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.”

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.” —

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.

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….

Earth Day

planetI have mixed emotions about this day, but I do like some of the promotions associated with it. There is a nifty kids’ consignment store over in Buford that is having a big sale today, urging their customers to buy used. For kids, that’s generally a win-win, as children’s clothing is often not worn out before it is out-grown, and as kids are hard on their clothes, cheaper options are better for play clothes. I noticed some emails from an online clothing vendor, which is offering sale prices and promotional buttons which say “used.” I’m not going so far as to wear one of those, regardless of how good buying and wearing pre-owned items is for the planet.

One of my friends works with elderly folk, doing both house-keeping and care-giving, and she recently brought me some bags of fairly nice clothing from a client who is downsizing. I’ve been going through those, listing some items on eBay, and setting aside some for charity. She was told to “get rid of them” by the client, so my friend had the choice of trash or wholesale charity, but she is a thrifty sort, as I am, so she went through them first. Some readers are going to say, “Yuck, I can’t imagine being that poor.” But, the truth is that neither of us is especially impoverished, but we do realize that the planet is better off when things are re-purposed or re-used.

In my kitchen, I have a compost bin, and I take it out regularly, adding to my compost pile in the back of my property. When I set out plants, I use the composted material for fertilizer, instead of using chemicals that aren’t good for me or the planet. When I’m away from home, I generally take a water bottle, rather than buying those. I use rags and towels when cleaning, rather than always using paper towels (which I can’t get hubby to do.) And, I’ve learned that Dawn+vinegar+water trumps most pricey cleaning products.

As a reader, I enjoy new and old books and magazines. These days, most of the content I read is in digital form, which sometimes saves significant amounts of cash, but it also prevents the waste associated with old or remaindered books. If you haven’t tried eBooks, this is a great time to take the plunge, as there is plenty of free and inexpensive content. Try the “Nook” app from Barnes and Noble, as it works quite well.

Earth Day is a chance to think or re-think consumption.

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.