Few books have the makings of both a bestseller and an administrator's reference. However, What Disturbs Our Blood by James FitzGerald may be a wonderful exception. Alongside its rave reviews and Writers' Trust of Canada Award, its contents may offer a powerful case study for current and future health services management and policy professionals. It goes backstage to an important time in health system history and, in so doing, sheds light on success factors and policy issues in research, ethics, discovery, public health, service delivery, mental health and other areas that we continue to discuss today. In this article, the reviewer offers 10 reasons why this book may be of interest to current and future administrators.

Few books have the makings of both a bestseller and a health administrator's reference. However, What Disturbs Our Blood by James FitzGerald may be a wonderful exception. The recipient of rave reviews and a Writers' Trust of Canada Award, this book tells the true story of a man and his family. It is victorious, vulnerable, tragic, at times funny, frightening and very thoughtful. It also provides historical insight into a number of health policy and management issues that we face today.

The FitzGerald clan is an iconic family in Canada's health research and public health history. Told through the lens of grandson James FitzGerald, a successful journalist, the story documents the intensely personal struggle of generations of his prolific family with addictions, illness and suicide. However, FitzGerald also documents their involvement in history-making research discoveries, approaches and policies relevant to health research, public health and service delivery. By capturing these personal and professional histories, he offers insights into issues that we are still actively addressing today.

Below, I outline 10 reasons why this book could be particularly helpful to health administrators of today and the future.

A Glorious Tradition of Research

What Disturbs Our Blood documents the painstaking development of many vaccines and discoveries that have changed the face of public health and healthcare. It describes the history of the rabies and diphtheria vaccines, the development of insulin, the inception of Connaught laboratories, the role of research and innovation during World War I and many other important discoveries and institutions. In so doing, the book underscores not only Canada's scientific prowess but its capacity to organize, partner and translate the benefits of research into life- and limb-saving measures as well as better quality of life. What Canada was able to do nationally and internationally, through research and innovation, is told in no uncertain terms. The vivid description of how these accomplishments occurred leaves the reader remembering that we have a tradition of research worth preserving. In an environment where we need to continually justify investments in health research and innovation and demonstrate measureable outcomes, the capacity to trace the long-term impact of research and innovation is particularly pertinent.

The Evolution of a Research Institute

Students of management are often taught to think in terms of helping to "create the organizational environments" needed to achieve certain goals and outcomes. What are some of the conditions necessary to stimulate research and innovation? A subplot in this book is something of a case study for the administrator on the relationships and inter-relationships that have resulted in diverse discoveries, for example, the rabies vaccine, the diphtheria vaccine, insulin and others. It is well known that cultures of innovation tend to breed more innovation. However, the documentation of why and how this happens in specific circumstances is a unique offering to the research and management communities. It some respects, it underscores the importance of focusing not only on each research goal but also on creating the environments in which research and innovation can thrive, even if the exact pathway cannot be predicted.

Canada's International Leadership in Public Health

Toronto's success in addressing major public health issues, described in this book, through mass vaccine production and the collaboration of researchers, institutions and governments earned it an international reputation of being "Toronto the Good." Experts from all over the world have come to Canada to observe our prowess in public health. Our past history in this arena is a tradition well worth preserving.

The Relationship between Public Health and the Delivery of Healthcare

As we consider how the vaccines described in this book were developed and mobilized, the intimate relationship between the delivery of healthcare and public health becomes very clear. Today, this relationship is often discussed, especially at the national and federal levels, as a duality that may artificially pit prevention against treatment and public health against service delivery. Perhaps jurisdictional differences in the roles of various levels of government as they pertain to health service delivery and public health measures perpetuate this. However, What Disturbs Our Blood reminds us that historically these two elements have stemmed from the same root and will likely continue to be most powerful when they are integrated rather than segregated.

The Development of World-Class Organizations

Canada is known internationally for outstanding academic healthcare organizations. This book describes the histories and origins of many research institutes and academic healthcare organizations in Ontario. Today, these organizations, like others across the country, are sought out internationally. Understanding their stories enables us to describe the strategies, structures and cultures that yield such successes. These descriptions become a practical tool for accelerating further achievements and avoiding known pitfalls.

A Spirit of Entrepreneurship and the Painstaking Process of Research

While theories of knowledge transfer and translation often distinguish between the "two communities" of researchers and administrators, this book highlights the entrepreneurial spirit of researchers and the scientific minds of the policy makers. Their successes are intimately aligned with their investment in partnership. For the administrator interested in the generation of research and innovation, FitzGerald makes an important point about the spirit of entrepreneurship and the painstaking process of research. From the description of the two-storey horse stable in which major vaccine discoveries were made, to the work of scientists and their families, he reminds us that the relationship between researchers and the resources that are culled to achieve a success can become intensely personal.

Hubris, Humility and Human Protection

While successful life-saving research is its focus, What Disturbs Our Blood also tells of the devastating potential of research occurring in the absence of the types of research safety and clinical care considerations for which Canada is known. Today, research studies presented to ethics review boards must be assessed in terms of potential risks and benefits. We have a good reputation for ethical reviews of research and the protection of human subjects. However, this book reminds us of the risks of complacency. Why did the tragedies described in experimental treatments occur? The narrative stimulates reflection on this question; this will be important to consider, particularly as Canada is challenged to expedite study start-up times to attract much-needed research investments.

A Troubled History in Mental Health

Whereas Canada has fared well in the capacity to generate and produce vaccines and treatments, its history in the treatment of mental illness is troubled. FitzGerald describes in no lack of detail the treatment of his family members through the health system as they struggled with mental illness and, in some cases, addictions. Remarkably, he documents what may have been the first mental health commission in the early 1900s. This reminds us that unless we pay more attention to exactly what goals we want to achieve and how we plan to accomplish them, we may be striking yet another commission in 100 years.

Culture, Character and Shining Moments

While there are tragic tales in this book, equally told are shining examples of character and culture that have resulted in policy decisions. For example, FitzGerald describes the thinking of researchers and policy makers surrounding the patenting of insulin. The decisions that were made allowed for its rapid mass distribution. In the case of various vaccines, the book describes a unique collaboration between pharmaceutical companies and government. It tells stories of researchers challenging the Nobel committee on issues of research integrity, and it has many other such examples.

Engagement and Final Thoughts

What is the 10th reason for future administrators to consider reading What Disturbs Our Blood? Greater insight can be gained when our minds and hearts are both engaged, and in his book, FitzGerald appeals to both reason and emotion. He strikes at historical, policy, research and administrator-level issues and documents a history that should not be forgotten. In so doing, he touches at core issues relevant to the health research and delivery ecosystems of today and the future.

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