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The new England journal of medicine "discovered" in the West. Centuries before Ed ward Jenner determined that mild cowpox ex posure conferred immunity to smallpox, Asians practiced variolation -- the controlled exposure to a carefully selected mild case of smallpox in one person to produce immunity in another. This same practice is followed today by some parents, who bring their unimmunized children to chicken pox or measles parties. Early remedies paved the way for later advances. Acupuncture was not readily adopted by Western doctors, but Bivins speculates that acupuncture helped to familiarize them with needles, domes ticating needles for later use in vaccines, drug delivery, and the drawing of blood. There are im portant lessons in this book for practicing physi cians. For example, techniques such as homeopa thy may have become popular not because of consistent efficacy but because the patients appre ciated attentive clinicians and were attracted to the treatment's benign nature and affordability. The Western physician, past and present, is made out to be mostly predatory and misguided. Bivins questions why researchers continue to as sess treatments from other cultures in a Western framework. Admittedly, we do not have the tech nology to measure qi or to visualize prana (which of course does not disprove their existence), but we do have the tools to objectively evaluate clinical interventions. With 60% of U.S. medical schools now offering some instruction in alternative med icine, and the commitment to research being made by the National Institutes of Health's National Center for Complementary and Alternative Med icine, there is an effort under way to evaluate practices that may hold promise and bring them into our evidence-based world. Bivins's book is a work of scholarship filled with thoughtful discussion, but it is largely devoid of colorful or memorable characters, a clear time line or plot, or clinical discussions -- all ofwhich would have made the book more appealing. Bivins does ask one provocative question, illustrated in part by the use of a question mark in the book's title: Why do we continue to use the word "alter native" when the popularity and complementary integration of some of these therapies, especially for the treatment of chronic conditions, continues to increase? There are now more patient visits to alternative medical practitioners than to primary care physicians in the United States. In the end, this book is about Western attitudes toward the non-Western world. It is a macroscopic analysis rich with philosophical reflection and historical observation that exposes the difficulty of exporting such therapies outside their original cultures and belief structures. Teresa L. Schraeder, M.D. Mount Auburn Hospital Cambridge, MA 02138 tschraeder@nejm.org asbestos and its diseases Edited by John E. Craighead and Allen R. Gibbs. 403 pp., illustrated. New York, Oxford University Press, 2008. $79.50. ISBN 978-0-19-517869-2. sbestos, a well-known carcinogen, is Aresponsible for the dramatic increase in the incidence of pleural mesothelioma among men in Western countries in the past 40 years. This in crease is a result of the substantial occupational exposure to asbestos throughout the workforce from the 1930s to the 1980s. The nature of the effects of asbestos on health is also one of the most controversial issues in occupational health, and in the rich body of scientific literature on the subject, almost any opinion possible has been doc umented. In this book, scientists with a long-standing history in asbestos research cover a broad variety of topics. The 16 chapters consider etiology, di agnosis, prognosis, and treatment of asbestosis, asbestos-related lung cancer, and mesothelioma of the pleura and peritoneum. In addition, there are discussions of epidemiology, risk assessment, and legal and litigation issues. As such, this book is a comprehensive source of information. The editors have given the contributors the freedom to express their personal viewpoints, and this approach is the source of the book's primary strengths and weaknesses. The facts and arguments presented by individ ual contributors provide interesting insight into the historical development of asbestos research. Most of the contributors have been part of this history, and they describe in detail the background and content of hallmark studies, including the initial observations by physicians, the consider ations involved in designing and conducting the studies, and the discussions that arose after the initial publication of these studies. These stories show that scientific progress -- especially in the epidemiologic studies showing the profound risks 544 n engl j med 359:5 www.nejm.org july 31, 2008 Downloaded from www.nejm.org by CARRIE B. WATERS DVM PH on July 31, 2008 . Copyright 2008 Massachusetts Medical Society. All rights reserved. book reviews for workers' health -- often depends on the duced in hundreds of laboratories worldwide, groundbreaking work of a few dedicated people. culminating in 2004 in the first antiangiogenic The highly personalized approach also has its therapy approved by the Food and Drug Admin disadvantages, since most contributors take a nar istration (FDA) to treat cancer, bevacizumab rative approach to presenting their opinions and (Avastin, Genentech). Although this monoclonal conclusions. Given the many thousands of arti antibody is the first in what we hope will be a use cles available on almost any topic in the asbestos ful class of therapeutics, antiangiogenic mono debate, key issues must be derived from a system therapy has not produced the dramatic results that atic review of the available literature, such as the were once expected. differences in carcinogenicity among fiber types, With few exceptions, solid tumors are driven the derivation of safe occupational exposure lev by proangiogenic mediators such as vascular en els, and the risk to public health posed by typi dothelial growth factor (VEGF) and basic fibro cal levels of environmental exposure. It is some blast growth factor. Such factors are intricately times difficult to disentangle the rigid scientific related to tumor biology in a manner that is still conclusions from the personal viewpoints in dis not fully understood. Antiangiogenic Cancer Therapy cussions of controversial issues. In some chapters, is a timely and worthwhile study of the complexi strong convictions are presented as scientific facts, ties of the clinical application of angiogenesis most notably in statements such as this one, from inhibitors. This book, probably the most compre chapter 8, which asserts that mesotheliomas "oc hensive of its kind, is nicely tempered in its assess cur rarely among persons exclusively exposed to ments of both the triumphs of antiangiogenic `chrysotile' and it is currently believed that `pure' tumor therapy and the gaps in knowledge that chrysotile does not cause the neoplasm," and this impede further successful treatments. Particularly one, from chapter 13, which states that malig evident is the need for biomarkers and for a better nant mesothelioma "is developing in septuage understanding of the molecular mechanisms at narians and octogenarians, whose only recognized work, as antiangiogenic therapy has its effects on consequential documented exposure to amphibole both endothelial and perivascular cell lineages. asbestos occurred during or shortly after World The editors and contributors of this book -- War II." including Folkman, who discusses tumor dor Overall, this book is a rich source of histori mancy and the angiogenic switch -- are leaders cal facts and studies on asbestos and its diseases, in the field. The chapters are divided into four yet highly personalized with strong individual parts, beginning with a comprehensive back viewpoints. It is less authoritative as a source for ground section on angiogenic factors and tumor risk assessment and litigation issues. biology that transitions into the second section, Alex Burdorf, Ph.D. Erasmus University Medical Center 3000 CA Rotterdam, the Netherlands a.burdorf@erasmusmc.nl which contains discussions of molecular targets suitable for this form of cancer therapy. The de scriptions of methods for identifying new molec ular targets include a nice discussion of genomic and proteomic-based techniques. Part III, which mostly highlights the drug-approval and regula antiangiogenic cancer therapy tory process, includes chapters about ongoing re search, including discussions of surrogate bio Edited by Darren W. Davis, Roy S. Herbst, and James L. Abbruzzese. 841 pp., illustrated. Boca Raton, FL, CRC Press, 2008. $199.95. ISBN 978-0-8493-2799-5. markers of antiangiogenic efficacy. The last part of the book is an in-depth analysis of current is sues concerning the use of antiangiogenic agents for specific malignancies. his year began with the death of ju A particular strength of this book is its "bench- Tdah Folkman, an enormous blow to the med to-bedside" treatment of anticancer agents. It ical and scientific communities. It was in the Jougruides the reader from each seminal finding to nal, in 1971, that Folkman published the seminal its relevance for the growth factor receptor, cell framework for his ideas about what is now known type, and disease. Excellent chapters deal with as tumor angiogenesis. The importance ofangio techniques for the identification of novel antian- genesis in preclinical cancer models was repro giogenic targets and offer a primer on how new n engl j med 359:5 www.nejm.org july 31, 2008 Downloaded from www.nejm.org by CARRIE B. WATERS DVM PH on July 31, 2008 . Copyright 2008 Massachusetts Medical Society. All rights reserved. 545