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Child health and the environment
  1. D Walters

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    Donald T Wigle, Oxford University Press, 2003, £35.00, pp 416. ISBN 0195135598

    When I first picked up this book I wondered for what sort of reader it was intended. It looked too small to deal with the enormous breadth of the subject in any great depth so I thought experts and workers in the field who might have wanted a thorough discussion on a particular issue would be deterred. I believed that it would not be attractive to paediatricians and other clinicians because it had a decidedly epidemiological approach to the subject. However, my opinions changed rapidly as I read on.

    The chapter topics and their ordering have been thoughtfully chosen. The first three chapters set the scene. The first is an overview, particularly of why children are different from adults and need special consideration because of their size, physiology, and behaviour. The second presents a concise introduction to the relevant epidemiological methods and to study design, and the third gives a context for risk assessment in the real world. Subsequent chapters deal in turn with specific environmental toxins and hazards which include (apart from the usual suspects of metals, pesticides, and hormones) radiation effects, air pollution and even the potentially dangerous contaminants of water. I began to wonder how the author had managed to pack in so much of interest in such a relatively small space but even so, more detailed information is available from a website at the author’s institution.

    It is claimed that it is the “first textbook to focus on environmental threats to child health”. I am sure this is true and for that reason alone this book is to be welcomed. Not only that, but it is one of the few books dealing with environmental issues that includes genetic and prenatal effects. Another virtue is the author’s obvious belief that environmental effects cannot be understood in isolation from the underlying biology they alter or influence.

    My conclusion is that this is an excellent book. It is up to date and well written, containing carefully selected information; for example, enough chemistry to understand the biological effects of PCBs and similar compounds, and a recap of normal endocrine function to allow appreciation of the action of environmental hormonally active agents. The book contains clear figures and useful collections of data on effects of potentially hazardous agents. Current safety standards for various pollutants are given in easily accessible tables. Just having this information collected into one volume would alone make the book a useful addition to the bookshelf for anyone with more than a passing interest in child health or the environment, whether they be student or expert. But the author goes further, by weighing and assessing evidence in order to state which associations between environmental hazards and health effects are proven and which are not, and also to point out which topics require more research evidence. For the information it contains and its balanced discussion I believe the book is a bargain at its price of £35.

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