Category Archives for Books
Like what I imagine to be many people’s journey into medical writing, I started with some large, contemporary figures; gaining insight into the physician psyche with Jerome Groopman, and honest appraisals of health systems from Atul Gawande. But I didn’t sit down to read Lewis Thomas until very recently.
Thomas is probably most famous for his essays originally published in the New England Journal of Medicine during the early-70s and collected into a National Book Award winning volume called Lives of a cell: Notes of a biology watcher. But the book I just finished is a memoir entitled The Youngest Science: Notes of a medicine watcher. Memoirs tend to come in two kinds: fascinating and drab. By extending his personal stories into the broader themes of medicine, science and, at times, language, Thomas plants his book firmly in the former. In this way he also manages to make his observations of medical systems and research resonant today. Literally every page is filled with wonderful pearls, so I am going to simply end this with an extended quote that, in poignant and clear prose, demonstrates that the workings of a hospital in 1937 are not so different from one in 2011:
It is an astonishment, which every patient feels from time to time, observing the affairs of a large, complex hospital from the vantage point of his bed, that the whole institution doesn’t fly to pieces. A hospital operates by the constant interplay of powerful forces pulling away at each other in different directions, each force essential for getting necessary things done, but always at odds with each other. The intern staff is an almost irresistible force in itself, learning medicine by doing medicine, assuming all the responsibility within reach, pushing against an immovable attending and administrative staff and frequently at odds with the nurses. The attending physicians are individual entrepreneurs trying to run small cottage industries at each bedside. The diagnostic laboratories are feudal fiefdoms, prospering from the insatiable demands for their services… The medical students are all over the place, learning as best they can and complaining that they are not, as they believe they should be, at the epicenter of every one’s concern. Each individual in the place, from the chiefs of surgery to the dietitians, the ward maids, porters, and elevator operators, lives and works in the conviction that the whole apparatus would come to a standstill without his or her individual contribution, and in one sense or another each of them is right.
And there’s more where that came from. Highly recommended.
What with Christmas only a week or so away, I decided I could dream up a few things I’ve been seeing around lately that would warm my heart and drain some loved ones’ wallets. But hey, we can all dream, can’t we?
Vancouver is a place where you can almost get away without a hat and gloves in the winter, but not quite. Couple that with the fact that we’re all bumbling around with phones that have those pesky touch screens on them and it’s a recipe for disaster. Item one on my list is a pair of gloves that I can use with my iPhone. After shopping around, my favorites are Dots Gloves. In coal. Plus if someone was really nice, they’d get me a copy of that new NEJM app, Image Challenge, so I could quiz some of my expert colleagues during these last few days before everyone leaves on holidays.
Then of course, like everyone, I sorta want an iPad. But not that bad, even though they make magic, according to the New York Times. One thing I do know: that violin app looks awesome. Plus, you could get one of these cases for it. Or for that matter, one of these cases. And not only that, but now your doctor might take one into the operating room, or maybe she will pass it to you to look at X-ray images together. And that might be especially useful this time of year, because what brings people together at the
hospital holidays more than sledding injuries?
I’ve been reading a lot this year, blogs, fiction, non-fiction, you know the drill. The subject of autism has come up recently in the press, especially with the release of that JAMA paper showing correlation with mitochondrial disfunction. Any new study on autism tends to generate a lot of heat, and this one was no different. For that reason, I’m hoping for a copy of The Panic Virus in which Seth Mnookin will lay out the issues, and (we hope) put to shame the strange and dangerous misinformation campaign coming from groups such as Age of Autism.
Speaking of books, I’ll also ask for a copy of The Night Shift by Dr. Brian Goldman. He’s a nice Canadian doctor, with all the honesty, good-nature and competence you come to expect from this great land. This book is filled with excellent and intense stories that sit nicely in the canon of ER-Lit. He followed me on Twitter, so I got his book from the library and got turned onto his CBC radio show in the process. That man knows the power of social marketing. Oh yeah, Oliver Sacks has book out this year, too, if you like that sort of thing (yeah, I do, too.)
I think that’s probably about it for my Christmas list this year. Just some hot chocolate, and some nice time at home with family. I have yet to catch up on some Christmas movie favorites, but there’s plenty of time to get in the spirit of things. Happy holidays.
Stiff was a pretty popular book back in its day (2003 or so) so I’m not going to dwell long on its excellence, which you can read about at length on the back cover. However, I will say that it was quite an enjoyable read, and very touching in a strange way. The cadavers Roach describes move, sag, limp and fester in ways that are unexpectedly poignant. They are infused with new life, though Roach is very explicit about separating the medical cadaver and its scientific importance from the human it once was, or, as she likes to call them, the previous owner.
The uses for cadavers are astounding, and go well beyond the gross anatomy lab of first year medical students. Forensic research, organ transplants and car safety are some of the projects that Roach explains throughout. She highlights some fascinating historical medicinal and scientific uses as well. Lots of it is gross, too, of course, but if you’re reading this, I have a pretty good idea that you can take it.
I was just reading about how some medical students are meeting live patients on their first day of school, instead of the cadavers that med schools typically introduce their first-years to. This is no doubt a good thing. But after reading Stiff, I think it sure would be a shame to see the cadavers of the anatomy lab, and the learning and empathy they can promote, not still have their moment in the sun.
Most of the book seems to be available online through Google, so check out the first chapter and see what you think (if you haven’t already).
The Decision Tree by Thomas Goetz is an excellent call-to-arms for personalized medicine and taking control of the options that you, as a patient, now have in our new era of healthcare. Goetz has an extraordinary ability (honed at Wired Magazine) to parse complicated scientific topics into clear and efficient prose.
He touches on many personal stories, some that have been heard before in medical non-fiction (like an Ashkenazi Jew being tested for BRCA1, the genetic mutation that often leads to breast cancer. An almost identical story is related, somewhat ironically, in one of Dr. Jerome Groopman’s early books, but more on him in a minute). Other stories are newer, and focus on some other possibilities of not only genetic testing but also of self-tracking and patient communities, and this is where the book really shines.
Goetz illuminates many of the technologies that are allowing modern patients track and control their health, such as Nike+, 23 and Me, PatientsLikeMe and many others. He also sheds new light on Weight Watchers and explains, by way of what we know now from other self-tracking programs (and other failed diet regimes), why the Weight Watchers model of “points” and group meetings has been so successful for so many.
The one thing that doesn’t quite stack up is the title of the book itself. It is my hunch that using the “decision tree” metaphor to explain the unique choices that we will all have to face as patients is an attempt to legitimize patient activism by translating it into a scientific and statistical model often used in evidence-based medicine (for an example of using decision trees in evidence-based clinical care, see here).
Integrating patient activism into the paradigms of modern medicine is difficult and requires the eloquence and dedication that Goetz provides in this book. Too often patients still meet the locked doors of the ivory tower. But Goetz does a good enough job explaining the different choices each of his examples faces, that the “decision trees” themselves do not add much to the book; if anything, they consistently struck me as over-simplified pictures of a situation just described in detail. It is vital to know and to learn the ins and the outs of your medical situation in order to assist your doctor in your treatment plan. But whether you jot notes in a book or mock-up your choices in SketchUp seems inconsequential.
It is also important that patients not forget the lynchpins of their care in the face of all these wonderful (but often distracting and sometimes frightening) technological tools: their doctors. I recently came across an excellent encapsulation of this book by @Doctor_V as compared to Dr. Jerome Groopman’s “How Doctors Think.” In it, he sets up the two books as opposite one another; the latter arguing for a golden-age of wisdom handed down by Harvard-trained “Masters of the Universe,” while the former seems to push self-tracking and patient activism so hard that there is hardly for a doctor in your care whatsoever. As a librarian, I’ll now be hard pressed to recommend either one without the other.
This is the strangest fad I had never heard anything about.
Dr. John R. Brinkley was one part politician, one part radio pioneer and several parts mad scientist. Looking for his next swindle to wreak upon the small town of Milford, Kansas, Brinkley stumbled upon the idea (already being tried in Europe by some notable medical pioneers) of transplanting animal sex organs into the human body in order to restore “sexual vigor” and to lengthen lifespan. Brinkley’s midwestern twist? Goats (instead of monkeys, of course).
Brock’s book reads like a bizarre steampunk novel, detailing the strange habits, notions and scientific advances of the 20s and 30s that led to a culture of medicine that would simultaneously accept and reject the notion that implanting animal glands could heal, inspire and “rejuvenate” the human body.
But Brinkley’s journey was not a solitary one. Along with Brinkley comes the parallel story of Dr. Morris Fishbein and the early days of the American Medical Association and its journal, JAMA. Now of course the official body for licensing standards in the US, the AMA didn’t always wield that power. It was the long history by quack doctors like Brinkley that led Fishbein to the landmark case with which Brock ends his excellent tale (and ultimately to their own demise). Likewise, JAMA did not always lead with the latest research articles, but with Fishbein at the helm, it often featured withering critiques of the swindles and quackery running rampant across the United States.
The story Brock weaves in Charlatan is thus the story of two men, Brinkley and Fishbein, and a nation, because in spite of his grotesque abuses, Brinkley was also a pioneer in radio broadcasting (helping to launch the Carter Family from his “border-blaster” radio station, XER; and establishing right-wing evangelical talk radio as an American staple), political campaigning (using a private plane to travel across the state in record time) and pharmaceutical advertising. Brock’s tale is peppered with strange and wonderful relics of the era:
As for the sponsors who made it all possible, they transformed customers’ lives with products like Kolorbak hair dye (which caused lead poisoning), Lash Lure (blindness), Radithor (“Certified Radioactive Water”), and Koremlu, later described by investigators as “a depilatory made from rat poison.” Lysol was touted as “a safe douche.”
In our age of participatory medicine and empowered patients, Charlatan is a wonderful read to remember the times in which it wasn’t always that way, and to remind us all of the importance of just how good (comparatively) we’ve got it these days. For health librarians, the insider’s view of Fishbein’s quest and an early JAMA is enough to keep you reading. For everyone else, the unbelievable quality of almost everything else should keep you entertained.