How do we determine how much we eat? Surely it depends on how hungry we are and how tasty the food is, but Brian Wansink argues that it depends just...moreHow do we determine how much we eat? Surely it depends on how hungry we are and how tasty the food is, but Brian Wansink argues that it depends just as much on external cues, like how much is on our plate, the shape of our drinking glasses, how fast other people at the table are eating, and so forth.
The best parts of this book are when he describes his experiments: the famous bottomless soup bowl, for example, or the chicken wing Super Bowl party experiment. (In the former he finds that if your bowl surreptitiously refills itself, you will eat far, far more than if it doesn't, because you are relying on the visual cue of how much soup is left in the bowl to tell you to stop eating, and in the latter he finds that if the bones aren't cleared away, they provide a reminder of how much you've eaten, and you'll eat fewer wings than if the bones are continuously removed from your sight.)
The weaker parts are when he tries to extend his findings to produce dieting advice. If our mindless eating causes us to eat a few extra calories a day and cause us to gain a few pounds a year without noticing, then theoretically we could change our habits to give ourselves slightly smaller portions, so slight in difference that we don't even notice, and so we can lose a few pounds a year without even noticing the difference. Fair enough, but I could pick that up from reading the experiments, and I thought the diet advice was a bit heavy-handed and repetitive.(less)
We truly live in a bacterial world. They live in the soil on which we walk, they swim in the water we drink, and they even float on particles of dust...moreWe truly live in a bacterial world. They live in the soil on which we walk, they swim in the water we drink, and they even float on particles of dust in the air we breathe. And for every human cell in our own bodies, there are ten bacterial cells, on our skin, in our upper respiratory tract, and all throughout our gastrointestinal tract, making up the human microbiome. Not only are these bacteria harmless to us, they’re actually healthy for us: industrial agrobusiness raises their animals on antibiotics because it causes them to gain weight, and when Louis Pasteur tried to raise mice under sterile conditions, they all died.
Which is not to say that we should throw out our antibiotics, stop washing our hands, and drink raw milk, because there are a few strains of Staphylococcus aureus, Listeria monocytogenes, Clostridium difficile, Enterococcus faecalis, Salmonella typhimurium, Shigella dysentariae, and Streptococcus pyogenes that can, and do, make us very sick and even kill us. The problem, however, is that when you use an antibiotic to take out a dangerous bug like Strep, you also raze your microbiome and leave yourself at the mercy of whatever bugs happen to be resistant to the drug you chose. As Rockefeller University microbiologist David Thaler says, “Whenever you make a sterile surface, you become a victim of whatever falls on it. It’s like plowing a field and not planting anything but instead trying to live on whatever weeds happen to pop up.”
The HIV field learned hard lessons about the dangers of serial monotherapy and have essentially solved the problem (in rich countries, at least) with HAART (highly active anti-retroviral therapy), but even if antibiotic-prescribing physicians learned the lesson to never give antibiotic monotherapy, additional challenges remain. Horizontal transfer of resistance genes among bacteria is very easy, so bugs in the microbiome naturally resistant to a couple of the drugs in the combination (and there are so many bugs in the microbiome that the probability of such a bug being resident, certainly among a population of humans, is not so remote) develop resistance to the remaining monotherapy in the conventional way, but then can pass all three resistance genes to any other passing bug, benign or pathogenic. Furthermore, although we frequently blame the development on antibiotic resistance on pushy mothers for demanding antibiotics for viral infections or on children for prematurely stopping taking their prescription, the fact remains that 89% of the antibiotics used in this country are consumed by livestock, and the vast majority of those are not given to sick animals, or even to prevent infection, but given at subtherapeutic doses because, for reasons of which we’re not entirely certain, they promote faster growth (possibly because the livestock’s microbiomes are getting trashed). Not only does giving subtherapeutic doses to healthy animals (of, in many cases, the very same drugs also prescribed to human patients facing life-threatening infections) produce an ideal laboratory for the production of antibiotic-resistant microbes, but this problem is exacerbated by the fact that farms do not face the same strict regulations for processing animal waste as municipalities do for processing human waste, so that antibiotic-resistant microbes, unmetabolized antibiotics, and plasmids containing antibiotic-resistance genes end up in the environment surrounding these farms.
As long as our therapeutic strategy is to kill bacteria, any drug we produce will inevitably select for resistance to that drug (even in people who don’t believe in evolution). One other, far more effective approach is to use the good germs to help us fight the bad ones. As far back as 1958, New York Hospital was able to eradicate a seemingly-intractable Staph. aureus 80/81 epidemic, one that had didn’t flinch at any of the best antibiotics available, merely by proactively inoculating newborns with a different strain of Staph. aureus: the good Staph eliminated the bad Staph. The treatment was cheap (they merely took a nasal swab from a nurse who, doctors observed, had much better luck with the babies she took care of than any of the other nurses did), had no observable side effects, and prevented countless deaths. Why don’t we currently embrace the microbiome transplant as standard therapy and not as a treatment of last resort? Good question.
The benefit of good bugs goes beyond merely crowding out the bad bugs. The “hygiene hypothesis” proposes that many diseases that have been rising in the last couple of centuries are a result from sudden alterations in the microbiome, with whom our immune system has been evolving for millions of years, caused by changes in hygiene, far too recent on an evolutionary scale for our immune system to adapt to. These diseases include not obviously auto-immune diseases, such as serious food allergies and ulcerative colitis, but, some researchers propose that stimulating a patients immune system with a Mycobacterium vaccae vaccine can cure not only autoimmune diseases such as Raynaud’s syndrome and peanut allergies but also diseases whose connection to the immune system is less obvious, such as metastatic melanoma.
No doubt the Dr.s Stanford had a great idea with their M. vaccae vaccine, no doubt they are charming individuals, and no doubt the patients who go to them for the monthly “dirt vaccine” (something that is apparently legal in England) are grateful for feeling better, but the author seems insufficiently skeptical. The patients who came to the Dr.s Stanford for their dirt vaccine, for whom it was ineffective in curing their cancer, are now dead and unable to speak up. The clinical trial designed to test the hypothesis of whether the vaccine actually makes a difference among lung cancer patients showed that it did not. This is why we have clinical trials.
To be fair, if I had inoperable metastatic melanoma, I too would probably start trying crazy therapies like dirt vaccines, and then if my cancer suddenly went into remission, I probably would not say, “Oh, it must have been a coincidence”. We, as humans, are of course all biased. The author, perhaps recognizing that, takes precautions to help strengthen her objectivity: incredibly meticulous, yet unobtrusive, endnotes, one of the greatest features of this book and one that is sadly lacking among too many pop science books. If I think, for example, that the author gives insufficient weight the clinical trial mentioned above, I can look up endnote 64 in Chapter 3 to find the citation in Annals of Oncology, and then head to the library to read the study myself and see whether or not it had the design flaws that the Dr.s Stanford claim. In the same vein, I can look up endnote 65, in which Dr. Stanford claims the supposed benefit among adenocarcinoma patients, to read “John Stanford et al., ‘Successful Immunotherapy with Mycobacterium vaccae in the Treatment of Adenocarcinoma of the Lung,’ unpublished”, and then give that the consideration I think it is due. In this way, if I feel that Jessica Snyder Sachs is at any point insufficiently critical, she has given me the tools to go read the evidence and judge for myself. Not only does it make her book that much stronger, but also it reinforces the point that science is not knowledge handed down from God (as so many science textbooks make it seem to be): every sentence in a science text results from observations, hypotheses, experimentation, and testing, and also plenty of heated arguments. As one of my biology professors from college said, “Every sentence in your textbook has blood behind it.”
And that’s what makes this book a great pop science book. Not only is it on a fascinating subject and carefully researched, as most pop science books are, but it also successfully conveys what science is all about. (less)
If I believed in a Canon of literature that every American simply must read for me to consider them sufficiently educated, this book would definitely...moreIf I believed in a Canon of literature that every American simply must read for me to consider them sufficiently educated, this book would definitely be on the list.(less)
An excellent primer in parasites, from microscopic details of their life cycles to detailed descriptions of the symptoms...moreA gift from my father-in-law.
An excellent primer in parasites, from microscopic details of their life cycles to detailed descriptions of the symptoms they cause in humans to our strategies to combat them, all told in a witty and eminently readable style. Each chapter generally covers a different parasite, from the familiar, such as tapeworms, Plasmodium (which cause malaria), trypanosomes (which cause sleeping sickness), and Onchocerca (which cause river blindness), to parasites I've never heard of, such as Anisakis (which can be found in sashimi), Babesia (which causes malaria-like symptoms right here in North America), and Giardia (which is so common I am surprised I have never heard of it, once again, right here in North America).(less)
Provides both advice for how to get a job in industry and specific descriptions of many different careers in biotechnology and drug development, including duties, pros, cons, and skills required. I learned a lot. (less)