Challenging the maladies

Not to spoil the story too much but the answer appears to be yes. You can die of a broken heart. Nikki Stamp, one of Australia’s few female heart and lung surgeons, loves the muscly organ that sits somewhere under the ribs. She admires its versatility and endurance and marvels at its influence on the entire body. If a marriage or a loving partnership goes south, she writes in Can You Die of a Broken Heart?, the sorrow can cause an actual pain in the chest.

Broken heart syndrome, or more technically takotsubo cardiomyopathy, is a bit like a heart attack. Rampaging emotions can prompt the body to release a flood of hormones such as adrenaline, noradenalin and dopamine that push the coronary arteries to spasm and contract, limiting the blood supply to the cells of the heart muscles and forcing the left ventricle to balloon outwards. Nine in 10 of those who have had ­takotsubo cardiomyopathy are women and for a long time the connection between heartbreak and heart disease was considered to be folklore.

Stamp, though, believes in the power of the mind to affect the body, and not just via heartbreak. Loving hugs from dear friends, relatives, lovers or spouses can prompt the release of oxytocin from the pituitary gland and this cuddle or love hormone usually makes an ill patient or a grief-stricken friend feel better.

Although she is a cardiothoracic surgeon, Stamp keeps this book largely free of difficult medical terminology. She skips lightly and ­easily from broken hearts to the wonders of mechanical hearts and the anatomical differences in women’s hearts, imparting little-known facts along the way.

Who knew that if a woman has a heart attack, she is more likely to die than a man who has one? Who knew that a heart attack in a woman can feel like a pain in the jaw, or in the top of the belly, or in the back?

Stamp paints her pictures of the heart with a broad brush. She looks at blood stickiness, at sleep deprivation, at genetic destiny. She uses patient studies to illustrate her themes: the man who ignored a ‘‘niggle’’ in his chest and wound up on a heart-lung machine; the anxious full-time carer whose heart started to trouble her in the middle of a medical consultation; the ­depressed heart-transplant patient who couldn’t give up smoking.

Can You Die of a Broken Heart by Nikki Stamp

It makes for interesting reading about the way bodies work. Or don’t work.

Wendy Mitchell’s body didn’t work in a common way. Jogging alongside the River Ouse in York, where she lives, she tripped and fell, banging her face on the pavement.

When the trip and fall happened again, and again, and she felt a fog in her mind and her speech began to slur, she saw a range of doctors and specialists. A stroke was diagnosed. After a few months she went back to work but her mind was still foggy. She didn’t understand things as quickly as she once did. She consulted a neurologist.

Asked to remember three words at the beginning of the consultation, by the end she couldn’t remember any of them. The neurologist’s horrifying opinion came by post: “It is possible that this is a profile of the early stages of a dementing process.”

At the age of 58, Mitchell was provisionally diagnosed with dementia, an incurable condition that leads to the creeping and inevitable loss of the ability to think and ­remember. (According to the textbooks, ­dementia is the overarching term for a group of conditions that cause brain function impairment, and Alzheimer’s is one of those.)

So the courageous Mitchell came up with a range of ingenious ways to deal with her incurable condition: alarms on her laptop to remind her to take her medicine and even to eat lunch; a forest of sticky notes used as reminders; photos of the insides of her cupboards pasted on the outside so she could find that missing sweater, or notepad, or tin of soup without opening every cupboard door in the house again and again and again.

Somebody I Used to Know by Wendy Mitchell

Her memoir, Somebody I Used to Know, ghostwritten by journalist Anna Wharton, is a warm, friendly, funny and often terrifying portrait of an energetic and bustling professional whose biggest concern, it seems, is the possibility that one day she may fail to recognise her daughters.

Unquenchably independent, and long divorced, Mitchell flatly refuses most intrusive care and lives alone with her reminders. After a long and taxing career with Britain’s National Health Service, she was forced to retire, so she fills her days as a “dementia ambassador”, making long and painstakingly planned journeys, giving speeches, talking to journalists, playing Sudoko and Scrabble to keep her mind active, and writing her daily blog.

All this activity is interspersed with terrifying blanks, those times when she can’t recognise long-familiar faces or surroundings, and she panics. As well as these intermittent terrors, she mourns her lost abilities: she can’t bake a cake any more, or lace on her sneakers and go for a run, or read a book through to the end. Her mind is going, along with her physical ability. All that remains is her indomitable bravery.

American doctor Jonathan Quick, who has worked on the front lines of the fight to control epidemics, knows about the courage needed in the face of disease.

The End of Epidemics by Jonathan D. Quick

The End of Epidemics by Jonathan D. Quick

In The End of Epidemics he estimates almost 400 new infectious diseases have been identified worldwide in the past 75 years. The ­accelerating age of jet travel has made it harder to isolate and control such outbreaks. Swine flu, bird flu, ebola, HIV/AIDS, SARS, zika, MERS: in recent decades the world has seen significant epidemics race from town to town, and nation to nation, leaving death, devastation, fractured families and poverty in their wake.

The so-called Spanish flu of 1918 killed as many as 100 million people worldwide. HIV/AIDS has killed 40 million since it emerged from Africa, probably via a monkey or ape that was killed and eaten. The ‘‘Hong Kong’’ flu, which leapt around the world, killed 700,000. Ebola, in its latest emergence, left entire nations devastated, savaging the already tiny numbers of doctors, nurses and health workers in Sierra Leone and Liberia. Often diseases that have jumped the species barrier from animals to humans, these maladies are mostly virulently infectious and often fatal. Without rapid, decisive and, sadly, often unpopular action, epidemics can take hold and spread with alarming speed.

A lecturer in medicine at Harvard, Quick’s predictions can be horrifying. Experts agree, he says, that a superbug will inevitably emerge at some point and create a global pandemic. The point is to be ready for it.

Quick explores the frightening laxness of a number of biocontrol labs around the world and the potential for terrorists to launch biological attacks, aided by ever more sophisticated technology, such as CRISPR, that scientists can use to mess with genes.

After he has frightened us silly with the increasing threat of epidemics, Quick turns to his main point: prevention. Disease surveillance and tracking, improved public health systems, a reduction of deforestation and an increase in farm biosecurity. Research has found, he says, these measures in combination could reduce infectious disease outbreaks by as much as half.

Well, sure, but hasn’t history proved, over and over, that humans (collectively) won’t lift a finger to prevent disaster until it is right there, on top of them? Sure, a pandemic may be brewing in an African jungle, or a Chinese pig farm, or via a mutating flu virus, but, considering recent efforts, little will be done until the bodies start piling up.

Randomistas by Andrew Leigh
Randomistas by Andrew Leigh

One disease that we have largely controlled is scurvy. Treatments for scurvy are on Andrew Leigh’s to-be-noted list in Randomistas: How Radical Researchers Changed Our World, along with the precise shade of blue of the Google tool bar, measures to deal with domestic violence, the jailing of juvenile offenders, teaching methods and untold numbers of pharmaceuticals. Each passed, or failed, the ultimate test: the randomised controlled experiment.

Randomised trials have shaped our world, writes Leigh, who is the federal opposition’s ­assistant Treasury spokesman and a former economics professor at the Australian National University. His arguments are persuasive. Forget hunches, intuition, or vague understandings, which have all too often led scientists astray. Test, test and randomised test again.

Assumptions, Leigh writes, are all too often wrong. Most people would think that a period looking after a crying, pooping, wakeful doll would discourage teenage girls from getting pregnant. Wrong. They were almost twice as likely to become teenage mothers. Some might assume that people in developing nations will value and use mosquito bed-nets impregnated with repellent if they are charged a small sum for them. Wrong. Free bed-nets are wildly popular and widely used. And the hunch that after-school programs help troubled youth. Wrong. They make no measurable difference.

With some of these sorts of trials, there needs to be a counterfactual to determine what would have happened if the trial or experiment had never been conducted. Very little in this world remains static and other factors can come into play. As Leigh writes, if you have a headache, take a pill and go to bed, and feel better the next morning, was it the pill or the night’s sleep that fixed the headache? Correlation does not imply causation. Just because nations where people eat a lot of chocolate win proportionally more Nobel prizes doesn’t mean eating chocolate makes you smart.

Randomised trials (and their cousins, the double-blind trials, where researchers don’t know whether they are handing out a placebo or a drug and the patients don’t know which they are taking) have shaped the world as we know it. Subjecting a plan, product or policy to one or more random trials requires a certain measure of courage. You need the steel to junk a plan that doesn’t work or a product that fails.

Randomistas is shoved full of different random trials, with fascinating stories on how they worked and what they found. Like any solid scientific reporter, Leigh has included an exhaustive index and pages of notes, as well as a guide on how to conduct a randomised trial.

His motto might be: “Test everything. Assume nothing.”

Can You Die of a Broken Heart? A Heart Surgeon’s Insight into What Makes Us Tick

By Nikki Stamp, Murdoch Books, 224pp, $29.99

Somebody I Used to Know
By Wendy Mitchell, Bloomsbury, 320pp, $24.99

Randomistas: How Radical Researchers Changed Our World
By Andrew Leigh, La Trobe University Press, 256pp, $29.99

The End of Epidemics: The Looming Threat to Humanity and How to Stop It
By Jonathan D. Quick, Scribe, 304pp, $32.99