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Winter 1999-2000
Vol. 62, No. 2

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MAKING A MERCK

Robert Berkow '59M (Res/Flw) gladly took on editing jobs 40 years ago while studying at the School of Medicine and Dentistry.

He figured the close-reading skills he could develop as an editor would later come in handy as a practitioner, when he would have to wade through medical journals to keep up in his chosen field of psychiatry.

For the past 25 years, Berkow has been using those same Rochester-honed editing skills to help the entire medical profession stay up-to-date through his post as editor of The Merck Manual of Diagnosis and Therapy.

The venerable mainstay of the medical profession celebrated its 100th anniversary with the 1999 edition, and for a quarter of the book's life, Berkow has been there as the manual's pages have paralleled the growth in modern medicine.

"You can follow the clinical practice of medicine during the last 100 years through the different editions," Berkow says. "It's all well documented."

First put out in 1899, the Merck Manual, as the book is known, is the longest continually published medical textbook in the country. It is also the most widely used, with more than 10 million copies printed (2 million in the latest edition) and with translations in 16 languages.

Berkow was thoroughly familiar with the manual when he came to Rochester to complete a psychiatry residency and fellowship in the School of Medicine's renowned program in what was then called "psychosomatic medicine." He stayed on as a part-time faculty member and as a private practitioner.

In 1974, when he took over the job of editing the publication of the pharmaceutical giant Merck and Company, Berkow moved to Philadelphia, where the manual's editorial offices are located.

The book sold about 350,000 copies then, outselling its nearest competitor by a four-to-one margin, but Berkow says the volume had become stagnant.

"We basically gutted it and started from scratch," he says of the overhaul. "We more than doubled the size and completely rewrote it. It really became a new book beginning with the 1977 edition."

For much of the work, Berkow turned to his colleagues at the School of Medicine and Dentistry. Of the manual's 280 authors, about 25 were Rochester faculty, by far the largest contingent from any one institution. (The Rochester tradition continues. For a list of alumni contributors to the 1999 manual, see Class Acts, 'Merck' Mine Rochester.)

The current edition encompasses nearly 3,000 pages, dwarfing the pocket-sized 192 pages of the original. That's not all that has changed as throughout its history the manual has tried to reflect state-of-the-art medicine.

The 1899 book advocated treatments like smoking tobacco to relieve asthma attacks and dosing patients with strychnine or arsenic to cure various other ailments.

The 1999 manual reads like a What's What of medical marvels: penicillin, insulin, vaccines, organ transplants, medical imaging from X-rays to MRIs, protease inhibitors and other new pharmacological breakthroughs, just to name a few.

"The book has always represented what a doctor needs to know to practice medicine," Berkow says.

Doctors have always been the book's top audience, closely followed by medical students, nurses, and others in the health professions.

But Berkow noticed early in his tenure that one out of every five owners of the manual was a nonprofessional. That led to the introduction in 1997 of The Merck Manual of Medical Information--Home Edition, a version of the book translated into nonmedical English. The book has sold more than 1 million copies.

"It was clear to me that the public wanted more sophisticated information," Berkow says. "In essence they wanted to know what the doctors know, and we decided to give it to them."

Berkow also has overseen the introduction in 1990 of The Merck Manual of Geriatrics and watched as new technology, particularly the Web, has made the manuals more accessible. (The manual can be searched through Merck's Web site at www. merck.com.)

Berkow, who also teaches at MCP Hahnemann University School of Medicine in Philadelphia, says he tries to infuse the book with many of the lessons he learned as a student at the University.

Intrigued by the interplay between mind and body and between mental states and physical health, Berkow came to Rochester to study with some of the pioneers in the field, such as John Romano and George Engel.

"It's a broad way of looking at human beings and how the mind interacts with different parts of one's biology in affecting health," Berkow says.

The Rochester influence shows up in some of the manual's touches that go beyond the clearly clinical. For example, sections on children with chronic disease note how parents and siblings might be affected in dealing with the illness, and a section on suicide includes information on how attending physicians might be affected by a patient's death.

"The kinds of things that I originally went to Rochester to be better at--and the kinds of things that Rochester has been almost a fountainhead for--are expressed in the Merck Manual as best one can in a general medical textbook," Berkow says.

But most of all he revels in a job that lets him use all his editing and medical skills.

"I've been given total independence on the project, and I have the chance to relate to some of the best medical minds in their fields," Berkow says. "I love it."

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