If books are like children...

This would have been my first born. Wow. What a gestation! Took forever. About a dozen publishers rejected the manuscript. Editor Michael Ames, then of Temple University Press, took a chance on me. His board wasn't completely convinced they should publish this book but he gave me an opportunity and lots of feedback. He told me that he liked how it came out. Still, they needed a physician to write a foreword. The research is pretty neat. I looked at resuscitative efforts in emergency departments and found out that precious few lives are saved. In spite of the heroic portrayal of these technologies on TV shows, out-of-hospital survival rates for CPR remain in the low single digits. Still, we have built an extensive emergency infrastructure that aims to link every cardiac victim with advanced life support and defibrillators. I argue that rather than saving lives, CPR actually saves sudden death, in the sense that with CPR everything humanly possible to revert the unexpected death has been done. CPR interrupts the dying process to give relatives and friends a chance to prepare for death. Since resuscitations are often more valuable for relatives than for patients, I advocate for involving relatives more in the resuscitation process.

 

 

Second Book.

Co-authored with the brilliant Marc Berg who cycled every four years through a career: physician, philosopher, sociologist, professor, and now health care consultant. In this book, we examine the advent of evidence-based medicine. We bracket the hype and hope invested in EBM and look at what change it brings on the ground. STS scholars like this book because it put research on standardization on the map. This is the book I am cited the most for. The book won the Merton book award from the American Sociological Association. I always imagine a Robert Merton action figure.

 

How do we make sense of suspicious and violent deaths?

I love the cover. You see doors of body coolers in a morgue. The bottom ones are a bit smashed in because the carts to transport bodies slammed against the doors. This remains my favorite book. The research was very tough. Not just because it consisted of observing autopsies but also because the research became a bit of an identity crisis. I look at the role of medical examiners in classifying suspicious deaths as either natural deaths, suicides, homicides, accidents, or undetermined deaths. Although forensic pathologists are the professionals charged with classifying suspicious death, pathology does not reveal the intent of the deceased or of others involved in the death. The central question of the book is why should we believe medical examiners? Or, put differently, what are the grounds of their professional authority? I argue that the decisions of medical examiners are influenced by their liminal position between the legal and medical world. Their dependence on law enforcement and clinicians for necessary information, their professional bias towards visible trauma and histology, and the potential contestation of their determinations in courts leads to a conservative classification of disease. Only when the evidence is a clear match with their specific area of expertise will medical examiners classify self-inflicted deaths as suicides and deaths at the hands of others as homicides. Consequently, some people will “get away with murder” and other deaths will not be classified as suicides, although friends and relatives may know or deeply suspect in the latter case that the death was actually self-inflicted. I frame the analysis of medical examiners through the perspective of the sociology of professions, arguing that the while medical examiners have a rare legal monopoly over death investigation, their “market shelter” also stifles innovation. This study was based on observations of more than 225 autopsies in a medical examiner’s office, review of autopsy files, and in-depth interviews with medical examiner’s staff. This book won awards from both the UK and US medical sociologists.

And now for a happier topic...

Birth should be a happy event. When sociologists put a question mark in a title like Saving Babies?  you should be suspicious.  You know the answer is going to be probably not. Newborn screening is a unique public health program that has been screening more than 99% of U.S. newborns since the 1960s. The program started with a handful of conditions. In 2005, screening programs adopted new technologies that led to an expansion to more than 50 rare genetic conditions. With my amazing co-author Mara Buchbinder, I studied the interactions between clinicians and families informed that their infant had a positive screen soon after the expansion of the program. We documented some of the unintended consequences of population-based screening programs. We noted the creation of new patient populations of asymptomatic people with positive screens but where the clinicians doubted that they truly had the disease. Because these newborns were caught in screening limbo and treated as patients even though they may not have the condition, we referred to them as patients-in-waiting. Because we had collected data over a three-year period, we were able to document the transformation of disease categories due to screening. We also examined the limits of screening programs to prevent the onset of some conditions. A premise of our work is a critical examination of what it really means to attribute life-saving potential to a population-based screening program. The book did not win any awards but it acquired an enemy.

 

Some methods.

Did you notice that this is the third orange cover for my books? And I don't even like orange that much. You learn quickly in publishing that you can't argue with publishers about covers. It just delays the publication date. This book is different from the others. It is a methods book grounded in the semiotic pragmatism of Charles S. Peirce. With former graduate student Iddo Tavory, I develop a method for qualitative data analysis that aims for theoretical innovations building upon existing theories and the methodological precepts of grounded theory. Abductive analysis has its own website.