Frimbo is an admirable erudite, reminiscent of Sherlock Holmes, while the “closed room” scenario with a handful of characters evokes Agatha Christie. The writing is accessible, the rendering of Harlem accents remarkable, and the accurate references to state-of-the art forensic medicine, using anatomy and chemistry, are engaging. The conversations between Archer and Frimbo explore the nature of science, faith, and psychology. 

Some passages contain philosophical observations: ‘Pure faith in anything is mysticism. Our very faith in reason is a kind of mysticism’ (p. 214).  
 
Fisher was an African-American physician-author whose clever novel contains only African-American characters, including the physician and the detective. Specialized in radiology, he lived most of his life in Harlem, but he had studied medicine at Howard University. The author of many short stories and plays, he was also a gifted musician and composer. He at died at the age of 37 from an abdominal cancer attributed to his work with X-Rays.   

The Conjure-Man Dies: A Mystery Tale of Dark Harlem
Rudolph Fisher  

Miscellaneous Original edition 1932  
Publisher University of Michigan Press 
Place Published Ann Arbor MI 
Edition 1992 
Page Count 316 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.   
Web image by Salah Ait Mokhtar 

In her 2011 book Blood Feud (also published as Blood Medicine), award-winning journalist Kathleen Sharp describes a wrenching example of whistleblowing in the pharmaceutical industry about a drug designed to promote the growth of blood cells.  

Beginning in 1992, Mark Duxbury and Dean McClellan became high flying salesmen for Johnson and Johnson, Ortho branch – happily promoting the anemia drug Procrit (or Epogen — erythropoietin). (Yes! that’s the same hormone sometimes abused by high-performance athletes.) Developed by fledgling Amgen, Procrit was licensed to Ortho for specific uses. The two salesmen rejoiced as their careers took off; during 1993, they earned bonuses and their stature rose. Soon however, Duxbury was being encouraged to promote the drug for off-label uses and in high doses—all to enhance sales. He began to realize that the drug was not safe when used in these situations: people were dying because their unnaturally thickened blood resulted in strokes and heart attacks. He was appalled by the fact that the company was giving kickbacks to prescribers who were making false claims to Medicare. 

Duxbury raised objections with his employer. For voicing concerns, he was ostracized and then fired in 1998. Along with the stresses of his work, the financial difficulties, and emotional turmoil, Duxbury’s home life collapsed, his marriage fell apart, and he worried about his daughter, Sojourner. He developed multiple health problems, including sleep apnea and dependency on drugs and alcohol. 

Duxbury enlisted the help of the famous lawyer Jan Schlichtman featured in the 1995 book, A Civil Action, by Jonathan Harr (also the famous 1998 film starring John Travolta). In 2003, they launched a qui tam lawsuit under the False Claims Act against his former employer. A qui tam case allows an individual to sue on behalf of the government (i.e. the people); if successful, the individual will be entitled to a portion of the proceeds. The process stalled but was revived in 2009. However, Duxbury died suddenly of a heart attack in October 2009 at age 49 with the case still unresolved. The potential value of his qui tam was unknown but was estimated to be 150 million dollars four years later.  

Contacted by Duxbury in 2004, author Kathleen Sharp, initially hesitated to take up the project. After the FDA issued increasingly alarming warnings about the dangers of Procrit in 2006-7, she began to take his concerns more seriously.  Relying on interviews and many documents from courts and private papers, Sharp reconstructed the events in a narrative that resembles a novel, with direct quotes and even the inner thoughts of the players. Duxbury’s death intestate comes as a shock to the reader, as it may well have been to the author. Reference notes support the unverifiable claims made in her narrative—placing it somewhere in-between “recreative” journalism and fiction. 

Since the publication of Blood Feud, the case was referenced in an unsuccessful suit by Duxbury’s daughter Sojourner against her stepmother in 2013 and an appeal of the same year, which gave judgement to the defendant (i.e. not Duxbury). Duxbury v. Ortho Biotech has become an important precedent cited in other qui tam cases into the present. 

Blood Feud raises concerns about the behavior of pharmaceutical companies in duping their own salesmen to generate income even at the cost of human life. But it also invites consideration of the too-often-neglected responsibilities of the health care profession and the government. The thorny legal aspects of the pharma industry and its regulation result in multiple lawsuits that contribute to the ever-higher costs of drugs. 

Blood Feud: The Man Who Blew the Whistle on One of the Deadliest Prescription Drugs Ever 
Kathleen Sharp 
Dutton, New York, 2011: 432 pages 

Web image by Medhum.org

What is Colombo’s heresy? True, he has consistently violated the Papal Bull of Pope Boniface VIII that forbad obtaining cadavers for dissection, but his scholarly eminence and friendship with Pope Paul III have protected him from recrimination. His heresy is far worse than simply ignoring a Papal Bull; in fact, Mateo Colombo has discovered a dangerous new anatomical structure, the clitoris! 

Mateo was called to the bedside of an unconscious holy woman named Inés de Torremolinos. In the process of examining her, the physician was amazed to discover “between his patient’s legs a perfectly formed, erect and diminutive penis.” (p. 105) He took hold of the strange organ and began massaging it. As he did so, there was an amazing response in his patient: “(Her) breathing became hoarser and then broke into a loud panting… Her lifeless features changed into a lascivious grimace…” (p. 107) Subsequent research undertaken with Mona Sofia, the resplendent whore, as well as with cadavers, confirmed the significance of Colombo’s discovery. 

At his hearing before the High Tribunal, Colombo explains his findings, which are far too complex and subtle to summarize in a short review (pp. 138-165). The finding of greatest interest, however, is that “there is no reason to believe that there exists in women such a thing as a soul.” (p. 151) In fact, Colombo contends he has proven that the “amor veneris” or clitoris performs in women “similar functions to those of the soul in men,” although its nature “is utterly different since it depends entirely on the body.” (p. 153) 

This novel was highly controversial when it first appeared in Argentina, and its denunciation by the sponsor of a major literary prize in that country sparked a literary scandal. The novel’s basic conceit is the analogy between Christopher Columbus’ “discovery” of the geographical New World in 1492, and Mateo Columbo’s discovery of the anatomical New World, the clitoris, a generation later.  

Like his explorer namesake, the Renaissance anatomist ventured forth into new territory, setting aside prejudice and popular opinion, as well as (in Mateo’s case at least) the weight of church authority. However, although the anatomist struck a blow for objectivity in observation, his interpretation of the findings was compromised by cultural bias, in this case, by pervasive misogyny. The human soul is the seat of reason; since women are controlled by passion rather than reason, perhaps they lack souls. When Colombo concluded he had discovered the organ that produces passion (“amor veneris”), he assumed that, since the clitoris generates female behavior, it must be analogous to the soul, which generates male behavior. Needless to say, this theory guaranteed some heated discussion. If you thought Descartes’ concept of the pineal gland as the seat of the soul was bizarre, try this one. 

Historical note: Matteo Colombo (c. 1515 – 1559) was an Italian professor of anatomy and a surgeon at the University of Padua between 1544 and 1559. While Colombo was not the first anatomist to describe the clitoris, he is credited as being the first who correctly identified the clitoris as a predominantly sexual organ. He was never tried for heresy. In fact, he was the personal physician of Pope Paul IV and his major work, De re Anatomica (1559), was published in Rome with ecclesiastical approval. The correct English translation of his Latin text reads “the clitoris is the site of women’s delight,” not “soul.” However, Andalhazi’s fictional re-imagining of Columbo’s life and work makes for a very provocative story.  

The Anatomist
Frederico Andahazi
New York, Doubleday, 1998 (215 pages) 

Web image by Tim Schmidbauer

Susan Sontag has said, “Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship in the kingdom of the well and in the kingdom of the sick.” Author Lina Meruane challenges the idea that people with illnesses are necessarily separated into a different kingdom than those who are not sick, asserting instead that illness can be part of anyone’s normality. She makes this case through her novel, Nervous System. The novel tells the stories of four family members and a boyfriend who, at one time or another, develop a serious illness or help take care of one of the others with a serious illness: it’s all illness, it’s all the time, it’s normal. We talk with Dr. Meruane about her idea of illness as normality as she presented it in the novel, and about how its atypical structure and its evocative and memorable prose contribute to the stories told and the ideas offered.

Co-host

Daniel Albrant

Source
Nervous System by Lina Meruane, translated by Meghan McDowell, Graywolf Press, 2021.

Links
–Lina Meruane’s bio
–Russell Teagarden’s blog piece about the novel, Nervous System, and his blog piece about the MRI scene in the novel.
–Russell Teagarden’s blog piece about Lina Meruane’s novel, Seeing Red.
–Video conversation between Lina Meruane and Meghan McDowell about Nervous System.
–Interview with Lina Meruane in LALT magazine about Nervous System.

A big thanks to Lina Meruane for sharing her thoughts on illness as normality and her writing processes.

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Web image by Medhum.org

Esther, daughter of a native healer who has some familiarity with and respect for Western medicine, envies and longs for Antonia’s Western training and attaches herself to her as a disciple. In her encounters with patients, Esther finds that she has an inexplicable gift for healing which baffles her as well as Antonia and complicates their already tenuous relationship. Esther’s gift forces Antonia to reexamine some of her most basic assumptions about what constitutes healing. 

The novel raises complex questions about the cultural, religious, and institutional contexts of medicine in a delicately drawn portrayal of relationships among characters whose divergent frames of reference complicate trust and understanding. One of the questions the novel addresses is not only how to heal the body, but how to heal the breach between cultures. In the development of the friendship between the American doctor and the African healer these questions are worked out in concrete particulars that fully honor both the pain and the hope involved in authentic cross-cultural dialogue. 

Antonia Saw the Oryx First
Maria Thomas 
Soho Press, New York 2007: 296 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.  
Web image by medhum.org.

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Conditions change once Sweet Home’s owner dies of a stroke and his widow brings in her brother-in-law and his young nephews to help run Sweet Home; the small liberties granted to the enslaved people are revoked by the new leadership, and cruelties ensue. The enslaved people, including Halle and a man named Paul D, plot to escape north; however, Sethe and her children are the only ones who succeed in doing so, only after she is violated by the nephews and brutally whipped by the brother-in-law for informing him of the assault. These events and Sethe’s flight are complicated by her near-full-term pregnancy. Approaching death from exhaustion and exposure, she is saved by a white girl who helps Sethe give birth. Her daughter is named Denver after the contextually benevolent white girl.  

Carrying her newborn, Sethe arrives at 124, greeted by her other three children, into the care of Baby Suggs. The bittersweet happiness of her arrival without Halle is marred one month later by the arrival of a team intending to reclaim Sethe and her kids for Sweet Home. Rather than allow herself and her children to be forced back into slavery, Sethe intends to commit infanticide and suicide, succeeding in the murder of her older daughter. This action effectively prevents them from being taken, and Sethe is exonerated of her charges. Despite this, her act of desperation crushes her family, eventually leading to Baby Suggs’ death and to the flight of her sons from the household. Eighteen years later, Paul D arrives at 124. He begins a relationship with Sethe and manages to evict the poltergeist.  

Soon thereafter, a strange woman arrives by the name of Beloved, the word Sethe had engraved on her child’s tombstone. Sethe is initially unaware of the stranger’s origins, and Paul D is effectively forced out by the new arrival. Once Beloved’s identity as the deceased child is understood, she, Sethe, and Denver become wrapped up in each other, blurring the lines of their identity. Sethe loses her job, but Denver manages to extricate herself to find work. Hearing of the family’s plight at the hands of the “unholy” Beloved, thirty black women of the area band together to purge 124 of her presence. Beloved leaves without a trace. Paul D eventually returns to 124, and memories of Beloved slowly fade into oblivion. 

Beloved is a pure work of art. Toni Morrison crafted a brilliant piece fueled by the lived experiences of enslaved people’s descendants in America and informed by the temporal proximity of the ratification of thirteenth amendment. The summary outlined above fails to capture the impact of the work’s nonlinear form, both in time and perspective. Flashbacks seamlessly interweave with the driving plot. Not only are the past and present difficult to distinguish, but this intermingling also elevates the past in status compared to the present, allowing the past to rival––and often exceed––the present in narrative importance. Time becomes a unique character, one whose primary achievement is the marring of other characters’ physical beings. Through this lens, the recapitulation of Sethe’s tree scars mirrors the historical impact of slavery on the modern-day United States. This context is further validated by the work’s inspiration, the life of Margaret Garner, an African- American enslaved woman who escaped, was recaptured, and who murdered her daughter while being returned to the South. 

Toni Morrison’s mastery of figurative language builds upon the nonlinearity of the piece. Her writing is powerfully displayed through allegories, the most notable of which is found on pages 248-252. Through Beloved’s perspective, Morrison blends hell and slave ships into one entity. This same section of the novel further unifies the perspectives of Beloved, Sethe, and Denver through a mélange of emotion and perception.  

The relevance of this piece to contemporary American politics and social issues is profound and disturbing. American history continues to discredit the experiences of people of color, particularly those of who identify as Black or African-American. This novel demands that we confront the United States’ history of racial oppression. Its magical realism provides new dimension to a historical narrative, allowing for greater imaginative accessibility to the meaning behind its story. As a last powerful image, I refer to the biblically paralleled coming of the four horsemen to “reclaim” Sethe: the sheriff assumes responsibility of reinforcing the dehumanization of Sethe and “addressing” her perceived cultural, psychological, and racialized aberrancy through punishment sans reformation.  

Miscellaneous 

Beloved
Toni Morrison

Awards
National Book Award Finalist for Fiction (1987); Pulitzer Prize for Fiction (1988); American Book Award (1988); Anisfield-Wolf Book Award (1988); Frederic G. Melcher Book Award (1988)  

Publisher Vintage 
Place Published United States 
Edition 2004 
Page Count 324 

Originally published on September 16, 1987 by Alfred A. Knopf Inc. 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database . 
Web image by Alex Conti

Agnes recognizes William’s unique potential and supports his choice to leave his family and head off to London to make his name in the theater world. Shakespeare rarely returns home to Stratford, and we only learn of his growing success indirectly. Agnes is forced to raise her children as a single parent and has to deal with her overwhelming grief when Hamnet dies. As she mourns the loss of her son, she is overcome with doubt about the fidelity of her absent husband, and her faith in their marriage is threatened. Ultimately, Agnes is given a playbill featuring the production of a new play written by her husband and she sets off on a trip to London to confront him on his own turf. She arrives uninvited at the Globe Theater in time to witness a performance of the play in which her husband has been able to channel his own grief at the loss of his son into one of the enduring literary works in the Western canon.  

I first became aware of this book in a New York Times article that appeared in the early stages of the COVID 19 pandemic shutdown. It was recommended as a worthwhile book to read in quarantine. I had never heard of Maggie O’Farrell but the two-sentence summary captured the book and author perfectly. I do not think O’Farrell is a prophetess, but she was nothing if not attuned to our times and circumstances. Assuming she was writing this novel well before coronavirus escaped the food market in Wuhan, the way she frames Hamnet’s death in the setting of the bubonic plague in Stratford is inspired. Her story captures the explosive fear that envelops the town as the plague spreads — you can feel the wind in your face as the townspeople slam the door shut in the face of anyone suspected or proven to be infected. The story is written in the present tense which heightens the sense of immediacy of events as they unfold for William and his parents, Agnes and her family, and the people living in Stratford. O’Farrell’s prose feels Elizabethan – in the description of glove making, removing honey from a beehive, preparing shrouds for the dead child. As I read, I found myself looking up many more words than usual; the language itself has the power to transport you back in time.  

But, while the choice of bubonic plague as the cause of death may have been fortuitous for book clubs and book sales in the world we lived in during the pandemic, I do not think it is the driving force in this book. The dominant theme is how we deal with grief from any cause. O’Farrell is not the first author to use the death of a child as a vehicle to explore the myriad consequences triggered by the loss of a loved one, especially for parents who lose a young son or daughter. The steady movement of the plot to the climactic scene in London makes Shakespeare’s response seem the more substantive. His literary genius has enabled him to channel his sadness at the loss of the son he adored into the creation of an authentic character into whom he could project all the hopes and dreams that he had for Hamnet.  

Interestingly, O’Farrell never names Shakespeare throughout the novel, referring to Shakespeare always as “he” or “him” I can only speculate what O’Farrell means to convey with this literary device. I think she is acknowledging that it is the truly rare individual who can accomplish what Shakespeare was able to do in redirecting his grief from personal sadness into a timeless literary masterpiece. We are thus like Agnes who must go through our day-to-day routine, try to find meaning in tragedy and the courage and strength to stay on our feet and continue to move forward. That is Agnes’ accomplishment — that she can summon the will to travel to London to confront William, and by her action have the goodness of heart to realize that her husband shares her loss. She is able to appreciate the gift he has been given to transform his personal grief into a meaningful expression that the world can share. With this newfound knowledge, her marriage will be reinvigorated, and their mutual love will be reinforced. Agnes is thus the named character who occupies center stage as the story unfolds.  

O’Farrell has written a truly beautiful book that brings to life the pain of loss and the capacity of men and women to endure. As we coped with the COVID-19 pandemic as individuals and communities, many were forced to deal with unexpected pain, suffering and death. Hamnet is a book for our time. Physicians and all other health professionals do their best to support families and communities as they deal with untimely loss of loved ones. I only hope that it will not set the bar too high on expectations of how to transform grief into meaning. We are not all going to be Shakespeares but we can hope to be Agneses, who can still find joy and meaning in our lived lives in the aftermath of devastating loss.   

Hamnet
Maggie O’Farrell 
Alfred Knopf, 2020: 384 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database 
Web image by Medhum.org

I am glad to report that Playground is a success on this count. In this most recent novel, Powers turns to the ocean as a backdrop for his story. He weaves together the narratives of three main characters. Todd Keane, who is the son of a successful businessman, grows up privileged in upper-crust Chicago. As a high school student in a top-tier private school in the 1970s, he is captivated by the relatively crude computers of the time, mounts the technology wave and feverishly rides it to professional success as an adult. Evie Beaulieu is literally and figuratively thrown into the water at a young age by her father, a deep sea explorer, and becomes obsessed with everything watery. She is more comfortable swimming deep beneath the ocean surface than walking on land. With the support of a gentle and self-effacing husband, she becomes a world famous oceanographer who achieves renown because of her ability to convey the magic and mystery of the ocean equally well to her scientific colleagues and young adult readers, echoes of Richard Powers himself. Finally, Ina Aroita grew up on the Pacific island, Makatea, but moved to the United States to pursue studies in the creative arts and becomes a sculptor. In college, she meets Todd and through him she is introduced to an important fourth character, Rafi Young, who pulls together the Keane-Aroita story lines.

Rafi grew up in the Black neighborhoods of South Side Chicago. He is a voracious reader from the first day of school and, defying the odds,  wins a scholarship to attend the same high school as Todd Keane. They meet over intense games of chess, advance to the ancient addictive game of Go, and develop a powerful but vulnerable friendship. They both choose to go to college at the University of Illinois, and Ina is drawn into their orbit.  Powers pulls all of these characters into a tight web that centers on the ambitious plan of an American company  to build a self-sustaining city that will launched from Makatea and will be submerged under the surface of the water. The residents of the island are being asked to weigh the pros and cons of the “seasteading” initiative and decide whether to approve it. The rationale offered by the proponents is that life in such a unique environment will enable the occupants of the submerged city to live in a realm outside the jurisdiction of any company and be free to pursue their intellectual pursuits and dreams about expanding the use of artificial intelligence, free of government interference and restrictions.

Extreme libertarianism meets AI wonderland.

Powers populates his literary world with characters we come to know well and grow attached to. It is a strength of Playground that they are believable and not simply spokespeople for a point of view. Powers explores many themes in this book. Games, those that people play casually for leisure, like chess, and those that they play intensely for success in life figure prominently in the novel. Todd and Rafi’s obsession with the ancient board game of Go, with its infinite number of possible outcomes branching out from a simple 19×19 linear grid, becomes an incubator for their ideas about computing capacity. Go provides an alluring framework to explore human behavior and model it for use by programmers of life-like computer surrogates. The game provides the initial inspiration for Todd to design powerful AI systems that can mimic humans and beat them at their own games. There is an appreciation of the growing potential for unpredictable outcomes as computer systems become more complex, machine learning diversifies, and neural networks become denser. The example that most impresses Keane (and Powers) involves the game of AlphaGo, an actual computer program, which was designed to play Go at championship level. Todd recounts his feelings of awe when the program  made an inexplicable move in a game against Ke Jie, the number one ranked player in the world at the time, that sealed the computer’s victory in a three-game match. This was something that was thought to be beyond the power of any computer (this same episode features prominently in the book Maniac by Benjamin Labatut).

In this novel, the inventiveness of nature and the unpredictability of human interactions far surpasses anything that AI accomplishes. The complexity of the natural world, its wondrous diversity, its unexpected vitality, is captured in incandescent prose as Powers describes the glowing colors of the deep-sea creatures. Can and will computers achieve a sense of stewardship and legacy? Will they develop an attachment to the environment around them and struggle to sustain it and pass it on whole to the next generation of computers in the same way that links people across and with future generations?

The novel reaches a climax and the ending involves an unexpected plot twist. The book is too much of a fun read for me to reveal it and spoil it for you. One hint — keep in mind that Todd Keane is an extraordinarily complex person. That said, what is striking is how marginally AI actually influences the actual outcome of the novel. It is more of a gadget play than an active player in the narrative. It is as if Powers himself is unsure how AI will impact those of us alive today and the generations that will come after us. If this is true for Powers, then it suggests that all of us should stay modest in our predictions of the future of AI. Reading Playground, I think he would remind us to keep in mind that however things turn out with AI, it will probably work out best if we remember the grandeur of nature and the human capacity to care deeply for one another and our environment, qualities that Powers describes with an expansive intelligence and poetic beauty.

Playground
Richard Powers
W. W. Norton & Co.2024.
381 pp (paperback)

Web image by Medhum.org

Literature mirrors the general culture. There has been a recent explosion of books in which AI is the central plot device moving the narrative forward to endings that range from a utopian fulfillment of human destiny to the catastrophic collapse of civilization and the annihilation of humankind. But AI infiltrated the literary space several decades ago. Philip Dick imagined a world in Do Androids Dream of Electric Sheep? where cyborgs were being hunted down because of fear that they might take over the world. In 2001: A Space Odyssey by Arthur C. Clarke, a robot named Hal murders nearly all the crew of a spaceship on a planetary mission because of a programming error. 

Speak by Louisa Hall is more recent addition to the AI library. But it was published several years before large language models became a routine tool to plan a vacation or write a letter of recommendation. Is it still worth reading in 2025? 

The novel is a composite narrative centered around five interwoven stories spanning the time period from 1663 to 2040. In the first narrative, a young Puritan girl who finds herself in an unwanted marriage, records her thoughts in a diary that she is writing on a treacherous ocean voyage to America. Fast forward to the 20^th century and we meet Alan Turing who is writing letters to the mother of young man to whom he was emotionally attached and who died prematurely. He is troubled by his inability at times to communicate with people. A decade later we meet Karl and Ruth Dettman, a couple whose families escaped Nazi Germany but under vastly different circumstances. The husband, Karl, is a computer scientist who has developed a program named MARY to enable computers to interact with humans. Ruth, his wife, is a historian who has built a career centered on the publication of old diaries like the one written by the young woman traveling to America. She is trying to convince Karl to expand the memory of his computer program and enrich it with more human material, but Karl stubbornly refuses because he is concerned about the power of his program to overwhelm its users if its database is expanded. Finally, we jump ahead to 2040, and we read the transcripts of the trial of Stephen Chinn, a man who is being prosecuted for the production of robots that are too life-like. Chinn is being accused of causing physical and psychological harm to the people who have used his robots and of weakening normal relationships between people. A young adolescent named Gaby, who was given a doll powered by a version of MARY, is one of his alleged victims. His own personal recollections are folded into the trial proceedings, as he tries to describe his intentions, justify his actions, and make amends for where they may have gone awry. 

Taking stock of our world today, there is clear evidence that AI can improve the day-to-day lot of people, make life more convenient and efficient, and promote better health outcomes. However, much of the current angst that permeates discussions of AI is focused on the potential economic and sociopolitical consequences. There is fear that systematic adoption of AI will lead to widespread loss of jobs and financial distress for people left behind. The generation of false data and uncontrolled dissemination of unfiltered information may, it is feared, foster social unrest and destabilize democratic institutions.  

All of these predictions, for good or for bad, center on the word “intelligence.” If it is defined as the creative use of information towards a specific goal– my definition, to be sure — then it exists along a gradient and there is not an opposing term. In that case, the mixed picture about the future of AI seems accurate. Humans can process information to both noble and destructive ends. If machines are provided information by humans, then it is likely that there will be worthy and flawed outcomes. It is not a reflection of the logical structures or neural networks that are built into us as humans or artificially placed into machines. It simply is the nature of intelligence. Information is agnostic and it can be processed in a limitless number of ways; there is no guarantee of what will happen when it is processed. 

On the other hand, if we center our predictions on the word “artificial,” there is an opposing term, namely “genuine.” Speak looks beyond AI as intelligence and forces us to think about its impact on interpersonal communication and interactions. The design of the robots that are being created in fiction and in our world of 2025 is steadily improving. The voices become more lifelike, the reactions more emotionally appropriate, the reactions more convincing. They display keen intelligence and manifest seeming empathy with their handlers. Like the artificial friend in Klara and the Sun by Kazuo Ishigura, the robots may even appear to have more feelings and awareness of the ever-changing psychological state of their owners than family members and friends. But it will always remain artificial. Speak forces us to ponder whether interactions between human beings have an element that cannot be programmed, that is not simply manipulation of information. It is that piece that accounts for the genuine nature of relationships between people and it is that component that is vital for human growth and maturation. The interconnected stories in Speak raise the concern that reliance on AI, in whatever embodied form it takes, to provide support and companionship may inevitably fail and leave damaged humans in its mechanical wake. The intelligence of AI may not be sufficient for humans to thrive. It remains difficult to put into words exactly what to call this additional component of human interaction. Thankfully, there is literature, and creative novels like Speak, to help us grapple with what it might be and to help us steer a course where AI is developed thoughtfully with full awareness of its limitations and potential for good and harm. 

SPEAK  
Louisa Hall 
EccoPress, New York 2016, 356 pp 
Web image by Medhum.org

Although his story opens with the establishment of the Johns Hopkins Hospital in 1876, Barry immediately takes a detour into the history of medicine dating back to Hippocrates, and traces the history of medical/scientific thought from Ancient Greece to the end of the 19^th century. He then introduces a series of physicians, scientists, and medical researchers who will play their parts in the story of the pandemic (this first section is called “The Warriors”) and outlines their training, research, and interactions.  

It isn’t until page 91 that he takes us to the rural Kansas county in which the story of the pandemic begins. For although it was called the “Spanish Flu,” that was actually an eponym of convenience; in fact, the first cases of pandemic flu seem to have arisen on the American prairie. However, newspaper reporting on the new pandemic was felt by the Allies and Central Powers alike to be contrary to the public interest (the war was still raging), so it was left to neutral Spain, whose king had come down with the disease, to publish the early reports. In this section, “The Swarm”, Barry also briefly reviews the basic (not to worry, very basic) microbiology of viruses and the history of some prior pandemics. He follows this with the section called “The Tinderbox,” in which he traces the events leading up to the entry of the United States into World War I, and the importance of that war and the political and social conditions surrounding it in the history of the pandemic. From here on in the influenza itself takes center stage; in sections called “It Begins,” “Explosion,” “Pestilence,” “The Race,” and “The Tolling of the Bell,” the rapid and lethal course of the pandemic is described in gripping (no pun intended) detail. The last two sections discuss the scientific advances (and some false starts) brought about by the cadre of researchers working day and night to tame the outbreak, and then Barry finally turns to the retreat of the virus and ultimate end of the pandemic. The book ends as it began, returning to the stories of the individual men and women of science who engaged in the battle to beat the disease of which it had initially been said by many that “[t]his was, after all, only influenza.”  

For anyone seeking to understand the 1918 influenza pandemic not only from a scientific and medical historical standpoint, but also with an appreciation of the political and sociocultural milieu in which it took place, you can’t do much better than Barry’s work. It is not short—it clocks in at 461 pages, with another nearly 40 pages of endnotes and a 20 page bibliography—but it is well-paced and reads smoothly; the narrative carries you along, a testament to the author’s writing style. Barry succeeds in putting a human face on the pandemic and creates a mental image of the horror of pandemic disease which can stand up alongside those we have of the Black Death of the mid-fourteenth century, with which it is often compared. For those of us who know the flu as a seasonal visitor, (for most of us a major annoyance, but nonetheless a disease that kills tens of thousands each year), the images of massive and rapid death—villages abandoned except for piles of corpses, trains that “left one station with the living…[and]…arrived with the dead and dying”—seem surreal. Barry paces the book in such a way that one can almost hear the stopwatch ticking in the background; The Great Influenza is scientific and historical reporting done with great attention to detail and to getting the medical facts right, but it is reporting done with a novelist’s flair.  

Even as the pandemic begins to recede, leaving in its wake not only the dead but those living with its sequelae, such as post-encephalitic syndromes (the Woodrow Wilson/Treaty of Versailles anecdote is particularly striking), the helplessness of medical science is reaffirmed; the pandemic recedes of its own accord, because the virus mutates to less virulent forms, and the very large number of those who have survived helps to create herd immunity.   

In the book’s Afterword, added in 2018, the author discusses and compares influenza pandemics which followed the 1918 experience, talks about some of the antiviral drugs introduced over the years and how they work, and speculates about what the next great influenza pandemic might look like and how it might be prepared for. His concern was prescient, although it would be a coronavirus, rather than influenza, that would cause widespread death and societal disruption. In fact, one of the most jarring aspects of this story is the fact that, if one changes the dates and the names, the tale bears an uncanny resemblance to the COVID-19 story, right down to the attempts at minimization by the government and even the isolation and victimization of an ethnic group (in 1918 the Germans, who were the enemy in the world war, rather than Asian-Americans, as it would be during COVID).  

The Great Influenza is a detailed, highly readable, and sobering account of an episode which demonstrated once again that despite what we may think, we are not the masters of the world in which we live, and that a microbe could rapidly kill on a devastating scale and upend society—again—and there was initially little that could be done to stop it.  

THE GREAT INFLUENZA: A Story of the Deadliest Pandemic in History
John Barry 
Penguin Books, New York, 2004 (reissued with new afterword, 2018)
461 pages 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database.
Web image by Medhum.org