Spring Brings the Best Mama Drama Ever.



Tot7 Shadow


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Dear Readers,

I am very excited about this latest novel in the Totlandia series: #7: The Twosies – Spring. 

Spring brings new life and emotional renewal. For the five women we love (and love to hate) in the Totlandia series, this gave me the perfect opportunity to ratchet up the drama.

The sixth episodic novel ended with a wedding, but also with a relationship in peril: that of Ally and Brady. In this latest episode, you'll discover how Brady’s quest to reunite Ally with her father may be the one thing that will tear their relationship apart. 

Also, in Book 6: the last scene left Bettina with a major dilemma: In Book 7, you'll find out if she succumbed to an easy fix for her problems, or if she embraces the challenge that may lead to the financial and emotional freedom she craves.

TargetDogBestAt the same time, Bettina’s mysterious disappearances are adding to Lorna’s anxieties to keep the club on an even keel up until she delivers her twins. Little does she know that a cruel trick by the power-hungry Kelly will curdle Lorna’s relationship with her mother-in-law, Eleanor;

As for Jade, she is given an opportunity of a lifetime to prove herself: both as an academic researcher, and as the perfect partner for her fiancé, Reggie. But will his assistant Samantha’s attentions come between them?

You'll also find out how far Jillian will go in fighting her former mother-in-law for custody of her deceased ex-husband’s infant child.

The good news: Caleb has taken to his new role as über-dad with gusto. The bad news: it’s causing trouble in the Pacific Heights Moms & Tots Club;

As always, the Totlandia series is filled with tons of moms behaving badly! Spring finds the Top Moms in full rev
olt! They know that their only hope of getting out from under Bettina’s thumb is to secure the files filled with their dirty little secrets, hidden deep within a sculpture to be auctioned off with the rest of her possessions. 
Let the bidding begin!

— Josie












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Housewife assassin Donna Stone must be more than just ready for her close-up if she’s to infiltrate a television reality show in order to stop the broadcast of a live terrorist attack.


Chaoxiang “Chucky” Chan joneses over three things: white-blonde blue-eyed kewpie doll pole dancers, Vancouver Canucks games (to which he has front row seats), and his $360,000 red Lamborghini Huracán.

Sadly, his car is in the shop getting some much-needed bodywork. It seems that its low-slung chassis ran over a fallen lamppost in the middle of the road. Chucky is the reason the lamppost was there in the first place. Cars seem to go bump in the night when you drink and drive while a stripper performs unmentionable acts.

Luckily, Chucky was wearing his seatbelt. However, the stripper’s bucket seat contortions left her with even more bodywork than the car’s. At least Chucky picked up her medical bills. She’ll always have a rod in her back, but the doctor assured her she’ll have a better nose than the one that got smashed when she was propelled through the windshield.

I’ve correctly guessed that Chucky would haunt Vancouver, Canada’s largest Lamborghini showroom in search of a replacement vehicle. And because my latest mission dictates that I be his replacement girlfriend, I got there a few minutes after him. To make it easy for him to see me in the role, today I wear a platinum blonde wig styled in a gamine cut. My contact lenses—really video feeds monitored by Ryan Clancy, my boss at the black-ops organization that employs me, Acme Corporation—are vivid blue. It’s also why I’m wearing a black push-up bra under my low-cut sheer white silk blouse, and a tight white mini-skirt with six-inch heels.

If you saw me, I wouldn’t blame you in the least if you thought my attire left nothing to the imagination. Bingo! That’s the point. To assure that Chucky gets it too, I sink into the passenger seat of a sleek black $1.9 million-dollar Lamborghini Centenarios roadster with my legs parted just wide enough that his imagination goes wild and his fifth appendage hardens. This is a predictable reaction since, as we circled each other in the showroom, he stared at my ass long enough to notice that there was no visible panty line.

I reward his smirk with a come-hither wink and a crooked index finger that invites him to join me.

My interest in Chucky has less to do with his bank account than that of his father’s: Huang Fu Chan just so happens to be China’s Minister of Natural Resources. During his administration, graft has boomed to new heights, thanks to too many collapsing mine shafts, and too few honest owners.

That is, until now. Chucky doesn’t know it yet, but Daddy Dearest disappeared about six hours ago. Acme’s guess is that he’s now the guest of the MSS—China’s espionage agency, the Ministry of State Security—and is being interrogated in some black site located deep in the Tian Shan Mountains. The lives of miners and the reputations of China’s current administration may be gone, but Huang Fu’s ill-gotten gains are an acceptable substitute.

Vancouver is bulging with fuerdai—superrich second generation trust-funders who, like Chucky, have no qualms spending their parents’ hard-stolen money on hot wheels and fast women, in that order.

Or is it the other way around? Not that it matters. In either case, today’s his lucky day.

When it comes to staying in his father’s good graces, Chucky’s sole responsibility is to hold onto the safety deposit box key that contains a list of the banks where Daddy has salted his cash stash. Chucky wears it on one of the silver chains around his neck, but not for long if I have my way.

Of course, at the same time, I won’t let him have his way with me.

After stealing the key, I’ll snatch the list from the safety deposit box so that Acme’s COMINT liaison, Emma Honeycutt, and our tech ops leader, Arnie Locklear, can hack the accounts. The CIA will then trade Huang Fu’s funds for a couple of Chinese-Americans who are being held as political prisoners.

After exchanging lascivious winks with me, Chucky saunters over to the car, leans in, and asks, “Want to go for a test drive?”

“Are you the salesman?” I purr. “Don’t count on me for your commission. In the club where I work, the tips aren’t that big.”

His chest puffs up. “I don’t sell ’em, I buy ’em.” To prove his point, he snaps his fingers at one of his two bodyguards. “Yo, Tong, grab the keys to this ride from the showroom manager.”

The goon shuffles off. A second later he returns with the key fob and tosses it to Chucky, who hops into the driver’s seat. Revving the engine, he asks, “Where to?”

I tweak his nipple under his skintight T-shirt. “Let’s hit the open road—say, up the coast? I know of a little cabin in the woods off the 99, right over Brunswick Beach.”

Chucky takes the requisite two-point-six seconds to prove the roadster can hit sixty miles-per-hour from zero.

We’re off.

We have a shadow: Chucky’s goon squad.

They have one too: my mission leader and main squeeze, Jack Craig. He follows in a nondescript black Lexus—a ubiquitous vehicle in well-heeled West Vancouver, and certainly not as ostentatious as the Lamborghini.

In case Jack loses us on the open road, Abu Nagashahi, another Acme operative, is several miles in front of us, in a white paneled van. Thankfully, the sluggish mid-day traffic over Lion’s Gate Bridge affords both cars excellent visual surveillance.

The whole time, Chucky won’t shut up. He rambles on and on about his assets and holdings, as if I’m a banker who can grant him a mortgage. No, it’s more like he’s got something to prove to a woman who isn’t acting at all impressed.

The babbling is to be expected. At every red light, he takes a hit of the cocaine in the vial dangling from the longest silver chain around his neck. It’s next to the one that holds the coveted safety deposit box key. Now and then I’m rewarded with a glimpse of it. I ache to jerk it off his neck and then shove him out the door into oncoming traffic, solving our problem in a quick and dirty way. But, no, I must follow Acme’s much more discrete plan for Chucky.

Traffic loosens up when we hit Highway 99 on the West Vancouver side of the bridge. Suddenly Chucky is doing his best to break the sound barrier—or at least achieve the speed claimed in the Lamborghini’s spec sheet: two-hundred-and-seventeen miles-per-hour.

Ten or so miles zip by us. In a flash, we’re as far north as Horseshoe Bay, where 99 becomes the appropriately named Sea-to-Sky Highway because of the way it clings to the cliff that winds its way around Howe Sound.

Can Jack keep up? I look in the side-view mirror to reassure myself that he can. Yes, he’s there, about a hundred yards behind us. Unfortunately, so are Tong and his buddy.

Suddenly, Chucky realizes I’m not paying attention to his boasts. Worse yet, I’m slapping away his groping hands. His eyes narrow as he blurts out, “Hey, um…how ’bout giving me some head?”

I snort. “What…are you kidding? So that I end up with a broken nose, like your last girlfriend?”

He looks over sharply, completely ignoring the fact that we’re weaving to and fro on hairpin curves. “Who told you that?”

I shrug. “Dude, it’s all over town. Sorry, but if I’m going to distract you, it’s going to be someplace we can both enjoy it”—I nod at the car with his bodyguards, now right on our heels—“but not with your cheering squad tagging along. What’s with the chaperones?”

“Haven’t you heard a word I’ve said, bee-hatch?” He takes his eyes off the road to lean in close. “I’m a very important guy! They come along to protect me.” He puts his hand between my thighs. “Look, sweet cheeks, if you make me happy, I’ll make you happy—”

He grabs me by my neck and shoves my head into his lap.

He figures out quickly that it was poor judgment on his part when I bite him—hard—on his thigh.

Chucky’s howl is cut off by the sound of glass breaking. A barrage of bullets shatters the rear window.

I duck onto the floor of the passenger seat.

Instinctively, Chucky looks behind us. As bullets hit his head, it explodes, sending skull fragments and brain matter in all directions.

When his body jerks in my direction, I see that his right eye is dangling from his optic nerve. His seatbelt holds him in place, but his foot has stiffened onto the accelerator.

I scream, “What the hell?”

Jack yells into my earbud, “Chucky’s bodyguards are shooting at the car!”

“Driver down!” I shout back.

The car is now racing along out of control. To take the wheel, I lean over his body and jerk it out of its counter-clockwise trajectory—

And off the road we go.

(c) 2016 Josie Brown. All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the publisher, Signal Press. (info@signaleditorial.com)


What is the name of Chucky’s goon?


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Winter’s chill isn’t just in the air. It also runs through the veins of all the women in the Pacific Heights Moms & Tots Club…


8:49 a.m.

Bettina Connaught Cross abhorred tardiness in any form, especially as it pertained to gatherings of the organization she’d founded: the Pacific Heights Moms & Tots Club.

The fact that she was already six minutes late to a very important meeting of the club’s Top Moms committee had her seething. Granted, her excuse was valid enough: she first had to walk her daughter, Lily, to kindergarten at the local public school, Lincoln Elementary.

They walked swiftly because the school was in the opposite direction from the Golden Gate Valley Library, where the meeting was taking place. Bettina would have given anything to have driven instead. But, because her deadbeat soon-to-be-ex-husband had embezzled from his financial clients and then skipped town, her car, along with all of their joint assets, had been seized by Federal agents. Despite providing information to the Justice Department investigator assigned to the case—Daniel Warwick—everything would be auctioned off in March.

A statue that held tremendous value to her was among the items seized. Documents containing scandalous secrets were concealed in its base. Bettina was using the files to blackmail the longest-serving members of the club’s Top Moms committee. It assured their votes on the club’s business would mirror hers, as opposed to siding with her sanctimonious co-Chief Executive Mom: her sister-in-law, Lorna.

It had been almost two months since she last heard from Daniel. If she were to be honest with herself, she’d have to admit she found him attractive. Although he’d been the epitome of legal and moral decorum, she thought he’d felt something for her too.

So why hadn’t she heard from him?

Because he was just using me to get to Art, she realized.

My God, get a grip on yourself! You’re acting like a bottom.

Angrily, without thinking she muttered, “My life is all a tangle.”

Lily frowned. “‘All a tangle’? Mummy, is that the same as, ‘O, what a tangled web we weave when first we practice to deceive’?”

Bettina stopped short in order to stare at her daughter. “Where did you learn that?”

“From Professor Pudberry. It’s from an epic poem by…by…Sir Wally Somebody.”

Bettina rolled her eyes. “Sir Walter Scott wrote it. Why, pray tell, did he even mention it, since it isn’t Shakespeare?”

Lily’s nod came with a smile. “He was making a point—that it is often mistaken as a Shakespearean quote. I can see why. Weaving lies gets people into trouble in Romeo and Juliet and other Shakespeare plays.”

“Pudberry—ha!” Bettina declared, while trying hard not to frown. Now that she could no longer afford Botox injections, she was terrified at the thought of getting wrinkles and scaring her daughter.

Time for bangs, she thought miserably, a style that would do nothing for her except hide the evidence of her grief. And since she could no longer afford to go to her stylist, she’d have to cut them herself. Art’s abhorrent actions were enough to give her gray hair, but the thought of using color out of a bottle made her even angrier at her current situation—and at those who seemed to relish in her plight.

Including Reggie Pudberry.

The last time they’d seen him was after an ill-fated trip to the Ikea showroom in Emeryville. To assuage her horror at being recognized in such a downscale emporium so close to Oakland, she and Lily then stopped for lunch in Berkeley, only to run into one of the PHM&T Top Moms: Jade Pierce, who was also Reggie’s new girlfriend. From what Bettina could tell, Jade was spying on Reggie as he ate with his gorgeous teaching assistant. By shouting Jade’s name, Bettina made sure Reggie saw her too. Jade guessed rightly that Bettina was trying to embarrass her. Jade’s way to retaliate was to taunt her regarding some threat that another Top Mom, Kimberley Savitch, had made against Bettina—

Or perhaps Jade was threatening to tell Kimberley something? If so, what could that secret be?

As if reading her mind, Lily asked warily, “Is Oliver’s mommy—Mrs. Pierce—still mad at you?”

Cold dread ran through Bettina’s veins. The thought of Jade in cahoots with Kimberley had her hurrying down the street even faster, despite her very high heels. “Who, Jade? I don’t know. I guess I’ll find out today. We must hurry, Lily! I’ve got to get to the meeting!”

“Grandmother would have driven me to school—if you’d have asked her,” Lily gasped as they ran. “You should be nicer to her, Mummy. In fact, you should be nicer to everyone. Maybe they’ll finally start being nicer back to you.”

She told herself that she was too winded to answer. But in truth, for once Bettina was beginning to believe that her daughter might be right.

Not that she’d ever admit that to Lily.

“Mummy, why don’t you ride the bus there?”

Bettina blanched at the thought. “The Connaughts have never taken public transportation,” she sniffed.

“That’s what I told Uncle Matt. He laughed at me. Then he dared me to ride it with him.”

Bettina scowled. “Who does he think he is, putting you in danger like that? The minute I get home from my meeting, I’m calling him to give him a piece of my mind!”

“It wasn’t bad at all. In fact, it was fun. And it was quick. My friends at school ride it all the time. They say a bus shows up every few minutes.” She pointed west, toward the next block, Van Ness. “They catch it there. Won’t that take you just a few blocks from the library?”

Lily was right. The bus stopped near Green Street, ten blocks north. Bettina could get off there and walk three blocks to the library. The whole thing would take ten minutes, tops.

“It’s only two dollars and a quarter,” Lily insisted. A sudden insight shifted the look of misunderstanding on her face to sympathy. “Is it that you don’t have the money? It’s a shame you pack a lunch for me every day instead of giving me lunch money. Otherwise, I’d have given it back to you, Mummy. Really.”

“I have the two dollars, thank you very much,” Bettina huffed. The thought of Lily eating a public school lunch was galling enough; that her daughter would have given up her lunch money so that she could ride the bus made her heart break. Smoothing Lily’s hair, she muttered grudgingly, “I’ll…think about it.”

She’d do it, but she didn’t want Lily to know—or worse yet, for her to tell Eleanor or Matt. And certainly not Lorna. She’d never survive such embarrassment.

They reached the school door just as the final bell rang. The last students were streaming in. Lily’s teacher, Liz Vanderbilt, was just about to close the door when she spotted Lily running up to her. Bettina winced as Liz beckoned her over as well.

“I’m so happy I caught you,” Liz said with a smile. “I wanted to ask you a special favor.”

“What is it?” Bettina asked impatiently. “I running late—”

“I’ll make it quick. It seems we’ve lost our volunteer class mother. I was hoping you’d honor us and take on the task.”

“Class mother?” Bettina frowned. “I don’t know, Liz. I mean…I’ve got my hands full with the Pacific Heights Moms & Tots Club—”

“Oh? But…Lily mentioned you’d relinquished some of your duties there, now that Lily is in school.”

“She has,” Lily insisted. “My Aunt Lorna is now in charge.”

“No, I’m still in charge!” Bettina muttered in a low growl. “She’s just helping out.”

“Which is why you’d be perfect in the role—and the duties are simple, really,” Liz insisted. “You’ll accompany me on our one field trip every month, and encourage the other parents to participate too.”

Me—riding herd over a bunch of welfare mothers? Bettina recoiled at the thought. That will be the day! “Liz, to be honest, I really don’t think it’s a good match,” Bettina said coolly.

Liz shrugged. “Not a problem. I guessed it might have been a long shot, but Lily insisted you’d be just right for it because you’re such a renowned leader.” She held out her hand to the girl. “We had better get to class.”

Bettina bent to kiss Lily, then turned away before her daughter’s pleading gaze made her say something she’d later regret.

She waited just long enough to watch Lily and Liz walk halfway down the hall before running down the street again.

She got to the bus stop just as a bus was pulling out. The driver must have heard her shout because he stopped short.

She scurried up the bus’s steps. She fumbled in her purse until she found two one-dollar bills, but no quarters. He sighed loudly, but let her on anyway. He also handed her a slip of paper.

“What’s this?” she asked warily.

He stared at her as if she were an alien from another planet. “Bus pass. Allows you to ride any bus for the next few hours.”

She nodded and started down the aisle, but almost lost her footing as the bus lurched forward. Every seat was taken, so she held onto an overhead strap.

Noting her pregnancy, a man stood up to offer her his seat. She nodded gratefully and sat down—

But a quick sniff made her realize why the man’s decision wasn’t chivalrous at all. Her seatmate, an older gentleman, probably hadn’t bathed in a week or more. The old man, toothless, smiled at her. Then he lifted a flask from his tattered jacket and took a swig.

Oh, my God, Bettina thought, by the time I get to Green I’ll smell like a brewery!

Realizing that Bettina was staring at him, the man winked and nudged her with the flask. “Wanna drink?”

“Thank you, but I’ll pass,” she muttered, then held her breath to avoid the stench of booze and his body odor.

Bettina’s timing was perfect. A second later, the man let loose with a long, loud fart.

Bettina sat straight up, mortified. To her surprise, no one else on the bus had any reaction at all. They were too busy scrutinizing their cell phones. Are these people inhuman? Where is their sense of decorum? For that matter, where is their sense of smell? I must be in Purgatory!

“Was that me, or you?” The old man’s question to Bettina was loud enough that even the bus driver could hear him, all the way in the front.

The teens in the seat in front of them snickered as they exchanged glances.

“I won’t even dignify that with an answer,” Bettina hissed back.

The old man looked down into his lap. “Did you hear that, Jolly Roger? She thinks she’s better than us.”

Bettina mustered the courage to see what the man was talking to—hopefully, not something that should have been zipped up—and if so, then certainly snipped off for horrifying anyone with whom he came into contact.

To her relief, it wasn’t any part of his anatomy. To her horror, it was a large brown rat.

Her shrill scream sent the rat scurrying off. Bettina leapt up so quickly that she turned over her purse. She grabbed her belongings as quickly as she could before heading toward the front of the bus.

The rest of the ride seemed interminable. If passengers weren’t ringing for stops at every corner, the driver would still somehow miss the next traffic light.

Finally, they reached her stop. She leapt off and practically ran the three blocks to the library, all the while gulping in fresh air to offset the stench of her seatmate. If only it could whisk away the memory of him as well.

She thought she’d pass out before making it to the library’s side door, but she didn’t. I survived, she reasoned. With shoulders straightened and her head held high, she took a deep breath and walked through the door—

Until she smelled it.

Really, not it, but her. She smelled just like the rancid old man.

Just at that moment, all heads turned to her. It was too late to turn back.

She thought, God, I hate being poor! That will have to change.

The sooner the better.

(c) 2016 Josie Brown. All rights reserved. This work is protected under copyright laws and reproduction is strictly prohibited. Permission to reproduce the material in any manner or medium must be secured from the publisher, Signal Press. (info@signaleditorial.com)


What is the name of the old man’s rat?

If you want, answer the question to


Good for any and all of Josie Brown's print books purchased at the 
Book Signing takes place Saturday, April 29, 2017, 3:30-4:30pm, 
Mitchell Room, Clarion Airport Hotel, 5311 S. Howell Ave, South Milwaukee, WI 


1. No purchase necessary.

However, to be entered, you must CORRECTLY answer the question based on the excerpts of either of these two books:

For THE HOUSEWIFE ASSASSIN”S TERRORIST TV GUIDE: What is the name of Chucky’s goon?

FOR TOTLANDIA 6: (WINTER, THE TWOSIES): What is the name of the old man’s rat?

If the questions are answered INCORRECTLY, your name will NOT appear below. However, feel free to try again.

2. The above-mentioned prize will be awarded to one entrant noted in the Potential Winners List seen below.

3. Only one entry per household. Forgotten if you’ve entered? Check the list below…

4. YES, you can gain bonus points! All you have to do is provide links for any reviews you’ve given for ANY of the Housewife Assassin or Totlandia books, in such online bookstores as Amazon, BN, iBooks, and GoodReads. Each and every book you’ve reviewed — previously or during this contest — will count toward a bonus point.

5. This contest is open worldwide.

6. Contest ends Midnight Pacific Time, Sunday, February 26, 2017.

7. All correct entries will be placed in a random drawing, to take place within 72 hours of the contest’s close. (If you DON’T find your name on the list, your answer may be wrong. Feel free to try again.)

8. The winning entry will be chosen from the drawing, and contacted within forty-eight hours of the drawing. Agreement to accept the prize will be given by winners before publicly announced, and updated here.  If you haven’t accepted the prize within 72 hours, another email will be sent to you reminding you of your prize. You’ll have 24 hours to accept it. Otherwise, we  will release it to another randomly drawn name.

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HA10 GGDResearch for This Book
When plotting my novels, I ask myself the question, “Can this happen? Is it plausible?” 
Even the plotting of a light mystery starts with copious research, especially when the topic pertains to bioterrorism, biogenetics, and an industry as complex as agriculture. In my case, advance research for The Housewife Assassin’s Garden of Deadly Delights began with conversations with professionals in particular fields, as well as articles in professional journals and established newspapers.  
Here are some interesting facts that are stranger than fiction:
1. Can plants carry a virus harmful to humans?
Yes. Ebola is a perfect example. Fatalities from this filovirus can run anywhere from fifty to ninety percent. Deaths can happen within a week. The Marburg, Lassa and Machupo viruses can be harmful, and in some cases fatal. As of the time I write this, there are no vaccines for these viruses.
2. Can a virus cause cancer?
Yes. In the course of researching plot points for this novel, I stumbled upon a plant virus known as cytomegalovirus, or CMV, which causes a particularly aggressive form of brain cancer in humans, in conjunction with the patients' genetic markers. CMV is quick acting, and deadly. Whereas there is no vaccine as of yet, the Brain Tumor Society and the NIH are funding a study at Duke University in the hope of developing one.

4. Will swine eat humans?

Yes, there is a precedent. Recent incidents include a case in which an Italian mobster boasted of a rival’s death-by-swine on a phone call intercepted by local police. Another sad incident was that of a seventy-year-old Oregon farmer whose only remains were his dentures. Another incident took place in Romania, where a farmer’s wife was knocked unconscious and was  being devoured when her husband found her and pulled her out of the pig pen. She died in the hospital. (See the article links, below.)

4. As for whether cows attack humans…
A six-year four-state study proves it sometimes happens. In my scenario, I had the consumption of corn tainted with a virus that leads to brain cancer as further motivation.
5. Can a person get killed by getting tossed under a corn harvester?

In December 2014, a Canadian farmer was a recent fatality. This syndicated article notes that he was the third such fatality—that is, via farm equipment—in the area. 

Here's an OSHA report on various farm accidents, including two that include harvesters (one corn, one tobacco). I've also noted a report on farm equipment deaths in Canada for 2014 here.

Again, I look for plausibility. This is, after all, a work of fiction.  
Below you'll find some if the articles referred to here.

Swine Eating Humans

Yes, there is a precedent. Recent incidents include a case in which an Italian mobster boasted of a rival’s death-by-swine on a phone call intercepted by local police. Another sad incident was that of a seventy-year-old Oregon farmer who only remains were his dentures. Another incident took place in Romania, where a farmer’s wife was knocked unconscious and was  being devoured when her husband found her and pulled her out of the pig pen. She died in the hospital. 

Were the hogs starving when they encountered these people? Was foul play involved? In the last two scenarios, unless we were there, we will never know.
Still, these deaths makes my plot plausible, especially when I’ve added the tainted grain scenario that affects the brain of those animals who ate the corn. 

Italian Mobster Sleeps with the Pigs

Published on Nov 29, 2013 /ITN News / Ashley Fudge

Police made a particularly grim discovery in Italy after they realised a mobster boss had been eaten by pigs. The details were uncovered when officers intercepted a phone call from a man who boasted about being one of the killers. While listening in, they heard the man admit how much he enjoyed hearing Francesco Raccosta's screams. ‘Operazione Erinni' has been investigating the mafia in southern Italy and a long-running feud between the Bonarrigo-Mazzagatti-Polimeni and Ferraro-Raccosta syndicate. Police said the murder of Raccosta demonstrated the “utmost ruthlessness and cruelty” of the mafia clans.”


Oregon Farmer's Grisly Death by Swine

Slate.com / October 2012 / Brian Palmer


An Oregon farmer was eaten by his hogs on Wednesday. The 70-year-old Vietnam veteran had gone to feed the animals in the morning, and his family found his dentures and scattered remains in the hog pen several hours later. Authorities are trying to determine whether the pigs deliberately killed the man. 

Yes. Cattle kill approximately 22 Americans per year nationwide, and the animals deliberately attack their victims in 75 percent of those cases, according to a 2009 study. About one-third of bovine killers have a history of aggressive behavior. Swine likely kill fewer people than cattle do, but there are no reliable data on this question. The CDC’s mortality statistics group together all mammal attacks apart from those perpetrated by rodents, dogs, and humans. The death count in the mammal-attack category averages about 73 per year, including cattle-related mortalities.

There are, however, plenty of anecdotes suggesting that swine are willing and able to kill humans. British pigs seem to have a particularly aggressive streak. In 2006, a 650-pound swine pinned a Welsh farmer to a tractor and bit him until the victim’s wife scared the attacker off with a water hose. The same year, a pig foraging in England’s New Forest—a hunting ground where farmers pasture their swine—caused a horse to throw its rider, then mauled the prone woman.

Livestock display an alarming ability to coordinate their attacks. A herd of cattle circles up to confront a perceived threat, with their backsides in the center of the circle and their heads lowered. They may even paw the ground, like a bull facing a matador. Of the 21 cattle-related fatalities in the Plains states between 2003 and 2008, five involved multiple animals swarming the farmer. Pigs are also known to attack cooperatively. In 2007, a sow in Norfolk, England knocked a farmer off his feet, enabling the other pigs to bite the man.

If confronted by an agitated pig or cow, back away and get behind a barrier such as a tree. It also helps to carry a large stick as a weapon and to make yourself appear larger.

October 2, 2012 / New York Daily News, Erik Oritz

A family member of an Oregon pig farmer discovered his relative's body parts scattered across the pen — a gruesome find leaving authorities to believe it was a case of hog eats human.

A pathologist couldn’t immediately determine whether the pigs were the actual cause of 70-year-old Terry Garner’s death, but a forensic expert at the University of Oregon will conduct further tests, CBS affiliate KCBY reported Monday.

“What a way,” someone who answered the phone at Garner’s home told NBC News.

Investigators aren’t ruling out the possibility another person could have been involved.

“Due to the unusual circumstances, the Sheriff’s Office is investigating to determine if foul play may have resulted in the death of Mr. Garner,” District Attorney Paul Frasier told KCBY.

Garner was at his farm near rural Riverton last Wednesday, when a family member went looking for him, according to The Register-Guard.

Garner’s dentures were first spotted inside the hog enclosure, and then other random body parts were located — although most of him had already been devoured, the newspaper added.

The Coos County Sheriff’s Office has a couple of theories on what occurred: Garner could have suffered a medical emergency, such as a heart attack, leaving him in “a position where the hogs could consume him,” according to a statement.

In another scenario, the swine — weighing about 700 pounds each — may have knocked Garner down, overwhelming him before killing him, authorities said.

It’s unclear exactly how many pigs live on the farm, but police believe one of them had been aggressive toward Garner before.

Pigs are omnivorous, and have previously been known to feast on people.

The 56-year-old wife of a pig farmer in Romania was knocked unconscious and eaten in the animals’ sty, UPI reported in 2004.

Her ears, half her face and fingers had been ripped off, a doctor said.


Romanian Farmer's Wife Life and Limbs

March 5, 2004 /  UPI

BRASOV, Romania, March 5 (UPI) — A small farming town in Romania is reeling Friday after learning angry pigs knocked a farmer's wife unconscious and began eating her.

The Sun of London reported Irma Molnar, 56, somehow fell into the animals' sty in Brasov, and likely frightened them badly.

Her husband, Sandor, found her badly maimed and rushed her to a local hospital where she died.

“Her ears and half her face were missing. Her fingers had also been bitten off,” said Dr. Dan Grigorescue.

Her husband was sedated and vowed to destroy the pigs.

“I'll never breed such beasts again,” he said.




As for whether cows attack Humans…

This four-state study proves it sometimes happens. In my scenario, I add the motivation of consumption of corn tainted with a virus that leads to brain cancer:


3. Can a person get killed by getting tossed under a corn harvester?

In December 2014, a Canadian farmer was a recent fatality. This syndicated article notes that he was the third such fatality—that is, via farm equipment—in the area:

Dec 3, 2014 / QMI AGENCY / Toronto Sun

LONDON, Ont. — A 46-year-old man was killed after becoming trapped in a corn harvester early Tuesday.

Brian McConnell, of Bruce County, Ont., is the third farmer to die in farm machinery this harvest season in southwestern Ontario.

In a statement, police warn farmers to “work within their limits and always ensure they keep personal safety in mind.”

The labour ministry, the coroner's office and Ontario Provincial Police are all investigating McConnell's death.





My Research Notes for The Housewife Assassin’s Terrorist TV Guide

HAH 14 Terrorist TV Guide Final - 1400W
Signal Press
eBook: 9781942052609
Trade Paperback: 9781942052777

amazon-2-icon imgres copy  unnamed  kobo-blue


As with all my novels, The Housewife Assassin’s Terrorist TV Guide began with an alluring “what if” premise. Mine came when researching improvised explosive devices—also known as IEDs.

Made to go undetected, IEDs are used as roadside bombs in military theaters of operation. Others are hidden by terrorists in public places. Tragically, not only do these bomb attacks kill the perpetrator’s enemy, they also claim the lives of innocent victims, often in areas of the world already devastated by war.

That said, the particular article that drew my attention appeared in the UK Mirror. It’s title:

Breast Bombers: Doctors Trained to Plant Explosives Inside Chests of Female Suicide Bombers

This very brief feature claimed the United Kingdom’s intelligence agency, MI6, as its source. It also quoted a briefing paper from the United States’ National Security Agency.

Further research brought me to a BBC article on the same subject.

It sounded plausible. But, is it possible?

As of the publication date of this book, there have been several known cases of body cavity bombs—that is to say, bombs embedded or inserted into willing humans and (I presume, unwilling) animals.

As of this day, there have been no known reports of successful breast implanted bombs.

Ah, but, just the thought of such an audacious plan was a perfect story device for the Housewife Assassin series.

Thus, my plot challenge:

How could a jihadist cell make the most of its opportunity to terrorize Americans?

Right then and there, the idea of having this ominous act take place on television was born.

To make the scenario more enticing, the terrorist would seek out a show with a viewing audience that watched a live broadcast. And ideally, the show would have a device to create ongoing audience interest and support for its cast. For these reasons, I made it an unscripted reality program that chose everyday families that the audience could root for, or boo. (We all know a Penelope Bing, am I right?)

This would also give the terrorist a shot to infiltrate the show.

And yes, so could Donna and Jack.

Of course, bringing back Addison Montague (Book 7: The Housewife Assassin’s Hollywood Scream Play) as the show’s producer gave them a leg up—or so they hoped.

Now, couple this with the means to kill innocent victims in the most vicious of ways—planting a device that blows them up from the inside—and the terrorists can wound the American psyche as well.

The sacrifices we are willing to make for love—of self, mission, money, fame, and more—is the overriding theme of this book. It is what drives the contestants to try out and compete for a spot on the show; and why they are manipulated into doing and saying things to their neighbors and their loved ones—not to mention millions watching at home.

Unfortunately for Donna and Jack, this time their quest to uncover the terrorists puts them in the public eye: something all spies loathe in covert operations. The fact that it turns their children’s world upside down is, of course, equally upsetting.

Each of the competing families has something in their backstory to lead you to suspect them. And by keeping the terrorists’ plan of attack a secret until the show’s last episode, Donna and Jack never know who is their real suspect—

Until you do.

I hope you enjoyed this latest Housewife Assassin tale as much as I enjoyed writing it for you.

—Josie Brown

Money makes any place magical. Proof of this: the dancing bunny of Ross, California.


Got to play yesterday a bit in Marin County, California. One of our favorite walks is in Ross, California, a very posh little village, just north of San Francisco's Golden Gate Bridge. Behind the stately gate is this beautiful home, a dancing bunny cavorts on the beautifully manicured front yard. You see it there, right? For that reason alone, if I were the owner, I'd smile every time i entered the house. (Okay, that, and the fact that the house is worth an estimated $10 million +).

This bunny is doing a happy dance, for good reason,



The Hybrid Author: Why You Should make the leap from Traditional Pubilshing


Most authors walk a financial tightrope. 

Hey, don't take my word for it. In a September 2015 an article on a recent Authors Guild survey of its members' incomes,  Publishers Weekly put it this way:

Guild quote in PW


Thank goodness for self-publishing. It saved my career, and those of many other authors I know.

Even with four novels (one optioned for television) and two-nonfiction books published traditionally, as early as 2010 I'd dipped my toe into the choppy waves of self-publishing. My subsequent success with it is why I now self-publish exclusively.

Whereas self-publishing has grown by leaps and bounds in the past ten years, ours wasn't the first generation to discover its financial rewards. Jane Austen, Emily Dickinson, Marcel Proust, and Walt Whitman self-published their books. Misery loves great company indeed.

But before self-publishing became a financially viable option for the current generation of writers, traditional publishing—that is to say, print books, primarily by one of the Big Five New York publishing houses—was the only venue for the sale and distribution of books. Even ten years ago, the thing authors love to do most—write novels—was not possible without running an unwieldy gauntlet that put their manuscripts in front of any literary agency that might deem the book sellable to a publisher, and any publishing house editor who might actually like it enough to purchase it. 

Besides editing, printing, and distributing a book, part of the publisher's job is also to promote it. For doing so  the publisher holds on to anywhere from 80-92 percent of the book's retail price.

(Yep, some authors get only an 8 percent royalty. Worse yet, royalties are paid twice yearly, and they are only paid if their books “earn out”—that is, return any advance paid, which may not happen for years if at all, what with the other variables tied to this equation, including book returns, of which there are no cut-offs; and perhaps the payback of advances of other books as well.)

Sadly, in traditional publishing, marketing is the last consideration—never the first—when purchasing a book from an author. Compared to other products as a whole—and entertainment products in particular, including films, music, magazines, and video games—it get a negligible budget, if any at all.

Don't take my word for it.  In this article regarding the breakup between bestselling thriller writer Steve Hamilton and his former publishing house, St. Martin's Press, Publishers Weekly outs its industry's dirty little secret: there is no there, there:


A book can be beautifully written, have scintillating dialogue and a page-turning plot. But without the adequate marketing and promotion that puts it in front of a targeted audience, a book is as dead as a beached whale. 

At this point in time, most Authors Guild members are traditionally published. Coupled with the Hamilton/SMP breakup, the Authors Guild survey certainly makes an excellent case for the guild to reconsider what it must do to protect its members. For example, the guild—along with literary agents and intellectual property attorneys—should insist that any publishing contract contain clauses that:

(a) Succinctly spell out a yearly quantitative financial base for the book, with instant reversion to the author if not met. Right now, most publishing contracts hold onto rights forever, under the assumption that digital distribution means that a book never goes out of print.

(b) Outline an advertising budget, tied to an actual, very specific media plan for the marketing of the book—at least for the first full year in print—and allow for immediate reversion of rights if there is no follow-through.

Is it any wonder that hybrid authors—that is to say, those authors who have been published traditionally, but then, like me, elected to publish their books independently of a publishing house—are a growing breed? Of course not. Like everyone else, authors have to eat. They have to pay rents and mortgages. They have to raise kids, and pay for health insurance, taxes, and all the other expenses that come from with being self-employed.

I know of many hybrid authors personally. Under the traditional publishing model, their advances and sales shrunk along with the demise of both chain and independent brick-and-mortar bookstores. Several were at the brink of financial disaster (homes soon to be repossessed, couch-surfing, near bankruptcy)  when they made the decision to walk away from traditional publishing contracts. Instead, they rolled up their shirtsleeves and did what they had to do to self-publish: write good books; have their books professionally edited and digitally converted; distribute their books—primarily as eBooks.

The successful one know they must also promote their books.

The good news for their readers: the books are priced lower than their offerings still distributed by their traditional publishers. 

The great news for these authors: now that they retain 70 percent of the book's retail price, they are making a sustainable living for themselves and their families.

Some are doing better than that, having already sold millions of books since starting this journey. Sylvia DayBarbara Freethy, Stephanie Bond,  Bella Andre, and Kate Perry are perfect examples of hybrid authors who took advantage of the changing bookselling marketplace to not just survive, but to thrive. And whereas Ms. Day, Ms. Andre and Ms. Bond still have one foot in traditional publishing, Ms. Freethy and Ms. Perry are in total control of every facet of their books' design, distribution and promotion. 

Another hybrid author who made the leap into indie publishing and never looked back was thriller novelist Barry Eisler. Recently I had the opportunity to interview him for the International Thriller Writers Organization's e-zine, “The Big Thrill.Some of what Barry says regarding his own thoughts as to the advantages of self-publishing versus a traditional publishing contract can be found in the article.

However, some of our Q&A were cut. Since they relevant to this post's topic, I've included them here:

If there were one (or two, or three) things you could change about the publishing industry and the novelist’s role within it, what would it be?

The first thing I’d like to change is the popular perception that organizations like the Authors Guild and Authors United primarily represent authors rather than establishment publishers. I have no problem with organizations advocating for publisher interests, but the dishonest way in which the AG and AU go about their publishing industry advocacy misleads a lot of authors. I could go on at length about this topic and in fact I have—so for anyone who wants to better understand the real agenda and function of these “author” organizations, I’d recommend starting with this article I wrote for Techdirt, Authors Guilded, United, and Representing…Not Authors.

But isn’t it true that the AG speaks out on various topics of concern to authors, like unconscionable contract terms?

Hah, the AG going after publishers is like Hillary Clinton going after Wall Street. I’ve had a lot to say about this, including thecomments I wrote in response to this post at The Passive Voice.For anyone who’s curious, just search for my name and you’ll find the comments, the gist of which is, when the AG wants to accomplish something, it names names and litigates; when it wants authors to think it’s trying to accomplish something but in fact isn’t (or, more accurately, when what it’s trying to accomplish is maintenance of the publishing status quo), it talks.

When the AG talks, it’s a head fake. The body language is what to look for in determining the organization’s actual allegiances and priorities.

Another thing I’d like to change is the generally abysmal level of legacy publisher performance in what at least in theory are legacy publisher core competencies. Whether it’s cover design, the bio, or fundamental principles of marketing, legacy publishers are content with a level of mediocrity that would be an embarrassment in any other industry. I’ve seen little ability within legacy publishing companies to distill principles from fact patterns (particularly patterns involving failures) and then apply those principles in new circumstances. Institutional memory and the transmission of institutional knowledge and experience are notably weak in the culture of the Big Five. My guess is that the weakness is a byproduct of insularity and complacency brought on by a lack of competition.

Agreed. Having spent fifteen years in advertising before becoming a novelist, I was abhorred as to what passed for “marketing and promotion.

I'd also like to increase awareness of the danger a publishing monopoly represents to the interests of authors and readers. No, I’m not talking about Amazon; “Amazon is a Monopoly!” is a canard and a bogeyman. I’m talking about the real, longstanding monopoly in publishing (or call is a quasi-monopoly, or a cartel), which is the insular, incestuous New York Big Five. An important clue about the nature of the organization is right there in the name, no? See also the Seven Sisters

Okay, another thing (and then I’ll stop because I could go on about this stuff forever): I’d like to see more choices for authors; new means by which authors can reach a mass market of readers; and greater diversity in titles and lower prices for readers.

Wait, that last set of wishes is already happening, courtesy of self-publishing and Amazon publishing—the first real competition the Big Five has ever seen, and a boon to the health of the whole publishing ecosystem.


Hybrid author success stories are now numerous. As author advocate Jane Friedman‘s wonderful blog points out,  Claire Cook, Harry Bingham, and William Kowalski are just a few other examples of novelists who made the leap and never looked back.

Products are created from a perceived need. Industries are created by providing sales and distribution venues for products.

But sometimes how the product is distributed changes also how the product is purchased by its consumers. 

Books—in whatever form they take—will always be needed. They entertain, they provoke thought, they provide knowledge.

In publishing, books are the products. Still, how books are distributed and sold doesn't change how they are made: by authors with the perseverance to write a good story, and then do what they can to find readers who will fall in love with it. 

In his blog post. William Kowalski puts it succinctly:

William Says

Well said.

Like Mr. Kowalski, Ms. Cook, and Mr. Bingham, I love what I do. Now that 2015 has come to an end, I now know that all my hard work toward creation and release of the my latest four books and a novella (The Housewife Assassin's Garden of Deadly Delights, The Housewife Assassin's Tips for Weddings, Weapons, and Warfare, The Housewife Assassin's Husband Hunting Hints, Totlandia Book 5, and Gone with the Body) was worth it.

It is confirmed by my bookstore royalties. More importantly, it is substantiated by the many kind comments received from my supportive readers. 

Thank you, readers, for taking a chance on me, loving my characters, and chatting up my books with others who they felt might enjoy them, too. 

Here's to a wonderful new year filled with more great stories from your favorite authors.


The Housewife Assassin’s Handbook is now an audio book. Listen to the first chapter here.



Yep, now you can hear the dulcet tones of Donna Stone*! (Really, Melissa Moran, who did a marvelous job, bringing her to life.

If you've got a Audible subscription, make it one of your monthly picks. Or buy it outright, and make it the first of your Housewife Assassin collection.



Happy hearing,


Yep, there IS a way to get autographed copies of my digital ebooks…


Josiebrown.com banner 17 books - NEWEST (3)
Remember, back in the day, when authors signed their paper books with a pen? 
Now that we're in a digital age, it's time someone came up with a way for authors to sign digital books, too. Well, someone has!
AuthorGraph.com now offers my digital eBooks, via Amazon.com. If you'd like a personalized autograph, here are the links:
TOTLANDIA 2 (Winter)
TOTLANDIA 3 (Spring)
TOTLANDIA 4 (Summer)
TOTLANDIA (Bundle of All Four Books)


Bizarre Bazaar #typepad #typepadstatus


In honor of the Great TypePad Cloud Crash of 2014, I've put up one of my Richard Avedon photos, It's an ad for Balenciaga, circa 1948, taken in the la Marais neighborhood, in Paris.  

This particular photoa  was part of an exhibit at @SFMOMA.

To me, it typifies the experience of public display. Each of us is a little strange and crazy in our own way. Even the model looks odd, as since and pinch-waisted as they've made her here. 

Here's to an online presence for all of the blogs and websites affected by the crash that is equally as spectacular!

— Josie




RIP Shirley Temple. Thanks to you, I’ll always put Animal Crackers in My Soup.

My mother introduced me to the films of the iconic child actress, Shirley Temple, when I was five. Mom, who was just a few years younger than Ms. Temple, was raised as a dancer because of her idol.

By the time of my own childhood, in the 1960s, many of Ms. Temple's films were already on television. I loved her pouty voice, and her snappy footwork with the likes of Bill "Bojangles" Robinson (The Little Colonel) and Buddy Ebsen (Captain January), to name a few.

And yes, I put animal crackers in my soup, and wanted to sail away on the Good Ship Lollipop. I already had a Curly Top. All I needed were the Dimples.

It was easy to laugh with Ms. Temple during every movie, but sometimes her touching performances made me cry —  when, say, she encouraged Clara to walk, in Heidi, and when she was the  Poor Little Rich Girl who found the father she thought she lost in during the Boar War, just before she was to be sent away to an orphanage.

I can carry a tune, but could never really shuffle off to Buffalo. So, a belated thanks to you, Shirley, for sharing your incredible talents with the rest of us.



Murder. Suspense. Sex. 
And some handy household tips.

Signal Press/ 978-0-9740214-0-9

ORDER NOW,  from

Amazon.com (US)  / Amazon.UK 
Also in all Amazon countries!

BN.com (99 cents)

Apple iTunes Bookstore  / Apple iTunes Bookstore (UK) 
In all iTunes countries!


— Josie

What’s “broke” in the American health care system? Hospitals overcharging– and politicians who let them. The lobbyists are killing us — literally.

This  article, which appeared in The New Yorker, is a must-read for all American voters.

 Of course patients should know costs — so that they can be outraged enough to demand change.

The real elephant in the room isn't "should they know?" but "why do patients, communities, and elected officials allow medical money machines – i.e., the hospital corporations — get away with pirate costs on even the smallest items?" 

Time to go back to regulation. Better yet, Medicare for ALL.

When it comes to life, death, sickness and health, hospitals that charge 1,000 for a toothbrush should not be allowed to stand between you and the care you need.
DECEMBER 23, 2013 / (c) 2013 The New Yorker 




Two months ago, I moved into a new apartment. On the first night, in the dark, I tripped and fell. It felt like I had badly scraped my shoulder, but when I looked in the mirror there was no torn skin—my collarbone was simply jutting at a new, funny angle. When I tried to push it back into place, I got nauseated, so I decided to try to sleep. I’ll wake up soon, I thought, and just pretend this never happened.

When that didn’t work, I Googled “rotator cuff tear” and “asymmetric shoulder.” It seemed like a benign possibility; lots of people with rotator-cuff tears lead healthy and productive lives. No luck. I called my mom, who happened to be visiting for the night and was at a hotel two blocks away (and who, like me, happens to be a cardiologist). When she arrived, we made a video of my shoulder to send to my orthopedist cousin for a diagnosis—a clever idea except for the fact that he was sound asleep. Our delay tactics exhausted, we faced the inevitable: I needed to go to the emergency room.


Next thing I knew, I was standing with my pokey shoulder in front of an X-ray machine. My mother called out to me from the radiology reading room: “You broke your clavicle.”

“O.K.,” I called back.

After being diagnosed, the rational next step would have been to turn my attention toward treatment. Instead, when two additional X-rays were taken, an orthopedist was called to review the films, and two slings were provided instead of one, I wasn’t thinking about what I needed to do to get better. I was doing arithmetic: How much was all of this going to cost?

“You’re so tough,” my mom said, when I refused, for about the fifth time, to even take a Tylenol.

“It’s not that,” I said. I waited until the nice doctor walked away and whispered, “Did you not hear about the toothbrush?”

The thousand-dollar toothbrush, to which I was referring, had first gained notoriety in 2010, when featured, among other absurdities like twenty-three-dollar alcohol pads and fifty-three-dollar disposable gloves, in a CNN special on exorbitant health-care pricing. Three years later, the buzz around said toothbrush grew when the New York Timesreporter Tina Rosenberg published a widely circulated piece called “The Cure for the $1,000 Toothbrush,” which described how the lack of price transparency in health care contributes to its exorbitant costs, and financial ruin for many Americans. Those pieces, along with Elizabeth Rosenthal’s five-part Times series and Steven Brill’s twenty-eight-page Time cover story, “Bitter Pill: Why Medical Bills are Killing Us,” have made the lack of price transparency in health care an intensely debated topic for both policymakers and the public. And it’s why sitting perfectly still to avoid pain made more sense to me than accepting a Tylenol, which I feared would cost me a hundred times more than what I would pay at the CVS next door.

The obvious antidote to price opacity is price transparency, but such transparency may have a range of effects, depending on where it is applied in the many layers of health-care delivery. For instance, there is emerging evidence that when hospitals publish prices for surgical procedures, costs decrease without a loss of quality. The Surgery Center of Oklahoma, for example, has been publishing its prices for various procedures for the past four years. Because the center’s prices tend to be lower than those of other hospitals, patients started coming from all over the country for treatment. In order to compete, other hospitals in Oklahoma began listing surgical prices; patients were able to comparison shop, and hospitals lowered their prices.

The calls for price transparency, though, have now moved beyond the hospital walls. Intwo recent opinion pieces, Peter Ubel and colleagues argue that doctors ought to directly disclose to patients the costs of recommended treatments. Out-of-pocket costs, they argue, can “cause more distress in patients’ lives than many medical side effects, and patients can decide whether any of the downsides of treatment are justified by the benefits.”

We must find better ways to make affordable, high-quality health care available to everyone. But is injecting price transparency into the patient-doctor dynamic by asking patients to consider costs a step toward achieving those aims? Or will we end up hurting most those we are trying to help?

The first problem with financial disclosure from doctor to patient is a practical one. Doctors rarely know how much their patients actually pay. Patients are covered by a variety of insurers, all of whom offer several plans, for which any individual patient has a different copayment and deductible, which he may or may not have met.

Let’s say, though, with a click of a button, a patient’s out-of-pocket costs for any given recommendation are readily available to both doctor and patient. There will be some situations for which two treatments with similar risk-benefit profiles exist, but costs are clearly divergent. Patients with systemic lupus, for example, often choose between two drugs, Imuran and CellCept; the benefits and risks of the drugs are similar, but the latter costs ten times as much. Under these circumstances, asking a patient to consider price in their choices seems wise.

But many common clinical scenarios are more complicated. Take heart-attack treatment, for which, Ubel and colleagues note, costs can approach forty thousand dollars per year. (The report from which the figure is derived actually suggests a range of three thousand dollars to forty thousand dollars, depending on the plan.) Heart-attack care typically begins when a patient comes to the emergency room with chest pain. A stent procedure to open a blocked artery is often life-saving, but only if done quickly. The longer you wait, the more heart muscle dies.

During my cardiology training, it was my job to describe the benefits and risks of this procedure to patients, and ask them to sign consent forms. I went over each risk in painstaking, non-jargon-y detail. You quickly learn, though, that certain risks are far more disturbing than others. Say “kidney damage,” which, while unlikely, is one of the more common complications, and most people seem relatively unfazed. Say “limb loss,” however—which, while possible, is unbelievably rare—and people panic. In weighing risks and benefits in these situations, it’s not the likelihood of the risk that matters but the ease of imagining it.

Now consider this same scenario and add to the list of potential risks, “Full disclosure: this might cost you as much as forty thousand dollars.” All of a sudden you have injected into a litany of the unfamiliar a “risk” that could not be more familiar: money. Who would not fixate upon this cost information in making medical decisions?

It’s also hard to quantify and convincingly describe the long-term costs of not getting treatment. So while it may be possible to tell someone the cost of a stent procedure, it will always be much more difficult to put a price on not getting the stent—which often includes frequent hospitalizations for heart failure, complicated medical regimens requiring intensive lab monitoring, devices to help the heart pump more efficiently, and sometimes even a heart transplant.

Everyone is prone to fixating on risks that come readily to mind while discounting those that may occur in the future. But the tendency to err in these predictable ways is magnified by how poor we feel in the first place. In their recently published book, “Scarcity,” the behavioral economist Sendhil Mullainathan and the cognitive psychologist Eldar Shafir describe the psychological consequences of feeling like you don’t have enough. The fundamental theme of the book is that scarcity, whether it’s from lack of money, time, or even human connection, “captures” the mind, depleting our mental reserves and giving us tunnel vision. As anyone on a deadline knows, such a mind-set can enhance focus and creativity. But more often, the feeling of scarcity, no matter its cause, leaves us more prone to making cognitive errors.

In one of the experiments described in the book, the authors asked people in a mall to consider hypothetical situations involving payments for a car repair. The subjects then completed tests for intelligence and impulse control. In the first scenario, subjects were asked to consider a relatively inexpensive car repair; afterward, there was little difference between high- and low-income participants on the intelligence tests. In the second scenario, however, the cost of fixing the car increases tenfold. When the same people repeated the tests, suddenly the poor fared far worse—the difference was akin to a thirteen-point drop in I.Q.

Based on this experiment and several others, the authors argue that the feeling of scarcity consumes the mind, causing us to behave in ways that are often attributed to personality, but may actually have more to do with context. No one, they argue, is immune.

I lead an undeniably privileged life, but the day I broke my clavicle, I was experiencing my own sense of scarcity. I had just moved, so I had spent lots of money all at once: the first and last month’s rent, cable and other utilities, and, most salient in my mind, a big wad of cash I had handed to the movers a few hours before the big break. And so I tunnelled. That’s why, after leaving the emergency room, while my mother read about treatment and recovery time for broken clavicles, I was frantically trying to understand my high-deductible health-savings-account insurance plan, unwilling to commit to further care until I knew how much I would pay. When it became clear that I would need surgery, and soon, as my mother tried to explain the various options—a big metal plate and screws versus a new technique, which would look better—I stopped listening after hearing the word “new” because “new,” in my mind, only heralded more expensive.

When I emerged from surgery a couple of days later, with the large, visible metal plate, I was delirious from the anesthesia, my heart rate was low, and my oxygen levels were falling. My surgeon insisted that I be admitted to the hospital overnight for monitoring and pain control. Though it was hard to remember to take deep breaths, it was not hard to remember that an overnight stay would cost thousands of dollars more than same-day care. “Take me home now,” I said to my mother.

Not surprisingly, I lost that battle. But in every other way, I won. I received outstanding care from a surgeon who is an expert in his field, ended up having far better insurance than I had initially understood, and have a mother who put her own life on hold to take care of me for a week. Though I will need a second surgery to take the metal plate out—which I wish I had thought about before—it feels like a win because rather than waiting two years, which was my surgeon’s initial estimate, I now have to wait only six months. But, most of all, I won because whatever scarcity had captured my mind was only temporary. For most people, it isn’t.

Transparency, as a concept, has tremendous visceral appeal. How can more information not be better? But information is not knowledge, and efforts to bring transparency to health care have previously failed, or caused unintended harm.

Millions of dollars, for example, have been invested getting restaurants to post calorie counts. Despite the fact that there is no evidence to suggest that these labels have decreased calorie consumption, and even some concern that low-income consumers may choose higher-calorie items, the Affordable Care Act mandates this approach for large restaurant chains. Another failed transparency effort, launched in New York State, involved using “report cards” to publish cardiac surgeons’ performance so that consumers would have better information. In this case, it was physician behavior that changed: the sickest patients, more likely to die and thus reflect poorly on the physicians’ performance, were increasingly turned away. Racial and ethnic disparities, which continue to plague all of health care, worsened.

In the weeks after surgery, stymied by dictation software and limited in what I could do, I spent a lot of time slowly wandering around New York City. In the same way that I had fixated on beautiful hair during times in my life when I had a regrettable haircut, I became enchanted by the loveliness of the clavicle—its symmetry and the amazing way it curves, which is unlike any other bone. But I also started noticing all the people who were broken—in slings like me, or limping along in awkward orthopedic shoes—a whole outbreak of hardship I had previously failed to register. One woman, when our paths crossed early one morning in Central Park, was wearing a sling just like mine. She smiled at me sympathetically and shook her head. “There’s a whole lot of that going around,” she said.

I wondered, but didn’t ask: Did she feel that she had enough to invest in getting fixed? Or was she still hoping, as I had so briefly, that with a little luck, she would mend?

Lisa Rosenbaum is a cardiologist, a fellow at the Philadelphia V.A. Medical Center, and a Robert Wood Johnson Foundation Clinical Scholar at the University of Pennsylvania.

(c) 2013 New Yorker Magazine



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