Saturday, November 17, 2007

Surgeon, heal thyself!

Book to be reviewed: The Surgeons.
Author: Charles R. Morris.
Reviewer: Ira Rutkow, W11.
Topic: Cardiac surgery.
Diagnosis: First half exciting. Second half woefully dry.

The medical magazine's stark headline said it all: "Stab wound of the heart -- suture of the pericardium -- recovery -- patient alive three years afterward." It was 1897 and Daniel Hale Williams, an African-American surgeon, reported what would become the country's earliest widely publicized case of successful heart surgery. At a time when the importance of monitoring blood pressure was little understood and the use of antibiotics, intravenous fluids and transfusions was decades away, the 39-year-old Williams's accomplishment opened a new vista in American medicine.

...[T]he author lapses into a soporific -- and unconvincing -- discussion of statistical analysis and "the promise of propensity scoring" to glean information from patient databases. The promise, it seems, is that alternatives will be found to random clinical trails: "Many RCTs, perhaps even most, are useless or worse. Partly that's because pharmaceutical companies have abused the trial process, but it's also because of the great difficulty and expense of running good trials." Such a complicated subject deserves a fuller, fairer and more expert treatment.

To read the closing chapters of "The Surgeons" is to long for the scalpel stories. Is the book an insightful and captivating account of heart surgeons and their amazing craft -- the subtitle, after all, is "Life and Death in a Top Heart Center" -- or a dreary socioeconomic study of health-care policy? "The Surgeons" has complications and cries out for a content transplant.

Oh well. You just can't have excitement and professionalism together, I guess.

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