Better by Atul Gawande

If we wanted to save more patients’ lives in the medical system, is it more important to fund research that could perhaps find cures, or would it be more appropriate to invest time and money in improving the standards already in place? The tendency for us to say ‘more research’ is almost a given, but Atul Gawande, surgeon and staff writer for The New Yorker, argues that the later can have far more drastic effects.

In Better, Gawande explains that in medicine, as in nearly all human endeavors, variations in performance create a bell curve where most participants are merely at or below average. In this collection of essays, he studies this idea in the medical community and looks to find what separates the positive deviants from the rest.

Gawande writes about such the importance of hand washing, something one would think is a given in hospitals and doctor’s offices, yet shockingly staph infections in hospitals are transmitted to 30% of patients, a number that could be reduced dramatically using tools already in place. The doctor also covers ethics in medicine, from the use of chaperones when examining patients of the opposite gender and the role of doctors in capital punishment.

In covering medical interventions in slightly abnormal pregnancies, he makes a strong case that many caesarian sections are given when the old method of using the clamps on an infant would work just as well with an equal or better chance of complications. When studying the differences between a first class treatment center for cystic fibrosis and an average one, Gawande argues that the main difference is the ability of the medical staff to treat the person more than the disease and to be willing to think outside the box when it comes to diseases with which we have made relatively little progress on a cure.

In a stirring conclusion in which he offers five pieces of advice to medical students on making a difference in patients’ lives, Gawande says that it ‘often seems safest to do whatever everyone else is doing, but a doctor must not let that happen—nor should anyone who takes on risks and responsibilities in society.’ Technology provides many solutions and enables advances in areas previously thought impossible. But it is human ingenuity that underpins technological advance, and sometimes it is simple human practices that have the biggest impact.

Better is an entertaining and informative collection of essays with lessons that go beyond the specifics of practicing medicine. I look forward to reading more from Dr. Gawande in the future.

Losing the Peace by William Leisner

As has been noted numerous times in this space, I was not a fan of the universe-changing Destiny trilogy. However, I have found the follow-ups to put an interesting spin on said events, so I was looking forward to reading the first full story centering on the Enterprise after the devastating Borg attacks, Losing the Peace by William Leisner. Full disclosure necessitates that I note that while Leisner and I have never met, we do have a friendly relationship on several Trek discussion boards and are mutual friends on LiveJournal.

Being refitted at McKinley Station, the crew of the Enterprise awaits their orders while taking leave. Unsurprising to anyone, the fact that the Federation is not in a position to send the fleet into unknown space becomes clear when President Bacco informs Picard that his ship will be needed close to home.

The refugee crisis is impacting several planets, especially the ocean planet of Pacifica, which you will of course remember is home of the Selkies, the race of Aili Lavena of the Titan. Beverly Crusher and Commander Kadohata lead a team to assess the refugee situation and provide what assistance they can. Leisner’s depictions of the refugee camp don’t really evoke the sort of crisis he trying to convey, but later in the novel, the reactions of outsiders to the 70,000 people stranded and living in tents does a lot to drive this home. But this situation overall serves not only a critique of the limitations of bureaucracies, but also of the very people those bureaucracies serve. Too often we think of government as the solution to our problems, as if there is a button on their desks they need merely press to provide assistance. The tension between the refugees and residents of Pacifica make this point without overstatement, and Leisner should be lauded for pulling this off.

However, the personal fallout from the crisis fails to be effective, but honestly this isn’t really the fault of Leisner. Instead, it is a result of the overall planning of Destiny and its aftermath; rather than seeing Earth or Betazed destroyed, we get Deneva. So the brunt of the crisis falls to seconday characters and cameos rather than squarely on the shoulders of the characters we have spent over twenty years investing emotion in. We first see this in the novel through the eyes of Arandis, the Risian played by Vanessa Williams in the worst episode of Deep Space Nine ever conceived. Risa was destroyed in the invasion, so it works pretty well to use her as a perspective to the crisis, but again it is hard to really feel the impact when the character is merely a guest star.

The invasion of the Borg wiped out the family of security chief Jasminder Choudhury, but she is such an undeveloped character that it is hard to empathize. In addition, the slimmest chance that her family is still alive is unrealistic to her for her family was apparently so good that they would never take a seat on an evacuation if it meant someone else would be unable to go as well. In fact, we later find out that her whole region was apparently saintly, for they left dozens of seats open rather than evacuate. I think that Choudhury’s struggle to deal with the deaths of her family might have been more compelling if she wasn’t all that close to them in the first place. Is she hadn’t spoken to her parents in years and wasn’t really upset about that situation, then the regret of never being able to make amends if she wanted to one day would be nonexistent.

Geordi deals with survivor’s guilt towards the beginning of the novel, but in unrealistic fashion apparently confronts these problems and heals himself in about fourteen seconds. The scenes as written work pretty well, but I kept feeling that these issues could have been drawn out over the whole novel, not only adding another subplot, but making the reader really see how characters they have invested in are suffering.

As the novel progresses, Picard disobeys orders only to have the clichéd result of that disobedience being the solution to greater problems. Admiral Akaar makes the brief but compelling case that the chain of command exists so that the wisest and most intuitive are at the top issuing orders, but that Picard obviously knew better in this and other situations so he is going to be promoted. His new position: director of relief efforts concerning the Borg invasion. But as must happen in order for the stories to continue, he turns down the promotion.

I’ve been all over this type scenario for years, but when the Federation is in a time of dire crisis and the powers that be have selected Picard as the man to lead the efforts in rebuilding, he feels no impetus to do so, no patriotic obligation to serve where he might most be needed. It’s not that I want Picard to no longer be in command of the Enterprise, rather I am tired of him being offered promotions that require the lack of verisimilitude when he turns them down. The impetus is to present Picard as a true explorer, but to me that doesn’t ring true with the character as presented. If he played his cards right, Picard could be the next president of the Federation; am I supposed to believe that someone isn’t whispering that into his ear?

Despite the main crux of this review, I think Leisner did a pretty good job with showing the fallout of the war. Without the overarching and strict plot structure, he is able to provide what amounts to a character piece. As the immediate aftermath of Destiny passes and the Federation gets ready to deal with the new threat of the Typhon Pact, it is nice to get such an intimate look at these characters and the aftermath of the Borg invasion.

Reading List: June 2009

I feel as though I have wasted the past month. I have written little, whether here or for school, and much of my reading has been confined to comic books. While I do have a paper in mind analyzing the layouts of Brian Michael Bendis, I am not sure that I can really call much of what I did read 'research.' As much as it pains me to admit, I am not sure that I work all that well alone. Rather, I tend to be much more productive with tight deadlines and when I am attending class where I can bounce ideas off and gain new insights by listening to my colleagues. Last summer was quite unproductive as well, but since I am done with classes forever, or at least until I pursue another degree, I need to learn how to get some real work done.

Anyway, the library turns out to be a great source of comics. Since I started using it as my main source for obtaining books, I've read at a much quicker pace than I usually do. Of course, it helps that I can just sample things without shelling out a penny. Minus the large amount of taxes I now pay, of course.

Continuing my quest to actually recommend something for you, I would have to say that Bill Bishop's The Big Sort was by far the best book I read this past month. I intended to write up some thoughts on it, but it all just seemed to be summarizing Bishop's arguments. Along with the work of Ken Robinson and a timely trip home to see my family, this book made me not only better understand the environment I was raised in, but has caused me to question in what sort of environment I want to raise my own children. Bishop argues that our immediate culture (neighborhood, peer group, church, etc.) have become homogenized over the past thirty years as people purposefully though often unconsciously move to be with people that think the same way they do. Check out the review on the New York Times website.

In the month of June, I completed 26 books and/or graphic novels:

• The Push Man and Other Stories by Yoshihiro Tatsumi
• The Corrections by Jonathan Franzen
• Ultimate Spiderman: Public Scrutiny by Bendis & Mark Bagley
• Sleepwalk and Other Stories by Adrian Tomine
• Delicate Edible Birds by Lauren Groff
• Ultimate Spiderman: Venom by Bendis & Bagley
• The Chris Farley Show by Tom Farley, Jr. & Tanner Colby
• Outliers by Malcolm Gladwell
• Decimation: X-Men: The Day After by Peter Milligan, et al.
• Civil War by Mark Millar & Steve McNiven
• Shards and Shadows edited by Margaret Clark & Marco Palmieri
• The Big Sort by Bishop
• Batman R.I.P. by Grant Morrison & Tony S. Daniel
• Sin City: Hell and Back by Frank Miller
• Ultimate X-Men: New Mutants by Bendis & David Finch
• Ultimate Spiderman: Irresponsible by Bendis & Bagley
• Abandon the Old in Tokyo by Tatsumi
• Not the End of the World by Kate Atkinson
• Ultimate Spiderman: Cats and Kings by Bendis & Bagley
• Ultimate X-Men: The Tempest by Brian K. Vaughan & Brandon Peterson
• Ultimate X-Men: Cry Wolf by Vaughan & Andy Kubert
• X-Men: Deadly Genesis by Ed Brubaker & Trevor Hairsine
• Born Standing Up by Steve Martin
• Remix by Lawrence Lessig
• 52, Volume One by Geoff Johns, et al.
• Ultimate Spiderman: Ultimate Six by Bendis & Hairsine
  

Seeing as I am still not using this blog in the way I had intended originally nor the way I had thought of going a few months ago, I have no idea whether or how often I will post here again. I wait until something strikes me, but you see how productive that has been. Questions, comments, etc.

The Plagiarism Allegations Against Chris Anderson

Though you might have trouble finding it now that the round the clock coverage of dead celebrities has flooded all media of any kind, earlier this week Waldo Jaquith of the Virginia Quarterly Review discovered several instances of plagiarism in Chris Anderson’s new book, Free. I’ve been looking forward to this book for a few months now, having read The Long Tail back in February.

I’m not all that interested in going back over something others have done better, but I do want to briefly note something. Anderson and other Web 2.0 figures vociferously defend the right of creators to mash-up other works and create new things out of them. When remixing video/audio, it isn’t often that one is really accused of plagiarism; no one is trying to pass off the actual rapping of Dr. Dre as their own. Yet when writing, such a mash-up doesn’t signify the input of others in the same way, something I struggled with in May when I tried to do something by barely rewriting a couple of dozen articles about the Kindle into several sustained arguments. I included links as a sort of citation, but only because I was so uncomfortable with the process.

Anderson’s book is not a scholarly work, but that doesn’t mean he should be excused from citing his material appropriately. That said, I think the argument could be made that he was ‘sampling’ the work of others and integrating it into a larger whole that makes a different, or perhaps just broader, point. Maybe I can put it better another way.

Imagine this: rather than printed text, let’s say that Anderson is making a video. He uses the same pieces he is accused of plagiarizing in his video, but instead of taking them from other printed texts, he instead uses clips of the authors giving a speech where they say the same things. Why is this not plagiarism too? Does the fact that someone other than Anderson would be on video enough of a citation?

In fact, plagiarism is a broad term. For instance, were I to do something in one of my graduate classes like Anderson has done here, it would be considered plagiarism. As would me downloading an essay off the web and turning it in as my own work. But the latter is outright fraud, while the former could be characterized as merely careless. Inadvertent plagiarism shouldn’t be excused, but it likewise shouldn’t be considered the same crime as deliberate copying. Even scholarly, uncited copying was rampant for years and years until the attitude toward citation became a norm.

This is an unfortunate situation, and to his credit, Anderson has owned up to his error and been quite apologetic. Yet I worry that with all this negative coverage, people will be put off of what could be a book full of good points. The mere fact that Anderson didn’t use quotation marks when he should have does not render his argument null and void. He was wrong, but it might not be as bad as it’s being made out to be.

Mirror Universe: Shards and Shadows

I intended to write a blow-by-blow review of each story in this book, but I find myself unable to summon that sort of effort. In fact, I’m not really sure what made me seek Shards and Shadows out after all these months; perhaps something to do with upcoming DS9 books tat take place in the Mirror Universe, perhaps a lack of genuine passive fun when it comes to my reading pile. But what I do know is that despite some failures, the collection of short stories is worth your time.

Two years ago, Pocket published six short novels that took place entirely within the Mirror Universe, as depicted in such memorable Star Trek episodes as 'The One Where Evil Spock Had a Goatee.' The experiment was a success, and shortly thereafter this collection was announced in order to tie up some loose ends and expand the universe. For instance, Margaret Wander Bonano explains how Captain Kirk acquires the Tantalus Device that allows him to disappear people, all the while fleshing out the character to seem more than the raging mad man he was depicted as in the episode.

Stories that take place later during the Klingon/Cardassian Alliance and the Terran Rebellion set the stage for some of what surely will follow in the upcoming DS9 book The Soul Key. Susan Wright pits Intendant B’Elanna Torres against Kes in a psychological, telepathic battle. Keith R.A. DeCandido tells an interesting epistolary story about the politics and scheming of the Alliance command. Jim Johnson follows Keiko Ishigawa and her adjustment to life as one of the top commanders in the Terran Rebellion.

This isn’t to say that all these stories are good, Johnson’s is a story we’ve seen a million times with someone set up to look like a traitor even though we know she won’t be because she’s the hero, but they do weave a broader tapestry of the universe and blurs the line between the good/evil division that the DS9 episodes reduced the struggle to. Other stories miss the mark entirely, like Michael Jan Friedman’s ‘The Traitor,’ which focuses on Luc Picard who was so uninteresting in The Worst of Both Worlds and has an ending that renders the entire story pointless.

And while I understand that the fiction-only characters have a following, stories like James Swallow’s ‘The Black Flag’ about the mirror equivalents of the Vanguard crew and Peter David’s next tale concerning New Frontier are too insular to really work here. And where cameos of characters might work on television, the medium of print doesn’t handle the tossing out of names for their own sake so well. I might have been more interested in Pennington than in a Reyes with a laser eyeball. (If you have no idea who these people are or why you should care, then I think you understand my problem with these stories.)

Though it has been praised by those I respect, I found the worst story of the collection to be Dave Stern’s ‘Nobunaga.’ First of all, I hate stories that end up as a dream, simulation, etc. Secondly, and this may not be a fair criticism, but with the ending of Age of the Empress depicting the resurrection of Archer, I wanted to see the story picked up from there. Instead, we get nothing more than a couple of sentences to bridge the rift, not to mention an Archer that much more resembles the one from our universe than the one depicted in In a Mirror, Darkly.

There are stories that really work well here, like Wright’s and DeCandido’s, some that are just fun like Mack’s and Christopher L. Bennett’s, and a couple that just didn’t really work for me. Nothing lives up to the tall bar that Mack set with The Sorrows of Empire, but the collection does succeed in fleshing out the mirror universe, making it a place that really calls for more stories to be told. This book rekindled an interest in the fiction line that I felt was fading fast, and now I am looking forward to picking up some of the newer releases.

The Chris Farley Show

No one was more surprised than me to see a biography of Chris Farley show up on the several of the Best of 2008 lists last year. Like a lot of people, I was a fan of Farley in the loosest sense; I enjoyed him on SNL and will admit to laughing quite a bit at Tommy Boy, but for the most part he seemed like a one-note comedian. I was surprised to find out just how talented and therefore tragic his early death was by reading The Chris Farley Show, an oral history of sorts compiled by Farley’s brother Tom and professional writer Tanner Colby.

I picked up the new paperback copy two weeks ago and flipped through it, surprised to see that the majority of the text was made up of compiled quotes from interviews with those close to Farley. The book is structured into three sections, called acts, which follow a fairly predictable pattern. Act One leads up to Farley joining the cast of Saturday Night Live, Act Two deals with the struggles with addiction and sobriety, while Act Three chronicles the decent into addiction that ultimately killed the man. Predictable as this may be, the different perspectives provided by using the actual voices of interviewees rather than the clinical voice of a traditional biography offer real feeling in insight not just into Farley, but also into some of the well-known people who knew him.

Farley wasn’t a stand-up comedian, but rather an improvisational actor, something that shouldn’t really surprise anyone who has followed some of the more successful casting choices on SNL since. Yet what isn’t so widely known is that almost everyone who knew him thought that he could have made a fine actor, even be an Oscar contender, if he could just find the right vehicle and get his act together. I had not heard that David Mamet had written a script for Farley based on the life of Fatty Arbuckle, only to see the project wind up forever in limbo due to Farley’s inability to get insured due to his drug problems. Since finishing the book last week, I have often wondered what such a movie would have been like. And with Jim Carrey winning a couple of Golden Globes, it doesn’t seem too much of a stretch to imagine Farley being honored as well.

Farley’s struggles with his weight were a source of his comedy yet painful for him at the same time. He struggled with wanting to break free of the roles he seemed confined to, where ‘everyone always laughs when Fatty falls down,’ and into something more complex and fulfilling. Such a struggle is commonplace among such actors, yet the book illustrates his feelings with such emotion tat it is hard not to be moved.

Tom Farley is the force behind this project, and he should be commended for the frank portrayal of his brother’s life that is shown in this book. Things aren’t whitewashed at all, and a nuanced picture of the life of Chris Farley shines through. Different people remember events differently, and both voices are heard. This is especially true with regards to the famous Chippendales scene with host Patrick Swayze. Its popularity can be testament to it being a success, but many like Chris Rock argue that it demeaned Farley in a way that surely led him further into addiction for a skit that had no real comic payoff beyond laughing at a fat man.

Unfortunately, Farley seems to be viewed as another John Belushi, a SNL star who just couldn’t escape his addictions. But as The Chris Farley Show demonstrates, he was much more than that. For those interested in reading a compelling story of misunderstood man told in a unique way, the stars have aligned for this is the book for you.

The Corrections by Jonathan Franzen

‘The alarm bell of anxiety’ that Alfred and Enid Lambert hear ringing on the first page of The Corrections will ring for the reader as well throughout the first 12 pages of Jonathan Franzen's much-hyped third novel. The belabored metaphors suffusing these pages and the hysteria of an episode in which nothing more happens than the mailman comes to the door will make even the most forgiving of readers wonder, ‘Should I actually read the next 540 pages of this?’

The answer is yes. Not only does the novel immediately improve, but the realization that Franzen probably intended the difficult beginning comes quickly, when Chip, Alfred and Enid's feckless middle child, is introduced. Fired by the college where he taught for sleeping with a student, Chip relocates to New York City where he takes up part-time legal proofreading, writing for an arts monthly, and begins work on a screenplay entitled ‘The Academy Purple,’ which opens with a six page monologue. ‘My idea,’ Chip tries to explain to his girlfriend as she's leaving him, is ‘to have this 'hump' that the moviegoer has to get over. Putting something off-putting at the beginning, it's a classic modernist strategy. There's a lot of rich suspense toward the end.’

It seems too obvious to be a coincidence — the hump at the beginning of the screenplay reflecting the hump at the beginning of the novel, especially as the care and control that Franzen exerts over his characters, their relationships and the locales they inhabit in the remainder of the novel becomes apparent. Nothing else in the book is as clunky as the opening pages.

There is not much plot to The Corrections: Enid, the social-climbing, prudish, delusionally optimistic matriarch, wishes to reunite her family in the fictional midwestern city of St. Jude (St. Louis) for one final Christmas. The enthusiasm of the other family members for a holiday together is muted.

Alfred, afflicted with Parkinson's disease and increasingly addled by dementia, is too concerned with his weakening mind to pay much attention to Enid's plans. Irascible and emotionally distant, the principled, repressed man is left confused and only occasionally lucid; he struggles constantly to comprehend what's around him, but it's an effort he's growing weary of, a mental state artfully and disturbingly described by Franzen.

The Lambert children are wary of returning home for their own reasons. Gary, the eldest son, a banker, is married to the beautiful but manipulative Caroline, who refuses to travel to St. Jude and wages war on Gary through their three sons, bribing the boys with Broadway tickets and computer games to stay home with her in Philadelphia. Chip, who impulsively flies to Lithuania with the ex-husband of his ex-girlfriend to start up an Internet fraud scheme, is seeking to avoid what he sees as the multiple failures of his life. Denise, the youngest child, is a hip, tense, talented, workaholic, sexually confused gourmet chef, whose separate affairs with the owner of the restaurant she works for and his wife get her fired. None see time spent together as the means to alleviate any of those issues. That all three are in St. Jude by Christmas morning is surprising to Enid and the reader until he/she realizes that for the book to work a final gathering of the family is necessary and therefore inevitable.

Franzen's ability to craft over 500 compelling pages out of this small domestic drama is a credit to his skills as a novelist. He manages, with the novel's relatively small cast of characters and minimal storyline, to cover topics as diverse as consumerism, the restaurant business (though not altogether accurately), the love-hate tension of intimate relationships, the collapse of Lithuania's political system, metallurgy, the stock market and cruise ship culture.

The book's only distracting flaw is a lengthy bit about Axon Corporation, a biotech firm developing a 'revolutionary' treatment for brain disorders and mental illnesses. Gary and Denise attend an investment luncheon given by the company; there's a video, and a painful question and answer session. This portion is a too-blunt bit of social commentary, and a not very original one. The trend to medicalize quirks of personality and moods, and consumers' willingness to be medicated, has been thoroughly examined many times before, and as a central theme of the novel, fails to resonate.

Franzen's commentary is more effective, his satire more cutting, when embedded in a character's activities or opinions. Enid, expecting an elegant, sophisticated experience on a cruise up the East Coast, is confronted instead with people wearing T-shirts marked with sayings such as ‘Old Urologists Never Die, They Just Peter Out.’ Her resentment — ‘It rankled her that people richer than she were so often less worthy and attractive’ — is double-edged. Enid wants to be those people even as she reviles them.

The real success of the novel, though, lies not in the commentary but in the characters — Alfred and Enid are especially alive. They evolve, in the course of the novel, from being caricatures of Midwestern suburbia to being fully realized people, with a complexity and dignity rare in fictional characters, even as their progression diverges dramatically. Alfred declines to the point of needing a nursing home; Enid reveals a capacity for self-awareness and growth not hinted at in the book's beginning. The remaining Lamberts and the other characters are less-finely drawn, although each has a distinctive voice and perspective not likely to be confused with any other character. Franzen’s only real misfire is that the denouement seems to implicate one character as responsible for the ills of the others, and with his removal from the playing field, everyone else’s life gets remarkably, if perhaps coincidentally, better.

Near the end of the novel, Chip has an epiphany. He realizes why no one, including himself, liked his screenplay: He'd written a tragedy instead of a farce. 'Make it ridiculous,' he says to himself. It seems like another insight from the screenplay into the novel, perhaps one Franzen had himself in the early drafting process, a reminder that to read the story of the Lambert family too seriously is misguided.