I am not exactly disillusioned with Janet Malcolm, but I’m not not disillusioned with her. Her writing remains as beautifully clear and elegant as I ever thought it was. She is still the person I turn to when David Foster Wallace has worn me down with his ceaseless locutions. Lo:

Human nature is such that when we are suddenly taken up by someone whom we consider superior and admirable, we accept his attentions calmly, whereas when we are dropped we cannot rest until we feel we have got to the bottom of the person’s profound irrationality. Nor can we easily accept the verdict sent down to us through the mortifying silence of someone who has found us wanting and has packed up and moved on. We protest it, each in our way — our futile ways, since the more effective is our protest the more surely do we drive away the person whose love we have lost not because of anything we did, but because of who we are.

Good, right?

On the down side, I am finding that Malcolm’s acknowledgement of the ethical problems posed by journalism does not inoculate her against those problems. Whereas the controversies she covers in her literary biographies remain interesting and relevant — we won’t stop caring about what sort of person Sylvia Plath was, or about the inherent problems of someone like Bronwyn Hughes controlling Plath’s letters and estate — something like In the Freud Archives feels pointlessly petty and gossipy. Viz.:

[Jeffrey Masson said,] “Wendy [O’Flaherty] was even worse, in her way, though I thought, Well, at least she’s a woman. I remember once trying to touch her, and she looked at me and said, ‘Frankly, I don’t think you’re man enough to have an affair with me.’ I ran into this sort of thing everywhere I went at Harvard.

and much later in the book:

[Wendy O’Flaherty said,] “I gather from other people that [Masson’s] not nice to anybody, but he certainly has always been beastly to me. I wouldn’t sleep with Jeff, and he might have regarded that as a kind of gauntlet.”

This sort of thing feels like a waste of Janet Malcolm’s — or anyone’s — time. So much of In the Freud Archives — and this was true of The Crime of Sheila McGough and The Journalist and the Murderer as well — is spent in quoting long, complicatedly self-justifying speeches from people who feel they have been dreadfully wronged. Malcolm cycles through various interviewees and their feelings of having been wronged — Jeffrey Masson, denied curatorship of the Freud Archives following an ill-advised Times article; Kurt Eissler, who comes off rather sweet actually in his Freud apologetics; Peter Swales, also taken under Eissler’s wing and later abandoned when he proved to be insufficiently fond of Freud.

And, just, why bother? Most of the people you meet in the world could probably be drawn on to talk about Wrongs Done to Me by People I Did Not Realize Were Terrible Until Much Too Late, but that gets wearisome pretty quickly — as do, to my infinite regret, a number of Janet Malcolm’s books, including In the Freud Archives. (But not The Silent Woman, which I still really love, and maybe it’s just because I’m more interested in troublesome literary executors than I am in scholars who went around scandalizing Freud’s name in the 1980s when Freud was still (sorry Freud!) relevant to mental health practice.) Wearisome and not worthwhile.

Cover report: I like the faux-wrinkly business the British cover has going on, but I think the American cover is more visually interesting. I am also fond of collage where pieces of the collage have writing on them. So that is my bias. I will accept counterarguments.

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Bad Pharma is my first book for Long-Awaited Reads Month, hosted by the very lovely Ana and Iris. I thought it would be fitting to start off with a Long-Awaited book recommended me by Ana. In fact I am fudging a little bit: the book has only been out for a year or so, so the Long-Awaited part is actually the author, Ben Goldacre, whom I’ve been interested in since Ana reviewed his first book, Bad Science, in 2009. It counts, though, right? My library doesn’t have Bad Science! I SAY IT COUNTS.

Ana described this book as “a book with a relatively simple thesis and a very detailed elaboration.” Excellent way of putting it. Nobody will be surprised to hear that Big Pharma has been engaging in shady practices. What Ben Goldacre does in Bad Pharma (affiliate links: Amazon, B&N, Book Depository) is to detail all the genres of shady practice engaged in by the pharmaceutical industry and the people it pays, and why each of these practices, individually and in concert with one another, harms patients and medical outcomes.

Bad Pharma holds no surprises from an ethical perspective — you know that pharmaceutical companies have too much power in the high-stakes business of researching medicines and getting them out to patients. The devil, as so often, is in the details, and the details aren’t always what you’d expect. Goldacre isn’t shy about calling out industries and individuals by name when necessary, but he’s more interested in systemic issues that affect the medical industry broadly. For instance, the great majority of clinical trial data remains unpublished in major medical journals, and in fact unfindable. The fault in this cannot be attributed to any one source (people at all levels of the medical trials procedure contribute to it), but altogether it creates a gaping hole in our knowledge about the medicines we use every day.

I loved–and was, you know, appropriately appalled at–learning what the lacunae in our medical knowledge are. Missing trial data is one. Another is the substitution in drug trials of “surrogate outcomes” such as cholesterol numbers for the truly important outcomes like heart attack and death. When a new drug for lowering cholesterol goes on the market, the trial data that got it approved by the FDA doesn’t actually show whether the drug decreases your chance of having a heart attack or dying. This isn’t out of malice, necessarily, so much as it’s out of rush. But there’s no system of running follow-up studies to find out whether this drug, in addition to lowering your cholesterol, ultimately lowers your risk of heart attack. Sometimes it turns out a drug that lowers your cholesterol greatly increases your risk of dying of a heart attack; but studies testing for this don’t get performed systematically on drugs that already have FDA approval, so it’s a crap-shoot whether you will ever find out this information.

Another area of missing information: Most everyday drugs need not prove they are better than existing drugs in order to receive FDA approval, just that they are better than placebo. All well and good, but Goldacre says that tests comparing long-term outcomes between drugs that treat the same condition are — like trials checking on the real outcomes rather than surrogate outcomes, above — rare and spotty. Doctors — and Goldacre admits that he does this too — make decisions about prescriptions based often on folk wisdom and marketing, rather than on true knowledge of which drug works the best. They aren’t doing it out of negligence. They truly have no way of knowing which drug is best.

If you’re at all interested in medicine and failing systems, I highly recommend Bad Pharma. Goldacre occasionally strays into this tone of “we’re-all-jolly-good-sorts-in-this-together”, which is annoying, but apart from that the book is engaging and well-written, and Goldacre proposes solutions — some that seem very very workable, others less so — to all of the problems he brings up.

Cover report: Britain and America both have the same sort of idea, but I think the American cover manages it better. It’s also more readable, with the important information front and center.

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So Ana and Iris are hosting a Long-Awaited Reads Month in January! I intended to read something much more ambitious for it, but honestly, I have been awaiting Green Grass, Running Water longer than almost anything on my TBR list. Part of me had given up hope that I’d ever be able to read it because the library never has it. Never. No library ever. I can place holds until my face falls off and this book will never, ever arrive.

Green Grass, Running Water is hard to put a synopsis too. There’s a lot going on here. The central plotline is about four Indians — they are called Ishmael, Hawkeye, The Lone Ranger, and Robinson Crusoe — who have escaped from a hospital and are telling origin stories. They might be women or they might be men. It’s unclear. The stories they are telling all feature women, certainly, and the nurse who was on duty when they vanished is sure they were women. The women of their stories are constantly running up against Christian myths and white soldiers, which does not typically end well for them.

Other parts of the book deal with a group of Indians who all come from the same reservation and have lived their lives on it or away, or on it and away. They are all dealing with their heritage in different ways or not at all, but the action of the book pulls them all back together for the Sun Dance. One is considering having a child. One made a few small mistakes in his life that prevented him from having the job and education he wanted. One is holding back a major hydraulics project by refusing to leave the house his mother built by hand. All of them encounter, in one way or another, the old escaped Indians.

It’s not always clear what’s happening in Green Grass, Running Water, which can bother me in some books. And it bothered me a bit in this book, but because the characters were always so willing to go with it, I was willing to go with it too. My favorite parts were the stories told by the four old Indians. I loved the clash between the Indian stories and the Christian stories. In particular, I loved how these stories dealt with the wiping away of Indian identity and individuality by subsuming them into manageable ideas of Indians, figures subservient to the protagonists; and how the four old Indians each ended up taking over the protagonist identities. For instance:

Here, says a nice-looking man with a grim mouth, and he hands Changing Woman a towel. What’s your name?

Changing Woman, says Changing Woman.

Call me Ishmael, says the young man. What’s your favorite month?

They’re all fine, says Changing Woman.

Oh dear, says Ishmael, looking through a book. Let’s try again. What’s your name?

Changing Woman.

That just won’t do either, says the young man, and he quickly thumbs through the book again. Here, he says, poking a page with his finger. Queequeg. I’ll call you Queequeg. This book has a Queequeg in it, and this story is supposed to have a Queequeg in it, but I’ve looked all over this ship and there aren’t any Queequegs. I hope you don’t mind.

Ishmael is a nice name, says Changing Woman.

But we already have an Ishmael, says Ishmael. And we do so need a Queequeg.

But in the end of this story, Ishmael drowns and Changing Woman takes up his name.

My favorite things, as you can probably tell, were all the parts that dealt with white portrayals of Indians. This comes up over and over again throughout the book, not only in the stories told by the Indians, but in the media consumed by the other characters. Eli, a retired professor living in his mother’s hand-built house, reads a lot of Westerns where the noble Indian character nobly gives up his white girlfriend and dies nobly in battle. Alberta and Charlie end up in the same hotel watching the same spaghetti western where the savage Indians are outnumbered and slaughtered by the brave white men. All of these parts are gorgeously acerbic.

Just, way to go, Thomas King. Green Grass Running Water was everything other bloggers have said it is. It’s funny and heartbreaking and strange and delightful. I am indebted to the always-lovely Heather for sending me her copy. In the spirit of passing on the joy, I am offering this copy to you, my fellow bloggers! Drop me a note in the comments if you want it, and I’ll draw a name at the end of the month. International readers are welcome to enter! This book is good enough I’m willing to pay the extra postage to let you enjoy it.

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