Editor of book hits back

EDITOR,—Henry G Burger, an internationally renowned endocrinologist, devotes half his review of Drug Therapy in Reproductive Endocrinology, which I edited, to what he claims are errors and misleading information.1 It is therefore regrettable that the errors and misinformation (with the exception of one error, for which I take full responsibility) are his and not those of the authors.

Firstly, the book does not state that “the combination tablet containing only 2 mg cyproterone acetate is ‘a highly effective treatment for severe hirsutism.’” For severe hirsutes it recommends the addition of cyproterone acetate (CPA; 100 mg daily) to the standard combination tablet of 35 μg ethinyloestradiol and 2 mg cyproterone acetate (Dianette), specifying that “in patients with severe hirsutism, additional CPA is required to improve the effect of Dianette on hirsutism.”

Secondly, Burger states that the book does not refer to measurement of testicular volume in clinical assessment. It does, saying, “When puberty commences in girls or 10 ml testicular volume is attained in boys, pubertal acceleration occurs.” It repeatedly emphasises the importance of measuring testicular volume in assessing the response to treatment for hypogonadism.

Thirdly, Burger states that “The book contains an extensive pharmacopoeia” (it doesn't) and criticises the inclusion of lynoestrenol on the grounds that it is unavailable. However, the introduction to the pharmacopoeia, which Burger clearly did not read, states, “The drugs listed … are limited to those recommended by individual authors for treatment of reproductive endocrinological problems… The details given for each drug are not exhaustive, nor were they intended to be so. Interested readers can amplify … their knowledge by reference to standard pharmacological textbooks.” Lynoestrenol had to be included in the pharmacopoeia because it is mentioned in the section on oral contraceptives.

Finally, although as the editor I accept full responsibility for having missed the single use of the term “buccal testosterone” as opposed to “oral testosterone,” elsewhere in the chapter in which this error occurs and elsewhere in the book (including in the pharmacopoeia) the term “oral testosterone” is used. Burger knows well that this book is not for patients, so for him to state that this error will cause “puzzlement to the patient when he collects capsules containing an oily solution of the steroid and is faced with the challenge of placing two in his cheeks three times a day and allowing them to dissolve” is misleading to readers.

None of us is immune to criticism, and I always welcome constructive comments. Factual errors by a reviewer are, however, another matter and not—in Burger's own words—“trivial complaints.”