Customer Reviews

The Dose Makes the Poison: A Plain-Language Guide to Toxicology, 2nd Edition

5 star:		(5)
4 star:		(7)
3 star:		(2)
2 star:		(2)
1 star:		(2)

 

 

Dr. Ottoboni has two simple objectives in writing this book: to descibe the basics of toxicology and to refute unscientific views about chemicals and their toxicity that lead to unwarranted scares. She accomplishes her goals, but with some discomfort for the reader. Her style is that of a didactic bureaucrat and there are many words that could have been trimmed by an assertive editor. Considering the technical nature of the book and its many scientific assertions, it is inexcusable that the book has no footnotes. Apparently the reader is supposed to accept her declarations at face value. Ottoboni occasionially falls into a trap that she herself warns against by commenting about issues on which he has no expertise. She says, for instance, that the "medical profession now generally accepts the premise that stress can exert a profound influence on the course of many illnesses. Stress can actually be an etiologic (causitive) agent for some cases of such diseases as high blood pressure, ulcers, allergies, colitis, and even cancer." Unfortunately for her, the fact that it was generally accepted did not make it true that ulcers are caused by stress. They are now known to be caused by a bacteria and the former claim that they were caused by stress is a major embarassment to medicine, which made this bogus claim in lieu of proof. It is also highly contestable that the other diseases she names are actually caused by stress, and she offers no evidence for her claim. (Medicine has a tragic history of attributing many diseases to emotional disorder, not the least of which was epilepsy, but Ottoboni shows no awareness of this.) Ottoboni should have restricted herself to what is proven, not what is "accepted." When she writes that "an authority in one field is not, of necessity, an authority in all of the others" she should have understood that that also applies to herself. Instead of this expensive book I would suggest a couple of very well written and documented books that go at the same issues from different perspectives. The first is Edith Efron's "The Apocalyptics : How Environmental Politics Controls What We Know About Cancer," and the second is the recent book, "The Skeptical Environmentalist," by Bjorn Lomborg. Both are superb, readable and worth buying. Borrow the Ottoboni book from the library.

Update: This review is for the second edition. I see now that a third edition has been published which no longer mentions stress as a cause of ulcers. It also shows that Dr. Ottoboni has taken on a co-author, so perhaps it addresses my criticisms. I'll give it a read.

This book is an introduction to the field of toxicology written for informed audiences who may not have a background in science. Frank is a toxicology consultant who works in the field of pharmaceutical registration. Ottoboni is a toxicologist for the California State Department of Public Health and the author of previous editions of this book. The book's topics include the following: what are chemicals, what harm do chemicals cause, what is toxicology and how is it studied, mutagenesis, carcinogenesis, and reproductive toxicity, epidemiology, and the study of risk. End material includes a brief bibliography, a list of abbreviations, a glossary, and an explanation of moles and Avogadro's number. The text is illustrated with a few photographs, illustrations, graphs, and chemical diagrams.

I found this book quite clear and accessible, even though the material covered can be rather complex. The authors' descriptions of such topics as LD50 or the importance of routes of exposure are quite easy to follow and helpful for making sense of toxicology reports. As I read through the book, however, I kept getting the sense of a hidden agenda: virtually all the examples and discussion point out that toxins aren't as dangerous as people might think. The authors even note how the tragedy of the Bhopal disaster was due to shoddy manufacturing processes, not the pesticides being produced. This claim may be true, but there certainly must be other cases where pesticides and other poisons have caused demonstrable harm to humans; however, such examples are never brought out in this text. Readers are cautioned to note the source and quality of toxicity information they encounter, and to avoid exaggerated ire from anti-chemical demagogues, but the importance of carefully examining and perhaps discounting research supported by industry giants showing the supposed safety of their products is avoided in this text.

Risk assessment, one of the key foundations of toxicology, receives only a brief discussion at the end of the book. It would have been useful to have a little more in-depth coverage of this topic, or at least a practical example or two. Overall, the information in the book seems to be accurate. But there is an odd claim towards the end of the book, "there are no documented cases of human cancer from exposure to trace quantities of chemical carcinogens." What about arsenic in drinking water? Given long enough exposures, arsenic at concentrations of 50 ppb, or perhaps even less, is associated with increased risk of skin, lung, bladder, liver, prostrate, and breast cancer; such exposures, and their resultant cancers, are becoming more common as populations shift to drinking groundwater without prior testing for toxic metals. Perhaps the authors meant that, as with tobacco, no particular case of cancer can be specifically linked to a particular exposure, or that a single exposure to a trace quantity of toxin does not lead to cancer; at the very least, the statement is unclear, ambiguous, or misleading, given the clear links between chronic exposures to trace quantities of certain chemicals and cancer. Thus, while the book is informative and clear, readers should keep in mind a possible bias towards understating the dangers of chemicals.

I have a longstanding interest in poison, and picked up The Dose Makes the Poison right on the heels of finishing Deborah Blum's The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York. Although the subject matter and a few case studies overlap, they couldn't have been more different. The Dose Makes the Poison is not entertaining popular science or even particularly entertaining. It's exactly what it claims to be: a crash course in toxicology for the interested layman.

As such, it is thorough, knowledgeable, and reads like an introductory science textbook. (It took me over a month to get through it.) M. Alice Ottoboni, a toxicologist with the CA Dept of Public Health, and Patricia Frank, a toxicological consultant for the pharmaceutical industry, undeniably know their stuff as they lay out the principles behind toxicology, experimental methods, risk assessment, etc. The writing is clear, if dry, and fairly easy to understand. At times, the book does come off as a tad condescending. Although geared for the general public, the authors don't think much of us, characterizing us as irrational and prone to hysterical responses. This might be true, but it's hardly the most persuasive way to educate us!

For a science book, it also comes across as a bit defensive and leans pro-industry. I was startled by the seemingly random defense of plastic in the opening chapters in which the authors conclude that it's the public's responsibility to cut up six pack rings to protect sea animals, not industry's to come up with safer packaging. I agree in theory, but the participation rate in even basic recycling programs doesn't bode well for the effectiveness of this approach. In a different example on labeling, Ottoboni and Frank show that regulation is more effective than education, yet the emphasis throughout is squarely on educating the public on risk assessment. Given how much of the book is devoted to showing how difficult it is to produce scientifically sound conclusions about chemical risk, I'm surprised by how little space the precautionary principle gets.

The Dose Makes the Poison makes a strong case that public hysteria over most chemicals is scientifically unjustified and gives us tools for evaluating alarming headlines and chemicals in our own lives. Yet I'm not sure it presents a full picture. The authors concede that our current tests may not pick up all the effects of chemicals or show how they interact, but the overall message is that a substance is probably of negligible toxicity unless definitively proven otherwise. It's a valid view point, but I would be interested to see how a toxicologist from a different background, say the EPA, would respond.

The chapter on experimental methods was difficult for me to get through. I'm not categorically opposed to animal testing for medical purposes, and the authors present good reasons to continue to use animals due to the scale of the experiments needed, but I was taken aback by how high the cost of toxicological knowledge is. The authors also defend cosmetic animal testing, including the infamous rabbit eye tests, as necessary for our safety. The question they don't ask is whether some types of knowledge do not justify the cost, especially since we already have so many well-tested, effective ingredients to use in non-essential cosmetics.

I have definite ideological differences with the authors, and they color this review, but in all fairness, The Dose Makes the Poison offers a thoughtful perspective on the widespread panic over chemicals. I agree that rational, informed decisions are better than automatic condemnation of chemicals, but I also think it's possible to come to different conclusions than the authors do about what role (and how big) we want chemicals to play in our lives.

The book is an interesting read, however, I think it falls a little short of the promise of "plain-language". There is sufficient discussion of chemical bondings and statistical math to make this more on the level of a book appropriate for a short seminar class. It is certainly helpful to have a basic background in biology and chemistry, but even without that deeper understanding the book is informative. Particularly so the examples of how government approval works and how that can't completely cover health concerns; there are always still unknowns and that is why guidelines seem to be constantly changing.

Also, there is no homeopathy in this book if that is what you are looking for. Certainly the same concepts of varying effects based on dilution are discussed, but usually only in the context of how much before a given compound becomes deadly.

Any chemical can be poisonous in the right dose. Drink two gallons of water all at once and you could very well die. Even too much vitamin D is harmful, while smaller amounts are essential. There is a lot of very interesting information in this book, such as the fact that rats can't vomit - which is why manufacturers of rat poison add a chemical that induces vomiting in case dogs, cats, or children (who *can* and frequently *do* vomit) consume their product. It was also interesting to know why you're not supposed to induce vomiting if you swallow gasoline. And I really found the information about mercury poisoning to be interesting, although I do wish they'd told us exactly how to clean it up.

But for all the fascinating information in the book, there was a lot more that just sounded like a chemistry or toxicology textbook (although maybe not as dense). The subtitle says "A Plain-Language Guide to Toxicology," and for the most part it is very plain... but not always. Sometimes words and terms were not explained, and other times they were just repeated a bit too oft. And it didn't help that the tone of the book is sometimes a bit lecturing.

The authors make the point that chemicals are usually maligned by the public and sensationalized by the media. We blame (or at least suspect) them for every illness and especially vilify "synthetic" or man-made chemicals. (In truth, Mother Nature's cupboard is more dangerous than man's.) The fact is that modern chemistry has improved our lives dramatically and a little understanding on our part is very eye-opening. The book also explains the difficulties in determining risks and side-effects of consumer goods, how they are tested (including animal subjects), and the measures used by toxicologists. And while the book makes a lot of good points, it's not always the kind of book you'd describe as "couldn't put it down."

First, this is a book that discusses what toxicity is, the routes it travels in, how toxins interact with the body, with a special emphasis on mutagenesis and cancer. It is not a reference book where you can look up specific chemicals to see what they do and how much is safe. The book was written to dispel public fears of chemicals and how they work, giving the educated reader an understanding of toxicology and of dose-dependent reactions. The revision appears to make the language simpler, with a nod towards household chemicals and new issues like nanoparticles, but leaves some seriously outdated information untouched. I have compared the second edition which I own to the third edition and see little reason to upgrade.

The author, Alice Ottobani and her new co-author Patricia Frank comes from conventional backgrounds which may dull their sensitivity say, to the ways that toxins epigenetically affect fetuses when they do not actually cause gene mutations. (Indeed the word "epigenetic" is only used to refer to chemicals, ignoring years of recent research that shows how environmental affects can persist for generations.)

The primary shortcoming of the book is that it tends to look at toxicity levels in a vacuum. For instance the discussion on Sodium fluoride shows that in water it may lead to increased bone density and mottling of the teeth if levels are over 3-4mg/day. But most Americans not only have fluoride in water, but in toothpaste, mouthwash and even tea. More importantly we have exposure to a vast number of new chemicals and while each of them may individually have low toxicity, the cumulative effect of the combined toxins may be quite a bit more dangerous. Fish in most major rivers of the US now have sizable numbers of intersex individuals, believed to be from excreted hormones from birth control pills, hormonal medications and xenoestrogens from plastics and pesticides.

Information on Vitamin D is sadly out of date, suggesting a level of toxicity far below safe doses and only acknowledging rickets as a side effect. (Rickets requires a ridiculously low level of Vitamin D to prevent, compared to say cancer or diabetes.) They say ."Daily doses of more than 2,000 iu (five 400iu capsules per day) should be taken only under medical supervision." However the body itself will manufacture 25,000 iu daily from sun before stopping (the body does not manufacture overdoses.) And most Americans are chronically low in serum levels of Vitamin D, often requiring doses over 10,000 iu to increase levels in the blood to a safe 50-100 ng/ml. Diabetics and people with cancer frequently require higher levels. The statements were forgivable in the 2nd edition, but were not revised despite a considerable body of evidence available before the publication of the third edition.

The book is quite interesting in its discussion of how chemicals react in the body, discussing routes of exposure,effects differing by age, sex and biochemical individuality, LD50 calculations and risk margins,the regulatory framework and study design. Despite its shortcomings, I find that the book is well worth its lower price and should be read by anyone dealing with health, the environment and environmental activism, as well as by lay readers who are interested in the topic.

I was expecting a book that would give some guidance concerning the toxicity of various chemicals and environmental contaminants. This book contains very little of this sort of information; rather it is a very general and basic introduction to the field of toxicology.

WHAT IS IN THE BOOK - The book is divided into eleven chapters, covering the following:

1) What are chemicals - A very, very, basic review of chemistry, starting with idea of atoms and molecules. Natural chemicals are contrasted with man-made ones.

2) What harm do chemical do - A review of harmful properties, such as flammability, radioactivity, corrosiveness, and poison toxicity. This is a very general discussion with little or no specific examples.

3) What is toxicology - This chapter starts with a history of the subject, beginning with Ancient Greek observations regarding the toxic nature of plants and animals and goes to the present. It is very general and finishes with a section "What Do Toxicologists Do?

4) What Factors influence the toxic effects of chemicals - In some ways this is one of the chapters that present the substance of the book. It explains that the degree of toxicity of a substance depends upon many factors, so simple levels of toxicity must be qualified by many factors such as: acute versus chronic exposure, surface exposure versus inhalation versus ingestion, routes of exposure and elimination, other factors such as sex and age. This chapter does contain some specific information, but it is dispersed throughout the chapter.

5) How is toxicology studied - This chapter covers experimental methods used in toxicology and the study of how chemical can alter genetic material. It also includes a brief section of animal rights, but it is biased towards chemical and pharmaceutical companies when it states "... have concern for the quality of life for their experimental animals and the prevention of pain and suffering in them".

6) General Toxicology - This is another chapter that presents the substance of the book. It starts by defining LD50 and LD80 (the dose where there is 50% and 80% mortality). The chapter contains come useful charts that show the variation of mortality with dose level, but these are general charts, not ones that contain data that is specific to a particular chemical. It contains a table of toxic chemicals and antidotes, but no data as the specific dose where they become toxic. It contains an interesting table that contrasts toxicity levels for a 10 kg (22 pound) child versus a 70 kg (154 pound) adult, but it is general, not keyed to any specific chemical.

7) Mutagenesis and Carcinogenesis - This chapter amplifies the some of the material discussed in chapter 5, as it discuses changes in genetic material due to chemical exposure and changes which result in cancer. It discuses induction periods (the length of time between exposure and cancer detection) and threshold levels (levels below which there is no toxic effect, and whether or not such a threshold exists). The end of the chapter discusses "the real world" and gives some examples. Again the discussion are all general in nature.

8) Developmental and Reproductive Toxicology - This chapter is focused on the reproductive system and the growing fetus. It contains a few examples, such as Thalidomide.

9) Case Studies in Toxicology - This chapter is the one that contains a bit more specific information, but it is limited to: dioxins, PCB's, the Bophal disaster in India, Minamata disease (methyl mercury), DDT, heavy metals (lead and cadmium), Zinc, Plastics, Bisphenyl A (BPA), indoor air pollution (formaldehydes), Fen-Phen, Vloxx and Thalidomide.

10) Epidemiology - An interesting chapter that gives the history and basic postulates of this field. It also contains a defense of science and scientists against a feeling that the general public distrusts them.

11) A study of risk - This chapter covers the general ideas of risk as statistical analysis of risk. It covers the ideas of risk versus benefit and risk analysis, but only in a very general non-mathematical manner.

The book contains a bibliography, list of web sites of interest, abbreviations, a glossary of terms and an index. There is also an appendix that discusses atomic weights, molecular weights, Avogadro's number and atomic number.

WHAT IS NOT IN THIS BOOK - This book does not contain very much specific toxicological information. There are no tables showing common chemicals and environmental contaminants and their levels of toxicity. For instance, there is no table showing the toxic levels of radiation exposure, which would have been very helpful is assessing the effect of the Japanese nuclear reactor accident. There are no tables showing how much of a common household chemical that might be toxic for a child, although I understand why one is always better off calling a poison control center, rather than relying on a table. The fact of the existence of poison control systems is discussed.

WHAT IS MY OVERALL ASSESMENT - I was hoping for a book with much more specific information and was therefore very disappointed. As shown by the listing of the material in each chapter, this would be an OK book if all you want is a general discussion of toxicology, however, it provides very little specific information. I would rate this book only one star if all you were interested in was toxicology data. I rate it higher because I found the general discussions of toxicology to be interesting, even if it was not what I was hoping for.

This is the best explanation of the complexities of toxicology that I have ever seen. We all know that very small doses of any chemical are not harmful and massive doses of anything can be deadly. Even water is a poison if the dose is large enough. The issue is where the transition from benign to dangerous is and the steepness of the transition curve. Furthermore, the toxicity of many chemicals is vastly different across species, there are even some that are benign in the standard test animals such as rabbits and guinea pigs yet have a much higher toxicity in humans. The reverse is also true; a chemical can be deadly to rabbits and other test animals yet relatively benign in humans.

The situation is even more complicated by the range of toxicities among the different groups of humans. Some chemicals have a vastly different effect on males and females and others differ across age groups, being dangerous for children and insignificant for adults. Some chemicals are dangerous for elderly people and incidental for the young groups or even toxic for adults and more benign in children.

These complex problems with examples are all presented in this book, which is fascinating reading, although some knowledge of chemistry and physiology will be helpful, although not required. If you read this book then the next time you watch a news program and hear, "the toxicology results will take weeks" you will understand why there is such a time lag. It is a rare book, a technical one that could serve to both educate the public and be a primer in the education of health-care professionals.

Basically the gist of the book is that anything in large amounts can kill you. However, it splits down the complexities of various toxins in use today in everything from pesticides to vinyl chairs. Makes one scratch their head and think, no wonder there is so much cancer, lupus, and systemic fungal disease today. Where we used to die like flies from measles and pneumonia, now we live longer, more miserably, through the advances of chemistry. yippee. Kind of a depressing book, but still very useful. Don't buy mixes, cook from scratch. Breast feed your child unless you have no choice. Makes me want to leave the city and hide, but where I live the ground water is naturally full of arsenic, so, there you go.

The authors are knowledgeable, but this is hardly plain-language writing. I think someone may be confused as to just what that means. It doesn't mean conversational language, as on page 55 ("By the way, if you ever need a handy Web site to convert into and out of the metric system, go to [URL].") It means not writing things like this, on the same page: "The dermal route for administration of drugs can be used for compounds that are required at relatively low levels and can be placed in ointments, creams, or patches for delivery onto or through the skin. In some cases, these low levels can lead to amelioration of symptoms..."

What would have been better? Something like "Delivering drugs through the skin is a good option when the doses are low and the drugs can be made into an ointment, cream, or patch. Sometimes, these low doses can improve symptoms..." Those sentences could be greatly improved upon themselves, but they're a lot "plainer" and easier to read than the original. And I rewrote them in less than a minute.

This is just one example on one page. The book is full of writing like this. It's readable (though I've seen better writing on the subject), but one thing it is definitely not is plain-language -- which appears to be the point of the book in the first place. If that's what you're looking for, you will be sorely disappointed.