I accumulated some books I found interesting over the last several months, knowing I would eventually take time off on vacation and have a chance to delve into them more than my schedule normally allows.
This has become a tradition, and one that I’ve enjoyed, including the books reviewed in 2023 (The Cancer Letter, Aug. 11, 2023).
While spending a week in Europe this summer, there was less time to sit for very long with a book in places like Rome, nor would my family take kindly to my missing planned activities with them.
We went to a couple of nice Italian restaurants while briefly in Rome, one on the evening of our arrival near the water, called Antico Traiano, where the service was amazing and the pasta, pizza, and seafood were out of this world. I would recommend Corte Al Bigio Chianti Classico 2020 red wine. After dinner, we walked by the water and enjoyed a beautiful sunset among locals and tourists.
The Hilton Garden Inn at Rome’s airport is a good place to stay due to the convenience and great staff. They have a free shuttle from the airport. The next day we stopped by La Fraschetta Romanesca near Vatican City for lunch, as recommended by our driver, Maurizio Giovanelli. Maurizio has a sense of humor and told us about his family when he joined us for lunch. We had been to the Vatican in the past but not inside St. Peter’s Basilica.
We had a great tour guide named Lorenzo Di Salvo, who told us many stories over a couple of hours about Michelangelo and Bernini, centuries of history, art, floors, ceilings, statues of many popes, and their burial places, including the place where the bones of St. Peter are located.
Lorenzo shared many interesting tidbits, including how Italians feel about and are protective of the precious contents of the Basilica, the personalities and the politics of some popes with some kings, and evolution of how the church raised money through forgiveness of sins. One such opportunity will occur at the 2025 Jubilee, an event years in planning with many millions of visitors expected.
The current Pope, we understood, takes time off in July when we were there visiting, is not in great health, and, in any event, doesn’t meet with groups of visitors on Saturdays (only on Wednesdays with prior arrangements). But we were able to get a blessing for my disabled daughter Jennifer.
Overall, visiting St. Peter’s Basilica is highly recommended as a bucket list item, and we may return in the future with better planning to get her another blessing, maybe even from the Pope himself.
The books reviewed are:
- The Pattern Seekers: How Autism Drives Human Invention, by Simon Baron-Cohen
- On Call: A Doctor’s Journey in Public Service, by Anthony Fauci, MD
- When Women Ruled the World: Six Queens of Egypt, by Kara Cooney
- The Surrender Experiment: My Journey into Life’s Perfection, by Michael A. Singer
- The Structure of Scientific Revolutions, by Thomas S. Kuhn
- Accidental Medical Discoveries: How Tenacity and Pure Dumb Luck Changed the World, by Robert W. Winters, MD
- Henrietta Lacks: The Untold Story, by Ron Lacks
- How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, by Otis Webb Brawley, MD and Paul Goldberg
The Pattern Seekers: How Autism Drives Human Invention
A book I was eager to learn more about is Simon Baron-Cohen’s “The Pattern Seekers: How Autism Drives Human Invention,” published in 2023. The book came to my attention when the editor of Science magazine, Holden Thorp, earlier in 2024 shared a bit about his journey with cognitive diversity.
As the book starts out, a young boy named Al, who was late in beginning to talk by the age of four, had a habit of asking for clarifications and frequently asking “why.”
I immediately realized this as a trait that I have and one that, when I was in college, presented some challenges, because during that time college professors were not to be questioned about the unknown so much, as it would reveal their limitations. Unless I thoroughly understood how something worked and why it worked, there was often a block to learning, remembering, and applying what came more easily to others.
Al would go on to be homeschooled, where he excelled in many ways to “pursue his passion for seeking patterns in the world.” Al was a true genius who taught himself physics and Morse code that he used to make money at the age of 16 when he left home. He would experiment at night, learning how machines work, building his own to transmit Morse code.
Another child named Jonah, whose mother was worried because she was told by her pediatrician that the “late talkers… are more spatial, more musical, more mathematical—they love patterns.” When Jonah eventually started talking, “he was pointing to classify objects, for himself” very precisely, such as “This is a porcini mushroom.”
The book features the lives of gifted individuals in different centuries, their successes (won’t spoil it here) as well as their challenges, including social difficulties and obsessions. Of interest to the author (an autism researcher) is the origin of inventiveness and its links to autism. He puts forth a theory that suggests certain genes that are involved in autism may promote inventiveness through “if-and-then” patterns after having curiosity and asking “why” or “how” questions.
However, he comes back to the “playful curiosity” of a child that is in all humans.
The book offers a glimpse into thought processes such as the “systemizing mechanism” in all our brains and how this can lead to invention and discovery. When we apply “if-and-then” rules, we understand a system better with observation, experimentation, and modeling. This is why some who are gifted are super good at building mental spreadsheets.
The reader learns about different types of brains, some good at systemizing, and some better at empathy, while others are “balanced,” and yet others are more at extremes. It was interesting to learn that most people are not Type B (balanced), that there are similarities between “hyper-systemizers” and those with autism, and that “systemizing and empathizing can be a zero-sum game,” with biological factors including sex differences.
Who knew that prenatal exposure to testosterone increases systemizing and reduces empathy? Or that autistic people who record information well are hyper-systemizers with hypermnesia and make up for challenges with cognitive empathy by having intact affective empathy.
Who knew that prenatal exposure to testosterone increases systemizing and reduces empathy? Or that autistic people who record information well are hyper-systemizers with hypermnesia and make up for challenges with cognitive empathy by having intact affective empathy.
They are upset by other people’s suffering and try to figure out how to help them. Another way to think about hyper-systemizers is that they are perfectionists, something many in STEM fields can relate to.
The book walks through human evolution and how the systemizing mechanism may have led to key inventions and advances in history perhaps coinciding with a cognitive revolution as a result of genetic change.
Psychologists and others will appreciate chapters comparing humans, apes, and chimpanzees, including use of tools, understanding causality, and how humans came to invent so much. The book speaks about neurodiversity and where the next Thomas Edison or Elon Musk may come from, and how employers need to understand that when they conduct job interviews, those with autism have challenges.
It remains unclear how the autistic talents and learning disabilities relate to each other and there are speculations about why there is much anxiety and OCD among those with autism. But with the limitations, there is also hope for the future to be made by those with autistic traits.
On Call: A Doctor’s Journey in Public Service
I have never met Dr. Fauci, nor have I been in the same auditorium to hear him speak. But I’ve respected him for decades as the leader of his field and longtime editor of “Harrison’s Principles of Internal Medicine,” and I do recall the AIDS epidemic well, as a medical student in Miami in the early 1980s.
He was a world authority on the topic at the time, along with Dr. Margaret Fischl in Miami and Dr. Richard Chaisson in San Francisco (he was later my attending when I saw patients on the AIDS ward at Johns Hopkins during medical residency in the late ’80s).
I have heard Dr. Robert Gallo, who studied the AIDS virus years ago, give a keynote while I was in medical school in Miami. Anyone who went to medical school in the early 1980s, especially in cities where HIV was common—in hospitals in New York, San Francisco, or Miami—knows well what seeing young men actively dying from severe immune suppression and opportunistic infections in the lungs, brain, and elsewhere looks like, not to mention Kaposi sarcoma, lymphoma, diarrhea, and dementia.
Early in my career, I considered working on HIV research but decided to pursue cancer instead. Having just gone through (hopefully the worst part) the COVID-19 pandemic and having Dr. Fauci still there as the expert authority for guidance to the world, I looked forward to reading the book “On Call: A Doctor’s Journey in Public Service,” by Anthony Fauci, MD, published in 2024.
There has been controversy about the origins of SARS-COV-2, the role of NIH in funding “gain-of-function” research in Wuhan, and how both Dr. Fauci and past NIH Director Francis Collins have endured the controversies that evolved since early 2020.
So, I wanted to see what Dr. Fauci was saying, firsthand.
The book begins with a preface that mentions how Dr. Fauci received a call sometime in 2020 from Albert Bourla, CEO of Pfizer, who shared the results of a phase III trial of the Pfizer COVID-19 vaccine that revealed 90% efficacy, much better than was expected. This was the realization of the hope that would turn the tide on the COVID-19 pandemic. I was personally incredibly relieved and fortunate to get the first vaccination in December of 2020 as a medical professional.
In his autobiography, Dr. Fauci goes on to describe his journey from his birth on Christmas Eve in 1940 in Brooklyn, NY.
The reader learns about Dr. Fauci’s childhood as a second-generation Italian American growing up in a close-knit neighborhood, and the early impact of the nuns at Our Lady of Guadalupe had on his path to the very competitive Regis High School in Manhattan, and to the College of the Holy Cross in Worcester, MA.
We learn about his love of basketball, his days as a point guard (as much as he loved basketball, it was not in the cards given his height), who first called him Tony, his love of the humanities, his summer activities, including as a member of a union of laborers in New York (and how one time he was asked to leave an auditorium at Cornell he would later return to).
Using a broom handle to play stickball on the street in Brooklyn where you were considered a wimp if you didn’t hit the ball a distance of two manhole covers reminded me of my own childhood in Brooklyn three decades later, near Kings County Hospital, where my dad worked, and some of the rough, poor neighborhoods like Bedford-Stuyvesant—and the movie “The Lords of Flatbush.”
I begged my parents to move to Queens because I was terrified to go to the high school featured in that movie. In those days, they talked tough about playing frisbee with the manhole covers in Brooklyn.
Dr. Fauci walks us through his path in medical school at Cornell, his love of medicine, his mother’s diagnosis with advanced cancer in the liver that took her life within eight weeks when he was in his fourth year, his decision to stay at Cornell for residency as first in his class, and his path to NIH, where the first question he was asked by Dr. Sheldon “Shelly” Wolff was whether he liked soft shell crabs. He arrived at NIH as a result of his choice to serve in the United States Public Health Service during the Vietnam War.
It was fascinating for me to read about how Dr. Fauci, who had become interested in infectious disease that could be cured, studied immunology with Dr. Wolff (who also became his friend and best man). In particular, he studied Wegener’s granulomatosis, and he used drugs like Cytoxan and steroids at doses to suppress overactive immune systems and inflammation.
This happened within an environment where the very same drugs were being used to treat malignancies at NCI two floors above, and, in that same environment, physicians-scientists like Dr. Fauci could study clinical specimens from the patients they were treating a few yards away on the wards of the clinical center at the NIH.
I saw textbook examples of Wegener’s granulomatosis, as it was referred to then, at Johns Hopkins Hospital, including the triad of nasal sinus, lung, and kidney inflammation with associated bleeding, where, during the late 1980s, sick patients were being given low dose Cytoxan plus steroids by rheumatologists. This disease is well-known by internists with cognitive skills.
At that time, Johns Hopkins was very strong academically in rheumatology, and there were also plenty of great private docs in the community. Later on in my career, after oncology training, I came to realize that low-dose oral Cytoxan was something doctors can give more easily than high-dose chemotherapy, and it was much less scary.
During residency, while looking from the perspective of rheumatology in the late ’80s, giving Cytoxan was much more mysterious and required much more knowledge or skill than that of a resident, especially because dangerous chemotherapy pills could be taken at home, where side effects could also occur. It was hard for me, early in training in the late 1980s, to picture how such things could be managed for an outpatient from the perspective of inpatient medicine where bad things happen, the current world of hospitalists.
I loved reading about Dr. Fauci’s decision to remain at the NIH as a senior investigator to achieve a “multiplier effect” through a combined career of medicine and research. He worked out a deal with Shelly Wolff to return to Cornell for a year as chief resident, which years earlier was on his mind and would have opened doors for a career in clinical practice.
By 1981, Dr. Fauci saw the first reports of opportunistic infections initially in gay men in San Francisco and New York, but later elsewhere, including female IV drug users and other heterosexual transmissions of a new disease we now know as AIDS.
He describes his thought processes about what this could have been and his decision to change career path in some ways, possibly due to fate, as he was both an immunologist and infectious disease specialist. He also spoke of early skepticism by others of his choice.
During the 1980s, Dr. Fauci cared for hundreds of patients with AIDS at the NIH and describes the ravages of the disease he and his colleagues there and elsewhere helplessly observed and its impact on physicians on the front lines as akin to PTSD. Dr. Fauci shares stories of evolution of his research as the HIV virus was discovered, his personal life including how he first met his wife of nearly 40 years, Christine, who is a nurse, running marathons, and his rise to lead the NIAID.
It was great to read about his non-negotiable conditions that made him the first to continue doing research and seeing patients in such a leadership position of great impact, and the youngest to assume such a position at the time.
Between his friendship with then-Vice President George H. W. Bush and Sen. Edward M. Kennedy (D-MA), Dr. Fauci, since the 1980s, had the respect and highest access in government across party lines.
There are some good lessons to learn from Dr. Fauci from the days when he became director of NIAID, such as taking the time to learn about the institute locally and broadly, recognizing parts that were “sleepy” or “lacking in a palpable sense of urgency,” the art of “budget-busting lite” and doing things like advocating for doubling AIDS research funding with Congress, and succeeding at doing things no one had done before.
Other lessons included staying in touch with what was happening at the epicenter of the epidemic, for example, by visiting Greenwich Village, a place he knew very well, and seeing the devastation of very ill people walking the streets, often with spots on their faces from Kaposi sarcoma.
Lessons in leadership included his efforts to create a national research focus on a single disease and to advocate for more and more funding despite pushback by some. Dr. Fauci recounts his first meeting with Dr. C. Everett “Chick” Koop, another Brooklyn boy, who was referred to him as a patient and who became U.S. Surgeon General.
Their 30-year personal and professional friendship—and impact Dr. Koop had through his report on AIDS and efforts to raise awareness—are described, as are chapters on AIDS research, impact of AIDS on colleagues, AIDS activism, and his meeting with Vice President George H. W. Bush in 1987.
I enjoyed reading about advice Dr. Fauci received, such as when your advice is sought and you tell the truth, those seeking the advice may not want to hear what you have to say, and you may never be invited back, for example, to the White House. He was advised not to “fall into that trap” of sugar-coating information to avoid the “shooting the messenger” outcome.
Between his friendship with then-Vice President George H. W. Bush and Sen. Edward M. Kennedy (D-MA), Dr. Fauci, since the 1980s, had the respect and highest access in government across party lines. He was offered the NIH director job by the first President Bush and turned it down, because he said he could serve better doing what he was already doing. This earned him even more respect from the president.
Dr. Fauci describes the experiences with developing a vaccine against HIV dating back to 1987 and the many challenges and mysteries that were encountered. This is certainly interesting reading!
He recounts having to explain to President Clinton what some of the difficulties were and how it might help to have a Vaccine Research Center at the NIH. President Clinton made it happen while he was in office within two years, but the AIDS vaccine remained elusive. And, of course, other progress was made with protease inhibitors so that AIDS is no longer a death sentence. Global AIDS relief would become a priority.
Dr. Fauci recounts in vivid detail his presence in New York on the day of the Sept. 11, 2001 attacks, and his return to Washington, DC. He was needed to take part in plans to respond to bioterrorism threats including anthrax threats that would surface in ensuing months and kill a number of people around the country, and threats of other unknown attacks and worries about smallpox.
Then, there was SARS and Project BioShield that was authorized to spend $6 billion over 10 years. Dr. Fauci was invited to the White House during the Obama administration at a time of threat from H5N1, H1N1, and need for vaccine preparedness, but also on people’s minds were risks for Guillain-Barre with vaccines. There are chapters about Ebola and Zika before we get to COVID-19, “a disease like none other,” that was being discussed at the White House by Jan. 2020.
Dr. Fauci was recognized by President Trump because he heard about him from Lou Dobbs (who died recently) but had also met him once before. That conversation was about “identification, isolation, and contact tracing.” It was recognized quickly that a vaccine would be needed. It was interesting to read that Dr. Drew Weissman was mentored by Dr. Fauci in his NIAID lab from 1991-1997. The sequence of the virus was available by Jan. 10, 2020, and efforts were underway at NIAID to create a vaccine and there were parallel efforts at Moderna, Pfizer, and BioNTech.
Dr. Fauci recounts a night he was called by President Trump after 10 p.m. and how he indicated the importance of not underplaying the seriousness of COVID-19, and how the president the next day at a rally referred to the “new hoax.” This was before COVID-19 hit Italy in Feb. 2020. He recounts a visit by President Trump to the vaccine center at NIH and explains why early on he didn’t recommend masks to avoid a stampede on masks due to lack of availability. As the seriousness and reality of the pandemic set in, Dr. Fauci describes the atmosphere at the White House that was hostile to the press and the president’s desire to latch on to any possible solution, such as hydroxychloroquine, that Dr. Fauci said did not work.
Dr. Fauci stuck to who he was as a physician and longtime editor of “Harrison’s Principles of Internal Medicine” in contradicting the White House. He recounts how he then became a target.
He kept a brutal schedule and remained amicable with the president. He describes the famous press briefing that he did not personally attend where the bleach disinfectant was talked about. The president chose to not wear a mask, and the vice president didn’t wear a mask when he visited NIH.
Dr. Fauci recounts his complex relationship with the president who also wanted to “be good” with him. The president did get angry at Dr. Fauci when the latter suggested to JAMA by June that vaccine immunity would wear off and boosters would be needed. The chapter “He Loves Me, He Loves Me Not” goes on and on with the ongoing drama that readers of the book can read as the months went by in 2020. Joe Biden took office on Jan. 21, 2021, as Dr. Fauci was “straddling parallel universes,” and while some things changed, he has had unpleasant congressional hearings and has had to deal with ongoing accusations.
On one topic Dr. Fauci states clearly: “The smear campaign soon boiled over into conspiracy theories. One of the most appalling examples of this was the allegation, without a shred of evidence, that an NIAID grant to the Eco-Health Alliance (EHA) with a sub-grant to the Wuhan Institute of Virology (WIV) in China funded research that caused the COVID pandemic.”
But he also states, “As it stands, the origin of SARS-CoV-2 remains uncertain, and there are still heated discussions over whether it was the result of a ‘lab leak’ or was a natural spillover from an animal reservoir to humans…That is why, as I have often stated publicly, we must keep an open mind to the origin of COVID, as I do…Keeping an open mind about both possibilities does not mean that one cannot have an opinion.”
In the epilogue, Dr. Fauci states that “my story is about what it means to devote one’s life to public service.”
When Women Ruled the World: Six Queens of Egypt
During my time away this summer on the Mediterranean, while not too far from Egypt, I saw a post on Facebook with a striking image of an Egyptian pharaoh named Ramesses II (or Ramses II) taken with a local Bedouin standing by for perspective on the size of the statue.
The post referred to the giant foot as a giant step which immediately reminded me of a certain giant leap for mankind.
I posted to X (formerly Twitter), “The huge statue of Ramesses II in Luxor, Egypt, shows what may be an original giant step for mankind? This giant step preceded the small step representing the giant leap for mankind that came later.” Ramesses II was an impactful pharaoh, and it has been debated whether he was the pharaoh during the time of Moses and Exodus.
In any event, this piqued my curiosity, and while searching for “Ramses and Moses,” I quite unexpectedly came across an interesting phone interview of Kara Cooney from Dec. 2018, by Simon Worrall entitled “The truth behind Egypt’s female pharaohs and their power.” I hadn’t read the book yet, but I was interested to see what I could learn from the interview about the remarkable women who ruled Egypt.
There was savagery “that makes the sopranos seem like lambs,” and a somewhat disappointing theme that the female rulers were parts of conservative dynasties to maintain rule over centuries when there were no male heirs. However, some female rulers were truly great, although again Cooney reiterates “these women in ancient Egypt were serving a patriarchy,” and changed their identity as, for example, Nefertiti, who “had herself renamed and was no longer depicted in that feminine way.” She does bring out something about the Egyptian queens that “The Egyptians knew that women ruled differently, that they weren’t warlords or rapists, they weren’t going to throttle you in the night. Not that they’re not capable of murder. But fewer women commit violent crimes today and we should assume that it was the same in the ancient world.”
In Kara Cooney’s book “When Women Ruled the World: Six Queens of Egypt,” published in 2018, Merneith, Neferusobek, Hatshepsut, Nefertiti, Tawosret, and Cleopatra ruled as heads of state in different dynasties at different times during a 3000-year period BC. The author states: “In the long run, ancient Egypt was no less cruel and oppressive to women than every other complex society on Earth—but, here, they snatched the gift away after graciously bestowing it. So even ancient Egypt—the only state that consistently allowed female rule—suffered a woman leader only when it had to, expunging her from the eyes of her people as soon as possible.” It is clear these women ascended to power “through political consensus” and were elevated “to the top precisely because a woman doesn’t usually resort to military conquest and fractious aggression.”
They weren’t all peaceful. The author does acknowledge “the Egyptians were light-years ahead of us in their trust of female power.” The author published the book at a time when she had been teaching a class on women and power in the ancient world for years where there was a focus on “gender disparity,” and at a time when the topic came into public discourse much more, including in politics in America. The role of women in power in Egypt’s history of continuity of the blood-line within different dynasties minimized “political threat,” given the close family relationships involved, as a preferable solution versus a male uncle of an “underage nephew-king.”
It is interesting that during the first dynasty around 3000 BC, a “chosen King’s Brothers may have been considered so hazardous to the succession that they were killed in a ritualized and sacred setting.” Some women also posed a threat if their son wasn’t the chosen one, and so some were sacrificial victims, although there are other explanations where they were needed in the king’s afterlife. As many of the victims were known to a new king, “The first day of a kingship in Dynasty 1 was characterized not by joyous celebration, but by deep grief and loss… When the king died, hundreds went with him.”
This brutality and ritual is described to the reader as it was practiced in the early dynasties, such as the time of Merneith who “probably ruled six to eight years for her young son, until he reached the age of about 16 or 17.” Her tomb was discovered in 1900 and is described along with some of the detective work to figure out her status as a queen. Her tomb itself was a display of her power and likely she co-reigned with her son after he became king. But her name was no longer mentioned on lists of kings from a few reigns later.
A twist in the logic appears because some of the female rulers had no heirs and were the last of a dynasty but were allowed to rule for reasons that are discussed, including in the manner in which they ruled as differently from men who might have “scorched earth policies.” Some of this has to do with “fervent religious beliefs” that “a king was actually divine on body and soul.” Another issue that comes out is “perplexing” to the author that any dynasty would have no male heirs given the harem structure and “sacred duty.”
I am not sure how the author concludes “a few of the kings in Egypt’s history had little interest in women and wanted to sleep with men instead” given that this was “always unwritten, mind you.” It is also unclear why suddenly with a young king, “the king’s seed might be infertile,” although incestuous relationships are documented in ancient history and this could have such effects, even while preserving wealth and power within a royal family. It is speculative and based on knowing human nature that “hasn’t changed much in the last 4,000 years.”
The author portrays Egyptian dynasties as clinging to inbreeding to keep power while risking sterility for a 3,000-year period. Malformed bones, cleft palates, large heads, club feet and “intellectual deficiencies” have apparently been noted among offspring of kings’ sisters. The reader learns that “Tutankhamun, with his own clubfoot and DNA showing incestuous origins, represents such systemic choices. The two stillborn fetuses found in Tutankhamun’s tomb are evidence of what happens.” The book highlights inbreeding and “royal incest.”
I will interject here that, for over a decade, I have had issues with mummies being excavated and analyzed as they never gave informed consent. One could argue that we are learning about important human history but one could also argue that history and some secrets of an ancient civilization should remain buried or at least have some safeguards in place. I also suspect Egypt is not unique in such a history of royal incest and there are royal families that remain in the world today and have for hundreds of years. There are also other ancient civilizations with dynasties.
Modern politics is woven in the book in places describing how “authoritarian regimes thrive on placement of family members in positions of power,” with reference to “Trump’s base” and “Howard Stern radio interviews in which Trump openly discusses the sexual attractiveness of his own daughter.”
An important point the book makes is that a family dynasty was more than continuing a blood-line, but also “it was about continuing a balance between elites; continuing the economy of trade, mining, and agricultural check and balances; continuing the pact between the gods and men; continuing the divine kingship itself.” Other references to modern politics include “Still, a woman in power must masculinize more than her dress,” with Hillary Clinton in 2016 getting “the message to de-feminize her speaking style,” and that this phenomenon is not new given the history of Neferusobek as Egypt’s first female king.
Hatshepsut broke some rules by acting as “regent for a boy who was not her son,” and extended her power for over two decades as the longest ruling female leader of Egypt. To her credit she is remembered as having “left Egypt better off than she’d found it,” even if later in history some who followed her tried to erase her to take their own credit. During her tenure and before and despite her “path breaking and glass-ceiling busting,” she supported “Egypt’s patriarchal system.”
It is clear that rituals of selecting the next king are shrouded in mystery to this day, but it’s also evident that money and influence by the elite was at play (as well as benefit to elites from a given outcome).
Reading this book, at some level, I was looking for wisdom from the female rulers in terms of what made them successful or how and why they were better and what can be learned for the benefit of today’s world. What I realized I was learning was how rulers such as Hatshepsut maintained power for as long as she did as a king’s daughter with connections, as one who surrounded herself with those whose ambitions could serve her interests, by figuring out how to get the elites to compete with each other often in similar roles in her government, and through a “veil of ideology.”
These tactics made her unstoppable at the time along with erasing the boy-king who was bedside her, who was not her son. She succeeded with no bloodshed. She was so powerful that we don’t have personal information on her and there was “no place for any political competitors to disseminate human details to discredit her.” She tried to have her daughter Nefrure succeed her, but it was unclear if she ever did, given the circumstances that are described.
In the long-term, she “lost economic and political influence…to keep it in the short-term” by “selling posts for influence and support.” But “she had control of the money,” and built many temples.
The author describes other modern examples of men taking credit for women’s ideas, including the story of James Watson, Francis Crick, and Rosalind Franklin.
In the rest of the book, the lives and rules of the remaining female rulers are described.
The chapter about Cleopatra is particularly interesting in that her rule took place many hundreds of years after the prior female ruler, but she built upon the achievements of those who came before her. She was of Greek origin. Unlike others, there are texts from Cleopatra herself and much about her from Roman politicians, in some cases described as “propaganda.” She was very ambitious and managed to achieve “succession via her own children, as a man would.”
Reading this book, at some level, I was looking for wisdom from the female rulers in terms of what made them successful or how and why they were better and what can be learned for the benefit of today’s world.
The title of her chapter is “Cleopatra: Drama Queen.” But a flavor of her tenure includes “Ptolemaic life was one of persistent PTSD. There were duplicitous alliances, blades slipped between the ribs, and extensive poison lore, reaching, and level of domestic chemical warfare,” and “Such an existence must have been soul-destroying. Brother killed sister. Wife worked against husband. Father executed daughter. And, all the while, these family members were inbred in a self-protective system of royal incest to keep outside competition from coming into the family. To be a Ptolemy was a difficult and dangerous thing.”
The relationship of Antony and Cleopatra is laid out as are the politics between Rome and Egypt, self-serving human nature and inevitable challenges of world domination.
In the epilogue, the author deals with some stereotypes of men and women and some of the lessons learned from when women ruled the world.
We had an amazing tour guide while visiting Ephesus named Selin Usun. Her late father was one of the original tour guides in Turkey and her family now has many tour guides. In Turkey, tour guides attend tour guide school and learn many things so that, for example, when they take tourists to see carpets being made, they already know how carpets are made.
Selin is well-spoken, educated, and may have a future as diplomat or ambassador. When she learned that I am a physician and oncologist, she took extra attention to point out relics of interest. Selin pointed out the caduceus symbol on a stone with its two snakes often used as a symbol in medicine but also showed us Hermes with a staff on his left hand with intertwined snakes.
Hermes’s caduceus in mythology came to be when he threw his staff at two snakes that were fighting, and the snakes wrapped around the staff and so it symbolizes peaceful resolution. The two snakes of the caduceus in Ephesus are not to be confused with the rod of Asclepius that has one snake. Asclepius is an ancient Greek god of healing and medicine. We saw a headless statue of Alexandros, and Selin told us he discovered malaria and used eucalyptus to treat it.
Selin spoke about hygiene and told us that medicine is all about the dose—what could be a poison can also be a cure. She had some great stories about a Turkish coffee tradition when a groom and his family goes to meet his bride and her family, he is offered Turkish coffee with salt instead of sugar to gauge his character. She spoke about the Amazon female society of Turkey, religion, Turkish food, and mentioned that Turkey’s name was officially changed recently to Türkiye because the Turkish people didn’t like the name Turkey that is like the bird eaten on Thanksgiving.
The Surrender Experiment: My Journey into Life’s Perfection”
“The Surrender Experiment: My Journey into Life’s Perfection,” by Michael A. Singer, published in 2015. I had no idea what this book was about before I started reading it. The author of “The Surrender Experiment” begins with an interesting premise: if life can manifest the DNA molecule on its own, not to mention create the human brain, how is it that we feel that we have to control everything on our own?
He goes on and proposes the basis for an amazing experiment to test the question whether it’s better to fight reality to make things his way or to let go and serve the forces of reality that managed to create the entire perfection of the universe. He would pursue exerting free will within the forces existing around him and says that he did this for 40 years leading to surprisingly powerful results.
At some level, it felt like a laissez-faire notion and one that is at odds with the medical profession, not to mention goals of building programs and centers within the university. In our professional endeavors, the goals are purposeful and not to be left to chance by the forces around us. We strive to prolong life and to build excellence with specific goals and metrics.
So, with that in mind, I proceeded to read the book to at least understand how this may lead to inner peace and maybe some appreciation of his perspective and how to apply it or maybe realize it’s not necessarily at odds with what I just said.
At the age of 22, the author counts a subtle yet transformational event in his life, where he found himself in an awkward moment of silence and suddenly changed his perspective on the situation, such that he was more of an observer. He made a joke about the person inside his head, telling him what to say. As I read what the author was saying, referring to an inner awakening, I couldn’t help but think, “Who is this guy with voices inside his head speaking to him?”
It turns out the guy was hearing voices and trying to figure out if others had similar experiences, but people just gave him strange looks, and he was also really interested in getting the voices to stop. He was also saying that he thought if he mastered a foreign language that the voices would speak to him in that language and if he understood what the voices were saying, without expending effort on translation, then it meant that he had mastered the language. But I couldn’t understand what would cause the voices to speak inside this author’s head in a different language.
A friend of his in his doctoral program gave him a book entitled “Three Pillars of Zen,” by Philip Kapleau, about Zen Buddhism. Even though he was brought up Jewish, by the time he got to college, he was not religious.
When he started reading the book he realized that this was what he was looking for, a way of “quieting the mind.” The book directed him to meditate, which he started doing on his own by following what the book said to do. Then, he started hearing another voice about “what is beyond” him as during meditation he reached another state of mind. The state was peaceful and one that he wanted to remain in or at least have it coexist with other things he needed to be doing while maintaining the inner peace.
Michael Singer’s life began to change as his new being started to have issues such as his wife deciding to leave him. “In place of a married man with a defined career path, my thoughts started to envision myself as a meditator who was seeking a deeper truth.”
When summertime came, he decided to travel to Mexico without a plan and found a spot above some hills with glorious views where he stayed for weeks. He had been warned about safety, but then experienced an act of kindness with an 8-year-old boy bringing some milk to the American on top of the hill. He spoke about how he “followed the flow” and could see the “experiences as a gift from life.” Another experience on his way back “left an indelible impression on my mind to stop letting that scared person run my life.”
I particularly enjoyed reading a chapter entitled “Unexpected Inspiration” about when he went back to Gainesville to attend graduate school in economics and was on the verge of deciding to drop out of school and was feeling unmotivated. The economics department chair was like a father figure who encouraged him to get through his coursework, but he was missing classes and tried to negotiate with one of his professors to base his grade on his final term paper and other exams.
He describes how he wrote the paper by freeing himself from pressure, avoiding the library, and just allowing his creativity and logic to take over. I found his inspiration to be inspiring!
The author of ‘The Surrender Experiment’ begins with an interesting premise: if life can manifest the DNA molecule on its own, not to mention create the human brain, how is it that we feel that we have to control everything on our own?
As I read on, I found myself thinking about the transcendentalist Henry David Thoreau, who spent time at Walden Pond, owned by Ralph Waldo Emerson. I learned about them in high school while growing up in south Florida attending Coral Gables Senior High, and I always remember the quote by Emerson: “to be great is to be misunderstood.”
Michael Singer and his friends built a house in 1971 where he would look forward to meditating. The house would become his “temple,” his ”monastery,” and he “vowed to use it well.” He would get another book, “Autobiography of a Yogi,” by Paramahansa Yogananda, and would realize “I had merely stuck my toe into the ocean Yogananda was swimming in,” and that he “had gone far beyond” his “beyond.”
The book goes on with the “experiment of a lifetime” where he lets “life take charge,” and the great opportunities that came his way in academia!
Letting go had many rewards. He published his thesis that sells on Amazon. He became known as a Buddhist and started a group he would lead in a north Florida prison. Chapters about a temple, chakra, and ashram would follow along with more growth in his life in his path to running a $300 million computer software company and launching the Medical Manager, a corporation that would become publicly traded and have a relationship with WebMD.
The book definitely has unexpected directions and some surprises that await the reader.
The Structure of Scientific Revolutions
“The Structure of Scientific Revolutions,” by Thomas S. Kuhn, published initially in 2012 as the 50th anniversary edition. I love reading a book that starts with these three sentences: “Great books are rare. This is one. Read it and you will see.”
The first edition of this book was written in 1962. Physics was where the action was at the time. 1962 was also the year of the Nobel prize for the double helix and the structure of hemoglobin.
In the preface the word structure, which appears in the title, is highlighted because revolutions have structure. In the structure of scientific revolutions, not surprisingly there is an existing paradigm, and then there are anomalies that ultimately lead to the establishment of a new paradigm. An interesting idea is one of “incommensurability,” which during a paradigm shift, the “ideas in assertions cannot be strictly compared to the old ones.” Another idea that is brought out is that “progress in science is not a simple line leading to the truth,” but rather “progress away from less adequate conceptions of, and interactions with, the world.”
I was reading these words while on vacation at Elia Beach in Mykonos as I was trying a drink called the Moscow mule, made of vodka, lemon juice, green apple, and ginger beer. Definitely a great drink and fitting, as the Cold War is no more—and it was in Greece that mathematical postulates were transformed to proofs, as the author points out.
There have been many scientific revolutions over the centuries, and some are recounted including those of Immanuel Kant, Max Planck, and Albert Einstein. A comment was made about American society and how many things that are incremental are sometimes referred to as revolutionary. This is also the case in biomedical science. The book has a rather long introductory essay, followed by a preface and an introduction before setting the stage for the chapters that I am still reading.
Accidental Medical Discoveries: How Tenacity and Pure Dumb Luck Changed the World
As a scientist, I’ve learned that we learn much from unexpected results. I’m never disappointed in seeing results that counter expectations or challenge preconceived notions. After all, the scientific method involves building on existing knowledge, generating new hypotheses, and trying to disprove them.
As such, I was eager to see what the book by Robert W. Winters, entitled “Accidental Medical Discoveries: How Tenacity and Pure Dumb Luck Changed the World,” published in 2016, had to say. The author shares that he became interested in the history of medicine as a first-year medical student at Yale University School of Medicine, where he mentioned the story of Mrs. Anne Miller, wife of the athletics director at Yale, whose life in 1942 was saved through Professor John Fulton obtaining some precious newly available, but in limited amounts, penicillin. The book and Dr. Winters’s interest is in the role serendipity played in medical discovery.
It was interesting to read that Charles Darwin in the early 1800s witnessed two surgeries before anesthesia in a chapter about Fanny Burney, who had agonizing breast surgery to remove a tumor causing pain and inflammation. The vivid description of agony highlights the endured horror at the time including scraping the knife against the breastbone.
Experience with nitrous oxide, aka laughing gas, went the way of circuses and shows where people inhaled the gas. An accident onstage at a show enlightened a dentist named Horace Wells that the gas could be used in tooth extractions. Wells went to MGH to demonstrate the power of the gas, but it didn’t go well.
I had read about this story before and visited the Ether Dome at MGH (with the Interurban Clinical Club) where, after the mishaps in front of skeptical doctors, “sulfuric ether” or “sweet vitriol” also came into use. I recall that the Ether Dome is high up in a building at MGH because it was meant to be isolated in early days of surgery without anesthetics (so that those below would hear less of the screams of patients).
The book mentions some fun-loving people (including some physicians) who took part in “ether frolics” or parties with ether and nitrous oxide for what in modern times is referred to as “recreational uses.” Pain-free operations were being conducted in the 1840s as a result of the accidental discoveries.
There was some academic drama with a Boston dentist named William T.G. Morton who “claimed the spotlight” with use of ether after the failed nitrous oxide demonstrations he had arranged 18 months earlier. “Morton was not only a bold dentist, but he was also a gifted publicist and a sly businessman.”
After a demonstration of ether use in a 24-minute operation in the Ether Dome, the course of surgical practice changed worldwide. Patent disputes and their resolution and more drama for recognition await the reader including a bill “in 1854 in the U.S. Congress that promised a $100,000 prize to the discoverer of anesthesia, if one could be determined.”
Chloric ether or chloroform came later as a less volatile sweet-smelling anesthetic that was used in childbirth, but it carried risks. Then, cocaine came—“Freud’s Favorite”—but it, like morphine, was addictive.
Freud’s collaborator Carl Koller discovered the anesthetic properties of a 2% cocaine solution in the eye of a guinea pig, a discovery that would impact eye surgery by the 1880s. “While cocaine’s popularity increased, Koller’s did not. Koller was certainly famous, but being Jewish and working in the hotbed of antisemitism of Vienna, he encountered widespread hostility.” Koller moved to Mount Sinai in New York in 1888 and was later honored back in Vienna in 1930.
Other examples of accidental discoveries are provided.
The discovery by H.J. Almquist of vitamin K in chickens fed a sardine meal that developed hemorrhages that were prevented by Alfalfa is interesting to read. His paper, submitted to Science, was rejected because a conflicting paper on the cause of hemorrhages was submitted by his colleagues from the same department at Berkeley!
Almquist’s paper was eventually published in Nature, “but left Almquist in second place for claiming priority of the discovery of a new vitamin and a potential candidate for the Nobel Prize (awarded to Dam in 1943).
Also interesting is the discovery of warfarin that “began with a bleeding cow” in Wisconsin. “Sweet Clover Disease” or “bleeding disease” motivated veterinarians to track down the cause to sweet clover hay the cows were fed and that caused their fatal bleeding. The chapter has good stories about Karl Paul Link as an “outspoken iconoclast” and his co-worker Arnold Stahmann, who pursued number 42 of the analogues that was patented as warfarin. Stories about credit would come out after Link’s death.
It is interesting reading about smallpox, and that “infected the human race about 10,000 years ago, probably in Egypt. The mummified head of the Egyptian pharaoh Ramses V bears the pockmarks of smallpox.” We learn about Dr. Edward Jenner, who knew about the protective effects against smallpox by prior infection of a milder cowpox in milkmaids and who inoculated an 8-year-old with pustule fluid from cowpox, and later inoculated the child with live smallpox virus! He had difficulty getting others to follow-up or to even publish his work in a reputable journal. He ended up publishing his observations in a book in 1798 that described the first time a disease had been prevented.
Early in my career, I had previously heard of vaccinia virus which is the cowpox virus, and the inoculation that came to be known as vaccination. But there was opposition in part due to deviations from Jenner’s protocol, resulting in serious side effects. Jenner had personal tragedies, losing family members to tuberculosis. By 1980, smallpox was eradicated, although there may be stockpiles of the virus at CDC and in Russia.
I’m never disappointed in seeing results that counter expectations or challenge preconceived notions. After all, the scientific method involves building on existing knowledge, generating new hypotheses, and trying to disprove them.
A detailed accounting of the observations in 1928 of Alexander Fleming, the discoverer of penicillin, awaits the reader in a chapter about “the crucial role of weather.” The discovery occurred as Merlin Pryce, Fleming’s colleague, was decontaminating some plates. “As the plates in the stack were slowly sinking in the bath, Pryce noticed that the top one, still above the level of the bath, contained a white fluffy mold, around which was a clear zone where the bacteria had been killed.” There was a mold lab one floor below Fleming’s lab.
Interestingly, while Fleming, a trained physician, published his observations, he didn’t recognize the value for patients, and the publication was later picked up on at Oxford University by Ernst Chain and Howard Florey. The first animal experiments and human use are described and will be enjoyed by the reader.
There is also an amazing story about the first use of penicillin to treat a close friend of Fleming who had streptococcal meningitis. Fleming, Chain, and Florey won the Nobel Prize in 1945. Other discoveries are described with some common themes of chance disputes that arose and Nobel Prizes that were won.
There is a chapter about peptic ulcers that describes observations by Dr. Robin Warren at the Royal Perth Hospital in Australia that ultimately led to a Nobel Prize.
Dr. Warren died on July 23, 2024 in Perth.
Warren and his collaborator Dr. Barry Marshall described the bacteria they isolated as the cause of chronic gastritis and peptic ulcer disease. The chapter has interesting reading for gastroenterologists; the discovery and natural history of Helicobacter pylori infection, a similar illness in children, described by Sir William Osler in 1910;those interested in the serendipity; and also those in opposition to pharma that was making billions on H2 receptor antagonists.
There are a number of chapters about heart drugs, tranquilizers, thorazine, lithium, vitamins, insulin, Viagra, and even x-rays. A takeaway is to keep an open mind, as you never really know where the next breakthrough discovery will come from.
Henrietta Lacks: The Untold Story
I had previously read Rebecca Skloot’s “The Immortal Life of Henrietta Lacks,” and so, I wanted to read the book by Ron Lacks, the oldest grandson of Henrietta Lacks: “Henrietta Lacks: The Untold Story,” published in 2020.
Ron talks about why he wrote the book, and starts by saying something about Rebecca Skloot as the “woman who exploited my family for her own gain.”
Well, I wasn’t expecting to read that, and so, now, I looked forward even more to reading this book.
Ron also recalls hearing a comment made on national television (Baltimore’s WJZ) by Gayle King, calling his deceased aunt Deborah (the family calls her Dale) “crazy,” which touched a nerve with him. Dale was Henrietta Lacks’s daughter. Ron says he wanted to “clear the record” about his family as “not some poor, uneducated, black family in need of pity or saving.”
He gives examples of portrayals and exploitations of his distant family members, and distortions of the truth that necessitated his corrective action through this book, because “it matters a lot.” “So, I will tell this story. I’m not worried about whose feelings get hurt or who doesn’t like what I have to say. This is about truth and reclaiming the Lacks family legacy.”
We learn that Henrietta Lacks’s white great-grandfather owned a plantation in Clover, VA, in an area called Lackstown. Henrietta worked in tobacco farms and had her first child Lawrence (Ron’s father) at the age of 14. In the 1920s, it wasn’t uncommon for cousins to marry, and Ron takes issue with Rebecca Skloot’s portrayal of his family as ignorant, “evil and incestuous.”
Lawrence grew up living with his mother Henrietta, and was the only one of her children who knew about her life before moving to Baltimore when she was 21. There are memories of horseback riding, swimming, cookouts, and fishing in rural Virginia.
Ron heard from his father about Henrietta’s knowledge of the stars and constellations, from fond memories sitting by a fire pit looking at the stars and telling stories among Lacks family members. Ron never heard anything bad about the white side of the family that owned a lot of land and mentioned that “Henrietta’s white grandfather left them a nice piece of land to farm and raise their family.”
Henrietta married at the age of 20, moved to Baltimore with her husband Day who worked with Bethlehem Steel, and they lived in a house in Turner Station (now known as Dundalk), “a thriving community” of Black middle-class families. Ron is proud of his family that were only two generations out of slavery and resents Rebecca Skloot’s portrayal. Henrietta is remembered as a fun-loving classy lady who went to nightclubs to dance and “to see entertainers like Billie Holiday and Cab Calloway.”
After her fourth child was born, Henrietta developed cervical cancer, diagnosed at Johns Hopkins in 1951 when she was 31. Ron recounts some stories he got from his father, Henrietta’s oldest son, about the times she was getting treated at Johns Hopkins. The family felt like second-class citizens, sometimes waiting in their car until she was done with her treatment.
At the time, Johns Hopkins did not have a good reputation with the Black community, and there were major issues with mistrust of doctors and what they did. They were suspicious of why Henrietta was getting so much attention. It is recalled that on the day she died, a biologist named George Otto Gey went on national television with a vial of cells called HeLa claiming that cancer can now be studied because now they had cells, something he couldn’t do for 20 years before.
Ron recalls visiting Lackstown during his childhood and how many houses were seen on a dirt road where different family members lived. He mentions a misrepresentation by Rebecca Skloot that Henrietta couldn’t write, saying “I feel that is a racist, stereotypical lie,” as “she even wrote in cursive.” He recounts family history in Baltimore and vacations in Virginia emphasizing there was neither poverty nor racism in his upbringing.
Henrietta’s family found out about her immortal cells 24 years after her death. They were never told over the years, even though they went to Johns Hopkins for care. They also couldn’t get information from the hospital, according to Ron, who is troubled because Rebecca Skloot was able to get information. He remembers family members including him (at age 16) being interviewed about his grandmother’s cells by Rolling Stone magazine, but he only understood the significance when he read the article after it was published.
Ron mentions blood samples being taken from family members, but they didn’t understand why, and didn’t believe it had anything to do with seeing if family members were at risk for the cancer Henrietta had, as they took samples from males and she had cervical cancer. Ron brings up the false portrayal of his mother in Skloot’s book and also the movie as a “hateful, bitter woman.” He does admit 50 pages into the book that Skloot got something right in her book about some things that happened after Henrietta’s death, with her youngest children being sent to live with their cousins where they were abused.
In a chapter entitled “Who’s the Real Snake,” Ron gets into issues asserting that Skloot is the real villain who made millions while Henrietta Lacks’ family got nothing. There are more trust issues, mention of incorrect diagnosis by unlicensed doctors, questions about whether Johns Hopkins made money off the HeLa cells which they have denied.
He thinks there was a coverup of “murder,” and that Skloot was part of it while others who were trying to help the family who were Black were distanced. Ron gets into the dynamic between Skloot and the Lacks family including his aunt Dale. He portrays Skloot as caring only about the money, being manipulative, and refusing to remove inaccuracies from her book and excluding other things. He mentions family photos that were taken and published without permission, including the cover of Skloot’s book that is “all over the internet.”
The family says they never got their photos back as they were promised. And he repeats in several places in the book about how Rebecca Skloot divided his family, taking advantage of some for credibility. HBO offered little money for “consulting” by family members before the movie, and many didn’t sign the company’s contract.
Ron met Oprah, who owned rights to Skloot’s book, but says he didn’t get the chance to tell her many things that he wrote about in his book. The HBO contract had terms where the family felt they couldn’t talk about Henrietta’s story and could not speak out against the HBO story, so they refused to sign. Ron says he feels like Oprah “was duped by Rebecca Skloot too,” and didn’t like how she and Gayle King disrespected his aunt Dale on national television.
There is little doubt that Henrietta Lacks’s cells have had great impact on the world including contributing to six Nobel Prizes. This book adds the perspectives of those closest to Henrietta in her family, and makes the points it set out to do.
Speaking engagements became contentious after Skloot’s book and the HBO movie, with further division among family members and resentment for how things were being controlled. Some of that press brought out that the family didn’t make money or get royalties from the book or the movie. Henrietta Lacks’s genome was also published without consent, something that led to an “NIH deal” at a time when the family was divided and where Ron says his father’s wishes as the eldest son of Henrietta were not honored.
The family is also not happy about how Rebecca Skloot controls the Henrietta Lacks Foundation that she started, including that “the process of getting help from the foundation is really degrading.” Ron states, “it was so humiliating and frustrating that I ended up calling the foundation to ask them why we have to beg for help from her when she has profited so much from my family.” The family started its own Henrietta Lacks Foundation but lost control of it, possibly due to Henrietta’s son showing signs of dementia.
There is little doubt that Henrietta Lacks’s cells have had great impact on the world including contributing to six Nobel Prizes. This book adds the perspectives of those closest to Henrietta in her family, and makes the points it set out to do.
How We Do Harm: A Doctor Breaks Ranks About Being Sick in America
I wanted to get back to reading the book by Dr. Otis Webb Brawley with Paul Goldberg titled “How We Do Harm: A Doctor Breaks Ranks About Being Sick in America,” published in 2011, as I had started to read it early during the COVID-19 pandemic, but then became distracted.
I particularly recall a graphic description by Dr. Brawley of healthcare disparities with late diagnosis as the book starts with a chapter entitled “Chief Complaint” and starts with: “She walks through the emergency-room doors sometime in the early morning. In a plastic bag, she carries an object wrapped in a moist towel.”
This occurred at Grady Memorial Hospital in Atlanta where the actual “chief complaint” in the medical record read: “My breast has fallen off. Can you reattach it?”
This chapter is available on the Cancer History Project.
Dr. Brawley wrote this book during his tenure as chief medical and scientific officer at the American Cancer Society. He was also the founding director at Grady’s cancer center. I had the privilege and honor of interacting with him as an American Cancer Society Research Professor when I served on the ACS Council of Extramural Grants back in 2015-18, and have continued to admire him as a leader in our field and an opinionated original thinker who sticks to his beliefs.
Dr. Brawley describes Grady as “a monument to racism…shaped like a capital letter H,” where “in the 1950s and ’60s, white patients were wheeled into the front section, which faces the city. Blacks went to the back of the H.” That building, according to Dr. Brawley, replaced an older, even more segregated situation of two buildings known as “the Gradys.” The hospital takes care of the sickest, poorest, uninsured, the “cops and firemen,” and the loyal “small contingent… older black folks with insurance” who only go there for their care.
The hospital’s ER, built on the first floor in time for the 1996 Atlanta Olympics, was where the injured went after the bombing, according to Dr. Brawley. He reminds the reader that “Tuskegee is about two hours away from here,” as “a huge, flashing CAUTION sign in the consciousness of Southern black folks. It explains why they don’t trust doctors much and why good docs such as Tammie have to fight so hard to earn their elementary trust.”
Dr. Brawley describes his encounter with the patient and her “automastectomy,” this one being different, having brought in the detached breast for reattachment. The problem we learn has gone on for years (nine years to be precise). The doctor, who surmises the disease must be widely disseminated and “feels a wave of frustration and anger,” lets his colleagues step up “to awaken…compassion,” as he sees “In the case of Edna Riggs, the abstract, scholarly term health disparities acquires a very real smell of a rotting breast.”
We learn about Edna’s insurance problems, difficulties with sick leave, and her fear of dying and of “the system.”
“Would the doctors scold her? Would they experiment on her? Would they give her drugs that caused nausea, vomiting, hair loss? Would the hospital kill her?” And she lost her health insurance (and her family’s) during those years when her employer required expensive co-pays.
Of course, insurance matters, as Dr. Brawley points out, as far as patient outcomes, especially when disease is detected and treated early. Lack of insurance contributes to cancer mortality each year in the US according to ACS and Dr. Brawley. Equally sad, “uninsured patients cannot afford pain medicines. The social programs that give them medication heavily ration pain meds,” and “even if you have health insurance that will pay for your treatment, you may still not be able to afford to receive it.”
The injustice is palpable, as some women choose mastectomy over lumpectomy plus radiation to avoid losing their jobs.
The reader, including expert oncologists, will appreciate the depth of analysis of differences in triple negative breast cancer between white and Black women with consideration of many biological and societal factors. I like these quotes from Dr. Brawley: “My friend Samuel Broder, when he was the director of the National Cancer Institute, used to say that poverty is a carcinogen,” and “If you are a caring doctor, you realize she is just fifty-three, with kids and folks who love her, and your motivation is akin to a philosophy of Wayne Gretsky: ‘You miss every shot you don’t take.’”
A chapter on “Brawleyism” gives us a glimpse into Dr. Brawley’s roots, including his great-great-grandfather Edward McKnight Brawley, who was a Baptist minister and president of Selma University, and Edward’s son Benjamin, who “became one of the premier black intellectuals of his generation,” and “was the dean of Morehouse and later the chairman of the English Department at Howard.”
Otis’s form of Brawleyism is grounded in science, and after long observation he concludes, “no incident of failure in American medicine should be dismissed as an aberration. Failure is the system, and those of us who are not yet its victims are at high risk of being sucked into its turbines.”
And as far as a healthcare system, with some claiming it’s the best in the world, Dr. Brawley differs in pointing out life expectancy, infant mortality rates, homicides, and accidents that are preventable. Ability to pay is a decisive factor in outcomes, as Dr. Brawley states, “In the back rooms of American medicine, the analysis of the patient’s financial durability has a glib name: a wallet biopsy,” resulting in denials of health care to over 50 million Americans at the time of the publication of the book.
But he also points out that “wealth can increase your risk of getting lousy care.”
I have personally seen that repeatedly in my own career.
Dr. Brawley advocates for a “rational system of healthcare” to cut waste, fraud, and abuse and to get away from “instead of using these interventions to benefit patients, we use them to maximize revenues, and often harm patients.”
He is critical of “evidence-based guidelines…that are anything but evidence-based guidelines.”
“Instead, the purpose of many of these documents is to protect the specialties’ financial stake in the system.” He mentions something important perhaps as a solution: “Proponents of science as a foundation for health care have not come together to form a grassroots movement, and until this happens, all of us will have to live with a system built on pseudoscience, greed, myths, lies, fraud, and looking the other way.”
Dr. Brawley asks the question: “Now I wonder, can all of us benefit from a dose of skepticism? Can the healthcare system make itself trustworthy, become accessible and driven by science?”
In chapters about “Cadillac Care” and “Skepticism,” Dr. Brawley describes experiences in care where the well-off may not be so well-off. This comes through loud and clear with what happened with bone marrow transplantation for breast cancer that was tested and practiced in the 1990s but not after the 1999 ASCO plenary session.
Dr. Brawley writes about a special patient of his named Helen Williams, who received a bone marrow transplant at a time when it was experimental and had complications that contributed to large medical bills. Helen would later find out and understand that she was not informed about the chances of cure based on available knowledge at the time.
The reader, including expert oncologists, will appreciate the depth of analysis of differences in triple negative breast cancer between white and Black women with consideration of many biological and societal factors.
I took care of many patients with auto-BMT as a clinical fellow at Johns Hopkins in the early 90s. I don’t recall if they were all participating in clinical trials, but would assume they were. According to Dr. Brawley, “at least twenty-three thousand women underwent the procedure outside clinical trials. Some estimates are much higher—thirty-five thousand to forty thousand. Meanwhile, only a small number of American women—fewer than fifteen hundred—received this treatment in randomized clinical trials.”
We also learn about Dr. Brawley’s life growing up in Detroit, how his parents tried to make ends meet, how he had understood much by the age of five, his respect for the nuns at his Catholic school, and how at one point he wanted to become a bishop.
And we appreciate his sense of humor when he says, “What do 5-FU and Otis Brawley have in common?” You’ll have to read the book to get that answer, because Otis is not a thymidylate synthase inhibitor.
I particularly enjoyed, as a colorectal cancer oncologist, the case with stage IIIB and Dr. Brawley’s interaction with his patient and his fellow on the results of the MOSAIC trial leading to use of FOLFOX as standard adjuvant therapy in colorectal cancer, the Mayo Clinic and Roswell Park regimens of administering 5-FU, and Forrest Gump. You’ll have to read about that, too.
It is amusing to read Dr. Brawley’s analysis of the motivation of a private practice doctor in Atlanta as “a puzzling combination of laziness and greed.” One may wish to add ignorance, which he brings in later as “Doctors who don’t know what they don’t know—and don’t care—are dangerous.”
One thing I took away from Part I of the book is that Dr. Brawley brought out the best in serving at a charity hospital in the field of oncology and the excellent care provided that helped patients, Black and white alike. It is clear he enjoyed his work as an attending physician at Grady.
“How We Do Harm” is exemplified in a chapter called “Red Juice” that exposes failure in medicine with approval of drugs like Procrit and Aranesp to boost red blood cell counts, how companies marketed drugs to treat “cancer fatigue” through direct-to-consumer ads, and how such practices led to added costs and actual harm.
The chapter mentions Brian Leyland-Jones after writing in The Lancet Oncology that he “was urging his colleagues to disregard the evidence and go by his opinion instead.”
At the time, FDA was taking notice that erythropoietin may promote tumor growth “largely because the agency’s head of oncology, Richard Pazdur, is a natural skeptic who concluded that the studies pointed to overuse of these drugs, and their potential dangers.”
Dr. Brawley served on ODAC and shares his experience at the meeting in the chapter on “Tumor Promotion,” where he referred to a drug that stimulates cancer growth as a “tumor fertilizer” and asked, “What data do you have to assure me that this is not Miracle-Gro for cancer?” The chapters are interesting and have much more, including how analysts hang out, looking for hints that can impact stock prices. The FDA added restrictions, thanks to Dr. Brawley, patients, and patient-advocates.
There are several chapters that share stories from Dr. Brawley’s residency, a time when he enjoyed the ER and saw much that is wrong with American health care. “The House of God”makes a cameo appearance here, too, and brings back memories that most physicians who trained in the late 80s would relate to.
The intersection of ER care and hospital medicine care with oncology by someone who went into oncology is also interesting and fun to read, and his mastery and compassion with terminal cancer come through with “death in this case is not a failure of the system.”
But he is also human and experiences what many doctors experience in difficult situations. The issues faced in the 1980s are still faced today—only the costs are much higher. The harm he focuses on in the chapter “Saving Mr. Huzjak” is one from futile treatment all the way through the chapter “God is Calling.”
Besides unraveling “how we do harm,” Dr. Brawley provides life experiences in medicine, including the wisdom of others, such as his teachers and mentors, how he ended up at the NCI for fellowship training, and his experiences there, including a front row view of “the war on cancer.” He reminds the reader about the NCI director’s authority to inform the president of what is needed in that war through a “Bypass Budget.”
It was interesting to read what Dr. Brawley had to say about what was going on at NCI in the mid-80s, including research on HIV and how NCI influenced how the AIDS-associated lymphoma and Kaposi’s sarcoma were treated. He also shared how different training in oncology is at the NCI as far as seeing and treating common cancers versus rare cancers.
In describing practices by Emil “J” Freireich on the leukemia ward at NCI giving platelet transfusions for the first time, he says, “this was 1955. The concept of ‘informed consent’ did not fully enter medicine until years later.” A history of oncology drug development is there for the reader to enjoy along with how prevention was viewed by some, and ethics and safeguards in phase I studies.
One other thing I’ll mention is reading this book reminded me of having written about the Gordian Knot (The Cancer Letter, Aug. 5, 2022).
There are numerous other examples in the book of harms inflicted upon patients for the interested reader, along with other experiences Dr. Brawley shares with remarkable lifelong recall with amazing detail to make the point.
There are many lessons, insights, and much wisdom.
