University of California Press Blog

Dangerous Pregnancies: New UC Press Podcast with Leslie Reagan

We are pleased to announce that Episode 30 of the UC Press podcast series is now available. In this episode, Chris Gondek of Heron and Crane Productions speaks with Leslie Reagan about the German measles (rubella) epidemic of the 1960s, and its lasting effects on abortion, disability rights, and politics in America. Reagan explores this story in her book Dangerous Pregnancies.

You may subscribe to the monthly podcast feed that contains the individual episodes using your RSS aggregator or directly via the iTunes store. You can listen to individual author interviews from the episodes at our podcast page. Listen to this podcast now.

Cancer Screening and Early Detection

Last week, the American Cancer Society issued a statement clarifying its position on routine cancer screening. Upholding its existing guidelines for early detection, it affirmed that many cancer screening tests are proven to save lives, but that cancer screening is not perfect: “Sometimes cancers get overlooked. Sometimes cancers get misdiagnosed. Sometimes aggressive cancers can appear even after a clear screening test. It is important to acknowledge these limitations, understand them, discuss them with your doctor, and decide what is right for you,” it said.

Cancer is complicated, and there are no simple answers--the decision to screen or not to screen depends on many factors, and ultimately lies with the individual and his or her doctor. Challenging the idea that more testing is always better, H. Gilbert Welch (pictured), a physician, researcher, and the author of Should I Be Tested for Cancer? Maybe Not and Here's Why, encourages people to approach cancer screening with a full understanding of both its advantages and its risks. In the book, he explores the issues raised by screening and early detection, including the risks of overdiagnosis and overtreatment, and presents a detailed picture of what cancer screening tests can and cannot do. In order to help improve the communication and understanding of health data, Welch and his colleagues Steven Woloshin and Lisa M. Schwartz co-authored Know Your Chances: Understanding Health Statistics, which provides readers with the tools to interpret health statistics and better understand risk.

Paul Farmer's Path to Medicine

Paul Farmer, author and co-founder of Partners in Health, appeared on a recent panel at Dartmouth College called Reflections on Leadership for Social Change, part of the inauguration ceremony for Dartmouth's new president. In this excerpt, Farmer recalls his lifelong desire to become a doctor, and how a college class in medical anthropology spurred him toward his work with Partners in Health.

Paul Farmer is author of the forthcoming Partner to the Poor. A portion of the proceeds from the sale of this book will be donated to Partners In Health.

Author Frank Huyler on Writing and Medicine

Novelist, emergency room doctor, essayist, poet — Frank Huyler is singular among writers. His second novel, Right of Thirst, was released to rave reviews this spring. UC Press has just published a new paperback edition of Huyler’s first book, the 1999 classic Blood of Strangers. We sat down with Huyler to talk about medicine, writing, and health care in America.

When Blood of Strangers was first published, narrative books on medicine were pretty rare. What interested you in the process of writing a first person account of the field?

It wasn’t calculated.  I’d written poetry pretty much exclusively when I was younger, but during my residency I realized that there were stories of great power everywhere around me.  So much medical writing is cerebral and distant, but the experiences I was having were the antithesis of that, to the point where the analytical intelligence hardly seemed to apply.  I wrote them down as I experienced them, or perhaps more accurately as I remembered them.

Do you think the popular perception of doctors has changed in the past ten years?

Well, it hasn’t gotten better.  Doctors are increasingly seen as employees, as cogs in the machine, and to a great extent we are.  It’s still a privileged profession, but it’s safe to say that it lacks the grand authority of the past. 

What do you think of the increased number of personal memoirs and reflections on medicine that have come out since The Blood of Strangers?

It’s an interesting phenomenon.  Partly it’s because of the drama inherent in the material, which television has taken full advantage of, and partly it’s because the public is both terrified and fascinated by the realities of illness and death that are so often denied or contextualized by popular culture.  Deep down we all know it’s there, these sorts of books are windows into it, and we want to look. 

Do you have any thoughts you'd like to share about health care reform, either on the small or large scale?

That’s a huge subject, but the bottom line is that our current system is immoral and appalling for a country as rich as ours.  With the exception of the very young and the very old, we have decided that health care is a commodity rather than a right, and the consequences for those at the bottom are both brutal and cruel in virtually every way.  Yet the system is also deliberately inoculated against the efficiencies that a true free market might create. 

 Your new novel Right of Thirst has just come out. How was the transition from memoir to fiction writing?

Certainly there is a difference between recounting lived experience and generating a purely imagined world, but that difference isn’t as great as one might think.  One always makes choices in what to say and how to say it.  Nonfiction is easier, in the sense that it requires less imagination, but it’s not a categorical distinction, at least for me.

Do you still collect stories from your practice?

Not formally.  But I didn’t with The Blood of Strangers, either—I simply wrote down what I remembered.  In a way that served as a filtering device: what stood out in my mind were the stories that had the greatest effect on me.

Does being a writer have any effect on your practice or perspective of being a doctor?

Writing is a means through which I try to make sense of the events I see and am part of, but I don’t think it’s helped me be a better doctor.  There’s a lot to be said for limited reflection in the clinical world, because medicine is above all else practical work.  It’s what you do that counts, not what you think. 

The Blood of Strangers is still widely read and still taught in medical schools throughout the country. What about it do you think keeps it so relevant?

It’s hard to know, of course, but I think it’s because I tried to be true to the experience, to the immediate moment, and to let the stories speak for themselves.  I tried not to get in the way, if that makes sense.  And the stories could take place anywhere, really, at any time.  So it’s not the kind of thing that easily becomes dated, or at least I hope not.  Whatever the reason, it’s great to see that it’s still being read.

Have you read anything lately that you've especially enjoyed?

I read a lot, and there are many books I enjoy.  If I had to pick a single relatively recent book it would be Austerlitz by WG Sebald, who was killed in a motor vehicle crash a few years ago. 

Danger to Self: New UC Press Podcast with Dr. Paul Linde

We are pleased to announce that Episode 28 of the UC Press podcast series is now available. In this episode, Chris Gondek of Heron and Crane Productions interviews Dr. Paul Linde, author of Danger to Self: On the Front Line with an ER Psychiatrist. Linde discusses his experience as an emergency room psychiatrist, navigating social, medical, and legal issues to connect with patients and help them heal.

You may subscribe to the monthly podcast feed that contains the individual episodes using your RSS aggregator or directly via the iTunes store. You can listen to individual author interviews from the episodes at our podcast page.
Listen to this podcast now.  

Health Care and Human Rights

Paul Farmer, author of the forthcoming Partner to the Poor, among other books, is committed to restoring health, hope, and social justice to people in the world's poorest areas. His work as a physician and co-founder of the organization Partners in Health (PIH) is rooted in the conviction that good health is not a privilege, but a basic human right that is often denied to the very poor.

To ensure this essential freedom, PIH addresses poverty as well as illness. In destitute areas from rural Haiti to Russia and Rwanda, PIH’s community-based model provides medical care, employs community health workers, and targets poverty as a main cause of poor health. By working to meet people's basic needs as well as treating the sick, this approach saves lives while improving the overall level of health and opportunity in the area.

NOW on PBS recently profiled health care in Rwanda, where PIH, the Rwandan government, and community health workers are working to restore health, vitality, and the right to a healthy life. This partnership is based in solidarity: "Whatever it takes," says the PIH vision, "Just as we would do if a member of our own family—or we ourselves—were ill."

Universal Health Insurance in Historical Context

David Blumenthal and James A. Morone's The Heart of Power: Health and Politics in the Oval Office was featured on the New York Times Book Review's front cover this Sunday. "This timely and insightful book puts President Barack Obama's quest for universal health insurance in historical context, and gives new meaning to the audacity of hope", wrote reviewer Robert Reich. Read more on the NYTBR site.

Count on Americans to Do the Right Thing

"Count on Americans to do the right thing, after they've exhausted all other possibilities."
--Winston Churchill

Watch James Morone, co-author The Heart of Power, talk health care reform on the CBS Evening News:

Watch CBS Videos Online

Attempting to Reform Health Care, Again

Rawhide is an unlikely name for someone who does any good in the world. Also known as the much-loved Ronald Reagan, the man whose Secret Service code shares a name with a New Orleans gay bar, an old Western TV series and a horse riding camp did more for health care policy than one might think.

Says who?

For starters, David Blumenthal and James A. Morone, co-authors of The Heart of Power: Health and Politics in the Oval Office. In podcast interviews with Science Friday and NewsHour, Morone, Professor and Chair of Political Science at Brown University, talks about the importance of presidential leadership in pushing through health care reform.

He explains a few things you might not know or be willing to admit. For example, while Reagan originally said Medicare represented "the end of freedom," he actually tried to expand the program while in office. And Richard Nixon himself tended to be liberal on health care. According to Morone, this stemmed from his family's tribulations with tuberculosis, which killed both his younger and older brother. Similarly, George H. W. Bush (or Timberwolf, in Secret Service terms) was "very focused on getting the prescription drug reform" through, partly because his sister died of leukemia.

What's the trend here? It would appear that, historically, it's been mostly Republican Presidents who worked to push through health care reform issues.

Democrats probably won't want to hear this, and likely not their Republican rivals either, but Richard Nixon "created what has become the democratic health care legacy" in this country today. That one simple fact makes this bickering and back-and-forth in Congress seem a little off the mark. Health care is an issue that has come up time and time again, during the presidencies of Timberwolf and his son Tumbler (Bush Junior), that of Eagle (Clinton), of Volunteer (Johnson) and now of Renegade (President Obama).

In 2008, 43.8 million people under the age of 65 were uninsured, which included 8.9% of children under the age of 18. In 2007, a third of firms did not offer health care coverage to their employees. The United States spends nearly $100 billion each year to provide health services to uninsured residents, often for diseases that are either preventable or more effectively treated at an earlier stage.

Previous presidents tackled health care reform, but rarely succeeded because what they were proposing was expensive and risky. Finger pointing and lie mongering are not going to cut it this time. If we spend money on anything today, it should be universal health coverage, where benefits far outweigh the immediate cost. That being said, Renegade needs all the public support he can muster.

Why You Should(n't) Get Screened for Cancer

On your list of activities that you need to think twice about, you probably haven't penciled in cancer screening, but a recent article in the New York Times could have you reaching for the nearest writing utensil. The title of Natasha Singer's article, In Push for Cancer Screening, Limited Benefits, pretty much says it all.

Exploring why national campaigns promoting regular screenings for numerous types of cancer do not necessarily benefit the general public, she notes that such screenings have not actually been "proven to reduce the death toll from cancer for people without specific symptoms or risk factors."

Citing the "Check your neck" campaign intended to raise awareness about thyroid cancer, Singer quotes Steven Woloshin, who co-authored Know Your Chances: Understanding Health Statistics with H. Gilbert Welch. Because it kills an estimated 1,600 Americans each year, Woloshin argues that thyroid cancer is actually a rare disease about which few people should worry.

Before co-writing Know Your Chances, Welch published a book of his own, entitled Should I be Tested for Cancer?: Maybe Not and Here's Why."

In an April op ed piece for the Los Angeles Times, he takes on prostate cancer screening, arguing against the popular misconception that regular screenings benefit the population as a whole. He cites the fact that this phenomenon leads to more diagnosed cases of smaller or slow-growing cancers that don't pose the same threat as the prostate cancer behind 3% of deaths for men. This means that patients go through unnecessary treatment for what the author labels "pseudodisease", thereby suffering such side effects as urinary incontinence and impotence.

Not exactly a walk in the park.

Both articles reference the recently published results destined to clarify the effectiveness of two large, randomized prostate cancer screenings. Since one study is European and the other American, and they contradict one another -- the Europeans found that regular prostate cancer screenings saves lives while the Americans didn't (see video below for details). So, the only thing anyone can be sure about is that nothing is sure, though the European study estimates that, for every life saved through screening, there are 50 men undergoing unnecessary treatment.

Welch doesn't take a stand on either side of the issue and instead asks that people talk to their doctor about regular cancer screening, in order to get the whole story. He explores this and other issues in Should I Be Tested for Cancer?; a particularly eye-opening chapter explains how to understand cancer statistics and, along the way, attacks the validity of the numbers behind the “five-year survival rate”.