Man is an animal suspended in webs of significance that he himself has spun...

Thursday, August 28, 2014

US Citizenship Renunciation Fees to be Raised 422%

The rumours over at the Isaac Brock Society are confirmed.  This morning in my mailbox was this link from a lovely lady in the UK.

Renunciation of U.S. Citizenship About to Get More Expensive: From $450 to $2,350

That is, as the blogger points out, a 422% increase.

And the State Department's justification for this rather outrageous fee raise?

Well, it's a complicated labor-intensive procedure:
"The CoSM demonstrated that documenting a U.S. citizen’s renunciation of citizenship is extremely costly, requiring American consular officers overseas to spend substantial amounts of time to accept, process, and adjudicate cases. For example, consular officers must confirm that the potential renunciant fully understands the consequences of renunciation, including losing the right to reside in the United States without documentation as an alien. Other steps include verifying that the renunciant is a U.S. citizen, conducting a minimum of two intensive interviews with the potential renunciant, and reviewing at least three consular systems before administering the oath of renunciation. The final approval of the loss of nationality must be done by law within the Directorate of Overseas Citizens Services in Washington, D.C., after which the case is returned to the consular officer overseas for final delivery of the Certificate of Loss of Nationality to the renunciant."
And demand for this service is strong (yep, they say that).  450 USD, they say, was already below cost and they are just raising the fee in order to not lose (more) money on the service.

Now I'm just an old lady and I don't pretend to be the brightest crayon in the box but if the goal here is to "break even" then they are looking at this all wrong.  Read the outline of the procedure again. Does that sound efficient to you?  Just the assumption that any US citizen showing up to renounce his US citizenship doesn't really understand what he/she is doing and has to have it explained ad nauseum (intensive interviews?) and then be sent off to a corner like a little kid to reflect on it before being allowed to come back and do the deed, is just ridiculous.  Right there I'd say just treating people like adults and assuming that they do know their own mind would save a lot of time, money and hassle all around.

And the narrative that will come out of this fee raise is not likely to focus on "cost recovery" at US consulates around the world but on what is going to be perceived as a punitive act on the part of the US government.  It looks like they are so embarrassed by the renunciation numbers and the lines to renounce at the US consulates that they are looking for ways to reduce or slow down the demand.  Think about that.  Has the state of US citizenship in the world really come to the point where the US government thinks that Americans have to be actively discouraged from renouncing?  

That is what people are likely to take away from this news.  That the United States is trying to keep it's citizens captive by finding quasi-legal methods to interfere with their right to expatriate under international law.

(And there is a very good post and a lively discussion (as always) over at the Isaac Brock Society here.  79 comments already as I type this. )

Wednesday, August 27, 2014

Why I just One-Starred a Book on Goodreads

Picked up a book this morning with enthusiasm.  A non-fiction book (I won't tell you which one) that got a 4+ rating on Goodreads and a mention on a site I respect.

30 minutes of reading and I came to a paragraph that went something like this:
There is a personality trait that is perceived to be very desirable and very important for getting along in today's world.  This personality trait, according to two sources the book cites, is related to DNA and is primarily found in Europeans and North Americans, not in Asians or Africans, because the former are descendants of emigrants.
That is just an unbelievable assertion to make and, frankly, that kind of argument for me is pure racism.

So I closed the book, deleted it from my Kindle and went straight to Goodreads and gave it a one-star rating which means, "I did not like it."  What I didn't do was a write a review expressing my feelings and explaining my rating.

Left the house, did my morning shopping and now I'm back and really wondering if I did right.

In fact, I think I screwed up.

Ever see the Christopher Hitchen's talk where he says (paraphrasing here because I don't recall the exact quotation): "How do you know you are right about anything if this is all you've ever been taught and you have never really bothered to let anything challenge your own programming?"

So here I am having a negative visceral reaction to something I've read and I don't even bother to check out the sources cited.  That's not very intellectually honest of me, is it?  Or terribly courageous.

Was I too hasty?  Should I delete my rating on Goodreads and go back and finish the book so I can give it a fair review?  Should I go and read what the two sources cited have to say before I condemn them?

Surely I can do better than this. OK, I found it very offensive but feelings aren't facts.  If what was said in this book really is utter BS, then surely there are better reasons for criticizing it than just my sense of outrage.

But I'm really torn because I don't want to continue reading the book and I'm not sure I could be fair even if I did finish it.

Your thoughts on this would be much appreciated.

Tuesday, August 26, 2014

Amazon in the Hexagon

The main newspaper in my hometown Seattle recently came out with an article about Amazon's efforts to operate in France:   Amazon ignites culture clash over France’s beloved bookstores.
I'm sure that everyone knows what Amazon is (that big on-line retailer) but you might not know that Amazon was founded in Seattle and is part of a number of other international companies that came out of the US Pacific Northwest (some others are Starbucks and Boeing).

There is a long history of American companies trying to break into the European market with uncertain results.  Nancy Green's latest book (which I highly recommend) about The Other Americans in Paris (many of whom were American businessmen) has an entire chapter devoted to doing business in the Hexagon.  It wasn't easy in the twentieth century and it's not a cake walk now.

From the tone of the article Amazon seems to be annoyed that they actually have to negotiate and adapt to other markets and other business environments.  Their issue is not that they are failing internationally, but that they are not as successful as they would like to be.  Now what is more likely here, folks?  That all these countries are going to see the light and change their ways so that Amazon's business model can stay the same wherever they go?  Or, that they are going to have to adapt and stop whining because the rest of the world is not like the United States?

The French want some protection for local bookstores and the Germans want their labor laws respected, and just what in the heck is wrong with that?  For that matter, the Pacific Northwest being something of a hotbed of what Americans call "liberalism" (left-wing thinking such as it is in the US), it strikes me that many Seattleites, Portlanders and the like might just come down on the side of France and Germany in this fight.

And it looks like I'm on to something.  Powell's Books, which is something of an institution in Portland, Oregon, USA, got a big boost from Stephen Colbert of the Colbert Report (a US TV program that is widely watched).  Colbert's books are published by Hachette.  Have a listen:



So it's not just the Europeans (UK, France and Germany) kvetching and being "unreasonable" - there are bookstores and authors in the United States who have issues with Amazon as well and now some are calling for a boycott.

When I was studying for my MBA (in Europe) one of the classes was on corporate responsibility and a lot was said about the "contract" under which companies operate anywhere.  Not the legal framework, mind you, but the social context.  The right of any company to do business is conditional (even in "free market" countries) and where a company is perceived as a being a bad actor, they can lose a lot of business and credibility, too.  What I've outlined above is a lot of bad publicity for Amazon with some major stakeholders all over the world loudly expressing their discontent.  (And is it not ironic that this criticism travels the world using the same technology on which Amazon has based its business?)

Perhaps if they are not happy with their profits in Europe, a better way to go about it is to engage the stakeholders (a group which, by the way, includes, but is not restricted to, shareholders).  That is not "cultural exception" logic - it is simply good business practice:
"Employees, customers, suppliers and distributors, other allies and partners, communities where the company locates facilities (or where the supply chain members are located), owners and investors, creditors, and local, regional and national governments are among the stakeholders to whom it makes sense to pay attention..."
This quotation is from Total Responsibility Management by Sandra Waddock and Charles Bodwell.  It is available here on Amazon.  A modest suggestion to Amazon's management - you guys and gals might want to start reading some of the books you sell.

Sunday, August 24, 2014

Want to Renounce? Join the Queue....

Patrick Cain of Global News has some new information about U.S. citizenship renunciations in his recent article,  Want to shed U.S. citizenship? Get in line.  He's reporting that the U.S. embassy in Toronto, Canada has so many requests for renunciation interviews that the first available appointment is now late January 2015.

For months now rumours have been floating around that such and such U.S. embassy's renunciation appointment calendar is filled up (Paris, for example) but this is the first hard evidence I've seen and it comes from a country that has one of the largest U.S. citizen populations in the world. Canada is estimated to have around a million U.S. citizens (that includes duals) while the American "colony" in Paris probably does not exceed 100,000.  But even in Paris there is anecdotal evidence that the embassy is struggling to meet the demand.  When a French citizen was outed as a U.S. citizen by his French bank earlier this year, Le Figaro had this to say:
"Désarçonné, le Franco-Américain, qui n'a aucune attache outre-Atlantique, envisage alors de renoncer à cette pesante nationalité. Mais renseignement pris auprès de l'ambassade américaine, le délai est bien trop long (plusieurs mois)."
("Flabbergasted, this Franco-American, who has no attachments on the other side of the Atlantic, thought to renounce this unwanted nationality. But after inquiring at the American embassy, the delay [to renounce] was too long (several months).")
Phil Hogden's commentary on the Cain article is quite good.  His last point in particular which is about the official renunciation procedure which went from one appointment to two appointments and is now back to one.  Why it went to two in the first place is any one's guess (and furthermore it does not seem to have been consistently applied in all U.S. embassies worldwide) but, yes, it does look like an attempt to slow down the process and get people to reflect (perhaps change their minds?) before the deed is done.

And how many of those renunciations actually end up on the Name and Shame list in the Federal Register is any one's guess.  What we do know is that there are individuals out there who have publicly renounced and for some reason their names were never included (or were included many months after the deed).  Some of them are quite miffed about it.

Renunciations are not, however, the whole story.  To appreciate the magnitude of this "rush to the exit" phenomenon and its impact on U.S. citizenship, I suggest that two other numbers should be looked into as well.

1.  Certificates of Loss of Nationality.  There is renunciation and there is relinquishment and the latter is often touted as an easier, softer, cheaper way.  Maple Sandbox has a good explanation of the difference here but, in a nutshell, a U.S. citizen just has to commit an expatriating act with the intention of giving up U.S. citizenship to be halfway out the door.

One of those acts is taking on another citizenship.  So  what can happen is an American citizen who became a Canadian citizen in 1972 and never renewed her US passport or voted (or any other act that might imply that she wanted to remain an American citizen) can file papers with the local consulate documenting the act and the intent and requesting a certificate of loss of nationality (CLN) backdated to 1972 when the relinquishing act was performed.

And what works for her will also work for someone who took on, say, Italian citizenship a few days ago.  He can go to the local U.S. consulate and file the same papers and then wait for the CLN to come in the mail.   Not all cases are as simple as these two but hopefully you get the gist.

But what that means is that the most accurate number of U.S. citizenship renunciations/ relinquishments is not the count in the Federal Register but the number of Certificates of Loss of Nationality issued (renunciations + relinquishments = CLNs).

2.  Consular Reports of Birth Abroad:  U.S. citizens abroad can go to the local consulate in the host country to report the birth of a new US citizen (a child born abroad to parent(s) who fulfill the requirements to pass along their U.S. citizenship to their offspring).  The purpose of such a pilgrimage to the local consulate is to get a determination that the child was indeed born an American citizen and acquire the documentation necessary to, say, apply for a US passport.

But here's the kicker - this is entirely voluntary.  No American parent abroad has to make such a report and furthermore reporting or not reporting the birth makes no difference whatsoever in the status of that child:  if his parent(s) fulfilled the requirements for passing along US citizenship then that child is a US citizen by birth, albeit an undocumented one.  Nothing prevents that child from claiming US birthright citizenship later in life.  It's just a matter of gathering the right paperwork.

So put yourself in the position of an American abroad with a new baby.  Do you report the birth and get the passport/social security number right away? Or do you wait until the child can make up his or her own mind whether he wishes to claim US citizenship or not?

There is anecdotal evidence that the latter is becoming more and more common and that would make sense.  But is it true?  No one knows.

Both of these things should be looked into by an intrepid, inquisitive soul in order to get a much better perspective on the state of US citizenship today.  A simple Freedom of Information Act request should suffice.

(And before I forget, there are rumours that the current US citizenship renunciation fee will be raised from 450 USD to 2 or 3,000 USD.  No idea where it came from but welcome to an Internet world, folks, where information flows fast and furious and where a US cit with news in China can pass that info along to a US cit in Germany in minutes.  And that is also something to look into - the new American abroad networks which connect American communities around the world.  Something to watch and frankly I am amazed that more migration experts in the US haven't clued into this yet...) 

Saturday, August 23, 2014

Flophouse Citizenship and International Migration Reading List Updated

Time for another update of the Flophouse citizenship/migration reading list. New books are in green. I highly recommend all the titles below - read them and you will never look at citizenship or migration the same way again. All the underlined titles take you directly to the book on Amazon (U.S.). I would really appreciate suggestions for other titles that might be of interest. I promise to read and add them to the list if I think they are good.


Global Marriage: Cross-Border Marriage Migration in Global Context (2010) by Dr. Lucy Williams.  Outstanding look at cross-border marriages from a global perspective.  Williams takes on the myths, stereotypes about foreign brides (and grooms) and counters them with solid research. A refreshing antidote to the many silly things said about those "marriage migrants."

The Scramble for Citizens: Dual Nationality and State Competition for Immigrants (2013) by David Cook-Martin.  A fine book that looks at migration from Spain and Italy to Argentina in one era and the reverse migration from Argentina back to Spain and Italy of those immigrants' descendants in another.  The author does a fine job of showing how it is almost impossible for a state to make (and make stick) immigration/emigration and citizenship law unilaterally.  There is a larger context with sending and receiving states competing for the productive power and loyalty of immigants/emigrants.  This competition takes place over generations which may (the author says) have interesting implications for large receiving states like the United States.

Democracy and the Foreigner (2003) by Bonnie Honig.  Great read.  Honig takes the idea of "the foreigner" as a vexing issue to be solved through assimilation or rejection and turns it around.  Are there circumstances when the stranger is not a problem at all, but rather a solution to what ails a community?

Migration and the Great Recession:  the Transatlantic Experience (2011) edited by Demetrios Papademetriou et al.  If you were wondering how the economic crisis in the first decade of the 21st century had an impact on migration, this book of essays from the Migration Policy Institute is good place to begin.  Data from the U.S., U.K., Spain, Portugal, Ireland, Sweden and Germany.

Anthropology and Migration: Essays on Transnationalism, Ethnicity, and Identity (2003) by Caroline Brettell. An anthropologist looks at migration, transnationalism, and assimilation/integration through a population she knows well: the Portuguese diaspora. (Flophouse review here.)

Moving Matters: Paths of Serial Migration (2013) by Susan Ossman. .A look into the minds of "serial migrants." Those who immigrate once (like all other migrants) and then do something that shatters the standard immigrant tale - they move on. (Flophouse review here.)

International Migration in the Age of Crisis and Globalization (2010) by Andres Solimano. Well-written, well-argued book.  The author is ambitious and confronts some of the most difficult topics around migration:  Why is International Migration Such a Contentious Issue?  Are Goods and Capital More Important than People?  Don't Always 'Blame' the North, and so on.

The Citizen and the Alien:  Dilemmas of Contemporary Membership (2006) by Linda Bosniak.
Refreshing take on the dilemmas of citizenship and democratic ideals.  Who is included/excluded and on what basis?  The problem of democracy and the legal permanent resident. Complex questions with no easy answers.

A Nation of Emigrants:  How Mexico Manages Its Migration by David Fitzgerald (2009)  The internal American battle over immigration from Latin America is a very public debate but it's only half the story.  Mexico, the U.S.'s southern neighbor and a major sending country, has made and is still making policy to manage its emigration and its emigrants.  This is an extraordinary book and there is much to be learned from Mexico's efforts and policies - even when they have failed.

The Sovereign Citizen:  Denaturalization and the Origins of the American Republic (2013) by Patrick Weil  Really superb book.  Excellent research into the un-making of American citizens in the 20th century.  

Citizenship and Those Who Leave:  The Politics of Emigration and Expatriation by Nancy L. Green and Francois Weil (2007)  I contend that you cannot talk about immigration without also discussing emigration.  A fine work - excellent chapters on how states (UK, Holland, U.S., France and others) have tried to manage emigration.

Citizenship and Immigration by Christian Joppke (2010) This one covers a wide variety of old and new ideas about citizenship.  A good place to begin for someone who is just delving into how immigration/emigration and citizenship are entwined. Joppke refutes the idea of the decline of citizenship - an argument worth reading..

International Migration and the Globalization of Domestic Politics edited by Rey Koslowski.  Some very good insights into how international migration and diaspora politics affect politics back in the home country.

Immigration and Citizenship in Japan by Erin Aeran Chung (2010) Excellent book about Japan as a country of immigration. "Japan is currently the only advanced industrial democracy with a fourth-generation immigrant problem." Chung tells the story of how this came about and the impact this has had on modern Japanese citizenship law.

Rights and Duties of Dual Nationals:  Evolution and Prospects edited by David A. Martin and Kay Hailbronner (2003)  Fine set of articles on dual citizenship and such things as military service, extradition, political rights (Peter Spiro), denationalization and many others.  Pricey but worth every penny.

International Migration and Citizenship Today by Niklaus Steiner (2009).  A very fine book on the political, economic and cultural impact of immigration.  He frames the discussion around two essential questions:  What Criteria to Admit Migrants?  and What Criteria to Grant Citizenship?

Citizenship Today: Global Perspectives and Practices edited by T. Alexander Aleinikoff and Douglas Klusmeyer (2001).  This was one of the best books I read on the topic of citizenship with essays by Patrick Weil, Karen Knop and Richard T. Ford, among many others.   I particularly enjoyed Ford's contribution called "City-States and Citizenship" which was, for me, a real revelation.

States without Nations:  Citizenship for Mortals by Jacqueline Stevens (2009) A strong critique of birthright citizenship in all forms and a call for citizenship based on residency.  

The Perils of Belonging: Authochthony, Citizenship, and Exclusion in Africa and Europe by Peter Geschier (2009).  Outstanding read.  States make citizens and states can also "unmake" them.  Nativism and the never-ending debate over who really "belongs."

The Politics of Citizenship in Europe by Marc Morje Howard (2009).  A really fine study of the citizenship policies of the oldest member-states of the EU.  Read this book to grasp how citizenship laws have changed over time and the reasons why.

The Future Governance of Citizenship by Dora Kostakopoulou ((2008).  Good overview of the current citizenship models and a proposal for an "anational" citizenship framework.

Beyond Citizenship:  American Identity After Globalization by Peter Spiro (2008).  Excellent book that examines how globalization has changed the value of citizenship overall and American citizenship in particular.  Very thoughtful.  Very well-written.

Qu'est-ce qu'un Français? by Patrick Weil (2002).  Mr. Weil spent over 8 years in the archives researching this book and it is fascinating.  France has been something of a test lab for just about every combination of jus soli and jus sanguinis citizenship possible.  Everything has been tried and tried again.  I read the book in French but it is also available in the usual places in English.

Gender and International Migration in Europe by Eleonore Kofman, Annie Phizacklea, Parvati Raghuram and Rosemary Sales (2000).  If you are looking for some empirical evidence (as I was) for how migration, immigration policy and citizenship rights have different outcomes and impacts for women, this is a good place to start.

The Birthright Lottery:  Citizenship and Global Inequality by Ayelet Shacher (2009) An attack on both jus soli and jus sanguinis methods of transmitting citizenship.  Fascinating argument.

Aliens in Medieval Law:  the Origins of Modern Citizenship by Keechang Kim ((2000).  I've been meaning to write a post about this book since it has a very original take on the historical roots of modern citizenship.  I recommend it highly. 

Human Rights or Citizenship? by Paulina Tambakaki (2010)  Interesting ideas about how traditional models of citizenship and  human rights legislation are in conflict.

International Migration, Remittances and the Brain Drain edited by Caglar Ozden and Maurice Schiff  for the World Bank (2006)  This book contains a number of very interesting essays about the economic impact of remittances and brain drain/gain.  The editors point out that the potential for economic benefit for all parties (individuals and sending and receiving countries)  is substantial but policy decisions need to be made carefully (we are talking about people after all).

Let Them In:  the Case for Open Borders by Jason L. Riley (2008)  The author makes a very radical argument for simply opening the doors and letting people move where they wish.

For info I have created a Citizenship and Migration book list on Goodread's Listopia here.  Good place to read reviews and find quotations from the above books.

Thursday, August 21, 2014

FATCA Lawsuit Filed in the Federal Court of Canada

And here we go, folks.

On August 11, 2014 the eggs to be broken in the making of the FATCA omelet refused to crack.

In early August the first lawsuit against the extra-territorial American law FATCA was filed in the federal court of Canada (statement of claims here and press release here)

For those of you who are still a bit confused about the fuss over FATCA,  allow me to give you a quick recap.   The Foreign Account Tax Compliance Act is an American law that was voted in 2010 by the U.S. Congress as part of the HIRE Act. It requires foreign banks to report the account information of all U.S. persons (U.S. citizens and Green Card holders) to the American IRS and imposes draconian fines on foreign entities for non-compliance.

Touted as one of the latest and greatest solutions to tax evasion, it got off to a rocky start in 2011 and the U.S. government quickly understood that it wasn't going to work as written.   So the U.S. Treasury Department came up with a rather creative solution, the Intergovernmental Agreement (the IGA), in which the U.S. bargained with other countries over the terms of FATCA information exchange.  I use the word "creative" because no one, not even international tax experts and U.S. lawmakers, is 100% sure what these agreements are exactly and if they are legal under U.S. law.  Moreover, in every IGA is list of non-reportable account types which means that it's leakier than a sieve and horrendously complicated to implement.  An example, if you are an American in France your PEA will most likely be reported but your Livret A won't ever be.

However, the IGA's made FATCA more palatable and countries started to negotiate and sign up, enticed by the idea of reciprocity - US banks reporting account information to Mexico, France and other countries around the world.  The Canadian IGA was signed in February of 2014.

Amid all this government to government negotiation and request for comments from the financial industry around the world, one group of stakeholders in FATCA was completely left out of the equation:  the people who were actually going to be affected by this legislation.  Ah, but we don't have to listen to criminals, right?  Not so fast, folks.  This law is so broad and so rife with unintended consequences that the FATCA rain falls on the just and the unjust alike.

Imagine the utter shock of a US Person who is tax compliant in both the US and the country of residence being informed that they can no longer have a checking, savings or retirement account because of FATCA. Or, even better, some poor individual being told by his or her bank that he is not just a taxpaying citizen of his country but is also in fact a US citizen and as a result he loses his rights under local law because, in this brave new world of information exchange, US status trumps all other statuses, including other citizenships.   A Frenchman in France who is deemed to have a connection to the US under FATCA is suddenly something less than a full citizen in his own country - he has been stripped of certain rights with the full agreement of his government.

And here we finally come to the Canadian lawsuit.  The plaintiffs claim that FATCA as it is being implemented in Canada violates the Canadian Charter of Rights and Freedoms which among other things, shields Canadian citizens from unreasonable search and seizures and assures equal protection/non-discrimination in the application of the law. Ginny and Gwen, two very courageous women, are "Accidental Americans".   They were born in the US but have lived in Canada most of their lives and they not willing to be reduced to semi-citizenship in Canada.  They are Canadian, they live in Canada, and US status should make no difference whatsoever in what rights they have under Canadian law.  Period.

If you wish to argue otherwise, please think hard about the implications of that.  Could a law made in Mexico that violates the rights of Mexican-Americans under the US Constitution be nevertheless applied to them with the blessing (nay, the full participation and enforcement) of the US government?   And it is all the more troubling when one sees all the situations where individuals do contest the attribution of citizenship  without their consent by a country they don't live in and don't consider themselves to have duties and responsibilities to. All dual citizens everywhere in the world should pay close attention to how this shakes out.

If any of you out there are interested in supporting this cause there are a couple of ways you can help.  Ginny and Gwen have really gone out on a limb here by going public and they could use your moral support.  You can send them a note here.   Another, of course, is through a donation which you can make here.

Bon courage, mes amies!

Tuesday, August 19, 2014

In the Empire of the Sick, Cancer is King

Every so often I stumble upon a book that in retrospect could have been damn useful had I read it much earlier.  The Emperor of All Maladies by Siddhartha Mukherjee was published in 2010 and won a Pulitzer prize for non-fiction in 2011.   I was diagnosed with breast cancer in early 2012.

Cancer was hardly one of my preoccupations in 2010.  I was 45 years old and as far as I knew I was in good health. It was a great (and unpleasant) surprise to me in 2012 when the radiologist saw not one, but two tumors in my right breast, several other areas in the left one that were "suspicious" (one of which turned out to be another tumor), and clear evidence of infiltration into the lymph nodes.  And from that day forward cancer ceased to be an abstraction that happens to other people and became deeply personal.

While my empathy grew as a result of my experience, I must admit that my perspective did not.  If there was a bigger picture to ponder, a better understanding of the whys and wherefores of my diagnosis, active treatment and recovery left little time for it. (Shall I refuse my chemo because I do not understand how it works?)

Mukherjee's book is the big picture - a biography of cancer from the first allusions handed down to us from antiquity, to the most recent theories and treatments. If that sounds dry and uninteresting, I assure you that it is anything but.  Mukherjee is a gifted storyteller and what an abundance of stories he has to tell.

Mastectomy, chemotherapy, radiation therapy, HER, ER, triple positive, BRCA1/2, tamoxifen (to cite just a few of the dizzying array of names and acronyms today's breast cancer patient has to digest) all have long histories.  How and when they came to be part of the oncologists toolkit, and the political and social context around their development and use, are fascinating reading.

Some of the stories, however, are downright troubling.  The history of chemotherapy was one that made me wince.  To know that it began with testing on children without their or their parent's consent with some horrendous outcomes in the early days puts one's own experience (and suffering) with it in an entirely different light.  It is not comfortable to know that one is the direct beneficiary of so much suffering under such ethically questionable conditions.

Equally uncomfortable is Mukherjee's acknowledgement that theories and treatment options were quite often not based on rational step-by-step methodologies, but on instinct and intuition - what he refers to as "inspired guesswork."  One can be grateful for (and alive because of) the existence of brilliant well-timed insights, while being uneasy with the chanciness of it all.  For those living with stage IV cancer (or those of us who understand quite clearly that today's stage II can became tomorrow's stage IV in a heartbeat) there are no certainties that new and effective treatment options for what one has are "just around the corner."  This is the cosmic crapshoot of life in spades.

And yet, Mukherjee is optimistic.  There is progress, measurable progress, he says, and I believe him.  It's not just new treatments and new theories (his focus) but the attention now paid to the patient and his/her quality of life (mine).  I note that Axes 4 and 5 of the French national Plan Cancer (2009-2013) are about patient care and life during and after cancer.  When I compare my experience with that of my mother-in-law's nearly 20 years ago, mine was and continues to be so much better.

One (minor) criticism of the book:  how very U.S.-centric it is.  Is that because the bulk of cancer research was and continues to be done in the United States?  Or does it represent a bias on the part of the author?   A result perhaps of his being an English-speaker based in the US which meant that he favored local sources and thus didn't (or couldn't) look too closely at cancer research in other countries?