Category: medicine

Atul Gawande on The Checklist Manifesto

To coincide with his giving this year’s Reith Lectures, I thought I would re-release this interview with Atul Gawande from 2011, in which I spoke to him about The Checklist Manifesto and how something as simple as a checklist could have dramatic, positive benefits in healthcare.

“We have people at the frontline who have great expertise – we couldn’t have people in medicine who are better trained, working harder, or given more technology to get their jobs done – and yet the puzzle is that for many of the steps along the way, such as in surgery, we have seven million people a year globally left disabled or dead through complications. At least half the time, we know that it’s from failures to use knowledge that already exists, steps in care that could have avoided it. And so understanding how we close the gaps, not just of ignorance but, for want of a better word, what we have to call ineptitude, is fundamental.”

Jon Ronson on The Psychopath Test

Early on in his book The Psychopath Test, Jon Ronson writes:

I’d never really thought much about psychopaths before that moment and I wondered if I should try and meet some. It seemed extraordinary that there were people out there whose neurological condition, according to James’s story, made them so terrifying, like a wholly malevolent space creature from a sci-fi movie. Psychopath-Test cover detailI vaguely remembered hearing psychologists say there was a preponderance of psychopaths at the top, in the corporate and political worlds – a clinical absence of empathy being a benefit in those environments. Could that really be true? And I decided, no, it would be a mistake to start meddling in the world of psychopaths, an especially big mistake for someone like me who suffers from a massive surfeit of anxiety.

Having explored the world of extremists in Them, and the wilder shores of the US military’s psychic operations in The Men who Stare at Goats, Jon decided to turn his attention to psychopaths. In this entertaining interview, he explains why. To listen, click here.

And to read the first chapter of the book, click here.

The Oxford Textbook of Medicine

Oxford Textbook of Medicine 5/eEarlier this year, just before Oxford University Press’s flagship medical title, the Oxford Textbook of Medicine, went online for the first time, I met all three editors of the book and interviewed them about it. The book attempts no less than a full digest of the current state of medical knowledge, and is therefore a huge – and hugely ambitious – undertaking.

I was keen to find out more about the values which underpinned the book and also the practical side – how is it possible to stay on top of such a vast and ever-changing field, what does the future hold for the book now that it has gone online, and what are the pleasures of working on such a long-term project?

Though the book is intended primarily for professionals, it also finds its way into other contexts; it’s often cited in courts of law, for example. So I hope that this interview will be of interest to medics and non-medics alike. After all, it’s far from unlikely that at some point in your life a medic will refer to this book with reference to your own health care…

Key to speakers’ initials:

DAW – David A. Warrell, Emeritus Professor of Tropical Medicine and Honorary Fellow of St Cross College, University of Oxford

TMC – Timothy M. Cox, Professor of Medicine, University of Cambridge; Honorary Consultant Physician, Addenbrooke’s Hospital. Cambridge

JDF – John D. Firth, Consultant Physician and Nephrologist, Addenbrooke’s Hospital, Cambridge

1. First I asked about the origins of the book and the principles on which it was founded (DAW). Click here to listen to David Warrell’s answer.

2. What is the audience for the book and how is that reflected in its content? (JDF, DAW) Click here

3. What sort of contributors have the editors recruited to the project? (JDF, TMC) Click here

4. What brief do the contributors get before they write their chapters? (JDF, DAW) Click here

5. What does the move online mean for the Oxford Textbook of Medicine and how will the book maintain its relevance? (JDF, DAW) Click here

6.  Do the editors need to be constantly aware of the need to balance the theory and practice of medicine in their presentation of it in the textbook? (JDF, DAW, TMC) Click here

7.  Medicine is practiced in very different economic, political and cultural contexts around the globe. How does the Textbook cope with that fact? (JDF, DAW) Click here

8. Does complementary medicine belong in a book on evidence-based medicine? (TMC) Click here

9. The chapter on psychiatry says explicitly that some readers may find it an unnecessary add-on. Clearly this is not a view shared by the book’s editors. (TMC, DAW) Click here

10. I remarked that successive editions of the book must have reflected the changing role of the physician over the past decades… (TMC) Click here

11. … and also of course changes in human behaviour. (TMC) Click here

12. I wondered whether in a sense the whole book was a reflection of the editors’ view of what the ideal physician would be like. (JDF, DAW) Click here

13. How will updates happen now that the book is available online? (JDF) Click here

14. Is there a danger that, with all the advances in contemporary medicine, the Textbook may cease to be able to keep up with progress? (JDF, DAW) Click here

15. Finally I asked all three editors for their personal impressions of being an editor of this flagship publication. (TMC, JDF, DAW) Click here

3. Books of the Year – Louise Foxcroft

Louise FoxcroftOur third guest reviewer of this year’s publishing highlights is Cambridge-based historian of medicine, Louise Foxcroft.

Louise won the Longman/History Today Prize in 2009 for her book Hot Flushes, Cold Science: A History of the Modern Menopause. You can hear a podcast in which she discusses the book here.

And here are Louise’s favourite books of the year:

Brian Dillon Tormented Hope

Michael Frayn Father's Fortune
Antonio Damasio Self Comes to MindBrian Dillon’s Tormented Hope: Nine Hypochondriac Lives (shortlisted for the Wellcome Prize 2009) is a terrific account of a debilitating but abstract condition.

It is told through the experiences of articulate sufferers: Proust, who expired, his fears vindicated, in his cork-lined sick room; Warhol who had a dread of doctors and hospitals but couldn’t avoid them; the glamorous Glenn Gould loved his prescription drugs and medical paraphernalia but died of self-neglect; and Boswell, the London Magazine‘s resident “Hypochondriack”, used exercise, regular dining and lots of sex to help him deal with his bodily fears.

All these anxieties were made worse by the fallibility of doctors who had few medicines but plenty of platitudes, and whose knowledge was said to progress one funeral at a time. Anyone with the merest twinge of health anxiety, and that’s probably all of us, will be fascinated.

Michael Frayn is one of my favourite writers, his novels are always funny, tragic, clever, and very perceptive. My Father’s Fortune: A Life is another one, like Spies, that I will re-read endlessly.

Self Comes To Mind: Constructing the Conscious Brain is an excellent piece of popular science by Antonio Damasio, Professor of Neuroscience Brain and head of the Creativity Institute at the University of Southern California. Damasio’s writing is lyrical and concise, so that difficult concepts are made clear and are a pleasure to read.

He illustrates how the conscious mind results from the smoothly articulated operation of many brain sites with the analogy of an orchestra and its conductor, but in this case it is the orchestra and its performance that produces the conductor. The great paradox, he says, is that our self is our entry into knowledge, and yet here we are questioning it. He makes thinking about your self seem quite acceptable

Summer Reading Choices: Louise Foxcroft

Louise FoxcroftLouise Foxcroft is the author of Hot Flushes, Cold Science: A History of the Modern Menopause, which won the Longman History Today prize for Book of the Year 2009.You can listen to my interview with Louise about this book by clicking here.

Here are her holiday reading recommendations:

In the early summer, ready to get away from the drizzle, I reread Graham Greene’s Travels With My Aunt and The Towers of Trebizond by Rose Macaulay. The English have always been very good at producing caustic aunts who can’t stay put but who can tolerate the young and irritate the rest of the family with their fantasies, politics, and unsuitable lovers. There was a distinct glut of them after the first world war and it was obviously difficult to know what to do with them.

Travels with my AuntOn the whole, the aunts seem to have made life up as they went along, so the first idea you have to expunge from your mind is that aunts are in any way dull or cosy. Graham Greene’s aunt appears late in the life of his bank manager hero and upsets his staid, suburban, rose-blighted bachelor existence with cannabis, South American criminals and papery love-making. Rose Macaulay’s aunt arrives on a camel, disappears into Communist Russia trailing a Catholic priest, and utterly fails to sympathise with her niece’s long and poignant love affair with a married man. Both books are cuttingly funny. Both can make your eyes brim. Dust swirls, foreigners confuse, and families maintain the closeness that distance can always provide.

Towers of Trebizond coverIn June I found myself at Glastonbury [no-one was more surprised than me. It was terrific: all you have to do is ignore the main festival stuff, Stevie Wonder and all that, and lurk around the periphery where very surprising things happen] and I was given a copy of Ismail Kadare’s The Siege. This is a bleak account of the blockade of an Albanian Catholic citadel by the Ottoman Army in the early fifteenth century. First published in 1969 following the Soviet invasion of Czechoslovakia, Kadare’s Albania was feeling ‘the icy breath of the colossus on its doorstep’.

Kadare The SiegeThe paranoia of the siege mentality is meticulously picked over and man’s inhumanity to man is ruthlessly and cleverly exposed. The translator, David Bellos, describes the book as an anti-historical novel; it is frighteningly modern and present.

The rest of the summer, indeed year, has been devoted to slimming. Not because I too am a colossus but because I am writing a cultural history of diets and dieting, two and a half thousand years of losing weight (and how to do it). Of the many diet books I have digested so far, I am most fond of Eustace Chesser’s Slimming for the Million [currently unavailable], but this is mainly due to Chesser himself rather than his regime. He is the essence of doctorly charm and discretion, altruistic and gentlemanly, but even he came a cropper over his next book, Love Without Fear, which landed him in court on an obscenity charge in 1942. You get the feeling that all the maiden aunts in Christendom couldn’t shift the heavy hand of respectable mores. It would take another world war to pave the way for that.

Le Monde diplomatique podcast – Barbara Ehrenreich

Smiley plugIn this month’s edition of Le Monde diplomatique I have a piece about US journalist and campaigner Barbara Ehrenreich and her latest book, called Smile or Die in the UK and Brightsided in the US.

I interviewed Barbara on a snowy evening in Bristol last month before she appeared at the Festival of Ideas to explore her thesis that the relentless promotion of positive thinking is undermining America and its effects are being felt all round the world.

If you’re unconvinced that positive thinking is creeping into more and more areas of life, here are some facts with which I began my article:

“George W Bush was head football cheerleader in his senior year at prep school. The most popular course offered by Harvard University in 2006 was positive psychology. The total US market for “self-improvement products” in 2005 was estimated at $9.6bn. Last month, during the Haitian earthquake, the top international story on happynews.com – which publishes only good news – was “Prince William attracts crowd in New Zealand”. There are at least four different species of breast cancer awareness teddy bears. Sales of the self-help book The Secret (2006) (“the secret gives you anything you want: happiness, health and wealth”) by former Melbourne TV producer Rhonda Byrne exceed 7 million.”

Listen to the podcast by clicking here to make up your own mind whether there is something here to be worried about.



31. The Making of Mr Gray’s Anatomy

Richardson: Making of Mr Gray's Anatomy

“What’s so wonderful about Carter’s illustrations [for Gray’s Anatomy] is that they are not abject people, they are not shown as lumps of meat, they’re not shown as undignified, they’re not shown in pain. In fact, many of the illustrations are quite noble…

“It’s the first real anatomy book for students to be published since the development of chloroform, anaesthesia in general, and I think these bodies are chloroformed bodies. They are not being treated as though they are social outcasts; they’re being treated as human beings.”

My guest on this week’s programme is medical historian, Ruth Richardson. Ruth has written a fascinating history of how the most famous medical textbook of all time came to be written – Gray’s Anatomy, which is still going strong after more than 150 years and 40 editions.

She shows that its success was down to not just Henry Gray, who wrote the text, but also to Henry Carter, who provided the illustrations.

In the interview we talk about the very different fates of these two men and also about how medicine as a career was changing in the mid-nineteenth century. But, as you’ll hear, much of Ruth’s sympathies go to the workhouse poor, who in death provided the models for the illustrations in the book.

26. Who owns your body?

Body Shopping cover

“This is what I think is really surprising to most people: you don’t actually own your body, in the sense that tissue taken from it and used afterwards is yours to use as you see fit.

“The law traditionally took the view that tissue, once it had left the body, was what was called ‘no one’s thing’.

“And it took that view because traditionally the tissue wasn’t of any value. It is modern biotechnology that has given it this value.”

This podcast is an extended version of an interview I did with Donna Dickenson for Blackwell Online about her book Body Shopping: Converting Body Parts to Profit.

We talked about the global commodification of the human body, from the sale of eggs and the “grave-robbing” of bones to gene-patenting.

Donna’s approach is not to sensationalize these issues, shocking though they often are, but to look at the big questions we as a society need to face in their ethical, legal and scientific context.

25. Menopause and medicine

Louise Foxcroft: Hot Flushes, Cold Science

Hot Flushes, Cold Science cover

“There was a physician called John Fothergill in the late eighteenth century who said that it was amazing that women had been taught to dread this natural phenomenon.”

As Louise Foxcroft’s sometimes shocking history of the menopause shows, Fothergill was very much in the minority.

The medical profession in Fothergill’s day was just beginning to cotton on to the idea that the menopause offered a lucrative new subject for treatment.

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