Overdignosed— a brief review and commentary

OverdiagLike many people in the USA, I am concerned about the state of our health care. Don’t get me wrong, I’m grateful to live in a country that has lots of great medical facilities and practitioners. But, I’ve watched people go through some pretty difficult situations, too, so I read Over-diagnosed: Making People Sick in the Pursuit of Healthcare in hopes that I’d learn more about what sometimes goes wrong with our healthcare system. This book offers some first hand insights from three physician authors, and I learned a great deal from it.

Many of the chapters have a “case study” to frame the discussion. One of the most memorable is the story of an older gentleman with a borderline diagnosis of diabetes. In the interest of keeping those blood sugar numbers in the optimal range, the principal author (Dr. H. Gilbert Welch) prescribed medication. Unfortunately, the gentleman’s blood sugar dropped, causing him to lose control of his car, resulting in an accident that broke his neck. The gentleman survived, but he had to wear a halo brace for many weeks while his neck healed. When it was all over, the doctor and patient agreed that the best practice in his case would be to forgo the diabetes medication. This anecdote is a great way to illustrate how over diagnosis can make people sick!

Each chapter explains how modern testing, coupled with ever changing standards for “normal,” have resulted in more and more people being diagnosed with something. The approach is cautionary, explaining that many times a diagnosis might be correct, but if the condition is unlikely to cause the patient any reduction in quality of life, or end the patient’s life early, then it is far better to not treat the disease. However, once diagnosed, both the patient and most physicians will be reluctant to “watchfully wait.” Indeed, the principal author states in the introduction that he does not have routine checkups, even though he works in healthcare and could easily do so. Instead, he waits for something to go wrong. As the old saying goes, “If it ain’t broke, don’t fix it.”

The mammogram is probably the first test that my doctor wants me to have done, but our author states that for most women, they do more harm (due to radiation) than good. Aggressive cancers can develop in the one to two year interval between tests, but slow growing cancers can result in over-reaction by doctors and patients. Also, many women go through the “false positive” situation, which might mean more testing, including a breast biopsy. I’ve known several women who had that done, only to find out that the mammogram was incorrect (or incorrectly interpreted.)

Another interesting story is a conversation between the author and a pharmaceutical rep. The latter was touting the benefits of a drug for women with bone density issues. After a friendly discussion, the drug company rep admitted that the greatest risk for these women is mostly hip fractures, which can lead to all sorts of problems, including premature death. The author states that helping women prevent falls, though physical therapy and other practical measures, would be much more useful. And the testing phase of the drug was eventually discontinued due to subjects developing bone cancer.

The author is firm in his stance that patients are often over-tested and over-diagnosed. He believes that many doctors do this out of an interest in finding answers for their patients, and not merely in making more money. He is also firm that the threat of a law suit can be a driver for hyper testing and the end result of over-diagnosis. I’m all for people having the right to seek redress in the case of gross malpractice, but doctors who have been the defendant in a case, win or lose, will often err on the side of caution and order tests that probably aren’t needed and will refer cases that are only marginal. The costs of this mind set are not negligible, as tests can costs hundreds or even thousands, and that doesn’t include the costs of treating a condition that might not need any treatment. Nor does it address the mental stress of having a chronic “condition.”

Common sense is sorely lacking these days. Certainly many aspects of modern America are getting totally weird, so I guess it is not unusual that medicine is affected. I am grateful to Dr. Welch and his fellow authors for this very cogent discussion of the problem of over diagnosis. I am seriously contemplating what to say at my next doctor visit, when I will face that computerized list of items that modern medicine says I need, but just might result in me joining the long list of those who are “over-diagnosed.”

Born with Teeth—A Memoir; review and commentary

Born Mulgrew

Kate Mulgrew’s Memoir

My guess is the first I heard of Kate Mulgrew was when she starred in Mrs. Columbo, but that’s not a certainty. Like many fans of all things Star Trek, I was both thrilled and a bit concerned when Mulgrew was very publicly named the newest captain in the fourth iteration of that television franchise, Star Trek Voyager. And, I was rather amazed to by her character in Orange is the New Black, in a role that is far from her roots as a distinctive and attractive leading lady.

Regardless of when one first noticed Kate Mulgrew, she is a force on the screen. Recently, I read her memoir, which has the curious title Born with Teeth. Apparently, she was indeed born with teeth, which were extracted so she could feed properly. For Mulgrew’s fans , there may not be all that much new information, but the style of her prose does illuminate readers on her perspective in regards to matters that matter most. The narrative is mostly linear, although she skips a lot of years and events. First, the reader learns just how dedicated she is to her craft and how much work it has been. Second, readers will become better acquainted with Kate’s large family, and see how they have influenced her. One of my favorite passages is when, as a schoolgirl, Kate invited her artist mother to hear her recitation of poems she had written. Upon learning about the program, Kate’s mom, Joan, gives her a copy of a poem (The White Cliffs of Dover) to read, and during the school program young Kate not only read her poems, but she read the classic poem so well that her audience was almost in tears. Afterward, Kate’s mom told her that she could either be a bad poet or a great actress. Apparently, Kate took those words to heart, because from that early age, she put all of her effort into becoming an actress.

Fans of Ryan’s Hope (a soap opera that was Kate’s first big break in television) or Star Trek Voyager (perhaps her most influential role) will find a few gems, but she doesn’t concentrate on those stints. Instead, what Mulgrew writes about is relationships. While filming Ryan’s Hope, Kate became pregnant, and as she was not married and quite young, she assumed she’s have to leave her job. Instead, the pregnancy was written into the show, and her character gave birth a few days after Kate did it in real life. The Mary Ryan character kept her baby, but Kate gave up her daughter for adoption. Later, she expends both time and money in an attempt to find her biological daughter, and that search is a focal point of the memoir.

Certainly, Mulgrew has experienced quite a lot of grief, as one of her sister’s died of a brain tumor and another succumbed to pneumonia. Romance has not always been easy, either. Mulgrew also writes of her loves—her first husband, Robert Egan, and the sons that he fathered, and how divorce affected her and the boys. Later, she reveals how her love for her second husband, Tim Hagan, endured a rather on again then off again period. The memoir ends as she meets her daughter and her relationship with Hagan finally settles into marriage.

I’m a science fiction fan (and writer) so I was just a tad disappointed in this memoir. I’d love it if Kate would do as Shatner has done and publish a book about her time portraying Captain Janeway. Perhaps she will, when she has more time, for she does seem to be one busy lady.

Trinity is Free for Three (days)

Beginning at midnight on July 14, the giant-sized internet seller of books and other sundries will be offering the eBook version of my science fiction novel, Trinity on Tylos, for free! I’ve seldom used this option, but as their Prime Day promotions will be going on, I thought I might get a few people to download it. If I’m really lucky, I might get another positive review, too. Anyway, here’s the book cover; just click for a link to the sale.

ToT_cover_final_webLG

Here’s an excerpt of my favorite review of the novel:

TRINITY ON TYLOS… is instead a thought-provoking book that will challenge one’s beliefs about the importance of motherhood, duty, and sacrifice. At times, the choices made by Venice and even Allie are ones the reader will disagree with and perhaps even be angered by them. However, one of the trademarks of a well-written novel is its ability to inspire others to debate. TRINITY ON TYLOS accomplishes this and so much more. Pamela J. Dodd has truly demonstrated her gift as a writer with this stunning book.” —

The Princess Diarist by Carrie Fisher— brief review and commentary

DiaristI’ve met a few people who have never seen Star Wars or any of its prequels and sequels. Weird, huh? For me, when it premiered in 1977, it was the best science fiction film I’d ever seen, and to this day, it ranks among my favorites. The characters leapt off the screen and into the pop culture of the United States. Even those unfortunate folk who mistakenly believe the film has nothing for them are probably familiar with some of its tag lines, such as, “May the Force be with you.” Literary critics sometimes opine that writers can tap into themes that go far beyond what they, as writers, envisioned, and I do believe that George Lucas managed that with Star Wars. Much has been published about his source material, from Saturday morning serials to Joseph Campbell’s Hero with a Thousand Faces. Yes, the film has some flaws, but it gets a lot of things right, including setting, plot, and especially character. Casting a young Harrison Ford as the scoundrel Han Solo was a great choice, as was Sir Alec Guinness as Obi-wan Kenobi, and Mark Hamill certainly looks the part of a young man on a heroic quest. Perhaps the most controversial choice would be casting the very young Carrie Fisher as a princess, but who else could have blended innocence, sass, and strength the way Fisher did?

For some forty years, Fisher was both herself and Princess Leia. Video of interviews and even stage performances document how much the role influenced her career and her life. But, Fisher was also an able writer; indeed, she wrote multiple books and was often called upon to assist screen writers as a “script doctor.” Her last book, published shortly after her death, is a witty and poignant recollection of the filming of Star Wars, a three month interval that she documented via journaling.

The Princess Diarest includes both journal entries and some poetry, mostly about Fisher’s affair with co-star Harrison Ford. The framework, that is her introduction and conclusion, are far more interesting to me, as they benefit from the wisdom and perspective of those forty years after the filming of Star Wars. While the diary entries can be interesting, mostly they reflect the infatuation of youth. The framework, however, was fascinating, just like the author.

Some people never saw her performance in Star Wars, but it’s likely that they heard her voice, as she did quite a bit of voice work, or saw her in other roles. The world lost an icon when Fisher died in 2017. Her talents were many, but some roles can’t be left behind, and Princess Leia Organa was such a role.

A romance from the grave

Texas FreeRecently, I updated my credentials to virtually check out books from my local library. Free is a good price, right? Unfortunately, apparently, there is little demand for science fiction at my library, so I looked at titles in the romance genre.

When I first read romance novels, I had a list of authors who were my “go to” writers. One of them was Janet Dailey. Generally, she did a good job of integrating setting, plot, and character, and that’s no easy task, because romance writers are under a lot of pressure to produce, produce, produce. Romance readers seem to be perpetually thirsty for new novels, and I saw a new series by Janet Dailey, so I checked out Texas Free,  copyright 2018.

The opening states that the events happened in 1985, which would have been at Dailey’s peak, in terms of both popularity and proliferation. The story is actually a good one, if a bit formulaic. Rose Landro returns to her childhood home in Texas, on the run from a Mexican drug cartel. Unsure of her welcome, but desperate, she stakes her claim on land that should have been hers, as it belonged to her grandfather who had intended to deed it to her before his untimely demise. As the land is an access point to water for cattle, her stake is controversial, and the reader follows the twists and turns of the plot, wondering if Rose will succeed in establishing a homestead, and if any of her neighbors will assist her in her quest.

Janet Dailey has penned a great many books, but the copyright page indicates that this one belongs to a “Revocable Trust” created by some folks who share the same last name. So, is this “Tylers of Texas” series a repackaged group of novels from earlier, or are her heirs using a ghost writer? I suspect the latter, as Janet Dailey died in 2013.

Ghost writing has been around a long time, and there are sometimes very good reasons for using the process. Celebrities who are good at something else often write books, but the more honest ones have a “with so and so” under the author line. Both Tom Clancy’s and Robert Ludlum’s publishing careers have gone on without the author as other, named writers, do the work, but these ghost writers are a least named in the fine print. As I have the eBook version of Texas Free checked out, I might not be seeing it, but if there is an acknowledged ghost writer I didn’t find it. On the other hand, authors I know have reprinted their books with new titles to “up date” them. I kinda think that is cheating a bit, but reputable writers do it.

As I have a back list title that I republished as an eBook (Trinity on Tylos) I am not complaining about republishing, but unless there is a dusty old manuscript, or computer file somewhere, a back list title should be just that. A novel written by someone other than the named author breaks the contract between a publisher and the reader. If I see an author’s name, I expect that the author wrote the book, and I doubt that I am alone in that expectation.

The entire Tylers of Texas series has publication dates after 2013. FYI.

The Apocalypse Troll by David Weber

TrollI’ve been re-reading some titles that I have in my “Nook” library, as I am unsure of what will happen with that since Barnes and Noble has sold out. One of my all time favorite science fiction authors is David Weber, who is best known for his series writing, especially the books about Honor Harrington. However, early in his career he wrote a few stand alone books, including The Apocalypse Troll. It’s a thrilling story, well told, and very much showcases Weber’s knowledge of military tactics and the geography of North Carolina.

As the story opens, Colonel Ludmilla Leonova is assigned the task of attacking an instrument of the dreaded “Kangas” a Troll, slang for a human brain in a mechanized body. This brain, conditioned to fight and kill humans, is not quite indestructible, but very close. Leonova is both brave and determined, however. She’ll seek and destroy this enemy of humanity, through space and time itself.

Thus, Leonova ends up on earth in the year 2007, and as this book was released in 1999, a near future story when it was written. After her fighter crashes, she is rescued by Captain Dick Ashton, who is incredulous, but convinced by her steady demeanor and the advanced tech of her space suit and weapon that she had indeed traveled back in time in pursuit of a malevolent enemy. This sounds as if it very much strains the concept of suspended disbelief, but the captain also convinces the upper echaleons of United States military and the President himself that Leonova is who she says she is, and that the Troll is somewhere on the planet, ready to wreak havoc on humanity. Weber does this quite skillfully, introducing a panoply of characters, one of his trademarks.

All sorts of military hardware and personnel are put into play as the Troll uses a less than honorable religious leader to whip susceptible citizens of the southeastern U.S. into angry mobs, and western North Carolina becomes the battleground.

Weber’s story is a good one, and the reader isn’t left with that sense of “what next?” that accompanies series books. For fans of David Weber, this story is a treat, and for readers who haven’t yet read any of his military fiction, it is a good introduction. The book is still available used and an an eBook from the publisher, as well as other sources.

Book selling for negative profit?

I’ve sold books online via Amazon (and I’ve listed on eBay also) for several years. Unless I got very, very lucky, I seldom made much money on those books. However, recently, I’ve seen negative profits. That’s right— the fees and postage are so high that Amazon is getting all the profit.

See this screen shot:

Amazon fees

Basically, the math isn’t in the seller’s favor here. For a $2.00 book sale, Amazon charged me $3.69 in fees, and for a $2.50 book sale, Amazon charged me $3.76. Even with the actual shipping cost being slightly less than the customer paid, I lost money, as I had to provide shipping materials and get the item to a post office. The only reason I got paid at all was the $6.56 book had a fee of $4.37. Sadly, since my state (Georgia) insists that Amazon collect sales tax on these used book sales, the buyer is not getting good value either. That book cost the buyer nearly $7, which is not a good deal for a used pamphlet.

Clearly, Amazon is not the best solution for book selling any more, so I removed all listings wherein the “fee” was as much or more than the book. Those will either be listed on eBay, or donated.

While I really love putting books into the hands of readers who will enjoy them, there is no sense in losing money to this relentless corporation.

iBooks and eBay—a winning combo

liver-rescue-apples

Apples and Apple, Inc.

As a reader of eBooks, I’ve been exploring new ways (and revisiting old ones) to view content. Recently, I saw a title touted on Facebook, and a quick look at eBay revealed several purchase options, including an eBook which was offered as a pdf file. I paid a golly whopping .99, and it arrived via email. Not quite as quick as Big A, but the seller offered pretty quick service. I tried reading the file via my email app, but that didn’t save my place, so I downloaded the file to iBooks. Winner, winner, but no chicken dinner. However, the iBooks app is a very good way to read a pdf file, and the app is easy to use, just like other, more well known ways to view eBook content. Certainly, the price was right, too.

When Big A (the relentless internet seller) decided to give me the old “heave, ho” I was a bit concerned about when and where I’d get new books to read, as I am not buying from them at the moment, but that fear has been allayed by the eBay and iBooks combination. The title I purchased is “Liver Rescue” which I won’t review, as I sincerely hope my readers don’t need it, but I’ll let you know that one way to help the liver is to eat lots of apples. Actually, I am very pleased to get a 500+ text for a buck, and the advice to eat a fruit I really like is welcome, also. Thanks eBay! And thanks to Apple, for making such an intuitive app for the iPad. Reading about apples on an Apple product is quite appropriate, isn’t it?

Nook—a second look at the eBook app

NOOK-feature-300

Nook is an app and a device!

Since big A decided to fire me as one of their “Associates” I have set aside my K—  library for the moment, and am re-reading some older titles via the Nook app on my iPad. For readers who aren’t familiar with this, it is basically the eBook platform used by Barnes and Noble. While I have not purchased many books via B & N, I was once a very loyal customer at Fictionwise. When B & N bought out Fictionwise in 2009, I was able to keep some, alas not all, of the content I had purchased, by adding the Nook app, so those books became part of my Nook library. And, as there are quite a few titles there, I am looking through the library, seeing if anything is worth a second read. One of the best aspects of eBooks is that the “keeper shelf” takes up no room in my house!

The Nook app works like other eBook apps; the raw file format is ePub. In their review of eBook apps, CNET judged it as #3, and it is quite good. I find the animation associated with page changes very pleasing; it looks just like flipping a physical page! I also like having basic info at the top of the screen (date, time, % of battery are all available) as well as the typical (in print format) of two facing pages, with the title on one side and the author name on the other. Apart from a page number, which is not possible as the file must adapt to the reader’s screen size, the interface is very book-like, and I mean that as a compliment. As an app, it is a bit quirky, however. For instance, getting back to the library can be a bit of a chore, as one must first get a more info screen, and then the option to move around a bit becomes available.

There is a library screen, a bookstore screen, a quick link back to the current book being read, and something called “Readouts” which is a bit of sales pitch mixed with freebies and information. The library screen shows “Recent Reads” and “Recent Purchases” as defaults, and there are tabs with “All titles” and “Shelves” which are, of course, organizing tools. Unfortunately for me, the only way I can find some of the oldies is via the “search” feature, but it works quite well. For instance, I didn’t finish my last name before both of my titles popped right up!

I use my iPad (mostly) for reading, so I’m using the free app, but Barnes and Noble is currently offering a 7 inch screen Nook for about $50, and a big screen (10 inch) for $130. When eBooks were new to the market, most were priced substantially lower than their print counterparts, and sometimes that is still true. Lots of classics are free, of course, but lower priced options can be, well, garbage. Overall, the prices at B & N are a bit higher than their ginormous internet competitor, but the store’s interface is elegant. Also, the content is a bit more “curated” than the content over at Big A, where just about anyone can sell anything, regardless of quality.

Since I’ve been reading via the Nook app, I have begun researching the possibility of pulling Trinity on Tylos out of the K— exclusive program and publishing it via ePub to other bookstores. Perhaps Barnes and Noble readers would buy a few digital copies. Stay tuned….