Archive for March, 2010

Twilight (Twilight, #1) by Stephenie Meyer   no comments

Posted at 10:36 pm in Book review

Twilight is the first volume of Stephenie Meyer’s staggeringly successful series, which I had managed to be only dimly aware of until I found it in paperback at Manhattan’s aptly-named Books of Wonder.

Bella Swan, who serves as the narrator, has moved from Phoenix (which she inexplicably loves) to Washington State to live with her father. Bella was not popular at her old school, but this does not seem to be the whole reason for her move. Things have changed at her new school, where she has attracted the attention of the beautiful, but odd and stand-offish, Cullen family. Edward Cullen in particular becomes her friend.

The Cullens turn out to be vampires, though of an unusually scrupulous sort who do not drink human blood. Skirmishes with less-friendly vampires ensue, as Bella and Edward try to stifle their growing–and dangerous–feelings for each other.

The plot moves along briskly, and is entertaining. But having finished Twilight, I didn’t feel especially driven to read the next volume in the series. It doesn’t quite rise to the level of compelling. Fun, though.

Written by Lorin on March 15th, 2010

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The Immortal Life of Henrietta Lacks, by Rebecca Skloot   no comments

Posted at 1:05 am in Book review

Open google and type in “HeLa cells,” and a million and a half hits appear. This is because these cells are used and known universally throughout the medical world: far, far more than any other cell line. What has been much less well known is that HeLa stands for Henrietta Lacks, the woman from whom the original cells were taken. In The Immortal Life of Henrietta Lacks, Rebecca Skloot–a born storyteller–set out to tell both stories, Henrietta’s and the cells’.

In 1951, Henrietta Lacks, a poor African-American woman living in Baltimore, was diagnosed with a virulent form of cervical cancer, and began receiving treatment at Johns Hopkins. During the same period, scientists had been trying to culture an “immortal” cell line: a line of cells that would survive for an extended period of time in the laboratory. All of their attempts had failed.

Without the knowledge of Henrietta or her family (a common practice), doctors took samples from her cervix and sent them to a lab to culture. Several days later, it became clear that they had finally found an immortal cell line–HeLa, as it was named, following the conventions of the time, multiplied rapidly and was virtually indestructible. By the time Henrietta died, eight months later, her cells were famous.

In the intervening years, HeLa cells were used for everything from the development of the polio vaccine to testing how cells survive in space. But Henrietta’s family did not learn of the cell line until decades later, and then were repeatedly frustrated in their attempts to pry information from the medical world, which rarely told them anything, and provided information of only the most technical kind.

The family’s difficulties were exacerbated by both their scientific illiteracy and their timidity about challenging doctors. Neither is a condemnation: in a country where the reality of evolution is still being debated, the Lackses’ failure to understand cells is hardly shocking. Nor is it surprising that they felt unable to stand up to the vastly better-educated doctors at Johns Hopkins.

Nonetheless, one of the most haunting passages in the book describes a conversation between a Hopkins researcher and Henrietta’s husband Day. Day believed the researcher to have said that Henrietta was still alive at Johns Hopkins and being experimented on. He asked no questions of the researcher, and issued no demands. The value of both scientific literacy and a middle-class sense of entitlement is compellingly clear.

As HeLa cells made vast contributions to medical knowledge and large profits for medical companies (though never for Johns Hopkins), Henrietta’s family remained extremely poor, often unable to afford health insurance. Resentment and confusion grew within the family, and Henrietta’s daughter Deborah–Skloot’s lead character, who became a friend to Skloot over the ten years she spent working on the book–was driven almost to a nervous breakdown.

Finally, though, the family began to learn the facts surrounding HeLa. A sympathetic Austrian researcher led Deborah and her brother to a bank of freezers containing their mother’s cells. Deborah warmed a vial in her hands. “You’re famous,” she whispered. “Just nobody knows it.” Thanks to Skloot’s marvelous book, they do now.

Written by Lorin on March 15th, 2010

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Game Change: Obama and the Clintons, McCain and Palin, and the Race of a Lifetime by John Heilemann, Mark Halperin   1 comment

Posted at 1:02 am in Book review

Game Change, by Mark Halperin and John Heileman, tells the riveting (and deeply fun) human story of the 2008 election–which was vastly more dysfunctional than anyone knew. As Halperin pointed out recently, it gives one pause to realize that the Clintons had only the fourth most dysfunctional marriage in the campaign: the Edwardses, the Giulianis and the McCains all had exceedingly troubled unions.

Screaming fights in front of the staff abound; spouses are jealous of the candidates’ relationships with their advisers; Bill Clinton behaves like Bill Clinton; John Edwards blatantly carries on an affair; and Elizabeth Edwards, in stark contrast to her public persona, seems to be truly deplorable. And everyone swears incessantly. Only the Obamas–though certainly not depicted as perfect–emerge as genuinely likable characters.

The candidates’ styles were, not surprisingly, reflected in their campaigns. Clinton and McCain both ran operations in which the staff despised each other, and McCain’s campaign lacked even the semblance of real organization. It is shocking that a presidential campaign can be run this sloppily; Game Change observes that Sarah Palin was vetted so hastily that it resembled the selection process for an assistant secretary of agriculture, not a potential vice president. The authors manage to evoke a certain amount of sympathy for Palin, who was put into an enormous role for which she was not qualified, without any preparation, or any organizational structure to back her up. The Obama campaign, on the other hand, was run with tremendous efficiency by people who respected each other and worked together like adults.

By the end, with Edwards abandoned by his party and McCain’s campaign widely ridiculed, it seems clear that Obama got exactly what he deserved.

Written by Lorin on March 15th, 2010

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The Checklist Manifesto: How to Get Things Right, by Atul Gawande   no comments

Posted at 1:00 am in Book review

Many of the loftier things in life rest on surprisingly mundane details. Think of democracy: it’s a very big idea, but can be undone by very small administrative errors. A few years ago in Maryland, a local election official forgot to put the cards needed for voting machines into the supply boxes for some polling places. Those polling places became fully functional hours late. In effect, this means that people were disenfranchised. What that election official needed was a checklist.

In The Checklist Manifesto, Atul Gawande makes the case that most complex situations are helped by checklists. A well-designed checklist, as he envisions it (and as the brilliant checklist writers of Boeing envision it) is not exhaustive, but covers the most important and easily forgotten details of a procedure. Equally importantly, it fosters teamwork among the people performing the procedure, whether they are medical staff in an operating room, or an airline crew flying an airplane. It does so in part by mandating that all participants introduce themselves to each other, which not only creates a sense that they are part of a team, but can also embolden the less-powerful members to speak up when it is important to do so.

Gawande repeats the story of an Austrian girl saved from drowning that he rivetingly told in the New Yorker, and reveals that the hospital which saved her (in an extremely long and difficult series of medical procedures) had attempted to save drowning victims before, but had never succeeded: until they implemented a checklist, a detailed and well thought-out set of protocols for what should happen from the first moment when a drowning is reported.

The building trade is another example. Gawande describes how it has moulded itself in a world grown too complex to accommodate the traditional master builder system (in which one architect had control of all details of the building process). As he points out, it is rather miraculous that so many large buildings manage to go up with so little incident. Builders achieve this, you will not be surprised to learn, through an elaborate system of checklists. Gawande discussed this at the 2009 New Yorker festival.

Gawande also weighs in on heroism in an increasingly complex world. The Miracle on the Hudson, as he describes it, was due not to the sole work of the captain, but instead to the teamwork of the entire crew — which was guided by a set of checklists. Heroism, Gawande suggests, though occasionally the work of a single, inspired individual, derives more often from the disciplined teamwork of a group of people.

The Checklist Manifesto, though less focused on medicine than Gawande’s previous books, continues his work of bridging the knowledge gap between medical workers and everyone else. He is also, as in his past books, quite ready to admit to his own failings. He confesses that he only grudgingly adopted a checklist in his own operating room (he didn’t want to be a hypocrite), but now says that he has “yet to get through a week in surgery without the checklist’s leading [them] to catch something [they] would have missed.”

Sadly, no matter how much evidence accrues for the value of checklists, Gawande describes an uphill battle in persuading organizations to use them. It is to be hoped that this work will help change that.

This is an important book. It shows us how to do things, sometimes extremely important things, better, and that doing things better is not about what we think it is about. In fact, it is often vastly less glamorous and more mundane than we expect. In The Checklist Manifesto, Gawande shows us a kind of perfection. The kind of perfection achievable by flawed, disorganized, easily distracted human beings. It’s a beautiful idea.

Written by Lorin on March 15th, 2010

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