Book 321: The Coming Plague

 

"Overall, Swine Flu and Legionnaires' Disease boiled down to the same set of troubling perceptions for the American public, and, to a lesser extent, the Canadian, Mexican, Australian, New Zealand, and European publics: something new and very scary was coming; nobody was sure what it was, but the experts were certain it was dangerous; the federal government seemed quite distressed about the matters, but the experts and authorities didn't seem to agree as to what, if anything, should be done to protect the public; and it was all costing taxpayers a pretty penny. In both cases, public apprehension would eventually yield to impatience and allegations of incompetence, even scandal."

Dates read: June 10-21, 2019

Rating: 7/10

I just want to kick off this review by noting that I read this book well before "covid" was a string of letters I'd ever think to put together. I considered going back and re-writing this based on what we know now, but I thought it was more genuine to preserve my reaction to the book as of the time I read it. Anyways! Of all the times I've ever been sick, I don't know that anything has been as unpleasant as the times I've had the simple flu. The soaring fevers, the aches, the blocked up sinuses that make sleep so difficult...it's several days of feeling just utterly wretched, followed by several more where you just feel weak like a kitten. But of course, I've never been really sick. I've had the odd bout with pneumonia, which I also do not recommend, but generally I've been in good health. I do appreciate living in the world of antibiotics.

Once upon a time, a simple strep throat or upper respiratory infection could literally kill you. And it wasn't even that long ago, really! Penicillin was discovered less than 100 years ago. What it might be like to return to a world in which there were not effective antibiotics is one of the many topics covered in Laurie Garrett's The Coming Plague. In this large volume, Garrett investigates how the world continues to be vulnerable to infection, the consequences we might face for the widespread overuse of antibiotics in the modern world, and the way in which our own actions continue to bring us into contact with new agents of disease. She takes a broad look at trends in epidemiology: the emergence of Ebola, the discovery of Legionnaire's Disease, toxic shock syndrome, and of course, the spread of AIDS. And she doesn't shy away from an examination of the underlying systems that help perpetuate the spread of infection, particularly among the poor.

I found the most compelling portion of the book to be its examination of the AIDS crisis. I came of age in a world where AIDS was just a fact, and this is the first time I really got a sense of the fear that the beginning of the epidemic created. Hemophiliacs and gay men just...dying, in large and inexplicable numbers. The way that no one knew what was happening, or how this new disease spread, and (heartbreaking) the difficulty of getting government systems, controlled by conservative Republicans, to care about an illness that was affecting a group of people that they were just not interested in helping. There's an urgency there which really comes across strongly and made it hard to put down.

Garrett is a journalist by trade, and it shows in the writing of the book. The Coming Plague is strongest when she's focusing less on the recitation of facts (like she does when she talks about the process through which some microbes become antibiotic resistant, which feels like struggling through a science class) than on telling a story about people. There are some dynamic personalities, like Dr. Joe McCormick, that show up again and again in the fight against emerging infections, and this work shines when she lets them and the patients they treat take center stage. For the most part, she does keep the focus on people and the systems in which they operate in a way that keeps the book moving along, but it does occasionally bog down when she tries to get too heavily scientific, and in a book this long, it's a tricky bog to escape from.

I found myself wondering as I was reading this book who exactly Garrett had in mind as the target audience. It's got over 600 pages of text before endnotes, and the print on those pages is not large. It seems too long, and too detailed, to get wide traction in the general population of readers. But it's not scholarly or academic in nature, either. I'm a reader who is prepared to do some intellectual work, especially when reading nonfiction, and by the time I had only 150 pages left I was ready to be done even though the material I was reading was just as good as what had come before it. If she'd cut out some of the more science-oriented material, I think it would have kept the book moving better and more accessible to readers. As is, this is good, particularly if you have any interest in epidemiology, but feel free to skim through the more dense portions if they're not catching your interest. 

One year ago, I was reading: The Secret Life of Bees

Two years ago, I was reading: Whores of the Devil

Three years ago, I was reading: The Mind's Eye

Four years ago, I was reading: Thank You For Smoking

Five years ago, I was reading: Orange is the New Black

Six years ago, I was reading: Creative Mythology

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Book 321: The Coming Plague

Book 217: The Immortal Life of Henrietta Lacks

"Black scientists and technicians, many of them women, used cells from a black woman to help save the lives of millions of Americans, most of them white. And they did so on the same campus—and at the very same time—that state officials were conducting the infamous Tuskegee syphilis studies." 

Dates read: March 17-21, 2018

Rating: 7/10

Lists/awards: The New York Times bestseller

Do you own your body? It seems like an absurd question, but it's a real one. After all, it wasn't so long ago that bodies could be bought and sold on the open market. Nowadays, for the most part, it seems like you own your body while it's a part of you, but what about when parts of it become detached? A pulled tooth, a fingernail clipping, a vial of your blood for testing. Once it's removed, who does it belong to?

In 1951, a 30 year-old black woman, a mother of five, walked into Johns Hopkins and was diagnosed with cervical cancer. She underwent treatment, but didn't survive very long. While she was being treated, a sample was taken of her cervical cells, both the cancerous and non-cancerous ones. Each was cultivated, but while the latter cells died, the former grew and wouldn't stop growing. As was the custom at the time in that lab, the cell line was named after the person it came from: the first two letters of the first name, then the first two of the last. Henrietta Lacks. HeLa. One of the most widely used cell lines in the world for decades, but the person behind it was lost and some people even thought the original donor's name was Helen Lane...until Rebecca Skloot published The Immortal Life of Henrietta Lacks, which told the story of the woman and her descendants for the first time.

Well, "donor" might not have been the correct word to use up there, because Henrietta didn't knowingly "donate" anything. Instead, the doctors working on her took the samples without bothering to ask her permission, which was standard practice at the time. And the ethics of this sort of thing, the evolution of informed consent, is a key part of the book, which Skloot weaves around the story of the Lacks family. How fast medical science has grown, and how slow the field's understanding of or willingness to comply with what is right has been in trying to keep up with it. In a world where all you need to get a basic understanding of your genetic picture is $100, to spit in a tube, and 6-8 weeks for processing, what kind of protections should be around that data? We likely still don't know the full implications of something like that being hacked or leaked.

This book has become a science classic already, and it's easy to see why: Skloot is a talented storyteller, and for most of the book's run does an admirable job of keeping her three pieces (Henrietta herself, the HeLa cells/medical ethics, and the story of the Lacks children) in balance. She does great work in digging up what little information there is about Henrietta's short life, mostly through the connections she managed to build with the children Lacks left behind. I've got some grounding in science research from my days as a psychology student, and I know about some of the more egregious bullshit doctors used to get up to (especially with the poor and people of color), but even I was shocked at how lax regulations on human research used to be and how deeply the focus was on getting data at any costs. I was chilled by the story she recounts of a researcher, who the Lacks children believe was untruthful with them when she encountered them years before the book was written, expressing her longing to be able to get material (i.e. blood) from those same people to perform tests.

The reason I haven't rated this more highly, then, is that it starts to drag at the end, becoming more a story about how the story was reported, which tends to bother me unless it's in small doses. It's clearly rooted in a deep, real fondness for Deborah Lacks, one of her primary sources, and a desire to do justice to her story too...but for me, it didn't have the power of the larger narrative and didn't quite work. That being said, this is a story everyone should read and I definitely recommend it to a wide audience.

One year ago, I was reading: A Tale for the Time Being

Two years ago, I was reading: Mansfield Park

Three years ago, I was reading: Helter Skelter

Four years ago, I was reading: Creative Mythology

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Book 217: The Immortal Life of Henrietta Lacks

Book 147: Migraine

"But we now encounter a much more fundamental problem, which springs from the fact that migraine cannot be considered simply as an event in the nervous system which occurs spontaneously and without reason: the attack cannot be considered apart from its causes and effects. A physiological statement cannot enlighten us concerning the causes of migraine, or its importance as a reaction or item of behavior. Thus a logical confusion is implicit in the very formulation of such a question as: What is the cause of migraine? For we require not one explanation or one type of explanation, but several types, each in its own logical province. We have to ask two questions: why migraine takes the form(s) that it does, and why it occurs when it does."

Dates read: May 20-26, 2017

Rating: 6/10

I first started getting migraines when I was about 18. I'd gone on the Pill, and suddenly found myself getting these awful headaches. For a couple years, I didn't make the connection, and just thought they were especially bad normal headaches. But when I was driving home from a shift at Blockbuster and literally had to pull off to the side of the road and barf, I finally went to see my doctor. When I told her about the excruciating pain on one side of my head that I got periodically, she diagnosed me with migraines and gave me Imitrex and the first time I took one, it was like magic. Within about an hour, the pain just...stopped. I could go about my life like a normal person. It was like a miracle.

It took me a few more years to figure out that the headaches were tied to my menstrual cycle and there's a whole series of nonsense that's connected to that, but that's not the important part. The important part is that as both a migraine sufferer and a devoted fangirl of Oliver Sacks, I was of course going to pick up his book Migraine. It's a quasi-scientific text, but I think it's still accessible to a popular audience. It just needs be an informed popular audience, or at least one willing to get their Google on when he starts talking about neurotransmitters.

Sacks takes a comprehensive look at migraines, beginning with setting them into historical context (they've been around at least as long as recorded history) and then describing the two basic types of migraines: with aura ("classical migraine") and without aura ("common migraine"). He goes into detail about the symptoms of the two, beginning with the common migraine, which is distinguished primarily by an intense, usually one-sided headache and some degree of nausea, and then proceeding to classical migraine, which is similar but also very different. The classical migraine has a visual component known as the "aura", which often takes the form of  bright colors or patterns clouding the visual field. He then discusses possible causes, triggers, and treatment options.

In my experience (which is admittedly as a person with a psychology degree), Oliver Sacks' writing style, which bursts with curiosity and enthusiasm, tends to override concerns about technicality. That being said, of the many books I've read of his, this the most textbook-like. Assuming that the primary audience to which this book will appeal will be migraine-sufferers who already have some background information about their condition, I think it's fine. Even as a fairly savvy consumer, I learned things about migraines that I didn't know before. Since I'm the type of person who doesn't have aura, I was surprised to learn that it's actually fairly common for people who do get aura to get just the aura, without any headache component. Migraine sufferers will also be able to see how many of their symptoms are more common than they thought. I also found myself very grateful that my migraines debuted after the use of triptan drugs to treat migraines became standard, since I know my Imitrex is a lifesaver and previous drugs sound like they were generally less effective with more side effects. I'd definitely recommend this book to people curious about migraines, since I think it distills a lot of research and thought into one volume. Unless you're otherwise interested or a Sacks completist, though, it's probably not worth your time.

Tell me, blog friends...how many of you also suffer from migraines?

One year ago, I was reading: Stay With Me

Two years ago, I was reading: The Professor and the Madman

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Book 147: Migraine

Book 129: A Leg To Stand On

"And in that instant, I no longer knew it. In that instant, that very first encounter, I knew not my leg. It was utterly strange, not-mine, unfamiliar. I gazed upon it with absolute non-recognition...The more I gazed at that cylinder of chalk, the more alien and incomprehensible it appeared to me. It seemed to bear no relation whatever to me. It was absolutely not-me—and yet, impossibly it was attached to me—and even more impossibly, 'continuous' with me." 

Dates read: February 26-March 2, 2017

Rating: 7/10

When I was in college, I quite often used a shortcut to get back to my apartment after a night at the bars. It was a short, dark path than ran next to a parking garage. I almost never saw anyone back there. A few times I saw some homeless people, but no one ever tried to stop me or talk to me. Thinking back on it, it sounds like the beginning of a horror film: a young, drunk, small college student walks down a secluded path into the dark. But it never occurred to me to be afraid. And, obviously, nothing ever happened.

We often feel impervious to danger until something happens to frighten us. In his memoir A Leg To Stand On, Oliver Sacks recalls a time in his life that began with a hike on a solo trip to Norway. Sacks was an adult man who frequently traveled and was in excellent physical condition, so the idea of going for a hike alone didn't phase him in the least. It wasn't until a chance encounter with a bull during the hike lead to a fall that drastically injured one of his legs that he realized how very precarious his situation was. The leg was incapable of bearing any weight. No one knew where he was. It would get dangerously cold at night, and the path was little-traveled enough that he very well might not be found until it was too late. Somehow, miraculously, he managed to get himself back down the hill where he was discovered by locals. But that was just the beginning of his tale.

After surgery to repair the grave damage to his leg, he woke up to feel as though that leg wasn't really his. It was like the opposite of phantom limb syndrome: instead of feeling as though a limb that had been amputated was still there, Sacks felt like his existing limb wasn't a part of his body. His recovery, both from the underlying injury and the neurological symptoms, make him, for the first time since he'd become a doctor, a patient. He finds himself feeling meek and helpless, and even though his situation wasn't contagious, he's treated as though his suffering might be.

Eventually, he did recover, and continued to be physically active and practice neurology and write books. But it's not hard to imagine that this experience of being a patient helped inform the compassion in his work. Writing case studies is a delicate balance: there can be an exploitative edge to it, the feeling that the writer is mining suffering for their own pecuniary gain. But for my money, Sacks' works never come off that way. The things that come across clearly are his endless curiosity for how the brain works, how symptoms can be treated, and a respect for the fundamental humanity of the people he worked with and tried to help. Which is why I've been such a big fan of his books, and why I'm a little sad each time I finish one because I know it means there's one more that I'll never again get to experience for the first time. I found this one in particular a fascinating medical memoir, and a moving meditation on the experience of being a patient. I would definitely recommend it, especially for anyone who works in the medical field.

Tell me, blog friends...have you ever realized how unsafe something you did unthinkingly was?

One year ago, I was reading: If We Were Villains

Two years ago, I was reading: We Need To Talk About Kevin

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Book 129: A Leg To Stand On