Extra Life: A Short History of Living Longer

by Steven Johnson

As a species we have doubled our life expectancy in just one hundred years. All the advances of modern life--the medical breakthroughs, the public health institutions, the rising standards of living--have given us each about twenty thousand extra days on average. There are few measures of human progress more astonishing than our increased longevity.

This book is Steven Johnson's attempt to understand where that progress came from. How many of those extra twenty thousand days came from vaccines, or the decrease in famines, or seatbelts? What are the forces that now keep us alive longer? Behind each breakthrough lies an inspiring story of cooperative innovation, of brilliant thinkers bolstered by strong systems of public support and collaborative networks.

But it is not enough simply to remind ourselves that progress is possible. How do we avoid decreases in life expectancy as our public health systems face unprecedented challenges? What current technologies or interventions that could reduce the impact of future crises are we somehow ignoring?

Genres: Science, Nonfiction, History, Health, Audiobook, Medical, Medicine

320 pages, Hardcover

Published May 11, 2021

About the author

Steven Johnson is the bestselling author of twelve books, including Enemy of All Mankind, Farsighted, Wonderland, How We Got to Now, Where Good Ideas Come From, The Invention of Air, The Ghost Map, and Everything Bad Is Good for You.
He's the host of the podcast American Innovations, and the host and co-creator of the PBS and BBC series How We Got to Now. Johnson lives in Marin County, California, and Brooklyn, New York, with his wife and three sons.

Reviews

[Clif Hostetler · Rating 3 out of 5]

This book describes the history of the development of various innovations that have contributed to the extension of the average life spans of humans. This book repeatedly makes the point that the development and adoption of these innovations were more complicated and involved a wider array of individuals than indicated by the popular stories often told of their beginnings. In almost every case there was opposition to these innovations when they were first proposed.

There are many different innovations that have contributed to extended life spans. This book offers the following summary ranking that divides them into groups of millions, hundreds of millions, and billions of lives saved.

MILLIONS:
AIDS cocktail
Anesthesia
Angioplasty
Antimalarial drugs CPR
Insulin
Kidney dialysis
Oral rehydration therapy
Pacemakers
Radiology
Refrigeration
Seat belts
HUNDREDS OF MILLIONS:
Antibiotics
Bifurcated needles
Blood transfusions
Chlorination
Pasteurization
BILLIONS
Artificial fertilizer
Toilets/Sewers
Vaccines

The following excerpt comments on the originating sources of these innovations.

... the most fundamental and inarguable form of progress we have experienced over the past few centuries has not come from big corporations or start-ups. It has come, instead, from activists struggling for reform; from university-based scientists sharing their findings open-source style; and from nonprofit agencies spreading new scientific breakthroughs in low-income countries around the world.

The following excerpt makes an observation I've thought of many times. We are lucky that the most recent pandemic occurred after development of techniques of virus identification and the science of gene sequencing.

When the SARS-CoV-2 virus first emerged in China in the final weeks of 2019, the organism was identified within a matter of weeks. (By contrast, just four decades ago, at the beginning of the AIDS pandemic, it took three years to identify HIV.) And within days of the coronavirus discovery, the genome of the virus had been sequenced, and that genetic profile had been shared with research labs around the world.

[Mal Warwick · Rating 5 out of 5]

Ask just about anyone why we live so much longer these days, and the answer will come quickly. It’s the doctors, right? Continuing advances in medical science surely account for those centenarians who keep cropping up on obituary pages. After all, human life expectancy more than doubled over the past century, from a global average of 32 years in 1900 to 73 today. But was it the doctors who brought that all about? Steven Johnson says not. In Extra Life: A Short History of Living Longer, he argues with jaw-dropping effectiveness that medical advances are just one of many factors that explain why we’re living longer—and by no means the most important. “Most historians now agree,” he writes, “that, in total, medical interventions had a limited effect on overall life expectancy until the end of World War II.” And many of the most significant improvements took place much earlier.

We’re living longer—an extra lifetime’s worth

Make no mistake about it: Steven Johnson has not set out to debunk the myth of medical miracles. He has simply extended the boundaries of his inquiry, looking more deeply and farther afield for an understanding of how the human race has managed to gain “an entire extra life in just one century.” The “extra 20,000 hours of life” we now enjoy represent “truly one of the greatest achievements in the history of our species.” And those who have brought it about include not just physicians and surgeons but statisticians, activists, political leaders, journalists, bureaucrats, and international administrators as well.

What has really made the difference?

To put Johnson’s case in perspective, he cites just three factors that have accounted for saving the lives of billions: artificial fertilizer, toilets and sewers, and vaccines. Those that have saved hundreds of millions include antibiotics, bifurcated needles, blood transfusions, chlorination, and pasteurization. The list of advances that have saved millions of lives is much longer and includes much of the progress we attribute to doctors. Among those advances are the AIDS cocktail, anesthesia, angioplasty, antimalarial drugs, CPR, insulin, kidney dialysis, oral rehydration therapy, pacemakers, radiology, refrigeration, and the three-point seat belt. The twenty-one factors Johnson includes in this hierarchy account for the lion’s share of the explanation for why we are living so much longer these days.

A “network narrative,” not a “genius narrative”

Johnson emphasizes “the difference between the ‘genius’ narrative and the ‘network’ narrative.” In the former, a reflection of the Great Man Theory of History, a brilliant lone individual achieves a breakthrough that makes all the difference. Think Edward Jenner (smallpox vaccination) and Alexander Fleming (penicillin). But, as Johnson makes clear, each of these exceptional men was a player in a large cast—a network—that brought their discoveries to the public. “You can extend life with a miracle drug or a new form of surgery or an fMRI machine. But you can also extend life by crunching the numbers, or making a public stand in support of a new treatment, or creating institutions that allow for new kinds of global collaboration.” This is history as it should be written, not with a narrow view of one or another episode or trend but with an eye on the Big Picture.

About the author

Steven Johnson is the author of ten nonfiction books, largely about science and technology, which have received critical acclaim and won several literary awards. He has also been deeply involved online and on television. Johnson was born in 1968 and grew up in Washington, DC, where he attended the prestigious St. Albans School. He holds a bachelor’s degree in semiotics from Brown University and a master’s in English literature from Columbia. He now lives with his wife and three sons in Brooklyn.

[Laura Hill · Rating 5 out of 5]

Thank you to Riverhead Books and NetGalley for providing an advance copy of this book in exchange for my honest review. The book will be published on May 11th, 2021.

A compendium of the major advances in life expectancy throughout human history. With an engaging, story-mixed-with-research style, Johnson devotes a chapter to each of the major contributions: Vaccines; Data and Epidemiology; Pasteurization and Chlorination; Regulations and Testing; Antibiotics; Safety Technology and Regulations; and Anti-Famine Interventions. While some of the stories were familiar to me, many of them were brand new. Even those I was familiar with were actually new to me: I hadn’t been aware of quite how devastating the problems were or all the tangled issues that snaked their way through solution adoption on a widespread scale.

The introduction states that the book is “a study in how meaningful change happens in society.” The ongoing theme is that it is the network of people and not just the genius that makes these massive changes possible — the journalists, activists, reformers, and amplifiers. He hammers this point frequently, accusing society of “… condensing a complex network of agents into a single heroic scientist.” And it is interesting in every case — how long it took and how hard people worked to get a solution to a horrific problem actually adopted.

The last chapter focusses on the future — AI drug design; a cure for malaria; syndromic surveillance; animal surveillance to stop virus jumping; and immunotherapies for cancers. There is some discussion of the negative impact on the planet of all these extra bodies but not much. I would have liked at least a little discussion on the need for additional birth control giving the teeming state of the world’s population.

The book makes for easy and engrossing reading. The numbers involved are astonishing, and the stories from discovery to scale to distribution eye opening. More intriguing than most fiction!

[Steve · Rating 4 out of 5]

Great science writing about the main things that have doubled average human life expectancy in the last couple hundred years. I especially liked that he dug beneath the typical story about the discovery of penicillin for example. Yeah, the story of Alexander Fleming and his moldy Petri dish is gone over, but so many other people and institutions were involved. Really shows how progress in these matters is a group project, and different fields of science all contribute.

[Florin Pitea · Rating 5 out of 5]

Very well documented, informative and relevant. Highly recommended.

[Erikka · Rating 5 out of 5]

I can’t say enough about Johnson’s books. He has such a unique way of thinking about the world, like Malcolm Gladwell. This was a lovely little book about why we’re living longer, what adjacent possibles led to huge leaps in life span, and what work we have left to do. It’s well researched, has excellent citations, and provides ample food for thought. I really enjoyed this and discussing it with my husband.

[Bjorn · Rating 3 out of 5]

Makes a good case for remembering all the things that have happened to make us NOT die young over the last 150-odd years, and that they mostly happen through complex networks rather than the work of lone geniuses. All that said, it could have built into something more, said more about how we can use those examples to solve problems facing us now, rather than go on some speculation about us never dying at all.

[Lisa · Rating 5 out of 5]

I have liked this author’s work since his book about John Snow and the epidemiology of the cholera outbreak in 19th C London. This book drew heavily on his previous work and expanded it into many ways that science has increased life expectancy. It is a comprehensive list of advances that the author has cleverly grouped into concepts. He included vaccinations; pasteurization; chlorinated water; germ theory and sanitation; scientific methodology development with RCTs, epi and stats; regulatory bodies including WHO, CDC and FDA; penicillin; auto and industrial safety standards; and famine reduction using advanced agrology methods. The world population is not increasing because of reproduction but because of improved life expectancy. He synthesized all the information into future prospects of longevity and the morality of health discrepancies between wealthy and poor countries and communities. He pointed out that the antivax crazies are not new to the present but quacks and anti science factions have always been around. My personal rating system usually awards no more than three stars for nonfiction since I am not the content expert to know what was accurate or complete. But I rate this higher because it is comprehensive, well organized, and an excellent reading experience.

[Andy · Rating 1 out of 5]

I don't get it. In the introduction, the writer correctly explains why it is "misleading" to say that people are "living longer" or that we have gained an "extra life." Nevertheless, the title, the subtitle, and language throughout the book reinforce "living longer." Life expectancy has increased mainly because fewer children die, not because 35-year-olds now live an extra 35 years. This confusion has huge implications for all kinds of national policies and personal decisions. For people who know about public health, there's nothing much new here, so the value is in clarifying things for the general public, but I don't see how it's clarifying to be so thoroughly misleading.

Some better books on related topics:
The Role Of Medicine: Dream, Mirage, Or Nemesis?
The Mirage of Health: Utopia, Progress, and Biological Change
The Origins of Human Disease
The Great Filth: The War Against Disease in Victorian England
Rats, Lice, and History: Being a Study in Biography, Which, After Twelve Preliminary Chapters Indispensable for the Preparation of the Lay Reader, Deals With the Life History of Typhus Fever
The Making of a Tropical Disease: A Short History of Malaria
Smallpox: The Death of a Disease: The Inside Story of Eradicating a Worldwide Killer

[Kathleen Gray · Rating 4 out of 5]

Interesting and informative. Johnson has pulled together essays on the multiple ways progress has allowed us to live longer. Vaccines and antibiotics are obvious , yes, but some of these are things I hadn't thought about, such as auto safety. You might be familiar with some of the individuals he highlights but others are lesser known (and sent me down the rabbit hole of Wikipedia). I treated it as a collection and read it a section at a time. Thanks to Edelweiss for the ARC. A timely read.

[Sunethra · Rating 4 out of 5]

Steven johnson has a knack for examining everyday ideas in a novel way.

In extra life he makes us appreciate innovations driven by networks of diverse types of doers in contrast with the hyper popular lone genius/inventor model. In every chapter, I was surprised and humbled by a different way of thinking about the quiet yet revolutionary impact of several well known innovations.

Change happens in sometimes directed yet more often than not unexpected ways. You'll come away with a new appreciation for how every type of person can and does contribute to life enhancing innovation!

[Sean Owen · Rating 4 out of 5]

"Extra Life" sets out to explain how global human life expectancy doubled in the past 100 years. First Johnson clarifies the common misunderstanding that it's that individual people are living longer. It's actually that because so many fewer people are dying young average life expectancy has increased. Take a walk through any old graveyard in a small New England town and you'll be struck by the sheer quantity of graves of children. The idea of most children safely making it to adulthood is fairly new.

You might be expecting the book to be anecdotes of medical inventions, but as Johnson makes clear these aren't the real heroes in the story. While antibiotics and vaccinations play roles it's ultimately more prosaic things like clean drinking water, sewage systems and public safety authorities that deserve the credit.

The book the evidence presents creates a massive rebuttal to libertarians and those advocating for small government. Progress does not often come from private industry pursuing profit. Often, as with auto safety, they have to be dragged kicking and screaming. Instead, progress comes from public health authorities, public record keepers, university research institutes, and the work of dedicated activists pushing for action.

It's an easy interesting read and some of the successes like smallpox going from dreaded killer to non-existent stand as some of the greatest human achievements.

[Benita · Rating 5 out of 5]

I first learned of this book from an article by the author in the New York Times. (If you want to just read the article, you will get the gist of much of the book in a succinct form.) I found his overview of the many things that have contributed to a lengthening of our life expectancy full of unexpected and expected items. Of course vaccines and antibiotics, of course sanitation. But statistics, and soil science? Having read the book, those are now rating an "Of course!" from me. Johnson writes in a way that is understandable and engaging for the non-specialist, and has helped me look at the world in very different ways. He does a good job of playing up the roles of the unsung in spreading the widespread adoption of the results of scientific breakthroughs. I (like many, I suspect) knew of Fleming's discovery of penicillin, but had no knowledge of the international effort to figure out how to mass produce it during World War II, an effort on par with the Manhattan Project. I do wish he had included Florence Nightingale in his discussion of the role of data analysis in improving life expectancy, but that is a small quibble with an excellently told story.

[عدنان عوض · Rating 4 out of 5]

يتحدث الكتاب عن أهم الانجازات الانسانية التي أدت إلى مضاعفة عمر البشرية، تحديداً إطالة متوسط العمر المتوقع وتقليل معدل وفيات الأطفال. حيث يختار الكاتب ستيڤن جونسون -بمعايير معينة- عدة انجازات ويسرد أهم المساهمين فيها وقصصهم.

وبالرغم من أن العديد من القصص قد تبدو مألوفة، مثل قصة اللقاحات أو بسترة الحليب أو اختراع المضادات الحيوية إلا أن جونسون يعيد سرد هذه القصص من بُعديَن مختلفين:
الأول: أن بطل هذه القصص/التغيرات لم يكن شخصاَ واحد كما في الروايات الشائعة. وإنما عدة أشخاص من عدة تخصصات في عدة أماكن وعلى فترات تاريخية مختلفة. فلا يكفي مثلاً اكتشاف آلية عمل اللقاح، بل لابد من وجود من يطور آلية تصنيع فعالة، وطريقة حفظ اللقاحات، وطريقة حقن آمنة، وجهد شعبي لاقناع الناس، ومساواة في تقديم الخدمة الصحية للجميغ وغير ذلك. لينتقل جونسون بذلك من مفهوم البطل الفردي صاحب التغيير إلى شبكة التغيير التي تتكون من عدة شخصيات/تخصصات/أماكن/أزمنة لكل منها دوره المهم.
البُعد الأخر: أن أهم الشخصيات التي ساهمت في مضاعفة عمر البشرية في المئة السنة الماضية لم يكونوا من داخل الحقل الطبي، بل على العكس تماماً. فقائمة الشخصيات تشمل علماء الكيمياء والناشطين والسياسيين والمؤسسات البحثية والحكومية وغير ذلك. وكان الأطباء في آخر سلسلة التغيير هذه.

تحدث جونسون في ختام الكتاب عن اطالة عمر الانسان بهذه التغيرات قد أحدث تغيرات سلبية، منها زيادة عدد سكان الأرض وتأثير ذلك على البيئة. وختم بتوقعاته لأهم التغيرات التي ستطيل عمر البشرية في القرن الجاري، لكني كنت في انتظار أمر آخر: بعد اطالة عمر البشرية، ماهي أهم التغيرات التي حسنت من جودة حياة الانسان؟ وهل كان لهذه التغيرات أبعاد سلبية مباشرة؟.

أهمية هذا الكتاب بالنسبة لي تكمن في دعمه لقناعة راسخة لدي وهي أن الصحة وطلب الصحة تكمن في الأساس في المجتمع حيث تُعاش الحياة، وأن طلب الاستشفاء في منشآت الرعاية الصحية، مثل المستشفيات، يُعد من آخر مراحل طلب الصحة. وأن الأطباء هم أحد ممثلي هذه العملية وليسوا الوحيدين.

[Ben Rogers · Rating 3 out of 5]

+1 Life

While it may not soar to extraordinary heights, it offers a worthwhile exploration of the subject matter.

Johnson delves into various aspects of living longer, presenting a mix of interesting insights and moments that could be perceived as somewhat kitschy. The book covers a range of topics, from medical breakthroughs to lifestyle choices, all with the goal of understanding and improving our chances of a longer lifespan. While it's difficult to predict the exact outcomes of our efforts, the book encourages us to focus on specific factors that can positively influence our longevity.

While Extra Life may not provide groundbreaking revelations, it still offers a valuable perspective on the pursuit of a longer life. Johnson's research and storytelling abilities are evident throughout the book, ensuring that readers gain some useful knowledge along the way. Although not every chapter may resonate equally with every reader, there are certainly moments of intrigue and inspiration to be found.

In summary, Extra Life: A Short History of Living Longer by Steven Johnson offers a worthwhile exploration of the quest for a longer and healthier life. While it may not reach extraordinary heights, it presents a mix of interesting insights and moments that might be perceived as kitschy.
Johnson's research and storytelling abilities contribute to the book's value, even if not every chapter resonates equally with every reader.

Whether you're seeking to gain knowledge on the subject or contemplating your own lifestyle choices, this book provides a solid starting point.

3.3/5

[Deane Barker · Rating 4 out of 5]

I love Steven Johnson. He's one of my favorite authors. He writes mainly about the history of science and technology.

This book is about the history of how we began to live longer. The average lifespan has gone up so much in the last couple of centuries, and what caused that?

Here's the list:

* Vaccines
* Epidemiology
* Pasteurization and chlorination
* Antibiotics
* Automobile and industrial safety
* Increased food production

He goes deep into each one and explains the history, what led to it, and how it changed the world. Along the way, he paints the picture of a society slowly moving forward and resolving "the catalog of evils" that plagued us for thousands of years.

No one writes science as well as Johnson. Each chapter is clear and compelling. (I highly recommend all his other books.)

Today, we truly don't know how good we have it. There was so much that could have killed us in the past. And we slowly resolved each one.

This book made me hopeful for the future, despite the insanity that COVID has visited upon us.

[Natalie · Rating 3 out of 5]

Life expectancy doubled since the 19th century. What scientific discoveries helped us get there? Among them is solving a mystery of cholera, discovering milk pasteurization, inventions of antibiotics and vaccines. All of these were critical in fighting deadly diseases that took human lives untimely. Book is very thorough and, honestly, I could have used a shorter version and spent less time. If you are curious and don't have much time - author gave a great summary of his book in a wonderful 15min TED talk. :)

[Dave Reads · Rating 5 out of 5]

In “Extra Life,” science and technology writer Steven Johnson shares what he describes as ‘one of the greatest achievements in the history of our species.” It was the rapid increase in the human lifespan. In 1880 the average person would live until the age of 40. By 2010, that number increased to 80 years. We gained an “Extra Life.”

He writes about medical advancements, including vaccinations against smallpox and other diseases, scientific advances like what caused people from getting sick from cholera or unpasteurized milk, and understanding ways of keeping us safe (wearing seatbelts).

Among the critical points of the book:

- People in the shortest-lived countries today will, on average, outlive those of your grandparents’ generation.

- Today, more than 99 percent of children in rich countries survive, and more than 96 percent worldwide.

- A handful of medical and other breakthroughs have extended human life expectancy and decreased child mortality.

- People were living longer not because of medical interventions but because of an overall improvement in the standard of living, thanks largely to agricultural innovations that put more food on the table.

This is a fascinating book that celebrates our past understanding and makes us wonder what the future will hold.

[Liz · Rating 5 out of 5]

A fascinating book on the factors that have contributed to an increased life expectancy, many of which were not medical. Most of the major impacts have been in the last century. It makes you want to be around during the next century to see the future advances, or maybe not, as environmental factors created by mankind may lead to a reversal.

[Laura · Rating 4 out of 5]

I never would have thought that a book about how data has literally saved our lives could be so fascinating.

[Jake · Rating 3 out of 5]

Interesting. This book details the breakthroughs that have given the average human 20,000 extra days of life. Surprising fact: of all the life saving and life prolonging measures mentioned in the book, only the 3 point seatbelt came from the private sector. Tech bros may be overrated.

[Arianne X · Rating 5 out of 5]

The Human Virus

Ironically, the exponential growth rate of the human population looks most like that of replicating cancer cells or a virus, i.e., an unhealthy growth. The latest threat to human longevity and survival is humans. Our expansion and survival create barriers to expansion and obstacles to survival. For example, climate change resulting from human activity is primarily driven by the size of the human population rather than the use of fossil fuels. The use of the same fossil fuel technology by a population one order of magnitude smaller would have no meaningful impact on the global environment. But the technology itself makes the higher population inevitable.

This book offers an updated way of thinking about disease. For example, a pandemic is by definition a collective, not an individual problem. Thinking in terms of community benefits instead of personal rights is an alien way of thinking for many demented Americans. It requires thinking of illness in a different manner, as a community malady and not simply as the sickness of an individual. It requires a change in perspective. Disease is more effectively prevented by thinking of it in terms of geography to be contained and transmission to be halted rather than as simply an individual illness to be treated. That is, understanding the macro trends in disease and mortality patterns is the most effective way of keeping individuals healthy rather simply treating diseases in individuals. Simply stated, diseases such as Covid are more easily prevented than treated but this is still understood by the anti-science, anti-expert, anti-vax, anti-public American public.

There is also a form of ‘virus’ in human thinking about illness. Thinking in terms of community benefits instead of personal rights is an alien way of thinking for many Americans. It requires thinking of illness in a different manner, as a community malady and not simply as the sickness of an individual. It requires a change in perspective. Disease is more effectively prevented by thinking of it in terms of geography to be contained and transmission to be halted rather than as simply an individual illness to be treated. That is, understanding the macro trends in disease and mortality patterns is the most effective way of keeping individuals healthy rather simply treating diseases in individuals. For example, cholera was eradicated with an updated sewer system (a public investment), not improved medicine. Another example is the invention and of use of refrigeration to eliminate the health hazards caused by spoilage. Simply stated, diseases such as Covid are more easily prevented than treated but this is still not understood by the anti-expert, anti-science, anti-vax public.

[Rick Elinson · Rating 5 out of 5]

This is a remarkable analysis of the great increase in life expectancy world-wide in the last century. Before 1900, human life expectancy hovered around age 35, but now it is 70 years or greater. Much of this increase is due to the tremendous reduction in infant and childhood mortality. Johnson describes a mixture of scientific advances (immunization, antibiotics, pasteurization, clean water, nitrate fertilizers) and conceptual and methodological advances (life expectancy tables, randomized control trials, vital statistics). He emphasizes the importance of both the innovation and the tortuous path to acceptance of the innovation. As a result, Johnson highlights many people whose achievements are usually not mentioned, certainly not in comparison to all those generals and politicians who populate our history textbooks and to whom we erect statues.

My one criticism is the presence of the last chapter where Johnson tries to outline some possibilities for the future. That attempt is especially incongruous after Johnson's recounting of the unlikely sources of many of the important public health measures that have led to the great increases in life expectancy.

[Paul Sand · Rating 2 out of 5]

[Imported automatically from my blog. Some formatting there may not have translated here.]

I listened to Nick Gillespie interview the author, Steven Johnson, about this book on his Reason Podcast. I must have been impressed enough to put it on my get-at-library list. I have been generally both favorable and unfavorable to Johnson's work in the past. This one gets an "OK for history, not great on policy" grade.

It's the story of how we (as in: First World Humanity) went from (in the UK) about 35 years of life expectancy at birth back at the turn of the 18th century, to nearly 80 years now. It's a great story, but Johnson's answer turns out to be: a lot of things (listed, for our convenience, on pp xxviii-xxix), from "AIDS cocktail" to (generally) "Vaccines". There's a PBS Documentary, if you prefer getting history that way.

The book's chapters each concentrate (roughly) on a single threat to human life and how that threat was (at least partially) solved: smallpox, cholera, raw/adulterated milk, bogus elixirs and medicines, bacterial infection, unsafe cars, famine. Johnson is a good, punchy writer and his relating of history is grabbing.

But he's way too moon-eyed about government regulation. Heroic efforts by the FDA, CDC, WHO, etc. are fawningly described. The white-knight bureaucrats ride over the hill to save us! But he wrote the book as Covid was in full swing; he could have (but did not) go into the bungling, foot-dragging, and "for your own good" nanny statism that probably cost lives in the US and abroad. That would complicate his story, sure. But it feels like this omission was probably intentional for that reason.

When reviewing his list of "life-saving innovations" he bemoans "how few of them originated in the private sector." Um, fine. But all of them were developed in rich countries with (I'm being redundant here) a thriving private sector. You don't get innovation from socialist countries, and you don't get it from poor countries (again, quite a bit of overlap there.) Johnson could have, but didn't, explore that.

And then, in his concluding chapter, Johnson speculates on radical life extension, using clever gene engineering to turn off the cell-level aging process in humans. Oh, oh, says Johnson: "Is it right to allow some people some people to live forever, while condemning others to death and the slow decline of aging, based solely on how much money they have in the bank?" (Emphasis added.)

"Allow?"

Geez, Steve. Read Heinlein's Methuselah's Children and notice how much you sound like the bad guys here.

I can't imagine a world where you can't have life-extending medical intervention unless everyone else is provided with it at the same time. That logic would prevent every one of the innovations Johnson describes. I'm not sure he's thought that through, and his cheap demagogic point about "money in the bank" is a sure sign that he hasn't.

[Lance Eaton · Rating 4 out of 5]

Johnson returns with another enjoyable and intriguing exploration that considers what are the factors in the last few hundred years that have led to a near doubling of human life. It's not an extensive history nor a history that explores this through the genius model of history (a history that frames it in the solitary figures who did "great deeds"). Rather, Johnson delivers a network history that explores the conditions and structures that created the changes in thinking to introduce practices, tools, and advocates to widened the Overton Window (the range of socially acceptable ideas around a subject) to include these newer ideas. That's not to say he ignores the more well-known names but places them in a larger context that shows how without other elements, they would not have been able to help shift the paradigm. Beyond that, Johnson's book provides a powerful commentary on the importance and value that government, public health, and public advocates have had over the centuries in creating methods, regulations, and infrastructures that have not only allowed many more people to live but to add some 20,000 days to our lives collectively (some variation based on different demographics but still much more additive to life compared to even 100 years ago). Some of the topics he dives into include data collection, inoculation, vaccines, double-blind testing, pasteurization, chlorination, nitrates in farming, and safety regulations for motor vehicles. By and large, markets did not and were not interested (and at times, vehemently opposed) to addressing these issues that caused large-scale harm and devastation. Rather, the changes needed to be implemented by governments, academia, medical practitioners, and the like. In total, Johnson's book is one that is fascinating thinking about the factors that create change and also, strong evidence about the importance of having a public sphere that can work to protect, support, and enhance life in ways that private industry often fails to do.

[Lauren Hiebner · Rating 3 out of 5]

This book covers the improvements made in reducing the infant mortality rate which translates to an increased human life span. Johnson explains the developments that increased man’s life expectancy such as vaccines, the collection of data and epidemiology, pasteurization and chlorination, the testing and regulation of drugs, antibiotics, automobile safety, fertilizers, and understanding soil as a living organism. Johnson notes that scientists and physicians are only part of this process, it also needed activists, reformers, and evangelists to get something out for the general public and to fight resistance to new developments. “Real change often requires a first step of convincing people that the existing problem is not inevitable; and devising solution requires a diverse network of talents, building on each other’s work.” Johnson also notes that most fundamental innovations and progress have come from activists and reformers more so than big corporations. Regarding data, Johnson says that collecting data on people on ventilators and deaths from Covid19 is after the fact and doesn’t help much. The data to collect for prevention is at the beginning when a disease is found in animals (chickens mainly) and first transferred to people. That is useful data. Johnson also quoted Martin L. King Jr. when he said, “Of all the forms of inequality, injustice in health is the most shocking and the most inhuman.” Unfortunately, this inequality still exists today, as demonstrated with the Covid19 virus. Finally, Johnson points out the we have two external and two internal threats to life expectancy today. Internally - heart disease and cancer; Externally - mosquito born diseases and lack of clean drinking water. These continue to be a threat today to life expectancy around the world. A very timely book and a good read.

[José Antonio Lopez · Rating 3 out of 5]

Steven Johnson has a unique way to interconnecting events in history and create engaging narratives. Extra Life is his most recent work. It is a journey through the "recent" history of advancements to extend life, specially of children.

Johnson leans heavily in favor of government interventions and distrust private solutions. It may be a fact that cases of private abuse or neglect originated government intervention; yet Johnson misses the fact that public regulars also have made progress slower (FDA drug approval evidenced with COVID 19 vaccines), promoted cronyism (COVID 19 pharma were granted protection from future liability), and chosen winners and losers (USDA promoted Food Pyramid).

Cases like Swill Milk of the late XIX can be judge today as wrong because much was learned after them. It is not fair to assume that the private enterprises would not learn, keeping up with rough practices, demanding government agencies to keep them in line. Also it is simplistic to assume that government agencies are selfless, well intentioned and correct.

Had Johnson stick to the scientific narrative and the organization of historic facts, while keeping distance from politics Extra Life would be a four star book. For those interested in this fascinating history of human progress I rather recommend A Good Time to Be Born: How Science and Public Health Gave Children a Future by Perri Klass.

[Ed Bernard · Rating 5 out of 5]

OK, let’s start with this — Steven Johnson could make the assembly of a phone book sound fascinating, so it’s no surprise that this book is riveting. However, despite the title, it is NOT about current advances in the science of aging. Instead, Johnson begins with the fact that human life spans have been increasing at an astounding rate since the Enlightenment, and proceeds to explain why. He enumerates some of the most impactful advances — germ theory, modern epidemiology, seat belts, massive improvements in soil fertilization — then explains how these things came to pass. Along the way, he also upends the myth of the brilliant man (mostly men, a few women) having “aha” moments as the springboard for these improvements — instead, he argues that all substantive changes were accomplished by large networks of individuals. In particular, he pays tribute to those who helped disseminate crucial intellectual breakthroughs, or assisted in the manufacture of things like antibiotics, which rarely gets much love in traditional origin stories of important advances. In his conclusion, maybe in response to the current political climate in the US, he reminds us that virtually none of the most important developments began or were even nurtured in the private sector — other than seat belts, which were invented by Volvo, all the key research was either supported by or commissioned by governments (even Volvo, having developed the seat belt, chose not to enforce its patent and make seat belt technology available to all). This is simply a great popular science book, beautifully written, powerfully argued and brilliant as an overview to this subject, thanks to which we all have about 10,000 extra days on Earth enjoy.

Grade: A

[Mary · Rating 3 out of 5]

I was keyed into this book from an interview the author gave on a popular statistics radio show I listen to from the BBC. Who should be interview Johnson, but Tim Harford, who mentioned in his recent awesome book that if there were an 100-year newspaper the headline would probably be about the precipitous drop in infant and child mortality.

Johnson agrees, but appears to have never met a streak of silver without searching for the cloud behind it. Chicken is a cheap, healthy, relatively low-impact form of protein for billions of people who might otherwise not be nourished? Fine until avian flu might show up. Drugs testings and approval means that medicines no longer kill us and, by the way, also cure what they're advertised to cure? Okay, but some medicines are expensive. People are living longer, healthier lives and are less likely to suffer the heartache of losing a child? Yeah, well, global warming.

The last one is particularly annoying, because he only glancingly mentions the demographic transition at the end of the book, and then by way of (of all places) central planning in China. He is so enamored of government intervention throughout the text that he doesn't seem to be able to see that South Korea and Italy, Puerto Rico and Japan all experienced a demographic transition without anyone telling them to.

Having since researched Johnson after reading the book, I see that he's a medical science journalist, perhaps a little out of his area here, for which he may be excused. The broad strokes of the progress of the last 100-120 years are still breathtaking... or breathgiving?

[William Schram · Rating 5 out of 5]

For untold millennia, human life expectancy hovered around 35 years old. Granted, this was an average. People could live longer than that, but many did not. The biggest hurdle to living longer was getting out of childhood. From smallpox to cholera, many diseases plagued humanity.

Author Steven Johnson explores the reasons for our doubling of life expectancy over the past few generations. Vaccines, the germ theory of disease, pasteurization, sewer systems, antibiotics, and many incremental improvements contributed to living longer. There are many unsung heroes in that sense.

Another case is the medical practice. Doctors had little recourse besides snake oil and placebos to cure you before the 1940s. There wasn't a system in place to test whether a medicine worked or not, and the FDA wasn't in place to check. People deride bureaucracy for its plodding pace, but in some cases, it saved many lives. Think of the thalidomide problem.

Some causes of death were by our design. Automobiles are a great example. An engineer at Volvo developed the three-point safety belt, but "Safety doesn't sell." In America, consumers were resistant to the idea of wearing seat belts, and no one bought them. Many people died in automobile accidents, and people thought it was a result of going too fast.

"Extra Life" is a fascinating book. Johnson connects different fields of inquiry to explain the lengthening lifespan of human beings, and he does it with panache.