BOOK REVIEW: Chloroform by Linda Stratmann

Chloroform: The Quest for OblivionChloroform: The Quest for Oblivion by Linda Stratmann
My rating: 4 of 5 stars

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Stratmann’s book tells the story of the rise, fall, and debauchment of the anesthetic known as chloroform. As such, most of the book — particularly in the first half — is a medical history that offers detailed discussion of the debates that went on between doctors as to whether chloroform was the best form of anesthesia available, or whether an alternative approach was superior. (Contenders include: ether, nitrous oxide, or the old-fashioned approach of no anesthesia whatsoever.) The book also discusses a number of cases in which chloroform was used in the commission of a crime, or was speculated to have been. On the topic of vice, the use of chloroform as a recreational drug is also described. For those who aren’t medical historians, the explorations of chloroform in crime, vice, and licentiousness are where the book gets intriguing, and they tend to take place in the latter half of the book. [That makes sense from a chronological perspective as it took some time before laypeople became aware of the range of uses of this substance.]

The book is well-written and follows the intrigue. That said, it’s definitely a niche work. I came at it from the strange direction of one who is interested in consciousness (and, by extension, how it is lost.) This book could appeal to those interested in the history of medicine, true crime, or recreational drugs, but, regardless, it’s a niche within those niche fields.

The book has graphics, annotations, a bibliography, and even an appendix that describes the chemistry of chloroform. It comes with all the bells-and-whistles one might expect of a scholarly book, but tells a story skillfully. The author is neither a journalist nor a scientist, but she seems to have done an extremely thorough job of research.

If you only read one book on the history of chloroform this year, make it this one. [Disclaimer: As far as I know, this is the only history of chloroform, and it’s certainly the only one that I’ve read to date.]

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BOOK REVIEW: How to Change Your Mind by Michael Pollan

How to Change Your Mind: The New Science of PsychedelicsHow to Change Your Mind: The New Science of Psychedelics by Michael Pollan
My rating: 5 of 5 stars

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Psychedelics have been coming back into mainstream interest of late. Until recently, this renewed interest mostly occurred quietly through a continuation of scientific study, a promising line of inquiry that was aborted in the late 1960’s. There is growing evidence that these substances may be useful for combating depression, anxiety, and addiction – as well as their other, long-known benefits. (It should be noted that while it seems the writing is on the wall for these substances to become medically legitimate, it remains controversial whether they will be legalized for use by well individuals – though some were legalized in the US for a small religious group that takes them as a sacrament of their faith.) This book by the immensely popular immersion journalist, Michael Pollan, has brought the topic front and center into mass awareness, and may help turn the tide of a sullied public image.

Because these substances remain widely unknown or misunderstood, allow me to present some background — much of which Pollan discusses in varying degrees. Unfortunately, the term “psychedelic” has become so loaded with layers of meaning that it’s not optimal for discussing the topic at hand. Literally, psychedelic means “mind manifesting,” but its common meaning is tied up in notions of 1960’s counter-culture and even with styles of art and music. However, alternative terms are also troublesome. “Psychoactive substances” (i.e. chemicals that change mind states) encompasses a much broader selection of molecules and medicines – though it’s probably the most neutral term used popularly today. “Hallucinogens” is also problematic because a large portion of consumers of these substances don’t have hallucinations – at least not of the full-blown variety people normally associate with that term (i.e. seeing sights that one genuinely believes exist, but don’t.) Pollan opts to largely stick with the loaded term of psychedelic, and thus will I throughout this review.

Psychedelics are chemical substances that change one’s mindset, typically creating euphoria, shutting down “I”- centric parts of the brain such that one feels a “oneness” commonly described in the mystical traditions from around the world, and which, yes, often generate sensory experiences that aren’t reflective of the actual environment (hallucinations.) The downside is found in the fact that the substances produce constructive experiences, which means they amplify what’s in the subject’s mind, and, therefore, can result in “bad trips” in which people hallucinate terrifying products of their own subconscious mind. Pollan focuses heavily on three of the most popular psychedelics: psilocybin (naturally produced in a common species of mushroom), LSD (a chemical synthesized from ergot fungus that grow on rye), and DMT (which is most famously an active ingredient in Ayahuasca, a concoction long brewed by Peruvian Shamans.) Mescaline, which is well known from the writings of Aldous Huxley, is another popular psychedelic, but one which Pollan only mentions in passing.

To wrap up the background portion of the review, a little history. Psychedelics have been used by shamanic traditions around the world since time immemorial. In 1938, Albert Hofmann, a chemist for Sandoz Laboratories, accidentally synthesized LSD. That marked the (re-) introduction of psychedelics to the modern Western world (the ancient Greeks were believed to have mixed something with their wine that sounded like it had psychedelic properties.) Unbeknownst to most, between Hofmann’s invention and the late 1960’s, there was a promising line of research on the use of psychedelics for various conditions as well as in non-medical domains – e.g. relating the psychedelic experience to religious / mystical experience.

Unfortunately, there was a two-pronged turn of events that would end in these substances being made illegal and categorized “Schedule I” (which deems them not only risky / requiring care of use, but also denies they have any legitimate medical use – the latter seems to be proven demonstrably incorrect.) The well-known prong in the death of psychedelics resulted from the substances becoming tied into the 1960’s counter-culture, at first through shoddy scholarship by academics – most famously Timothy Leary – and then through recreational use that typically stripped away the rituals and “protocols” that had allowed shamans and mystics to safely use these substances for millennia. The second prong was government-sanctioned shenanigans in which LSD was used and misused in an attempt to create everything from truth serums to mind-control agents – most famously the MK-Ultra Program, and its sub-projects such as Operation Midnight Climax during which the CIA illegally used prostitutes to “roofie” their customer’s drinks with LSD so that a spy could covertly watch to determine whether the johns got loose-lipped or not. (Note: Pollan writes at length about the former aspect [i.e. Timothy Leary, Ken Kesey, et. al.] though not as much as books like Lattin’s The Harvard Psychedelic Club or Wolfe’s The Electric Kool-Aid Acid Test. However, Pollan only gives passing mention to MK-Ultra.) Psychedelics might have remained out of the popular consciousness and only of interest to the fringe of society that was involved with “hard drugs” had it not been (in addition to renewed scientific interest) for a blooming interest by Silicon Valley engineers and executives who took to “micro-dosing” psychedelics to obtain creativity gains.

Now, I’ll get to the review, proper: As I mentioned, Pollan refers to himself as an “immersion journalist,” which means that he provides a two-in-one book. The first element is what one would expect in a popular science book on psychedelics, i.e. he reports on the scientific findings, the key history and background information, and delivers quotes from people he interviewed. The second element, however, is description of his own psychonautic journey. Pollan consumed psilocybin mushrooms, LSD, ayahuasca (DMT), and also a substance excreted by a toad that lives in Mexico and the Southwestern US. The reader gets both Huxlian “trip reports” (though Pollan remains much more scientific-minded and less mystical than Aldous Huxley) as well as the objective overview of the topic.

The book consists of six chapters as well as front and back matter. The first chapter discusses the psychedelic “renaissance,” i.e. how it came to be that these substances brought back from the dead – i.e. being purely of interest to “druggies” and far-flung shamanic traditions. Chapter 2 deals largely with mushrooms, and specifically psilocybe mushrooms that are the most popular and common type of psychedelic mushroom. Pollan spent time with Paul Stamets, a world-renowned expert on all-things fungi and the man who – literally – wrote the book on psilocybe mushrooms. Chapter 3 focuses heavily on LSD, including its development and rocky history. The fourth chapter is a “travelogue” in which Pollan discusses his own experiences in taking these substances. The penultimate chapter is about the neuroscientific findings. There is much that remains to be known, but yet somethings are well-known. These substances generally mimic the neurotransmitter serotonin (though mescaline, for example, mimics dopamine.) There is also a fascinating discussion of how these substances may temporarily reduce activity in the default mode network, which is prominent in generating one’s sense of self. The final chapter examines the findings of research into the use of psychedelics as a treatment for medical conditions – particularly depression, anxiety (especially death anxiety of terminal patients), and addiction (contrary to a widespread notion, resulting from these substances being lumped in with “hard drugs,” psychedelics not only aren’t addictive, but – in many patients – they counter addictions to more dangerous drugs, such as alcohol – yeah, you read that right.)

The book contains the usual ancillary matter, including: a glossary, bibliography, and notations. As the approach is narrative, graphics are minimal.

I found this book to be highly informative and extremely readable. The use of stories to convey information makes it engaging while it educates. I would highly recommend this book for any readers who are interested in psychedelics as medicine or a mystical experience.

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BOOK REVIEW: Anarcha Speaks by Dominique Christina

Anarcha Speaks: A History in PoemsAnarcha Speaks: A History in Poems by Dominique Christina
My rating: 5 of 5 stars

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This collection of poems, written by Dominique Christina and selected / arranged into a story by Tyehimba Jess, tells the story of a slave woman who was used for medical experimentation. Most of the poems are in the voice of this woman, Anarcha, and are conveyed in a slave dialect. However, a few are from the perspective of Dr. Marion Sims, the doctor who used Anarcha (and other slave women) for research and experimental procedures. Even without the cues in the poem titles, it’s easy to tell when these switches in voice occur because the doctor’s poems are in “proper” English, as opposed to Anarcha’s dialect. I should point out, while I can’t tell you how accurate the slave dialect is, I can say it presents no challenge to the reader’s understanding of the story or of the imagery or metaphor of the poetry.

The events described in these poems are based on a true story. Anarcha developed a fistula (a hole in bodily tissues that’s not supposed to be there) as a complication of carrying a child, and as a result suffered persistent bleeding. Anarcha’s owner handed her over to Dr. Sims to repair the fistula and stop the bleeding, which would require the development of a new procedure. Sims is often called the father of modern gynaecology, and was lauded with statues and honors. However, in recent years, his image has been tarnished by the fact that many of his advancements were only possible through the non-consensual examination of, and experimentation upon, slave women.

I should point out that, while reading this book has made me interested in learning more about the details of the story, I can’t really comment on the degree to which the poems accurately convey history. From the little I was able to garner from quick internet research, there are wide-ranging views on Dr. Sims and his research. Some think Sims belongs in Josef Mengele’s corner of hell. (Note for non-history buffs: Mengele is the Nazi doctor who experimented on Jews and other prisoners during the Second World War.) Others believe Sims was genuinely working to heal the slave women and wasn’t solely motivated to find a treatment for paying patients, and that — in the context of his times — he should be considered a fine, if fallible, doctor. I don’t know how much is know about what was in Sim’s mind or how it matched his behavior, but at a minimum he seems to have been much less delicate with his slave subjects than he would have been with his patients in terms of subjecting them to pain and humiliation.

I will say that the poems in Anarcha’s voice feel authentic, i.e. they feel like they convey truth about what would go through a person’s mind when put in her position. Her humanity is felt. In a few cases in the Dr. Sims poems, that authenticity feels like it breaks down, and one thinks, “no one sees themselves that way” – an instance of self-deification springs to mind. That said, perhaps it’s an accurate depiction. More than one doctor has been known to be colossally narcissistic on occasion.

That said, this is a poetical work and not a historical account, and so the beautiful language, clever metaphors, and emotional resonance of the work are what serve to make it a book that should be read. I would highly recommend this book for all readers. Even if you aren’t typically a poetry reader, you’ll find this free verse collection readable because of its story and the insightful view into the mind of Anarcha it presents.

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BOOK REVIEW: The Psychobiotic Revolution by Scott C. Anderson, et. al.

The Psychobiotic Revolution: Mood, Food, and the New Science of the Gut-Brain ConnectionThe Psychobiotic Revolution: Mood, Food, and the New Science of the Gut-Brain Connection by Scott C. Anderson
My rating: 5 of 5 stars

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For centuries there have been cases in which a change in diet –often accidental– led to relief from a mental illness. However, given the sporadic nature of such effects and the complete lack of understanding of microbes, the enteric nervous system (i.e. the gut’s own “brain” that communicates with — but is also autonomous of — our “first” brain,) and the complexity the symbiotic relationships involved, these anecdotal cases had limited influence on the state of medicine. However, recent years have seen an explosion of understanding in this domain. This has resulted in a vast number of books being written on the role of microbes in the gut for overall health, the role that changing diet can have on changing our microbiota, and related topics such as how the overuse of antibiotics can have a deleterious effect on health by tossing out the microbial baby with the bath water. This book touches on all those topics (and more) as it explores the role of our bacterial hangers-on on our mental health.

The book consists of nine chapters. The chapters are organized so as to first present one with the necessary background to understand how changes to one’s gut microbiota can improve one’s health —particularly one’s mental health (though many of the mental illnesses influenced by microbiota are linked to physical ailments)— before moving on to the specifics of what microbes have been shown to have a given effect and what diseases can be influenced by consumption of probiotics.

The first five chapters give the reader an introduction to the topic and an overview of information one needs to know to understand the later chapters. Chapter three gives one an overview of the changing profile of one’s microbiota over the course of one’s life. Particular emphasis is given to one’s youth and to the transfer of bacteria to infants. [Readers may be aware of the problem that c-section births result in a failure of babies to receive a dose of beneficial microbes imparted by passage through the vaginal canal.] Chapter four takes one on a quick ride through one’s alimentary canal from mouth to rectum, with particular emphasis on questions such as how bacteria survive the stomach’s acid bath, and which parts of the digestive system contain which microbes (and to what effect.)

The last four chapters dig deeper into the specifics. These chapters look at specific probiotics, how one can get them into one’s system, and what science has found out about probiotics and psychobiotics (like probiotics, but specifically ones that influence mood and mental states) effects on specific ailments. Chapter eight, which deals with major diseases, does cover physical ailments as well as mental ones because – as mentioned— these afflictions often go hand-in-hand. The last chapter (Ch. 9) looks at where this body of knowledge is going. It delves into practices that are presently well-established, such as fecal matter transplants, but also into challenging works-in-progress such as attempts to develop narrower spectrum antibiotics so that we can get the life-saving benefits of these medications without their crippling side-effects.

The book has many graphics, as one would expect from a work that investigates such a complex scientific topic. I can’t really speak to the quality of the graphics as the review copy I read didn’t have completed graphics. However, the subjects of the graphics seemed appropriate and well-placed. The book also has a glossary, annotations, and a further reading section to assist the reader in the study of this subject.

I found this book to be informative and engaging, and would highly recommend it for anyone interested in the role of microbiota on mental health. The text was well-organized and readable. Given the scientific nature of the material, it’s easy for such a book to become ponderous, but the authors made attempts to keep the tone light and the presentation non-intimidating.

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BOOK REVIEW: The Lost City of the Monkey God by Douglas Preston

The Lost City of the Monkey God: A True StoryThe Lost City of the Monkey God: A True Story by Douglas Preston
My rating: 5 of 5 stars

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Preston tells the story of his participation in an expedition into the Mosquitia region of Honduras in search of a lost city, alternately called the White City (i.e. La Ciudad Blanca) or the City of the Monkey God. Preston was acting as a correspondent for National Geographic and was part of a larger team including a photographer, filmmakers, archaeologists, and a team of ex-Spec Ops escorts. It’s not a simple and straightforward tale of Indiana Jones types chasing after the artifacts of a long collapsed civilization (though it does capitalize on that sense of intrigue greatly from the title to the telling of both the historic and contemporary searches for this fabled lost city.) The book tells several stories that occur about and around this search, and they are arguably more interesting.

One of these side stories is the historic accounts of past explorers who searched for the White City. Those were the individuals who more closely corresponded to Indiana Jones–both because they didn’t have an airplane with a state-of-the-art Lidar system (lidar is the light/laser version of radar or sonar), and because they were more likely to engage in tomb-raiding and artifact robbery. This isn’t to say that the expedition that Preston was on didn’t have its share of snakes, quickmud, and other hazards that are the only reason that a huge city from a past civilization would remain undiscovered in the present day. The region in which the expedition took place had not only all the natural hazards of dense jungle, but the human hazards posed by operating in territory controlled by drug cartels. That said, they didn’t have to machete through hundreds of miles of jungle with no idea of where they were likely to find their objective.

One of the most interesting side stories occurred when Preston and many of the members of the expedition came down with leishmaniasis, a nasty tropical disease vectored by sandflies. The disease has a treatment that’s almost as likely to kill one as is the disease. It’s almost impossible to completely get rid of the disease. One can be cured in the sense of being made asymptomatic, but one may remain a potential carrier waiting to be bitten again and to pass the nasty parasite onto another sandfly so they can infect someone else. There are several elements of the disease story that are intriguing. The most interesting is speculation about the role that disease might have played in the sudden evacuation of this lost city. This is informed by a broader discussion of how “Old World” diseases spread through the “New World” with crippling effect. Another is how diseases are neglected when they almost exclusively infect poor and rural people (until a National Geographic correspondent tracks it back to the continental US, that is.)

For those outside of archaeology, one of the least interesting, but still interesting, side stories is that of the intense controversy in the field. Preston is very forthcoming about his talks with scholars who were angered and outraged by the use of terms like “Lost City” which hearken back to a period in which tomb-raiding was the norm and Westerners stole and shipped priceless artifacts back to the West by the ton. These internecine wars of academia reinforce the idea that this isn’t just musty history, but involves questions that many people feel intensely passionate about.

There is a photo section that provides images of both the cast of highly discussed people and a few of the artifacts uncovered. There’s also a section of sources and citations.

I found this book to be fascinating and I’d highly recommend it. Those interested in exploration and adventure tales will find it of obvious interest, but those with a curiosity about public health may find it unexpectedly of interest.

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5 Books to Introduce You to Your Gut Microbiota

5.) The Wild Life of Our Bodies by Rob Dunn: This book takes a broad look at the role that hangers-on have on  human life.

 

4.) The Psychobiotic Revolution by Scott C. Anderson et. al.: This book focuses on the role that our gut microbiota have on our mental well-being–which increasingly appears to be substantial.

 

3.) Missing Microbes by Martin J. Blaser: The focus of this book is on how our love of antibiotics in every form– from pills to antimicrobial soaps–is killing us by denying us microbiotic diversity and robustness.

 

2.) 10% Human by Alanna Collen: Collen’s book addresses many of the same issues as the other books mentioned, but–as the title suggests–it emphasizes the fact that a human has 10 times as many hangers-on of other species as it does cells that are contiguous to the body. (If you’re wondering how this could be, it’s because the human body has some pretty big cells [some macroscopic, in fact] and the bacteria and other single-celled species tend to be relatively tiny.)

 

1.) I Contain Multitudes by Ed Young: This is probably the most highly-regarded of the books on this subject. It was considered one of the best science books of 2016.

BOOK REVIEW: Lumbar Herniated Disc by Veritas Health

Lumbar Herniated Disc: The Essential Guide to Finding Back Pain ReliefLumbar Herniated Disc: The Essential Guide to Finding Back Pain Relief by Veritas Health
My rating: 3 of 5 stars

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I picked up this 60 page guide when I was having low back problems involving a slight nerve impingement. The good news is that it provided enough information to eliminate lumbar herniated disc as cause of my particular problem. That’s not saying nothing because low back problems are notoriously difficult to pinpoint and a cause often remains undiagnosed. The bad news is that this, inexpensive but not free, guide didn’t offer anything that couldn’t be found at respectable online sites like WebMD or The Mayo Clinic for free.

The guide is organized into 11 brief chapters that run from understanding what a lumbar disc is and how it becomes herniated through various treatments (self- and doctor-administered.) It also explains when the situation warrants seeing a doctor.

There are plenty of graphics in the book from computer-generated anatomical imagery to simple line drawings. They are beneficial to understanding the nature of the condition.

My recommendation would be to consider whether you need to have access to this information at times when you don’t have access to the internet. If that’s the case, it’s worth the small cost. If not, you’ll probably feel it didn’t really offer any value-added over free online sites.

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BOOK REVIEW: Better Balance by Salamon and Manor

Better Balance: Easy Exercises to Improve Stability and Prevent Falls (Harvard Medical School Special Health Report Book 6)Better Balance: Easy Exercises to Improve Stability and Prevent Falls by Suzanne E. Salamon
My rating: 4 of 5 stars

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Balance is one of those qualities that one takes for granted until it fails. Actually, given our bipedal stance, it’s extraordinary that we aren’t falling down all the time. Achieving a stable upright posture takes a lot of complex anatomy and physiology operating flawlessly. I picked up this book because I believe a yoga teacher should be cognizant of the range of capacities for balance that might be seen while teaching. If one teaches students in their 20’s to their 40’s, the need for balance modifications and capacity building might not come up much. It’s when one deals with the very young as well as older students that one sees flawed balance in large measure. [And—let’s face it—the very young can fall down 30 times, pop right back up each time, and be all the stronger for it, and so mature students are the major concern.]

This isn’t the first book in this series of Harvard Medical School Guides that I’ve read and reviewed, and probably won’t be the last. (see: “Your Brain on Yoga,” “Guide to Tai Chi,” and “Low Back Pain.”) I’ve found the series to be beneficial because it presents scientifically sound information, but isn’t afraid to give alternative approaches—such as yoga and tai chi—their due when the studies show that said activities are of benefit. This book is no exception. At several points the authors mention tai chi as being beneficial, and the book includes a yoga balance workout as one of the six that it contains.

The book is organized into 13 sections (i.e. chapters.) The first chapter describes how our vestibular (inner ear), visual, and proprioceptive (the nervous system elements that track where one’s body parts are) systems interact to keep us upright.

Chapter 2 presents an overview of a range of conditions that affect balance. Some of these influence balance specifically and exclusively, but many are conditions that one might not associate with balance problems though they’ve been shown to increase the risk of imbalance. There are sections about which medications have side-effects adversely affecting balance as well as what your doctor may be able to do about balance problems.

Chapter 3 is a “Special Bonus Section” and is of particular importance to mature readers or those who care for said individuals. The topic is preventing falls, and this section describes common causes of falls and offers checklists of considerations for setting up the environments in which those with balance problems will be active.

Chapter 4 introduces various types of activities that improve balance, and chapter 5 is a brief guide to considerations relevant to beginning a balance workout such as whether to consult one’s doctor and what safety precautions should be considered.

In chapter 6, the authors propose how balance workouts can be merged into one’s overall fitness plan. A lot of this chapter is an introduction to exercise—e.g. how much is needed, and what the benefits are. Then there are some tips about how to smoothly merge balance with other exercises.

Chapter 7 presents more specific considerations for beginning balance workouts. Unlike chapter 5, this section provides information about equipment, warm-ups, and how to interpret the instructions for the workouts. The latter is beneficial because the workouts are in a one page per exercise format, and this section negates the need to be needlessly repetitive.

The next six sections (chapters 8 through 13) are various balance workouts that are organized in an easiest to hardest format. The first is a beginner’s workout, which is performed with a chair—used for sitting in some exercises and as a prop in others. The second is a standing balance workout that features simple static balance maneuvers. The level of challenge is similar to that of the first workout, except that one is without a chair prop. The third workout adds in movement to help maintain balance through steps and motion. The next workout is similar but utilizes another prop, a 360 step (a circular step of similar height to the more common Reebok rectangular step, but circular.) The penultimate workout uses a pseudo-balance beam. The author’s mention a product put out by Beamfit, but other manufacturers produce a similar product. It’s a low, dense foam beam that sits on the floor. The last workout utilizes classic Hatha Yoga poses, and features both expected poses like tree pose (vrksasana) and others such as down dog (adho mukha svanasana) that might come as a surprise.

There’s a resources section and glossary at the end. The book presents many graphics, most notably photos of each of the exercises in the six workouts.

I’d recommend this book for anyone who needs an overview of the problems of balance and what can be done about them. It’s short, readable, and user-friendly.

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BOOK REVIEW: The Science of Breath by Swami Rama et. al.

Science of BreathScience of Breath by Swami Rama
My rating: 4 of 5 stars

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This is an oldie, but a goody. The first edition came out in 1979, but as its intent is to provide an overview of the anatomy and physiology of breath for yoga practitioners, the fact that it doesn’t access the bleeding edge of respiratory science isn’t all that detrimental.

This short book consists of four chapters. Two chapters are by the famous yogi Swami Rama, and the other two are written by medical doctors. The first chapter is an introduction to breath from the yogic perspective. It both explains why it’s so important to understand and work with breath and introduces the mythic physiology (prana, nadi, chakra, etc.) that has historically been used to explain pranayama (breath exercises.)

The second chapter is written by Dr. Alan Hymes and it explains the mechanics of respiration. While Chapter 2 focuses on the anatomy of breathing, it begins with an explanation of cellular respiration to introduce the role of breath in powering muscles. There is a fine explanation of the operation of the diaphragm and the intercostal muscles in breathing.

Chapter 3 is written by Dr. Rudolph Ballentine, and it delves into the role of the nose and nasal cavities in respiration. Breathing through the nose is emphasized in both yoga and many other systems of breath training (e.g. the Buteyko and Wim Hof methods.) This is because the nasal cavities perform many useful functions such as moisturizing and warming air, capturing pollutants, and extract heating and moisture from exhaled breath. Besides exploring nasal anatomy and physiology, Dr. Ballentine describes jala neti shatkarma (nasal cleansing with salt water) and nadi shoudhana (alternate nostril breathing.)

The final chapter, written by Swami Rama, mostly describes various techniques of pranayama (breathing exercises) and related practices bandhas and mudras (locks and seals in which bodily parts are contracted or constricted.) However, the chapter begins with a mix of physiology and mythic physiology. That is, it explains some topics not addressed earlier–such as the interaction between the nervous and the cardiovascular systems as well as chakra.

My standing complaint about books that weave together science and pseudo-science is mitigated a bit herein. My problem with putting these ideas together is that it can be difficult for the reader to determine what concepts reflect reality and which offer models to help one visualize energy. However, except for the last chapter, this book does a good job of keeping these ideas separate. The chapters by the medical doctors present the science with minimal intrusion of unscientific concepts. Swami Rama does present science and mythology together, but not so much scrambled together in a confusing mish-mash.

Chapters 2 through 4 use a number of graphics to help present the material. In the middle chapters these largely consist of line drawings to convey the relevant anatomical features or physical actions. The last chapter adds photographs to demonstrate relevant postures. There is a page of recommended readings, but it’s more of an advertisement for other books put out by the Himalayan Institute than the recommendation of books on the science of breath.

I found this book to be educational. It packs a lot of useful information into a concise package and is readable to a layman. I’d recommend it for yoga practitioners and others who are engaged in breath work.

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BOOK REVIEW: The Checklist Manifesto by Atul Gawande

The Checklist Manifesto: How to Get Things RightThe Checklist Manifesto: How to Get Things Right by Atul Gawande
My rating: 5 of 5 stars

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Checklists have a bad, bureaucratic rap. Like Taylor’s time and motion studies and forms filed in triplicate, checklists seem to exist only to compound the drudgery of the workplace. Furthermore, many of the sectors in which checklists are most necessary are also those in which they are certain to be resisted—i.e. places in which there is a strong leader who is unused to having his or her instructions challenged: e.g. operating rooms and airplane cockpits. The element that ties those two locations together (along with other places where checklists are found) is that they are domains in which extremely complex activities take place, and in which one missed detail can have tragic consequences.

While the main story being told in this book is about the author’s experience leading a task force to build a surgical checklist and research its efficacy via a global study. However, Dr. Gawande takes us on the rounds of industries that found checklists before medicine did, and which had a thing or two to teach doctors about building and using them—notably the construction and air travel industries.

The book consists of nine chapters. After an Introduction that features a surgical case exemplifying how unexpected case characteristics can easily be overlooked when seconds count, the problem of extreme complexity is described as a rationale of the need for checklists in Chapter 1. While we tend to think we humans are tailor-made for complexity, the fact of the matter is that we aren’t. Mother Nature gives no capabilities that aren’t demanded to survive in the environment in which one evolved. So while we’ve done a great deal of cultural evolution to increase our capacity to deal with complexity (checklists included), the fact of the matter is that our minds and bodies are limited instruments. We can only hold a few items in short-term memory at once. We are no good at multi-tasking—despite the fact that most people feel otherwise. And when stress throws us into “fight or flight” mode, we develop tunnel-vision, not helping our capacity to see the minutiae in the big picture.

Chapter 2 delves into the checklist as solution to the aforementioned problem of extreme complexity. This chapter begins with the story of a bomber aircraft that had awesome capabilities but was deemed too complex for a single pilot to fly. (All it needed was a checklist.) The chapter then goes into medical examples. The first is a study of one of the major cause of infections: central line insertions. This offers a prime example of a procedure in which medical staff members know exactly what to do, but often small details are overlooked leading to disastrous outcomes. Then there is the case in which a little girl was saved against apparently impossible odds, in part due to a checklist performance.

Chapter 3 is entitled “The End of the Master Builder,” and as that name suggests, it’s largely about the role of checklists in construction. Construction can be compared and contrasted with medicine. The major similarity is that both fields have such high degrees of complexity that many specialists must be involved. The major difference is that time isn’t so critical in construction. (Just stopping and mulling over a solution is frequently not an option in surgery.) The biggest takeaway of this chapter is that it’s not only the tasks to be performed that need to be on the checklist but also the communication between team members.

Chapter 4 explains how centralized decision-making can be death in complex environments. The principle case discussed was how Wal-Mart out-performed the government in the wake of Hurricane Katrina in large part because leadership supported but did not dictate to managers of the stores in the storm-damaged area. However, the most fascinating piece of information for me was the explanation of why Van Halen had its infamous contract rider about having a bowl of M&M’s with all the brown ones removed. Apparently, no one cared about the candy. It was just an easy way to see at a glance whether anyone had been through the minutiae of the document–minutiae that included critical information such as how much weight the stage had to accommodate—i.e. safety issues not so easily observed but which would be potentially devastating if missed.

Chapter 5 tells the story of the World Health Organization (WHO) contacting Dr. Gawande and his first attempt at building and implementing a surgical checklist. As to be expected, there was a lot about that initial trial that wouldn’t work.

This led the author to go to what he calls “The Checklist Factory” in Chapter 6. Said “factory” is at Boeing, and it writes and updates all the checklists for Boeing aircraft—which are then modified by the individual airlines, presumably within limits governed by regulatory agencies. While the construction people taught Gawande that communication had to be on the checklist, the aircraft people taught him the need to simplify. One can’t put every detail on the list, only those that could be easily overlooked with devastating consequences. (i.e. One doesn’t need to write “Make an incision” because that’s impossible to forget, but one does include “Ensure antibiotics were delivered.”) Boeing also taught the author that there are two different flavors of checklist: READ-DO and DO-CONFIRM.

Chapter 7 describes the pilot study of the revised surgical checklist in eight hospitals in eight different countries (four developed and four developing.)

Chapter 8, “The Hero in the Age of Checklists,” explores the problem mentioned above about there being resistance in a many sectors (including medicine) because those leaders have rock star vibe going. We admire risk-takers and those who excel under pressure, but checklists seem to run counter to those traits. Thus, even when it’s clear that checklists save lives, there can be a reluctance to adopt them. Of course, as in the airline industry, eventually the checklist becomes accepted, and its use becomes second nature.

Chapter 9 tells of one of the author’s own surgical foibles, and how it led him to work to improve the procedure in order to reduce the risk of that kind of accident. It’s also an example of how the checklist kept the tragedy from being much worse.

This book has its sources annotated, but contains no graphics or other ancillary matter.

I’d recommend this book, particularly for those who work in the domain of complexity. However, I read it because it was referenced in a book I’d read on decision-making under fear. So it may also be of interest to you if you’re into questions of optimal human performance.

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