Atul Gawande (2014)

An exploration of end-of-life care – something that’s of interest to us all, of course, but very seldom addressed properly. And that’s Gawande’s essential point: people leave decisions about their last days until their last days, and so have a far worse time of it than perhaps they need to.

There’s much more to this book that this, though. Gawande explores the different approaches to assisted living and hospice care, the ways in which focusing on social rather than medical aspects can lead to far better outcomes, and shares his own family’s experiences with the difficulties that gradual illness can bring. (This is perhaps the greatest contribution of the book, and shows an enormous openness of spirit to share something so personal.) He demolishes the utopian visions of multi-generational living that sometimes cloud the debate, showing that this brings its own tensions: different to those of our more individualistic society, but certainly no less divisive. If nothing else, he shows that there is an alternative to medicalising old age, and that this is something we should all work towards in our own self-interest.

4/5. Finished Sunday 27 September, 2015.

(Originally published on Goodreads.)

Margaret MacMillan (2013)

A fine and detailed history of the period.

The First World War remains an enigma: how did the sustained period of peace that preceded it suddenly end so catastrophically? How did a relatively small triggering event become so magnified so quickly?

MacMillan explores the background of the politics and personalities with great care and thoroughness. She highlights several factors that are under-stressed in other histories, notably the broader impact of the Anglo-German naval race (by spoiling otheriwse improving relations between the countries) and the damaging impact of the Dreyfus Affair on the French army (by making a military career less attractive to ambitious individuals). She provides much deeper explorations of several events that are often mentioned only in passing, for example the Algeciras conference. She also spends great care on the different views of the same events as seen from opposite sides, and on the way that actions that one side saw as purely defensive appeared anything but from the standpoint of other countries.

But what really stands out is the fatalistic acceptance that many Europeans – both leaders and ordinary people – had for the concept of an impending war. That seems at odds with the prevailing peacefulness between the Great Powers, and certainly seems strange from a standpoint of modern public opinion: how could people accept the end of peace so easily, especially for a conflict that would be fought close to home for almost all of them? While it’s possible to argue that people hadn’t appreciated the impact that machine guns and barbed wire had on military dynamics (despite the evidence of American Civil War), that seems too technical an explanation for such a concerted act of folly.

One stylistic touch that I didn’t like is the rather trite use of modern analogies. Comparing German statesmen appearing in military uniform with the behaviours of modern dictators doesn’t seem to me to add much to the text, or to the understanding of the motivations involved. But that’s a minor quibble about what is certainly a fine discussion of events that still fascinate more than a century later.

5/5. Finished Wednesday 9 September, 2015.

(Originally published on Goodreads.)

Richard Hytner (2014)

A book on how to shine from the shadows.

While most books on leadership concentrate on the leaders, and especially on how to become a more charismatic leader, this book takes the opposite tack: how to be a loyal supporter and an “invisible” leader even if you never take the top spot. As a dedicated introvert and fan of Niccolo Machiavelli, this is definitely a position I can understand.

Hytner divides leaders into A’s and C’s, where A’s seek the limelight and C’s seek to wield their influence more discreetly. He sprinkles his presentation with some great examples of modern-day partnerships and how they work. He explores the different supporting roles needed in organisations, and the things that the headline leader needs – both positive in the sense of providing advice and research, and negative in the sense of reining-in and keeping grounded – that can best be provided by someone comfortable in their anonymity. In that sense this is a book both for those wanting to be better C’s, and for those A’s who want to choose their consiglieri wisely.

One observation that I wasn’t expecting was the idea of moving between the A and C role, that a C might aspire to move into the A position after a period of consolidation, or that an A might benefit from time spent out of the limelight as a C. Both these strike me as problematic for reasons of basic personality structure, but in any event they point to essential value of both the top jobs and their close supporters, and the need to manage both equally in a well-functioning organisation.

4/5. Finished Sunday 30 August, 2015.

(Originally published on Goodreads.)

Rebecca Skloot (2010)

Part scientific history, part social history, this is as much a book about modern American social exclusion as it is about one of the most important scientific breakthroughs of all time.

The science is nowhere near as well-known as it should be. The cancerous cells of a dying African-American woman became “HeLa”, the first “immortal” cell line, and at a stroke revolutionise the study of diseases. Using just one of Skloot’s several examples, HeLa allowed proper rigorous comparisons of different treatment regimes for the polio vaccine. Since then, HeLa has been at the centre of almost every major medical trial and breakthrough, and is still a critical component of education and research fifty years later.

HeLa was given away for free to researchers in an act of enormous generosity – and also, it has to be said, because it happened in an era before the major profit motive invaded medicine. But that is of no comfort to the descendants of Henrietta Lacks, the cells’ original “donor”. Not only are there serious questions of consent and the ethics of openly sharing material that can be used to identify and profile the likely medical histories of her descendants; they remain so poor that they live in situations almost unrecognisable as the 20th century Western world, dependent on charity because of lack of health insurance. Indeed, Skloot’s descriptions of “Lackstown”, where everyone is related and sharing a common lack of basic services, healthcare, or employment, is the most riveting part of the book. In many ways it evokes some of the Victorian reportage – People of the Abyss, The, for example – but without any ambition to bring about similar social change. The Lacks’ conditions are described, deplored, and in some sense accepted in a way that’s quietly troubling.

The last section of the book is also fascinating, reviewing the continuing history of consent as applied to tissue samples where rights of privacy and ownership collide with research goals and the public good. Skloot does a good job in showing how inherently complicated these issues are, and doesn’t fall into the trap of taking simple sides.

4/5. Finished Tuesday 18 August, 2015.

(Originally published on Goodreads.)