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Food has always been a biohazard
THE LANCET
A classic hepatology text Diseases of the Liver and Biliary System Sheila Sherlock, James Dooley. Oxford: Blackwell Science. 1996. Pp 714. £69.50. ISBN 0-86542-906-5.
he first edition of Sheila Sherlock’s book appeared in 1955, and this is now the 10th edition. All the previous versions but one have been reprinted and the book has been translated into Spanish, German, Greek, Portuguese, Japanese, and Italian. In the past two editions, James Dooley has been incorporated as a coauthor. All this clearly indicates that this book has been and is a tremendous success and should be considered, without doubt, the classic hepatology text. Several aspects characterise this book: clarity, uniformity, and a direct writing style, combined with comprehensive and very useful tables and well-designed figures. The references are always appropriate and current. These characteristics clearly define the personalities of Sheila Sherlock and James Dooley as clinicians and scientists. The 35 chapters are very well
T
designed and clinically oriented. The volume covers normal liver anatomy and function, the most reliable liverfunction tests, all the techniques that aid in the diagnosis of liver diseases, such as liver biopsy and imaging, the syndromes commonly found in liver disease, such as hepatic encephalopathy, ascites, portal hypertension, jaundice, and cholestasis. Furthermore, all the most important and most frequent liver diseases are described including hepatitis, cirrhosis, drugs and the liver, primary biliary cirrhosis, sclerosing cholangitis, alcohol and the liver, inherited liver diseases, hepatic tumours, biliary diseases, and liver transplantation. There are four very interesting chapters devoted to the liver in childhood, in pregnancy, in systemic diseases, and in infections. However, for me, the most outstanding chapters are those devoted to portal hypertension, viral hepatitis, chronic
Food has always been a biohazard Spoiled The Dangerous Truth About a Food Chain Gone Haywire Nicols Fox. New York: Basic Books. 1997. Pp 434. $25. ISBN 0-465-01980-3. icols Fox has addressed an important medical and publichealth topic. She has done so in a highly problematic and flawed book. Perhaps the way to think about Spoiled is the way to think about the laws of kosher—there may be at the root important health reasons for its recommended policies, which include vegetarianism, but while one can believe them or not (belief being beyond argument) objectively they seem in their extremeness to be of questionable practical usefulness. The point of Spoiled is summed up on page 19: “Changes in the ways we produce, process, and distribute food, along with changes in our lifestyle and culture, have created niches for emerging foodborne pathogens”. The argument to this effect is the book, and on the positive side, Fox at times illustrates her thesis with agility, harnessing the fact that the epidemiological process of tracking down the source of infectious disease
N
1786
can resemble a good mystery. One example: Fox tells of the time that Kim Cook, Centers for Disease Control and Prevention, was faced with a strange outbreak of intense diarrhoea, cramps, fever, nausea, vomiting, and bloody stools—and all in people recently returned from Disney World. But “one of the first things that struck Cook was that none of the people affected was actually from the surrounding area. Orlando residents visited Disney World too. Why weren’t they getting sick? He realised that one thing local residents did
hepatitis, imaging of the biliary tract, interventional radiology and endoscopy, and gallstones and inflammatory gallbladder disease. It is remarkable that all the most recent data regarding molecular genetics that have allowed the identification of the gene for several hepatic diseases, such as Wilson’s disease and Gilbert’s syndrome, are included. In addition, in the chapter on viral hepatitis the most recent advances obtained by use of molecular virology are very well described. As indicated in the preface of the 10th edition, the book is devoted to students, interns, postgraduate trainees, generalists, and even specialists. From my point of view, this 10th edition has all the necessary requirements to be very useful for all hepatologists, gastroenterologists, internists, and other specialists of other disciplines, including surgeons. Yet again, this edition has surpassed those that have gone before. I predict, as in the previous editions, an undoubted editorial success.
Juan Rodés Hospital Clinic I Provincial de Barcelona, Villarroel, 170, 08036 Barcelona, Spain
not do was stay in the hotels. There was something about the hotels that seemed to be putting people at risk”. The culprit in this case turned out to be Salmonella gallinarum in the hotels due to freshly squeezed orange juice, probably from oranges infected by chicken manure used as fertiliser in the orange groves. But there are numerous culprits lurking in Spoiled. Clostridium perfringens, Staphylococcus aureus, Bacillus cereus, Campylobacter, Listeria, Escherichia coli O157:H7, and Shigella all make appearances, as well as others like Yersinia that can grow at ⫺1°C.
Vol 350 • December 13, 1997
THE LANCET
Vol 350 • December 13, 1997
The lady’s death
William Hogarth (1697-1764)
National Gallery
There are microwave ovens that heat unevenly and thus fail to destroy pathogens, and there are old bugs such as Cl botulinum that find new niches in food. Even new cooking techniques pose risks: for example, a restaurant that for a new recipe only lightly sautés its fiddlehead mushrooms produces 30 diners with diarrhoea and vomiting. “What was new here”, Fox writes, “was that people had been preparing fiddleheads in nontraditional ways without a thought as to whether there was something protective in the traditional way . . . Whenever we do something differently, even when it seems an improvement, we open a door into the unknown”. Not only meat but fruits and vegetables, which now arrive fresh from who knows where in the world, carry disease. “It shouldn’t take a research scientist to figure out that importing fresh vegetables from abroad is an effective way of importing microbes.” Fine. But then there is the rest of the book. As intriguing as public-health processes can be, there is a limit to the number of times we can be intrigued by yet another epidemiologist asking yet another series of the same questions. Fox passes the limit early on, repeating numerous times that chicken, dripping often-infected juices, is placed on the same conveyor belt as the ice cream. She tells us that there is no such thing as “stomach flu”, a rubric under which food poisoning is frequently dismissed, and then in the next chapter tells us again. At 400 pages, the book is about 150 pages too long. The vaguely New Age purple prose does not inspire confidence: a memory of childhood was that “a freshly grown tomato was an orb of rich sensation. The lusty color, scandalously sensual texture, and overwhelming odor I had not yet identified the tomato for what it was— profoundly erotic”. Um, OK. Fox in fact recommends such stringent food preparation and eating habits that even a serious vegan would find them onerous. The descriptions of contamination, mostly of meat, almost literally drip loathing, and sure enough, the book ends with an ode to the backto-nature vegetarianism Fox herself practises. The fetishism of food pervades the book, and the result is a tone that resembles messianic fervour. “Food is basic and essential and wrapped not in mystery but in comfort, familiarity, and trust. Contaminated food is the ultimate betrayal.” I would say that ultimate betrayal involved a bit more than a case of salmonella-induced diarrhoea, which
An exhibition that centres on Hogarth’s Marriage A-la-Mode is currently showing at The National Gallery, London. Hogarth portrays a moral drama of contemporary life, the story opening with an ill-matched arranged marriage between the foolish son of a bankrupt nobleman and the headstrong daughter of a rich City of London alderman. Love never develops, and the disaster that ensues (adultery, venereal disease, murder, and suicide) is predictable. The narrative unfolds in six scenes, of which The Lady’s Death is the last. The exhibition, which runs until Jan 18, 1998, includes six other paintings and about 20 engravings by Hogarth as well as Roubiliac’s terracotta bust of the artist. can result from carelessness and which is, fundamentally, a health problem. It is a serious one, but it is a health problem. And Fox fails to make the case that the hyperbolic thesis in the subtitle, The Dangerous Truth About a Food Chain Gone Haywire, is real. She tries, but hers is a profoundly ahistorical view. “When we have to treat what we eat like a biohazard, something is seriously wrong.” In fact, the reason human beings have been
Book in brief Diagnosis and management of tropical diseases In tropical and subtropical regions, infectious and parasitic diseases are a major cause of death. This handbook covers the clinical features, diagnosis, and surgical treatment of the main tropical diseases, including Chagas’ disease, schistosomiasis, typhoid fever, various forms of tuberculosis, cutaneous leishmaniasis, and tropical myositis. (Tropical Surgery. Edited by Ricardo V Cohen, Frederico Aun. Basel: Karger. 1997. Pp 335. $49. ISBN 3-8055-6497-X.)
cooking food for thousands of years is precisely because our microscopic friends the bacteria ensure that food is, has always been, and always will be a biohazard. But a more modulated treatment of the problems with our food supply would, unfortunately, probably not have yielded Fox a book contract. In the end, the substance of the subject matter—the dangers of foodborne pathogens—is inherently compelling, and information on it is important. You don’t necessarily need to look to Spoiled. It is itself grossly infected with hyperbole, repetition, and questionable motivation. At the same time, one could do worse than Spoiled, worse in this case being ignorance of the problem. Constant and increasingly rapid changes in the food supply mean that foodborne pathogens and the problems of combating them is a problem that merits serious, constant attention. And we need to be aware of that and take part in protecting ourselves. As this book points out. Chandler Burr 826 Aspen Street, NW, Washington, DC 20012, USA
1787
A classic hepatology text Diseases of the Liver and Biliary System Sheila Sherlock, James Dooley. Oxford: Blackwell Science. 1996. Pp 714. £69.50. ISBN 0-86542-906-5.
he first edition of Sheila Sherlock’s book appeared in 1955, and this is now the 10th edition. All the previous versions but one have been reprinted and the book has been translated into Spanish, German, Greek, Portuguese, Japanese, and Italian. In the past two editions, James Dooley has been incorporated as a coauthor. All this clearly indicates that this book has been and is a tremendous success and should be considered, without doubt, the classic hepatology text. Several aspects characterise this book: clarity, uniformity, and a direct writing style, combined with comprehensive and very useful tables and well-designed figures. The references are always appropriate and current. These characteristics clearly define the personalities of Sheila Sherlock and James Dooley as clinicians and scientists. The 35 chapters are very well
T
designed and clinically oriented. The volume covers normal liver anatomy and function, the most reliable liverfunction tests, all the techniques that aid in the diagnosis of liver diseases, such as liver biopsy and imaging, the syndromes commonly found in liver disease, such as hepatic encephalopathy, ascites, portal hypertension, jaundice, and cholestasis. Furthermore, all the most important and most frequent liver diseases are described including hepatitis, cirrhosis, drugs and the liver, primary biliary cirrhosis, sclerosing cholangitis, alcohol and the liver, inherited liver diseases, hepatic tumours, biliary diseases, and liver transplantation. There are four very interesting chapters devoted to the liver in childhood, in pregnancy, in systemic diseases, and in infections. However, for me, the most outstanding chapters are those devoted to portal hypertension, viral hepatitis, chronic
Food has always been a biohazard Spoiled The Dangerous Truth About a Food Chain Gone Haywire Nicols Fox. New York: Basic Books. 1997. Pp 434. $25. ISBN 0-465-01980-3. icols Fox has addressed an important medical and publichealth topic. She has done so in a highly problematic and flawed book. Perhaps the way to think about Spoiled is the way to think about the laws of kosher—there may be at the root important health reasons for its recommended policies, which include vegetarianism, but while one can believe them or not (belief being beyond argument) objectively they seem in their extremeness to be of questionable practical usefulness. The point of Spoiled is summed up on page 19: “Changes in the ways we produce, process, and distribute food, along with changes in our lifestyle and culture, have created niches for emerging foodborne pathogens”. The argument to this effect is the book, and on the positive side, Fox at times illustrates her thesis with agility, harnessing the fact that the epidemiological process of tracking down the source of infectious disease
N
1786
can resemble a good mystery. One example: Fox tells of the time that Kim Cook, Centers for Disease Control and Prevention, was faced with a strange outbreak of intense diarrhoea, cramps, fever, nausea, vomiting, and bloody stools—and all in people recently returned from Disney World. But “one of the first things that struck Cook was that none of the people affected was actually from the surrounding area. Orlando residents visited Disney World too. Why weren’t they getting sick? He realised that one thing local residents did
hepatitis, imaging of the biliary tract, interventional radiology and endoscopy, and gallstones and inflammatory gallbladder disease. It is remarkable that all the most recent data regarding molecular genetics that have allowed the identification of the gene for several hepatic diseases, such as Wilson’s disease and Gilbert’s syndrome, are included. In addition, in the chapter on viral hepatitis the most recent advances obtained by use of molecular virology are very well described. As indicated in the preface of the 10th edition, the book is devoted to students, interns, postgraduate trainees, generalists, and even specialists. From my point of view, this 10th edition has all the necessary requirements to be very useful for all hepatologists, gastroenterologists, internists, and other specialists of other disciplines, including surgeons. Yet again, this edition has surpassed those that have gone before. I predict, as in the previous editions, an undoubted editorial success.
Juan Rodés Hospital Clinic I Provincial de Barcelona, Villarroel, 170, 08036 Barcelona, Spain
not do was stay in the hotels. There was something about the hotels that seemed to be putting people at risk”. The culprit in this case turned out to be Salmonella gallinarum in the hotels due to freshly squeezed orange juice, probably from oranges infected by chicken manure used as fertiliser in the orange groves. But there are numerous culprits lurking in Spoiled. Clostridium perfringens, Staphylococcus aureus, Bacillus cereus, Campylobacter, Listeria, Escherichia coli O157:H7, and Shigella all make appearances, as well as others like Yersinia that can grow at ⫺1°C.
Vol 350 • December 13, 1997
THE LANCET
Vol 350 • December 13, 1997
The lady’s death
William Hogarth (1697-1764)
National Gallery
There are microwave ovens that heat unevenly and thus fail to destroy pathogens, and there are old bugs such as Cl botulinum that find new niches in food. Even new cooking techniques pose risks: for example, a restaurant that for a new recipe only lightly sautés its fiddlehead mushrooms produces 30 diners with diarrhoea and vomiting. “What was new here”, Fox writes, “was that people had been preparing fiddleheads in nontraditional ways without a thought as to whether there was something protective in the traditional way . . . Whenever we do something differently, even when it seems an improvement, we open a door into the unknown”. Not only meat but fruits and vegetables, which now arrive fresh from who knows where in the world, carry disease. “It shouldn’t take a research scientist to figure out that importing fresh vegetables from abroad is an effective way of importing microbes.” Fine. But then there is the rest of the book. As intriguing as public-health processes can be, there is a limit to the number of times we can be intrigued by yet another epidemiologist asking yet another series of the same questions. Fox passes the limit early on, repeating numerous times that chicken, dripping often-infected juices, is placed on the same conveyor belt as the ice cream. She tells us that there is no such thing as “stomach flu”, a rubric under which food poisoning is frequently dismissed, and then in the next chapter tells us again. At 400 pages, the book is about 150 pages too long. The vaguely New Age purple prose does not inspire confidence: a memory of childhood was that “a freshly grown tomato was an orb of rich sensation. The lusty color, scandalously sensual texture, and overwhelming odor I had not yet identified the tomato for what it was— profoundly erotic”. Um, OK. Fox in fact recommends such stringent food preparation and eating habits that even a serious vegan would find them onerous. The descriptions of contamination, mostly of meat, almost literally drip loathing, and sure enough, the book ends with an ode to the backto-nature vegetarianism Fox herself practises. The fetishism of food pervades the book, and the result is a tone that resembles messianic fervour. “Food is basic and essential and wrapped not in mystery but in comfort, familiarity, and trust. Contaminated food is the ultimate betrayal.” I would say that ultimate betrayal involved a bit more than a case of salmonella-induced diarrhoea, which
An exhibition that centres on Hogarth’s Marriage A-la-Mode is currently showing at The National Gallery, London. Hogarth portrays a moral drama of contemporary life, the story opening with an ill-matched arranged marriage between the foolish son of a bankrupt nobleman and the headstrong daughter of a rich City of London alderman. Love never develops, and the disaster that ensues (adultery, venereal disease, murder, and suicide) is predictable. The narrative unfolds in six scenes, of which The Lady’s Death is the last. The exhibition, which runs until Jan 18, 1998, includes six other paintings and about 20 engravings by Hogarth as well as Roubiliac’s terracotta bust of the artist. can result from carelessness and which is, fundamentally, a health problem. It is a serious one, but it is a health problem. And Fox fails to make the case that the hyperbolic thesis in the subtitle, The Dangerous Truth About a Food Chain Gone Haywire, is real. She tries, but hers is a profoundly ahistorical view. “When we have to treat what we eat like a biohazard, something is seriously wrong.” In fact, the reason human beings have been
Book in brief Diagnosis and management of tropical diseases In tropical and subtropical regions, infectious and parasitic diseases are a major cause of death. This handbook covers the clinical features, diagnosis, and surgical treatment of the main tropical diseases, including Chagas’ disease, schistosomiasis, typhoid fever, various forms of tuberculosis, cutaneous leishmaniasis, and tropical myositis. (Tropical Surgery. Edited by Ricardo V Cohen, Frederico Aun. Basel: Karger. 1997. Pp 335. $49. ISBN 3-8055-6497-X.)
cooking food for thousands of years is precisely because our microscopic friends the bacteria ensure that food is, has always been, and always will be a biohazard. But a more modulated treatment of the problems with our food supply would, unfortunately, probably not have yielded Fox a book contract. In the end, the substance of the subject matter—the dangers of foodborne pathogens—is inherently compelling, and information on it is important. You don’t necessarily need to look to Spoiled. It is itself grossly infected with hyperbole, repetition, and questionable motivation. At the same time, one could do worse than Spoiled, worse in this case being ignorance of the problem. Constant and increasingly rapid changes in the food supply mean that foodborne pathogens and the problems of combating them is a problem that merits serious, constant attention. And we need to be aware of that and take part in protecting ourselves. As this book points out. Chandler Burr 826 Aspen Street, NW, Washington, DC 20012, USA
1787