A formulaic, if impassioned, Rx by the executive director of the Association of American Physicians and Surgeons, whose answer to runaway medical costs and uneven care is to put patients, not health care managers, back in the driver's seat. Jane M. Orient is an LMD, a local medical doctor, who practices internal medicine in Tucson, Ariz. Her irreverence towards the establishment is implicit in her definition of an LMD, ``a term of derision used by significant persons such as full professors to refer to doctors in the world outside the academy. The term connotes a bumbler or hick who somehow got an M.D. degree.'' Orient takes money only from patients, not from third- party payers. Because she's chosen to be independent from managed care networks, she is increasingly a ``superfluous woman,'' i.e. her medical opinion doesn't count. Orient compares the state of American medicine to that of an overmedicated patient, one suffering toxic effects from drugs prescribed to regulate conditions that were best left alone. Her answer is decentralization. ``Medicine,'' she argues, ``is based on the doctor-patient relationship founded on the Hippocratic Oath—not on an administrative flowchart. Remember, you can fire your doctor if you like. You can't fire your bureaucrat.'' Orient reviews the pros and cons of the British, Canadian, and German health care systems, as well as the AMA's practice guidelines, and concludes that a free market is the best alternative and the one that does the least harm. In a final chapter called ``Getting It Right,'' she issues her own plan: (1) restore insurance, as opposed to a system of managed care, (2) decrease government regulation, and (3) encourage charity to the poor. A conservative argument against increasing government regulation and bureaucratization of American medicine in the tradition of such free-market thinkers as Milton Friedman.
Pub Date: May 22, 1994
ISBN: 0-517-59011-5
Page Count: 288
Publisher: Crown
Review Posted Online: May 19, 2010
Kirkus Reviews Issue: March 15, 1994
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
PERSPECTIVES
Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.
“Quality of life means more than just consumption”: Two MIT economists urge that a smarter, more politically aware economics be brought to bear on social issues.
It’s no secret, write Banerjee and Duflo (co-authors: Poor Economics: A Radical Rethinking of the Way To Fight Global Poverty, 2011), that “we seem to have fallen on hard times.” Immigration, trade, inequality, and taxation problems present themselves daily, and they seem to be intractable. Economics can be put to use in figuring out these big-issue questions. Data can be adduced, for example, to answer the question of whether immigration tends to suppress wages. The answer: “There is no evidence low-skilled migration to rich countries drives wage and employment down for the natives.” In fact, it opens up opportunities for those natives by freeing them to look for better work. The problem becomes thornier when it comes to the matter of free trade; as the authors observe, “left-behind people live in left-behind places,” which explains why regional poverty descended on Appalachia when so many manufacturing jobs left for China in the age of globalism, leaving behind not just left-behind people but also people ripe for exploitation by nationalist politicians. The authors add, interestingly, that the same thing occurred in parts of Germany, Spain, and Norway that fell victim to the “China shock.” In what they call a “slightly technical aside,” they build a case for addressing trade issues not with trade wars but with consumption taxes: “It makes no sense to ask agricultural workers to lose their jobs just so steelworkers can keep theirs, which is what tariffs accomplish.” Policymakers might want to consider such counsel, especially when it is coupled with the observation that free trade benefits workers in poor countries but punishes workers in rich ones.
Occasionally wonky but overall a good case for how the dismal science can make the world less—well, dismal.Pub Date: Nov. 12, 2019
ISBN: 978-1-61039-950-0
Page Count: 432
Publisher: PublicAffairs
Review Posted Online: Aug. 28, 2019
Kirkus Reviews Issue: Sept. 15, 2019
SEEN & HEARD
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