Book Review

When Illness Goes Public: Celebrity Patients and How We Look at Medicine

N Engl J Med 2007; 356:1793-1794April 26, 2007

Article

When Illness Goes Public: Celebrity Patients and How We Look at Medicine
By Barron H. Lerner. 334 pp., illustrated. Baltimore, Johns Hopkins University Press, 2006. $25. ISBN: 978-0-8018-8462-7

The first thing readers should know about this engaging and important book is that it is apparently dangerous to one's reputation to read it in the presence of academic physicians. I noticed this as I sat and read it in various locations at my own medical school. Doctors passing by would scan the title, see the cover — a flashy, silver-screen backdrop with a filmstrip of celebrity portraits — and then snicker. When I inquired, I learned that their view was basically this: medicine is noble, Hollywood is ignoble; therefore, there could be no worthwhile study of the intersection of the two, and no serious intellectual would be caught reading such a book.

I believe they are wrong. In his latest book, Columbia University physician and historian Barron Lerner has done a beautiful job of tracing the degree to which celebrity patients have reflected and shaped the modern American understanding of doctors, patients, and illness. We may like to believe that modern medicine represents primarily the judicious application of science to the art of healing. But as Lerner suggests, the way people experience the doctor–patient interaction and the patient–illness interaction is often determined less by the best available evidence than by the big-name stories that become attached to particular medical disorders.

Take, for instance, the story of John Foster Dulles, secretary of state under President Dwight D. Eisenhower, and his battle with colon cancer. The timing of the diagnosis — in 1956 — put Dulles at a turning point in the attitudes of doctors and patients toward openness about serious illness. Indeed, Lerner shows that Dulles was at the axis of that turn. The honesty of his doctors with him and his honesty with the American public marked a notable shift in social norms about serious illness, especially cancer. Although his surgeons may occasionally have been overly optimistic in their reports to the press, Lerner shows that in general the press remained honestly pessimistic about Dulles's fate and that this public, pessimistic honesty brought forth novel, intense conversations about the role of faith and personal strength in healing, as well as about various experimental approaches to cancer. Lerner shows that throughout the 20th century, highly public cases, like those of Dulles, Lou Gehrig, and Brian Piccolo, became touchstones for how patients (and their doctors) would think and talk about major illnesses.

John Foster Dulles and His Wife, Janet, Leaving Walter Reed Army Hospital in Washington, DC, March 7, 1959.

When Lerner speaks of “celebrity patients,” he has in mind two classes: people like Dulles, Gehrig, and Piccolo, who were already famous and then became ill, and “ordinary” people who became famous because of their illnesses. In the latter category, Lerner traces the stories of Libby Zion, the young woman whose death in 1984 led to limits on resident work hours; Barney Clark, the recipient of the first artificial heart; and Lorenzo Odone, a boy with adrenoleukodystrophy whose parents' search for a cure was made famous in the 1992 film Lorenzo's Oil.

Through exquisite analysis of primary and secondary sources — including many important oral histories collected by the author himself — Lerner shows how many layers of history and mythology lie beneath all of these epic tales. In each case, he demonstrates the real uncertainty (medical and historical) behind the seemingly simple tales often told by the media and aggrieved survivors, such as Libby Zion's father, Sidney. Lerner also reveals the fragile humanity of each of the real people at the centers of these narrative vortices.

This book is a pleasure to read because of its compelling storytelling and analysis. But it is more than that — it constitutes a critical contribution to our understanding of how Americans have come to think about illness, treatment, and in-hospital death in the age of celebrity.

Alice D. Dreger, Ph.D.
Northwestern University, Chicago, IL 60611