But there is still plenty for feminists to do, even in the Western world, if they are to achieve the equality that they are striving for. The UK’s Margaret Thatcher and Germany’s Angela Merkel are still the only women to have become leaders of major Western powers. Women are still in a small minority as elected representatives at both local and national levels. Moreover, average pay levels for women remain significantly below those for men.
In other countries, including Iran, the challenge for feminism is far more extreme. In a world where women and girls endure anything from stoning for adultery and enforced marriage to sexual exploitation and barred access to education and careers, feminism remains very much a vital cause.
[1] Women got the vote in New Zealand as early as 1893 and in Australia in 1902, in Finland in 1906 and in Denmark, Norway and Iceland between 1913 and 1915.
#18 Bread
There are few smells more enticing, more delicious than the aroma of freshly baked bread – as warm and comforting as a thick duvet on a winter’s day and appetising enough for supermarkets to pump it into their stores in the knowledge that it will make people hungry enough to buy more food. There are few aromas, apparently, if any, which are so universally appealing and guaranteed to make people drool.
It’s impossible to tell, of course, whether we humans liked the smell instantly when the very first loaf was baked long ago, or whether its attractiveness has gradually seeped into our subconscious over time, through its associations with security and sustenance. But the power of that smell wafting through the air is ample testament to the simple brilliance of bread as an idea. Even if it were nothing more than this matchless aroma, bread would be a great idea, but its real value is as a foodstuff.
It is quite simply one of the most nutritious and healthy foods there is, and it is hardly surprising that it is a staple for billions of people around the world. While it is true that man cannot live on bread alone, few other foods have bread’s ability to provide day-to-day sustenance. It is above all a cheap source of the basic carbohydrate fuel we need to give us energy.
Yet bread is much more than just fuel for the body. It also contains fibre from the bran, the outside of the wheat, which helps digestion, and vitamins B1 and B3 which extract energy from food and keep the eyes, skin and nervous system healthy. A good supply of these vitamins is vital since the body cannot store them – and in poorer countries where bread is scarce, people often suffer from diseases like beriberi and pellagra due to lack of B vitamins.
Bread is also one of the most important sources of calcium in the diet – essential for healthy bones and teeth. Bread’s calcium content may not be altogether natural. Because nearly everyone eats bread in the UK, millers are legally required to add a certain amount of calcium to white and brown flour to boost people’s intake of the mineral. This has played a significant role in the virtual elimination of the childhood bone disease rickets from developed nations. When you learn that bread is also a major dietary source of iron (for healthy blood), folic acid (good for pregnant women) and minerals such as selenium, sodium, potassium, magnesium, copper, phosphorous and manganese, it’s clear why bread is such a good food. There are downsides, though, as I’ll come back to later.
Bread is one of the oldest recipes in the world, one of the first foods humankind ever ate that wasn’t either eaten raw or cooked as it came. Maybe it was the very first. At heart, it’s a very simple recipe, which just involves grinding grass seeds to a powder or flour, adding water to make a paste or dough, rolling it out, then baking it slowly. But if you think how many people cannot make their own bread today, you begin to realise what an achievement it was to come up with the idea in the first place, when no one had done anything remotely like this before.
Of course, we have no idea who those unsung innovators were, but they probably lived in the Middle East. In 2005, researchers found wild grain seeds, grinding stones and a stone oven at a 23,000-year-old site, Ohalo II, near the Sea of Galilee. Large ancient granaries in Jordan show that by at least 11,000 years ago, bread-making was well established. And there is ample evidence to show that bread was central to the diet of Ancient Egyptians. Archaeologists have even found (very stale) loaves of bread in Egypt dating back at least 5,000 years.
Remarkably, the earliest breads were not so very different from breads cooked around the world today. They were flatbreads, similar to Indian chapattis and naans, Middle Eastern pita breads, Arabic khubz and Mexican tortillas. The idea of leavening – raising bread to make it fluffier and lighter with gas bubbles from yeast – is fairly ancient too. It may have been discovered accidentally when a mix of flour meal and water was left standing for some time, allowing yeast grains, which occur naturally on wheat, a chance to ferment and create a lighter dough full of air. ‘Legend has it,’ report the European Confederation of Breadmakers, ‘that a slave in a royal Egyptian household forgot about some dough he had set aside. When he returned, it had doubled in size. Trying to hide the mistake, the dough was punched down furiously and baked. The result was a lighter bread than anyone had ever tasted.’ Nowadays, of course, yeast is added artificially, but for a long time, just adding this ‘sour dough’ to the next day’s bake was the normal way of leavening bread. There are Egyptian hieroglyphs from over 5,000 years ago which show bake-houses with dough rising next to bread ovens.
In some parts of the world, bread is still made much as it was in those early days, and in countries like France, craft bakery is a fiercely protected tradition. But in places like the UK most bread is made by an industrial process such as the Chorleywood bread process (CBP), which turns out a product that resembles and maybe even tastes like traditional bread, but is made in a very different way.
Instead of allowing the dough to ferment and rise for a few hours, the CBP gets air and water in almost instantly using high-speed mixers. So the whole process is much, much faster and can be entirely automated, which keeps the price of everyday bread very low. But it calls for extra yeast and chemical oxidants to get the air in, harder fat to maintain the structure, and also extra water.
In some industrially made breads, the hard fat is tough, hydrogenated trans-fats. But bad publicity about the health risks of trans-fats has persuaded some bread-makers to replace them with palm oils, which may turn out to be just as bad.
Although some traditional breads like ciabatta have a high moisture content anyway, industrial breads tend to contain much more water than comparable traditionally made loaves. Extra water means not only a significant saving in flour costs, but that the soft bread that people like can be achieved with tough lower-grade flour.
Getting the bread to hold together with all this extra water was easy with chlorinated ‘bleached’ flours, but these were banned in 1998 in the UK for health reasons. Now many bread-makers achieve the same with enzymes.
Moreover, the whole industrial bread-making process is so destructive of bread’s natural vitamin and mineral content that they have to be ‘restored’ with artificial vitamins and minerals added to the flour. Add to that a range of bleaching chemicals such as benzoyl peroxide and chlorine dioxide, both skin and respiratory tract irritants, to make the bread look nice and white, and others to stop the flour sticking at high temperatures and you have quite a cocktail!
So the bread you buy in supermarkets may be just a bit less nutritious than traditional bread. In fact, in large quantities it could even be a health risk because of its high salt content. In the past, normal fermentation was quite enough to give bread a good flavour. The drastic cut in fermentation times in industrial processes means extra salt has to be added to stop the bread tasting like cardboard. According to some estimates, bread is now the biggest source of salt in the average diet – and that high salt intake brings attendant health risks.
All of this might take the sheen off the idea of bread being the greatest thing since, well, unsliced bread … So, of course, maybe it is good, properly made bread that is a great idea, not all bread.
The
se caveats aside, bread has rightly been revered for its central role in much of the world’s diet over many thousands of years. Bread’s wonderful combination of simplicity, wholesomeness and food value mean that in many cultures it has come to symbolise our most basic need for sustenance, characterised in the Christian Lord’s Prayer, ‘Give us this day our daily bread’ and by the naming of the family’s basic provider as the ‘breadwinner’. It is no coincidence that in Arabic, the words for ‘bread’ and ‘life’ are nearly the same. It is that essential.
#17 Vaccination
Vaccines are the greatest medical success story of all time. In the developed world, they have been so effective at eradicating many infectious diseases that it is easy to forget just how terrible these once were. Smallpox, diphtheria, polio, tetanus, measles, whooping cough, typhoid, rabies, anthrax and many other diseases were not distant and occasional threats. They were ever-present monsters that stalked people throughout their lives and kept them in a constant state of fear.
Today, we rightly feel it is a tragedy if any young child dies. Yet just six children out of every 1,000 born in the UK, for instance, die before the age of five. That is sad enough, but in 1750 only one child in three survived beyond the age of five. Every child would expect to witness most of his brothers or sisters dying, or at least see their lives permanently blighted by disfigurement or disablement. In the developed world, disease has been so far banished to the dark corners of an occasional threat that it is hard to imagine what it must have been like to live with this high level of mortality. Even in poor parts of the world, where disease is still rife, it is not the mass murderer it used to be.
Of course, there are other factors involved in the dramatic reduction in disease, such as better diet and hygiene, better living conditions, improved medicines and so on, but vaccination is far and away the most important – because it works to prevent disease no matter what all the other conditions are.
The statistics are astonishing. Smallpox, which once killed 2 million people a year and disfigured many more, has been wiped out entirely. Polio, which even twenty years ago was claiming 300,000 victims a year, now affects under 2,000. Deaths from measles around the world have dropped from 6 million a year to under 1 million. Tetanus, which once killed many babies, has been virtually eradicated in two-thirds of developed countries. The incidence of whooping cough has been reduced by 90 per cent. The reduction in diphtheria has been equally dramatic. Disease is in retreat around the world and it is largely thanks to vaccination.
It all began with smallpox. Smallpox was a highly contagious disease that spread rapidly. It affected people of all ages and races. In every year of the eighteenth century, nearly half a million people in Europe – and countless others elsewhere – died from the disease. It claimed the lives of one in every five Londoners. And those who caught the disease and were lucky enough to survive were often scarred for life with pockmarked faces.
In China, though, they had discovered a way to combat the disease. They noticed that once people had survived smallpox, they never caught it again, no matter how much they were exposed to the disease. So the Chinese scraped material from the scabs of victims of milder forms of smallpox and rubbed it into a scratch on healthy people who had yet to catch the disease. Some people died quickly from the infection, but most survived, and seemed to gain the same immunity to the disease as those who had been through it properly. The practice of ‘variolation’, as it has become known, spread across Asia to Turkey, where it was noticed by the British ambassador’s wife, Lady Mary Wortley Montague. Lady Mary was so impressed that she had her own children inoculated[1] like this, and introduced the practice to the British upper classes.
It was a high-risk strategy, since many perfectly healthy people exposed themselves to smallpox and caught the disease, even if many more gained immunity. Then in the 1790s, a young country doctor named Edward Jenner was wondering why so many dairymaids had perfect complexions and seemed immune to smallpox. He guessed it might be because they had been through a similar, but much milder disease, known as cowpox, caught from the cows they milked. Medical ethics then were clearly not what they are now. Jenner decided to deliberately infect his gardener’s young son, James Phipps, with material from the blisters of a dairymaid suffering from cowpox.[2] A few weeks later, he deliberately tried to infect young James with smallpox. James proved to be immune and remained so all his life.
After further trials, Jenner was able to persuade the British government of the effectiveness of his technique. Across Europe and North America, governments introduced compulsory programmes to vaccinate children and the incidence of smallpox dropped dramatically. The last case of smallpox in the United States was reported in 1949. In 1959, the World Health Organisation launched a programme to eradicate smallpox from the world entirely. It would have been impractical to vaccinate everybody. So instead, people were vaccinated in rings around any infection site to stop the disease spreading. It proved so effective that the last case of smallpox in the world was reported in Ethiopia in 1976 and in 1979, scientists announced that vaccines had eradicated smallpox from the world.
Vaccination works because the body has its own remarkable line of defence, the immune system. Whenever the body is exposed to a pathogen (a disease-causing germ), it reacts by producing floods of proteins called antibodies unique to that specific germ. It’s important that the antibodies are unique because apart from attacking the germ directly, they act as beacons to trigger a massive attack by other aggressive body cells – and it’s important that these fighting cells only target the enemy and don’t expose the body to ‘friendly fire’.
It takes a little while to produce the right antibodies, and the body may suffer the symptoms of disease before they are ready to mount their counter-attack. Eventually, if they are successful, the germs are beaten and the body recovers. The next time that the body encounters the germ, however, the antibodies are ready to target it quickly and eliminate it before the disease develops.
The aim with vaccination is to prime the immune system with the right antibodies by exposing it to dead, weakened or partial versions of the pathogen. These harmless pathogens trigger the production of antibodies, but don’t cause the disease. With some vaccines, a single exposure is enough. With others, immunity needs to be built up gradually with a short series of vaccinations. Sometimes, the production of antibodies may drop off after a decade or so, and a ‘booster’ may be needed to restore immunity.
The challenge with vaccinations is to find the right vaccine. The vaccine has to trigger the production of the right antibodies, but it clearly should not make the patient ill. Medical scientists have no doubt that the best way of combating nearly every disease is to find a vaccine. With some diseases, one vaccine seems enough to provide long-term immunity. With ’flu, however, new variations of the virus are appearing all the time, and a new vaccine has to be developed to combat each one, so that those vulnerable to winter ’flu need to get a new vaccination every autumn to protect them against this year’s version. Some diseases, like HIV, are very hard to create an effective vaccine for, since HIV actually turns the victim’s immune system against him or her, but the rewards of success are so high that many researchers are devoting their entire lives to finding one.
Vaccinations, though, are becoming a victim of their own phenomenal success. They not only work to protect individuals; they also confer immunity on whole communities in what is called ‘herd immunity’. Once a high proportion of people in the community have been successfully vaccinated, the germs are eradicated before they can spread. So even those who have not been vaccinated, and the few in whom the vaccine has not worked properly, are protected against the disease. This is why mass immunisation programmes are often compulsory. Herd immunity only works effectively if, typically, 95 per cent of people are vaccinated.[3]
The problem is, though, that once herd immunity has built up to a certain level, the chances of catching the disease are very small. So people be
gin to wonder if the occasional side-effects of vaccinations are more of a risk than the disease itself. Individually that may sometimes be true. In recent years, there has been a well-organised anti-vaccine campaign to persuade parents not to immunise their children. The campaigners forget, of course, that the only reason why the side-effects of some vaccines are worth thinking about is because of the extraordinary success of immunisation programmes in eradicating the disease in the first place.
The campaigners seemed to have scored a major victory in 1998 when British doctor Andrew Wakefield published an article in the Lancet apparently demonstrating a clear link between the MMR (Measles, Mumps and Rubella) vaccine and autism. Wakefield’s research was later discredited and he was struck off in 2010. But the damage was done. As the media spread alarm, take-up of the vaccine dropped dramatically. Uptake of the MMR, which at 92 per cent had been almost at the herd immunity level, plummeted to 80 per cent. Serious cases of measles rose from just 56 in 1998 to 1,348 in 2008, with two children dying from the disease, the first for a long time.
The point is that vaccination is extraordinarily effective at disease prevention even on an individual level. But its success leaps to another level when the whole community is vaccinated, creating herd immunity. That’s how smallpox was eradicated. But this means that with some diseases people must be willing to accept a small personal risk of side-effects from the vaccination for the sake of massive benefits to the community as a whole.
The reality is that vaccinations have saved the lives of hundreds of millions of people already. We’ve already looked at the smallpox success, but it has been at least partially repeated with dozens of other once deadly or crippling diseases. In the USA, for instance, diphtheria declined from a high of 206,939 cases in 1921 to just one in 1998; whooping cough declined from 265,269 cases in 1934 to 6,279 in 1998; and measles has fallen from 894,134 cases in 1941 to just 89 in 1998. New diseases are being successfully fought all the time. Since the introduction of the haemophilus influenzae B (Hib) vaccine in the 1990s, for instance, the incidence of the distressing disease Hib meningitis, which once killed tens of thousands of children, has declined in Europe by 90 per cent and in the USA by 99 per cent.
The World's Greatest Idea Page 20
