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.

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.

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?

Where do you buy your car “farkles”?

cargo trayMy oh my, WordPress didn’t like the spelling of “farkles.” That’s more of a motorcycle term, I suppose, but it basically means shiny stuff that might actually do something to help the vehicle. My rather limited research indicates that this is a portmanteau word, based on sparkle and function. When hubby gets a new ride, he often wants to invest in some farkles.

Having bought (perhaps I should say perpetrated, based on its performance thus far) a new-to-us ride, I shopped online for some accessories. I began on eBay, but ended up purchasing via a site that insists I remove all links to its site. Anyway,  I wanted genuine Toyota items, and our local dealership isn’t known for giving big discounts on much of anything. Via a relentless online vendor, I got some All Weather Floor Liners (deeper and more sturdy than floor mats) and a Genuine Toyota Cargo Tray, which is also deeper than a mat, if not quite as heavy. While not exactly “shiny” these items are handsome and quite functional.

The car looks a bit better with these accessories. Now, if I could just buy a cushier ride….

Thoughts on Car Buying

2000My sometimes hated (but mostly beloved) minivan is no longer in my possession. After a few days of car shopping, I traded it in for a used Toyota. The van, a Honda Odyssey, was sixteen years old, so I suppose it was time. Still, it ran beautifully on the way to the dealership, so that drive was bittersweet. On the way, I passed by a yard sale, offering bikes and other things I might have purchased, because having things to do at Grandma’s house is where I am in life, but I didn’t stop, knowing that those items would probably not fit in the trunk of the sedan I was planning to purchase.

Buying a car has changed since I bought my first vehicle, that’s for sure. Now, the first contact is often online. Whether one picks the “chat” function or sends an email, there will soon be a contact. The phone starts ringing. Go in for a test drive, and (in Athens, Georgia) there is a mandatory meeting with the “sales manager.” Then, a couple of times, I got an email to see if the salesman met my expectations.

After I finally said I might be interested in a used Honda, I got an offer of $500 for my old van. As it has been more truck than family vehicle for a while, with the typical bumps and scrapes associated with that duty, I wasn’t expecting much. But, that deal had me paying more than the maximum KBB value on the seller’s car, with half the typical auction estimate on mine. Really, that wasn’t what I wanted to hear.

Eventually, I ended up at a more rural dealership which didn’t use the “meet the manager” approach. I got $900 for my old van, which was still a very low number, and a newer car for less money. Oh, and I got to keep the new to me car overnight and take it for an inspection prior to purchase. The dealer even gassed it up for us before the extended test drive.

After I’ve had this vehicle for a while, I guess I will know if it was a good purchase. But, I can say that the pressure to buy was less out in the country. In the mean time, I guess I’ll be looking for some accessories for the “new to me” ride.

Solo— a Star Wars Story

Solo posterOur son is a big time Star Wars fan, and he initially said he planned to skip this movie. Based on the box office stats, apparently a lot of folks felt the same way. However, a friend apparently convinced him to go see it, and he came back raving about how much better it is than Star Wars Episode VIII. Last evening, hubby and I went with him to our very small local theatre to see Solo- A Star Wars Story before it closes up and leaves for cable and the Red Box.

I did like it rather a lot. The cast is really great, from a decent likeness of the main character by Alden Ehrenreich to a fabulous supporting cast with veteran actors including Woody Harrelson and Paul Bettany, as well as modern favorites such as West World star Thandie Newton and Game of Thrones star Emilia Clarke. The look and feel of the film, although a bit dark, is up to Disney and Star Wars standards, too. While I thought there was too much action (if such a thing is possible in a summertime blockbuster film) all of it was top notch.

For real fans of the series, there are some pluses and minuses of course. The film does a good job of filling in the small and big pieces of the original trilogy, especially those that occurred in the original film, Star Wars: A New Hope. Example: Han Solo proudly tells Obi Wan Kenobi that the Millennium Falcon made the Kessell run in 12 parsecs. How? When? And why was that important? Solo fills in all those blanks. How did Han and Chewy meet? Again, this film supplies some answers. Overall, the script writers (father and son Kasdan and Kasdan) performed a minor miracle in getting so much into two action packed hours.

Although I’ve read that it was a marketing problem, or a saturation problem—no one knows for sure why Star Wars fans have not embraced Solo. That’s too bad, because it is in many ways very similar to the much better received Rogue One: A Star Wars Story— it fills in blanks in the original film, gives us new characters to love and hate, and is a visual spectacle with a very good musical score.

Beat the summer heat and go see Solo—A Star Wars Story soon. Very soon, because it will be moving to video in a few short weeks.

Some Science Behind My Science Fiction

Having just read an article in Popular Science online about what a”Generation Ship” might look like, I was gratified to see that some of the core concepts in my science fiction novel, Trinity on Tylos, are firmly rooted in science.

The article speculates about what challenges the multi-generation inhabitants of a colonizing venture (based on an extrapolation of current space technology) might face. Topics addressed include propulsion, medical issues, livestock, and robot workers.

In Trinity on Tylos, the alien captain of the Archeonite III has a big problem: his colony of survivors died out, but he has the ability to grow little Archeons from stored genetic material. He just needs some baby mamas, and my characters Venice Dylenski and Alathea Duke end up with the task. In the Popular Science article, We Could Move to Another Planet with a Spaceship Like This, the author mentions that “speculators say it’ll take 20,000 souls to start a healthy population on a new world. One space-­saving tip: Bring frozen embryos and people to diversify the gene pool upon arrival.” That’s right out of my novel, where Azareel and his android medical team design the embryos that Venice and Alathea gestate.

As in the Popular Science article, robots are probably going to be the grunt workers of the future. In my novel, the Archeons use robots (as they take the form of their makers, I call them androids) as workers. A limited but technologically proficient population would no doubt employ robotic workers, freeing the populace to supervise or take on  tasks that require a more creative mind.

Trinity on Tylos is a complex story, because it goes beyond being just a space opera and delves into human relationships, made more complicated by the limited number of people with whom the characters interact. Also, it is a story of surviving on a somewhat hostile planet, solving such issues as having enough water to irrigate crops. The Popular Science article mentions farming as one of the most necessary activities once the generation ship reaches a new planetary home. Indeed, when I wrote Trinity on Tylos, I remembered the words of William Bradford, a leader of the pilgrims who settled Massachusetts, who wrote “what could they see but a hideous and desolate wilderness, fall [sic] of wild beasts and wild men—and what multitudes there might be of them they knew not.” Survival is not easy, and the Popular Science article, although very positive in outlook, does not ignore the difficulties that might face the future generations of humans whose journey began with some adventuresome ancestors.

Technological progress and science fiction often go hand in hand, because what writers dream up, engineers can (sometimes) make happen. However, the reverse is also true— when creating a science fiction story, there must be some science blended in with the fiction. Trinity on Tylos is science based fiction, and it is available for your Kindle reader or Kindle enabled device; just click on the cover art.

 

What’s it about? A non-review of La La Land.

La La LandThe other evening, I told hubby that I wanted to see La La Land on HBO Go. Like many men, he is a direct, compartmental thinker, and he wanted a succinct description, like a phrase. Complex sentences and paragraphs are too much after a hard day at the office, so I said, “It’s a musical.” And he said, “What kind?” Based on the tone as well as the question, I was getting the drift that he didn’t want to try this one, so I said something like, “We’ll talk about it later.”

Today, weary of grading essays, I turned our sorta smart TV to HBOGo and found La La Land. Before the end of the opening number, a sort of modern fantasy about singing and dancing in traffic, I was already glad that I decided to forgo explaining the film to my husband. He is just not gonna go for this sort of film.

That’s not to say it is bad, for it certainly isn’t. But, this clever film is not going to be pigeon holed into a category, although HBO places it under “romance.” The film pays homage to Hollywood in particular and the entertainment industry more generally, and the characters certainly are passionate about their craft, but they struggle to pave a path to personal success. Work gets in the way of their relationship, but there are some seriously romantic scenes in this film. Ryan Gosling and Emma Stone have both moved up a few notches in my estimation, based solely on the way they conveyed emotion through song and dance and just looking at the camera.

As I was searching for an answer to “What sort of movie (or musical) is it?” I read several reviews. The one at RogerEbert.com comes the closest to explaining it, and I don’t want to spoil it or plagiarize, so I will merely provide the link. However, should hubby ask again, which I rather doubt, I have my answer: “It’s a different sort of musical.” Yep, it isn’t peculiar, nor avant gardé, nor off-beat. It is just different.