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Tuesday, January 28, 2020

Review: The Body - A Guide for Occupants

I've bounced of a number of other Bill Bryson books before, so I approached The Body with low expectations. To my surprise I found myself reading the book in earnest, highlighting passage after passage. Here he is about lifespan:
Many factors determine life span, of course, but it is a fact that men who have been castrated live about as long as women do. In what way exactly testosterone might shorten male lives is not known. Testosterone levels in men fall by about 1 percent a year beginning in their forties, prompting many to take supplements in the hope of boosting their sex drive and energy levels. The evidence that it improves sexual performance or general virility is thin at best; there is much greater evidence that it can lead to an increased risk of heart attack or stroke. (Kindle Loc 2490)
 I remember reading in one of John Medina's books about how hunter-gathers might walk as much as 10 miles a day. Here's Bill Bryson debunking that:
According to The Economist, some American companies have begun offering rewards to employees who log a million steps a year on an activity tracker such as a Fitbit. That seems a pretty ambitious number but actually works out to just 2,740 steps a day, or a little over a mile. Even that, however, seems to be beyond many. “Some workers have reportedly strapped their Fitbits to their dogs to boost their activity scores,” The Economist noted. Modern hunter-gatherers, by contrast, average about nineteen miles of walking and trotting to secure a day’s food, and it is reasonable to assume that our ancient forebears would have done about the same. (Kindle Loc 2968)
 Ok, that's all stuff you already know. But here he is on the puzzle of allergies, and the increasing rate of asthma among children:
An estimated 300 million people in the world have asthma today, about 5 percent of adults and about 15 percent of children in those countries where it is measured carefully, though the proportions vary markedly from region to region and country to country, even from city to city. In China, the city of Guangzhou is highly polluted, while nearby Hong Kong, just an hour away by train, is comparatively clean as it has little industry and lots of fresh air because it is by the sea. Yet in clean Hong Kong asthma rates are 15 percent, while in heavily polluted Guangzhou they are just 3 percent, exactly the opposite of what one would expect. No one can account for any of this... (Kindle Loc 3551)
In children, it is closely associated with both being obese and being underweight; obese children get it more often, but underweight children get it worse. The highest rate in the world is in the U.K., where 30 percent of children have shown asthma symptoms. The lowest rates are in China, Greece, Georgia, Romania, and Russia, with just 3 percent. All the English-speaking nations of the world have high rates, as do those of Latin America. There is no cure, though in 75 percent of young people asthma resolves itself by the time they reach early adulthood. No one knows how or why that happens either, or why it doesn’t happen for the unfortunate minority. Indeed, where asthma is concerned, no one knows much of anything.  (Kindle Loc 3567)
As we all know, it's Speaking English that kills you. There's a significant amount of medical history in the book, with lots of tidbits like this one:
in 1970 Congress canceled the only comprehensive federal nutrition survey ever attempted after the preliminary results proved embarrassing. “A significant proportion of the population surveyed is malnourished or at a high risk of developing nutritional problems,” the survey reported, just before it was axed. (Kindle Loc 3986)
 Bryson doesn't shy away from politically inconvenient facts, such as the US being the worst country in the world to get healthcare in the developed world:
Even now, however, there is huge variability in maternal mortality rates among countries of the developed world. In Italy, the number of women who die in childbirth is 3.9 per 100,000. Sweden is 4.6, Australia 5.1, Ireland 5.7, Canada 6.6. Britain comes only twenty-third on the list with 8.2 deaths per 100,000 live births, putting it below Hungary, Poland, and Albania. But also doing surprisingly poorly are Denmark (9.4 per 100,000) and France (10.0). Among developed nations, the United States is in a league of its own, with a maternal death rate of 16.7 per 100,000, putting it thirty-ninth among nations. (Kindle Loc 4830)
But even within the US, it's not evenly distributed. Much of the medical problems the US has can be addressed. For instance:
 California addressed preeclampsia and the other leading causes of maternal death in childbirth through a program called the Maternal Quality Care Collaborative, and in just six years reduced the rate of childbirth deaths from 17 per 100,000 to just 7.3 between 2006 and 2013. During the same period, alas, the national rate rose from 13.3 deaths to 22 deaths per 100,000. (Kindle Loc 4859)
Of course, this stuff doesn't make the news, and the libertarians are happy to tell you that "government can't solve any problems," even when other countries with government run healthcare manage to do far better than the USA's private system.
 The second thing that can be said with regard to life expectancy is that it is not a good idea to be an American. Compared with your peers in the rest of the industrialized world, even being well-off doesn’t help you here. A randomly selected American aged forty-five to fifty-four is more than twice as likely to die, from any cause, as someone from the same age-group in Sweden. Just consider that. If you are a middle-aged American, your risk of dying before your time is more than double that of a person picked at random off the streets of Uppsala or Stockholm or Link√∂ping. It is much the same when other nationalities are brought in for comparison. For every 400 middle-aged Americans who die each year, just 220 die in Australia, 230 in Britain, 290 in Germany, and 300 in France. These health deficits begin at birth and go right on through life. Children in the United States are 70 percent more likely to die in childhood than children in the rest of the wealthy world. Among rich countries, America is at or near the bottom for virtually every measure of medical well-being—for chronic disease, depression, drug abuse, homicide, teenage pregnancies, HIV prevalence. Even sufferers of cystic fibrosis live ten years longer on average in Canada than in the United States. What is perhaps most surprising is that all these poorer outcomes apply not just to underprivileged citizens but to prosperous white college-educated Americans when compared with their socioeconomic equivalents abroad. (kindle Loc 5798)
You would think that being wealthy in the US would protect you from a lot of health problems, but it turns out that  many of the problems are systemic:
“Even wealthy Americans are not isolated from a lifestyle filled with oversized food portions, physical inactivity, and stress.” The average Dutch or Swedish citizen consumes about 20 percent fewer calories than the average American, for instance. That doesn’t sound massively excessive, but it adds up to 250,000 calories over the course of a year. You would get a similar boost if you sat down about twice a week and ate an entire cheesecake. (Kindle Loc 5816)
And of course, that idiot driver will kill you just as easily in a country where no one has a choice but to drive everywhere:
 the United States records a really quite spectacular 11 traffic deaths per 100,000 people every year, compared with 3.1 in the United Kingdom, 3.4 in Sweden, and 4.3 in Japan. (Kindle Loc 5826)
 Finally, I enjoyed his treatment of longevity as well:
The longest-lived person that we know of was Jeanne Louise Calment of Arles, in Provence, who died at the decidedly ripe age of 122 years and 164 days in 1997. She was the first person to reach not only 122 but also 116, 117, 118, 119, 120, and 121. Calment had a leisurely life: her father was a rich shipbuilder and her husband a prosperous businessman. She never worked. She outlived her husband by more than half a century and her only child, a daughter, by sixty-three years. Calment smoked all her life—at the age of 117, when she finally gave up, she was still smoking two cigarettes a day—and ate two pounds of chocolate every week but was active up to the very end and enjoyed robust health. Her proud and charming boast in old age was, “I’ve never had but one wrinkle, and I’m sitting on it.” (Kindle Loc 6072)
In any case, the book's chock full of fun reading (I'm not even using half the stuff I highlighted for future reference), and even occasionally has some actionable stuff. Recommended.

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