This Is Going to Hurt: Secret Diaries of a Young Doctor

This Is Going to Hurt: Secret Diaries of a Young Doctor by Adam Kay

The author worked as an ob/gyn in the British National Health Service. He had plenty of experiences as a young doctor. Detailed birth plans were often thrown out the window when the fetus had other ideas. Hours could be very long, with limited sleep or any time outside of work. Standards and work regulation could seem very arbitrary. Bodily fluids could be all over the place, with risk of HIV possible. Even the British medical system is far from perfect.

The First Shots: The Epic Rivalries and Heroic Science Behind the Race to the Coronavirus Vaccine

The First Shots: The Epic Rivalries and Heroic Science Behind the Race to the Coronavirus Vaccine by Brendan Borrell

The government helped enable a rapid deployment of a COVID-19 vaccine primarily by getting out of the way. The government showed that it was not prepared to handle a large-scale pandemic. In some cases, the were learning in real time. In other cases, the actions were just plain stupid. They were both too aggressive and too slow to respond. Quarantining people on a cruise ship was a great way to increase spread of the disease. Willy-nilly quarantines did little to slow things down. Knowledge of the outbreak in China was kept under wraps before it "escaped". Previous research into other coronavirus vaccines enabled rapid development of vaccines. However, they refused to allow them to be used under a compassionate use exemption until after trials completed. The government was too concerned with control and perfection. This slowed the rollout of tests and new treatments. If people have a 30% of dying, does it make sense to hold out for something that is only 2% more effective? Then there were state governors with their own policies. Cuomo in New York seemed to be great at helping to maximize the negative impact of the virus. He would force the infected to commingle with the vulnerable and later prefer vaccines to be thrown out rather than be used by people not on the list yet.

The bulk of the book describes government response and Operation WarpSpeed. The rapid production of the vaccine was enabled by the Trump administration. What would have happened with another president at top? Did Trump slow things down? Or did his zaniness help speed up the vaccine release? The "process" seemed to be the biggest slowdown. There was a mix of competition and collaboration that helped bring about the release. Moderna was primarily going within the system. Pfizer tried to do things more on its own. There was also Johnson and Johnson as well as a few others that never quite made it. Are we prepared for the next pandemic?

Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection

Everything Is Tuberculosis: The History and Persistence of Our Deadliest Infection by John Green

You can look at many world events through the lense of Tuberculosis. World War I may have been started due to TB. (The assassins of "ugly hat" guy were dying of TB and had nothing to lose.) Creativity was seen as something influenced by TB. 

Today tuberculosis is curable. However, most of the victims are in the poorer, less developed world, while the cures are readily available in the developed world. The book focuses on the plight of a boy with multi-drug resistant tuberculosis. He went through various failed treatments, before finally getting the special treatment needed to save his life. (The drugs were initially cost prohibitive and restricted.) It does seem like a simple solution would be to make the drugs and diagnosis tools cheaper and more readily available. However, there are challenges. There are already many strains of TB that are resistant to the most common treatments. What if they do become resistant to other drugs? TB treatment requires taking the drugs for a significant length of time. Would doling out more the drugs lead to more resistance? There is also the problem of finding new cures. Pharmaceutical companies have been doing little research into TB drugs because it is primarily a low-income problem with little potential revenue stream. The common TB tools and drugs are criticized for being too expensive. This brings a double-edge problem. Why spend the effort without the return. Since government's fund the research, shouldn't these drugs be nearly free? Alas, even with government research funding, there is still significant effort to produce and ship the drugs. What would be the best way to wipe out the disease?

The author is a novelist who came into tuberculosis through some personal encounters. The book is a personal rather than scientific view of the disease, though it does provide some basic scientific background.

Grow and Hide: The History of America's Health Care State

Grow and Hide: The History of America's Health Care State by Colleen M. Grogan

The United States spends huge amounts on health care, but only achieves middling health outcomes. Despite heavy dependence on private companies, American government spends more on the health system than many countries that have fully funded government health systems. This book details the history of public healthcare and the way that the system has been steadily grown, while the true government involvement has been hidden.

At the outset, public health improvements were tied closely to sanitation improvements. Garbage collection and sewage handling were key areas of public health. Alas, this was al done in city governments, which were beholden to patronage systems. Doctors did not want to be beholden to random patronage employees, so worked to separate out public health from areas like trash collection. There was also a difference between "public health" and "individual health". This was deemed important and would lead to much of the "hiding" of true government health expenditures.

The health care system has continued with this grow and hide since. The healthcare industry is eager to take government funding when offered. The industry will even work to write regulations to their benefit. Then they will complain about state interference when it gets in the way. Both Democrats and Republicans are guilty of expansion of this super expensive highly-regulated healthcare system. the current "privately funded" healthcare system has become a means where the maximum number of private entities can extract government money. Investors, such as private equity have realized this and swept in to get their share of the healthcare bonanza. All in all, ths US likely spends more public money on healthcare, yet also requires citizens to spend a huge amount of private money to top it off. With so many feeding at the trough, reform has become difficult, and attempts often lead to more benefits for the entrenched interests. (See Obamacare). The book does a great job of identifying the problem and its history, which alas, has few easy solutions.

The Deep Places: A Memoir of Illness and Discovery

The Deep Places: A Memoir of Illness and Discovery by Ross Douthat

The author started to feel some weird medical symptoms. He went to various doctors to diagnose. They couldn't find the cause. He even tested for Lyme disease and came up negative. Many suggested he see a mental health doctor. Eventually he did get diagnosed for Lyme disease. He went through various treatments and saw varying degrees of success. Meanwhile, the family had moved to their "dream" house in the country and later had to sell it to move closer to doctors. The book ends with Covid outbreak. He was prepared. Lyme often has doctors being more cautious with patients requesting more cutting edge or drug-based treatments. There is also some speculation it could have been part of government experiment gone wild.  It is an interesting book that explores personal impact of a disease as well as how it changes world views.

Super Agers

Super Agers by Eric Topol

Today, many people are living longer, but are they thriving in these years? This book looks at how we can extend our lives while also living in a way that we can enjoy life. Not surprisingly some of the best treatments are simple - exercise, healthy heating and social activities. The author goes through various conditions and always seems to come back to those same basics. There are also various drug treatments discussed. Many are quite costly. Some seem like great cures. However, there are often consequences in other areas. A lot of coverage is given to obesity and possible drug treatments there. Analyzing genes and finding appropriate ways to customize treatments and use genetic techniques are also helpful. The author is very positive towards AI. We can utilize AI and other knowledge to provide more customized treatments and screening. There are many screening techniques that do not have solid evidence behind them. There are also some that would greatly benefit to appropriate tailoring to the individual. There are many people that live comfortably in their 90s. We can likely increase that further. However, there are also concerns about equity. The rich have access to more drugs and healthy lifestyles. What about the poor?

Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again

Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again by Eric Topol

Health care is in a bad state now. There are huge numbers of people working in the field, yet doctors only spend a few minutes with their patients. They spend time working with (proprietary) medical record systems. They are encouraged to maximize the value units that they produce. There is an emphasis on treating conditions without a focus on the overall quality of life. Doctors are also people and more likely to see what they know or have seen recently.

How can technology help? Currently, technology has allowed for all sorts of fancy testing, images and procedures. But these may be done excessively. AI can help with some of the more tedious parts of health care. AI is getting good at transcribing conversations and can enter medical records. AI can also provide various bots for interacting with patients. (People are even more willing to share details with AI than with real people.) AIs can also take over much of the "grunt" work in radiology. AI can identify many of the suspected issues. Radiologists would then focus on the more unique aspects. They would also have more time to speak with others. AI can also help in scrubbing medical records to help provide more accurate diagnosis. 

In the ideal world, AI will come to take over much of the routine aspects of healthcare, leaving doctors to focus on the personal interactions. Will this come to fruition? Or will AI bots just come in as a substitute way for the health industrial complex to make more money?  Can the system really pivot to focus on overall health and quality of life? 

Pox Romana: The Plague That Shook the Roman World

Pox Romana: The Plague That Shook the Roman World by Colin Elliott

A plague broke through the Roman world and killed a large portion of the population. It helped amplify some of the problems that were occuring in the empire. In some cases, the responses were worse than the problems. Price controls seem like a good solution until they cause a shortage. A form of religious piety also arose as an attempt to appease the gods. Alas, this also involved attacks on those that were "different" (like Christians). The Christian ended up doing better despite the persecution. They cared for the sick. This helped them gain immunity and thus greater numbers survived.

We are unsure what the plague was that hit Rome. Perhaps it was small pox, or perhaps it was something else. There seemed to also be a plague in China around the same time, so it could have been global. There seemed to be a significant reduction in human activity during this time. Records in the Greenland ice confirm some of this changes. The epidemic was likely spread via soldiers and trade. The city got hit harder, likely due to people living in close quarters without immunity. Modern medicine can also trace some of its roots to the Roman plague.

The book is very cautious in the analysis. There are many possibilities. We are not sure what happened, but it can be fun to analyze.

Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle

Breakthrough: Elizabeth Hughes, the Discovery of Insulin, and the Making of a Medical Miracle by Thea Cooper and Arthur Ainsberg

In the 1920s, the best treatment for diabetes was a starvation diet. This would allow somebody to live a few more months of life, but with a significantly degraded quality of life. The hope was that this would allow them to live long enough for a potential "cure" that would just be around the corner.

In Canada, Frederick Banting was a maverick doctor who talked his way into a research position in Toronto. He was convinced that he could help isolate a substance from pancreatic tissue that could treat diabetes. With Charles Best and James Collip they extracted what was to be named insulin and injected into to dogs that were forced to be diabetic. They had success in reducing the diabetic symptoms. John MacLeod was the "adult supervision" that helped give their research credibility and run the clinical trials. Eli Lilly in Indianapolis was also interested in the work and led their work to help mass produce insulin. They were one of the first drug companies to have a research arm. They were able to have more success producing large quantities of insulin than the Toronto labs. This was one of the earlier cases of patent and technology transfer by educational institutions and the start of "big pharma".

Banting was quite a character, and seemed to have issues with many people. His story was intertwined with the story of Elizabeth Hughes. She was the diabetic doctor of a high ranking politician (who narrowly failed to get elected president, and later served as secretary of state.) She was among the first Americans to receive insulin and was able to live a long life with the injections. 

The Messenger: Moderna, the Vaccine, and the Business Gamble That Changed the World

The Messenger: Moderna, the Vaccine, and the Business Gamble That Changed the World by Peter Loftus

Moderna started out as a brash biotech, trying to find uses for a novel mRNA technology. The company was able to raise significant amounts of funding, but did have a bad IPO. It also had a reputation for working employees very hard. When the COVID-19 pandemic came about, they were ready to quickly develop a vaccine. Then they came to the challenges of running a big clinical trial and produce large quantities. With the government assistance, they they were able to go through the process must faster than normal. The vaccine was a success (though Pfizer beat them to market with a similar mRNA vaccine.) The vaccine worked and mRNA seemed to be better than "old" vaccine technology. Will this be the future of vaccine development? 

Letters

Letters by Oliver Sacks

As per the title, this is a posthumously published collection of letters written by Oliver Sacks. He was a prolific letter writer. There are a mixture of different types of communication. Some are personal letters that deal more with his experience in life. Others are more science focussed, responding to concerns about research and publications. Through the letters, we can learn about the unfolding of Sack's career. He is concerned with the "mechanical" approach to medicine. He doesn't want to treat everybody as a statistics, but wants to explore the person to reach a solution. He has done work with people with neurological conditions. Some may appear commotose, but can be awakened. Others are essentially "dead", but kept alive mechanically. Drugs can help those with Parkinson's, but they may also have negative side effects. He does not believe there is a possible "miracle drug". He has struggles with medical bureaucracy and education. His Jewish background and sexuality come out at various times in his life - especially near the end as he is diagnosed with cancer. It makes for an interesting "biography" told all from primary sources.

The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure

The Invisible Siege: The Rise of Coronaviruses and the Search for a Cure by Dan Werb

Coronaviruses have been around for a long time. However, they have only been extensively studied in the past few decades. Previously they were most commonly seen as just causing a common code and only studied by an odd dedicated researcher. This all changed with SARS. It appeared in Asia in the early 2000s. It was deadly and started to attract a great deal of interest. There was work to sequence as well as to identify the source. Work was also started on vaccines. However, after it was contained, the enthusiasm died off. 

A decade later, Mers appeared. This was also extremely deadly. Interest in Coronaviruses popped up again. It also lead to tracing the source - and identifying camels instead of bats as an animal vector. This one was also contained, and interest again died off. 

In 2020, Covid-19 started to spread. The people had been doing work on coronaviruses and vaccines were ready to jump into action. Covid-19 ended up causing a widespread worldwide pandemic. People could carry and spread the virus without showing symptoms. It could be deadly for some people, but for others they suffered minimal (or no symptoms.) This allowed it to spread much more than the previous viruses. Luckily, the past research enabled vaccines and treatments to be quickly put into place. (Though in the field of medical research, a year is seen as amazingly fast.)

This book covers the history of coronavirus research. It does a great job of putting Covid-19 in context of the previous viruses. There are a number of factors involved. Politics and relationships can be as important as science. Countries and rulers are reluctant to admit they have a problem. This can make it difficult for scientists and public health official to identify and combat the virus. One scientist that had success built up relationships by way of non-judgemental science. Science also had internal conflicts, with those advocating open science versus those concerned about patents and financial return. Money is needed to bring drugs to market, but if vaccines are too expensive, the poorer parts will not receive it, limiting world immunity.

Wonder Drug: The Secret History of Thalidomide in America and Its Hidden Victims

Wonder Drug: The Secret History of Thalidomide in America and Its Hidden Victims by Jennifer Vanderbes

Thalidomide was once seen as a wonder drug that could help with many conditions with minimal side effects. It came from German pharmaceutical companies and was used in Europe. In the US, it was never fully approved. However, it had been used extensively in "trials". It was later determined that the drug could lead to birth defects when taken during pregnancy. This was thought to be a "European problem". Alas, the "trial" in the US had a much greater scope than anyone knew. The record-keeping was lacking and the doctors had little knowledge of the drug and had spread it to many others. Many people took it without knowing what it was. The book primarily covers the history of the drug and the politics involved with regulating the drug industry. The end drags on with quests for lawsuits and the difficulty in suing many years later. (You wonder what the point is doing this decades later. Would it really help people?) Only recently has the drug been approved by the FDA for limited use cases. The book tries to set up some heroes, but tends to focus more on the facts rather than narrative.

Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims, and Bad Advice - How to Tell What's Real and What's Not

Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims, and Bad Advice - How to Tell What's Real and What's Not by Nina Shapiro and Kristin Loberg

Healthcare is filled with hyped up fads. Many of these are based on the flimsiest of evidence. It can be hard to distinguish hype from valuable practices. This book mentions a number of not so good medical practices, and has a few general guidelines. One positive from the book is acknowledgment of the placebo effect. Placebos can provide benefit - even if you know they are only placebos. As long as it doesn't cause harm, we can still use it. For others, it gets complicated. Smoking was once argued as beneficial by doctors, while drinking was condemned. Now smoking is universally identified as bad, while moderate drinking is sometimes seen as beneficial.

People can be a little stupid when it comes to probabilities. A parent may drive a long distance to get organic produce. The driving has a greater probability of harm than the possible organic benefit. There are many other cases where we are drawn into hype. Many processed foods start with healthy ingredients, but process much of the benefit out of it. Screenings such as Mammograms and X Rays may identify conditions, but they also cause harm in themselves and can result in false positives that result in harmful treatments.

Medical treatments can be trickier. We can try to identify the current best practices. However, these may change. How do we know if our "alternative" treatment is quackery or the future of medicine?  Perhaps the best bet is to take it all. "Complementary" medicine can be helpful. Traditional medicine can also be helpful. If we can easily identify the expected benefits and harms of both we can make good decisions. Alas, getting the data can be challenging. The book did point to a source for probabilities, but finding it is challenge.

Attending: Medicine, Mindfulness, and Humanity

Attending: Medicine, Mindfulness, and Humanity by Dr. Ronald Epstein M.D.

Medical school can focus heavily on knowledge and procedures. However, medicine involves personal interaction with patients in intimate areas of life. Successful doctors understand the humanity and work to build appropriate relationships. This can help uncover true health problems as well as their solutions. A surgeon must balance the time in the zone following the process, with time breaking and responding to anomalies. Being assertive, humble, and a good communicator are all skills that are needed to be a successful doctor.

Isolation Ward

Isolation Ward by Joshua Spanogle

CDC employee Dr. Nate McCormick is investigating a dangerous new disease. It seems to have impacted mentally challenged women. He goes through a few different leads and hunches to uncover the source. There is a bit of sexual depravity as well as questionable research involved. He has to fight various bad guys and defend his job as he tries to get to the conclusion. The story is engaging and poses some interesting things to ponder in our quest to find "cures". The "miracle" cures may not be as safe as we think.

Bad Therapy: Why the Kids Aren't Growing Up

Bad Therapy: Why the Kids Aren't Growing Up by Abigail Shrier

Therapy may. be making us much worse. Therapists often have good intentions. They are trying to help. However, they may help "uncover" problems that did not exist previously. (People have a tendency to remember the bad, and more discussions about it may amplify it.) Therapy also encourages a self-focus that can distract from the growth and better integration in society.  Therapists also have financial incentive to continue therapy. There is rarely an event that can be marked as a "cure", thus therapy can go on indefinitely. It can be even worse for children. They can easily be convinced of issues by the manner of questioning. A well-mannered child is a much easier client than a bi-polar adult, making them a much better client to hold on to.

What is the alternative to therapy? Removing phones from children may provide a greater increase in mental health than a visit to a therapist. Maybe we do just need to allow for more personal communication all around. It seems too often the suggestion is for "professional help", when what people really need is a friend.

Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health

Change Your Diet, Change Your Mind: A Powerful Plan to Improve Mood, Overcome Anxiety, and Protect Memory for a Lifetime of Optimal Mental Health by Dr. Georgia Ede MD

I had hopes that this book would be a good analysis of diet and mental health. Alas, it was a diet book pushing the keto diet. The author would proclaim that we cannot trust any epidemiological studies because they are not good randomized, controlled studies. We also could not trust pronouncements of the benefits of certain diets because they had not been studied enough. Instead, we should just focus on an all-meat diet because it is "natural". We should trust that it is good because there have been no big studies on it. Wait? Didn't we just criticize other diets as being bad because there were problems with the studies? Oh, but for keto diets, the problems with the studies mean that they missed out on it being good. It just comes across as selective analysis to push a certain diet. 

There are some good points, but even they are not without issue. It is easier to get the nutrition we eat while just consuming meat without supplementation. But if the world would do that, we would probably be driven to cannibalism after we had used up all land and driven wild game to extinction. The author tries to spin other studies on their head. The compounds that plants produce that are supposed to help us fend off bad things? Well, plants make them to fend off pests, so they must be bad for us also.

At times the author does try to be balanced. There are even some attempts at vegetarian-type keto diets. But, it does feel half-hearted. The key point is that super-processed food is not so great for us. Beyond this book just schills a diet with confused and contradictory scientific logic.

The Song of the Cell: An Exploration of Medicine and the New Human

The cell is a key part of most life. Complex organisms are made up of many different cells all responsible for specialized functionality. The science behind our knowledge of the cell took many different turns and even involved some significant competition (and deaths). This takes us on the discovery of the cells and how they work. Then explores the application of this and some of the modern advancements of cellular research. Some of the popular advancements (such as so called "test tube babies") have been achieved by people that do not have cellular biology as their primary focus. While others have been part of mainstream cell biology work. Understanding cells can help us to treat many different diseases and help understand more about life in general.

Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health

​Natural experiments can be used to perform experiments that would be difficult (or impossible) to perform in a fully randomized trial. These "experiments" are carried out by analyzing data to  focus on certain attributes of interest while controlling for other attributes. One example was looking at flu shots by birthday. Children with summer birthdays typically have their well child visits at a time when a flu vaccine is not available. They must return at a later time to get the shot. This extra friction leads to a lower flu vaccination rate and a higher prevalence of the flu. 

The book looks at many other random experiments. They typically used anonymized insurance or medicare claims. They also pull down datasets of doctors, events and other things to correlate. Somet results are counter-intuitive. Emergency heart operations tend to have a higher success rate when a cardiology convention is going on. Some lend themselves to explanation. Younger hospitalists tend to have better outcomes because they are more knowledgeable in the latest practices. However, older doctors that see the greatest number cases tend to also have good performance, likely because they have had a chance to learn modern practices. With surgeons, older surgeons do have better outcomes.

There were many other examples of experiments in the book. The authors have a very open approach, with a willingness to accept criticism of their methods. There may be confounding circumstances that impact the results that are seen. People often change their behavior when they know they are being measured. Trying to improve medical outcomes can be extremely challenging. If we find a good measure, participants will often find a way to maximize that measure without necessarily improving overall outcomes. How do we make medicine better? We need to look at the big picture of the human experience, but also realize that humans are providing the medical care. The experience of receiving the care can be as impactful as the actual care received. How do we maximize everything? We have a significant challenge.