One-Minute Book Reviews

February 25, 2008

A Report From the Frontlines of the Cosmetic Surgery Boom Returns in Paperback

Filed under: Nonfiction,Paperbacks — 1minutebookreviewswordpresscom @ 1:38 am
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Heard about the Detroit radio station had a contest called “New Year, New Rear” and gave the winner $15,000 worth of liposuction? You would have if you’d read Beauty Junkies: In Search of the Thinnest Thighs, Perkiest Breasts, Smoothest Faces, Whitest Teeth, and Skinniest, Most Perfect Toes in America, (Broadway, 304 pp., $14.94, paperback), just out in paperback with a new subtitle (replacing Inside Our $15 Billion Obsession With Cosmetic Surgery). How did we get to the point that some people don’t blink when they hear about a “New Year, New Rear” promotion? What are the social, emotional and medical costs of the cosmetic surgery boom? New York Times reporter Alex Kuczynski www.alexkuczynski.com gives fearless answers in a skillful blend of reporting, social commentary and advice to people who may submit to the knife or needle.

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

February 12, 2008

Ishmael Beah Says He Was Shot ‘Three Times on My Left Foot’ But Suffered No Serious Damage — Can Any Soldiers, E.R. Doctors or Others Explain This?

Another scene I don’t understand from the memoir of the man who claims to have been a child soldier

On this site I try to keep reviews short enough that you can read them in a minute if you skip the supplemental material at the end, so I’ll often give one example instead of three or choose a brief quote from a book instead of a long one. But enough questions have been raised about the credibility of Ishmael Beah’s A Long Way Gone that I’d like to mention a scene from it that didn’t appear in my original review. In this scene Beah talks about continuing to fight after receiving “many bullet wounds” and about foot injuries don’t appear to have left him with a limp or a need to use a cane.

Beah’s account of his injuries seemed implausible, but I don’t have a medical or military background. Would anyone with expertise in such fields like to comment on the following?

Ishmael Beah says in A Long Way Gone that he received “many bullet wounds” in a firefight in Sierra Leone but kept attacking a village his squad was trying to take. He adds that after 24 hours, he and his fellow soldiers seemed to have achieved their aim.

Then they were attacked again, and he was hit three times in the left foot: “The first two bullets went in and out, and the last one stayed inside my foot.” The third bullet, he says, was later removed with “crooked-looking scissors” by a “sergeant doctor” in the Sierra Leone army at a base camp. After leaving the army, Beah entered a hospital and was told that medical tests showed that nothing was “seriously wrong” and he would just have to take medications until his next checkup.

Quotes from pages 156–158 and 163.

Links: The original review of A Long Way Gone appeared on this site on Feb. 27, 2007. www.oneminutebookreviews.wordpress.com/2007/02/27/. A reading group guide was posted on March 5, 2007 www.oneminutebookreviews.wordpress.com/2007/03/05/.

© 2008 Janice Harayda. All rights reserved.

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

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