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4.2 out of 5 stars
So Much for That
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79 of 83 people found the following review helpful
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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45 of 48 people found the following review helpful
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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54 of 58 people found the following review helpful
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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3 of 3 people found the following review helpful
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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36 of 40 people found the following review helpful
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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1 of 1 people found the following review helpful
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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8 of 9 people found the following review helpful
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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19 of 22 people found the following review helpful
TOP 100 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:

"..in 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 15 March 2014
Shep Knacker is our main character along with his wife Glynis and his best friend Jackson. Shep has sold up his family business in the hopes of going to "the Afterlife" traveling to and living in his one chosen place on earth with his loved ones. Years on and he has decided this is the day he is leaving whether his family join him or not, he is going. Sadly his wife has some life changing news and Shep will be staying to help her face her diagnosis and pay for the health care she requires.

The book gives a bleak look at how much health care in the US can cost both between Glynis and his friends little girls care, she has FD, Familial dysautonomia. The book has a lot of medical information both on Glynis's condition and Jackson's daughter. I found this really interesting but have to say the book isn't purely about cost or the medical system however it is a large theme throughout the story.

Shep is a fairly simple chap, has done well financially and wants to move to a more civilized country. His nature and duties keep him home to look after his wife. He is a doormat, used by just about everyone in his life and it isn't long in the story before we find out and see how little he is respected. The characters are not very nice people at all, I actually hated his sister who is one of the most vilest creatures I have ever read about.

I am never sure how I feel about this writer, I read we need to talk about Kevin, started off not impressed then couldn't put it down. This one captured my interest, however had the medical side not been in it I am not sure I would have found it as engaging as I did. It is a book that certainly makes you think and I wanted to see it out to the end. 3/5 for me this time, I would read this author again but won't be rushing out to buy all her work.
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on 20 November 2013
This well expressed opinion does not offend for the usual reasons that a review might. It is, however, inappropriate because it centres upon one aspect of the book and uses it to express an opinion on the cost and ineffectiveness in the use of chemotherapy in the treatment of cancer. The contributor describes himself as an oncologist and, therefore, claims authority for his view. As well as questioning the efficacy of palliative treatment, it juxtaposes cost against limited life extension and questions the false hope extended by medical carers that is often clung to by families and patients. The view is reasonable as one perspective but it far from the only one.

The reviewer continues: "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." Worse, it goes on to write: "Patients expectations of palliative chemotherapy, and particularly the much publicised new drugs, are inappropriately raised by their own hopes". Really? Diagnosed at various times with three types of cancer, the latest one required bone marrow transplant that my age forbade. Kept alive by regular and massive blood transfusions, I had the time to read on the internet of a limited trial by St Thomas' Hospital of the use of Thalidomide. Thanks to this, four years later, I am still around and able to make a nuisance of myself by objecting to inappropriate reviews. Years, not weeks.

There may well be readers of these reviews for whom this hope is important and who may not have chosen to stumble upon such a bleak representation by a "professional" in a book review of a fine writer. I suggest that such generalised opinions are best left to dedicated areas of the internet for these discussions and medical journals where they can be knowledgeably argued against. "Hope" is not solely the preserve of a specialist in this type of illness and best left to discussions between the individual patient and their consultant.

Lionel Shriver is a superb writer. She deserves literary criticism not a questionable clinical exposition.
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