When an Autism Diagnosis Comes as a Blessing

Posted on May 14, 2012 by admin

Blazing My Trail: Living and Thriving with Autism. Published by the author. Kindle, $7.99.

Reviewed by Steve Silberman

It's fashionable to say that autism has become a fashion.

If you think overweening psychologists are hastily applying labels like Asperger syndrome to quirky nerds who should be perfectly capable of making their way in the world with no special help, assistance, or accommodations, you have plenty of company. This past January, for example, the New York Times ran two op-eds in one day making that claim, including one by a young novelist named Benjamin Nugent who declared, "Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome."

The source of his authority on the subject, apparently, was that Nugent himself once received such a diagnosis as a teenager — at the urging of his mother, a psychology professor — and appeared in an educational video called Understanding Asperger's in a "wannabe hipster polo shirt." Now, however, Nugent has come to believe that the behavior his mother took for the telltale signs of a developmental disorder was merely his geeky teenage lifestyle, which included spending "a lot of time by myself in my room reading novels and listening to music." He went on to say that the cure for his misdiagnosis was moving to New York City, where he was finally able to meet other formerly bookish kids and schmooze with them in cafés. Having left his dreary foray on the spectrum behind him — followed by a "long time" of sulking in his mother's presence for having put him through the ordeal — he's now a professor of creative writing in New Hampshire.

Nugent's glib report surely provided a kind of comfort to some readers, who could return to their lives secure in the knowledge that many of these "Aspies" whom one keeps hearing about are simply "withdrawn, bookish kids" unnecessarily labeled by their histrionic parents with the help of psychologists eager to vault aboard the latest diagnostic bandwagon. After spending the past couple of years interviewing and spending time with autistic people and their families for a book, however, I can tell you that Nugent's experience is the exception, not the rule.

Everyone I've met who has been diagnosed with Asperger's syndrome or other form of autism faces profound challenges in day-to-day life. Even the most "high-functioning" autistic people (a term I now avoid using, because it renders certain forms of cognitive disability harder to see, while obscuring the gifts and competence of those branded as "low-functioning") work tremendously hard to find and sustain friendships; to manage the jarring changes that intrude into the most carefully planned-out schedules; to maintain their composure in noisy sensory environments; to get hired for jobs worthy of their intelligence and skills; and to navigate their way daily through a minefield of unspoken social rules and cues designed by and for people whose brains are wired differently from their own.

That's one reason the revision of the criteria for autism in the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders – the bible of psychiatry used to determine diagnosis, access to services, and reimbursement from insurers — has become so controversial. Even psychiatrist Allen Frances, who led the task force that developed the criteria in the DSM-IV, has gotten into the act, claiming that spectrum diagnoses have become "faddish." Many autistic self-advocates suspect the American Psychiatric Association is about to pull a diagnostic sleight-of-hand by shaving off a portion of the population that would have been eligible for an Asperger's diagnosis under the DSM-IV criteria, and give them a newly minted diagnosis of Social Communication Disorder, which has no legacy services or support systems. Some fear the APA is trying to finesse the increasing scarcity and overloading of services for autism, when budgets are being slashed in the name of austerity, by manipulating labels to lower demand.

There is no question that people diagnosed with Asperger's syndrome have an authentic need for help, long after they've "aged out" of the meager support provided to kids until they turn 21. Contrast Nugent's breezy anecdotes about pissing off his schoolmates by "trying to speak like an E.M. Forster narrator" with this description of attempting to absorb an ordinary conversation written by Rachel Cohen-Rottenberg, one of the most passionate and articulate disability-rights bloggers, and author of a new ebook called Blazing My Trail: Living and Thriving with Autism. "When I hear, I see the spelled-out words in my mind, and I have to internally read and translate those words in order to understand their meanings. As a result, even in quiet environments, I cannot keep up with verbal input for more than five or 10 minutes without falling behind, unless the other person slows down his or her speech and leaves a number of pauses in which I can respond. Pacing is everything."

Or consider this list of activities that Cohen-Rottenberg identifies as particularly challenging:

Food shopping

Sweeping and mopping the floor

Cooking

Driving

Running errands

Going to appointments

Planning, executing, and transitioning between tasks

Working at a job

Making friends

Autistic people in Cohen-Rottenberg's generation never got the chance to be diagnosed with Asperger's as kids, because the diagnosis didn't exist. It's easy to forget that just 40 years ago, there was no concept of a broad, inclusive spectrum that encompassed accomplished professionals like Temple Grandin and autistic people who may never learn to speak or put on their clothes in the morning without help. (Indeed, Grandin's debut memoir, Emergence, was initially billed as the first book by a "recovered" autistic person, because the idea that an autistic woman could enroll at a university, earn an advanced degree, and become a leader in a demanding field didn't seem possible.)

On websites for parents, an autism diagnosis is often framed as a heartbreaking event, an occasion for grieving the typical child they'd planned for. That's understandable and human, but it's illuminating to read statements like "Don't Mourn for Us" by autistic adults like Jim Sinclair, one of the pioneers who has inspired a generation of self-advocates to view their autism as an essential part of who they are, rather than as a pathology they might be cured of someday.

For Cohen-Rottenberg, who was 50 years old when she was diagnosed, the label arrived as a blessing. She felt she finally understood why she had been relentlessly bullied and teased when she was young; why she found certain environments that other people enjoyed (such as crowded restaurants) unendurable; why her first marriage went off the rails; and why she had to work so hard to parse non-verbal cues that her peers can take for granted. "I was like a person with mobility issues trying to run a marathon every day and keep up with people whose bodies worked differently from mine. Burnout was inevitable," she writes. "In a few short years, I seemed to go from a lifetime of being super-functional to struggling with basic things… It was my lifelong ignorance of being autistic that was catching up with me."

Unlike many of the ebooks reviewed at Download the Universe, Blazing My Trail offers no multimedia bells and whistles; it's just text with a few family photographs. But it represents the promising potential of the form to provide a venue for highly skilled writers who might never have been able to convince a corporate publisher that their message was capable of engaging a mainstream audience.

Cohen-Rottenberg's first ebook, The Uncharted Path, available as a PDF, recounted her difficult upbringing and her path to diagnosis. "My attempts at making contacts always felt a bit like trying to drive a car by gripping the steering wheel with my teeth," she wrote. Blazing My Trail continues the story, and addresses how she and her second husband, Bob, have worked as a team to manage her sensory sensitivities and social challenges while building a happy life together. Her unaffected honesty makes Blazing My Trail an uplifting journey — not in the usual sense of being a heroic saga of a narrator "overcoming" disability with pluck and guile; but by bearing witness to the power of accepting and celebrating oneself exactly as one is.

Cohen-Rottenberg comes through her writing as a wise elder of her tribe and a role model for young people, as well as a smart critic of social attitudes toward disabilities, both visible and invisible. "If we lived in a society that took human diversity for granted, that made room for difference as a deeply held value, every one of us would benefit," she says. "Our view of one another would become much more expansive, much more respectful, and much more compassionate. Ultimately, we might even see one another as perfectly different and perfectly human."

Steve Silberman is writing a book about autism and neurodiversity called NeuroTribes: Thinking Smarter About People Who Think Differently for Avery/Penguin 2013. He is a contributing editor of Wired magazine and one of Time's selected science tweeters (@stevesilberman). He lives with his husband in San Francisco.

Leonardo: The First Great Science Ebook

Posted on May 4, 2012 by Carl Zimmer

Leonardo da Vinci: Anatomy Touch Press Ipad. $13.99 Publisher site

Reviewed by Carl Zimmer

There's no point in beating around the bush. Leonardo da Vinci: Anatomy is simply the best ebook about science that I have ever encountered. To me, it is the exemplar of what ebooks can be.

Leonardo da Vinci: Anatomy comes from Touch Press, whose lavish apps we've reviewed before at Download the Universe (Gems, The Solar System, The Elements). I've personally toyed around with all three of those apps, and while they each offered a number of pleasures, each one felt limited in one way or the other. Gems, for example, lets you twirl diamonds and rubies, but, as Virginia Hughes noted in her review, it doesn't tell you much about them or about their place in human history. The Solar System, reviewed by Jennifer Ouellette, has some very impressive features for navigating among the planets, but Jennifer noted that it lacks a clear story.

Given this track record, I launched Leonardo da Vinci: Anatomy expecting a good-looking but flawed production. No shortcomings came to light, so I tried looking for them. I looked hard. And I couldn't find any. Leonardo da Vinci: Anatomy has everything I could ask for in an ebook about one of the greatest stories in the history of science: a pioneering work on anatomy that was lost for over four hundred years.

Living during the Renaissance, Leonardo's initial understanding of the human body came from ancient scholars like Galen and Aristotle. He was taught that animal spirits traveled through giant holes in the head and then flowed into the nerves. He was taught that blood was produced in the liver and then flowed outward to the ends of the body. One reason that these obviously wrong ideas persisted for over a thousand years was that medieval scholars did not conduct their own autopsies or experiments. Galen and and company had figured out everything there was to know about anatomy, so the best thing they could do was read, not conduct research.

With the Renaissance, that obedience began to crumble. Leonardo was the quintessential do-it-yourself-er. He conceived of new kinds vehicles and weapons; he investigated optics and geology. Wikipedia has set aside a separate page for a startling long list of his accomplishments.

Leonardo also became obsessed with human anatomy, and did not hestitate to make up his own mind about it. He dissected human cadavers. To figure out how the heart worked, he created a glass model of it. To probe the brain, he injected hot wax into the head of a freshly slaughtered ox.

As I wrote in my book Soul Made Flesh, Leonardo had a hard time breaking free from the old notions of how the body worked. When he discovered that the head did not contain three linked chambers, he couldn't break free from the old theory of animal spirits. He could not accept that perhaps the brain itself was responsible for thought. Likewise, although Leonardo discovered a valve in the aorta, he did recognize that blood circulates around the body, pumped by the heart. Nevertheless, his drawings were the greatest anatomical works that existed in his time. Not only were they anatomically correct, but they displayed his artistic mastery.

Leonardo actually came close to publishing a textbook of anatomy while he was living in Milan, but battles in 1511 drove him from the city and he never quite managed to finish it before his death in 1519. Instead, his drawings remained hidden away until the twentieth century.

Today, the Royal Collection is unveiling the largest ever exhibition of Leonardo’s anatomical drawings at The Queen’s Gallery in Buckingham Palace. They also teamed up with Touch Press to create an app based on the show. All the members of the team brought their A game to this undertaking. Leonardo da Vinci: Anatomy contains a richly informative narrative about the artist's hidden career as an anatomist, written by Martin Clayton, Senior Curator of Prints and Drawings at the Royal Collection. It is illustrated elegantly with Leonardo's drawings, as well as interactive images of human anatomy as we know it now. You can see for yourself just how good his drawings of the heart or uterus were. You can turn arms to see how well Leonardo appreciated the body's biomechanics.

These components are copious but never intruding. And they always answer the question raised in the reader's mind by the text. Videos from historians and scientists end each chapter–usually I hate these features, but in Leonardo, the talking heads actually have something to say.

The app also contains Leonardo's notebooks themselves. The interface for this part is nothing short of brilliant. You can search through the pages by organ or system. Each page is presented in its original state, scanned to exquisite resolution. Tap the screen, and the app instantly translates the inscrutable notes Leonardo scribbled by his drawings. Each page is also annotated with useful explanations of what Leonardo was contemplating with each image.

Three decades after Leonardo's death, Andreas Vesalius published Fabrica, which has long been considered the first modern work of anatomy. Leonardo da Vinci: Anatomy demonstrates that Fabrica was not the only masterpiece of the body to come out of the Renaissance. Not many ebooks can claim such achievements.

Zimmer author photo square Carl Zimmer writes frequently about science for the New York Times and is the author of 13 books, including A Planet of Viruses

Artificial Epidemics: You’re Not Really Sick, You’re Overdiagnosed

Posted on April 20, 2012 by Carl Zimmer

Artificial Epidemics: How Medical Activism Has Inflated the Diagnosis of Prostate Cancer and Depression, by Stewart Justman. Now and then Reader, 2012. Publisher's site, Kindle, iBooks, Kobo

Reviewed by SciCurious, guest reviewer

"In the mid-1990s I found myself on a committee charged with reviewing medical expenditures under my university's health plan. Like the rest of the country, the members of the plan had fallen in love with anti-depressants, which accounted for our largest single drug expense-several hundred thousand dollars annually, as I recall. When someone around the table commented that this was a lot of money to be laying out for mood-altering pills, a defender countered, "If they prevent one suicide, they're worth it!" Argument ceased. No one in the room, including myself, was aware that anti-depressants actually increase the risk of suicide, particularly in patients up to twenty-four years of age."

This opening scene from Stewart Justman's Artificial Epidemics sets the stage for a tangled, convoluted tale of two distinct diagnoses–prostate cancer and Major Depressive Disorder–and how intensive screening for these diseases has rendered us all overdiagnosed. Justman, a professor of Liberal Studies at the University of Montana, has made a long study of cancer, publishing several books including Do No Harm: How a Magic Bullet for Prostate Cancer Became a Medical Quandary and Seeds of Mortality: The Public and Private Worlds of Cancer. Artificial Epidemics, a slim, 22-page eBook appears to be an attempt to bring together his previous writing on cancer with another highly-diagnosed and talked about disease: Major Depressive Disorder.

"The campaign against depression and the campaign against prostate cancer both used inflamed arguments and appealed to fixed ideas," Justman writes. He lays the bulk of the blame for the resulting "artificial epidemic" on medical activists, who have taking screening for these diseases to large segments of the population. Justman also argues the screenings for prostate cancer and depression suffer from an “absence of appropriately discerning methods,” and thus help in the push toward the overdiagnosis of the American population.

His solution? Stop the screening, stop the treatment. We are not sick, we are overdiagnosed.

Justman’s concerns regarding prostate cancer are not particularly new. Prostate-specific antigen (PSA) testing has been controversial since the beginning. As Justman notes, “the same vial of blood divided in two may give different PSA readings.” Medical experts have also voiced criticism about the cut-off points for diagnosis for prostate cancer. Since the treatment for prostate cancer can be invasive, the U.S. Preventative Services Task Force has proposed that when men score an initial PSA that only barely reaches the threshold for cancer, they should not immediately start treatment. Instead, they should undergo so-called "watchful waiting."

Justman sees the same problems with oversensitive analyses and overdiagnosis in Major Depressive Disorder. But his argument also goes beyond against current screening practices. He's against the diagnosis of depression itself.

"The possibility that much 'depression' might not be a disorder at all has been drowned out by medical activism,” Justman writes. He scoffs at the World Health Organization's prediction that depression is soon to become the second leading cause of disability across the globe as “hubristic.” He argues that it's far too easy to diagnose, given that the symtoms include things like feeling tired, overeating, or not finding pleasure in things. "According to this checklist, I would qualify for a diagnosis of Major Depressive Disorder if I simply had too little energy and had trouble staying asleep–as in fact I do…In point of fact, my symptoms are not diagnostic of anything."

What is Justman’s response to these two ‘artificial epidemics’ of prostate cancer and depression? Sit down, relax. "Much of what is called cancer is not destined to cause death-and so too, much of what is considered depression resolves itself without medical intervention." He wants the screenings to stop, and overdiagnosis to end. Justman proposes an appeal to prudence. "Prudence deems life without sadness a utopian fantasy, silent cancer a tolerable reality, and the medicalization of the human condition an aggressive expansion of professional authority."

Unfortunately, while Justman’s statements about prostate cancer diagnoses are well researched, his mockery of Major Depressive Disorder is both insulting and ill-conceived. What's more, his arguments for both prostate cancer and depression are made in complete incoherence. The narrative jumps from prostate cancer to depression in the same paragraph. Here he even makes the leap within the same sentence: "Setting a two-month period for allowable grief is like setting the threshold for an abnormal PSA at a figure that trades off a reduction of false negatives with an inflow of false positives."

Justman composes long, run-on sentences in an effort to show how prostate cancer and Major Depressive Disorder diagnoses are similar: "Both PSA testing, which appeals to evidence presumed to exist, and testing for depression, which appeals to diagnostic criteria conceded by the psychiatrist in charge of the composition of the third edition of the DSM to be seriously defective, reveal conflicted attitudes toward evidence-based medicine itself." The net result is an exhaustive and repetitive reading experience. In the end, I’m just confused and beginning to think my prostate has been experiencing depressed mood.

In this tangle of prostate cancer and depression, the focus of the title is lost. I have yet to read how, exactly, medical activism has influenced clinicians and insurance companies to collude with them in the overdiagnosis of the nation. Instead, the book impresses the idea of overdiagnosis, without offering any clear solution except to stop diagnosing.

Here Justman confuses the ideas of diagnosis and treatment. While it makes sense to delay invasive treatments and track the progress of an already diagnosed disease, stopping screening and diagnosis would merely ignore the problems. Prostate cancer is still the second leading cause of death in men. Additionally, Justman’s flippant attitude toward Major Depressive Disorder ignores the real suffering of patients, and adds to the stigma these patients experience. But Justman clearly believes depression is not a real problem and most prostate cancers as fine.Just put on a smile, stop wallowing in your emotions. That prostate enlargement probably doesn’t mean anything.

After spending so much time reading Justman’s incoherent arguments, dismissive delivery, and his final, confusing appeal to “prudence”, my only recommendation is that if you are concerned about issues with prostate cancer or Major Depressive Disorder diagnosis and treatment, go read something else. The writing is bound to be less confusing. After suffering through 22 long pages of this ebook to write this review, I’m afraid my prostate needs an antidepressant.

Scicurious is a PhD in Physiology, and is currently a postdoc in biomedical research. She loves the brain, and so should you. She writes for The Scicurious Brain at Scientific American Blogs and Neurotic Physiology on the Scientopia Network. Follow on Twitter @Scicurious.

A Disorganized Celebration of Skulls

Posted on April 13, 2012 by admin

SKULLS. 2011 by Simon Winchester. Touch Press. iPad. App webpage.

Reviewed by Brian Switek

No set of bones better exemplifies the natural history of an animal than its skull. Postcranial skeletons are all well and good – the vertebrae, limbs, and associated parts all testify to how an animal moved and behaved – but skulls are the most iconic aspects of a creature’s ossified frame. The skull is the seat of the brain, and, therefore, the senses, and the critical details of how an organism perceived its world can be detected from this complex arrangement of bones. As much as any group of bones can, a skull summarizes the essence of an organism – to draw from my beloved non-avian dinosaurs, a Tyrannosaurus or Triceratops skeleton would just not seem as magnificent without their fantastic, iconic skulls attached.

Not everyone shares my affection for skulls. I learned this the hard way. A few years ago, I spotted a bleached raccoon skull along the side of a trail in the New Jersey woods. I put the skull in my camera bag, carried it home, and put the cranium in my desk drawer. Fortunately for me, my wife has been very kind about my fascination with bones and thought nothing of it. But when my wife’s best friend was petsitting at our apartment a few months later, and said friend opened my desk in search of a pen, she was horrified to see raccoon remains staring back up at her. To me, the skull was a representation of the raccoon’s life and evolution, but she saw the skull as a symbol of death and decay.

Simon Winchester’s Skulls – an ebook-iPad app hybrid – explores the various meanings of the haunting bones. Skulls are objects of natural history, have been misappropriated to support discrimination, and can act as warnings of impending doom. What a skull means rests in the eye of the beholder (and those eyes, of course, are set into skulls themselves.)

Skulls was not what I was expecting. I thought the app was going to be a virtual museum of various specimens that users would be able to manipulate to get a better look at the various components of the craniums. And while there is that aspect to the program, Skulls tries to be more.

Each of the app's interactive skull images is organized within twelve different sections which focus on cranial components, how the bones are collected, and the cultural meaning of skulls. In the introduction, which outlines what a skull is, a series of representative specimens stream past on the right side of the screen as Winchester explains on the left, with certain keywords linked to particular skulls. (Users can read at their own pace, or choose to have Winchester read to them in his halting cadence.) On that first page, the word “majesty” is linked to one of the fabricated crystal skulls which led Steven Spielberg to run the Indiana Jones franchise into the ground, and the simple mention of “skulls” at the bottom corresponds to the strange cranial architecture of a long-spine porcupinefish. The piscine skull looks like good inspiration for one of H.R. Geiger’s techno-biological horrors.

There’s more than one way to explore the selected skulls. Readers can proceed linearly through each of the twelve short sections, they can hit the “gallery” button at the top of the screen to explore the highlighted skulls in each section, or can simply tap “The Collection” on the main page to bring up a constantly-rotating collection of alphabetized skulls. The best part of the latter option is the ability to view multiple skulls side-by-side via the “compare” button. The saber-fanged weapons of a Smilodon look all the more fearsome when viewed directly next to the much shorter, stouter canines of its distant, living relative, the lion.

But this is also the most frustrating feature of Skulls – the app only allows users to zoom in and rotate along the horizontal axis. You can’t flip the skulls to have a look underneath, or explode skulls to play with their various parts. With a little more effort, Skulls could have acted as a rich, virtual reference for anatomy students or anyone interested in learning more about osteology, natural history, and evolution. Instead, Skulls is more of a virtual museum – you can look, but your ability to learn directly from the bones is severely constrained. (Ironically, the publisher of Skulls, Touch Press, lets you to flip planets and moons in another of their apps, The Solar System, which we reviewed last month.)

Though limited, the app’s gallery of spinning skulls is fun to fiddle around with. The ebook portion only left me puzzled. While I greatly enjoyed the format of having parts of the text correspond directly to the stream of skulls on the right side of the virtual page, there was no central narrative or story. Winchester jumps from a general overview of skulls to a profile of skull collector Adam Dudley before moving on to bizarre cranial modifications and the meaning of osteological iconography. There is no flow between sections – they all stand on their own and vary in style. “A Skull’s Component Parts” – in which Winchester avoids actually describing the various bones which make up a skull – is presented in an encyclopedia format, while Winchester’s visit to the skull of 17^th century Ottoman military leader Kara Mustafa Pasha was composed as part history and part travelogue. And section 6 – “The Skull of the Dodo” – feels entirely out of place. Winchester says almost nothing about dodo skulls, and instead recapitulates the extinction and artistic representations of the extinction icon.

Strangest of all, Winchester goes on a brief tear about paleoanthropology in the “Science and Pseudoscience” portion of the book. After addressing how some misguided researchers used craniometry to buoy their own racist notions, as well as recapitulating the Piltdown Man scandal, Winchester settles into a wandering discussion of human evolution. “It can fairly be said,” Winchester writes, “that in the history of biological science never has so much been imagined by so many on the evidence of so little than those who have studied the skull and wondered about human evolution.” Granted, specimens of fossil humans are rare and often quite fragmentary, but Winchester does nothing to support his claim that much of what we think we know about our ancestors is “imagined.” Indeed, rather than support his claim, Winchester quickly moves on to say that the human skull has changed only little in the past three million years and that human evolution has ultimately halted. The first statement feels contradictory to the rest of the section – in which Winchester mentions how brain size, brow ridges, teeth, and facial construction have changed among our prehistoric kin – and the second assertion is only armchair philosophizing. While changes to our physical form might not be apparent, there is a growing body of scientific evidence that human evolution continues to this very moment and can be tracked in our genes.

Ultimately, Skulls feels like a disorganized tour of a virtual curiosity cabinet. There are lots of fascinating tidbits along the way, and Winchester shows a clear enthusiasm for his subject, but I reached the bottom of the last page without understanding what the point of the entire exercise was. Skulls is a disorganized celebration of cranial bones and is of little utility as a reference. I couldn’t help but laugh in disagreement when, in the last section, the app dubbed itself “a near-perfect survey” of skulls. The mashup of biography, history, editorial, and encyclopedic catalog made Skulls feel like a concept stretched too thin and spread too wide. Unlike an actual skull, the app’s various components never come together to create a functioning whole.

Brian Switek is a freelance science writer and author of the book Written in Stone: Evolution, the Fossil Record, and Our Place in Nature. He regularly blogs about paleontology at the WIRED Science blog Laelaps and the Smithsonian blog Dinosaur Tracking. His next book – A Date With a Dinosaur: On the Road With Old Bones, New Science, and My Beloved Brontosaurus – will be published next year by Scientific American/FSG.

Steven Gilbert Really, Really Wants You to Know About Poison

Posted on March 29, 2012 by admin

A Small Dose of Toxicology, 2nd edition, by Steven G. Gilbert, 2011, E-pub, Kindle, pdf,

Reviewed by Deborah Blum

In 2004, a Seattle-based researcher, Steven Gilbert, published a 280-page paperback titled A Small Dose of Toxicology. You might not guess from that modest title that the author was on a scientist on a crusade. But he was. He is.

"It's critical that we scientists be more engaged with the public," he says."We're talking about environmental issues that are having a bigger and bigger impact on our lives." He had big goals for the book too – he wanted it to contribute to public awareness, to encourage people to demand more of a government response, greater corporate responsbility. He wanted it to change things: "We have an ethical responsibility to our children."

Gilbert had a long-time background in the study of poisonous things. He received a PhD in toxicology from the University of Rochester in 1986. He was founder of the non-profit Institute of Neurotoxicology and Neurological Disorders in Seattle, an affiliate professor at the University of Washington. His particular area of study was in the area of low-dose exposures to toxic chemicals, an area that he was uneasily aware remained poorly understood.

And after some years, he just wasn't sure that the paperback was having the hoped for effect. Or that his publisher was particularly enthusiastic. So he decided to take it on as a DIY project. "I was originally disappointed. Then, I thought, well I could do this myself." First, he started a website, Toxipedia, which provides a free, searchable database of information on toxic chemicals. And then he started his own e-book publishing company, Healthy World Press, and published the second edition of A Small Dose of Toxicology himself.

The book is one of three now published by Healthy World and all follow the same model. They are offered as free downloads in either e-pub, Kindle, or pdf format from the Toxipedia website. There's a requested donation to Gilbert's non-profit but it's not required. "My first goal wasn't to make money," he said. "It was to have an impact."

I contacted Gilbert after discovering his e-book on the Toxipedia site. This was not, um, my first visit there in search of poisonous information. It's a natural consequence of writing a book about poisons and blogging on that same subject over the last few years. Really. Although sometimes I worry that the search history on my hard drive, riddled with visits to Toxipedia, the Agency for Toxic Substances and Disease Registry, and their ilk suggests the habits of a fairly iffy character.

But anyway – and more to the point, I recognized in Gilbert's work an awareness not unlike my own - that we exist in a chemical world, that we've yet to map that complicated terrain or fully understand its risks. And that as our adventures in chemistry – taking as a simple example, rising levels of carbon dioxide in the atmosphere – change our planet, there's an imperative need to do tell that story better.

Still I was curious.

One can admire the crusade and still wonder if it's actually accomplishing anything. I wondered whether Gilbert's decision to go to e-self publishing improved the paper product in any meaningful way. And it's with those questions in mind that I now want to address the book directly. For comparison purposes, I downloaded it in two different versions on my iPad, as an e-pub (which went direct to my iBooks library) and as a pdf. It's also possible to simply read the book on-line here.

At its most basic, A Small Dose of Toxicology remains a reader-friendly reference book. As my pdf version tells me, it's still 280 pages. It has 21 chapters (although I had to count them because in the e-version, they are not numbered in the table of contents). The book starts with an overview – "Toxicology and You" , followed by a brief history of poisons and their studies, followed by chapters that focus on a specific toxic substance or issue. The first three chapters do this through a lens of everyday consumption: alcohol, caffeine, nicotine. The book then explores such famously poisonous materials as arsenic, mercury and lead before moving onto subjects such as as endocrine disrupters and radiation exposure.

In other words , it contains many small doses of information about many toxic things. You can see exactly why a poison-obsessed writer like myself would go for the material. But the better thing about it is that it's not written for someone like me. Gilbert is aiming for a more general audience (he tells me he hopes to see it used in high school classrooms) and he succeeds in making this a solidly written, clear, and occasionally fascinating exploration of toxic chemistry.

Of course, it's hard to make poison too boring. Still, he has a nice technique of using everyday examples to create level-headed explanations, for instance in this section on calculating a toxic dose:

"There are approximately 100 mg of caffeine in a cup of coffee. The actual amount of caffeine depends on the coffee beans, how the coffee was prepared, and size of the cup. And adult weighing 155 pounds (about 70 kg) who consumes this cup of coffee would receive a dose of 100 mg divided by 70 kg or 1.4 mg/kg of caffeine. The importance of including body weight becomes clear if you consider a child who weighs 5 kg (about 11 pounds). If this child consumed the same amount of coffee, the dose would be 100 mg/5 kg or 20 mg/kg, more than ten times higher than the adults."

And he weaves such examples throughout his story, later calculating the half-life of a cup of coffee in the body (about four hours), later again looking at the effect of pregnancy on that half-life question: "During the last two trimesters of pregnancy, caffeine metabolism decreases, and the half-life increases to about twice normal, or 8-10 hours. This means that after caffeine consumption both the material blood levels and the infant's exposure will stay higher for a longer period of time."

These facts and examples are neatly ordered. Each chapter begins with a "quick facts" chart, followed by a history of the specific poison and its use in society (lead in pipes and paint, mercury in thermometers and so forth), followed by case studies – the recent discovery of lead in children's lunch boxes where it was used to stabilize the plastic – followed by information about health effects, ongoing research, and government regulations.

Occasionally, though, the author goes beyond textbook into advocacy: "We need to reduce the use of lead in a wide range of consumer products," Gilbert writes in the chapter about that heavy metal. These opinionated moments and his sense of story telling, lift the book beyond standard textbook. Although I suspect that also means that it won't appeal to readers from the anti-environmental movement.

But, you may ask, couldn't he present the advocacy and information just as neatly in a print format? And I've come to believe that he couldn't. Oh, the downloaded books have some of the usual glitches we find in these early days of e-book publishing. I complained earlier that the table of contents in the pdf version didn't provide page numbers for chapters. The iBook version I downloaded skipped the table of contents entirely (I could have tried again for a better result but I just flipped over to the pdf for the information).

But, but, the e-version does work in ways that would just not be possible in print – by which I mean that it offers a dazzling array of live links to additional information and resources. The introduction is followed by four pages of links to regulatory agencies and other organizations around the world that archive information on toxic materials. Further links stud the text and there are yet more at the end of each chapter. Not to mention links to graphics, powerpoints, interactive posters.

Gilbert is especially proud of his Milestones of Toxicology poster, which you can link to from the book or here from the website. The poster has now been translated into ten languages, mostly recently Arabic. A Chinese translation is in the works. He also likes the idea that as publisher of his own e-book, he can keep it updated. When I talked to him, he was already planning to add new research papers into the book and, in fact, planning a third edition that would make better use of his website and contain more hyperlinks to Toxipedia.

Yes, empire-building already out in the digital universe. But in a good cause. We really do need to know more about poison.

Deborah Blum is a Pulitzer-prize winning science writer and the author of five books, most recently the best-selling The Poisoner's Handbook: Murder and the Birth of Forensic Medicine in Jazz Age New York. She is a professor of journalism at the University of Wisconsin-Madison.