Biochemical Disorders in Human Disease

It is becoming increasingly apparent that most diseases are caused by biochemical abnormalities (congenital, nutritional, or acquired through the influence of outside factors such as poisons or microorganisms) and that in those where biochemical abnormalities do not primarily cause the disorder, they play an important role in its course and development. A book purporting to discuss biochemical disorders in human disease should therefore embrace all of medicine and much of surgery. Moreover, since one cannot discuss the abnormal state without a clear understanding of the normal, such a book should also include a comprehensive review of normal biochemistry. This is a large order-perhaps more than can fairly be asked. It is certainly more than has been produced in the present book. This volume contains 20 essays by 31 authors. The chapters are organized by system (e.g., gastrointestinal, cardiovascular) rather than by disease, although a few diseases (diabetes, porphyrias) have separate chapters. There is no single place where the organized sequence of events leading to energy utilization, substrate dissimulation, or synthetic reactions is discussed. In their preface, the editors say that they feel that the present form of organization will best serve the interests of general medical readers. To me, however, this organization seems wasteful and disjointed. There is considerable passing discussion in the various chapters of the role of highenergy phosphates in energy transport, of the need for coenzymes, of the central role of pyruvate and of acetyl-coA, but there is no single place where the reader can see how these and many other important factors interlock. As a result, the authors labor under an immense handicap. Forsham and Mortimore, in their chapter on Diabetes and Hypoglycemia, recognize this by heading each section with a reference to a standard textbook of biochemistry; but what is the advantage of a book on the biochemistry of disease if it does not contain enough biochemistry to permit the authors to discuss the diseases in biochemical terms? The absence of an introductory section on biochemical integration also causes a good deal of wasted space. The general pattern of biochemical reactions is similar in the liver, kidneys, muscle, gut, brain, etc.; but since there is no single discussion of these similarities, the author of each section is forced to flash a few pertinent fragments of the biochemical pattern before his readers. This causes repetition without integration. The order of the chapters confounds the confusion, since the chapters on carbohydrate metabolism and nutrition, which might have served as a skeleton on which to hang the details of abnormalities in other systems, are placed in the second half of the book. Part of my dissatisfaction with this book probably also arises from differing interpretations of the meaning of biochemistry. To me, this implies an investigation of basic mechanisms at a chemical level. Much of the investigation must concern itself with enzymatic reactions, and with the anatomical arrangements within the cell which control or modify these reactions. The influence of genetic abnormalities and substrate storage and transport also would play a large part here. Apparently, not all of the authors in this