Wednesday, December 24, 2014

Doctoring (the Evidence)

If there's any advantage to having been intermittently under the (unbelievably dreary!) weather lately, it's the fact that I had the chance to read two really interesting books.

Brendan Reilly's One Doctor: Close Calls, Cold Cases and the Mysteries of Medicine (2013) is an engaging and eye-opening memoir.  At the time when it was written, Reilly was Executive Vice Chair for Clinical Affairs at New York Presbyterian-Hospital/Weill Cornell Medical Center.  His narrative opens on a Saturday morning in the ER--as Reilly quickly points out, he's one of the few doctors who still works on weekends--and follows Reilly and the cases he encounters of the span of several weeks. Midway through the narrative, Reilly reflects back on his years as Chief Medical Resident at Dartmouth College.

 In an era of increasingly specialized medical practice, Reilly represents a dying breed of primary care physician--the generalist.  In One Doctor, he examines the significance of the many changes he has witnessed in the health care industry over his 40-year career.

The fact that health care in the US is, ultimately, an industry driven by profit is perhaps one of the strongest notes that Reilly's memoir sounds.  As he considers his own experiences, he incorporates some startling statistics.

For example, in 1975, "health-care spending in the US amounted to 6 to 7 percent of the nation's $1.6 trillion gross national product.  Thirty-five years later, in 2010, US population had grown 50 percent... and health care spending had grown more than 2000 percent (to 17% of the nation's $14.6 trillion gross domestic product)" (164).

As Reilly points out, we have some of the most expensive health care in the world.  The question is, who benefits?  Definitely not the patient, Reilly argues. He points out that, in 2000, 98,000 people died in the hospital, as a result of medical mistakes.  That's more than the number of people who died of breast cancer (42,000) and in car accidents (43,000), combined (29).  It's slightly little less than the number of people who died of HIV (16,000), breast cancer and auto fatalities combined.

In short, Reilly's memoir will make you angry and, if you've even been a patient or compelled to advocate for a patient (particularly an elderly patient), you'll find much of what he says all-too-familiar.  His book is a long-overdue wake-up call, but it's one that the health care industry probably doesn't want anyone to hear.

In a similar vein (excuse the pun), I also really enjoyed Deborah Blum's The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York (2010).

In chapters organized around specific poisons (arsenic, wood alcohol, radium, thallium, carbon monoxide, chloroform, cyanide, mercury, and ethyl alcohol), Blum examines the work of Charles Norris, New York City's first Chief Medical Examiner and forensic chemist and toxicologist Alexander Gettler (pictured below, circa 1922).

Blum's narrative looks at how and why the rise of forensic medicine accompanied the "social experiment" known as Prohibition (and its ultimate demise).  Her style is an interesting and informative blend of scientific fact--did you know that radium is similar in chemical structure to calcium, and that this is why, when absorbed, it quickly travels into the bone marrow?--and historical event (Blum looks at various prominent cases of poisoning and murder that made headlines in the first half of the 20th century, along with issues of worker-safety that evolved during the Depression).

It's a fascinating angle from which to considerJazz Age America, and Blum offers a compelling account of the unsung heroes who helped to raise awareness about the dangers of toxic compounds that were, unfortunately, all-too-readily available in the decades before government regulation.

If you're looking for interesting and informative reading, I highly recommend both Blum and Reilly's respective texts.

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Ralph Waldo Emerson once wrote, "Life is short, but there is always time for courtesy."