Tag Archives for Books
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.
