This package offers the combined benefits of both the print and the web-based presentation, for the very reasonable additional price of approximately $60 over the cost of the book alone. G&G is the acknowledged authority on the properties, mechanisms, and uses of the major drug classes. One of the most successful books in the history of medical publishing (more than 1,000,000 copies sold!), it is renowned worldwide for detailed but clinically applicable coverage. The G&G Digital Edition includes LOT access to G&G On Line, with its advanced search engine, PDA "cut and paste" capability, hyperlinked references, and other new features developed specifically for G&G On Line.

Pharmacology Goodman and Gilmans The Pharmacological Basis of Therapeutics Digital Edition edited by Laurence L. Brunton, John S. Lazo, and Keith L. Parker, 11th ed, includes online subscription, drug database, and PDA download capability, 2021 pp, with illus, $195, ISBN 0-07-146804-8, New York, NY, McGraw-Hill Medical Publishing Division, 2006. JAMA. 2006;295:2791-2792.

It's here. It's improved. It's worth the cost of replacing prior editions. It's well worth the time to read.

The 11th text edition and first digital edition of the classic Goodman and Gilman's The Pharmacological Basis of Therapeutics is a worthy successor to all that has come before. For the first time with neither a Goodman nor a Gilman among authors or editors, the influences of the original authors remain: not just the brand-name title but book organization, perspective, style, and teaching philosophy.

The new book is smaller (by 127 pages, three chapters, and one quarter inch in width). Still, it's got more: new chapters on membrane transporters, drug metabolism, pharmacogenetics, and inflammatory bowel disease bring the student some of the latest pharmacology developments. A pesky chapter on ethanol remains, justified more by the ways in which ethanol interferes with human physiology and pharmacological therapies than by its nearly extinct clinical uses, which occupy only three paragraphs. The reader will not miss the chapters that have been removed, including those on vitamins (about which some information has been retained in other chapters), solvents and pesticides, and the history of anesthesiology.

Now with 16 major sections, the basic organization of the text largely resembles that of prior editions. General principles comprise the first section, which has five chapters, and also the first appendix, "Prescription Writing and Patient Compliance." Sections 2 and 3 cover drugs acting at nerve terminals and in the central nervous system, respectively. Five sections are organized by disease targetssection 4, inflammatory diseases; section 7, parasitic diseases; section 8, bacterial, viral, and fungal diseases; section 9, neoplastic diseases; and section 15, toxicology. Eight other sections are organized by organ system. The second appendix, on optimizing dosage regimens, still holds my single most favorite drug reference, G&Gs Pharmacokinetic Data table, now filling 94 pages with half-lives, volumes of distribution, clearances, and concentration data.

Most chapters begin with background information on normal anatomy and physiology of the systems being discussed, some history of early pharmacologic developments in the field, and an overview of the diseases to be treated, including signs and symptoms, populations at risk, and global impacts of disease. Discussion of drugs belonging to that chapter often includes their cellular targets, mechanisms of action, absorption and elimination kinetics, and clinical and adverse effects. Molecular drawings are provided; US brand names are often listed. Numerous tables and multitone diagrams condense, simplify, and sometimes explain this large body of knowledge.

Now, five decades after newborns died because their chloramphenicol doses were calculated via extrapolation from studies of the drug's behavior in adults, four decades after thousands of babies were born with malformations due to in utero thalidomide exposures, three decades after the diethylstilbestrol disaster was explained, 25 years after the benzyl alcohol gasping syndrome was described and salicylate exposure was linked to Reye syndrome, 12 years after the US Food and Drug Administration (FDA) Pediatric Final Rule, nine years after the FDA Modernization Act, and four years after the Best Pharmaceuticals for Children Act, and with more than 100 pediatric-specific labeling changes listed by the FDA,1 this textbook still inexplicably lacks discussion of pharmacology for children. Whether the editors assume that children are just little adults or that children don't get sick, it is time to teach about developmental pharmacology, differential susceptibility, pediatric compliance, pediatric absorption and elimination kinetics, and pediatric dosing.

Other significant omissions are problematic. Although some chapters provide dosing information in milligrams, and some give milligrams per dose and doses per day, the text replaces neither the Physicians' Desk Reference nor a clinician's dosing handbook. While many prototype drugs are discussed in great detail, subsequently developed drugs in each class receive less attention, and, too often, recently approved and marketed drug entities are mentioned only as in development or sold elsewhere.

The exciting addition to this textbook is the digital edition, an Internet site where the full text of the book appears, with quality reproductions of all figures and tables. This is much more than another copy of the textbook: each section has links to updates (articles describing recent developments related to that chapter, including newer drugs), to related sections of the textbook, and to clinical practice guidelines and patient education materials. Included on the Internet site are access to the Gold Clinical Pharmacology database, with extensive information about prescription and over-the-counter medications, continuously updated; pictures of most solid and liquid dosage forms; and ample discussion of potential drug-drug interactions. Newly approved drugs are included, and all drugs, not just class prototypes, get thorough treatment. Many parts of this digital edition can be transferred to readers' various electronic devices: computer, cell phone, digital organizer, or music player.

With many of the text's deficiencies remedied via the digital edition features, this latest edition of Goodman and Gilman's The Pharmacologic Basis of Therapeutics should be within arm's reach of all who prescribe drug therapy. If only theyd take the time to read it.

Marcel J. Casavant, MD, Reviewer Children's Research Institute and the Ohio State University Columbus casavant@chi.osu.edu

REFERENCES 1. US Food and Drug Administration Center for Drug Evaluation and Research. Pediatric exclusivity labeling changes. Updated March 22, 2006. Available at: http://www.fda.gov/cder/pediatric/labelchange.htm. Accessed March 28, 2006. Book and Media Reviews Section Editor: Harriet S. Meyer, MD, Contributing Editor, JAMA.

BOOK REVIEWSGoodman and Gilmans The Pharmacological Basis ofTherapeutics: Digital Edition, 11th EditionEdited by Laurence L Brunton PhD, John S Lazo PhD, Keith ParkerMD PhD, Iain Buxton DPh, and Donald Blumenthal PhD. Published byThe McGraw-Hill Companies, Inc., New York, NY, 2006. ISBN 0-07-146804-8. Clothbound, xxiii + 2021 pp. (26 × 21 cm), $195.www.mcgraw-hill.com

Therapeutic Area: Medical pharmacology and therapeutics are coveredextensively.

Format: A conventional print edition and new digital, self-assessment,and board review (not described here) editions are available. Thisdigital version contains differences in links to other McGraw-Hill productsdepending on specific subscriptions the reader may have. Institutionalsubscriptions may include access to Harrisons Online, HurstsThe Heart, LANGE Educational Library, Current Medical DiagnosisandTreatment, Tintinallis Emergency Medicine, Fitzpatrick Color Atlas,and Williams Obstetrics. With all subscriptions, the digital version allowsfor subject search and links to McGraw-Hills AccessMedicine resources,including related updates and contents, Diagnosaurus (DDx personaldigital assistant [PDA] software), and drug information (gold standardpractice guidelines, patient education material, health news frommajor newspapers).

System Requirements: An individual Internet subscription providesaccess to the digital version until August 2009. Any recent Web browsersoftware should be adequate on a PC, while Macintosh requires InternetExplorer or a similar browser. The access code for Internet subscriptioncan be used only once to establish access and is not transferable. For individualsubscriptions, only one person at a time may access the digitalversion with the username and password.

Audience: While this book was once intended for pharmacologists, itis now a superb source of information for all healthcare professionalsand a must for practitioners and students seeking training in the therapeuticsof drug use.

Purpose: As the editors state, the purpose of this textbook was “tocorrelate pharmacology with related medical sciences, to re-interpret theactions and uses of drugs in light of advances in medicine and the basicbiomedical sciences, to emphasize the applications of pharmacodynamicsto therapeutics, and to create a book that will be useful to students ofpharmacology and physicians alike.”

Content: The book is broadly divided into 15 sections and 2 appendices.Different sections contain between 1 and 12 chapters each. A totalof 65 chapters were written by 99 authors, representing world-renownedexperts. Every chapter in the electronic version begins with a table ofcontents section, while each section of a chapter is linked to other sectionsof the same chapter; the references are linked to PubMed.As expected, both the text and electronic versions provide comprehensiveand concise information for different therapeutic drug classes. Organsystems and disease entities are discussed in the context of pharmacotherapeutics.In addition, basic principles of pharmacokinetics and pharmacodynamics,as well as drug transporters, drug metabolism, and pharmacogenomics(as new chapters), are included. Application of the basic principlesof pharmacology to the care of individual patients is discussed in anew chapter entitled “The Science of Drug Therapy.” The first appendixcontains principles of prescription order writing and patient compliance,whereas the second is a table with pharmacokinetic data.

Usability: With its design, this book and its user-friendly digital version,which allows for frequent updates, is an easy-to-use source of comprehensive,concise, and high-quality information in pharmacology.

Highlights: Most chapters have been extensively revised, with a fewconsolidated or eliminated from previous editions. Besides new editors,there are also new authors. Despite the large number of authors, the editorsclaim that every effort was made to assure uniformity throughoutthe chapters appears to be accurate. High-quality figures and tables complementthe text. Although this textbook has historically been publishedevery 5–6 years, the current digital edition allows for biweekly updatesat the publishers Web site, including new drug developments and approvals.As further evidence for an increased emphasis on therapeutics,clinical summaries at the end of chapters discuss essential concepts relatedto the clinical application of drugs. In the digital version, an advancedsearch engine, PDA “cut and paste” capability, and hyperlinked references,as well as links to other McGraw-Hill resources, allow for efficientand broad-based information retrieval. For instance, Diagnosaurusprovides differential diagnosis of symptoms, signs, and diseases.

Limitations: Within the textbook, it might be desirable to have a dedicatedchapter about therapeutic drug monitoring (TDM) and to complementthe pharmacokinetic data table in the appendix with additionalTDM information, such as specimen type, optimal collection time, andtherapeutic and toxic drug concentrations. Although some of this informationis presented throughout the text, it is not readily accessible in oneplace. The digital version shares some of the limitations common to otherelectronic textbooks. For instance, figures and tables are not alwaysdesigned for optimal printing. Likewise, the text is presented in the middlecolumn of the screen without an option to increase the viewing areaby hiding one or both neighboring columns containing linkage information.

Comparison with Other Related Books: Despite availability of othermajor pharmacology textbooks, Goodman and Gilmans remains thegold standard in the field.

Reviewers Summary: This textbook with its complementary digitalversion is an outstanding resource at a reasonable price. The digital versionsextensive links to McGraw-Hills medical Web sites with an easyto-use design provide for quick, convenient, and comprehensive informationretrieval.Reviewers: Gyorgy Csako MD, Senior Scientist, Department of LaboratoryMedicine, National Institutes of Health, Bethesda, MD, andFrank Pucino PharmD, Ambulatory Care Clinical Pharmacy TeamLeader, Pharmacy Department, Clinical Center, National Institutes ofHealth

Drs Brunton, Parker, and Lazo form the author team of Goodman and Gilmans 11e. Brunton is renowned for his expertise in cardiovascular pharmacology and cellular signaling; Parker is chief of the endocrine service as the outstanding UTSouthwestern School of Medicine; Lazo is a specialist in cancer pharmacology and Professor at the University of Pittsburgh.

Dr. Buxton is Dean of the new School of Pharmacy at the University of Nevada; Dr. Blumenthal is Professor of Pharmacology, University of Utah. Brunton, Buxton, and Blumenthal are the editors of GandG On Line.