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June 21, 2007

Madden in The Gazette: Irish histories and novels offer sources of inspiration - excerpt

Madden_2






Forkhill Protestants and Forkhill Catholics 1787-1858

By Kyla Madden
McGill-Queen's University Press, 240 pages

By Pat Donnelly, June 9, 2007

...Another McGill-Queen's history book recently found its way into my hands, via my own Irish roots-searching path. Kyla Madden's award-winning Forkhill Prostestants and Forkhill Catholics, 1787-1858, is an academic work, based on a thesis. Although the bulk of it is a little dry for the casual reader, Madden reveals a flair for lyrical prose. She sums up with a briliant meditation on the true nature of history, using astronomical terms: "The moments of recorded history are like stars scattered through a vast galaxy. The brightest stars in this galaxy draw our gaze and we join them, one to another, creating historical narratives that are constellations unto themselves. The structure that these narratives provide helps us make sense of history, but the system is not flawless."

She goes on to say that because history tends to document the extraordinary rather than the ordinary, through necessarily subjective narratives, we must be careful not to allow them to "assume a degree of permanence and unassailability that they do not deserve." Or, in other words, don't believe everything you read in the newspapers (or history books), folks -- not even this one.

Madden's view that there's a lot more to Northern Irish history than the old saw of sectarianism is timely (peace seems to have settled in there at last), as well as refreshing. And her book told me things that I never knew about my paternal ancestors, who were Catholic, and their Protestant neighbours, including details about the lives of ordinary women.

Neusner on On Point: Jewish vs. Christian Beliefs

Aired: Tuesday, June 19, 2007 11-12PM ET
To listen to this story, click here.
By host Tom Ashbrook:

Long before he was Pope Benedict the 16th, then-Cardinal Joseph Ratzinger was already a fan of Rabbi Jacob Neusner. He called his book "A Rabbi Talks with Jesus," "by far the most important book in Jewish-Christian dialogue in the last decade." Now that he's Pope, they're still talking, in the exalted dialogue and debate of theologians.

This is history-making. It's the first time in centuries that a Pope and a rabbi have talked like this. And it's not all sweet talk. We couldn't get the Pope on the line, but we've got the rabbi.

This hour On Point:  a conversation with the Pope's rabbi, Jacob Neusner.

Guests:
- Jacob Neusner, professor of the history of theology at Bard College, senior fellow at the college's Institute of Advanced Theology, and author of more than 900 books. He has corresponded with Pope Benedict for more than a decade.
- Father Richard Neuhaus, prominent Catholic priest and writer, and editor-in-chief of "First Things," a monthly journal of religion, culture and public life.

June 14, 2007

Neusner: A Rabbi Talks with Jesus featured in Jesus of Nazareth review

History's Greatest Liar
By Lisa Fabrizio
The American Spectator, June 13, 2007

We all think we know him, or at least we're forever trying. Every Christmas and Easter, documentary makers seek to redefine him, or simply to find him. But who is the real Jesus Christ? In the Catholic Church's tradition of sharpening doctrine by answering its critics, Pope Benedict XVI has taken on the task of pushing back decades of reconstruction of the "historical" Jesus with Jesus of Nazareth, his first book since his election to the episcopal see of Rome.

At the age of 80, when most men are taking a well-deserved rest, Pope Benedict -- who in 2005, after a half-century of service to the Church desired only to retire to a quiet life in his beloved Bavaria -- has released these first ten chapters of a two-part work that has been four years in the making, because, as he states, "I do not know how much more time or strength I am still to be given."

His urgency stems from his fear that modern historical-critical attempts at finding Jesus have resulted in the common belief that "we have very little certain knowledge of Jesus." He laments that recent scholarship has detached Jesus from God so that he has been reduced to an "anti-Roman revolutionary working -- though finally failing -- to overthrow the ruling powers; at the other end, he was the meek moral teacher who approves everything and unaccountably comes to grief."

Students of the Baltimore Catechism know why we were created: to know, love and serve God. But who is he? Mankind has always feared the unknowable, how much more so the unknowable Creator? How can man possibly approach such power and majesty as he sees daily in the created nature of the world? How can we love a God of pure power unless we are convinced that he is also pure love?

This book, taken in conjunction with his first encyclical, Deus Caritas Est (God Is Love), is Pope Benedict's answer. This work, he stresses, is not one of official teaching but the culmination of his "personal search for the face of the Lord," and one that is intended for the illumination of all those who also seek him. As such, although there is a glossary included, it resounds not with complex theological jargon but sings in the language of love.

He begins by explaining that Jesus is new; the new Adam, and even the new Moses. He cites the Old Testament pledge that "The Lord your God will raise up for you a prophet like me from among your brethren -- him you shall heed" (Deut 18:15). He then recounts that although Moses had friendship with God, he was not allowed to see his face (cf. Ex 33:18-23), implying that the promised "prophet like me" will be granted what Moses was denied: "No one has ever seen God; it is the only Son, who is nearest to the Father's heart, who has made him known" (Jn 1:18).

With this new Moses comes a new Torah; the essence of which is contained in the Beatitudes. And in delivering them in the Sermon on the Mount, he alarms the people because he was "teaching them as one having authority, and not as their Scribes and Pharisees" (Mt 7:29). In other words, he is not only proclaiming the law but claiming equality with the Lawgiver. At this point, Benedict begins a fascinating discourse; almost a dialogue with the Jewish scholar Jacob Neusner, author of A Rabbi Talks with Jesus.

Neusner's book is itself a dialogue where he is present at the Sermon on the Mount and then follows Jesus to Jerusalem where he speaks with him about what he feels are exhortations to ignore two or three of God's commandments concerning the Sabbath and familial relationships, both of which are at the heart of the Jewish social order. The pope's response -- which fills 25 pages -- is a must-read for Jews and Christians alike and makes one ardently wish to be a fly on the wall at a mythical sit-down between Benedict and Neusner.

There are many such exchanges and references to writers such as Rudolf Bultmann, Joachim Jeremias, Pierre Grelot, Romano Guardini and Hans-Peter Kolvenbach that fill this book with insights and inspirations from all sides of the exegetical spectrum. And all these Pope Benedict explores with the utmost humility and compassion in this 335-page volume. Yet he returns over and over to the main thrust of the question of the identity and mission of Jesus of Nazareth:

What did Jesus actually bring, if not world peace, universal prosperity and a better world? What has he brought? The answer is very simple: God. He has brought God. Now we know his face, now we can call upon him. Now we know the path that we human beings have to take in this world. Jesus has brought God and with God the truth about our origin and destiny: faith, hope, and love.

Christian teaching suggests that Jesus Christ was either everything he said he was -- most notably the son of God -- or the world's most prolific and pathological liar. Those for whom this question remains unanswered would do well to begin their search anew by sharing in this profound meditation of the "Servant of the Servants of God."

Lisa Fabrizio is a columnist who hails from Connecticut. You may writer her at mailbox@lisafab.com.

June 05, 2007

Suzanne Evans in the Ottawa Citizen: Using grief to fuel patriotism

Evans_300col_copyOttawa author looks at how mothers of fallen soldiers are used to foster support for war

Janice Kennedy
The Ottawa Citizen
Sunday, June 3, 2007


Mothers of Heroes, Mothers of Martyrs:
World War I and the Politics of Grief

By Suzanne Evans
McGill-Queen's University Press, 224 pages

If they hadn't already been killed or maimed that December of 1915, husbands and brothers and sons were huddling in muddy trenches overseas, their absence a deep shadow over the approaching Christmas holiday. Canadians, especially Canadian women left to tend the home fires, needed hope, consolation, inspiration.

It came in an article published by Everywoman's World, the most widely-read magazine in the country during the First World War -- distributed to 67,000 homes in 1915, and 125,000 two years later. The article, titled I Am A Proud Mother This Christmas, was by a "Mrs. E.A. Hughes," a widow who had just received a telegram informing her of the death of her son, Pte. Danny Hughes, her only remaining child.

In the story, she describes her initial fleeting sadness, followed by her realization of the greater truth: "I am a proud mother this Christmas. For I gave Canada and the Empire a Christmas present. I gave them my chiefest possession ... I sacrificed the life of my boy."

That historical nugget is just one among many found in the new book by Suzanne Evans. Mothers of Heroes, Mothers of Martyrs: World War I and the Politics of Grief is crammed with such fascinating stories -- and with fascinating postscripts.

Researching the Mrs. Hughes story, the 50-year-old Ottawa writer uncovered something intriguing. Since no one with Danny's profile turns up in any of the archived documents of the time -- something easy to check today but not within reach of the average citizen 92 years ago -- Mrs. Hughes and her Danny, who died so valiantly in action, may in fact have been a fiction.

Rich with analysis and anecdote, Mothers of Heroes, Mothers of Martyrs, Evans' first book, looks critically at the manipulation of emotional impact for a cause.

She says the image of the sacrificing war mother has long been a potent, and useful, symbol.

"We think we would do anything to keep our children safe," says Evans, a mother herself. "A story like the Mrs. Hughes one takes that expectation and turns it around, so that anyone listening to it must say, 'What is the cause for which this mother is willing to sacrifice her child?' -- and then, 'I wish to follow this cause.' I think that is what the propagandists of World War One were hoping. These stories were designed to gain followers."

And gain followers they did, as mothers by the thousands bade brave farewells to the sons they sent off to fight for King and country. More than 60,000 Canadians, most of them young, were killed during the First World War. It is not mere coincidence, Evans points out, that Canada's Memorial Cross medal -- known as the Silver Cross and issued for wives and mothers of soldiers who have died in military action -- has its origins in that conflict.

Evans, who shares her comfortable Alta Vista home with two daughters and her husband, novelist Alan Cumyn, has a doctorate in religious studies from the University of Ottawa. She first became intrigued by the topic of war mothers when she stumbled upon the phrase "mother of martyrs" while reading a book about Islam. The reference was to Palestinian women of the first intifada.

"It floored me," she recalls. "I couldn't imagine a mother being proud of the sacrifice of her son for a cause -- and showing joy. At first, I just thought, 'Well, that's gross,' and I closed the book and put it away. But it stuck like a burr in my brain."

Evans started looking into history and went back as far as the late first and early second century BCE, during the time of the Maccabees, when a Jewish mother appears as the first recorded "mother of martyrs." (The Bible story tells of the mother's seven sons who are all tortured for their faith before her eyes and prior to her own death. The last one, the youngest, dies after his mother strengthens his resolve not to renounce his faith to save his life.) But such stories, while proving the antiquity of the willing-mother-of-martyrs phenomenon, were too far away in time and place to provide context for its modern counterpart.

"I thought, 'It will make it easier to understand if I can find something else closer to home, in my own culture.'"

The idea came one Remembrance Day nearly 17 years ago. Bundling her young daughter into her stroller, Evans went downtown to the ceremonies at the National War Memorial. Seeing the Silver Cross mother, she found herself thinking about the enormity of loss felt by mothers who lose children to war, and went on to research the history of the Silver Cross.

"World War One became my access point to understanding stories from other places and other times." It was not her era, but it was her culture. In her family, she says, there are all kinds of stories of women, including her great-grandmother, who willingly saw their sons off to war.

"This is my English Canadian heritage," says the Toronto-born Evans, "and I don't think of my family as being crazy or warmongering. So if that's there for us, it can be a way of understanding other places, a way of understanding that it's not madness, it's war."

Looking for echoes of familiarity in other parts of the world, especially in current conflicts, Evans says she found them -- present-day mothers willing to sacrifice their children, and government recruitment posters geared at women, urging them to give their sons to the cause.

In other words, the gulf between the Mrs. Hugheses of 1915 and today's Islamic "mothers of martyrs" proved to be no gulf at all.

As she threw herself into the research that would eventually become both her doctoral thesis and the new book, Evans found another source of cultural support as well. Her husband was also researching the First World War for his 2003 novel, The Sojourn and its 2006 sequel, The Famished Lover. (In fact, two of Cumyn's arresting photos of wartime statues, stone portraits in grief, appear in Mothers of Heroes, Mothers of Martyrs.)

But as she finished the book, and as the Canadian death toll in Afghanistan rose, it became increasingly apparent to her that the present ties with the past lie in more than a resonance with intifada mothers.

"It's incumbent upon us to ask questions," she says of the mission in Afghanistan. "I have seen how stories of old martyrs have been used as touchstones to create a background and add a whole world view to modern stories."

She was especially uneasy about the way Canadian officials used the rededication ceremonies at Vimy in April, drawing glorified parallels between then and now.

"When you see the picture of Mr. Harper with his hand on the wall of the monument, it's like the power of that mythology infusing him. He becomes a war leader."

While she does not compare Afghanistan to the 1914-18 conflict, where the death toll was a thousand times higher, she thinks the machinery of martyrology is at work in much the same way.

Evans says there is a direct connection between her academic focus on religious studies and the issues of her new book. Raised in a distinctly secular home and professing no single faith herself ("They all fascinate me"), she says she nevertheless maintains a profound respect for the practice of religion -- as long as it doesn't become a bludgeon.

"It can be a tool for great things, for wonderful kindness and love and action in the world. And people can also use it and misuse it according to their desires."

In the First World War, she says, as in wars from the beginning of time, it was assumed that "God was on our side," whichever side that may have been. She cites one of the letters that her husband has from a great-uncle who fought during that conflict. "He writes that something really snapped in him when, on the battlefield, he saw the buckle on a German uniform. And it says, in German, 'God is on our side.'"

Religion or maternal love, Evans is distressed by the kind of manipulation that exploits and twists and serves a sometimes dubious cause.

"The whole idea of offering a son, and now daughter, to fight for a cause and be sacrificed turns our expectation of motherlove on its head," she says, alluding to the present because these days there is no escaping it.

The mythologizing that comes of such reversals, she suggests, tends to silence people at a time when there should be no silencing. "In times of war, people seem to dispense with questions rather than raise them." And that, says Evans, is not the answer.

Not as long as there are sons and daughters dying for someone's idea of a cause. Not as long as there are mothers left behind to mourn.

Janice Kennedy is a senior writer at the Citizen.

To listen to an interview with Suzanne Evans please visit CBC's The Current website: http://www.cbc.ca/thecurrent/2007/200705/20070507.html

Gerhard P. Bassler, Vikings to U-Boats Wins WANL Rogers Cable Non-fiction Award

Bassler_300col The Writers' Alliance of Newfoundland and Labrador Announces the Winners of The 2007 Newfoundland and Labrador Book Awards



St John's, NL: Patrick Warner, Winner, The E J Pratt Poetry Award for There, there, Véhicule Press, 2005, and Gerhard P Bassler, Winner, Rogers Cable Non-fiction Award for Vikings to U-Boats: The German Experience in Newfoundland and Labrador, McGill-Queen's University Press, 2006.

The winners were announced at 2:30pm yesterday, May 15, at a special celebration held at Government House, St John's, NL. This year marks the 11th year of the Newfoundland and Labrador Book Awards. Winners were presented with a check for $1,500 and each finalist was awarded $500.

Judges for Non-fiction were Anne Budgell, Degan Davis, and Kathleen Winter.

Gerhard Bassler's original work succeeds in dispelling what he calls the myth of Newfoundland and Labrador's purely British heritage. He does it with a tone of regret for what might have been, if not for two World Wars. It was German-speaking Moravian missionaries in Labrador who first created a written form for Inuktitut. German technology imported from Lunenberg influenced dory design in Newfoundland. Roman Catholic Bishop Fleming went to Hamburg to find an architect for his new Basilica in St John's. There were many more cultural and commercial contributions but Bassler points out that in this "closed society," Germans were always regarded as foreign. That is, until the events of two wars made things worse. Germans, even those who had done missionary service in Labrador for decades, were classed as potentially dangerous enemy aliens. The cloud of suspicion caused government authorities to deny Jewish refugees fleeing the Third Reich safe haven in Newfoundland. They had the same enemy, but they were too German to be welcome here. Bassler describes a small but vibrant German community, doing business, marrying, holding public office, and now gone. What lingers in Newfoundland is a stereotype created by wartime propaganda and faint traces of German presence in family names and Labrador Inuit who can still count in German.

June 04, 2007

Translating Montreal Awarded 2006 Gabrielle Roy Prize

Simon_sherry Gabrielle Roy Prize 2006
Association for Canadian and Quebec Literatures

Press Release
May 31, 2007

For immediate release

The Association for Canadian and Quebec Literatures (ACQL) is pleased to award the Gabrielle Roy prize (anglophone section), which each year honours the best work of literary criticism published in English, to Sherry Simon, for Translating Montreal: Episodes in the Life of a Divided City, published by McGill-Queen's University Press. Of the eighteen books submitted to the jury by presses across the country, the work of Sherry Simon distinguished itself by its originality, scope, and interdisciplinary rigour. Simon's exhaustive analysis of linguistic and cultural transfers in Montreal's writing communities is informed by her keen understanding of the spatial, political, and cultural dynamics of the city, its history, and its intersection of languages. By examining various "moments of translation," Simon demonstrates how these communities speak for and to each other in a work that historicizes the changing face of Montreal, from a colonial city neatly divided by the English and French solitudes, to the "reconquest" of the city by the emerging Quebecois identity during the Quiet Revolution, and finally, to the inter-cultural and inter-lingual cosmopolitan city of today. Simon chronicles the first "crossings" of the linguistic and cultural divide that was Montreal in the early 1960's between the Partis Pris writers and Anglo writers such as Malcolm Reid and F.R. Scott. A.M. Klein's influence is also crucial to an understanding of Montreal, and the "confluence of languages" in his poetry is brilliantly analysed in chapters dedicated to the city's sizeable body of Jewish writing. These, Simon argues, initiated the city's "culture of translation" which would have influence for decades to come. Simon then examines the inheritors of this culture of translation through the writing of Gail Scott, Jacques Brault, Nicole Brossard, and Erin Moure, among many others. She also provides a penetrating analysis of the litterature migrante movement in the 1980's, including writers such as Emile Olivier, Marco Micone, and Dany Laferriere. Simon argues that the points of contact between communities in this unique city offer up productive and stimulating tensions which emerge in the rich writing of Montreal, and her engaging, lively, and personal work is a testament to and example of this productive tension.

The jury has also voted to give an honourable mention to Paula Ruth Gilbert's Violence and the Female Imagination, published by McGill-Queen's University Press. Gilbert's comprehensive and detailed work examines representations of female cruelty and violence in recent Quebec fiction by women.

Renseignements:
Domenic Beneventi
President du jury (section anglophone), ALCQ/ACQL
Departement des lettres et communications, University de Sherbrooke
domenic.beneventi@gmail.com

Nortin M. Hadler: If There's No Benefit, Why Tolerate Any Risk? The Lessons of Avandia, Vioxx, Bextra and Baycol

Opinion
Nortin M. Hadler
ABC News
June 1, 2007

We have all grown accustomed to the scare of the week.

Each week we learn about another hazard that is lurking in our environment. We learn of something we are not doing that we must do -- or else.

We must eat fish, but not all fish. Last year if you fed your child butter you were negligent; this year if you feed your child margarine you are negligent. Tomatoes are health foods, or not.

We, the healthy, are taught that life is a minefield. We, the healthy, seem to have an insatiable appetite for scares of this sort. We leap to our own defense regardless of the reliability of the scare, the validity of the remedy or the expense.

With increasing fervor, the ill amongst us are learning a corollary lesson. The vaunted American health care system can be hazardous to your health.

First we learned that hospitals were dangerous places; if evil infections don't get you, errors by the staff might. But you don't need to be hospitalized to be at risk from modern medicine. Every week we have learned that another device or another pill was a Trojan horse, waiting to unleash some horror down the road.

Today I want to consider the question that should precede an assessment of hazard. In order to weigh a hazard, one must have a handle on the benefit.

The more the benefit, the more we might countenance some hazard. Likewise, if there were no important benefits then we would tolerate absolutely no risk.

Several common medical interventions have recently come under the gun and even succumbed to the identification of a measured, important, and putatively likely hazard that has been bellowed by the media -- often perking up the ears of the plaintiff's bar.

There are important lessons regarding the assessment of benefit in these examples:

Drugs to Treat Adult Onset, Type 2 Diabetes

Avandia is one of a newer class of drugs designed to lower the blood sugar of adults whose blood sugar is higher than is said to be good for them.

As we age, our own insulin is less effective in helping our blood sugar enter our cells to provide an energy source. Some of us have this tendency earlier than others, particularly if we have a big gut-to-butt ratio and/or we're poor.

This higher blood sugar and its fellow-travelers (higher blood pressure, higher cholesterol, and lesser wealth) are associated with earlier death, but only if any or all are particularly severe.

For over 50 years medicine has recruited the pharmaceutical industry to smite each of these "risk factors" a mighty blow in order to spare us grief. Avandia is another attempt to tackle persistently elevated blood sugar.

It works. It lowers the blood sugar. Furthermore, the earlier generations of drugs designed to do this also lower the blood sugar. They work too.

However, no one feels better for a lower blood sugar. Some feel worse or get fatter depending on the drug. And no one feels worse for a high blood sugar, except for the rare patient with adult onset type 2 diabetes who can mobilize an extremely high blood sugar.

It's like "high" blood pressure.

So Avandia does nothing for the quality of your life. Does it do something else -- save your life, or postpone the horrid complications some patients can get with adult onset type 2 diabetes and its fellow travelers?

We don't know for Avandia. However the precedents are daunting. Long-term experiments, randomized controlled trials, with earlier generations of drugs that lower blood sugar are not encouraging. One famous trial lasted over a decade.

There is no precedent for any of these drugs saving a life, a limb, an eye, kidney or anything else important. There is no demonstrable benefit except the lowering of blood sugar. Who cares?

I have practiced medicine for 40 years. I have never prescribed a pill to lower blood sugar. I still see no reason to do so. If I am disadvantaging my patients, it's to a trivial degree at most. However, I know I am sparing them known and unknown hazards.

And I won't let you measure my blood sugar or the measure of its persistent elevation, the hemoglobin A1c. I don't care, and I won't care till there is compelling science that something meaningful can be done if it is elevated.

Drugs to Treat Painful Joints

Vioxx and Bextra were pulled off the market because of data suggesting they imparted a tiny hazard for heart disease. It's perhaps a slightly more convincing hazard than that purported for Avandia, but there's little here worthy of alarm.

I am a rheumatologist. I have never prescribed Vioxx, Bextra or their cousins such as Celebrex. But I never prescribed them for reasons other than their possible effects on the heart.

Do you know that no drug of this class has ever been shown to be more effective than aspirin? Do you know that no drug of this class has ever been shown to be safer than aspirin? Only Vioxx convinced some who are swayed by tiny differences. But Vioxx never convinced me.

Why would I ever prescribe this class of drugs? I don't care if there are TV advertisements claiming magical effects like you, too, can skate on ice. I don't care if the occasional patient swears nothing else helped. I am unwilling to prescribe a drug that has no important benefits over the old standbys and has no long-term track record for safety.

I spend much more time explaining my philosophy to my patients than the seconds required to fill out the prescription, or to give a sample. By the way, neither drug company sales people (detail representatives) nor drug samples are allowed in my clinic -- and never have been allowed. I'll take the time to explain my philosophy or stop practicing medicine.

However, I am a "senior" clinician; if my students, and there are many out there, practiced the way I taught them, they'd starve. There is something horribly rotten in the United States, not in Denmark.

Drugs to Lower Cholesterol

Baycol is a statin. That's a drug that lowers cholesterol. It was pulled from the market because of about 50 cases of a complication that almost never occurs unless you are on a statin.

This is a complication that causes the muscles to die, and often the patient follows. It occurs occasionally with all statins (Lipitor, Pravachol, Simvastatin, Crestor, and others). But somehow the number of cases ascribed to Baycol lead to its banishment and not the others. After all, the common wisdom is that lowering cholesterol is too good a thing to pass up.

It is true that cholesterol is a "risk factor" in people who do not have an extraordinary family history of youngsters dying of heart disease. But it is not that much of a risk factor. If you have a particularly high LDL cholesterol (the "bad" cholesterol), and a particularly low HDL cholesterol (the "good" stuff), you are harboring a 2-3 percent mortal hazard.

That means you are at risk for living a year less than others born when you were. Very few of us have even this degree of risk. For most it is a matter of months, if you believe such a tiny risk is measurable.

It is true that these statins can lower your bad cholesterol.

It is true that maybe they can spare you a heart attack, but that's a real MAYBE.

It is also true that no study has shown it can spare me death before others born when I was born. That's true for men of my generation. There are no compelling studies for people who are not men of my generation.

Now you know why I won't let anyone check my blood cholesterol. Why bother? You can lower it, but you can't do anything for me that I would consider meaningful. I'd rather not know if I have any special risk of earlier death, even the tiny risk imparted by high cholesterol.

Merck is faced with a class action law suit because its advertising allegedly suggests benefits from Lipitor for women when there is no supporting science. I don't think there are benefits for anyone in the general population.

I have never prescribed any drug of this class.

Caveat Emptor (Buyer Beware)

I have written commentaries for ABCNEWS.com relating to the lack of benefit from stents and mammography. I will not reiterate these since they are readily available in the archives.

The lesson is obvious. We, all of us, need to demand that no drug be licensed without a demonstration that it is meaningfully effective.

Today, the game is to generate evidence of any effect. We should demand much more than evidence for a surrogate effect such as lowering cholesterol or lowering blood sugar. We should demand more than evidence of an infrequent benefit that is not that crucial. We should demand robust evidence for a meaningful effect.

Then these tiny, remote harms would be countenanced.

Then all the hype, the "me too" drugs, and the profitable silliness would be dark history.

Then we would all be better off.

Dr. Nortin Hadler is professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, and an attending rheumatologist at University of North Carolina Hospitals. He is the author of The Last Well Person.

Review: Nortin M. Hadler, The Last Well Person: How to Stay Well Despite the Health-Care System

Hadler_reprintReviewed by David A. Bennahum
The Pharos, Winter 2007

The Last Well Person: How to Stay Well Despite the Health-Care System
By Nortin M. Hadler
McGill-Queen's University Press, 328 pages


In a remarkably well-written and stimulating book Nortin M. Hadler, professor of Medicine and Microbiology/Immunology at the University of North Carolina, challenges a number of medicine’s most cherished certainties. Written for the general public, the book should, however, be read by all physicians and then recommended to their patients. Surveying the plethora of health information and medical advice to which the average healthy American citizen is subject he writes that “The Last Well Person is written for all those well people who feel their sense of wellbeing is under attack.” p4 Hadler hopes “to inform the reader who is well how to feel well.” p4 and to accomplish that goal builds his book, as he says, on four footings:

1. Recalling the teachings of Karl Popper, who taught the author’s generation to question all certainties, and of Daniel Federman, his mentor at Harvard who expected students to become insightful and questioning physicians. In effect, to be compassionate yet critical thinkers.
2. To understand the social consequences of disease and its impact on a patient’s daily life and employment.
3. The understanding that to be well is to be able to cope with morbidity.
4. To understand that the author is not against medical science, rather he favors a critically rigorous science.

As he writes, “The Last Well Person is a treatise on medicalization that is informed by science, clinical reality, and an analysis of life’s morbid experiences—even episodes of disease. . . .armed with skepticism and a critical intellect it is possible to benefit, safely and effectively from modern medicine without being harmed in the process.” p6

Chapter 1 is a critical analysis of what the author entitles “Interventional Cardiology and Kindred Illusions.” He points out how much less common heart attacks are today then a generation ago:

• My chance of having a heart attack at sixty is about 50 per cent less than my father’s chance when he
was my age.
• If my father had suffered his first heart attack when he was my age, his five-year potential for survival would have been about 50 per cent. If I have a heart attack, my likelihood of living another five years is at least 95 per cent—without any specific interventions.
• If I take a baby aspirin daily from the time of my first heart attack, the likelihood of surviving five years rises to better than 97 per cent. pp 7– 8

In effect he asks why “heart attacks and strokes . . . hold North Americans in thrall.” p18 p 8 Having reviewed a large number of the major studies he then goes on to challenge the conventional wisdom that coronary artery bypass surgery and angioplasty, except for the three per cent with left main coronary
artery disease, extend life, over medical therapy alone. He then sadly points out that, while the emperor has no clothes, this is a $100 billion annual business.

To abandon this theory would be to shut down interventional cardiology, nearly all of cardiovascular surgery, and many surgical supply houses and biotechnology firms. It would dramatically downsize most
hospitals and critical-care units in the United States and free up over $100 billion annually. Since 1987,
cardiovascular disease has been the largest source of health-care spending in the country and the costs keep escalating, with cardiologists and cardiovascular surgeons providing fodder for an enormous supporting industry.p27

This is an extraordinary challenge to the certainties of mainstream medicine. When I discussed this book with a cardiovascular surgeon, an old friend and university professor, he became indignant, but was unable to bring me a single paper in refutation of Dr. Hadler’s assertions. On the other hand, another cardiologist ruefully conceded that there was much truth in Hadler’s critique of the surgical treatment of heart disease.

Hadler continues with an evaluation of diet, lifestyle, and health. He argues that for most people economics determine diet and exercise and that community and economic class are crucial to lifestyle change. Always the iconoclast, he agrees that the cholesterol and low-density lipoprotein (LDL) lowering
statins can offer a modest benefit to those who have experienced a myocardial infarction and for those who have had a stroke, but where is the proof that statins can prevent cardiovascular events in the worried well? Interestingly, the October 3, 2006, issue of the Annals of Internal Medicine questions the target numbers for LDL cholesterol set by the National Cholesterol Education Panel. The plethora of benefits attributed to statins includes Alzheimer disease, rheumatoid arthritis, and possibly other autoimmune diseases. This sounds to my mind distressingly like a new panacea in the making.

The author continues with an analysis of colon screening for colorectal cancer. He concludes that:

I suspect that a defensible approach to screening that spares us the risk of dying from colorectal cancer before our time will remain a will-o’-the-wisp for some time to come.p76

In a quite thorough analysis of breast cancer treatment, the author again challenges the prevailing wisdom of the medical community. First reminding the reader that in the 1960s the famous surgeon Oliver Cope realized that radical mastectomy had not improved the survival of women with breast cancer, yet no medical journal would publish his observation. After reviewing the data on mammography in the diagnosis of breast cancer Hadler concludes:

If we take the most optimistic approach to these data as they relate to women in their forties, it is much ado about almost nothing of value. Much the same perspective applies to mammography in women fifty years of age or older.p9

His chapter on prostate cancer screening is brief, but again he questions the wisdom of screening and the psychological and physical harm that can result. Whether the American population can become educated rather than frightened remains to be seen. In his opinion, “PSA screening is disappointing at best and probably harmful.” p99

In Part Two, “Worried Sick,” the author hopes to prepare the healthy person for the promise of medicine.

The Last Well Person is the one who is able to confront clinical science without being medicalized and to
harness it for personal benefit. I have written this book to prepare the reader for this task.p 0

In subsequent chapters he examines “Musculoskeletal Predicaments,” “Medicalization of the ‘Worried Well,’" “Turning Aging into a Disease,” “Health Hazards in the Hateful Job,” and “Why Are Alternative and Complementary Therapies Thriving?” Each of these chapters is not only stimulating, but will be very helpful to patients.

In “Epilogue: A Ripe Old Age,” the author offers a summary of his thinking and then follows with an extended annotated bibliography which will be of great interest to physicians. He suggests that:

Standing up to the moral entrepreneurs and the health-care delivery system they have nurtured is a lonely and demanding task. It is painfully so for your physician, if she is so inclined, and very time
consuming. Common practices, algorithms (therapeutic roadmaps), guidelines, and reimbursement schemes all stand in the way of independent thinking. Your physician can arrange for a cardiac catheterization far more readily than he can manage the considerable time to discuss why it may not be necessary. There are many physicians, including my own students, who would gladly assume that latter role if the health-care delivery system made it feasible. If you find such a stalwart iconoclast in the current climate, you are fortunate.p204

This is a wonderful book that I have greatly enjoyed reading and rereading for this review. It has already formed the basis for a Grand Rounds in Internal Medicine, “On the Ethics of Prognosis,” that I and several of my gerontology and palliative care colleagues presented several months ago. In preparing that presentation, I returned to Alvin Feinstein’s 1967 book, Clinical Judgment, the book that arguably initiated the search for an evidence-based medicine. And that is precisely what Nortin Hadler argues for, that in the absence of solid evidence we should not hesitate, as physicians and patients, to trust our intuition and respect our critical faculties in our encounters with the health care system.

Dr. Bennahum is the book review editor of The Pharos, and a member of its editorial board. He is emeritus professor of Internal Medicine at the University of New Mexico School of Medicine. His address is:
707 Notre Dame Drive NE
Albuquerque, New Mexico 87 06
E-mail: dbennahum@salud.unm.edu

June 01, 2007

Legalizing Misandry: Excerpt from The Times Literary Supplement Review

Nathanson_legalizing Against the male stream
Review by Jean Bethke Elshtain
The Times Literary Supplement
March 30, 2007





Legalizing Misandry: From Public Shame to Systemic Discrimination Against Men
By Paul Nathanson and Katherine K. Young
McGill-Queen's University Press
680 pages

"There are some things you cannot make up unless you are gifted with an imagination far more fertile than my own. Take, for example, the case of the student who suddenly disappeared from a class I was teaching on "Feminist Politics and Theory" many years ago at a large state university. The student had clearly disapproved of my critique of radical feminist separatism. I suspected her abrupt departure from class meant she was dropping the course. Three weeks later, she appeared during my office hours looking both disconsolate and dishevelled with a furry ball of a puppy in hand. Her hair was cropped short, the make-up was off, and she wore the costume of the moment, farmer's denim overalls.

I asked her what had happened. The story, in brief, was that she had decided to leave school in order to advocate the radical feminist cause full-time. To complete her commitment, she had moved into a separatist feminist collective. Tears began to flow at this point. She had gone grocery shopping and noticed some children giving away puppies in front of the store. Beguiled by puppies, she took one home. But the puppy was banished by order of the collective. Why? It was a male puppy, and hence toxic.

Nor was this an isolated incident..."

---

"The second volume of a projected trilogy, Legalizing Misandry tells a dismal story. The first, Spreading Misandry (2001), concentrated on the way 'negative stereotypes of men' became 'pervasive', their goal being to 'demonstrate that misandry had become deeply embedded in popular culture'. This second volume explores the many ways in which what the authors call a 'legal double-standard' has emerged in Canada and the United States, a standard that accepts as fact depressing accounts of male-female interactions, whether in marriage, work, education, or other fields of human endeavor."

---

"The authors interweave public perceptions of men with what is happening in our laws, our educational systems, our welfare institutions, and our workplaces. Ideologically drive 'misandric' notions are perpetrated by an elite culture that is tough on anyone who dares to dissent. The evidence they have amassed is impressive and concerning."

---

"Anyone who cares about the human goods of justice and equality should take note. Nathanson and Young conclude their book 'on a note of pessimism. Like many other segments of our increasingly fragmented society, women now have a very heavy investment in the rhetoric of victimhood' - one reason why ideological feminists cannot unambiguously celebrate all the advances and significant gains of recent decades. If the 'underlying problem' is 'maleness itself', there is no possible correction. You can never do enough by way of compensation and 'pay-back'. Nathanson and Young do not find attractive a society that makes ugly assumptions about half of its members. None of us should."

John Shaw, The Blue Mountains and Other Gaelic Stories from Cape Breton

Shaw_300col Review by Paul Robinson
Atlantic Books Today, Spring 2007







The Blue Mountains and Other Gaelic Stories from Cape Breton
By John Shaw
McGill-Queen's University Press, 224 pages

The Blue Mountains is a bilingual - English and Gaelic - anthology of 30 stories collected by respected Celtic scholar John Shaw from seventeen Cape Breton storytellers. That's one way of looking at it: a book primarily of interest to the ethnologist or the academic researching a paper for a learned journal. But The Blue Mountains deserves a better fate.

This is bedrock Cape Breton material. If we want to know how we got from there - the era of my South Bar grandmother and even earlier - to here - an Inverness Premier more comfortable at a ceilidh than a cabinet meeting - we can try the following approach for our reading pleasure.

Start at the back of the book with the "reciters." These are (regrettably, this should soon read "were," as the passage of time has taken its toll), invaluable purveyors of Gaelic oral tradition who recited for John Shaw and made the collection possible. Among the 17, the late Joe Neil MacNeil is possibly the best known. Nearly 20 years ago, he graced memorable multi-lingual (Gaelic, Mi'Kmaq, French and English) storytelling night in Halifax. Dan Angus Beaton and Dougie "The Gill" MacDougall are also here. As we absorb the salient details of the warehouse of knowledge these people represent, we take note of their communities. They are the community voices of a Cape Breton, an eastern Nova Scotia, that is now mostly memory.

Imagine you are a guest on All Hallow's Eve at a Gaelic storytelling in a candle-lit shieling on the ground of the Highland Village at Iona, Cape Breton. The stories are being told in their original language, and you, like me, do not understand a word of it. But you catch the rhythm and, more importantly, the sense of the unexpected, the evident detail in something mysterious that causes those around you to suck in their breath and, invariably, to collapse into laughter when the punch line is delivered. Soon enough your neighbour whispers a translation, but even without it, there is something compelling in just listening and feeling the beat of language.

Now, you are ready to dip into the 30 stories, but first a word to the cautious. If you think the adventures of Harry Potter are over the edge, you are in for a surprise. Beginning at the back of the book sets the stage and provides it own mood. Then, move among the pages rather than starting on page one and reading in sequence, story after story. You can get bogged down, so use the variety of the stories to keep the mind lively. If that doesn't work, there is always a nip of whisky to provide its own sparkle. There are seven groups of stories to keep your imagination working overtime. You could choose from the "Tall Tales," then a "Historical Legend," and conclude your first session with a longer selection, Red Conall of the Tricks, taken from the "International" section. You will soon get the hang of stories that end abruptly with the unexpected, those that go on and on until you begin to wonder where the end is, those that captivate with the magic of a trickster, and - are you ready for this? - those that deal with the tantalizing temptations of the flesh.

Finally, I must acknowledge my appreciation of the publisher, McGill-Queen's University Press, both for this and an earlier work. In 1987 John Shaw provided a signal service in helping preserve the Gaelic voice in our region by editing and translating Joe Neil MacNeil's Tales Until Dawn: The World of a Cape Breton Story-Teller. Without the contributions of both editor and publisher, Nova Scotia's story would be even more incomplete.