July 16, 2008

When Do We Call the Game? THE MERCY RULE by Perri Klass (Houghton Mifflin, July, 2008)

THE MERCY RULE by Perri Klass (Houghton Mifflin, July, 2008)
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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515
16 San Rafael Drive, Rochester NY 14618
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         Can women do it all? Perri Klass, the multitasking pediatrician-writer and author of THE MERCY RULE (Houghton Mifflin, July, 2008), seems to manage it. But Dr Lucy Weiss, Klass's alter ego and central character, seems less sure what she can and cannot do. As for me, I wonder what Klass is trying to say about how well working women can fulfill their responsibilities to family and patients—or whether they risk losing themselves along the way.

        Rereading THE MERCY RULE, I’m still not sure where I stand. My daughter objects to Klass, arguing that she is smug, that her tone implies that yes, certain women can do it all. But Lucy has so many balls in the air that she finally becomes partially disconnected from her family, from the lost women she works with in her job, and even from herself.

       With THE MERCY RULE, form follows function. Honing in on the complications of balancing the demands of the medical profession with the equally (even more?) demanding  profession of being as good a parent--and a wife-- as possible, THE MERCY RULE  feels more  like a group short story than a novel.
 
        The title asks questions that it does not answer. For the benefit of the non-cognoscenti like me, Wikipedia defines  the “mercy rule” as a sports expression, also known as the slaughter rule. The mercy rule ends the game  “when one team has a very large and presumably insurmountable lead over the other.” It quits when the team is ahead. In the Little League where Freddy, Lucy’s odd, mathematically sharp and socially inadept son, plays, the coach calls the game because of the Mercy Rule. A billionaire father, out to have his son outplay the boys, protests, “In life, there are no Mercy Rules.”  Although she believes that “life is full of Mercy Rules, and I follow them as much as I can,” she doesn’t say a word to the obnoxious billionaire.

          Once a foster child going from hand to mouth and foster home to foster home, Lucy was saved when  her beloved sixth grade teacher adopted her.  Lucy Weiss is then a survivor, a pediatrician  running a Boston clinic for neglected children and their forgetful, abandoning  mothers. The stories are about judging parents and children, figuring out what parents and outsiders can  do to make children’s lives better.

         Although Lucy attempts to balance her family life with her professional job, she suffers from a lack of focus, most disturbingly in the last section where the narrative voice changes and speaks dizzyingly to the reader:

         “If you are in any kind of trouble, call me,” concludes the unidentified narrator, ostensibly speaking for Lucy. “Find a way to call me. Call me from anywhere…I want to know we are connected. I will always answer…always hear…always come. Look what the phones can do, nowadays. Look how that can change the story. And the right connection at the right moment is all it takes.”

         But cell phones don’t always work. Connections falter. As a result, even though Lucy’s group short story might make an interesting selection for a  book club, it gets a little lost on the road. Finally, we don’t know where we –or Lucy—can go from here.

June 26, 2008

Which Would You Rather? Worry or Die?

WORRIED SICK: A PRESCRIPTION FOR HEALTH IN AN OVERTREATED AMERICA by Nortin M. Hadler (Caravan/Univ. North Carolina Press, June,2008) and OVERTREATED: WHY TOO MUCH MEDICINE IS MAKING US SICKER AND POORER by Sharon Brownlee (Bloomsbury, January, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,
585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

       Tim Russert is dead.  Wiped out and gone. Although doctors knew he had heart disease, they didn’t realize it was fatal. Like more than the men felled by fatal heart attacks, Russert had no chest pain. A diabetic, he was overweight.

        In 1998, a CT heart scan found Russert’s calcium was 210, which meant his risk of a heart attack was high. Should he have had an angiogram? His cardiologists didn’t think so. If the angiogram had shown the clots in Tim Russert’s vessels, would bypass surgery have saved him?. Even after his death, doctors differed on what an angiogram would have indicated. After his death, his internist asserted, “The number one predictor of mortality is waist circumference.”  Was that all?

        A week after Tim Russert’s death, Drs Ezekiel Emanual and Victor Fuchs published an article in the JAMA (Journal of the American Medical Association) deploring “The Perfect Storm of Over-utilization.” Arguing for reducing overutilization to control costs by altering the combination of physicians’ training and attitudes and patients’ wishes and worries,  vaguely they say “The best hope for reining in costs is to devise financial incentives for physicians and patients that result in greater health value.”

        In the same vein is Sharon Brownlee's book,OVERTREATED - Why Too Much Medicine Is Making Us Sicker And Poorer (Bloomsbury Press, December, 2007).  Brownlee argues that  “much of mainstream medicine's therapies and treatments are never double-blind tested and the financial structure of the current system is literally killing people.” 

        Worse yet is Nortin M. Hadler’s new book WORRIED SICK: a PRESCRIPTION FOR HEALTH IN AN OVERTREATED AMERICA ( Caravan/University of North Carolina Press, June, 2008).  Hadler’s diatribe s should not be confused with Arthur Barsky’s book of the same name, WORRIED SICK: Our Troubled Quest for Wellness ( Little Brown, 1988). A legion of other polemics on “overtreatment” ignoring undercare crowd the web sites on staying well.                       

        Claiming “they,” doctors, “health“ providers, even medical writers like me can make us sick with worry., these worry wart writers stagger readers’ imaginations.

        It’s up to you. Which would you rather? Be worried sick? Or dead? And would a cacophony of medical advisors, positive and negative, keep you well (or well-er)? Maybe yes, maybe no.

        Still, fair is fair. Warnings are in order. Books like Hadler’s and Brownlee’s, articles like Emanuel’s are hazardous to your health.

        From our point of view (a blogger's privilege), worrying sick is better than dying young. Could Tim Russert’s life have been saved by early, aggressive medical action? .. Like their patients, doctors differ. Some are aggressive, some more passive. Everyone has a point of view. That’s why there are books. And blogs like this one. Read them and see for yourself.

        But reading and warnings aren’t all we need. The night Tim Russert died, we had dinner with a Pulitzer Prize journalist. Shaken by Russert’s death, my pot-bellied husband and our girthy dinner companion skipped bread, potatoes, dessert.

        Until the next day. When the brownie brigade started marching again.

552 words

May 06, 2008

CAN WORDS REPLACE PROZAC? THE MAN WHO MADE LISTS: LOVE, DEATH, MADNESS, AND THE CREATION OF ROGET’S THESAURUS by Joshua Kendall (Putnam, April, 2008)

THE

MAN

WHO MADE LISTS: LOVE, DEATH, MADNESS,

AND

THE CREATION OF ROGET’S THESAURUS by Joshua Kendall (Putnam, April, 2008)

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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515

16 San Rafael Drive

,

Rochester

 

NY

 

14618

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            Can words replace Prozac? Well, maybe. At least, words were the treatment of choice for Scientist-Physician-Wordsmith Peter Mark Roget, creator of ROGET’S THESAURUS.  Born into a family cursed by emotional illness, suffering from an obsessive-compulsive disorder, Roget began making lists when he was only eight years old—long before he grew into the man who harnessed his fetish for order with words and most of all, their categories and relationships.

Joshua Kendall, Roget’s biographer, notes, “As a boy, he stumbled upon a remarkable discovery—that compiling lists of words could provide solace, no matter what misfortunes might befall him.  As an adult, he kept returning to the classifications of words and concepts. Immersion in the nuances of language could invariably energize him and keep his persistent anxiety at bay.”

Obsessed with his desire to impose order upon a chaotic world, trying to classify the strange relationships between language and life, focusing on words “that always constituted a means to an end…disseminating scientific knowledge that ultimately had some useful purpose,” Roget studied medicine and became a successful

London

physician.

But sorrow dogged him. Married at 46 to Mary Hobson, beautiful, smart,  rich, and 16 years younger than he, Roget was crushed by her death from breast cancer nine years later when she was only 38. Still, words supported him. Fifteen years after Mary’s death, he published the BRIDGEWATER TREATISE  “the culmination of his lifelong pursuit, begun in his childhood notebook, to organize the animate world.”

Science and medicine provided insufficient comfort. Even a mistress, whom he preferred to his depressive daughter Kate, was not enough. Finally, retiring in 1848, Roget gave new meaning to the word, “retirement.” In 1852, Roget published the first edition of his THESAURUS.  Until his death at 90, Roget continued to work on his “treasure” (the English definition of the Latin “thesaurus”), modifying, improving, tweaking as he went along.

Roget’s was not the first treatise on “synonymy” and language. Bishop John Wilkins’ 1668 Essay towards a Real Character and Philosophical Language and Hester Lynch Piozzi (Samuel Johnson’s friend)’s 1794 British Synonymy preceded the Thesaurus. But classifying, organizing, categorizing words and their relationship to each other and to experience made Roget’s a first in its own right.

For reasons unknown but guessed at, lists (there’s that word again) of the many doctors who also became writers rarely include Peter Mark Roget’s name. Yet it was his scientific training that helped him harness his penchant for organizing words into the treasure that writers still depend on today.

A glance into Microsoft’s so-called “thesaurus,” a look at the insufferability of the email clogging our computers, makes us realize how today’s world is giving short shrift to Roget’s undertaking.

Words alone do not a communicator make. Roget’s self-enclosed life proved that. But words with thought can enrich our lives and make us look beneath the surface. We owe Roget a debt. For who could ask for anything more?

April 17, 2008

CAN EMPATHY BE TAUGHT: WHEN DOCTORS BECOME PATIENTS by ROBERT KLITZMAN

WHEN DOCTORS BECOME PATIENTS by Robert Klitzman (Oxford, March, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,
585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

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       When Harcourt bought CHANGE OF HEART: The Bypass Experience, my book interviewing 1100 veterans of coronary bypass surgery, I was elated. Flush with my success, I tried to convince them to publish my next book of interviews with 100 doctors who were veterans of coronary bypass surgery.

        “Nobody will be interested,” retorted the editor. But he was wrong.

         Robert Klitzman’s important new book, WHEN DOCTORS BECOME PATIENTS, proved just how wrong one editor can be. 

         Klitzman interviewed 70 physicians, male and female, young and old—from 25 to 87, all victimized by a variety of chronic and acute diseases including lymphoma, breast cancer, skin cancer, Huntington’s disease, heart attacks, depression, bipolar distress, and an overly high incidence of HIV.

         Whatever their illnesses were, disease was isolating. Even though their different illnesses mandated a variety of diagnoses, treatment, responses,  and coping mechanisms, many sick doctors felt left on their doorsteps by calloused and unsympathetic colleagues. Since 34 percent of  doctors in Klitzman’s study were HIV positive or suffered from frank AIDs, most opted for secrecy. But the four women physicians killed by metastatic cancer within a year after Klitzman finished his book also faced “peripheralization and discrimination.”  One physician reporting that her colleagues “treated me as if I were dead.”

          Even if these doctor-patients wanted to talk to their physicians, communicating  with physicians was a tough ball game.  Here, the doctor who is sick confronts the same barriers as the non-doctor who wants to communicate with his or her physician.

          A Berlin Wall blocked the two sides of the bedside. Perhaps fearful of their own futures, healthy doctors acted threatened by their sick colleagues. Many healthy MDs expected the sick to continue toting work loads despite their diseases. Some sick physicians, denying the inroads of illness, carried their share of patient care for as long as possible. Others gave in, willingly or unwillingly, to patienthood’s unwelcome passivity. Checking up on their doctors along the way, some found better doctors to care for them, others were distressed by the MDs they found.

           Like the rest of us hit by illness, these doctors hated being sick, hated the world of patienthood, hated being burdens, hated how disease had changed them in the eyes of other doctors. Hospital gowns, patronizing paternalism, humiliated them. Superspecialists ignored them. Colleagues turned their backs.

           What did sickness teach these doctor-patients? Written on their flesh was the truth behind Kafka’s words: “To write prescriptions is easy. To come to an understanding with people is hard.”

           Klitzman believes that doctors who have been sick can learn from the ways their own doctors treated them. As a result, they “assessed this treatment with more knowledge and higher standards of comparison than do other patients…In doing so they offered insights and epiphanies that could help both other patients and providers.”

           Learning empathy from their own experiences, most of these doctor-patients became better doctors, gentler, more understanding after they had battled with illness. They learned to “put myself in my patients’ clothes, “ to ask themselves, “How would I  react?”

           For every doctor is a possible patient. No one is immune. The white coat is not a shield. It’s just a white coat, stained with the blood of others, with the striving, successes, and defeats of caring for others. Medical school, internship and residency, rarely teach physicians that patienthood lies waiting for each of them, ready to pounce when least expected.

          The doctors in Klitzman’s book are special.  They were willing to trust Klitzman with their stories, albeit occasionally glossed over with denial. Their illnesses taught them “that they, too, will one day be patients, that the boundary between physicians and patients is, in the end, nonexistent.”

           Readers, patients, doctor themselves must wonder: Do doctors have to be sick to understand what it means to be a patient? Is sickness a mandatory course in every physician’s education. Klitzman asks, “Can empathy be taught?” It’s a good question.

          Physicians are victimized by the same invasions of the flesh as those striking their patients. Some physicians sicken and die at an early age. Others live long but the infirmities of age, chronic disease, or acute illness beset them.

          How do physicians, trained to help others, deal with their own physical illness? Do they continue to practice? Do age or disease limit their ability to care for sick patients? Do they or their colleagues recognize what is happening to them? Does anyone help them?

           Klitzman’s study raises many questions. How do physicians deal with their medical problems? Does being a physician exacerbate their physical problems? Do colleagues help—or hinder? How do care-providers treat physician-patients? The same as other patients? Better? Worse? What do physicians learn from going through major surgery or critical illness? From living with a chronic disease? How do these experiences affect their dealings with patients? Are they better doctors? If so, why?

           Looking back, how well—or poorly—do physician-patients believe they were diagnosed, treated, monitored, and mentored? How well or poorly did they treat themselves? Will their experiences help other physicians? Help patients? Help themselves?

          The medical literature contains little about physicians trying to cope with physical disease, whether chronic or acute. Almost no studies examine the dilemmas of physicians who are care-“providers” of physician-patients. Few medical schools adequately address clinicians’ well-being. These educational lacunae  waste our most precious medical resource. For students, residents, and senior physicians all need to learn about the special problems of doctors confronting acute or chronic diseases—or even the not-so-“golden years” inflicted by the aging process.

         Physicians providing care to physician-patients need special guidance. They need to unlearn the myths about doctor-patients that might compromise their care.

          Klitzman’s book opens the door to the particular problems of sick or aging physicians. Readers everywhere, non-doctors and doctors alike should take it to heart.

March 20, 2008

SUBTITLES AND TRUTHS--PUPPY CHOW IS BETTER THAN PROZAC: THE TRUE STORY OF A MAN AND THE DOG WHO SAVED HIS LIFE by Bruce Goldstein

PUPPY CHOW IS BETTER THAN PROZAC: THE TRUE STORY OF A MAN

AND THE DOG WHO SAVED HIS LIFE by Bruce Goldstein (DaCapo Press,

Perseus Books Group, March 15, 2008)

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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515 16 San Rafael Drive, Rochester NY 14618
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          Nowadays, most books have subtitles (I should talk; my books do, too). It’s as though writers are dissatisfied with the bare bones of their titles. They want to reach out from the hidden bottom shelf of a crowded bookstore and grab you by the sleeve. “Stop!” the subtitles order. “Don’t go into somebody else’s would-be masterpiece. Read me instead!”

        Bruce Goldstein’s adoring memoir, PUPPY CHOW IS BETTER THAN PROZAC: THE TRUE STORY OF A MAN AND THE DOG WHO SAVED HIS LIFE (DaCapo Press, Perseus Books Group, March 15, 2008), is a perfect example of the popular subtitling genre. If you’re a dog lover, the subtitle will convince you to grab this book. Bend down, drop your umbrella and purse on the way, and see what Goldstein has to say for himself about his love affair with a Labrador retriever puppy.

        Victimized by a virulent bipolar disorder, out of a job, dumped by his girl, and unable to respond to psychiatric therapy and a parade of such drugs as lithium, Paxil, Wellbutrin, and, of course, Prozac, Goldstein was well on his way to giving up. He calls one early chapter before he  meets his puppy, “Mom, I Don’t Want to Go to Life Today.” And he doesn’t.

       At last, heeding his psychiatrist’s desperate recommendation to get a dog, he braves a hurricane to adopt the last (and best?) of a Labrador litter. Black as the proverbial ace of spades, his dog is dubbed “Ozzy” after heavy metal’s Prince of Darkness, the Satanic figure who haunts Goldstein’s imagination. Soon, this furry bundle takes over Goldstein’s life—while calming his lonely fears.

         With Ozzy at his side, Goldstein is lonely no more. Ozzy magnetizes women on the streets of New York. His “puppy harem” oohs, aahs, and “stuck to me like the New York Knicks defense.” Walking his dog followed by a caravan of women, Goldstein realizes, “I finally had an epiphany of sociological and biological proportions. I had finally solved the puzzle man had been trying to figure out since the beginning of time: all of these years the key to meeting beautiful women was picking up a bag of fresh puppy poop.”

          Ozzy is not only “man’s best friend,” he turns out to be “Manic’s best friend,” returning the frantic, obsessed Goldstein to the world he would leave behind. Goldstein gives Ozzy, “my mood-swing messiah” all the credit for keeping him on an even keel. “Thanks to Ozzy, I was really looking forward to my future—the place I thought I’d never get to see.”

         Goldstein ends his story with a poignant prayer, “I thank God this book was written by Bruce Goldstein. Not in memory of.”

        Is PUPPY CHOW overly sentimental? Maybe. But humor saves it. Is it for dog lovers only? Maybe. And then again, maybe not. Because the subtitle is right. Ozzy does save Bruce’s life. More, it’s about what we all, sick and well, must learn to expect from ourselves, no matter what. And finally, it’s about how the magic of love, even a dog’s love, can save us when we’re lost.

March 19, 2008

WHY CAN'T A WOMAN BE MORE LIKE A MAN? SEX DIFFERENCES IN THE BRAIN: FROM GENES TO BEHAVIOR ed by Jill B. Becker, Karen J. Berkley, Nori Geary, Elizabeth Hampson, James P. Herman, Elizabeth A. Young

SEX DIFFERENCES IN THE BRAIN: FROM GENES TO BEHAVIOR ed by Jill B. Becker, Karen J. Berkley, Nori Geary, Elizabeth Hampson, James P. Herman, Elizabeth A. Young
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Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515--16 San Rafael Drive, Rochester NY 14618
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       “Why can't a woman,” moans MY FAIR LADY’s Professor Henry Higgins, “be more like a man?” Proffering his accepted superiority of men, Higgins’s litany complains, “Women are irrational,  Can't a woman learn to use her head? Why do they do ev'rything their mothers do? Why don't they grow up- well, like their father instead?” Finally, Higgins throws up his hands, ““Why can't a woman take after a man? Why can't a woman be like me?

        Higgins isn’t the only one who wonders about sex differences. From time immemorial (and even before), the differences between the brains and behavior of men and women have teased and tantalized academicians and researchers. Husbands, wives, and lovers have all protested the hollow emptiness of “Vive le difference.” 

        Despite this, the crossroads between sex, brain, and behavior have only recently become a field for serious exploration. Sherry Marts, vice president of scientific affairs for the Society for Women’s Health Research, states in her preface to the seminal new guidebook, SEX DIFFERENCES IN THE BRAIN: From Genes to Behavior, edited by Jill B. Becker, Karen L. Berkley, Nori Geary, Elizabeth Hampson, James P. Herman, Elizabeth R. Young (Oxford U Pr, Dec, 2007): “Scientific evidence of sex differences in the brain is only regularly emerging now.”

         And emerge it has. For questions continually nag: Why are men and women so different? What factors, biological and cultural, account for their divergences and disparities? How will new and better knowledge help men and women understand each other, build better relationships in the future? How will it translate into better health care for both men and women?

        Recognizing the need for bridging the chasms in our knowledge of the health discrepancies between men and women, Doctor Becker and her five colleagues have written and edited a brilliant, long-overdue guidebook leading us to better understanding, treatment, and care of men and women.

        SEX DIFFERENCES divides in three parts, what we already know, what we need to know, and how our knowledge will affect the neurobiology of disease and the treatment of neurological disorders.

        In the very first chapter, Turk Rhen and David Crews ask the crucial question: “Why Are There Two Sexes?” After that, Margaret McCarthy and Arthur Arnold sum up what we know about sex differences in “What’s old and what’s New.”

        This introductory section examines research and methodological issues, insights and challenges, as they affect both “Hormone-Behavior Relations,” in non-human animals and most specially in human animals. Understanding and monitoring the menstrual cycle is then essential information for grasping the way that  male and female brains, stress systems, and pharmacogenomics function. Jill Becker has tellingly focused her attention on these subjects for the last two decades.

        The fascinating second section zeroes in on the interaction between neurobiology and behavior. Chapters hone in on steroid receptors and their influence on sex differences in behavior, another Becker specialty. Other topics include dissimilarities in affiliative behavior and social bonding; motivation, movement; energy, obesity, and eating;  children’s play; neurocognition of language (“why don’t you ever talk to me?”); and visuospacial perception. If they do nothing else, these researches prove how different we really are. And how important it is for us to understand those differences.

         Devoted to the neurobiology of disease, the last section covers male and female responses to infectious and autoimmune disease (why is fibromyalgia visited upon more women than men?), pain (which gender is more likely to become addicted?), anxiety, mood, Parkinsonism. As Boomers and their parents join the aging multitudes in the future that awaits all of us, the penultimate chapter on aging and Alzheimer’s diseases (yes, plural) is a particularly important resource for casual readers, clinicians (neurologist and non-neurologists), patients and families.

        One caveat: We hope the Becker group will continue listening carefully to men and women and recording their findings. Certainly, we hope they are at work on a companion volume to fill the lacunae in this text.  For what about such other common autoimmune diseases as arthritis and diabetes which the book does not mention? What about a more detailed discussion—apart from steroidal and hormonal levels--of the differences between male and female sexual desire, fulfillment, satisfaction, and oncomitant tendencies to infidelity (not limited to governors of New York).

        In the meantime, the inquiring reader will find it helpful to consult the plethora of books on genes (Tower lists 28 for 2008 in its catalog!). Turning to the March 18th, 2008 issue of the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (JAMA), which is devoted to genes, genetics, and genomics, will add a world of information to the Becker group’s excellent guidebook.

       While scientists and researchers have long needed a book like SEX DIFFERENCES, its readership should not be limited to academia. The questing student of any age will find answers to many thorny questions—as well as more challenges to his or her perspectives and relationships.

March 16, 2008

WHOSE BLOOD MATTERS MOST? WHAT DO GENES TELL US? BLOOD MATTERS by Masha Gessen

BLOOD MATTERS: From Inherited Illness to Designer Babies: How the World and I Found Ourselves in the Future of the Gene  by Masha Gessen
(Harcourt, April, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, email: nywriter@rochester.rr.com,
585-385-1515, 16 San Rafael Drive, Rochester, NY 14618

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       In this “Information Age,” what do we do with our so-called “knowledge.” How can we use it to make the best decisions? Or, at the very least, better decisions? How does the bursting, ever-changing world of genetics inform us about what we should do? Or what we can do?

        Tower Books lists 28 books about genetics and genomes coming  out this year. On March 18th, 2008, the Journal of the American Medical Association (JAMA) will publish a group of theme issues in its own pages and in its Archives of Dermatology, Neurology, Ophthalmology, and Surgery on Genetics and Genomics. Gearing its focus to “Personalized Medicine in a Variety of Specialties,” it aims to examine “the challenges that medical breakthroughs engender.”

         Two years ago, a UK publishing house commissioned my book, GENETICS FOR THE NON-GENETICIST PHYSICIAN.  Although the book is already outdated, it shows how underprepared physicians feel about integrating genomics into the everyday practice of medicine.

          Where can all this research, all these publications, lead us? Can they help us decide what to do about our own thorny medical problems?

          Although one of Tower's 28 books, Masha Gessen’s BLOOD MATTERS is subtitled From Inherited Illness to Designer Babies: How the World and I Found Ourselves in the Future of the Gene (Harcourt, April, 2008), her text disagrees with the promise—and ostensible premise--of her subtitle. By the end of the book, the reader is left still wondering what she would do were she in Gessen’s shoes.

          In 2004, Gessen learned  she had inherited the BRCA1 gene, predisposing her to breast and ovarian cancer.  Bitterly blaming her mother and grandfather for visiting this “deleterious mutation” upon her, she set out to avert the evil decree, which is, she tells us, more common among Ashkenazi Jewish women.

          What should she do? Should every at-risk individual for hereditary disease undergo testing? If the test is “positive” for disease—meaning that the future may be negative, should she opt for major surgery? In Gessen’s case, should she undergo prophylactic removal of her breasts and ovaries? Should she wait and see?

           Is it a blessing or a curse to know about a predisposition to breast cancer? What about other diseases that Gessen discusses, such as Huntington’s disease, where nothing can be done? What about the very rare “maple syrup disease” found among Mennonites, where the future is so bleak for its victims?

           Gessen hones in on her own life and choices, which are the primary focus of her book. Yet the sections about the choices facing Huntington disease’s sufferers are the most telling. Although breast cancer is not universally fatal by a long shot, Gessen seems most able to identify with individuals who might have inherited the viciously fatal Huntington disease gene. 

           When she talks about designer genes, she seems to leave her subject behind. Gessen would have done well to concentrate on four major areas surrounding common chronic adult-onset diseases: outcomes of genomic medicine; aspects of consumers’ needs for  information; physicians’ delivery and counseling of genomic medicine; and communication barriers to integrating genomic medicine into useful preventive care and treatment.

          In her JAMA study (2008:299 [11]: 1320-1334) Maren T. Scheuner asks seminal questions that Gessen never addresses: “do patients who receive counseling and testing have better clinical outcomes in terms of mortality, decrease in incidence of disease, and better clinical responses to pharmaceuticals? And at what cost?"

BLOOD MATTERS is regrettably too self-involved to take the reader along with Gessen on her journey. The interested reader would learn more about what genes mean to our own medical care--our own futures-- by examining the provocative set of articles in the Genetics/Genomics Theme Issue of the JAMA.

650

March 06, 2008

NEW PARTS FOR OLD--CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb,

CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, WWW.WRITINGDOCTOR.TYPEPAD.COM, email: nywriter@rochester.rr.com, 16 San Rafael Drive, Rochester, NY 14618. 585-385-1515

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        What makes a quack run? What drives a pseudo-doctor, “Dr” John R Brinkley, to practice  quack medicine rather than trying to heal the sick? What makes his nemesis, a power-hungry, AMA quack-buster, Dr Morris Fishbein,  pursue this charlatan for more than 25 years? And what drives countless patients, men and women, “as guileless as the wide-mouthed shad.” to the charlatan’s door for help from whatever ails them?  What turned an era, into “the golden age of quacks”  And finally, is that era it over yet?

          Ostensibly the story of one of America’s greatest quacks, “Dr.” John R Brinkley, Pope Brock’s ironic, witty chronicle of CHARLATAN (Crown, Feb, 2008) is about all the forces, individual and cultural,that contributed to Brinkley’s medical “successes” and finally, his downfall.

         Playing upon the American dream of endless youth, of  “rejuvenation,” (still alive-and-well as America’s favorite pipe dream) Brinkley’s greatest triumphs initially sprung from embedding billy goat testicles into the human scrotum and later even into women’s ovaries.

        But in 1931, medicine caught up with him.  After the Kansas State Medical Board tallied 42 countable deaths at Brinkley’s hands, with untold numbers of deaths after patients left Brinkley’s “hospitals,” it revoked his medical license. At the same time, the Federal Radio Commission, revoked his radio license. Undaunted, Brinkley ran for governor of Kansas—and almost won. His campaign pioneered airplane whistle-stops all over Kansas aided and abetted by radio promotion. In case you hadn't noticed, these innovations are still alive and kicking today.

         After the licenses' revocations and the loss of the governorship,Brinkley got the Kansas message. He moved to Texas. In Del Rio, Texas on the Mexican border, he built a mansion fit for a charlatan and a hotel-like “hospital” for prostate surgery patients. Ever the innovator, he used Mexican-based radio to promote himself and his medicine.

         And he made money. Lots of money.  He charged $750 for “gonad surgery,” but his fee for prostate surgery was only $250 a pop. Always, it was cash on the barrelhead—before the operation—just as present-day surgical offices insist on insurance cards and co-pay before the visit.

          Money made money. He bankrolled “Border Blasters,” his high-potency radio shows emanating from his million-watt station, XERA, in Villa Acuna, Mexico into the most powerful station broadcasting on American air waves. Patients heard and flocked to Del Rio for glandular injections—and later, bargain-basement prostate surgery.

         One of XERA’s claims to fame was Brinkley’s Medical Question Box. Listeners sent in letters detailing their health problems. Brinkley prescribed treatment bought from pharmacists hired to kickback percentages of sales. Something like Senator Bill Frist’s long-distance diagnosis of  Terry Schiavo’s problems. As the song goes, “ainsi c’est toujours le meme chose.”

         Del Rio was good to Brinkley. During his five years of broadcasting and prescribing, he pocketed about $12 million. But in 1938, another Del Rio doctor began stealing Brinkley’s thunder by selling the same operations for a lower fee.

          So Brinkley moved to Little Rock, Arkansas in 1938. But Brinkley's Midas touch had become tin. Things were going wrong. In 1939, he lost a libel suit against his obsessed Ahab, Dr. Morris Fishbein. Not only was Fishbein the longtime editor of the American Medical Association (JAMA) and AMA president, but he was an equally egotistical firebrand, who had spent much of his professional life committed to bringing Brinkley down.

          Brinkley’s testimony inadvertently helped Fishbein’s case. On the stand, Brinkley admitted that his surgery was something like a vasectomy. Further, his celebrated Formula 1020 for rejuvenating male desire and performance was only dressed-up colored water.

          After Brinkley lost his appeal, the judge  accused him of being “a charlatan and a quack in the ordinary,well-understood meaning of the words.” Hearing this, disgruntled patients filed civil suit after civil suit. Down on his luck, declaring bankruptcy in 1941, Brinkley was indicted for mail fraud. With the suits pending and dogged by ill health, Brinkley died alone of a blood clot in 1942.

          What made Brinkley run? CHARLATAN, despite its wondrously deft insights isn’t sure. Whether greed alone powered his engine or a healthy (word used inadvisedly) dose of egotistical narcissism fueled his exploits remains unknown. In fact, what made Fishbein run? Fishbein was so much a mirror image of Brinkley—albeit law-abiding and medicine-upholding—that the two were American medical twins.

        If Brinkley himself was dross, CHARLATAN is gold. Brock’s history of American medicine’s feats and flaws, achievements, anecdotes, and trickery invites the reader to compare medicine then with medicine now. In one of the many nuggets of little-known Americana sparking his tale, Brock reports that more than 400 of the 526 radio stations accepted no advertising because “Radio Czar Herbert Hoover, the secretary of commerce, declared it ‘inconceivable that we should allow so great a possibility for service to be drowned in advertiser chatter.’”

         Hoover was, of course, right. Radio, television, email, the internet are awash in "advertiser chatter," offering an open-sesame to the "flim-flam" of 2008. Reading Brock's tales of these medical machiavellis is not only fun, but it  should sound a much-needed alarm about medicine's present-day gimmick-providers.

NEW PARTS FOR OLD--CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb,

CHARLATAN: America’s Most Dangerous Huckster, the Man Who Pursued Him, and the Age of Flimflam by Pope Brock (Crown, Feb, 2008)
Review by Nancy Yanes-Hoffman, THE WRITING DOCTOR, .writingdoctor.typepad.com, email: nywriter@rochester.rr.com, 585-385-1515,

16 San Rafael Drive

,

Rochester

 

NY

 
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        What makes a quack run? What drives a pseudo-doctor, “Dr” John R Brinkley, to practice  quack medicine rather than trying to heal the sick? What makes his nemesis, a power-hungry, AMA quack-buster, Dr Morris Fishbein,  pursue this charlatan for more than 25 years? And what drives countless patients, men and women, “as guileless as the wide-mouthed shad.” to the charlatan’s door for help from whatever ails them?  What turned an era, into “the golden age of quacks”  And finally, is that era it over yet?

          Ostensibly the story of one of America’s greatest quacks, “Dr.” John R Brinkley, Pope Brock’s ironic, witty chronicle of CHARLATAN (Crown, Feb, 2008) is about all the forces, individual and cultural,that contributed to Brinkley’s medical “successes” and finally, his downfall.

         Playing upon the American dream of endless youth, of  “rejuvenation,” (still alive-and-well as America’s favorite pipe dream) Brinkley’s greatest triumphs initially sprung from embedding billy goat testicles into the human scrotum and later even into women’s ovaries.

        But in 1931, medicine caught up with him.  After the Kansas State Medical Board tallied 42 countable deaths at Brinkley’s hands, with untold numbers of deaths after patients left Brinkley’s “hospitals,” it revoked his medical license. At the same time, the Federal Radio Commission, revoked his radio license. Undaunted, Brinkley ran for governor of Kansas—and almost won. His campaign pioneered airplane whistle-stops all over Kansas aided and abetted by radio promotion. In case you hadn't noticed, these innovations are still alive and kicking today.

         After the licenses' revocations and the loss of the governorship,Brinkley got the Kansas message. He moved to Texas. In Del Rio, Texas on the Mexican border, he built a mansion fit for a charlatan and a hotel-like “hospital” for prostate surgery patients. Ever the innovator, he used Mexican-based radio to promote himself and his medicine.

         And he made money. Lots of money.  He charged $750 for “gonad surgery,” but his fee for prostate surgery was only $250 a pop. Always, it was cash on the barrelhead—before the operation—just as present-day surgical offices insist on insurance cards and co-pay before the visit.

          Money made money. He bankrolled “Border Blasters,” his high-potency radio shows emanating from his million-watt station, XERA, in Villa Acuna, Mexico into the most powerful station broadcasting on American air waves. Patients heard and flocked to Del Rio for glandular injections—and later, bargain-basement prostate surgery.

         One of XERA’s claims to fame was Brinkley’s Medical Question Box. Listeners sent in letters detailing their health problems. Brinkley prescribed treatment bought from pharmacists hired to kickback percentages of sales. Something like Senator Bill Frist’s long-distance diagnosis of  Terry Schiavo’s problems. As the song goes, “ainsi c’est toujours le meme chose.”

         Del Rio was good to Brinkley. During his five years of broadcasting and prescribing, he pocketed about $12 million. But in 1938, another Del Rio doctor began stealing Brinkley’s thunder by selling the same operations for a lower fee.

          So Brinkley moved to Little Rock, Arkansas in 1938. But Brinkley's Midas touch had become tin. Things were going wrong. In 1939, he lost a libel suit against his obsessed Ahab, Dr. Morris Fishbein. Not only was Fishbein the longtime editor of the American Medical Association (JAMA) and AMA president, but he was an equally egotistical firebrand, who had spent much of his professional life committed to bringing Brinkley down.

          Brinkley’s testimony inadvertently helped Fishbein’s case. On the stand, Brinkley admitted that his surgery was something like a vasectomy. Further, his celebrated Formula 1020 for rejuvenating male desire and performance was only dressed-up colored water.

          After Brinkley lost his appeal, the judge  accused him of being “a charlatan and a quack in the ordinary,well-understood meaning of the words.” Hearing this, disgruntled patients filed civil suit after civil suit. Down on his luck, declaring bankruptcy in 1941, Brinkley was indicted for mail fraud. With the suits pending and dogged by ill health, Brinkley died alone of a blood clot in 1942.

          What made Brinkley run? CHARLATAN, despite its wondrously deft insights isn’t sure. Whether greed alone powered his engine or a healthy (word used inadvisedly) dose of egotistical narcissism fueled his exploits remains unknown. In fact, what made Fishbein run? Fishbein was so much a mirror image of Brinkley—albeit law-abiding and medicine-upholding—that the two were American medical twins.

        If Brinkley himself was dross, CHARLATAN is gold. Brock’s history of American medicine’s feats and flaws, achievements, anecdotes, and trickery invites the reader to compare medicine then with medicine now. In one of the many nuggets of little-known Americana sparking his tale, Brock reports that more than 400 of the 526 radio stations accepted no advertising because “Radio Czar Herbert Hoover, the secretary of commerce, declared it ‘inconceivable that we should allow so great a possibility for service to be drowned in advertiser chatter.’”

February 20, 2008

FIGHTING THE GOOD FIGHT: CANCER ON $5 A DAy**(CHEMO NOT INCLUDED): HOW HUMOR GOT ME THROUGH THE TOUGHEST JOURNEY OF MY LIFE by Robert Schimmel with Alan Eisenstock

CANCER ON $5 A Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life by Robert Schimmel with Alan Eisenstock (DeCapo Press, Lifelong, Perseus Books, March 15th, 2008).

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com, 585-385-1515.
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         “If you live long enough,” my father used to say, “a little rain has to fall on your parade.”  But it wasn’t a little rain that hit Robert Schimmel, the cheerfully bawdy, stand-up comedian. It was a tsunami. Actually, not one tsunami, but four (so who’s counting?).

         In one decade, Schimmel’s beloved son, Derek died of a brain tumor; a heart attack hit Schimmel when he wasn’t looking; and his 22-year marriage with his first wife, Vikki split acrimoniously. Finally, cancer sidelined him on the cusp of a big break in his career.

         Yet, Schimmel managed to keep his head above water and move on. Struck by stage-three non-Hodgkins lymphoma, he hit the treatment trail head on.  Though cancer is no laughing matter, Schimmel tried to make a joke—or several jokes—about what even he admits was “the toughest journey of my life, ” which he records in his brave new book,CANCER ON $5 A Day (*chemo not included): How Humor Got Me Through the Toughest Journey of My Life (DaCapo press, Lifelong Books, Perseus Books, March 15th, 2008).

         As Alan Eisenstock, Schimmel’s co-author observes, “Cancer gave Robert Schimmel more material to write about. But it also gave him more heart. The disease made him see the world through wider, wiser eyes. He became more patient, more resolute, and more conscious of the power of the moment…cancer taught him how to love what he has…and his gift, making people a laugh; to love every day he’s alive.”

        With cancer as their ill-gotten muse, Schimmel and Eisenstock wrote CANCER ON $5 A DAY. Their mission, they say, was to cheer the spirits of everyone—and anyone—fighting “the Big C.”

        Although Schimmel is one of Comedy Central’s 100 Greatest Comics, and although the publisher says that “he keeps us laughing by riffing” about all the battles engendered by fighting cancer, his book is actually not funny. Instead, it’s a tribute to the resilience of the human spirit when it refuses to give up.

         Aiming at the jokey side of cancer (if such there be), Schimmel reports on the ironies of cancer's travails, peculiar events like a wig salesman trying to sell him wigs for every spot denuded by chemotherapy (yes, every spot). He can’t get over his overwhelming desire for sex during chemotherapy. “Feeling horny,” says Schimmel, “is life-affirming.”

         But cancer’s dark night of the soul keeps breaking into the tale of his long, stormy treatment. So, too, does Schimmel’s predilection for erasable, deletable (not delectable) adjectives, which might make his journey a less appropriate trip for some cancer veterans.

         Raw language or not, Schimmel’s courage is inspiring.  For CANCER ON $5 A DAY aims at making cancer victims believe that “Schimmel got through it. Maybe there’s a chance that I can make it, too.” Of course, there are no guarantees.

        But Schimmel maintains,. “It’s those things that define who you are. That was Job’s test. Flee or fight. I chose to fight.” CANCER ON $5 A DAY is an invitation to the fight with no holds barred.

February 17, 2008

SUFFERING ISN'T LIMITED ONLY TO MAINE: A HEALING TOUCH: TRUE STORIES OF LIFE, DEATH, AND HOSPICE ed by Richard Russo

A HEALING TOUCH: TRUE STORIES OF LIFE, DEATH, AND HOSPICE, ed. Richard Russo (Down East Books, April, 2008)

Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, at www.writingdoctor.typepad.com, nywriter@rochester.rr.com

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The impulse behind A HEALING TOUCH: TRUE STORIES OF LIFE, DEATH, AND HOSPICE, ed. Richard Russo (Down East Books, April, 2008) is salubrious—or as salubrious as tough times will permit. Its purpose is to awaken long and short-term sufferers of chronic and acute illness—and their caretakers—to the help, the surcease available from hospice care.

In its pages, Richard Russo and five other writers from Maine depict the dark worlds of individuals beset by the demons of death and disease. The stories vary from parents attempting to recover after their son’s sudden death in an auto accident to a couple trying to live with Alzheimer’s disease's depredations.

The skills of the authors also vary, with Russo's writing leading their ranks. Still, their messages are the same. They show how smart Socrates was (actually, nobody except his son ever doubted Socrates's brain power) when he said, “Count no man happy until he’s dead.” Each tale shows people flourishing only to be cut down by the evil spirits lurking on the edges of life.

This little book hones in only, albeit nobly, on the Hospice Volunteers of the Waterville (Maine) Area. The proceeds from its sales will go to the Waterville Hospice. As such, it serves the world of an individual hospice in Maine. It even seems to be a marketing tool for this specific hospice.

But tragedy doesn't limit itself to Waterville, Maine. The rest of us sufferers and caretakers  who live outside Waterville’s gray skies, may find A HEALING TOUCH’s focus too narrow to offer us the helping hand we crave. The possibility of awakening non-Maine dwellers to the varieties of surcease offered by their own local hospices is then regrettably limited.

It might be worthwhile for Down East Books to consider publishing a companion volume along these lines. Such a book would include other hospices and writers from all over the country. Individuals everywhere who have been victimized by life’s depredations could then find resources and support that they need so badly.

Meantime, readers of A HEALING TOUCH may unearth suggestions about where to find help from their local hospices. We hope so.

February 10, 2008

IT'S NOT SUCH A SECRET: THIS COMMON SECRET: MY JOURNEY AS AN ABORTION DOCTOR by Susan Wicklund (New York: Public Affairs, Jan, 2008)

Susan Wicklund. THIS COMMON SECRET: My Journey As An Abortion Doctor (New York: Public Affairs, 2008) Review by Nancy Yanes Hoffman, THE WRITING DOCTOR, www.writingdoctor.typepad.com, www.nyhwriter.com, nywriter@rochester.rr.com 585-385-1515

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There’s an election going on (in case you hadn’t heard). Listen to Obama and Clinton, even to McCain and Huckabee perching restlessly on the cusp of the presidency. But with all their talk about CHANGE vs EXPERIENCE, what do they think when nobody’s listening? What will they do if elected? Does anyone except McCain, Bush's "true conservative," whisper a word about ABORTION? About stem cells? Or, perish the thought, about the Supreme Court repeatedly eroding Roe vs. Wade, as it "celebrates" its 35th birthday?

Yet at least 40 percent of American women—voters all--have had an abortion. Nobody talks about it although abortion is more commonly performed than tonsillectomy or pulling wisdom teeth.

Dr. Susan Wicklund’s memoir of her life, THIS COMMON SECRET (New York: Public Affairs, January, 2008), reveals the huge sacrifices demanded by her life as an abortion provider  As an innocent high-school graduate, Susan Wicklund began her fight in the abortion battles reacting against the cruelty of in her own abortion provider. Whenever the young Susan asked a question, the doctor replied, “Shut up!”

Ever after, she couldn’t shut up. She resolved to provide better care for other women in the same boat. Somehow, this feisty young girl, "poor as a church mouse," managed to become a midwife, go to college, obtain her M.D., cope with an internship's rigors, and open a general practice.  All this, while caring for her only child, Sonja.

THIS COMMON SECRET bursts with stories of Wicklund’s life (“Call me Sue,” she instructs patients) and the lives of her patients of all ages, religions, classes, backgrounds. The abortion barricades fill its pages: protesters’ omnipresent intimidation and violence stalk her. Her daughter needs a police escort to go to school.  The protesters scream imprecations at women coming to her clinic. They follow Dr. Wicklund to the airports where she travels endlessly from one remote Western clinic to another.

But she never gives up, never shuts up. She talks to, listens to every woman coming to her distant clinics. If a woman is ambivalent about abortion, if it seems she is doing this because other people are coercing her, Wicklund advises her to wait and be sure before she goes ahead.

Nonetheless, she makes a case against the 24-hour waiting period, the rules about obtaining parental consent, the Supreme Court’s increasing restrictions. The Court asserted that government  needs “to protect women from their own decisions.” This from a Court and a political party ostensibly devoted to interfering less in people’s lives.

Wicklund particularly fears “professional protesters, "mostly men, for whom protesting is a full-time obsession. They target different regions in the country or particularly vulnerable clinics. They bring their hate-filled slogans, their planes that fly over towns and cities pulling banners depicting bloody babies, their confrontational tactics. When they come to town, I wear my bulletproof vest and carry my gun. Unfortunately, their views have infiltrated the laws and policies of our country and the lives of my patients.”

Wicklund’s life is devoted to her patients, her own choices in the war over choice. But fighting battles for women deserving the right to safe, legal abortions has been enormously costly.. The prices she paid—and those paid by people she loves and who love her—were and are egregious. Depicting them honestly, she admits her losses, without regret.

Abortion protesters have been increasingly successful in corroding women’s rights. Between 1982 and 2000, the number of abortion providers has dropped 37 percent from 2,900 in 1982 to 1,819 in 2,000. The “graying of providers,” 60 percent are older than 50, is a serious problem. Even Dr. Wicklund, now 53, had to close her abortion clinic, the only one in Montana, to help care for her ailing parents.  Lonely and alone, fighting the abortion battle, takes its toll.  Wicklund sounds as though she, too, is suffering from burnout.

Worse yet, medical schools, like politicians, are simply not addressing these trends. “Most physicians are graduating with little more than circumstantial knowledge of abortion,” reports Medical Students For Choice (MSFC.org), an organization of 10,000 medical students. trying to “stand up in the face of opposition, work to destigmatize abortion provision among medical students and residents, and persuade medical schools and residency programs to include abortion as a part of the reproductive health services curriculum. “ MSFC aims at “training a new generation of pro-choice doctors in leadership, advocacy, and organizing skills.”

THIS COMMON SECRET should be required reading for medical students, residents, patients (aren’t we all),families, and politicians waving their election flags. That’s pretty much all of us.

February 03, 2008

THE SEARCH FOR THE FATHER: MY FATHER'S HEART by Steve McKee

         “A man,” said Freud in Mourning And Melancholia, “doesn’t become a man till his father dies.” But as Wall Street Journal reporter Steve McKee tell his father’s story—and his own--, he does not become a man until he wrote My Father’s Heart (Da Capo Press, Perseus Books, January, 2008) nearly 40 years after his father’s death.

          Steve McKee’s father “dropped dead,” as they call it, in 1969, when Steve was 16 and his father was only 50. Ironically, he and his father had just finished watching “The Immortal,” a television movie about a man whose blood gave him immunity to disease, including heart disease. After that, another medical show, “Marcus Welby, MD” was beginning.

         These medical televisionaries were no help to John McKee, Steve’s father. “A heart attack slammed him off the back of the couch while we were watching television.” As simply as that. Days before, a doctor’s checkup had “declared him fine.” Nothing new here. The family’s cardiac curse had killed all the McKees in their 40s or early 50s often after a doctor’s verdict had announced a clean bill of health.

          When Steve told his sister Kathy that he’d finished the book about their father, “Kathy let a short silence hang between us on the phone. ‘I hope,’ she finally said, ‘I hope that when you’re done with this that you’ll like Dad more and think better of him...And I hope you can forgive him for dying when he did, and the way he did.’”

          McKee quickly changes the subject. He reports that 80 million Americans have some form of cardiovascular disease, that 325,000 individuals “will die from what is termed ‘out-of-hospital’ or ‘emergency room’ sudden cardiac arrest.” 

          Repeatedly he joins statistics with the personal adding, “the classic heart attack of popular lore, just like Dad’s on September 30, 1969.” Again and again, McKee says, “It was just the two of us at home that night. He was fifty. I was sixteen,” a fact he cannot get over as he tries to figure out how and why his father had to die.

         In McKee’s search for the father, for finding out who his father was and by extension who he is, the son left behind,  he tries to learn why his father did so little to prevent his second heart attack  He portrays his father as a chain-smoking, hard-drinking, job-hating Type A, reminiscent of Willy Loman in Arthur Miller’s Death of a Salesman. It seems to the son that the father gave up the fight after his first heart attack. But why?

        Again and again, pegging statistics to the personal, McKee reminds himself  that every heart attack happens to a someone who is a husband, a wife, a father, a mother, a checkout clerk, or someone at the gym…”The lives and then the deaths of every one of these people will affect millions, millions, millions of others…. I know. It happened to me. It is the story I’ve been writing all my life. The father leaves; the son remains.”

        Why does it take McKee almost four decades “to finish the story I have been writing all my life. Finally.”? He has to grow up --and older--before he can forgive his father for dying. He has to learn on his own flesh how little his obsessive self-discipline and exercising did to avert the evil decree. Until he recognizes his genetic complicity, until he sees that he never knew his father—and his father didn’t know him, he can’t forgive his father for dying—for leaving him to learn on his own.

         Once he is older than his father was when he died, he can come to grips, at least partially, with his father’s death.. Early on, his coach tells him, “Your father just died and you will never get over it…but you will get used to it.” Kind as the coach may have been, neither Steve McKee nor the rest of us who lost a father to a sudden heart attack, ever “get used to it.”  McKee says of his father’s witnessing his own father’s heart attack, “Maybe Dad never got used to it.”

          My Father’s Heart rambles. The writing sometimes lapses into unfortunate, everyday Buffalo-York vernacular. But when the story returns to McKee’s father, to his empty life, his early death, to what his death has taught Steve McKee, the writing tightens and reaches out poignantly across the page.

         In writing about his father’s heart after learning that he, the son, is also a prisoner of heart disease, McKee finally realizes that his father’s death gave him life and taught him how to live. “The night I watched Dad die, I watched me die, too. My life began the night his ended. Learn from me, he said. And so I did. I have become who I am because of him…And I am alive.”

         This book, “an attempt to share the memory of my father,” helped Steve McKee grow up. As My Father's Heart ends, Steve McKeee can run a five-kilometer race with his adopted son Patrick. Freed from the McKee curse, Patrick is a victim of juvenile diabetes. Patrick's diabetes taught Steve "we are who we are, whoever that is."

        As they race together, McKee rejoices, “Father and son, shoulder to shoulder.” My Father's Heart may be the talisman keeping Steve alive to race into the future with his son.

January 25, 2008

JUDAH FOLKMAN, ANGIOGENESIS PIONEER, IS GONE

Judah Folkman was too great a human being, too generous-spirited a physician, too humane a man, too brilliant a creative researcher in the field of angiogenesis and anti-angiogenesis for www.writingdoctor.typepad.com to let his death go unremarked on our pages.

Only 74, Dr Folkman was working on his computer in the Red Carpet Lounge of the Denver airport while waiting for his plane to Vancouver, where he was scheduled to give one of his unforgettable lectures. Suddenly he keeled over and died of an apparent heart attack.

He lived a long life--but not long enough. The son of a Reform rabbi in Columbus, Ohio, Judah Folkman went to Ohio State University when he was only 16 years old. There, he became the protege of Dr Robert Zollinger, an old-time surgical great. When he told Dr Zollinger that he wanted to go to medical school and become a surgeon, Zollinger put him in his surgical lab to do surgery on animals.

"You don't become a painter when you're 21," snorted Zollinger. "You don't become a composer when you're 21. You begin honing your skills when you're very young. And that's the way it should be with you and surgery."

So Judah Folkman began doing surgery in Zollinger's lab when he was 16. Four years later, when he applied to Harvard Medical School, Zollinger sent Folkman to Dr Francis Moore, the eminent chief of surgery at Boston's Peter Bent Brigham Hospital for an interview. Moore took Folkman into his lab and watched him operate on the animals there. Within minutes, Moore called the admission office to say, "Accept Folkman to the school. Now."

Thus, began his 40 years in Boston. Eleven years after begin graduated from Harvard Medical School in 1957, Folkman, at 34, became its youngest Professor of Surgery and Chair of the Department of Surgery at Boston's world famous Children's Medical Center. Director of the Vascular Biology Program at Children's Medical Center, Folkman's innovative research and unyielding determination led him to found the fields of angiogenesis and antiaangiogenesis despite the nay-saying of other physicians discounting his early theories.

His work on angiogenesis and antiangiogenesis lead to the development of many drugs that have saved the lives of patients with cancer and restored the vision of people with degenerative retinal diseases. Many cancer survivors are alive today, many victims of retinal disorders can see today because of Dr Folkman's dogged research and creativity.

But what the patients remember best is the kindness and communication of his patient care. He was always available, never cut patients short, listened, listened, and listened, and then advised and followed through afterwards. Dr Folkman found no detail too small, no chore too great a burden. He was never too busy for anyone's questions or problems.

Even though Judah Folkman had been on the short list for the Nobel Prize for several years, death beat the Nobel Committee to the punch.

We shall not see his like again. We can only hope that the countless medical students, residents, and researchers throughout the planet who were mentored and inspired by Judah Folkman, the man, and Dr Folkman, the great medical visionary and research activist, will burnish his memory by following in his very big footsteps.

January 23, 2008

Buying a Cure--What Business Know-How Can Do for a Disease--Jerome Groopman, NEW YORKER, 1-28-08

Check out Jerome Groopman in Jan 28, 2008 New Yorker on Kathy Giusti's organization. "Buying a Cure--What Business-Know-How Can Do for a Disease. It's an inspiration--as is most of Groopman's writing.

January 22, 2008

The Writing Doctor Changes Her Tune

So much medicine, so much health care, so many people sick, so many people offering advice. So-oo, the Writing Doctor has decided to specialize. From now on, we will only be reviewing books about medicine, be they by physicians, medical students, interns (see our latest offering), patients, and possible patients, which includes all of us.

If you're an author, a publisher, or a veteran of illness, send us your book for review ASAP. Be sure to include the pub date and any and all pertinent info about the author, the book, and what it will mean to the reading public.

January 19, 2008

Doctor's Baptism under Fire: Sandeep Jauhar's INTERN: A Doctor's Initiation (Farrar Straus Giroux, Jan, 2008)

INTERN: A Doctor's Initiation by Sandeep Jauhar (Farrar, Straus, Giroux, Jan, 2008) Review by Nancy Yanes-Hoffman, www.writingdoctor.typepad.com, www.nyhwriter.com, nywriter@rochester.rr.com, 585-385-1515, NYH Communication Group, 16 San Rafael Drive, Rochester, New York 14618

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         By what magic alchemy is an ambivalent, doubting, overworked, overwhelmed , guilt-ridden, exhausted, experimental physicist--complete with a doctorate in physics-- transformed into another sort of a doctor--a practicing physician? How do we who will all be patients someday, no matter how much we try to escape our fate, define a doctor? What do we expect from him or her? How do they live up to our expectations? How do they fail us? How can doctors and patients break down the wall between them?

          What does the boot camp known as “internship”-- or more recently as “residency”-- do to change fourth-year medical students into thinking, practicing, deciding, questioning, questing doctors? How can we ascertain which doctors will be there when we need them to do the best they can for us?

          In 21 chapters pairing medical anecdotes with crucial questions about his own medical journey, Dr. Sandeep Jauhar’s INTERN: A DOCTOR'S INITIATION (Farrar Straus Giroux, 2008) traces the brier-strewn path of his painful initiation into medicine’s rigors. In these 21 chapters, he achieves a medical adulthood, characteristic of 21 years of  growing up into a man and a doctor.

          The book divides into three sections. ”Switching Horses” incorporates Jauhar’s leap from quantum physics, a “hard” science, to medicine, not always a science, but still much harder to serve than physics' research. “Cracking Up” depicts his near-drowning in the slough of his own physical disease and psychological despair. Finally, “Reconciliation” records the tormented young doctor, Lazarus-like, somehow learning to compromise and cope with the demands and vicissitudes of the medical “culture.”

           Dr. Jauhar covers a lot of bases that most  medical students, interns, and yes, attending physicians might be unwilling to recognize, admit, or try to change. As an example, he talks about “informed consent,” that myth governing our decisions no matter what the choices, healthy or sick. For how can we ever be adequately informed about consequences of our decisions—especially when we’re sick?

           In some ways, medicine, but particularly internship as Dr Jauhar depicts it, is a crap game where the dice are always loaded against the players. For patients differ. Age, sex, desire for life, yearning for surcease all play a role. Doctors differ in their ability, willingness, or unwillingness?—to understand, to communicate, to care.  The Jauhar brothers differ in their attitudes toward medicine and patients. Time is the eternal enemy. Its winged chariot always ready to abandon a telling detail, hurry by a last word that might push the hapless patient into a waiting grave.

           For whom did Dr Jauhar write this book? “My hope," he writes, “is that readers, on their own journeys—many of them in the medical profession—will draw lessons and perhaps even inspiration from my experiences (which) will be especially relevant to medical students preparing to make their own forays into the hospital.” Perhaps. But Dr Jauhar’s strengths and weaknesses differ markedly from those of many other green residents. Struggling with his own limitations, his sharp-eyed observations, and the fierce strictures “of the strange new culture I found myself in,” he  feels “buried in a waking hell of my own (and others?) expectations.”

           What about patients? How will they react to Dr Jauhar’s stories? The chaos and indifference he depicts is frightening. Early on, another intern remarks of their teachers: “It’s strange that all week they’ve hardly mentioned the patients….These are the people we’re going to be learning on. It’s like they’re already invisible.” Looking back, Dr Jauhar comments “I don't think the tales should frighten patients--just make them more aware of doctors' fallibility and the importance of advocating for themselves.”  But his memoir of a young doctor coming to terms with his own inadequacies and those of his profession does not show patients how to find an advocate somewhere in the greyly echoing, antiseptic corridors of a hospital.
       
            INTERN focuses on the growth process of an individual intern. Occasionally it touches too lightly on points that deserve far more attention.  The discussion of the "Night Float” notes that “errors due to faulty transfer of information are at least as frequent as those due to fatigue from being on call overnight." True. But it's worth examining that argument in the light of the current trend in staffing with "hospitalists." The myth of Informed Consent deserves more details on Jauhar's concept of "soft" vs. "hard" paternalism.

            The second edition deserves a glossary, showing the nuances of such ugly, house officers’  slang as "gomer." One of my least favorite words in the language, “gomer” means “get out of my emergency room,” but it is never defined in terms of the barriers between patients and doctors. Even a word such as DNR isn’t defined for the non-conoscenti.
       
            Dr. Jauhar has taken many controversial stances in his articles for the NY TIMES, many of which are chapters in his book. Medicine should be all the better for it. Interestingly, the book—and the man--change in the middle when he becomes sick and learn how a patient feels. Something happens.  It's as though the doubting Thomas (or Sandeep) begins to compromise his high ethical standards with the exigencies of day-to-day medical pressures.

             His mentors grade his development. “Residents were judged in seven categories: clinical judgment, medical knowledge, clinical skills, humanistic qualities, professional attitudes and behavior, medical care, and overall clinical competence. The ratings were on a scale from one to nine plus written descriptions for each scale like “indecisive in difficult management situations” or “reasons well in ambiguous situations,” ”pedestrian diagnostic ability,” “establishes sensible differential diagnoses””not giving into the urge to put down patients.” Scoring sevens, eights, and nines, he is pleased even though most patients would want a solid nine-point scorer.

         INTERN stops short after the internship. It doesn’t include Jauhar’s specialty training in heart disease at Bellevue or what’s happening now that he is in practice specializing in heart failure. It doesn’t compare doctors’ personalities. The differences between Sandeep, the thinker, who treats heart disease medically and his brother, Rajiv, the activist doer, an invasive cardiologist at the same hospital are worthy of Sandeep's analysis.

         A missing last chapter should have reflected  on the man he became as a doctor. It needs to expand on his introductory assertion that “so much about medicine still troubles me; sometimes I still want to muddle through things; sometimes I’m still not sure cardiology was the right choice.” In other words, where is he now?

         Caveats aside, having experienced Sandeep Jauhar’s baptism under fire during his internship, wondering medical students, worried doctors of all ages, and strong-stomached patients can only hope that Sandeep Jauhar is saving this material for another book. With all his energy and his sharp-eyed perspectives, he ought to be hitting his computer soon.

December 20, 2007

Not Such a Hot Meal: FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) by David Cay Johnston (Portfolio, Dec 27, 2007)

December 20, 2007

Not Such a Hot Meal: FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) by David Cay Johnston (Portfolio, Dec 27, 2007)

FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill by David Cay Johnston (Portfolio, December 27th, 2007)
Review by Nancy Yanes Hoffman, www.writingdoctor.typepad.com, nywriting@rochester.rr.com.
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         “The rich,” said F. Scott Fitzgerald, the Roaring Twenties’ chronicler of corruption, “are very different from us.” Now,  80 years later, David Cay Johnston’s brilliant new book, FREE LUNCH: How the Wealthiest Americans Enrich Themselves at Government Expense (and Stick You with the Bill) (Portfolio, December 27th, 2007), demonstrates how much the richest of the rich are different from you and me.

          Yes, “They have more money,” as Hemingway, unimpressed, replied to Fitzgerald.  But Johnston, Pulitzer Prize-winning tax expert of the NEW YORK TIMES and Rochester resident, makes clear how much  money the super-rich steal from the rest of us--and what they cost us. Addicted to money, the rich buy themselves ever-bigger chunks of political power--and we must pay the bill.

         Who are these super-rich? How do they fill their already bulging pockets? In 2005, 300,000 individuals, constituting the top tenth of the top one percent of Americans, had incomes greater than the poorest 150 million Americans struggling to make ends meet at the bottom of the economic pyramid. The much-squeezed middle class--you and me?-- squirm between them. Our pockets are increasingly empty, picked by political and corporate grabbers to make the very rich even richer. The poor, middle classes, and even the moderately rich (the group that my mother called “comfortable”) have neither hors d’oeuvres nor a place at the super-rich’s free lunch buffet. Never sated, the super-rich think their billions aren’t enough.

          Feeding the ever-hungry super-rich at the campaign finance table  takes a high-powered team. More than 35,000 lobbyists crowd Washington’s K Street. They act as free lunch’s waiters, sommeliers, and maitre-d’s.  This horde of lobbyists doesn’t act alone. They require chefs--politicians all-too eager to serve access and influence to the highest bidder.  Without their connivance—and contrivance, there would be no free lunch.

         Johnston reminds us how Ronald Reagan asked prospective voters  “Are you better off now than you were four years ago?” Their resounding “no” elected Reagan. Three decades later, the bottom 90 percent of Americans, Johnston’s “vast majority,” living models for Edward Hopper’s paintings, must answer with another  “NO.”  “Getting by on about $75.00 less each week than it did a generation earlier,” their annual income continues to skid downhill.

         With the economy flourishing--at least ostensibly, what happened to everybody at the bottom of the pile?  “Where,” asks Johnston, “did all the money go?”  It went to the top, where super-rich money usually goes. Ready to be skimmed, it soared into corporate profits, options, CEO’s salaries. It went to the top tenth of the top tenth of Americans (got that?). Their portion of the economic pie was the greatest since 1929, just before the Twenties stopped roaring and fell flat.

        In its rampantly unequal distribution of unbridled wealth, Johnston finds the United States unlike its democratic colleagues, Canada, Europe, Japan, Australia, and New Zealand. Our wild concentration of money at the top follows in the footsteps of three major nations: Russia (yep, Russia), Mexico, and Brazil. Like us, these countries have an explosively burgeoning class of billionaires at the top mirrored by an even more explosively growing poor class and an increasingly stressed—and downwardly spiraling middle class.  Even though “these four countries are societies in which adults have the right to vote,” says Johnston, “…real political power is wielded by a relatively narrow, and rich segment of the population.”

         Johnston, a Socratic gadfly, makes the case for restoring old-fashioned rules, which “define a civilization.” For “Without rules, there is no civilization…Wherever the world has civilizing rules based on some moral or practical principle, we see prosperity and freedom.” But the rule book has changed. At least, in this country: “In America, the long expansion of who plays a role in deciding the rules has ended. The base of influence has begun to contract. In part, because of the campaign finance system, which transfers power to those who donate and who steer donations.”

         Selling power to the highest bidder invites abuse: “To those who lust for power, of what use is acquiring power unless they can abuse it? …The philosophy of the power monger is no different from that of the cancer cell, which mindlessly seeks growth for the sake of growth until it overwhelms its host.”

         Johnston is a great phrasemaker. His supporting cast covers the waterfront from Aristotle, Plato, and Virgil,  to Jeremiah, Adam Smith, John Locke, and the Founding Fathers.  Every page brims with quotable lines: “Karl Marx never envisioned commercial sports as the opiates of the masses.” “Cheating, like pregnancy, is not a halfway condition.” In “Selling the Furniture of Modern Society,” Johnston seeks solutions to where the money goes, “Instead of a Whodunit, this one is a Whogotit.”

          FREE LUNCH is replete with nauseating examples of political sales crying out for moral Prilosec—or better yet, Ipecac. Johnston indicts governmental actions that deliberately enrich irresponsible corporations and individuals. He arraigns the rich for steering American jobs to less expensive workers in other lands. The list of corporate, individual, industrial predators is endless: HMOs, big Pharma, “Goldman Sachs, Lehman Brothers, MBNA, Citibank…exploit the poor, the unsophisticated, the foolish”; Donald Trump, Warren Buffett, Steve Jobs, John Snow, Kennie-boy Lay, George Steinbrenner (before the Mitchell Report on steroids), Mike Keiser, builder of the most expensive golf courses in America, Tom DeLay, Dennis Hastert, Thomas Scully (head of Medicare), Bush, Cheney, and their minions, the golden parachutes of Jack Welch and Bob Nardelli, and a host of followers.

          After all that, what can we do? How can we get the country back on track? Tellingly, FREE LUNCH contains 26 chapters accusing the super-rich buyers and political sellers of stealing the power rightly belonging to the rest of us. Yet only one chapter details what we might do to stop free lunches for the super-rich and anyone else pigging out at the trough.

          Still, Johnston has faith in arousing Americans to participatory democracy. In both PERFECTLY LEGAL: The Covert Campaign to Rig Our Tax System to Benefit the Super-Rich—and Cheat Everyone Else and FREE LUNCH itself, he argues that we have a moral obligation to be active members of society.  He urges us to remember that “when they invented taxation based on ability to pay, they invented democracy…We are not the United States of Me or the United States of You. We are the United States of America. We are a society.”

          Apparently worried that Johnston's current litany of super-rich political cheating may be a Christmas “downer,” the publisher delayed its release till December 27th.  Yet the timing of this must-read book is perfect. For Johnston’s  call to arms is a great way to begin 2008, to “get us thinking as a nation about how every single free lunch cheats us all (because) in the end, we must be the ones who make our government work, fulfilling the preamble to our Constitution. No one else,” concludes Johnston, “is going to do it for us. Reform begins with you.”

          It’s a tall order, but with FREE LUNCH’s exhortations at hand, we may awaken to ways of proving Johnston right. 2008 may be a better year--because we will finally try to make it so.

November 28, 2007

NBCC RECOMMENDED LISTS OF BOOKS TO READ

We're joining the crowd. We'll be posting the NBCC's Recommended Lists of Best Books to Read.

Take a look, see what PW had to say, then start reading the ones you missed. Send us comments if you'd like. They and you will be welcome. You always are.

PW COMMENTS: "'Bestseller lists just capture what people are buying, not reading. My hope was to create a list to show what people are recommending to each other—saying, ‘you must read this’—which is how books really travel,' said John Freeman, president of the National Book Critics Circle, which, today, launched its Most Recommended List, a monthly list of book recommendations compiled from votes cast by NBCC members as well as famous writers and critics, including John Updike and Cynthia Ozick. Every month, the NBCC plans to poll its membership, as well as many other well-known writers and critics, for their recommendations in fiction, nonfiction and poetry, listing the top five books with the most votes.

"The first list, which is posted in full below, includes many of the usual suspects—such as Philip Roth, Junot Diaz, and NBA winners and finalists Denis Johnson, Edwidge Danticat, Tim Wiener, and Robert Hass—but also a few surprises, like indie press success Out Stealing Horses by novelist Per Petterson, and Next Life by experimental poet Rae Armantrout.

"As far as how the word about the list will get out, according to Freeman, most of the publicity will be online. Powells.com and Amazon.com have agreed to post the list on their blogs, the Academy of American Poets and the Poetry Foundation will post it on their sites, and, said Freeman, “several dozen newspapers will run it," including Star Tribune in Minneapolis, Harford Courant, the Las Vegas Weekly, the Seattle Times, the Alibi in New Mexico, and the Sacramento News & Review.  Also, "some independent bookstores are passing it among their buyers and a few will post it on their sites, and it will appear on blogs of individual NBCC members."

Here is the first installment of the list received 11-28-2007:

Fiction

1) Junot Diaz, The Brief Wondrous Life of Oscar Wao (Riverhead)
2) Denis Johnson, Tree of Smoke (Farrar, Straus & Giroux)
3) Michael Chabon, The Yiddish Policeman’s Union (HarperCollins)
4) Philip Roth, Exit Ghost (Houghton Mifflin)
5) Per Petterson, Out Stealing Horses (Graywolf)

Nonfiction

1)Edwidge Danticat, Brother, I’m Dying (Knopf)
2)Alan Weisman, The World Without Us (St. Martin’s)
3)Noami Klein, The Shock Doctrine (Metropolitan)
4)David Michaelis, Schulz and the Peanuts (HarperCollins)
5)Tim Weiner, Legacy of Ashes (Doubleday)

Poetry

1) Robert Hass, Time and Materials: Poems 1997-2005*
2) Zbigniew Herbert, Collected Poems: 1956-1998 (Ecco)*
3) Robert Pinsky, Gulf Music (Farrar Straus & Giroux)*
4) Rae Armantrout, Next Life (Wesleyan)
5) Mary Jo Bang, Elegy (Graywolf)

*These three titles tied for first place in the poetry category.

November 17, 2007