A well-documented, unnerving, fascinating study for anyone adrift in the American health care system.
An ingenious exploration of “natural experiments” that influence medical care.
Physicians and researchers at Harvard, Jena and Worsham open with a teaser claiming that children born in summer suffer influenza more often than those born in autumn. Readers may be confused until they reveal the results of millions of insurance claims. Parents tend to follow pediatric guidelines for yearly checkups, and they recommend using a child’s birthday as a reminder. Flu shots become available in the fall, so some children are immunized during their yearly checkup. The vaccine isn’t available during the summer so those parents are told to make a fall appointment; many don’t follow up, so their children get sick. The text is full of such intriguing and surprising facts and trends. When cardiologists go on vacation, their patients’ death rates drop significantly, likely because the substitutes are less aggressive in treatments. Most doctors prefer action over inaction, and so do those they care for. Sick patients want their doctor to “do something.” Hearing that waiting is the best course is often greeted as bad news. In a parallel study, patients with metastatic lung cancer were either given standard cancer treatment or simple palliative care. The palliative care patients were more comfortable—and also lived longer. Few readers will ignore the long section on who makes the best doctor. Backed by millions of records, mostly of hospital discharges and deaths, the authors determine that graduating from the best medical school makes no difference. Experience matters for surgeons, who improve with age, but not for internists. Women doctors perform as well as men in most specialties and a little better as internists, and doctors trained internationally are just as effective. Pandemic politics provides a concluding shock. Republicans and Democrats died in equal numbers early in the pandemic, and with the vaccine came a highly politicized anti-vaccine movement, after which excess deaths among registered Republicans jumped to over 150% higher than those of Democrats.
A well-documented, unnerving, fascinating study for anyone adrift in the American health care system.Pub Date: July 11, 2023
ISBN: 9780385548816
Page Count: 320
Publisher: Doubleday
Review Posted Online: April 17, 2023
Kirkus Reviews Issue: May 15, 2023
PERSPECTIVES
Cogent, well-timed ideas for meeting today’s biggest challenges.
Helping liberals get out of their own way.
Klein, a New York Times columnist, and Thompson, an Atlantic staffer, lean to the left, but they aren’t interrogating the usual suspects. Aware that many conservatives have no interest in their opinions, the authors target their own side’s “pathologies.” Why do red states greenlight the kind of renewable energy projects that often languish in blue states? Why does liberal California have the nation’s most severe homelessness and housing affordability crises? One big reason: Liberal leadership has ensnared itself in a web of well-intentioned yet often onerous “goals, standards, and rules.” This “procedural kludge,” partially shaped by lawyers who pioneered a “democracy by lawsuit” strategy in the 1960s, threatens to stymie key breakthroughs. Consider the anti-pollution laws passed after World War II. In the decades since, homeowners’ groups in liberal locales have cited such statutes in lawsuits meant to stop new affordable housing. Today, these laws “block the clean energy projects” required to tackle climate change. Nuclear energy is “inarguably safer” than the fossil fuel variety, but because Washington doesn’t always “properly weigh risk,” it almost never builds new reactors. Meanwhile, technologies that may cure disease or slash the carbon footprint of cement production benefit from government support, but too often the grant process “rewards caution and punishes outsider thinking.” The authors call this style of governing “everything-bagel liberalism,” so named because of its many government mandates. Instead, they envision “a politics of abundance” that would remake travel, work, and health. This won’t happen without “changing the processes that make building and inventing so hard.” It’s time, then, to scrutinize everything from municipal zoning regulations to the paperwork requirements for scientists getting federal funding. The authors’ debut as a duo is very smart and eminently useful.
Cogent, well-timed ideas for meeting today’s biggest challenges.Pub Date: March 18, 2025
ISBN: 9781668023488
Page Count: 320
Publisher: Avid Reader Press
Review Posted Online: Jan. 16, 2025
Kirkus Reviews Issue: Feb. 15, 2025
BOOK REVIEW
PERSPECTIVES
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
PERSPECTIVES
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