Saturday, April 25, 2009

95 (2009 #20). Overtreated

by Shannon Brownlee

Subtitled, "Why Too Much Medicine is Making Us Sicker and Poorer," I read this book on the recommendation of a friend who is a librarian and has a medical background as well. My husband's right carotid artery is 70% blocked, and the doctors (internist, cardiologist, and vascular surgeon) all recommend an endarterectomy. However, the surgery is not without risks, and 70% falls right in that borderline area where, if asymptomatic (for strokes and TIAs), you could go either way. This book specifically mentions this procedure (on pages 204-205), which was why she suggested I read it.

It's an eye-opener. Author Shannon Brownlee has a master's degree in biology and writes on medical and health care topics. On page 9, Brownlee says her book "is an exploration of three simple questions. What drives unnecessary health care? Why should we worry about it? And once we understand how pervasive it is in American medicine, how can we use that knowledge to create a better system?"

Brownlee shows how doctors, hospitals, and drug and device manufacturers are rewarded (mostly by health insurance systems) for how much care they deliver rather than how effective it is. Coupled with most Americans' tendency to want SOME kind of treatment when they go to a doctor, either medication or tests, even when unneeded, Brownlee shows how costs are driven up while quality of care usually does not improve.

Brownlee uses numerous (often scary) examples throughout the book to illustrate her points, and concludes with a chapter that recommends some changes in current health care practices - but not socialized medicine. She gives the Veterans Administration hospitals as an example of a system to model - which surprised me, simply because I did not know they were that good. She also recommends electronic medical records, something that I am surprised is so slow to be adopted in the medical field.

The book is easy to read and understand - EXCEPT for the horrible end notes! She doesn't use standard footnotes, nor any numbering at all in her end notes, and it is difficult to find the sources for some of her statements. And some of those you can find don't make sense. For example, when she states on page 204 that "vascular surgeons performed about eighty-eight thousand unnecessary carotid endarterectomies in 2002, thereby causing an unknown number of strokes," the end note references personal communication with a British neurologist, and a published study that compares the outcomes of endarterectomies with another procedure, stenting. It's not at all clear what, if anything, supports her 88,000 figure - and that, in my opinion, is the biggest weakness of this book. I would certainly recommend reading it, but keep this weakness in mind.

Wednesday, April 15, 2009

94 (2009 #19): Matrimony

by Joshua Henkin

I won this book in a giveaway, and it includes a chance to do a chat (via conference call) with the author in a book club meeting.

However, I'm not sure if I will be recommending this book to my book club. It was...just okay. I'm not sure there is a lot to talk about, especially for our members, who are all pretty much my age or older, especially when the book is about a couple who are 17 in 1986 when the book begins.

They are Justin and Mia, attending fictional Graymont College in Northington, Massachusetts, where they fall in love and marry right about the time they graduate, mostly because Mia's mother is dying of cancer. Flash forward about four years, and now they are in Ann Arbor, Michigan. Mia has earned a masters degree and is now working on a doctorate to become a psychotherapist. Julian is trying to write a novel and teaching English composition on the side. Julian flies out to Berkeley, California, to visit his old Graymont roommate, and learns he and Mia slept together. Julian leaves Mia (but they don't divorce) and goes to Iowa City, Iowa, to participate in the famous Writer's Workshop there. They get back together and wind up in New York City, where Mia is a practicing therapist and Julian is still working on his novel. The book ends in 2005 when they are 36, back in Northington for a reunion. Julian is about to have his first novel published, they have a dog and are expecting a baby.

That's most of the plot. The book is mostly a character study. Perhaps it was the characters' generation, perhaps it was the fact that Julian was wealthy enough to afford to take 20 years to complete his novel, but I just couldn't care about these characters. I'll have to see if anyone else in my book club has read the book and if they are interested in discussing it. (Now, if I'd won one of the grand prizes, 12 copies of the book plus an author chat, we'd definitely be discussing it!)

I did think it was interesting that this book had a similar structure as American Wife, with parts designated by where one or both characters were living/visiting at the time. I'm also intrigued by the cover. My paperback has the design above, with the pairs of shoes that bug me, because the woman's blue shoes look like that of a little girl (although perhaps that is because my feet and those of my husband are about the same size). I find I prefer the cover of the hardback edition, with the toothbrushes:

Saturday, April 11, 2009

93 (2009 #18). American Wife

by Curtis Sittenfeld

I got this book from the Random House Readers' Circle program - it was a surprise. It's a thinly veiled novelization the life of Laura Bush. Of course, the names have been changed, as has the location (they're from Wisconsin, not Texas). Of course the book has been made more "scandalicious": Alice Lindgren Blackwell, the future First Lady, has a lesbian grandmother, her first sex with the brother of her high school boyfriend (after he dies when she crashes into his car – the fact that Laura Bush had a similar accident at 17 is true), and an abortion. Oh, and her childhood best friend accuses her of boyfriend-stealing (although to me it seems to be the other way around).

Some facts are altered - her father-in-law was only a former governor, not a former vice-president and president, and her mother-in-law is a snob whose own children (four boys, one a Congressman, no girls) call her "Maj," short for "Her Majesty," a nickname she apparently likes. (This was puzzling to me, as I always thought of Barbara Bush as mild-mannered - perhaps "Maj" was based more on Barbara's mother-in-law, based on hints in a July 2000 article in the New York Times). Charlie and Alice Blackwell only have one daughter, not twins. But Charlie does become co-owner of a baseball team (the Milwaukee Brewers, not the Texas Rangers) and governor of his state, and eventually United States President.

The reader (should) know this book is fiction, but there’s enough fact in it to make one wonder...what if?

Author Curtis Sittenfeld, who described herself as “a 28-year-old woman, a registered Democrat, and a staunch enough liberal,” first wrote of her admiration for Laura Bush in a 2004 Salon story. In an interview in the same journal shortly after American Wife was published in 2008, Sittenfeld describes the book as “loosely inspired by Laura Bush and that Laura Bush's life is a point of departure.” She cautions, “If you don't know if something in the book has some real life parallel to the Bushes, then you should assume it's made up…. I feel like 85 percent of this book is made up.”

She had read Ann Gerhart’s Laura Bush biography, The Perfect Wife, and “I just started writing based on what I recalled from that. I'm obsessed with structure in writing, so I conceived of this book as having four sections, each one built around a major real-life event that happened to Laura Bush. Everything else is made up. So I felt that I was creating a character, and didn't need to research Laura Bush's soul.” The four sections are designated by addresses: Alice’s childhood home, her home in Madison while a young teacher and librarian, her home with Charlie in Milwaukee, and of course 1600 Pennsylvania Avenue.

I liked this book much more than I thought I would. I especially enjoyed the plot twists with Alice’s former best friend and the dead boyfriend’s brother. I admire both George and Laura Bush (I think his intelligence is underrated), but I can see how some conservatives will be bothered by this book, particularly when they forget it IS fiction. Sittenfeld also doesn’t do a very good job of masking her personal dislike of Charlie/George, particularly in the last section, although even she has said, “I think Democrats are as likely to find it too sympathetic as Republicans are likely to find it too unsympathetic....I see Bush as a president and as a person separately....I understand that there are people out there who either can't or don't want to make that distinction.”

Friday, April 10, 2009

92 (2009 #17). The Graveyard Book

written and performed by Neil Gaiman

This 2009 Newbery winner was better than I expected. I didn't really care for Gaiman's American Gods, and I'm not much of a fan of horror or fantasy - The Graveyard Book has a little of the first and a lot of the second. But so many people were so happy about this book winning the Newbery that I decided to listen to the audiobook right away after purchasing it for our library's collection.

A toddler wanders away from his home after his parents and older sister are murdered, and into a nearby graveyard, where he is adopted and raised by the mostly-ghostly residents and renamed Nobody Owens, "Bod" for short. There are a number of similarities to Rudyard Kipling's The Jungle Book. Indeed, in an interview with The New York Times published January 26, 2009, Gaiman stated that he used to take his son to ride his trike in a graveyard across the street from their yardless house:

“I remember thinking once how incredibly at home he looked there,” Gaiman said. “I thought you could write something a lot like The Jungle Book and set it in a graveyard.”

Bod has a number of amusing adventures as he grows up (I especially liked his playmate at age 5, Scarlett Amber, whose parents think Bod is her imaginary friend), but the story eventually turns dark when he is 14 and the murderers of his family come back to do in Bod as well. This was actually the weakest part of the book for me, as Gaiman doesn't explain the backstory very well. It's never very clear why Bod's family is murdered and why he is still targeted, nor just who (or what) his two main protectors (Silas and Miss Lupescu) really are.

Still, I can see how this book would be really popular with children who are fans of Harry Potter, Lemony Snicket, and the like. With its cast of eccentric characters, many with wonderfully old-fashioned names, it will probably make a great movie. And Gaiman did an outstanding job reading his book aloud. This book would work as a read-aloud for about fourth or fifth grade, and an easy read for middle-schoolers.

© Amanda Pape - 2014

[The audiobook, and a print copy for reference, were borrowed from and returned to my local public library.]

Sunday, April 05, 2009

91 (2009 #16). The Book Thief

by Markus Zusak,
read by Allan Corduner

I REALLY enjoyed this book, more than I thought I would! It takes place in Germany before and during World War II, in the fictional town of Molching, which is apparently supposed to be Olching, a town also on the Amper River, not too far from Dachau (the well-known concentration camp) and Munich. The “book thief” (the title makes more sense as the story progresses) is Liesel Meminger, who is nine years old when the book begins in January 1939, on the way to her foster parents, Hans and Rosa Hubermann in Molching.

Markus Zusak did a great job of drawing the reader in by using Death as his narrator. Death is more world-weary than Grim Reaper, and he cares about the characters, the same way I did. I have to admit at first when I realized who the narrator was, I thought it was going to be yet another teen fantasy book. The prologue in particular was a bit puzzling (I had to smile about Death needing a vacation, but his talk about colors was confusing), but the book made more sense after that, and the prologue will become clear when re-read after finishing the book.

I think having Death as the narrator helped to underscore the sheer magnitude of the Holocaust, because Death--who must surely be rather immune to most horrors--was so affected by what was happening in the concentration camps. I also found the image of Death sitting by the chimney of the gas chamber, gently, reverently and lovingly gathering souls into his arms, profoundly moving.

I thought this book did remarkably well in giving a feel for the very real horrors of World War II and the Holocaust without being overly macabre. Zusak used foreshadowing to suck the reader in by having Death nonchalantly mention things that happened later in the story and then going back and narrating everything in chronological order.

Zusak is Australian, but his mother is German and his father is Austrian, and he incorporated stories they told him about their lives during World War II into the book. Interestingly, while the book is often classified as young adult in the United States, Zusak originally wrote it for adults.

The narrator on the audiobook is English character actor Allan Corduner, who is Jewish and whose mother was born in Berlin. He did a fantastic job with the voices! The book included German words and they were always translated the first time they were used. I learned some new German insults! :)

This is the type of book that teaches numerous lessons and I think anyone would enjoy reading it. It was a sad but remarkable story covering a very tragic time in human history; yet Zusak gives us hope for humanity in the compassion, the strength and the dignity some people showed in the face of a world gone mad.

“We have these images of the straight-marching lines of boys and the ‘Heil Hitlers’ and this idea that everyone in Germany was in it together. But there still were rebellious children and people who didn’t follow the rules and people who hid Jews and other people in their houses. So there’s another side to Nazi Germany,” said Zusak in an interview with The Sydney Morning Herald.

I would most definitely read The Book Thief again. This is the type of book you can read and reread and take something new away from it each time. I would recommend this book to adults and teens without hesitation. I am suggesting it for my local book club. It was long (over 500 pages) but the chapters are short and such a quick read, and it was hard to put it down.

Saturday, April 04, 2009

90 (2009 #15). Blindness

by Jose Saramago,
read by Jonathan Davis

I listened to this audiobook because my long-distance book club back in Washington state was reading it earlier this year. I think the book was chosen because Saramago won the Nobel Prize for Literature in 1998, three years after this novel was first published in Portuguese in 1995.

This is a horrific novel about the dystopia that ensues after an epidemic of inexplicable blindness. At one point, the events that occur are so disgusting and disheartening (gang rapes, among other things) that I simply had to stop listening to the audiobook and switch to a different book. I picked up a paper copy of the book at my university library and skipped ahead to the end. That was encouraging so I did go back and listen to the rest of this audiobook.

The audiobook is definitely the preferred format. Saramago uses little punctuation, apparently in all of his novels. Sentences run on for entire paragraphs, paragraphs go on for pages. The original translator died before his work was completed and another completed the revisions, and the translation comes across as word-for-word rather than edited. Being an allegory, the location and characters are all unnamed - the latter are referred to as "the doctor," "the doctor's wife," "the man with the eye patch," "the girl with the dark glasses," "the boy with the squint," and so on. Attempting to read the dialogue can be very confusing, as it's not clear who is speaking. The narrator, actor Jonathan Davis, does an excellent job using slight variations in voice to make each character unique - AND he pauses appropriately in this (too-)wordy book, making it easier to follow the story.

I used the cover from the print edition I used for this post, rather than less-interesting cover from the audiobook, which is a tie-in to the 2008 movie starring Julianne Moore. She's one of my favorite actresses, but I have no desire to see this movie. I'm glad I finished the book, but this is not one that I would re-read, nor would I recommend it to others.