‘A searing, deeply humane collection of essays about medical practice that has all the makings of a modern classic’

Participated: U.S. Military Personnel Serving and Casualties,”
2004 (http://web1.whs.osd.mil/mmid/casualty/WCPRINCIPAL
.pdf ). Some experts have argued that the DoD online data is in-
accurate, because of changing definitions of who is wounded
(see J. B. Holcomb, L. G. Stansbury, H. R. Champion, C. Wade,
and R. F. Bellamy, 
Journal of Trauma
60 [2006]: 397–401). If fig-
ures are restricted to casualties known to have required at least
some hospital care, the lethality rate for the American war
wounded was 23 percent in World War II (using army-only
data), 23 percent in the Korean War, and anywhere from 16 to
24 percent in the Vietnam War (the definitions for Vietnam re-
main contentious to this day). (These data are from G. Beebe
and M. E. DeBakey, 
Battle Casualties: Incidence, Mortality, and Lo-
gistic Considerations
[Springfield: Charles C. Thomas, 1952]; F. A.
Reister, 
Battle Casualties and Medical Statistics: U.S. Army Experi-
ence in Korea
[Washington: Department of the Army, 1973]; R. F.
Bellamy, “Why Is Marine Combat Mortality Less Than That of
the Army?” 
Military Medicine
165 [2000]: 362–67.) Using this def-
inition of wounded, lethality of war wounds for American
troops in the Persian Gulf War was 24 percent; in the current
wars in Iraq and Afghanistan it has been no higher than 12 per-
cent.
57
For more on Ronald Bellamy’s concept of the “Golden Five
Minutes,” see his chapter on combat trauma in his 
Textbook of
Military Medicine: Anesthesia and Pre-Operative Care of the Combat
Casualty
(Washington: Department of the Army, Office of the
Surgeon General, Borden Institute, 1994), pp. 1–42.
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262
Notes on Sources
Naked
77
The U.K. standards on physical examination etiquette are de-
scribed in the General Medical Council’s report 
Intimate Ex-
aminations
(London: General Medical Council Standards
Committee, December 2001) and in the Royal College of Ob-
stetricians and Gynaecologists’ 
Gynaecological Examinations:
Guidelines for Specialist Practice
(London: Royal College of Ob-
stetricians and Gynaecologists, July 2002).
78
I relied on three reports in particular in considering the eti-
quette of American examinations: The Ad Hoc Committee on
Physician Impairment’s 
Report on Sexual Boundary Issues
(Dal-
las: Federation of State Medical Boards of the United States,
April 1996); C. E. Dehlendorf and S. M. Wolfe, “Physicians Dis-
ciplined for Sex-Related Offenses,” 
JAMA
279 (1998): 1883–88;
and J. A. Enbom and C. D. Thomas, “Evaluation of Sexual Mis-
conduct Complaints: The Oregon Board of Medical Examin-
ers, 1991 to 1995,” 
American Journal of Obstetrics and Gynecology
176 (1997): 1340–48.
79
Data on patient-initiated sexual behavior toward medical stu-
dents comes from a report by H. M. Schulte and J. Kay in 
Acad-
emic Medicine
69 (1995): 842–46.
What Doctors Owe
87
Much of the detail on the American medical malpractice sys-
tem comes from research by my colleagues David Studdert,
Michelle Mello, and Troy Brennan of the Harvard School of
Public Health. See, for example, D. M. Studdert et al., “Negli-
gent Care and Malpractice Claiming Behavior in Utah and Col-
orado,” 
Medical Care
38 (2000): 250–60, and D. M. Studdert et
al., “Claims, Errors, and Compensation Payments in Medical
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Notes on Sources     263
Malpractice Litigation,” 
New England Journal of Medicine
354
(2006): 2024–33. Two excellent reviews of what we know about
the American malpractice system are D. M. Studdert, M. M.
Mello, T. A. Brennan, “Medical Malpractice,” 
New England Jour-
nal of Medicine
350 (2004): 283–92 (that’s a short one), and Tom
Baker’s 
The Medical Malpractice Myth
(Chicago: University of
Chicago Press, 2005) (that’s a longer one).
108 For more on the National Vaccine Injury Compensation pro-
gram, see D. Ridgway’s description in the 
Journal of Health Poli-
tics, Policy, and Law
24 (1999): 59–90, and also the program’s
Web site, www.hrsa.gov/osp/vicp/.
109 The New Zealand malpractice system is detailed by M. Bis-
mark and R. Paterson in “No-Fault Compensation in New
Zealand,” 
Health Affairs
25 (2000): 278–83.
Piecework
116 William Hsiao outlined his evaluation of the relative amount
of work involved in the different tasks physicians do—the rela-
tive value scale—in two principal articles: W. Hsiao et al., “Re-
source-Based Relative Values: An Overview,” 
JAMA
260 (1988):
2347–53, and W. Hsiao et al., “Measurement and Analysis of
Intraservice Work,” 
JAMA
260 (1988): 2361–70.
120 William Weeks’s studies of how much physicians work and
earn and the comparison with other professions were pub-
lished in W. Weeks and A. Wallace, “Time and Money: A Ret-
rospective Evaluation of the Inputs, Outputs, Efficiency, and
Incomes of Physicians,” 
Archives of Internal Medicine
163 (2003):
944–48, and W. Weeks and A. Wallace, “The More Things
Change: Revisiting a Comparison of Educational Costs and In-
comes of Physicians and Other Professionals,” 
Academic Medi-
cine
77 (2002): 312–19.
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264
Notes on Sources
126 The amount of money currently spent on health care in the
United States is tracked by the government, and the figures are
available from the Medicare Web site: www.cms.hhs.gov/
NationalHealthExpendData/.
128 Information on doctors’ incomes relative to average workers’
incomes was found in Derek Bok’s fascinating book 
The Cost of
Talent
(New York: Free Press, 1993) and in data from the Ber-
telsmann Foundation’s International Reform Monitor (see
www.reformmonitor.org).
128 Evidence on the health and financial consequences of lacking
insurance can be found in Jack Hadley’s “Sicker and Poorer,”
Medical Care Research and Review
60 (2003): 3S–75S.
The Doctors of the Death Chamber
130 The full opinion of United States District Judge Jeremy Fogel in
the case of
Michael Angelo Morales v. Roderick Q. Hickman
is a riv-
eting and surprisingly readable document (No. C 06 219 JF; Dis-
trict Court, Northern District of California: February 14, 2006).
Also see the appeals court’s ruling specifying what participat-
ing anesthesiologists would be required to do to ensure a rapid,
painless death for an inmate (
Michael Angelo Morales v. Roderick
Q. Hickman
, No. CV 06 00926 JF; U.S. 9th Circuit of Appeals:
February 20, 2006).
132
The history of lethal injection and other execution methods is
told in Stephen Trombley’s fine book 
The Execution Protocol: In-
side America’s Capital Punishment Industry
(New York: Crown,
1992). Similarly intriguing is Ivan Solotaroff ’s 
The Last Face
You’ll Ever See: The Private Life of the American Death Penalty
(New York: HarperCollins, 2001).
134
Ethics codes for participation in executions by different med-
ical professions can be found as follows: The American Medical
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Notes on Sources     265
Association’s position was published in 
JAMA
270 (1993): 365–68,
and is available on the www.ama-assn.org Web site. The Soci-
ety of Correctional Physicians puts its ethics code online at
http://www.corrdocs.org/about/ethics.html. The American
Nursing Association’s position statement on nurses’ participa-
tion in capital punishment is available at http://nursingworld
.org/readroom/position/ethics/prtetcptl.htm. The American
Pharmaceutical Association’s current policies are found in its
“policies related to the practice environment and quality of
worklife issues,” available at www.aphanet.org.
136 Current data on death penalty cases is available from the Death
Penalty Information Center Execution Database at http://
www.deathpenaltyinfo.org/executions.php.
137
The seminal study on physician participation in U.S. executions
is 
Breach of Trust
(Philadelphia: American College of Physicians
and Physicians for Human Rights, 1994).
141
The survey I cite on the level of physician awareness of ethics
guidelines on participation in executions was published by N. J.
Farber et al. in 
Annals of Internal Medicine
135 (2001): 884–88.
152 On the U.S. government’s recent willingness to use medical
skills against individuals for state purposes, see Stephen Miles’s
Oath Betrayed: Torture, Medical Complicity, and the War on Terror
(New York: Random House, 2006).
On Fighting
159 Watson Bowes Jr.’s study of aggressively resuscitating prema-
ture infants was published with his colleagues M. Halgrimson
and M. A. Simmons in the 
Journal of Reproductive Medicine
23
(1979): 245.
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266
Notes on Sources
The Score
172 Information on the normal anatomy, physiology, and process
of labor, as well as the abnormalities that can occur, is taken
from F. G. Cunningham et al., eds., 
Williams Obstetrics
, 22nd ed.
(New York: McGraw-Hill, 2005).
176 The details of the history of obstetrical techniques and compli-
cations are from numerous sources, in particular: J. Drife, “The
Start of Life: A History of Obstetrics,” 
Postgraduate Medical
Journal
78 (2002): 311–15; R. W. Wertz and D. C. Wertz, 
Lying-In:
A History of Childbirth in America
(New Haven: Yale University
Press, 1989); and D. Trolle, 
The History of Caesarean Section
(Copenhagen: University Library, 1982).
179 For more data on the modern experience of childbirth, in-
cluding on how commonly laboring mothers turn to medical
interventions such as electronic monitors, epidurals, and labor-
stimulating medication, an excellent source is E. R. Declercq et
al., 
Listening to Mothers: Report of the First National U.S. Survey of
Women’s Childbearing Experiences
(New York: Maternity Center
Association, 2002).
184 Historical data on perinatal mortality for mothers and new-
borns are from the U.S. Centers for Disease Control.
185 Shortly after Virginia Apgar’s death, her friend and colleague L.
Stanley James published his eulogy, “Fond Memories of Vir-
ginia Apgar,” in 
Pediatrics
55 (1975): 1–4. Another key source of
information on her life is A. A. Skolnick, “Apgar Quartet Plays
Perinatologist’s Instruments,” 
JAMA
276 (1996): 1939–40. An ex-
cellent review of the development and importance of her score
is M. Finster and M. Wood, “The Apgar Score Has Survived the
Test of Time,” 
Anesthesiology
102 (2005): 855–57.
188 The 1979 ranking of specialties’ use of randomized trials was
undertaken by the father of evidence-based medicine, Archie
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Notes on Sources     267
L. Cochrane, in his article “1931–1971: A Critical Review with