Better (29 page)
Authors: Atul Gawande
| 188 | The 1979 ranking of specialties' use of randomized trials was undertaken by the father of evidence-based medicine, Archie L. Cochrane, in his article "1931-1971: A Critical Review with Particular Reference to the Medical Profession," in G. Teeling-Smith and N. Wells, eds., Medicines for the Year 2000 (London: Office of Health Economics, 1979). |
| 190 | Watson Bowes Jr. and V. L. Katz published a 1994 review of studies of forceps deliveries, including a comparison with Cesarean sections, entitled "Operative Vaginal Delivery," in Current Problems in Obstetrics, Gynecology, and Fertility 17 (1994): 86. A 1979 Australian study, for example, compared 296 forceps deliveries with 101 Cesarean sections and 207 spontaneous vaginal deliveries. The children did equally well, including on IQ and motor tests at age five (W. G. McBride et al., "Method of Delivery and Developmental Outcome at Five Years of Age," Medical Journal of Australia 1, no. 8 [1979]: 301-4). A few studies showed some practitioners could achieve better results with forceps. A 1990 study, for example, compared 358 forceps deliveries with 486 Cesarean sections at UCLA and found that, while the infants had no differences in their Apgar scores or rates of birth trauma, the mothers had fewer complications and less blood loss with forceps (R. A. Bashore, W. H. Phillips Jr., C. R. Brinkman III, "A Comparison of the Morbidity of Midforceps and Cesarean Delivery," American Journal of Obstetrics & Gynecology 162, no. 6 [1990]: 1428-34). |
| 197 | A definitive review of the benefit and risks of elective Cesarean sections for pregnant mothers at full term was published in March 2006 by the National Institutes of Health and is available from their Web site, www.nih.gov. It is entitled "National Institutes of Health State-of-the-Science Conference Statement: Cesarean Delivery on Maternal Request." See also H. Minkoff and F. A. Chervenak, "Elective Primary Cesarean Delivery," New England Journal of Medicine 348 (2003): 946-50. |
| T HE B ELL C URVE | |
| 206 | Information on bell curves in hernia repair is from data collected for a Veterans Administration study: R. J. Fitzgibbons et al., "Watchful Waiting vs. Repair of Inguinal Hernia in Minimally Symptomatic Men," JAMA 295 (2006): 285-92. Risk-adjusted neonatal ICU outcomes are from the Vermont Oxford Network Database ( Health Affairs 23 [2004]: 89). In vitro fertilization center outcomes are available from the CDC at www.cdc.gov/ART. |
| 208 | An intriguing examination of the U.S. government's ill-fated Death List is S. T. Mennemeyer, M. A. Morrisey, and L. Z. Howard's "Death and Reputation: How Consumers Acted upon HCFA Mortality Information," Inquiry 34 (1997): 117-28. |
| 209 | For more on the superior performance of LeRoy Matthews's CF treatment program in Cleveland, see W. J. Warwick, "Cystic Fibrosis: Nature and Prognosis," Minnesota Medicine 50 (1967): 1049-53; L. W. Matthews and C. F. Doershuk, "Management-Comprehensive Treatment of Cystic Fibrosis," Minnesota Medicine 52 (1969): 1506-14; and American Thoracic Society, "The Treatment of Cystic Fibrosis: A Statement by the Committee on Therapy," American Review of Respiratory Disease 97 (1968): 730-34. |
| 211 | No one has done more to tease apart the relative contributions of genetics, sociodemographics, and differences in treatment programs in cystic fibrosis than Michael S. Schecter, a pediatric pulmonologist and CF expert at Hasbro Children's Hospital, Providence, Rhode Island. See in particular his article "Non-Genetic Influences on CF Lung Disease: The Role of Sociodemographic Characteristics, Environmental Exposures, and Healthcare Interventions," Pediatric Pulmonology 26 (2004): 82-85. |
| F OR P ERFORMANCE | |
| 237 | Data on the inadequacies of mammography screening in the United States come from two articles: K. A. Phillips et al., "Factors Associated with Women's Adherence to Mammography Screening Guidelines," Health Services Research 33 (1998): 29-53, and K. Blanchard et al., "Mammographic Screening: Patterns of Use and Estimated Impact on Breast Carcinoma Survival," Cancer 101 (2005): 495-507. |
| 242 | For more on the increasing longevity of much of the world's population and the resulting shift in patterns of disease, see the World Health Organization's The World Health Report 1999: Making a Difference (Geneva: World Health Organization, 1999), and J. A. Salomon and C. J. L. Murray, "The Epidemiologic Transition Revisited: Compositional Models for Causes of Death by Age and Sex," Population and Development Review 28 (2002): 205-28. |
| A FTERWORD: S UGGESTIONS FOR B ECOMING A P OSITIVE D EVIANT | |
| 251 | That favorite essay of Paul Auster's is "Gotham Handbook," in Collected Prose (New York: Picador, 2003), and I owe to it not only the first rule but the structure of this chapter--and an understanding of the importance of talking about the weather. |
| 255 | The study of forgotten surgical tools was published in the New England Journal of Medicine 348 (2003): 229-35. |
| 255 | Lewis Thomas's quoting of John Ziman is in his essay "On Societies as Organisms," in Lives of a Cell (New York: Penguin, 1974). |
Among several people indispensable to this book, my research assistant, Ami Karlage, comes foremost. She is whip smart and insanely resourceful and had better ways she could have spent three years of her life. But she helped research every chapter here and was essential to my making this book as rich and accurate as possible.
If Ami gave in breadth, my wife, Kathleen Hobson, gave in depth. She has made my successes and failures her own. She has pushed and encouraged this book and talked me through my uncertainties and confusions about it. And she made writing it possible alongside everything else in our life together.
I also owe particular thanks to my friends Burkhard Bilger, Henry Finder, Malcolm Gladwell, and David Segal. Four
of the smartest people I know, they gave generously of their time and energy in thinking through my ideas for this book. I am lucky to have Henry as my editor at the
New Yorker
, as well--he not only midwifed the five chapters here that had begun as magazine pieces but has been my closest mentor for my writing career. The other essential person for that career has been David Remnick, who has let me continue as a
New Yorker
staff writer despite having to accommodate the demands of my surgical career. The opportunity to write for the magazine means more to me than I can possibly say.
The great Sara Bershtel of Metropolitan Books was my editor for
Better
, as she was for
Complications
. And she has proved to be the kind of book editor one hears no longer exists: she cares deeply about writing and ideas, and she edits. Her colleague Riva Hocherman also offered invaluable suggestions. Both made this book better in every way.
My longtime friend Tina Bennett has also been, for the past seven years, my agent, an arrangement that would ordinarily be considered dicey. But her judgment is impeccable. She is indefatigable. And she has proved as wise and loyal in her advocacy as an agent as she has in her devotion as a friend.
Several of the chapters began as articles I had written for the
New England Journal of Medicine,
and I am grateful to Debra Malina, Greg Curfman, Steve Morrissey, and Jeff Drazen of the
Journal
for their support, advice, and encouragement.
Finishing this book would not have been possible without the understanding and support of my surgical colleagues, in particular: Michael Zinner, the chief of surgery at Brigham and Women's Hospital; Stan Ashley, the chief of general surgery at Harvard Vanguard Medical Associates; and Francis
"Chip" Moore, my surgical partner. Thank you also to Susan Cramer, Shilpa Rao, and Katy Thompson of Brigham and Women's Hospital, Arnie Epstein of the Harvard School of Public Health, and John Sterling of Henry Holt Publishing.
Finally, I want to give my deep thanks to the patients and colleagues who appear, named and unnamed, in this book. They gave me permission to try to tell their stories, and that is the most generous and vital gift of all.
A
TUL
G
AWANDE
, a 2006 MacArthur Fellow, is a general surgeon at the Brigham and Women's Hospital in Boston, a staff writer for
The New Yorker
, an assistant professor at Harvard Medical School and the Harvard School of Public Health, and a frequent contributor to
The New England Journal of Medicine
. His first book,
Complications: A Surgeon's Notes on an Imperfect Science
, was a
New York Times
bestseller and a finalist for the 2002 National Book Award. Gawande lives with his wife and three children in Newton, Massachusetts.