Extra Life: A Short History of Living Longer

 Steven Johnson, “Extra Life - A Short History of Living Longer,” Riverhead Books, 2021, 252 pp. .

My brother Joseph recommended this book: It is well-worth reading.

Extra Life tells the story of how just in one century the rising life expectancy of the world’s population has risen enough to give us, on average, an entire extra life:  from 30 years to 80 years, and in that same century we have reduced the death-rate of children by more than a factor of ten.  The author details that these extra days and years came from vaccines; randomized, controlled double-blind experiments; and the decrease in famines as we became better farmers, just to name few.  (e.g. the simple toilet may have saved a billion lives). 

However, I was most surprised that most historians believe that, in total, medical interventions had a limited effect on overall life expectancy until the end of WWII.  Before that point, advances were canceled by the lingering delusions of leeches and arsenic, all the ludicrous lingering interventions of heroic medicine serve as a useful reminder that ‘Western” medicine—for all of its recent achievements—had a miserable track record for most of its existence. 

My Notes:

 Pg. Xiif:  The first sign of the 1918 flu was in March of that year at Camp Funston, a US military training camp (now Camp Riley in Kansas).  Within a week, in April, more than a thousand soldiers had been hospitalized at the camp, thirty-eight of them died.

 Pg. xx:  All the advances of the last three or four centuries—the scientific method, the medical breakthroughs, the public health institutions, the rising standards of living—have given us about twenty-thousand extra days of life on average.  Life expectancy has risen since 1688 from an average of 30 years at birth to 80 in the United Kingdom.

 Pg. xxviif:  Rough estimates of some selected life-extending innovations:

Innovations extending millions of lives:  AIDS cocktail, Anesthesia, Angioplasty, Antimalarial drugs, CPR, Insulin, Kidney dialysis, Oral rehydration therapy, Pacemakers, Radiology, Refrigeration, Seat Belts.

 Innovations extending hundreds of million lives:  Antibiotics, Bifurcated Needles*, Blood Transfusion, Chlorination, Pasteurization.

 Innovations extending billions of lives:  Artificial fertilizer, Toilets/Sewers, Vaccines.

 * The bifurcated needle is a narrow steel rod, approximately 2.5 inches (6 cm) long with two prongs at one end. It was designed to hold one dose of reconstituted freeze-dried smallpox vaccine between its prongs. Up to one hundred vaccinations can be given from one vial of the reconstituted vaccine.

 Pg. 10:  A man named Graunt attempted to calculate the population of London in the mid-1660s and came up with a figure quite close to 400,000 which current historians believe is quite accurate.  He then calculated the life expectancy of a child born then as only seventeen and a half years.

 Pg. 18:  Historians now estimate that the hunter-gather society's life expectancies were somewhere between thirty and thirty-five years, with childhood mortality rates upward of 30 percent.  Almost a third of the population—in both hunter-gatherer societies and seventeenth-century London--died before they reached adulthood.  Thomas Hobbes had published his remark ‘nasty, brutish, and short- just a few years before Graunt started dabbling with the Bills of Mortality.

 Pg. 19:  This view of Homo sapiens health over time is sobering: despite all our achievements, we had remained trapped beneath the long ceiling of thirty-five years of life expectancy, with a third of all children dying before adulthood.  Human beings had spent ten thousand years inventing agriculture, gun-powder, double-entry accounting, perspective in painting—but these had failed to move longevity one bit.

 Pg. 28:  George Washington’s medical care at the end of his life is nothing short of torture.  As he lay in bed the Dr. drained approximately twelve ounces of his blood.  Over the course of the next ten-hours, two other doctors bled Washington four more times, extracting as much a one hundred additional ounces.  Removing at least 60 percent of Washington’s blood was only one of the curative tactics used. His neck was coated with a paste composed of wax and beef fat mixed with an irritant made from the secretions of dried beetles, one powerful enough to raise blisters, which were then opened and drained.  He gargled a mixture of molasses, vinegar, and butter; his legs and feet were covered with a poultice made from wheat bran; he was given an enema; and, just to be on the safe side, his doctors gave Washington a dose of calomel—mercurous chloride—as a purgative.  Scholars now call this period the age of heroic medicine—full of grand schemes and bold interventions that clearly did more harm than good.  Even at the start of WWI, bloodletting was still deemed a good practice.

 Pg. 32f:  Most historians now believe that, in total, medical interventions had a limited effect on overall life expectancy until the end of WWII.  Before that point, advances were canceled by the lingering delusions of leeches and arsenic, all the ludicrous lingering interventions of heroic medicine serve as a useful reminder that ‘Western” medicine—for all of its recent achievements—had a miserable track record for most of its existence.  And in fact, the first intervention to have a meaningful positive impact on life expectancy didn’t originate in the West at all.

 Pg. 53:  A decade or so after Jefferson’s pioneering experiments inoculating his own household for smallpox, in 1813, Congress passed the Vaccine Act, with the aim to ‘furnish genuine vaccine matter to any citizen of the US.”  In England, the Vaccination Act of 1853 required all children under three years of age to be administered a smallpox vaccine.    

 Pg. 58:  It is hard to credit any institution more than WHO which eradicated smallpox, the last known infection occurring in 1975.

 Pg. 68:  Despite the widespread adoption of vaccination, overall life expectancy in the US declined by thirteen years between 1800 and 1850.  The twin revolutions of Enlightenment science and industrialization had transformed both England and her former colonies across the Atlantic, creating new economic and political systems, driving immense technological change: factories, railroads, telegraphs.  Yet where life expectancy was concerned, the world’s most technologically advanced societies appeared to be going in reverse.  Meaningful improvements to overall mortality would not arrive until the last decades of the nineteenth century, previewing the dramatic takeoff that would transform life expectancy on a global scale in the next century.

 Pg. 100:  Today all pasteurized milk is produced using the basic technique Pasteur identified in 1865.  And yet in the US, pasteurization did not become a standard practice in the milk industry until 1915.  This lag from discovery to implementation might well have cost millions of lives around the world.

Pg. 113:  From 1900 to 1930, infant mortality rates in the US dropped by 62 percent, one of the most dramatic declines in the history of that most critical of measures.

 Pg. 115:  When you ask people to list the great innovations of the early twentieth century, they invariably list planes, automobiles, radio, television—not pasteurized milk or chlorinated drinking water.  It is likely that personal health interventions—as opposed to the public ones, such as sewers and water filtration systems—did not have a meaningful effect on human life expectancy until 1950.  Vaccines had saved many lives over the preceding century, but the rest of the field of medicine had barely advanced from the mercury poisoning that was used to treat the mad king George III. 

 Pg.117:  In some extreme cases, cholera victims have been known to lose as much as 30 percent of their body weight through expelled fluids in a matter of hours.  As early as the 1830s, doctors had observed that treating patients with intravenous fluids could keep them alive long enough for the disease to run its course, by the 1920s, treating cholera victims with IV fluids became standard practice in hospitals.  An alternative, known as oral rehydration therapy, or ORT, gave third-world countries a chance.  The treatment is almost maddeningly simple: give people lots of water to drink, supplemented with sugar and salts.  Yet, the medical establishment ignored ORT.

 Pg. 127:  The entire pharmaceutical industry was almost entirely unregulated for the first decades of the twentieth century.  The Bureau of Chemistry, created in 1901 only ensured that the ingredients listed on the bottle were actually present in the medicine itself.  If you wanted to put mercury or cocaine in your miracle drug, the FDA had no problem with that as long as you mentioned it on the label.  It took a national tragedy to change this preposterous state of affairs.  Bayer AG in the early 1930s developed a new class of drug called sulfanilamides, or ‘sulfa’ drugs, a less-effective forerunner of modern antibiotics.  In 1937, Harold Watkins hit upon the idea of dissolving the drug in diethylene glycol, with raspberry flavoring added to make the concoction even more palatable to children.  Children began dying, by the time the FDA recovered the last bottle, seventy-one adults and thirty-four children had died.  At the time the FDA was only allowed to check that the drug tasted like raspberries, not whether it would kill you or even if it would cure you.

  Pg. 130:  One might think that the market itself would provide adequate incentives for the pharma companies to produce effective medicines.  But medicine is not like TVs.  You are inclined to think medicines work because of the placebo effect and each person’s immune system often heals the body on its own.

 Pg. 138:  By 1962 a new way emerged for looking at data.  The formal name for the innovation was randomized, controlled double-blind trials, usually referred to with the shorthand RCT.  Of all the late arrivals of intellectual and technological history—the bicycles and the typewriters—the RCT may well be the most puzzling, and the most consequential.

 Pg. 162:  Penicillin was invented sometime after 1928 and by the middle of 1944 it was a material force in the world, saving thousands of lives a week, and giving the Allied countries a quiet but critical advantage over the Axis powers. 

 Pg. 174-185:  Three times as many Americans have died (four million) in automobiles than died in all military conflicts going back to the Revolutionary War.  The largest impact on automobile safety came from Volvo in Sweden, the three-point seatbelt design.  The design brought together a shoulder and lap belt that buckled together in a V formation at the passenger’s side.  By 1959 Volvo was selling this as a standard feature and chose not to enforce the patent.  (Only Ralph Nader’s and his book “Unsafe at any Speed”  finally brought this innovation to the American public).

 Pg. 201ff:  The Irish potato famine of the late 1840s killed roughly one-eighth of the population and forced another quarter of the population to emigrate, mostly to the US. 

 More than 120 million people are believed to have died from famines worldwide between 1870 and 1970.

 Pg. 209:  By the 1950s, the poultry industry had discovered that feeding chickens vitamin D supplements—fortified with antibiotics—allowed them to live indoors without exposure to sunlight; before long, industrial-scale coops crowded as many as thirty thousand chickens into wire cages so small that the birds did not have room to spread their wings.  You could produce one pound of chicken meat with just two pounds of grain, while a pound of beef required seven pounds of grain. 

 Pg. 234ff:  Experts now predict that we could much more effectively prepare for the next pandemic by stopping an emerging zoonotic disease before it makes the jump from animal to human.  Animal surveillance could ward off the potential pandemic that experts have historically worried about the most: an influenza outbreak and unintended consequence of those sixty billion chickens we now have for food is the most likely next pandemic source.  A hundred dead chickens could tell the story of a future infection—and maybe even stop it from emerging at all.   For a decade the US funded a program that performed exactly this sort of animal surveillance, discovering more than a thousand new viruses in the process.  Despite the fact that it cost a mere $200 million to run over that period, the Trump administration shut it down in the fall of 2019, only a few weeks before reports began surfacing of an alarming new viral outbreak in Wuhan, China.

 Pg. 239:  Antibiotic innovation has stalled because Big Pharma has lost interest in the field.  Expensive drugs to treat cardiovascular disease and cancer are where the money is.  Cheaper drugs like penicillin and its descendants—which are only taken in small doses—don’t move the needle economically for these for-profit firms. 

 Pg. 249:  Most agricultural societies appear to have taken thousands of years to return to the life expectancies and childhood mortality rates enjoyed by hunter-gathers.  The original appearance of farming as a mode of economic production was every bit as catastrophic to longevity as the factories of Northern England were in the early 1800s. 

 Addenda:

 The three areas of most impact for billions of people have been:

Artificial fertilizer

Toilets/sewers and

Vaccines.

 

Around 1660 there were about 500 million people on earth; by 1920 about 2 billion, now approaching 8 billion. Experts project a leveling off at about 10 billion but with climate change, growth may begin to reverse at some point.