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Death and Other Options: How To Think (Hopefully!) About Global Health

What’s Killing Us:  A Practica Guide to Understanding Our Biggest Global Health Problems by Alanna Shaikh. TED Books 2012, Kindle, iBookstore, Nook

Reviewed by Tom Levenson

The last decade of the seventeenth century was a great age for London’s media junkies. Paper had become cheap enough to permit the emergence of the first  real newspapers in the English-speaking world.  The censors saw their reign end in 1696, the year after Parliament declined to renew the Licensing Act. With that, printers no longer had to fear harsh penalties for operating an unapproved press.  Free lance journalism was emerging as a plausible way to make a sort of a living – even if one of its most prominent practitioners, Daniel Dafoe, did do his stint in debtor’s prison.

Given all that, it’s no surprise that a torrent of what we may call new media poured forth. If you had something to say and even quite modest means, you could say it – and plenty did. Readers could lay their hands on learned disputes on the question of singing in church; coiners advising the government on the best methods to prevent counterfeiting; at least one poem by a law student on the subject of long vacations.

All of these appeared in the form that truly came into its own in the 17^th century. That would be the pamphlet: a modest tract, easier to write, cheaper to print, swifter to plow through than any scholar’s tome…

…All of which is to say that there is nothing new under the sun.

Flash forward roughly three hundred years, and lay your digital mitts on the subject of this review, Alanna Shaikh’s What’s Killing Us.  It is an e-bite of an argument, less than forty pages to cover Shaikh’s top-ten list of global health problems.  It is a pamphlet by any other name, and hence an example of one of my favorite everything-old-is-new-again gifts of the digital revolution. 

One note before getting to the meat of Shaik’s work. Sharp-eyed readers will see that I’ve left unmentioned one property of What’s Killing Us.  It’s a TED book, and TEDity has come in for its lumps here. This one doesn’t, or shouldn’t, in part because it does not attempt to reduce the difficult reality of global health to a trademarked Big Idea.  Instead, it is an example of what TED promises but does not always deliver – a guide to thinking about a the complexity of an issue that enables – really demands that -- the reader join in figuring out what the hell to do.

The Science of Sports: An eBook Goes for the Gold, Gets A Bronze

The Science of Sports: Winning in the Olympics. Scientific American $3.99   Kindle, iBook, Nook,  Sony Reader

Guest review by Jaime Green

I love the Olympics, although I'm not sure why. Maybe it's the special-occasion feel, or the every-two-years anticipation--a longer wait than for next Christmas. (I do remember when both summer and winter games were held in the same year, though not well enough to recall whether the four-year wait heightened the thrill or if the crush of excitement was too much, gymnastics and archery only six months from figure luge and ski jump.)

The exotic sports at the Olympics also add to its thrill. Sure, people will snark about the two weeks a year we care about synchronized diving --“Where were you during world championships last year!?”--but for those two weeks we do care! We cram our brains with obscure knowledge. Every four winters we learn about triple axels and the salchow--how the heck to spell salchow--and then we let it all go dormant for the next four years, until we can debate the finer points of fencing again.

It's this thrill of the unusual, and of learning its finer points, that I was looking for in Scientific American's ebook, The Science of Sports: Winning in the Olympics. And coming into it looking for that angle, I was disappointed that the book stayed so true to the first part of its title: the science of sports. That's what this ebook is full of. What it is not full of, and what I missed, was the science of the Olympics.

This first ebook from the editors of Scientific American reads much more like a collection of articles than a single work, and as such it is a perfectly serviceable survey on the science of sports. Pieces are divided into eight sections: The Psychology of Winning, Pushing Human Limits, Drugs and Doping, Concussions, Comeback from Injury, Gear that Gives an Edge, Fitness: Expert Advice for You, and Closing Ceremonies. The pieces, written especially for this ebook by individual Scientific American editors and contributors, explore the physiology, biochemistry, and neurobiology of sports. They also examine recent incidents, such as doping scandals, that bring science and sports together in less savory ways.

Although the lack of unity was sometimes frustrating on a straight-through read--back-to-back articles sometimes retread each other's ground, re-explaining a concept or re-defining a blood protein--it still makes for a nice collection to pick your way through. There's no need to read in order, so you can follow your interests, from the mental acuity of an elite athlete to the most common Olympic injuries and then over to how playing sports can boost children's brain power. You'll learn something cool whichever path you take. And there's a lot to learn. Even if you didn't need this ebook to teach you that the ACL isn't the Achilles tendon but is actually in the knee, there is satisfyingly deep discussion of topics ranging from psychology to blood doping to the physics of prosthetic legs.

The questions tackled in this ebook go beyond the science of sports, too, in several cases engaging with the ethical questions that scientific advances raise. Do steroids make better athletes, or do they make cheaters? How many restrictions should be put on young athletes to protect their brains from concussions? Where does an athlete find the balance between improved performance and dangerously low body fat? These questions make interesting food for thought, and perhaps also foundations for important decisions. The ramifications extend far beyond the Olympic arenas.

Yet I still wished this ebook spent more time within those Olympic arenas. Many pieces focus surprisingly squarely on the topic of the ebook's subtitle: winning. It's as if the ebook's authors decided that Olympic equals elite, and then just wrote about how elite athletes win. But I don't care if Michael Phelps gets the gold. I care that he is stunning to watch. (In the pool, I mean.) And I want to know the science behind his performance--of something that feels specifically, uniquely Olympic. Articles that focused on baseball and American football felt similarly dissatisfying. They're sports, yes, but hardly what we think of as Olympic sports. (In fact, now that baseball's been dropped from the games, neither is an Olympic sport.) For readers drawn to this ebook for the Olympics and not for the sports, this may be a disappointment.

Also potentially disappointing--or virulently frustrating, depending on your level of investment--are some gaps in the scientific and athletic arguments. Jesse Bering's piece, “Why We Love Sports: Success of the Fittest,” proposes that sports compel us as fans and spectators because they serve as a demonstration of reproductive prowess. (Think of football as the peacock tail-feathers of our species.) This argument itself is a stretch. Sports audiences are so dramatically weighted toward men who are not looking to the field for mates. Bering doesn't even give the plausible counterarguments lip service. What about the primal need for play? Tribal affiliations and the strengthening power of us vs. them? The evolution and ritualization of hunting and combat practice? Heck, maybe even mirror neurons, who knows?

In a piece called “Does Exercise Really Make You Stronger?” Coco Ballantyne asserts that “the longer, harder and more often you exercise, the greater the health benefits.” She fails to offer the important caveat against overtraining, which plagues professional and devoted amateur athletes alike, with increased risk of injuries and often dramatic negative effects from overstressing the body. An article on preventing shin splints was similarly narrow-sighted, failing to mention the calf-strengthening exercises that have saved the shins of every new runner I know. 

The highlights of the book examined the subjects that I, and most readers, have no experience with. The articles on top-level cyclists and swimmers, on Olympic runner Oscar Pistorious' prosthetic legs, drew me in much more and carried that charge of the slightly esoteric that make me love the Olympics. Even an article on advanced swim gear brought a little frisson of elite, advanced technology. And “Who Wins the 40-Yard Dash: Squirrel, Elephant, Pig, Human?” armed me for some fun small-talk to fill the breaks between track and field events over the next two weeks.

For the most part, though, the science here is decidedly pedestrian. Readers who want to learn about the geometry of a rhythmic gymnast's twirling ribbon or how a pentathlete slows her heart rate before she shoots will have to wait. Maybe there will be something for us in another four years.

 

Jaime Green is a graduate student in Columbia's MFA writing program. Her work has appeared in The Awl, Spezzatino, The Hairpin, and Parabasis. She is writing a book about the possibility of life in the universe.

An overstuffed colon and a perfectly sized Kindle Single

An Unexpected Twist, by Andy Borowitz. Kindle Single, $0.99 (free borrowing with Amazon Prime).

Reviewed by Seth Mnookin

Last week, The New Yorker found itself in the news as the result of a newly acquired blog. I know what you’re thinking -- “Enough already with Jonah Lehrer!” -- but this had nothing to do with journalistic ethics or onanism or anything else that might get the folks at Poynter all hot and bothered; this had to do with a blog that is proudly, deliberately “composed entirely of lies,” a blog whose author assured his readers that he will strive to be “as inaccurate as always, and if I ever write something that turns out to be true you have my deepest apology and my promise that it won’t happen again.”

I’m talking, of course, about The Borowitz Report, which Andy Borowitz started 11 years ago as an outlet for his daily, 250-word send-ups of the news. (This morning’s entry: "N.R.A. Proposes Sweeping Ban on Movies.") In that time, Borowitz has become one of the most lauded satirists in the country -- think of him as a literary Jon Stewart. His name graces the cover of one of the most successful Library of American volumes ever (The 50 Funniest American Writers* (*According to Andy Borowitz)). He was voted by Time magazine readers as having the #1 Twitter feed in the world. He even hosted the National Book Awards -- twice.

He also got married (in early 2008) and had a daughter (in late 2009). It’s what happened in between those two events that supplies the content for An Unexpected Twist, which Amazon recently named the best Kindle Single of the first half of the year. Borowitz's essay begins with him bloated, severely constipated, and turning down his wife’s suggestion of a midday quickie, which, he acknowledges, “should be a sign that something is terribly wrong.”

The Frankenstein Universe: How The New York Public Library Blew Up the Ebook

Frankenstein: The Afterlife of Shelley's Circle. The New York Public Library. Web site. iPad app. Free.

Reviewed by Carl Zimmer

"Reviewed" is too generous a term for this post. If I set out to write a proper review this colossal labyrinth of an ebook, you would have to wait for weeks, perhaps months, for my verdict. But since this particular work is free, I think the most that's necessary is to point you in its direction and wish you well. I downloaded Frankenstein this morning, and I've been enjoying perusing it greatly. While it's not a perfect ebook, I expect I'll be delving back into it for a long while.

Frankenstein comes to us from the New York Public Library. If you've ever been there, you've probably seen one of their impressive exhibits. As one of the greatest libraries in the world, the New York Public Library is also a great literary museum. To put on an exhibit, they will typically select some of the finest treasures from their collections, such as rare books, letters, maps, and prints. Frankenstein is like an exploded version of one of their exhibits. It's drawn from the Carl H. Pforzheimer Collection of Shelley and His Circle. As I wandered through the app, I sometimes wonder if there was anything in the collection that they didn't include in it.

At the core of this ebook is Mary Shelley's classic meditation on science and humanity's urge towards creation. Here you can listen to a dramatic reading from one chapter. The ebook contains accounts of the making of novel, as well as its reception. Essayists contemplate the powerful hold the story has had on us ever since, and how we've adapted its themes to science's progress, from the advent of nuclear weapons to our age of stem cell manipulations and genetic engineering. The whole project is lavishly illustrated with paintings and photographs.

This morning on the ArtsBeat blog at the New York Times, Jennifer Schuessler wrote that "the app spins out widely and wildly." I have to agree with her. I found myself paging through stills from a disastrous 1981 Broadway production of Frankenstein that closed after one night, and asked myself, "Why am I looking at this?" I can't say that the experience gave me any insight into the book's place in our culture. The essays on Shelley's circle of friends veer off far from her novel. The app includes not one but two graphic novels. Frankenstein is also loaded with interactive features, which are nicely integrated technologicaly, but not thematically. While reading the piece on the making of the novel, you are invited to pop out a poll: "Do you get the most inspiration from creating on your own?" Why, yes I do! The app then informed me that 84% of the 13 people who voted agree with me. How 'bout them apples?

The ebook also has some technical flaws. I'm still clinging to my iPad 1, and I find that Frankenstein slows down its performance like no other ebook I've used. On more than one occasion, it even crashed. Which is odd, given that Frankenstein deals mainly in texts and pictures, which should make pretty modest demands on a tablet device. On top of the app's slow performance, it displays its essays in small windows that you have to scroll through, which took me back to the early days of the web. Sometimes when you follow a link, the app dumps you into the web-site version, as if you've fallen into a parallel universe. 

If you find yourself annoyed by anything in Frankenstein, bear two things in mind. 1. It's free. 2. One touch of the screen will quickly take you to a different part of the app. Any time I've gotten bored by something in Frankenstein, I've found myself intrigued seconds later by one of the hundreds of elements of this app.

Perhaps that's the true sign of the greatness of Shelley's novel. The book was a Big Bang, and the universe it created is still expanding.

 

Carl Zimmer writes frequently about science for the New York Times and is the author of 13 books, including A Planet of Viruses

At the Edge of Life

Dead or Alive by Erika Hayasaki. Kindle Singles, $1.99.

Guest review by Jude Isabella

About 42 percent of the way through Erika Hayasaki’s Kindle Single, Dead or Alive, a book about Near Death Experiences (NDEs), I experienced a freaky coincidence. I was in the field with a team of scientists when a member of the crew started telling me about a horrific accident he had been in a year before. I asked him if he still had nightmares. Not as often, he answered, before telling me about the out-of-body experience he had in the operating room, when he suddenly found himself above the action, looking down on his body as doctors and nurses struggled to save his life.

"I don’t know why I’m telling you this," he said. “I’ve told almost no one and I don’t like to talk about it.” The subtext being, he keeps it to himself to avoid either one of two reactions: disbelief or way too much belief.

Hayasaki explores this treacherous territory in Dead or Alive, investigating the science behind NDEs. The story is perfect for the length of a Kindle Single: the study of NDEs is in its infancy and so there's little solid scientific evidence. A longer book would be repetitive, recounting endless anecdotes and relying too heavily on speculation.

Hayasaki opens Dead or Alive with the NDE experienced by her uncle, Richard K. Harris, a lawyer turned writer. It sounds like the typical NDE description familiar to anyone who reads, watches movies, television, or roams the Internet, complete with tunnels, brilliant lights, and the presence of already departed loved ones.

It’s a brave place to start. If not for the fact that Hayasaki is a former reporter for the Los Angeles Times, (where she wrote several articles that inspired this book), I might have rolled my eyes and left Dead or Alive to languish in the “Books” collection of my Kindle. But Hayasaki understands something fundamental about NDEs — the universality of NDE descriptions can make them less credible, since anyone can describe an NDE whether they’ve had one or not. To give the experience some specificity, she focuses on Harris, recounting his experiences before his own brush with death.

By introducing both Harris and his NDE, Hayasaki hooks the reader. It becomes paramount to find out if NDEs can be scientifically explained. Is it just the product of a brain trying to make sense of dying? Or is it possible that a meta-consciousness awaits us all at the end?

Hayasaki delves into past writings about NDEs. In the mid-1970s the psychologist Raymond Moody interviewed 150 people who had been declared dead and were then revived. From the interviews he drew a universal description of NDEs, which, it turns out, have been reported throughout history. Research has accelerated since Moody’s study. A number of studies suggest that a lack of oxygen to the brain may be the cause of NDEs. Hayasaki interviews NDE researchers, even finding a neurosurgeon who experienced an NDE himself.

This is compelling reading. Who does not want to know if science can determine if death is final? (Less compelling is Harris’s story, which Hayasaki weaves into her narrative. Hayasaki never knew her uncle well. He had distanced himself from his family, and he died of cancer soon after they met.) And when it comes to the subject of NDEs, Hayasaki’s timing is impeccable. Baby boomers are reaching the age when their family and friends are starting to die. The cynic in me says the latest research on NDEs is driven by a dominant generation accustomed to questioning the status quo. Boomers, after all, made 40 the new 30 and 50 the new 40. They can’t cheat death, so they’re questioning it through science.

The non-cynic in me says technology is the true driver of this research. It’s easier than ever to study NDEs. Better brain maps courtesy of medical imaging equipment have allowed scientists to stimulate specific parts of the brain with electrodes to induce out-of-body experiences in test subjects, for example. With MRIs scientists can study test subjects’ brains as they recall NDEs. And scientific papers on the topic have turned up in journals like The Lancet and Trends in Cognitive Sciences.

Although studies often focus on the out-of-body experiences associated with NDEs, I didn’t know until reading Dead or Alive that people near death frequently say they feel nothing as they gaze at their corporeal forms, however broken and distressed they might look. When my new acquaintance, the accident survivor, expressed the same sentiment, I hadn’t read far enough into the book to know that about NDEs and I doubt he scoured the Internet looking for lesser known details. This volunteered bit of information, his hasty retreat from the conversation, and reading the book, made me think the NDE experience — brain-based or not — is more real and profound to people than I had previously accepted. 

It’s hard to tell if Hayasaki believes NDEs reside only in the brain or that consciousness lives on despite the body’s death. The balance of probabilities tips toward the brain studies and their conclusions so far. But ultimately no one knows what happens after death and in Dead or Alive I get the sense that Hayasaki is asking us all to keep our minds open. 

 

Jude Isabella writes about science for kids and grown-ups. She has written for The Walrus, New Scientist, Archaeology Magazine, Canadian Geographic, and other publications. Her books, Chit Chat, a Celebration of the World’s Languages will be published fall 2013 by Kids Can Press, and Salmon: a Scientific Memoir in spring 2013 by RMB. Follow her on Twitter.

When an Autism Diagnosis Comes as a Blessing

Blazing My Trail: Living and Thriving with Autism. Published by the author. Kindle, $7.99.

Reviewed by Steve Silberman

It's fashionable to say that autism has become a fashion.

If you think overweening psychologists are hastily applying labels like Asperger syndrome to quirky nerds who should be perfectly capable of making their way in the world with no special help, assistance, or accommodations, you have plenty of company.  This past January, for example, the New York Times ran two op-eds in one day making that claim, including one by a young novelist named Benjamin Nugent who declared, "Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome."

The source of his authority on the subject, apparently, was that Nugent himself once received such a diagnosis as a teenager -- at the urging of his mother, a psychology professor -- and appeared in an educational video called Understanding Asperger's in a "wannabe hipster polo shirt." Now, however, Nugent has come to believe that the behavior his mother took for the telltale signs of a developmental disorder was merely his geeky teenage lifestyle, which included spending "a lot of time by myself in my room reading novels and listening to music." He went on to say that the cure for his misdiagnosis was moving to New York City, where he was finally able to meet other formerly bookish kids and schmooze with them in cafés. Having left his dreary foray on the spectrum behind him -- followed by a "long time" of sulking in his mother's presence for having put him through the ordeal -- he's now a professor of creative writing in New Hampshire.

Nugent's glib report surely provided a kind of comfort to some readers, who could return to their lives secure in the knowledge that many of these "Aspies" whom one keeps hearing about are simply "withdrawn, bookish kids" unnecessarily labeled by their histrionic parents with the help of psychologists eager to vault aboard the latest diagnostic bandwagon. After spending the past couple of years interviewing and spending time with autistic people and their families for a book, however, I can tell you that Nugent's experience is the exception, not the rule.

Everyone I've met who has been diagnosed with Asperger's syndrome or other form of autism faces profound challenges in day-to-day life. Even the most "high-functioning" autistic people (a term I now avoid using, because it renders certain forms of cognitive disability harder to see, while obscuring the gifts and competence of those branded as "low-functioning") work tremendously hard to find and sustain friendships; to manage the jarring changes that intrude into the most carefully planned-out schedules; to maintain their composure in noisy sensory environments; to get hired for jobs worthy of their intelligence and skills; and to navigate their way daily through a minefield of unspoken social rules and cues designed by and for people whose brains are wired differently from their own.

That's one reason the revision of the criteria for autism in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders -- the bible of psychiatry used to determine diagnosis, access to services, and reimbursement from insurers -- has become so controversial. Even psychiatrist Allen Frances, who led the task force that developed the criteria in the DSM-IV, has gotten into the act, claiming that spectrum diagnoses have become "faddish." Many autistic self-advocates suspect the American Psychiatric Association is about to pull a diagnostic sleight-of-hand by shaving off a portion of the population that would have been eligible for an Asperger's diagnosis under the DSM-IV criteria, and give them a newly minted diagnosis of Social Communication Disorder, which has no legacy services or support systems. Some fear the APA is trying to finesse the increasing scarcity and overloading of services for autism, when budgets are being slashed in the name of austerity, by manipulating labels to lower demand.

There is no question that people diagnosed with Asperger's syndrome have an authentic need for help, long after they've "aged out" of the meager support provided to kids until they turn 21. Contrast Nugent's breezy anecdotes about pissing off his schoolmates by "trying to speak like an E.M. Forster narrator" with this description of attempting to absorb an ordinary conversation written by Rachel Cohen-Rottenberg, one of the most passionate and articulate disability-rights bloggers, and author of a new ebook called Blazing My Trail: Living and Thriving with Autism. "When I hear, I see the spelled-out words in my mind, and I have to internally read and translate those words in order to understand their meanings. As a result, even in quiet environments, I cannot keep up with verbal input for more than five or 10 minutes without falling behind, unless the other person slows down his or her speech and leaves a number of pauses in which I can respond. Pacing is everything."

Or consider this list of activities that Cohen-Rottenberg identifies as particularly challenging:

 Food shopping

Sweeping and mopping the floor

Cooking

Driving

Running errands

Going to appointments

Planning, executing, and transitioning between tasks

Working at a job

Making friends

Autistic people in Cohen-Rottenberg's generation never got the chance to be diagnosed with Asperger's as kids, because the diagnosis didn't exist. It's easy to forget that just 40 years ago, there was no concept of a broad, inclusive spectrum that encompassed accomplished professionals like Temple Grandin and autistic people who may never learn to speak or put on their clothes in the morning without help. (Indeed, Grandin's debut memoir, Emergence, was initially billed as the first book by a "recovered" autistic person, because the idea that an autistic woman could enroll at a university, earn an advanced degree, and become a leader in a demanding field didn't seem possible.)

On websites for parents, an autism diagnosis is often framed as a heartbreaking event, an occasion for grieving the typical child they'd planned for. That's understandable and human, but it's illuminating to read statements like "Don't Mourn for Us" by autistic adults like Jim Sinclair, one of the pioneers who has inspired a generation of self-advocates to view their autism as an essential part of who they are, rather than as a pathology they might be cured of someday.

For Cohen-Rottenberg, who was 50 years old when she was diagnosed, the label arrived as a blessing. She felt she finally understood why she had been relentlessly bullied and teased when she was young; why she found certain environments that other people enjoyed (such as crowded restaurants) unendurable; why her first marriage went off the rails; and why she had to work so hard to parse non-verbal cues that her peers can take for granted. "I was like a person with mobility issues trying to run a marathon every day and keep up with people whose bodies worked differently from mine. Burnout was inevitable," she writes. "In a few short years, I seemed to go from a lifetime of being super-functional to struggling with basic things… It was my lifelong ignorance of being autistic that was catching up with me."

Unlike many of the ebooks reviewed at Download the Universe, Blazing My Trail offers no multimedia bells and whistles; it's just text with a few family photographs. But it represents the promising potential of the form to provide a venue for highly skilled writers who might never have been able to convince a corporate publisher that their message was capable of engaging a mainstream audience.

Cohen-Rottenberg's first ebook, The Uncharted Path, available as a PDF, recounted her difficult upbringing and her path to diagnosis. "My attempts at making contacts always felt a bit like trying to drive a car by gripping the steering wheel with my teeth," she wrote. Blazing My Trail continues the story, and addresses how she and her second husband, Bob, have worked as a team to manage her sensory sensitivities and social challenges while building a happy life together. Her unaffected honesty makes Blazing My Trail an uplifting journey -- not in the usual sense of being a heroic saga of a narrator "overcoming" disability with pluck and guile; but by bearing witness to the power of accepting and celebrating oneself exactly as one is.

Cohen-Rottenberg comes through her writing as a wise elder of her tribe and a role model for young people, as well as a smart critic of social attitudes toward disabilities, both visible and invisible. "If we lived in a society that took human diversity for granted, that made room for difference as a deeply held value, every one of us would benefit," she says. "Our view of one another would become much more expansive, much more respectful, and much more compassionate. Ultimately, we might even see one another as perfectly different and perfectly human."

Steve Silberman is writing a book about autism and neurodiversity called NeuroTribes: Thinking Smarter About People Who Think Differently for Avery/Penguin 2013.  He is a contributing editor of Wired magazine and one of Time's selected science tweeters (@stevesilberman). He lives with his husband in San Francisco.

 

 

 

 

 

 

Leonardo: The First Great Science Ebook

Leonardo da Vinci: Anatomy Touch Press Ipad. $13.99 Publisher site

Reviewed by Carl Zimmer

There's no point in beating around the bush. Leonardo da Vinci: Anatomy is simply the best ebook about science that I have ever encountered. To me, it is the exemplar of what ebooks can be.

Leonardo da Vinci: Anatomy comes from Touch Press, whose lavish apps we've reviewed before at Download the Universe (Gems, The Solar System, The Elements). I've personally toyed around with all three of those apps, and while they each offered a number of pleasures, each one felt limited in one way or the other. Gems, for example, lets you twirl diamonds and rubies, but, as Virginia Hughes noted in her review, it doesn't tell you much about them or about their place in human history. The Solar System, reviewed by Jennifer Ouellette, has some very impressive features for navigating among the planets, but Jennifer noted that it lacks a clear story.

Given this track record, I launched Leonardo da Vinci: Anatomy expecting a good-looking but flawed production. No shortcomings came to light, so I tried looking for them. I looked hard. And I couldn't find any. Leonardo da Vinci: Anatomy has everything I could ask for in an ebook about one of the greatest stories in the history of science: a pioneering work on anatomy that was lost for over four hundred years.

Living during the Renaissance, Leonardo's initial understanding of the human body came from ancient scholars like Galen and Aristotle. He was taught that animal spirits traveled through giant holes in the head and then flowed into the nerves. He was taught that blood was produced in the liver and then flowed outward to the ends of the body. One reason that these obviously wrong ideas persisted for over a thousand years was that medieval scholars did not conduct their own autopsies or experiments. Galen and and company had figured out everything there was to know about anatomy, so the best thing they could do was read, not conduct research.

With the Renaissance, that obedience began to crumble. Leonardo was the quintessential do-it-yourself-er. He conceived of new kinds vehicles and weapons; he investigated optics and geology. Wikipedia has set aside a separate page for a startling long list of his accomplishments.

Leonardo also became obsessed with human anatomy, and did not hestitate to make up his own mind about it. He dissected human cadavers. To figure out how the heart worked, he created a glass model of it. To probe the brain, he injected hot wax into the head of a freshly slaughtered ox.

As I wrote in my book Soul Made Flesh, Leonardo had a hard time breaking free from the old notions of how the body worked. When he discovered that the head did not contain three linked chambers, he couldn't break free from the old theory of animal spirits. He could not accept that perhaps the brain itself was responsible for thought. Likewise, although Leonardo discovered a valve in the aorta, he did recognize that blood circulates around the body, pumped by the heart. Nevertheless, his drawings were the greatest anatomical works that existed in his time. Not only were they anatomically correct, but they displayed his artistic mastery.

Leonardo actually came close to publishing a textbook of anatomy while he was living in Milan, but battles in 1511 drove him from the city and he never quite managed to finish it before his death in 1519. Instead, his drawings remained hidden away until the twentieth century.

Today, the Royal Collection is unveiling the largest ever exhibition of Leonardo’s anatomical drawings at The Queen’s Gallery in Buckingham Palace. They also teamed up with Touch Press to create an app based on the show. All the members of the team brought their A game to this undertaking. Leonardo da Vinci: Anatomy contains a richly informative narrative about the artist's hidden career as an anatomist, written by Martin Clayton, Senior Curator of Prints and Drawings at the Royal Collection. It is illustrated elegantly with Leonardo's drawings, as well as interactive images of human anatomy as we know it now. You can see for yourself just how good his drawings of the heart or uterus were. You can turn arms to see how well Leonardo appreciated the body's biomechanics.

These components are copious but never intruding. And they always answer the question raised in the reader's mind by the text. Videos from historians and scientists end each chapter--usually I hate these features, but in Leonardo, the talking heads actually have something to say.

The app also contains Leonardo's notebooks themselves. The interface for this part is nothing short of brilliant. You can search through the pages by organ or system. Each page is presented in its original state, scanned to exquisite resolution. Tap the screen, and the app instantly translates the inscrutable notes Leonardo scribbled by his drawings. Each page is also annotated with useful explanations of what Leonardo was contemplating with each image.

Three decades after Leonardo's death, Andreas Vesalius published Fabrica, which has long been considered the first modern work of anatomy. Leonardo da Vinci: Anatomy demonstrates that Fabrica was  not the only masterpiece of the body to come out of the Renaissance. Not many ebooks can claim such achievements.

 

Carl Zimmer writes frequently about science for the New York Times and is the author of 13 books, including A Planet of Viruses

Artificial Epidemics: You’re Not Really Sick, You’re Overdiagnosed

Artificial Epidemics: How Medical Activism Has Inflated the Diagnosis of Prostate Cancer and Depression, by Stewart Justman. Now and then Reader, 2012. Publisher's site, Kindle,  iBooks, Kobo

Reviewed by SciCurious, guest reviewer

"In the mid-1990s I found myself on a committee charged with reviewing medical expenditures under my university's health plan. Like the rest of the country, the members of the plan had fallen in love with anti-depressants, which accounted for our largest single drug expense-several hundred thousand dollars annually, as I recall. When someone around the table commented that this was a lot of money to be laying out for mood-altering pills, a defender countered, "If they prevent one suicide, they're worth it!" Argument ceased. No one in the room, including myself, was aware that anti-depressants actually increase the risk of suicide, particularly in patients up to twenty-four years of age."

This opening scene from Stewart Justman's Artificial Epidemics sets the stage for a tangled, convoluted tale of two distinct diagnoses--prostate cancer and Major Depressive Disorder--and how intensive screening for these diseases has rendered us all overdiagnosed. Justman, a professor of Liberal Studies at the University of Montana, has made a long study of cancer, publishing several books including Do No Harm: How a Magic Bullet for Prostate Cancer Became a Medical Quandary and Seeds of Mortality: The Public and Private Worlds of Cancer. Artificial Epidemics, a slim, 22-page eBook appears to be an attempt to bring together his previous writing on cancer with another highly-diagnosed and talked about disease: Major Depressive Disorder.

"The campaign against depression and the campaign against prostate cancer both used inflamed arguments and appealed to fixed ideas," Justman writes. He lays the bulk of the blame for the resulting "artificial epidemic" on medical activists, who have taking screening for these diseases to large segments of the population.  Justman also argues the screenings for prostate cancer and depression suffer from an “absence of appropriately discerning methods,” and thus help in the push toward the overdiagnosis of the American population.

His solution? Stop the screening, stop the treatment. We are not sick, we are overdiagnosed.

Justman’s concerns regarding prostate cancer are not particularly new. Prostate-specific antigen (PSA) testing has been controversial since the beginning. As Justman notes, “the same vial of blood divided in two may give different PSA readings.” Medical experts have also voiced criticism about the cut-off points for diagnosis for prostate cancer. Since the treatment for prostate cancer can be invasive, the U.S. Preventative Services Task Force has proposed that when men score an initial PSA that only barely reaches the threshold for cancer, they should not immediately start treatment. Instead, they should undergo so-called "watchful waiting."

Justman sees the same problems with oversensitive analyses and overdiagnosis in Major Depressive Disorder. But his argument also goes beyond against current screening practices. He's against the diagnosis of depression itself.

"The possibility that much 'depression' might not be a disorder at all has been drowned out by medical activism,” Justman writes. He scoffs at the World Health Organization's prediction that depression is soon to become the second leading cause of disability across the globe as “hubristic.” He argues that it's far too easy to diagnose, given that the symtoms include things like feeling tired, overeating, or not finding pleasure in things.  "According to this checklist, I would qualify for a diagnosis of Major Depressive Disorder if I simply had too little energy and had trouble staying asleep--as in fact I do...In point of fact, my symptoms are not diagnostic of anything." 

What is Justman’s response to these two ‘artificial epidemics’ of prostate cancer and depression? Sit down, relax. "Much of what is called cancer is not destined to cause death-and so too, much of what is considered depression resolves itself without medical intervention." He wants the screenings to stop, and overdiagnosis to end. Justman proposes an appeal to prudence.  "Prudence deems life without sadness a utopian fantasy, silent cancer a tolerable reality, and the medicalization of the human condition an aggressive expansion of professional authority." 

Unfortunately, while Justman’s statements about prostate cancer diagnoses are well researched, his mockery of Major Depressive Disorder is both insulting and ill-conceived. What's more, his arguments for both prostate cancer and depression are made in complete incoherence. The narrative jumps from prostate cancer to depression in the same paragraph. Here he even makes the leap within the same sentence: "Setting a two-month period for allowable grief is like setting the threshold for an abnormal PSA at a figure that trades off a reduction of false negatives with an inflow of false positives."

Justman composes long, run-on sentences in an effort to show how prostate cancer and Major Depressive Disorder diagnoses are similar: "Both PSA testing, which appeals to evidence presumed to exist, and testing for depression, which appeals to diagnostic criteria conceded by the psychiatrist in charge of the composition of the third edition of the DSM to be seriously defective, reveal conflicted attitudes toward evidence-based medicine itself." The net result is an exhaustive and repetitive reading experience. In the end, I’m just confused and beginning to think my prostate has been experiencing depressed mood. 

In this tangle of prostate cancer and depression, the focus of the title is lost. I have yet to read how, exactly, medical activism has influenced clinicians and insurance companies to collude with them in the overdiagnosis of the nation. Instead, the book impresses the idea of overdiagnosis, without offering any clear solution except to stop diagnosing.

Here Justman confuses the ideas of diagnosis and treatment. While it makes sense to delay invasive treatments and track the progress of an already diagnosed disease, stopping screening and diagnosis would merely ignore the problems. Prostate cancer is still the second leading cause of death in men.  Additionally, Justman’s flippant attitude toward Major Depressive Disorder ignores the real suffering of patients, and adds to the stigma these patients experience. But Justman clearly believes depression is not a real problem and most prostate cancers as fine.Just put on a smile, stop wallowing in your emotions. That prostate enlargement probably doesn’t mean anything.  

After spending so much time reading Justman’s incoherent arguments, dismissive delivery, and his final, confusing appeal to “prudence”, my only recommendation is that if you are concerned about issues with prostate cancer or Major Depressive Disorder diagnosis and treatment, go read something else. The writing is bound to be less confusing. After suffering through 22 long pages of this ebook to write this review, I’m afraid my prostate needs an antidepressant.

Scicurious is a PhD in Physiology, and is currently a postdoc in biomedical research. She loves the brain, and so should you. She writes for The Scicurious Brain at Scientific American Blogs and Neurotic Physiology on the Scientopia Network. Follow on Twitter @Scicurious.

 

 

A Disorganized Celebration of Skulls

SKULLS. 2011 by Simon Winchester. Touch Press. iPad. App webpage.

Reviewed by Brian Switek

No set of bones better exemplifies the natural history of an animal than its skull. Postcranial skeletons are all well and good – the vertebrae, limbs, and associated parts all testify to how an animal moved and behaved – but skulls are the most iconic aspects of a creature’s ossified frame. The skull is the seat of the brain, and, therefore, the senses, and the critical details of how an organism perceived its world can be detected from this complex arrangement of bones. As much as any group of bones can, a skull summarizes the essence of an organism - to draw from my beloved non-avian dinosaurs, a Tyrannosaurus or Triceratops skeleton would just not seem as magnificent without their fantastic, iconic skulls attached.

Not everyone shares my affection for skulls. I learned this the hard way. A few years ago, I spotted a bleached raccoon skull along the side of a trail in the New Jersey woods. I put the skull in my camera bag, carried it home, and put the cranium in my desk drawer. Fortunately for me, my wife has been very kind about my fascination with bones and thought nothing of it. But when my wife’s best friend was petsitting at our apartment a few months later, and said friend opened my desk in search of a pen, she was horrified to see raccoon remains staring back up at her. To me, the skull was a representation of the raccoon’s life and evolution, but she saw the skull as a symbol of death and decay.

Simon Winchester’s Skulls – an ebook-iPad app hybrid – explores the various meanings of the haunting bones. Skulls are objects of natural history, have been misappropriated to support discrimination, and can act as warnings of impending doom. What a skull means rests in the eye of the beholder (and those eyes, of course, are set into skulls themselves.)

Skulls was not what I was expecting. I thought the app was going to be a virtual museum of various specimens that users would be able to manipulate to get a better look at the various components of the craniums. And while there is that aspect to the program, Skulls tries to be more.

Each of the app's interactive skull images is organized within twelve different sections which focus on cranial components, how the bones are collected, and the cultural meaning of skulls. In the introduction, which outlines what a skull is, a series of representative specimens stream past on the right side of the screen as Winchester explains on the left, with certain keywords linked to particular skulls. (Users can read at their own pace, or choose to have Winchester read to them in his halting cadence.) On that first page, the word “majesty” is linked to one of the fabricated crystal skulls which led Steven Spielberg to run the Indiana Jones franchise into the ground, and the simple mention of “skulls” at the bottom corresponds to the strange cranial architecture of a long-spine porcupinefish. The piscine skull looks like good inspiration for one of H.R. Geiger’s techno-biological horrors.

There’s more than one way to explore the selected skulls. Readers can proceed linearly through each of the twelve short sections, they can hit the “gallery” button at the top of the screen to explore the highlighted skulls in each section, or can simply tap “The Collection” on the main page to bring up a constantly-rotating collection of alphabetized skulls. The best part of the latter option is the ability to view multiple skulls side-by-side via the “compare” button. The saber-fanged weapons of a Smilodon look all the more fearsome when viewed directly next to the much shorter, stouter canines of its distant, living relative, the lion.

But this is also the most frustrating feature of Skulls – the app only allows users to zoom in and rotate along the horizontal axis. You can’t flip the skulls to have a look underneath, or explode skulls to play with their various parts. With a little more effort, Skulls could have acted as a rich, virtual reference for anatomy students or anyone interested in learning more about osteology, natural history, and evolution. Instead, Skulls is more of a virtual museum – you can look, but your ability to learn directly from the bones is severely constrained. (Ironically, the publisher of Skulls, Touch Press, lets you to flip planets and moons in another of their apps, The Solar System, which we reviewed last month.)

Though limited, the app’s gallery of spinning skulls is fun to fiddle around with. The ebook portion only left me puzzled. While I greatly enjoyed the format of having parts of the text correspond directly to the stream of skulls on the right side of the virtual page, there was no central narrative or story. Winchester jumps from a general overview of skulls to a profile of skull collector Adam Dudley before moving on to bizarre cranial modifications and the meaning of osteological iconography. There is no flow between sections – they all stand on their own and vary in style. “A Skull’s Component Parts” – in which Winchester avoids actually describing the various bones which make up a skull – is presented in an encyclopedia format, while Winchester’s visit to the skull of 17^th century Ottoman military leader Kara Mustafa Pasha was composed as part history and part travelogue. And section 6 – “The Skull of the Dodo” – feels entirely out of place. Winchester says almost nothing about dodo skulls, and instead recapitulates the extinction and artistic representations of the extinction icon.

Strangest of all, Winchester goes on a brief tear about paleoanthropology in the “Science and Pseudoscience” portion of the book. After addressing how some misguided researchers used craniometry to buoy their own racist notions, as well as recapitulating the Piltdown Man scandal, Winchester settles into a wandering discussion of human evolution. “It can fairly be said,” Winchester writes, “that in the history of biological science never has so much been imagined by so many on the evidence of so little than those who have studied the skull and wondered about human evolution.” Granted, specimens of fossil humans are rare and often quite fragmentary, but Winchester does nothing to support his claim that much of what we think we know about our ancestors is “imagined.” Indeed, rather than support his claim, Winchester quickly moves on to say that the human skull has changed only little in the past three million years and that human evolution has ultimately halted. The first statement feels contradictory to the rest of the section – in which Winchester mentions how brain size, brow ridges, teeth, and facial construction have changed among our prehistoric kin – and the second assertion is only armchair philosophizing. While changes to our physical form might not be apparent, there is a growing body of scientific evidence that human evolution continues to this very moment and can be tracked in our genes.  

Ultimately, Skulls feels like a disorganized tour of a virtual curiosity cabinet. There are lots of fascinating tidbits along the way, and Winchester shows a clear enthusiasm for his subject, but I reached the bottom of the last page without understanding what the point of the entire exercise was. Skulls is a disorganized celebration of cranial bones and is of little utility as a reference. I couldn’t help but laugh in disagreement when, in the last section, the app dubbed itself “a near-perfect survey” of skulls. The mashup of biography, history, editorial, and encyclopedic catalog made Skulls feel like a concept stretched too thin and spread too wide. Unlike an actual skull, the app’s various components never come together to create a functioning whole.

 

Brian Switek is a freelance science writer and author of the book Written in Stone: Evolution, the Fossil Record, and Our Place in Nature. He regularly blogs about paleontology at the WIRED Science blog Laelaps and the Smithsonian blog Dinosaur Tracking. His next book - A Date With a Dinosaur: On the Road With Old Bones, New Science, and My Beloved Brontosaurus - will be published next year by Scientific American/FSG.

Steven Gilbert Really, Really Wants You to Know About Poison

A Small Dose of Toxicology, 2nd edition, by Steven G. Gilbert, 2011, E-pub, Kindle, pdf, 

Reviewed by Deborah Blum

In 2004, a Seattle-based researcher, Steven Gilbert, published a 280-page paperback titled A Small Dose of Toxicology. You might not guess from that modest title that the author was on a scientist on a crusade. But he was. He is.

"It's critical that we scientists be more engaged with the public," he says."We're talking about  environmental issues that are having a bigger and bigger impact on our lives." He had big goals for the book too - he wanted it to contribute to public awareness, to encourage people to demand more of a government response, greater corporate responsbility. He wanted it to change things: "We have an ethical responsibility to our children."

Gilbert had a long-time background in the study of poisonous things. He received a PhD in toxicology from the University of Rochester in 1986. He was founder of the non-profit Institute of Neurotoxicology and Neurological Disorders in Seattle, an affiliate professor at the University of Washington. His particular area of study was in the area of low-dose exposures to toxic chemicals, an area that he was uneasily aware remained poorly understood.

And after some years, he just wasn't sure that the paperback was having the hoped for effect.  Or that his publisher was particularly enthusiastic. So he decided to take it on as a DIY project. "I was originally disappointed. Then, I thought, well I could do this myself." First, he started a website, Toxipedia, which provides a free, searchable database of information on toxic chemicals. And then he started his own e-book publishing company, Healthy World Press, and published the second edition of A Small Dose of Toxicology himself.

The book is one of three now published by Healthy World and all follow the same model. They are offered as free downloads  in either e-pub, Kindle, or pdf format from the Toxipedia website. There's a requested donation to Gilbert's non-profit but it's not required.  "My first goal wasn't to make money," he said. "It was to have an impact."

 I contacted Gilbert after discovering his e-book on the Toxipedia site. This was not, um, my first visit there in search of poisonous information. It's a natural consequence of writing a book about poisons and blogging on that same subject over the last few years. Really. Although sometimes I worry that the search history on my hard drive, riddled with visits to Toxipedia, the Agency for Toxic Substances and Disease Registry, and their ilk suggests the habits of a fairly iffy character.

But anyway - and more to the point, I recognized in Gilbert's work an awareness not unlike my own -  that we exist in a chemical world, that we've yet to map that complicated terrain or fully understand its risks. And that as our adventures in chemistry - taking as a simple example, rising levels of carbon dioxide in the atmosphere - change our planet, there's an imperative need to do tell that story better.

Still I was curious. 

One can admire the crusade and still wonder if it's actually accomplishing anything. I wondered whether Gilbert's decision to go to e-self publishing improved the paper product in any meaningful way. And it's with those questions in mind that I now want to address the book directly. For comparison purposes, I downloaded it in two different versions on my iPad, as an e-pub (which went direct to my iBooks library) and as a pdf. It's also possible to simply read the book on-line here.

At its most basic, A Small Dose of Toxicology remains a  reader-friendly reference book. As my pdf version tells me, it's still 280 pages. It has 21 chapters (although I had to count them because in the e-version, they are not numbered in the table of contents). The book starts with an overview - "Toxicology and You" , followed by a brief history of poisons and their studies, followed by chapters that focus on a specific toxic substance or issue. The first three chapters do this through a lens of everyday consumption: alcohol, caffeine, nicotine. The book then explores such famously poisonous materials as arsenic, mercury and lead before moving onto subjects such as as endocrine disrupters and radiation exposure.

In other words , it contains many small doses of information about many toxic things. You can see exactly why a poison-obsessed writer like myself would go for the material. But the better thing about it is that it's not written for someone like me. Gilbert is aiming for a more general audience (he tells me he hopes to see it used in high school classrooms) and he succeeds in making this a solidly written, clear, and occasionally fascinating  exploration of toxic chemistry.

Of course, it's hard to make poison too boring. Still, he has a nice technique of using everyday examples to create level-headed explanations, for instance in this section on calculating a toxic dose:

"There are approximately 100 mg of caffeine in a cup of coffee. The actual amount of caffeine depends on the coffee beans, how the coffee was prepared, and size of the cup. And adult weighing 155 pounds (about 70 kg) who consumes this cup of coffee would receive a dose of 100 mg divided by 70 kg or 1.4 mg/kg of caffeine. The importance of including body weight becomes clear if you consider a child who weighs 5 kg (about 11 pounds). If this child consumed the same amount of coffee, the dose would be 100 mg/5 kg or 20 mg/kg, more than ten times higher than the adults."

And he weaves such examples throughout his story, later calculating the half-life of a cup of coffee in the body (about four hours), later again looking at the effect of pregnancy on that half-life question: "During the last two trimesters of pregnancy, caffeine metabolism decreases, and the half-life increases to about twice normal, or 8-10 hours. This means that after caffeine consumption both the material blood levels and the infant's exposure will stay higher for a longer period of time."

These facts and examples are neatly ordered. Each  chapter begins with a "quick facts" chart, followed by a history of the specific poison and its use in society (lead in pipes and paint, mercury in thermometers and so forth), followed by case studies - the recent discovery of lead in children's lunch boxes where it was used to stabilize the plastic - followed by information about health effects, ongoing research, and government regulations.

Occasionally, though, the author goes beyond textbook into advocacy: "We need to reduce the use of lead in a wide range of consumer products," Gilbert writes in the chapter about that heavy metal.  These opinionated moments and his sense of story telling, lift the book beyond standard textbook. Although I suspect that also means that it won't appeal to readers from the anti-environmental movement.

But, you may ask, couldn't he present the advocacy and information just as neatly in a print format? And I've come to believe that he couldn't. Oh, the downloaded books have some of the usual glitches we find in these early days of e-book publishing. I complained earlier that the table of contents in the pdf version didn't provide page numbers for chapters. The iBook version I downloaded skipped the table of contents entirely (I could have tried again for a better result but I just flipped over to the pdf for the information).

But, but, the e-version does work in ways that would just not be possible in print - by which I mean that it offers a dazzling array of live links to additional  information and resources.  The introduction  is followed by four pages of links to regulatory agencies and other organizations around the world that archive information on toxic materials. Further links stud the text and there are yet more at the end of each chapter. Not to mention links to graphics, powerpoints, interactive posters.

Gilbert is especially proud of his Milestones of Toxicology poster, which you can link to from the book or here from the website.  The poster has now been translated into ten languages, mostly recently Arabic. A Chinese translation is in the works. He also likes the idea that as publisher of his own e-book, he can keep it  updated. When I talked to him, he was already planning to add new research papers into the book and, in fact, planning a third edition that would make better use of his website and contain more hyperlinks to Toxipedia.

Yes, empire-building already out in the digital universe. But in a good cause. We really do need to know more about poison.

 

Deborah Blum is a Pulitzer-prize winning science writer and the author of five books, most recently the best-selling The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York. She is a professor of journalism at the University of Wisconsin-Madison.