Author: authoress

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.

Strength In What Remains

The Book of the Week is “Strength In What Remains” by Tracy Kidder, published 2009. This is the biography of a man named Deo who miraculously survived the genocidal violence that spilled over from Rwanda into Burundi in 1994-95.

Deo grew up in the latter nation, where his family, of the Tutsi tribe, did farming and herding in the mountains near Lake Tanganyika. In the 1970’s, the Catholic church owned and operated his one-room schoolhouse. His parents, who believed in education, could ill-afford the school tuition of one dollar. They were able to buy him a pencil but not a pen.

The Germans and later, Belgians (colonizers of Rwanda and Burundi) engendered hatred between the Hutus and Tutsi tribes.  In 1995 in Burundi, a two-month killing spree led to the deaths of hundreds of thousands of people.

During that time, Deo was attending medical school in Bujumbura, Burundi’s capital, far from his home. He found himself in a traumatic and dire situation; traumatic in that he witnessed gruesome scenes, including those of deteriorating corpses of humans and cows lining the roadside, and dire, in that there were hostile soldiers everywhere, seeking out people who looked like Tutsis, pursuant to their facial features  (similar to the way Nazis sought out Jews during the Holocaust) and torturing and murdering them. Over the next decade, Deo was able to overcome his seemingly overwhelming difficulties and fulfill his dream.

Burundi’s people continued to suffer long after the violence was over. There was poor regard for human rights, especially among those injured in the tribal warfare who were indigent. (A lot of those lucky enough to survive, were rendered indigent by the tribal warfare). In the late 1990’s, hospitals had a special section for patients who could not pay their medical bills. They could not be discharged until they paid up, during which time they were given neither care nor food. Family and/or friends were expected to assist them. In addition, the bodies of deceased patients could not be released to their families unless the bills were paid.

This blogger found Deo’s story remarkable and suspenseful. However, she is giving the author the benefit of the doubt with regard to a few ambiguous passages in the book, attributing them to a bad editorial decision. The passages occur in the first half. In the middle, the author explains that over the course of two years, Deo told him his story, and “I’m sure that the account of his escape suffered here and there from memory’s usual additions and subtractions, and there was no direct way to verify a lot of it…” This warning should come at the very beginning so that native New Yorkers will not question the geographic accuracy of the following passages, referred to above:

 

“On a day in his sophomore year he was riding the subway home from Columbia [University] and remembered that he hadn’t talked to Claude [in Burundi] for weeks. He got off at 125th Street.” [The story says that Deo was an undergraduate, attending classes at the Morningside Heights campus, not the medical school, and at the time, he was staying with people downtown]

“He figured he needed only twenty dollars a week for subways to and from Columbia, and sometimes he could save part of that by walking from lower Manhattan to the campus up in Harlem.” [same comment as above]

“Deo pushed the grocery cart down the sidewalks of Eighty-ninth Street. There were times when he felt crushed by the height and humiliated by the splendor of the buildings in this part of New York.” [West or East 89th Street? This is an important distinction to New Yorkers.]

 

The Flame Trees of Thika

The Book of the Week is “The Flame Trees of Thika” by Elspeth Huxley, published in 1959.  This autobiographical account depicts the early 20th century lifestyle of adventurous light-skinned people from British Empire countries who chose to move to Thika, a town outside of Nairobi, Kenya. The author’s father was seeking to make a fortune in five years by starting a coffee plantation. The author, an only child, was five or six years old when her family moved from Great Britain.

The family hired a number of dark-skinned natives to help to build a new home, and perform household and farm-oriented chores as servants. The natives populating the area were mostly from the Kikuyu tribe. They believed spirits dwelled in particular inanimate objects such as the gramophone and paraffin lamps, and those spirits in the latter would obey only Europeans. Having no use for currency, they were paid in tin mugs and goats instead. Their sleeping quarters were built on stilts so that goats could sleep underneath them. Their windowless thatched huts were quite warm, as there was always a fire burning in them to ward off lice.

Other couples lived nearby– South Africans of Boer descent, and from Edinburgh, Scotland. The husband of the latter left to go poaching in the Belgian Congo. The wife was a former nurse who tried to provide medical treatment to the natives. Unfortunately, she had only Epsom salts for medicine. Malaria, bubonic plague, smallpox, yaws, parasites, typhoid, elephantiasis and blackwater were common. Several people whom the author met, died of various causes.  Another neighbor had brought along her two pet dogs, whose coats had daily to be covered in paraffin to protect against ticks, and whose food was boiled to kill worms.

Ponies and mules were used for transporting goods and traveling. The ponies had to be returned to a mosquito-proof stable before dark every day,  lest they contract horse sickness. The arrival of the neighbors’ piano and trophies warranted a surrounding house for the prevention of weevil infestation. After heavy rains, emergence of killer ants warranted that houses be surrounded by hot ashes.

Weeding was women’s work, which was done with continuous singing. Every day, the women (who were three times as productive as men) walked from their faraway homes to do the job, only to return to have to do numerous household chores, and give their entire pay to their fathers.

The ending of this volume hinted strongly that there was to be a sequel.

Try to Tell the Story – Bonus Post

Some people scoff at the endurance of Great Britain’s aristocracy.

The following passage from the book “Try to Tell the Story” by David Thomson, published in 2009, explains why there is still a royal family:

“What is the royal family for? So that shaggy-dog stories may be told about their absurd status. What does that do? It makes them human and trivial. With what result? We knock along with them. Yet somehow the silliness of royalty excuses us from final realities– we can’t cut off their heads again because… well, they’d be offended, wouldn’t they. The way they are if you talk to them first. It’s a fatuous rigmarole, but it helps explain why an allegedly grown-up nation still drags along with these poor idiots.”

Another interesting concept raised by Thomson’s autobiography involves an education experiment. Post-WWII, the English government enacted an Education Act. The Act provided financial assistance to bright boys from lower socio-economic classes, affording them the opportunity to attend an English “public school” (actually what Americans would call a private school, reputed to have high standards). Thomson was one of the lucky few who participated. He attended Dulwich College (high school, in America), and did sufficiently well to gain acceptance to a college at Oxford University. However, his apprehension about his family’s ability to pay tuition there, prompted him to attend film school instead. Due to cases such as Thomson’s, the government’s education experiment was discontinued.

Peter Stuyvesant, Boy With Wooden Shoes

The Book of the Week is “Peter Stuyvesant, Boy With Wooden Shoes” by Mable Cleland Widdemer, published in 1950. This is a children’s biography of Peter Stuyvesant. He had adventures growing up in Holland, and as an adult in Curacao and Brazil and New Amsterdam while serving as a political representative for the West India Company from the mid-1640’s through the 1660’s. Despite his arrogance, bad temper and stubbornness, he was a born leader.

When he arrived in New Amsterdam, Stuyvesant was appalled to find that farmyard animals ran rampant in the unpaved streets. In addition, fire hazards such as wooden chimneys and whole houses made of wood, and reed roofs, abounded. He paved the streets with cobblestones, and mandated the use of brick, stone and tile. He also shored up the city’s defense: “The men had to build a fort to protect them from the enemy who may come by sea, and a wall across the island to separate them from wild animals of the forests and ‘red men.” Stuyvesant traded furs, meat and fish for the Native Americans’ blankets, beads and wampum, but he would not give them firearms.

The Burghers and Councilmen ignored Peter’s wish to fight an English takeover of New Amsterdam. So the English took over and it was renamed New York, after the brother of the King of England, the Duke of York, in September 1664. Peter returned to Holland for four years, then returned to New York because he liked it so much.

The Case of Joe Hill

The Book of the Week is “The Case of Joe Hill” by Philip S. Foner, published in 1965.  This is the story of the grave injustice perpetrated against Joseph Hillstrom (“Joe Hill” was the American-English translation).

In the early 1900’s, American managers of industry had politicians on their side and violent opposition to unions was commonplace. In 1914, the Swedish-American was wrongly accused of murder, and because he was a member of a vilified socialist labor organization, “International Workers of the World,” local authority figures (and possibly the Mormon Church) in Utah– where his trial was held– conspired to convict him.

He was a well-known, prolific writer of socialist songs. Despite the legal funds and political support from solidarity-minded labor groups around the world (support that included an urgent appeal to President Woodrow Wilson), the trial ended badly for him.

This account is reminiscent of the book, “Big Trouble” by J. Anthony Lukas, published in 1997, a 1905 case in which two union activists were wrongly accused of murder and denied due process, too.

Don’t Try This At Home

The Book of the Week is “Don’t Try This At Home” edited by Kimberly Witherspoon and Andrew Friedman, published in 2005.  This is a compilation of anecdotes from chefs who encountered some difficult situations during their careers. Some told of “making lemons from lemonade” and others gave a general overview of their experiences.

Four chefs whose stories were particularly intriguing, include Daniel Boulud, David Burke, Marcus Samuelsson and Geoffrey Zakarian.

Boulud recounted an episode in which, as culinary chairman of a fundraising event, he and his staff and extra hired help were required to make 1,200 servings of pea soup.  The “400 pounds of a variety of five peas” were to be stored in “25-gallon stainless steel containers set in ice water.”  Certain people failed to stir the soup hourly overnight, as they should have done, so it fermented.  The next morning, “All twelve hundred servings’ worth, was sour, useless garbage.”  The guests would be arriving that evening and were expecting high-end pea soup.

Burke is another chef who also saw a serious problem for which he had to come up with a solution quickly. He was supposed to cater a man’s fiftieth birthday party at which there would be a surprise dessert, envisioned by the wife.  She wanted a greatly enlarged, custom-made French dessert (“floating islands”) that would serve 200 guests. However, all of the meringues to be used in the dish collapsed, producing a very unprofessional look.  It could not be presented at the end of the meal.  What to do?

It was a language barrier that caused the Swedish-speaking Samuelsson excessive grief while he was working at a restaurant in Switzerland.  This was on New Years’ Eve, no less– one of the biggest nights of the year for business. He was asked to make terrine, which required proper setting of gelatine.  He had never used powdered gelatine before, could not understand the German, French and Italian instructions on the package, and did not ask anyone for help. The resulting concoction smelled bad, and resembled bathtub mold. Was it too late to salvage the situation? Samuelsson’s anecdote was the only one in the whole book that exhibited admission of error and true introspection. Kudos to him.

Zakarian tells of how he became a foodie. When he fell in love with France on a college assignment, he scrapped his academic plans to enjoy the fine food there instead.  Even so, as a starving student, he led a frugal existence, until two strokes of great good luck allowed him to partake of more luxury than otherwise.

A Boy Named Shel

The Book of the Week is “A Boy Named Shel: The Life and Times of Shel Silverstein” by Lisa Rogak, published in 2007. This biography describes the life of the cartoonist, children’s poet and songwriter.

Silverstein was an eccentric, creative thinker who collaborated with other like-minded individuals.  He started out as a cartoonist. However, his social skills were poor. One such friend of his who was interviewed for this book remarked that he never stayed in one place for long.

As an adult, whenever he got bored with a conversation he might be having with a friend at an eatery where they met to exchange ideas, he would simply get up and leave without warning. He would also switch residences frequently– he kept several inside and outside the United States. Fortunately, he could afford to do whatever he liked, whenever he liked, once royalties started rolling in from sales of various works he wrote, such as the best-selling classic children’s book of poems, “Where the Sidewalk Ends,” the song “A Boy Named Sue” (sung by Johnny Cash) and the rather depressing children’s book “The Giving Tree.”

Although Silverstein had difficulty getting along with his father, he still grieved at his father’s death.  He realized “You never get over it.”

An Unquiet Mind

The Book of the Week is “An Unquiet Mind” by Kay Redfield Jamison, published in 1995.  This autobiography tells the story of someone with bipolar disorder (also called manic-depressive illness) who had gone undiagnosed until, ironically, she started working on her PhD in psychology.

Jamison was showing symptoms in high school– hearing music in her head, clear as a bell, and staying up all night, sometimes more than one night, energetically completing schoolwork. Sometimes she spoke too fast for people to understand her. A little later, she went on credit-card spending sprees and could not remember them afterwards. She also fell into periods of extreme depression. Each continual up-and-down cycle lasted about three days. She theorized that she had inherited the disorder from her father.

When Jamison got to graduate school, she was given a questionnaire on symptoms of her condition. That was the first time she got an inkling that she was mentally unbalanced.  Read the book to learn how she dealt with this revelation.