One-Minute Book Reviews

May 5, 2022

How a Drug Startup Scammed Patients, Doctors, and Insurers Until Its Founder Got Caught

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If you love to read good books about crooks, the American drug companies are the gift that keeps on giving. Last year’s hit was Patrick Radden Keefe’s Empire of Pain: The Secret History of the Sackler Dynasty, a story of the misdeeds by the OxyContin maker Purdue Pharma, which became finalist for the National Book Critics Circle Award for nonfiction and winner of other honors.

Now comes Evan Hughes’ The Hard Sell, a story of crime and punishment at Insys Therapeutics, the once high-flying drug startup that in some ways makes Purdue Pharma look a choir of angels. Founder John Kapoor is doing five-and-a-half years in a federal prison, and more than two dozen of his executives, sales reps, and doctors were convicted of crimes related to illegal promotions of the company’s signature drug, Subsys, a fast-acting opioid linked to more than 100 deaths, according to an investigation by Frontline for PBS.

Interesting in reading more? Here’s my take on the scandals on Medium:

https://janiceharayda.medium.com/how-a-drug-startup-screwed-patients-doctors-and-insurers-33d33aabda2b

May 18, 2012

What I’m Reading … Susan Gubar’s ‘Memoir of a Debulked Woman: Enduring Ovarian Cancer’

Filed under: Memoirs,Nonfiction,What I'm Reading,Women — 1minutebookreviewswordpresscom @ 1:39 pm
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“What I’m Reading” is a series about books I’m reading that I may or may not review later

What I’m reading: Memoir of a Debulked Woman: Enduring Ovarian Cancer (Norton, 296 pp., $24.95), by Susan Gubar.

What it is: A feminist scholar’s memoir of the medical “calamities” she endured after undergoing the standard medical treatment for advanced ovarian cancer, known as debulking surgery.

Why I’m reading it: Few authors have written in depth about having advanced ovarian cancer, partly because few women survive the disease long enough to do it.

Quote from the book: “the state of contemporary approaches to ovarian cancer is a scandal.”

Probability that I will review the book: 100%

Publication date: April 2012

Read an excerpt from Memoir of a Debulked Woman or learn more about the book.

About the author: Gubar co-write The Madwoman in the Attic: The Woman Writer and the Nineteenth-Century Literary Imagination, a book widely used in college classes.

You can follow Jan (@janiceharayda) on Twitter by clicking on the “Follow” button in the right sidebar.

© 2012 Janice Harayda
www.janiceharayda.com

March 1, 2011

‘Early Diagnosis Is a Double-Edged Sword’ — Quote of the Day

Filed under: Quotes of the Day — 1minutebookreviewswordpresscom @ 9:29 pm
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Early diagnosis can hurt you, three doctors argue their new Overdiagnosed: Making People Sick in the Pursuit of Health (Beacon Press, 228 pp., $24.95). Too many Americans are being treated for conditions that will never cause symptoms, let alone death, say H. Gilbert Welch, Lisa Schwartz, and Steven Woolshin. Some people contend that no harm can come of the “epidemic of diagnosis”:

“But the truth is that early diagnosis is a double-edged sword. While it has the potential to help some, it always has a hidden danger: overdiagnosis—the detection of abnormalities that are not destined to ever bother us. …

“the conventional wisdom is that more diagnosis—particularly, more early diagnosis—means better medical care. The logic goes something like this: more diagnosis means more treatment, and more treatment means better health. This may be true for some. But there is another side to the story. More diagnosis may make healthy people feel more vulnerable—and, ironically, less healthy. In other words, excessive diagnosis can literally make you feel sick. And more diagnosis leads to excessive treatment—treatment for problems that either aren’t that bothersome or aren’t bothersome at all. Excessive treatment, of course, can really hurt you. Excessive diagnosis may lead to treatment that is worse than the disease.”

You can read the introduction to Overdiagnosed on Scribed.

© 2011 Janice Harayda. All rights reserved.

 

September 20, 2010

Funeral of a Small-Town Doctor / From the Memoir ‘The Good Times Are All Gone Now: Life, Death, and Rebirth in an Idaho Mining Town’

Filed under: Memoirs,Nonfiction — 1minutebookreviewswordpresscom @ 11:47 am
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Julie Whitesel Weston grew up in Kellogg, Idaho, in the 1940s and 1950s, when it was “a wide-open, Wild West town” with brothels and gambling dens that attracted men who worked for the Bunker Hill silver mine. Her father, a doctor, examined the prostitutes twice a month for venereal diseases. He also made middle-of-the-night house calls and received venison and elk steaks from patients, whom he asked, “How’s your body?” After setting up his practice, Glen Whitesel stayed in Kellogg until he died in 1978, and sometimes played the snare drum for Tommy’s Trio at the Sunshine Inn.

Julie Whitesel recalls her childhood in her recent memoir The Good Times Are All Gone Now: Life, Death, and Rebirth in an Idaho Mining Town (University of Oklahoma Press, 2009). In this excerpt, she describes her father’s funeral, attended by friends such as real-estate developer Jim Bening and attorney Bob Robson.

“An honor guard of nurses, each dressed in white starched cap, dress, and stockings, stood like wings on either side of the elaborate coffin at the front of the church. His doctor partners served as pallbearers, along with Jim Bening and Bob Robson, and an extra six of friends, a double ring of hands. Townspeople – miners, wives, businessmen and women, gambling and drinking buddies, Tommy’s Trio, my friends, their parents, teachers, coaches, patients, not-patients — filled the church, spilled out into the parking lot, sang hymns, shed tears. The Episcopal priest, Father McReynolds, who had been one of my father’s gin rummy partners and was shaking with Parkinson’s disease, eulogized him.

“‘How’s your body?’ he began. A low wave of laughter filled the church. ‘No one who knew Doc Whitesel would ever say he was without failings. But I like to think he earned a place in heaven in spite of those failings, common to us all, in one form or another. Glen was our doctor, our friend, and an irreplaceable man in Kellogg, Idaho.’ He faced the casket and added, ‘See you later, alligator.’”

You can learn more about The Good Times Are All Gone Now on the sites for the author and for University of Oklahoma Press.

You can also follow Jan Harayda on Twitter at twitter.com/janiceharayda.

© 2010 Janice Harayda. All rights reserved.
www.janiceharayda.com

May 29, 2010

Psychiatrist Daniel Carlat Diagnoses His Profession’s Ills in ‘Unhinged: The Trouble With Psychiatry’


“Psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.” Unhinged

Unhinged: The Trouble With Psychiatry. By Daniel Carlat. Free Press, 256 pp., $25.

By Janice Harayda

Has the profession of psychiatry lost its mind? You might think so after reading this relentless and mostly successful assault on current practices in the field.

Daniel Carlat focuses in Unhinged on the harm that he believes has resulted from the march of psychiatry away from psychotherapy and toward the better-paying practice of prescribing drugs. And he forges links between that shift and many ills in his field, including scandals at top-flight hospitals, one-sided articles in medical journals, and pharmaceutical-company payments to doctors who hawk questionable drugs to their peers.

Some of the statistics in Unhinged are chilling. In 2006, an estimated 10 percent of all 10-year-old boys in the U.S. were taking the stimulant Ritalin or an equivalent each day, and shabby medicine often accounts for its use or that of other psychotropic drugs. Psychiatrists routinely write prescriptions after 15- or 20-minute consultations. They know so little about the biology of most mental illnesses that they prescribe based on little or no science. And they mislead patients by presenting as fact theories formed by working backward from the discovery that a drug seemed to ease the symptoms of a disease. One of the most popular of those theories holds that depression results from a “chemical imbalance” in the brain:

“… the fact that many antidepressants increase levels of serotonin has led to a serotonin deficiency theory of depression, even though direct evidence of such a deficiency is lacking. By this same logic one could argue that the cause of all pain conditions is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain.”

Carlat delivers his indictment in a crisp, journalistic style that serves him well, though he writes with less depth and elegance than his fellow physician Atul Gawande. But he doesn’t take his critique of the profession as far as it warrants. He clearly wants psychiatrists to do more psychotherapy but doesn’t make a strong case that patients would benefit from this – only that they would benefit from fewer bad drugs. He seems to take for granted that psychotherapy “works.”

This view clashes with that of respected critics of the profession such as the social scientist Robyn Dawes, who drew on decades of research for his brilliant House of Cards, which argues that psychotherapy itself is a con game: There is no evidence that psychiatrists or psychologists are better at counseling than minimally trained civilians, and both types of professionals have strayed so far from their roots in the study of human behavior that they offer little more than glorified intuition.

Unhinged may have the worthy effect of prompting patients to demand better explanations for why certain drugs are recommended for them — and it would be welcome for that reason alone — but it has little to say to people who remain unconvinced that psychotherapy would be better than the cavalier prescribing of Prozac or Wellbutrin. If psychiatrists are as willing as Carlat suggests to pimp for drug companies, why should Americans trust them with their deepest secrets?

Best line: “ … psychiatry has become a proving ground for outrageous manipulations of science in the service of profit.”

Worst line: Carlat says that an Ambien drug rep named Valerie once gave him a gift worth about $25, and later that day, he saw a patient and thought, “Why not prescribe Valerie’s drug for this patient?” That phrasing is too neat. Carlat also appears to be rationalizing in some of his comments on why he served briefly as a paid drug-company rep for the maker of Effexor.

Caveat lector: This review of Unhinged was based on an advance reading copy. Some material in the finished book may differ, and some people in it are composites.

Furthermore: Carlat is a psychiatrist in Newburyport, MA, specializing in psychopharmacology, and an associate clinical professor of psychiatry at Tufts University School of Medicine.You can follow him on Twitter at a @dcarlat (www.twitter.com/dcarlat). Carlat tells why he quit giving paid talks for drug companies in the New York Times article “Dr. Drug Rep.” Some of the material in Unhinged about brain scans appeared in different form in an article he wrote for Wired, “Brain Scans as Mind Readers?”

Contrary to the date you see under the headline, this review was posted on May 31, 2010. WordPress appears to be having technical problems that have led to scrambled dates. For this reason, I’ve removed a May 30 post about my forthcoming review of the young-adult novel The Things a Brother Knows.

You can follow Jan Harayda (@janharayda) on Twitter at www.twitter.com/janiceharayda.

© 2010 Janice Harayda. All rights reserved.
www.janiceharayda.com

May 24, 2010

Has Psychiatry Lost Its Mind? A Review of Daniel Carlat’s ‘Unhinged’ Coming Soon

Filed under: Nonfiction — 1minutebookreviewswordpresscom @ 9:36 am
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In late 2007 the psychiatrist Dan Carlat wrote a provocative article about why he quit giving paid talks for drug companies, many about Effexor, an anti-depressant that causes high blood pressure. Now he’s back with Unhinged: The Trouble With Psychiatry (Free Press, 256 pp., $256), a book that indicts his profession for shunning therapy for the more lucrative practice of prescribing medications. A review of the book will appear soon on One-Minute Book Reviews.

October 27, 2009

‘Smile or Die’ – Barbara Ehrenreich’s ‘Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America’

Taking aim at the “prosperity gospel,” “positive psychology” courses, and teddy bears designed for breast-cancer patients

Bright-sided: How the Relentless Promotion of Positive Thinking Has Undermined America. By Barbara Ehrenreich. Holt/Metropolitan, 235 pp., $23.

By Janice Harayda

When I was a book editor, I often had to reassure freelancers that they had the right to give negative reviews. Critics never apologized for praising books, but they did apologize for panning them – even when they had done so brilliantly.

At first, I thought freelancers were worried that they would get fewer assignments if they wrote unfavorable reviews, because some editors do prefer to publish praise. But many seemed reluctant to criticize books even after I had explained that I didn’t care whether reviews were positive or negative: I cared whether they were fair, honest and well written.

Barbara Ehrenreich suggests a possible explanation for the reluctance in Bright-sided, a spirited broadside against enforced optimism in medicine, psychology, business, religion and other fields. She argues that faith in “positive thinking” has become so ingrained in American society “that ‘positive’ seems to us not only normal but normative – the way you should be.”

Ehrenreich found when she was diagnosed with breast cancer that a cult of optimism pervaded articles and books about the disease that made her feel isolated instead of supported. “No one among the bloggers and book writers seemed to share my sense of outrage over the disease and the available treatments,” she writes in a chapter ironically called “Smile or Die: The Bright Side of Cancer.” “What causes it and why is it so common, especially in industrialized societies? Why don’t we have treatments that distinguish between different forms of breast cancer or between cancer cells and normal dividing cells?”

Instead of finding answers, Ehrenreich kept coming across articles by women who claimed that they owed their survival to a “positive attitude” – even though the death rate from breast cancer has changed little since the 1930s and there is no consistent evidence that staying upbeat extends the life of those who have the disease, though it may have many other benefits. She also found that “positive thinking” can exact a terrible price in self-blame if a cancer defies treatment. As the oncology nurse Cynthia Rittenberg has written, the pressure to think positively is “an additional burden to an already devastated patient.”

“Smile or Die” recycles some of the material from Ehrenreich’s award-winning essay, “Welcome to Cancerland,” but is still the strongest chapter in Bright-sided. Other sections of the book describe the wholesale effects of “positive thinking” better than they show their retail cost to ordinary Americans. Ehrenreich argues cogently that the emerging field of “positive psychology” is based heavily on bad or no science. But the same is also true of some older forms of therapy that apply similar principles, as the Robyn Dawes documented in his superb indictment of the betrayal of scientific standards in psychotherapy, House of Cards (Free Press, 1996). So why focus on “positive psychology” when other types of therapy have done more damage, if only because they are more widely used? Ehrenreich describes an unflattering interview with the high priest of “positive psychology,” the psychologist Martin Seligman. But she seems to have talked to no one burned by his teachings – which shouldn’t have been hard to do, given that more than 200 schools and colleges offer courses in his field.

In a chapter called “God Wants You to Be Rich,” Ehrenreich faults the so-called “prosperity gospel” preached by superstar pastors like Joel Osteen, whose churches offer “services that might, in more generous nations, be provided by the secular welfare state,” such as pre- and after-school programs. Certainly those ministries may foster self-blame. (If God wants you to be rich and you’re not, you don’t have enough faith.) But if the churches that promote the “prosperity gospel” are offering low- or no-cost day care that enables parents to seek prosperity by holding jobs, doesn’t that count for something? You sense that such programs are exactly kind of thing that Ehrenreich might love, if only they weren’t endorsed by pastors who wear too much gel in their mullets.

No less important: A blurred line exists between innate optimism – which may be genetic — and the enforced optimism of disciplines like “positive psychology” and the “prosperity gospel.” To what extent are advocates of “positive thinking” creating an attitude and to what extent are tapping or reinforcing one that’s already there? Ehrenreich sidesteps the question. But if optimism is in our genes, it may do little good to argue as she does that we need replace “positive thinking” with a “vigilant realism.” Joseph Hallinan takes a less extensive but more practical approach to the subject in his Why We Make Mistakes (Broadway, 2009), which deals in part with the research on errors based on overconfidence – a trait often indistinguishable from “positive thinking.”

Overall Bright-sided is much more theoretical than Nickled and Dimed, for which Ehrenreich took a series of low-wage jobs to show how corporations exploit blue-collar workers, or her more recent Bait and Switch. But it makes a needed assault on an idea that too often goes unchallenged in America: that “positive thinking” is always a good thing. Ehrenreich is right that a deep and unacknowledged anxiety often underlies efforts to block out unpleasant thoughts. “Positive thinking” requires a continual effort to deflect “negative” ideas, she notes, and it can be exhausting. “The truly self-confident, or those who have in some way made their peace with the world and their destiny within it, do not need to expend effort censoring or controlling their thoughts,” she writes. “Positive thinking may be a quintessentially American activity, associated in our minds with both individual and national success, but it is driven by a terrible insecurity.”

Best line: Ehrenreich notes that breast cancer has given rise to a highly commercialized industry of products for patients, including “infantilizing” teddy bears: “Certainly men diagnosed with prostate cancer do not receive gifts of Matchbox cars.”

Worst line: “All the motivators and gurus of positivity agree that it is a mistake to watch the news.” How does Ehrenreich know? Has she talked to them all? In my experience the self-styled motivators, with a few exceptions including Rhonda Byrne (The Secret), urge people to limit – not eliminate – exposure to bad news.

Editor: Sara Bershtel

Published: October 2009

Read an excerpt (the first pages) from Bright-sided or listen to an audio excerpt.

Furthermore: For more on optimism and illness, see the post “‘The Tyranny of Positive Thinking’ and Cancer Patients — A Physician-Author Says That It’s Not Always Best to Tell People to ‘Be Optimistic’.”

© 2009 Janice Harayda. All rights reserved.
www.janiceharayda.com

September 28, 2009

Excuses Used by Aetna, Prudential and Blue Shield to Deny Health-Insurance Claims — From T. R. Reid’s ‘The Healing of America’

I was going to read The Lost Symbol over the weekend but picked up T. R. Reid’s elegant indictment of health care in the U.S., The Healing of America (Penguin, 277 pp., $25.95). And I was hooked after the first sentence: “If Nikki White had been a resident of any other rich country, she would be alive today.”

Reid had his bad shoulder examined by doctors in other well-off democracies that included France, Germany, Great Britain, Japan and Canada. And he uses the results as a springboard for exposing flaws in arguments made by insurers and others against adopting practices that work overseas: “It’s all socialized medicine over there,” “They ration care with waiting lists and limited choice,” “Those systems are too foreign to work in the United States,” and more.

Until I can review The Healing of America, here’s a brief excerpt from the book about the excuses used by major insurers to reject claims:

“In other developed countries, insurers are required to pay every claim. But U.S. insurance companies deny about 30 percent of all claims, although some of these are eventually paid through an appeal process. The reasons cited for denying valid claims can be ingenious. When our family lived in Japan, the friendly adjusters at Prudential used to deny our claims for medical or dental care on the grounds that the bills we submitted were denominated in yen. Somebody at Prudential had determined that the Japanese yen was a foreign currency; that violated the rules. My company later switched our health insurance to Aetna, which employed a similar dodge: The adjuster said she couldn’t pay our claims because she couldn’t call the doctor’s office to verify the bills. It seems that Aetna had a phone system for its adjusters that didn’t allow international calls, so our claims had to be denied.

“The most maddening of all the profit-maximizing mechanisms in the U.S. health insurance industry is the practice known as ‘rescission,’ a legal term that means ‘We’re canceling your coverage.’ This occurs when an injured person who has been paying premiums for months or years has a serious accident or contracts a serious disease, which can mean serious bills for the insurance company to pay. At that point, the insurer’s Rescission Department digs through all the records, looking for a reason to cancel the sick person’s coverage. For example, Steven Hailey, a machinist in Cypress, California, paid his health insurance premium every month. Then he was hit by a truck. He was still being treated for his injuries when Blue Shield of California wrote to tell him that his coverage had been canceled because his weight was too high. He would have to pay the hospital bills himself – about $450,000 worth of bills.”

September 3, 2009

What If You Had an Autistic Disorder and Didn’t Know It? Tim Page’s Memoir of Growing Up With Undiagnosed Asperger’s Syndrome, ‘Parallel Play’

Filed under: Memoirs,News,Nonfiction — 1minutebookreviewswordpresscom @ 12:40 pm
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Tim Page is a friend, and I’m in the acknowledgments of his acclaimed biography of the novelist Dawn Powell, which – you will not be surprised to hear – I love. So I can’t review his new Parallel Play: Growing Up With Undiagnosed Asperger’s (Doubleday, 196 pp., $26). But Janet Maslin writes in today’s New York Times that this “improbably lovely memoir” shows in “fascinatingly precise detail and often to pricelessly funny effect” what it’s like to have his autistic disorder and not know it. And nothing in her review conflicts with what I know about Tim, who won the Pulitzer Prize for his music criticism for the Washington Post before he decamped to academia. The Times has also posted an excerpt from Parallel Play, a book that is an expanded version of material that appeared in The New Yorker.

www.twitter.com/janiceharayda

August 26, 2009

Before Ted Kennedy’s Brain Tumor, There Was Johnny Gunther’s

Filed under: Classics,Memoirs,News — 1minutebookreviewswordpresscom @ 11:40 am
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Malignant brain tumors such as that of Sen. Ted Kennedy (1932-2009) are uncommon enough that they have received less attention in books than many other types of cancer. One exception to the pattern is Death Be Not Proud, John Gunther’s eloquent memoir of the death of his 17-year-old son, Johnny, from a fatal glioma diagnosed when he was in high school. American views of cancer have undergone a sea-change since the book was first published in 1949. But this modern classic remains one of the finest accounts we have of the physical and emotional toll that a malignant brain tumor takes on patients, even those who might seem to have all the advantages. This post first appeared in 2008.

www.twitter.com/janiceharayda

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