to formulating a plan of care. It has been a great help in the clinical setting and in the classroom.

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