The following review appeared in the Scotsman on 1st November 2017. Follow this link for the original article. Thanks again to the Scotsman and the Wellcome Trust.
There’s a line of non-fiction books which advance their subjects as having changed the world. Recent examples include cod, salt, cooked food, potatoes, tea, sugar and coffee. Given that sleep occupies a third of our lives and a lack of it kills within weeks, neuroscientist Matthew Walker’s claims for its central importance in Why We Sleep stand as good a chance as any of bearing scrutiny. Early on he sets out his stall with the following: “What if the real question is: why did life even bother to wake up? Considering how biologically damaging the state of wakefulness can often be, that is the true evolutionary puzzle here, not sleep.” So there we have it: consciousness itself could be no more than a risky afterthought. Cogito ergo sum? More like somnio ergo sum.
Walker’s book begins as an enjoyable tour through the history of sleep science. We hear of Kleitman and Richardson’s six week stay inside Mammoth Cave in Kentucky, where it was first demonstrated that the body’s internal clock ran in circadian (nearly 24-hour) cycles. He goes on to describe the discovery of REM and NREM sleep, before moving on to sleep’s myriad benefits: “Scientists have discovered a revolutionary new treatment that makes you live longer. It enhances your memory and makes you more creative. It makes you look more attractive. It keeps you slim and lowers food cravings. It protects you from cancer and dementia. It wards off colds and the flu. It lowers your risk of heart attacks and stroke, not to mention diabetes. You’ll even feel happier, less depressed, and less anxious. Are you interested?” I have a feeling all these benefits have been claimed for exercise and a healthy weight and diet, but still: it’s a pretty impressive list.
Most compelling are his arguments against early school start times (particularly in the US), where teenage brains are being systematically sleep-deprived, and his description of the effects of sleep deprivation on the body are excellent, and should be required reading for anyone who thinks they can get by with less of it.
The book does have its flaws, however. There are instances where Walker cites poor quality or low-powered studies, or extrapolates freely from their conclusions. For instance, referring to a trial of elderly people woken up by alarm clocks, he states they “will suffer a spike in blood pressure and a shock acceleration in heart rate.” Following this he suggests: “Think of the multiplicative abuse your heart and nervous system will suffer across a life span.” And yet the trial as presented showed absolutely no evidence for this. Then the central question: how many hours of sleep are optimal? Of the observed rise in mortality rate beyond nine hours Walker states: “the causes of death in individuals sleeping nine hours or longer include infection (eg. pneumonia) and immune-activating cancers… It is simply that some illnesses, such as cancer, can be too powerful for the mighty force of sleep to overcome.” Yet this is not backed up by reviews of the evidence, which have concluded that lack of sleep and excess sleep are independent risk factors in themselves: that even after individuals with major co-morbidities were excluded, there was still a rising mortality rate at the extremes.
I would have liked to see more description of Walker’s day to day work in the sleep laboratory, and the clinical conditions are rather skimmed over. He discusses the use of Prazosin for the treatment of nightmares in PTSD (post-traumatic stress disorder), and I understand he has a personal interest in this because it fits with his neurobiological model of REM sleep as overnight therapy. Nevertheless, this blood pressure medication is not licensed for the condition in the UK, and he should perhaps have mentioned the far greater evidence and efficacy overall for using SSRIs (anti-depressant medication).
He contends that the functions of REM sleep lie in procedural memory, creativity and emotional wellbeing, and these arguments are well presented. Within this Walker includes his own theory: that REM was part of a “re-engineering of sleep... that rocketed homo sapiens to the top of evolution’s lofty pyramid.” This is an interesting idea, but with its inclusion I would have liked some of the other competing theories for REM function (eg. predawn warming of the brain, threat rehearsal) to have had an airing as well. A little more discussion of the culture and history of sleep, and especially of dreams, would have brightened up what is sometimes a rather dry factual account. However, the book contains some fascinating ideas, and Walker’s suggestions for how society and government and educational establishments might change their attitude to sleep are laudable. And yes: he left me more convinced than ever of sleep’s importance.
The following review appeared in the Scotsman on the 30th August 2017 (follow this link for the original article). Thanks once again to the Scotsman and The Wellcome Trust.
The Less You Know The Sounder You Sleep tells the life story of Dasha and Masha Krivoshlyapova, Russian conjoined twins who were born in 1950 and who died in 2003. Juliet Butler interviewed them many times while she worked as a translator in Russia, and has previously published a biography of their lives – which, she informs us, was “heavily edited by Masha,” the dominant twin. This novelisation, then, is an attempt to tell Dasha’s story, and what a magnificent achievement it is.
The book begins in 1956, at the Paediatric institute in Moscow, when the twins are six. They are living in a box – a glass box, cot-sized – and are bored. They want to go home for the weekend with a member of staff they’ve become attached too, who they call mummy. “She’s not your mummy,” a cleaner barks at them soon afterwards. “Your mummy probably went mad as soon as she saw you two freaks.”
The girls, we learn, were taken from their real mother at birth and subjected to barbaric experiments: “We both get all crunched into the corner of the cot to hide when we see it’s Dr Alexeyeva come in, and we start crying, because it means it’s time for our procedures.”
The exact nature of these “procedures” is revealed only later on in the book, and they make for disturbing reading. So far so grim-sounding, but in fact this book is anything but. The Less You Know... is a searingly frank and sympathetic portrayal of two very different women: Dasha, our narrator, who’s smart, sensitive, honest and loving; and her sister Masha who is quite the opposite: vicious, foul-mouthed and psychopathic – and outrageously funny with it. While receiving a lecture Dasha recounts: “(He) starts going on about Equality and Justice and Doing No Wrong. It’s a bit awkward, as we’re standing next to the little kid Masha tried to stuff down the rubbish chute the other day.”
There was a risk that Masha could turn into a figure of hate – especially given her incessant casual cruelties to Dasha – but we stay onside because we sense she’s a survivor, and because her sister obviously loves her. Dasha’s voice as narrator is a wonderful achievement, and there’s much to be moved by here as she recounts her life, not least the moment the twins see themselves in the mirror for the first time: “...we saw this lumbering, ugly thing with bits sticking out everywhere rocking towards us... like nothing we’d ever seen before. It was me and Masha. It was how everyone sees us. I won’t even think about it now, it makes me sick.” Of the girls’ first time outside, she recalls: “My head’s spinning like it does when we do loads of somersaults. There grass is mushy, not hard like the floor, and there are no walls anywhere to keep us upright... It’s too big, there’s too much space, there’s nothing keeping us in!”
The girls grow up and move to a school for invalids in Novocherkassk, where they make friends, including Slava, who Dasha falls in love with. Then after a grading which condemns the girls to invalidity and lifelong state support they move back to Moscow, where the new administrator, on warning them against self-harm, tells them icily: “Our statistics for suicide are the best in Moscow. So if you intend to die, we shall ensure it’s of natural causes.”
The girls spend their lives struggling against the oppression of the system and the ignorance of “healthies”: “Ugh... you should’ve been drowned at birth,” is a fairly typical reaction from people who encounter them.Set against this, though, are those who treat them with love and humanity, most memorably Aunty Nadya, who battles Kafkaesque soviet bureaucracy to get two passports rather than one, and who is there (unforgettably) for them in the final hours of their life.
This novel, while always being an accessible read, offers profound insights into the effects of early deprivation on two very different people, and into the daydreams we nurture in order to survive; it tells us about love in impossible circumstances, and about the loneliness of never actually being alone. And the importance of having something to hope for. “Olessya always used to say that happiness lies in three things,” Dasha tells us. “Having someone to love, something to do and something to hope for. At least I’ve got the first and last.” For the second: do yourself a favour and read this wonderful book.
Book review: The Enlightened Mr Parkinson: The Pioneering Life of a Forgotten English Surgeon, by Cherry Lewis
This review appeared in the Scotsman on 3rd May 2017 (follow this link for the original article). Thanks once again to the Scotsman and The Wellcome Trust.
Parkinson’s disease is a neurodegenerative condition which affects millions of people worldwide, and yet surprisingly this is the first popular scientific account of the life of James Parkinson (1755-1824), who first described the illness in his classic treatise, ‘An Essay on the Shaking Palsy’, published in 1817. Still more surprising because Parkinson himself was a fascinating figure, a veritable enlightenment polymath: surgeon-apothecary, geologist, palaeontologist and political radical, as Cherry Lewis’s excellent new book The Enlightened Mr Parkinson: The Pioneering Life of a Forgotten English Surgeon makes clear.
Parkinson was 62 when his treatise was published, towards the end of a rich professional life and a turbulent private one. Lewis, an honorary research fellow at the University of Bristol, is a geologist by training, and has written about Parkinson before with respect to his work in this field and in palaeontology (known then as oryctology).
The book begins by describing Parkinson’s upbringing in Hoxton, then a village about to be engulfed by London’s urban sprawl at the time of the industrial revolution, and within a few pages we’re grounded nicely in the sights, smells and social changes of the time. During a seven-year apprenticeship Parkinson trained to become an apothecary like his father: learning to grind and mix his own medicines, how to diagnose minor ailments, let blood and purge and blister his patients (medical practitioners of the 18th century still believed in the Hippocratic notion of bodily humors, and tried by these means to rebalance them.) After this he trained as a dresser (surgeon’s assistant) on his way to later becoming a surgeon. Parkinson would generally have treated poor and lower middle-class patients; if he attended to the servants of the wealthy he would be admitted via the back door (while the physicians, arriving in a chaise at the front door, administered to the family themselves.)
Around this time Parkinson worked in a receiving house, where “bedraggled bodies, most of them pulled from London’s waterways, could be taken for treatment.” Enlightenment society appeared to share the later Victorian dread of being buried (or dissected) alive, and it seems the roots of resuscitation were as much about proving death as preserving life. I was surprised to learn attempts were being made even then to “defibrillate” the heart – in fact Parkinson may have been one of the first to carry out such a procedure, using a “portable electrical machine” he kept in his pocket.
During the late 18th century, the Age of Revolution, Parkinson turned into something of a political radical, perhaps inspired by the poverty and inequality he had witnessed during his rounds. In 1792 he joined the London Corresponding Society, whose main objective was parliamentary reform – particularly universal male suffrage (only 2 per cent of the population were eligible to vote). Parkinson began writing for the anti-government fortnightly Hog’s Wash, writing (dreadful) poems under the pseudonym “Old Hubert.” Then in 1794 he was caught up in the Pop Gun Plot, an alleged conspiracy to assassinate the “Mad King” George III, which reads like a precursor of McCarthy-era American paranoia. He most comes to life during an account of his interrogation by the Privy Council, including no less a figure than Prime Minister William Pitt the Younger. Parkinson’s tart replies reveal a proud man who risks serious consequences by admitting his authorship of “seditious” pamphlets.
His later career demonstrates a wealth of talent and interests. In 1799 he published no fewer than five books, including his Magnum Opus, Medical Admonitions, a medical advice guide for families. He was an advocate of social reform and made recommendations for the regulation of child labour and asylums, and was a supporter of smallpox vaccination; he designed a hernia truss the poor could make cheaply for themselves, and wrote about gout (which he himself suffered); and he wrote foundation works in Geology and Palaeontology. And of course there was his ‘Essay on the Shaking Palsy’, in which he described the cardinal symptoms of Parkinson’s disease for the first time: a seminal work which led Jean-Martin Charcot 50 years later to propose the illness be named after him.
Lewis writes in an enjoyably digressive style: her descriptions of medical practice at the end of the 18th century, and of changing life in east London, are particularly engaging. My only quibble would be the last chapter, which traces Parkinson’s descendants to New Zealand and the present day; this reveals nothing about the man himself. This aside, Lewis’s book shines a light on Parkinson, and gives something of the name back to the person: a man whose interests ranged far beyond medicine, and whose social engagement, and engagement with his time, sings from the page.
This review appeared in the Scotsman on 25th February 2017 (follow this link for the original article). Thanks to the Scotsman and The Wellcome Trust.
Making vaccines is difficult. Or more precisely, making safe vaccines is difficult. In 1942 around 330,000 US servicemen were exposed to the Hepatitis B virus after being given a yellow fever vaccine contaminated with donor plasma; nearly 150 of them subsequently died. Then in 1955 a polio vaccine with live (not attenuated) virus paralysed almost 200 people, and killed 10. So at the start of 1960s the race was on to create vaccines that were not only effective, but also safe.
Viruses grow and replicate inside cells. Therefore in order to create viral vaccines in bulk, ready supplies of cells are a prerequisite. Ideally, these cells should, to paraphrase the American anatomy professor Leonard Hayflick, be clean, safe, normal and noncancerous. This would necessarily rule out the famed HeLa cells (everlasting cancer cells taken from Henrietta Lacks, and described in Rebecca Skloot’s book The Immortal Life of Henrietta Lacks); but what cells to use instead?
This is the focus of Meredith Wadman’s excellent new book, The Vaccine Race: Science, Politics and the Human Costs of Defeating Disease. Hayflick’s research into cell lines, described in the book, was pivotal in the creation of a critical rubella vaccine, at a time when major epidemics of the illness caused terrible birth defects. At the outset of Hayflick’s career in the late 1950s, there was growing awareness that cell cultures derived from animals might contain unrevealed viruses which could cause illness, or even trigger cancers. His goal was to find (and mass-produce) the safest human cells for vaccine production. This he eventually achieved by using lung cells from the aborted fetus of a Swedish woman, identified in the book only as Mrs X.
Her permission was never sought for this: one of many dubious ethical decisions which Wadman’s book explores. She also describes how orphans held in institutions and infants born to women in prison were used to test the experimental vaccines utilising Hayflick’s cells and then, perhaps most contentious of all, Hayflick’s decision in 1968 to take all of his cell cultures (catchily named WI-38s) with him to his new professorship at Stanford University, when in fact he had agreed to leave some behind at the Wistar Institute in Pennsylvania. This would lead to a long-running legal battle which almost ended Hayflick’s career – though ultimately it was also the catalyst for proper legislation regarding the ownership of cells and the process of vaccine creation.
Rubella, or German measles, was at that time one of the main targets for vaccine research. Major outbreaks were occurring every six years or so. The illness in children and adults is generally mild; but for women contracting rubella during early pregnancy it’s a different matter entirely. The virus targets growing cells at a specific phase of fetal development, causing Congenital Rubella: heart defects, hearing loss and eye defects, in a clinical syndrome first described by Dr Norman Gregg, an Australian ophthalmologist. In the US alone, 20,000 babies were born with Congenital Rubella during the 1964 outbreak, and in the aftermath there was a desperate need for safe, mass-produced vaccines before the next major outbreak, anticipated to be in 1970.
Wadman makes fascinating comparisons between rubella and the currently newsworthy Zika virus: both viruses causing mild illness in the mother, but major birth defects in the fetus. But her book really hits its stride is in part two, where it focuses on rubella, and horrifyingly, rabies – the case descriptions of children affected by this illness are heartbreaking. Despite the title, however, it’s a slow starter, possibly too detailed in places, and I must admit to glazing over at mentions of biotech shareholder dividends and US government legislation. Also, I would have liked more about the MMR scandal of the late 1990s and early 2000s, described elsewhere as “Perhaps the most damaging medical hoax of the last 100 years,” if only to show how much mass vaccination is taken for granted today.
Hayflick’s WI-38 cells – shared widely around the world – have helped to provide vaccines against (among others) polio, measles, rabies, chicken pox, and hepatitis A. To date billions of people have been vaccinated. The Vaccine Race takes in all of this, plus cell death, human ageing and the ethical dilemmas of owning living tissue, and is in the end an important story, well told.
*The Vaccine Race, by Meredith Wadman, Doubleday, 448pp, £20
My novel The Last of us was published by The Borough Press in April 2016.