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.

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?

Claimed by the Warlord— a quick review

WarlordRecently, I read a science-fiction/fantasy romance by Maddie Taylor. Overall, this novel was a good read, but some reviewers gave it a thumbs down due to the “discipline” used on the heroine. And, I totally get that, as the character didn’t really do much to warrant that behavior on the part of the alpha male. On the other hand, I read (some years ago) the science fiction series by Sharon Green wherein there is one heck of a lot of love/abuse in the tumultuous relationship between the heroine and her lover. I’d call this one “Sharon Green lite” in terms of spanking. There’s not much else for the “me, too” set to object to. However, this novel does have other, somewhat graphic, scenes associated with the precarious situation that sets the action of the novel in motion. Indeed, the author’s ability to describe the effects of terror inducing situations upon Princess Aurelia is the best part of the novel.

As many stories do, this one begins in medias res, where the Princess has been captured, auctioned to the highest bidder, and awaits her fate at his hands. There is intrigue and treachery aplenty, and the plot does have some twists and turns. Although this is more romance than science fiction or fantasy, it has enough suspense to keep readers swiping the electronic pages. The author does have a way of making the cold seem colder, the hot seem hotter, and the terror seem, well…I’m sure you get the picture.

For readers who like a blend of steamy hot romance, a dash of space opera, a good sprinkling of fantasy, and some scenes that are not necessarily comfortable (but totally fictional) then Claimed by the Warlord is a good read. For readers who are made of sterner stuff, Sharon Green’s Terrilian series is now available in eBook form, as well as in  vintage paperback.

For Honor We Stand— quick review

51buujujxsl._sl250_I’ve enjoyed this series by H. Paul Honsinger, a trilogy that begins with To Honor You Call Us, as a space opera for fans of David Weber or others in that vein. Lots of authors try this sub-genre (and my Trinity on Tylos dabbles in it for a few chapters), but most such efforts don’t hold my interest. Honsinger’s universe and characters are well thought out, and therefore more entertaining than other authors.

His villains (the Krag) are truly obnoxious, and his hero, Captain Max Robichaux, has the right stuff to be a hero, but isn’t perfect, which is an unfortunate side-effect of being too heroic. Authors much achieve some balance, and Honsinger does that quite nicely. The captain’s side kick is Doctor Sahin, who is a bit like Dr. Watson’s being a sounding board for Sherlock Holmes. The situation is dire, for the enemy and the lengthy war have affected the human race in negative ways, such that surrender is unthinkable and victory an uncertain quest.

For Honor We Stand  is the middle book in the series, so I hope to read the final book soon, and I’ll try to post a more through review of the trilogy.

America by Charles Kuralt

Okay, this book is seriously vintage as it was published in 1995, but my hubby is recently retired, so he wants to do some traveling. But, when and where should we travel? A friend mentioned that a CBS news feature reporter who spent much of his career “on the road” discussed his favorite places to be in Charles Kuralt’s America, and the narrative relates his first year of retirement, where he spent time visiting them, at the best time of year to be in those spots. Despite the passage of time, the weather and scenery is no doubt much as it was in Kuralt’s retirement year, so the book is still relevant.

What’s special about this book is the magical prose that Kuralt employs to describe his series of destinations. In January, he spent time in New Orleans. As he is riding from the airport to his hotel in the French Quarter, he says, “I could have closed my eyes in the backseat of the taxi and known where I was purely by the pungent accent washing over me from up front.” I once worked with a lady from Louisiana, and the accent is unique, for sure. Kuralt further states that there are ” three main themes of the city: family, music, and food.” All three are the subject of his discourse, and apart from not actually tasting the jambalaya and crawfish étouffée, the reader feels as if he, too, had visited New Orleans. In February, Kuralt visited Key West, and again, he makes the reader feel like a participant in the trip. March’s destination was Charleston, a city that I’ve visited, but Kuralt stayed longer, met more natives, and has some interesting stories to share. In April, Kuralt ended up enjoying the emerging sign of spring, daffodils, which sounds incredibly boring, but it is not when Kuralt describes them.

In May, he is traveling again, and his destination is again in the south—Grandfather Mountain. His discussion of this scenic area of North Carolina includes everything from what makes the best barbecue to why one should make the drum of a banjo from squirrel skin. Kuralt packs more information into each chapter than I’ve read in several guide books for the area. June he spends in Ketchikan, Alaska; July in Ely, Minnesota; and August in Boothbay Harbor, Maine. Kuralt’s love of boating and fishing is apparent in all of these destinations, as it is in his September destination of Twin Bridges, Montana. For local color in October, Kuralt visits Woodstock, Vermont. As the weather in the north chills, he goes to Rio Grande Valley, New Mexico, soaking up history along with the sunshine. For December, he returns to the place where he made his home for many years, New York City. However, as Kuralt explains, people don’t live in New York; rather, they live in a neighborhood within the city. Again, he gives the reader several examples of people and places in the city, which is decorated for the holidays in his prose.

Charles Kuralt’s “On the Road” feature stories for CBS news on television were a part of my youth. His voice rings true in this rambling, but never unfocused, narrative. For those who remember him, this is a nostalgic read. For those who don’t know his work, the book could serve as an introduction to a time when people didn’t spend time on their smart phones and computers, but spent leisure time in scenic places, learning from the people who inhabit those places. I’m glad that my friend recommended this book so highly, because I certainly enjoyed savoring it.