BOOK REVIEW: Madness: A Very Short Introduction by Andrew Scull

Madness: A Very Short IntroductionMadness: A Very Short Introduction by Andrew Scull
My rating: 5 of 5 stars

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This is yet another of the many “Very Short Introduction” books from Oxford University Press that I’ve been pleased to read and review. The series offers concise overviews of a wide range of topics that are presented by scholarly experts. This particular book is a historical examination of the changing approaches to mental illness from the ancient world where such a condition might be attributed to demonic possession to more recent times in which drugs and decarceration / defunding of asylums have become the dominant approaches to mental illness. Along the way the book shines a light on the immense difficulty experts have had in understanding what mental illnesses are and how they can best be dealt with. The book not only looks at the real-world response to mental illness, but also explores how it’s been treated in fiction from “Hamlet” to “One Flew over the Cuckoo’s Nest.”

The book consists of six chapters. As one would expect of a book from a historian’s-eye view, its organization is chronological, but the arrangement of time periods by chapter reflects changing approaches to mental illness. Chapter one focuses on the ancient world, during which we begin to get glimpses of madness in the written record. Chapter two, entitled “Madness in Chains,” focuses on the 16th through 18th century, during which Bethlem [Bedlam] Hospital was the cutting edge. That the institution’s nickname becoming a synonym for chaos and confusion says a lot. It was a time of brutal measures that did little to reduce the trauma of mental illness. The chapter also discusses madness in Elizabethan literature, famously that of Shakespeare.

Chapter three shifts to the 19th century, an era in which incarceration became more widespread as well as coming to be thought of as the best that could be done for the insane. In Chapter four, we learn about the rise of psychoanalysis as well as the increasing employment of treatments that involved the physical body – infamously, the lobotomy.

Chapter five is one of the most intriguing parts of the book. Entitled “Madness Denied” it opens with an exploration of the difficulties that arose from all the war-related cases of mental illness that came about as a result of the two World Wars (and others.) It also discusses a movement to overturn the prevailing approach to insanity, most famously and vociferously argued by the Scottish psychiatrist R.D. Laing, a clinician who had a mix of promising and disastrous results from his experimental approach which used LSD, but few other medicines. What I found most interesting, however, was the discussion of the growing recognition that there was a false front in the idea that psychiatry was beginning to really understand mental illness and its treatment. This was exemplified by the Rosenhan experiments in which sane volunteers checked themselves into asylums and, for the most part, the doctors and staff couldn’t tell that they were sane (though, interestingly, in at least some cases the other patients did call it out.) The troubles in classifying and diagnosing mental illnesses have also seen in the vexed history of the “Diagnostic and Statistical Manual of Mental Illness” [DSM,] a guide meant to get mental health experts on the same page about what’s what. [As opposed to ten psychiatrists offering ten different diagnoses of a given patient.] While a worthy attempt, the DSM has not – thus far – succeeded, though it could probably be argued that progress has been made.

The last chapter brings the reader up to the current period, a period dominated by two trends – first, mental illnesses being treated overwhelmingly pharmaceutically; and second, the closing of asylums and the concurrent ill-effects that have come about, societally speaking.

The book has a few graphics, mostly black and white art and photos used to enhance the reading experience. There are also appendices of references and recommended readings.

If you are interested in the history of psychiatric medicine, I’d highly recommend you check out this brief guide. It may not give you all the information you’re looking for, but it’s a good first stop to organize your thoughts on the subject.

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BOOK REVIEW: Breath Taking by Michael J. Stephen

Breath Taking: What Our Lungs Teach Us about Our Origins, Ourselves, and Our FutureBreath Taking: What Our Lungs Teach Us about Our Origins, Ourselves, and Our Future by Michael J. Stephen
My rating: 5 of 5 stars

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Out: January 19, 2021

 

This book explores the crucial role of breathing in human existence, discussing evidence of how breathing practices can contribute to healing of numerous illnesses, investigating the range of threats — from pollution to smoking to toxic dust — that can threaten our ability to breath, and examining a number of diseases that can disturb a person’s breathing. This book is primarily a popular science look at pulmonary medicine. Unlike other breath-related books that I’ve reviewed, this book is mostly about what can go wrong with our lungs and what medical science is doing to combat these threats. The story of how breathwork and changing breathing patterns can improve health and well-being is addressed, but that’s not the book’s central focus. The book uses plenty of stories (e.g. case studies) and what I call “fun facts” to keep the reading from becoming too dry or clinical for a neophyte reader.

The book consists of fifteen chapters. The first two chapters provide basic background information to help understand how the Earth happens to have the oxygen-laden air necessary for our type of life (Ch. 1) and how the lungs exploit that air in fueling our bodily activities (Ch. 2.) Chapter thee explores how breathing begins in newborn babies, explaining that the lungs are the only major organ that doesn’t start working until we are out in the world, and lung inflation doesn’t always go smoothly. The fourth chapter discusses how breathwork (including — but not limited to — yogic pranayama) has been shown to improve health for those experiencing a range of conditions, including: depression, addiction, PTSD, and pain, as well as how breath and meditational practices contribute to better health, generally.

Chapter five investigates the intersection of the respiratory and immune systems, explaining how autoimmune conditions, allergies, and asthma come to be. In chapter six, the author discusses one of the most common and widespread diseases in the world, tuberculosis (TB,) a disease which not only threatens the lives of many, but also sits dormant in a huge portion of the population.

Chapters seven through nine each deal with hazardous materials that are inhaled into the lungs. The first of these chapters is about smoking, and it focuses on the question of how nicotine acts in the body to create intense addictions – as well as what has and hasn’t worked to help people break said addiction. Chapter eight is about pollution. (As resident of a city of twelve million people, I found this to be a particularly disturbing chapter because air pollution is a hazard that is too easy to be blind to if one doesn’t suffer from respiratory problems.) Chapter nine investigates a range of breathable hazards including smoke, dust, and asbestos, and it does so through the lens of the rescue and cleanup at the World Trade Center after the dual collapse of the twin towers on 9-11, an event which released all sorts of toxic material into the air, hazards for which most responders were ill-equipped.

Chapter ten through twelve are about ailments that may or may not be linked to environmental causes like the ones mentioned in the paragraph above. The first of these is idiopathic pulmonary fibrosis, which, by definition, is a condition that arises from an unknown cause, an ailment which involves a stiffening and thickening of lung tissue (which must be thin and supple to allow gas exchange and the expansion and contraction of the breath cycle.) Chapter eleven focuses on lung cancer, which is often due to an inhaled hazard (most notably, smoking,) but not necessarily. While the other chapters of the book focus on breathing as a process by which we take in oxygen and expel carbon dioxide, chapter twelve turns to a different role played by breath, one that is crucial to the activities of our species, breath as a means to control the voice.

Chapter 13 describes the process and challenges of lung transplant. As mentioned in the discussion of pulmonary fibrosis, lung tissue is rather delicate material, and so it was no easy task to transplant it. Furthermore, because the lungs are a point at which the external world (air) contacts the body’s internal systems the challenges are even greater than for those organs that are hermetically sealed within bodily tissues.

The last two chapters focus on cystic fibrosis (CF.) Chapter fourteen explores the nature of the disease and the slow, but promising, path towards treating it. CF is a genetic condition in which the lack of a single amino acid wreaks havoc on the ability of cells to process minerals. The last chapter tells the story of two cases of CF. The first story – involving a ten-year-old whose family had to struggle against a policy that essentially locked their child out of the lung transplant list – is particularly engrossing.

As someone who practices breathwork, I found this book to be interesting and insightful. While it is heavily focused on pulmonary medicine, it does offer insights that will be beneficial to those who are not afflicted by respiratory ailments. If one wants to know more about medicine as it pertains to respiration, this is definitely an interesting and readable choice. However, even if one is infatuated with breath more generally, I believe you’ll find in this volume a great deal of beneficial food-for-thought.

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BOOK REVIEW: Pandemics: A Very Short Introduction by Christian W. McMillen

Pandemics: A Very Short IntroductionPandemics: A Very Short Introduction by Christian W. McMillen
My rating: 5 of 5 stars

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This book explores disease pandemics through the lens of History. I open with that because this is a topic that can (and has) been addressed through many different disciplines, and a reader expecting biological or epidemiological insights is likely to be disappointed. However, if one is interested in questions of how, where, and with what impacts various diseases spread, this book provides a concise overview for seven select pandemics: The Plague, Smallpox, Malaria, Cholera, Tuberculosis, Influenza, HIV/AIDS.

This book belongs to Oxford University Press’s “A Very Short Introduction” series, a massive collection of brief guides outlining a wide range of scholarly topics. This title complies with general guidelines of the series, presenting the basics of a subject in a manner accessible to a neophyte, citing sources and providing recommendations for further reading, and offering graphics to support the text where beneficial.

As mentioned, the book delves into the seven pandemics listed in the opening paragraph, and does so in the order in which they are listed. Each disease is presented in its own chapter – so the book consists of a prologue, seven chapters, an epilogue, and back matter (i.e. citations, recommendations for additional reading, and the index.)

Obviously, these seven pandemics don’t represent a complete history of disease pandemics. The book was published in 2016, well before the COVID-19 pandemic (though readers will certainly read some prescient-sounding statements — particularly in the epilogue,) but not even all past epidemics classed as pandemics are addressed. [It should be noted that there is no perfectly agreed upon dividing line between epidemic and pandemic.] Still, this book includes the biggest and most globally-widespread pandemics, but it also covers a diverse collection of diseases, including: contagious, vector-borne, and water-borne illnesses, as well as bacteria- and virus-induced diseases. It’s worth noting that The Plague is a worthy first case not only because it’s one of the diseases that has most shaped human history, but also because there’s not a great deal known about disease before then. (During the relatively recent 1918 “Spanish” Flu pandemic, the medical community still didn’t know anything about viruses, and so one can imagine how little ancient people would have understood about these causes of death.)

As the book shares information about the pandemics and their impact on the world, it also teaches one something about how medicine and science progressed as a result of these events. This is famously evident in the case of Cholera, a disease whose unusual characteristics with respect to spread baffled doctors until a clever investigator learned that cases were tied to a common water well. The case of Cholera is a prime example of how changing one’s approach can resolve a stubborn question, looking at the cases spatially offered an immediate insight that other modes of investigation had failed to present.

I found this book to offer interesting insight into pandemics. If you are looking to understand the history of disease pandemics, this is a great book with which to start one’s study.

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BOOK REVIEW: Spillover by David Quammen

Spillover: Animal Infections and the Next Human PandemicSpillover: Animal Infections and the Next Human Pandemic by David Quammen
My rating: 5 of 5 stars

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SPILLOVER is a fascinating and in-depth exploration of zoonoses – i.e. diseases that can jump from various animal species into humans. This continues to be a germane topic in the face of our current zoonotic pandemic – COVID-19. The book came out in 2012 / 2013, but has seen a groundswell of interest because it’s the most well-known popular work on this subject. One will read a few sentences in the book that seem prescient, but the author and the many experts he consults would be the first to state that this is no act of mystical precognition. Rather, a zoonotic pandemic seems to be an inevitability given humanity’s huge and growing population and the nature of our interactions with the rest of the animal kingdom. Of course, no one could say precisely when or what pathogen would lead to “the next big one,” of which – it so happens – we are currently amid. Though coronaviruses do come up as potential candidates, but so do others (e.g. certain strains of influenza.)

The book is organized differently than most. It’s cut up into bite sized chunks, with 115 chapters that are usually not more than a few pages each. However, chapters aren’t the relevant unit of interest so much as the book’s nine parts, each of which takes on a particular zoonosis, or class thereof. Because zoonoses are such a huge topic, the author focuses on a few that are of particular interest for varied reasons, including: the challenge of tracking the disease’s origins, the potential to be the next big one, the global influence of some diseases, as well as other reasons a particular zoonosis generates an interesting story.

The first part explores one of the lesser known zoonoses (except for in locales where outbreaks have occurred, e.g. Australia,) Hendra virus. While a common species of bat (the flying fox) is the reservoir for Hendra, what makes the story gripping for humans is that humans contract the disease through the intermediary of horses. While interaction with exotic wildlife is the the mode throughout the book, the fact that, here, transmission occurs from one of humanity’s closest animal friends increases the closeness-to-home effect.

Part two shifts into one of the most dramatic and well-known of the zoonoses, Ebola virus. Ebola is familiar from Richard Preston’s book “Hot Zone,” though Quammen does explain how Preston sensationalized and overstated the physical effects of the disease. [Presumably what Preston did was take the most vicious looking case and describe it through as dramatic of analogies as possible, such that it became unrecognizable from the typical case.] At any rate, it’s a disease that grabs one by the fear center because – while it doesn’t spread readily – it’s highly lethal and is unarguably an unpleasant way to go.

Part three delves into malaria and P. falciparum, the bug that causes it. Malaria has profoundly shaped human existence in the tropics. A vector-borne disease carried and passed by mosquitos, Malaria is widespread throughout much of the world and continues to generate debilitating effects. Many concepts are drilled into one while reading this book, and one worth mentioning here is the differentiation of reservoirs and vectors. A lot of the stories in this book revolve around scientists’ searches for reservoirs – the species where the pathogen resides in waiting. It’s often much more difficult to uncover a reservoir species than it is a vector (vectors invariably coming into direct contact with humans, whereas reservoirs can be far removed from humans.)

Part four investigates Severe Acute Respiratory Syndrome (SARS.) This is one of the most relevant sections because SARS is a corona virus — like COVID-19 — and it served as a harbinger of a corona virus pandemic. SARS is also at least vaguely familiar to most people as it was a relatively recent epidemic.

The next two sections zoom out a bit and, instead of diving down into one zoonosis, they each consider a range of bacterial and viral zoonoses, respectively. Part five discusses Q fever, Lyme disease, Psittacosis, and other bacterial diseases that enter humans by way of other animals. Part six explores a range of viral diseases and – in the process – gives a bit of a lesson as to why viruses present such a risk as well as how different viruses work. This section covers rabies and Nipah virus.

Part seven tells the story of the search for the Marburg virus origin and reservoir. Marburg is similar to Ebola, but the story of the epidemiological search for it makes for intriguing reading. Part eight discusses HIV-AIDS and its simian predecessor, SIDS. What made this fascinating to me was that I learned that HIV has been around (at least) since the first decade of the twentieth century. If you’re like me, you associate the origin of AIDS with the 1980’s. However, with so many people regularly dying from so many different conditions in central Africa, it wasn’t obvious that those killers were getting an added help from a virus that crippled immune systems. It also took scientist a while to realize that SIDS was resulting in the death of chimpanzees. (It’s possible for a reservoir to be unaffected by a disease, and this is what they first thought to be the case.)

The final part is a wrap up that zooms out to look at the nature of episodes of ecological imbalance and “outbreaks” of species. In this case, “outbreak” is used to describe any explosion of population growth of a species. While the section opens with a species of caterpillars [forest tent caterpillars] that would occasionally flare up, killing off trees on a large scale, it discusses human population growth as an outbreak that – like all others – will inevitably end one way or another. This section also discusses influenza (which isn’t a major topic earlier in the book,) presumably because it had been the lead candidate at the time for the “next big one.” And “the next big one” is a related overarching theme in this section.

The book is annotated and has an extensive bibliography. There are few graphics, but there are maps that are helpful for those who aren’t familiar with the areas where many of these disease outbreaks originated (e.g. central Africa.)

I found this book to be intriguing. It teaches the reader some basics of epidemiology as it goes about telling the story of the spread of these diseases. [e.g. It will help one distinguish virulence and transmissibility – terms that are often used by neophytes interchangeably, but which are distinct in important ways.] However, the focus is always on the story and, therefore, it keeps these lessons interesting throughout. I’d highly recommend this book for those who are interested in the pandemic, zoonoses, or the challenges of combating disease.

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BOOK REVIEW: Healing Mushrooms by Richard Bray

Medicinal Mushrooms: Healing Mushrooms for Immune Support - Improve your Memory, Reduce Inflammation, and Fight Cancer (Urban Homesteading Book 7)Medicinal Mushrooms: Healing Mushrooms for Immune Support – Improve your Memory, Reduce Inflammation, and Fight Cancer by Richard Bray
My rating: 4 of 5 stars

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This guide offers a concise overview of the medicinal use of fungi. It’s a soup-to-nuts examination of how to utilize approximately thirty different mushrooms for treatment of a wide variety of ailments.

The book consists of eight chapters. Each of the first three chapters is quite brief and provides simple background information about mushrooms as medicine. The detailed information begins with chapter four, which provides an in-depth overview of fungi and the characteristics by which which some of them derive health and medicinal benefits. Chapters five and six repeat some of the same information, but from opposing angles – making it easier for the reader to find the information they are seeking. Chapter five describes the mushrooms, including a brief mention of the uses of each. Chapter six, on the other hand, introduces a range of ailments and medical conditions, and suggests which of the mushrooms have been studied as remedies. There are endnotes, directing one to the papers in which the scientific results appear. This is also where one finds information on dosages.

Chapter seven shows various approaches to preparing mushrooms for use as medicine. Not all of the mushrooms can be eaten, some require tinctures or other preparations to be made, and this chapter explains how to do that work in a step-by-step fashion. For the mushrooms that can be eaten, it describes the relative merits of different cooking methods. The last chapter discusses where to obtain mushrooms. It offers considerations for foraging mushrooms, but also tips for commercially acquiring them.

The book has many graphics. These include color photos of the various species of mushrooms as well as some drawings and diagrams throughout. The chapter on preparation has graphics interspersed within the textual directions to offer a visual indicator and break up the text. As mentioned, there is a huge set of paper references arranged as endnotes linked to the places (largely in chapter six) where findings are cited.

If one is wondering, the book does not discuss any mushrooms with psychoactive (psychedelic) properties (e.g. psilocybe.) Many of the mushrooms included will be well known to culinary mushroom users (e.g. button, portobello, enoki, lion’s mane, chicken-of-the-woods, shiitake, and oyster mushrooms.) Others were familiar to me [as someone with a minimal knowledge of mushrooms] even though it wasn’t from their culinary use (chaga, reishi, and jelly ear.) And a few of the fungi I was unfamiliar with before reading the book.

I found this to be a useful book. It’s concise and offers attractive and useful graphics. If you are interested in medicinal mushrooms, check it out.

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BOOK REVIEW: Pale Rider by Laura Spinney

Pale Rider: The Spanish Flu of 1918 and How It Changed the WorldPale Rider: The Spanish Flu of 1918 and How It Changed the World by Laura Spinney
My rating: 5 of 5 stars

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Before the present-day COVID-19 pandemic, the Spanish Flu of 1918 seemed to be a largely forgotten historical footnote. It was overshadowed by its more explosive, if less lethal, co-event, World War I – the war that was fallaciously believed to hold the promise of ending all wars. Furthermore, Spanish Flu never achieved the mystique of the Black Death. In fact, among the fascinating questions this book examines is why such a world-changing event isn’t more diligently studied. Of course, these days there is a sort of grim desire to understand what happened in 1918 and what – if any – lessons can be learned.

[Which isn’t to suggest that that Influenza virus pandemic was perfectly analogous to the present Coronavirus pandemic. In 1918, science was still at a state in which there remained debate about whether the disease resulted from a bacterium or a virus, and — in some sense — it didn’t matter because they didn’t have good treatments for either. For COVID, we had accurate tests in short order, and will no doubt have a vaccine at some point in the coming months. That said, I’m not dismissive of COVID-19. As I understand it, COVID’s R-nought (reproductive ratio), and the fact that both pre-symptomatic and asymptomatic transmission occur make the current pandemic serious business. Furthermore, while scientific understanding has increased radically, human psychology is surprisingly similar and some of the same conspiracy theories and wishful thinking that made things worse a hundred years ago may prove to do the same today.]

The strength of Spinney’s book is that it takes global perspective. It doesn’t fixate on the United States (where the 1918 Flu was first understood to its own, new disease) or Europe (where it was inexorably linked to the fighting, and got its fallacious name of “Spanish Flu.”) In addition to these locals, Spinney’s telling visits and revisits China (one of the alternative candidates for ground zero,) India (which suffered tremendous fatalities from the disease,) Brazil, and a number of other countries around the globe.

The book’s twenty-two chapters are arranged into eight parts. While these divisions are topically organized, emphasis is given to the stories being told and so said topics aren’t in one’s face but are, rather, background that is subtly presented in narrative form. Chronological consideration is tertiary. The penultimate part (Part VII) does explore the world in the wake of the Spanish Flu, but discussion of attempts to find the true index patient (a.k.a. patient zero) don’t take place until chapter 11 [Part V.] [To clarify, the acknowledged patient zero was a soldier at a US military base in the middle of America, but there are widely divergent thoughts about how long the disease might have been infecting people before that – masked either by the war or by the lack of data collection and reporting throughout the world. The only thing that is widely agreed upon is that the “Spanish Flu” didn’t originate in Spain.] I’m certainly fine with meandering on chronology in order to serve a more appealing narrative.

A lot of the subjects covered are interesting, but are what one would expect, e.g. what was it like to live in the midst of Spanish Flu. Therefore, I want to focus on a few topics that I found particularly interesting because they were illuminating, but weren’t necessarily what I anticipated. One set of topics addressed sheds light on just how different a time 1918 was. I suppose different people have different ideas about how modern the early 20th century was — relative to today. To me it was interesting to hear about church leaders calling upon people to attend services because there was an idea that the Flu was a result of god finding humanity’s “lack of faith disturbing.” [I quote Darth Vader, not this book’s author.] I’m sure there are priests and preachers saying the same these days, but I also suspect those voices are so far into the lunatic fringe as to not merit much attention, but not so in 1918 (and, thusly, many went to sit in high-density churches only to spread the flu more effectively than any virus could hope for.) Another interesting insight into the level of modernity was Spinney’s explanation of the fact that medicine, as we know it, had not yet risen to a favored spot above approaches like homeopathy and shamanism. Lest it sound like I’m engaging in the outhouse fallacy; I will say that people are falling in many of the same holes despite more advanced understanding of viruses – particularly as regards to people’s desire to impose order and purpose on a natural event.]

The other discussion that I found unexpected and revelatory was about the dearth of art and literature on the subject of the 1918 Flu. Spinney describes the effects of Spanish Flu on many major artists of the time, but goes on to discuss how few of those who survived the flu in 1918 brought it into their works. She does also discuss some of the works that did come about, as well.

I found this book fascinating from cover to cover. The fact that it covered so much ground geographically as well as topically was part of that intrigue. Learning what changes occurred in the wake of the 1918 Flu has certainly helped me consider what to expect in our future. The similarities and differences between then and now also surprised me. Just like today, there were a lot of wildly bizarre conspiracy theories from people who had to make sense of both the randomness of the Flu’s action and the fact that it put such a nasty a crimp in their lifestyle. It’s also interesting to consider some of the more intellectually stimulating theories – e.g. that part of the reason for the lethality of Spanish Flu is that in the theater of war, the virus didn’t benefit from the internal restraint usually shown (because people were dying so rapidly) and so mutations that favored a quick and harsh influence made gains. [For those who aren’t aware, it was the second wave of the Spanish Flu that was really nasty. The first wave was like seasonal flu for almost everyone, and by the third wave the virus didn’t have much of a reservoir of those without acquired immunity and so petered out relatively quickly.]

If you want to learn more about Spanish Flu, I’d highly recommend this book – particularly if you are interested in the global story and the after-effects of the disease.

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POEM: Ode to My Immune System [Day 8 NaPoMo: Ode]

I

Accused of failing to think about you,
I cannot deny that it’s true.
My lymph bristles with white blood cells
that make invading me treacherous hell.
And leucocytes are just a start,
marrow and spleen each play a part.
I can’t thank you all in this strophe,
but if I could I’d give you each a trophy.

 
II

I can’t say I recall each time I’ve been sick,
but my T-cells must surely have a nice trick
cause they’ve got them etched from first to last,
dating back fifty years in my past.
And if my thymus weren’t a taskmaster
I fear my life would end in disaster
for my body would self-cannibalize.
[And if that idea gives me teary eyes,
tears have antimicrobial enzymes.]
If I had to think about all the times
my NK-cells shivved a potential tumor,
I couldn’t maintain such good humor.

 
III

My ode is almost done, and many were left out.
The truth is there’s a lot that I don’t know about.
So, it’s not that I don’t love my antibodies.
Nor that I think their work is shoddy.
I just didn’t do well enough in Chemistry
to describe their heroism with rhymed brevity.
Skin, lung cilia, gut mucus, and macrophage
each deserve more words up on this page…

than have smarts to write.

BOOK REVIEW: The Immune System: A Very Short Introduction by Paul Klenerman

The Immune System: A Very Short IntroductionThe Immune System: A Very Short Introduction by Paul Klenerman
My rating: 5 of 5 stars

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This is a volume in the “A Very Short Introduction” [AVSI] series put out by Oxford University Press on a wide variety of scholarly subjects. As the series title suggests, the central objective of AVSI books is to pack as much of the fundamentals of a topic into as slim a package as possible. I read quite a few of these to get the gist of a subject without a lot of extraneous information. In short, they are brief and provide a high caliber understanding of the topic, but they aren’t written to be entertaining and they assume a basic scientific literacy. They usually weigh in at between 100 and 200 pages. (In this case, 144 pp.)

I found the seven chapters were optimally arranged. Chapter 1 describes and delineates the immune system, which isn’t as easy as it might seem. Putting the immune system inside neat borders is hard. If you simply describe it as the body’s defensive system, you quickly run into problems at the edges of competing classification. Sure, B cells and T cells are clearly part of the immune system, but what about skin and mucus membranes? Where does the lymphatic system end and the immune system (which uses it extensively) begin?

Chapters two and three explore the two major divisions of the immune system: the innate and the adaptive. These days, with COVID-19 at the center of global attention, the distinction is probably clear to most. The innate system isn’t geared to take on specific invaders. It has the advantage of being able to fight almost any invader, but the disadvantage of not being able to keep up with invaders that grow rapidly, are good at disguise, or both. An adaptive system response is what we all lack for COVID-19 because it only recently jumped to our species (well not “all of us,” those who had it and are recovered have adaptive immunity and that’s why they don’t have to worry about getting it again [those who have properly working immune system, at least.]) The adaptive response recognizes specific invaders and can raise an army against them tremendously quickly. Vaccines train the adaptive system to build such a response (typically by injecting a weakened strain into the body, but more detail is provided in the final chapter.)

Chapter four is entitled “making memories,” and it is an extension of chapter three. It further investigates adaptive immunity by focusing on the question of how the body develops a memory of those invaders it’s crushed in the past (or that it learned to crush by way of vaccination.)

The next two chapters delve into the two opposing ways the immune system can fail. Chapter five is about immunological failure, or how and why the body sometimes isn’t up to defeating invading adversaries. Most famously this is seen in HIV / AIDS patients, but there are other ways that the system fails in its job as the body’s bouncer. Chapter six looks at what happens when the immune system is too aggressive. [It’s important to realize that not only does the immune system check out foreign bodies, it also checks the tags on the body’s own cells, killing those that don’t display a proper “tag.”] The two major categories of over-performance are: autoimmune disorders (when the body wrongly attacks its own cells) and allergies (when the body goes all “This is Sparta!” on relatively benign foreign objects.)

The last chapter looks briefly at what work is being done in medicine these days involving the immune system, including approaches to vaccines, immunotherapy, biological therapies, and work on inflammation and the how the immune system is linked to aging.

If there was one topic I wish was better (more extensively) handled it would be discussion of what is known about how and why lifestyle choices influence immune system operation. There was a mention of how smoking has been linked to a specific immune system deficiency, and a general comment on how diet and exercise appear to be linked to increased effectiveness of autophagy (the body’s process of self-consumption and recycling of cells,) but that’s pretty much it. As there is a lot to cover in a small space, it’s hard to be too critical about this, but it seems like a crucial topic (if not as scientifically sexy as vaccine research, which is discussed relatively extensively.)

I found this book did as advertised, give me the immune system basics in a quick read. It has simple illustrations to support the text, and has a table of abbreviations — which can be beneficial given the hugely abbreviately nature of the immune system physiology. There is also a “further reading” section, but it’s heavily focused on textbooks – versus presenting popular science books that cover the material in a more light and entertaining manner.

I’d highly recommend this book if you have a basic scientific literacy and want just the facts on immunity without a lot of meandering narrative.

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Thoughts of a Traveler Traveling Amid the COVID-19 Pandemic

I just returned from a week of traveling in Rajasthan and Punjab for Holi and Hola Mohalla, respectively. Because my trip involved only domestic travel within India, there were no formal disruptions, but evidence of concern about the virus was widespread.

The first thing one notices is that instead of a few East Asian tourists protecting themselves against the poor air quality of megalopolises, at least a third of those traveling were wearing masks. Some unknown percentage of these travelers presumably have sound, medically-directed reasons for donning the masks (e.g. they have some sort of infection, they have compromised immune systems, etc.) but for many they are merely a security blanket. I suspect the reason that “wear masks” isn’t a part of the advice of public health experts has to do with the two types of masks that one sees:

First, the type that are to keeping out virus as a chain-link fence is to keeping out mosquitos.

Second, the type that will keep out virus (if worn / changed as directed,) but which — because they are expensive and hard to come by — are worn far too long, such that they become a nice warm, moist petri-dish pressed up against one’s face.

I don’t begrudge anyone a security blanket. In fact, a lot of what I’m suggesting herein are ways to maintain a confident and positive attitude so your immune system can be its awesome self — whatever that takes. My worry about the mask phenomena is that some people seem to believe that if one little viral agent makes it inside their body they are doomed. That’s simply not the case. If a viral marauder gets into your body, its chances of being escorted right back out by your body’s mucosal bouncers, swallowed whole by a macrophage, dissolved in your stomach’s acid bath, or otherwise being discovered and destroyed by your body’s sentry force is quite good.

In short, a mask isn’t your last line of defense. It’s a first line of defense that’s followed by an immune response that is swift and deadly to foreign invaders. It should be noted that nose-breathers already have a kind of mask, in the form of the nose and nasal passages. When you breath through your nose, your natural filtration system is at work. If you tend to breath through your mouth (particularly during inhalation) you have a lessened defense.

If you have trouble maintaining nose-breathing under all circumstances, I’d recommend a pranayama (yogic breathing exercises) practice. I don’t know how well it’s established by study, but I’ve found that I breath much more effectively and consistently through my nose since I’ve regularly practiced pranayama. Another helpful yogic tool is kechari mudra, which has helped me to even run without mouth breathing. (Kechari mudra involves curling the tongue so that the bottom of the tongue rests against the soft palate at the back of the roof of one’s mouth. This seems to reduce turbulence that would be created by air swirling in one’s oral cavity, and makes more of a direct line of travel for the breath in and out through the nasal passageways. At a minimum, it focuses one’s attention on the area the breath is passing through, and makes one aware of the breath.)

All this talk about one’s immune system keeping one safe may seem a bit pollyannaish or over-optimistic. Don’t get me wrong, I follow and would recommend others follow all the basic precautions regarding washing one’s hands and minimizing hanging out in high density environments — particularly high density environments with high-risk individuals. (i.e. for the asymptomatic [or alternatively-symptomatic individuals, i.e. those who have something but probably not COVID-19] who think they absolutely must be tested to have peace of mind, realize that you are likely walking into a high-risk environment and increasing your chance of self-fulfilling prophecy. Just sayin’. If you are able to rest comfortably, you might want to consider doing so.)

Back to the issue of being irrationally optimistic or a Pollyanna. My response is: fair enough. But there is an upside to being overly optimistic (if cautious) but none-whatsoever to being a worrier. Again, by being “a worrier” I’m not talking about taking precautions, I’m talking about obsessing or being needlessly pessimistic about the bodily systems (e.g. your immune system, your lymphatic system, your digestive system, etc.) that are keeping you safe all day and everyday.

I’d say if there is an upside to the pandemic, it was in reminding me to practice gratitude toward my body, my immune system, my gut bacteria, etc. — all of which keep me feeling excellent 99.9% percent of the time. Does that mean I think I can’t catch infection? No, it doesn’t, but it does mean that if I catch one my body will be much more effective at defending itself.

So when people ask me why I’m not worried about traveling, it’s because my immune system is awesome and I’m thankful for it every day.

A couple of post-scripts:

– I’ve been seeing the swarm of memes about toilet paper shortage in the US. Having moved to a part of the world that recognizes that wiping one’s backside with dry paper isn’t the height of sanitary practice, all I can say is: “You might want to look into what most of the world does most of the time.”

– I understand that there is a desire to curtail a wider spread of the virus, but this easily tips into a form of xenophobia — “a your COVID-19 is worse than our COVID-19.”  If a person is without symptoms, being Chinese (or from any other country with many cases) doesn’t mean that they are Typhoid Mary.

BOOK REVIEW: Pain: Considering Complementary Approaches by NCCIH

Pain: Considering Complementary ApproachesPain: Considering Complementary Approaches by National Center for Complementary and Alternative Medicine
My rating: 4 of 5 stars

Online here

 

The National Center for Complementary and Integrative Health (NCCIH) has put out a new edition (dated 2019) of its pamphlet (about 50 pages) about how useful various complementary practices are in helping patients reduce, or cope with, pain. The NCCIH is a center in the National Institutes of Health (NIH) that serves as a clearinghouse for information about how alternative and complementary practices perform in treatment of various ailments. While alternative (instead of mainstream medicine) and complementary (in conjunction with mainstream medicine) are quite different, in almost all cases this work herein is reporting on the latter basis. The complementary practices in question include: yoga, taiji, meditation and mindfulness, massage, acupuncture, chiropractic manipulation, relaxation methods, and others.

Complementary approaches to treatment of pain is a particularly salient topic these days as the mainstream medical approach (giving patients pills to gobble down) has resulted in what many have called a “crisis” of opiate addiction. So, if it’s possible to reduce the grip of pain with practices that at best have numerous other health benefits and at worst do no harm, than that’s a pretty good outcome.

Chapters three through eleven form the pamphlet’s core, and all but the last of those look at one complementary practice each, including (in order): acupuncture, massage, meditation, relaxation techniques, spinal manipulation, taiji (a.k.a. tai chi, or tai chi chuan), yoga, and dietary supplements and herbs. Chapter 11 discusses a few additional (less popular) practices. These chapters follow a three-prong approach: 1.) is it safe? 2.) does it help mitigate pain? and 3.) where can I find more information? [Spoiler alert: In almost all cases the answer to #1 is roughly “Yes, for most people, but possibly not for you. Check with your doctor,” and to #2 is usually something like: “there is some preliminary evidence that in certain cases certain people may have benefited.”] The chapters before (ch. 1 & 2) and after (ch. 12 to 14) provide background context and additional information.

On the positive side, it’s great that this information has been gathered together and packaged into a readable format with pictures and easy to read text.

On the down side, this was clearly a document put together by a committee of bureaucrats in consultation with lawyers. It is so laden with qualifiers and spongy speak that it’s impossible to discern how strong the evidence is for the various practices or how one compares to another. I felt that they could have given the same information in a three-column table in which the first column is the practice, the second column is “can’t hurt to try*” [*provided your physician concurs,] and the third column would be “nah, this stuff is fake.” [Spoiler alert: almost everything besides homeopathy would have the first column checked, but the consensus seems to be that homeopathy is pseudo-scientific quackery designed to sell water at medicinal prices.]

This booklet is available on the web for free, so if you’re interested, check it out. But don’t expect to come away with any profound insights. It’s not that kind of booklet.

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