I recently spoke with him about the book. What follows has been edited for length and clarity.
You make a lot of jokes throughout the book. How is humor important to our health?
For one, it can help to highlight hypocrisy and inconsistencies in a way that other modes of communication don’t. It’s also just good for you, which you can see in this story I tell about a woman, Beth Usher, who is a certified humor professional. As a doctor you might scoff at that title, you know, like it’s New Age trivial stuff. But it’s not. Beth had to have half of her brain removed, ultimately by Ben Carson, to fix an extremely rare condition called Rasmussen’s encephalitis that was causing her to have hundreds of seizures every day at the age of 5. He grabbed a bunch of headlines and fame for Beth’s surgery, and it was miraculous, but afterward she was left by medical science to live life with half a brain. That’s it. That was medical science’s solution. The idea of making life livable afterward, and making her happy, that came through her connections in the world of professional humor. And now she speaks and works with people to help them find humor in their lives. If you look back at her story and what made the biggest relative differences — medicine was able to keep her from not dying. That’s obviously huge. But in terms of making life good, that was the certified humor professional program.
Why is it important to drink Vitaminwater?
I say this many times in the book, that if you aren’t getting at least 10 doses of Vitaminwater a day, you need to worry.
But seriously, I think one of the most interesting arguments you make is that the knowledge necessary for answering what might look like silly questions is actually important to personal health. Is the idea that ignorance contributes to problems, like people drinking sugar water disguised as something healthy?
Yes, that’s it. We do need vitamins, but if you eat a marginally balanced diet, even in our modern food system, you will get your vitamins. The word really refers to an array of chemicals that have no related structure or function. The first one that was discovered was thiamine. It was found to be vital to existence, in that if you were deficient you got diseases. (The word vitamin comes from “vital amine.”) Soon it became evident that there were other compounds that people needed, which upended popular germ theory at the time, the idea that disease was caused by the presence of something. Now there were diseases — scurvy, beriberi, rickets — that were caused by the absence of something. It was almost like magic that you could cure someone with scurvy, bleeding to death out of every orifice, just by giving them an orange. So at the time it made sense that taking more of these life-giving compounds, these vital amines, would be better for you. We know that’s not true, but marketers still use that angle.
Another theme of your book is misallocated resources, financial and mental. We make bad decisions with our money and time.
Absolutely. Medicine is a place that is classically bad at allocating resources in a way that is efficient for improving health. We often focus on fancy-seeming lifesaving therapies, but don’t think enough about how to take limited resources and give quality life years to as many people as possible. As a doctor, I know that we don’t tend to think about our career in terms of maximizing the amount of health in the world. We tend to think about things on a case-by-case basis, and we’re moved by stories of individuals that make miraculous recoveries, or pioneers of high-tech advancements, which get all the awards and all the press. But with regards to human capital and financial investment in these advancements, they may not be as good as simply adding bike lanes or making sure that people have access to a high-quality food system and safe places to sleep at night.
That brings up another problem. Even if we want to invest in something like a high-quality food system, it feels like there’s no agreement about what that looks like. Is it paleo? Is it vegan?
I know, as someone in journalism, that my audience hears about points of conflict and fads, because that’s what gets publicized. In fact, though, most experts in food and nutrition do agree about what’s healthy food, and there’s been a basic consensus on what is healthy for a long time. There have been diversions, like the low-fat craze, but the baseline has generally remained constant. Fresh fruits and vegetables, whole grains, nuts and seeds and legumes — eating a diet heavy in those is most likely to support a healthy life.
One complicating factor, which you touch on frequently, is financial conflicts of interest — corporate research funding in food and in supplements. If our collective health depends on understanding these basic consensus truths about diet, trust is a big problem. Which voices do we trust?
If you see people who have complexity and nuance in what they are saying, and aren’t trying to turn you against a huge group of people — “The Medical Establishment,” or “The Media” …
You’re just saying that because you’re both of those.
[laughs] Right. Of course, these kinds of broad sweeping claims, the idea that everyone who is involved with research or distributing the truth is corrupt, that’s nonsense. The people who say that are trying to create a space where they can claim anything, like that their buttered coffee improves brain capacity. I criticize financial conflicts of interest, but not by saying that you can only trust me, or you can’t trust the establishment on anything.
You highlight how we fall in love with the extremely expensive robot that performs surgery, or the talented surgeon, but we don’t romanticize the people who are in the trenches every day, making sure that you get exercise, eat healthfully, don’t become obsessed with impossible beauty standards.
There’s something about professional medical knowledge that is like a badge of honor. When I was in medical school I was proud, and I don’t think at that age I would have been as proud to be helping get bike lanes put into cities.
Which, in a way, brings us back to Ben Carson, who is in charge of the Department of Housing and Urban Development. You talk about that in depth, the idea that where you live affects health in profound ways. Changing a neighborhood is like a medical intervention that might affect far more lives than a flashy new surgical technique, right?
We have an image in the prologue of the book based on a pyramid developed by the Centers for Disease Control and Prevention. At the very top of the pyramid are clinical interventions, but the base is socioeconomic conditions and surroundings. The health-care system in the traditional sense is far from trivial, but on a large scale most of what determines our health and longevity is day-to-day decisions we make, the environment we live in, how much stress we are under, how much sleep we get. And these are all factors that may seem like less sophisticated problems than what might be solved with brain surgery, but are at once more complex, and solving them we stand to gain much more. We know there are huge discrepancies in life spans in L.A., a difference of 10 years between West L.A. and Watts. That won’t be fixed by doctors, at least not in the traditional sense.
This is hard to do — to think about individual health, and specific interventions, but also to think about ourselves as part of a community.
Anecdotes are powerful. We like to hear individual stories, stories about miraculous recoveries, not piles of impersonal statistics. That’s what we’re moved by, the story of one kid who had an adverse reaction, and we don’t want our kid to be that kid. So I try to acknowledge that in the book, but also build stories of individuals into a broader narrative of what health is and how to think about it.
It reminds me of another image from the book, of people walking in a park, that’s labeled “immune system.” That’s in the section where you answer the question “Can I boost my immune system?” How do you get from people wondering if they can prevent catching colds by taking vitamin C to that image?
I’m very interested in the idea of the immune system. It was the first bodily system, to my understanding, that didn’t correspond to a specific set of physical organs. Instead, it was a diffuse network of cells throughout our body, and includes the skin, which acts as a barrier to microbes. We initially thought of it as what defended “self” from “other,” but now we understand that the system is interacting with the “other.” We know this about our microbiome now, too, that it interacts with the environment, and we can’t think of ourselves as separate individuals walking around defending ourselves from the bad things outside of us.
That’s amazing, the idea that our immune system is somehow collective.
Yes, I love the idea that your immune system is also made up of the people you just interacted with, and whatever you’ve gotten on your hands, and these factors are shaping our biome, which in turn shapes our immune system. It’s all connected, it’s all a big web.
It’s so hard to wrap my mind around, because I’m so invested in the idea of myself as a self-contained, autonomous thing, that protects itself. And that gets in the way of believing that investing in the health of my community is, actually, investing in my own health.
It’s a very liberal understanding of the body. Would you want to live at the end of a cul-de-sac, and fortify it with a huge wall, and watch as the world around you sinks into poverty and crime? What, will you just never leave your compound? Hire armed guards? What does your existence become? People think they want everything for themselves, but they really don’t, and they won’t thrive that way. And that’s how the body works. That’s how health works too.