Written in 1968, before abortion was legal, it is a murder involving a botched abortion and the arrest of a respected doctor. The protagonist is certa Written in 1968, before abortion was legal, it is a murder involving a botched abortion and the arrest of a respected doctor. The protagonist is certain that his friend, a physician colleague is innocent and the victim may not actually have been pregnant. He takes time off from work to investigate. This is a very good novel that takes on a complex topic. Appendices added later, update the reader on the various positions, pro and con, as well as medical ethics surrounding abortion....more
Interesting and enlightening true stories about how dramatic accidents and injuries have influenced the development of many medical approaches. Fong deInteresting and enlightening true stories about how dramatic accidents and injuries have influenced the development of many medical approaches. Fong describes the underwater survival that can occur when the water is very cold, and how that information inspired the cooling of the body to increase chances of patients undergoing some surgeries. He describes polio epidemics and the evolution of positive pressure ventilation from the "iron lung" as well as the development of intensive care units. He discusses how the development of cosmetic surgery and skin grafting arose in response to severely burned English fighter pilots during WWII.
He also describes the development of advanced trauma life support by a physician whose family suffered a serious car accident in a rural area, and it took hours for appropriate interventions to become available.
The author's description of the physiological changes in deep diving and space were also interesting, especially the problems related to weightlessness in space.
He uses many true stories of trauma and injury which adds interest to the scientific information, which is written for the lay person. ...more
This is a wonderfully readable history that takes us from paleolithic plagues to the present! Kennedy's focus is on the huge, and usually neglected, roThis is a wonderfully readable history that takes us from paleolithic plagues to the present! Kennedy's focus is on the huge, and usually neglected, role that microorganisms have had on history from the stone age onward. While the exact nature of some of the earliest infections is hard to determine, the study of ancient bones and teeth can provide DNA of specific organisms. It seems probable, for example , the the advent of modern humans and the rather rapid demise of Neanderthals was more likely due to the influx of microbes carried from the tropics of Africa to the immune-naive Neanderthals. These Hominins were well adapted to the cooler latitudes and had some social interaction with new arrivals. (Most non-African humans today possess small amounts of Neanderthal DNA.) The author also cites dramatic battles and even wars that were "won" due to rivals who became infected with epidemics such as plague (Yersinia pestis), cholera, typhoid, typhus and other deadly pathogens. Frequently, the outcomes of wars depended more on mortal infections than mortal weapons, or skills of leaders. The medieval plagues, especially the "black death", killed up to 60 % of Europeans, setting the stage for dramatic social reorganization. It is clear that more recent pestilences allowed Cortez and his small army to destroy the highly developed civilization in Mexico, and also aided Pizarro in his conquest of the Inca empire. It has also been well established that the European contact with North America resulted in the decimation of the Indigenous people from infectious diseases, to which the Europeans had developed immunity from centuries of exposure to diseases that "jumped" from an array of domestic animals. The Native Americans had no immunity as smallpox and measles tore through native communities leaving abandoned villages. Infectious diseases also played a major role in the development of slavery and the slave trade in the U.S. Europeans who were brought over to work in agriculture, especially in cane plantations in the south and the West Indies, died like flies from mosquito-borne diseases, such as malaria and yellow fever, to which West Africans had some resistance, having lived for centuries in areas prone to these infections.
As anthropocentric beings, we frequently forget the amazing effects that microscopic creatures had, and are having , on our history and lives....more
This is a very readable book about how microbes develop resistance to dangerous substances. The author provides some historical background, much of whThis is a very readable book about how microbes develop resistance to dangerous substances. The author provides some historical background, much of which I was familiar with, but also includes incidents of dreadful infections that killed patients because the organism was resistant to all available antibiotics.
He discusses the problems of over use and abuse of important drugs. For example, easy availability of antibiotics in many developing countries without prescription, people who take a few pills and "save" the rest for subsequent infection, the massive use of these drugs in agriculture and aquaculture (fish farms), and the difficulty of legally limiting these uses.
He also discusses th alarming dearth of new antibiotic research, since these drugs may be very expensive to discover, test and produce.
He is, however, somewhat positive about the increasing understanding of the problem with new models for drug discovery and collaboration across cultures and countries. ...more
This is a fascinating book! The author has done many studies, as have others, on the physical and emotional impact of trauma. Initially working with PTThis is a fascinating book! The author has done many studies, as have others, on the physical and emotional impact of trauma. Initially working with PTSD patients in a VA hospital, testing showed brain changes in those patients. Thes changes are accompanied by depression, a "short temper", hyper sensitivity, irritability, flashbacks, constant fear, anxiety and problems with anger management. As brain imaging and other studies have shown, memories related to the trauma are fragmented, and stored in a part of the brain separate from ordinary memories. The author contends that, while talk therapy can be somewhat helpful, medication only blunt the effects, and only as long as they are taken. His conclusions, supported by many other studies by psychiatrists and neurologists indicate that there are ways to re-integrate traumatic memories with normal ones, helping the patient recognize the danger is in the past and not able to re-traumatize patients as in PTSD. "The challenge of trauma treatment is not only dealing with the past but...but enhancing the quality of day-to-day experience." The author contends that when you are not fully in the present, you go to places where you did feel alive, even if they are filled with horror and misery, such as in war, abuse, neglect.
Dr. Van der Kolk presents several therapeutic modalitiesthat have been shown to be very effective with trauma patients. They include the following: "Owning Yourself"- revisiting the traumatic events AFTER you feel safe enough not to be re-traumatized. Mindfulness, a good support network, sensory integration-movement, dance, touch, massage, yoga music, writing - can all be very helpful modalities. In addition, he suggests a somewhat new technique, EMDR, or eye movement desensitization and reprocessing.) This process resembles REM sleep, a phase that helps integrate memories, that is often limited in traumatized people.
I do not think that most current mental health interventions are really successful in traumatized people and its seems that the therapeutic approaches presented in this book would be far more effective. I also believe that many of our current social ills result from a lack of a congruent approach to care of individuals who have suffered significant trauma.
The author and many of his colleagues have proposed criteria for developmental trauma disorder to be incorporated into the DSM....more
This is a very interesting (and non-technical) discussion of various ailments affecting the nervous system. Topics include illnesses related to DNA mutThis is a very interesting (and non-technical) discussion of various ailments affecting the nervous system. Topics include illnesses related to DNA mutations (Huntington's Disease),an early onset dementia that affects people in their 30s and 40s, Alzheimers dementia, with plaques and tangles observed in the brain at autopsy; behavior changes brought on by Pick's Disease, a genetic glitch on chromosome 17 leading to fronto-temporal dementia.
In part two, he discusses those neurological conditions brought on by aberrant proteins causing severe autoimmune responses. In one case, a small ovarian tumor contained many different types of cells including neuron-like cells bearing NMDA receptors. The woman's immune system produced millions of antibodies to NMDA receptors, destroying them and causing serious mental changes, especially affecting memory. The patient was cured, although with some permanent memory loss, with high dose steroids and removal of the ovarian tumor. Another problem involves glycine, the smallest neurotransmitter, which can be attacked by antibodies resulting in spasms and agitation. Both tetanus toxin and strychnine affect glycine signaling, by different mechanisms. Then there are misfolded proteins (prions) that cause "mad cow disease" and Creutzfelt-Jakob disease.
In part three, the author discusses "brain invaders and evaders" There are vitamin deficiency diseases that affect the brain. For example, B12 deficiency, which is not uncommon in lacto-ovo-vegetarians and alcoholics. Another is thiamine, once caused by eating only white rice. Pellagra, which killed over 100,000 people in the South, affecting mostly the poor with a niacin deficient diet in the 1930s. Niacin is critical in the production of nicotimamide adenine dinucleotide (NAD) essential to energy production in all cells.
The author adds a lot of interest and suspense in presenting case histories as well as the history of the evolving knowledge of causes, treatments and prevention of these neurological conditions, as well as the scientists who have studied them....more
This is a very well-written and researched book on the Sackler "dynasty". This devastating portrait of greed reads like a novel. It shows how wealth, This is a very well-written and researched book on the Sackler "dynasty". This devastating portrait of greed reads like a novel. It shows how wealth, prestige and influence in the right places makes it easy to escape any significant consequences for the deaths of hundreds of thousands and the devastation of communities all over the country.
Arthur Sackler and his two brothers were born in Brooklyn of immigrant parents. Arthur, the oldest , was the most energetic and the prime mover in the marketing of Valium, from which the family reaped a large fortune.It seems that although all the brothers became medical doctors, their primary rationale for that was to add professional and academic weight to their pharmaceutical marketing. (Hippocratic oath be damned: First, do no harm..)
Arthur purchased Purdue Frederick for his brothers. This company, later Purdue Pharma, developed a slow release oxycodone they called Oxycontin. Then, with no research or testing on its addictive properties, heavily marketed the drug directly to physicians through an army of drug reps who were programmed to disclaim any concerns about its habit-forming properties, and encouraged its use for all types of acute and chronic pain. (This occurred after it was clear that MS Contin, a slow-release morphine only half as strong as oxycodone had been shown to be subject to abuse and addiction.) The family co-opted physicians, manipulated the FDA and raked in billions. Meanwhile, the brothers, their families and several wives built mansions, bought Chinese antiquities, and made significant donations to multiple museums and universities on both sides of the Atlantic.
By the time the third generation of Sacklers took control, hundreds of thousands had been killed by addiction to "oxy" and often to heroin when they could no longer get oxycontin. They had a legacy: of ovverdoses, suicides ruined lives, families and communities.
When the law actually investigated the situation, it was too late. AND, because the drug had been FDA approved (through fraud and manipulation, their fine was minimal in comparison to their massive accumulated wealth.
The greed of these people and their indifference to the massive suffering they caused, makes them EVIL in my mind.
They unfortunately imparted a dark stain on their Jewish heritage and the medical profession....more
This is a very interesting, well-researched history of mental illness and its treatment. While it is scientifically and historically rich, there is alThis is a very interesting, well-researched history of mental illness and its treatment. While it is scientifically and historically rich, there is also a personal element as the author has suffered from depression.
Riley focuses in the beginning, with the "anatomists"(who hoped to find structural abnormalities in the brains of the afflicted) through a thorough review of Freud. He discusses the callous treatment of the insane and the more helpful "cottage retreats" which stressed peaceful surroundings, good nutrition and empathic conversation.
He reviews the development of anti-depressants, their usefulness and problems, including side effects.
I found the section on the newest drugs and their combination with supportive therapies interesting. Also fascinating: the newest ideas related to the microbiome and its contribution to health and disease. Those organisms in our gut, produce some of the most important neurotransmitters, such as serotonin, dopamine and GABA, chemicals that are known to affect brain function.
To his credit, he also reports on the state of global mental health services (not good!) and the need to provide access to therapies. Interestingly, there has been a range of strategies that are inexpensive and productive and can be used in underdeveloped countries. Case in point: Developed in Africa -the training of respected elders. These members of the community can sit and listen to those with depression, calming them and making useful suggestions. These connections have shown great promise.
This is an informative book and I highly recommend it....more
Deep into the Covid 19 pandemic, many Americans refuse to get the (free) vaccine available almost everywhere in this country. Some falsely believe it Deep into the Covid 19 pandemic, many Americans refuse to get the (free) vaccine available almost everywhere in this country. Some falsely believe it to be dangerous or ineffective, and a significant number of people reject ALL vaccines for themselves or their children. Although some of this vaccine-phobia has been been brought on by bizarre and outlandish information on the internet, much of the vaccine rejection can be traced back to studies by a London researcher implying that vaccines are the cause of autism. While autism has increased dramatically over the past few decades, and the symptoms are often (but not always) seen to develop shortly after children receive their MMR vaccine, (measles, mumps and rubella), correlation is not the same as causation! Dr. Wakefield's research involved a small number of children, many of whom were referred to him by lawyers working a class action suit to show vaccine causation.
Although his studies could not be duplicated by other researchers, the results were immediately reported widely in the media. For parents desperate to prevent or reverse autism, and to scapegoat companies producing vaccines, suing for financial support, Wakefield's study gave them just what they wanted to hear. When it became clear that the MMR vaccine was not the cause of autism, those parents and their supporters turned to blaming the minute amounts of mercury in the vaccine's preservative. Some vaccines were subsequently produced without mercury. Autism continued to increase unabated, partly due to broader diagnostic indices, and including those with minimal symptoms.
However, understandably, parents of autistic children were desperate for a cure. And many individuals and companies were more than willing to provide "cures" for a price. Among the therapies purported to cure or decrease the symptoms of autism were (are) chelation therapy, behavioral therapy, anti-fungal drugs, dietary changes including high doses of vitamins, minerals and immunoglobulins, non of which have shown any promise in curing autism.
At this point, autism is determined to be primarily genetic in origin, with the involvement of many genes, and possibly some unknown environmental influences as well.
The sad part of all this, besides the tragedy of having a child with autism, is the number of children who may be exposed to serious childhood illnesses which are completely preventable with vaccines.
Dr. Offit provides lengthy notes and a bibliography.
This book is very readable and should be seen as a good example of how some "science " can be hijacked for personal gain, resulting in misinformation and possible serious illnesses, not to mention the devastation of failed "treatments".
I highly recommend it for those who may have doubts about vaccines, and other interested parties. ...more
Although this book looked interesting on the library shelf, I was immediately put off by the author's unbelievable claims that changing diet can "cureAlthough this book looked interesting on the library shelf, I was immediately put off by the author's unbelievable claims that changing diet can "cure" or greatly reduce anxiety, depression, many chronic conditions (including multiple sclerosis!), many other neurological conditions including cognitive decline!
His claim is that fat is the body's main fuel and our focus on decreasing fats in the diet and increasing carbohydrates has led to multiple disease states. He is not completely off the mark here as we have seen high carb and processed food diets have led to a huge increase in obesity and diabetes. It is also true that we need cholesterol and our bodies make it. He also is on target when he bashes GMOs due to the use of altered seeds (Round-up ready) resulting in agribusiness using massive amounts of the glyphosate weed killer that damages pollinators and farm workers.
He recommends a diet low in carbohydrates and gluten free; avoidance of artificial sweeteners and all "junk foods" , fat free and low fat foods and many fruits (?!) He suggests eating many vegetables, along with wild-caught fish and grass-fed meat, sesame oil and extra virgin olive oil and many supplements.
While many of these suggestions are appropriate, I believe a balanced diet makes supplements a big waste of money. Many of his suggestions are beyond the reach financially for the majority of working and even middle class folks, not to mention poor people.
Although he provides many anecdotal stories of cures related to his recommended diet, the book is short on long term studies of specific diseases and their responses to the high fat, low carbohydrate diets he recommends.
I would not recommend this book as there are many better books available on diet and nutrition....more
This was a hard book to put down! It is a fascinating true story of a family with 12 children, six of whom suffer(ed) from schizophrenia. Chapters descThis was a hard book to put down! It is a fascinating true story of a family with 12 children, six of whom suffer(ed) from schizophrenia. Chapters describing the lives of the family members and the devolution of the minds of those suffering from mental illness alternate with chapters describing multi-faceted research projects on the causes and treatments of schizophrenia. Both aspects of the book are intriguing. After WWII, a seemingly normal couple, who make several different places their home, depending on Mr. Galvin's work situation, eventually land on Hidden Valley Road in Colorado where Mr. Galvin found work with the Air Force. Beginning in the 1940's baby boom, the couple started a family-large even for the times. The fist 10 children were all boys, the last two, girls. As they grew older, several things become clear: The home was very chaotic, the father was often away, discipline was minimal to none, physical fighting among the boys was common and often quite violent - both outdoors and in the house. There seemed to be no consequences for this behavior, and it seem that the mother was in denial that this behavior was unacceptable. While the boys mostly did well academically and were high school sports heroes, apparently with positive futures, one by one the boys developed mental illness, losing touch with reality. As the severity increased, they were medicated, and hospitalized, rotating in and out of mental institutions. While six of the boys eventually became very ill, four of the boys and both girls appeared mentally stable, although psychologically affected by the brothers' illnesses and abuse, including rape. Lots of research was done, including family studies, genetic studies, brain imaging, evaluation of medications (most of which have been in use for many years and produce serious side effects. ) The upshot is that this particular family suffered considerably-- and schizophrenia remains somewhat of a mystery. The causes appear to be a combination of several/many genes that may provide vulnerability to the disease. It is likely that these genes can be set in motion by "nurture" i.e. the environment of the child. Situations that were obvious in this family, such as fighting (some of which involved head injuries), sexual abuse, and general chaos and lack of any parental"brakes" on unacceptable behavior could have been significant factors. Sadly, it seems we are not much closer to finding the cause(s) of schizophrenia or a cure for this horrendous disease....more
This is a stunning and valuable book! Whitaker recounts the dramatic increase in mental illness over the past few decades and sets out to find an explThis is a stunning and valuable book! Whitaker recounts the dramatic increase in mental illness over the past few decades and sets out to find an explanation. The number of mentally Americans has tripled in just 20 years! This is partly demonstrated by the massive influx of applications for disability based on mental problems. And "mental illness", previously rare among children, is exploding.
He delves into the history of psychobiology, and the development of multiple drugs to treat various mental conditions. The thrust was to find "magic bullets" such as the antibiotics that had been such a boon in the treatment of infectious diseases. Psychiatrists needed to compete, and psychoanalysis and talk therapy--long, tedious, and often ineffective --could not compete with medicine's growth. In part by accident, and later on purpose, various drugs were developed that affected behavior, theoretically allowing mentally ill patients to become functioning members of society. The outcome of these developments are far more sinister.
Investigating the history of mental illness, Whitaker learns that patients diagnosed with schizophrenia and depression in the past, when treated humanely in a structured environment, most often were discharged within a year and went on to live relatively normal lives, with jobs, relationships, marriages. A very significant majority never suffered a relapse.
When the psychiatric drugs were developed, they were focused on changing neuronal pathways in the brain. The neuroleptics affect the dopamine receptors and selective serotonin re-uptake inhibitors (SSRIs) increase serotonin levels. AND YET---changes in these neurotransmitters has not consistently been shown to be causative of these psychiatric states!!!
The American Psychiatric Association - desperate to identify the biological basis of mental illness, in collusion with the National Institutes of Mental Health and big Pharma, developed drugs to address psychiatric ailments and did superficial studies showing efficacy. But longer term results- hidden from the public- show just the opposite: not only serious side effects, but also deterioration in function, cognition and multiple physical effects such as suicidal ideation (and suicides), sleeplessness and weight gain--along with frequent relapses and hospitalizations.
The short and long term results of treatments that rely far less on drugs have been shown to be far superior (but less remunerative to big Pharma and psychiatrists.) Multiple studies from other countries have borne this out!...more
This is a fascinating and really well-written book about blood. Everything you always wanted to know but were afraid to ask!
Blood is mysterious (stillThis is a fascinating and really well-written book about blood. Everything you always wanted to know but were afraid to ask!
Blood is mysterious (still) and is both a tissue and an organ required for life.
George traces the history of the development of the use of blood transfusions to save lives, from crude experiment with animal blood, through direct transfusions (patient to patient), to the use of blood banks and mobile units for use on or near the battlefields. She discusses the development of identifying the various blood types and the importance of typing and matching in transfusions.
There is a chapter on leeches and their use in both ancient and modern medicine. They are particularly useful in re-grafting of amputated fingers, ears, etc., preventing venous buildup, swelling and consequent tissue death.
There is a chapter on Janet Vaughan, a brilliant Welsh woman who was pivotal in developing blood banks in Britain.
Then there was (is?) a down side of transfusions: the transmission of blood-borne infectious diseases, including hepatitis C and HIV. George visited townships in South Africa (Capetown) a community of high unemployment and poverty, where she worked with Doctors Without Borders (MSF) to learn about the clinics there. They are working to introduce medications for the infected and safe sex practice. There is a great deal of interesting information about HIV and it history, including the fact that former President Mbeki refused to believe that HIV caused AIDS, and recommending folk "cures" allowing its easy spread in South Africa.
The author discusses plasma (blood with the cells removed) and the fractionation producing Factor VIII, a clotting factor missing in hemophiliacs, which , early on, the transmission of HIV to these patients from the life-saving factor pooled from hundreds of donors,
There is an interesting few chapters on menstruation and the many cultural beliefs, taboos and practices surrounding it. This includes isolation of menstruating women in cold dark huts in Nepal, concepts on uncleanness and untouchability. There is a serious lack of sanitary products in many arts of the undeveloped world. George identifies organizations working to educate the populace and provide supplies at a reasonable cost. A wonderful chapter is about Muruga- a man in India sensitive to his wife's issues with her period. He was determined to produce pads at a lower cost than those from big corporations. Ultimately, he invented a simple machine to make them and these machines have been shipped all over India and other poorer countries.
The author discusses controversies around paying blood donors, as well as current discussions related to the possible advantages of transfusing whole blood, after decades of using mostly component: packed cells, plasma, platelets, factor VIII, Factor IX.
Today, more blood is given to cancer patients than to those suffering trauma.Cancer chemotherapy can attack bone marrow (where blood cells are formed) and these patient need blood components. But current thought is that for trauma, whole, fresh blood may be the best.
I learned a lot from this book and highly recommend it!...more
This book is a well-researched and science based polemic on aging and agency over our bodies.
The author describes the culture of anti-aging products,This book is a well-researched and science based polemic on aging and agency over our bodies.
The author describes the culture of anti-aging products, cosmetic surgery , screenings, and meditation, dietary and exercise as means of prolonging life. The bottom line here is an illusion of control-and the acceptance of physical realities, while enjoying life. She rails against constant screenings which can be life-saving for those in high risk categories, but which frequently identify small abnormalities which would never lead to disease, but which invite intervention. No matter how much we spend, diet, meditate or exercise, we lack much control over our physical selves.
The most interesting and enlightening aspects of the book involve recent studies of the immune system, particularly the macrophages-white blood cells that propel themselves with pseudopodia (like amebas) and can slip through membranes. They have been shown to attack normal tissues resulting in autoimmune diseases - and even "shepherd tumor cells across membranes thus providing a path foe metastasis." Clearly, these cells do not "think" but possess some sort of agency over which we have little if any control.
Ehrenreich states "Once I realized I was old enough to die (i.e. in the seventies), I decided that I was also old enough not to incur any more suffering, annoyance or boredom in pursuit of a longer life. " Eating good food and moderate exercise improve feelings of well-being and helps us remain active-but need not be pursued to extremes to stave off death nor illness.
Of course she recommends seeking medical help for urgent problems, but encourages the reader to beware of diagnoses where the "disease" is a normal facet of aging, conjured by a drug company that have developed expensive treatments that often have serious side effects. (an example is osteopenia) She recommends avoiding the medical/industrial complex- "How often do we really need dental x-rays, mammograms and various scans?" She is particularly perturbed by the medicalization of dying. Thus aspect really resonated with me as I spent many years working in hospice care, as a nurse and as a manager of a hospice. It is really disturbing to see patients who are clearly terminally ill being offered more and more toxic treatments for a gain of a few days or weeks- when their quality of life is really limited, and the strain on families is extreme.
Ehrenreich also describes the emotional impact of ritual encounters with the medical profession. She examines the question of how scientific medicine really is. Controlled studies of various treatments and medications are relatively sparse, ditto for prevention services. What do doctors base their practice on exactly? Much of their formal education brings little to bear on it. Intensive courses in organic chemistry, cell physiology and biochemical cycles are not particularly helpful. Interactions with patients have improved in my opinion, mainly due to physicians of more diverse backgrounds, gender, race and nationality. However, throughout the 20th century, most practitioners were white men of relatively privileged backgrounds, having little in common with their patients to whom they felt quite superior.
She summarizes by referring to obsessive "working out" in the gym as "crushing the body" and obsession with meditation and mindfulness "mad". She debunks the concept of "visualization" in harnessing the immune system to fight cancer.
Overall, this is a very readable brilliant and incisive book that should be read by everyone-especially if you are over 50!...more
This is a well-written and thoroughly researched book about medicine in this country. Clearly, we are seriously lagging behind the rest of the developThis is a well-written and thoroughly researched book about medicine in this country. Clearly, we are seriously lagging behind the rest of the developed world in terms of cost, outcomes, delivery and access. There are numerous reasons, some of which are political, economic or ideological. What Brownlee is not in doubt about is that we have the power and money to fix it, but apparently not the political will.
This is not a new book, having been published in 2007, however, the problems she points out have barely been addressed, except perhaps with the Affordable Care act in terms of access. So much more needs to be done.
So what are some of the systemic problems she discusses?
---"If you build it they will come" We are not talking about a baseball diamond here but high tech diagnostic equipment, hospital beds, "state of the art" specialty units, etc. Wherever these exist, they are utilized to the max. Interestingly enough, however, the outcomes for patients utilizing them are not particularly improved. What is improved is the bottom line of the hospital or facility with these accouterments. Multiple studies have shown that in areas where there are top notch cardiac cathetrization labs available, many more caths-and stents and even surgeries are performed that in areas where they are not available--and the outcome of this is that many of these procedures were never necessary. Availability drives use, not patient need. "Supply is inducing demand."
--- Hospitals are some of the most dangerous places to be. Medication errors and infections are not uncommon. thousands of patients are injured or killed every year because of these adverse events.
---Many treatments including dramatic, new ones with terrible side effects, have never been studied for effectiveness. One example is the use of high dose chemotherapy and rescue with bone marrow transplant-for advanced breast cancer. This treatment has been shown to be ineffective in producing a cure. (And this is on top of the prolonged use of radical mastectomy when lumpectomy and radiation have been shown to be just as, if not more effective for breast cancer treatment.) These treatments provided lots of money for doctors and hospitals however. There are other common treatments that are either of questionable use or have been proven to be useless in most cases-spinal fusion being one.
---Over reliance on expensive diagnostic tools. Some of these expose patients to large doses of radiation and are not even needed. Some are done at the request of patients, of course, because they know they are available and will not cost them anything due to their insurance. Of course advanced diagnostic equipment is useful and often of critical importance. But doctors need to hone their diagnostic and physical examination skills, develop intuition, listen to patients and not just order tests because they can. They drive up the costs for all of us. Preventive scans and diagnostic imaging falls into this "usually unnecessary" category. Two problems here: the feeling that you are fine because the scan did not show any problem and the scan shows some irregularities (which would probably never result in a health crisis) that result in unnecessary and costly interventions.
---Direct to consumer advertising- usually of medications, but also devices and procedures. This is just plain disgraceful. The only other developed country that allows this is New Zealand, which is one reason drugs are so much cheaper in other countries. Drug companies: (don't even get me started) are spending more on advertising than on research and development. They invent diseases and disorders that few have ever heard of, then advertise just the right (expensive) medication for it. They control congress and the FDA. Patents were extended to 20 years from 17 and many new drugs are very similar to older, cheaper ones, but hyped to make them seem much better. (Example: Celebrex and Naproxen). Drugs are often poorly tested: small sample, specific samples (i.e. tested on patients who are not the likely population to use the drug), tested only against placebos, not other drugs known to be useful for the disease or disorder, etc. Then foisted onto the unsuspecting public, only to be withdrawn from the market a few years later due to disastrous side effects. (example: Vioxx causing pulmonary hypertension). They literally "Foster a condition then align it with a product," (in the words of medical marketing and media). Even articles in respected medical journals are often written by drug company marketers, and come complete with the names of qualified physicians as authors: ghostwritten! And most physicians rely on information in these journals.
---The decrease in the family physician, the generalist, is another big problem. Many patients see several specialists depending on what particular system is bothering them at any given time. The result is that none of the doctors see the whole picture and often work at odds with one another --and the patient. This is all very costly of course, and can result in over medication and over treatment in general. It results in less access and self diagnosis as well.
The author has a lot of good things to say about how managed care should be. She has investigated some of the positive changes made by the VA system and suggests that they be made in other areas of health care access. She seems upbeat and hopeful that our care "system" can be improved, but I am not convinced, based on the political power of the players in this country. This is 2018. Access is still a problem and costs have continued to climb, while the actual life expectancy in the US has decreased. Most Americans still think more treatment is always better than less and are insulated from the costs by insurance. We have a very long way to go!
I recommend this book to any interested in the health care dilemmas we need to fix.
This is a beautifully written treatise on the practice of medicine, and surgery in particular and how imperfect practitioners can (and usually do) strThis is a beautifully written treatise on the practice of medicine, and surgery in particular and how imperfect practitioners can (and usually do) strive for better and better outcomes. The drive for perfection (though unreachable) is more important in this field than most others because the lives of others depend on it. He recounts real life situations, his fears and concerns, the importance of focus, diligence and ingenuity. This sense of striving, failing and working to do better has applications far beyond the practice of medicine. He discusses the business side of practice- the need to make a living and manage the "business of doctoring". But this area is so complex, particularly in this country. Doctors often need to know the ins and outs of multiple insurance plans and networks, decide whether to see patients who cannot pay deductibles, or who have no insurance, and still keep the practice afloat. Gowande recounts the amazing developments on the battlefield that have saved the lives of severely wounded soldiers. (It is wonderful that some of these techniques can be applied to other patients. I do have concerns about salvaging those so wounded as to question whether their lives are worth saving-so severe are the deficits they are left with.) He also addresses the practices involved in birthing. He brings up the practice of forceps deliveries, which if used in skilled hands is much safer than c-sections. However, learning the proper use of them is actually more difficult than surgery despite a slew of possible complications, both for the current delivery and future ones as well. So C-sections prevail.
This is a thoroughly readable and interesting book and I highly recommend it....more
This is a very useful book--for everyone who ever takes medications--which is about everyone!
Granted, Dr. Weil was speaking to the converted when I reThis is a very useful book--for everyone who ever takes medications--which is about everyone!
Granted, Dr. Weil was speaking to the converted when I read this book. I have long been of the opinion that Americans in particular seem to think that there should be a pill for everything and that will relieve them of needing to take responsibility for their health. We are an incredibly over medicated populace, a situation which is tremendously costly both financially and in the damage done by the drugs themselves. Tens of thousands of deaths per year result from adverse reactions, drug-drug interactions, misuse/abuse of drugs, and medication errors in facilities and at home.
Several factors underlie this huge problem: the greed of big Pharma, direct marketing to consumers, soft-pedaling the dangers of the drugs to both physicians and patients, and physicians finding it easier and less time-consuming to write a prescription rather than spend time with patients to look at patient lifestyles, eating habits, exercize, etc.
Dr. Weil takes aim at most major categories of drugs, including statins, sleep aids, antibiotics, drugs to control stomach acid, drugs for diabetes and osteopenia. He also tackles the problems of medicating children and the elderly.
There are a few big takeaways: 1. As drugs are used over time, many become less effective as the body adjusts to their effects. 2. Many drugs are unnecessary--the body can and often does heal itself. 3. There are many approaches to maintaining health and dealing with problems that should not involve medications as a first response. He is clear that most minor infections will resolve on their own, cholesterol and blood sugar can often be controlled with diet and exercise alone. Hypertension can often be managed with the same diet and exercise, as well as stress management techniques such as meditation. Chronic pain can often respond to non-medical interventions as well, including acupuncture, massage and physical therapy.
This is a thoroughly researched, easy to read book, including some interesting case studies, that provides some excellent suggestions for an integrated approach to health and the management of various conditions. It is written by a respected medical doctor and I would encourage everyone to take the time to read it....more
This is a small but thoughtful volume by Siddhartha Mukerjee. Beautifully written.
The author uses examples from his real life medical practice to consThis is a small but thoughtful volume by Siddhartha Mukerjee. Beautifully written.
The author uses examples from his real life medical practice to consider how medicine is more than science. In one example, he sees a patient who has lost a great deal of weight and is tired and run down. He is a well dressed businessman, who was apparently in good health until recently. The most likely diagnosis is cancer (lung?) but all tests for this come back negative. When the doctor sees him in the lobby talking to a young man who appears to be a current or ex-drug user, the intuition comes to him. The patient has AIDS. And tests confirm it. Law 1. A strong intuition is more powerful than a weak test. He goes on to explain the importance of looking at the whole person, and that tests always have some degree of error--false positives and false negatives--which makes the intuition aspect critical.
When certain patients with the same dire diagnosis and the same treatment are virtually cured, others may be totally unresponsive to treatment. We see these as outliers. But we have a lot to learn from them. Why do some respond and others don't? Studying this can lead to new therapies. Law 2. Normals teach us rules; outliers teach us laws.
Every science suffers from some human bias. The author gives some interesting of medical science studies that have the same problem. We want the tests to turn out in a certain way. Data can be evaluated in different ways. We need to look for these biases and know they exist. Law3. For every perfect medical experiment, there is a perfect human bias.
I highly recommend this little book for anyone in the healthcare field. ...more
Dr. Parker presents a compelling case for choice. Deeply Christian, he is moved by a sermon by Dr. Martin Luther King about the Good Samaritan. He focDr. Parker presents a compelling case for choice. Deeply Christian, he is moved by a sermon by Dr. Martin Luther King about the Good Samaritan. He focuses on real Christian compassion, which includes providing safe abortions for women in need without judgment. Dr. Parker gave up a lavish lifestyle to become an itinerant physician performing abortions in the deep south.
Throughout the narrative, his clear compassion for the women he cares for is evident. He continues to be a champion for women's rights to total reproductive healthcare.
The book is uplifting (sometimes tearfully so) and a wonderful resource for those on the frontlines of the battle for choice.
This is a fascinating book by a physician and a great writer. Using real life cases as the focus of the book, he uses the examples and outcomes to disThis is a fascinating book by a physician and a great writer. Using real life cases as the focus of the book, he uses the examples and outcomes to discuss many complications in medicine. Not necessarily medical or surgical complications, but philosophical complications. He asks many thought-provoking questions emerging from his experiences. Who should make decisions regarding treatment, for example. Should the knowledgeable party-the doctor-make decisions alone? This is considered paternalistic and often problematic. Should the patient decide? After all, it's his/her body. The best decision making should involve both. However, in real life this is not always possible, as he shows in several vignettes. Is the patient mentally competent to make decisions? They should be informed of their options in clear language. They should work with the physician to decide on treatment. But the patient may have undisclosed issues, the information provided may be biased or incomplete. There may be emergency situations in which the doctor must make the decision. And with all of this, both patient and physician are humans and are fallible. Mistakes are made. There are cost-benefit issues, family members at odds with the patients wishes.
Throughout the book, the record of his experiences, he is honest and human. Always aware of the enormous responsibility of his role, aware of errors of judgment, he remains a compassionate voice.
Some subjects included are the complexity of pain and how it can vary from patient to patient and be present when there is no physiological reason for it. He discusses the connection between pain and the brain. There is an interesting section on hyperemesis of pregnancy, unrelenting blushing, morbid obesity and other pertinent topics.
This is a highly recommended book for anyone who is ill, for physicians and humans in general!...more
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