Serendipity, chance and the anatomy of discovery in Happy Accidents

From The Week of April 6th, 2014

Serendipity is a constant throughout our lives. Whether it is the tragedy narrowly avoided or the good news received at just the right moment, its unexpected gifts and arrows have the power to delight, to terrify and to change our world. For who hasn't had the course of their existence altered by a moment unlooked for, a circumstance not considered? But for all of serendipity's capacity to change our moods and our lives, is it not, on some level, merely a means by which to explain the strange oddities that chance sometimes throws up? Is it not an evocation of some external force to explain a lack of vision? The absence of the mental clarity to consider all that lies before us? Whatever its implications, it lies at the heart of this fascinating history of medicine from Mr. Mayers.

Of all the industries that have been redefined over the last two centuries, few have experienced more change, and more advancement, than medicine. As late as the 19th century, doctors were little more than priests when it came to their capacity to heal. They had a handful of steadfast remedies with which they could attempt to mend the broken, but their knowledge of the human body was about as poor as their comprehension of the world around them. Germs and diseases had yet to be discovered, let alone studied. And curatives were often as poisonous to the patient as the affliction. Comprehension of the world and all its forces was so poor that, even when radiation was discovered at the turn of the 20th century, it was thought to be beneficial, even therapeutic. It wasn't until cancers began to erupt from these applications that the true cost of playing with such fundamental forces was revealed. Ignorance, creating assumptions, creating dogmas, until those dogmas were shattered in the face of hard truths.

But as dark as the 19th century may have been for medicine, the 20th was a revolution. Where prior centuries had been a wasteland of discovery and understanding, treatments for cancer, Tuberculosis, bacterial infection, heart attacks and high blood pressure all became widespread. Even the mysteries of the brain were, to some degree, conquered with drugs that successfully fought numerous strains of mental illness. In les than a hundred years, the doctor's toolbox expanded from prayer and good fortune to hundreds of possible remedies for any of a host of formerly lethal conditions. But just how did these magnificent discoveries eventuate? Were humans suddenly smarter, more intuitive, more understanding of the human form and its connection to the broader world, or were there other forces at play?

A persuasive argument for the virtues of screwing up, Happy Accidents is an engaging adventure through the slap-dash, serendipitous world of medicine and the discoveries that have shaped its last hundred years. Morton Mayers, himself a medical doctor, divides his chronicle up into sections, each of which sheds light upon the fundamental workings of the heart, the cell,the circulatory system, the blood and even the brain. His intent is not so much to give his readers a refresher on high-school biology, though he does this admirably, as to illuminate the anatomy of the breakthroughs, the circumstances that surrounded the key insights that not only pulled back the curtain on the innerworkings of these systems, but that lead to revolutionary cures that have restored life to the terminal and sanity to the doomed. In each case, from antibiotics to antipsychotics, from Lipitor to Lithium, he exposes a startlingly clear pattern of ignorance that was dispelled by happenstance, leading to awareness and, finally, to solutions.

Underpinning Mr. Mayers' work here is the understanding that humans invariably operate based on a collection of assumptions that become, in their certainty, unhelpfully dogmatic. X should not work on Y because of Z. But of course, truths are only true until they are proven false. The sun revolved around the Earth until it didn't. The Earth was 6,000 years old until it wasn't. Emotions stemmed from the heart until they didn't. Certainty; giving way to puzzlement in the face of contradictions; forcing the forging of newer, better certainties; starting the process all over again until perhaps something like knowledge is possessed. However, given the discomfort of living in constant doubt, we like certainty. We cling to it and we are damned by it. For it blinds us to the discoveries, the connections, that would be obvious to us if we were willing to try everything rather than being dismissive out of hand and waiting for random chance to drop fortunate outcomes into our laps.

But as wonderfully as the author constructs this argument, and as much knowledge as he drops on the reader during its repeated demonstration, his proscriptions for its rectification seem inadequate. Mr. Mayers levels an accusatory finger at everyone, from big pharma to big government, to explain why this age of rapid discovery has slowed, why fewer treatments than ever are being discovered. And perhaps he is right to blame these forces interfering with good research. However, Happy Accidents is nothing if not a book about the narrow mindedness of humanity, of how we have to practically be smashed over the head with a gong before we see what's before us. And so crediting serendipity for the golden age of medicine and then blaming institutions for its end seems, at best, inconsistent and, at worst, blind to the possibility that we have plucked all the low-hanging fruit. We have made most, if not all, of the simple discoveries that it's possible for chance to gift to us, that what remains are more systemic discoveries that will require open minds and collaborative efforts to achieve.

Happy Accidents is a dense and deeply rewarding adventure through the human body and the men and women who reduced it from mysterious phenomenon to a highly complex machine that we've gone a long way to explaining. For this knowledge alone, a must read. For those intrigued by happenstance and randomness, no disappointment will be found within these pages. But for those looking for solutions to the intriguing problems posed here, the answers will have to be sought out elsewhere. (4/5 Stars)

The history and science of that most desired part of the female anatomy in Breasts

From The Week of June 3, 2013

As much as we'd like to think that humans are creatures of the mind, empowered by intellect, shaped by morals and fired by curiosity, we are still driven by the base desires for what we can see, touch and taste. We can create the most complex technologies and philosophize at length over the finest points of Aristotelian logic, we can implement free-market economies and devote our days to the beauty of the printed word, and still we are consumed by food and sex, by shelter and family, by kisses and caresses. Perhaps this is well. There is, after all, a great deal of joy and comfort to be found in the treasures of fleshy, epicurean delights. And yet, these same excitations have the power to consume us, to reduce our grand intellects to the pursuit of pleasure at the expense of all else. Of these temptations, few hold the power and the objectification of the female breast, a truth expanded upon in Florence William's eminently engaging exploration.

Throughout recorded history, in carvings and sculptures, in song and story, we have celebrated the breast. It has been a source of nourishment and obsession, of critiques and signalling, of pleasure and frustration. It comes in a dizzying array of forms and sizes, a symbol of sufficient power as to warrant the creation of taboos in its name. But what is the breast made of and why has it become such a potent symbol of womanhood?

From the academic controversies that have swirled around its origins to the medical research that has revealed its vital role in the nourishment of newborns, Ms. Williams attempts to not only answer these questions, but to provide this most fetishized part of the female anatomy with some entertaining context. Beginning with its uniquely omnipresent manifestation in human women and ending with a sobering analysis of the ways in which it acts as a dumping ground for toxic chemicals that have accumulated over the lifetime of its host, she investigates, in Breast, its form and function, its social impact and its medical mysteries, all in an attempt to better understand this object of so much cultural attention.

Alternately humorous and chilling, Breasts is no fluffpiece masquerading as literature. There is no titillation here, nor is there any moral posturing. It is a serious and sincere attempt to determine the value and the purpose of the breast, to record its history, to measure its trends and to predict, in some limited way, its future. Drawing upon dozens of interviews and almost as many personal experiments with diet and environment, Ms. Williams sifts years of data and research into an eminently readable chronicle that leaves the reader as informed about the breast's physiology as he is about its augmentation. To have reduced such a mountain of information into such a digestible and engrossing product is, to say the least, a triumph.

While readers will be no doubt entertained by the vicarious glimpse of the breast-augmentation industry, Breasts is strongest when it stands firmly on scientific ground. Ms. Williams familiarizes us with fat and milk glands, with estrogen and other hormones. But most importantly, she enthusiastically joins with those researchers who have sounded the alarm about the way in which our modern world has disturbingly played with and reprogrammed the female body, tricking it into maturing earlier and earlier. These trends suggest devastating consequences for women in the future, exposing them to a host of savage cancers that have the power to rob them of good health and good fortune. Her call to arms, for increased regulation of these damaging chemicals, is heartfelt and level-headed. There's no wailing here, no rampaging feminism masquerading as popular science. Ms. Williams is calm, clear and thorough in a manner that should inspire plaudits.

Women's health is a fraught field in which to wade, one that contains as many opinions as it does curatives, as many clarion calls as it does conflicts. Breasts won't avoid drawing criticism. But that its purpose is clear, its motives pure and its conclusions eye-opening ought to earn it a place of prominence, even amongst this challenging crowd. (4/5 Stars)

An excellent, playful takedown of the DSM5 in The Book of Woe

From The Week of May 27, 2013 Compared to the talents and the weapons claimed by the great diversity of life on Earth, humans are an unremarkable species. We cannot hide ourselves in plain sight nor poison our enemies with venom. We cannot glide through the skies nor survive at the bottom of the oceans. But what we lack in tusks and gills, wings and exoskeletons we make up for with the power to think, an ability that has given rise not just to dreams and language, science and culture, but the only advanced civilization to have ever graced our planet. Our minds are remarkable machines that evolution has shaped into tools that we will use to rise beyond our base genetics, our root circumstances, and take to the stars. But for all its glory and its plasticity, the human mind is not without its flaws. For while it has enabled some to make discoveries that have re-imagined our world and our universe, it has also steered some into the pits of hell, condemning them to lives of madness and confusion, obsession and disassociation from which it is difficult to recover. And it has encouraged yet others to study these malformed minds to both glean knowledge of their illnesses and to aid in their healing. But just how successful has that effort been to catalogue and heal the array of human mental afflictions? Gary Greenberg explains in his fascinating polemic. The diagnostic and Statistical Manual (DSM) is the psychiatrist's handbook. An oft-revised classification of mental illnesses, it is an encyclopedia of disorders that range from the disassociative to the obsessive. Though largely confined to the psychiatric community, the alphabet soup of its terminology, BP, OCD, BPD, has spilled over into mainstream culture, causing some to prematurely diagnose themselves with its theatre of mental horrors while motivating others to rebel against its labels, rejecting them as nonsense. Between, it has given rise to an eruption of proscriptive drug use unimaginable fifty years ago, a result that none of its authors could have predicted. The DSM has undoubtedly been beneficial to some. Its classifications, assembled from thousands of studies, have helped clinicians accurately recognize and properly treat mental illness in their patients. However, the DSM is simultaneously, and unavoidably, the work of men and women who cannot escape the biases of their culture. Thus, over the years, "afflictions" such as homosexuality have been included in its pages, proscriptions offered for its curation. These incidents damage the Manual's credibility. For if illnesses can so easily slip in and out of its pages, then what truly is mental illness? Can we ever know? The result of both a career as a clinician and the most recent and controversial revision of the DSM, The Book of Woe is an excellent and utterly unforgiving examination of the DSM: its history, its implementation and its architects. Though Mr. Greenberg pays particular interest to the pointed criticisms of the DSM5 by Allen Frances, the author of the previous version, this exercise in mud-slinging is merely an entertaining and clarifying lens through which to view the ways in which the DSM has impacted psychiatrists, their patients and the wider culture. In this, Mr. Greenberg is clinical in his ruthlessness, raising awareness of the numerous ways in which the DSM's various revisions have been exploited by doctors and pharmaceutical firms to create highly profitable drugs of dubious effectiveness at the expense of patients and their concerned families. This work is hardly the first to raise such concerns, but they are handled here with both care and passion. Though much of The Book of Woe's critiques of the DSM5 will be of little interest to non-psychiatrists, Mr. Greenberg is effective in taking the reader into the anatomy of a diagnosis, not only revealing how thin the line is between mental health and mental illness, as defined by the DSM, but the ways in which such diagnoses offer hope to bewildered families seeking answers. The author poignantly captures just how desperate some people are to get help, help that, at times, the DSM actually hinders instead of aids. The Book of Woe only re-enforces the critical importance of being one's own best advocate, of questioning everything as a means to getting the proper diagnosis, a task made all the more difficult when one's mind is clouded by illness. The Book of Woe is certainly not without its flaws. Mr. Greenberg barely even attempts to be objective about the DSM5, featuring here its critics far more than its promoters. Moreover, he has chosen to prominently focus on the bumps in the road to the DSM5's publication, making it seem as though the book is a nonsensical result of bureaucratic bumbling. His desire to emphasize these flaws gives what would appear to be a distorted view of the DSM5's quality. However, even in this, Mr. Greenberg's work serves a purpose, chiefly, to reveal the degree to which the APA has deployed all the typical and despicable tools of a bureaucracy on the defensive to fend off criticisms and discredit its criticizers, a reality that leaves the APA looking both disorganized and greedy. For those interested in the history of the DSM, The Book of Woe is a wonderful read, full of colorful characters and powerful minds. But for those looking for a good catfight between deeply interested parties, looking to preserve both fame and fortune, look no further. (4/5 Stars)

Human folly and the power of Malaria clash in Shah's The Fever

From The Week of April 1, 2013

From trees to tigers, from eagles to kelp, evolution has shaped our world for billions of years. Without it, Earth would be little more than a volcanically active water world with a few single-celled organisms listlessly occupying various oceanic vents and superficial pools. There would be no other life, nothing to revel and no one to do the revelling. It is, then, a necessary driver of permanent change. But for all that humanity would not exist without evolution's many gifts, it also presents some problems. For what worked to create us can just as easily work to create things to kill us. Evolution was not a means to our end. It is a means to the development of life. And for all that we may have outpaced our fellow species on the race to intellect, we have not, and never will, corner the market on the right to exist. This is made chillingly clear in Sonia Shah's sweeping biography of a most pernicious and persistent disease.

For nearly half the lifespan of the human species, Malaria has infected our world. Generated from pools of stagnant water in which mosquito larvae happily grow, this crippling illness spreads from these humid nurseries in the saliva of female mosquitos who, with every successful attack upon a living target, inject Malaria's devastating payload into the bloodstreams of their unwitting victims. From there, the disease spreads to the liver, a base from which it can, over the next few weeks, cause havoc to its host, lashing it with debilitating fevers and headaches which, if sufficiently severe, can be fatal. Even if malaria was self-aware, though, it would not care about these consequences of its existence. For its only purpose is to exist. And this it achieves by infecting the blood of the host, blood which is then slurped up by other mosquitos eager for a meal.

So what can be done about this? Ever since humanity has had the tools to battle disease, it has been fighting Malaria. But though there have been soem successes in creating medicines that armor uninfected hosts against Malaria's impact, there is, as yet, no vaccine. Worse yet, some of the agents developed to fight Malaria have strengthened the disease, bestowing it with teeth it once did not require. Failures in the medicinal front have turned inquisitive minds to the prospect of chemically eradicating Malaria's delivery system, the mosquito, efforts that famously culminated in the widespread application of DDT, a wonder insecticide that soon proved to be a poison chalice. Hopes remain for a vaccine, but until then malaria persists, at the cost of hundreds of thousands of lives a year.

Depicting the pathological, sociological, medical and evolutionary histories of Malaria and its impact on the world, The Fever is a stark account of ingenuity and failure. Ms. Shah weaves a terrifying tapestry of Malaria's causes and effects, a dismaying portrait matched only by her tragic, and at times shocking, account of humanity's calamitous attempts to eliminate this most effective infectious disease. Tales of failed drugs, boastful promises and arrogant assumptions culminate in a truly disturbing portrait of the degree to which humanity leaps before it looks. For so eager are we for cures to the afflictions that trouble our days that we are willing to apply them before we fully understand their consequences, a hastiness that has lead to unimaginable ecological damage.

As much as Ms. Shah's account reserves its most effective blows for these failures, it is equally free with praise for the low-tech methods we've developed to fight Malaria. From mosquito nets to the draining of the stagnant pools that are malaria's breeding ground, the disease has been forced to retreat from many parts of the world. Unfortunately for the impoverished, however, most of these retreats have occurred in the developed world, causing Malaria to be, much like AIDS, a problem experienced by others, elsewhere.

The Fever might well have done with some first-hand accounts of Malaria's impact, the better to exemplify Ms. Shah's arguments. Nonetheless, it is a riveting demonstration of how little we actually control our world and how much we rely upon systems like evolution, that are far older than us, for defenses against the threats that live and grow across Earth's ecology. Wonderfully edifying... (4/5 Stars)

The cultural and medical histories of Rabies engagingly explored in Rabid

From The Week of March 25, 2013

Viruses reek havoc upon the human mind. For not only do they have the power to starve it of resources, reducing it to an unintelligent sludge, they can attack it through fear, divesting it of all rationality and making of its host an exceedingly soft target. Despite the innate difficulties of battling a scourge one cannot see, however, many of these viruses have been brought to heel, their effectiveness muted by science. And yet, some remain to haunt us, some that refuse to have their claws so easily clipped. Mr. Wasik and Ms. Murphy marvellously documents the most infamous of these vehement holdouts in his excellent chronicle of Rabies.

For all but the last few centuries of its existence, humanity has been blind to the threat of viruses. Its conceptions were limited to what it could taste, touch and feel. So while the species had soem understanding of what was harmful to its health, it could not even imagine the ecologies that lingered beyond the vistas of human vision. And yet, something had to be there. For tribal man could see quite well the consequences of contracting deadly viruses, chiefly, the loss of their companions felled by nothing more than the sudden onset of ill health.

First with the ancient Greeks and then with the Arabs, this understanding began to evolve, but not before superstition had taken hold. Before we knew why, we knew how. And in the case of Rabies, this was particularly apparent. For one had to but wait a few days after being bitten by an enraged subset of mostly friendly animals to feel the deadly consequences: the nightmares, the fear of water, the sleepless nights, the creeping death.

Devils and demons were conjured up to explain such violent and terrifying punishments. And yet, few of these could imagine the truth, that Rabies was a most insidious virus, a chain of genetic information with the singleminded goal to propagate, to spread, to consume. Eschewing the most conventional routes of pathogen's (the blood stream), it attacked the nervous system, inching its way up to the brain which, defenseless against its ravages, succumbed to that most straightforward kind of madness, the bite, a most expeditious method of passing copies of itself on to the next, inviting target.

From the characteristics that made it legend to the scientists who reduced it to mere mortality, Rabid is an entertaining journey through the history of Rabies. Penned by a veterinarian (Murphy) and a journalist (Wasik), it competently mixes humor with fact to create a most edifying illumination of a genetic sequence that, though relatively rare, particularly within civilization, has nonetheless had a profound impact on our conception of horror. The authors contend that the myths that gave birth to vampires, werewolves and zombies were all heavily influenced by our fear of the bite which does not merely emanate from our distaste for pain, but from something far more elemental, an aversion born of memories written into our heritage.

Rabid has its stumbles. It makes almost no attempt to advance our understanding of Rabies' genetic properties. Moreover, it seems, at times, much more concerned with its cultural impact than its medical one. But these are minor gripes in what is otherwise a thoroughly engrossing read that winningly captures the full might of science, particularly its capacity to isolate a problem, reduce it to its component parts and to deduce, through trial and error, a method of rectifying it. Here, this is particularly exemplified in the time the history devotes to Louis Pasteur, the famous French scientist who, in addition to discovering germs, took a largely successful swing at Rabies as well, reducing it from a fearful unknown to a problem that could be vaccinated if not cured. This, along with an intriguing comparison of how the East and West conceive of Rabies' primary carriers, allows Rabid to easily overcome its drawbacks.

This is eminently consumable work. And yet, for all its lightness, Rabid possesses sufficient depth to leave the reader's knowledge of the world of viruses significantly advanced. Most satisfying... *4/5 Stars)

Entertaining historical mysteries in The Hangman's Daughter series

From The Week of February 25, 2013
As much as the well-heeled would have us think otherwise, society runs thanks to dirty work. From glittering skyscrapers to speeding trains, from internet searches to life-saving medical equipment, countless men and women had to lay those bricks and dig those tunnels, unspool those undersea cables and test those machines, knowing that failure would, at best, cost people their lives and, at worst, undermine society's faith in the virtues of civilization. It is easy for us to forget these truths. For the souls who labor to keep our streets safe, our supermarkets stocked and our houses electrified are largely invisible, their efforts unheralded by a world far more fixated on the feats of the extraordinary than the toils of the masses. The efforts of millions to make the human world go round... This is a truth as relevant now as it has been at any point in the history of agricultural man and it is one explored with delight and darkness in Mr. Potzsch's entertaining series.

Seventeenth-century Germany was a grim and savage place. Riven by the Thirty Years' War, an apocalyptic conflict that claimed the lives of millions while leading to the widespread disintegration of law and order, it was comprised of a series of fiefdoms at the heart of the Holy Roman Empire. It laid claim to philosophers and universities, powerful armies and advancing technologies, and yet it was also consumed by the corrosive fire of religious discord that, having erupted from the rise of Protestantism, had spent the last hundred years washing across much of civilized Europe. But as much as the war's cost was monetarily incalculable, it took an even graver price from the men who were paid or compelled to perpetrate its atrocities and from the families who were forced to bear its deprivations. Such scars are generational, wounds that cannot easily be forgotten.

Jakob Kuisl's entire life was defined by the great war. The son of a town hangman, he disavowed his family's calling for the life of a mercenary. But when, after many years of senseless slaughter, this life proved too dark for his soul, he took up his father's fallen sword and became an executioner. As much healer as killer, Kuisl is as skilled with poisons as curatives, as capable of breaking bones as mending them. And yet, though he and his brothers perform necessary services for the people, they are viewed with suspicion and disrespect by the communities that pay them, communities that impose upon the hangmen a dishonor emanating from their own shame. Despite the obvious injustice, there's nothing Kuisl or his like can do about this disregard except live with honor and do what must be done.

Home from the war, circumstances conspire to keep Kuisl busy. For not only does his hometown require his services, but murder seems to follow him wherever he goes. Devils and ghosts, priests and traitors, stalk his steps and those of his fiery daughter who herself is enchained by the hangman's life. Together, they must endeavor to live free in a world that scorns them, all while meting out some kind of justice in a world that has been without it for so long it might not even recognize its righteous glow.

Though far from masterpieces of fiction, the novels of The Hangman's Daughter are entertaining fair from a promising German author. Translated into English and sold through an amazon imprint, each of the collections stories -- there are four to date -- follow the familiar mystery model, kicked off by a death, often gruesome, that the heroes then proceed to solve over the next several hundred pages. Though this formula is, by now, quite wrote, the deep-seated historical flavor of Potzsch's work elevates the series out of the mundane and into the engagingly foreign as our familiar, modern moralities and customs are thrown aside for a world rooted in gods and superstition.

This is undoubtedly the series' greatest virtue. For though its three core characters -- Kuisl, the bearish and brooding hangman; Magdalena, his stubborn and tempestuous daughter; and Simon, her diminutive but devoted admirer -- are interesting, if somewhat predictable, it is the world that mesmerizes. For though religion is still prevalent in the 21st century, it is a faith confined largely to the church. Science has compelled Christianity to largely withdraw in defeat from the battlefield of society, government, philosophy and especially medicine, leaving our days to be defined by data, by logic, by facts. The opposite is true in Potzsch's conception of 17th-century Germany the society of which is almost entirely subsumed by religion. Every mystery and every murder, every insult and every dispute, is viewed through the lens of faith which, unfortunately, allows many of the men and women raised in this time to seize upon God as an easy answer. Strange markings on the backs of children? It must be witchcraft. Women succumbing to fever and moments of madness? It must be the devil. snap judgements are made because they can be, because there is nothing like science to stand up to these unreasoned conclusions, to refute them with researched truths.

But though the series succeeds in its wish to entertain, it falls short of excellence. For Potzsch is far too captivated by masterminding Kuisl into a 17th-century detective to actually show us the man's occupation. Rarely do we actually see Kuisl perform his duties, let alone with anything other than supreme reluctance which smacks to this reader like an author unwilling to sully his hero with even a whiff of injustice. Strange, really, for Potzsch is quite content to bestow upon Kuisl a savage backstory, but this too is glimpsed only through faded recollection and not the fullness of Potzsch's dark prose. A similar criticism could be leveled at Magdalena, the eponymous hangman's daughter if, that is, she was relevant enough to bother with criticism. The woman may be charmingly self-possessed, but she is rarely anything more than a device for the author to advance the story. We're never truly made to feel the chafing of the constricted life she is forced to lead.

Entertaining work. These are fun mysteries to blow through on a weekend. However, they suffer from the plain fact that others have done better. The inevitable comparisons with Ariana Franklin and the like do not flatter The Hangman's Daughter. (3/5 Stars)

The Drowned Cities by Paolo Bacigalupi

From The Week of June 25, 2012

Loyalty is a fascinating virtue. A necessary substrate in the psychology of social animals, it is capable of compelling us to act against our own best interests in order to lend aid to those for whom we have this feeling. It's not difficult to imagine how such a powerful force helps bind us to families and communities, but does it have a place in modern life? Our world seems ever-more-dominated by self-interest, by analytics that seek to reduce to economics the unquantifiable magic of relationships and the emotions that underpin them. Loyalty is a leap of faith, an act of generosity given in gratitude,or in hope of a return. How can that be quantified? Clearly Mr. Bacigalupi is musing over this question as well for it dominates this blood-soaked companion to Ship Breaker.

In a future America ravaged by environmental decay, political collapse and tribal warfare, life along the Potomac river is as humid as it is difficult. Every inch of ground for hundreds of miles around the capital of the sundered United States is claimed territory, turf for gangs and warlords to hold, abuse and contest until their dying breaths. Efforts by foreign governments, who've had more success weathering the decline of human civilization, to intervene on behalf of the innocents, to bring order and peace to a war-torn land, have spectacularly failed. And now those assets have been withdrawn, leaving behind a tangled web of hardcore capitalists who can find a market for anything from kidneys to salvaged steel.

The biological product of happier times, when the UN and China were still attempting to disarm the warring factions, Mahlia is a castoff, a half-American, half-Chinese female left behind by the exodus. Her parents, who once traded in art and souvenirs from the Accelerated Age, are gone now, dropping her out of the relative privilege of her upbringing and into an adolescence of hardship and turmoil as a nursing assistant to a humanitarian doctor practicing on contested ground. When her best friend, Mouse, is taken hostage by a half-man, a transhuman hybrid trained up to be a super soldier, Mahlia's so desperate to liberate her friend that she does not pay the proper respect to the soldier boys who've encamped at the doctor's practice. And so, when she resists them and all they want from her, she begins a long and troublesome odyssey that will take her to the heart of the old America in search of the only boy whose ever earned her trust.

Though the author, at times, does his best to wear out his work's central theme, The Drowned Cities is, nonetheless, emotive science fiction. Mr. Bacigalupi is a talented builder of worlds, conveying cultures of meaning with but a few telling paragraphs. The result is an engrossing experience that will leave only the most cynical readers unmoved by the hardships the novel's characters are forced to endure. The cities of the novel's dramatic title refer to the metropoli that once dominated the southeastern United States, cities now swallowed by rising tides, swollen rivers and unimaginable storms that rip and tear at the Atlantic coast. The images of streets and squares, office towers and highways, transformed into 22nd century swamps are haunting suggestions of a possible future.

For all of the novel's imagistic force, Mahlia is its most potent weapon. An innocent plunged into a degraded world, she is an outsider, a creature branded as much by her Asian appearance as by her humanity. But as much as she might appear to be naive and exploitable, her will is formidable. Setting great store by human decency, she is loathed to surrender anyone who has demonstrated to her a measure of kindness and gentleness in a world of harshness and war. This steely determination rescues Mahlia from the trope of the princess in rags and positions her as a futuristic heroine, a creature of necessity who refuses to abandon her humanity.

For all its virtues, The Drowned Cities is a more laborious novel than the smoother Ship Breaker. Here, Mr. Bacigalupi has essentially two aims; to perform an autopsy on loyalty and to give his western readers an idea of how the other half live. The former manifests in the form of Mahlia's quest to save Mouse after he'd once saved her from a brutal fate at the hands of zealous soldiers. The latter resides in Mouse who is forced to be a child soldier in a rebel army. The former seeks to understand what we owe to those who've been kind to us. The latter tries to demonstrate the anatomy of an army fuelled by all of the recklessness of untamed adolescence, their cunning and their savagery. With these two strands, the author has summoned the spector of the LRA, packaged it into science fiction and used it to tell a tale about the nature of humanity and kindness that, while effective, is heavy-handed.

There's brilliance here, passages that fans of Mr. Bacigalupi's work will devour. But there are low lights as well, lulls that I have not seen in his other fiction. Still, well worth the read, especially for those interested in a science-fictional take on some of the darkness that stalks our own world. (3/5 Stars)

The Emperor Of All Maledies by Siddhartha Mukherjee

From The Week of January 23, 2011

Those of us who have watched friends, relatives, colleagues, battle cancer have some conception of how devastating it can be, mentally and physically. But no matter how empathetic we are, we, the watchers, the outsiders, will never understand what it must be like to have ones own body turn on itself in a rabid, mindless effort to grow and devour. It is a kind of betrayal, the bodies we've relied on for so long malfunctioning, glitching, killing. Though I don't imagine this biography of cancer will bring much solace to those who've already endured this disease, for the rest of us, it shines a penetrating light on an illness that, in spite of awareness walks, government promises, and hundreds of billions of dollars spent on research, is doggedly determined to defy us, to destroy lives.

After a quick tracing of cancer through antiquity, Dr. Mukherjee devotes himself to sketching out the rise of modern cancer research. From Sidney Farber's experimental treatments in the 30s and 40s which lead to the creation of the Boston-area Jimmy Fund, to the genetics labs in California which are producing cutting-edge therapies designed to sever cancer's access to the resources it needs to proliferate through the body, the history of the disease, the painful successes and the monumental failures, is both thorough and engrossing, It's the other two strains to the narrative here, though, that give this piece heart. Firstly, Dr. Mukherjee openly and empathetically relates his experiences as a doctor treating cancer, the baffling remissions and the soul-crushing losses. The emotional toll of the day-to-day grind of doctors treating and patients fighting offers the reader a glimpse of the kind of mental strength necessary to bear up under the weight imposed by this harmful condition. Secondly, he sketches moving portraits of key figures in the fight against cancer, including their contributions and their blunders. It's fascinating to read their theories about cancer's origins and the best ways to stop it.

This is vivid and well-balanced work. A 500 page biography about cancer ought to be tedious and depressing. But Dr. Mukherjee has a better grasp of pacing than some authors of fiction, switching effortlessly between the hard science and the human story. Disappointingly the history of cancer research seemed far too America centric. Reading this, one would think that cancer research has never been conducted outside the United States. I can well imagine that the Second World War had a chilling effect on such work in Europe, and elsewhere, relative to the United States, but that was 65 years ago now. They haven't made a single breakthrough? Additionally, I would've liked to read a bit more about cancer's possible causes and the investigative efforts to divine them, but it may be that trying to cover all the contributers, from environmental factors to cellular senescence, would balloon this book out to mammoth proportions. In any event, the flaws only marginally mar the excellence here. (4/5 Stars)

Another Day In The Frontal Lobe by Katrina Firlik

From The Week of May 16, 2010

Dr. Firlik, an American neurosurgeon, has compiled, here, an interesting blend of genres. Part memoir, part neurosurgery 101, and part odyssey through the human brain, Another Day In The Frontal Lobe could easily be three separate novels, and yet her composite functions surprisingly well.

Though television shows like Gray's Anatomy have gone some way to illuminating the lives of neurosurgeon's, it's difficult to trust a scripted drama when it is not compelled to be truthful. Dr. Firlik's account of the long years of schooling and how socially isolating they can be is poignant. The hospital becomes such a center of focus that it's difficult to build a life outside ones career and ones colleagues. Even so, Dr. Firlik seems well-aware of what she has gained in the bargain, highly specialized knowledge that allows her to perform extraordinary feats of medicine which, even half a century ago, would have been unthinkable. And this is the second stage of her novel, describing in detail the trials and tribulations of the operating room: its composition, its tools, and its personnel. She mixes in enough of her casework to create a tasteful recipe of human interest and solid science which keeps the reader engaged long enough to transition into the part of her work that shines brightest.

I imagine the human brain will be an object of fascination for many decades to come as it stubbornly refuses to relinquish its many secrets. And such, there is plenty of room for speculation concerning its workings and its most vital systems. Dr. Firlik discusses in this final, successful section the current events of neurology, from the exciting concept of neuroplasticity to Dr. Firlik's fascination with Transcranial Magnetic Stimulation which has been put forward as a possible solution to any number of neurological problems. Her thrilling conclusion, a rumination on the future of Neuroscience and the improvements in the human brain that we may be able to induce as soon as 20 years from now, left me more than a little giddy, for what this will mean for humanity, and jealous, of Dr. Firlik. For she has clearly chosen a life path which has placed her at the heart of a profession rapidly evolving, a profession which will have a great deal of influence upon the shape of the 21st century.

A bit too scattered at times, but it gains momentum as it proceeds to an excellent conclusion. (3/5 Stars)

The Immortal Life Of Henrietta Lacks by Rebecca Skloot

From The Week of February 28, 2010

Every so often, I stumble across a book whose subject is so startling, so bewildering, that I find myself almost breathless as I read its most riveting sections. The Immortal Life Of Henrietta Lacks is the latest installment in this rare line of unexpected delights. Ms. Skloot, a freelance writer on science, skillfully entwines two narrative strains to create an edifying and exciting tale of discovery and injustice that I won't soon forget.

Henrietta Lacks had a difficult life. An African American woman, living in the first half of the 20th century, she did not escape the poverty of her upbringing which continued to plague her family after her death. Though much of her life appears to have been lived without an overabundance of happiness, she is described as an even-tempered, kind person who should have been better served by those who claimed to be her societal superiors. Diagnosed with cervical cancer, Ms. Lacks was treated at Johns Hopkins. However, like many others afflicted with her illness, the treatment was unsuccessful and, only months later, she died at the age of 31, leaving her children to be raised under less than pleasant circumstances. Though, for the scientific community, this is where Ms. Lacks' story ends and their journey begins, Ms. Skloot is not so dismissive of the woman science forgot. She befriends Ms. Lacks' family and exposes, here, a life, a family, and some of the ugly secrets of 20th century medicine its practitioners would like to forget.

Hela. That is the name science gave to what researchers found in Ms. Lacks' tumor. Unlike anything they had seen before, these cells were somehow alive. In fact, sixty years on, they are alive still and have been utilized in what Ms. Skloot estimates to be something like 60,000 scientific experiments. Though the process is still not entirely understood, Ms. Skloot describes in detail the evolutionary end-around Ms. Lacks' cancer cells performed to achieve immortality. Infinite division, infinite repair, infinite cancer. The immortality of Ms. lacks cancer cells did not save her, but they have contributed to saving millions of lives since.

connecting the life of Henrietta Lacks with her remarkable cells, Ms. Skloot creates a story that should have been told decades ago. But sometimes, those of us who consider ourselves educated have the largest egos. And the most enduring barrier to truth is ego, is it not? The Immortal Life Of Henrietta Lacks rights a grievous wrong and, in doing so, teaches us about life, science and humility. An excellent read. (4/5 Stars)

Stiff by Mary Roach

From The Week of December 13, 2009

Stiff is assuredly one of the strangest works of nonfiction you shall ever have the fortune of reading. Delightful, disgusting, jaw-dropping and charmingly concise, this is Ms. Roach's adventures in the world of cadavers: their study, their uses, their numbers, their habits. She watches them used in crash tests and in practice sessions for doctors, all while recounting the history of the cadaver and the invaluable role it has played in the advancement of science and the human anatomy. If you are easily disgusted or offended, this is not the book for you. But anyone else with a curiosity about this most bizarre aspect of medical science, read on. I dare you not to snicker, even once. (3/5 Stars)