One-Minute Book Reviews

January 2, 2008

Do These Genes Make Me Look Fat? Gina Kolata’s ‘Rethinking Thin’

Can you lose weight through willpower alone? Maybe not, says a science writer’s book about the myths, misconceptions and half-truths about diets

Rethinking Thin: The New Science of Weight Loss — and the Myths and Realities of Dieting. By Gina Kolata. Farrar, Straus and Giroux, 257 pp., $24.

By Janice Harayda

You know how some people say they can eat anything and not get fat? And how others insist they gain weight if they so much look at a Caramel Pecan Brownie at Panera?

Their claims may be less far-fetched than they sound. In Rethinking Thin Gina Kolata makes clear that dieters have been misled for decades by academic and other experts who promote strategies that haven’t been proved to help people achieve long-term weight loss. Among the oversold tactics: willpower, talk therapy and removing soda and snack machines from schools.

Rethinking Thin also casts doubt on the popular behavior modification techniques, such as portion control, that drive many weight-loss clubs and programs. Studies at the University of Pennsylvania and elsewhere have found that dieters lose more weight and keep it off longer if they join groups that give them “tools to track and change their behavior toward food and to recognize and defuse risky eating situations.” But Kolata notes that this doesn’t mean that they do better because they are adjusting their behavior: “It could also be that better results arise from the accountability that they feel when they commit themselves to coming, time after time, to a meeting where they will be weighed and where they will talk about their eating and whether it is under control.”

If willpower doesn’t help most people stay thin, what does? Perhaps above all, having slim parents. No small value of this book lies in Kolata’s willingness to say two things diet experts rarely acknowledge: first, that people don’t get fat because of psychological problems and, second, that in the struggle to stay thin, genes matter. Rethinking Thin offers persuasive evidence that fat and thin people suffer equally from stress, anxiety and depression and that weight is to a large extent inherited. This doesn’t mean that trying to lose weight is a fool’s errand, but it does mean that some people will always have to work much harder than others to stay thin. And if you have trouble keeping a New Year’s resolution to lose weight, the fault may lie less with you than with all those Size XXL branches on your family true.

Best line: “Free will, when it comes to eating, is an illusion.” Kolata is summarizing the views of Jeffrey Friedman, an obesity researcher at Rockefeller University, and his colleague, Bruce Schneider, and much of her book supports this view.

Worst line: Kolata quotes from e-mail she received from an obesity researcher at Johns Hopkins who was responding to a question she had asked: “You are very perceptive, my friend.”

Published: May 2007 www.fsgbooks.com

Furthermore: Kolata is a science writer for the New York Times who lives in Princeton, NJ.

(c) 2008 Janice Harayda. All rights reserved.

www.janiceharayda.com

December 29, 2007

If You’ve Made a New Year’s Resolution to Lose Weight, You May Want to Make Another Resolution to Read ‘Good Calories, Bad Calories’ Before You Start Your Diet

Good Calories, Bad CaloriesHave you made yet another New Year’s resolution to lose weight?  You may want to check out Gary Taubes’s Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease (Knopf,  601 pp., $29.95), which I wrote about in October  www.oneminutebookreviews.wordpress.com/2007/10/09/. This isn’t a diet book but one that investigates many of the claims that underlie other diet books.

Based on an exhaustive review of the scientific research, Taubes argues that obesity “experts” have demonized fat on the basis little or no evidence. Refined carbohydrates, he says, are a greater threat to health. And those fat-free brownies may hurt you more than foods that have more fat but fewer carbs. “Dietary fat, whether saturated or not,” he concludes, “is not a cause of obesity, heart disease, or any other chronic disease of civilization.”

(c) 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

December 28, 2007

Take One Misdiagnosis and Call Me in the Morning – Jerome Groopman’s ‘How Doctors Think’

A Harvard Medical School professor says that physicians’ faulty logic can kill

How Doctors Think. By Jerome Groopman, M.D. Houghton Mifflin, 291 pp., $26.

By Janice Harayda

It’s flu season, and that’s bad news for you if you have an obscure disease with flu-like symptoms. Your doctors’ diagnoses might reflect a confirmation bias (a tendency to find what they expect to find), an availability error (a decision based on how easily examples come to mind) or other cognitive flaws that Jerome Groopman describes in this engaging bestseller.

Groopman’s thesis is that a doctor’s state of mind strongly affects clinical decision-making. And many of his examples are eye-opening if paradoxically commonsensical. Do doctors’ friends get better care? Not necessarily, Groopman says. A doctor might hesitate to prescribe a necessary but painful test for a friend. Do doctors favor the sickest patients, who may need their care the most? Actually, they prefer healthy ones. One social psychologist found that “the sickest patients are the least liked by doctors, and that very sick people sense this disaffection,” Groopman writes. Apparently many doctors feel they have worked in vain when a disease resists treatment and stop trying to help. How Doctors Think

Much of this is so interesting that you wish this book didn’t reflect biases of its own. One is that it slights mistakes that result from factors other than cognitive flaws, such as fatigue, poor training and inadequate supervision.  “Experts studying misguided care have recently concluded that the majority of errors are due to flaws in physician thinking, not technical mistakes,” writes Groopman, a professor at Harvard Medical School and staff writer for The New Yorker.

But when you go to the end notes of his book to look for the source of that hard-to-believe “majority,” you read: “Although the frequency of misdiagnosis has been studied, few researchers have focused on its relationship to physician cognition.” So who are those “experts” who found that most errors result from doctors’ thinking?  The notes name only one expert who found such a “majority,” a researcher who had studied “serious errors that led to malpractice claims.” But Groopman says that the majority of all errors result from physicians’ thinking, not the majority of errors that lead to malpractice suits. Either his end notes are incomplete or he misrepresents in the book some of the material he cites in the notes.

At the very least How Doctors Think leaves a different impression of the causes of mistakes than the chapters on medical errors and problem doctors in Atul Gawande’s Complications, a more cogently argued book by another physician who writes for The New Yorker.  Gawande quotes from a landmark series of papers in the New England Journal of Medicine that reported that one percent of all hospital admissions involved negligence that prolonged the stay or led to death or disability of the patient. A smaller study of the treatment of cardiac arrests found that “27 of 30 clinicians made an error in using the defibrillator – charging it incorrectly or losing too much time figuring out how to work a particular model.”

Groopman is a bit like a coach who blames the problems in baseball on the character flaws of individual players instead of the culture that produced them. He says that doctors “desperately” need patients to “help them think.” If that’s true, it reflects badly on the entire American system of medical education, training and certification, not just on individual physicians. Clearly many doctors need more than “help” thinking logically – they need to learn how to work the defibrillator.

Best line: “When a patient tells me, ‘I still don’t feel good. I’m still having symptoms,’ I have learned to refrain from replying, ‘Nothing is wrong with you.’ The statement ‘Nothing is wrong with you’ is dangerous on two accounts. First, it denies the fallibility of all physicians. Second, it splits the mind from the body. Because sometimes what is wrong is psychological, not physical. This conclusion, of course, should be reached only after a serious and prolonged search for a physical cause of the patient’s complaint.”

Worst line: Groopman says his book is for people who aren’t physicians “because doctors desperately need patients and their families and friends to help them think.”  Isn’t it bad enough that we have all those TV commercials telling us to ask our doctors if we need a certain drug because, basically, they’re too dumb to figure it out on their own? Do we need this kind of smarm from doctors, too? Groopman doesn’t mention that there are 285 doctors for every 100,000 people in the U.S. and, if he’d written his book for doctors, he might make a lot less money.

 

Recommendatiom? A good but one-sided book. If you’re interested in medical errors, consider reading the chapters called “When Doctors Make Mistakes” and “When Good Doctors Go Bad” in Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science (Holt/Metropolitan, 2002) www.gawande.com instead of or in addition to How Doctors Think

Editor: Eamon Dolan

Published: March 2007  www.jeromegroopman.com  and www.houghtonmifflinbooks.com

One-Minute Book Reviews is for people who like to read but dislike hype and review inflation. It is also for people who dislike long-winded weasel reviews that are full of facts and plot summaries but don’t tell you what the critic thought of the book.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

November 13, 2007

The ‘Tyranny of Positive Thinking’ and Cancer Patients — A Physician-Author Says That It’s Not Always Best to Tell People to ‘Be Optimistic’

Can you give too much encouragement to people who are ill?

By Janice Harayda

Not long ago, I reviewed Betty Rollin’s Here’s the Bright Side and objected to its theme that all human suffering holds “a hidden prize waiting to be found.” I argued that some losses are so sad — the death of a child, say — that urging people to find their “bright side” is cruel.

Later I read some interesting, related comments by Jimmie Holland, chair of Department of Psychiatry and Behavioral Sciences at the Memorial Sloan-Kettering Cancer Center. They appeared in an article Leslie Brody wrote about caring for her husband, who has pancreatic cancer, for the New Jersey daily, The Record, on May 20, 2007.

“Think twice before telling the patient to ‘be positive,’” Brody wrote. She added:

“Dr. Jimmie C. Holland, author of The Human Side of Cancer and a pioneer in the psychological aspects of the illness, has written about the ‘tyranny of positive thinking.’ When people insist patients should ‘be optimistic,’ they imply that those who get sicker may be to blame for not trying hard enough to stay upbeat and conquer the disease.

“Holland says a patient’s mind-set might help him stick to a grueling chemo regimen, but it’s less clear whether attitudes and emotions in themselves can affect tumor growth or the body’s response. Patients — and their families — should feel free to vent depressing and anxious thoughts without being judged.

“Instead of saying ‘Chin up,’ or, ‘You’ll be fine,’ it’s better to say, ‘Hang in there,’ or ‘We’re thinking of you,’ or ‘We’re hoping for the best.’”

Links: To read the original review of Here’s the Bright Side, click here www.oneminutebookreviews.wordpress.com/2007/08/21/. To read about The Human Side of Cancer, click here www.humansideofcancer.com.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

October 9, 2007

Gary Taubes’s ‘Good Calories, Bad Calories’ (Books I Didn’t Finish)

 

The latest in a series of occasional posts on books I didn’t finish and why I didn’t finish themGood Calories, Bad Calories

Title: Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control, and Disease. By Gary Taubes. Knopf, 601 pp., $29.95.

What it is: An investigative report on the diet advice fed to us by government and other nutrition authorities. A major theme is that obesity “experts” have demonized fat on the basis little or no scientific evidence. Refined carbohydrates, Taubes argues, pose a greater threat to health. And those fat-free brownies may hurt you more than foods that have more fat but fewer carbs. Taubes sums up his conclusions in a 10-point list on page 454. Point No. 1 is: “Dietary fat, whether saturated or not, is not a cause of obesity, heart disease, or any other chronic disease of civilization.”

How much I read: The prologue and first chapter, the epilogue, and a couple of chapters in between, nearly 100 pages.

Why I stopped reading: I liked this book and, because of it, had a salad for dinner instead of the steamed pork dumplings from the Chinese place. But it develops ideas I’d read in other books and in an article Taubes wrote for The New York Times Magazine (“What If It’s All Been a Big Fat Lie?,” July 7, 2002). So its arguments, though strong, weren’t strikingly new to me. And Good Calories, Bad Calories is getting so much attention, it didn’t seem to need me as much as, say, books by obscure poets who live on canned ravioli because those ultra-refined carbs are all they can afford.

Best line in what I read: “Between 1987 and 1994, independent research groups from Harvard Medical School, the University of California, San Francisco, and McGill University in Montreal addressed the question of how much longer we might expect to live if no more than 30 per cent of our calories came from fat, and no more than 10 percent from saturated fat, as recommended by the various government agencies…

“The Harvard study, led by William Taylor, concluded that men with a high risk of heart disease, such as smokers with high blood pressure, might gain one extra year of life by shunning saturated fat. Healthy nonsmokers, however, might expect to gain only three days to three months …

“The UCSF study, led by Warren Browner, was initiated and funded by the Surgeon General’s Office. This study concluded that cutting fat consumption in America would delay 42,000 deaths each year, but the average life expectancy would increase by only three to four months. To be precise, a man who might otherwise die at 65 could expect to live an extra month if he avoided saturated fat for his entire adult life. If he lived to be 90, he could expect an extra four months. The McGill study, published in 1994, concluded that reducing saturated fat in the diet would result in an average life expectancy of four days to two months.”

Worst line in what I read: None by Taubes. So let’s go with a clinker written by the New York Times’s Jane Brody, who kept promoting high-fiber diets long after large-scale studies showed that they had few or no long-term benefits: “But dietary fiber … has myriads of benefits,” Brody wrote. Taubes quotes this line in a chapter on fiber that debunks much of the media hype about it.

Recommendation? This is not a diet book, but a book in the spirit of Eric Schlosser’s Fast Food Nation and Greg Critser’s Fat Land. Don’t miss Taubes’s brief and low-keyed – but nonetheless damning — analyses of Brody’s Personal Health column in the Times.

Published: September 2007 www.aaknopf.com

Furthermore: Taubes is a correspondent for Science magazine who, according to his dust jacket, is “the only print journalist who has won three Science in Society Journalism awards, given by the National Association of Science Writers.”

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

August 6, 2007

Emily Rapp Writes in ‘Poster Child’ About Life After Her Foot Was Amputated

A former poster child for a March of Dimes chapter in Wyoming had a meltdown after years of trying to persuade herself that her disability made her no different from others

Poster Child: The Story of a Broken Girlhood. By Emily Rapp. Bloomsbury, 240 pp., $23.95.

By Janice Harayda

Emily Rapp was born with a birth defect that required the amputation of her left foot just before her fourth birthday. She adapted so well – in her own eyes and others’ – that at the age of six she was a poster child for her March of Dimes chapter in Wyoming.

But her view of her condition began to change in college, where she read a book of essays by women with disabilities. One contributor wrote that others tended to view people with disabilities “either as helpless things to be pitied or as Super Crips, gallantly fighting to overcome insurmountable odds.”

A great virtue of Poster Child is that it avoids those extremes. In this lucid memoir, Rapp gives a much more complex view of what it meant to walk first with braces, then with a wooden leg and finally with a Flex-Foot, “a prosthetic limb that featured a suction socket and a hydraulic knee unit.”

Poster Child is not a perfect book, partly because Rapp’s effort to understand her disability seems to be a work-in-progress. After years of pretending to be just like anybody else, Rapp developed undiagnosed anorexia in high school. But she did not seek counseling until she had a meltdown, including severe panic attacks, as a Fulbright Scholar in Korea. And in her final pages she at times sounds as though she has traded her earlier beliefs for the new jargon she absorbed in therapy. In the next-to-last chapter, she writes:

“I realized that if I did not break free of my faulty logic, I might spin forever in a destructive trap of my own making, and then I would never be whole.”

That is pretty much the party line for cognitive behavioral therapy, the standard treatment for panic attacks: If you’re having attacks, it’s because you need to fix your “incorrect” thinking. But much of the evidence in this book suggests that Rapp’s problems were caused not by her “faulty logic” but by others’ cruelty and insensitivity. Rapp also doesn’t make clear whether she overcame her anorexia, which once caused her to stop menstruating and carry only 98 pounds on her 5’6″ frame. This is the equivalent of an unresolved subplot in a novel, and the lapse isn’t irrelevant to the story. Anorexia is generally regarded as a condition that involves a desire for control, and some research suggests that it commonly reflects anger with the opposite-sex parent. Rapp says little enough about her father, a Lutheran minister, that you wonder if he had more to do with this story than she lets on.

Such inconsistencies in the last 50 or so pages rob Poster Child of the unity of such as memoirs as Autobiography of Face. But it is still a very good book, maybe the best we have about growing up as an amputee. It also has a powerful message for parents, teachers, health-care workers and others who repeatedly tell children with disabilities, as Rapp’s mother did, “You are just like everybody else.” The question that lingers is: If you tell children with disabilities that they’re exactly the same as others, what happens when they figure out that they’re not?

Best line: Born with one leg shorter than the other, Rapp attracted stares long before her amputation. She says the questions began soon after she took her first steps: “Whenever she was asked, ‘What happened to your baby?’ Mom replied, ‘Oh, she is okay. She just has one leg shorter than the other, and the brace helps her walk.’ She became comfortable with this standard response. It didn’t bother her when children asked her what was wrong with me; she felt that their curiosity was innocent and natural. She got annoyed only when adults asked or, worse, expressed condolences (‘I’m so sorry; it must be so hard’) or dispensed useless medical advice like ‘There are medical advances every single day’ or ‘God works in mysterious ways; at least she looks happy.’ And according to my mother, I was.”

Worst line: Rapp writes that on “a pleasant summer afternoon” in Colorado, “The smell of dry sagebrush and lilacs hung in the air.” A post by the Colorado State University Extension Service says that in Colorado lilacs bloom, as elsewhere in the U.S., in the spring – specifically, in May.

Editor: Annik La Farge

Published: January 2007

Recommendation? An excellent book for reading groups, not just because it’s so well-written but because it has implications for how Americans respond to many kinds disabilities, not just to amputees. Poster Child may especially interest reading groups at houses of worship that have ministries to or programs for people with disabilities.

Caveat lector: This review was based on an advance reading copy. Some material in the finished book may differ.

Links: www.emilyrapp.com and www.bloomsburyusa.com

(c) 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

July 18, 2007

Atul Gawande Tells What You Can REALLY Expect When You’re Expecting

A surgeon looks at the pros and cons of forceps, Cesarean sections, epidural anesthesia, fetal heart monitors and other fixtures of modern delivery rooms

Better: A Surgeon’s Notes on Performance. By Atul Gawande. Holt/Metropolitan, 273 pp., $24.95.

By Janice Harayda

Last year the New York Times published an article on a remarkable medical study that found that – contrary to a near-universal belief – pushing during labor helps neither the mother nor the baby. The study also found that women who were told to push may have more urinary problems after the delivery. One of the doctors who did the survey, published in the American Journal of Obstetrics and Gynecology, said that the research did not mean that women should never push. Instead, he said, they should do “what feels natural to do – and for some women that would be no pushing.”

I had two reactions to this news. First, if I were pregnant, I would ask my obstetrician if he or she planned to tell me to push and, if so, why, given there seems to be no benefit to doing this during every birth. Second, why didn’t we know this news sooner? Why have doctors for so long inflicted the needless agony of pushing on women? I had no idea what the answer to the second question might be until I came across a striking fact in the chapter on childbirth in Atul Gawande’s Better: Most doctors pay lip service to the idea that nothing should be used in medicine unless it has been properly tested and shown to be effective by a respected research center, preferably through a double-blind, randomized trial.

“But in a 1978 ranking of medical specialties according to their use of hard evidence from clinical trials, obstetrics came in last,” Gawande writes. “Obstetricians did few randomized trials, and when they did they largely ignored the results.”

That observation helps to explain why Gawande, a surgeon and writer for The New Yorker, may be our most important medical writer. Unlike many others working in the field, he doesn’t write mainly about the latest developments in medicine. He digs deeper, looking for the “why” behind the “what,” while taking on extraordinarily complex topics. But his writing is rarely harder to understand than in his lines about the 1978 survey of medical specialties. He seems to make a grail not just of accuracy but of clarity.

The chapter on childbirth in Better shows his work at its finest. It deals largely with why so many women have Cesarean deliveries, which account for about 30 percent of American births. Many people explain the statistic by saying that Cesareans are more convenient and lucrative for doctors than vaginal births. Gawande argues persuasively that there is a larger reason for the pattern. And part of it has to do with the virtual disappearance of forceps from delivery rooms.

In the 1960s fewer than 5 percent of deliveries were Cesareans and more than 40 percent involved forceps. And those numbers are related. Gawande makes a strong case that in the hands of experts, forceps are safe (according to some research, safer for mothers than Cesareans). But forceps are hard to learn to use properly – a process that can take two years. And if forceps are used by inexpert doctors, the results can be disastrous. Cesareans are easier to master. And this has led hospitals to phase out forceps and, in many cases, do C-sections instead. To discourage the inexpert from using forceps, Gawande says, “obstetrics had to discourage everyone from using them.” This change has come at a cost. Gawande notes that, as straightforward as Cesarean deliveries can be, they can go wrong. The baby can be lacerated. If the head doesn’t come free quickly, the child can asphyxiate. The mother also faces risks:

“As a surgeon, I have been called in to help repair bowel that was torn and wounds that split open. Bleeding can be severe. Wound infections are common. There are increased risks of blood clots and pneumonia. Even without any complication, the recovery is weeks longer and more painful than with vaginal delivery.”

With all of this, Gawande isn’t trying to frighten women away from having Cesareans or bring forceps back to every community hospital. He is instead trying to show the trade-offs that medicine involves. And this is only a small part of what he says in his chapter on childbirth, “The Score,” which also covers such delivery-room fixtures as fetal heart monitors, epidural anesthesia and the labor-inducing drug Pitocin. It is an even smaller part of what he has to say in the 11 chapters of Better that deal with subjects other than childbirth, including advances in military medicine and the need for doctors to wash their hands more often.

Women who are pregnant may reach for books like What to Expect When You’re Expecting and The Girlfriends’ Guide to Pregnancy. And patients who are facing surgery may turn to guides to their illnesses. But both groups could benefit from also reading this fine collection of essays. For some of them, Better may just be better.

Best line: Gawande writes about the Apgar score, which rates a newborn’s health: “In a sense, there is a tyranny to the score. While we rate the newborn child’s health, the mother’s pain and blood loss and length of recovery seem to count for little. We have no score for how the mother does, beyond asking whether she lived or not – no measure to prod us to improve results for her, too. Yet this imbalance, at least, can surely be righted. If the child’s well-being can be measured, why not the mother’s, too?”

Worst line: None.

Editor: Sara Bershtel

Published: April 2007

Furthermore: The New York Times article on pushing during labor, “Rethinking the Big Push During Contractions, appeared on Jan. 3, 2006, page F8. I can’t link directly to it, but here’s a link to a similar reprint in its sister publication, The International Herald Tribune. When you click on the following link, you will reach a page that says “Multiple Choices” and see another link that looks just like it (below the phrase “Available Documents”). You have to click on that one, too, to read the story (which appears below an article on “lazy eye”): www.iht.com/articles/2006/01/04/healthscience/snvital/php/php.

Links: Gawande has posted many of his articles on medicine at www.gawande.com.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

May 30, 2007

‘Japanese Women Don’t Get Old or Fat’ (Books I Didn’t Finish)

Maybe this is how the new Miss Universe stays thin?

Title: Japanese Women Don’t Get Old or Fat: Secrets of My Mother’s Tokyo Kitchen. By Naomi Moriyama and William Doyle. Delta, 274 pp., $12, paperback.

What it is: One woman’s theory of why Japanese women have the lowest obesity rate in the world (3 percent) and the highest life expectancy (85 years) even though the country has “millions of stressed-out, nonexercising people who are smoking and drinking their way to early graves.”

Where I stopped reading: At the beginning of Chapter 4, entitled “How to Start Your Tokyo Kitchen, or Yes, You Can Do This At Home!” (page 67).

Why I stopped: You’d need to have a more serious interest in Japanese cooking than I do to read more than I did. The first three chapters explain the Japanese philosophy of eating as seen by Tokyo-born Naomi Moriyama, who moved to the U.S. at the age of 27. And these sections are interesting and well-written, though rooted in the views of an earlier generation (that of the author’s mother). Many Americans may be surprised to learn that the Japanese love desserts, especially chocolate. “One elegant Tokyo department store now offers shoppers their own accounts in a Chocolate Bank – you buy an amount of gourmet chocolate, the store keeps it in its temperature-controlled chocolate vault, and you stop in to make a withdrawal any time you want.” But after the first three chapters, the book turns into a collection of recipes for what Moriyama calls “Japanese home cooking.” “This is not a diet book,” she says. “And it’s not a book about making sushi.”

Best line in what I read: The Japanese philosophy of eating includes the concept of hara hachi bunme – “eat until you are 80 percent full.”

Worst line in what I read: I stopped before the recipe-intensive section. But even the recipes in earlier chapters call for ingredients that might be hard to find outside big cities. Among them: dashi, kombu, mitsuba, shiso leaves and bonito flakes.

Editor: Beth Rashbaum

Published: November 2005 (Delacorte hardcover), January 2007 (Delta paperback). This site has video clips of Moriyama’s Today show appearance: www.japanesewomendontgetoldorfat.com

© 2007 Janice Harayda. All rights reserved.
www.janiceharayda.com

At least 50 percent of all reviews on One-Minute Book Reviews cover books by women. Except during holiday weeks, books by female authors typically appear on Mondays and Wednesdays and books by male authors on Tuesdays and Thursdays. Please consider linking to this site and telling others about it if you’re frustrated by how often Sunday book review sections consist mainly of reviews books by male authors, written by male critics. To my knowledge One-Minute Book Reviews is the only site that, while reviewing books by both sexes, has had from the start a publicly stated commitment to parity for female authors. Thank you for visiting this blog. — Jan

Atul Gawande Takes the Pulse of the Medical Profession

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True or false: More people go crazy when the moon is full.

If you said “true,” you probably haven’t read Atul Gawande’s Complications: A Surgeon’s Notes on an Imperfect Science (Picador, $14, paperback), a stylish collection of essays by a Boston surgeon and contributor to The New Yorker. Gawande reviewed more than a hundred studies of how lunar phases affect human behavior after his fellow doctors warned him to expect more hospital admissions when the moon was full. He found that researchers had pored over all kinds of evidence – police logs, homicide statistics, emergency room visits and consultations with psychiatrists. The result? There’s no relation at all between craziness and the full moon. Some studies have suggested the opposite – that full moon has a beneficial effect on human behavior.

This is the kind of fascinating material regularly dispensed by Gawande, who also wrote the new Better: A Surgeon’s Notes on Performance (Metropolitan, $24). The essays in Complications deal with subjects from doctors’ mistakes to patients with terrifying diseases like necrotizing fasciitis (known, somewhat misleadingly, “flesh-eating bacteria”). Gawande often takes controversial positions. He challenges the idea – cherished by many doctors – that surgeons need “good hands,” saying the continual practice of surgery matters more. (Doesn’t the quality of the practice matter? What about education? Can practice make you a great surgeon if you went to a medical school or work at a hospital that’s a step away from losing its accreditation?) But part of the appeal of Complications is that Gawande www.gawande.com has the courage to risk saying things other doctors won’t and the rhetorical skill to give his views force. He never hides behind a cardboard shield of medical omniscience. And he deals with a wider and more offbeat range of medical topics than physician-authors like Oliver Sacks and Sherwin Nuland. So you may enjoy Complications even if you couldn’t get through The Man Who Mistook His Wife for a Hat or How We Die.

© 2007 Janice Harayda. All rights reserved.

www.janiceharayda.com

May 17, 2007

Nigel Marsh’s ‘Fat, Forty, and Fired,’ a Memoir of Unemployment

An English advertising executive in Australia discovers that – surprise – caring for his children is harder than he thought

Fat, Forty, and Fired: One Man’s Frank, Funny and Inspiring Account of Leaving His Job and Finding His Life. By Nigel Marsh. Andrews McMeel, 288 pp., $19.95.

By Janice Harayda

A couple of decades ago, American newspapers regularly published articles by men who had decided to stay home with their children and realized – to their amazement – that the work their wives did was actually hard. These gee-whiz accounts became a journalistic cliché fast enough that they have pretty well played themselves out here.

But apparently the trend still has life in Australia, where Nigel Marsh’s memoir of nine months at home with his family earned him spot next to Dan Brown and John Grisham on the bestseller lists. Not that Marsh signed on for the project as willingly as some of those former American “househusbands” who have since been recast as “stay-at-home dads.” Born and raised in England, he was the CEO of an advertising agency when a merger left him jobless. Instead of going right back to work, he decided that he wanted to stop being “a bit player in my own family” and spend more time with his wife, Kate, and four children under the age of 9.

Fat, Forty, and Fired is a breezy account of this experience that reads at times like a book fished out of an American time capsule from the 1980s, or a treatment for an offbeat Australian version of The Simple Life with the author alternately playing the roles of Paris Hilton, Nicole Richie and one of their hosts. Marsh pats himself on the back when his stint as a school cafeteria volunteer goes well, and he’s irritated when his wife doesn’t “thank” him for dressing his twin daughters. Fortunately, Kate sets him straight quickly: “Why should I thank you when you do the basic things that you should be doing anyway?” And his book becomes more interesting as he flings himself other goals – to lose 30 pounds, train for an ocean swimming race, and conquer the alcoholism that he’d been denying even while knocking back six beers a night after work.

By the end of the nine months, Marsh has achieved several of his aims. But his hope of achieving “a more balanced life” is another matter. Recidivism sets in almost as soon as he takes a new job as CEO of Leo Burnett Australia. And he concludes that all the books and articles that tell men how to achieve “work-life balance” are not only misguided but part of the problem, because men can’t “have it all” any more than women can. That may be true, you have the sense that he’s known that all along. So what did he really gain from his experience?

In his time off, he quit drinking, lost weight and had many lyrical moments with his children, who play amusing and at times poignant roles in the book. And such gains, he suggests, were enough. “I may be struggling,” he admits, “but the struggle is slightly more enjoyable less damaging to those around me than it was a year ago.”

Best line: One of the strongest chapters deals with how people reacted after learning that Marsh had quit drinking. One group insisted bizarrely that he’d never had a problem with alcohol: “I was somehow offending these people’s sense of what a ‘real’ drunk’s story should be. I wasn’t a professional drunk – I was merely third division. Pathetic. My life hadn’t gone off the rails enough for them. If only I could have an affair, lose my job, or maim someone in an accident, I’d be a first-class guy. It just didn’t impress these people that I stopped before a dramatic disaster befell me.”

Worst line: Marsh’s treatment of most subjects is skin deep and sinks into psychobabble when he tries to sum up what he learned from his time off. He says the hiatus “started me on a personal journey” and that “I’m basically working on the habit of counting my blessings, not whining about the challenges.”

Reading group guide: A readers’ guide to Fat, Forty, and Fired was posted, before this review, on May 17, 2007, and is archived in the Totally Authorized Reading Group Guides category. This is guide is not just for book clubs but is also for individual readers who would like to learn more about the book.

Caveat lector: This review was based on the advance readers’ edition. Some material in the finished book may differ.

Published: April 2007

Links: www.fatfortyandfired.com

© 2007 Janice Harayda. All rights reserved.

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