Reviewing a book that argues a case
A review of a book built on a thesis — a polemic, a theory, a collection of essays with one argument running through them — states the argument accurately before assessing it, shows the reader how the argument runs through the book, checks the claims against evidence outside the book, and keeps the verdict on the scholarship apart from the recommendation.
The argument in the book's own terms
A 2007 review of Thomas Joiner's Why People Die by Suicide sets out the thesis in the book's own terms. Dissatisfied with the view of suicide as an act of weakness, the author puts forward that perhaps toughness, not weakness, is integral to completing it, and presents three factors that come into play when a person considers, attempts or carries out suicide: a perceived sense of burdensomeness on others, a thwarted connectedness with others, and an acquired ability to enact significant self-harm. The first two are frustrations of fundamental human needs, and the third accumulates, since repeated dangerous experiences become unthreatening and multiple attempts allow a person to work up to death as the instinct for self-preservation erodes. It reports the evidence the author cites for the first two factors, correlations between suicide rates and immigration, times of national crisis and the performance of local sports teams, and his account of how they may explain differences in suicide by race, gender and age.
Two other 2007 reviews do the same for books built on an argument. One, of a book on end-of-life decision-making, follows the author's method: a detailed account of one contested case, then the history of the medical technologies and legal cases that became the impetus for legislation on the right to die. It states the argument the author builds throughout the book, that decisions about health care should reflect the reader's wishes and that medical technology has made those decisions exceedingly complex. It gives the book's message as the book gives it, a sequence of instructions to the reader: fill out a health care power of attorney, talk with the person named as agent about Terri Schiavo and the other end-of-life stories that come up, tell the family and anyone else who might be in the room when health care decisions are made about that conversation, give copies of the document to the agent, other family members and the doctor, and then, in the book's words, "Go live." The other, of a book on hormone therapy, gives the organising claim in the authors' own words, quoting the preface on a unifying theory that hormone therapy tends to be beneficial when started early after menopause and harmful when started late, and then reports that the book goes on to delve much more deeply into the many variables that enter into the decision each woman must make.
A Winter 2015 review of Dennis Rosen's Vital Conversations: Improving Communication Between Doctors and Patients carries the book's working distinctions as well as its thesis. The author, a paediatric pulmonologist and sleep specialist, argues that physicians can heal the health care system, which the review calls expensive and wasteful, by taking the time and making the effort to understand patients' needs before prescribing treatment. The review gives his three independent but interacting unhealthy conditions — disease, a measurable physiological state such as a urinary tract infection; illness, the patient's behavioural response to a disease, such as pain or suffering; and sickness, a society's definition of an unhealthy person and of that person's roles, such as blaming a patient for having cancer — and the barriers to communication that physicians are asked to remove, which are a physician's personal bias and irrelevant heuristics, visits too brief to understand the patient's condition, a patient's denial or shame, and the undue influence of third-party payers and providers. It reports what the book asks of each side — physicians to build trust and teams by giving medical information and a meaningful context for discussing disease and treatment options, by getting the patient's buy-in, and by giving compassion, empathy, encouragement, integrity and respect; patients to control the agenda of visits, communicate with candour and own their health care, with checklists of responsibilities for both. The review closes on the outcome the book expects, a system less expensive, more efficient in producing desirable health outcomes and more appealing to physicians and patients than the present one, which the reviewer calls "something we all deserve", without testing the evidence for it.
A Fall 2018 review of Arnold R. Eiser's The Ethos of Medicine in Postmodern America: Philosophical, Cultural, and Social Considerations (Lexington Books, 2014) states the thesis in the author's own terms before judging it. It asks how postmodern American culture has contributed to growing centralised bureaucracies, falling physician morale and a changed patient–physician relationship, and reports that the author, drawing on cultural observations from leading postmodern thinkers, seeks a perspective for understanding changes in health care delivery and what can be done to improve the system. It holds that society should prioritise public discourse on the impact of what the author calls the three big C's of American medicine — consumerism, computerisation and corporatisation. He questions whether advances in computing have improved patient care as much as they have increased corporate control and profit, and argues that corporate influence and bureaucratic control through computerised performance measures and protocols have reduced clinicians' decision-making for the individual patient. He reflects on the erosion of the patient–physician relationship and the potential reduction in individualised care, both of which have occurred over the half century in which physician burnout has been rising. He holds that changes in patients' responsibilities are integral to an improved system — completing advance directives and modifying expectations to reflect realistically what current medicine can do — and the review says these changes could lead to a more responsible citizen-patient model rather than a strict consumerist one.
A Winter 2017 review of Elisabeth Rosenthal's An American Sickness: How Healthcare Became Big Business and How You Can Take It Back (Penguin Press, 2017) opens on the figures that frame a polemic's case: a Seattle mother's $44,873.90 bill for an emergency fallopian tube removal; hospital costs up 149% from 1997 to 2012 and making up 40% to 50% of a $3 trillion industry, with physicians' bills at 20% to 30%, drugs and devices at 15% and ancillary services at 20% to 30%, and insurance costs outside that total. It then gives the argument as the ten rules to which the author attributes the dysfunction of the American health care system: more treatment is always better, so default to the most expensive option; a lifetime of treatment is preferable to a cure; amenities and marketing matter more than good care; as technologies age, prices can rise rather than fall; there is no free choice: patients are stuck, and stuck buying American; more competitors vying for business does not mean better prices and can drive prices up, not down; economies of scale do not translate to lower prices, and big providers can simply demand more; there is no such thing as a fixed price; there are no standards for billing; and prices will rise to whatever the market will bear.
A Spring 2017 review of Saul J. Weiner and Alan Schwartz's Listening for What Matters: Avoiding Contextual Errors in Health Care (Oxford University Press, 2016) opens with the book's case rather than its thesis. A patient the book calls Mrs Garcia kept missing dialysis and returning to the emergency room until a resident asked why and learned that she had to care for her children, who were in a hospital far from the dialysis centre, after which her treatment was arranged at that hospital and the visits stopped. The review then states the central question: what happens to a treatment plan when a physician misses contextual clues, such as concern about finances, caring for a parent or child with medical needs, or the death of a child, that would suggest a different approach from evidence-based medicine or clinical practice standards.
A Summer 2017 review of Chris Jennings's HIV/AIDS in South Africa: The Facts and The Fiction (2012) lays out a contrarian book's argument and its evidence as the author's. It sets the question the book asks — why the predicted "African Holocaust" never came, when Africa's population had passed a billion and South Africa's had nearly doubled — and states the author's aim in his own words, to challenge misconceptions so that "resource allocations and health care interventions work to serve the benefit and not the detriment of populations in need", in a qualitative work supplementing an earlier book and built on data from more than 3,000 journals and reports. It then reports the core of the argument as his: that a 2009 United Nations figure of 5.6 million South Africans infected rested on estimates rather than on surveillance, the systematic collection, analysis and interpretation of disease data; that a United Nations estimate of 2.9 million people living with HIV in 1997 sat beside only 136,000 HIV-related deaths reported by the national statistics agency between 1997 and 2008 ("If the mean survival rate is 11 years, a lot of these people should have died by 2008"); that outside urban hospitals few testing facilities exist, so people immunocompromised by malnutrition, tuberculosis or malaria are reported as HIV cases on symptoms such as rapid weight loss and diarrhoea; and that where testing happens, highly sensitive rather than more specific assays may generate many false positives.
How the argument runs through the book
A 2008 review of Joseph V. Simone's Sustaining the Dignity and Nobility of Medical Care, a collection of essays first published in a trade paper for cancer physicians and nurses, states the argument that runs through the collection: that any attempt at meaningful health care reform must not lose sight of what the author calls the essential nobility of providing medical care. It reports the author's view that many of the challenges facing physicians have to do with ethics and money, which has been true since the practice of medicine began but seems more relevant now because more money is at stake in the medical marketplace than ever before. The essays, two to four pages each, are arranged into seven chapters covering the practice and policy of patient care, the quality of cancer care, living with dying, being a doctor, medical ethics and values, leadership in medicine, and cancer research. The review lists the questions the essays put: whether something should be done to contain medical costs and, if so, what, how and who should decide; how truthful physicians should be with their patients, especially those who are dying; what the solutions are to providing basic health care for everyone; what the best way is to assess the quality of care provided by physicians and health care organisations; and why the public has seemingly lost trust in the medical community.
The same review places the book in its moment. The book appeared while the need for health care reform was again in the US national headlines as candidates vied for the presidency, with the economic impact of the spiralling cost of medical care and the then-current figure of 47 million uninsured Americans as the terms of debate.
A Fall 2015 review of Robert L. Klitzman's study of institutional review boards, The Ethics Police? The Struggle to Make Human Research Safe, tells the reader how to read the book, in three passes: a first reading brings to light the breadth of the subject, from the views of medical and legal experts to patients' rights, organisational momentum and epidemiological impact; a second allows a deeper understanding of the boards' complexities and of issues most readers may not have considered; and a third, followed by a period of extended mulling, can help uncover some of the implications of the findings. The review opens as the author does, with his father's enrolment in a clinical trial after a cancer diagnosis, and calls the book sometimes academic in tone but relevant across many disciplines and worthy of careful study. It states the question the book asks, whose rights the boards are designed to protect, the study participants' or those of the organisations that sponsor the research, and gives the takeaway message it finds a bit startling: the opportunity to improve clinical outcomes and research with human participants lies not only in developing better technologies but also in the process by which they are tested.
The 2007 review of Why People Die by Suicide describes how the case is made. The author examines suicide from several angles — existing theories, contributing neurobiological and genetic factors, and societal patterns — and builds his argument methodically, supporting his theories with evidence from his own research, clinical anecdotes, world history, current events, the medical literature, nature and popular culture, and repeatedly tying the information back to the thesis, which the review finds at times overdone but mostly a reiteration of the main messages. The review notes that the book is referenced and indexed, which makes it a useful tool for research on suicide, and it names the author's standpoint as a survivor of his father's suicide, whose frank, compassionate voice complements the dissertation-like content.
The 2017 review of An American Sickness says how the case is built: the author applies the rules to insurance, hospitals, physicians, pharmaceutical companies, medical device companies, testing and ancillary services, contractors and consultants, research and medical conglomerates, and backs a harsh critique with historical context and numerous examples and references. The second part of the book, it reports, turns to what patients can do immediately and to systematic changes in legislation and policy.
The 2017 review of Listening for What Matters describes the evidence as well as the claim: nearly ten years of work in which unannounced standardised patients, actors going undercover, audio-recorded their visits to physicians who had been told of the study beforehand and could decline to take part, with the recordings, charts and bills analysed to see whether clues were detected and acted on; an observational study of real visits; a basic tool for judging how well physicians listen for the clues; and six characteristics of a physician who contextualises care. The finding it reports is that physicians were more likely than not to miss the clues.
The claims against evidence outside the book
A June 2014 review of Peter Gøtzsche's Deadly Medicines and Organised Crime, a critical book about the pharmaceutical industry, checks the book's headline statistic, its claim about progress against cancer and its argument about corporate law-breaking against outside evidence, and looks closely at what its reference list actually cites.
The verdict on the scholarship and the recommendation
A March 2013 review of Ben Goldacre's Bad Pharma finds the book's scholarship poor and still holds it worthy of attention, keeping the two judgements explicitly apart. It gives the book's take-home message as the reviewer reads it, that we simply cannot trust the evidence we see about the efficacy and safety of drugs in common use, aimed not only at the pharmaceutical industry but also at regulators, doctors, academic clinical researchers and ethics committees. It documents the distance between the evidence the book promises and the evidence it uses. The review's overall impression is that the author decided from the start to tell as powerful a story as possible that the whole system of drug research is flawed, rather than to follow the evidence in a scholarly manner. The recommendation is argued separately: it would be a mistake to dismiss the book as based on poor scholarship and therefore unworthy of attention, because despite the shortcomings in its use of evidence it makes some important points whose validity is not in doubt. The review names those points individually, on publication bias, on studies from the past and on the data regulators hold.
The 2014 review of the book on the industry sets out its objections in the body and then says plainly what the book is worth to a reader: the reviewer cannot think of any good reason to buy it and recommends saving the money.
The 2018 review of the book on the ethos of medicine judges it in three moves: the author's experience as a professor of medicine and researcher in medical education innovation, patient education and bioethics is relevant to the questions he poses; the subheadings and mini-summaries make each chapter's purpose clear; and although he spends more time on the problems than on potential solutions, the interdisciplinary discussion gives a solid framework, and the shift he proposes from a profit-centred to a more patient-centred system is a large collaborative undertaking worth considering by patients, health care providers and anyone working in health services research.
The verdict of the 2017 review of the book on HIV in South Africa judges the book's case and its power to persuade separately. The meticulous research and clear presentation of data make a strong case, in the review's judgement, for how misconceptions about the prevalence of HIV in South Africa are perpetuated, leading to billions of dollars being invested in HIV while pneumonia, tuberculosis, diarrhoea and malnutrition are neglected; but a mechanical style and a reliance on letting the data speak for itself, with none of the experiences of physicians, patients or policymakers, make the book less compelling and less likely to enter public discourse than it would otherwise be.
The 2017 review of the book on contextual errors reports the authors' remedies before giving a hedged verdict. Because the skills are not formally taught in medical school, the authors developed and evaluated a workshop on medical decision making for fourth-year medical students, with positive preliminary findings — the resident who questioned Mrs Garcia being one example of its success — and the model was extended to other members of the health care team; they envision audio recordings used as a source of feedback for quality improvement and hope the model will be incorporated in the medical education curriculum. Its verdict is that it is not yet certain whether health care providers agree with all the recommendations, but that people in the health care field, regulators, medical educators and patients may find the perspective interesting and informative.
A Spring 2017 review of David R. Kopacz's Re-humanizing Medicine (Ayni Books, 2013) endorses a book without testing any of its claims. It states the thesis and the structure — a reflection on dehumanised, corporatised practice in five sections, from the paradigms of contemporary practice through the principles of holistic medicine and transforming oneself to bringing holistic principles into a practice and rehumanising the culture of medicine, with the self-help sections kept succinct — and then endorses the book as nourishing the soul of practising physicians first, which, it says, may translate into more humanised treatment of patients.
The verdict of the 2017 review of An American Sickness calls the book a potential guidebook for American health care reform and closes, in the reviewer's own voice, on a call for the general public to fight the industry that has capitalised on sickness: "We must do so for our own health."