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on 16 November 2010
As one of the main characters lives in the United States and develops incurable inoperable cancer, she receives several courses of treatment all of which have to be funded by and adequate health insurance plan, and so therefore in large part by the patients family, depleting their life savings. Most reviews of the book therefore focus on criticism of the American Healthcare system, but as an oncologist I saw it as a fascinating insight into the dilemmas of cancer patients and their families when they are undergoing palliative chemotherapy, whether it be with traditional or novel treatments.

In the United States, the cost of these treatments is borne by patients, usually via medical insurance policies, whilst in the United Kingdom it will be taken on by the NHS provided the drugs were NICE approved and would only be paid for by individuals if they were not.

Reader of Shriver's novel witness a patient going through ultimately futile treatment with significant toxicity, whilst her hopes are inappropriately raised by her oncologist and her colluding family and friends, at least initially however after the cancer and chemotherapy have taken an increasing toll, her husband asked the doctor how must he estimates the treatment has cost. "About two and a half million," replies the oncologist. "What do we get for that," enquires the husband. "I think it gave her a good 3 months extra," says the doctor. "It may have been extra," says the husband, "but none of it was good". This sentiment rings true. Patients expectations of palliative chemotherapy, and particularly the much publicised new drugs, are inappropriately raised by their own hopes, the media, and sadly often by their treating physician.

We do not always detail the precise benefits of these treatments, and indeed many cancer patients think their treatment might extend their life by a number of years whereas in reality, if successful the benefit is measured in terms of weeks or months. This book is a useful and salutary reminder of just what cancer treatments really `cost'.
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on 16 August 2010
Lionel Shriver's latest novel is first and foremost about the death-denying culture all Western countries live in. Not a pretty subject for a novel but her skill as a writer drew me in (against my better judgement at first as I felt I was being manipulated (which I was) and that she was just piling on the agony (which she was). She homes in on the relentless upbeat focus on getting better at all costs. It is a shocking (to a European) indictment of the American healthcare system and she includes a succinct paragraph on the latter's historical context (P.262) so we know how things came to be so. In addition to her central theme, her sharp insights into the way we live now - Property prices "homeowner smugness", Abortion, profound physical disability, modern care homes "architecturally lobotomised" - haunt you after you've put the book down. So all things told, it deserves 5 stars for being a thumping good read though I wonder if we should all be sending David Cameron & Andrew Lansley each a copy as a cautionary tale of what will happen if they let the long arm of capitalism recruit the medical establishment to do its bidding.
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TOP 500 REVIEWERon 7 June 2010
I first experienced Lionel Shriver's writings in her tour de force of a book We Need to Talk About Kevin: a book that left me drained by the powerful feelings and events. In 'So much for that' the author again stirs a tremendous emotional response in me by her heart-rending story of the destruction of Shep Knacker's dreams for his future caused mainly by having to pay huge amounts of money to try and save his wife's life after she's diagnosed with an aggressive form of cancer. Shep is also put upon by members of his extended family and by life in general. This all sounds like a dreary and depressing story, but it isn't. OK, it makes me feel angry at the unfairness of the American health 'service', about which the author is excoriating in her dissection of it's inadequacies, but Shriver's writing is so acerbic, witty and often funny that I am captivated to keep on reading.

The author delves into taboo areas of human feeling and behaviour and makes one wonder at how one would react under similar stressful situations both as the patient or as a bystander to others suffering. There's some grim, and accurate, sections relating Shep's wife's extreme side-effects from her chemotherapy: so not a book, perhaps, for those undergoing similar treatment. Nevertheless, I think it's a terrific book that makes me even more grateful that the NHS exists.

This is one of those books that stays with you long after you've finished reading it. Not only is it an engrossing story, but it is also a thought-provoking analysis of the value of life, beliefs, and how to deal with the approach of death.
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on 15 April 2012
I have to say this is one of the most powerful and memorable books I have read in a long time. I finished it a week ago and haven't started a new book yet as my head is still spinning from all the issues of this book. Lionel Shriver is angry and articulate, which is a winning combination. Her rage is balanced by her humour and you can't help but be drawn in to the lives of her characters. I found the book ultimately uplifting and hopeful- that the human spirit can and does rise above the trappings of capitalism. However, given that David Cameron's hypocritical and disgusting government have just got their healthcare bill through the house of Lords it is a depressing reminder of where we may find ourselves in the UK in the not too distant future. Eat fruit for breakfast and do what you can to avoid the plight of Shep and Glynis as we may not have our wonderful NHS for much longer.
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on 28 March 2010
Amongst other things this book made me realise why we in the UK are so very fortunate to have the NHS and must fight to protect it. I wasn't expecting to enjoy a book about terminal illness, its effects on family and friends, but I found that I did enjoy it immensely. Although So Much For That is at times harrowing and frightening, it is also at other moments very funny indeed. Lionel Shriver's new novel is very rewarding and thought-provoking. I will be recommending it to my friends.
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on 26 August 2012
An interesting book on many levels. As a novel, it is flawed - over-long, laboured in places, lots of telling of irrelevant back-story and a laughably implausible finale. Some of the diatribes I sense belong more to the author than her characters. But it is a page-turner -after the first few chapters where I struggled to get a handle on the characters, especially Flicka, I couldn't put it down.

It's essentially a critique of the consequences of applying market principles to health care. Capitalism relies on creating needs where none previously existed and health care is no exception. The NHS isn't immune - as new drugs and treatments are developed, of course people will want them but at least, so far, the NHS hasn't gone into partnership with the ultimate capitalist racket of insurance, which makes money out of fear.

Few reviewers have mentioned the parallel story to the escalatingly expensive and futile cancer treatment, that of botched penis enlargement surgery - a parallel being the real-life breast enhancement scandal. Plastic surgery in all but the most extreme cases seems to me to be an indicator of decadence ... but then the arguments get more subtle. What about cosmetic dentistry? Botox? In the States I once sat in a restaurant where the lighting revealed everyone had whitened teeth (gleaming an odd shade of blue) and most women had identically perky breasts - it was horrifying and yet if people have the money, who is to say it can't be spent on 'enhancement'.

Other 'health' threads in the novel concern a life-limiting illness and the case of the protagonist's father who can no longer live independently. Throughout, the moral and emotional impacts are explicitly set against the financial cost - chapter headings show Shep's declining bank balance. At the end we learn that prolonging life for a few months through the misery of chemo, cost in the region of 2 million dollars. One of the cruellest and most recognisable elements is the doctor's refusal to be honest about the prognosis and the fake need for 'hope'.

I found the novel disturbing - but was glad to have read it. Like 'Kevin', it holds a mirror to our sick society with its dread of death and aging and refusal to be adult. The portrayal of the African paradise was an idea too far that didn't ring true and glided over the health concerns of those at the other end of the material spectrum. Issues of entitlement, hope, marital and parental obligation are all elements that could keep The Moral Maze going for several weeks. A good one I would imagine for book clubs.
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on 8 July 2010
I am always surprised by Lionel Shriver's writing. Her characters are always unlikeable, her plots always contrived but i find her prose so engaging that everytime i start one of her novels i cannot stop reading until the end. With a topic as grim as terminal illness, marital stress and debt, that can be quite an emotional strain. Shriver has set out to write an indictment of the US healthcare system (or rather, industry) and the characters sometimes seem incidental against the larger issues they debate (and debate them they do, in abstract terms, much more than any real people i know). But somehow i find, as i did with the 'post-birthday' and 'kevin' books, that your own hopes and fears get tangled up with the characters' and you need to see it through. Unlike the previous novels mentioned, I cannot say i really enjoyed 'so much for that' as the overall tone is so cynical, it will also be too close to home for a lot of people due to the difficult social and family issues, but it has a sweet natured centre if you stick with it. I would recommend 'so much for that' to healthcare reformers and, albeit cautiously, to friends.
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TOP 500 REVIEWERon 5 June 2011
The inadequacy of the US health insurance system; the complex, shifting emotions within a relationship in which the wife is struck by possibly terminal cancer; the dynamics of a family in which one child has a degenerative disease: these themes could combine to make a moving and opinion-changing masterpiece, but call for a subtlety and lightness of touch to make so much pain bearable. For the first half of the book I felt oppressed by the opposite, that is, the tsunami of words, the detailed, by turns pettifogging or unsavoury descriptions, lengthy digressions and rambling rants, always three or more examples where one would do. There are also some very original or telling comments, although they are at risk of getting lost in all the verbiage.

The story begins with Shep Knacker packing a bag to present his wife with an ultimatum: the time has come for him to travel to the idyllic African island where he has decided to settle, and he plans to take off whether she accompanies him or not. This could serve to reveal a good deal about our "hero" but instead becomes a pretty negative description of his wife. I would much rather have discovered what Glynis is like through situations and dialogues than be told what to think. Admittedly, some descriptions are very striking:

" art school, Glynis had not chosen her medium by accident. She naturally identified with any material that so fiercely refused to do what you wanted it to, whose form was resistant to change and responded only to violent manhandling. Metal was obstreperous. Were it ever mistreated, its dents and scratches caught the light like grudges." It's the last sentence that stands out for me.

Then the story moves on to Shep's "best friend" Jackson, whose exaggerated diatribes I admit to finding amusing and telling. It took me a while to realise that his sparky but odd daughter is in fact disabled with an obscure physical condition that blights not only her life, but that of the entire family. I felt very discouraged at this stage. Was so much suffering really necessary?

Also, in the midst of the wealth of unpleasant detail about bodily malfunctions, the opportunity is missed to enact, rather than report second-hand , some dramatic scenes, such as the point at which Glynis tells Shep she has cancer, and his initial reactions as his chance to escape evaporates, or to explore his feelings towards a woman he is prepared to leave until he hears of her need for his health insurance. This would not only have made the story more emotionally engaging, but also shown a clearer progression of the character's thoughts. Yet Shriver is capable of being very incisive, as when she closes a chapter with Shep's admission to himself that he only has enough money to realise his dreams if Glynis "dies soon".

As it is, the links between stages in both dialogue and scenes are at times clunky and contrived, and major new developments may seem to occur too abruptly, such as the degree to which Jackson has "reached his limit", when you might have expected Shep to be in this state.

Another limitation is that none of the characters seems to be afflicted by the sense of anguish based on deep love, or the fear of loss of a companion. This may be acceptable for Shep because he is ultra practical and pragmatic, but makes for a less moving story, in which you care too little for in many ways unlikeable people.

Perhaps I became inured to all this suffering, but the book improved for me as I persevered, and the last hundred pages or so seem the best: well-paced, plot strands coming together well, an ending which was remarkably positive, and avoided sentimentality, mawkishness or the cop out of not knowing how to finish the dilemma one has created. However, even here there is a superficiality in the personal relationships, a kind of "cold heart" and skimming round the depths of real grief.

I acknowledge Lionel Shriver's undoubted talent, but wish she had made the book shorter, checked her narrative for overkill (no pun intended), and toned down some of the cynical wisecracking humour, perhaps the product of an attempt to write like an American male.
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on 30 October 2013
I'd not read anything by Shriver prior to reading this, her ninth novel - not even We Need To Talk About Kevin - but was prompted to do so by a doctor commenting that this novel was an accurate portrayal of the impact of a healthcare system which is not free at the point of (ab)use - unlike our beloved NHS in the UK.

While the novel is indeed about the US healthcare system, it's not really ABOUT the US healthcare system - in the same way that Lord Of The Rings isn't really ABOUT elves, orcs and hobbits. So Much For That is about mortality, the meaning of life and human relationships - so, just the boring stuff!

Shepherd `Shep' Knacker is in his early 50s. Throughout his adult life he's dreamed of giving up the rat-race and moving to a developing country where the cost of living is a fraction of that in the US. He and wife, Glynis, use their yearly holidays as reconnaissance missions but as the years go by, as Shep works hard, building up a $700,000 nest-egg, Glynis clearly loses interest.

The novel begins as Shep plans an ultimatum. He buys tickets to Africa and tells Glynis that he's leaving, with or without (but preferably with) her. Glynis listens as Shep attempts to persuade her to accompany him and then drops a bombshell. She has inoperable cancer - mesothelioma - a nasty cancer of the lining of the lungs caused by asbestos exposure.

Shep drops his plans like a handful of hot stones and devotes all his energy to his role as dutiful husband. He's also a dutiful son (to his aged father who ends up in a nursing home), brother (to his feckless, selfish, demanding sister) and friend (to Jackson, his best friend and co-worker).

As the novel unfolds, Shep's nest-egg dwindles alarmingly, Glynis suffers as a result of all the various `treatments' for her cancer, Jackson comes to terms with his own medical problem and rails against `the man', Shep's sister becomes more demanding and the three main characters ruminate on `what it's all about'.

I struggled a little to get into this novel. None of the characters seemed, initially, particularly likeable. Shep seemed to be little more than doormat. Glynis seemed self-absorbed and callous. Jackson seemed simply boorish. But - presumably as a testament to Shriver's writing skills - as the novel progressed so I came to like - and care about - them all.

Some reviewers have praised the book because it tackles the problems of the US healthcare system. Others have criticised it for the same reason. Perhaps due to my medical background, other than some astonishment at the cost, this didn't really get in the way for me at all.

Shriver handles Glynis's terminal illness - and Shep's reaction to it - exceptionally well. I read the last 80 pages or so in one session and was - I'm not ashamed to admit - in tears at certain points. Sure, the ending involved a plot development which wasn't quite believable but, hey, it's fiction!

Shep's surname was something of a stumbling block for me. I kept thinking `Inspector Knacker of the Yard' which will mean something only to those who can recall `The Two Ronnies' (a British TV sketch show) from the late 70s.

A very good book, very well written, about the important stuff in life. Highly recommended. I will be reading some of Shriver's other books in due course.

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on 6 September 2011
I bought this book as the first few pages seems suggestive of a tone of writing and plot that would be of interest - a man sneaks thought his own house packing his bag to flee his so-thought of boring life before he gets too old. Alas, the book quickly descended into a drawn out and rather technical play of illness and fighting against the horrors that is the medical system in America.

Not for me. Well written but more suited to be a book about why America needs to change its health care system then a ficton novel.
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