• What We’re Reading This Summer 2022


    Senior ophthalmologists share the best of what they’re reading this summer. Share what you’re reading and send your review to our book review editor, Robert L. Stamper, MD at scope@aao.org.

    David and Goliath: Underdogs, Misfits, and the Art of Battling Giants
    By Malcolm Gladwell
    Reviewed by Alfredo A. Sadun, MD, PhD

    Malcolm Gladwell is well known as a thoughtful intellectual who comments on social, political and cultural affairs.  Many of us heard his interesting insights on COVID-19 and other diverse issues during a conversation with his cousin and our Academy CEO Stephen McLeod during the closing session of AAO 2020.

    “David and Goliath” might be his best work. It is a collection of essays that explores the psychology of dominance and power versus being the underdog with weakness. Most stories, including the title story, describe an obvious mismatch where one side is very superior to the other. But that often hides the advantage held by the underdog who is no longer confined to battling by conventional methods. Hence, the weaker side is compelled to be creative and this, as well as overconfidence by the stronger side, confers unexpected advantages.

    David, the Biblical shepherd boy, beats the strong and well-armed giant, Goliath. He does so by being different. He doesn’t wear armor. He moves about, launches stones from his sling, taking advantage of his well-honed skill set. More importantly, he may have been very lucky. Gladwell buys into the post-hoc reasoning that Goliath was acromegalic from a pituitary tumor and, therefore, may have had bitemporal hemianopsia. David weaved in and out of Goliath’s intact visual field and confused him.

    Regardless of whether this is fanciful or an example of retrospective ascertainment bias, it’s an imaginative demonstration that we should not assume that the obvious trappings of power will always prevail. There is a freedom and creativity that comes from not being the big and established giant who is constrained as he cannot foolishly squander his greater size.

    Perhaps, Russia’s adventures in Ukraine provide us another example. Gladwell gives us other examples of inventiveness born of necessity. Gladwell describes several people who grew up with dyslexia who did much more than adjust to their problem. As examples, a famous trial lawyer and a famous film producer, both with dyslexia, learned to read people and provoke them into behaving in ways they found uncomfortable, and this played to the dyslexic’s advantage.

    IKEA’s founder, Ingvar Kamprad, also had dyslexia and consciously acted in a way others found to be “disagreeable”, but he built a giant company with that as an advantage. Seeing strength where others see weakness is a good trick.

    Klara and the Sun
    By Kazuo Ishiguro
    Reviewed by Robert L. Stamper, MD

    Computer-driven devices have taken over many tasks previously thought to be limited to humans: toll taking, taxi driving, flying jet planes, driving trains, delivering packages, diagnosing diseases and even performing surgery.

    Computers learn. So, what is it about us that make us human? Is it emotions such as caring, love, contentment, anger, jealousy, loyalty? Is it knowledge of our own mortality? Could artificial intelligence understand friendship, love, forgiveness? These are some of the questions raised in Nobel Prize winner Kazuo Ishiguro’s novel, “Klara and the Sun.”

    Like his previous novel, “Never Let Me Go,” Ishiguro imagines a dystopian American future in which children of the privileged class get genetically modified to allow them to learn faster, grooming them for the privileged jobs. However, they are schooled at home by computer and so get little exposure to other children.

    Their parents can purchase an artificial friend (AF) for the child, much like some purchase pets to assuage the loneliness of their life. These androids are programmed to be keen observers and dedicated caretakers and companions for their wards. They are solar powered. We first encounter Klara as she tries to make sense of a world seen only through the window of the store in which she is for sale. Her wry and sometimes profound observations on “human” nature are part of the charm of this unusual story.

    Eventually, Klara is bought by a family whose daughter, Josie, is sickly as a side effect of the genetic manipulation. Klara learns almost everything about Josie and can imitate her. Josie’s mother takes advantage of this by grooming Klara to take Josie’s place should she die. We follow the close relationship that develops between the two as well as with Josie’s only other friend, Rick, who is naturally intelligent but destined for a limited future since he has not been genetically altered. We follow these relationships as Klara, Josie and Rick grow and as Rick and Klara try to find ways to heal Josie. Herself receiving power from the sun, Klara feels the sun holds the key to a treatment for what ails Josie.

    In this strange, sad but wistful journey, we, along with Klara, learn lots about loneliness and how love, loyalty and friendship can develop and fade. Although the setting is almost bizarre, there are enough similarities to our own time that we could almost believe how we could get there. One feels the force of a brilliant writer. The prose is beautiful, and the plot turns are unexpected. This is the kind of book that pops up in your thoughts long after you have finished it.

    From Strength to Strength: Finding Success, Happiness, and Deep Purpose in the Second Half of Life
    By Arthur C. Brooks, MD
    Reviewed by Samuel Masket, MD

    In the opening sequence of “From Strength to Strength” we learn of an unnamed but widely recognized and highly regarded aging public figure who was lamenting that “he might as well be dead” as he sensed that his fame, power and influence had waned with time.

    Contrast that scenario with the story of a patient I encountered some years ago: Apparently at one time he was a very well-known and successful professional designer. In the course of our conversation, he mentioned that young clients tended to prefer younger designers and that he had become aware of his impending professional obsolescence. But he stated quite clearly and proudly that “I might be a has-been, but at least, I am not a never-was.” He appeared to understand his involuntary transition and be comfortable with his station; his statement was most impactful, and I have quoted it on more than one occasion.

    How can we account for the stark contrast between the manner in which these two people approached the effect of age on their image of self-worth? That is the essence of the book.

    The author, a retired formerly powerful “think tank” CEO turned social scientist, aiming at a reading audience of hard striving success addicts, makes the case with reasonably good evidence that intellectual and physical prowess decline much earlier in life than most realize, and that an understanding of those inevitabilities can allow one to move from a high achieving position to a more internally satisfying lifestyle. He introduces the concepts of “fluid and crystallized” intelligences and how one can transition from one to the other.

    Among the more salient points that he makes is that the successful professional may be more gratified by the image that he/she portrays rather than their internal true self. In making his point he refers to the mythical Narcissus, who according to the author, was in love with his image, but not himself. He encourages us to consider that who we genuinely are is not the same as the title/position we hold or the image that we project.

    He refers to his personal journey, including Indian philosophy learned from a guru, spiritualism, theology and religion; but not all of these passageways may be appropriate for the reader, atheists in particular. He also refers to family matters and uses Johann Sebastian Bach and his relationships with his children as an important example on “passing the baton.” But his main point — that senescence is unavoidable and that transitioning from one lifestyle to the next can and should be gratifying — is clear and universally appropriate. It is my sense that this is a message of great significance to SOs, and I recommend the book as a transitional primer.

    Scientist: E.O. Wilson: A Life in Nature
    By Richard Rhodes
    Reviewed by Alfredo A. Sadun, MD, PhD

    I’ve always enjoyed the author, Richard Rhodes. In one of his famous works, he described the amazing physicists who created the atomic bomb.

    So, when I saw that he had written a piece about E.O. Wilson recently, I jumped at the chance. Soon after I finished this book, I heard that Wilson had just died at the age of 92. This made me glad that I was honoring Wilson by reading and writing about his work. Wilson was once a professor of mine. I took his course on ants at Harvard (students at MIT and Harvard were allowed one course per semester at the other institution).

    I found Wilson to be intelligent, gentle, earnest, and wildly enthusiastic. And his ideas were extremely fresh and imaginative. His early ideas on ant behavior set the seeds for his later works on sociobiology that shook many fields and institutions up. Rhodes wrote this Wilson biography lovingly, and treated Wilson with kid gloves whenever he described the scientific, political and academic controversies.

    It was evident that Rhodes had become a close friend of Wilson. But I liked that intimacy and the point of view that came with it. As Rhodes said, Wilson could be said to have “saved” evolutionary theory by explaining the big bugaboo: altruism. Richard Dawkins later popularized Wilson’s famous explanation for altruism in his book, “The Selfish Gene.”

    In studying the social behavior of ants and other animals, Wilson established the new field of sociobiology. He eventually concluded that human behavior is largely the product of heredity and the environment in a mathematically coherent way that calculates the amount of genetic preservation. Thus, he implied that there is really no such thing as free will; he called this the "genetic leash.” Not surprisingly, this caused a great blowback that came from what today we might call the political correctness police.  

    In particular, Wilson was severely criticized, rather unfairly, by those who didn’t read or understand his work, mispresenting him as an anti-feminist. They complained that Wilson's "deterministic view of human society” was seen as giving an excuse to the powerful. Wilson was also targeted by several Cambridge scientists, including the famous Stephen Jay Gould. These scientists, buttressed by liberal activists, accused Wilson of racism and misogyny. While presenting at the podium to the American Association for the Advancement of Science in 1978, Wilson was attacked by audience members who poured a pitcher of ice water on his head. Wilson accepted a dry handkerchief and finished his lecture.

    My favorite quote of Wilson, which is most relevant in today’s tribalistic society, is: “People would rather believe than know.”

    Quest for the Presidency: The Storied and Surprising History of Presidential Campaigns in America
    By Bob Riel
    Reviewed by J. Kemper Campbell, MD

    George Washington was elected unanimously by all 69 electoral college voters in 1789. His reelection in 1792 was the last non-contested campaign.

    Today’s voters may feel that our quadrennial spasm to choose a new leader has only deteriorated since then. There have now been 59 presidential elections in the United States, and the reviewer has voted in 15, convinced each time that his vote would have some immediate impact upon his own future. Despite backing some winners and some losers in these contests, the reviewer has somehow managed to stay afloat as the U.S. ship of state has steamed ahead under each captain without striking an iceberg.

    Freelance political journalist Bob Riel has provided a succinct and nonpartisan description of each of the previous election contests in his eminently readable new book, “Quest for the Presidency.”

    Beginning with George Washington’s oath of office in New York and ending with the contentious election of 2020, Riel is careful to remain as neutral as possible throughout the book, concentrating on the election campaigns and not the victors’ presidential performance. Along the way he provides insights into the transmogrification of American politics by real-world historical events.

    Riel organizes the campaigns into seven different eras and introduces each by beginning with the clever conceit of discussing politics over coffee at gathering places appropriate to the eras. He begins at New York’s Fraunces Tavern in 1774 and ends at the original Starbucks in Seattle in 2008.

    This book is recommended for readers who may not give a Whig about the Bull Moose Party but are eager to passionately support either of today’s parties in 2024.

    Democrats may be surprised to find that their party staunchly defended state’s rights until the 1960s. Republicans may be equally amazed that their party was devastated when the 1860 convention chose an unknown, compromise candidate who was considered a “fourth-rate lecturer.” He was, of course, Abraham Lincoln.

    Readers appalled by today’s negative television ads will realize that mudslinging is a longstanding American tradition. The Whig candidate in 1844, Henry Clay, was once characterized as “a notorious Sabbath-breaker, Profane Swearer, Gambler, Common Drunkard, Perjurer, Dueler, Thief, Robber, Adulterer, Man-stealer, Slave-holder, and Murderer.” And that was in an era before Twitter.

    In summary, Riel’s book will serve as a savory appetizer for those readers with a taste for another juicy campaign in 2024.