Thursday, April 17, 2014

Redshirts, by John Scalzi

This is an unusual book.  In 2456, our hero, Dahl, gets assigned to a spaceship.  He notices that on every away mission a low ranking crew member gets killed.  And the captain, chief science officer, and a poor guy named Kerensky always live through the mission (although Kerensky always gets badly hurt).

What happens next is strange and I won't say a word because it would all be a spoiler.

I kind of liked it when I closed the book, but as I think about it a bit, I can't decide if I really do like it or really don't like it.  Strange.


Redshirts: A Novel with Three Codas

Hell's Corner, by David Baldacci

The trick to enjoying this sort of book is to suspend disbelief and just go with the flow.  Of course the super hero super spy will succeed, of course the bad guys will fail - unless there's a sequel in the works and some of them have to progress to the next book...

This novel features a continuing character of Mr. Baldacci's; Oliver Stone, also known as John Carr is our hero. He is the spy equivalent of Captain America.  As in prior novels with this character, there's an assortment of odd civilians, the "Camel Club" who are similarly equipped to do things that normal people just can't do.  And this episode adds a new colleague in a British MI6 agent Mary Chapman.

I almost feel guilty for wasting a couple of hours on this (given that I'm reading a couple of much better books at the same time), but hey, it was fun.


Hell's Corner

Wednesday, April 16, 2014

Departed, by Nick Stephenson

I always like to write a few words about books I've read.  But in this case, let me just cut to the chase: one star, not worth bothering with.

Departed (Leopold Blake Series)

The Yacoubian Building, by Alaa Al Aswany

This is a lovely novel.  Its focus is not on plot so much as on people; similar in that regard (at least to me) to the writing of Gabriel Garcia Marquez.   The story centers on the Yacoubian Building in downtown Cairo, and some of its residents.  The building is the only common thread and the novel is all about the varied characters and their lives.  As such, there's no unifying denouement; at the end, we've had the enjoyment of learning about these folks and then the story is done.

Some reviews suggest that Al Aswany's book can't be fully enjoyed by someone who isn't familiar with Cairo or the political history of Egypt (at least up until 2002 when the book was first published).  I disagree.  These topics are supporting actors; the leads are the people and the author does a terrific job of bringing them to life, with texture and color.


The Yacoubian Building

Tuesday, April 15, 2014

Over-diagnosed: making people sick in the pursuit of health, by Gilbert Welch

Everyone should read this book, but I fear that few will.  Partly because it is perceived as a difficult topic.  No worries there:  Dr. Welch and his co-authors make this as easy and straightforward a read as possible.  Even if you barely passed high school biology or math, you'll have no problems here:  the science is simple, the statistics are very clearly explained.

Another reason folks might not read this is that they are comfortable delegating their personal health decisions to physicians.  The facts indicate that this is not a good plan.  The whole point of Dr. Welch's research is that physicians often do things that provide no statistically significant improvement to lifespan but do have a statistically significant likelihood of negative side effects.

If your auto mechanic suggests an expensive diagnostic for your engine when you bring your well-running car in for a routine oil change, and then suggests a follow on test because the first was inconclusive, and these are expensive tests, and there's a chance that your engine will be ruined by the testing, you might want to have a better sense of what's going on.  If all this happens while your car is running perfectly well, with no symptoms of trouble, then you're in a situation quite analogous to the superfluous diagnostic medical scanning that Dr. Welch writes about.

Dr. Welch is careful to not pick on his colleagues.  Although he does note that a physician's primary sources of information tend to be funded by drug companies or medical equipment manufactures. In addition, there are many economic reasons to ignore science and statistics, sub-conscious or not.  A big factor is that a doctor, like anyone else, is often most comfortable with the "old wives tales" that they know.  This sort of thing has gone on for centuries.  One example, not from the book, is that of Dr. Ignaz Semmelweis.

Semmelweis noticed that mothers would give birth in a hospital's obstetrical clinic only to die of puerperal fever soon after -- with a mortality rate of 10% to 35%.   That's a scary amount of preventable death for a hospital.   He determined that if doctors would wash their hands with a chlorinated lime solution (similar to today's anti-bacterial soaps), they could take the mortality rate down to below 1%. You don't need to be a doctor nor a statistician to see that this is a good deal.  So what happened?

In spite of published facts, Semmelweis' observations conflicted with the established, normative medical practice of the time.  So his ideas were soundly rejected.   It took about 20 years before Dr. Joseph Lister succeeded in getting doctors to accept the science, and only then because he built on the concepts that Louis Pasteur introduced.   Most folks have heard of Listerine mouthwash, named after Lister. Nothing is named after Semmelweiss.   But lots of women died in those intervening years.

I use this example because it is so very obvious to us today that one should wash one's hands -- and yet, it took decades to get doctors to do it.  It is difficult to realize sometimes that throughout history scientists have been labeled heretics because their data did not conform to then-current practice.  In the 21st century we tend to feel as though every problem has been solved, and that we've got it all right. But maybe not so much, and Dr. Welch's book points out clear examples of facts not convincing physicians.  This problem of normal practice not aligning with the facts, but going on anyways, is old news.  It happened to Galileo, who had the audacity to propose that the earth rotates around the sun.  It happened to Semmelweiss, and many others.  And as Dr. Welch's book makes quite clear, it happens yet today.  

Okay, so back to the book for some modern day examples.  Back in 1996, the US Preventative Services Task Force (USPSTF) recommended against routine obstetrical ultrasound.  Why?  Because they found that there is just no substantive benefit.  The highly respected Cochrane Collaboration (which eschews any financial support from drug firms or equipment companies) agrees.  But every single expectant mother that I have met since 1996 gets an ultrasound; I bet that's true for you too.   The USPSTF has given up on the topic, because they recognize that this unhelpful and potentially negative scanning procedure is such a common practice that no one would listen to them anyway.   [pp112-113] Yikes.

But there's more.  Also in 1996, the USPSTF recommended against routine fetal monitoring (the belt put around an expectant mother to monitor the about-to-be-born baby's heart beat).   Once again, the Cochrane Collaboration agreed, noting that monitoring increased C-section rates by 66%, and that the risk of that to baby and mother is enormously worse than the potential benefit.  What is that benefit?

About one in a thousand babies would avoid a (non-fatal) seizure compared to two in a thousand without the monitoring.  A one in a thousand change.  But even then, no improvement in baby's health as measured by Apgar score, respiration, pulse, conditions like cerebral palsy, need for ICU - nothing.   Yet, again, it is such a common practice that the agency feels it would be tilting at windmills to try to change it (even though doing so would clearly, from the numbers, save lives and reduce negative side effects).  [pp105-106]  Did I say, Yikes?

There's lots more in the book, from mammograms to PSA tests to blood pressure and diabetes.

By now you should be considering that there is real value in reading this book, if only to make us better informed consumers of the medical industry.

Dr. Welch has done an extraordinary job of stating the facts, acknowledging the ambiguities, and making it clearer for individuals to understand the tradeoffs of their diagnostic scanning choices.   Even if you continue to use screening that the facts might indicate you oughtn't, you'll have a better understanding of what the issues are.

Overdiagnosed

Monday, April 14, 2014

The Long Divorce, by Edmund Crispin

This mystery novel is set in the UK in 1950.   It is old fashioned, not because of that setting, but because there's no real violence, no car chases, no foul language, but just a puzzle of a mystery.

I wasn't fortunate enough to stumble across this book, I was guided to it.  A former colleague, uncommonly well read and erudite, pointed me to this title, and I'm grateful.

It turns out I've become habituated to the action hero type of modern mystery (which usually isn't much of a mystery at all) and I didn't realize how much I miss the puzzle mystery genre until reading this fine book.   I look forward to reading more of the series.

The Long Divorce: Gervase Fen #8

Duty: Memoirs of a Secretary at War, by Robert Gates

This is an excellent book.  Former Secretary Gates left a job he really enjoyed, President of Texas AM University, to return to public service and lead the Department of Defense at the request of Former President Bush (43) and stayed on in that role for most of President Obama's first term.   This book focuses primarily on the US war actions in Iraq and Afghanistan, and in its most interesting parts, on the functioning of the government.

If you aren't really into understanding the details of military manpower deployments, this book is still interesting enough to pick up:  skip those parts and stay for the reality of how things are run.

As much as I am a fan of Secretary Gates' book, it took me a very long time to get through this - it was just too depressing.  No, not the description of war and the impact on soldiers' lives and families - although that is always at top of mind in any discussion of our military.  Rather it was the extraordinary dysfunction of the US military apparatus at its most senior levels, the absolutely criminal incompetence of much of the US Congress, the number of critical leaks to the press by those in high positions, and the arrogant and ill informed staffing of President Obama's senior White House civilian team.

The repeated discussion of leaks quite upset me.   The same folks who want to lynch anyone associated with WikiLeaks are frequent leakers themselves:  Pentagon brass, White House staffers, Congressmen, you name it!   I really do not understand why Secretary Gates didn't have every single one of these leakers, whether on the DoD team or the President's, indicted for treason.   But the fact that the President lives with leaks - on Sunday morning news shows, in newspapers, in blogs - as a way of life when it comes from varied parts of his administration simply removes any moral high ground for prosecuting folks like Julian Assange.

Secretary Gates' description of the behavior of the most senior military and civilian DoD staff is also disheartening and demoralizing.  Service leaders prioritized their own turf over doing what is right for our soldiers in the field.  The Defense Department seems like a lumbering organization that consistently fails to urgently consider the needs of our soldiers and their families, but is quick to make excuses for its errors.  And even the Secretary of the Department is unable to fix the culture, perhaps because it is difficult to fire middle managers, even senior managers, in the military, or perhaps it would have taken more of a full time effort than Secretary Gates was able to devote to fixing the mess when he was busy fighting two US wars during the years he was in his position.   I imagine that if he couldn't do it, then it is unlikely to be fixed in the future.  

The implications of the lack of urgency?  Soldiers harmed in IED explosions because vehicles that would protect them weren't a priority - but humvees, made in some Congressman's district (AM General is clearly a big campaign contributor), were still on the books even though the military didn't want more of them.  So were aircraft that cost billions (yes, that's billions with a "b") but were either unnecessary or just too expensive to justify outside of a Congressman's desire to have local business move on at the expense of not only the budget (that we all pay taxes for) but at the expense of equipment that might be far more effective for our soldiers on the ground.

Drones, which could fly unmanned in dangerous regions for air cover, were not a priority in the Air Force because the only promotions and medals went to those who flew manned aircraft - unlike the attitude of the Army which saw drones as a way to advance positions more safely.   Would you want your friends or children to enter a military that - at the very top of the chain - treats their lives in such a cavalier fashion (even if the bulk of the military chain of command is actually quite competent).

Moving on to Congress:
"Why did I so dislike being back in government...?   From the bureaucratic inertia and complexity of the Pentagon to internal conflicts within the executive branch, the partisan abyss in Congress on every issue from budgets t the wars, the single-minded parochial self interest of so many individual members of Congress, and the ... micromanagement [of the Obama administration's civilian staff]..."
Congress, in particular, is described as a disaster.  Secretary Gates points out the outrage of the US Congress over Afghanistan's slow progress towards enacting important legislation in their country -- when the US Congress has been no more effective in enacting important legislation, funding the government responsibly ("... the failure of Congress to do its most basic job: appropriate money."), or running things well themselves.
"I was exceptionally offended by the constant adversarial, inquisition like treatment of executive branch officials by too many members of Congress across the political spectrum - a kangaroo-court environment in hearings, especially when the press and television cameras were present."
"I was constantly amazed and infuriated at the hypocrisy of those who most stridently attacked the Defense Department for being inefficient and wasteful but would fight tooth and nail to prevent any reduction in defense activities in their home state or district no matter how inefficient or wasteful."
"While American politics has always been a shrill, partisan, and ugly business... we have rarely been so polarized and so unable to execute even the basic functions of government... I believe that is due to the incessant scorched-earth battling between Congress and the president... but even more so to the weakening of the moderate center of both parties in Congress.  Progress in America historically has come from thinkers and ideologues on both the left and the right, but the best of those ideas have been enacted into law through compromise. Now moderation is equated with lacking principles, and compromise with 'selling out.' " 
And finally, noting that the most dovish people in any discussion of war are the military commanders who have to send their troops off to face death and massive injury:
"Too many ideologues call for the use of the American military as the first option rather than a last resort to address problems.  On the left, we hear about the 'responsibility to protect' as a justification for military intervention in Libya, Syria, the Sudan, and elsewhere. On the right, the failure to use military force in Libya, Syria, or Iran is deemed an abdication of American leadership and a symptom of a 'soft' foreign policy...And so the rest of the world sees America, above all else, as a militaristic country too quick to launch planes, cruise missiles, and armed drones deep into sovereign countries or ungoverned spaces.... But not every outrage, every act of aggression, every oppression, or every crisis can or should elicit an American military response."

I have a hunch he was talking about Senator McCain as much as anyone in that last quote; my sense is that McCain wanted US troops in Syria last year, and probably at the time of this writing, he'd like to see US troops in the Ukraine, positioning a war with Russia.   He scares me, but that's beyond Secretary Gates' book.

This is a terrific book because it is a reveal of what happened in the US government under two radically different presidents (Bush 43 and Obama), and is told by a very credible and politically unaffiliated source.

Duty: Memoirs of a Secretary at War

Tuesday, April 8, 2014

Si-cology, by Si Robertson

There's a television reality show on, called Duck Dynasty.  I've never seen it.  But I saw this book by one of the characters on the show and decided to read it.  This wasn't the best use of my time.  The book isn't bad, but it is lightweight.  I suppose Mr. Robertson's biography just doesn't compete with, say, Winston Churchill 's.

Si-cology 1: Tales and Wisdom from Duck Dynasty's Favorite Uncle

Monday, April 7, 2014

Thrive, by Arianna Huffington

Ms. Huffington's book is interesting and full of common sense wisdom.  It feels a bit flimsy, and doesn't sum up the messages very clearly.  Just in writing this, I have to struggle a bit to put order to the key insights:  money and power are insufficient metrics to a well-lived life.  A third metric is required, and Ms. Huffington describes it in broad brush strokes as including: our health and well being (mental and physical), paying attention to intuition (just like Gavin DeBecker says!), keeping a child's sense of wonder, and giving of compassion, time and effort to those in need.

Maybe Ms. Huffington was making a point by omitting the kind of bullet list summary that would make me more comfortable.  Or maybe she just goofed.  It is still worth reading, but really it is no Lean In.

Thrive: The Third Metric to Redefining Success and Creating a Life of Well-Being, Wisdom, and Wonder

Wednesday, March 26, 2014

Lifelong Running, by Ruth Heidrich

I met Dr. Heidrich earlier this year in Hawaii; her energy and enthusiasm was contagious.  So I was eager to read her most recent book.   The target audience for this easy to read book is an older person - only in that she's clearly not writing for high school or college age folks, although the information would be just as applicable.   Dr. Heidrich is trying to build enough interest in exercise that even the most sedentary of us might climb off the sofa and take a walk outside; she expects that to become a run and a habit.

If you've thought you should get some exercise but had a bunch of good excuses to not go running, this book will help you break through the myths and get yourself going. It is a fast, informative and fun read.

Lifelong Running: Overcome the 11 Myths About Running and Live a Healthier Life

By the way, this is her baseball card. Yes, some people carry business cards, but Ruth Heidrich gives out baseball cards instead!