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Citing numerous studies that might be surprising to both lay and professional readers, Dr. Rakel makes a compelling case for the efficacy of empathic, compassionate, connective behavior in medical care.  Words, touch, body language, and open-ended questions are some of the ways caregivers communicate compassion, and they have been shown repeatedly to make significant differences in the rate of healing. The first half of the book develops the implications of these claims; the second half offers instruction and insight about how physicians and other caregivers can cultivate practices of compassion that make them better at what they do.  

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Hillel D. Braude, a physician and a philosopher, has written an important, albeit dense and narrowly circumscribed, study. While “Intuition in Medicine” is the main title, the subtitle, “A Philosophical Defense of Clinical Reasoning” is a more accurate description of the book, which originated as a doctoral dissertation.  While some of the prose will appeal only to specialists, there are important and thoughtful analyses of such topics as Evidence-Based Medicine, modern dehumanized medicine, the relation of beneficence and automony, and principalist ethics in general. Throughout, intuition is narrowly conceived and in the service of clinical reasoning, as it applies to standard, Western physicians and not to other healers (or nurses), and the emphasis is on interventive medicine to cure illness and relieve suffering more than on health promotion.
 
Braude writes in the introduction that intuition has long been understood to be “a direct perception of things,” but he resists a more precise definition: “Rather than defining and using a single concept of intuition—philosophical, practical, or neuroscientific—this study examines intuition as it occurs at different levels and in different contexts of clinical reasoning” (xviii).  Eight chapters explore these different levels in such topics as moral intuitionism, Aristotle’s phronesis (or practical reason), the rise of statistics (a basis for Evidence-Based Medicine), and C. S. Peirce’s notion of abduction. Braude’s careful analysis traces historical and theoretical developments in analytic philosophy and how these may be applied to clinical reasoning.  He uses an impressive range of thinkers: Achenwall, Albert, Allan, Andre, Ashcroft, Aristotle, Bacon, Barrow, Barton, Beauchamp, Bergson, Bernard, Bichat, Black, Bottero, Bourdieu, Brody, Browne—just to take names headed by A or B.  Throughout, Braude puts in dialectic two poles of a spectrum arguing that they both have contributions to make. He believes that between them is an “ethical space,” where discoveries and applications can be made.  One pole, which he clearly favors, includes the following qualities:  Aristotelian practical reasoning, naturalist approaches, primacy of beneficence, fact and value joined, case-based, individual patients, narrative experience, anthropocentric focus, and tacit/organic knowledge (Polanyi). The other pole, less desirable, includes Kantian abstraction, nonnaturalist approaches, primacy of autonomy, fact and value separated, Evidence-Based Medicine, large groups of patients, statistical correlations, mechanist/positivist foci, and Dualism (Descartes).

Braude believes intuition is a cognitive process but has other dimension, the corporeal and the social. While these provide a grounding, intuition for him is generally rational. He also argues for medical care at the personal, face-to-face level, not through applications of algorithms.   A brief conclusion, “Medical Ethics beyond Ontology” clarifies some of the arguments and sketches some valuable notions from Husserl and Levinas. He writes “intuition . . . does appear to be fundamental for human judgment” because “an intuition faculty” can “extract universals from the particular” (p. 170).  Drawing on Husserl, he defines phenomenological intuition as “the primary means through which objects are presented to consciousness.” This affirmation includes the basic human, which is also the focus for medicine. For Levinas (and my summary is much too brief), “interhuman solidarity” is a source for medical care, a form of responsibility that is different from Foucaultian power relationships, ethical rules and priniciples, or “an uncritical acceptance of medical authority” (p. 177).

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Victoria Sweet describes her training in medical school, residency, and work in various clinics and hospitals. From all of these she forms her own sense of what medical care should include: “Slow Medicine” that uses, ironically, the best aspects of today’s “Fast” medicine.   

Her dramatic “Introduction: Medicine Without a Soul” describes poor—even dangerous—care given to her elderly father at a hospital. An experienced physician, she calls Hospice and saves him from a “Death Express” the hospital has “quality-assured” (pp. 6, 8). 
 
The book continues with 16 chapters in chronological order. The first ten describe Sweet from a late ‘60s Stanford undergrad and “a sort of hippie” (p.14), next a learner of “facts” in preclinical studies at Harvard, plus the clinical rotations (including Psychiatry, Internal Medicine, Pediatrics, and electives), then an internship as a doctor and her work in various clinics and hospitals. Throughout she’s collecting skills, concepts, even philosophies (Jung, feminism, Chinese chi, value of stories). She also describes particular patients important to her learning. She dislikes “just good enough” medicine at the VA (p. 95), “unapologetic budgetarianism” (p 141), medicine that is reductive and uncaring, and futile care for dying patients.  

Halfway through, we find an “Intermission: In which Fast Medicine and Slow Medicine Come Together.” With a year off, Sweet signs on as physician for a trekking group headed for Nepal. Unexpectedly, she treats an Englishman in the Himalayas. Returning home, she treats a man whose pulse is declining and rides a helicopter with him to a hospital. She realizes that she can take on the full responsibility of being a doctor, including when to use Fast medicine and when to use Slow.  

The following chapters deal with the 1980s emergence of AIDS, a hand injury to Sweet (she sees herself as “a wounded healer,” p. 182), her new understanding of medicine as “A Craft, A Science, and an Art” (Chapter 12) and conflicts between medical care and economics-driven medicine (“checked boxes,” administrators, quality assurance, even outright corruption).  She scorns use of the labels “health-care providers” and “health-care consumers” (p. 211) and discovers Hildegard of Bingen’s medieval vision of medicine. She works for 20 years at Laguna Honda, the topic of her earlier book God’s Hotel (2012). Chapter 16 closes the book with “A Slow Medicine Manifesto.”  

Sweet pays tribute to her teachers, both in a dedication to the book, and throughout the pages: professors, preceptors, nurses—especially a series of Irish Kathleens—and patients. There are some 20 case studies of patients throughout the book, their medical dilemmas, their personalities, and Sweet’s Slow Medicine that involves creating a healing relationship with them, finding the right path for treatment, even watching and waiting.

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Several threads tie together this ambitious, beautifully digressive reflection on eros and logos in the experience of illness and the conduct of medicine and health care, which takes into account what a complex striation of cultural legacies, social and political pressures, and beliefs go into both.  Framing his reflections on the role of unknowing, altered states, inexplicable events, desire, hope, love, and mystery in illness and healing is a fragmented, poignant narrative of Morris’s own experience of watching his wife succumb to the ravages of early Alzheimer’s. 

Her disease is one that leads both professional and intimate caregivers to the same question:  what do you do when there’s nothing left for scientific medicine to do?  Conversations about palliative care are broadening, he points out, and medical education is making more room for the kind of reflection the arts invite and for spirituality as a dimension of illness experience and caregiving.  Guidance in such explorations can be found in ancient literature, especially in the archetypes provided by the Greek and Roman myths.  Morris makes astute and helpful use of his own considerable training in literary studies to provide examples of how eros and logos—complementary contraries—have been conceived and embodied in a somewhat polarized culture and how incomplete health care is when it doesn’t foster the capacity to dwell in and with unknowing, possibility, indeterminacy, and mystery.  Knowing the limits of scientific medicine may, paradoxically, make it better.  Certainly it can help keep our engagements with illness—always relational, always disruptive, most often to some degree bewildering—humane.

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Eric Kandel, the 2000 Nobel Prize winner in Physiology or Medicine, has an abiding interest in art for its own sake, and also in how art can inform his primary work in brain science, especially as both art and science can be understood through reductionism.

My central premise is that although the reductionist approaches of scientists and artists are not identical in their aims—scientists use reductionism to solve the complex problem and artists use it to elicit a new perceptual and emotional response in the beholder—they are analogous (p. 6).  

Kandel’s aim, however, is more than just explaining how reductionism is used in brain science and in modern art. He is also out to show in a larger sense how science and the arts, which now exist as “two cultures,” are more alike than not. 

My purpose in this book is to highlight one way of closing the chasm by focusing on a common point at which the two cultures can meet and influence each other—in modern brain science and in modern art. Both brain science and abstract art address, in direct and compelling fashion, questions and goals that are central to humanistic thought. In this pursuit they share, to a surprising degree, common methodologies (p. 3).   

This slim volume comprises four parts amply supplied with schematics of brain structures and nerve tracts, and with reproductions of modern art works. The two middle parts are concerned with how reductionism applies to brain science and to art, respectively. The introduction places the topic within the context of the two-culture divide. The final part argues that art reduced to a set of core elements (e.g., form, line, color, and light) can add to the understanding of how the brain works, just as brain science reduced to a set of core elements (e.g., top down and bottom up processing of images) can add to the understanding of how art can be perceived and used to evoke certain responses.      

Bottom up processing refers to “universal rules that are largely built into the brain at birth by biological evolution and enable us to extract key elements of images in the physical world, such as contours, intersections, and the crossings of lines and junctions” (p. 22) This inborn circuitry is all that is needed for perceiving figurative art, and as a result produces uniform perceptions among viewers. Top down processing refers to the information the brain needs to perceive images when bottom up processing is insufficient, like in the case of abstract painting. It “incorporates the information our brain receives from the external world with knowledge based on learning from earlier experiences and hypotheses testing.” This includes “people we have seen and known, environments we have been in, as well as memories of other works of art we have encountered” (p. 23). Top down processing thus brings the viewer into the creative process and results in differences in perceptions among individuals of a particular work of art.  

In Kandel’s and many others’ telling, modern art was the response to the advent and expanding use of photography. No longer was figurative painting needed to render life as it is. Artists became free to explore and experiment with other ways to generate perceptions of life. Starting with impressionism and progressing through abstract expressionism and pop art, Kandel describes how painters in particular reduced their art to form, line, color, and light. They invited—demanded—that viewers participate in creating what they perceive. Brain science was able to use these elements also to map places in the brain where this processing takes place and to associate these elements with the different responses they produce. To illustrate these concepts, Kandel features the works of Turner, Monet, Kandinsky, Mondrian, de Kooning, Pollock, Rothko, Morris, and Warhol among others.  

In the end, Kandel is asserting—hoping—that reductionism in art will serve brain science because it will show “how we process unconscious and conscious perception, emotion, and empathy.” (p. 188). And, that reductionism in brain science will help artists “enhance traditional introspection with the knowledge of how some aspects of our mind work” (p. 189).

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This monograph is an important contribution—along with the Health Humanities Reader (2014)—to the burgeoning field of health humanities, a new academic field and the presumed replacement for (and expansion of) medical humanities. While the medical humanities included philosophy, literature, religion, and history, health humanities includes many more disciplines, and the creative arts.
This book is dense with theory and abstraction, but it imaginatively and intelligently promotes the notion that health is a larger and more useful concept than disease, which dominates and limits standard medicine. 

Five authors are listed for the book as a whole; none are attributed specifically to any of the eight chapters.
 
The first chapter “Health Humanities” promotes health humanities as an expansion of medical humanities to include more people (including unpaid caregivers and patients), social and national well-being, and the arts, such as dance, music, and visual art. We need to consider wider ranges of meaning, agency, and patients’ varying life stories. Unpaid caregivers have been neglected, even though “the majority of healthcare as it is practiced, is nonmedical” (p. 13). Medicine per se has been too science-based and too disease oriented, but critical theory and the arts can be “enabler[s] of health and well-being” (p. 19) with many applications to hospitals, clinics, homes, and neighborhoods.

“Anthropology and the Study of Culture” describes a wide range of inquiry, both worldwide and throughout human time, including rituals, conceptions of disease, health, death, and impacts for patients. Some cultures believe in spirit possession. The Chinese have worked with qi (life energy) for millennia. Cultural studies look at popular media, spiritual perspectives, also local and subcultural values.
 
“Applied Literature” discusses pathographies, including mental illness (for example, self-harm); it reviews concepts from Rita Charon and describes how reading groups can promote well-being. Literature expands our understanding of humans well beyond the biomedical gaze. Closely related, “Narrative and Applied Linguistics” reviews notions from Osler, Barthes, Bruner, Propp, Frank, and others. Patients want, beyond technical expertise, healthcare personnel who will help them co-create an enabling narrative. New techniques in linguistics include analysis of a corpus of usage, for example, teen language, thereby gaining approaches to young patients who cut themselves.

At 23 pages, the longest chapter is “Performing Arts and the Aesthetics of Health.” It posits that all arts are uniquely human because they are relational, aesthetic, and temporal (with time in a kairos sense, not just chronos). The arts fit into health practices, which also share the same three qualities. The arts promote coherence, agency, communication, expression, and social wellbeing, traits that are described specifically in music, dance, and drama. Similarly, the next chapter “Visual Art and Transformation,” promotes this particular art, whether elitist or popular, as communicative and transformative. The making of art can be healing. 

“Practice Based Evidence: Delivering Humanities into Healthcare” argues against Evidence Based Practice and its limitations. Instead of Randomized Controlled Trials, smaller, more qualitative studies may be more accurate and useful. Practice Based Evidence (and feminist and postmodern approaches) all create wider and deeper notions of validity.

“Creative Practice as Mutual Recovery” suggests that caregivers, whether professional or lay, also find healing as they deliver care.

In “Concluding Remarks” we read, again, that  “the majority of health care and the generation of health and well-being is non-medical” (p. 153). Medicine and medical humanities are “too narrow a bandwidth,” but health humanities can support all caregivers, various institutions (including schools), self-care, and complementary medicine.   

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This short but complex book assesses the many, current risks to all life on earth and considers some avenues for repair that may provide hope for the future. E. O. Wilson, a distinguished scientist, describes how all life on earth is inter-related. With a long view to the past and a wide view of the present—from microscopic creatures to humans—Wilson praises our planet’s biodiversity and warns of the dangers that may cause it to collapse; these dangers are human-related. Humans are an apex predator, smarter than all other creatures, but we are also too numerous, using too many resources, and causing various pollutions, including global warming. The health of the world and the health of all its creatures—humans included— are, for better or worse, interlinked forever.   
A Prologue warns that we are playing an “end-game” with the earth. To avoid a point of no return from mass extinctions, Wilson proposes a bold plan of setting aside one-half of the earth in reserve in order to stabilize the survival of humans.  

Part I, “The Problem,” describes the damage to our planet, on a par with the Yucatan asteroid 65 millions years ago, the so-called Fifth Extinction. We live in a narrow biosphere threatened by dying species, invasive species, collapse of interdependency, pollution of air, land, and water, loss of the commons, overhunting, human population growth, and outright habitat destruction (including the many impacts of climate change). He states, “the Sixth Extinction is under way” and “human activity is its driving force” (p. 55).   

Average time for recovery from each of the five previous extinctions is 10 million years. 

Self-centered humans do not understand the vast complexity of nature, including the many species not yet studied. He imagines far-distant geologists observing, “What a terrible time it was for people, and for the rest of life” (p. 9).  

Part II, “The Real Living World,” criticizes some conservationists who see nature in service to humans. Wilson says we are not owners of nature but stewards. He describes the abundant life of the Great Smoky Mountains National Park and a typical seashore as well as the extinction of the Ivory-Billed Woodpecker. Wilson contacted “eighteen of the world’s senior naturalists,” asking for suggestions for the “best reserves” to shelter “plants, animals, and microorganisms” (p. 135). Fifteen pages lovingly describe their recommendations of 33 places around the world. He concludes that “a great deal of Earth’s biodiversity can still be saved!” (p. 136).  

Part III, “The Solution” states, “The only solution to the Sixth Extinction is to increase the area of inviolable natural reserves to half the surface of the Earth or greater” (p. 167). Wilson reviews crises of water and food, and he warns against “self-inflicted disaster” that could wipe out most species by the end of this century. He provides two examples of restoration projects, the long-leaf pine lands in Florida and Gorongosa National Park in Mozambique. He believes the population bulge to ten billion people will be temporary.            

Wilson rejects geo-engineering of the oceans or the atmosphere as well as a proposed use of a passing asteroid. He argues that synthetic biology has promise for improving our brains for moral reasoning and ecological understanding. We need altruism (all working for all) and biophilia (deep love of nature).

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The aim of these reflections on uncertainty in medicine is not to discredit evidence-based medicine or to incite suspicion of the careful and caring processes by which most clinicians arrive at the advice they give.  Rather it is to change conversations among practitioners and between them and their patients in such a way as to raise everyone’s tolerance for the inevitable ambiguities and uncertainties we live with.  If the public were more aware of the basic rules of mathematical probabilities, how statisticians understand the term “significance,” and of how much changes when one new variable is taken into account—when a new medication with multiple possible side-effects is added to the mix, for instance—they might, Hatch argues, be less inclined to insist on specific predictions.  He goes on to suggest that there is something to be gained from the challenge of living without the solid ground of assurances.  When we recognize the need to make decisions with incomplete information (a condition that seems, after all, to be our common lot) we may refocus on the moment we’re in and see its peculiar possibilities. Changing the conversation requires a critical look at medical education which, Hatch observes, “measures a certain type of knowledge essential to medical practice, but it consequently engenders a conception of medicine best described as overly certain . . . .” 

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In this volume, Gonzalez-Crussi trains his sights on medical history, applying his lyrical writing skills to essays that he hopes will help preserve the humanistic core of the medical profession. Because of its brevity (250 pages), he apologizes for its focus on "Western medicine since the inception of the scientific method"(p.xi), but does note that he acknowledges "the continuity between ancient and modern medicine...[and] the contributions of the Orient, and of epochs predating the dominance of the rational spirit" (p.xi).What distinguishes this volume beyond the writing is the thematic organization. It begins with the Rise of Anatomy and Surgery, but then moves to Vitalism and Mechanism, The Mystery of Procreation,  and Pestilence and Mankind, before finishing with a look at Concepts of Disease, The Diagnostic Process and Therapy (including a brief focus on psychiatry). In the last section, Some Concluding Thoughts, Gonzalez-Crussi returns to his motivations for writing this short history, citing the mixed blessings of scientific progress whose gains, for example, are offset by those who "appear to try to 'medicalize' every aspect of human life" (p.210).

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