One-Minute Book Reviews

September 18, 2008

Maybe You Don’t Need That Colonoscopy or Those Statins — A Noted Doctor Challenges the Medical Establishment – ‘Let My Polyps Go’

Angioplasties and stents are "good ideas that proved bad."

“Dr. Hadler sees no evidence that mild high blood pressure or mildly elevated blood sugar pose much of a risk to longevity — certainly not enough to warrant the aggressive drug treatment often offered for them. The same goes for … the modest elevations in serum cholesterol that, these days, spell a statin drug for life for many healthy people.”

Self-help books that urge you to micromanage every health risk have become disease unto themselves. So it was cheering to see the New York Times giving serious attention to a new book by a noted physician who still believes that less medicine can be more.

Abigail Zuger, an internist and frequent contributor to Times, recently reviewed Worried Sick: A Prescription for Health in an Overtreated America (Univesity of North Carolina Press, 376 pp., $28), by Nortin M. Hadler, “a rheumatologist and professor of medicine at the University of North Carolina who is a longtime debunker of much the establishment holds dear.” Zuger wrote:

“Dr. Hadler may not actually keep a skull on his desk, but he might as well. We are all going to die, he reminds us. Holding every dire illness at bay forever is simply not an option. The real goal is to reach a venerable age — say 85 — more or less intact.”

Zuger adds that Hadler believes the way to achieve that goal is to ignore much of the conventional advice:

“Reviewing the data behind many of the widely endorsed medical truths of our day, he concludes that most come up too short on benefit and too high on risk to justify widespread credence.

“Dr. Hadler sees no evidence that mild high blood pressure or mildly elevated blood sugar pose much of a risk to longevity — certainly not enough to warrant the aggressive drug treatment often offered for them. The same goes for the extra 20 pounds that make you overweight but not obese, and the modest elevations in serum cholesterol that, these days, spell a statin drug for life for many healthy people.

“He deplores the careful attention we pay to the state of our coronary arteries. Angioplasties, stents, coronary artery bypass grafts — all these procedures, he writes, ‘should be consigned to the annals of good ideas that proved bad.’

“As for the screening that purportedly keeps us safe from cancer, mammography and the blood test for prostate cancer are, in his view, blunt cudgels that can harm as much as help. Nor does he want any part of routine colonoscopies: ‘Let my polyps go.’”

Zuger compared Worried Sick with a new guide by Nancy Snyderman, a surgeon and the chief medical editor of NBC News, who — as anyone who has watched her televised reports may know — is ever-ready to parrot the medical establishment’s prescriptive-flavor-of-the-week. And though Zuger doesn’t come down on the side of either approach, her review is lively, open-minded, and worth reading www.nytimes.com/2008/06/24/health/24book.html?ref=science.

To read more about Hadler and Worried Sick, click here uncpress.unc.edu/browse/book_detail?title_id=1545. Hadler’s book and individual chapters from it are available in e-book or downloadable formats through the Caravan Project www.caravanbooks.org/.

© 2008 Janice Harayda. All rights reserved.
www.janiceharayda.com

January 8, 2008

Backscratching in Our Time — Gina Kolata and Jerome Groopman

The latest in a series of posts on authors who praise each other’s work in a way that may have financial benefits for both

 

I usually post these examples of backscratching without comment, but this one is bad on so many levels, I’d like explain why. A pillar of journalistic ethics says that reporters should avoid not just conflicts of interest but the appearance of conflicts. Gina Kolata is a science writer for the New York Times who has used Groopman, a professor at Harvard Medical School and a bestselling author, as a source. As the comments below make clear, she accepted a favor from Groopman — the blurb for Rethinking Thin — that could put money in her pocket if, say, you bought the book based on his recommendation or if a paperback or overseas publisher paid more for the reprint rights because of the quote (and quotes can affect the amount offered). Kolata has compounded the problem by selecting one of Groopman’s essays for Best American Science Writing 2007, a decision that has almost certainly put money in his pocket, given that contributors to anthologies typically receive an up-front fee or a percentage of the royalties or both. She also used on the cover of the paperback edition of her earlier Flu a quote from Groopman that appeared in the Boston Globe, which is owned by the New York Times. It gives me no pleasure to say any of this because I enjoy Kolata’s work for the Times and regard it as far superior to that of her colleague Jane Brody, who writes the Personal Health column. I also admired much about Flu, Rethinking Thin and Groopman’s How Doctors Think www.oneminutebookreivews.wordpress.com/2007/12/28/.

 

Jerome Groopman on Gina Kolata

“Kolata is a seasoned reporter, and knows how to craft a riveting tale … a masterly recounting of medical history.”

Groopman in a review of Kolata’s Flu: The Story of the Great Influenza Pandemic (Touchtone, $15, paperback) in the Boston Globe, Dec. 12. 1999. “A masterly recounting of medical history” appears on the cover of the paperback edition of Flu.

 

“An incisive, thought-provoking examination of a subject that concerns us all. This book will educate and illuminate those seeking solid information about the struggle to lose weight.”

Groopman in a blurb on the cover of Kolata’s new Rethinking Thin: The New Science of Weight Loss — and the Myths and Realities of Dieting (Farrar, Straus & Giroux, $24)

Gina Kolata on Jerome Groopman

“I also liked Jerome Groopman’s New Yorker article, ‘Being There.’ It raises an issue I had never considered, and in an unforgettable way …”

Gina Kolata on why she choose Groopman’s article as one of the best of the year, in her introduction to Best American Science Writing 2007 (HarperPerennial, $14.95, paperback), edited by Kolata and Jesse Cohen.

One-Minute Book Reviews welcomes suggestions about authors should be in “Backscratching in Our Time,” a series in inspired by “Logrolling in Our Time” in the old Spy magazine.

© 200X 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

May 30, 2007

Atul Gawande Takes the Pulse of the Medical Profession

Filed under: Essays and Reviews,Nonfiction — 1minutebookreviewswordpresscom @ 1:18 pm
Tags: , , , , , , , , ,

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

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