BOOK REVIEWS 107

the expanding discipline of travel medicine. They broadly define this to be those aspects of human health and disease related to geographical movement. With no less than 120 contributing authors the editors have co- ordinated comprehensive coverage of the field in a little over 500 pages with a minimum of repetition. The geographically varied institutional affiliations attest to the book’s global perspective.

The introductory chapters give authoritative over- views of the travel industry and current travel medicine best practice. These include a thoughtful chapter on ethical tourism. The information sources’ chapter is particularly useful, covering travel medicine websites and travel clinic software. Using this resource I was able to identify my nearest specialist travel health clinic in less than 5 min. A brief regional guide discussing geographical risk profiles works rather less well than a more systematic section on environmental risk factors. In the particularly good marine section I was fascinated to read informative first-hand accounts of both the pleasures and dangers posed by the ingestion of fugu (pufferfish).

Disease-specific sections follow and are sensibly weighted. Thus extensive coverage devoted to travel- lets’ diarrhoea (32 pages) and malaria (34 pages) arms the clinician to advise on prevention, and to investigate and treat these conditions whilst a page on anthrax provides sufficient information to maintain vigilance given the current scare. The remainder of the book covers the travel health risks for particular population groups. Revealing my own bias I found travel health for children thinly covered.

The accompanying CD-ROM was a disappointment, being simply a searchable PDF version of the book. Granted this threw up 5 references for anthrax com- pared to a single one in the text index. One of these informed me that the Japanese cult Aum Shiurikyo sprayed anthrax on several occasions from buildings and vehicles without effect. Sapiens . . hmmm! The wise travel-medicine specialist and interested generalist will keep an up-to-date edition of this essential work close to hand.

Matthew Ellis Consultant PaediatricianlSenior Clinical Lecturer in Child Health Westgate House Southmead Hospital Bristol BSlO SNB, UK

Principles of Biomedical Ethics, fifth edition. T. L. Beauchamp &J. F. Childress. New York: Oxford Uni- versity Press, 2001. xiv+454pp. Price Q9.95. ISBN O- 19-514332-9.

The revision of the Declaration of Helsinki in Edin- burgh in 2000 has ensured that bioethics is uppermost in the thoughts of most researchers, especially those who work in developing countries. The subsequent furore engendered by the National Bioethics Advisory Committee in the USA, and the Nuffield Committee on Bioethics in the UK, has served to highlight the problems, and to show just how little most of us under- stand about the ethics of medical and paramedical practice. Thus a book that professes to provide a basic understanding of the issues should be a welcome addi- tion to the library.

The general reader should be warned that any excur- sion into the world of ethics and morality is to enter an area that is very alien to the scientific mind. It is a world of opinion and theory, inhabited by authors who speak personally, writing in a very personal manner. Equally one has to come to grips with ideas that are more philosophical than grounded in the facts that research- ers normally use. However, once one has overcome

these difficulties, it is possible to appreciate the com- plexity of the issues and dilemmas. The authors exam- ine, from historical first principles to the present, the basis of ethics, and establishing norms of morality and of moral character. They then focus on the principles that are more pertinent to the ethics of medical prac- tice: respect for autonomy (essentially the consent process), non-maleficence (to treat or not to treat), beneficence (improving quality of life, and balancing risks and benefits), and finally the concepts of justice within healthcare, and professional relationships, espe- cially within the clinical-trial arena.

Throughout the book there are examples of ethical problems, and legal challenges, and it is here that the authors fail the general reader, since the vast majority of these are from US legal precedent, organizations and experience. Indeed, the non-US reader would be justified in believing that ethics is a purely American preserve, so few are the references to the rest of the world, and in particular issues relating to practice in developing countries. Biomedical ethics should be uni- versal, and the guiding principles common to all who practise within the caring professions. It is therefore surprising that there is only passing reference to global ethical statements such as the World Medical Associa- tion’s ‘Declaration of Geneva (1949)’ and no reference whatsoever to the Declaration of Helsinki when the matters of clinical trials are discussed. However, pro- viding one accepts these omissions, this book is a useful introduction to biomedical ethics, especially with respect to the essential ground rules and basic theory.

GlaxoSmithKline GSK House Brentjord Middlesex TW8 9GS, UK

John Horton

Urban Health and Development. A Practical Manual for Use in Developing Countries. B. Booth, K. Martin & T. Lankester. London and Oxford: Macmillan Education Limited in association with Tearfund and TALC, 2001. vi+378pp. E12.50. ISBN O-333-67934-2.

The 3 authors of this very practical handbook are all experienced in health and development programmes in the Third World, particularly within the slum popula- tions of its big cities. That their feet are firmly on the ground is shown in a personal letter from the authors to the readers: they warn of the size of the tasks, the liability to discouragements and the dangers of burn- out in the work which the book so practically and helpfully covers.

The book is divided into 5 parts. An introduction to the characteristics of the urban poor is followed by a step-by-step description of the principles and practices of developing a community-based health and develop- ment programme. The third part covers health care which-includes a chapter on identifying and working with narticularlv vulnerable families who are failing to cope.- The fourth part deals with the principles &id development of environmental improvements: housing, water supply, waste water and other environmental hazards. A final part discusses important management issues, in particular cooperation with others, both peo- ple and agencies, and sustainability. There are 3 appen- dices: a list of references, publishers and resources; hints as to the approach to a donor; and the develop- ment of a logical framework analysis, with its pros and cons. A comprehensive index completes the text.

The task of developing an effective urban com- munity-based health and development programme (CHDP) is described in a detail which underlines the