All Creatures Great and Small

The Book of the Week is “All Creatures Great and Small” by James Herriot, published in 1993. This is a lighthearted account of Herriot’s training as an aspiring rural veterinarian in 1930’s England. A crotchety yet experienced character showed him the ropes. The author gradually developed confidence in curing the afflictions of pigs, cows, horses, etc. The job was suitable for neither the squeamish nor faint of heart.

Healing Hearts

The Book of the Week is “Healing Hearts” by Kathy E. Magliato, M.D., published in 2010. This is a personal account detailing one woman’s experiences trying to balance her medical training and career, with her family life.

She details various issues, including but not limited to: the long, rigorous road to becoming a full-fledged doctor in her specialty; the discrimination she faces in a male-dominated field; the job emergencies that cut into quality time with her family; and the healthcare crisis in the United States.

Magliato and her husband have a combined 43 years of education and training in medicine. She, in cardiac surgery; he, in liver transplants. She describes the hardships she faces when passionately attempting to save lives. She must ignore her own physical needs while standing for, say, fifteen hours in a row to help provide patients with a replacement heart, or veins or valves. She needs to hold particular medical instruments in place for many minutes without flinching, lest she harm the patient.

Magliato predicts a collapse of the American health care system. The reason is simply that health insurance companies do not pay what hospitals bill them; rather, they pay what they feel like paying. An insurance company might be billed $385,000 for heart surgery hospitalization, but it might pay the hospital only $54,000.

“…a hospital is ecstatic whenever it collects more than 10% of the bill. How can hospitals not only survive but be able to deliver state of the art care when their price is not met? They can only increase their quantity until the hospital is full. They can only cut their costs until the delivery of quality health care is jeopardized.”

The Emperor of All Maladies

The Book of the Week is “The Emperor of All Maladies, A Biography of Cancer” by Siddharta Mukherjee, published in 2010. Through this tome, the author, an attending cancer physician, researcher and assistant professor of medicine, discusses the history of cancer– how it came to be named, treated and researched through the centuries, and how it develops on the cellular level. He also talks about how cancer statistics can be manipulated to give people the impression that the illness is more common than it really is (to scare people into getting tested and treated), or– that treatment (including drugs and surgery) is more effective than it really is.

In ancient times, cancer was rare because lifespans were short. Several other diseases (tuberculosis, dropsy, cholera, smallpox, leprosy, plague or pneumonia) killed people before cancer would. More prevalent cancer testing has also made cancer a more common culprit in the cause of death, rather than, say, the labels, “abcess” or “infection.”

In modern times, specific factors, (like smoking and changes in public hygiene and diet) have increased the incidence of some kinds of cancer, and reduced the incidence of others.

The author points out the difficulties in determining whether detecting cancer early, helps save lives. Some cancers are quick-killing and others are slow-growing. If someone is diagnosed with an early stage of quick-killing cancer. whose treatment is rigorous and unsuccessful, is that a better situation than one in which someone has the quick-killing kind without knowing it, but goes about blissfully living his life, and dies quickly once he is diagnosed? Perhaps the former person lived six months longer, but given his lack of enjoyment of life after diagnosis, he might as well have died sooner.

The  author also writes regarding testing, “Using survival as an end point for a screening test is flawed because early detection pushes the clock of diagnosis backward.” Say we have the hypothetical scenario of cancer patients A and B. They both developed the exact same kind of quick-killing cancer at the same time. Say patient A’s illness was diagnosed in 1985 and she died in 1990. Patient B’s illness was diagnosed in 1989 and she died in 1990. But since doctors diagnosed A’s cancer earlier, it seems, falsely, that she lived longer and that the screening test was beneficial.

In 1976, a highly regarded mammography study was done on 42,000 women in Malmo, Sweden. The results showed that a significant number of women 55 years and older benefited from breast cancer screening– the lives of one fifth of them were presumably saved than otherwise. “In younger women, in contrast, screening with mammography showed no detectable benefit.” Many additional studies thereafter reinforced this conclusion by 2002: “In aggregate, over the course of fifteen years, mammography had resulted in 20-30 percent reductions in breast cancer mortality for women aged fifty-five to seventy. But for women below fifty-five, the benefit was barely discernible.”

Mukherjee also describes a moral issue that can arise when it comes to the testing of cancer drugs. A company was reluctant to spend hundreds of millions of dollars to do further testing on what appeared to be a promising new drug for a rare kind of leukemia that might (or might not) benefit only thousands of people. Thousands is considered a small number, compared to millions of individuals whom a drug might help in the long run. The company could spend the same amount of money helping millions. Patients for whom all other treatments had failed, aggressively pushed to be included in the drug trial, arguing it could save their lives. The company did eventually agree to test the drug, but on a small scale. The drug was wildly successful in its first decade for those few who were treated with it. However, a few years later, cancer cells had become resistant to the drug. A next-generation drug had to be developed to continue to keep those patients alive.

The author tries to explain why, even with all the resources currently poured into research for a cancer cure and improving treatment, many cases are still fatal even in industrialized countries. Nevertheless, he points out– there are pitifully few resources being thrown into prevention. I suspect it is just not as lucrative as research and treatment.

Time on Fire

The Book of the Week is “Time On Fire” by Evan Handler, published in 1997. The author, a Broadway actor, tells his readers how he survived a five-year bout with myelogenous leukemia in the early 1990’s. His condition necessitated various extreme treatments from which, at that time, fewer than half of patients emerged alive. He details them, good and bad, he received from various medical facilities, whose names he mentions. One action he took, among others, was to get a private hospital room so as to minimize his stress level. One should spare no expense when one is fighting for one’s life. This intense survival story was inspiring, rather than depressing.

Over My Head

The Book of the Week is “Over My Head” by Claudia L. Osborn, published in 2000.  This depressing memoir describes what happened to the author, a medical doctor, after she sustained a severe head injury.  She was, without wearing a helmet, bicycling in the Rocky Mountains with a friend when she was hit by a truck. She did not remember the accident.  The damage done to her brain prevented her from resuming her career. Osborn was referred to New York University’s head trauma program to try to recover her ability to live a normal life.  The program features group therapy.  Read the book to learn the kinds of techniques used to help brain-damaged individuals regain cognitive skills, and how the author fared thereafter.

To Know A Fly

The Book of the Week is “To Know A Fly” by Vincent G. Dethier, published in 1962.  This thin, little paperback book discusses how scientists attempt to understand the behavior of a fly.  Those who pull off the legs or wings of flies either come to a bad end or become biologists.

“The [required] college education not infrequently is as useful for acquiring proficiency in the game of Grantsmanship as it is for understanding biology.  No self-respecting modern biologist can go to work without money for a secretary, a research associate, two laboratory assistants, permanent equipment…” a car, books, animals and their accompanying accessories, etc., and a vast quantity of money (called overhead) “to the university to pay for all the transcribers hired to handle all the papers and money transactions that so big a grant requires.”

There is much to be said for the fly as an experimental animal.  The author describes in detail some clever experiments involving the fly’s eating habits and capacity to learn.  “To know the fly is to share a bit in the sublimity of Knowledge.”