SW. Ser. Mrll Vol. 17. No. 8. pp. 517-5’2. 19X3 Pergamon Press Ltd. Printed in Great Britain

Social Work and General Medical Practice. by JUNE HUNT- oped for helping social work and medicine understand INGTON. Foreword by MARGOT JEFFERYS. George Allen & themselves better as a means of putting their respective Unwin. London. 1981. 196 pp. E12.50 (paper) f5.95 houses in order.

Huntin@ton’s effort to subject the relationship between what she terms the “occupations” of social work and gen- eral medical practice to disciplined sociological scrutiny and analysis makes for lively, informative, and provocative reading. Her study derives from the opportunity she was given to serve as a participant observer to the introduction of social work into a general medical practice in Sydney, Australia. She is thus able to provide first-hand evidence of “the social construction of inter-occupational reality, the development of meanings and rules in situ. and attempts by practitioners to articulate their own occupation’s back- ground meanings to members of another occupation”.

Departmenr of Community Medicine Mourn Sinai School uf Medicine of The City U&wrsiry o/’ New York New York, NY, U.S.A.

BESS DANA

Smoking: Psychology and Pharmacology, by HEATHER ASH- TON and ROR STEPNEY. Tavistock, London, 1982. 222 pp. $19.95

As a correction for the limitations of a case study of one particular practice organization and one social worker,.Dr Huntington -turned to the literature of seven countries to provide a more comprehensive base for the identification and analysis of the factors affecting inter-occupational col- laboration. The reach of her inquiry into the literature extends beyond those writings that deal specifically with the relationship between social work and general medicine. It encompasses both the antecedents of that relationship as reflected in the. earlier literature of medical social work and, of particular significance to her findings and rec- ommendations. an insightful review of what the author terms the “identity literature of each occupation”, i.e. those tasks and articles that “address the questions what is social work and what is general practice”.

Reduced Tar and Nicotine Cigarettes: Smoking Behavior and Health. edited bv DEAN R. GERSTEIN and PETER I. LEVIKIN for the Committee on Substance Abuse and Ha- bitual Behavior, Commission on Behavioral and Social Sciences and Education, National Research Council. National Academy Press, Washington, DC. 1982. 52 pp. No price given

Coffin Nails and Corporate Strategies, by ROBERT H. MILES in collaboration with KIM S. CAMERON. Prentice-Hall, Englewood Cliffs, NJ. 298 pp. $18.95 (paper) $1 I.50

Relevant data from both the literature and real life as observed by the author are skillfully interwoven in the five chapters (parts) that constitute the book as a whole. Part One introduces the reader to the sociological perspective which provides the conceptual frame of references for the work. Part Two places social work and general medicine within their respective occupational structures, comparing and contrasting the demographic variables, conditions of work. income levels and the sources from which they are derived and types of clientele that influence the behavior of each “occupation” and the relationship of one to another. Parts Three and Four deal with the similarities and differ- ences between the cultures of the two occupations. In con- trast to Part Two, which is more descriptive than dynamic, both the language and the content of these two com- ponents of the work speak tellingly to social work’s re- lationship to medicine. (In fact Dr Huntington might well have been an eavesdropper on many a social worker-phy- sician encounter. U.S.A. style.) Part Five provides the reader aith a well organized and clearly stated tabular summary of the analysis of the data and a brief but telling consideration of the significance of the findings for future collaboration between social workers and general medi- cine.

It is now just 30 years since the American public, thanks to The Reader’s Digest, began to worry about cigarettes. In the interval. those early puffs of anxious speculation have merged into a harsh stream of facts: 6 or 7 years are knocked off the cigarette smoker’s life expectancy. and not only the smoker but his or her family and co-workers suffer measurably increased morbidity from the habit. Yet the manufacture of cigarettes remains one of the most pro- fitable enterprises in America. because a third of adults continue to smoke and the average smoker now consumes half again as many cigarettes as in 1953.

There are, it seems, two major reasons for the paradoxi- cal durability of the cigarette habit. First, nicotine de- livered in this dosage form is highly addicting; as long as a healthy percentage of teenagers (who tend to discount the remote consequences of cigarette smoking) can be recruited to the habit, a fairly stable market for cigarettes can be maintained. Second, the net effect of regulatory efforts has been, presumably by inadvertence, to protect the cigarette industry and not the consumer.

As Margot Jefferys points out in the foreword, itself a contribution of no mean significance to the overall quality of the book. Dr Hungington is not the first to recognize that conflict is an inborn characteristic of the social wor- ker-physician relationship, deriving both its particular form and substance from factors in the social, cultural. intellectual and political environment. .Nor is she alone in her recognition that both social work and general medicine must deal \vith their own identity conflicts if they are to be able to tiork effective]! w,ith each other. What is unique is the analytical framework which Dr Huntington has devel-

Ashton and Stepney. two productive and painstaking British investigators, have written a thorough and readable book on smoking behavior. Their approach is even- handed, and they give full weight to alternative hypotheses that might account for the natural history of cigarette use. the smoker’s pattern of motivations and the phenomenon of compensation for lowered nicotine content of cigarettes. They offer a responsible and comprehensive review of the literature and their very cautiod in evaluating the addiction hypothesis underscores, for me, the credibility of nicotine dependence as the paramount influence on cigarette con- sumption. Indeed. the book’s most useful contribution may be its elegant chapter discussing smoking as a psychologi- cal tool-i.e. a means of controlling states of arousal and focusing attention. By showing how nicotine serves not only to shift the user along the spectrum from pain toward pleasure but also under certain circumstances to improve performance. Ashton and Stepney make it clear that nico-

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