Review of Compulsive Acts, Elias Aboujaoude, 2008


This book did not impress me much at all. A far more readable and useful books on obsessions and compulsions is David Adam’s “The Man Who Couldn’t Stop” which I regularly recommend to patients. I did some book reviews for Fortean Times from 2003 til around 2008, I think this is likely to have been one of the last – none seem to have a life online but will turn up in various archives I have.

Compulsive Acts: A psychiatrists tales of ritual and obsession

The best that can be said of Elias Aboujaoude’s Compulsive Acts is that it’s an easy read. Director of the Impusive Control Disorders Unit at Stanford University School of Medicine, one would hope that Aboujaoude would give both the general and specialist reader some great insight into the world of compulsion. He ranges from obsessive-compulsive disorders to pathological gambling and problematic internet use, yet never really rises above the level of a decent magazine article, in say Time or Newsweek.

In his introduction Aboujaoude makes much of the weighty ethical dilemma facing him putting pen to paper. Clearly the issue of confidentiality looms over every medical writers wishing to make use of the material presenting every day. However Aboujaoude’s throat-clearing and disquisitions on storytelling in his Mediterranean ancestry serve to annoy when it finally comes to the writing itself. In his fictionalised composites, Aboujaoude adopts an irritatingly breezy style, as well as betraying a tin ear for dialogue and a weakness for twee framing devices (in particular his receptionist Aurora, an attempt at down-to-earth wisdom) Furthermore, the cases seem to progress neatly to their conclusions (not necessarily happy or successful ones) and lack real drama. One feels that Aboujaoude must have a decent book inside him – if only it could be compelled to come out.

3/10 – Far from compulsive

Helen Pearson, “The Life Project”, Review in TLS 29/03/17

I have a review of Helen Pearson’s “The Life Project” on the UK birth cohort studies in the current TLS. The full article is behind a paywall so here is the preview:

Born to fail

To a non-Briton, the oft-repeated assertion that the NHS is “the envy of the world” can grate. If imitation is the sincerest form of envy, the world’s laggardly adoption of free-at-point-of-use health care is perhaps the truest mark of how much emotional investment the rest of the world really has in the UK’s health system. Early in The Life Project, her book on the British birth cohort studies, Helen Pearson describes them as “the envy of scientists all over the world”. In this case, envy is easier to precisely pinpoint; birth cohort studies have become all the epidemiological and social scientific rage in recent decades, especially around the turn of the millennium. My own daughter, born in 2008, is a member of the Economic and Social Research Institute’s “Growing Up in Ireland” birth cohort.

1946 is the Year Zero of birth cohorts. The low interwar birth rate had caused much…



Review of “Take Me To The Source: In Search of Water” and “The Blue Death” – TLS, 2008

Apologies for the hiatus. This is my submitted copy rather than the review as it appeared in the TLS. I re read most of Rupert Wright’s book a few years ago. This was the first time I came across the concept of water charges, which seemed to strike everyone else in Ireland as something completely out of this world in late 2013. I greatly preferred Wright to Morris and found his debunking of the “the world’s next war will be over” idea (I nearly typed meme!) convincing.

Take me to the source: In search of water. Rupert Wright

The Blue Death: Disease, Disaster and the Water We Drink. Dr Robert D Morris

Thales of Miletus, the earliest identifiable philosopher and scientist (in a fairly loose sense of both terms) held that “everything is water.” That this is the first philosophical and first scientific statement is no accident; water is central to human existence. In the West, however, the words of Jake Gittes in “Chinatown” are apt – “I turned on the faucet, it came out hot and cold, I didn’t think there was a thing to it. “Rupert Wright, who has previously written books about life in the Languedoc region, begins his discursive, digressive, suitably elusive book with the sudden cessation of water supply in his French home. When he bought the place, the fact that it came with its own water supply was another romantic touch. Only when it stopped did he realise that there was indeed “a thing to it.”

Wright has written an entertaining tour of the world of water, if such a tautology is possible in a world that is mainly water. From the gigantic excavation of a third water supply tunnel for New York, happening almost invisibly to passers-by in Midtown Manhattan, to asommelier instructing bored Parisians in the appreciation of spring and mineral water, to the hunger-striking Bishop of Barra in Brazil trying to stop the damming of the São Francisco River, humanity’s relationship with water is by turns inspiring, absurd, and tragic.

Water policy is steadfastly unsexy. All over the world, Wright notices, oil ministers are Harvard-educated, Rolex-wearing, Armani-clad; water ministers wear cheap suits and use their mobile phones to tell the time. Wright is no reflex contrarian, but his scepticism about some of the received wisdom about water and water policy is bracing. One truism of bien pensant opinion he  seems wearied by is the wars of the coming century will be a fought over water, a notion he imagines Flaubert consigning to a contemporary Dictionnaire des Idées Reçues. Only one war, he writes, has ever definitively been fought over water – “more have been fought over salt.” Water has been a tool of war rather than a cause of war, and the need for water drives co-operation as much as competition (Europe’s oldest law court the Tribunal de las Aguas de la Vega de Valencia, consists of eight magistrates who have convened every Thursday at midday since the Tenth Century to ensure the fair distribution of Turia River water.)

Wright is much more interested in how writers and artists have described and depicted water. Poetry flows throughout. He is particularly enraptured by the single flowing sentence that is Bloom’s reflection on water in Ulysses. That dry systemiser Stephen Dedalus disliked bathing and suspects ‘aquacities of thought and language’; hydrophilic Bloom boils the kettle and embarks on an epic sentence of reverie and connection about water. Three other texts especially inspire Wright – John Cheever’s “The Swimmer”, Roger Deakin’s “Waterlog” and Charles Sprawson’s “Haunts of the Black Masseur: The Swimmer as Hero” and he has something of the ruminative charm of Deakin and the digressive erudition of Sprawson.

No mention of Ulysses in Dr Robert D. Morris’ “The Blue Death” (Morris, incidentally, uses his professional title on the book’s cover.) While Rupert Wright does not gloss over the lethality of water-borne infections and the mass misery and death that can be caused by consuming water, Morris, a public health physician and water researcher, focuses exclusively on water-borne threats. Water, as a substance itself, is not centre stage – indeed is hardly mentioned. An aside that “safe water is not an end, but a process, an ongoing struggle in which improvement is always possible and often necessary. Purity, it turns out, is fleeting” is the closest we come to the philosophical reflections of Wright.

He begins with the tale of John Snow and the Broad Street pump. Snow is to epidemiologists what Indiana Jones is to archaeologists, and Morris lays of the suspense a little thick: “Snow felt he was finally closing in on the proof that might muffle his critics. The ground itself would need to shake to divert his attention from the task at hand. He would soon discover that an epidemiological earthquake like no other had its epicenter on the north side of the Thames.” We move on to the battles over cholera of Robert Koch and Louis Pasteur (“like seasoned gunfighters, they would meet in the streets of Alexandria with test tubes blazing until only one man was standing.”)

The tone shifts suddenly halfway through. Morris is no longer describing the heroic age of epidemiology and public health, but is centre stage. A meta-analysis he performs linking  long-term consumption of chlorinated water with cancer earns him the suspicion of the water treatment industry and, it seems from his own account, the Environmental Protection Agency. Again we are reminded that water is “unsexy” – public attention, for Big Water, means bad news. Outbreaks of cryptosporidium in Milwaukee in 1993 and E. coli 0157:H7 in Canada in 2000 illustrate the weaknesses of water processing systems that have changed little in a hundred years. Morris is no neutral in these matters, and closes the book with an eight point plan for ensuring safe water (step 7, by the way, involves the universal use of point-of-use filtration for drinking water.)

Wright writes ruminatively, philosophically, sub specie aeternis,, while Morris is the researcher in the arena of current controversy and impatient with the slow pace of change. Wright is amusedly tolerant of bottled water and its attendant absurdities; Morris is angered by a fad whereby more water is used to produce the bottle than goes inside. Both aim to reveal the truth about the ubiquitous and invisible substance that we are learning not to take quite so much for granted – water is everywhere, water is eternal, water is indestructible, and water is scarce, fleeting, and fragile.

“Wise pearls of refractive and cataract surgery revealed in charming style” review of 101 Pearls In Refractive, Cataract and Corneal Surgery. Eurotimes, Jan 2007

PDF of the original is here. I was always billed as “MD” by Eurotimes, despite repeated requests to change it on my part. This review is again fairly typical. My musings on evidence based practice and the possible return of clinical wisdom seem germane to the considerations I wrote about here . Credit to the subeditor for the haiku-like title (too many syllables though)

“Wise pearls of refractive and cataract surgery revealed in charming style”

There is something of a tradition in medical publishing of books claiming to provide “pearls” or “clinical gems” or “clinical secrets”.

These are never primary textbooks that could be used for study, but supplement basic knowledge, and mirror a learning technique of definite effectiveness.

We like to think the practice of medicine is a rational exercise, the application of knowledge gleaned from evidence-based sources and from a rigorous training in the basic sciences that underpin medicine.

The fact is, however, that our practice is very often based on the cases that stick in the mind, those that illustrate some point or other much more effectively than, let us be honest, any amount of high-minded praise of evidence-based practice.

After all, a little introspection will reveal that we remember the unusual, the striking, the individual, far more than the great mass of material we are instructed to recall. Of course, properly applied, evidence  basedpractice flows from the individual case to the peer-reviewed paper, and not the other way round.

Melki and Azar have assembled an international cast of contributors to produce this concise, clear, practical volume, which is aimed at practitioners and assumes a certain degree of familiarity with surgical technique, indication and practice. So this is a typical “pearls” book – not one for the student or the beginner but one for the active practitioner, guiding and advising the actual process of clinical medicine. In this case, the surgeon of the anterior chamber.

There is something charming and collegial about this approach, an approach that conjures up old-fashioned images of medical training and education as a body of knowledge handed down, apprenticeship style, from older practitioners to younger ones.The “pearls” book concept presumably began life as a compilation of the sayings of certain eminent clinicians.

Again, the current of medical education and training now – as well as reforms and/or tinkerings (delete according to taste) with medical training  – is towards self-directed,“problem-based” learning. Fashions change in medical training as much as any other field, and there is something to be said for the older approach. No doubt it will return to some degree.The notion of “expertise” of senior clinicians – or even not so senior ones – counting for much is old-fashioned in medicine.Yet have we lost something in the rush to elevate the meta-analysis of a series of double-blind randomised controlled trials as the measure of all things?

Claes H Dohlman, professor of ophthalmology at Harvard Medical School, contributes a foreword to this second edition as he did to the first edition. Dohlman writes of the apparent presumption of the editors in taking on three enormous areas in a single, relatively compact text.“However, instead of trying to grind through the topics in the traditional way, resulting in superficiality, the authors have cleverly singled out a series of discrete key issues along the cutting edge of this surgery.” Thus the “pearls” of the title.

So what are the pearls? Given that there are 101, the reader will forgive the absence of a list of each and every one.There are 25 subsections, aggregations of pearls so to speak, which begin with surgical planning with wavefront tomography and end with posterior keratoplasty. Each “pearl” is essentially a little section of text, with the accent on practical advice and issues, and at the end an “Always Remember” box succinctly summarises the crucial point. In between, every technical area is covered – as explained above and reiterated by Dohlman in his Foreword, this is not and does not claim to be a comprehensive textbook or, indeed, a manual of every single step of surgery, but a supplement to these sources. The pearls very often relate to the use of specific technologies in surgery, and practitioners may need familiarity with and indeed availability of these technologies to fully benefit from the book.

There is no doubt, however, that what is described is cutting edge, if the pun can be excused, and consistently reflects a high standard of practice which all practitioners should aim to emulate.The pearls also cover anaesthetic issues as well as those relating to particular points of surgical technique and preoperative work-up.

Thus, the relatively slim size and portability of the book. It is attractively presented, with good clear fonts on highquality paper, and a range of full-colour photographs and diagrams.The book I reviewed was a soft-cover edition with an attractively colourful cover. It is a snappy cover that reflects the snappy concept contained therein.

Overall, I was impressed with this book, which will complement comprehensive textbooks for the trainee ophthalmologist of the anterior section, with access to the technical innovations mentioned.