Drop Dead Healthy

The Immune System

The Quest to Conquer Germs

THANKS TO MY COLD, I’ve decided to devote this month to germs. It’s a topic of great passion for me.

For years, I’ve been a huge consumer of germ porn. Perhaps you’re familiar with the genre. I’m talking about those news segments that warn you that there are more germs on your remote control than on your toilet seat. Your sponge is a hot zone, and your wallet should be handled with a biohazard suit.

The news will cut to footage of unwashed hands under black light, all Jackson Pollocked with glowing purple germ splotches.

I love the elaborate metaphors they use to convey the unimaginable number of germs. You have more germs in your gut right now than humans that ever lived on earth. (This is true.) If the germs on your hand were turned into drops of water, they’d fill an Olympic swimming pool (also true). If the germs in your door handle were turned into letters on a page, the resulting document would be longer than the collected works of Joyce Carol Oates, and that includes her young adult fiction and boxing essays (probably true).

I love when they do a close-up on a particularly menacing-looking Aspergillus or a Clostridium. Check out those flagella! So titillating.

Germ porn probably isn’t good for me, but it provides a perverse masochistic pleasure. It feeds into my germaphobia, a condition I’ve been struggling with for years, long before it became a familiar trope for TV detectives. (A couple of random examples: I prefer the air shake to the handshake. I don’t like to clink wineglasses during a toast, unless I can clink the bottom of the glass, where the germ colonies are presumably sparser. And so on.)

Julie hates when I watch germ reports. She’s on the opposite end of the spectrum. Our society is too hygiene obsessed, she says, and it’s turning us into immunological pansies. Go ahead, she’ll tell the boys, play in the sandbox, despite what Daddy says about residual fecal matter. Drink from that water fountain. A few months ago, Zane was eating an ice-cream cone from the overpriced ice cream shop in our neighborhood. Then his scoop fell on the sidewalk. Amazingly, he didn’t get upset. Instead, he got down on all fours and started licking it off the pavement like a golden retriever. A woman walking behind him gasped, “Oh my God.” But Julie? She had no problem with it. New York is one big dinner plate.

Which is why she’s even less happy about the visit I’m about to make. I am meeting with the Ron Jeremy of microbial fetish videos: Dr. Philip Tierno, the director of clinical microbiology and immunology at New York University Langone Medical Center. Also known as Dr. Germ. You might recognize Tierno from his segments on the Today show. The one on pillows featured millions of skin-eating dust mites, and has made me lose at least a week of sleep. He’s the expert of experts.

“He’s an enabler,” Julie says. She might have a point.

But if my goal is to be the healthiest person alive, I have to figure out the best way to conquer these germs.

I arrive at Tierno’s midtown lab, where I find him studying a slide of toxic bacilli. He’s bald, with a neat white beard and round wire-rim glasses. He sticks out his hand to greet me.

What? Dr. Germ wants to shake hands? That makes no sense at all. I respond by offering him my elbow for an elbow bump.

“Ah, this guy knows what he’s doing,” says Tierno. I beam. We go back to his cluttered office, filled with a microscope, eleven bottles of cleaning fluids, and two thousand biology books stacked in towering piles. Bach plays in the background.

First, Tierno wants me to know that germs suffer from some bad PR. Most bacteria are harmless. In fact, human beings are mostly germs. We are walking around with 90 percent germ cells, and just 10 percent human cells with our DNA. Germs are in our gut, in our mouth, in our eyebrows.

We came from germs. The oldest sign of life on earth is a fossilized germ cell found in Australia from 3.5 billion years ago.

“There are 156,000 categories of germs around, but only a small percentage are pathogenic. Maybe two thousand of these.”

Ah, but those two thousand—you don’t want them anywhere near you. Consider that infectious disease is the second leading cause of death in the world after cardiovascular disease. Here’s a disturbing statistic: Every year, a hundred thousand people in the United States die because of infections they got at the hospital (they are called nosocomial infections). Another one: Every year, germs in food sicken an astounding 76 million people in the United States, according to the Centers for Disease Control.

Dr. Tierno started his road to germ whisperer when he was in eighth grade and read a biography of Louis Pasteur. I mention I’m a fan of Joseph Lister, the British surgeon who first developed the idea of sterile surgery.

“Semmelweis was an even bigger hero,” says Tierno, of the Hungarian physician Ignaz Semmelweis. “He used to wash his hands after dealing with pregnant women, whereas most obstetricians just wiped their hands on their smocks, and killed patients by passing an infection from one woman to the other.”

Hand washing is one of Dr. Tierno’s passions. He thinks America needs a massive public education campaign on it, along the lines of our antismoking PR blitz. “It’s the single most important thing you can do for your health,” he says. “Eighty percent of all infections are transmitted by direct or indirect contact.”

The key is to do it well, which few of us do. Most of us are hardly better than the French aristocrats in the court of Louis XIV. Back then, says Tierno, doctors advised washing only the tips of the fingers, for fear that water transmitted disease.

Tierno—who says he hasn’t had a cold in four years—walks me down the hall to the bathroom for a hand-washing demo. He splashes water on his hands, squirts the liquid soap, and lathers up for thirty seconds before returning his hands under the water.

“Around the wrists. In between the fingers. Getting each nail.”

He squishes and slides his palms together. He digs under his nails with his thumb and flicks his wrist. It’s a virtuoso performance, like Yo-Yo Ma playing the cello or Al Pacino screaming obscenities. It’s a long way from the average person’s five-second dunk.

“Happy Birthday, Philly Boy,” he sings as he finishes up. “Happy birthday to you.” (For those who don’t know, you’re supposed to sing the entire birthday song during washing, to make sure you take your time.)

When we get back to his office, I grill him on the questions he gets from every John Q. Germaphobe:

Do Purell and other hand sanitizers work?

Yes. “You need to make sure you use enough. A quarter-size dollop.” Tierno, along with the CDC, recommends alcohol-based gels if you can’t wash your hands.

“I love it, but my wife hates the smell,” I tell him.

Dr. Tierno sniffs his hands. “What’s to hate? Tell her it’s like vodka.”

Incidentally, I spent some time on the Purell website, where you can find a list of ninety-nine places germs lurk (in-flight magazines, movie tickets, gas-pump keypads, hotel room a/c controls, and on and on). It’s hilarious and terrifying. The only place they don’t mention is the Purell dispensers themselves. You know they’re coated with germs. It’s one of health’s cruelest catch-22s.

Do Purell and antibacterial soap create supergerms? Like MRSA?

“No. Germs don’t develop a resistance to alcohol or antibiotic soaps. They can develop a resistance to antibiotics.” Tierno recommends against popping antibiotics every time you get a cold. But at least in Tierno’s view, Purell and antibacterial soaps don’t cause supergerms.

Should I use antibacterial soap?

“Ordinarily, you don’t need antibacterial soap. You can get along with regular soap and warm water.” The exception is when you’re cooking foods, especially meat. Incidentally Tierno doesn’t believe that triclosan, a controversial chemical in many antibacterial soaps, poses any danger (more on toxins later).

What about a face mask?

He wears them on planes. “One time I was going to France, and I had a lady coughing right in back of me. And I asked the stewardess to have her moved to another seat because she was very sick. And the stewardess said, ‘The plane is full, I can’t.’ I didn’t have my mask, and I caught a cold three days after that.” He won’t let that happen again.

As I leave, I give him a copy of my Bible book. He thanks me, though he admits he’ll wipe it down before reading.

I walk out feeling both exhilarated and stressed out. Julie’s right. He is an enabler.

The Hygiene Hypothesis

In the interest of equal time, I decide to look into those on Julie’s side of the germ fence. Many scientists agree with her.

They’ve named their theory the Hygiene Hypothesis. The idea is that children in modern first-world countries aren’t exposed to enough germs, a situation that throws off the development of the immune system. Our immune cells don’t get the chance to learn to recognize and assassinate the bad guys. Our overly sanitized world could be responsible for the dramatic rise in allergies and asthma.

I call up an immunologist named Mary Ruebush, author of Why Dirt Is Good, a rallying cry for the Hygiene Hypothesis.

“The pendulum has swung,” she tells me. “The first few millennia of human evolution, there was no thought of cleanliness. Then, when we realized there’s a link between cleanliness and health, we went overboard.”

Like Tierno, she claims superior health. “I don’t remember having a cold or a headache, and I have absolutely no standards of hygiene whatsoever.”

I suppress my instinct to say that I’m glad this is a phone interview.

“My standard for hand washing is this: If they look dirty or smell bad, then I wash them,” she says.

Like Tierno, she has her own scary story about a plane ride.

“I sat next to an eight-year-old child who was traveling by himself. He proceeded to wipe the seat, the armrest, and the tray table before he would sit down. I was horrified.”

I tell her about how my son licked ice cream off the sidewalk. “Good for him,” she says. “He is going to be a healthy adult.”

When I get off the phone, I tell Julie about Ruebush’s thesis. “That’s a wise woman,” Julie says.

Later that night, when Julie drops a cucumber slice on the floor, she bends down to pick it up and put it on Zane’s plate.

“Hygiene Hypothesis!” she says gleefully. It’s her new catchphrase.

I decide to spend a week implementing Tierno’s Germ Battle Plan on myself. I promise Julie I’ll leave her and the kids out of it.

In his book The Secret Life of Germs, Tierno gives a list of antiseptic-living suggestions, which I’ve transcribed onto my computer. On a Wednesday morning, I begin to implement them. Here’s a small sample:

• Wipe down the phones and remote controls weekly. (Does wiping them with a moist paper towel really get the germs off? I wish I could boil my electronic equipment.)

• Soak all produce for five to ten minutes in a solution of water, hydrogen peroxide, and vinegar. (“Hydrogen peroxide?” asks our babysitter as I pour some into a bowl of apples. “Is that safe? I thought that’s what you use to dye hair.” It’s in the book, I tell her.)

• Wash underwear separately from other clothes to prevent a transfer of fecal residue.

• Dry laundry in the sun, because the UV radiation kills germs (a clothesline doesn’t work in New York, so I lay my shirts on the outside part of the air conditioner).

• Remove showerheads and clean them with a wire brush to root out legionella, the cause of Legionnaires’ disease (still have to do this).

• Vacuum curtains and upholstery regularly.

• Zap damp sponges in the microwave for one or two minutes.

• Put hypoallergenic sheets and pillowcases on your bed to keep the dust mites from snacking on your dead skin flakes, because dust mites can cause allergies. (The sheets I bought are kind of slippery, but they make me feel better. Tierno himself takes his germproof sheets with him when he goes to a hotel. I put that on my to-do list.)

It’s been half a day, and I’m not even close to finishing my list. Germ warfare is a full-time job. Though I do notice something strange. Aside from being busy, I have another feeling: righteousness.

Maybe it’s my imagination, but now I crave more order in every part of my life. I’m more annoyed when Julie’s late to dinner. I’m more concerned when my son Jasper hangs around with the rambunctious elements in his class.

Does my punctiliousness have anything to do with my germ obsession? Perhaps not. But the brain is an odd place, and it’s possible that germaphobia has colored my moral view. I read a fascinating New York Times op-ed by two scientists who argue that the more obsessed you are with germs, the more politically conservative you become.

They conducted an experiment in which they asked subjects about their “moral, social and fiscal” attitudes. “Merely standing near a hand-sanitizing dispenser led people to report more conservative political beliefs,” they write. “Apparently, the slightest signal that germs might be present is enough to shift political attitudes toward the right.”

The professors—Peter Liberman at Queens College and David Pizarro at Cornell—offer the explanation that early humans often came into contact with other tribes that harbored dangerous germs. So humans evolved to have a feeling of disgust at The Other, which helped keep interactions to a minimum. This sense of disgust is correlated to a conservative, more wary-of-foreigners worldview.

When I told one of my token conservative friends this theory, he said it sounded absurd. But, he added, at least it gave him license to call liberals dirty.

Checkup: Month 5

Weight: 164

Push-ups till exhaustion: 36

Dollars spent at GNC on supplements that have iffy scientific support (e.g., açaí berry, resveratrol): $127

Avocados consumed: 1.5 per day

The big breaking news for this month is: My gym sessions are altering my body. My chest has a little curve to it, like a very gentle slope on a putting green. When I went running the other day, I could feel my pecs bounce. This experience is new and curiously exhilarating.

I’m spending an embarrassing amount of time every night studying my torso in the mirror, trying to discern the progress. I have fantasies about running into Vlad the caveman and hearing him say, “I’m sorry for those comments about your chest. Boy, how wrong I was!”

I now understand why all these reality-show stars walk around with their shirts off. If you spend that much time sculpting your body, you want to display your work of art. Otherwise, it’s like keeping a Brancusi in the garage under a sheet.

I’ve started to notice other men’s bodies as well. I have biceps envy. I look for their veins in their arms and compare them to mine. Never before have I cared about having visible blood vessels.

Or maybe I did. Looking back, I don’t think I admitted to myself how much I’ve been self-conscious about my concave chest for years. I pretended not to care. I pretended I was above such concerns. But I also hated changing in the locker room, and would keep my T-shirt on at the beach.

My new hint of muscle makes me crave more. At the suggestion of my friend Tim Ferriss—author of The 4-Hour Body—I’m taking daily doses of the supplement creatine, an acid found in skeletal muscle.

At the same time, I’m aware that this obsession with size is ridiculous. There’s only a mild correlation between what we consider healthy looking, and being healthy—especially when it comes to muscle definition. Do the Okinawans in Japan—the longest-lived people on earth—have six-packs abs? I doubt it. Not in the pictures I’ve seen.

On the food front, I’m still working on my portion control. Before each meal, I say my 80 percent prayer (this is from the Japanese proverb that you should eat until you are only four-fifths full). I’m observing my chewdaism. I’m addicted to these diabolical dried mangoes, so, at the suggestion of social psychologist Sam Sommers from Tufts University, I’ve repackaged them into a bunch of tiny Ziploc bags—one mango slice per bag. It actually works. My mind thinks that it’s getting a full portion, even if the portion is one slice. My mind, in other words, is an idiot.

But despite my limited victories with portion control, I keep coming back to the fundamental question: What the heck should I put in those portions? What should I eat? Which of America’s ten thousand nutrition experts should I listen to? I pledge to make answering this question my next month’s mission.