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WE ASKED NINE EXPERTS TO TELL US ABOUT THEIR FAVORITE NEW BOOKS ON MEDICINE.

Arthur Frank, professor of sociology at the University of Calgary and author of At the Will of the Body: Reflections on Illness (Houghton Mifflin, 1992) and The Wounded Storyteller: Body, Illness, and Ethics (Chicago, 1995).

"My hope is that the significant medical advances of the future will not so much be in technology, but in recovering the personal qualities of caring. In Not All of Us Are Saints (Hill & Wang, 1994), David Hilfiker tells of leaving his medical practice in rural Minnesota to live and work among the homeless in Washington, D.C. Practicing 'poverty medicine,' he finds himself almost as powerless as his patients; confronting his 'own kind of brokenness,' he discovers new abilities to care. Hilfiker's view of medicine as a spiritual calling finds a complement in Rachel Naomi Remen's Kitchen Table Wisdom: Stories That Heal (Riverhead, 1996). As a young physician, Remen says she 'had no sense of awe.' Like Hilfiker, she surrenders traditional medical power in order to claim the power of her own brokenness. Remen and Hilfiker teach physicians and ill people alike that care begins when we see others, and ourselves, with awe."

George Anders, medical reporter for the Wall Street Journal and author of Health Against Wealth: HMOs and the Breakdown of Medical Trust (Houghton Mifflin, 1996).

"If Henry Kaiser and Sidney Garfield hadn't met in the Thirties, the modern-day health-maintenance organization might still exist. But it wouldn't be as pervasive, as powerful, or as big a break from traditional fee-for-service medicine. The interplay between Kaiser and Garfield, the industrialist and the doctor--and both men of ego and vision--created the vast Kaiser-Permanente HMO network. That important story in the development of American health care is ably told by John Smillie's thorough (if blandly titled) historical study, Can Physicians Manage the Quality and Costs of Health Care?:The Story of the Permanente Medical Group (McGraw-Hill, 1991). Smillie worked for years in the Kaiser system and is sympathetic to its values. Yet his research is thorough enough that both fans and critics of HMOs can find much to draw upon."

Lisa Cartwright, professor of English and visual and cultural studies at the University of Rochester and author of Screening the Body: Tracing Medicine's Visual Culture (Minnesota, 1995)

"In a recent Lingua Franca, Alan Sokal posed the question, Will theorizing about the social construction of AIDS help cure AIDS? His answer was no. In a plenary address to the 1996 meeting of the Society for Literature and Science, Paula Treichler offered ten reasons why Sokal should have said yes. For almost a decade, Treichler has provided some of the most incisive theorizing about the public and professional politics of HIV/AIDS. This work is collected in How to Have Theory in an Epidemic: Cultural Chronicles of AIDS (forthcoming from Duke). The essays, written during her tenure as a professor at the University of Illinois medical school, demonstrate the now broadly accepted point that the changing construction of AIDS (what constitutes this syndrome, which communities are labeled 'at risk') has tremendous bearing on both treatment of people with AIDS and research toward a cure."

Theodore Marmor, professor of public policy and management at Yale University, author of Understanding Health Care Reform (Yale, 1994), and co-author of America's Misunderstood Welfare State: Persistent Myths, Enduring Realities (Basic, 1992).

"I would recommend that those interested in health care forgo the momentary enthusiasm for all manner of nostrums about managed care, unmanaged care, integrated delivery systems, disintegrated delivery systems, etc., and turn to a book that will be worth reading in the next century. Managing Scarcity: Priority Setting and Rationing in the National Health Service by Rudolf Klein, Patricia Day, and Sharon Redmayne (Open University, 1996) has profoundly affected my thinking about health care and public management. It is a brilliantly written exposition of the experience of British authorities in allocating resources among broad categories of care--a veritable conceptual road map of the various ways health care professionals sort out who gets what, when, and why."

Arthur Kleinman, professor of anthropology and psychiatry at Harvard and author of The Illness Narratives: Suffering, Healing, and the Human Condition (Basic, 1989) and **Writing at the Margin: Discourse Between Anthropology and Medicine (California, 1996).

"Increasingly," says Kleinman, "I find books on the subject of suffering important because they extend the range of concern for the humanities and medicine from disease processes and treatments to the broader context of meanings and relationships." His favorite in this category is David Morris's The Culture of Pain (California, 1991). "The chapter on tragedy might just be the best account of why medicine fails in its treatment of chronic-pain patients: namely, because it fails to understand that pain, experienced not just as physical complaint but as suffering in the broad sense, is a profound challenge to meaning. Morris's analysis suggests how cultural representations and collective experiences may mediate body-self relations so that in encounters with serious illness, the moral, the political, the economic, and the medical are hopelessly entangled."

Robert Hahn, professor of anthropology at Emory, a medical doctor, and author of Sickness and Healing: An Anthropological Perspective (Yale, 1995).

Hahn chooses Marcia Inhorn's Quest for Conception: Gender, Infertility, and Egyptian Medical Traditions (Pennsylvania, 1994). "It's a remarkable synthesis of ethnography about infertile Egyptian women's attempts to have children, history of the development of Egyptian medical ideas and practices from ancient times, and contemporary political and economic analysis. What makes the book stand out is Inhorn's powerful personal sketches of the lives of the women she studies. What makes it especially relevant to anyone studying the developing world is its applied anthropology: her proposals for combining the contributions of traditional healers and modern biomedicine and for embedding both in programs that redress broader political-economic problems."

Margaret Lock, professor of anthropology and social studies of medicine at McGill University and author of Encounters With Aging: Mythologies of Menopause in Japan and North America (California, 1995).

Lock notes that "a steady stream of books has appeared over the past twenty years dealing with medicine as a social enterprise." The contribution of anthropologists, she says, "is noteworthy because these authors usually take a critical position about biomedicine, which, they argue, must be interpreted as historically and culturally produced. In ** The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton, 1995), Allan Young argues that PTSD is neither timeless nor intrinsically unified but that it is nevertheless painfully real for patients. Through historical analysis he shows how the idea of traumatic memory was created in the nineteenth century, and, through ethnography in a psychiatric unit, he shows how it is sustained today."

Charles Rosenberg, professor of history and sociology of science at the University of Pennsylvania and author or editor of sixteen books on medical history, including The Care of Strangers: The Rise of America's Hospital System (Basic, 1987) and Explaining Epidemics and Other Studies in the History of Medicine (Cambridge, 1992).

"We hear a great deal today," Rosenberg observes, "about something called 'the health care system' -- which is usually shorthand for economic arrangements. In this one-dimensional discourse, the patient's experience disappears. But we do have a growing body of work that focuses incisively on the way in which health care institutions affect ordinary people." He singles out Laurie Abraham's Mama Might be Better Off Dead: The Failure of Health Care in Urban America (Chicago, 1993) and Susanna Kaysen's Girl, Interrupted (Random House, 1993). "Abraham's book provides a powerfully circumstantial account of an African-American family as it tries to negotiate its way through the maze that constitutes public medicine. Kaysen's is a brief but compelling account from the patient's perspective of a psychiatric hospital that can take its place alongside the classics of the genre such as Sylvia Plath's The Bell Jar and Hannah Green's I Never Promised You a Rose Garden."

Daniel Chambliss, professor of sociology at Hamilton College and author of Beyond Caring: Hospitals, Nurses, and the Social Organization of Ethics (Chicago, 1996) and Champions: The Making of Olympic Swimmers (Morrow, 1988).

"According to Renee Anspach's Deciding Who Lives: Fateful Choices in the Intensive-Care Nursery (California, 1993), traditional bioethics is rapidly becoming irrelevant. Under the old model, an autonomous physician struggled in the pure air of his (typically 'his') own conscience with life-and-death decisions. Now, organizational priorities dominate, and the big ethics judgments (who gets insurance? who gets surgery? whom do we try to keep alive?) are governed by rules set up by committees at huge insurance companies. This means that studying medical ethics is now the job of sociologists, and Anspach is simply brilliant in detailing the collective decision making of physicians and the folk psychology they use in dealing with families. It's a great book for learning how things really work in hospitals."

--Rick Perlstein

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