PILLS THAT WORK - PILLS THAT DON'T, by Gideon Bosker, MD, Fawcett Columbine, Ballantine Books, New York, 1998, 432 pages, $16, ISBN: 0-449-91273-6.

Dr Bosker, geriatrician at the Oregon Health Sciences University, dedicates this book to his patients who, over the years, have taught him the difference between pills that work, and pills that don't. This is another patient book which is in tune with the popular trend of patients finding medical information from the press, the web, and friends. Bosker recognizes that many times physicians, frequently because of institutional pressure, fail to spend sufficient time to customize their patient's drug regimen, sometimes delegating the task to the nurse practitioner or even the physician assistant. The drug regimen is so important that it cannot be delegated. The pages are spiced with Herman cartoons, and in one, the character tells his doctor, "I feel a lot better since I ran out of those pills you gave me." Bosker deplores the bottom line "Profit-wise, pill-foolish" decisions of HMOs. He feels this book helps fill the information gap.

Bosker had previously presented many of the concepts and specific drug choices in a technical style for professional health care providers in his 1996 book, Pharmatecture: Minimizing Medications to Maximize Results. Bosker has presented these principles of optimizing drug regimens to 50,000 physicians in a thousand different hospital and clinic settings using a systematic "less is more" philosophy. Bosker is convinced that this consumer-driven revolution is the perfect,--and at present the only--viable antidote to physician and institutional deficiencies. In section II, he begins each chapter with an introduction, "Pills of Wisdom" which provide a broad overview of the treatment options available for medical conditions, an analysis of the risks and benefits, and a brief discussion of recent innovations in drug therapy.

This book is, however, more than pills that work and those that don't. It is actually a lay person's medical text as seen from the therapeutic front which, of course, includes the diagnosis as the patient sees it. Bosker's book is highly effective, and we can recommend it to our patients, who in turn will teach us from what they learn, as therapy becomes a two-way clinical discussion.

Del Meyer, MD