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.

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?

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.

 

The Martian— a quick review and some commentary

The MARTIAN coverOften, I choose to read indie published books rather than those from the “big six” publishers, because I find the content of indie books to be a bit more raw, unpolished, and (sometimes) unique. Yes, I am disappointed from time to time (as in my previous post) but I keep trolling for new authors and books. However, recently, Goodreads sent out a newsletter and the science fiction book of the year was Andy Weir’s The Martian. The blurb caught my eye so I bought it, but didn’t begin immediately, as I was slogging through a book on SEO (search engine optimization) at the time. Over the weekend, I began The Martian, and I was hooked. Like from the first page, I was seriously into the story.

The plot is not a new one. An astronaut is marooned on Mars. His fellow crew members are on the way home, believing that he is dead. But, this astronaut is determined and a heck of an engineer, so he keeps finding ways to use what is at hand to survive. After a while, the NASA folks figure out he is still alive, so they are trying to figure out how to get him home. Yes, it is really suspenseful. But sometimes it is laugh out loud funny, because the main character is quite a character.

Actually, this book was so engaging that I began to question my quest for good indie books. If the big guys are publishing this kind of science fiction, then I should be looking at the best seller lists again. So, after finishing the book, I did a wee bit of research and learned that Weir’s book was originally self-published via Amazon’s Kindle Direct (yeah!) and only after it sold thousands (at 99 cents, because that’s Amazon’s minimum price) in the first three months did big publishing come calling. Now, it is the basis for a movie starring Matt Damon.

The book is cool. Weir’s evolution as a writer is seriously cool. Many of the self-published and small press published writers, including yours truly, would love to have this sort of rags to riches experience. The impediment to that is having a really great book. The Martian is such a book. So, my suggestion is read it now and try to wait for the film version. Gravity won an Oscar, so the way is paved for another near future space adventure to do well at the box office.

Coolest cover art

I’ve been looking online for information about the new versions of David Weber’s Honor Harrington novels— there’s a video game, comic books, and a forthcoming movie! While the news is interesting, the art files coming from the comic books are seriously cool. I am looking forward to all of it, especially the film version, because Honor is one of my favorite characters of all time.

But, I saw some cover art files from an artist in Europe who is absolutely nailing the image I have of Honor and her universe in my miid. Wonderful, powerful images. Check this out, HH fans!

honor_among_enemies_2_by_genkkis-d5c6lhm honor_harrington___field_of_dishonor_by_genkkis-d72fwyj honor_harrington_war_of_honor2_by_genkkis-d2mtz6ahonor_harrington_flag_in_exile_by_genkkis-d2mty9d

There are more files, as well as some interesting discussion between fans and the author over at Deviant Art.

Honestly, I am simply blown away by the talent and the skillful interpretation of the artist.