Showing 1 - 10 of 48 annotations contributed by Teagarden, J. Russell

Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: History

Summary:

In a 1976 Archives of Neurology essay, the neurologist Robert Katzman successfully argued for relabeling “senility” as “Alzheimer’s disease.” He urged rejecting various forms of dementia and senility as common consequences of aging, and accepting them as a disease requiring all the attention any other important disease deserves. Now medicine and society had a problem—"The Problem of Dementia,” the famed physician Lewis Thomas called it in a 1981 essay published by the popular magazine Discover, and he noted that, suddenly, “a disease of the century” had arisen (p. 3).

Forty years on, Jason Karlawish thinks there is still a problem, but in keeping with Katzman’s call, he refers to “The Problem with Alzheimer’s.” Based on the history he covers and the experiences he shares in this book, nothing of much significance has occurred since “The Problem of Dementia” became the “The Problem of Alzheimer’s.”

Karlawish is a physician who cares for people with Alzheimer’s and a researcher delving into “issues at the intersections of care, ethics, and policy” (p. 5).  He draws on his experiences in this book, which he describes as “the story of how once upon a time, Alzheimer’s disease was a rare disease, and then it became common, and then it turned into a crisis.” Karlawish wants to answer why during the time between Thomas’ essay and the year 2010, “nothing really changed,” and how that could be the case in “the richest and most powerful nation.” (p. 6) He tells this story in four parts.

The first part concentrates on efforts clinicians and researchers were making following Thomas’ call to distinguish Alzheimer’s disease from normal aging, other dementia types (e.g., frontotemporal, Lewy body), and precursor syndromes (e.g., minimal cognitive impairment). They were looking for definitive clinical patterns, imaging studies, diagnostic tests, and pathologic markers for the disease. 

In the second part, Karlawish goes back in time to when Alois Alzheimer first found what are known today as “plaques” in the brain of a patient who had an early onset of severe, progressive dementia. He traces the attention this finding drew to eventual advances in imaging and biochemistry aimed at diagnosis. Karlawish also covers how a cascade of events over the decades following Alois Alzheimer’s finding disrupted the pursuit of a pathophysiological basis for dementia. These events included the rise and dominance of Freudian psychology; followed by two world wars; the cold war; the overshadowing of AIDS; Medicare political and funding constraints; tussles among patient advocacy groups; loss of asylums where care and research had coexisted; clinical failure of the first drug; and the continued debate over whether dementia is a consequence of aging or is a disease. 

Karlawish moves on in the third and fourth parts to cover what “we will have to learn to live with the disease so as to improve the lives of persons...to provide the care they need to live well at home...and repair the broken system” (p. 171). Success in his view requires integrated biological, psychological, and social components. He reports the progress on each of these three fronts: some failed approaches continue to fail (such as drugs targeting amyloid); some psychological interventions show promise (though at times causing moral tension); some of the social configurations engineered for Alzheimer’s patients, families, caregivers, and society have produced triumphs and some disasters. He has much to say about why and how this search must go on, but with some much-needed course corrections. 

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This is Your Mind on Plants

Pollan, Michael

Last Updated: Oct-21-2021
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Investigative Journalism

Summary:

Michael Pollan is curious about human consciousness and how humans alter it using a variety of molecular compounds. This curiosity took him first to three mind-altering psychedelic drugs: psilocybin, lysergic acid diethylamide (LSD), and 5-MeO-DMT (“The Toad”). He reported his findings and personal experiences in a 2018 book, How to Change Your Mind. His curiosity yet untamed, Pollan expands his project to three mind-altering compounds found in plants: opium, caffeine, and mescaline in his latest book.

Pollan’s investigation is born of his vocation as a gardener “fascinated by our attraction to these powerful plants as well as by the equally powerful taboos and fraught feelings with which we surround them.” He’s further attracted to them for the way in which when “we take these plants into our bodies and let them change our minds, we are engaging with nature in one of the most profound ways possible” (p. 3). The sources he chooses are the opium poppy for opium; coffee and tea for caffeine; and peyote and San Pedro cacti for mescaline. 

Opium, caffeine, and mescaline represent the range of mind-altering properties available from plants of interest to Pollan. In opium he saw a sedative, in caffeine a stimulant, and in mescaline a hallucinogen, or as he characterizes them, the “downer, the upper, and the outer,” respectively (p. 4). Their effects on consciousness do not feature dissolution of the ego, as is the case with psychedelics, and indeed, they can solidify ego. Seemingly most important to his selection, however, was that,

Taken together, these three plant drugs cover much of the spectrum of the human experience of psychoactive substances, from the everyday use of caffeine, the most popular psychoactive drug on the planet; to the ceremonial use of mescaline by Indigenous peoples; to the age-old use of opiates to relieve pain. (p. 4)
The book comprises an introduction and a chapter each covering opium, caffeine, and mescaline. The introduction describes his dual interest in the ancient human drive to fool with consciousness, and in plants that produce mind-altering substances as evolutionary features. Pollan also touches on how civilizations, ancient and current, aid and combat the use of these substances, at times simultaneously. In the chapter on opium, Pollan updates his April, 1997 Harper’s Magazine article about his experience growing opium poppies as the war on drugs peaked in the mid-1990s; in this version he reconstitutes the section he left out for fear of arrest and conviction that has since abated. In the next two chapters, Pollan separately reports on how caffeine and mescaline affected his consciousness. Because he was already a heavy caffeine user, Pollan had to give up coffee and tea if he was to discern its mind-altering effects, but for mescaline’s mind-altering effects, he had to find a source, a setting, and a guide through the maze the Covid-19 pandemic created.

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Cyril Wilkinson and his wife Kay make a pact. On Kay’s eightieth birthday, when Cyril is already eighty-one, they will commit suicide together. Cyril, a physician in the British National Health Service (NHS) secured a supply of secobarbital as the means to their end. It was 1991. They have planned well ahead; another twenty-nine years will pass before Kay’s eightieth in 2020. 

Motivating the pact was the death of Kay’s father after “a good four years of steady deterioration, followed by a solid ten of nothing but degradation” from dementia (p. 7). They had just arrived home from his funeral service, and were reflecting on what they had been through. At one point, Cyril says, “Your father frankly made me suicidal—or homicidal—or both. Half an hour in his presence passed like a mini ice age,” and then promises Kay, “I will do almost anything to keep the two of us from acceding to such a fate” (p. 12). But Kay is dubious. 

That’s what everyone says...Everyone looks at what happens to old people and vows that it will never happen to them...Somehow they’ll do something so their aging will proceed with dignity...Everyone thinks they have too much self-respect to allow a stranger to wash their private parts...Then it turns out that, lo and behold, they’re exactly like everyone else! And they fall apart like everyone else, and finish out their miserable end of their lives like everyone else. (pp. 12-13)
And so Kay dithers over the next few months whether to agree to the pact, but once her mother begins showing signs of dementia; “I’m all in,” she tells Cyril (p. 17).

Cyril and Kay proceed through the subsequent twenty-nine years, with Kay raising their three children, retiring, finding new work and passions; Cyril going on and on about politics, the NHS, old people; and both watching their remaining parents pass on, traveling to far-flung locations, becoming grandparents, aging. Then the day arrives; happy birthday, Kay? 

The novel structure is simple or complex depending on how a reader approaches it. The first chapter sets up the pact. The second chapter leads up to the day of reckoning and becomes the first story telling what became of the Wilkinsons’ plan. The next eleven chapters envision alternative scenarios unfolding from choices Cyril and Kay make before and on their pre-determined end date. Some scenarios stem from one or both of them not going through with their pact. Some scenarios involve recognizable and available options today, and some are wholly futuristic and unattainable. Some scenarios are happy, some are sad, all are unsettling. These chapters can read as independent stories offering different choices and endings. But they can also be read as interdependent and collectively building toward a point of view on the question: Should we stay or should we go?   
 

The interdependence and complexity of the chapters arise from the through lines among them. From the third chapter on, for example, the first few sentences of each chapter are taken verbatim or slightly modified from some part of a preceding chapter. Other blocks of text appear in one or more chapters. One through line even extends beyond the book to another of Shriver’s novels (So Much For That). Kay and Cyril exhibit the same personalities and preferences, and express the same general hopes and desires through all the chapters. Other through lines are shared events or recurring arguments and debates; however, not always with the same outcomes.

The four years preceding Kay’s eightieth birthday overlap both the decision of the United Kingdom (UK) to leave the European Union (“Brexit”) and the Coivd-19 pandemic. Thus, during the time Cyril and Kay are deciding whether they will actually leave or remain on Earth, the UK is deciding whether to leave or remain in the European Union, and while Cyril and Kay are seemingly willing to die rather than fight the ravages of old age, millions of people are willing to fight the ravages of Covid-19 rather than die. These juxtapositions pop up often giving the Wilkinsons’ decision added poignancy.


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Joji

Pothan, Dileesh

Last Updated: Jun-13-2021
Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

“Grandpa is in quarantine,” Popy tells the delivery man through his face mask in the opening scene. His grandfather was not in quarantine; Popy had ordered an air gun using his account and now needed to conceal it from him. But, because the movie is set during the Covid-19 pandemic, the delivery man could easily believe Popy’s story and hands over the package with the gun.  

Popy is a teenager living in a multigenerational household in India, which in addition to his grandfather, Kuttappan PK Panachel, includes his father, Jomon, two uncles, Jaison and Joji, and Jaison’s wife, Bincy. They live on a sprawling and prosperous plantation Kuttappan owns near Kerala. Imperious and parsimonious, Kuttappan keeps tight control over his domain and family. As the movie begins, we see cracks forming in the family from the continuous pressure he exerts. The pressure affects Joji most.

Though he dropped out of an engineering college, Joji seeks wealth and independence, but his attempts to attain riches yield little until Kuttappan suffers a stroke. From the time of his father’s struggle for survival until his death, Joji plots to hasten his father’s demise and secure the family fortune for himself. Lives are lost, and so are Joji’s aspirations. 

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The Father

Zeller, Florian

Last Updated: Apr-26-2021
Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

The basic plot of The Father mirrors the all-too-common trajectory people with dementia follow: first they deny any problems; then they progressively need more in-home assistance; and then they require institutionalization. This scenario, however, gets obscured when watching the film’s main character—the father—wrestle with quotidian activities and familiar faces. The viewers wrestle with him, and become just as confused and rattled. Florian Zeller, the screenwriter and director, admits he wants viewers feeling what people with dementia feel. He succeeds in the movie as he succeeded in the Broadway play version preceding it.

The father, Anthony, lived in his London flat with help from hired caregivers and his daughter, Anne, who lived nearby. After Anthony banished several caregivers on grounds they were unnecessary, Anne moves him into her flat, and when he’s too much for her there, she moves him to a nursing home. We’re never quite sure, though. Zeller makes the two flats and the nursing home look almost identical. He changes Anne’s story at different times: she’s still married after ten years; she’s been divorced for five years; she’s relocating to Paris with a lover; she was never relocating to Paris; she relocated to Paris. Anne appears as a different person on occasion and the husband she may or may never had appears as different people. Zeller overlays these confusing surroundings and events by jumping forward and backward in time, and repeating some scenes with slight variations. Eventually, Anthony says, “strange things are going on around us.” Viewers will feel the same, and that’s the point.

The movie ends as Anthony awakes in his nursing home room. Just as we are lured into thinking we have returned to the common dementia trajectory at its end, we see his nurse is the person who had appeared as Anne before, and his room looks like the bedrooms in both his own and Anne’s flats. We wonder.

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Motherless Brooklyn

Lethem, Jonathan

Last Updated: Apr-12-2021
Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Fiction

Genre: Novel

Summary:

Lionel Essrog is the narrator and main character of the novel, although when his Tourette syndrome kicks in, he might introduce himself as: “Liable Guesscog, Final Escrow, Ironic Pissclam, and so on” (p. 7). Tourette syndrome is a neurological condition causing involuntary, repetitive movements and vocal sounds (e.g., words, utterances, growls)—tics. 

Lionel lived at the Saint Vincent Orphanage in Brooklyn, New York until a local “penny-ante hood,” Frank Minna, recruited him and three other “white boys” to do his bidding as a “motley gang of high-school-dropout orphans.” (p. 291) Truck piracy was their first line of work, all the while oblivious about why they were moving boxes from one truck to another. Minna expanded his business into more lucrative and dangerous activities under the façade of a limousine service and private detective agency. He gets too close to the sun and is murdered. Lionel liked Minna, who became a father figure to him, accepted his Tourette quirkiness, and even conspired with him to throw their clients off balance when it served their purpose. Though Lionel admitted, “We were as much errand boys as detectives,” he recasts himself as a bona fide detective and makes finding the murderers his raison d’être. (p. 156) 

In typical murder-mystery fashion, Lionel must wend his way through complex relationships and find hidden clues to solve the case. In not-so-typical fashion, he contends with the Tourette syndrome accompanying him; Tourette is a major character in the book. Together, they find who murdered Frank Minna. 

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Elizabeth is Missing

Walsh, Aisling

Last Updated: Feb-16-2021
Annotated by:
Teagarden, J. Russell

Primary Category: Performing Arts / Film, TV, Video

Genre: Film

Summary:

Maud’s dear friend Elizabeth is missing, suddenly. Maud’s dear older sister Sukey is long missing. And, Maud’s mind is missing more and more. These three facts and how they relate to one another form the matrix of this movie. Maud Horsham is an elderly widow living alone with help from a home health aide’s daily visits, and from an attentive, if occasionally resentful daughter and a loving teenage granddaughter. She is well into the inexorable decline dementia brings, but at a stage where the support in place and reminder notes she leaves around are enough to keep her functioning. 

On a routine visit to her friend Elizabeth, and while they dig in Elizabeth’s garden, Maud comes across the top of a compact that immediately takes her mind to a scene seventy years before when her sister Sukey was applying makeup with what looks to Maud as the same compact Sukey had in her hand. This flashback starts the story of Sukey’s unsolved disappearance as a young adult. A couple of days later, Maud and Elizabeth are to meet outside the Salvation Army store where they both once worked. Elizabeth never shows. 
 

Elizabeth is Maud’s only remaining friend, and Maud sets off to find her. Her search triggers many flashbacks and hallucinations from the time of Sukey’s earlier disappearance, which she then becomes determined to solve. Maud’s worsening dementia often frustrates her own efforts in these parallel missions and also causes family, friends, and officials to doubt her findings and assertions. The parallel stories each have twists, turns, and surprises all the while Maud’s dementia is progressing to where she can no longer live on her own. Nevertheless, Elizabeth is found, Sukey’s grave is found, but Maud’s mind is never to be found again. 

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

Carlo Cipolla chronicles the 1630 bubonic plague outbreak in Northern Italy. At various places in the text, he refers to his compact volume as an “essay,” a “tale,” and a “book.” Readers during the 2020 coronavirus pandemic could call it a “prologue,” a “warning,” or a “horror story foretold.”  

The plague ravaged much of Northern Italy from 1630 to 1631. Cipolla focuses on a particular village, Monte Lupo, because “so exceptionally rich is the documentation of [its] story that it allows the historian to recapture emotions, attitudes, and behavior of common people.” The documentation led him to uncommon detail “on the relationship between Faith and Reason, Church and State at a social level” (p. ix). 

Reading like an historical essay, Cipolla first sets up the tensions arising between the Church and State Church during the plague epidemic. The “scientific revolution” had advanced enough by 1630 that regional Health Magistrates acted based on experience rather than faith. Most clergy and their followers still “preferred to believe rather than observe…[and] had not the slightest doubt: processions and similar ceremonies were the only way to placate divine wrath and put an end to the scourge” (p. 7). But, the divide between Church and State in this case is not so clear as that, Cipolla notes, because some of the senior Health Magistrates served as high-ranking church leaders themselves. 

Cipolla points to public health measures taken in Northern Italy before the 1630 plague outbreak that might have, ironically, heightened tensions, even though they were born from the terror and suffering epidemics caused during the previous two centuries. The changes that resulted were, in Cipolla’s view, “a strange mixture of brilliant intuition, sound common sense, and absurd prejudice” (p. 12). However rational these measures seemed, “they caused great misery and severe privations [through] the segregation of entire families in their homes, the separation of kindred in the horror of the pesthouses, the closing of markets and trade, the consequent lack of work and wide-spread unemployment, the burning of furnishings and goods” (p. 13). By the time the plague took hold in 1630, necessary public health measures were already unpopular.
 

Cipolla uses the walled-village Monte Lupo as his case study. Around 150 families lived inside its walls when the plague struck during the summer of 1630. He details how Health Magistrates struggled to gain control of the outbreak while facing open rebellion fueled by “ignorance, egoism, avarice, and bullying” (p. 14). He names and profiles key figures and describes various events. 

The central event in Cipolla’s tale is a “procession” in Monte Lupo featuring a crucifix people believed had “miraculous properties” (p. 41). The Health Magistracy took aggressive actions to prevent and then stop the procession. Alas, Cipolla reports: “All this was in vain. It was like preaching to the wind: the church was soon packed with men and women, boys and girls, who had come to gaze at and adore the crucifix,” (p. 47). Festivities carried into the evening and on to a neighboring town (San Miniatello). Mayhem, illness, and death ensued. 
 

The last death in Monte Lupo occurred on August 11. Cipolla follows the subsequent investigations searching for people encouraging exposure to a lethal, contagious disease, and for people who became infected and died as a result. He reflects on the juxtaposition of epidemiological methods used to stop the epidemic and the fight religious leaders and followers waged against them. He muses about “emotions, attitudes, and behavior of all segments of a society in a period distant in many ways from our own” (p. 85). Written in 1977, the objects of his musing were only four decades distant from becoming evident again. 

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Annotated by:
Teagarden, J. Russell

Primary Category: Literature / Nonfiction

Genre: Treatise

Summary:

The author, Ezekiel J. Emanuel, says his book title “is a terrible question” (p. 1), because “it is not possible to select the best health care system overall.” However, he continues, “it is possible and reasonable to make judgments about better and worse systems” (p. 351), such as considering “which country has the best consumer choice,…the most innovative health care system,…or best addresses the needs of chronically ill patients” (p. 7). And, that’s what he does.

Emanuel and his research partners compare eleven, high-income countries: United States, Canada, United Kingdom, Netherlands, Norway, France, Switzerland, Canada, Australia, Taiwan, and China. They examine eight content areas: history; coverage; financing; payment; the delivery of care; prescription drug regulation; human resources; and future challenges. These content areas serve as the subject headings for the chapters covering each country. In the penultimate chapter, “Who’s the Best?,” Emanuel assesses and judges each content area across countries. (Spoiler alert: the United States does not fare well.) The concluding chapter is built around “six lessons for improving the US health care system” (p. 385), followed by a coda where Emanuel considers how his findings relate to the coronavirus pandemic.

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Summary:

Elizabeth Siegel Watkins reports on the use of estrogen alone and in combination with progestin for women during menopause and after menopause from the 1890s until the book was published in 2007. She concentrates on the sixty years between 1942 and 2002. The event Watkins uses to mark 1942 as an important moment is the U.S. Food and Drug Administration (FDA) approval for the estrogen product Premarin as hormone replacement therapy (HRT) in women with menopause symptoms. The event she uses to mark 2002 is the release Women’s Health Initiative (WHI) findings that showed estrogen is not the “elixir of life” that many thought it was then.  

Watkins builds her story off the trajectory of estrogen use during this sixty-year period, which spanned two peaks followed by two crashes. The estrogens for HRT first crested in the early 1970s before its use dropped dramatically in 1975 on uterine cancer fears. Estrogen use began to rise in the early 1980s on regained confidence from combined use with progestin to reduce uterine cancer risk and from hopes that bone loss could be prevented and even reversed. This resurrection continued through the 1990s as estrogen use during and after menopause became “associated with reduced risk of colon cancer, prevention of tooth loss, lower incidence of osteoarthritis, increase in bone mass, reduced risk of Alzheimer’s disease, and lower rates of death from all causes” (p. 241). 
 

Based on surveys of prescribers and prescription data during this time, Watkins concludes that “physicians who saw menopausal women as patients were…enthusiastic prescribers of HRT” (p. 244). They remained enthusiastic, making Premarin the most prescribed pharmaceutical product through much of the 1990s and until 2002 when the WHI trial was stopped three years early because it showed that HRT failed to produce the expected benefits, and even worse.
Women who took the estrogen–progestin pills, as compared with those in the control group who took placebo pills, increased their risk of breast cancer by 26 percent (relative risk of 1.26), coronary heart disease by 29 percent (1.29), stroke by 41 percent (1.41), and pulmonary embolism (blood clot) by 213 percent (2.13). (p. 271)
The investigators advised clinicians based on these results, that HRT “should not be initiated or continued for the primary prevention of coronary heart disease” (p. 271). Watkins quotes an editorial from the Journal of the American Medical Association that went further in saying that the trial “provides an important health answer for generations of health postmenopausal women to come—do not use estrogen / progestin to prevent chronic disease” (p. 273). HRT prescriptions plummeted.  

These clinical inputs into the trajectory of estrogen are just the bare bones of estrogen history. Watkins fills in the story: 
The story of estrogen is woven from several strands: blind faith in the ability of science and technology to solve a broad range of health and social problems, social and cultural stigmatization of aging, shifting meanings and interpretations of femininity and female identity, and the pitfalls of medical hubris in the twentieth century. (p. 1)
Watkins weaves these strands into the story of estrogen, which she tells in a chronological fashion, often as the subjects of individual chapters. Some include: the implications of rising feminism; pharmaceutical company promotional activities; the roles of patient advocacy organizations; FDA requirements for patient information about prescription drugs; generational differences in views of menopause; evolving research methods and evidence standards; and cultural shifts and mainstream media influences. 

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