Stephen Klaidman On "Saving the Heart."

Show: FRESH AIR
Date: MARCH 07, 2000
Time: 12:00
Tran: 030701np.217
Type: FEATURE
Head: Medical Journalist Stephen Klaidman Discusses `Saving the Heart'
Sect: Medical
Time: 12:06

This is a rush transcript. This copy may not
be in its final form and may be updated.

BARBARA BOGAEV, GUEST HOST: From WHYY in Philadelphia, this is FRESH AIR.

I'm Barbara Bogaev, filling in for Terry Gross.

On today's FRESH AIR, the multibillion-dollar cardiology business. We talk with medical writer and ethicist Stephen Klaidman. His new book, "Saving the Heart," chronicles the history of heart disease treatments and how financial incentive can influence decisions about patient care.

Also, senior editor and columnist Barbara Wallraff of "The Atlantic Monthly" tells us about editing novelists and academics. She has a new book about language usage.

Rock critic Ken Tucker reviews "Voodoo," the new CD by the R&B singer D'Angelo.

And music critic Milo Miles reflects on the world musicians who have died of AIDS and the secrecy that surrounded their illness.

That's all coming up on today's FRESH AIR.

First, the news.

(NEWS BREAK)

BOGAEV: This is FRESH AIR. I'm Barbara Bogaev, filling in for Terry Gross.

In the past 30 years, new drugs and high-tech treatments such as angiograms, bypass surgery, and angioplasty have cut the death rate from coronary artery disease in the United States by 50 percent. Still, heart disease kills more than 700,000 people each year. That's more than cancer, strokes, and AIDS combined.

Costing some $90 billion health care a year, heart disease is a high-stakes specialty.

In his new book, "Saving the Heart," Stephen Klaidman examines the collaboration between heart disease specialists, medical technology entrepreneurs, and drug companies that has given rise to the high-tech cardiology industry. And he suggests that profit motive and conflicts of interest might be adversely affecting patient care. Klaidman is a senior research fellow at the Kennedy Institute of Ethics at Georgetown University.

He points out that after you've had a heart attack, you have to decide which treatments and procedures will be the best for you. I asked Dr. Klaidman if the data is conclusive about which treatments are most effective -- if you do your research, whether it's clear which path to take.

STEPHEN KLAIDMAN, "SAVING THE HEART": No. Except in a relatively small number of cases, if your blocked arteries, your left main coronary artery, which feeds blood to the left ventricle, which is the main pumping chamber of the heart, then in most cases surgery is indicated, and you get better results in surgery.

If you've had three blocked arteries and your left ventricle is not pumping adequately, once again the chances are pretty good that surgery is your best choice.

With many other things, maybe most other things, the best cardiologists, the best surgeons are likely to disagree about what the optimal treatment will be. And even with surgery are many different kinds of surgical treatments that you can use.

So you need to learn a lot, but even when you've learned a lot, you still may end up making your decision based on really nonmedical considerations that have to do with your quality of life after the treatment.

BOGAEV: In your book, you write about the history of the many high-tech treatments, surgical and nonsurgical, that have been developed over the past few decades for -- to treat coronary artery disease, and you look at bypass surgery, which was, I suppose, the first surgical technique.

And you write that throughout the '70s, there were a number of studies conducted of the value and the effectiveness of bypass surgery that questioned whether it worked or not, or whether it was, as you write, "an expensive pain reliever." But at the same time, more and more surgeons were performing bypass.

Do you see it, the story of bypass surgery, as a cautionary tale about this and other high-tech interventions, especially in cardiology, that their use and their popularity outrun the research?

KLAIDMAN: It's a cautionary tale with a relatively good outcome, that is to say, bypass surgery was being used hundreds of thousands of times before it was absolutely clear that it was a treatment that would provide a sufficient benefit to warrant the use of such a highly invasive procedure.

Over time, after the three big clinical trials that were conducted, I think it's safe to say at this point that in a great many cases, it is the best available treatment.

But once again, some of the reasons for that are quality of life reasons as opposed to strictly medical reasons, such as a better mortality outcome. In other words, that you're less likely to die. And there are things like the length of time you can count on having a normal life after the surgery's been performed. Generally speaking, it's a lot longer than with angioplasty, and with state-of-the-art bypass surgery today, you may get 15, 20 years or more of pain-free, active living.

With angioplasty as opposed to bypass surgery, you might find yourself back in the lab three to six months later having another procedure. This happens in 30 to 40 percent of the cases.

So these are the kinds of choices you might have to make. Even when drugs enter into the picture, some people would prefer not to take drugs every day for the rest of their life, so they will opt for surgery. Other people would simply prefer never to have their chest cut open.

BOGAEV: So let's talk about weighing the nonsurgical options. Angioplasty -- first, I have to say, it has a kind of amusing history. You write that it was invented by a guy nicknamed Crazy Charlie?

KLAIDMAN: Well, he invented the original technique in the peripheral arteries, not in the coronaries. Crazy Charlie Goddard (ph), who I think probably was called Crazy Charlie mainly by surgeons who were worried that he was going to take away some of their business, he had the unfortunate look of a madman. But I don't think he was really anything but clear-minded and sane.

BOGAEV: Now, the technique was perfected or developed in the late '70s, but it took off immediately. Did the clinical results justify its popularity, or is angioplasty a good example of, I suppose, the thesis of your book, that high-tech intervention appeals to surgeons for reasons sometimes that have nothing to do with patient care?

KLAIDMAN: I think it's probably the best example in the book. And I've quoted one very renowned interventional cardiologist to the effect that we probably do 50 percent more angioplasties a year in the United States than we need to do. Other cardiologists think his number might be a little bit high, but they agree in principle and think it's 25 percent, 35 percent, maybe 100,000 additional angioplasties a year in this country, maybe 250,000 worldwide, that really aren't necessary.

Now, there are all kinds of factors driving that. I mean, one is what they call themselves the oculostenotic effect. You see a blockage and you open it, whether there's a clinical reason to do that or not. And there also, as I mention many times in the book, financial reasons for using an interventional treatment.

This is something cardiologists can do for which they get a lot of money. If they prescribe drugs, the drug companies get rich. If they send the patient to surgery, the surgeons get rich. This one they can do themselves, and it pays well.

BOGAEV: Well, what makes things even more complicated for patients considering options is that there's a whole battalion of differing techniques and systems for performing some of the new what they call minimally invasive surgeries. You profile one company called HeartPort. They are pioneering a technique of keyhole surgery.

What does their story tell us about the way in which market forces influence how heart disease is treated?

KLAIDMAN: Well, I think it's worth looking at two companies at the same time, because they came along right about the same time, and they took on the same challenge in two different ways. And HeartPort was one of them, the other one's called Cardiothoracic Systems.

HeartPort developed a system to treat coronary artery disease through a small incision using a heart-lung machine and stopping the heart while the surgery was being performed, which is the way it's done in traditional bypass surgery, the difference being that you're now operating through a small incision.

The other company, Cardiothoracic Systems, developed equipment to do the same kind of operation on a beating heart, not using a heart-lung machine. When they started up in the mid-'90s, HeartPort was miles ahead. They had started earlier, they had a large market capitalization, pushing a billion dollars, and C.P.S. had to catch up with them.

The financial community was placing its bets. And for the most part in the beginning, they were placing their bets on HeartPort because they thought the advantages were that using the heart-lung machine, you could manipulate the heart and you could do surgery on arteries on all surfaces of the heart, whereas the beating-heart procedure was limited to arteries on the front surface of the heart. You could not manipulate it because it was beating.

And so early on, there was a tremendous run-up in the HeartPort stock. To make a long story short, we're now roughly four years down the road. HeartPort has a market capitalization in the range of $50 million. Cardiothoracic Systems is probably close to 10 times that at this point, or maybe not quite that much. And it turns out that surgeons simply found the HeartPort procedure too hard to do.

It still probably has a future, because it is true that it gives you greater flexibility in performing the surgery. But for the moment, the surgeons that do heart operations, the small number that are doing these keyhole operations, are finding it more comfortable to do it on a beating heart than to try to use a catheter-based system to hook up the patient to a heart-lung machine and to use the very long instruments that were developed to do the surgery through this keyhole incision.

BOGAEV: Where does this leave the patient? I suppose this is the story of medicine, this melding of technology, of commerce and science. There's nothing really all that new there. There were always snake oil salesmen and there were always drug companies peddling drugs to doctors, now directly to consumers.

Is your point that it's a matter of scale with the new high-tech interventions, that commerce is now dangerously tipping the scales away from patient safety or patient consideration more than ever before?

KLAIDMAN: I think it's correct to say that it is tipping the scales in that direction. Whether it is at this point tipping the scales dangerously in that direction or not is a very hard judgment to make. I think that many clinical judgments are being made with a commercial consideration, where in the past there was none.

Surgeons, angioplasty operators, have interests in companies. They have interests in specific procedures. They've always had intellectual interests. Now they have financial interests as well. And I think that when such interests enter into a clinical decision, there is a risk that a patient will get an inappropriate treatment.

And I think there is a genuine need to be concerned about that. I have to say that some of the best cardiologists I've talked to over the last three years are concerned about it. There is talk about it in the community. But at the moment, none of them seem quite sure just how to get a handle on it.

BOGAEV: Well, surgeons using these methods, what's the data on their holding stock in the companies, or how much they could be or are swayed by financial investment?

KLAIDMAN: The answer to the first question is that some of them do hold stock. The amounts vary dramatically. I recount the story of one interventional cardiologist who had a roughly $10 million stake in a company and who was also the head of the clinical trial that was testing the device, the principal investigator on the clinical trial that was testing the device. That's about the clearest conflict of interest I've ever seen, and this particular fellow claimed that there are no such things as conflicts of interest. He didn't believe in them.

I talked to numerous surgeons who are using the new keyhole procedures, and at least three that I can think of offhand held small stock positions in the companies. It varies widely. And we're -- it's worth noting also that you tend to be talking about some of the very best surgeons who have these interests, because they're the ones that the companies are interested in having with them. They're the ones who are innovative and devise these new procedures.

BOGAEV: Do you think that these surgeons should be banned from having financial stakes in medical technology? And is that even realistic?

KLAIDMAN: I don't think it's realistic. I think surgeons, physicians, all have a duty, a moral duty, to let their patients know what kinds of conflicts they have. And I suggest in the book that this be done very simply, that they produce a very straightforward form in which they lay out their financial holdings, their financial conflicts of interest.

This is not going to put an end to conflict of interest, it's not going to put an end to bias. It's just going to be one more warning for people who are faced with making decisions about treatment. And I think it's a right-to-know issue.

BOGAEV: You said it's a moral obligation. Should there be a policy of full disclosure?

KLAIDMAN: I think there should be. I think the professional societies, like the American College of Cardiology, the American Heart Association, which is a different kind of organization, but the major organizations in the field probably ought to take a stand on this issue about disclosure.

BOGAEV: Stephen Klaidman is my guest. He's a senior research fellow at the Kennedy Institute of Ethics at Georgetown University. His new book is "Saving the Heart," about developments in treating coronary artery disease. We'll talk more after this break.

This is FRESH AIR.

(BREAK)

BOGAEV: My guest is medical journalist Stephen Klaidman. His new book about coronary artery disease is called "Saving the Heart."

Do you also see commercial factors affecting the way in which specialists in cardiology and these other high-tech fields practice, in that they're becoming more focused on the research, rather than the clinical work, whether there's a pull towards research and technology development?

KLAIDMAN: One of the things I regret not having done for this book is to try to figure out just what percentage of the community of cardiologists are actually involved in research in any serious way. One thing that is fairly clear is that a lot of the ones who are at the top of the profession are involved in research because it's the researchers who publish in the journals and build their reputations.

I'm not convinced that the best researchers are necessarily the best clinicians. I think there's little doubt that there are people with tremendous clinical skills, that is to say, they know how to evaluate a patient, they know how to take a patient's history, they know how to evaluate clinical trial results and apply them to an individual patient, and it's tremendously important to remember that patients are all different, their disease manifests itself in different ways, and the results of any clinical trial are statistical averages.

A good clinician is somebody who figures out how to treat the patient in front of him. And there are plenty of physicians like that who do not go anywhere near research. They're just good clinicians.

But I think it is probably safe to say at this point that the field is being driven by research, by the development of new devices almost day in and day out. And it makes it very hard for nonresearch-oriented practitioners to keep up with the latest advances. And you are absolutely right that a lot of the high-tech treatment that is done is consumer-driven, that is to say, a patient comes in and says, I've read about this, I want it.

BOGAEV: Now, you write that cardiology is the high-tech field. Is the rest of medicine -- and you've been covering -- you've covered medical issues for 23 years as a journalist -- is the rest of medicine following in cardiology's wake? And do you see a problem with that?

KLAIDMAN: I think that cardiology is, given the size of the field, it's an exception. I don't -- you know, cancer treatment, for example, is less device-oriented than cardiology. I mean, high tech becomes a term of art here. For example, in many areas of medicine now, the cutting edge research is in genetics. And certainly there's a strong sense in which genetics is high-tech medicine, when you're talking about analyzing the genetic causes of disease, isolating individual genes that influence specific disease processes, you're using very high-tech technology to carry out these experiments.

The difference with cardiology, I think, is that it's actually in treatment that you use these methods, and in an odd sort of way it's technology, but is it really high tech? I mean, surgery is still surgery, even if you do it through a small incision. Putting a -- you know, a plastic tube into somebody's artery and threading it up -- femoral artery and threading it up into the coronaries is almost a plumber's technique in a way, you know.

So "high tech" in a way is misleading. I think "device driven" is probably a better term. You're using an awful lot of hardware in coronary disease, in heart disease, probably more so than in most other areas. Ophthalmology, I mean, there are other fields in which there's sophisticated hardware being used as well.

But because of the volume, coronary disease stands out.

BOGAEV: Stephen Klaidman, I want to thank you very much for talking with me today on FRESH AIR.

KLAIDMAN: It's a pleasure. Thank you for having me on the show.

BOGAEV: Stephen Klaidman's new book is "Saving the Heart: The Battle to Conquer Coronary Disease."

I'm Barbara Bogaev, and this is FRESH AIR.

(BREAK)

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 877-21FRESH
Dateline: Barbara Bogaev, Philadelphia
Guest: Stephen Klaidman
High: Medical journalist Stephen Klaidman Medical journalist Stephen Klaidman is Senior research fellow at the Kennedy Institute of Ethics. His new book, "Saving the Heart: The Battle to Conquer Coronary Disease," takes a look at the treatments developed -- like angiography and balloon angioplasty -- to help patients recover from the damages of heart disease. He also charts the way the field of cardiology has become a multi-billion dollar business, and the conflict that arises between medical ambition and financial incentive and the best treatment options for patients.
Spec: Health and Medicine; Media; Diseases

Please note, this is not the final feed of record
Copy: Content and programming copyright 2000 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 2000 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Medical Journalist Stephen Klaidman Discusses `Saving the Heart'

Show: FRESH AIR
Date: MARCH 07, 2000
Time: 12:00
Tran: 030702NP.217
Type: FEATURE
Head: Barbara Wallraff Discusses `Word Count'
Sect: News; Domestic
Time: 12:45

This is a rush transcript. This copy may not
be in its final form and may be updated.

BARBARA BOGAEV, GUEST HOST: This is FRESH AIR. I'm Barbara Bogaev, in for Terry Gross.

It's been five years since R&B singer D'Angelo has released a new CD, but that didn't prevent his new collection, "Voodoo," from going straight to number one the first week of its release. Rock critic Ken Tucker examines the appeal of the 25-year-old singer and songwriter.

(AUDIO CLIP, SONG EXCERPT, D'ANGELO)

KEN TUCKER, ROCK CRITIC: D'Angelo doesn't make any pretenses about doing anything particularly original on "Voodoo." His liner notes cite all the influences you hear on this CD, Stevie Wonder, Marvin Gaye, Jimi Hendrix, George Clinton, Sly Stone, Al Green.

What D'Angelo has tapped into is a young audience not very familiar with this 1970s canon of rhythm and blues, and he summons up the aura of that era very enjoyably.

(AUDIO CLIP, SONG EXCERPT, D'ANGELO)

TUCKER: At a time when most black male pop artists are working in the hip-hop territory, D'Angelo is an unabashed romanticist who concentrates on luring female listeners into his musical bachelor pad. If you've seen the video that accompanies this next song, called, "Untitled: How Does It Feel," you know what I'm talking about.

The wildly popular video is just a shot of D'Angelo, stripped to the waist to expose an exceptionally buff bod, flexing and posing while, oh, yeah, singing.

(AUDIO CLIP, EXCERPT, "UNTITLED: HOW DOES IT FEEL," D'ANGELO)

TUCKER: Five years ago, D'Angelo's debut album, called "Brown Sugar," suggested a crooner who was looking to revive the ballad style of Teddy Pendergrast (ph) and Smokey Robinson. The new "Voodoo" has a rougher edge and, more daringly, long song lengths that take their instrumental time to work up to D'Angelo's nothing-special, pitching-woo lyrics.

It means that most of his songs will have to be shortened for radio air play. We've been lopping off the long instrumental intros to most of the songs I've played here. But it also means that "Voodoo" works best at home for the listener as a fine, leisurely makeout album.

(AUDIO CLIP, EXCERPT, "THE LINE," D'ANGELO)

TUCKER: That song is called "The Line," and that's how D'Angelo comes across, as a smoothie with a line for the ladies. His image regularly veers into unctuousness. Unlike his heroes, Marvin Gaye and Stevie Wonder, D'Angelo doesn't really have much to say, but the guy's only in his mid-20s, and maybe once the lure of the gym fades and his pecs get a little saggy, he'll start flexing his equally impressive musical muscles to craft a makeout album with brains as well as brawn.

BOGAEV: Ken Tucker is critic at large for "Entertainment Weekly."

Coming up, "The Atlantic Monthly"'s grammar maven.

This is FRESH AIR.

(BREAK)

BOGAEV: Barbara Wallraff is "The Atlantic Monthly"'s Miss Manners of grammar. A senior editor at the magazine, she also writes a regular column in which she both humorously and tactfully answers readers' questions about English grammar and word usage.

Now she's collected the best of the columns in her new book "Word Court." In the book, you'll finally learn the difference between "nauseated" and "nauseous," whether it's OK to sometimes split infinitives, and how to use the word "like" correctly.

Terry Gross spoke with Barbara Wallraff recently about working with writers at "The Atlantic" and dealing with a reader's queries about English grammar.

TERRY GROSS: You once got a letter about a sentence that you'd written, and the sentence was, "This isn't something that we can blame President Clinton for." What was the reader's problem with your sentence?

BARBARA WALLRAFF, "WORD COURT": It's that old preposition at the end thing. And people who care about language learn from their English teacher, who cared about language, learn from her English teacher, who cared about language, that you're not supposed to put prepositions at the ends of sentences.

But if you trace this back to where it came from, it had to do with what was good sentence structure in Latin, and it's -- there are a million situations in which the natural way to write that sentence, to say that thing, has a preposition at the end of it. There were a lot of people kind of in support of what I was saying about prepositions at the end, were telling me about Winston Churchill's famous remark, when somebody had changed a preposition at the end of one of his sentences, "That is something up with which I will not put."

And that sentence certainly does a good job of telling you that putting the preposition out of the end position does not make a sentence sound better or more natural.

GROSS: So this all dates back to Latin, huh?

WALLRAFF: Well, some of it does. There are a lot of bits and pieces of our language that are from Latin. There are a lot of strictures that grammarians have been handing down that have to do with Latin, like the rule about not splitting an infinitive. Splitting infinitives is something that you could not do in Latin because the infinitive was one word, so at some point someone thought it would be a good idea to say that we shouldn't split infinitives in English.

GROSS: There's a few usage things that really constantly baffle me, like when to use "that" and when to use "which." And I've even read usage books about this, and I find that within several days I've forgotten whatever it is I have learned about "that" and "which."

WALLRAFF: Oh, Terry, did you read my -- is it three or four pages on that topic?

GROSS: Yes. Summarize, like, how we should deal with "that" and "which" for us.

WALLRAFF: Well, the phrase that everybody tells you, and it comes from "The Elements of Style," is, "the lawnmower that's in the garage" versus "the lawnmower, which is in the garage." That "lawnmower that's in the garage" kind of implies that there are other lawnmowers, and I'm talking to you about the one that's in the garage. But if I say "the lawnmower, which is in the garage," that implies that there is one lawnmower, and I'm just happening to tell you where it is.

GROSS: Well, you make it sound simple.

WALLRAFF: Is this doing it for you?

GROSS: Yes, that's very good. I mean, that's a question of remembering which is which.

How about "different from" and "different than"? Which is correct?

WALLRAFF: Well, the simple answer about "different from" and "different than" is just that "different from" is standard American English, and "different than" is arguable. You should try, if you can, to put together a construction that uses "different from." And if you absolutely can't, if you end up with something like, "This word has a meaning different from that which I thought it had," and you just absolutely wince at a point like that, you're allowed to head for "This word has a meaning different than I thought."

GROSS: You write in your book that you're concerned with what you describe as "durable usage." What do you mean by that?

WALLRAFF: The first thing you see when you walk into "The Atlantic Monthly"'s offices is wall of "Atlantic"s stretching back to volume one, 1857. And you can pull one of those old books off the shelf and begin reading excerpts from a novel by Henry James or something by Walt Whitman or something by Henry David Thoreau. And suddenly you are transported into the mind of a person who lived 140 years ago.

To me, that is a really magical thing about language, that you know what somebody else was thinking. And we mess up our ability to understand what people were thinking the more we allow language to change freely. And I wouldn't say that there aren't new words, like "to fax" or "to roller blade" that we need, because there weren't fax machines in Thoreau's day. But where we have thoughts that remain pretty much the same, or things that remain the same, keeping the words that refer to them the same, so that we will be able to understand -- so that people in the future will be able to understand us as well as we can understand people from the fairly remote past.

If you go back and look at Chaucer, you can barely follow that at all, and it's because language has changed so much since that point. So I really believe in trying to keep language similar to the way it was 50 years ago and hope that it'll stay similar 50 years from now so that people will be understand us.

GROSS: Do you find that younger people in particular are always objecting to certain rules of grammar because either they didn't learn them, or they found them too complicated, and they think why bother? What -- people will understand me. What's the difference?

WALLRAFF: You know, and we all have dialects, or we all have ways of talking that we use with our friends when we're in private contexts. Every little subculture has its own little aspects of language that are private. But there should be -- there is a public language, and it is standard English. It's the language that sort of the leaders of everything throughout America speak.

And it's nice to have both. It's nice to have your own way of speaking in your own community, and a common way of speaking that we can all share.

GROSS: As somebody who speaks live, or live on tape, on the radio, I wonder if you think that speech should be treated differently than writing when it comes to the role of grammar, rules of grammar. In other way -- in other words, should I be allowed to get away with a little bit more than the writers in "The Atlantic"? Because they can write and they can edit themselves. They have you to edit them afterwards. Whereas I'm just talking as I'm thinking out loud.

WALLRAFF: Well, on the one hand, you're absolutely right, I think that every writer needs an editor, and that we all write things that we think we haven't put well and have a chance to revise, and it comes out a lot better. And if I'm doing a book signing or an event like that, I like to do some reading and some regular speaking, because I think you can see the difference in the forms of language by that.

But on the other hand, I have to tell you that I get a lot of letters from people who are annoyed when people like you, who are paid to speak, don't speak properly, and the feeling is that if you -- if this is your job, you should do it well. So I'm not sure everyone is willing to grant you extra leeway.

GROSS: Well, that does seem fair. If it's your job, you should do it well. That's -- it is a good point. (laughs) Does it...

WALLRAFF: You're doing beautifully. You are.

GROSS: Does -- do people get nervous when they talk to you? Do they get nervous about their grammar and start correcting themselves mid-sentence?

WALLRAFF: They do. I'm really sorry about that, and I'll have to say something egregious just to calm them down.

GROSS: (laughs) How do you think you learned grammar? Did you have particularly good teachers when you were young? Do you think you just were particularly interested in it, or had a good ear for it, the way musicians have a good ear for music?

WALLRAFF: It all started when I was very small, and my father would correct my grammar and correct my pronunciation. "The word is not `COMF-ter-ble' but `COM-for-ta-ble,'" things like that.

I realized when I became a young adult, when I went off to college, I'd come home and then maybe I'd borrow a novel from the bookshelf to take back on the plane with me. I realized he was a little more that way than most people because all the typos would be neatly corrected in the margin, and the first time some -- a character was referred to, if the character's name was John, and they didn't tell you -- the author didn't tell you the character's last name, there'd be a little asterisk by John's name and down at the bottom of the page, the last name of the character would appear and a page reference for where it first was.

So being very careful about language and having a lot of respect for words was something that I was just brought up in.

GROSS: Didn't it irritate you when your father would correct your grammar or your pronunciation?

WALLRAFF: Oh, no, I don't really think so. I loved my father, and it was part of his teaching me how to be a proper adult.

GROSS: Do writers ever take it personally when you make a change in a sentence?

WALLRAFF: Sometimes they do, but you try to make it clear to them that it's not meant as a personal thing. And it you don't put your work in terms of, I changed your sentence because I like my version better, but put it in terms of, Well, here, see what you think.

There was a sentence, "Confronted with the lack of sure knowledge, many assume that they are being manipulated for devious political reasons." And you think about that sentence, and you know what it means, but I changed it to, "Uncertainty makes many people mistrustful." And the writer too can see that that's a lot easier of a thought to get your mind around.

GROSS: It's both clearer and more graceful.

WALLRAFF: Thank you. Thank you.

GROSS: (laughs) Can you edit yourself as well as you edit other people?

WALLRAFF: I like to think I can. There is a period -- for me, there's a period when I've written something that all I -- I feel like a writer about it. If I can wait for a few days or weeks or months, I can look at it again. And I did have the opportunity with the "Word Court" book to look at the manuscript some months later. There it was in galleys, it wasn't even in my own typescript. And I found that there were places where I was able to be my own editor, and I like to think helped myself a lot. I'd think, Oh, wait a minute, I forgot to make that point.

So if -- given time, I can do both things. And I do think I'm a better editor than I am a writer, so it's helpful.

GROSS: Well, Barbara Wallraff, I want to thank you very much for talking with us.

WALLRAFF: Thank you.

BOGAEV: Barbara Wallraff is a senior editor at "Atlantic Monthly." Her new book is "Word Court."

(BREAK)

BOGAEV: Coming up, Milo Miles on the secrecy surrounding world musicians who have died of AIDS.

This is FRESH AIR.

(BREAK)

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 877-21FRESH
Dateline: Barbara Bogaev, Philadelphia
Guest: Barbara Wallraff
High: Barbara Wallraff is senior editor at "The Atlantic Monthly" and author of the magazine's "Word Count" column. Her new book about language usage is "Word Count: Wherein Verbal Virtue Is Rewarded, Crimes Against the Language Are Punished, and Poetic Justice Is Done."
Spec: Media; Television and Radio; Education

Please note, this is not the final feed of record
Copy: Content and programming copyright 2000 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 2000 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: Barbara Wallraff Discusses `Word Count'

Show: FRESH AIR
Date: MARCH 07, 2000
Time: 12:00
Tran: 030703NP.217
Type: FEATURE
Head: World Music Suffering at the Hands of AIDS
Sect: News; International
Time: 12:52

This is a rush transcript. This copy may not
be in its final form and may be updated.

BARBARA BOGAEV, GUEST HOST: When Israeli singer Ofra Haza died on February 23 at the age of 41, the cause of death was reported as massive organ failure. The day after her funeral, the Israeli newspaper "Ha'Aretz" confirmed rumors that Ofra Haza had died of AIDS.

Known internationally for her crossover dance tunes, Haza was a hero to her native conservative Yemenite community, and there was a huge outcry from them about respecting her wishes for privacy. Her family had requested the facts not be released while she was still alive, but the secrecy was maintained after she died.

Music critic Milo Miles says the stories of Haza and two other world music stars who struggled with the illness underscores the difficult legacy of AIDS.

(AUDIO CLIP, SONG EXCERPT, OFRA HAZA)

MILO MILES, MUSIC CRITIC: The international music community has dealt with superstars dying of AIDS for well over a decade now, and sadly, very little has changed. The recent death of Ofra Haza immediately brings to mind the terminal illness of Franco of the Democratic Republic of the Congo and Fela Kudi (ph) of Nigeria. In varying degrees, all three cases reflect the severe discomfort that still clouds any discussion of AIDS.

When guitarist and bandleader Franco died in 1989, he was probably the most famous musician in Africa. He did more than anyone else to create Succus (ph), the most widely popular style of music in the continent. Known as the sorcerer of the guitar, he was a huge, roly-poly fellow, and whispers began when he appeared suddenly thin and haggard on new album photos.

He came clean to the extent that one of his last hits was the very pointed anti-AIDS anthem, "Attention le SIDA (ph)."

(AUDIO CLIP, EXCERPT, "ATTENTION LE SIDA," FRANCO)

MILES: Despite "Attention le SIDA," Franco's circle denied the rumors to the end and claimed liver disease was the problem.

Fela Kudi's denial went way beyond that. He had been an all-purpose fighter against oppression in his career, and he plainly considered the stigma of AIDS to be his final enemy.

(AUDIO CLIP, EXCERPT, JAZZ PIECE, FELA KUDI)

MILES: Fela vigorously denounced any suggestion that he had AIDS, even ignoring the advice of his physician brother. This is Fela at his mystagogic anti-Western knowledge worst. Reportedly many of his uneducated fans still refuse to believe that such a potent and powerful star could die from AIDS.

It's a very sour note to conclude a tumultuous and fascinating career, but it's just as discordant to reduce Fela to nothing more than a famous AIDS denier. In fact, the persistent obsession with the way Franco and Fela died gives support to Ofra Haza's desire to keep the secret. She certainly feared not only the shame attached to the disease, but that it would become the first thing anyone remembered about her.

Courage and frankness are the only weapons that can vanquish the disgrace that shadows AIDS. At the same time, the living have a responsibility to the famous dead. We must not let their tragic end become their main story.

BOGAEV: Milo Miles is music editor at Rock.com.

FRESH AIR's executive producer is Danny Miller. Our interviews and reviews are produced by Amy Salit, Phyllis Myers, and Naomi Person, with Ann Marie Baldonado, Monique Nazareth, and Patty Leswing, research assistance from Brendan Noonam.

For Terry Gross, I'm Barbara Bogaev.

TO PURCHASE AN AUDIOTAPE OF THIS PIECE, PLEASE CALL 877-21FRESH
Dateline: Barbara Bogaev, Philadelphia, Milo Miles
Guest:
High: With the recent death of Israeli singer Ofra Haza to AIDS, World music critic Milo Miles reflects on the world musicians who have died of the disease, and the secrecy that surrounded their illnesses.
Spec: Music Industry; AIDS; Diseases; Death

Please note, this is not the final feed of record
Copy: Content and programming copyright 2000 WHYY, Inc. All rights reserved. Transcribed by FDCH, Inc. under license from WHYY, Inc. Formatting copyright 2000 FDCH, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to WHYY, Inc. This transcript may not be reproduced in whole or in part without prior written permission.
End-Story: World Music Suffering at the Hands of AIDS
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.