Extra Life. The Astonishing Story of How We Doubled Our Lifespan by Steven Johnson

"The average person born in the United States a century ago could expect to live a little more than forty years. Today that number is just below eighty years. And Americans are four times more likely to live into their hundreds than they were a few decades ago." 

In Extra Life, science author Steven Johnson explores the many reasons why this is so beginning with the discovery of a way to vaccinate against the speckled monster, as smallpox was sometimes called. In Chapter 1, Johnson delves into the earliest history of how mankind worked to defeat the scourge of smallpox. 

In Chapter Two, solving the mystery of cholera, a disease common in the crowded cities of the nineteenth century, which killed millions.  In this chapter, Johnson focuses on the 1854 Broad Street cholera outbreak. 

Chapter 3 explores the efforts of W.E.B. Du Bois, a civil rights activist and author to improve the lives of Black Americans. Du Bois mapped data in an area of Philadelphia called the Seventh Ward, that was the city's largest Black community. His research demonstrated that African Americans were "dying at a rate about 5 percent higher than their white neighbors." Du Bois showed that this shortened life expectancy was due to poor living conditions, a consequence of the way American society was organized.

The pasteurization of milk is discussed in Chapter 4. In the United States, drinking a glass of milk in the 19th century could kill you, especially if you were a child. As cities grew larger, providing safe milk became a serious problem without refrigeration. Johnson goes into detail on how many cities had large herds of cows, and the practices to produce large quantities of milk that ended up killing children. Louis Pasteur's discovery that heating liquids killed off germs was only the beginning. It would be a half century later before pasteurization was a standard practice. But it's implementation lowered the death rate in children.

In Chapter 5, Beyond-The-Placebo-Effect, the regulation and testing of new drugs is examined. Many new drugs were never tested and only pulled off shelves when there were deaths. It would be well into the 20th century before RCTs and other practices were implemented to ensure drug testing and efficacy.

In Chapter 6, the discovery and impact of antibiotics is detailed while Chapter 7 delves into the development of safety features in cars, as automobiles became the predominant mode of transportation. Chapter 8, Feed the World explores the decline of famine due to our ability to produce ammonium nitrate (a compound in artificial fertilizer) and to mass-produce meat protein. In Chapter 9, Johnson reviews all of the amazing innovations that have increased human life expectancy as well as suggesting that we need to continue working and discovering new ways to improve health and quality of life.

Discussion

Extra Life offers younger readers a shorter version of Johnson's book of the same name. In this version of Extra Life, Johnson provides summaries of the same major innovations that improved quality of life, health care and safety, that he explored in his book for adult readers. In considering these innovations, Johnson delves deeper into the backstory, either identifying unsung heroes or exploring how such innovations became a matter of public policy.

One such unsung hero was Frances Oldham Kelsey who refused to approve the use of thalidomide as a sleeping pill in the United States, thus saving tens of thousands of babies from being born with malformed limbs. Another little known hero was Nathan Straus, a German immigrant to America, who was deeply concerned about child mortality and who was determined to provide a supply of safe milk to young children. He not only funded pasteurization plants but fought to have unpasteurized milk outlawed. 

An example of how Johnson delves deeper into the backstory is the story of the development of the smallpox vaccination. In Extra Life, readers will learn about Lady Mary Montagu, who contracted smallpox at the age of twenty-five and survived to travel with her husband to the Ottoman Empire in 1716. There she learned about a custom of exposing children to smallpox - a procedure now known as variolation. It was this technique, brought to England by Montagu that allowed Edward Jenner to develop his first vaccination for smallpox. As Johnson writes, "On the one hand, we have the satisfying narrative of brilliant Edward Jenner, inventing vaccination on one day in 1796/ On the other, we have a much more complicated story, where part of an idea emerges halfway around the world and migrates from culture to culture through word of mouth, until a perceptive and influential young woman takes note of it and imports it to her home country, where it slowly begins to take root, ultimately allowing a country doctor to make a key improvement on the technique after decades of using on his own patients."

One of the main points Johnson makes about the innovations that contributed to increasing our lifespan, is that these are often not just the work of one "genius" or brilliant scientist, but often a collaborative effort. A perfect example of this is the discovery of penicillin, which is attributed to Robert Fleming. However, the story is much more complicated than that and as Johnson writes, "The triumph of penicillin is actually one of the great stories of international multidisciplinary collaboration. It is a story of a network, not an eccentric genius. Fleming was a member of that network, but only one of many. He seemed to have not entirely grasped the true potential of what he had stumbled upon."

It's clear from Johnson's book, that the innovations he highlights have made significant strides in lengthening lives around the globe. And he encourages his readers to be the next generation in this constant goal, of improving lives. Extra Life is engaging, informative and filled with many interesting but little-known stories that make it a wonderful read. 

Johnson includes a section on Recommended Reading, Notes for each of the chapters, and a Bibliography. This well-written, short book is highly recommended for young readers who are interested in medical history, and public health. 

Book Details:

Extra Life. The Astonishing Story of How We Doubled Our Lifespan by Steven Johnson
New York: Viking Life      2023
121 pp.

Fred & Marjorie: A doctor, a dog and the discovery of insulin by Deborah Kerbel

Dr. Frederick Banting had just finished a long surgery at the Hospital for Sick Children. On his break he walked by a room where the parents of a young girl are just being told their daughter has diabetes. As there is no cure, she has a few months, maybe a year before she will die. As Fred and another doctor try to relax on the steps of the hospital, a stray street dog begs for food and Fred gives it a bun.

At a hospital some of the sickest patients were those with juvenile diabetes. In 1920 doctors knew that diabetes was somehow connected to problems with the pancreas. But the connection was not understood. What was known was that the only treatment was starvation.

Meanwhile the stray dog continued to wander the streets of Toronto, even hanging around the hospital.

After his residency at Sick Kids ends, Fred left Toronto for London, Ontario where he set up a small medical practice. But business was slow, so Fred decided to visit the University of Western Ontario to see if he could obtain a teaching position. He was able to work as a part time instructor in anatomy and surgery.

A few weeks into his teaching job, Fred had to prepare a lesson on the pancreas. It was something he knew nothing about, so he spent time reading and researching. And then he had idea as to how to determine the pancreas's involvement in diabetes.

On the advice of Professor Miller from the University of Western, Fred sought out Professor J.J.R. Macleod at the University of Toronto. Macleod, a professor of physiology listened as Fred described his idea. It was to remove the pancreas from a dog making it diabetic, after which they would tie of the external ducts in the pancreas of a second dog to isolate whatever substance the pancreas is making. This substance would then be injected into one group of diabetic dogs to see if they regained their health. 

Professor Macleod was skeptical because Fred was an orthopedic surgeon with no research experience. Nevertheless, Fred begged Macleod for a lab to conduct his experiment and a team of dogs. Macleod agreed but told Fred he had to wait until the end of the school year for a lab to be free. The stage was now set for the unbelievable discovery that would save the lives of millions of people from a slow death due to diabetes.

Discussion

Frederick Banting and Charles Best's work to isolate what would become known as insulin, was one of the most significant medical discoveries of the the twentieth century. Until their groundbreaking work, insulin which is the hormone produced by the pancreas to allow the body to process sugar, was unknown at the time. Extracting, identifying and developing a way to purify it so it could be given to diabetics, saved hundreds of millions of children from death. It was so monumental, that the 1923 Nobel Prize in Medicine was awarded to Banting and Macleod.

Frederick Banting was born on a farm near Alliston, Ontario in 1891. Initially Banting enrolled in a general arts course at the University of Toronto in 1910 but he did not complete his first year. He then enrolled into the medicine program in 1912, with a specialty in surgery. With the onset of World War I, Banting attempted to enroll in the Canadian Army but was rejected due to poor eyesight. He was accepted into the Canadian Army Medical Service. Banting graduated with a bachelor's degree in medicine in December, 1916. 

Banting was eventually sent to England where he first worked at the Granville Hospital. Banting was sent over to the front lines and was wounded in the Battle of Chambrai. After spending some time healing in hospital, Banting eventually returned home where he worked at the Christie Street Hospital for Veterans in Toronto. After he was demobilized, Banting completed his internship in surgery at the Hospital for Sick Children. 

The graphic novel Fred & Marjorie picks up Banting's story at this point. His idea for a possible treatment of diabetes came to him, October 31, 1920 while takes notes from Moses Barron's in preparation for a lecture. Initially he presented his idea to Dr. F.G. Miller at the University of Western Ontario who referred him to Prof. J.J.R. Macleod at the University of Toronto. Although Macleod was skeptical of Banting's idea, he made arrangements for Banting to carry out his experiments at Toronto in the spring. With the help of his assistant, Charles Best, a recent graduate of physiology and biochemistry, the two men worked diligently, overcoming many problems. By the end of July they were able to inject one of the diabetic dogs with the extract from the pancreas which resulted in lowering the animal's blood sugar level. They knew they were on the right track.

In Fred & Marjorie, Kerbel focuses on Frederick Banting's contributions, and his relationship with a stray dog he named Marjorie. In her retelling of this remarkable event, Kerbel notes that it is "based mainly on firsthand accounts as they were recorded at the time and remembered years later, although some parts of the timeline were condensed in the interest of pacing." As a result, this graphic novel is short, and to the point, focusing on the most important events in the time line it covers, and limiting the telling to just the two major characters, Banting and research as well as his relationship with one of the research dogs, Marjorie.

Marjorie was also known as Dog 33. Her life before she became one of the laboratory dogs was imagined by the author, but her contributions to the experiment were real: she survived very long on the insulin treatments, proving that there was a way to treat diabetes.

In her note titled, An Ethical Dilemma, Kerbel  discusses the use of animals, and in this case, dogs in medical experiments. She mentions that Banting experienced conflicting emotions about the use of dogs in the experiments. He was after all, taking healthy dogs and making them diabetic in order to test his theory that something produced by the pancreas controlled the level of sugar in the blood. Kerbel captures some of Banting's conflict in her story. She portrays Banting developing a friendship with many of the dogs, despite Charles Best telling him researchers should never allow themselves to become emotionally attached to the animals. However Banting, who grew up on a farm and who loved animals, couldn't help himself. There are panels showing Banting concerned for the dogs, making sure they get out of the stuffy, hot rooms for some air during the summer heat, and even having their pictures taken because he considers the dogs to be heroes. 

Eventually the stray whom Banting names Marjorie becomes part of the research and is eventually chosen for the most important step of their work, a longevity experiment. Kerbel portrays Banting's intense emotions when he knows that Marjorie, surviving seventy days on the pancreatic extract, must be put down.The panels show Banting in tears, devastated at her death.

Fred & Marjorie is illustrated by Canadian artist, Angela Poon.

Fred & Marjorie will appeal to fans of graphic novels, to those interested in science and Canadian scientists. Short and sweet, beautifully illustrated, this graphic novel is engaging and informative.

You can read more about the discovery of insulin from the University of Toronto's website, The  Discovery  and Early Development of Insulin: https://insulin.library.utoronto.ca/

Book Details:

Fred & Marjorie: A doctor, a dog and the discovery of insulin by Deborah Kerbel
Toronto: Owlkids Books     2021
55pp.