This painful episode is the emotional focus of Topol’s 2019 book “Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again.” The surgeon’s inhumanity was glaringly evident; in reality, Topol himself was suffering from arthrofibrosis, which is a very rare inflammatory joint condition associated with scarring in two to three per cent of cases of knee replacements. Topol owes his recovery not to medications but to the gentle, personalized physical rehabilitation regimen offered by a sympathetic therapist.

Topol argues that an artificial intelligence algorithm could have identified Topol’s high predisposition to arthrofibrosis through digestion of his teenage case of osteochondritis dissecans along with matching this condition against the medical literature. Such a scenario where doctors fail to pay attention to their patients, Topol terms “shallow medicine,” or “an age when patients are living in a world of inadequate data, inadequate context, and inadequate time.” In Canada and throughout North America, the clinic visit time has shrunk to single digits, and the introduction of the electronic medical record system turned doctors into “data entry technicians” with a computer screen in front of them.

The core brilliance of the book lies in its paradox: the development of smart machines is our best chance to regain this lost human factor. By delegating to algorithms the performance of mundane tasks such as clerical work, diagnostic pattern recognition, and administrative “grunt work”, we can ensure the “gift of time”, which can be used to look patients in the eye, listen to their story, and truly empathize with them.

For the realization of the described future, Topol outlines the triple combination: “deep phenotyping”, “deep learning”, and “deep empathy”. Deep phenotyping implies defining every individual molecule-by-molecule, environmentally and behaviorally – collecting continuous, multilevel data “from prewomb to tomb”, including their DNA genome, RNA, proteins, gut microbiome, and biosensors.

Topol describes incredible applications of deep learning neural networks in working with big data. For example, if you give a retinal image to the world’s top specialists in eye diseases and ask them to find out the gender of the patient, their accuracy will be a coin toss of 50 percent. The deep learning algorithm, however, will be able to recognize the gender with more than 97 percent accuracy.

The book discusses the rapid sequencing of the genome of a baby boy at the Rady Children’s Hospital. The baby was undergoing status epilepticus, a condition involving continuous and life-threatening seizures. It took only twenty seconds for the algorithm, using natural language processing technology, to process the medical record of the baby and correlate it with nearly five million genetic variants to identify the metabolic deficiency in the ALDH7A1 gene. The seizures were stopped instantly by simply providing vitamin B6 and arginine to the baby.

However, the author doesn’t subscribe to technological optimism. He tells us the story of a cantankerous septuagenarian patient with severe idiopathic pulmonary fibrosis who suddenly felt very fatigued. Topol identified an 80% blockage in his right coronary artery, but if there had been an algorithm in place, it would not have allowed a stent operation since no scientific literature suggests the fact that opening a right coronary artery solves the problem of systemic fatigue.

But Topol stuck to his clinical instincts and inserted the stent into the artery. And the patient recovered miraculously. The complicated interplay between the stiff lungs of the patient and the blood circulation system of his heart had never been documented in any medical literature before. The right ventricle was functioning under high pressure, and the stent released the stress. It’s a great reminder of how unique and complicated each patient is and will always remain so.

There is an additional issue that Topol talks about – “the black box problem”. We may create unsupervised machine-learning algorithms capable of predicting the moment of developing schizophrenia or diagnosing skin cancer like a dermatologist, but we don’t understand how they do what they do. Topol believes that medicine involving such high risks as healthcare cannot have “black boxes”, which may be tampered with and have their calibration shift.

However, Topol’s chapters devoted to mental health stand out for being especially convincing. For instance, he mentions a virtual human experiment conducted by Jonathan Gratch, where participants from Craigslist shared their intimate secrets with the “Ellie” on-screen avatar. What is notable is that patients felt much less inhibited when sharing their secrets, believing that they communicated with a machine, not a human-controlled avatar, because of the fear of being judged. Moreover, according to Topol, the process of digital phenotyping – monitoring smartphone typing latency, scrolling speed, voice inflections, Instagram filters, etc. – can predict depression.

It is important for the Canadian audience to emphasize the issue of data ownership raised by Topol. He speaks about a “digital republic” of Estonia using blockchain and ensuring that its citizens legally own their personal medical data, something that does not happen in North America.

At the end of the day, Deep Medicine is a superb, funny, and compelling manifesto. It cautions that if we do not resist the attempts by the administrators of our health systems to turn artificial intelligence into nothing but an excuse for seeing more patients in the clinic, we will merely speed up the process of dehumanizing the practice of medicine. If we succeed, we will have managed to break down the “keyboard barrier.”

This review is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before making significant changes to your health or wellness routine.

The post Can Artificial Intelligence Restore Empathy to Medicine? A Review of Eric J. Topol’s “Deep Medicine” appeared first on Canada's Health Magazine.

With such an opening by Atul Gawande in his book “The Checklist Manifesto: How to Get Things Right,” Atul Gawande raises a very compelling thesis that in the twenty-first century, the problem is not one of ignorance but of ineptitude. As a Harvard surgeon and writer at The New Yorker, Gawande argues that while science has equipped us with “stupendous know-how,” there is so much of it that we cannot use it safely and effectively.

Gawande’s book will be of interest to a Canadian audience trying to navigate the increasingly complicated healthcare landscape. Gawande notes that we are fixated on “great components”: great drugs, great technology, and great experts; yet there seems to be little attention paid to how all these pieces fit together. This means we live in a world where, even with all our brilliance, we forget the “stupid stuff.”

The book serves as an intense “infotainment” ride by constantly leaping between the cockpit of the Boeing planes and the construction site of the enormous skyscrapers. Gawande’s stories are at their most effective while dealing with the 1935 crash of the Model 299 plane, a plane so advanced that it was considered “too much airplane for one man to fly”. What came to the rescue of the nearly bankrupt Boeing company was not increased pilot training but just a simple index card with “dumb stuff” like releasing brakes.

From a wellness perspective, it becomes necessary to acknowledge the skill of Gawande in breaking down the “Right Stuff” syndrome prevalent in many professions. According to him, the traditional model of the hero, which involves being a renegade who manages to make it by virtue of his audacious and cunning nature, is in fact a weakness in an era where there is a great deal of complexity involved. This new professionalism has four components – selflessness, competence, integrity, and above all, discipline.

The heart of the book explains Gawande’s involvement with WHO in developing a “Safe Surgery Checklist.” The developed checklist with nineteen items seems very simple, with a focus on “killer items,” which can be fatal if forgotten, yet are easy to forget. It includes verification of whether the surgical team has the right patient and right surgical site, as well as administration of antibiotics up to sixty minutes before the cut.

Certainly, one would expect critics to find the checklist approach “ridiculously primitive,” and as Gawande himself reports, many surgeons were certainly upset at the idea that they needed one. But the results of the pilot study cannot be overlooked; in eight hospitals around the world, including Toronto General Hospital, the implementation of the checklist was linked to 36 percent fewer complications and 47 percent fewer deaths.

But more importantly than just checking off tasks, the evaluation of the book also takes into account the psychology of teamwork. Gawande points out the “activation effect”; the simple fact of introducing oneself by name and occupation increases the chances of speaking up when an issue arises. It is proposed to treat communication as the final “cognitive net” capturing the errors present in everyone’s minds.

Another interesting part is where the author enters the financial world to show how the “cocaine brain” – a primitive reward circuit activated by money-making opportunity – drives even talented investors to cut some corners. He gives examples of investors who started using checklists in order not to forget about the “basics” when analyzing financial statements, like reading footnotes for cash flow.

The prose is informal and urgent; however, the author is very careful to note that checklists are tools that help to remember the basic facts, rather than the “comprehensive how-to guides”. The purpose of the list is to support the expertise of the specialist, not to take its place. Gawande’s personal experience of having almost killed his patient on the table, as a result of the torn vena cava, is a perfect acknowledgment of human fallibility. As for the result, his patient survived, thanks to the extra blood stored in the blood bank thanks to the checklist.

In “The Checklist Manifesto”, Atul Gawande presents his work as a brilliant example of scientific writing which reveals the miraculous nature of the ordinary. The author asserts that it is essential for people to recognize their weaknesses and utilize an approach in order to compensate for their “inevitable human inadequacies”. For all those who want to know why something goes wrong, Gawande offers a practical manual for the vessel of life.

This review is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before making significant changes to your health or wellness routine.

The post The Simple Device That Is Keeping People Alive During an Age of Excessive Complexity: An Analysis of Atul Gawande’s “The Checklist Manifesto” appeared first on Canada's Health Magazine.

To most of us, the gut is a “Quasimodo” in the body’s architecture – unappealing, uneven and disregarded until it erupts in “fumes” during some social occasion. While we marvel at the beating heart and brilliant mind of the brain, we overlook the intestinal tract with a combination of reticence and embarrassment.

In her acclaimed book entitled “Gut: The Inside Story of Our Body’s Most Underrated Organ”, German medical scientist Giulia Enders offers us the idea that this 20-foot-long, winding tube is indeed a marvel of organization requiring no more power to function than a 100-watt bulb.

As someone who can enlighten Canadians amid the recent onslaught of “gut health” advertising, Enders is certainly a humorous narrator. She does not simply teach biology; she makes the science accessible, bringing us through a tour of the “inner forest” of Grade XII science revisited.

The story starts off with the question which would forever change Enders’ life, “How does pooping work?” That is followed by an amazing explanation of a performance which consists of two nervous systems working together. Enders takes us through the introduction to the internal and external sphincters, “no nonsense little guy,” which represents our unconscious self and “faithful servant” of our conscious self, respectively. The area between them serves as a “taster” area where sensor cells determine whether what is coming is solid or gas and give a report to the brain.

A section which is interesting and provocative for contemporary health enthusiasts includes a discussion of the “porcelain thrones.” According to Enders, such common problems of Westerners as hemorrhoids and diverticulitis do not exist in 1.2 billion people who defecate while squatting. She states that the problem in the civilized world lies in the fact that the sitting posture of defecation forms a bend in the tube that prevents the hatch from opening fully. The advice that she gives to people who are not willing to use squat toilets is quite practical and easy: lean forward and rest your feet on a stool.

In addition to the mechanics of defecation, the book contains information about the importance of the gut as the largest sensory organ of the body. According to the author, the “housekeeper” – a migrating motor complex – starts a cleaning wave an hour after the process of digestion. It is this process that makes people feel that well-known rumbling in the abdomen that Enders says is not caused by the fact that we are hungry, but indicates that the gut has had enough time off from snacking to clean itself.

Being a health critic, however, it is necessary to admit that the most influential aspect of this book is connected with the discussion of the gut-brain axis. Enders explains that the gut is the only organ that has an autonomous nervous system; once disconnected from the brain, it continues to work happily. “Gut brain” produces more than twenty hormones and, probably, the most surprising fact, it creates 95 percent of serotonin in the body. Moreover, Enders suggests that an “unhappy gut can lead to an unhappy mind,” implying that irritating signals from the gut might affect the brain’s emotional centers, thus causing anxiety and depression.

The last third of the book is devoted to a discussion of the microbiome – 100 trillion bacteria that live in our body. Enders regards it as a kind of ecosystem that we have to “cultivate” instead of just cleaning. Thus, she describes the “bad guys,” who are “sombrero-wearing” Salmonellae and “good guys,” which form the main training camp for the immune system.

Enders gives us a more realistic approach to probiotics and prebiotics, not resorting to clichés surrounding a “miracle cure” for every single illness. She argues that whereas probiotics are like “temporary workers who are hired during stressful or antibiotic conditions,” prebiotics – that is, the indigestible fibres in onions, garlic, asparagus and cold potato salad – are the “meals hearty enough to give our good bacteria an edge.”

The text is written in a very understandable manner, thanks to the quirky illustrations done by the author’s sister, Jill Enders. Even though some might say that the “poop talk” goes beyond the necessary level of detail, it comes across as very professional, with the focus being put on providing the reader with accurate information. It even includes research done at Canada’s McMaster University, where gut bacteria were shown to trade behaviour characteristics of shy and outgoing mice.

“Gut” is a wonderful example of science communication that makes you feel “miraculous” instead of “gross”. The author successfully convinces his readers that they are not only the owners of their thoughts but also the protectors of a tiny universe inside them. This book is a must-read for people interested in learning the manual of their own vessel and, maybe, showing some sympathy towards their “inner forest”.

This review is intended for informative purposes only and does not serve as a source of medical advice. Always consult with your healthcare provider before making any changes in your health/wellness practice.

The post Why Your Microbiome is the Secret to Wellness: A Review of Giulia Enders’ “Gut” appeared first on Canada's Health Magazine.

Mukherjee resists the academic style of a textbook by introducing what he refers to as a “red line” that cuts across the scientific narrative with a personal account of his own family’s battle against mental illness. His two uncles, Rajesh and Jagu, and his cousin Moni are presented as characters with “splintered minds.” Mukherjee introduces this element as a means of setting stakes for the narrative and elevates the historical account of biology into an intriguing investigation into the definition of identity. Should there be a kernel of illness within the family line, how does one separate this from their own sense of self? His father calls the gene Abhed, which translates into “indivisible” or “identity.”

The value of infotainment of the historical segments lies in its magnitude. First and foremost, Mukherjee displays the qualities of a novelist by providing us with a picture of Gregor Mendel as an obsessive, dim-witted yet highly intelligent gardener who had the habit of counting several thousand peas to discover the “alphabet of the code.” Next comes the mention of James Watson and Francis Crick, who have been referred to as the “self-appointed jesters in a court of fools” who discovered the structure of DNA and established the “central dogma” of biology.

Nevertheless, as a critic of the concept of wellness, it is necessary to point out that the book is really provocative if it takes the discussion from laboratory practice to clinical practice. According to Mukherjee, modern medicine has for a long time functioned in the mode of “mirror writing,” when we understand wellness through the prism of its opposite – the lack of abnormality. As a result of the Human Genome Project, however, we now know how to address genetics in terms of “normalcy.” However, it is a double-edged sword because, according to the author, we are now approaching the era of “previvors.”

One of the major criticisms by the book about “nature vs. nurture” is especially apt for today’s health-conscious individuals. According to Mukherjee, genes do not represent “blueprints,” which mean one outcome, but “recipes.” Just like quadrupling the quantity of butter does not only make the cake tastier but may ruin its structural integrity altogether, genetics combined with environmental factors and sheer luck may yield unexpected results. The author describes it as the “last mile” issue, since genetics may show a possibility of having a particular nose or personality but fails to cover the last mile to define a person’s concrete individuality. This point is emphasized through the eerily similar twins who raised separately smoke the same cigarette brand and marry women with the same name due to their “idiosyncratic and serendipitous events.”

The criticism of “newgenics” in Mukherjee’s writing marks one of the strongest examples of his journalistic integrity. While the horrors of state-endorsed eugenics have been left behind by history, today we have entered into what Mukherjee calls a “regime of gene management,” motivated by individual autonomy. With the ability to “read” the fetal genome and “write” away any mutations thanks to techniques like CRISPR, the line between “extraordinary suffering” becomes ever-changing. The question becomes, will the eradication of the genes that cause schizophrenia end our suffering, or will it erase the creativity too?

The language used by the author can be considered heavy at times, although it is never so oppressive as to overwhelm the reader; however, the huge size of the human genome (consisting of 3 billion base pairs), mentioned by Mukherjee (which would occupy 1.5 million pages if put into print), poses a threat to become an obstacle on occasion. Nevertheless, the writer succeeds in driving the plot by going back to the “triangle of considerations.”

“Gene” is a work of scientific journalism that perfectly achieves the difficult task of being both a “terrifying wake-up call and a hopeful roadmap.” This book is one reminder that even as we have come from a certain script, we are not automatons created out of it. According to Mukherjee, the “imperfect” is our paradise, and the need to make humans homogeneous and “normalize” them must necessarily take into consideration the necessity of sustaining diversity. The book is essential reading for everyone who seeks a manual for their body, which is currently involved in the “intercontinental arms race” to rewrite it.

Book Title: The Gene: An Intimate History.
Author: Siddhartha Mukherjee
Year: 2016

The post Is Your Destiny Written in DNA? A Review of Siddhartha Mukherjee’s “The Gene” appeared first on Canada's Health Magazine.

Beyond Genetics: How Evidence-Based Nutrition and the “Daily Dozen” Put Health Back in Your Hands

The book has been divided into two sections titled “Why” and “How”. In the former part of the book, the reader will be presented with information about the fifteen leading causes of mortality in America (and Canada alike), such as heart diseases, high blood pressure, mental illness (depression), and cancer. The latter part describes the “Daily Dozen” plan that the author has developed from all his knowledge of health matters.

The first main point of Greger is that we have a lot more control over our biology than may seem from the point of view of our genetics. The author states that the scientific evidence has proven that genetics contributes not more than 10% to 20% of risk in most of the leading causes of death in humans. The author claims that there should be a need to stop thinking that genetics makes us ill and calls “the Standard American Diet” an acronym of SAD.

From the viewpoint of wellness, the tone of the author is very persuasive. He notices that medicine can be compared to mopping the floor around an overflowing sink, instead of just turning off the water. For Greger, this “tap” is our own behaviour, particularly our diet. There is one shocking study where he states that only 1 percent of people received a high “Healthy Eating Score.”

Another noteworthy “infotainment” feature of the book is Greger’s “Traffic Light” system. In this scheme, green light foods (fresh plant products) need to be consumed in abundance, yellow light foods (processed plant foods or fresh animal foods) need to be limited, and red light foods (processed junk or meats) are virtually excluded. The Traffic Light concept is easy to memorize, although Greger is realistic enough to admit that perfection shouldn’t become an obstacle to improvement. Even though he admits having had a “grease tooth” for pepperoni pizzas and bacon cheeseburgers, the scientist manages to bring his high science down to the level of a common person’s experience.

Nevertheless, the book isn’t completely devoid of controversial topics. As regards the food industry, Greger doesn’t show much respect to the medical establishment or governmental bodies involved in promoting dietary guidelines. In particular, the author criticizes the U.S. healthcare system that emphasizes the number of procedures rather than their quality, often ignoring the necessity of nutrition education, as “no one profits from lifestyle medicine”. Besides, he mentions the help he got from a wealthy Canadian philanthropist named Jesse Rasch, who supported the transfer of his research activities to a non-profit basis.

However, Greger’s discussion of particular foods brings life to the reader’s shopping cart. He believes there are foods that have special characteristics and cannot be substituted. For example, he advocates the “Hack and Hold” method of preparation for broccoli, explaining that the process of producing sulforaphane, a chemical responsible for fighting cancer, necessitates an enzyme that is destroyed in heat. Thus, the broccoli needs to be chopped and then left for forty minutes before cooking. Additionally, he advocates amla fruit (Indian gooseberry), which he claims can be the most antioxidant-loaded food on the planet, and ground flaxseeds for their miraculous effects on reducing blood pressure in laboratory experiments.

It is important to note that some readers might see Greger’s long and extensive citation list, taking up more than one hundred pages, as a benefit, while others will perceive it as unnecessary. The writing style of the author flows in an unstoppable flow of data, making the reading experience similar to being lectured by a very concerned scientist. Even though the work is highly readable, the quantity of “Daily Dozen” (beans, berries, greens, turmeric, etc.) is probably too much for a typical suburban household trying to survive another hectic Tuesday evening.

According to the author, heart disease is a matter of choice, supported by historical evidence that in rural Africa and China, people did not suffer from such problems due to their low-sodium, plant-based diet. But most importantly, the author encourages the audience not to give up. In fact, there have been cases in which pioneers, including Dean Ornish and Nathan Pritikin, managed to open up arteries and reverse the process of disease through lifestyle changes.

In the case of Canada, with a constantly overloaded healthcare system due to chronic diseases, Greger’s speech is quite relevant. The author does not encourage people to eat better; instead, he asks them to reconsider their view on aging. According to the author, modern society has become so proficient in adding years to the period of its decline (“sicklier”).

“How Not to Die” can be regarded as an outstanding work in terms of popularizing science. This book is a terrifying alarm as well as a hope for the future. Even if one does not consider switching from coffee to hibiscus tea and amla powder in his breakfast porridge, he will find many reasons to change his views on health in Greger’s work.

The post Can You Eat Your Way to a Longer Life? A Review of Michael Greger’s “How Not to Die” appeared first on Canada's Health Magazine.

This is the quintessential Bryson approach: taking the mundane reality of our physical existence and presenting it in shocking, often pricey, statistics and historical curiosities. As a nation of Canadians living in an era of high-speed living, Bryson provides a rather sobering, yet celebratory, reality check in reminding us that we are, in fact, “warm wobbles of flesh” that we take completely for granted.

The book is more like a witty and gruesome tour of a highly complex museum than a dense medical textbook. Bryson’s main thesis is that the body is a miracle of self-organization. We are a group of inert materials – the same stuff we find in a pile of dirt – and we somehow decide to be “us.” From the density of the DNA in every cell (which would stretch ten billion miles to Pluto and beyond if woven into a single strand) to the fourteen thousand blinks we make every day, the scope of what goes on inside us is “positively enormous.”

Perhaps one of the most interesting things about Bryson is that he is able to humanize the history of science. Instead of just describing the immune system, he introduces us to the “noble and selfless” scientists who risked their very lives to study it. He tells us about the “harrowing experience” of novelist Fanny Burney, who had to undergo a mastectomy in 1810 without any anesthesia. This is just one of how Bryson keeps the reader interested, even in chapters that are essentially just a refresher on Grade XII biology.

However, the book is not without criticism. As a critic of wellness, one must say that Bryson becomes much sharper – and perhaps more necessary – when writing about how we deal with the form we inhabit. The author argues that we are currently living in a slow-motion “suicide by lifestyle.” He argues that for most of our history, we were killed by infectious diseases. Now, however, we are killed by our own decisions. He argues that 70% of the diseases that kill us today, such as type 2 diabetes and some heart diseases, are “mismatch diseases,” or diseases that occur when our hunter-gatherer bodies are trying to survive in a world of sedentary lifestyles and overeating.

Bryson’s treatment of nutrition is especially interesting to the contemporary wellness seeker. He unmasks the “massive racket” of the antioxidant supplement industry, pointing out that there is no scientific evidence to support the idea that these supplements will counteract the effects of aging. He also unmasks the insidious effects of sugar, pointing out that Heinz ketchup is nearly one-quarter sugar, more sugar per volume than Coca-Cola. His advice on how to deal with this is refreshingly simple: stick to the outside aisles of the supermarket.

Another issue the author addresses is the “more is better” philosophy that is commonly found in medicine. The author argues that America is spending more on healthcare than any other nation in the world. However, America is ranked mediocre at number thirty-one when it comes to life expectancy. The author also addresses the issue of “incidentalomas,” which are discoveries made during routine checkups. These discoveries lead to overtreatment, which is harmful to patients. The author argues that some medical procedures, such as the testing for prostate cancer, are “hardly more effective than the flip of a coin,” leading to surgeries that alter the lives of patients for something that might never have harmed them.

Bryson is at his best when he is debunking myths, and he sets the record straight: “We don’t lose most of our heat from our heads, we don’t use only 10 percent of our brains, and the eight glasses of water a day thing has no basis in science whatsoever.” This is all done in a witty manner, so the book doesn’t feel like a lecture.

The writing moves along at a breakneck pace, and this is perhaps the only flaw with the book. The author is in such a hurry to get to everything from the “Microbial You” to the “Nether Regions” that some subjects, such as the pain of chronic pain or migraines, are dealt with in just a handful of paragraphs. Of course, this is probably done to avoid bogging down the average reader with too much cellular detail.

The prose moves at a breakneck pace, and this may be the only problem with the book. The author is so intent on getting through everything from “The Microbial You” to “The Nether Regions” that he glosses over such things as the suffering that is chronic pain or the intricacies of migraines, but perhaps this is a ploy to prevent the layperson from getting lost in the details of cell structure.

In the last chapters, Bryson’s writing becomes less full of wonder and fuller of urgency. “For every year of increased life expectancy we have gained since 1990, only ten months of that are ‘healthy’.” We have become very good at adding to the duration of our deterioration, but less successful at adding to our wellness. Bryson’s final advice on the secret to life, after reading thousands and thousands of pages and talking to experts, is surprisingly unglamorous: “Eat a little less, move a little more.”

The Body: A Guide for Occupants is a magnificent example of science communication, capable of evoking in the reader a sense of being “cosmic and miraculous,” while also keeping them aware that they are a “warm wobble of flesh” inhabited by trillions of microbes who do not even realize they exist. It is a book that all occupants of a human body should try to read, to understand the manual for the vessel they find themselves in, and perhaps even treat it a bit kindlier.

The post Your Body Explained Like Never Before: A Fascinating Tour from Head to Toe appeared first on Canada's Health Magazine.

The Cave of Constant Darkness.

In 1938, two men took hospital beds into Mammoth Cave, Kentucky, which is one of the deepest caves on Earth, where no sunlight penetrates. Professor Nathaniel Kleitman and Bruce Richardson stayed in total darkness for thirty-two days to find out if our bodies would ever forget how to measure time. They learned that our bodies have an internal, “endogenous” clock that ticks away regardless of whether we have sunlight or not, and it has a rhythm of about twenty-four hours.

We have been biologically programmed with an internal, rhythmic clock that controls our very survival, despite all the artificial lights that surround us.

The internal clock, which is located in the suprachiasmatic nucleus, is a small group of 20,000 nerve cells that orchestrates all the events of our lives, from our core temperature to our metabolism and hormonal secretions. When we do not heed our internal clock, we are not simply “tired”; we are out of synchronization with our bodies.

Being mindful of our internal clock is the first step towards regaining our health.

The Collision of Efficiency and Biology.

We are currently existing in a 24/7 society, which values productivity over physiology. This approach, which can be called an ‘industrialized’ approach, has led to the sleep loss epidemic that the World Health Organization refers to.

For Canadians who are feeling the ‘grind’ of the new economy, sleep deprivation is sometimes not the issue of lacking the strength to make better choices, but rather the result of the way that we have organized our communities.

By becoming supporters of chronodiversity, we can unleash massive amounts of human potential.

The Architect of the Night.

Matthew Walker, a neuroscientist with twenty years of research on the mysteries of the mind, has written Why We Sleep as a scientific intervention. He wants us to know that sleep is not the absence of wakefulness; it is an exquisitely complex, metabolically active process. His work proves that every single organ in the body, and every single process in the brain, is enhanced when we sleep and diminished when we don’t.

Sleep is the single most effective way to reset our brain and body health each day.

Walker’s work has also shown us that sleep has two different masters, or functions: one is called NREM (Non-Rapid Eye Movement) sleep, and the other is called REM (Rapid Eye Movement) sleep. “NREM sleep is like a master gardener, clearing out the weeds of unnecessary neural connections, whereas REM sleep is like a master pruner, strengthening the remaining connections.”

We need these two types of sleep to be smart and emotionally well-functioning.

A National Emergency for the Body.

The effects of this kind of chronic short-sleeping, however, are not limited to the grogginess one feels in the morning. In fact, research has shown that the effects of short sleep are a “significant tax on our physical well-being.” Walker also points out studies that show that sleeping fewer than six or seven hours per night is “strongly linked to a weakened immune system and the onset of various other serious and chronic diseases, including some types of cancer and Alzheimer’s.”

In fact, sleep is not just ‘rest,’ but the brain’s ‘nightly power cleanse,’ helping to process metabolic waste products that have built up in the body during the day.

The Canadian Context: Safety Comes First.

As Canadians face the challenges of our troubled healthcare system, the importance of the role that sleep plays in preventative healthcare has never been more salient. Although it is not possible to ‘sleep our way’ out of the problems that plague our system, recognizing sleep as a basic building block of health, similar to diet or exercise, allows us to begin to advocate for a stronger Canada. In making small changes where we can, we are not simply resting; we are working towards a more caring, better-rested world.

A well-slept Canada is a stronger, more productive, and more compassionate Canada.

Closing Reflection.

We must reclaim our right to a full night’s sleep without being judged as lazy. Sleep is our “chief nourisher in life’s feast,” something that evolution has granted us, which we have foolishly discarded so quickly. Tonight, as you go to bed, remember that sleep is the bridge between despair and hope. By choosing your pillow over your device, you are choosing life, and by extension, all its vibrancy.

The best version of yourself is only one good night’s sleep away.

The post The Nightly Elixir: Why Sleep is the Billion-Dollar Secret to Living Longer appeared first on Canada's Health Magazine.

A Hmong Child, Her American Doctors, and the Collision of Two Cultures.

Where it all started…

Midnight lights buzz at a pitch found only in hospitals. Inside Merced Community Medical Center’s ER, a “Code Blue” broke the hush of handwriting on paper logs. Room B, bright with sterile glow, held little Lia Lee. The child was jerking against seizures labelled status epilepticus by white-coat voices. A circle of medics leaned close. Needles pushed into fragile skin. Air forced past choked tissue. Drugs pumped in heavy waves.

Each move aimed at one goal: keep her breathing.

Just beyond the chaos stood Lia’s mother and father, Foua Yang and Nao Kao Lee – quiet. They were simply watching. What unfolded before them felt like another world entirely. For them, seizures are caused by broken signals in the brain, but qaug dab peg – the spirit catches you, and you fall. They saw a spirit seizing Lia. Instead of urgent medical care saving lives, they saw forceful hands pinning down their child while outsiders poured poisons into her veins, draining something deep inside.

Inside those four walls, barely twenty feet across, two worlds pressed hard against each other. Not only machines beeped – silence between them carried its own heavy sound. One group saw sickness through data. For them, numbers were climbing on screens. For the other, it felt like whispers passed down through generations.

Neither could fully hear what the other said, even though both groups were driven by the same desperate compassion.

Core of the book.

This moment defines Anne Fadiman’s The Spirit Catches You and You Fall Down. It is a work of deep storytelling that reads less like clinical reportage and more like sorrow etched across generations. Though trained as a careful journalist, Fadiman writes with quiet rhythm, piecing together the story of Lia Lee, born in 1982 to Hmong parents escaping the aftermath of America’s hidden conflict in Laos. Behind every fact rests something heavier: effort without result, care leading only to fracture.

Opening these pages means watching sureness crumble. Fadiman refuses to name a wrongdoer. As Sherwin Nuland, doctor and writer, once put it, her story holds no evil figures – nor shining champions either. Instead, faces appear as they truly were: small at times, yet sometimes grand. What kills is not hate. It is the communication strategies that never crossed the gap.

‘Fish soup’ becomes a thread through which Fadiman weaves her story. For the Hmong, naming components fall short. What matters lives in tales of nets, storms, currents, and what elders recall beneath bridges. In much the same way, grasping Lia’s seizures demands more than medical charts. It pulls you into escape from mountain villages, secret alliances with American agents, and broken promises. Finally, silence on wide concrete streets far from any riverbank.

Underlying Premises.

Lia’s situation was full of layers, nothing like the stripped-down method used by most Western medicine. Her doctors – Neil Ernst and Peggy Philp, a married pair working in pediatrics – saw her body as a machine breaking down. These two were skilled physicians, described as bright-eyed, careful, and driven. When the Lees did not give the mix of Depakene and Dilantin exactly as written, the couple interpreted it as putting their daughter at risk. In their eyes, not following directions meant either poor understanding or lack of effort.

Still, the Lees feared the treatment more than the illness. To them, health meant balance, not battle. Pulling out blood-drained life force; once gone, it did not come back. They believed the afterbirth wasn’t trash but armour for the spirit on its journey home. Fits weren’t flaws – they were signals. Her parents thought she might grow into a healer, someone touched by unseen powers. Cold precision in medicine felt like coldness itself.

When beliefs clash.

When beliefs clash like this, harm follows fast. Once, officials decided the parents’ choices put their child at serious risk, so they took Lia away and sent her to live elsewhere. This move came from doctors who thought it would keep her alive, but instead tore everything apart at home. Her health still slipped, showing wilder moods, sharper struggles each day. Losing her cut deep – so deep the Hmong name such pain tu siab (broken liver), meaning spirit gone quiet before death.

The heart of the book beats in this clash between body and spirit. At one point, a physician insists medical facts outweigh family faith when treating a sick child. Yet a therapist replies sharply that calling such logic “fair” misses the cruelty hidden inside it. Saving flesh through operation might cost something else entirely – a soul lost forever. Fadiman doesn’t ease us out of that ache; she holds still while we face it.

One path leads straight to heartbreak, no surprise there. At four years old, following a huge seizure is a shock in itself. And experiencing moments where parents pointed at medicine while doctors named the illness – Lia’s mind never recovered. Movement stopped. Speech vanished. Doctors saw only hours left. But back in her family’s arms, surrounded by plant-soaked baths and constant warmth, she stayed alive much longer. Medically labelled gone, unreachable.

Yet inside those walls? Crowned. Cherished. A girl without words who somehow meant everything.

Fadiman pokes hard at Western medicine, yet her tone carries care. Biomedicine isn’t neutral. It is layered with habits, speech patterns, and assumptions. Much like how a visitor might see Hmong faith in dabs as a strange ritual. What gets called “compliance” turns out to be power dressed as duty, expecting surrender instead of shared effort.

The Uncomfortable Truth.

The book makes you want an answer even when there isn’t one. Crossing such a deep divide doesn’t come with a clear step-by-step path. Still, what Fadiman leans into is dialogue instead of force. Into view comes Arthur Kleinman – a figure trained in both psychiatry and culture studies – who laid out eight straightforward communication prompts to uncover how patients make sense of their condition. He suggests questions such as: “How do you name what’s wrong?” or “What part of being sick frightens you most?” If Lia’s medical team had used those words at the start, then truly tuned in, maybe disaster wouldn’t have slipped away – but grief could’ve sat between them equally.

What happens when medicine meets meaning?

The Spirit Catches You and You Fall Down shakes how you see a medication label. Silence inside a doctor’s office gains weight after reading it. Doctors trace brain signals with machines, and they recognize the ache in a parent’s voice.

Back we come, then, to the hospital room. Machines chirping, parents motionless by the wall. Not about who won or lost. More like this: inside today’s medical world, where everything feels urgent, talking clearly isn’t merely a convenience – it counts as a dire necessity. Do we need to heal bodies? Yes, doctors do that efficiently. Yet Lia Lee’s life whispers something harder for all of us: real care sometimes means stepping into someone else’s way of seeing.

Even when it wobbles under your feet.

The post The Spirit Catches You and You Fall Down By Anne Fadiman appeared first on Canada's Health Magazine.

A compelling “biography” of cancer, from history to science to patient stories. Reads like a thriller but packs a scientific punch.

Some books teach you.
A few unsettle you.
But once in a rare while, a book reorients your understanding of life itself.

Siddharth Mukherjee’s The Emperor of All Maladies did that for me. I picked it up expecting a medical history. What I found was a sweeping human drama – a story where the villain is not a monster from the outside, but a mutation from within.

This is not a book about cancer. This is a book about the human race caught in a 4,000-year war with its own biology.

The Lens: A Biography of a Shape-Shifting Enemy

Rather than conceiving of cancer as the problem in medicine, Mukherjee frames it as an ever-changing character, adapting, resisting, and outwitting us.

Through this lens, the book becomes:

The genius lies in giving cancer an arc — one that forces the reader to confront the uncomfortable truth: as long as we live longer, cancer will always be with us.

Three Micro-Stories That Anchor the Experience

Mukherjee never overwhelms with data; he anchors insight in human stories. A few stayed with me:

But none of these stories spoil the book; they light up the soul.

How the Book Changes You

Before reading, I thought about cancer as a modern epidemic – the nightmare of our times.

After reading, I realized:

The central message of Mukherjee’s brilliant book lands with quiet force: to understand cancer is to understand ourselves – our biology, our limits, and our relentless will to endure.

What Mukherjee does really well is

Where the Book Falters (Just Slightly)

The ambition the thousands of years, the dozens of therapies, and multiple scientific revolutions can be overwhelming at times.

You may need pauses to absorb the weight of what you’re reading.

But this density is also its power.

Mukherjee respects the reader enough to tell the full truth.

Verdict: Read This If…

This is not merely a book about disease.

It is a book about human perseverance, written with the precision of a scientist and the empathy of a storyteller.

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I am not a big fan of technical writing. But visiting hospitals as a patient or a caregiver gives you a different perspective on life and living. The same happened to me while reading the book of the month.

An Unflinchingly Honest Memoir

The theatre is silent except for the rhythmic beep of monitors and the low hum of ventilation. Under the intense white light, a landscape more alien and intricate than any on Earth is exposed: the living human brain. It pulses with a gentle, hypnotic rhythm, its glistening surfaces a tapestry of veins and arteries. This is the domain of Henry Marsh, a senior neurosurgeon whose memoir, “Do No Harm”, invites us into this sanctum of impossible choices.

With a scalpel in hand, he maneuvers around the fragile jelly holding the entire world of a person: his memories, his ability to love, even his consciousness. The tumour he is after is nestled deep within this vital tissue. A millimetre too far to the left, and the patient might not ever be able to speak again. A fraction too deep, and paralysis follows. Every move is a calculated risk, every decision a tightrope walk between a miraculous recovery and abysmal failure. It is a place of profound meaning but also one of profound terror.

This is the world Marsh lays bare in his unflinchingly honest memoir. It is not a story of heroic triumphs but a textured and deeply human account of what it means to hold another’s life and self in your hands.

Turning Toward Uncomfortable Reality

Modern culture often treats surgeons as infallible gods in scrubs, figures of ultimate authority and skill. We need to believe in their perfection as a shield against our own fear. “Do No Harm” systematically dismantles this myth. Marsh turns his gaze toward the subject medicine itself often avoids: the fallibility of the doctor. He writes not to shock, but to reveal a more complex truth—that neurosurgery is a profession of profound uncertainty, where success and failure are often separated by the thinnest of margins.

The title of the book is a direct reference to the Hippocratic oath, an ideal which Marsh reveals is fraught with compromise. Brain surgery often causes harm as part of the attempt to help. This is what makes Marsh’s achievement so radical: he confesses to this without reserve, confronting us with the uncomfortable reality that, after all, doctors are only human.

The Weight of the Philosophical Detachment being in the Gown

Each chapter in “Do No Harm”, named for a specific medical condition, plunges the reader into another high-stakes drama. We are there for the triumphs, like the delicate removal of a tumour from a pregnant woman, which saves her sight and her life. But Marsh gives equal, if not more, weight to the disasters. He refers to the “small cemetery” every surgeon carries within them, that place of bitterness and regret where one revisits one’s failures.

He recounts in agonizing detail the cases that haunt him: a young man left paralyzed after a marathon surgery went catastrophically wrong in its final hour; a misdiagnosis that led to a patient’s death, and the subsequent anger of the family. He is equally candid about his frustrations with the bureaucracy of the National Health Service (NHS), describing senseless inefficiencies and management directives that often stand in the way of patient care.

What elevates the book is Marsh’s philosophical introspection. Having studied philosophy, politics, and economics at Oxford before turning to medicine, he grapples with the profound mysteries of his work. How can the physical “jelly” of the brain produce the immaterial magic of consciousness? He is searingly honest about the emotional detachment required to perform his job, and the moments when that detachment shatters – particularly when his own infant son required brain surgery.

The Courage of Coming to Terms with Being Fallible

Ultimately, “Do No Harm” is not a book about medicine as much as it is a book about humanity. Marsh’s greatest contribution is not his pioneering work in awake craniotomies, but his courage in admitting his fears, his errors, and his regrets. In a profession that demands an aura of certainty, this vulnerability is a radical act of generosity. It gives patients and their families a more realistic, compassionate, and empathetic understanding of the immense pressures doctors face.

Marsh reveals that the most compassionate approach lies not in pretending to be infallible but in discussing the shared vulnerability of doctor and patient alike.

A Canadian Reflection

For Canadian readers, Marsh’s candid critique of a public health care system will deeply resonate. The frustration he has with budget cuts, maddening IT systems, and top-down managerial dictates mirrors debates of Canadian health care to this day. Such wide-ranging issues as resource allocation challenges, tensions between administrative efficiency and patient-centeredness, and the inordinate burdens on medical professionals are universal themes.

Marsh’s memoir thus serves as a strong reminder that, even as the structures of our health systems may differ, the human drama at their core is the same: the need for candour, compassion, and a willingness to acknowledge and confront failure transcends borders.

Closing Note

“Do No Harm” is a challenging, elating, and deeply affecting book. Marsh’s prose is both beautiful and unsparing, taking the reader along with the triumphs and tragedies of his career with remarkable candour. It may make some readers anxious, but it will leave all with a renewed appreciation for the fragility of life and the immense courage it takes to intervene.

Henry Marsh does more than just pull back the surgical curtain. He invites us to look at the flawed, fearful, and compassionate human being holding the scalpel, and in so doing, he reshapes our understanding of what it means to heal, to fail, and to care.

The post Book Review: “Do No Harm” by Henry Marsh appeared first on Canada's Health Magazine.

A Scene Few of Us Imagine

The students lean in. Their hands hesitate for a moment, then steady. Every movement here—the awkward first cut, the pause before a correction, the repetition of a gesture—will one day be performed in an operating room, only then the stakes will be measured in beating hearts.

It’s an image that can feel unsettling, even invasive. Yet behind the strangeness lies something profoundly generous. Someone once alive, with memories and attachments, chose to become a teacher after death.

This is the world Mary Roach explores in Stiff: The Curious Lives of Human Cadavers. It is not a book about dying, but about the afterlives of bodies. And in her hands, what could have been morbid becomes both illuminating and unexpectedly funny.

Turning Toward What We Avoid

Modern culture keeps death at a distance. We outsource it to hospitals, funeral homes, and institutions. The language is softened, the details hidden. Roach refuses to play along. She turns her gaze directly on the subject most of us avoid and asks: what do the dead actually do for the living?

The answer, it turns out, is far more than we realize. Cadavers have been the silent collaborators behind many of the advances we now take for granted: surgical breakthroughs, safer cars, forensic tools that bring justice to families. Roach’s achievement is to bring these contributions to light without stripping them of dignity.

The Hidden Work of the Dead

Each chapter of Stiff is a doorway into a space few readers have entered. In one, Roach describes how crash-test facilities once relied on cadavers before switching to modern dummies. These bodies endured impact after impact, giving engineers data no machine could replicate. The seatbelt you click into place every morning is part of that legacy.

In another, she takes us to a “body farm,” where donated corpses are left outdoors in different conditions so scientists can map how decay unfolds. It’s unsettling to read about the choreography of flies, maggots, and microbes, yet that research allows investigators to pinpoint time of death with startling accuracy. Without it, many murder cases would remain unsolved.

And then there are the classrooms, where donated heads and limbs allow medical students to make mistakes in a place where mistakes do not kill. Every confident surgeon, every smooth incision in a hospital, is built on hours spent learning from the dead.

What makes the book so readable is Roach’s voice. She never sensationalizes, never treats cadavers as props for shock. Instead, she writes with journalistic precision and a comic touch, as if she knows when the reader needs a joke to cut through the tension. Her humour is never cruel; it’s the kind that makes unbearable material just bearable enough to confront.

The Radical Act of Generosity

As strange as the details may be, Stiff is not really about the macabre. It is about generosity. Every cadaver in Roach’s pages was once a person who chose to keep giving after death. Their bodies became data, practice, or evidence. Their final act was one of service, an extension of community that most of us never consider.

In a culture that often measures generosity in money or hours, this is generosity at its most radical. Roach captures this tension perfectly: the mix of strangeness and nobility, of science and service. Reading Stiff is to realize that the very things we rely on for safety and healing—the airbag that deploys in a crash, the surgeon who saves a life—are built on these silent contributions.

A Canadian Reflection

For Canadian readers, Roach’s message resonates in a particular way. We often speak about giving back, about serving community beyond ourselves. Stiff presents that ethic in its most extreme form. It asks: what does it mean to contribute after you are no longer here to see the result?

It is an uncomfortable question, but also an inspiring one. In a society that tends to sanitize death, Roach restores a sense of meaning to what happens after. The dead are not simply gone. They remain present, woven into the fabric of the everyday—into the safety features of your car, the precision of your doctor, the justice of a solved case.

Closing Reflection

Stiff is not for the faint of heart. Some readers may put it down for a moment, unsettled by the imagery. Yet those who keep going will find a book that reshapes how we think about both death and life.

Mary Roach transforms the macabre into meditation. She makes you laugh in one sentence and pause in the next. And when you finish, you carry with you a new respect—not only for the science that cadavers make possible, but for the people who chose to remain useful even after their last breath.

Five Takeaways from Stiff

The post Book Review: Stiff: The Curious Lives of Human Cadavers by Mary Roach appeared first on Canada's Health Magazine.

A Tour Through the World of Quacks, Claims, and Questionable Cures

Why This Book Matters for Ordinary Readers

In Bad Science, British doctor and writer Ben Goldacre takes us on a lively ride through the world of health misinformation. He shows us how shaky research, clever marketing, and media excitement distort our understanding of science. This isn’t a book for medics in white coats. It’s for you and me — people who simply want to make sense of the flood of health advice coming our way every day.

Goldacre has a rare gift. He writes about complicated science without being boring. He is funny even when he reveals how easily we are fooled. And he gives us tools for spotting the deceptions so we can protect ourselves.

The “Oh No, Not That Too?!”” Moments

There are many remarkable examples in the book. Some are especially meaningful to Canadian readers:

Why We Keep Falling for It

Some of Goldacre’s charm lies in the fact that he never blames regular people for being misled. The real culprits are systems that incentivize hype over reality. Media organizations hunger for attention. Businesses hunger for sales. Self-proclaimed gurus hunger for power. In that competitive market, cautious science is hardly ever given a hearing.

Goldacre shows us science not as facts, but as a process — slow, cautious, and self-correcting. He reminds us that one study is never the whole story. Science builds up like a recipe: it needs many good ingredients, tried many times over, to make a reliable dish.

Analogies That Stick

Goldacre is at his best when using down-to-earth metaphors. Here are some that stuck with me:

These analogies make complex ideas easy to understand and remember, even for readers who haven’t studied science since high school.

Questions Worth Asking at the Dinner Table

Bad Science will leave you wanting to ask questions — not in some boring academic way, but in the way you would in a lively discussion over a meal or a cup of coffee:

1. Why are we so attracted to miracle cures, even when we think they are too good to be true?
2. Should learning to read health news be a part of basic literacy in Canadian schools?
3. What is the media’s responsibility in fact-checking health stories prior to publication?
4. Can placebos have a healthy role to play in modern medicine if we are honest about it?
5. How do we balance open-mindedness to new possibilities with skepticism toward untested assertions?

The Emotional Punch

For all the humour, there is a serious sting to this book. It hurts to recognize how regularly we have depended on awful evidence. Maybe we bought some mega-expensive supplement, shared a miracle headline on Facebook, or worried about an overblown risk.

But the book also sets us free. Once you see the smoke and mirrors, you are not so easily fooled. You learn to wait, to say, “Show me the evidence.” You’re empowered to challenge clever ads and suspect gurus.

Goldacre never does tell us all to become scientists. Instead, he gives us easy habits. Look for large, replicated trials. Distrust absolute claims. Look who might profit from a story. These habits form a kind of everyday armor against bad information.

Why Canadian Readers Should Care

In Canada, we are in a country where we trust health professionals and believe in universal healthcare. But we’re just as susceptible as anyone else to wellness trends, online misinformation, and media sensationalism. From detox teas peddled on Instagram to vitamin hype on pharmacy shelves, the need for keen thinking is constant.

Bad Science offers us just that — logical reasoning, with a pinch of humour. It serves as a reminder that science is the best friend of hope. Good science saves lives, if only we can safeguard it against manipulation.

The Verdict: A Must-Read Vaccine Against Health Hype ★ ★ ★ ★ ★

Ben Goldacre’s *Bad Science* is not just a book. It’s a survival guide for the health consumer of today. It arms us with skepticism, wit, and curiosity. It’s the kind of book that makes you double-check what you put in your body and what you share on social media.

Hot Take for the Group Chat:

Goldacre just made me side-eye half of the bottles in my kitchen cabinet. I’m pretty sure I have to take a few things back to Costco.”

P.S. If you have a family member who falls for every forwarded WhatsApp solution, gift wrap this book. Consider it a public service.

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