Monday, August 25, 2008

Ezekiel Emanuel

Ezekiel J. Emanuel is chairman of the Department of Bioethics at the Clinical Center of the National Institutes of Health.

He has published widely on the ethics of clinical research, health care reform, international research ethics, end of life care issues, euthanasia, the ethics of managed care, and the physician-patient relationship in professional journals as well as the popular press.

His books include the Exploitation and Developing Countries: The Ethics of Clinical Research (co-edited with Jennifer S. Hawkins).

Earlier this month I asked him what he was reading. His reply:
I like to alternate my reading between fiction and non-fiction. The non-fiction books mainly, but by no means exclusively, focus on biographies and histories, especially American history.

I have just finished Conrad Black’s biography of Franklin Roosevelt. A massive but amazingly well written book. (A wonderful read if you want to expand your vocabulary.) The thesis that Roosevelt was a Machiavellian idealist—that is, someone who used Machiavellian manipulation to implement idealistic policies that bettered the condition of the average American—is fascinating, and one any Democratic politician should heed. Black illustrates this thesis with multiple examples. The one I like best is how Roosevelt manipulated Joe Kennedy to endorse him in 1940 to secure the Catholic vote, and then completely discarded Kennedy when he quickly returned to his pro-German rantings just after the election. It is hard to understand how such a masterful writer and observer of human beings got caught up in his own business crimes, but now that Conrad Black has 6 years in prison, we can only hope he turns his great talents to another wonderful biography, maybe this time of some great person who still needs a brilliant biography, say Albert Gallatin, Edwin Stanton, Charles W. Eliot or Abraham Flexner.

I also just finished Barry Schwartz’s The Paradox of Choice: Why More is Less. This is a wonderful analysis of how the brain works in decision-making and the implications for consumer choice. It synthesizes some of the work of Kahneman and Twersky as well as many recent studies on human choices and fMRIs of the brain while people are making decisions. The fact that having a choice among 24 jams leads people to buy fewer items than if they are offered a choice among 6 jams is something we need to keep in mind when designing all sorts of programs—such as pension plans and health insurance options. I also think we give too little heed to the importance of “adaptation”—that we adapt to our circumstances, both bad circumstances as well as new luxuries that quickly become needs. The implication that once we have something we are loathe to give it up and begin to view it as essential has important implications for many things, not the least of which is raising children. Finally, I love Schwartz’s point that being a maximizer is inimical to happiness while being a satisficer is much more likely to make you content is very welcome.

I read Nathan Englander’s The Ministry of Special Cases, a dark but humorous meditation into Argentina’s dirty war. Englander is clearly the heir to Kafka. His ability to take horrible situations and refract them, making us see the absurdity, the inhumane treatment of people, and yet laugh at ourselves and at human adaptation to these situations is amazing. This book leaves the reader with the unsettling sense that as humans we crave meaning, and do our best to make it impossible, that we torture each other along the way to be sure the other person is not able to lead a meaningful life.

I just finished John Banville’s The Sea. It is a short novel about the death of a spouse by cancer and the memories of other losses it revives. Wonderful imagery and wonderful descriptions of adolescent behaviors. Having cared for many dying cancer patients and families as an oncologist, I did not find the portrait of the wife’s demise, the gnawing feeling of the inevitable, as realistic as it might be. The sinking, hollowing out feeling of a terminal diagnosis, the ferocious, almost blinding battle against the “death sentence” did not seem to me present. But Banville is great on the avoidance of talking about cancer. His brief but poignant descriptions reminded me that this might be the way we in the West have adopted the very old idea that verbalizing or explicitly mentioning some horrible thing, such as dying from cancer, actually, causally, makes it occur. We avoid talking about cancer even when everyone knows the same information. It seems that we might believe that if we don’t speak the words, somehow terminal cancer and death can be evaded.

I was on a longish trip and finished Banville. The house I was staying in did not have much but did have James McPherson’s Drawn with the Sword which is a collection of essays on the Civil War. As a Civil War buff—but not expert—I liked his thesis that there was no inevitability to the North’s victory. What made the difference was better leadership and luck. The North had a better commander-in-chief in Lincoln but also had better generals. Grant, Sherman, and Sheridan out performed the Confederate generals in the West and then came to Virginia to beat Lee. These generals used their material advantage to win battles. McPherson is also good on emphasizing the role of luck—luck at Antietam and Gettysburg, and luck in Sherman’s capture of Atlanta allowing Lincoln to win.

A couple of weeks ago I had the chance to read Yertle the Turtle for the thousandth time to a 14 month old. Along with The Sneetches, it is simply one of the great works of 20th century literature. Dr. Seuss is fantastic—an astute observer of human behavior and a wonderful moral teacher without being moralistic. As a child growing up in the 1960s I thought Yertle the Turtle was written about Lyndon Johnson and Vietnam. Only many decades later, when I had my own children, did I realize it was written in 1958 long before our tragic debacle in Vietnam. How brilliant and prescient, how much more universal the insights. We all want to be king of all that we can see, not just the muddy water of our own Salmasond Pond. And the fall if that drive becomes all consuming and pathologic, is too true. Yertle is a story every politician, CEO, president of an organization—all of us, in fact—should read periodically, just to remind us.

I just picked up American Prometheus about J. Robert Oppenheimer. A riveting book which I am only 20% through. After that my next book is A Farewell to Alms: A Brief Economic History of the World.
Learn more about Ezekiel J. Emanuel's research and publications.

--Marshal Zeringue