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Drug-Induced Liver Disease
  1. S D Taylor-Robinson

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On the face of it, this hardback does not sound like a very good bedtime read and splashing out £195 might seem a little extravagant for what might appear to be some dry tome that would readily gather dust on a shelf. It was therefore with some trepidation that I received this ostensibly uninviting 773 page beige and green covered book, and turning the pages quickly, the casual reader might still be deceived into casting it into the nether regions of a desk drawer or the dimmer corners of an office. However, I am pleased to say that these were all poorly grounded misapprehensions, because this is an expertly written and very neatly edited book by a whole galaxy of experts, covering the mechanisms of drug induced liver injury in an easily readable format (who cannot stand up and say that paracetamol/acetaminophen poisoning is a mystery to most mere mortals, despite the fact we all know the antidote?). The book also contains a comprehensive set of chapters on the hepatotoxicity of specific drugs for quick and easy reference, which is set firmly in clinical context, and for the generalist, a very useful clinical section on diagnosis and management of drug induced liver disease.

Another reason not to look at such a book might be that many of those emanating from the USA have an American perspective only, but this is a real exception as at least one third of the chapters are written by authors from countries as far apart as Switzerland and India and the book as a whole develops a truly international theme. It is well referenced in a very authoritative and up to date way, and sheds light on a whole host of topics that are bothersome to most gastroenterologists, such as the usage of methotrexate in psoriasis and rheumatoid arthritis (with helpful guidelines on when to offer baseline and follow up liver biopsy and to whom), antituberculous agents (and when to worry!), and in this day and age, sections on psychotropic agents, drugs of abuse, and importantly, when many patients are keen to seek out the veritable pharmacopoeia that can be found in the average health food shop or in Chinatown, an authoritative compendium on alternative medicines, vitamins, and natural hepatotoxins. With the increasing incidence of certain liver tumours, I found sections on the adverse effects of hormones (covering everything from adenomas, focal nodular hyperplasia, and frank malignancies to vascular abnormalities in the liver) and on environmental toxins very interesting and informative.

While it is true to say that at the price, most people would not want to rush out and buy a copy immediately, I would wholeheartedly recommend that every hospital library invests in a copy for use by gastroenterology trainees, trainees from other disciplines, and even the odd consultant gastroenterologist! The book would be very useful for hospital pharmacists, nurse practitioners, and also for medical students who need to reference the subject in more depth. However, on considered reflection, I think that most gastroenterology units should think carefully about buying a copy—with increasing drug usage by patients, illicit or otherwise, it is an exploding problem. The book provides an aide memoire for those that need it and it won’t gather dust for long!