Why We Get Fat

Title: Why We Get Fat – And What to Do About It
Author: Gary Taubes
Publisher: Alfred A. Knopf, 2011 (First)
ISBN: 9780307272706
Pages: 257

In India at least, a person who had recently constructed a new house is an expert 'architect' among his friends and relatives for a few years after the event. Likewise, one who successfully cut short his body weight has the moral authority to preach and pose as a dietary consultant. My body weight was 93 kg in January 2023, and I was tottering into obesity with no control on food intake. I took an exercise regime of walking 6-8 km daily, avoided snacks with evening tea and replaced rice at dinner with chapatti. Within three months, in April 2023, my weight came down to 76 kg, which is still maintained even though some additions in the food intake had taken place and walking is now reduced to 2 km a day. That was why I was interested in this book, especially at the author's assertion that 'the physicians have a flawed belief system that stipulates that the reason we get fat is that we eat too much and/or move too little. So, the cure is to do the opposite'. This got me intrigued, since I had done the same thing and got spectacular results as expected. Instead of eating less and exercising more, the author recommends a low-carbohydrate diet. This may help dietary fat to get burned for energy and keep the person's weight in control. I now think that this logic may have kept my body weight at the lower level in recent time even without much reducing food nor overindulging in physical activity. Gary Taubes is a correspondent for Science magazine. His articles about science, medicine and health have appeared in several magazines and is the author of many books on the same themes.

It is an established fact in modern medical science that the way to lose weight is to eat less and exercise more. However, Taubes' main argument in this book is that eating less and moving about more is not a remedy for weight gain. Prescribing low calorie diets for obese and overweight patients leads only to modest weight losses that are transient. Exercising more is no guarantee to lose weight. Poorer people do more physical work, but they are claimed to be fatter than affluent people. This is a contentious point, since this is definitely not valid in the case of India. Maybe the author is recounting his experience in the US. However, Taubes does not underrate the efficacy of physical exertion because he admits that 30 minutes of moderately vigorous physical activity five days a week is necessary to maintain and promote health, but there is no evidence to prove that doing so would make us lean. If we increase our physical activity, we will only work up an appetite. It will make us hungry and chances are that we will increase the calories we consume to compensate. The energy we consume and the energy we expend are claimed to be dependent on each other. Change one, and the other changes to compensate. The author underlines this main argument with the claim that the entire science of obesity got caught up in the circular logic of the calories-in/calories-out hypothesis and it has never been able to escape from this stranglehold.

This book also outlines the metabolic mechanism of its argument, along with experimental results. He describes an experiment in rats with its ovaries removed. This resulted in estrogen deficiency. If estrogen is not available, an enzyme called LPL draws fat out of the blood and stores it in cells, making the animal fatter. To compensate for the absence of this fat in other organs, it eats more. If food is then not available in sufficient quantity, it turns slothful to conserve energy. Fatness is thus caused by the better ability to absorb dietary fat. He concludes with the smart-sounding remark that 'we don't get fat because we overeat; we overeat because we are getting fat'. It was the Germans and Austrians who had founded and done meaningful research in the fields related to obesity. After World War II, the anti-German sentiment in the medical community deliberately neglected their work done in this area. The essential mechanism of weight regulation is that fat is continuously flowing out of fat cells and is circulating around the body to be used for fuel and returned to fat cells if it is not used. Fat is stored as a cluster of three types of fatty acids known as triglycerides. The cluster is too large to pass through the cell membrane. Anything that works to break down those triglycerides into their component fatty acids so that it escapes those cells works to make you leaner. There are dozens of hormones and enzymes that play a role in these processes. Insulin is the primary regulator of that metabolism. An enzyme called HSL breaks down triglycerides and release fatty acids to the blood stream. Insulin suppresses the operation of this enzyme, thereby making the animal fatter. The effect of insulin is to make us fatter.

The single most important advice a reader should take from this book is that one should minimize the amount of carbohydrate in order to remain lean. It's the carbohydrates that ultimately determine how much fat we accumulate because the secretion of insulin is linked to the presence of carbohydrate in the blood. Weight loss regimens succeed when they get rid of the fattening carbohydrates in the diet; they fail when they don't. Some people are predisposed to get fat, but this predisposition is triggered by the quantity and quality of carbohydrate we eat. Again, the fewer carbohydrates we take in, the leaner we will be. The book sounds a warning to those with a sweet tooth. Sugar is addictive to humans in the same way the psychedelic drugs are and for much the same biochemical reasons. In the 1960s, the focus was changed to avoid high-protein items like red meat as far as possible and to shift to carbohydrates. The medical community took this step apparently to ward off cardiac problems caused by the higher cholesterol content in red meat. The author opposes this established wisdom, but he quotes only anecdotal evidence in support of his claims. A science writer such as the author should know better than to rely on anecdotal stories which are no better than hearsay. Besides, research conducted around World Wars I and II and till 1980 are quoted throughout the narrative with no comments on whether later research has confirmed or repudiated any of these results. Readers should exercise a little bit of scepticism because he is taking on the entire medical community on his accusation that they are all wrong on this point. He adds that it was in the 1980s that the medical world adopted the fallacious calories-in/calories-out hypothesis. Another factor worth noting is that the author assumes that those foods which humans are adapted to in the long time when hunter-gatherers flourished would be good for us even now. Agriculture and the resultant carbohydrates were in our diet for only 0.1 per cent of our species' total existence. In the remaining period red meat obtained by hunting was the primary source of food. Hence, the author argues, that it will not be bad for our health.

It is to be accepted that Taubes has made a neat argument in favour of including more protein-rich substances like red meat and curtail intake of carbohydrates in our diet to keep our bodies slim. However, his substantiation of the arguments lacks rigour and readers get a distinct feeling that the narrative is not authentic as far as scientific facts are concerned. Some contentions like obesity is associated also with poverty and not with prosperity alone is not readily digestible as also his claim that poorer people are fatter. Another unfounded assumption is that cancer is prevalent in vegetarian societies like the Hindus of India (p. 171). As is common with many hoax theories in the medical field, he argues that big pharma companies intervene in discussions on health to suit their needs. Similar is his bold remark that health officials hesitate to discuss the concepts put forward in this book because it contradicts what they have been telling all along.

The book is recommended.

Rating: 2 Star

The Pandemic Century

Title: The Pandemic Century – A History of Global Contagion from the Spanish Flu to Covid-19

Author: Mark Honigsbaum

Publisher: WH Allen, 2020 (First)

ISBN: 9780753558287

Pages: 357

 

Natural and manmade disasters strike human societies every now and then. As the world is just getting back on rails after the disastrous spread of Covid-19, other infectious diseases like monkey pox threaten from some corners. Similarly, when the threat of a major war was ebbing after the last one in 2003 Iraq, Russia invaded Ukraine. War and pestilence have been legendary evils that afflict mankind. This book narrates the major outbreaks of diseases in the century from the end of World War I in 1918. The end of the long drawn-out War coincided with the outbreak of Spanish Flu which killed 50 million people across the globe. The disease’s spread was greatly enhanced by the demobilized soldiers returning home from the warfronts. The book is about the events, processes and the reasons why epidemics strike despite our best efforts to predict and prepare for them. Mark Honigsbaum is a medical historian and journalist specializing in the history of infectious disease. He is a lecturer in the department of journalism at the City University of London.

 

Influenza struck in 1918 when there was no idea of what a virus was and how it caused diseases. Bacteria were known, but antibiotics lay two decades in the future. Convalescence at a comfortable location, eating good food and avoiding mental tension were the prescribed antidotes to serious illnesses. As such, such an infection was de facto death sentence for the poor who could not afford the cost of recuperation. Concentration of recruits from rural and urban districts in overcrowded barracks led to the pandemic’s unusual characteristics. Contrary to normal, people of the age group 20-40 died most. It was years later that it was understood that it was caused by a virus. Though influenza was a viral infection, bacteria of the Bacillus family were also identified in many people. Mysteriously, these bacteria were not found in other patients. This contradiction baffled many researchers pursuing a cure. It was only later that it was realized that this bacteria was only a fellow traveler. In some cases it caused death, but the primary agent was the H1N1 virus.

 

Doom-mongers usually cite the occurrence of new and exotic diseases as a corollary to growth in science and technology. Conspiracy theorists allege that all major epidemics are caused by leakage from bio-warfare labs or deliberately spread by high-end pharma companies for commercial gain. Honigsbaum presents a simple but logical explanation for the outbreaks. Humans exert powerful evolutionary pressure on micro-parasites due to their changing social and cultural behaviours or through their impact on the environment of animal and insect ecologies. Sometimes these pressures select for a particularly virulent strain of the parasite or present it with an opportunity to colonize a new host and extend its ecologic range. Technologies and changes to the built environment designed to improve hygiene and ameliorate the conditions of life are giving rise to new threats to health and wellbeing. Legionella pneumophilia has been around for millennia, but it was not until we began building cities and equipping buildings with indoor plumbing and hot water systems that we presented the bacterium with a new ecological niche in which to prosper. This bacterium causes the Legionnaires’ disease which is spread through cooling towers of central air-conditioning systems in large buildings. The part on infections from pet birds and animals warns readers of the risks associated with close intimacy to pets. Parrots and parakeets experience mild infection of psittacosis when young but would never show any symptoms in the wild. In captivity – crowded, filthy and without exercise or sunlight – a flare up of the infection is to be expected. Psittacosis, or parrot fever, can be fatal to humans.

 

Honigsbaum notes with a touch of warning that new diseases come out all the time and it is particularly ironic when medical science practitioners unknowingly assume that they have obtained all knowledge that is there to know regarding diseases and its aetiological agents. AIDS was the epidemic that drove home the lesson that despite vaccines, antibiotics and other medical technologies, infectious disease had not been banished but posed a continuing and present threat to technologically advanced societies. If AIDS had struck in the 1950s, scientists would not have identified it, as the contemporary understanding of retroviruses was very limited. As such, the epidemic broke out at precisely the moment when scientists working in oncology and retrovirology specialists were inclined to believe that a retrovirus was the cause and possessed the tools and technology to test the hypothesis. This argument is ideal food for conspiracy theorists who claim that the HIV virus leaked out from a research lab. However, we have to keep in mind that coincidence is the one thing these people cannot cope with. This brings us to a discussion on the methodology of science and why existing theories have to be revised occasionally. The author elaborates that there is no such thing as absolute certainty in science. Paradigms are constantly being refined by new observations and if anomalies are found, it may be discarded and a new paradigm may come to supplant it. The best scientists welcome anomalies and uncertainty, as this is the way scientific knowledge advances.

 

The book discusses several outbreaks of deadly diseases that shook the medical community at a fundamental level and which produced anxious moments for the administrators. All of them affected the developed world or in cases such as Ebola, had the potential to cause infections in the developed world. Diseases that are endemic to the underdeveloped world are not seen here. What is repeatedly stressed however is the ease with which a contagious disease that entered a human body can reach any part of the world in a matter of just three days, helped by air travel and interconnectivity of the various parts of the globe. In the case of the 2002 SARS outbreak in Hong Kong, the disease infected several people in a particular floor of the hotel in which they were staying. Before it affected people in other floors, the disease reached Canada as one person flew there. The book was published in early 2020, so only a brief mention of the arrival of Covid-19 is given. The author expresses his concern at the prospective death toll in India where he assumes that the infrastructure is nonexistent to handle a disease of this magnitude. Left liberal activists of India had raised this concern with false arguments which the author is unable to spot. It contains an opinion piece by noted novelist Arundhati Roy that ‘although Kerala boasts 38,000 government hospitals, the same is not true of other Indian states where the public health system has been starved of funds and few tests are being conducted’ (p.278). If you do a search, you’ll find that Kerala has only 1200 hospitals and would be struck by the disconnect these so called ‘intellectuals’ have with reality and reason. In the end, India ended up doing far better than most developed nations in death toll, hospitalization and vaccination.

 

The book is recommended.

 

Rating: 3 Star

 

What Really Happened in Wuhan

Title: What Really Happened in Wuhan

Author: Sharri Markson

Publisher: HarperCollins, 2021 (First)

ISBN: 9781460761083

Pages: 422

 

The sudden onslaught and quick global spread of the Covid 19 virus undermined the global society’s safety and security in myriad ways. Millions perished, with thousands not getting basic medical care even in first-world countries. Harsh lockdowns crippled the economies of many nations. The spread of the disease was so fast that large chunks of people suddenly fell ill that imposed a heavy cost on businesses. The virus originated in China but that country tried to hide the occurrence of this mysterious disease in its midst. By the time evasion was out of the question, the virus had already spread to other parts of the world. Even then, it was thought to have originated naturally and diffused through a wet seafood market in Wuhan. China was believed to be complicit in suppressing information on the outbreak for obvious reasons. As a few months went by, scientists were alarmed by the rapid proliferation capacity of the virus. This was found to be due to a protein that appeared to be perfectly designed to attack the human respiratory tract. Doubts arose, because the disease originated near the premises of the Wuhan Institute of Virology (WIV) which specializes in studying different corona viruses and was known to be involved in increasing the ferocity of pathogens in order to produce effective vaccines. This book addresses the question whether the virus had accidentally leaked out of the lab due to incompetent safety protocols. Sharri Markson is an Australian journalist and talk show host. She has been at the forefront of breaking news regarding the origins of Covid 19 pandemic since early 2020. She lives in Sydney, Australia.

 

It must be accepted that China was literally overwhelmed by the early growth rate of patients. Non-disclosure of the true reason for casualties was enforced on health workers who were demanded not to talk to media or to express their opinion on social media platforms. Automated detection systems wiped objectionable content clean within minutes of their posting. People who steadfastly insisted on bringing out the truth were taken into custody and detained. In the meanwhile, dead bodies were piling up, left to decay for days in hospital corridors because Chinese authorities refused to officially record any deaths. The bodies were nothing more than a logistical problem for them. After the initial onslaught was endured, China denied human-to-human transmission of Covid 19 even though it was known to them for a month.

 

Markson narrates the invidious suppression methods unleashed by the Chinese state to keep the secret under wraps. China shut down domestic travel from Wuhan for medical concerns, but still allowed international flights to leave the city. Neither did it advise foreign governments to be aware of the risk of people returning from Wuhan. News of the virus was first broken by the Program for Monitoring Emerging Diseases (ProMED) only on Dec 30, 2019. This is galling as we now know that the outbreak began a full two months back in October of that year. China had to reluctantly confirm the news and switched on a massive cover up operation. All mentions of terms such as ‘unknown Wuhan pneumonia’ or ‘Wuhan seafood market’ were removed from social media. What made this operation so effective was the readiness with which many western scientists and health professionals endorsed the Chinese stand. Scholars who had professional links to virus research in China did not disclose their conflict of interest and acted like impartial arbiters.

 

The author accuses Wuhan Institute of Virology (WIV) as the institution from which the virus inadvertently escaped. After some tentative suggestions of biological warfare and deliberate release, she finally concedes that the escape was due to some accident. This institute was comparatively new and boasted of Biosafety Level 4 (BSL 4) protocols in place. The institute was set up with French collaboration and technical support. But after the entity began its operation, the French experts were unceremoniously kicked out. For an institute doing research work on corona viruses, it observed substandard and negligent biosafety practices. US scientists also took part in the research for another reason. Obama administration banned gain-of-function research on viruses. This refers to a genetic technique of multiplying a pathogen’s virility many times by tweaking its genome. So they outsourced their research to China and specifically to WIV, where lax standards applied. The author confirms that US public money was funding dangerous projects at WIV which was having no biosafety standards for handling deadly pathogens. This book also alleges that the Covid virus, which is exquisitely matched to humans, might be a product of this collective effort and had been worked on in a lab using humanized mice.

 

Markson makes a seething attack on the World Health Organisation (WHO) whose involvement was lukewarm and partisan to China. It accepted the Chinese arguments without demur even when they flew in the face of common logic. Unnerved by procrastination from China, the US, Australia and New Zealand effected a travel ban on China, but WHO rebuffed them, sanctimoniously advising the nations to take decisions that are ‘evidence-based’ and ‘consistent’. This book is a good effort of journalism, but it does not always follow the time-tested methods in science to ascertain the truth of a proposition. An Australian virus researcher named Petrovsky found a lab origin for the Covid virus. However, his paper did not pass the mandatory peer review process which returned the paper as conspiracy theory. The scientific dictum is that if you can’t convince your peers that your theory is at least plausible, it probably isn’t. However, the scholar and the author accuse the scientific community of cover up. Eventually, he released the paper directly to the general public who are not competent to evaluate the veracity of his claims. The author must understand that this is not valid research.

 

The book is unnecessarily large for the point it wanted to convey. In spite of this big arsenal, the author has not been able to convincingly make out the case for a lab leak and also Chinese military’s involvement in the Wuhan lab for developing deadly biological weapons. The WIV was built, tested and run with input and funding from European and American agencies and it is highly improbable that the institution can do military research without awakening suspicion in them. It may indeed be probable that the virus leaked out of the lab but what Markson offers as evidence in support of the claim is just hyperbole and conjecture. The undue length of the book exhausts the readers, especially because she could have served her purpose with a volume that is half this size.

 

The book is recommended.

 

Rating: 2 Star

 

Killing Us Softly

Title: Killing Us Softly - The Sense and Nonsense of Alternative Medicine

Author: Paul Offit

Publisher: Fourth Estate, 2013 (First)

ISBN: 9780007532964

Pages: 322

Mankind is at present going through the most prosperous era of its existence on the planet. Even while sustaining the largest population ever, many of them are well fed and taken care of. Hunger is, of course, still a curse to reckon with, but it is a legacy of the past and persists where unsettled conditions generated by civil war and turmoil prevail. An average person lives many years, if not decades, more than his forefathers did three or four generations ago. This revolution in life expectancy was achieved with spectacular progress in agriculture, medicine and technology. Needless to say, this explosion in productivity was made possible by shrewd application of scientific principles in these fields. However, people in modern societies are developing an aversion to science and its methods. They crave for organic farming and natural fertilizers, while wanting to throw out chemical fertilizers and pesticides. In the medical field, the overarching concern is with harmful side effects of medicines used for life-threatening diseases. What organic farming is to agriculture is what alternative medicine is to healthcare. A long list of recipes and products are trumpeted in the conventional media and on the Internet. Most of the products advertised by homeopathy, Ayurveda and chiropractic offer solace little more than placebos. But these formulations can sometimes turn deadly too, as they demand their followers to shun modern medicine altogether. Not counting the exorbitant amounts they charge from patients, the atmosphere of scientific denialism associated with these practices is cause for concern. This book provides an overall view of the leading figures of alternative medicine and how it is practiced with its snake oil formulations. Paul Offit is a pediatrician specializing in infectious diseases and an expert on vaccines, immunology and virology. He is a professor of vaccinology at the Perelman School of Medicine at the University of Pennsylvania.

Alternative medicine has earned more respect than skeptics credit them and the author mentions that 42 per cent of US hospitals offer some form of alternative therapies. Patient demand is cited as the reason for this shift from established custom. This is in turn emphasized by the widespread notion – even among educated people – that mainstream medicine offers unnatural remedies with intolerable side effects, while alternative medicine employ natural substances which are safe by corollary. Nothing can be more distant from the truth. Offit lists a number of natural products which are deadly toxins even in trace quantities. In fact, all therapies should be held to the same high standard of proof or we’ll continue to be hoodwinked by healers who ask us to believe in them rather than in the science that fails to support their claims. There is no such thing as conventional, or alternative, or complementary medicine. There’s only medicine that works and medicine that doesn’t. The best way to sort it out is by carefully evaluating scientific studies, and not by visiting Internet sites, reading magazine articles or simply talking to friends. Extensive clinical tests should be the sole basis for introducing or discarding a new drug. Of the 51000-odd nutritional supplements on the market, only four might be of some benefit proved by testing. Appeals on the long ancestry of alternative therapies like acupuncture and Ayurveda shall fool no one. The very fact that a system had stayed unchanged for millennia only proves its inadequacy to treat modern ailments.

Endorsement by celebrities is another trick by which charlatans captivate people’s minds. Scientists renowned in their field of research sometimes side with dubious products. The book tells the case of Linus Pauling, who was the only person to win two unshared Nobel Prizes – for chemistry and peace. Unfortunately, at the height of his reputation, he turned an advocate of quackery. He believed that vitamin C is the antidote of many diseases from common cold to cancer. Advocates of the megavitamin industry advised astronomically huge dosages in the range of 18000 mg per day. But studies show intake of vitamins in large doses increases the risk of heart diseases and cancer. The bitter irony was that Pauling’s wife died of stomach cancer and Pauling himself suffered from prostate cancer and passed away as a result. Steve Jobs, the founder of Apple and one of the world’s leading innovators, was diagnosed with pancreatic cancer. His was a neuroendocrine tumour and had excellent chances of recovery with early surgery. But, Jobs was a man of strange beliefs and practices. He used acupuncture, herbal remedies, bowel cleansings and a special cancer diet of carrots and fruit juices for nine crucial months after diagnosis! By the time he agreed to surgery, time was definitely not on his side. The cancer had spread and the innovator died of a treatable disease.

Quacks and shamans had always tried to sell their products to a gullible public. Statutes to regulate this trade began to be enforced by early twentieth century. This book contains an interesting narrative of the acts came into being in the US in spite of the hurdles put in its way. The Pure Food and Drug Act of 1906 made it mandatory for the manufacturers to list out the ingredients of each recipe. The Food, Drug and Cosmetics Act of 1938 required safety testing before drugs were sold. The Kefauver – Harris Amendment of 1961 to the 1938 act forced the manufacturers to show that drugs were not only safe but effective. However, legal control began to loosen thereafter. The Proxmire Amendment of 1974 took FDA out of pursuit of the megavitamin industry. The ace regulation that gave the food supplement industry free rein was the Dietary Supplement Health and Education Act of 1994. This statute so thoroughly defanged the FDA that the law was mockingly referred to as the Snake Oil Protection Act.

As the book nears the end, one question comes up prominently on the reader’s mind. If the alternative remedies are so harmful and bad for health, then why do people flock to them with good results at least occasionally? Also, for terminally ill patients who have been forsaken by modern medicine, what’s wrong in trying out alternative medicine? Offit anticipates these questions and earmarks two chapters to explain this paradox. Alternative medicine works solely by the placebo effect, in which the patient feels confidence in the doctor and believes that the medication given to him will cure the disease and the feeling sometimes cures him! Often, even sugar pills and plain water can heal many maladies. The mechanism of betterment is analyzed in detail. If the alternative practitioners had left it at that, there was no problem. However, the author identifies four ways in which placebo medicine crosses the limit to quackery. The first is by recommending against conventional therapies that are helpful. Then they promote potentially harmful therapies without adequate warning. The third is that they drain the patient’s money. Most of these treatments are very costly. The fourth and lasting method is by promoting magical thinking, scientific denialism and encouragement of neglect of sound scientific principles.

The book is very easy to read with a thoroughly humorous presentation and complex concepts neatly explained. It attacks the false premise that doctors are evil and mainstream medicine can’t be trusted. Marketing hype with the terms ‘organic’, ‘natural’ and ‘antioxidant’ are examined threadbare and effortlessly routed. What the book lacks is a front-on attack on the bogus principles of homeopathy and the use of heavy metals in ayurvedic remedies. Both these topics get only scant attention and the caveats given by the author are fleeting. One or two chapters detailing these subjects would add much interest to future editions. The book provides a huge collection of notes compiled at the end.

The book is highly recommended.

Rating: 4 Star

The Island of the Colour-blind

Title: The Island of the Colour-blind

Author: Oliver Sacks

Publisher: Picador, 2012 (First published 1996)

ISBN: 9780330526104

Pages: 361

Islands are unique in many ways. The separation guaranteed by the vastness of the sea ensures subtle changes in the language and culture of the societies inhabiting them and the mainland, even though one is an offspring of the other. Not only in sociocultural mores, the isolation brings about genetic changes in the people, animals and plants. This was observed and characterized in great detail by none other than Charles Darwin himself, by his famous voyage around the globe in HMS Beagle. The rate of changes accumulated in the genome in response to natural selection against local conditions prevailing in an island will be far greater than that on the mainland. Darwin was amazed and encouraged by the sharp evolutionary changes he observed on the Galapagos Islands, which finally led to his theory of evolution. With this in the background, we turn to this book that showcases two remote islands in the Pacific Ocean, distant thousands of miles from the continents, in which two grotesque illnesses are widely prevalent in the indigenous populations. In Pingelap, total colour-blindness is fairly common, and in Guam, a neurological disease called lytico-bodig, that exhibits symptoms of Parkinsonism and paralysis affects a section of the populace born before 1945. The author visits these islands in turn, muses on them and the probable causes. Oliver Sacks is a physician and the author of many books. Born in London and educated at Oxford, he now lives in New York where he is Professor of Neurology and Psychiatry at Columbia University.

There are many places in the world where first cousin marriage is common. In many parts of India itself, this was the norm before education and better living standards threw open the door to the outside world to those languishing in fetid superstition. Science has categorically outlined the dangers of inbreeding including widespread prevalence of genetic disorders, to mention nothing about the eventual impoverishment of the gene pool. Genetic diseases are marked often by recessive genes. Since every person possesses two sets of genes inherited from the father and mother, if one copy of the gene is healthy, the recessive gene stays dormant, without causing its harmful effects. The person with one faulty gene acts as a carrier of the disease, but the ailment itself will not be expressed in his body. When too much breeding occurs between people who are closely related, the chances of an offspring getting two copies of the recessive gene heightens. The higher than normal incidence of lunacy and other genetic defects observed in Kerala’s matrilineal society of the previous centuries may be taken note of. Pingelap Atoll’s people had to pass through a natural catastrophe that forced them to resort to inbreeding as a case of necessity. This paradise-like atoll in the middle of the Pacific vastness was hit by a huge typhoon in 1775. Most of the inhabitants perished. Out of the thousand or so dwellers, around twenty, mainly from the chief’s family, survived. The population slowly picked up over the decades, but the harmful effects of inbreeding began to tell heavily on the society’s well being. The loss of colour vision, called achromatopsia, spread among the descendants. The patients lacked all sense of colour, losing the cone cells in the retina which distinguishes colour. They depend only on the rod cells, which normal people use to see in darkness. As a result, people suffering from the disorder find it difficult to fully open their eyes in bright sunlight. This is accompanied by squint. Some semblance to normal human eyes can be generated by the liberal use of dark sunglasses. There is no cure for the disease as yet. Among the general population in other parts of the world, the rate of incidence is 1 in 30,000 whereas it is an astounding 1 in 12 in Pingelap.

Sacks presents another startling phenomenon from Guam Island in the Pacific, which falls under U.S. administration. It is a U.S. military base, with a large area of the island out of bounds for ordinary citizens. The indigenous people in this lovely tropical island is afflicted with a paralyzing sickness called lytico-bodig, somewhat related to encephalitis lethargica. The sufferers show symptoms of Parkinson’s disease or display extreme inability to move muscles or speak. The disease worsens progressively, and finally kills the patient. This disease affects only the indigenous people of the island. The cause of this ailment is still shrouded in mystery. The chapter offers an absorbing discussion on the probable causes of the disease. A strong contender is the cycad plant found in large numbers on the island, whose seeds are eaten by the people as a source of protein during droughts or famines. This was widely used during the Second World War when the island was under Japanese occupation and the local people were mercilessly starved. The highest incidence of the malady was on the people born during the war years when all they had to eat was the cycad seeds. After the island was retaken by American troops, matters returned to normalcy. There has not been a single case of lytico-bodig on the people born after the event. The cycad plant contains a neurotoxin that may be responsible for the deleterious effects, but elaborate preparation of the seed before consumption takes care of removing most of the toxin. Scientists posit that genetic predisposition and deficiency of minerals rich in calcium and aluminium may also explain the phenomenon. The last word has not been said yet.

The book is not just about diseases and cycads alone. It narrates a really adventurous travel to the beautiful Pacific islands. To reach Pohnpei, Sacks had to undergo some anxious hours in the form of a damaged plane tyre. Many of the islands in the Pacific are controlled by U.S. military. Repairs to the plane were carried out in a military base and the passengers were grudgingly allowed to stay on the island under the watchful eyes of the soldiers – a prospect equally disliked by both parties. The author gives a thrilling description of his journeys on the islands and the heaven-like beaches ideal for swimming or snorkeling. His revulsion to military bureaucracy is evident in more than one place in the book. Guam is a pretty island, but most of the prettiest beaches are under military control. Access is granted after thorough interrogation and that too, after forcing the visitors to wait for hours. But the author has not proposed exposure to radioactivity or other military-related causes for the spread of lytico-bodig.

An illuminating discussion on ancient plants like ferns and cycads that still exist in the world is also presented as a bonus. Apparently, this was facilitated by his visit to Rota Island, near Guam. This book includes a huge section of Notes that runs to about a third of the book. But they are very informative and readers don’t feel interrupted from the main story even though they have to frequently refer to these elaborate pieces of information. Nice sketches of the trees and plants are very apt to the theme. An expansive bibliography and index add to the attraction of the book. The book was first published nearly twenty years ago, and that may be why he has not included the names of those genes that cause the diseases. Not that the readers get any wiser by a cryptic acronym, but it contributes to a feeling that the malady is being studied in detail by the academia and pharma.

The book is highly recommended.

Rating: 3 Star

The Fever Trail

Title: The Fever Trail – In Search of the Cure for Malaria

Author: Mark Honigsbaum

Publisher: Pan Books, 2002 (First published 2001)

ISBN: 9780330481854

Pages: 333

Malaria is a scourge of mankind. Till a few centuries back, it afflicted all parts of the globe with equal severity, but is now confined mainly to the Third World. Millions of children die every year in sub-Saharan Africa due to this illness and the drain on the economy caused by the incapacitation of healthy individuals is considerable. It has killed 60 times more people than AIDS. The book presents a detailed historical narrative of the search for finding a cure for malaria. It tells the story of finding a natural cure in the bark of the cinchona tree in its natural habitat of South America and the epic struggle by a few spirited explorers to get its seeds out to the whole world for starting cultivations elsewhere. The book ends with a brief description of the state of the art in finding a vaccine for it. Mark Honigsbaum is a medical historian and journalist with a long standing interest in the history and science of infectious diseases. He is a regular contributor to British newspapers and has authored four books.

The cinchona plant is a miracle, in the sense that its bark contains the cure for malaria. The case of a single plant being the only effective remedy for a killer disease is rare. It is equally miraculous that man found out about the tree and its gift, as historians suggest that malaria was not endemic to South America. The disease came with the conquistadores from the Old World. The question of who discovered the febrifugal property of the plant may never be answered, but urban legend associates its widespread use with Dona Francisca Henriquez de Ribera, the fourth Countess of Chinchon in Spain, who was the vicereine of Peru. Legend has it that she became ill with malaria and the viceroy despaired of her life. When all else failed, a local Jesuit priest suggested the dried bark of a tree called ayac cara (bitter bark) or quinquina (bark of barks). The lady was cured after administering the bark and the story spread like wildfire. When Carl Linnaeus, the father of taxonomy was faced with the task of naming the species, he settled on cinchona, somehow omitting the first ‘h’ of the lady’s estate. The plant’s original habitat was South America. The finest cinchonas were very particular about the region in which they thrived. The best trees were found on the slopes of Cajanuma Mountain in the Loja province of Ecuador. Honigsbaum don’t keep the reader in suspense of how malaria came to the New World. He ascribes this with the slave trade, in which tens of thousands of Blacks were transported forcibly from the malaria-infected river banks of Africa. Some of the Africans have a natural genetic defence against the disease in the form of sickle-shaped cells in their blood stream, but they act as carriers of the sickness. It is notable that Africans were vulnerable to malaria for indeed a very long time that evolution has favoured a group of individuals with the trait of sickle cells, which of course produces other debilitating effects. The mosquitos which flourished in the half-cleared swamps of South America vectored the parasite Plasmodium falciparum among the natives as well as European settlers.

The book tells the story of transplantation of cinchona trees from South America to India and Java. By the 19^th century, quinine production had started on an industrial scale. Having the monopoly of the bark, the governments of Peru, Bolivia and Ecuador jealously guarded the trees, forbidding export of live plants and seeds. As the bark grew dearer in price, smuggling rose proportionately. Besides, excessive harvest of bark and indiscriminate felling of trees threatened the existence of the species itself. The British and Dutch governments watched the emerging scenario with growing alarm. The South American republics often fought amongst themselves and were breeding grounds for bloody revolutions and coups. Even though it amounted to looting of the biological asset of a sovereign state, it was in the interest of humanity to transplant the trees to save it from extinction and to produce quinine in large quantities for selling to the public at affordable prices. Several teams tried their luck on the slopes of Andes and its foot hills. Richard Spruce, Clements Markham and Charles Ledger were successful in getting the plants and seeds out of South America. However, while haggling over the price, some of it reached the hands of the Dutch. Soon, large gardens of cinchonas sprouted in Dutch Java and at Nilgiri and Darjeeling in India. The Javan plantations carefully grafted the trees to obtain fine specimens with huge quinine content, while the Indian trees got hybridized due to lack of scientific cultivation. Consequently, the cost of Javan quinine was lesser. The Dutch could sell it with greater profit too. By the 1880s, quinine price had reached rock bottom due to increased production in Asia. The South American bark industry collapsed as a result.

Even though the author gives an exhaustive description of the quest for cinchona trees – even by narrating the day to day incidents during the exploration – he glosses over the heroic search for the vector of the disease and Ronald Ross’ discovery that the mosquito was the medium of propagation of the disease. Common wisdom was that malaria was spread through foul air – miasma – found in the presence of swamps and marshes. This was overturned only in the 19^th century when researchers identified the mosquito to be the real culprit. Honigsbaum quotes Susruta, who was an ancient proponent of medical profession that five varieties of diseases are caused by mosquitos. But it is to be noted that Susruta does not identify malaria as such and definitely, this observation was far advanced than the medical line of thought in the middle ages.

The final few chapters of the book are devoted to the quest for finding a synthetic prophylaxis against the disease. Chloroquine is one of the most widely used remedy, but researchers are worried that the malaria parasite is growing resistance to the medicine. This is a terrifying prospect for global society considering the ease with which the malady spreads and it’s long lasting debilitating effects. The falciparum parasite was evolved a very long time ago, conferring on it many genetic traits for survival. A close ancestor of the parasite even has the ability to produce chlorophyll, showing its origin in the remotest antiquity when life itself made its first waddling steps. The book ends with a survey of the quest for finding a vaccine to malaria so that it can be prevented from affecting an individual, rather than as a cure. Researchers are working on the project worldwide, but big pharma’s budget is still not being allocated to it in sufficient measure. Among the researchers in the forefront of the study, the author gives pride of place to Manuel Elkin Patarroyo, a highly influential Colombian researcher. Even though his methodology appears to be a little dubious, his vaccine named SPf66 is still the most efficacious one, though it has much more miles to go before universal adoption. Honigsbaum ends the narrative describing the many initiatives which were projected to be on the verge of bearing fruit. This book was published in 2001, but even now, a vaccine for malaria is still elusive.

The book is very nicely structured with clear text accompanied by good photographic plates and maps. An informative section of foot-notes is given along with an exhaustive bibliography and a thoroughly comprehensive index. The narrative is very lucid and appeals to all classes of readers. The book includes flowery praise for the philanthropic contributions of the Wellcome Trust. However, when we realize that the author is currently working as a Wellcome Research Fellow at Queen Mary University in London, we begin to have doubts on the veracity of the assertion.

The book is highly recommended.

Rating: 3 Star