Signals: The Inside Story of Our Hormones
Author: Saira Hameed
ISBN-13: 978-0571389773
Publisher: Faber & Faber
Guideline Price: £20; 336pp
Chemistry is what we are, a fact underlined by our endocrinology: our hormones. Hormones act as keys or switches or signals in the body, with Signals being the apposite title of Saira Hameed’s excellent overview of disordered functionality in our normally fine-tuned internal milieux.
Hameed immediately argues that endocrinology is a “whole body – whole mind – whole person speciality”. Diagnosis sometimes requires the detective skills of a persistent Columbo type.
She highlights the often-tortuous narratives and plot lines of an endocrine patient’s history-telling, the hunt for a key reveal, the demand that the doctor listen carefully, undertake a close reading of the story.
Rather than a memoir, she gives us a succession of clinical vignettes that major in the pedagogic. We get explications of both common hormonal conditions such as type 1 and type 2 diabetes. Then there’s Graves’ disease, one form of thyroid overactivity, first described by one of Dublin’s finest – Robert James Graves.
There are more recherché albeit fascinating presentations as with an overly sleepy, overly hungry child with a craniopharyngioma, a tumour that impinges “like melted cheese to toast” on the hypothalamus – the Heathrow hub of hormones if you like: Endocrine Central.
Hameed is alert to the fallibility of the medical profession and sensitive to the insensitive use of language when dealing with those suffering from fertility issues or in need of replacement oestrogen or testosterone. She’s witnessed “car-crash” consultations, observed too how endocrinology is “prone to … silver-bullet subterfuge”. By this she means the ludicrous claims made online for “supplements” that lack a solid evidence base.
She’s also stealthily critical of Harley Street, noting that Thomas Addison – still famed for the description of his eponymous disease – was “either unable or unwilling to feign the solicitous emollience needed for a successful private practice”. The antipathy of academia to women in medicine is decried but pointedly Hameed asks the co-inventor of the insulin pen device – Sheila Reith (my old boss!) – to take a bow.
There’s an inherent hopefulness to Signals. Unlike other medical disciplines, the NNT in endocrinology – the number of patients needed to be treated for a drug be effective – is often just one. Hameed is an optimistic cheerleader for a speciality that currently is weirdly underrecruiting.