Books

Here you will find the reviews sorted alphabetically by book title.

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Las leyes de la medicina: apuntes acerca de una ciencia incierta, de Siddhartha Mukherjee

Although this is a fairly short book, barely seventy pages, it must be considered a key work in order to reflect on the nature of medicine as a science and the principles that should govern the relationships between healthcare and patients It should not be overlooked that the author, Siddhartha Mukherjee is a doctor specializing in oncology and research and in 2011 he received the Pulitzer Prize for the book The Emperor of All Maladies.

Right from the start Mukherjee informs us that “this book is about information, uncertainty and the future of medicine” (1) and he does so through his personal experiences. Thus, the author tells us how during the first year of residency, in 2000, he read a book of essays entitled La ciencia mes jove, which became a major life influence. In fact, during his reading the young doctor wondered if medicine is a science and if it has laws. 

From this entry, the author describes the three laws that medicine has in his opinion. The first law states that strong intuition is much more important than weak evidence and explains this through the story of a patient who suffered from unexplained fatigue and weight loss. And although at first glance it looked like it could be cancer, intuition led him to ask for an HIV test (2). The doctor explains that “in medicine, every diagnosis can be considered a game of probabilities (…) And at this point a premise comes into play that, at first sight, may seem peculiar: a test can only be correctly interpreted in the context of prior probabilities”.(3)

The second law points out that “normal” cases teach us rules; the “exceptions” teach us laws. To explain this, he not only uses two very powerful medical examples, such as mothers of children with autism and a genetic discovery about cancer. In this case it also explains how it was discovered that the planets orbit around the sun making ellipses and not circularly. The chapter ends with a very powerful sentence, which shows us the need to go further in tests and experiments, “And, the more we alter the physiology, the more variations we will see in the reactions and, therefore, the closer we will have to discover its hidden and internal logic”(4).

The third law states that for every medical experiment there exists a perfect human bias. Mukherjee believes that in medicine biases are particularly acute because of “hope: we want medicine to work. Hope is something beautiful in medicine – its most tender core – but also its greatest danger”(5). 

Ultimately, the author believes that the three laws described are personal, but adds that even if there are others, “I suspect they will be related to the nature of information and uncertainty”. And he adds, “doctors – Voltaire wrote – are men who prescribe medicines of which they do not know much, to cure diseases of which they know even less, in human beings of which they know nothing at all”(6).

1. Mukherjee, S. (2017). Las leyes de la medicina: apuntes acerca de una ciencia incierta  (p. 5). Empresa Activa

2. Mukherjee, op. cit., p.25

3. Mukherjee, op. cit., p.27 

4. Mukherjee, op. cit., p.49

5. Mukherjee, op. cit., p.59

6. Mukherjee, op. cit., p.70

Mitochondria and the Future of Medicine, by Lee Know.

Mitochondria, the organelles responsible for supplying the chemical energy for cellular activity, are the protagonists of this book divided into three main sections: The origins and evolution of mitochondria in human physiology; The Dark Side of Strength: Health Conditions Linked to Mitochondrial Dysfunction, and finally, Nourishing Strength: Nutritional and Lifestyle Factors to Improve Mitochondrial Health.

In the first chapter, interesting notes are made about the relationship between aging and mitochondria. So, in these pages it is clearly explained that “free radicals don’t damage the cell as much as we think. We produce a number of antioxidant enzymes that mop them up, and of course, if the cell does get damaged, there are repair mechanisms, and these are constantly at work. But the free radicals linked to aging do specifically damage the mitochondria, and especially their vulnerable DNA, which doesn’t have the repair mechanisms the rest of the cell has”(1).

In the pages dedicated to the Dark Side of the Force, diseases involving a malfunctioning of the mitochondria are described, such as cardiovascular, neurodegenerative, diabetes, infertility and cancer, among others. One of the most interesting points is the study of mitochondrial disease as a primary disease. That is, when it already exists from birth. Thus, for example, the author indicates that “a recent study of dilated cardiomyopathy found that about one in four patients (25 percent) had mtDNA mutations in the heart tissue”. Other mitochondrial disorders caused by mtDNA mutations are irritable bowel syndrome, diabetes, anemia or liver failure, among others (2).

The last chapter is focused on improving mitochondrial health through nutrition and lifestyle. For example, in one section the author talks about ketogenic and calorie restriction diets and points out that “now, growing evidence suggests that mitochondrial dysfunction and reduced bioenergetic efficiency occur in brains of patients with Parkinson’s disease and Alzheimer’s disease” (3). Lee Know also discusses the importance of moderate exercise. He thus indicates that “who are physically fit and active produce far fewer free radicals in the mitochondria than sedentary individuals do (…) During physical activity, physically fit and active produce far fewer free radicals in the mitochondria than sedentary individuals do”(4).

(1) Know, L. (2018). Mitochondria and the Future of Medicine  (p. 47). Chelsea Green Publishing

(2) Know, op. cit., p. 105

(3) Know, op. cit., p. 171

(4) Know, op. cit., p. 182

The telomere effect, by Elizabeth Blackburn and Elissa Epel

After finishing my degree in Pharmacy, this was the first scientific book I read. Certainly, I had touched telomeres very lightly during my studies, but I wanted to go deeper with the help of two experts. Elissa Epel is a professor in the Department of Psychiatry at the University of California, San Francisco, and Elizabeth Blackburn was awarded the Nobel Prize in Medicine in 2009 for discovering the enzyme telomerase.

The book, of almost 400 pages, is divided into four parts. The first focuses on the biological description of telomeres, while the second focuses on how stress, negative thoughts, depression and anxiety affect telomeres. Then, the third part shows some guidelines to protect the cells and, finally, the last forty pages explain how pregnancy and childhood influence the quality of telomeres. 

Among the concepts that are developed in the first pages, I would like to highlight the idea of ​​”Inflamm-Aging”. At this point, the authors explain that when a cell’s genes are damaged or its telomeres are too short, the cell knows that its DNA is in danger. For this reason, the cell reprograms itself and “releases molecules that can travel to other cells and ask for help” (1). But when telomeres have an abnormal response to damaged DNA, there can be an increase in pro-inflammatory cytokines that travel through the body and set off chronic inflammation. A territory suitable for the growth of cancer is therefore produced. 

A point and aside in the shortening of telomeres is the discovery of telomerase, the enzyme responsible for restoring the DNA lost during cell divisions. As the authors say, “telomerase produces and replenishes telomeres” (2). Its operation consists in refilling the telomeres by adding telomeric DNA to them. Thus, each time the cell divides, the telomeres gradually shorten until a point is reached that cellular signals stop the division process. But telomerase has the ability to add DNA and rebuild the end of the chromosome every time the cell divides.

One of the factors that leads to the decrease of telomeres is stress. So, the book explains that while the body is fighting stress, the immune system can stay strong for a while. But chronic stress suppresses aspects of the immune system, “leaving us more vulnerable to infections, producing fewer antibodies in response to vaccines, and causing wounds to heal more slowly” (3). Going into more detail, the book states that shortened telomeres promote inflammation and this ends up leading to tissue degeneration and an increase in diseases related to aging (4).

The book also discusses how people can take action to improve telomeres. One of the essential points is physical exercise, given that the authors believe that “being sedentary is terrible for metabolic health” (5). In this way, moderate aerobic resistance exercise performed three times a week for 45 minutes is recommended. As explained, exercise damages molecules and these can cause inflammation. Anyway, at the beginning of an exercise, autophagy is induced and this prevents inflammation.

Finally, I would like to point out the section dedicated to food advice. Despite not making any great discoveries, Blackburn and Epel emphasize healthy eating. Thus, as an example, they indicate that the increase in omega-3 in the blood (EPA and DHA) manages to reverse the shortening of telomeres (6). The contribution they make regarding vitamin D and telomerase is also noteworthy. Specifically, they cite a study that tested the intake of 2,000 IU of vitamin D per day (in the form of vitamin D3) for four months. The results indicated that during this period telomerase increased by around 20% compared to the placebo group (7).

1. Blackburn, E., Epel, E. (2018). The telomere effect (p.29). Orion Spring

2. Blackburn, op. cit., p.56

3. Blackburn, op. cit., p.91

4. Blackburn, op. cit., p.95

5. Blackburn, op. cit., p.177

6. Blackburn, op. cit., p.229

7. Blackburn, op. cit., p. 235