Wellcome Book Prize Shadow Panel: The Winner!

And the winner of the Wellcome Book Prize shadow panel is…

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See Rebecca’s full post on the decision here.

The winner of the Wellcome Book Prize will be announced  on Monday 30th April.

My predictions, with links to my shortlist reviews: I’m concerned that With the End In Mind, my least favourite on the shortlist, and a book that worried me in a number of ways, has a strong chance of taking it. But I still think To Be A Machine must be a contender, as must Lindsey Fitzharris’s wonderful medical biography of Joseph Lister, The Butchering Art.

I’d be surprised to see either Meredith Wadman’s The Vaccine RaceSigrid Rausing’s Mayhem or Ayọ̀bámi Adébáyọ̀’s Stay With Me take the prize, though this is not necessarily a judgment on the quality of any of those books. The Vaccine Race is perhaps too densely scientific for the average reader, though I enjoyed dredging up my A Level Biology to get through it, Stay With Me, a novel I liked very much, does not seem to me to put medical themes at its centre, and Mayhem’s fragmentary telling and huge gaps are likely to divide readers.

What are your thoughts on the most likely winner of the Wellcome Book Prize 2018?

Update 1/5/18: I was thrilled to hear that To Be A Machine has been pronounced the winner of the Wellcome Book Prize, and intrigued that both the shadow panel and the actual judges chose the same book. Having now read virtually the whole longlist, bar Behave and The White Book, I think that I’d still have selected O’Connell as the winner, though he’d have had stiff competition from Maggie O’Farrell’s I Am, I Am, I Am, which would definitely have made it onto my imaginary shortlist. Looking forward to seeing what happens with the Wellcome Book Prize next year!

You can read Rebecca’s report of the awards ceremony here.

Wellcome Book Prize Blog Tour: Mayhem

 

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I’m excited to be taking part in the Wellcome Book Prize Blog Tour today, featuring an extract from Sigrid Rausing’s Mayhem. This deliberately fragmentary, thought-provoking and intelligently observed memoir is best summarised in Rausing’s own words:

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This is a story about witnessing addiction. In some ways it’s an ordinary story: two people, Hans and Eva, my brother and his wife, met in recovery, fell in love, got married, had children, then relapsed. He survived; she did not. Addiction stories are the same the world over – the individuality of addicts is curiously erased by the predictable progress of the disease and of recovery. In our case, what made the story different was partly the fact that it became so public. Witnessing the apparently voluntary physical and mental decline of people you love is inexpressibly painful. In that context, whether the story is public or not doesn’t matter: the sadness and anxiety are so overwhelming that headlines are irrelevant. But you don’t want the media to own the story of your life. That might be a good enough reason to write a book. But I had also always assumed that when dramatic events occur, there would be a narrative, followed by a conclusion, to be filed in the family archive. The story would be told, probably by lawyers; facts would be revealed, and future generations of the family would know what happened. But it turned out that no one was collating the facts. There was no timeline and no coherent family narrative. And yet Hans and Eva’s addiction was the worst thing that had ever happened to us. It dragged us to the underworld of mute slow- motion grief, the realm of sudden breakdowns and uncanny delusions. It brought us rounds of disturbing disputes; time- consuming and complex exchanges of emails; endless reports and conversations; engagements with psychiatrists, therapists and addiction experts of every kind. It made me think deeply about the nature of family and the limits of our responsibility for one another; who we were, and who we had become. Hans and Eva got married in 1992. It was the culmination of years of recovery. They had gone to 12- step meetings; they had sponsors, they may even have sponsored others, and they gave money to addiction charities. By 1999, they had three children. Then, eight years after they got married, they had a catastrophic relapse. It lasted for twelve years. I was thirty- eight when it began; fiifty when it ended. I want to understand how it all began, long before the relapse. But who knows how, or why; what prehistory of emotions, or predestination of genes, leads people into addiction. I know some things. In the early 1980s, Hans, aged eighteen or nineteen, travelled with friends by train through the Soviet Union, China and India. In Goa they met some young Italian women staying on the beach: that was his introduction to heroin. Eva was an expat American, born in Hong Kong, raised in England. She became a drug addict when she was even younger than Hans. There were many rehabs along the way. In the late 1980s they happened to go to the same place. At this point they hadn’t met. Eva was further on in her recovery and had already left when she was asked by the rehab to persuade Hans to stay on – he was close to walking out, back into drugs. She had a knack, it seemed, of helping fellow addicts, and she did talk him into staying. They became friends. Sometime later – they were more than friends now – Hans took Eva down to my parents’ house in the country to meet the family. I remember her well, at that first meeting. She was leaning against the back of the library sofa in a pink Chanel suit; blond, thin, and a little guarded. She looked simultaneously young and old, conventional and wild, groomed and unkempt. She had grown up in London, but she seemed more American than English to me. Her mother was from North Carolina; her father had come to America from Europe quite young. My mother knew them; they had attended the same Families Anonymous group in Chelsea.

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My full Goodreads review of Mayhem can be found here.

Don’t miss the other stops on the blog tour this week, especially Rebecca’s review of Mayhem today.

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Finally, there are two public events happening in London at the end of the week, culminating in the announcement of the winner of the Wellcome Book Prize on Monday 30th April:

  • Wellcome Book Prize: Authors in Conversation, Saturday 28th April, 3-4.30pm, Wellcome Collection. Five of the six shortlisted authors will be discussing their perspectives on how medicine can touch our lives.
  • Wellcome Book Prize: 5×15, Sunday 29th April, 3-4.30pm, Cecil Sharp House. The same five shortlisted authors will be given 15 minutes each to present their work.

I’ll be attending, and live-tweeting from, the Sunday event, and am very much looking forward to it!

Wellcome Book Prize Shortlist: The Butchering Art

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My interest in medical history was sparked at the age of fourteen when I started studying Medicine Through Time for GCSE history (favourite school history module ever), where we romped through at least two thousand years of medical history in the course of relatively few lessons. Somewhere along the way, we learnt that Joseph Lister popularised antiseptics in medical treatment in Britain, leading to a dramatic reduction in deaths from post-operative infection, but that was about all. This book is a great, entertaining and immensely readable summary of how Lister came to accept Louis Pasteur’s controversial germ theory and how he put Pasteur’s findings into practice in hospitals across Britain, following in the footsteps of other pioneers of surgical hygiene such as Ignaz Semmelweis, the Hungarian physician who was eventually hounded out of his job for insisting on thorough hand washing, and died in a mental asylum.

I was a little concerned about the potential goriness of this book, but was relieved to find it less explicit than I had expected. While Fitzharris doesn’t shy away from depicting some of the excruciating detail of nineteenth-century surgery without antiseptic, and the horrors of infection in dirty and overcrowded wards, the book never feels gratuitous or titillating, and some of the very worst incidents are described as briefly as possible. Nevertheless, we are transported vividly to an utterly unfamiliar world, feeding my belief that the gulf between the early and late nineteenth century is in fact wider than the gulf between the late nineteenth and late twentieth. Life is so cheap in this period and the slightest wound can spell the end, as a number of unlucky surgeons find out for themselves.

Fitzharris is especially good at swiftly contextualising the world in which Lister lived and worked for readers who may not be especially familiar with nineteenth-century history. I currently lecture on the social and economic history of Victorian Britain, but still appreciated the way in which Fitzharris’s book filled in a number of gaps in my knowledge of the history of the medical establishment, and surgery as a discipline, during this period. It’s easy for me to feel a bit impatient with popular histories of periods or subjects that I know well, but Fitzharris strikes exactly the right note, writing clearly and accessibly with no dumbing down.

This book thoroughly deserves its place on the Wellcome Book Prize shortlist, and I would recommend it to historians and non-historians alike.

See also Rebecca’s review, Paul’s review and Annabel’s review.

Wellcome Book Prize Shortlist: The Vaccine Race

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The subject-matter of Meredith Wadman’s The Vaccine Race: how scientists used human cells to combat killer viruses seems to have taken a number of readers (including me) by surprise. Partly – at least in my case – this is due to not reading the sub-title and the book blurb properly. But it’s also because The Vaccine Race is about lots of things, all at once, so it’s difficult to summarise in a few sentences. One big story that Wadman is telling is about the life and career of Leonard Hayflick, best known today for discovering the ‘Hayflick limit’, or the fact that cells in a petri dish will only divide a fixed number of times before they cease to divide at all, and then die. While this may not sound especially exciting to non-scientists, Wadman emphasises both how revolutionary this was when Hayflick first proposed the idea in 1961, and how the discovery ‘opened the door to the study of cellular ageing.

Later, scientists such as Alexey Olovnikov would build on Hayflick’s work by proposing that the Hayflick limit was due to shortening telomeres on the ends of cell chromosomes. When cell DNA is replicated by DNA polymerase (the protein that copies DNA sequences when cells are dividing), DNA polymerase is unable to copy bits of DNA on the very ends of the chromosomes, and so the telomeres shorten each time. Olovinkov proposed that it’s these shortened telomeres that lead to cell ageing (although scientists think today that it’s much more complicated than that). This could be a book in itself – but actually everything I’ve just said is contained in a couple of short chapters of The Vaccine Race.

One of the main subjects of the book – although again, not its only concern – is Hayflick’s other key discovery, the development of the WI-38 cell line. In short, Hayflick grew cells from the lungs of an aborted human foetus to create healthy diploid cells (cells with two sets of chromosomes, like all human cells except egg and sperm cells) that could be infected with viruses. These cells could then be developed into ‘clean’ vaccines, addressing concerns about vaccines currently on the market, such as one rubella vaccine that was grown in green monkey cells even after researchers caught the Marburg virus from these monkeys. Wadman details how polio, rubella, adenovirus and rabies vaccines, among others, were developed from Hayflick’s WI-38 cells, and how, after initial resistance from the National Institute of Health (NIH) in the US, they came to be in great demand.

But alongside its account of the development of scientific knowledge, The Vaccine Race also touches on the history of biology as a discipline in the US during the period covered by the book (roughly 1940 to 1980, although it occasionally stretches back further or jumps forward.) Biographical sketches of the main actors, most notably Hayflick and his one-time colleague, Stanley Plotkin, play a significant role. Wadman also talks very briefly about how biological research was understood in the US at the beginning of this period, and how that changed. In short, she suggests, biology shifted from a form of public service to something that it was acceptable to make money out of. In 1980, two key events marked this metamorphosis: the Diamond v. Chakrabarty case, which allowed living things to be patented in the US for the first time, and the Bayh-Dole Act, which stopped ownership of inventions that had been developed through federal research funding passing automatically to the federal government. (One of my favourite scenes in the book was when Hayflick drove cross-country to a new job carrying a portable nitrogen freezer full of WI-38 cells, defying the rule that the government had automatic ownership of his work.) As a historian, I couldn’t help wondering (again) if it was all a bit more complicated than that; but Wadman doesn’t have the space to delve any deeper.

I enjoyed reading The Vaccine Race. Wadman writes clearly and compellingly, and given how much material she’s handling, managing to structure the book sensibly is a feat in itself. But I felt that The Vaccine Race was often not one thing or the other. Is it a history of biology in post-war America or a layman’s account of how vaccines are developed? Is it about cell ageing, immunology or epidemiology? I liked hearing about all these subjects, but I wondered if a tighter focus might have made the book more memorable, although it’s still very much worth a look.

Wellcome Book Prize Shortlist: To Be A Machine & James Smythe: I Still Dream

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The eighth-century English monk Bede described human life on earth as like a sparrow who flies into a banqueting hall from a storm, swoops through the warmth and comfort of the hall, and then flies out again into the wind.* To Be A Machine, Mark O’Connell’s exploration of the twenty-first century movement known as transhumanism, is basically about why we can’t stay in the banqueting hall. Why is the human mind confined to bodies that so quickly age, break down and finally cease to function? Should we accept death, or fight it? Is there a way to ‘liberate’ the mind from the body, or are the two inseparable? And how will artificial intelligence change our relationship with the world? O’Connell highlights how this postmodern set of beliefs often bears a close similarity to the thought of early Christians such as Bede and St Augustine. Transhumanism, like early Christianity, can seem both hopelessly optimistic and grimly deterministic. As Augustine wrote in City of God: ‘As far as this mortal life is concerned, which is spent and finished in a few days, what difference does it make under what rule a man lives who is soon to die?’

The idea of being ‘uploaded into the Cloud’, or attaining digital immortality, is perhaps familiar to us from sci-fi treatments of the idea: for example, Black Mirror’s San Junipero’. But O’Connell digs deeper, not only asking whether or not this will ever be possible, but what else it might be used for. To Be A Machine spends a lot of time with people on the edge of scientific respectability, although it’s often unclear how far they’ve travelled. (While reading the book, I kept thinking about how absurd modern medical innovations such as heart transplants must have seemed even shortly before they became possible.) O’Connell talks to Dutch neuroscientist Randal Koene, who’s working on what he calls ‘whole brain emulation’, or the uploading of minds. However, immortality ‘wasn’t something that especially exercised Koane as an end in itself.‘ Instead, O’Connell finds, he’s more concerned with ‘the limitations of creativity… how many things he wanted to do and experience, and how little time was allowed for the pursuit of those projects.’ (Back to the bird in the banqueting hall.) In Koane’s words, ‘I couldn’t work on some problem for a thousand years, or even travel to the next solar system, because I’d be dead by then.’ Other technological advances are also inadvertently feeding into whole brain emulation. Todd Huffman, a US technology entrepreneur, is working on technology to scan brains, which is currently ‘useful for more immediate projects like analysing pathologies for cancer research’ but could eventually be useful for emulation.

O’Connell covers so much in To Be A Machine that it’s impossible to do it all justice in a single review: other topics include AI and the technological singularity, robots, ‘cyborgs’ who are integrating technology into their own bodies, cryonic suspension and radical life extension. The book made me think so many things that I’m still sorting through them all now, weeks after finishing it. And yet one of its most attractive qualities is O’Connell’s honesty about his own reactions to the various technologies he encounters: he is fascinated, appalled, won over and turned off all at the same time. Often, I found that his description of his own internal questions would mirror mine. This is a really fantastic book, and for me, a clear front runner for the Wellcome Book Prize.

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Yes, I do find that tagline a little creepy.

James Smythe’s sixth novel for adults, I Still Dream, takes lots of the technology that’s explored in To Be A Machine and runs with it. The novel kicks off in 1997, when seventeen-year-old Laura Bow is designing an artificial intelligence, Organon, while constantly arguing with her mother about the amount she spends on dial-up internet and how she’s tying up the phone line (“from now on you’re allowed to use it at weekends only, when it’s cheap, and even then, only for an hour.”) This first section is an incredible set-piece in its own right, tying up with a neat twist ending where Laura realises she may have got more than she bargained for with Organon. I Still Dream then jumps forward in ten-year chunks, as big companies get in on the development of AI, and Laura and Organon are first sidelined, then shafted. However, will she and Organon be needed again when everything goes wrong?

It was pretty clear to me from the start – but again, perhaps only because I read To Be A Machine first – that this novel was going to deal with the technological singularity, the idea that artificial intelligence will suddenly accelerate beyond our capacity to control it. However, it touches on other transhumanist themes that I wasn’t expecting, including the prospect of being uploaded into the cloud (the novel takes its title, very satisfyingly, from Kate Bush’s 1985 hit ‘Cloudbusting‘). It also considers the fragility of the human body through a range of individual stories, from Laura’s father, who suffered from a brain tumour, to her father-in-law, who develops dementia, to Laura herself as she ages and dies. I Still Dream hence brings the questions posed by To Be A Machine vividly alive: how can we stay so attached to our physical bodies and brains as they start to glitch, and what we think of as our most essential self muddles and fades in the face of disease?

Structurally, I Still Dream didn’t quite work for me: its time jumps coupled with switching narrators kept jolting me out of the story, and some of the segments were inevitably more engaging than others. However, it’s an incredibly thought-provoking novel (having read and loved Smythe’s The Explorer and The EchoI’d expect no less from him) that never simply presents technology as bad or good but instead asks questions about how we use it. As Laura says when she warns the world about the dangers of a rival AI, SCION: ‘SCION’s like a toddler. And like any toddler, you teach it well, teach it morality and concepts of good and bad, and maybe it’ll grow up to not be a complete shit. But if you do nothing but sit it down in front of games… tell it that if something’s a danger to it it should fight back first? Where does that end?’ And Smythe always keeps the humanity of his story in sight. I found the final section of I Still Dream desperately sad, not because of any apocalypse caused by artificial superintelligence, but because of the familiar process of losing what we love as we age away from it.

I received a free copy of this novel from the publisher for review. 

*This parable is mentioned in Bernard MacLaverty’s Wellcome-longlisted Midwinter Break.

The Wellcome Book Prize Shortlist, 2018

The shortlist for the Wellcome Book Prize is out! The winner will be announced on the 30th April, and here are the six shortlisted titles:

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I’ve read two of the six shortlisted titles, Stay With Me and With the End In Mindand am currently reading To Be A MachineAs part of the shadow panel for the Wellcome Book Prize this year, I’ll be aiming to read the whole shortlist.

My predictions were surprisingly accurate (given my dismal record) – I guessed three out of six of the longlisted titles, Fitzharris, Wadman and O’Connell. The balance between novels, history, memoir, ‘proper science’ and ‘what it is to be human’ is much as I thought it would be.

I’m surprised to see Ayòbámi Adébáyò’s Stay With Me on the shortlist – I thought it was tremendously moving, but the medical theme is barely there. Similarly, I didn’t expect Sigrid Rausing’s Mayhem to make it to the shortlist, having heard very little about it, but I’m keen to find out more.

I’m very disappointed not to see Maggie O’Farrell’s wonderful memoir, I Am, I Am, I Am on the shortlist, and equally disappointed to see Kathryn Mannix’s With the End In Mind, which made me very uncomfortable. But I’m thrilled to see that the two books that I was most interested in reading next have made it to the shortlist – Mark O’Connell’s To Be A Machine and Meredith Wadman’s The Vaccine Race. And, even though I try to keep work separate from this blog, I’m grudgingly getting used to the idea of reading Lindsay Fitzharris’s The Butchering Art,which I suspect will teach me a lot about popular history and storytelling.

A final thought: this isn’t a criticism of this year’s longlist or shortlist, but I wonder why the prize seems to highlight so little speculative fiction or science fiction? It’s just occurred to me that this might be another interesting angle with which to consider ‘our relationship with health, medicine and illness’.

What are your thoughts on the Wellcome Prize shortlist?

 

Further Wellcome Book Prize Longlist Thoughts, 2

I’m partway through two of the other titles on the Wellcome longlist, so I thought I’d write a little bit about them before the shortlist is announced tomorrow.

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Bernard MacLaverty’s Midwinter Break is his fourth novel, but his first for the past sixteen years, so I wasn’t especially surprised to find I’d read nothing by him before (this isn’t the sort of thing I’d have chosen to read as a fifteen-year-old!) It focuses on an ageing Irish couple, Gerry and Stella, who have travelled for a short break in Amsterdam from their home in Scotland. Gerry has a problem with alcohol; Stella, reliant on her Catholic faith, is planning to leave him. MacLaverty precisely and perfectly charts this couple’s little rituals, shared knowledge and familiarities, even as they both feel they are living through the twilight days of a relationship that was once so much more. Both also think back to difficult times in their past during the Troubles. MacLaverty is especially good on the affection that Gerry still feels for Stella. He remembers bumping into her accidentally during an earlier period in their lives: ‘Her eyebrows went up with delight and she smiled her smile. He was elated and stood there blushing because he felt such elation. It was like the first time they’d met. And yet they’d been married about twenty years.’ 

The repetition of key phrases shows how much this couple know about each other even as they become distanced: both Stella and Gerry think of getting to sleep as ‘getting over’ but laugh when one of them says it out loud; Gerry looks out for places that serve coffee in small cups, as Stella likes it; when Stella says ‘Miracles come in all sizes. I should know’, Gerry knows immediately what she’s talking about. I’m about a third of the way through Midwinter Break, and looking forward to reading the rest. And yet, despite MacLaverty’s excellent prose, I can’t see it reaching the Wellcome shortlist, simply because the medical theme is, once again, very slight.

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Mark O’Connell’s To Be A Machine: Adventures Among Cyborgs, Utopians, Hackers and the Futurists Solving the Modest Problem of Death is a book that interested me more and more as I thought about it. Having read the first two chapters, I’m certainly keen to read on. O’Connell has decided to investigate ‘transhumanism – a movement predicated on the conviction that we can and should use technology to control the future evolution of our species… human existence, as it has been given, is a suboptimal system.’ He promises to think about the prospect of human cyborgs; minds uploaded into the cloud; and robots and AI. Transhumanism, he argues, seeks ‘liberation from biology itself’ which could also be seen as ‘a final and total enslavement to technology.’ Given how much I like Black Mirror, which often explores these kinds of questions, I’m keen to read more of To Be A Machine even if it doesn’t make the shortlist. My main concern with the book is how far O’Connell can balance his view on transhumanism. In short, I don’t want him to become a zealous convert, or to decide that All Technology Is Bad. He’s doing a good job of staying open-minded so far.

So what are my predictions for the shortlist? Like Rebecca, I have a mix of wishes and guesses:

  1. I Am, I Am, I AmMaggie O’FarrellI adored this memoir and will be pretty disappointed if it doesn’t make the shortlist.
  2. The White Book: Han Kang. I think a novel will be shortlisted, and the other two contenders (Stay With Me and Midwinter Break) are only loosely linked to medical themes. I’m also keen to read this, so would be glad to have an excuse to do so!
  3. The Butchering Art: Lindsay Fitzharris. This history-biography of Joseph Lister and Victorian medicine doesn’t especially appeal to me, but it’s not like anything else on the longlist, and I can see it being shortlisted for this reason.
  4. The Vaccine Race: Meredith Wadman. I think something in the category that I called ‘proper science’ will make it to the shortlist, and this is the one I’d most like to read.
  5. To Be A Machine: Mark O’Connell. Again, this offers something a bit different and, from a selfish perspective, I’m enjoying it so far!
  6. In Pursuit of Memory: Joseph Jebelli. This book on Alzheimer’s mixes memoir with the medical and seems like a classic Wellcome Prize pick to me, although I’ve not yet read it.

What are other people’s thoughts on the Wellcome prize shortlist?

Further Wellcome Book Prize Longlist Thoughts, 1

Since joining the Wellcome Book Prize shadow panel and writing up my thoughts on the longlist, I’ve read two more of the longlisted titles, Allan Jenkins’s Plot 29 and Kathryn Mannix’s With the End in Mind. Both of these books engaged my emotions, but in very different ways.

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Grief, isolation and pain

As I wrote in my original post, I first encountered Allan Jenkins’s Plot 29 when he spoke at a joint event with Alys Fowler, who was discussing her memoir Hidden NatureJenkins’s quietly devastating memoir retraces a fragmented childhood spent in and out of care, with one of his few constants being his older brother Christopher, whom he feels that he failed. The book is organised into month-long sections over the course of about a year and a half, so Jenkins’s memories of his past are interspersed with what’s happening each month in the present day, both in his beloved allotment and in his search both for the paper trail that records his half-forgotten childhood and DNA evidence that might link him to a biological family. The structure becomes even more complicated when we realise that Jenkins is deliberately only including memories that roughly fit into the time of year he’s writing about, although he has some leeway with this, given that the book spans more than one chronological year.

When Jenkins spoke about the writing of this book, he said that he had actually written each section in the month that it concerns, and although I didn’t find Plot 29 confusing, I did wonder if he’d perhaps placed unnecessary restrictions on himself. Fowler’s Hidden Nature has a similarly fragmented structure, but because her rules are less rigid, I felt that there was more direct resonance between her explorations of Birmingham’s canal network and the personal material of her story than Jenkins managed in Plot 29. Still, Plot 29 is a powerful exploration of the consequences of child neglect and abandonment. (Jenkins is not sure whether or not he was abused as a child, and the book is distinguished by the way that it emphasises that this doesn’t really matter – the simple disregard and disinterest he suffered was bad enough.) I don’t think that it belongs on the Wellcome shortlist, but this is not a criticism of the book itself – I just felt that the medical theme in the book was very slight. While Jenkins spends some time in therapy, the book is not really about mental health but about persistent guilt, enforced gratitude and an ever-expanding, ever-contracting sense of family.

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Anger and fear

Kathryn Mannix’s With the End in Mind: Dying, Death and Wisdom in an Age of Denial is written from her own experiences as a specialist in palliative care, and this proved, for me, both its strength and its downfall. The book is structured around a series of fictionalised case studies drawn from Mannix’s own experiences, many of which are deeply affecting. I was particularly touched by the stories of Sally, a young woman dying from melanoma who refused to accept that her condition was terminal, and Holly, a mum of two teenagers dying from cancer of the cervix, who suffered from a last bout of restless energy before passing away. Mannix writes particularly well on the characteristic patterns of somebody who is entering a gradual decline. As the hospice leader she’s working with on Holly’s case describes it to Holly’s daughters: ‘Have you noticed that she stops breathing from time to time? That tells me that she is unconscious, very deeply relaxed… That is what the very end of life is like. Just very quiet and peaceful. I don’t expect she will wake up again now.’

I find books of this kind difficult to review because the risk of sounding like you’re passing a (totally unqualified) judgment on the writer’s professional career. But ultimately I have to judge With the End in Mind as a book that Mannix has written, separating it from Mannix’s personal achievements, and in this context, it fell very short. It’s crucial to feel that you trust and respect the voice that is telling you such sensitive stories, but With the End in Mind left me feeling frustrated, angry and suspicious. This was for a number of interconnected reasons:

  • Unlike similar medical writers – Henry Marsh’s Do No Harm and Atul Gawande’s Being Mortal, Better and Complications come to mind – I felt that Mannix was keeping her professional distance, positioning the reader as her patient. Each section ends with a ‘Pause for Thought’ that I found simplistic and patronising, and unlike Marsh and Gawande, she writes virtually nothing at all about her own professional mistakes, although she says a little about other people’s. In every story, she positions either herself or her palliative care colleagues as the all-knowing voice of reason, and after a while, this started to feel a bit sinister.
  • This was compounded by her discussion of euthanasia, a subject that is obviously very relevant in this context. While I am broadly pro-euthanasia, I wouldn’t have minded if Mannix had directly challenged my views by offering up new evidence to support her obvious concerns about euthanasia options such as those offered in the Netherlands. Instead, I found her approach incredibly disingenuous. I almost stopped reading With the End in Mind after ‘Please Release Me: B Side’ where Mannix tells a story about one man’s unpleasant experience in the Netherlands that is entirely based on hearsay, and I realised that a number of stories she had been telling in that section had been deliberately engineered to emphasise the benefits of palliative care as opposed to euthanasia. Again, I would have found this less troubling if Mannix had been upfront about it: instead, she claims that ‘many of us in palliative care roles are exasperated by the trenchant, black-and-white opinions of the campaigners for either view [on euthanasia]’ but makes her own views pretty clear when she says at the end of the chapter on the Netherlands that ‘Once the euthanasia genie is out of the bottle, you must be careful what you wish for’, echoing familiar ‘slippery slope’ arguments. All of this made me very uneasy and uncomfortable.
  • Finally, Mannix uses the metaphor of ‘natural birth’ throughout the book to promote her vision of a ‘natural death’. She writes that ‘both processes can proceed safely without intervention, as any wise midwife knows.’ This infuriated me because of the damage, pain and suffering the language of ‘natural birth’ and the doctrine of little medical intervention has caused to women and their babies. Indeed, the Royal College of Midwives recently dropped campaigns for what they called ‘normal birth’ in recognition of this fact, although women are still denied the right to choose interventions like caesarians (in contravention of NICE guidelines on childbirth) as a consequence of this ideology. As the language of ‘natural birth’ is unfortunately quite common, I wouldn’t see this as a significant problem for Mannix if she didn’t repeatedly return to this metaphor across the course of her book. This, along with the problems I’ve noted above, left me doubting everything she said about birth and about death.

I received a free copy of this book from the publisher for review.

What’s next for my Wellcome Book Prize reading? I’m hoping to get to either Han Kang’s The White Book or Meredith Wadman’s The Vaccine Race before the shortlist is announced on March 20th.

The Wellcome Book Prize Longlist, 2018

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The Wellcome Book Prize, along with the Woman’s Prize for Fiction, consistently produces my favourite literary longlists and shortlists. As an historian of developmental psychology and psycho-analysis (among other things) and somebody with a strong amateur interest in medicine and healthcare, I always find that this prize, which highlights ‘the best new novels, memoirs and non-fiction that illuminate the breadth and depth of our relationship with health, medicine and illness’, brings me lots of new books to love. That’s why I’m so delighted to be part of a shadow panel for this year’s Wellcome Book Prize shortlist organised by Rebecca, alongside Clare, Paul and Annabel. Although the shortlist won’t be announced until the 20th March, I’m looking forward to digging into the longlisted books  I haven’t already read.

Medical fictions

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I read Ayòbámi Adébáyò’s Stay With Me when it was shortlisted for the 2017 Baileys Prize, and ended up ranking it third out of the six shortlisted novels. It’s a tremendously moving account of the life of a single Nigerian woman, Yejide, spanning almost thirty years from the military coups of the 1980s to the relatively more peaceful territory of 2008. I’d expected it to be a little cliched, but was surprised by how heartbreaking I found it. My only quibble with regards to the Wellcome Book Prize is that, although the story ostensibly deals with fertility, I wouldn’t call it a book that primarily engages with medical themes.

Bernard Laverty’s Midwinter Break, which deals with a long-married couple taking a break in Amsterdam, caught my eye in Waterstones when it was Book of the Week. While I’m keen to read it, again, I wouldn’t have pigeonholed it as a book that deals with health or medicine.

I was captivated by Han Kang’s The Vegetarian and so her new novel, The White Book, was always going to be a must-read for me. Deborah Levy in the Guardian describes it as ‘a fragmented autobiographical meditation on the death of the unnamed narrator’s baby sister, who died two hours after her birth’.

Memoirs of living and dying

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Maggie O’Farrell’s I Am, I Am, I Am was one of my top ten books of 2017, beating out stiff competition from the other Maggie O’Farrell book I read this year (This Must Be The Place). Subtitled ‘Seventeen Brushes With Death’, this memoir details all the near-death experiences of O’Farrell’s life – or at least, as she notes, those that she realised were near-death experiences. It’s beautifully-written; each section is incredible in its own right.

I heard Allan Jenkins talk about Plot 29which deals with his own childhood and that of his foster brother Christopher, at the Durham Book Festival. I was primarily there to hear the other writer he was paired with (Alys Fowler, discussing her wonderful memoir Hidden Nature) but was impressed by Jenkins’s consideration of how he’d dealt with such a sensitive subject, and the interconnections he made with a year of tending his allotment.

Sigrid Rausing’s Mayhem wasn’t on my radar at all before it was longlisted, but given my relatively new interest in memoir, I’m glad to have it highlighted. It deals with the impact of  drug addiction on a single family.

Busman’s holiday

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As a historian, I’m afraid I rarely read history for fun, but I’ve heard good things about Lindsay Fitzharris’s The Butchering Art: Joseph Lister’s quest to transform the grisly world of Victorian medicine. Apart from anything else, I’ve been interested in Storying the Past’s recent work on what academic history-writing can learn from fiction and storytelling, and so it will be good for me to see how Fitzharris addresses her work to a popular audience. I’m not hugely enamoured of the mock-Victorian sensation cover, but we shall see.

Proper science

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In contrast, I love popular science, and I’m particularly excited about Meredith Wadman’s The Vaccine Race: How scientists used human cells to combat killer viruses. It promises to tell the story of the major scientific breakthrough that led to the development of vaccines for a number of dangerous pathogens, including rubella. The novel I’m working on partly deals with the fourteenth-century Black Death, so I’m especially interested in epidemiology and epidemics at the moment (although did you know that we still don’t have a fully effective vaccine for bubonic plague?).

Robert Salpolsky’s Behave: The biology of humans at our best and worst is probably the title on the list that least appeals to me personally. I’ve delved a little into the history of the study of human behaviour for work and it just doesn’t capture my imagination. This is no reflection on the quality of Salpolsky’s book, but I won’t be reading this unless it makes the shortlist.

Joseph Jebelli’s In Pursuit of Memory: The fight against Alzheimer’s mixes the personal with the medical, as Jebelli recalls the death of his grandfather from Alzheimer’s and recounts his own career as a neuroscientist working on the disease. Again, this doesn’t instantly fit with my own interests, but it certainly looks important and worthwhile.

What it is to be human

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As anyone who has read my Top Ten Books of 2017 list might imagine, I’m especially absorbed by books about death and dying at the moment (and anyone who knew me as a young teenager obsessed with Lurlene McDaniel books might argue that this is an interest that has never gone away). So Kathryn Mannix’s With the End in Mind: Dying, death and wisdom in an age of denial, which explores her experiences working in palliative medicine, looks like a worthy successor to memoirs like Paul Kalanithi’s When Breath Becomes Air and Henry Marsh’s Do No Harm.

Mark O’Connell’s To Be a Machine: Adventures among cyborgs, utopians, hackers, and the futurists solving the modest problem of death deals with transhumanism, a word that I keep hearing bandied about, even though I have to admit I’m not quite sure what it means. (According to the blurb: ‘Transhumanism is a movement whose aim is to use technology to fundamentally change the human condition, to improve our bodies and minds to the point where we become something other, and better, than the animals we are.’) When I first heard about this book, I wasn’t sure it would be for me, but I’m getting more and more intrigued.

So: I’ve already read two of the longlist and want to read a few more before the shortlist is announced. To get a fair spread across the various genres I’ve identified here, I think I’m going to prioritise the Mannix, Wadman, Jenkins and Kang.

Do others have thoughts on the Wellcome longlist? Are there titles you’re especially keen to read?