Ever wonder how long you will live? We all query this at some point in our lives. Stephen Johnson (1968–present; “author of … books on the intersection of science, technology, and personal experience”1 ) asked and answered this question in Extra Life: A Short History of Living Longer.2  Recognizing that life expectancy has dramatically increased over the past century, Johnson notes that humankind has accrued “twenty thousand extra days of life on average.”2 Extra Life considers what accounts for this extension to our existence.

Johnson catalogues factors that have increased longevity, including anesthesia, on his list of innovations that have saved millions of lives. He offers an intriguing narrative of how medical and nonmedical people took step-by-step actions that connected the dots of information to enable breakthroughs in science, human health and welfare. He describes a lesson: multidisciplinary networking has great benefit in scientific inquiry.

Julius Comroe, M.D. (1911 to 1984; physician researcher) taught this lesson in Exploring the Heart.3  Scientific breakthroughs, he noted, are not brought about by one individual taking one giant leap from ground level to the mountain top; rather, small treks up the mountainside by a multitude are necessary to ultimately reach the pinnacle.

Johnson subscribes to this notion (i.e., a process of connecting the scientific dots to achieve medical breakthroughs). Extra Life provides a list of innovations that have increased life expectancy and saved lives: hundreds of millions saved by antibiotics and pasteurization of milk; billions by toilets, sewers, and vaccines. Like Comroe, Johnson notes: “developments represent the culmination of decades, if not centuries of work, conducted by hundreds of persons, complete with false starts, wild claims, and bitter rivalries. The breakthrough is really the latest in a series of small incremental advances, perhaps the one that has finally reached clinical relevance.”2  This sounds very compatible with our Journal’s mission: “Anesthesiology endeavors to be the vanguard of trusted evidence that moves the field forward, informs new discoveries, and improves practice.”4 

Johnson tells stories of connecting the dots. Individuals asked questions, gathered data, and linked their facts to the work of others, resulting in major medical practice breakthroughs. Each chapter has lessons for clinical and research anesthesiologists.

The chapter on infant mortality describes Lady Mary Montagu (1689 to 1762; English aristocrat) and Edward Jenner, M.D. (1749 to 1823; physician and immunologist), recognizing the value of vaccination to eradicate smallpox, a major factor in infant mortality.

In the chapter focused on the value of clean water, Johnson points out the importance of: (1) data collection and epidemiology employed by John Snow (1813 to 1858; physician anesthesiologist and medical epidemiologist) that resulted in the removal of the handle of the London water pump implicated in a cholera outbreak; (2) recognition of the negative impact of industrialization on life expectancy by William Farr, M.D. (1807 to 1883; British epidemiologist and medical statistician), whose work contributed to the founding of the Centers for Disease Control and Prevention; and (3) analysis of racial disparities in human health by W. E. B. DuBois (1868 to 1963; sociologist and civil rights activist).

A chapter considers pasteurization and chlorination, explaining how Frank Leslie (1821 to 1880; pen name of Henry Carter, a journalist, author of an exposé on milk as a “liquid poison”) and Louis Pasteur (1822 to 1895; a microbiologist and chemist) guided us to eliminate the transmission of the tuberculosis to human beings by processing and refrigerating milk.

The chapter on regulation of medications, ultimately through the creation of the U.S. Food and Drug Administration in 1953, explains how the persistent inquiry about the safety of thalidomide by Frances Oldham Kelsey (1914 to 2015; pharmacologist, physician, and Food and Drug Administration reviewer) was an essential ingredient in the development of our modern-day evidence-based study technique, the randomized, controlled, double-blind trial.

A chapter recounts the story of the discovery of penicillin that presaged development of our vast array of antibiotics, when Alexander Fleming (1881 to 1955; physician microbiologist) observed “the mold that changed the world.”2 

The chapter on automobile and industrial safety focuses on accidental death by machines. It was Nils Bohlin (1920 to 2002; Swedish mechanical engineer) who designed the seat belt for Volvo. The company released the design to the world as an open patent that enabled effective sharing of the discovery that has saved countless lives.

The final chapter describes the multiple settings in which reversing the world’s pockets of famine has extended longevity.

Extra Life is a fascinating read about things we don’t know and endeavor to understand. As was so aptly stated by Donald Rumsfeld (1932 to 2021; U.S. Secretary of Defense, 1975 to 1977 and 2001 to 2006), “there are known knowns … there are known unknowns … there are also unknown unknowns—the ones we don’t know we don’t know … it is the latter category that tends to be the difficult ones.”5  Physicians (i.e., anesthesiologists), be they clinicians or researchers, strive to understand all of the unknowns to provide the most effective and safe care of patients. Extra Life is a fascinating narrative about many individuals who pondered and solved known and unknown unknowns and how their successes have extended life expectancy. Anesthesiologists will benefit from reading Extra Life to appreciate how one can connect the scientific dots discovered by others and contribute to the breakthroughs that benefit humankind.

Steven Berlin Johnson biography.
Available at: https://stevenberlinjohnson.typepad.com/about.html. Accessed July 11, 2021
Extra life: A short history of living longer
New York
Riverhead Books
Exploring the heart: Discoveries in heart disease and high blood pressure
New York
W. W. Norton
ASA Publications author resource center.
Available at: https://pubs.asahq.org/anesthesiology/pages/authors. Accessed July 11, 2021
Defense.gov News Transcript: DoD News Briefing – Secretary Rumsfeld and Gen. Myers, United States Department of Defense (defense.gov).
February 12, 2002