http://blogcritics.org/ A sinister cabal of superior bloggers on music, books, film, popular culture, politics, and technology - updated continuously. en Copyright 2005-2007 by the authors Sun, 19 Dec 2004 16:13:19 EST http://backend.userland.com/rss Blogcritics.org custom software http://blogcritics.org/ Phillip WinnSunday, August 26, 2007, marks the switch of all Blogcritics.org article feeds from full-content to short-content. This is the result of several converging factors, and is unfortunately a permanent decision (as permanent as any decision can be on the web, that is). We are aware of all of the reasons that this is a Bad Idea, and we are aware that some of you will be quite upset about having to click on something to read the free content, and we're sorry. Unfortunately, despite great effort, full-content feeds are not currently economically viable. Two other factors are involved: full-content feeds have resulted in an unprecedented level of content theft, with BC content appearing on many websites, usually spam sites, without attribution or permission. This duplicate content causes a cascading set of problems, not the least of which is that search engines generally aren't favorable to duplicate content, and don't always guess correctly. Finally, our RSS advertising partner is strongly in favor of short-content feeds. We hope that you'll continue to subscribe to BC via RSS, and when an article grabs your eye, it's only a click away, still free on the BC website. Thank you for your understanding. Administration0@blogcritics.org Sun, 26 Aug 2007 12:00:00 EDT http://blogcritics.org/archives/2004/12/19/161319.php Sydney SmithBooks have taken over our house. They're underfoot in the living room, piled up on the dining room table, and cluttering the kitchen. Not that we're all that erudite, mind you. Too many of those books are along the lines of Captain Underpants and the Big, Bad Battle of the Bionic Booger Boy for me to pretend to any high intellectual caliber on the part of my family. We're just sloppy. Part of the problem is that with a family of six, we just don't have enough bookcase space to hold all of the various books that come and go from the library. But a greater part of the problem, at least in my case, is that there rarely seems to be enough spare time to read all of them, especially the ones we buy. As a result, there are books scattered hither and yon that I 've started but have yet to finish. But there are advantages to living in a house with books scattered willy nilly, especially when those books have been chosen by someone else. It's like being in a bookstore. You can sample a little here and there from a wide variety of topics. First of all, there are the medical books that I've collected hoping to review, but haven't been able to devote the time needed to do them justice. For those who yearn for immortality, there's Fantastic Voyage : Live Long Enough to Live Forever by Ray Kurzwell, "inventor, thinker, and futurist" and Dr. Terry Grossman, director of a "leading anti-aging clinic." The book is part how-to manual and part review of things to come if anti-aging technology fulfills its promise. Suffice it to say, the state of the art isn't yet perfect. In a related vein, there's Coping With Methuselah: The Impact of Molecular Biology on Medicine and Society, a book I don't have lying around my house, but which was reviewed favorably in this week's New England Journal of Medicine, even though it was written by committee:The book is the product of the collaborative efforts of 17 scholars, including three medical scientists (Drs. William B. Schwartz, John T. Potts, and Alan M. Garber); a large team of reputable economists, most of whom are from the Brookings Institution; an ethicist, Alexander Capron, from the University of Southern California; and a journalist, Nicholas Wade, of the New York Times. To transform the diverse expert opinions into a coherent book, two meetings among the contributors were organized: a planning meeting, which was held at Stanford University in 2001, and a conference, which was held at the Brookings Institution in Washington, D.C., in 2002. In addition to these efforts to harmonize the experts' opinions, the editors have provided six of the book's seven chapters with accompanying detailed comments (which are sometimes as long as the chapters they complement). These have been written by other experts -- in most cases, former discussants and opponents at the earlier meetings -- which makes for particularly interesting and useful reading because of the diversity of opinions.Sounds wonkish, but that doesn't mean it isn't interesting.For those of us worried more about keeping pace with the present, there's Reversing Osteopenia : The Definitive Guide to Recognizing and Treating Early Bone Loss in Women of All Ages. Although it isn't at all clear that taking drugs for bone density values that are on the thin side of normal is of any value, the book has some common sense suggestions for exercise and diet that certainly can't harm.You've heard of PMS, and IBS, but have you ever heard of IMS? That's Irritable Male Syndrome, and there's a book on managing it: The Irritable Male Syndrome : Managing the Four Key Causes of Depression and Aggression. Apparently, it's causes run deeper than nagging wives and backseat drivers. Planning to treat yourself to a complete physical for the New Year? You might want to peruse Medical Tests That Can Save Your Life : 21 Tests Your Doctor Won't Order. . . Unless You Know to Ask. Most of the tests are not recommended for routine health screening, but the authors do make an attempt to help the reader decide if they are at higher than normal risk for the conditions in question. The most useful section of the book, however, may be the "how to approach the doctor" part. In the non-medical department , there's FBI Girl : How I Learned to Crack My Father's Code, a memoir of growing up in a Catholic FBI family. Then there's the fictional The Distance Between Us, a novel of love and intrigue in the Middle East, and Tearjerker, the tale of love and frustration in the publishing industry.Among the non-fictional/non-medical books I keep meaning to read are Swamp Doctor: The Diary of a Union Surgeon in the Virginia and North Carolina Marshes and The Voices of Morebath: Reformation and Rebellion in an English Village. The first is the Civil War diary of Dr. William Mervale Smith of the 85th New York Volunteer Infantry. The good doctor has a soul that is often "depressed and weighed down," as well it might be, for an upstate New Yorker transported to the swamps of the South. His entries are short on medical details, but long on complaints about the Army hierarchy and army life in general. Most interesting sampled piece so far: an appendix contains the complete written examination he had to take to become an Army surgeon, including his answers. (This question was puzzling: "Name the roots and grains from which alcoholic drinks are distilled in various parts of the world." He knew some, but not all. Left out the potato and sugar cane, but then he wasn't much of a drinker.) The second is a look at the life of an English village as reflected in the accounting books of its priest. It doesn't sound very interesting, but the story begins when the village - and its priest - were completely Catholic under Henry VIII and ends fifty-four years later completely Protestant under Elizabeth I. In between, they lost their monastery (no great loss, the parish church got the fancy windows), had to hide their valuable vestments so the Crown wouldn't take them, rebelled and lost their church bells, switched back to Catholicism during the reign of Mary and then found their Protestant inner selves again on Elizabeth's accession. Best slice so far: for some reason, the village didn't build a cucking stool for punishing women scolds until after the Reformation, even though the chairs were common in England throughout the Middle Ages. The author speculates that the absence of devotion to Mary and to Saint Sidwell, a local woman saint, eroded respect for women in the village, but perhaps women were somehow embolded by the Reformation, making the chair more of a necessity.The best books in our house belong to my husband. Washington's Crossing by David Hackett Fisher is eminently browsable and chock full of wonderful nuggets of information. The introduction alone, a lesson in the art history of the famous Washington Crossing the Delaware painting, is worth the price of the book. And the chapter on the Hessian mercenaries was absorbing, too. My husband's current bedtime reading is Napoleon After Waterloo: England and the St. Helena Decision, which confines itself to the time that Napoleon spent onboard the British warship The Bellephron awaiting his fate. Best slice so far: the lengths the Admiralty went to avoid British lawyers and advocates bent on enforcing habeus corpus for the benefit of Bonaparte. My husband's fictional reading includes two historical novels by politicians, given to him as a wry gift so he could compare their story telling abilities. One is The Hornet's Nest: A Novel of the Revolutionary War by Jimmy Carter. It doesn't have any good bits and pieces to report. It reads, well, like Jimmy Carter talks -didactic and boring. My husband, a die-hard liberal, agrees. He hasn't been able to get past the first chapter. The other book is Gettysburg: A Novel of the Civil War, by Newt Gingrich, a fantasy of Gettysburg in which the South wins. Maybe it's because Gingrich has a background in history, or maybe it's because he hired a professional writer to help him, but it's a tale told better by far than former President Carter's. And speaking of books written by politicians, here's one I have actually read and enjoyed - The Accidental Pope by Ray Flynn. Also co-written with a professional writer, it isn't great literature, but it's thought provoking. An ex-priest now a widower and fisherman with a family, ends up being elected Pope after a joke by a Cardinal gets out of hand. As so often happens when an outsider comes to town, much conflict ensues. It won't win any literary awards, but it is entertaining.Now, I can clear the books off the table to make room for Christmas dinner. Books23438@blogcritics.org Sun, 19 Dec 2004 16:13:19 EST http://blogcritics.org/archives/2004/12/11/230221.php Sydney SmithThe hardest part of doing anything is getting started. That's probably why most of us never get around to starting our own business until life kicks us in the butt. Freedom's just another word for nothing left to lose, after all. For those who are thinking of striking out on their own, but can't quite get the motivation, there's Guy Kawasaki's The Art Of The Start: The Time-Tested, Battle-Hardened Guide For Anyone Starting Anything. Kawasaki, a former Macintosh evangelist (that's market-speak for salesperson, I think) is no stranger to the techno-geeks among us. Now, he's a venture capitalist, author, and motivational speaker. And evidently, someone who is very adept at landing on his feet.Although the book is written in the typical motivational, "how-to" style of short, punchy chapters, and peppered with vague motivational platitudes, it also has it's share of practical, useful information - whether your dream is to start a tech firm or a medical practice or a cleaning service. (You can "test drive" it here.) Chapters on refining a sales pitch (keep it short and to the point), writing a business plan (ditto), giving a presentation (down to the ideal number of slides and text size) how to talk to potential investors, creating a partnership (very good advice on when to bring in the lawyers), and how to "boot-strap" (live on nearly nothing until the money starts coming in) cover all the essential bases of any start-up. I was skeptical at first, but the more I read the book, the more I wished I had it when I started my medical practice. (Instead, I had The Complete Idiot's Guide to Starting Your Own Business and a manual from the American Academy of Family Practice.) And, although those two sources had a lot of the nuts and bolts information I needed, such as how to get a tax ID, and how to decide between an S Corporation or an LLC, they lacked the motivational inspiration and people-skill advice that Kawasaki's has. I never had to worry about explaining to the bank exactly what it is my business does since everyone knows what a doctor's job description is, nor did I have to worry about marketing myself since I already had an established patient base. But I certainly could have used the tips for interviewing potential employees and for interpreting today's vague words of recommendation from former employers. And the chapter on solidfying the details of a partnership, is alone worth the price of the book. (She said as she recalled the ruins of a failed partnership.) But perhaps the best part of the book is the reminder that even though you may have never had any prior experience running a business, the world is full of corporate masters who had similarly barren backgrounds. Think Oprah Winfrey. Books23170@blogcritics.org Sat, 11 Dec 2004 23:02:21 EST http://blogcritics.org/archives/2004/11/17/083020.php Sydney SmithTelevision Medicine: Caught the season premiere of Fox's new medical drama(?) "House." The protagonist, Dr. House, is a brilliant diagnostician who hates people. The premise is that each week he and his team will solve a baffling medical mystery. It's a hybrid of Becker and the New York Times Sunday Magazine "Diagnosis" column by Lisa Sanders. The show has its entertaining moments, mostly in the dialogue:Junior Doctor: Isn't that why we became doctors, to treat patients?Dr. House: No, we became doctors to treat illness. Treating patients is what makes most doctors miserable.Unfortunately, that's the highest point of the show, which is extremely weak when it comes to medicine, and to human nature. A few minutes with Dr. House and you have to wonder why anyone would keep on staff, even if he is brilliant. Not only does he refuse to see patients, he stomps around insulting everyone and popping narcotics in plain site ("Because they're yummy," he tells a patient who's been unfortunate enough to be forced upon him by the head of the hospital.) Dr. House walks with a limp, supposedly caused by an illness that destroyed his thigh muscles. That's the only clue we have as to why he's a nasty piece of humanity. And truth to tell, you don't have to give a doctor a disability and a drug habit to explain his misanthropy - a beeper and a couple of nights on call would serve just as well. But Dr. House's personality, as bad as it is, isn't the worst of the show. The entire medical establishment he inhabits will leave viewers familiar with the realism of shows like ER largely disappointed. Dr. House is head of "department of diagnostic medicine," whatever that is. Is he an internist who concentrates on diagnosis at the expense of treatment? Evidently not. He sees children as well as adults, and he prescribes treatment, too. And the entire department seems to be composed of Dr. House and his residents or fellows or whatever. (Their relationship to the great man is fuzzy, other than that their his subordinates.)Dr. House and his team spend hours thinking over the one problem case they have. They defer diagnostic testing for other less conventional means of diagnosis such as breaking and entering. This week's case turned out to be neurocysticercosis, or tapeworm in the brain. This is certainly an uncommon ailment, and one that would require diagnostic acumen and doggedness, but the show goes over the top for drama. The case patient was allergic to the contrast that was needed for an MRI to make the diagnosis. So, instead of doing a lumbar puncture or performing lab tests that most would use in the situation to make a diagnosis, the team breaks into her house to search for clues. They find some deli ham in the refrigerator and - "bingo!" diagnosis made. Hugh Laurie does a surprisingly good job playing angry white male. It's safe to say he's put Bertie Wooster behind him for a long time. He could even have a future as movie villain. But his performance, alas, is the only good thing about the show. Video22314@blogcritics.org Wed, 17 Nov 2004 08:30:20 EST http://blogcritics.org/archives/2004/11/14/174537.php Sydney SmithWe Have Met the Enemy, and They Are Us: Dr. John Abramson is somewhat of an anomaly. For starters, he's a family physician on the faculty of Harvard Medical School - an institution not known for its warm embrace of the family medicine concept. (In its place, they have something called the Department of Ambulatory Care and Prevention, staffed largely by internists and pediatricians and masters of public health, and oddly enough, funded by an HMO.) Which brings us to his other claim to anomalism - the publication of his book, Overdosed America : The Broken Promise of American Medicine. While other academics and health policy analysts point directly to the pharmaceutical industry as the root of all evil in our current healthcare system, Dr. Abramson correctly notes that the real roots of our problems lie in our culture - from the academic and health policy system to the professional and popular cultural mileau. Now, as healthcare systems go, ours isn't too shabby. We have the luxury of taking clean water and cheap, unspoiled food for granted. We live our lives free of the threat of death by bacteria. Most of us, no matter how poor, can find a doctor to take care of us in our hour of need. We don't wait for months for CAT scans or heart surgery, or to get an appointment with a doctor. We have a medical establishment that believes strongly in the importance of practicing medicine only with scientifically proven treatments - aka "evidence-based medicine." We have third party payers who monitor the quality of care by our physicians based on guidelines written by experts in their fields. However, as Dr. Abramson points out - an awful lot of the healthcare we get isn't the worth the money we pay. If our healthcare system were a car, it would be a Jaguar - fast, expensive, and beautiful on the surface, but little to offer for the long-haul. Part of the problem is the elusive nature of this thing called health. Like happiness, it's difficult to nail down. That's why our founding fathers claimed a right to the pursuit of happiness rather than the state of happiness. If only we were so wise when it came to defining our goals for health. Today, health and disease have much broader meanings than they did fifteen years ago. Fifteen years ago, disease meant illnesses caused by a malfunctioning of the body or outside invader, such as cancer or infections; today, disease includes the normal changes of aging, such as osteoporosis and thickening waist lines. Twenty years ago, to be healthy meant to be of sound mind and body; today it means a fine obsession with various biomedical measures of the body - from cholesterol level breakdowns to bone density values. What's more, we have a pill or a procedure to treat each of those biomedical measures of health. Is your LDL cholesterol a smidgen above the recommended guidelines? We can bring it down for just over a hundred dollars a month. Is your body mass index forever over 25? We can readjust your stomach to bring it down. Even better, we have insurance companies who are willing to pay for all of this. And if they don't, we'll pressure them until they do.Dr. Abramson doesn't spare the pharmaceutical companies any criticism. Our system of drug-financed medical reasearch and medical centers, corporate-sponsored professional organizations and medical education, and consumer advertising corrupts the decision making process of doctors, patients, and expert panels. The evidence central to evidence-based medicine can't be trusted because it's financed by drug companies. The practice guidelines that expert panels such as the American Heart Association publish which are supposed to guarantee we all practice high quality medicine can't be trusted because they're funded by drug companies. But that's only part of the problem. As Dr. Abramson says at one point in his book - "we have met the enemy and they are us." The problem can be traced back to the late 1980's and early 1990's when Medicare, Medicaid, and the baby boom population reached maturity. There was much hand-wringing at the time about the "crisis in American medicine," just as there is now. Then, as now, the crisis was the cost. The solution, which enjoyed wide support from all sectors of society - from the public, the medical profession, and politicians on both sides of the aisle - was the adoption of managed care, or HMO's. The public loved it because it meant they no longer had to pay for healthcare, at least not directly. For a minimum co-pay, and the price of their monthly insurance premiums, they would get unlimited access to their doctors and all the preventive care they needed - pap smears, mammograms, immunizations, and yearly physical exams, and drugs. The medical profession loved it because they believed passionately in the power of prevention and they also believed that by providing unlimited preventive care they could conquer disease. The insurance companies loved it because it shifted the inherent risk of their business to the medical profession. Politicians loved it because it meant that once Medicare and Medicaid beneficiaries were shifted to managed care programs, someone else would make the painful and unpopular decisions about rationing that are inevitably needed to rein in costs. It was win-win all around. Except it didn't quite turn out that way. The gatekeeping nature of HMO's turned out to be immensely unpopular - so much so that the insurance companies pretty much gave up on limiting benefits, lest they be accused of corporate malfeascence. Instead, they just raised premiums. The emphasis on prevention, and the willingness to pay for it, encouraged doctors and the public to accept expanded definitions of health and disease. Doctors could promote with impunity the necessity of having bone densitometry tests or fasting lipid panels done - and the necessity of treating values outside the defined norm - without giving much scrutiny to the actual benefit. And the public could accept it without much thought, since they didn't have to pay for it directly. Add to this mix the expansion of pharmaceutical advertising directly to the patient - who no longer had to worry about the cost of the product they were consuming, and you've got a recipe for unlimited demand, and unlimited spending. (The drug industry marketing departments knew a golden opportunity when they saw it. What other product has the luxury of advertising directly to a consumer who doesn't have to pay for it?)At the same time, the shift of Medicaid and Medicare patients to managed care plans meant less money for academic medical centers, who relied on these patients for their operating revenues. To remain competitive, they turned to private industry for funding, which in most cases meant the pharmaceutical industry. This relationship skewed the inherent bias in all research even further toward the positive, and meant that the emphasis would be placed on drug development rather than non-pharmacological management of disease and disease prevention. Those same researchers end up sitting on the expert panels that then write the guidelines that are supposed to guarantee quality care. It doesn't help that medical journal editors are by and large undiscriminating in the papers they publish. They, too, have their biases, and publishing papers that show positive results is one of them. So is publishing papers that suggest a revolution in treatment - such as reducing heart disease by treating cholesterol. They don't give the data much scrutiny in the process. And they never question the spin the authors give their data. Even worse, they press release that spin to the media for direct consumption by the consumer.And so we have our current system. A paper is published that suggests taking cholesterol lowering drugs cuts the risk of heart disease by 50%. In actuality, their data find that without the drug, 2 out of 100 people have a heart attack, while with the drug, only 1 out of 100 do. Their claim to a 50% reduction in risk is technically true, but misleading. The majority of people in both categories will do fine without the drug. But the authors have chosen to concentrate on the more impressive sounding relative risk reduction rather than the absolute risk reduction. It gets them more attention that way. The medical journal, and perhaps the author's institution as well, sends a press release to the media about these stunning findings. That week, the news is full of the amazing benefits of the drug. The company makes up television and print ads touting its benefits, too. Within the week, patients are asking their doctor about the cholesterol lowering drug that works saves so many lives. And the doctors? With any luck they'll read the abstract of the paper and conclude the drug must be beneficial, without ever noting the devil in the statistical details. And even if they did, they would have trouble convincing most people of the inadequacy of the drug given all the favorable publicity it's gotten. As a result, new drugs and treatments become accepted much more quickly than they otherwise would - and with much less scrutiny than they deserve. Dr. Abramson sees the solution to our cunundrum as more government oversight of the healthcare industry. He suggests we set up an impartial body, along the lines of the Federal Reserve Board, to monitor the quality of medical research and recommendations. In addition, he suggests that there be government funded universal healthcare coverage, which would pay only for those benefits deemed worthy by the oversight board. Dr. Abramson puts too much faith in the impartiality of government bodies. Even the Federal Reserve Board comes under criticism for being entirely a creature of the finance sector. The Institute of Medicine, which he also mentions as a model, is no less subject to bias. Their report on racism, for example, was written by people whose careers depend on the presence of racism. Their personal bias was to see racism even where it doesn't exist. Similarly, their report on errors in medicine was written by people who make their living selling safety systems and consulting on error reduction. Not surprisingly, the racism panel claimed racism was rampant (later debunked) and the error panel claimed more errors than statistically reasonable. Imagine what they would do with something like drugs and therapuetics which are much more subject to lobbying influence. History tells us that there's very little reason to expect our government to be immune to industry lobbying. As we've seen with Medicare spending and NIH research funding, all it takes is a celebrity or a Congressional relative with a disease to earmark money for its treatment. They're even more prone to influence from those advocacy groups and lobbyists who have the money for campaign donations. A better solution would be to move the decision making process, especially for preventive care, back where it belongs - between a patient and his physician. The only way to do this is for the patient to share at least some of the financial responsibility for their care. As long as someone else is paying the bill, the sky will be the limit. It's just human nature. A patient who has to pay for cholesterol lowering medication is going to be much more likely to question its benefits, and the doctor who has to justify the expense to his patient it is going to be much more willing to critique the evidence. This, of course, flies in the face of all that is politically correct in medicine. But, as Dr. Abramson so ably points out in his book, we aren't really getting very much in return for all of this very costly prevention. Isn't it about time that we all took responsibility for our share of the mess?ADDENDUM: For another take on the book, click here. Books22228@blogcritics.org Sun, 14 Nov 2004 17:45:37 EST http://blogcritics.org/archives/2004/07/20/141925.php Sydney SmithWho doesn't want a flat, wash board stomach? A "six-pack" as they say. It's a hallmark of youth. Something we enjoy before time and gravity work their mischief on our bodies. No one's immune. The little pot belly is as much a hallmark of age as gray hair and wrinkles. But David Zinczenko, editor-in-chief of Men'sHealth magazine has a solution - the Abs Diet: The Six-Week Plan to Flatten Your Stomach and Keep you Lean for Life. Or maybe it's the solution of his co-writer, Ted Spiker, it's hard to tell. They both get credit for writing it, but there are a lot of personal singular pronouns sprinkled throughout the book. At any rate, the solution is this: Fat is a slug. Muscle is a furnace. Increase your muscle mass and you'll burn more calories, thus losing weight and keeping it off - especially in that fat-hording belly area. The writing is engaging and often witty (Zinczenko? Spiker?). Sentences such as "Commercial bread baking has followed the same path as Michael Jackson - the whiter it gets, the less wholesome it becomes" and "Like the mother-in-law who tries to tell you how to raise your kids, fructose screws up a system that was working perfectly fine without it." sprinkle the prose, making what has the potential to be a very dull subject almost interesting. Although no references are listed, many are mentioned to bolster the authors' nutritional claims, making it, unfortunately, impossible to check up on them. The basics of the diet are sound: eating frequent, small meals each day rather than three large meals (the better to keep the munchies at bay), avoiding the empty calories of alcohol, and allowing yourself one diet-free day each week. The rest of the diet is on shakier ground - relegating foods to "power" groups, each of which is supposed to give you certain health benefits - building muscles, promoting weight loss, strengthening bone, fighting cancer, etc. While certain foods certainly enjoy the reputation of doing these things, their influence is small. No one should count on any one type of food to save them from pathology. The other centerpiece of the diet is the ingestion of something called "smoothies," a blended drink of yogurt, peanut butter, whey, and whatever else you can think of to give it some sort of flavor (berries, bananas, etc.) The authors say they're delicious. I'll take their word for it. Do they work? They probably do provide a certain sense of fullness that helps the dieter stick with their regimen - kind of like a homemade Slimfast.But, of course, if a true six-pack abdomen is what you're looking for, diet alone won't do it. You need to exercise those muscles to make them firm and strong, and the Abs Diet has no shortage of exercises for strengthening and tightening those abdominal muscles. In fact, exercise is as key to the program as diet. And rightly so. The program calls for some sort of exercise daily, which is a sensible approach to losing weight and keeping it off. Will the diet give you a six pack in six weeks, as one of its opening chapters claims? Will it increase your "staying power"? Maybe. But it's highly doubtful that the regimen, or any regimen, will turn this into this. Time's touch is not a gentle one, nor one so easily reversed. Books17653@blogcritics.org Tue, 20 Jul 2004 14:19:25 EDT http://blogcritics.org/archives/2004/05/21/081446.php Sydney SmithWho among us has not felt the nagging pain of an aching back? Very few, if the statistics are to be believed. Back pain affects up to seventy-percent of adults in developed countries (probably more in undeveloped countries where back-breaking labor is the norm). It even beat out Bob Woodward for the coveted cover story of Newsweek recently. As common as it is, though, not all back pain is the same. It can be caused by a multitude of ills - by muscle strain, by the wearing down of the little jelly cushions between the vertebrae ( degenerative disc disease), or by spontaneous compression fractures. It can be caused by arthritis in the small joints between the vertebrae. And sometimes the fault isn't even with the back, but with internal organs whose pain signals the brain can't distinguish from the back. (This is where a doctor comes in handy, to help sort out all of these potential causes.)Most of the time, though, back pain comes and goes after we've sat too long in a funny position or worked a little too hard in the yard. And most of the time, it's a self-limited problem that requires only a tincture of time and some ibuprofen to cure it. But for a small percentage of people, that nagging back ache is a constant companion. And an irritating one at that. It's for these people that rheumatologist Harris McIlawain has written his book The Pain-Free Back : 6 Simple Steps to End Pain and Reclaim Your Active Life. The six steps are fairly basic - exercising, eating right to keep your weight down, basic back hygiene ( proper body mechanics), relaxation techniques, "healing touch" ( accupuncture, massage, physical therpay, chiropractic maniuplation, etc.), and, in an attempt to appeal to the health craze of the day - alternative medications (herbs and supplements in this case.) It's a veritable smorgasboard of back pain therapies. Much of it is very good advice for those suffering from chronic mechanical or arthritic back pain. There are exercises for strengthening and stretching worn out back muscles, which can be very effective in treating and managing chronic back pain. There are even suggestions on comfortable sexual positions (with illustrations!) There are, however, few exercises in the book designed explicitly for those who suffer from pain caused by herniated discs. That particular problem responds best to a series of flexion and extension exercises that are, unfortunately, copyrighted. The other weakness is the list of alternative medications that can be used to help relieve back pain. Although they're probably safer than knocking back several Oxycontin a day, most of them are unproven and untested. While taking an unproven medication only risks wasting your money if it's ineffective, taking an untested one risks losing your health if it turns up with unexpected side effects.The rest of the book, however, has much to offer - from what to look for and expect in a physical therapist or chiropractor to recipes for low-calorie meals. It may not cure your aching back, but it could help you live with it. Books15848@blogcritics.org Fri, 21 May 2004 08:14:46 EDT http://blogcritics.org/archives/2004/05/13/190054.php Sydney SmithWe may flatter ourselves that we think therefore we are, but in reality our lives are much more than the sum of our thoughts. Our deeds and others' perceptions of us can be just as important in shaping the totality of who we are. Such is the theme, anyways, of Wylene Dunbar's My Life with Corpses. S. Oscar, or Oz (she's from Kansas), is the only non-corpse in her immediate family. Her mother was a corpse when she was conceived (how she does not say) and her father was a corpse in the making. Her older sister was also a corpse, having succumbed to "brain fever." This makes for an odd sort of childhood - one devoid of affection or emotion, except for that to be had from animals. But even corpses are not immune to the ravages of time. One day her family rapidly decomposes, and she is forced into the emotional, messy, world of a living foster family. She's rescued by a kindly neighbor who sends her to college where she studies philosophy and soon learns that academia, and the world in general, is filled with corpses.There are corpses of all manner in this book and it's difficult to keep them all straight. There are corpses who died in accidents or from medical illnesses. There are corpses who died when they lost their dreams. There are corpses who died by turning too far inward, disappearing into their minds as it were. There are corpses who died from emotional isolation. And there are corpses who were sucked into death by the corpses around them. The really dead and the metaphorically dead walk around with equal aplomb. The parents are a prime example - are they really dead or just emotionally dead? Most often it seems the latter. They both live lives of disappointed expectations and at one point they join a fundamentalist church looking for salvation. But if the dead have no souls, which the narrator goes to great lengths to make clear early in the story, why would they be worried about salvation? In the end, this is no zombie story, but a philosophical reflection of the many ways we can die without dying. It could just as easily be titled, My Life with Depressives. But that wouldn't be as catchy. Books15663@blogcritics.org Thu, 13 May 2004 19:00:54 EDT http://blogcritics.org/archives/2004/05/10/084233.php Sydney SmithThere's a movement afoot to stop labeling those who think differently as disabled, but instead to think of them as neurally diverse:As the number of Americans with brain disorders grows, so has skepticism toward the grab bag of syndromes they are being tagged with, from A.D.D. to Asperger's to bipolar I, II or III. But in a new kind of disabilities movement, many of those who deviate from the shrinking subset of neurologically 'normal' want tolerance, not just of their diagnoses, but of their behavioral quirks. They say brain differences, like body differences, should be embraced, and argue for an acceptance of 'neurodiversity.' And as psychiatrists and neurologists uncover an ever-wider variety of brain wiring, the norm, many agree, may increasingly be deviance.'We want respect for our way of being,' said Camille Clark, an art history graduate student at the University of California at Davis who has Asperger's syndrome, a form of autism often marked by an intense interest in a single subject. 'Some of us will talk too long about washing machines or square numbers, but you don't have to hate us for it.'And we don't have to medicate their eccentricities away, either, or label them as diseased: In an effort to rein in the number of diagnoses, the American Psychiatric Association imposed a new criterion in its latest edition of the Diagnostic Statistical Manual: an individual must now suffer from "impairment" to qualify as having one of its 220 psychological disorders. "We're not adequately differentiating normal from pathological if we just use the criteria that are in the syndrome definitions," said Dr. Darrel A. Regier, director of research for the American Psychiatric Association. ...But the most humane approach, some experts argue, may lie in redefining the expanding set of syndromes as differences rather than diagnoses. "We're doing a service on the one hand by describing many more of these conditions and inviting people to understand themselves better," said Dr. Edward Hallowell, a leading authority on A.D.D. "But when we pathologize it we scare them and make them not want to have any part of it. I think of these as traits, not disorders."And that's the way we should think of them. For too long we've been labeling everything that doesn't fit a preconceived "norm" as diseased, where the definition of normal is a Lake Wobegon standard of "all the women are strong, all the men are good-looking, and all the children are above average." And where everyone thinks and feels the same.It's refreshing to see a movement to shift away from the medicalization of differences, especially when it comes to the way the brain works. For people's brains don't work the same, and it would be a very dull world if they did. Some people are visually oriented, others language oriented. Some are pattern oriented, some oriented to the abstract, and some think only in the concrete. Those who are oriented toward visual cues and language have the easiest time of it in the world socially. They understand and are understood better by society at large because our society is more visually and languisticly oriented. While those who think in terms of the abstract have a tougher time understanding others and being understood themselves.This difference in thinking is astutely portrayed in the novel The Curious Incident of the Dog in the Night-Time by Mark Haddon. The narrator is a fifteen year old autistic boy who is very comfortable in the abstract yet logical world of math but acutely uncomfortable with the more subjective, messy, emotional world of language. His teachers at school don't have to teach him how to interpret or perform complicated math problems, but they do have to teach him how to interpret other people's body language, and what is and what is not socially acceptable. Here's his explanation of what it's like to navigate a languisticly and visually oriented world with a concrete, pattern-oriented mind:I find people confusing.This is for two main reasons.The first main reason is that people do a lot of talking without using any words. Siobhan says that if you raise one eye-brow it can mean lots of different things. It can mean "I want to do sex with you" and it can also mean "I think that what you just said was very stupid."Siobhan also says that if you close your mouth and breathe out loudly through your nose, it can mean that you are relaxed, or that you are bored, or that you are angry, and it all depends on how much air comes out of your nose and how fast and what shape your mouth is when you do it and how you are sitting and what you said just before and hundreds of other things which are too complicated to work out in a few seconds.The second main reason is that people often talk using metaphors....The world metaphor means carrying something from one place to another...and it is when you describe something by using a word for something that it isn't.......I think it should be called a lie because a pig is not like a day and people do not have skeletons in their cupboards. And when I try to make a picture of the phrase in my head it just confuses me because imagining an apple in someone's eye doesn't have anything to do with liking someone a lot and it makes you forget what the person was talking about.And yet, he has an intuitive grasp of such problems as the infamous Monty Hall problem or how to tell whether or not a number is a prime number. And what's more, when he's feeling overwhelmed by the real world of language and emotion, he finds solace in solving math problems.Now, let me be frank. I am not a mathetmatically oriented person. I am much more comfortable with the world of language and visual cues than I am with the abstract world of math. When I was a little girl, trying to learn the multiplication tables made me cry. Throughout my education, whenever I came to a mathematical equation in a textbook, I would skip it. It was like a foreign language to me. I could never convert those numbers to an image I could understand. Adding more than one or two digits is still a bit of a challenge for me. But thanks to my choice of a spouse, I now live in a family that is very comfortable in the world of numbers. My kids and my husband have an intuitive grasp of things that I have to work very hard to comprehend. There are times, when they are discussing things like how to always win the game of Nim, when I feel like I'm in a foreign country. And it is those times when I think, this is what it must feel like to be mildly autistic, to live in a world that thinks and expresses itself differently than you do. But thankfully, the real world is a friendlier place for someone like me. Now, if we can just make it a little friendlier for people like these. Books15532@blogcritics.org Mon, 10 May 2004 08:42:33 EDT http://blogcritics.org/archives/2004/04/25/082904.php Sydney SmithThe Kerry campaign has told some people not to bother trying to get elected delegates for the Senator in Ohio's post-primary caucus (warning: link requires a real pain in the butt registration process):Brennan Lafferty still isn't sure what happened to him on the way to the Ohio Democratic post-primary caucus. All he knows is that one minute he was a delegate candidate and the next moment he wasn't.Lafferty, 33, of Kent was one of several people whose names were removed from the ballot April 15 to select the remaining members of the Ohio delegation to the Democratic National Convention this July in Boston."It is very disappointing... I wasn't really involved in politics before, but this time I thought I had to be,'' said Lafferty, a reporter for a local business publication.Lafferty said he received an e-mail just before the post-primary caucus informing him that he was being eliminated from consideration."The e-mail didn't give an explanation. I was later told that it was the (Sen. John) Kerry campaign that decided to have me removed,'' continued Lafferty, who said he feels "duped.''And he wasn't the only one. Another candidate worked hard to gather supporters to vote for her, only to discover on polling day that she wasn't on the ballot:Chanille Boyd, 27, a social work student at the University of Akron, didn't get her name on the delegate ballot either, despite filling out her application weeks before the April 7 deadline."I went to the Summit County Democratic headquarters to file my application,'' said Boyd, who had hoped to represent the 13th Congressional District at the Boston convention.Boyd said she later called to follow up on the status of her application and was assured everything was fine and that her name would be on the ballot."I had gotten several people together, including my mother, to vote for me at the caucus at Litchfield Middle School,'' she said. However, when she and her entourage arrived at Litchfield, she discovered her name was missing."I'm still following up, trying to find out some answers. I don't want what happened to me to happen to anyone else,'' said a disappointed Boyd.Officials of the Ohio Democratic Party aren't happy with the situation. Their spokesman told the Akron Beacon Journal that it was the Kerry campaign who struck delegates from the ballot and that the Ohio party fought for their right to remain:Our goal is to be open and inclusive. If people want to run, we are all for it,'' he said.So why is John Kerry denying people the chance to participate in the Ohio primary process?Jim Ruvolo, Kerry's Ohio campaign manager, offered a partial explanation.He said the delegate ballots were reworked in some districts to ensure that the Ohio Democratic Party's affirmative-action goals were met.He said the delegate candidate list was "pared down'' to get the required number of minorities and women.The state party has set a goal of 35 slots for African-Americans, four for Hispanics, three for Asian-Pacific Americans, 10 for lesbians and gay men and six for young Democrats (ages 18 to 35)."The goal is to have the delegation look like Ohio,'' Roeder said.Here's an idea for the Kerry campaign. Apply the same principle to themselves. Take Kerry off the ballot and replace him with Al Sharpton. Politics15074@blogcritics.org Sun, 25 Apr 2004 08:29:04 EDT http://blogcritics.org/archives/2004/04/11/213819.php Sydney SmithRomantics have long had a love affair with the noble savage. Uncorrupted by civilization, primitive man lives in utopian simplicity - in total freedom, in harmony with the earth and with a soul as good and pure as the driven snow. That love affair is alive and well in the historical romance novel, Hadrian's Wall by William Dietrich. The time is the late 300's. Christianity is in its ascendancy and Rome is in the beginning of its decline. At the farthest reach of the Empire stands Hadrian's Wall, the last defense of civilization against the marauding savages of Caledonia. It's cold, wet, and rustic at the Wall. And about as far from Rome as a Roman can get. But it's there that the young and beautiful Roman maiden, Valeria, must go to save the senate career of her father.In exchange for a cash infusion from a noble family, her father has betrothed her to a Roman officer. Not only does the officer get the fair Valeria, but he gets a preferment - the command of a fort at the most western reach of the Wall. Valeria is a dutiful Roman - anxious to do good by her family and her new husband. She's also an adventurous, head strong girl who openly embraces the wild new world to which she's sent. But all is not well at the Wall. There's intrigue among the officers and there are barbarians in the woods. Soon, Valeria finds herself north of the Wall, a captive of one of the clans. And what does she find in the wild North? Freedom and love. Ah, for a life among the savages. Dietrich has done his research. The descriptions of Roman customs and culture are done well and are accurate. But he suffers from Romantic delusions when it comes to the barbarian tribes. In the novel's world, the Picts are a free, uninhibited and democratic people. The reality is more complex. They, like the Romans, had a hierarchy. They, like the Romans, had slaves. And they, like the Romans, had good men and bad men. And they weren't above brutality, as even Mary, Queen of Scots learned oh so many centuries later.The clash between cultures is a fertile field for novelist and historian alike, and it can make for compelling reading when not distorted by romance. When two very different cultures meet, there's no shortage of drama. And when they meet in one character it's doubly compelling. Norwegian novelist Singrid Undset explored the tensions between pagan Danes and Christianity from the pagan viewpoint in her historical novel Gunnar's Daughter, without resorting to romancing the primitive. And historian John Demos tells the true and intriguing story of Puritan New Englander Eunice Williams, taken captive by Indians, never to return - by choice - in The Unredeemed Captive. (Not only did she become a savage, she became a Catholic savage. A double horror for her Puritan family.) The fictional Valeria is herself an unredeemed captive. Seduced by the otherness of her captors, (not to mention the freedom to ride a horse wherever and whenever she wants and the good looking, muscular chieftain who falls in love with her), she willingingly leaves her Roman world behind forever. The weakness of Hadrian's Wall is that nothing is given away by revealing those details. The book is set up as a mystery. The chapters alternate between interrogations of witnesses by a Roman inspector sent to the Wall to solve the mystery of the missing Valeria and flashbacks to the story of the maiden, the garrison, and the barbarians. It's an unfortunate technique, for it gives away much of the mystery before it ever gets afoot. It also leaves nothing to the imagination when it comes to the motives and actions of the characters. If the reader has any doubt about a character's goodness or villainy, one of the witnesses in an interrogation scene will shortly set him straight. And that's a pity. For it makes what could have been a page-turner an all too predictable read instead. Books14628@blogcritics.org Sun, 11 Apr 2004 21:38:19 EDT