An intensive, mindful critique of modern health care that confronts its flaws and proposes solutions.

CARE EVOLUTION

ESSAYS ON HEALTH AS A SOCIAL IMPERATIVE

A report on the complex social and economic issues that are hindering significant patient health care reforms.

Physician and former chief medical officer for Centria Healthcare Merahn’s collection of insightful essays focuses on his view that improvements to health care networks should be a “social imperative” in order to sustain educational and economic progress and avoid systemic inequities. The source of Merahn’s frustration stems from inaction from decision-makers and medical professionals to embrace patient-focused methods of care delivery. He sees health care as a critical necessity—one that’s battered by the forces of economic instability, racial injustice, unconscious bias, politics, and free market capitalist dynamics. Merahn’s research discovered many health care professionals who felt disconnected from their peers and lacking strategies to repair the devaluation of their occupation. The author takes a broad view of his subject, astutely examining the history of American health care and how it’s been incrementally destabilized by “those with less selfless and less generous agendas”; he also addresses how it’s been defined by revenue economics rather than by a philosophy of delivering quality communitywide care. The author writes that although the Covid-19 pandemic has successfully and swiftly mobilized crisis teams across the globe and, in most cases, amply supplied them with the resources they need, it’s also exposed a glaring lack of equitable access to care due in part to systemic racism. He notes that the crisis has also alarmingly revealed a distinct population with “deficient scientific literacy.”

Driven by what he perceives to be glaring systemic inadequacies, Merahn intelligently outlines an evolutionary plan that includes fundamental improvements in clinicians’ financial stability, an organizational restructuring of the care delivery system, and a revised vision of the kind of coverage and support that the American system should be providing. The author leaves little room for doubt that quality health care is urgently needed by everyone and that the system’s goals have, over time, become derailed by the desire for profit and are in need of a remedy that isn’t solely based on “how we pay for care" and is "more about how we plan for care.” Merahn advocates for increased human connection and noncategorical approaches to illness that, in his view, would “transcend diagnoses and acknowledge the power of emotion in influencing interactions in relationships.” Improved attention to patient dignity, integrity, and privacy are also key to this restructuring, he notes. The major thrust of his argument is based on the belief that health care should be free of doubt and confusion; because it’s become mired in these states, there needs to be a redesign and focused return to a “whole-person” frame of mind. Although the author’s medical industry rhetoric and densely rationalized arguments may sometimes be difficult for readers outside of clinical settings to grasp, his impassioned demands for change are unwaveringly convincing. Merahn’s persuasive call for action advocates for no less than an overhaul—one that redirects attention away from “networks of self-interest embedded throughout the healthcare ecosystem.”

An intensive, mindful critique of modern health care that confronts its flaws and proposes solutions.

Pub Date: Nov. 10, 2021

ISBN: 978-1-7359415-2-3

Page Count: 149

Publisher: Conversation Publishing

Review Posted Online: Aug. 17, 2021

Kirkus Reviews Issue: Oct. 15, 2021

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A solid work of investigation that, while treading well-covered ground, offers plenty of surprises.

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PERIL

An account of the last gasps of the Trump administration, completing a trilogy begun with Fear (2018) and Rage (2020).

One of Woodward and fellow Washington Post reporter Costa’s most memorable revelations comes right away: Gen. Mark Milley, chairman of the Joint Chiefs of Staff, calling his counterpart in Beijing to assure him that even after Jan. 6 and what Milley saw as an unmistakable attempt at a coup d’état, he would keep Trump from picking a war with China. This depiction has earned much attention on the talking-heads news channels, but more significant is its follow-up: Milley did so because he was concerned that Trump “might still be looking for what Milley called a ‘Reichstag moment.’ ” Milley emerges as a stalwart protector of the Constitution who constantly courted Trump’s ire and yet somehow survived without being fired. No less concerned about Trump’s erratic behavior was Paul Ryan, the former Speaker of the House, who studied the psychiatric literature for a big takeaway: “Do not humiliate Trump in public. Humiliating a narcissist risked real danger, a frantic lashing out if he felt threatened or criticized.” Losing the 2020 election was one such humiliation, and Woodward and Costa closely track the trajectory of Trump’s reaction, from depression to howling rage to the stubborn belief that the election was rigged. There are a few other modest revelations in the book, including the fact that Trump loyalist William Barr warned him that the electorate didn’t like him. “They just think you’re a fucking asshole,” Barr told his boss. That was true enough, and the civil war that the authors recount among various offices in the White House and government reveals that Trump’s people were only ever tentatively his. All the same, the authors note, having drawn on scores of “deep background” interviews, Trump still has his base, still intends vengeance by way of a comeback, and still constitutes the peril of their title.

A solid work of investigation that, while treading well-covered ground, offers plenty of surprises.

Pub Date: Sept. 21, 2021

ISBN: 978-1-982182-91-5

Page Count: 512

Publisher: Simon & Schuster

Review Posted Online: Sept. 24, 2021

Kirkus Reviews Issue: Oct. 15, 2021

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An oft-ignored but fully convincing argument that “we cannot prevent the next pandemic without creating a healthy world.”

THE CONTAGION NEXT TIME

The Covid-19 pandemic is not a one-off catastrophe. An epidemiologist presents a cogent argument for a fundamental refocusing of resources on “the foundational forces that shape health.”

In this passionate and instructive book, Galea, dean of the Boston University School of Public Health, writes that Covid emerged because we have long neglected basic preventative measures. “We invest vast amounts of money in healthcare,” he writes, “but comparatively little in health.” Readers looking to learn how governments (mainly the U.S.) mishandled the pandemic have a flood of books to choose from, but Galea has bigger issues to raise. Better medical care will not stop the next epidemic, he warns. We must structure a world “that is resilient to contagions.” He begins by describing the current state of world health, where progress has been spectacular. Global life expectancy has more than doubled since 1900. Malnutrition, poverty, and child mortality have dropped. However, as the author stresses repeatedly, medical progress contributed far less to the current situation than better food, clean water, hygiene, education, and prosperity. That’s the good news. More problematic is that money is a powerful determinant of health; those who have it live longer. Galea begins the bad news by pointing out the misleading statistic that Covid-19 kills less than 1% of those infected; that applies to young people in good health. For those over 60, it kills 6%, for diabetics, over 7%, and those with heart disease, over 10%. It also kills more Blacks than Whites, more poor than middle-class people, and more people without health insurance. The author is clearly not just interested in Covid. He attacks racism, sexism, and poverty in equal measure, making a plea for compassion toward stigmatized conditions such as obesity and addiction. He consistently urges the U.S. government, which has spared no expense and effort to defeat the pandemic, to do the same for social injustice.

An oft-ignored but fully convincing argument that “we cannot prevent the next pandemic without creating a healthy world.”

Pub Date: Nov. 1, 2021

ISBN: 978-0-19-757642-7

Page Count: 280

Publisher: Oxford Univ.

Review Posted Online: Aug. 28, 2021

Kirkus Reviews Issue: Sept. 15, 2021

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