Choked: Life and Breath in the Age of Pollution

In the spirit of disclosure, I was asked to review this book; I did not select it myself. In the spirit of fuller disclosure, I am now recommending it widely and commend those who persuaded me to read it. I mention this because it mirrors the topic and my task. In short, I now know precisely why air pollution matters greatly, and even if it is often out of sight it should not be out of mind. Readers of this Journal may be skeptical, as I initially was, as to whether Gardiners’s 2019 book Choked: Life and Breath in the Age of Pollution deserves their finite attention. But, as Gardiner makes abundantly clear, the act of breathing matters more than anything else. Hyperbole notwithstanding, it should concern anyone who cares about health: whether practitioner, patient, parent, or politician. Beth Gardiner is an environmental journalist, rather than a scientist, clinician, or politician. She has written for the New York Times, the Guardian, and National Geographic. This 312-page, 12-chapter book is buttressed by an impressive 20-page bibliography. It is divided into 2 parts. Part 1 is essentially “the problem” or what she calls “holding our breath.” Part 2 is essentially “the solution” or what she calls “coming up for air.” She uses chapter 1 to persuasively outline how over 7-million annual deaths can be attributed to air pollution (more recent data suggests 9 million, or roughly 1-in-9 of all world deaths). Whatever the exact toll, air pollution—principally nitrogen oxides and tiny particles called PM2.5—is associated with more human deaths than smoking, AIDS, diabetes, and vehicle crashes combined. In short, by page 34, this clinician and parent was in no doubt that I needed to read on. Next, in chapter 2, Gardiner exposes the so-called "ground zero of pollution: Delhi. Chapter 3 is London (her home town); chapter 4, the coal belts of Poland; chapter 5, the megafarms of California, and chapter 6 covers low-income countries and the damage from indoor fires. You are left in little doubt that pollution is a profound silent killer. It takes years off lives and is especially cruel to low-middle-income countries. Over 40% of Americans breathe polluted air daily, but over 80% of people worldwide do. Hundreds of millions struggle with its myriad consequences, whether to our lungs, hearts, or brains. It is also linked to poor learning and mental illness. Part 2 starts with the seemingly prosaic Clean Air Act of 1970. However, it is why North Americans breathe air that, while more dangerous than I previously realized, is cleaner than that in most of Europe. This act is also one of the planet’s most impressive pieces of environmental legislation. It shows that change is possible and launches her argument that the way ahead includes going back. Gardiner then uses the next chapters to outline reluctant but praiseworthy innovators, such as the automakers, the city of Los Angeles, and even the Chinese. In her epilogue, it is made clear that, without vigilance, all of these precious gains could disappear in a (literal) puff of smoke. Typically, a book review includes criticisms. This is difficult given that Gardiner took this reader from idiot to relative savant and did so using engaging prose. Perhaps some readers would like practical advice regarding how they can affect change in their homes and communities. Perhaps some of this Journal’s subscribers want to know more about specific organ pathology or the pollution associated with anesthetic gas. Perhaps others will not care for Gardiner’s criticism of the current occupant of 1600 Pennsylvania Ave. However, in my humble opinion, she avoids ad hominem attacks and maintains a logical linear narrative throughout. It may be clichéd to compare environmental books to Rachel Carson’s 1962 Silent Spring. However, just as Carson alerted a sleeping world to the unseen dangers of pesticides, Gardiner has issued a powerful, rational, wake-up call regarding the worldwide “plague of dirty air.” Her take-home messages are tough to challenge, namely that health matters as much as profits, clean air should not be a partisan issue, and inaction or the wrong action is dangerous. She persuaded this doctor that I have a duty to engage with this mighty societal issue. I henceforth even hope to be a converter of others (a catalytic converter, perhaps). Much like when I work clinically, I do not want to wait until it is too late. Peter G. Brindley, MD, FRCPC, FRCP (Edin), FRCP (Lond)Departments of Critical Care Medicine and Anesthesiology and Pain MedicineDossetor Ethics CentreUniversity of AlbertaEdmonton, Alberta, Canada[email protected]

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