Out of the Deep I Cry - Julia Spencer-Fleming

The past ripples through time to the present, wherever one is. When Clare Fergusson, Episcopal priest of Millers Kill, melting snow trickling down the embrasure and puddling on the sill of the stained glass window, it's the first sign of impending trouble - the roof of St. Alban's can no longer be patched but must be comprehensively repaired - no mean feat when money's tight everywhere. Her pleas for funding are met by elderly Mrs Marshall, who offers to dissolve the Ketcham Family Trust, created by her mother in the fifties and used until now to fund a health clinic for the poor and uninsured.
As a contemporary mystery - the disappearance of clinic doctor Allan Rouse, perhaps at the hands of anti-vaccine campaigner Debba Clowe - is investigated by Millers Kill police chief Russ van Alstyne, details of a tragedy almost eighty years old begin to emerge; and threaded throughout is the ongoing, deepening attraction between Clare and the inconveniently married Russ, a connection that a brush with almost certain death forces them to acknowledge, and to finally name - love.
Spencer-Fleming packs so much into her novels - i intertwining plots, strong characters, forbidden romance and pitch-perfect dialogue. Deftly woven in are details about Prohibition and other historical accuracies, and she has a keen understanding of human psychology, particularly parental.
The heart of Out of the Deep I Cry, though, is epidemic illness and vaccination - fears about the use of the first antidiphtheria serum in 1924, the wildfire speed with which unchecked illness rampages, the devastating swathe it cuts, the inability of contemporary culture to appreciate this after decades safe from pandemic disease, and the fallacy of a thiomersal/autism connection. The writing is so incisive, clear and evocative that I feel strongly that Spencer-Fleming intended to convey a clear message, one I fully support.
In lesser hands this could have been strident, diminishing the power of the text as a whole. Here, however, it is an integral part of the plot, seamlessly integrated and beautifully conveyed. The passages where modern concerns about the alleged ills of vaccinations are contrasted with strikingly similar (and identically baseless) concerns from over eight decades ago, are subtle and well crafted.
The novel is chronologically layered, so that each time line unfolds with internal linearity but the present is interfolded with the seventies, the fifties and the twenties. This technique allows the precipitating events, some eighty-five years ago, to only slowly emerge, devastatingly exposed almost at the end.
The novel finishes, though, with its engine. The driving heart of the series is the relationship between Russ and Clare, both honourable people committed to the vows they took long before they met. An affair is an anathema to them both, but the measures they've taken thus far have done naught to dampen the mutual feelings of respect, attraction and intellectual pull they feel. I so look forward to seeing where Spencer-Fleming takes them next. - Alex

The Clare Fergusson/Russ Van Alstyne series:
1. In the Bleak Midwinter
2. A Fountain Filled with Blood
3. Out of the Deep I Cry
4. To Darkness and to Death
5. All Mortal Flesh
6. I Shall Not Want

Good Germs, Bad Germs - Jessica Snyder Sachs

In this interesting and accessible tome, subtitled Health and Survival in a Bacterial World, Sachs introduces the reader to the problems of microbial invasion with the devastating story of a young high school footballer who, with ferocious speed, succumbed to overwhelming sepsis from an antibiotic-resistant bacteria. Ricky's story is followed by Daniel's, a young boy with severe and multiple food allergies. What links these stories? They're both consequences of less than a century of attempts to combat microbes - often indiscriminately, even though our lives and well being depend on many germs, and with little thought for potential harm.
Over the next 230 pages Sachs describes the intersection between modern man and mutating microbe, from the evolution of germ theory to revelations about the bacteria (helpful and harmful) that dwell on and in us; from an unhealthy focus on 'hospital level' cleaning to the rise of multi-resistant bacteria; and concluding with three chapters that explore alternatives to the traditional use of antibiotics.
Sachs's meticulously researched work, much of which draws on leading research into an increasingly vital aspect of health, is beautifully synthesised and comprehensive. I was particularly interested in the section where Sachs discusses the evolution of our bacterial colonies over the course of our lives, no two of which are identical. This starts with the way newborn immune systems are boosted by ingesting maternal microbes, from the lactobacilli and bifidobacteria that are created in the mother's vagina and milk ducts respectively, but also from the tail end of her digestive tract:

it's no coincidence, but rather the result of natural selection that a newborn's head typically faces in the direction of its mother's rectum when the head first emerges and remains there until the next contraction delivers the shoulders and the rest of the body.

I was surprised to read of the direct link between high stress and intestinal microbe Bacteroides thetaiotamicron or B. theta, a bug associated with gene switching and possibly with how thriftily an individual metabolises energy.
Though slightly familiar with the hygiene hypothesis, the idea that maintaining an environment as close to germ-free as possible increases autoimmune and reactive disorders, I had no idea of the extent to which this was the case. I learned with interest that the kinds of microbes we're exposed to, particularly early in life, have potential lifelong consequences - children who are exposed in day care to many other children in infancy have dramatically lower rates of type 1 diabetes, while rates of multiple sclerosis and inflammatory bowel conditions like ulcerative colitis and Chrone's disease rise as sanitation improves. Similarly, children exposed to livestock, particularly stabled animals, are markedly less likely to develop allergies. Children are also far more likely to develop allergies and asthma if treated with antibiotics at a young age. And twins are more likely to have depression if their identical sibling has either of these conditions.

I have some knowledge of the growing problem of antibiotic resistance, so that aspect was less surprising to me than others, but I was impressed by Sachs's summation of the evolution of the problem, and the way she was able to convey frustration and impotence in the face of poor prescribing practices despite all physicians knowing the dangers of indiscriminate antibiotic use. Some of the findings Sachs reports, from the discovery of multi-resistant flora in never-hospitalised school children to the revelation that antimicrobial chemical triclosan (used widely in antibacterial soaps and other toiletries) can trip a bacterial genetic switch and trigger drug resistance on microbes never exposed to the antibiotics in question, were fascinating.

Antibiotics are used widely and relatively indiscriminately in agriculture, an aspect of the problem that Sachs thoroughly examines

Though recommendations about antibiotic prescribing are emerging - including the stunning (at least to me) revelation that three day courses of amoxycillin are as effective in treating bacterial pneumonia as the traditional ten day course - the outlook seems fairly dire.

But I was heartened by the research that, rather than just focusing on the next silver bullet antibiotic, is exploring alternatives to antibiotic therapies. I was also interested to read about research examining the possibility of using targeted bacteria to 'vaccinate' against cancers, and the idea of using positive strains of bacteria to outnumber harmful (or even less beneficial) varieties - a technique that may help reduce conditions as varied as dental caries and vaginal thrush.

Although I'm cautious about genetic modification of microbes, it sounds as though safety is a significant concern for researchers, and the boards that oversee them - safeguards include non-reproducible mutations and elements essential to the bug's survival that are not naturally available in that environment, meaning that failing to swish around mouthwash twice daily will kill off the tooth-protecting introduced Strep.

Most of all, I was hopeful when I read in the penultimate paragraph that we may one day aspire not to the death of microbes but "a relationship of symbiotic coexistence" with the flora that are so vital to our lives. - Alex

The Mystery of Breathing - Perri Klass

Neonatologist Maggie Claymore is devoted to her career, to the saving of the youngest and most innocent of lives. Her life is orderly and controlled - she rotates between the clinical service and research, her marriage (to Dan, a doctor she met when they were both medical students) is sound despite their inability to conceive, and they share their home with her best friend Sarah (a medical school drop out) and her two-year-old daughter Penelope.
Maggie likes her life, a far cry from her impoverished childhood to single mother Annalisa. When she receives an anonymous letter that breathlessly accuses her of falsifying information and being dangerous, it comes out of left field. Unable to dismiss it but equally unable to report it, Maggie begins to suspect those around her. As the harassment escalates the author takes up more and more of her time, affecting the way she speaks to people and her concern about the way she's perceived. Then posters start to go up, and the hospital hires an investigator, but the campaign is beginning to affect Maggie in ways neither she nor her nemesis could have predicted.
This could have been a taut, Joy-Fieldesque suspense novel, but Klass (a pediatrician and medical writer) has gone a more literary route. The text combines flash-backs to Maggie's childhood, the occasional flash-forward of (presumably) Maggie's future, and from about two thirds in, scenes from her harasser's perspective, including his/her underlying motivation (very little of which has anything to do with Maggie herself and much to do with what she represents).
The medical details are strong and decisive, even to someone with a health care background, with enough detail to convince without belabouring the point; they're so well integrated that it's clear this is the environment of the author rather than information researched for verisimilitude. The contrast in learning interest between medical students (will this be on the exam?) and interns (will this be something that could help me save a patient's life?) is one such example, and she accurately recreates an insider's perspective of hospital life.
Klass has a sure and decisive writing style that suits her protagonist, and which reminded me somewhat of Chris Bohjalian, though some of that may be the female-medical-provider-under-pressure context.
There are odd light moments from time to time (like the aside that, though Sarah dropped out, their medical school "

sticking by its unofficial motto, Hard to Get In, Impossible to Get Out, did not let her go; they told her that she was on an extended leave of absence, and when the time was right, she could of course come back and finish.

Klass has all too clearly attended mandatory team building workshops where creating Necklaces of Need and Stockings of Support have robbed her of time better spent doing actually useful work - having been there, too, I was impatient as Maggie for those scenes to be over!
Mostly, though, The Mystery of Breathing is humourless and literary. This is not to say that it wasn't compelling or interesting, and I found her analyses of hospital politics, particularly neonatal conflicts (and rules, like the inevitable failure to thrive of multimillion dollar IVF babies versus the irrepressible survival of the unwanted products of casual flings by drug-using minors) were enlightening.
The Mystery of Breathing is a gendered novel - it's no coincidence that both the protagonist and the investigator are women, and the reader is left wondering how the hospital administration would have reacted to a male doctor being similarly harassed. Though, as the perpetrator shies away from acknowledging (but Klass draws out), the preoccupation of women with how they're perceived, of needing to be liked and seen as nice, plays a significant role:

[her tormentor] wouldn't bother sending [ male doctor] the messages that [s/he] was quite sure had helped unhinge Maggie.. would not have been able to explain [the] sense that [he] would be at most mildly perturbed by letters telling him everyone hated him and no one trusted him as a doctor. [He] might be irritated, but on some very profound level, would not give a real big flying fuck

(I apologise for the bracketing, but on the off-chance you read it, the slow reveal of the identity of the poison pen writer significantly ads to the suspense).
I was both involved in, and felt separate from The Mystery of Breathing, and am not sure whether or not I like it, which is always an annoying position in which to find oneself. I certainly found the ending unsatisfying, unsatisfactory and a little disjointed, but that's how you know it's literature. I have another of Klass's novels at home, and though I'll wait a while before tackling the next there's no question that I'll do so before it's due back at the library. - Alex

Better – Atul Gawande

Subtitled A Surgeon’s Notes on Performance, this second collection of essays by the brilliant author of Complications doesn’t disappoint. As he did last time, Gawande explores a range of topical and relevant medical themes, beginning with an individual situation or case, expanding out to encompass the wider aspects of the issue, then bringing it back to the starting point. Each section articulates an aspect of good practice and positive deviance – the qualities that distinguish an ordinary practitioner from an extraordinary one.
Gawande’s exemplary qualities are Diligence (“both central to performance and devilishly hard”), Doing Right (the issues and conflicts that arise as a consequence of being a flawed human being), and Ingenuity (“a willingness to recognize failure… and to change.It arises from deliberate, even obsessive, reflection on failure and a constant searching for new solutions.”). Each section contains a number of thematically-connected essays that between them cover topics as wide ranging as the problems of hand washing in hospitals, the participation of health care professionals in applying the death penalty, medical litigation, and what separates a good cystic fibrosis service from a great one.
Gawande writes in an accessible, lucid and vivid manner that appeals as much to lay readers as health professionals. Tags and annotations distort my copy, because I found something valuable on almost every page – he articulates complex matters clearly and concisely, illustrates the macrocosm of medicine with vivid personal stories of individuals, and left me inspired. He is also refreshingly honest about his own failings, as an intern (in the introduction) and practitioner (particularly in the opening essay, about the difficulty of translating the acknowledged importance of vigilant hand washing into action). A valuable companion piece to How Doctors Think in terms of medical philosophy, Better should be required reading for all undergraduate medical students, as well as anyone who wants to write in the health care field. - Alex

Fat Politics - J Eric Oliver

Subtitled The Real Story Behind America's Obesity Epidemic, Oliver methodically and convincingly argues that the biggest issue with obesity is the panic rather than any health problems directly associated with being fat. As he states int he introduction, this is not the book he intended to write - a political scientist doing post-doctoral work, Oliver decided to investigate political aspects of the obesity 'epidemic' and discovered very little research had been done. The deeper he dug the more convinced he became that the science underpinning predictions and projections about weight and illness was (often profoundly) flawed, and almost always conducted by investigators with undeclared interests - ties to pharmaceutical and weight-loss companies, health care providers who will get reimbursement if being fat is officially deemed an illness, and scaremongers eager to increase the federally funded pie available if this is seen as a crisis.
Oliver also examines the American Protestant loathing of obesity that he believes lies at the heart of some of the researchers' convictions - a topic more thoroughly covered in Marilyn Wann's Fat! So? where she relates stories of women whose physicians were so focused on weight they ignored real medical issues.
Like many other anti-diet/size-acceptance campaigners, Oliver argues that the real culprit is poor diet, incessant snacking, and too little exercise, and that health care prevention programs would be better aimed at improving nutrition and encouraging exercise as ends in themselves rather than as means to reduce weight. That this sensible advice, offered by many before him, receives so little prominence is in itself an argument that the hysteria over obesity is run by something other than genuine concern.
Whether or now weight is a personal issue for you, all of us in the Western world are affected by the money pumped into funding for anti-obesity drugs, weight-loss programs supported by federal money (in Australia gym membership and weight-loss programs may be eligible for health insurance co-payment, 30% of which comes from the Federal government), and an atmosphere that encourages vituperation and prejudice based on size. The funding comes from taxes we all pay, and if it would be better used diverted elsewhere, this affects the thin as much as the fat it's aimed at. - Alex

Bad Science – Ben Goldacre

NHS physician Goldacre writes a column for The Guardian about bad science, and maintains a website on the same topic. Bad Science the book, which could have been a collection of columns, is an impressive overview of the manifold ways in which the scientifically illiterate public are manipulated and mislead by skewed findings, poor evidence, flawed research, faulty data, media spin and government hype to believe any number of erroneous things.
In most cases Goldacre uses a well-known example to illustrate a greater overall problem, though some individual issues are targeted for themselves as well. For example, dissecting homeopathy not only explains why evidenced-based medicine is the way to go (and what stringent research involves) but also opens the way for a comprehensive and fascinating discussion about the placebo effect.
While he reserves his greatest ire for ridiculous ideas embraced by government (the most notable of these, to a non-Brit, being the Brain Gym program introduced to a wide range of British schools), there's no shortage of other legitimate other targets.
Quite possibly my favourite chapter deals with Gillian McKeith, the self-styled nutritional guru and bowel obsessive who berates fat people on her popular TV show (and book of the same name) You Are What You Eat (as UK comic Dara O’Briain says, in that case she must mostly eat shrew). Goldacre examines her more dubious claims, like the ‘fact’ that eating plant foods high in chlorophyll will “oxygenate your blood” or that ‘skid mark stools’ are a “sign of dampness in your body” (believe me, you want your bowel to be damp – a dry bowel will perforate and haemorrhage in no time at all). He also dissects her apparently scholastic work (that references such peer-reviewed journals as Health Store News), and her credentials (which is how I discovered that the non-affiliated Australasian College of Heath Sciences is in Portland, Oregon). Most powerfully, he articulates the indisputable but often ignored fact that the biggest contributors to life expectancy and morbidity (and how well you are as well as how long you live) are not whether or not you eat walnuts for selenium and goji berries for their antioxidant properties but your socioeconomic status, income and education level – “you are what you eat, and people die young because they deserve it. They chose death, through ignorance and laziness, but you chose life, fresh fish, olive oil, and that’s why you’re healthy. You’re going to see eighty. You deserve it. Not like them.” Which reminds me strongly of Alain de Botton’s observation that the downside of living in a (perceived) meritocracy, where anyone can succeed as long as they just try hard enough, is that those who don’t succeed are therefore seen as lazy, stupid and/or deserving of their fate (see here for an interesting interview with him on the subject).
His chapters on communal reinforcement (where what peers think becomes reality to the extent that it can override what we see and know – think of the Emperor’s New Clothes) and the power of placebo are worth the price of admission in themselves. On top of that, though, are an admirable clarity of expression, transparent and logically constructed arguments, and a distressing revelation of how much of our perceived understanding of medical and scientific advances are dumbed down, distorted and misshaped by the media. As Goldacre points out, journalists see no need to dumb down other areas where there are technical and significant details that the uneducated layperson doesn’t understand (sport and finance, for example), that specialist rather than general journalists are expected to do the writing. But for science stories these rules change. I don’t know that I agree with his explanation of why this is – Goldacre, on several occasions, argues that arts students, intimidated at university by science they couldn’t and/or wouldn’t understand, now have the opportunity to turn the tables, and that they think it must be the same gobbledegook for everyone as it is for them. I do think that this idea that everyone has the right to an opinion and that all opinions are equally valid, and that if one ‘side’ of an argument is printed the other side have a right to reply, is oft times ridiculous. For example, there have been dozens of studies looking at a link between the MMR vaccine and autism. None of the valid studies (some of which, like the 7-year Danish study, have included thousands of children over an extended period of time) have shown any link at all. We know that vaccines protect children from devastating diseases, but parents still decide against vaccination based on a variety of reasons including the ‘other side’ of the MMR ‘debate’ – anecdotal information and fear. Goldacre says that, if he had a slogan for the book it would be “I think you’ll find it’s a bit more complicated than that.” I think this will be my new slogan for a whole range of things, from the cause/s of autism to indigenous affairs, the Middle East, Northern Ireland, drug and alcohol addiction, weight loss and maintenance, health care, global finance... and science. – Alex

Trust Me: I'm a Junior Doctor – Max Pemberton

This somewhat fictionalised diary account of Pemberton’s first year of medical practice conveys a strong and clear picture of the unexpected aspects of being an intern, from struggling with crippling sleep deprivation and useless consultants to inserting IVs (a skill not taught to medical students) and certifying dead bodies. The impact of death is something Pemberton returns to, a topic that’s too often inadequately covered during medical school:

Because we never actually think about medicine not working and people dying, it comes as a bit of a shock when we’re faced with it... The subject of death isn’t just avoided at medical school, but on the wards too. Dying people are seen as a bit of an embarrassment to doctors –
they’re reminders that we’ve failed in our jobs, despite the fact that dying is an inevitable consequence of being alive. Because of this, doctors tend to avoid dying people like the plague... It’s a bit unfortunate that a profession that continually comes up against death hasn’t yet come to terms with it.

True, but rarely openly acknowledged.
There’s also an articulate rant about the hypocrisy of middle-class recreational drug users, incidental humour (like his reflection, after a failed attempt at a night out with colleagues, that “the only thing worse than missing an avant-garde all-female dance interpretation of -Coriolanus is, surely, not missing it”), and quite a lot of acclaim for the underappreciated role of nurses.
This last is certainly balanced by criticism and concern about nursing roles. He discusses at comparative length his concern about allowing nurses in hospitals to prescribe drugs without having gone to medical school – if the UK situation is anything like that in Australia, the drugs he refers to are standard doses of over-the-counter medications like aperients and paracetamol (acetaminophen, without codeine), and can’t be given more than once without medical review. He also talks about his decision not to sedate an elderly, demented woman despite the nurses’ strong requests that he shut her up so they could have a quiet night. For Pemberton this was a difficult decision because he felt pressure to prioritise helping out the nursing staff (both because they’d been helpful and supportive in the past, and for fear that this would change if he didn’t accommodate their wishes) over the perceived best interests of his patient. Unfortunately, what neither the author nor, apparently, the nursing staff articulated was the effect of hours of demented screaming on the other, often quite ill, patients.
There’s also a heavy sprinkling of reflection on how bureaucratic rules (like a four-hour Casualty wait policy), outsourcing services, and cost-cutting adversely affect staff and patients, including a brief but reasoned discussion about MRSA (and how it’s not the fault – or at least, not just the fault - of poor hand washing technique in NHS hospitals). Pemberton’s argument for how and why private insurance undermines the NHS (using a transportation analogy) is strong and compelling, though I am a little biased - I'm also an advocate for universal health care, which is why I don’t have private insurance and as a result pay the Medicare levy surplice. Back to the book – on outsourcing parking, Pemberton recalls that “I witnessed the unbelievable sight of a man who had just seen his wife die in A&E being threatened with having his car towed away because he didn’t have a [parking] ticket.”
But the strongest impression I came away from Trust Me with was exhaustion – from the hours (as Pemberton points out, changing the law on how many hours they can work has – as in the US – only means junior doctors don’t get paid for all the time they put in) to the lack of support and sheer weight of responsibility. His entry about his biggest medical mistake particularly stands out in this regard – Pemberton, distracted by being responsible for a patient following an unfamiliar but potentially serious procedure, missed a serious but not uncommon unrelated medical issue. The patient was fine, the registrar was unhappy about having been woken in the middle of the night, and Pemberton was distraught, but all was fine. Of course, what lingered was both the knowledge of how differently it could have ended, and the fact that it was all around the hospital by the next day. I was tempted to reach through the book and tell him that there’ll be bigger mistakes coming down the track.Less funny and painful than the classic tale of a medical graduates’ first year of practice (the immortal House of God”), Trust Me is also more honest, more political, more reflective and more true (and thirty years newer). - Alex

Gravity – Tess Gerritsen

Although her marriage, to a man she still loves, is ending, something in Emma Watson’s life is going right – she’s finally going to participate in a NASA mission. Both she and Jack McCallum are physicians who’ve dedicated most of their lives to the pursuit of space travel, at least until a medical condition grounded Jack, and Emma’s excited that her team are finally scheduled to launch. When something goes dreadfully wrong on the international space station Emma’s selected to fly up early and, despite Jack’s misgivings, she agrees. By the time she arrives half the crew are dead or dying, from a mysterious contagion that has never been seen on earth before, and that potentially threatens the whole planet.
We meet a plethora of characters – from a deep-sea submersible diver in the opening scene through a marine biologist desperate to reveal the truth to two whole space station crews and the ground staff. The characters have a semblance of three dimensions, but on closer examination this is a trompe l’oeil crafted to disguise cardboard representations of characters. For example, no explanation is given for why Emma and Jack are at the divorce-paper-signing stage when both of them want to stay married. A better example might be Jared Profitt, a NASA White House Security council science adviser (I don’t know why “council” isn’t capitalised): we get a paragraph on how he doesn’t feel the heat of a Washington summer but is highly sensitive to cold, and the rest of the page covers his love of routine, from where he eats lunch to what he eats. “In many ways he was like those ancient ascetics, a man who ate only to fuel his body and dressed in suits only because it was required of him. A man for whom wealth meant nothing.” Why? We don’t know, but we did learn that his wife died – from pneumococcal pneumonia. Although, just one page later, we learn that he was unable to make it to an airport in time, as “necrotizing streptococcus has its own agenda, its own timetable for killing.”
Well, no. Streptococcus, necrotizing or not), is a microbe and thus has no agenda or timetable. This overwriting (do we really need both of these?) is typical of the prose, and mildly annoying. In another place, for example, a microbiologist is explaining to Jack (who is a physician, a researcher and a former NASA trainee astronaut) that microscopic means “not visible to the naked eye.” Thanks for that. The tautological descriptions, though, are not as annoying, however, as the sloppiness – was it pneumonia or a strep infection? Because they’re different bugs, and although she might have got one as a result of being immunocompromised by the other, either one killed her or they both did, and in either case you can’t list one in one place and another on the following page. If it doesn’t matter then don’t go in to detail and if it does matter get the detail right.
According to Tami Hoag (on the back blurb) Gravity is “deep, dark and very disturbing.” I, on the other hand, found it somewhat formulaic, diverting enough, but really predictable. All the check list elements are present – strong female protagonist in peril; a couple drifting apart but still in love; a plucky independent company struggling against the might of large corporations; the scientist who can’t face success and self-destructs; the Brit whose icy demeanour hides a passionate side; an isolated, mysterious scientist with a tragic past; a brave individual prepared to sacrifice herself for the greater good; scientists committed to the pursuit of knowledge and international cooperation; covert government agencies with hidden agendas and nondisclosure policies; technical scientific language to demonstrate the author’s commitment to research; unnecessary medical detail (ditto); a mysterious killer microorganism, loosed by science tampering with the unknown; an unstoppable highly contagious plague that culminates in an agonising and bloody death...
There were certainly a couple of interesting things (I’d never previously thought about the fact that, with no gravity to alert you, in microgravity if you drift off you stay asleep), but all in all this was disappointing and uninspired. – Alex

You: The Owner's Manual - Michael F Roizen & Mehmet C Oz

This prequel to You: On a Diet, is a comprehensive overview of how the human body works, with an emphasis on age and disease prevention. Structured around the metaphor of the body as a house, You: An Owner's Manual is divided into systems (heart and circulation, brain and nervous system etc). The authors combine breadth and depth of what is quite often complex information in a readable style, without dumbing it down. Illustrated throughout with cartoons demonstrating the system, exercises, or manifestations of disease, the text is also sprinkled with wry humour.
What I like so much about this series, and about Dr Oz (who I've seen on Oprah) is the engaging and forgiving nature of his approach. Many in the health field have a heav-handed, take no prisoners approach that comes down hard on those of us who move around a little (or a lot) less than we ought to, and/or eat evil foods, Drs Oz and Roizen are gentle. They allow for humanity, slips and falliability - the emphasis is on doing the best from here, rather than lamenting the terrible damage done thus far.
My anatomy, physiology, pathophysiology and diet and health knowledge is higher than average, but I was still surprised by some of the questions in the introductory quiz, and I was a little disappointed I only scored 82% - but I'll remember the ones I got wrong for some time. There's also a brain gym quiz, which reinforced for me that unscrambling letters to make words is the most difficult IQ task for me and therefore (according to the book) the exercise most beneficial for my intellectual health and longevity - like stretching, doing the stuff you're good at is less valuable than the stuff you're not.
They've summarised the key information into crib sheets, for strength trainig, the yogic Sun Saluatation, physical activity, sleep, a diet activity plan, and an overview of diet basics. Holistic practitioners who base their advice on large-scale studies (preferable randomised and double-blinded, the gold standard in imperical testing), there are also factoids about supplements and complementary practices, and why they don't recommend some of them.
It's this aspect that sets this series apart from other, lesser, diet and exercise advice manuals - the rationale for every element of their program is explained, including why more is often less, and why this isn't the final word, because there's more information being generated all the time.
This book is a brilliant foundation for anyone who has an interest in their long-term health and wellbeing. The plan is sensible, usable, practical and inexpensive (except perhaps for some of the supplements), and it's strongly grounded in real science. The sample diet plan, like every similar one I've come across, is a little unworkable for people living alone - too many ingredients that don't yield one serve (what do you do with the rest of the low-fat sour cream/½ container of water chestnuts), but that quibble aside this is pretty much pefect. - Alex

You: On a Diet – Michael F Roizen & Mehmet C Oz

I am an intermittent Oprah watcher – as I check the TV Week listings every Monday (yes, books are not my only weakness), I check out Oprah’s topics; months go by where I have no interest and then I find myself watching a couple of shows a week. Several years ago, through watching Oprah, I learned about the RealAge test, which was created by Drs Roizen and Oz. I think the test and the site are a great combination of solid information and good humour, managing to bypass extremes for a realistic middle road approach too often missing when it comes to lifestyle (ie diet and exercise) suggestions.
Although You on a Diet (follow up to You: The Owner’s Manual) is subtitled The Insider’s Guide to Easy and Permanent Weight Loss, and bannered with “Lose up to 2 inches from your waist in 2 weeks”, the contents are a refreshing blend of scientifically-based recommendation, holisticism, hints and moderation. While the central theme is certainly weight loss, the underlying ethos is about sustainability and the long-term picture for lasting better health.
To that end the guide includes not just standard sensible diet advice (like small plates for smaller portions, a high water intake, and moderate alcohol), recipes and a meal plan, but also information about specific foods to include, reduce or avoid. We should all, for example, opt for foods high in anti-oxidants, and incorporate nuts in general and walnuts in particular; reduce intake of red meat, fats in general and saturated fats in particular, but not eschew fats altogether; and avoid trans-fats, white and wholemeal breads and pastas – always chose wholegrain.
There’s a section on ensuring better sleep and why that’s important, an exercise regime, suitable for pretty much everyone, that incorporates cardiovascular work (walking) with stretching to promote flexibility, and meditation.
The information is well supported with evidence, and complicated information (like how satiety works and why it sometimes doesn’t) is not only clearly explained but also illustrated with cartoons. Rather than specific numbers, the authors focus on healthy weight ranges for height, and prioritise waist circumference over weight altogether. There’s also a strong acknowledgment that slips happen, and that the focus should be on ‘taking the next safe You-turn to get back on track’ rather than giving up entirely.
Scattered throughout are common myths, and why they’re being debunked, and each chapter ends with a précis. There are a couple of quizzes to help the reader determine which areas are the most challenging for them, links to online sources, and a generally reassuring overall tone. The program is sensible, sustainable and aimed at improving quality of life in the long term, a striking contrast to the more usual immediate-future-focused approach I encounter.
I have a strong health science background and have read my fair share of diet and nutrition books. You: On a Diet is one of the best I’ve read. I particularly like the moderate and reasonable approach, the fad-free content, and the well-supported advice. It’s a little indigestible if read in one sitting, but spaced out over a few days the whole is pretty impressive. I’ve already started to make a couple of changes, and printed out the website’s stretching routine. I’m also going to check out the first in the series. - Alex

The Anatomy of Hope - Jerome Groopman

Haematologist Dr Groopman has seen a lot of patients over the thirty years of his practice. In this book he uses clinical cases to illustrate how hope can help, and how lack of hope can interfere in the recovery of a patient. He traces a path from some of the first patients he was involved with as a student, through to more recent cases in his own practice, to his own experiences with chronic pain, to map the place of hope in health care. At the same time Groopman creates a picture of how health care in general, and medicine's image of its role, has changed over the last three decades.
This is not a New Age, 'have faith and beat cancer through the power of positive thinking' approach. Instead Groopman explores how belief, particularly in the form of hope or lack of hope, has a significant effect of the clinical picture. In the first case he recounts, Groopman talks about a patient who delayed seeking treatment for breast cancer, then was reluctant to have intervention, and opened up to him through their common heritage (she was Orthodox, he Observant) that the cancer was punishment from God because she strayed. She had no hope because you cannot (and should not) avert His will.
In the second case Groopman discusses his discomfort as a very junior doctor working as a locum in a country oncologist's practice - the experienced physician believed in deliberately withholding distressing truths because they would just cause depression for the patient and her family, even if this policy resulted in false hope, falsely high expectations and, in the end, lack of faith in the doctors.
He illustrates how the lack of hope can interfere with a patient's decision-making through the case of a former soldier who was adamant he was going to die, to the point where he wouldn't even consider intervention, had no hope of recovery because he'd seen a comrade die in ICU many years earlier and thought the same lay ahead of him. That man, too, had been told he could fight it, but succumbed, so that the words intended to sway him toward choosing life-saving intervention were heard as just so much hot air.
Groopman is able, as great writers can, to use one story to convey a multitude of messages. Tied in with the central topic of hope in medicine are reflection on the changing face of medical practice; his own journey as a clinician; what he's learned from patients, their families, and from skilled nurses; and the difference of opinions skilled doctors can have. He discusses his experiences as a patient and how both that and his counter-intuitive cure have coloured his view, and he talks about the case of a colleague diagnosed with the very cancer he spent his career fighting - and how intimately knowing the heavily-stacked odds doesn't necessarily equate to doing what everyone else thinks is reasonable.
I went to the library looking for Groopman's more recent work (which I found at uni), but am very glad I met this book. It is unsentimental but warm, detached but involved, articulate and informative and very interesting, and a text book example of how a writer can include the I in their narrative without losing academic rigour - something I'm aiming to achieve myself. - Alex

Snake Oil and Other Preoccupations - John Diamond

In 1996 journalist, broadcaster and columnist John Diamond first wrote of his concern about cancer – he had a throat lump that he was afraid might be cancerous. In his regular column for The Times he wrote about the scare, and his relief (tinged with the loss of drama) that it was only an unusual cyst.
Only it wasn’t an unusual cyst – Diamond had throat cancer, almost certainly secondary to smoking, and by the time he died in 2001 he’d had multiple surgeries, a permanent tracheostomy and significant resection of his tongue, had suffered through radio- and chemotherapy, and was being fed through a tube.
He also maintained columns in a number of publications, and was six chapters into a book debunking alternative or complementary therapies – many of which kind readers had written to him about. He opens by stating that he’s not interested in defending allopathic medicine – it’s not perfect, he knows the statistics about iatrogenic (hospital-caused) complications and waste and short-comings – but in examining the less-commonly critiqued arena of reflexology, homeopathy and the like. At the outset Diamond reports that he doesn’t deny that some remedies might help alleviate symptoms, make people feel better, or allow them to feel as though they have some control over their diseases – if that’s all it was, he says, there’d be no reason for him to write the book. Diamond’s issue is with those practitioners who report they can cure diseases (up to and including cancer) and that allopathic medicines make people sicker than the diseases they’re supposed to treat. Many practitioners say that this is an irresponsible position, that no reputable practitioner would make this claim, but nonetheless there they are, purporting to be reputable and claiming they can cure cancer.
Rather than focusing on specific claims about therapies, though he does look at some of these, Diamond concentrates on the meta-claims, like the argument that "the orthodoxy is hidebound and scared of change." While there’s sometimes resistance to new and counterintuitive ideas (like Warren and Marshall’s 1982 discovery that helicobacter pylori, a bacteria, is responsible for most stomach ulcers, not stress and lifestyle issues), any volume of a peer-reviewed medical journal will be full of articles contradicting, arguing against, or trashing researcher’s findings. And while it did take 12 years for the orthodoxy to swing around to the H. pylori thesis, that’s a short period of time – says Diamond – in terms of medical research, and it was accomplished without any apparent consensus from vast pharmaceutical conglomerates.
Compare this with naturopathic medicine: "I’ve never come across a herbalist who has revealed that a remedy used by his professional forebears has been discovered, after all, not to work, or a homeopath complaining that his craft is still stuck in the rut ploughed by homeopathy’s founder two hundred years ago." A point I’d never previously considered.
Sadly, Diamond died before he was able to finish – the book ends with the evocative sentence "Let me tell you why." The rest of the volume comprises a selection of his columns, from the very amusing "The Bland Leading the Bland" in 1988, through writings on first dates, Geneva (perhaps the only humorous writing about that apparently dour city), bottled water, reflections on Judaism, and fatherly obsession. In 1996 he first writes about this ‘cyst’ and his resulting experience of the private health care system in the UK, and over time his health understandably becomes more and more the focus of his writing. Throughout, Diamond is engaging, informative, admirably free of self-pity, and articulate, and the frustration he feels is palpable. Anyone interested in a critical but not overly technical critique of complementary medicine, and/or in the lived experience of being a patient and of dying, should go no further. I had never heard of John Diamond before I discovered this book while looking for something else, and my life would have been the poorer without that serendipidous discovery. – Alex
Alex 2007

The Maria Korp Case - Carly Crawford

In February 2005 a conservative Melbourne mother of two (an adult daughter from her first marriage, and a young son from her second) was reported missing by her husband. Four days later her body was found in the boot of her car, parked outside the Shrine of Remembrance - from the length of time missing, the fact that it was high summer, and the smell of decomposition, the police who opened the boot thought she was dead. Until she took a breath.
Rushed to hospital, Maria Korp was treated in ICU until doctors determined that she was irrevocably brain damaged to the point that she would never achieve any meaningful function. She was then discharged to a ward, breathing through a tube in her throat and fed through a tube in her abdomen, until the state's Public Advocate determined that feeding be discontinued, and Maria died on August 5th. As hospital staff tended her body, the police investigated what happened, and a tawdry tale emerged. Maria's husband, Joe, allegedly elicited his girlfriend, Tania Herman, to strangle Maria and dump her body. Though Joe Korp denied that he was involved, the evidence was fairly compelling. However he never stood trial, committing suicide by hanging (very possibly by accident) on the evening of his wife's funeral.
The story obviously has a number of titillating elements, I was more interested in the ethical dilemmas raised by the case. I also have a connection with the case, and was interested in how the story was handled by Crawford, a Herald Sun reporter.
She's clearly done a lot of research - there are quotes and descriptions of events in laborious detail, even when this adds little to the text, and she certainly gets the personality of Joe Korp - unquestionably the central character - across convincingly. I shouldn't have expected much from a tabloid journalist, but I did. From the very first paragraph the writing was overblown and dramatic:

... although the calendar read summer, autumn's precocious chill had driven most people indoors...

(Which, incidentally, it hadn't.)
The medical detail at times reads as though Crawford was present ("A ghastly array of tubes protruded from her mouth and throat"), which she was not; although the decision making of the Public Advocate is discussed, and contextualised in terms of recent relevant ethical issues (like the then-recent death of Terri Schiavo), this comprised only a small portion of the book. I appreciate that this is not necessarily of general interest, but there were huge swathes of journals reproduced, as well as minute discussion of barely-tangential material included, so it's not as though the whole thing was cut down to bare bones. What was missing in depth and resonance was made up for by insinuation, strained metaphor -

The Korp's... home was a fitting symbol of Joe and Maria's empty relationship. It looked good on the outside, but on the inside it was devoid of genuine warmth

- and hyperbole: "an indulgent spa bath", "Gust speaks quicker than a sinner at confession", "the storm of betrayal that was about to come thundering down" and more in similar vein.
In fact the tone was the hardest thing - I skimmed through it as quickly as I could, because the writing - jarring, prurient and florid - was almost painful:

For months death danced with Maria in an ugly, languid waltz. It courted her like a smitten schoolboy for a whole semester. It teased her in the playground. blocked her airway as she lay in hospital... But death gnawed through her tenacity. Beguiling, determined and with fate on its side, it prepared its reluctant partner for the last act.

Ugh. Ugh. ugh, ugh. If you're interested in the case you'll learn more from the transcript of the ABC's excellent episode of The Law Report. - Alex

Dancing with Dr Death - Virginia Kennedy with Dot Walker

In early 2005 the Australian media was filled with stories about an Indian-trained surgeon who had been linked with an increasing number of surgical infections, other complications, and deaths. Alongside the developing story of Dr Jayant Patel (who, it transpired, had already been restricted from performing some surgeries in Oregon and forced to surrender his medical license in New York) emerged the story of a whistle-blowing nurse whose job was threatened when she went to her local MP after numerous attempts at local resolution of the problem. The media dubbed Dr Patel "Dr Death", and the case sparked national debate about immigration (skilled and unskilled) and the state of rural health care, as well as a Commission of Inquiry.
Although I had some familiarity with the case, I hadn't followed it closely enough to be conversant with the names of all the players. Dancing with Dr Death was recommended by a nursing friend, and I suspected that without the recommendation I wouldn't have read it. In fact it was only when I saw it in the library while looking for another, related book that I was prompted to check it out. I assumed it was written by the whistle blower, and when I realised this was written by another nurse I assumed I had the wrong book, but Toni Hoffman hasn't written one. Kennedy, writing under a pseudonym to protect her career as a "qualified registered nurse", was assisted by Walker, "an author and educational consultant."
As expected, the book, which is subtitled "The Inside Story of Doctor Jayant Patel and the Bundaberg Base Hospital: A personal account by a nurse who worked at his side", discusses particular details of some of the incidents, including cases where Dr Patel has subsequently been found guilty of malpractice and murder. However the focus of the book is on the hospital itself - for the author Patel, with whom she had a friendly if guarded relationship, was a symptom of a far bigger problem, one which has not been appropriately addressed.
Originally from Tasmania - apparently a Mecca of Australian nursing - Kennedy was unhappy with the hospital layout, lack of equipment, poor staffing, actively unsupportive management and out-dated practices from the beginning. Kennedy's story is filled with example of "unprofessional attitude and lack of support or understanding from hospital administration." Some of her grievances are about genuinely unsafe practices, dangerously poor staffing levels, systemic complacency, and a management ethos that valued money about staff and patient well-being. Having heard from a nursing friend in Queensland about the apathy and general unhelpfulness of the organisation, I was interested to see that Kennedy also found the Queensland Nurses' Union to be of little or no assistance.
It is unfortunate that the impact of this is diminished by the sheer number of Kennedy's complaints - the first, which extends for the better part of two and a half pages, is an overly detailed account of her trip to get her uniforms; she is as outraged by the colour of them (burgundy and white, which she "was immediately repulsed by") as by anything else in the text.
There is an irritating lack of perspective ("What other career... would leave people so physically drained and mentally exhausted?"), the odd bizarre observation (following on from a discussion about complication rates of gallbladder surgery, she adds "even the more major surgery did not escape post-operative complications" - wouldn't you expect a higher rate of complication in more serious complications?), and had-I-but-known hyperbole: "I pictured in my mind the handshake and pats on the back between Peter Beattie and Dr PJ [sic] , and I wonder if the Premier wishes in hindsight he could have foreseen what the future held for the BBH" and "Yet unknown to me at this time, and probably more impacting, he obviously had other serious concerns. These without a doubt would have played heavily on his mind, governing his ability to know right from wrong. Little did I know what was about to unfold." This use of "impacting" occurs five or six times throughout the book.
Kennedy (a pseudonym) appears to have liked and respected Patel, and believes that his major problem was that he "over-rated his ability." Although the selling point of the book is the Patel connection, and from the lack of tight editing I strongly suspect it was commissioned and rushed out to catch the wave of public opinion, the author's main thrust is a diatribe against a system that she thoroughly hated. There's a lot in here that's worthwhile and important. It's just unfortunate that the message is obstructed by the overblown writing and diluted by irrelevancy. - Alex

Mary Roach: Spook - Science Tackles The Afterlife

Roach presents an examination of parapsychological research, investigating some of the theories about what becomes of the personality after death and some of the methods (both modern and historical) used to find supportive evidence for such theories.
The author makes it very clear right from the start that she is approaching this subject from an objective, scientific perspective rather than on a more esoteric level.
She includes a number of anecdotes (first and second hand), interviews a wide variety of people ranging from quantum physicists to EVP recording enthusiasts and tells of her experience at a school for mediums.
I had hoped, given the title, for more of an evaluation of scientific approaches used to investigate the afterlife than was presented here. However my disappointment was minor, the book was both entertaining and informative. The results of Roach’s study were interesting. The writing was easily accessible with minimal use of jargon. Footnotes provided interesting and often very amusing asides.
This is a great reminder that academic works need not be the dry, serious presentations they usually are. They can be both amusing and educational in the hands of a competent reporter-Lynn.
To read Alex's review of this book, click here

The Woman with a Worm in Her Head - Pamela Nagami

Dr Nagami has been an infectious diseases specialist since the early 1970’s. This collection describes some of her most memorable cases – either because of the unique diagnostic and therapeutic challenges they presented, or because of how they affected her life. The chapter of AIDS is particularly interesting in this regard: Nagami was already working in the field when the first US cases began appearing in the literature, and she recounts both her intellectual, specialist interest in the evolving picture of the disease, its diagnosis, early impact, and current management, as well as the personal impact AIDS had on one of her closest friends, fellow doctor Henry.
This blend of the personal and the professional (Nagami often intersperses what she was doing with her children into the narrative of an individual patient’s disease and treatment progression) is a unique and – for me – irritating addition to the more standard genre style of, for example, the divine Atul Gawande. This is not to say that other medical writers do not include personal details, but in general these tend to be related to their development as a clinician. I was significantly less interested in the minutiae of Nagami’s day-to-day life than the cases, but my engagement with, and Nagami’s ability to individualise, the cases is a tribute to her empathy and her ability. Not all of the cases are medical triumphs, but the humanity of the patients, and Nagami’s engagement with them as such, was evident throughout. She is also able to describe complicate pathology and intervention in a way that is accessible to the lay reader, without boring the more informed one.
This was an interesting read so soon after Where the Germs Are – Nagami reports that she is the only member of her family to be free of obsessive-compulsive symptomology, and she describes the affect of her work, and her concern of bring the microbes at the heart of her work, home with her. In addition to the cases reports, Nagami’s take home message is clear – don’t obsess over every surface and bug, but take appropriate precautions: vaccinate yourself and your children, and know when to seek help. The chapter on the life-threatening effects of varicella (chicken pbox) on adults should have every non-immune reader running for a vaccination, and made me inordinately appreciative of those miserable two weeks of itchy hell I experienced at age six. - Alex

The Mummy at the Dining Room Table – Jeffrey A Kottler and Jon Carlson

Thirty eminent therapists, in addition to the editors, have submitted their most memorable cases from decades of clinical practice. In some cases the patients were memorable because of how they affected the therapists practice. In others it’s because the cases or clients were startlingly unique. The enticing title of this collection comes from one of co-editor Carlson’s most memorable cases, of a family so devastated by the death of their matriarch that they (her husband and a dentist friend) mummified her and continued to live their lives with her as normal. The family itself wasn’t in therapy – it came to light in the course of couples counselling that Carlson was doing with the woman’s niece.
Some of the stories don’t have a satisfactory conclusion, usually because the patient or family terminated therapy or moved before the problem was resolved. This aspect could have been frustrating, but is framed as, and gives insight into, one of the realities of clinical work – you don’t always get a happy ending. Or any ending. As one of the editors notes, "that’s the frustrating thing about doing therapy – people sometimes leave before we are ready to let them go."
I particularly liked Scott Miller’s case of a nineteen-year-old man who, in the course of his preparation for an overseas missionary position, reacted to the pressure with reactive psychosis, and thought he was the Terminator. Instead of trying to convince him that this was not reality, Miller accepted the patient’s reality, and worked within that framework to effect change.
The editors have worked hard to preserve each therapist’s voice in the presentation of the cases, which serves to deepen the experience of reading. This book is fascinating for anyone who is interested in the odd ways people behave, the sequelae of abuse and dysfunctionality, the candid experiences of therapists (who in many cases admit that they didn’t know what they were doing but had nowhere else to go, therapeutically), different modalities of therapy, and anyone who wants reassurance that they’re comparatively normal. - Alex

My Year Off - Robert McCrum

In 1994, while still in his early forties and only recently married, Faber & Faber editor Robert McCrum had a serious stroke which left him with left-sided paralysis, impaired speech, and emotional lability. This book tells the story of what his first year post-stroke was like, using a combination of present day reflection and extracts from the diaries he and wife Sarah kept. The result is a vivid, honest and powerful insight into a world that few of us know about, at least until it happens to us or a family member.
I found McCrum's heavy use of literary reference understandable (given his career) but nonetheless irritating, though both my irritation and his references diminished as the book progressed. This should be recommended reading for health care professionals in general, and those who work in stroke medicine in particular. - Alex

Spook - Mary Roach

Spook: Science Tackles the Afterlife is a followup to Roach's fascinating book Stiff: The Curious Lives of Human Cadavers, which looked at what happens to bodies after death (including embalming, plastination, funeral practices and other interesting aspects). In Spooks she explores the question of life after death, from a history of the search for a soul (the impact of wishful thinking on scientific studies of sperm with microscopes, weighing dying bodies of people and animals to determine the weight of the soul), to the mid-nineteenth century ectoplasm hoaxes and claims by mediums, through to modern investigations into possible hallucinatory effects of electromagnetic fields, possible explanations for hauntings, and rigorous (in the academic sense) examination of near-death experiences (NDE's).
Roach has a fantastic writing style - well informed but accessible, and unexpectedly funny (particularly in her footnotes); on several occasions I actually laughed aloud, often to the consternation of fellow public transport users. For example, in the chapter on NDE's Roach says in the text that survivors often report having been met by deceased friends or family. The footnote reads:

Or occasionally, ex-husbands. A celebrity website reports that Elizabeth Taylor saw Mike Todd during her near-death experience. "He pushed me back to my life," she is quoted as saying. Whether this was done for her benefit or his is not clear. (p. 247)

This is a brilliant, interesting and informative work - I aspire to write as well as Roach. - Alex

To read Lynn's review of this book, click here