Book Review: "Origins" by Annie Murphy Paul

Origins
How the Nine Months Before Birth Shape the Rest of Our Lives
By Annie Murphy Paul
Free Press (September 28, 2010)

I thought the acronym FOAD stands for fuck off and die, but Annie Paul taught me it stands for "Fetal Origins of Adult Disease." Maybe I wasn't the only one with that association, because from her book "Origins, How the Nine Month Before Birth Shape the Rest of Our Lives" I also learned that this research field was later renamed into DOHaD - "Developmental Origins of Health and Disease." And that's what her book is about: The increasing amount of scientific evidence that besides our genetic inheritance and individual experience, who we are and what we will be is influenced by a third, and long neglected, factor - the nine months spent inside our mother's womb.

As the renaming of this flourishing research area indicates, these are interesting studies not only to understand the origins of diseases, but also as guides to the health of coming generations. Unlike our genetic information, the conditions in utero are to some extend accessible for prevention and intervention. It has long been known for example that the same genetic information (genotype) might come in different appearances (phenotype), but exactly how this mechanism works and how the phenotype is affected in particular during gestation has only recently become accessible to scientific investigation.

Annie Paul is a science journalist, and her book is a survey of recent and not-so recent studies on DOHaD, together with historical anecdotes and reports of interviews with scientists, all woven together with the story of her own pregnancy. The book's chapters are (guess) month one to nine, and the reference list is extensive. It is a well-written, classical and flawless piece of a good science journalism. It also comes with the typical weaknesses of the genre. While Paul has thoroughly scanned the literature, she reports rather than explains, and if she has an own opinion on a particular controversial issue, she does not offer it. Since in addition a book on such a popular level cannot explain in much detail the studies it reports on, the reader who doesn't go and check the literature himself has little chances to form an informed opinion. While Annie Paul cleans up with a few decade old myths (for example the advise that showering with baking soda increases the chances of conceiving a boy) most of her book is a collection of topics and studies presently under discussion, and also an outlook on studies planned and consequences of what we have learned or may learn.

She covers the influence of traumatic experiences and stress on the developing fetus, environmental toxins, drugs and medication, and preexisting conditions of the mother (such as overweight or diabetes). The reader learns that there are studies that claim to have shown eating a bowl of cereal in the morning increases a mothers' chance of having a boy - and others that claim the result is nonsense, that a mother's experience of high stress or periods of hunger affects more strongly the survival chances of male than female fetuses, and that daily chocolate consumption of a pregnant woman results in happier babies. Paul also briefly touches on economical factors, citing studies that have shown people born in periods of hunger or wide-spread disease do on the average have a lesser income as adults than those who were born before or conceived after the tough times.

Annie Paul does mostly just document the research, but a few paragraphs here and there she takes on the question what the impact of this research may be on our societies in the future and what the benefit of this area of science may be. She hopes that babies born in difficult social situations - often correlated with malnutrition, drug abuse, stress or trauma - will have chances of doing better than their parents if special care is taken of pregnant woman, or children at risk for problems can be identified in advance and offered targeted help. She also hopes that in cases of natural disasters or war, mothers-to-be will receive psychological support to prevent their babies from being affected.

This all sounds very sensible, but on several instances Paul comes close to arguing for this additional care by an improved economic output: Healthy and happy children grow up to be more productive adults, so our societies should have an interest in this investment. I have encountered similar arguments repeatedly when it comes to health care, and I am wary of the implications. It is a quite slippery slope. If you step on it, you easily slide down to where you'll find that investments that will not pay off should not be made. It is however very likely that understanding the origins of adult's diseases and problems will in some cases lead to a better understanding, but a treatment may not pay off in economic terms. To me, it is more a matter of empathy and solidarity, than one of productivity, to offer such support.

Taken together, Annie Paul's book has provided me with a bulk of interesting and entertaining study results, yet with little insight as to their scientific credibility. It has given me an excuse to munch down Stefan's chocolate, reminded me of the weakness of the male part of our species, and caused me a bad consciousness for not clearing my household of plastics containing Bisphenol A, whether or not scientists will eventually find them reason for concern. Paul's book is an easy read, yet I would have appreciated a somewhat deeper coverage of the underlying science. I'd give this book 3 out of 5 stars if I'd have stars to give - in other words, it's not a must-read, you can wait for the paperback version.