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: 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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BOOK REVIEW: The Story of the Human Body by Daniel Lieberman

The Story of the Human Body: Evolution, Health, and DiseaseThe Story of the Human Body: Evolution, Health, and Disease by Daniel E. Lieberman
My rating: 4 of 5 stars

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The story that this book tells is of a human body adapted and optimized for hunting and gathering that has been thrust by agricultural and industrial revolutions into conditions for which it is ill-suited. The central idea is that of the “mismatch disease.” The mismatch in question is a mismatch between the lives humans were evolved to lead and the ones that we have developed through cultural and technological progress. The human body is governed by what Nassim Nicholas Taleb calls “anti-fragility” or what biologists call “phenotypic plasticity.” Both terms say that our bodies get stronger when exposed to physical stressors and weaker in the absence of such stressors. We’ve now used culture and technology to reduce exposure to such stressors, while—at the same time—food is more available than ever and is in calorically dense / nutritionally sparse forms. This mismatch accounts for many problems. Of course, technology has also allowed us to reduce our exposure to dirt and germs, and this, after being once a boon, has begun to swing us into dangerous territory.

The 13 chapters (including the introduction) are divided into three parts in a logical manner to address the book’s objective. After an introduction that lays groundwork for understanding human evolution in a broad sense, the first part describes human evolution up to the point where culture became dominant force for our species. It clarifies how we became bipedal, how our diets developed, how we got smart, and the ways in which the aforementioned characteristics are interconnected. The second part shifts from Darwinian evolution to cultural evolution, and—in particular—elucidates the effects that the agricultural and industrial revolutions had on the human body. These cultural forces act much faster than evolution. While some argue that humans aren’t really subject to evolutionary forces anymore, owing to cultural and technological advances, Lieberman points out that Darwinian evolution does still effect humanity, but its effect is muted by comparison to fast-acting cultural developments. The final part looks at humanity in the present and projects out into the future. It considers what effect an over-abundance of energy and a declining need for physical activity have had on our species, and what can be done about it.

This book is thought-provoking, well-organized, and uses narrative evidence and humor to enhance readability. (A discussion of the absurdity of products in the Skymall catalog—e.g. luxury items for pet—is a case in point.) It certainly gives on a good education about human evolution. Furthermore, while there are many books out there that deal with mismatch as a cause of diseases like obesity and diabetes, Lieberman also addresses under-explored issues like postural problems from chairs, the influence of shoes on running gait, and the development of nearsightedness because of our close-focusing ways.

I’d say the book’s greatest flaw comes in its discussions of solutions at the end. The author puts all his eggs in the basket of wholesale solutions aimed to make society as a whole improve, while he could do more to share the details of what individuals can do to solve their own problems. Lieberman considers why natural selection won’t solve problems of mismatch and dysevolution. Then he considers how research and development and educational campaigns can only provide partial solutions. His ultimate solution is suggesting regulatory paternalism—e.g. what economists call Pigovian taxes–taxes designed to change behavior by making bad behavior (in this case sedentary lifestyles and over-eating / malnutrition) more expensive. Perhaps such solutions (which will remain political untenable for the foreseeable future in the US, at least) may be necessary, but one shouldn’t conclude that readers with better information and ways of approaching the problem can’t make a difference. I say this based upon the fact that a substantial (if minority) portion of the population is already doing the right thing—eating right, exercising, and not succumbing to modernity’s creature comforts. I, furthermore, say it as a one trained as an economist who has seen easier attempts at paternalism fail over and over again.

I’d recommend this book. I think it gives the reader insight into the problems caused by being evolved to be one thing while being groomed by culture to be another.

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BOOK REVIEW: Yogic Management of Common Diseases by Dr. Swami Karmananda

Yogic Management Of Common DiseasesYogic Management Of Common Diseases by Satyananda Saraswati

My rating: 4 of 5 stars

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The title of this book gives one a nutshell description. It’s a book that discusses what yoga practices are beneficial for various common ailments. These practices include not only asana (postures), but also pranayama (breathing exercises), shatkarma (cleansing practices), yoganidra (a relaxation technique), meditational practices, and dietary and other yogic lifestyle practices. The book also discusses both the medical and yogic explanations of various diseases, and provides enough background on the relevant anatomy and physiology to give a layperson an understanding of the basic causes of each disease (if known.)

The book covers about 37 classes of disease, and is arranged into seven parts by bodily system (head and neck, cardiovascular system, respiratory system, gastro-intestinal tract, joints and musculo-skeletal system, urogenital system, and a miscellaneous ailments section that deals with skin diseases and varicose veins.) Some chapters deal specifically with one disease, while others cover two or more related ailments (e.g. Bronchitis and Eosinophilia, Sinusitis and Hay Fever, or skin diseases.)

This book has a number of strengths. First, it’s grounded in a scientific view of these ailments and isn’t selling yoga as a panacea. As suggested above, the title was carefully chosen. It’s “Yogic Management of Common Diseases.” The word “Management” is a critical one. If you’re looking for a book about how yoga can single-handedly cure your Stage IV lung cancer, this isn’t the book for you. If you’re looking for a book on how yoga can help you live a better life if you have arthritis, diabetes, or are hernia prone—possibly in conjunction with medication or other medical treatments—this may be the book for you.

Second, the diseases covered seem to have been carefully chosen. The selection of common ailments is not just to appeal to a broad audience. Many of these ailments are caused by common lifestyle problems that offer relatively easy fixes. Other diseases may not offer any fix per se, and, therefore, the ability to live a high quality of life with the affliction may be valuable. Also, I know a number of the diseases covered are particularly promising candidates for a yogic solution / mitigation.

Having given the strong points, I will say there are a couple of weaknesses to the book as well. First, it’s not illustrated in any way. Given that there is a lot of discussion of biology and anatomy, there are places where a picture might be worth a thousand words. I will note that this isn’t a book for a yoga newbie. It uses Sanskrit names for practices without so much as a glossary. That said, yoga teachers and intermediate/advanced students will probably not find this much of a problem because they will have built an appropriate vocabulary or have the necessary reference close at hand. I didn’t deduct for the lack of explanation, because the book is clearly intended for established practitioners (the Introduction warns as much.)

The second weakness is that there’s no explanation of why the listed practices should work particularly well for the given disease. I think the book does a great job of explaining the nature of the disease for a non-expert reader. However, then it just lists practices by type (asana, pranayama, relaxation, diet, etc.) In some cases, the reader can easily make the connection, but in others it’s not so clear why one should do practice “X” for disease “Y.” I do realize that drawing these connections could be space-intensive and technical. The book is a nice slim 245 pages, and it could rapidly grow to an untenable length. However, I’m concerned that some of the recommendations might not be rooted in experience and observation.

I would recommend this book for yoga teachers and intermediate / advanced practitioners who are interested in yoga as a component of building a healthy body. If you are new to yoga, you will probably want to first familiarize yourself with many of the classic asana, pranayama, and shatkarma practices of yoga—otherwise you’ll have to look up terminology constantly.

It should be noted that this book is put out by the Bihar School (of Swami Satyananda Saraswati fame), and the same publisher has put out a number of books that delve much more deeply into specific ailments. (At least some of these are written by the same author, Dr. Swami Karmananda.) Also, let me say that while the school self-publishes through its Yoga Publications Trust, it puts out books on a large-scale, of high-quality, and they appear to be available globally through Amazon and the like. (Swami Satyananda Saraswati alone was extremely prolific and wrote the APMB, which is one of the seminal reference works on yoga.)

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