tip off

Recommended reading for your summer holidays, from Croakey contributors

“Not to be too grand about it, but a book ought to alter the reader’s life, add to the reader’s life, in some fundamental way. You have a compact with the reader that if he gives you the time then something will be better for him. His understanding will increase, an emotional satisfaction will ensue, a cathartic experience will take place. A book has to make something happen. A newspaper story informs, a magazine article entertains, and a book has to move you.”

This quote comes from an interview with an American journalist and writer, Richard Ben Cramer, who is cited in one of the books that I enjoyed this year: The New New Journalism: Conversations with America’s Best NonFiction Writers on their Craft, by Robert S Boynton.

Given that the season of book buying, reading and sharing is fast upon us, what do Croakey contributors recommend?

• Ben Harris Roxas, public health consultant, conjoint lecturer University of NSW

I Heard the Sirens Scream (2011) by Laurie Garrett, a Pulitzer Prize-winning science journalist and senior fellows for global health at the Council on Foreign Relations, is an engaging and highly detailed account of 9/11 and the subsequent anthrax mailing incidents.

Most of the book is in the first person and was written at the time of the events being described. Garrett looks at the way those events have transformed American culture in general, though she specifically focuses on what the health and health system implications of the World Trade Centre plume and the anthrax attacks have been.

Garrett contends that these events showed up fundamental weaknesses in the U.S.’ public health infrastructure but she goes on to say that endless restructuring has left many organisations even less prepared now, ten years later, and broke.

Worryingly, she also suggests that the accepted history of the anthrax mailings is incorrect and that there may have been broader bioterrorism links.

There’s a discussion on the book here or you can buy it from Amazon.

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• Michael Moore, Public Health Association of Australia

I suppose everyone else has seen the movie.  However, I finally got around to reading Kite Runner by Khaled Hosseini on the recommendation of my daughter who studies Farsi as part of a Masters Degree in Middle Eastern Studies at ANU.

At least I now know why she calls me “Baba jan” (a term of endearment the main character applies to his father).  I cannot help associating when I read and so the book allowed me to put myself in the shoes of a refugee family.

A particular insight was the impact on those who were of middle-class background and had the wherewithal to flee compared to those who without drive, cash, contacts or ability. It is not hard to extrapolate to those boat people who arrive in Australia after the most awful experiences and then are treated so poorly by the Australian system out of some fear that a tiny percentage might be terrorists.

The other book that really stood out for me was the last in the series by Tom Rob Smith: Child 44, The Secret Speech and Agent 6.

The three books are set in Russia in the depths of the post-war Soviet period.  Apart from being fast reading and interesting for those fascinated by things Soviet, the characters are real, wrestling with the issues that confront all of us.  In this case the main character being part of the Secret Police for part of the series brings issues about freedom, torture, control of the State and liberty into a very clear focus.

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• Dr Peter Arnold

The Prague Cemetery Umberto Eco. November 2011, Random House.

The most notorious forgery in history, influencing those responsible for the deaths of millions during the Hitler and Stalin eras, and for the displacement of close to a million from their homelands in North Africa and the Middle East, was the so-called Protocols of the Elders of Zion.

Umberto Eco has applied his encyclopaedic knowledge of European history and politics to trace the 19th century French origins of this document. It was, in fact, plagiarised from Maurice Joly’s 1864 The Dialogue in Hell between Machiavelli and Montesquieu—which had, of course, nothing to do with Jews.

Referring to the many historical characters whose words and actions contributed to the formulation of the Protocols, Eco has invented the author, the one fictional character in the book, Simonini. This master forger is the grandson of a man who, indeed, wrote a scurrilously antisemitic protest to the French government, a letter which formed the basis of the fictional character’s prejudices.

A Simonini-like character might well have been responsible, too, for the forged document leading to the wrongful arrest and imprisonment of the only Jewish Captain at French army headquarters, Alfred Dreyfus, falsely charged with espionage.
Eco not only demolishes the many ridiculous myths believed by anti-Semites; he also exposes the rank stupidity of racial, ethnic, nationalistic or religious prejudice.

If you’ve read Eco before, you’ll relish his intellect. If you haven’t, be warned—he’s a challenging writer, making his readers work hard to follow his meaningful, but sometimes apparently obscure, meanderings.

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• Dr Jan J Barendregt, School of Population Health, University of Queensland

I’ve been reading The Spirit Level, by Pickett and Wilkinson.  Subtitle:  “Why More Equal Societies Almost Always Do Better”.  The subtitle tells it all.

It is an international comparison between a group of high-income countries (including the US), and between the US states, of all kinds of indicators of wellbeing, including health indicators, against the level of income inequality.

The result: more equal countries do better on all indicators. The surprising result: this is true for all levels of income (this latter result may not be true for the highest 0.1% of income or so, but it is true for the highest quintile).

It is even true when the high level of income between countries (or US states) is the same: even then the health of these high-income level groups is worse in high inequality countries (or US states).

So why would this be? This is mostly observational data and ecological analysis, so a causal relation is a problem. But the mass of evidence on the many different indicators that the writers collected makes it very hard to believe that all these effects are due to some, as yet not discovered, common confounder.

In addition, there are some results of experimental studies into the effects of inequality on human behaviour.

I think Pickett and Wilkinson have shown beyond reasonable doubt that inequality is indeed a major driver of societal and individual wellbeing, including health. More equal rich countries are happier and healthier, even when not as rich as the richest.

This is a very important book, certainly in the light of the recently vastly increased income inequalities in some countries, including US, UK and Australia.

From this book we can conclude that this increase in inequality is clearly not in the best interest of our societies, including the best-off groups in our societies. Never mind the argument that we need to pay the top CEOs millions because they operate in a global market: even if we would be collectively poorer when these highest paid CEOs depart, we would as a society be better off because of less inequality. So what’s keeping us?

Meanwhile I’ve been reading lots of other books, of course. Most recently “We are all made of glue” by Marina Lewycka, known for her hilarious “A short history of tractors in the Ukraine”. “Glue” is moving, funny, and very original. Well worth reading.

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• Heath economist Professor Gavin Mooney

Having recently moved to Tasmania I read The Sound of One Hand Clapping by Richard Flanagan (Picador 1999). Tells us so much about Australia (and not just Tassie) and the stories of how so many have come here … and also about longings and regrets and the horrors of war. Deeply moving. Very, very dark but quite extraordinarily beautifully written. This really moved me as few novels do.

Revolutionary Doctors by Steve Brouwer, Monthly Review Press 2011.  (Monthly Review Press publish some great stiff!) On Cuban and Venezuelan health care and Cuban and Venezuelan doctors. Uplifting.

Another world of health and another health care world are possible.

As a Scot from Glasgow – that ‘No Mean City’ – with a mother from the rural poor and a father from the slums of that city, I read The Tears that Made the Clyde by Carol Craig (Argyll 2010).

This is a book that is special for Glaswegians but it is a story for all who have a concern about the social determinants of health and who see public health as being essentially political and incapable of being fully understood outside of a class analysis.

Then Bad Samaritans, The Myth of Free Trade and the Secret History of Capitalism by Ha-Joon Chang (Bloomsbury 2008). The title says it all.

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• Ann Larson, Social Dimensions, Geraldton

A recent favourite read is Rebecca Skloot’s The Immortal Life of Henrietta Lacks.  Mrs Lacks’ cancer cells called HeLo have been used in labs throughout the world and have been part of numerous medical breakthroughs for many decades.  The author tells the story behind the cells of this African American woman and her family.

It is a story of science, medical research funding, racism, poverty, human dignity and integrity in writing.  It is also a thrilling page-turner.

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• Professor Penny Hawe, works part time at the Population Health Intervention Research Centre at the University of Calgary, Canada, and a strategic research advisor at the Centre for Excellence in Intervention and Prevention Science, Melbourne.

Why is trust in science so fragile?

My “bestie” from school (we became friends at 13) told me recently that she has recently been diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD), in a past life.  Yes, you read that right. In a past life.

I thought I took the news pretty well, all things considered.

She has a masters degree  and two post graduate diplomas. She has recently enrolled in a PhD. I won’t say where. The sticking point for me will remain that she always beat me at maths. So I am a little biased in my assessment of her achievements.  She is currently working as a school teacher and University college undergraduate tutor. She is married to a highly respected Toorak-based GP.  They are both members of a group called School of ___________. They go off to courses on Plato and easy guide to learning Sanskrit. But they won’t tell me much more about this, as I am not a paid up member of this School. The emphasis here is very much on the phrase “paid up.” Enough people pay up for this group to run its own primary school.

While the GP allows her to apply her diploma qualification to regularly hypnotise their children (that is how you detect and treat people who have conditions in their past lives, by the way), I am pleased to report that both their children are fully vaccinated.

But my girlfriend is deeply unhappy about this.

This is where my book recommendation comes in. Seth Mnookin, The Panic Virus. Fear, Myth and Vaccination Debate.

It sets out to answer the question, “that with more facts at our finger tips than ever, why is trust in science so fragile?” It describes how perfectly reasonably people are driven to believe in health conspiracies.

It also describes how perfectly reasonable celebrities, like anti-vaccination champion Jim Carrey, are so well equipped to help drive those fears, because they work in industries which specialise in communication. These celebrities are naturally contrasted in the book with scientist schmucks like us, though in this case the unfortunate example is the President of the Institute of Medicine and the author is far too respectful to call, him or any of us, “schmucks”.

Yet when the cameras are shined on scientists we inevitably look like we have forgotten our lines and don’t really know the plot. Carrey on the hand is familiar and he is funny. Plus, even if you don’t like him, you’ve got to agree that he’s memorable.

Jim Carrey has ADHD in his current life. I learned that recently as well. Not that I feel this is naturally associated with his anti-vaccination views. But my girlfriend will likely think it significant.

So, where is this leading us? Mnookin has written a first class book.  You must read it. It will make your blood chill. That’s a metaphor.  I’m not speaking as a scientist right now.

But I am attempting to cross a divide that some of our ranks crossed years ago when they began careers in popular communication about health science. The future lies with them. Truly. Science has a lot to contend with when mainstream BMW drivers in Melbourne are unmoved by scientific facts.

The president of the Australian Science Communicators Network confessed to me the other day that he has been harbouring a plan to get actors to run improvisation workshops with scientists to shake us up a bit. To help us be creative. Imaginative. Hell, even human would do.  He’s following an idea of Alan Alda’s and a program at Stony Brook University.  I don’t think he’ll turn any of us into Jim Carrey. But if he makes us more influential with our science, in this life, then it’s worth our paying it our close, undivided attention.

(Penny Hawe is part of group helping the Centre for Excellence in Intervention and Prevention Science to establish a new two week residential course in Science Communication, along the lines of a successful program in Canada: www.banffscience.ca.)

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• Professor Paul Glasziou, Bond University

Unhinged: The Trouble with Psychiatry – a Doctor’s Revelations about a Profession in Crisis. Daniel J Carlat. Free Press, New York, 2010.

Daniel Carlat, a psychiatrist at Tufts University in Boston, is unhappy about the directions that modern psychiatry has taken. Two of the bigger issues behind this unhappiness are the narrowing of the focus of thinking about mental illness to a biological model, and the proliferation and expansion of diagnostic labels.

On the plus side, this combination has lead to more standardisation in psychiatry. But on the downside, it has lead to a DSM checklist mentality with a strong diagnosis = drug reflex and a consequent loss of the person and context of the “illness”.

The biological focus – the idea that all mental illness is some sort of neurotransmitter disorder – is simple and appealing but clearly a half-truth at best.

As Carlat observes: “By this same logic one could argue that the cause of all pain is a deficiency of opiates, since narcotic pain medications activate opiate receptors in the brain”. And hence the biological model’s logic would suggest that the treatment of all pain is an opiate. Of course, analgesics, antidepressants, and antipsychotics have been a boon for symptom relief – which is sometimes all that is needed. However, they have led to a neglect of the increasingly useful psychological therapies, which often offer better long-term outcomes.

Carlat cites by surveys and his own experience of this shift in modern psychiatry – away from psychotherapy and towards shorter consultations focused on medication review. While this has been financially advantageous to psychiatrists, it has not been all good for patients.

Compounding the problem of the diagnosis = drug reflex is the expansion and extension of psychiatric diagnoses. He neatly documents this increase with successive waves of the DSM handbook, and how it is set to continue with DSM 5 due for release in 2013. As a John Hopkins psychiatrist put it: “Pretty soon we’ll have a syndrome for short, fat Irish guys with a Boston accent, and I’ll be mentally ill.”

While many psychiatric entities would be accepted as medical entities, we have also seen a medicalising of many of the discomforts of life such as shyness (social phobia), and premenstrual tension (Premenstrual Dysphoric Disorder – PMDD). But of equal concern is the arbitrary cut-offs for many “disorders” that show a spectrum from the well to the ill, and the gradual lowering of these cut-offs. When Carlat ask Dr Spitzer, who lead the DSM III revision, why 5 symptoms were used as the cutoff to diagnose depression he replied, “Because 4 seemed like not enough and 6 seemed like too much”.

While this has created some standardisation of diagnosis, small shifts can mean that more of us are being defined as having depression, ADHD, or autistic spectrum disorder. The most disturbing example Carlat gives is the 40-fold increase (from 1994 to 2003) in the USA of children – as young as two -  being diagnosed with bipolar disorder, partly based on redefining mania as “irritability” in very young children.

So when a recent headline stated that 1 in 5 Americans had a mental health problem in the last year, I was not so much shocked by the extent of “the problem” but by the expansion of definitions of mental illness to include so many.

Over a century we have shifted from a rare few in asylums to 20% of the population being classed as mentally ill and potentially medicated. As a GP for the past 20 years, I have been discomforted by some of these trends in over-diagnosis and medication, but Carlat’s book gives an insider’s view of these trends. If you are also disturbed by these shifts in psychiatry, you might like to sign up to the coalition for DSM reform at: dsm5-reform.com.

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• Dr Peter Parry, psychiatrist, Flinders University

I am reading The Loss of Sadness: How psychiatry transformed normal sadness into depressive disorder.By Horwitz and Wakefield.

The main point the authors make is that severe major depression is a psychiatric illness that warrants medication and in very severe cases ECT.

However milder forms of depression are often normal (even sometimes if they meet the rather low bar of DSM clinical criteria for “major depression”) responses to distressing contexts and over-medicalising these states will often lead to the wrong focus and can disempower rather than empower people going through tough times and depressed mood states.  People in such circumstances still need support of course.

What is particularly fascinating is the mea culpa foreword to Horwitz and Wakefield’s book by Robert Spitzer, the US psychiatrist who was the priniciple architect of DSM-III and the current check-list decontextualised symptom focus to psychiatric diagnosis.

Spitzer says amongst other comments, that after putting sadness/depressed mood into an evolutionary framework that: “Horwitz and Wakefield then persuasively argue, as the book’s central thesis, that contemporary psychiatry confuses normal sadness with depressive mental disorder because it ignores the relationship of symptoms to the context in which they emerge. The psychiatric diagnosis of Major Depression is based on the assumption that symptoms alone can indicate that there is a disorder; this assumption allows normal responses to stressors to be mischaracterized as disorder.”

I think this book is a very timely (albeit published 5 years ago) one in an era of rather decontextualised symptom and brain focussed psychiatry.

I also read the first chapter (free online at the author’s blog) of Manufacturing Depression,  which I suspect makes similar points.

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• Physician Dr Michael Vagg

I read a brilliant book by Prof Fabrizio Benedetti from Uni of Turin called The Patient’s Brain: The Neuroscience of the Doctor-Patient Relationship.

Benedetti is a pioneer of placebo neuroscience, and his book is wide-ranging and well-researched account of the molecules, neurons, evolutionary biology and basic research into placebos and neurological responses to illness.

He also discusses the wider questions of why humans have evolved help-seeking and meaning-seeking behaviour, and how the social role of healing professionals came to be hard-wired into the brain. Available through Oxford University Press, and very highly recommended for the general science reader.

***

Health service executive, Dr Patrick Bolton

Resilience Engineering: Concepts and Precepts, Hollnagel E, Woods DD and Leveson N Eds, Ashgate 2006.

It presents the outcomes of a symposium on Resilience which is an attempt to go beyond the current “linear” model of safety and take into account complexity and systems theory. The idea draws on experience in many industries: chemical plants, aviation and NASA, healthcare etc. Among other ideas it is concerned about the interaction between technology and human psychology and sociology.

One interesting snippet is that empirical studies show that in the much vaunted airline industry the best technicians frequently depart from the procedures in the manuals in order to efficiently achieve the objectives of their work rather than the prescribed form.

The generalisation is that people in fact are often continuously working to avoid errors thrown up by the system. Thus, when things go wrong and are accounted to “individual error” there is a sense of accountability (dare I say blame) of individuals, which fails to acknowledge their greater successful efforts to deliver a safe outcome.

They also point out that the safety standards in aviation only apply to commercial flights. In order non-commercial flights, recreational flights, and ultra light flights are each orders of magnitude less safe. Clearly there are trade-offs for the people who use these forms of aviation, as there may be in different areas of healthcare (some home births spring to mind)

Whilst I differ from the authors in being convinced that their new model is wholly robust, the limits that they point to in current approaches such as Root Cause Analysis are convincing. In one case study they say “surprisingly, the formal process of investigating accidents in the company actually made deeper understanding of accidents and their sources more difficult” (p. 334). This particular case study is striking because it contains a couple of pages which to my mind might equally be applied to health:

“operators regarded the incident investigation and countermeasures as derived from views that were largely divorced from the realities of the workplace”

“during the investigation it was discovered that a very similar incident had occurred at another manufacturing plant in another country …the formal report writing about this previous incident was slow and incomplete … the safety people (at the plant where the second incident occurred) consciously classified the incident as irrelevant to the local setting”

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• Professor Jenny Doust, Bond University

Over-diagnosed: Making people sick in the pursuit of health. HG Welch, LM Schwartz and S Woloshin.  Beacon Press, Boston USA, 2011.

What are the greatest threats to health for people living in the developed countries of the world?

Both the medical journals and the popular press would have us believe that we are in the midst of a health care crisis, with rising tides of obesity, diabetes and other chronic diseases threatening to overwhelm the resources of our health care systems.

This book argues that for many people the greatest threat to their health is not too little health care, but too much.

The authors lay out how diagnosing diseases at earlier stages (such as screening programs), broadening the spectrum of disease to include lower thresholds (such as diabetes), labelling risk factors for disease as a diseases (such as hypertension) and the advent of new imaging and pathological techniques with increasing sensitivity have all combined to expose an increasing proportion of the population to over-diagnosis and subsequent medical treatment.

Over-diagnosis results in increasing health care bills, clouds health care policy and funding, but worst of all it exposes “patients” to medical treatments from which they are unlikely to benefit and where there is a high risk of harm.

The authors of this book have done an impressive job in collating the data from a wide variety of diseases to support their arguments.  Even better, it is a fascinating read.  It is not easy to explain why prevention may not be better than cure or why earlier diagnosis may not result in better outcomes for the patient.  The authors have not only made these complex issues understandable but also engaging.

Towards the end of the book, the authors explain how the interests of doctors trying to do their best for patients, the health care industry trying to sell more health care, the medical defence industry penalising doctors for missed diagnoses but not for over-diagnosis and a public which is increasingly anxious about illness converge to push the problems of over-diagnosis to ever greater levels.

The authors offer some advice for individuals wishing to avoid the maelstrom of the modern health care system, but there is a telling anecdote at the end of the book, which illustrates how difficult it is even for highly informed and educated patients to do this.  The few efforts to tackle the problem at a more system wide level have met with strong resistance.

The book is primarily aimed at a lay audience.  However, all health care professionals and policy makers need to read this book.  In a world where we will be increasingly concerned about the distribution of health care resources, understanding and tackling the problem of over-diagnosis and the harm that it is doing to millions of people should be a high priority.

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• Dr Mark Ragg, Ragg Ahmed

The Moon is Down, John Steinbeck. Beautiful, simply told novella in which people from one unnamed nation (a little like Germany) invade another unnamed nation (a bit like Norway) at an unnamed time (but published in 1942). It shows the ways humans think, as invaders and invaded, and the strengths people can show in resisting that to which they do not agree.

Mr M: The Exploring Dreamer, Soizick Meister. Meister is a Swiss-Canadian artist and illustrator who has been drawing and painting Mr M, a dreamer and misfit, for a long time. This book collects about 40 images and narrates a tale, almost without text, of something a touch surreal.

Monsieur Rat, Federica Mossetti. A small rat with a huge blue moustache searches for fame and glory and instead finds …

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• Oncologist Associate Professor Nicholas Wilcken

The Emperor of all Maladies: a biography of cancer, by Sidhartha Mukerjee is superbly put together, and you definitely don’t have to be an oncologist to enjoy it.

Wish I’d written it.

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• Terry Slevin, Cancer Council WA

For the summer read, how about The Emperor of All Maladies: A Biography of Cancer, by Siddhartha Mukherjee, a Pulitzer prize winner. It gives a broad perspective of cancer.

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• Professor Mike Daube, Professor of Health Policy, Curtin University

D’Arcy Holman’s Anonymity and Research: Health Data and Biospecimen Law in Australia is a fascinating and very readable monograph that anyone with in an interest in health should buy (and put on their reading lists) – the issues covered have relevance for us all, and are likely to affect all our areas of work.

If Professor Holman was merely a graduate in law and medicine with a Harvard MPH and a PhD in Epidemiology, that alone would be enough to arouse interest.  After all, epidemiologists with law degrees are a rare breed.

The fact that Holman is also one of Australia’s most respected and widely published epidemiologists, a recipient of the Sydney Sax Public Health Medal as well as the Francis Burt Chambers Law Medal, and the prime mover in establishing the iconic WA Data Linkage System tells us that this is a book that is destined to change the way that Australian health researchers and data custodians view their responsibilities and roles.

With typical clarity and attention to detail, Holman takes the reader systematically through the sources of rights, duties and protections that constrain the research use of health data and biospecimens and in many cases explains why those constraints have limits and are often over interpreted to the detriment of public health.

A timely feature of the book is the effort taken to explain the effects of anonymisation on the law of health data and biospecimens, an area that will be prove useful to those involved in developing data linkage systems and projects that rely on anonymisation to overcome privacy concerns.  The book is short (123 pages), concisely readable and very well referenced. Holman, typically, is donating all proceeds from the book to supporting younger researchers. It will become an essential and often-used addition to the public health professional’s reference collection.”

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• Dr Marie Bismark, public health lawyer, University of Melbourne

The Spirit Level and Bad Pharma are my two book picks.

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• Dr Tim Senior, GP working in Aboriginal health

Having just looked through the list of reading for over Christmas, initially with enthusiasm, then with increasing despair at the amount of stuff I shall never get round to reading, I can’t go past recommending How to talk about books you’ve never read, by Pierre Bayard (translated by Jeffrey Mehlman).

I have actually read this (!) and it’s brilliant, witty and reduces my guilt on looking through a list of recommended reading.

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• Jaelea Skehan, Acting Director, Hunter Institute of Mental Health

Tell Me I’m Here, by Anne Deveson – Penguin books.

I have read a number of biographies and autobiographies of people living with a mental illness.  Recently I went back and read this book because it had such a profound impact on me back in early 2001 when I first read it.  I was only weeks into what has become a career in the mental health field.  I have been recommending it to people ever-since but thought I should re-read it since almost 12 years has passed.

Anne Deveson writes about her son Jonathan and takes us all on a journey as her teenager is tormented by his schizophrenia.  It is told from the perspective of a mother and so real sometimes you can’t help but stop and take a breath.  Upon reflection, I have heard this story many times (although I wish I hadn’t), but Anne tells it in a way that stays with you.  It puts a face to the issue, one that (on re-reading) I don’t think has changed in remarkable ways.  We do some things better now than we did then, but we have a long way to go.

Why People Die By Suicide, by Thomas Joiner.

This book is not quite as hard going as it may seem from the title.  Then again, I am used to reading literature about suicide and suicide prevention.  Thomas Joiner (who the Hunter Institute of Mental Health brought to Australia last year and who returned this year for the Annual Suicide Prevention Conference) is a clinician, and academic and someone bereaved by suicide.  He brings all of these perspectives to his writing (and his presentations) about suicide.

Thomas Joiner poses a modern theory on why people die by suicide (and trust me, we were well overdue for a new theory).

According to his theory, we can narrow the over 200 risk factors for suicide and consider, instead, three core factors that mark those most at risk of death -  the feeling of being a burden on loved ones; a sense of isolation; and the learned ability to hurt oneself.

Thomas uses case studies and examples from real life (sometimes unrelated to suicide prevention) to tell a story, which makes this much easier to read that most other suicide prevention texts.  I often find myself considering new situations and whether Joiner’s theory would fit.  I guess that is what a good theory does.  I have given it to new staff, experienced colleagues and friends to read.  All have taken something away from it.

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• Anita Tang, NSW Cancer Council

In early 2012, I spent 10 days on holiday in Tasmania, and read three books – all set on islands…and all three books were gripping, moving and disturbing in their own way.

I devoured Past the Shallows within the first day of our holiday – started reading it at Sydney airport in the morning, and finished it at lunchtime. I couldn’t put it down – a compelling and tragic tale about two brothers struggling to survive under the ‘care’ of their father who ekes out a living as an abalone fisherman. Although set in remote Tasmania and with lots of time at sea, there is a strong sense of claustrophobia with all the characters trapped by their circumstances and history, and the story rapidly spirals to its breathtaking conclusion. It haunts me still. I had been saving this one for the trip because it is set in Tasmania, and I spent the rest of the trip looking for landmarks and references from the novel and couldn’t shake the story or the characters from my mind.

Caleb’s Crossing is set on a island on the other side of the world and several centuries ago. Inspired by the discovery that the first Native American graduated from Harvard in 1665 and was from Martha’s Vineyard, Geraldine Brooks has woven an amazing tale about a young girl who befriends Caleb and whose father (a Calvinist minister) becomes instrumental in Caleb entering Harvard. For me however, the power of this novel was in its ability to transport me to the 1600′s in astonishing detail, and the very sobering realities of life for young women of that time. And as someone with very little sense of history and an appalling lack of knowledge about various religions – I learnt at lot about both!

My last island book was the most disturbing - The Tall Man by Chloe Hooper – about the death in custody of Cameron Doomadgee on Palm Island and the subsequent investigations and legal proceedings involving the policeman Christopher Hurley. But it is so much more than that. The book tells the story of Palm Island and its evolution into ‘a kind of tropical gulag’; takes you right into the heart of the Aboriginal community on Palm Island; into the core of the police culture in QLD; and into the remote and wild parts of QLD that many of us will probably never experience. Chloe Hooper also spends a lot of time over the years with the Doomadgee family and trying to unravel the mysteries and seeming contradictions of Chris Hurley. She has created a gripping narrative that visits the events of the past that inevitably influenced this specific death in custody, as well as closely examining the case and its associated legal proceedings. The book is much more than a recounting of this disturbing episode on our race relations – it’s much more of an exploration of how we came to be a country that responded to the death in this way, and how we can ever find peace without justice. This book has been in my possession for years, and I am now sorry that I had not read it sooner.

And a more recent read –The Little Blue Book; the essential guide to thinking and talking democratic by George Lakoff and Elisabeth Wehling. Building on the insights of Don’t Think of an Elephant, this book takes as its premise that the neural processes that underlie cognitive frames and conceptual metaphors are largely unconscious and that language makes use of these deep modes of thought. In arguing that messaging and framing is much more than just about language, the book unpacks the moral frames and values underlying key public policy issues, revealing how easily language can be co-opted to reinforce these moral frames and values, and making useful suggestions for shifting the moral frames around these issues by changing our language. There is specific attention to current issues including food policy, environment and energy, the economy, health care and women’s issues.

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• Melissa Sweet, journalist, Croakey moderator

As I’ve also nominated at Inside Story, one of my picks from this year’s reading is Patrick Sullivan’s Belonging Together: dealing with the politics of disenchantment in Australian Indigenous policy. (Aboriginal Studies Press. 2011).

This book may be slim, at a mere 147 pages, but it whacks a hardball in the direction of the status quo in Indigenous policy, particularly the centralised power of government and bureaucracy, and the failure of whole-of-government policy and implementation.

For me it provided many “light bulb” moments – switching on a new way of thinking about Indigenous health and affairs. It also delivers a sharp response for those too-common times when people shrug their shoulders and roll their eyes about the “Indigenous problem”, often with unspoken assumptions around who is to blame for the lack of improvement in Indigenous Australians’ lives.

Sullivan’s critique of the role of hierarchical, centralised government, with an inward-looking focus on managerialism rather than community outcomes, in adding to the burdens of Aboriginal development is compelling and convincing, as is his argument that the role of the Aboriginal sector is under-acknowledged and overregulated.

Many of his themes have a wider resonance, to health and social policy more broadly.

His critique is constructive. While his diagnosis of “the government problem” is damning, he also offers some optimistic suggestions for fixes, including a regional governance model that bypasses the states and territories.

He is also optimistic about the shared futures of Indigenous and non-Indigenous Australians, arguing that we are “imbricated”, that we are all in this together. He concludes: “…Australian national identity will remain hollow at the core until we develop a sense of belonging together.”

****

And more…

Meanwhile, here are some recent releases that may be of interest to Croakey readers:

Why Calories Count, by Marion Nestle and Malden Nesheim

How We Do Harm: A Doctor Breaks Ranks About Being Sick In America, Dr Otis Brawley from The American Cancer Society, covered here by the New York Times

Bringing the Social Media #Revolution to Healthcare, from the Mayo Clinic for Social Media (reviewed here).

A reading list (with a US focus) for those with an interest in health journalism, compiled by Barbara Feder Ostrov.

A Short History of Progress by Ronald Wright, has been described by former BMJ editor Richard Smith as “the best book I’ve read in 20 years”. He says:  The book is pithy, witty, erudite, highly readable, full of marvellous quotes, and ultimately devastating”.

Richard Smith says: “The more people who read this book the greater our chance of long term survival.”

More power to the power of books…

 

 

 

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