Jason Karlawish

In “The Problem of Alzheimer’s Disease” Dr. Jason Karlawish, the co-director of the Penn Memory Center at the University of Pennsylvania School of Medicine in Philadelphia, provides a superb and comprehensive analysis of “the disease of the century”, from the standpoint of a clinician who routinely diagnoses and treats patients with all forms of dementia, including Alzheimer’s disease, who is also a physician researcher, bioethicist, and medical historian who has spent his career studying this dreaded and pervasive illness that has afflicted millions of people around the world, and adversely affected many other family members of the sufferers.

Karlawish begins by noting a landmark 1976 editorial in the journal Archives of Neurology by Dr Robert Katzman, the chairman of the Department of Neurology at Albert Einstein College of Medicine, titled “The Prevalence and Malignancy of Alzheimer Disease,” which first sounded the alarm about the high prevalence of this underrecognized cause of morbidity and mortality in elderly Americans, a disease that he estimated to be the fourth or fifth most common cause of death in the United States. His commentary did not fall on deaf ears, as the National Institute of Aging, a new division within the National Institutes of Health, chose Alzheimer’s disease as its primary focus, bipartisan political support for this dreaded disease led to more funding and greater public attention on this malady, and researchers worked tirelessly to discover diagnostic techniques that would permit earlier and more definitive diagnoses, and uncover new medications targeted at the processes that caused the disease to progress. Forty five years have passed since Dr Katzman’s call to action, yet Alzheimer’s disease has neither been cured nor alleviated to an appreciable degree.

Part 1 of "The Problem of Alzheimer’s" describes what Alzheimer’s disease is, how it is diagnosed, and how it differs from other forms of dementia, such as Lewy body disease. The stages of the disease are characterized, the burden of moderate and severe Alzheimer’s on spouses, children and other family members is chronicled, and the astronomical cost of care is mentioned. The modern history of Alzheimer’s disease is recounted, with detailed descriptions of the researchers and clinicians whose studies were the most important in advancing knowledge about it. Part 2 recalls the early history of the disease, which was first described by the German psychiatrist Dr Alois Alzheimer in the first decade of the 20th century, based on a small number of patients he cared for, along with meticulous studies of biopsied and stained brain tissue after their deaths, which first demonstrated the plaques and tangles that are characteristic of this form of dementia. In Part 3, Dr Karlawish describes the sociopolitical barriers that prevent Alzheimer’s patients from receiving adequate and optimal care for the disease and its sequelae, and Part 4 serves as a second call to action, while acknowledging the limitations and barriers that must be overcome to give the best care for these patients, along with the great distance that must be bridged before a true cure is achieved.

"The Problem of Alzheimer’s" is written for a lay audience, yet it has enough detail to satisfy scientists, clinicians and policy makers who wish to understand more about the science behind the different medications and diagnostic modalities available for people with the disease. My mother has moderate Alzheimer’s disease and is followed by one of Dr Karlawish’s colleagues at the Penn Memory Center, so this book was both essential and very helpful, now that I have assumed the role of primary caregiver of Mom after my father’s recent death.… (altro)

I registered this book at BookCrossing.com!
http://www.BookCrossing.com/journal/14208627

Sometimes fiction can tell the story better than nonfiction. I think this is one of those cases.

Sticking very close to the facts but moving a few incidents around a bit and occasionally changing names, Karlawish tells us how young Dr. Beaumont came to treat a wound in the side of a fur trapper on Mackinac Island in Michigan, and how that treatment led to an obsession.

Beaumont was an Assistant Surgeon for the young army. Having grappled his way up the ranks because he was financially unable to afford expensive medical school, Beaumont settled for the "assistant" title. But it rankled. Throughout his life he was driven at least in part by a need to prove that he was every bit as worthy as a Harvard graduate.

When he was called to tend to the young fur trapper, shot in the side accidentally, he did not think young Alexis St. Martin would survive. But he felt driven to try to save him, even going against orders and moving him to the island's small, inadequate hospital. After the danger appeared to be past, he was intrigued by what he saw in his patient's side. He was able to watch St. Martin's stomach digesting. At the time, not much was known about digestion and many assumptions were made. Beaumont was on the side of those believing digestion was a chemical process, and he wanted to prove it.

Thus began a many-year effort, with stalls when St. Martin disappeared for years and tended to his new family, and with Beaumont having to beg for assistance and money to pursue this study wherever he was stationed.

Karlawish doesn't seem to take many liberties with Beaumont's or St. Martin's characters. He provides dialog that seems appropriate and doesn't push beyond what is known about the men.

I would have liked more of a summary at the end of what information Beaumont provided that was unknown or unproven before, and how it has been useful over the years. Otherwise I felt it was a well-written and researched book that kept me interested all the way through.… (altro)

This novel is written by a physician about another physician alive almost two centuries ago and deals with an interesting ethical and moral dilemma. It’s based a on a real life story of doctor Beaumont and, by today’s standards, his ethically questionable experimentation on a young man whose life he saved.
In 1822 Dr. William Beaumont, an assistant surgeon in the American army stationed on Mackinac Island on Lake Huron, Michigan, found himself called to an accident in which a young French Canadian voyageur, Alexis St. Martin, took a full blast from an accidental discharge from a gun at a very close proximity. The wound involved both lungs and stomach, was big and complicated and there was little hope that the young man would survive.
Beaumont saved the young trapper’s life but as the wound was healing it became a big fistula into his stomach. Beaumont then, instead of surgically closing it, saw it as a research opportunity and in time became obsessed with probing it and studying digestion through it. The procedure went on for years and had reluctant acquiesce from Alexis who was first dependent on the surgical care of the wound, and then on financial support from Beaumont. As to the pain inflicted by the procedure, we are told that it wasn’t so much the pain as the discomfort and the feeling of nausea and faintness that the young man was experiencing.

By modern ethical and moral standards what Beaumont did is very questionable, even if what propelled him forward was the need for serving humanity as much as the thirst for his own fame. To judge him by our own standards alone would be anachronistic, though. We know from the book that his contemporaries were divided in the appraisal of his efforts- some condemned it, some praised it and found it highly commendable. What real value it has had in furthering our knowledge of digestion the book doesn’t say. My impression is that it remained obscure and not many scientists got acquainted with it. Beaumont, being no scientist, did not conduct his research according to any strict research standards either. As to fistulas, Pavlov to whom we owe Pavlov’s ‘conditioned reflex’, surgically made fistulas in dogs’ cheeks and stomachs to collect their saliva and gastric acid and study digestion. At least Alexis’ fistula was accidental.

Both of them and countless others used live subjects for experimentation to further medical knowledge. As Better Angels of Our Nature by Pinker informs us the ethical and moral standards have changed over the ages and are still changing in the direction of progress and minimization of pain, humility and towards providing informed consent. And, that’s a great development and one that we hopefully won’t veer from.

The book is quite engrossing and well written to boot. Reminiscent a bit of Immortal Life of Henrietta Lacks in its subject matter.… (altro)

I received this book for free as a Goodreads First Reads giveaway.

Wow. This is one of those books that make you feel like you're still a part of the character's life even after you have stopped reading. Dr. Beaumont's story is so relatable and so tragic, it's hard to pull yourself away from his experiences.

The inside flap of the book's cover says, "even as Beaumont's care of St. Martin continues for decades, the motives and merits of his attention are far from clear." This couldn't be more true. I found myself flip-flopping throughout the novel on who I felt was the victim and who was the oppressor. At some points, I felt like Beaumont was only acting out of altruism and charity, and that Alexis was ungratefully taking advantage of him. Then in the next chapter, I felt like Beaumont was using his power over Alexis unethically, and that Alexis was trapped in a hopeless, unfair situation. Beaumont admits that he is ambitious and wants to leave a lasting legacy, but his obsession seems to be driven by something deeper and darker, something that neither Beaumont nor the reader are able to truly identify.

Beaumont's obsession is truly tragic. There were so many moments where I wanted to grab Beaumont by the shoulders and shake him and yell, "Let it go!" He makes some progress and gains small successes, which encourage him to continue, but he loses so much over the course of the novel. There is a moment towards the end where it all starts to unravel, where it seems like everything he has done in his life is going to amount to nothing, and I just wanted to cry. I think it would be very difficult to read this book without getting invested in Beaumont's story, regardless of whether you view him as the victim, the oppressor, or both.

Full review posted on my blog, PidginPea's Book Nook.… (altro)