Showing 21 - 30 of 244 annotations tagged with the keyword "Medical Advances"

The Death of Cancer

DeVita, Vincent

Last Updated: Feb-04-2016
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Nonfiction

Genre: Memoir

Summary:

The book offers a detailed account by one of the nation’s leading cancer researchers of developments in chemotherapy over the past several decades, as well as the recent history of surgical and radiation treatments in the “war on cancer”—a term he resisted at first but finally embraced with full understanding of its implications.  The narrative touches on many of the writer’s own struggles over economic, political, and moral implications of what a NYT reviewer described as a “take-no-prisoners” approach to cure.  He also includes stories about disagreements with other researchers that give some insight into the acrimony that is part of high-stakes science.  At the NIH and later as head of the National Cancer Institute, DeVita faced many decisions about distribution of resources, how much to put patients at risk, and whom to include in clinical trials.  He provides his own point of view on those controversies frankly.  Not much mention is made of the causes of cancer, of nutritional or other complementary approaches, or the environmental factors in the spread of cancer. The strong focus on the book is on the development of chemotherapeutic treatments that have succeeded in raising survival rates, though few current statistics are cited.

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Dr. Mütter's Marvels

O'Keefe, Cristin

Last Updated: Jan-25-2016
Annotated by:
Glass, Guy

Primary Category: Literature / Nonfiction — Secondary Category: Literature / Nonfiction

Genre: Biography

Summary:

Those who are familiar with the Mütter Museum of the College of Physicians of Philadelphia, best known for its anatomical oddities, may have wondered about the institution’s namesake.  The author of this book, a poet and native of Philadelphia, endeavors to place Thomas Dent Mütter within the context of 19th-century American medicine.  

We learn here that notwithstanding being “medicated” with wine, surgical patients emitted such agonized screams that observers were known to vomit and pass out in their seats. We learn that Philadelphia was a cesspool of infectious disease for which there was no effective treatment.  We learn too of the rivalry (including behavior that would be considered unprofessional today) between the well-established school of medicine at the University of Pennsylvania (Mütter’s alma mater) and upstart Jefferson (whose faculty Mütter would join).  

In an era before the germ theory of disease became widely accepted, there was of course no concept of sterile technique.  To suggest that a surgeon should wash his hands was to imply he was not a gentleman because “all gentlemen were clean” (page 104).  Resistance to anesthesia was based not so much on concerns about potential danger but on the notion, when it came to obstetrics, that pain was a punishment for the sins of Eve.  Doctors could be downright sadistic to their patients, to the point of beating them like livestock.  That there was no concept of surgical aftercare meant that patients would be sent home immediately following an amputation. Victims of grotesque tumors and disfiguring accidents were considered “monsters” who lived lives of unimaginable misery.  

Enter Mütter, whose importation of plastic surgery from Paris to America brought hope to thousands of incurables.  He had an intuitive sense of the role of cleanliness in reducing morbidity and mortality.  He was a passionate advocate for anesthesia when it was seen as little more than a fad.  He abandoned traditional teaching methods that held a professor should be distant and unapproachable, and became beloved by generations of Jefferson students.  
 

In short, Mütter emerges as not just a likeable guy, but the forerunner of a whole new concept of what a good doctor should be, a sort of cross between P.T. Barnum and Mother Teresa.    

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Blood Feud

Sharp, Kathleen

Last Updated: Dec-01-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: History

Summary:

Beginning in 1992, Mark Duxbury and Dean McClellan are high-flying salesmen for Johnson and Johnson, Ortho branch – happily promoting the drug Procrit, (or Epogen -- erythropoietin), for anemia. The drug stimulates the bone marrow to produce more red blood cells. Developed by fledging company Amgen, it was licensed to Ortho for specific uses. Their careers take off, and they earn bonuses and stature, peaking in 1993. Soon, however, Duxbury realizes that he is being encouraged to promote the drug for off-label uses and in higher doses that will enhance sales and profits through kickbacks. He soon realizes that the drug is not safe when used in these situations. People are dying because their unnaturally thickened blood results in strokes and heart attacks.

He raises objections with his employer. For voicing concerns he is ostracized and then fired in 1998. Along with the stresses of his work, the financial difficulties and emotional turmoil, Duxbury’s home life is in tatters; his marriage falls apart and he worries about his daughter Sojourner (Sojie). He develops multiple health problems, including sleep apnea and dependency on drugs and alcohol.

Enlisting the help of the famous lawyer Jan Schlictmann (A Civil Action
), whistleblower Duxbury launches a qui tam lawsuit in 2002 against his former employer. This is a civil action under the False Claims Act, which can offer cost recovery should the charges prove warranted. The lengthy process is still going. The last ruling issued in August 2009 allowed the case to proceed. But Duxbury soon after died of a heart attack in October 2009 at age 49.

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The Physician

Gordon, Noah

Last Updated: Nov-17-2015
Annotated by:
McEntyre, Marilyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

When nine-year-old Rob Cole, child of poor 11th-century English farmers, loses his mother, he is consigned to the care of a barber-surgeon who takes him around the countryside, teaching him to juggle, sell potions of questionable value, and assist him in basic medical care that ranges from good practical first-aid to useless ritual.  When, eight years later, his mentor dies, Rob takes the wagon, horse, and trappings and embarks on a life-changing journey across Europe to learn real medicine from Avicenna in Persia.  Through a Jewish physician practicing in England, he has learned that Avicenna’s school is the only place to learn real medicine and develop the gift he has come to recognize in himself.  In addition to skill, he discovers in encounters with patients that he has sharp and accurate intuitions about their conditions, but little learning to enable him to heal them.  The journey with a caravan of Jewish merchants involves many trials, including arduous efforts to learn Persian and pass himself off as a Jew, since Christians are treated with hostility in the Muslim lands he is about to enter.  Refused at first at Avicenna’s school, he finally receives help from the Shah and becomes a star student.  His medical education culminates in travel as far as India, and illegal ventures into the body as he dissects the dead under cover of darkness.  Ultimately he marries the daughter of a Scottish merchant he had met but parted with in his outgoing journey, and, fleeing the dangers of war, returns with her and their two sons to the British Isles, where he sets up practice in Scotland.

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Will Starling

Weir, Ian

Last Updated: Oct-16-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1816 London, Napoleon has been defeated and troops have returned, including teenaged Will Starling, who survived the wars as assistant to the decent surgeon Alec Comrie. Will now serves Comrie in the city, still in strained circumstances.

Medical science has turned to the utility of anatomy, but material for research and teaching is scarce. Body-snatchers procure subjects from robbing graves—sometimes from murder—but they are not the only bad actors. Flamboyant, privileged Doctor Dionysius Atherton is trying to raise the dead by applying newly harnessed electricity to fresh cadavers.

From this ghoulish world of science and crime, young Will Starling tells his own tale, as your “Wery Umble Narrator.” Vivid scenes of wretched urban poverty, wanton cruelty, and selfless heroism march past to a grim ending.  

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Technology and Medicine

Campo, Rafael

Last Updated: Oct-06-2015
Annotated by:
Coulehan, Jack

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

A short (13 line) poem in which the poet-as-doctor describes his "transformation" from flesh-and-blood person into a machine in which "My hands are hypodermic needles, touch / Turned into blood . . . ." This doctoring-machine desires "a kind of intimacy / That won't bear pondering." For example, his mouth turns into "a dry computer chip" that cannot touch or feel or even say consoling words.

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Annotated by:
Donley, Carol

Primary Category: Literature / Poetry

Genre: Poetry

Summary:

This poem compares the grave robbing done in the 19th century in order to provide cadavers for medical training and research with the modern medical technologies that "rob" the dead of their rest by keeping them alive on machinery. Now the medical profession is "resurrecting" people before they're dead--delaying their deaths with machinery and drugs. "We cheat the dead of dying, with machines instead of spades." This poem also comments on the use of poor people who don't have the power to prevent this kind of denial of their rights.

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Welcome to Cancerland

Ehrenreich, Barbara

Last Updated: Sep-28-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Essay

Summary:

A “drive-by mammogram” leads the writer, Barbara, to a biopsy of a suspicious breast lump. She awakes from the fog of anesthesia to hear the surgeon’s bland remark: “Unfortunately, there is a cancer.” Welcome to Cancerland, a place where her identity is displaced by the vast implications of the diagnosis, another operation, and arduous months of chemotherapy. What works for her own peace of mind has little to do with the trappings of pink-ribbon sentimentalism in the survivors groups.

Barbara resorts to her knowledge of cell biology, asks to see her own tumor under the microscope, and contemplates the meaning of visualizing the malignant cells even if she does not believe the exercise can help her. She dissects the rank commercialism and denial in the survivor movement: let me die of “anything but the sticky sentimentalism in that Teddy Bear.” She decries the claims that cancer therapy makes better skin, better hair, and better people, with better bodies, especially when an implant on one side subtends a cosmetic procedure on the other.

Posting these thoughts on a chat line, she discovers that most women berate her attitude and suggest she needs a psychiatrist. But one dying woman agrees with her distress, and writes of having cancer, “IT IS NOT OK.” Admitting feminists can be found in the “survivor” community, Barbara faults its underlying tone for being coercively optimistic, infantilizing, and insulting to the dying and the dead. She is angry. Very angry, and her “purifying rage” spares no one: doctors, support groups, feminists, drug companies, and the Cancer Society. Nevertheless--and in keeping with her earlier work--she credits the women’s movement with helping to rid the world of three medical evils: the radical Halsted mastectomy, the practice of proceeding to mastectomy from biopsy without waking up the patient, and high dose chemotherapy.

Two disturbing ironies bring the essay to a close. The first, is the possibility that mammograms may not be saving or even prolonging lives, even as they detect cancers; they make women dwell in Cancerland for longer and cause too many “unnecessary” biopsies. The mammogram is a ritual, she says. The second irony lies in the role of the pharmaceutical industry which fosters the pink power movement –the ribbons, the teddy bears, the marathons-- while manufacturing the expensive poisons that seem to have anticancer side effects. These same companies, she argues, have also manufactured carcinogenic pesticides that pollute the environment. Having profitably poisoned women into having breast cancers, they continue to profit from poisons of chemotherapy.
She faults both the “cult” of the survivors movement and the American Cancer Society for their “unquestioning faith” in these imperfect instruments of action.

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Medicine: My Story

Berris, Barnet

Last Updated: Aug-25-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Nonfiction

Genre: Autobiography

Summary:

Born in 1921 to Jewish immigrant parents, “Barney” Barnett describes his life in medicine and education, from his earliest love of science and learning through his medical and residency education in general internal medicine, his success as an academic physician, and finally his judicious decision to retire.

An important leitmotiv is the antisemitism of the University of Toronto that kept him from a residency position (he went to Minneapolis) and a staff position (he was offered a one-year fellowship on a low salary in 1951).  Even after he was accepted as a staff member at the Toronto General Hospital (TGH), he was not promoted. Although he referred many patients to his TGH colleagues, only six ever returned the favor in the thirteen years he was there. Ironically, his Jewish background plucked him from this pedestrian position directly to the seat of Physician in Chief of Toronto’s Mount Sinai hospital (founded 1922) when finally it became a teaching hospital in 1964. 

While maintaining a practice in internal medicine, Berris became a liver specialist and researcher who introduced liver biopsy to Toronto. Known as a consummate diagnostician, he endeavored to enhance the research profile of his institution, integrating it with bedside instruction. He served on examining committees for the Royal College of Physicians and Surgeons, candidly describing the subjectivity of the process. He also served on many committees of the College of Physicians of Ontario, including discipline
, and describes the process used to investigate complaints with case examples.

His story includes vivid descriptions of some of the most famous figures in Canadian medical history, his teachers and colleagues – J.B. Grant, Arthur W. Ham, William Boyd, Ray Farquharson, K.J.R.Wightman, Arthur Squires, and Arnold Aberman. He was once involved with the care of the wife of David Ben-Gurion and Queen Elizabeth II.

Little is told of his personal life, although he admits that he often neglected his family for the press of work. His first wife, Marie, was a social worker; they had three children, one now a physician. She died of ovarian cancer; to care for her, he stepped down as chief in 1977.  In 1984, he married Thelma Rosen, an expert in education and widow of a pediatrician colleague. Together they went on a year’s sabbatical that allowed him to work in Singapore, Stanford University, and Sheila Sherlock’s lab at the Royal Free Hospital in London.

Some of the most engaging chapters contain clinical vignettes: stories about patients, the diagnostic workup, and their outcomes.  Like Richard Goldbloom (A Lucky Life
) and without diminishing his native abilities (which must have been considerable), he modestly attributes most of his success to luck.  

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A Dublin Student Doctor

Taylor, Patrick

Last Updated: Aug-14-2015
Annotated by:
Duffin, Jacalyn

Primary Category: Literature / Fiction

Genre: Novel

Summary:

In 1965, Dr Fingal Flaherty O’Reilly is traveling in his car with nurse Kitty when they come across a road accident and stop to help. The incident leads to reminiscing about his final years of medical training in Dublin hospitals in the 1930s.

Fingal has just returned from a stint in the navy. His student cohort includes a steady chum, a respected, brilliant woman, and a narcissistic pest–-all rather familiar tropes, comfortably portrayed. A picture of a hospital-based education emerges through teachers both kindly and rigid, a crusty head nurse who turns out to be a good soul, and a lovely student nurse, Kitty. Fingal’s professorial father disapproves of his son’s choice of a medical career and on his infrequent visits home, their relationship is tense.

Attractive to medical student readers are the clinical stories, the diagnostic dilemmas, and the stress of examinations. Social factors, such as poverty, unemployment, and discrimination, are intimately connected to the health of Fingal’s patients both as causes and results. His concern for his patients and those aspects of their lives earn him the respect of the head nurse and her student
.   

This story set in two time periods is partly a prequel to some of Taylor’s other tales, such as An Irish Country Doctor.

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