Audible listener who's grateful for a long commute!
I'd heard of Susannah Cahalan's "Brain on Fire" (2011), but I'd also heard Cahalan's a New York Post reporter. "A tabloid reporter?" I thought. "A writer from the rag famous for headlines like 'Headless Body found in Topless Bar' (April 15, 1983) and 'Weiner's Rise and Fall' (June 17, 2011)?" Clever headlines, sure - but aren't all tabloid writers as nutty as their ledes? "Maybe the job did her in," I thought, mentally dismissing the book.
My newspaper snobbery almost made me miss a very well written, insightful book based on sound, peer reviewed and published scientific research. In her mid-20's, working a dream job in New York City with a new boyfriend, Cahalan developed Anti-NMDA- (N-methyl D-aspartate) receptor autoimmune encephalitis, At the time - and probably still - people who develop signs and symptoms of that disease are diagnosed with psychosis of unknown origin, or schizo-affective disorder. The only really unexplainable symptom is seizures - others, such as abnormally high blood pressure, can be misdiagnosed as an concurrent, but unrelated problem.
Cahalan was lucky - she has a well educated family, and her bitterly divorced parents set aside their animosity to aggressively advocate and care for her. In fact, Cahalan's parents' new spouses were admirably supportive, despite Cahalan's paranoia - which had her saying particularly hurtful things to one and all. Even with parents and a boyfriend convinced Cahalan had more than "just a mental illness", pinpointing the cause was long and arduous - and almost didn't happen in time to prevent irreversible physical and mental problems. The treatment was an arduous course of steroids and intravenous immunoglobulins and plasmapheresis. Cahalan's care ended up costing her insurer over $1 mil, although if she had been properly diagnosed to begin with, the bill would have been 25% to 50% less.
Cahalan did something that was incredibly brave: she carefully researched and wrote about a situation that not only almost killed her, but also had her acting in ways that she later found were incredibly embarrassing. The most courageous admissions were about the hallucinations she knows she had - but are such vivid memories, she still half believes they were true.
Audible, I blame you for making me a newspaper snob in the first place. (That happens when the monthly subscription includes a 48 to 52 minute every weekday New York Times Audible Digest; your drive is about an hour; and the NY Times writing's usually pretty good.) Audible, I also thank you for knocking me off my literary high horse to find a writer worth the listen. I'm not going to start reading the New York Post, but I will look for other medical/scientific books by Cahalan. And, yeah, maybe I'll actually read a Post article along with an especially "punny" headline.
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I listened to Erich Maria Remarque’s “All Quiet on the Western Front” (1958) last summer. Remarque’s book is a short and powerful listen, in great part because of his descriptions, by a 19 year old German soldier, of battlefield maiming and subsequent deaths that were caused primarily by a complete lack of antibiotics. More soldiers died of infection, rather than the wound itself.
Thomas Hager‘s “The Demon Under the Microscope” (2006) begins with a description of the same World War I horrors, from the point of view of a World War I German medic, Gerhard Domagk. Domagk, who was employed by Bayer AG as a researcher, did not discover sulfonamide (sulfa). Domagk discovered that Bayer coal-tar clothing dye, which contained sulfa, was an antibiotic. The difference between what happened to World War I soldiers (gas gangrene, amputating limbs to stop the spread of infection) and World War II soldiers, who in general had neither, as astounding. Ironically, the Allied Forces more readily adopted sulfa.
Domagk was awarded the 1939 Nobel Prize in Physiology and Medicine for his discovery and development, but Adolf Hitler prohibited Germans from accepting the prize. He was finally able to accept the prize in 1947, after a “Planes, Trains and Automobiles” jaunt through post-war Europe to get to the ceremony.
A terrible incident with sulfa is almost entirely responsible for the United States’ Federal Drug Administration (FDA). Sulfa tastes bad, and it doesn’t easily dissolve in water. An enterprising and unregulated drug compounder mixed it with the sweet tasting diethylene glycol, which is closely related to the anti-freeze ethylene glycol. The senate rapidly passed laws strengthening the FDA, resulting in today’s carefully controlled regulations.
“The Demon Under the Microscope” was remarkably lively for a science and technology book, and rivals Eric Lax‘ 2004 “The Mold in Dr. Florey‘s Coat” for its intrigue and rivalries.
As a history book, it was a bit hard to follow as it moved from World War I to earlier centuries, and then back up to the 20th century.
The narration seemed fine to me, although as a non-scientist, I don’t know if the narrator’s pronunciations were correct or not.
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The day after I finished Seth Mnookin's "The Panic Virus" (2011) I heard Paul Krugman's March 30, 2014 New York Times Op-Ed "Jobs and Skills and Zombies." Referring to the 'skills gap', Krugman says, "It’s a prime example of a zombie idea — an idea that should have been killed by evidence, but refuses to die." Mnookin makes the same point about the idea that vaccines cause autism: that theory's long ago disproven, and anti-vaccine/autism activists should let it pass peacefully.
That isn't to say that vaccines are either entirely safe, or entirely effective. They are neither, and no one should fault actress/activist Jenny McCarthy for demanding an investigation, especially with the recent substantial increase in autism diagnoses. Mnookin discusses some spectacular public health failures, including a MMR (Measles, Mumps, and Rubella) vaccine campaign in the United Kingdom that killed 19 children in a small community. The vaccine, stored without preservatives at the time, was contaminated with staphylococcus. There have been polio vaccine campaigns that have given people polio, and still do - although it's usually a very mild case. Mnookin's point is that, after careful study, autism isn't a complication - even of the preservative thimerosol. And, by the way - thimerosol hasn't been used in vaccines in the United States for more than a dozen years.
[Reviewer's commentary: Navy Seals killed Osama bin Laden on May 2, 2011, using (in part) intelligence provided by Pakistani doctor Shakil Afridi administering CIA-funded Hepatitis-B vaccines in Abbatobad. The program was dramatized as a polio vaccine program in Kathryn Bigelow's 2012 movie "Zero Dark Thirty." According to a March 27, 2014 Huffington Post article, at least 30 polio health workers have been killed in Pakistan since then. That makes the odds of being killed while administering the polio vaccine substantially higher than the odds of having an adverse reaction to the polio vaccine.]
The book was well written and engaging, although it was a bit repetitive. That actually means, like Andrew Solomon's "Far From the Tree: Parents, Children, and the Search for Identity" (2012), various chapters can stand alone without the entire book. Solomon's book, by the way, has a lot of information on autism and disabilities and is a good follow up to "The Panic Virus."
Mnookin points out a problem for everyone: deciding not to vaccinate, especially against pertussis, or whooping cough, eliminates crowd immunity. As Nancy Shute reported for NPR on September 30. 2013, "Vaccine Refusals Fueled California's Whooping Cough Epidemic." In 2010, 10 babies in California who were too young to be vaccinated died.
Setting aside the 'good of the many' argument for immunizations, Mnookin drives home - with actual dollar amounts - that money and other resources that could be used to study the actual cause of autism, and to treat those on 'the spectrum' are being used to disprove a zombie theory. Dr. Temple Grandin, a PhD and widely respected scientist with autism recommended iPads for people with autism in her 2013 book "The Autistic Brain: Thinking Across the Spectrum." How many occupational therapists could have been hired, and how many iPads could have been purchased, for what the government has spent repeatedly studying the non-existent autism/vaccine link?
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