from The Textbook Letter, July-August 2000

Reviewing a high-school book in health

Holt Health
1999. 709 pages. ISBN of the student's edition: 0-03-051123-2.
Holt, Rinehart and Winston, Inc.,
1120 South Capital of Texas Highway, Austin, Texas 78746.

This Book Fails to Deal with the Real World

Philip R. Ziring

When I read the 1994 version of Holt, Rinehart and Winston's Holt Health, I found that it carried many serious defects and deficiencies [see note 1, below]. I've now inspected the 1999 version, and I regret to report that it is virtually the same as the 1994 book. Nearly all of the mistakes, misconceptions and distortions that I saw in the 1994 version are still in place, and Holt Health still fails to deal with the real world in which today's adolescents live their lives. Indeed, the 1999 Holt Health is even less relevant to the real world than the 1994 version was, because it fails to consider the implications of recent scientific advances such as the mapping of the human genome, new research into how the popular media influence the behavior of teenagers, and new findings about the effects of environmental conditions on the development of the brain in infants and young children.

Some of the mistakes that I noticed in the 1994 Holt Health were simple errors that could have been corrected easily, but here they are again, in the 1999 version. As examples: A chart titled "Sexually Transmitted Diseases" still contains errors in spelling. A photograph shows a girl who is holding a plastic device in her hands, and the caption says "Specifically prescribed inhalers can prevent asthma attacks," but the device the girl is holding is a peak-flow meter -- not an inhaler. A diagram of "How drugs enter the body" still teaches that inhaled medications for asthma enter the body through the nose. (They actually enter through the mouth.)

The problems with Holt Health, however, go far beyond the reprinting of misspelled words and small errors of fact. In the rest of this review, I shall draw attention to some of the book's deeper defects.

Wrong and Cruel

As they did in the 1994 Holt Health, the Holt writers again refer to Down syndrome as "Down's syndrome," and they again put forth the unqualified, false claim that Down syndrome is "An Inherited Disorder" (page 515). In reality, only 10% of all cases of Down syndrome involve heredity. Some 90% originate de novo, resulting from a derangement (called nondisjunction) in the replication of chromosome 21 during gametogenesis. It is wrong and cruel to teach a young student that if he has a brother, sister or cousin who exhibits Down syndrome, his family must be harboring genes that cause "an inherited disorder."

Down syndrome shows up again on page 516, in another passage that has been carried forward, virtually unchanged, from the 1994 book: "[W]omen over the age of 35," the Holt writers say, "are at a higher risk than younger women for giving birth to a child with Down's syndrome. Many doctors recommend that pregnant women over the age of 35 undergo a test called amniocentesis. This test is given at the end of the woman's first trimester of pregnancy. Amniocentesis can detect the presence of Down's syndrome, as well as other chromosomal defects."

That passage must be rejected for two reasons. Though nondisjunction in the replication of chromosome 21 becomes increasingly common as maternal age increases, the writers badly mislead the student when they imply that the likelihood of "giving birth to a child with Down's syndrome" increases suddenly, and apparently by magic, when maternal age reaches 35. More importantly, the reference to amniocentesis is so vague and craven that it is meaningless. Why do "many doctors" recommend amniocentesis? Why would any doctor perform a "test" that can detect chromosomal defects in a fetus?

The answer, of course, is that amniocentesis provides couples with information that they can use in making reproductive choices, including the choice to terminate a pregnancy if the fetus exhibits serious, irreversible defects. Holt's writers are obviously afraid to say this. They don't explain why the test is performed or why the results of the test may be useful, so they lead the student to believe that "many doctors" whimsically recommend a test whose results will have no utility at all.

The topic of amniocentesis could have been used, quite logically, as a starting point for a discussion of abortion -- a big issue in the lives of today's teenagers. (Remember that a large majority of our young people start to engage in unprotected sexual activity before they leave high school.) Holt Health, however, doesn't mention abortion anywhere. The complete absence of any mention of abortion is a one of this book's worst deficiencies.

Promoting Magic

Another deplorable feature of the 1999 Holt Health, carried forward from the 1994 version, is the promotion of folk remedies and magic. No matter what this schoolbook says, chicken soup is not "a medicine for various illnesses" in Jewish households. And even if aboriginal magicians call themselves "healers" and "undergo years of special training" to learn "ceremonies and rituals," they still are unable to provide any effective treatment of serious diseases or injuries.

The promotion of magicians and magical remedies is just one reflection of the Holt writers' anti-medical bias. That bias was obvious in the 1994 book and it remains obvious in the 1999. The practice of medicine is a serious matter, but Holt's writers say little about it. They fail to explain that modern medicine is based on biological science; they fail to describe the education of a physician (which typically includes four years of college, several years of medical school, and then several years of practical training at a teaching hospital); and they fail to describe the various medical specialists that a student is likely to encounter [note 2]. Yet these writers make a point of promoting various kinds of "therapy" that evidently don't involve any medical doctors. An illustration on page 172 presents a fictitious advertisement for "Jan Doe, Ph.D.," and the accompanying caption says that the advertisement "is representative of the kind of mental health services provided by counselors." The advertisement appears adjacent to a paragraph about "Chemical Therapy," in which the student sees that drugs "are prescribed" (by whom?) to correct a mysterious "imbalance of chemicals in the brain." On page 235 a paragraph headlined "If You Feel Suicidal" advises that a suicidal student "may need professional counseling with a psychologist or therapist." (In reality, suicidal impulses call for immediate medical consultation and perhaps for hospitalization.)

Trivializing Gun Violence

Now let me describe how Holt's writers mishandle the subject of firearms. Gun violence is a major public-health problem in the United States today, and students need to understand this. In Holt Health, however, the problem is trivialized and the political issues surrounding the control of firearms are blurred and misrepresented. In the 1999 version, as in the 1994, gun violence is acknowledged only twice. In the chapter titled "Preventing Abuse and Violence," a single paragraph cites "possession of a gun" as one of the "major risk factors related to homicide." And at the very end of the chapter called "First Aid and CPR" -- the last chapter in the book -- there is an article that purports to consider the question "Should gun-control laws be passed to reduce the number of violent deaths from gunshot wounds?" By tacking this article onto the end of a chapter to which it is plainly irrelevant, Holt's writers have made gun violence seem unimportant -- and the article itself is seriously flawed because the writers have omitted important points and have distorted important facts. Read, for example, what they say about the NRA:

The National Rifle Association (NRA) is the most powerful group that opposes gun-control laws. Citing the United States Constitution, the NRA's philosophy [sic] is that all citizens have the right to own and use guns for self-defense, hunting, and recreational purposes.

The Constitution? If Holt's writers had wanted to stimulate a thoughtful discussion of the matters in question, they would have augmented their reference to the NRA's "philosophy" by quoting the relevant words of the Constitution itself:

A well regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear arms, shall not be infringed.

Holt's writers leave students with an impression that the Constitution actually sets forth a "right" to own guns for self-defense, hunting and recreation, but the Constitution does no such thing. Instead of striving to inform students, the writers have resorted to deliberate obscurity so that they could avoid displeasing a pressure group. This is intellectual dishonesty.

Lost Opportunities

Finally I point out that these writers have repeatedly missed or ignored opportunities to inform students about important scientific topics. For example, nowhere in this book have I found any reference to the explosion of knowledge in the realm of molecular biology. Our new understanding of how the human organism functions at the molecular level is already leading us toward new treatments for conditions such as Alzheimer's disease, cancer and multiple sclerosis -- and these new treatments eventually will influence, in one way or another, the lives of most of today's teenagers or their families. The same knowledge explosion is also creating new career choices for young people, but this is not reflected in Holt Health.

Holt, Rinehart and Winston's writers and editors had five years in which to revise the 1994 version of Holt Health and turn it into a textbook that could have been valuable to teachers and students. Instead, they have merely made a few cosmetic changes, they have left a lot of old misinformation in place, they have failed to provide new information that students need, and they have produced a 1999 version that is pretty much the same as its predecessor.


  1. Editor's note: Philip R. Ziring's review of the 1994 version ran in The Textbook Letter for January-February 1995. [return to text]

  2. At the start of a section titled "What You Can Expect in Health Care," on page 571, the writers wrongly equate "primary care physician" with "family medicine physician," as if those two phrases were synonymous. A primary-care physician is usually a specialist of one kind or another, often an internist or a pediatrician. A family-medicine physician is a generalist who, after finishing medical school, has received introductory training in a number of fields, such as obstetrics and cardiology. [return to text]

Philip R. Ziring is a physician. He has practiced pediatrics in the San Francisco Bay Area and in Chicago (where he chaired the Department of Pediatrics at The Chicago Medical School and the Department of Pediatrics at Cook County Children's Hospital). He now lives in San Rafael, California, and serves as a medical consultant to the Department of Public Health of the City and County of San Francisco.


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