Crave: The Hidden Biology of Addiction and Cancer, by Raphael E. Cuomo, PhD
A Book Review by Tom Horvath, PhD
This compact and compelling book describes how our moment-to-moment actions regarding food, sleep and rest, physical activity level, electronic activities, relationships, and daily life in general contribute to increasing or decreasing our risk for developing cancer and other diseases. These actions often have the character of addictive behaviors, “the relentless cycle of stimulation and reward that defines ordinary life (pg. 1).” The impacts of these actions accumulate over time, altering “the internal landscape…the body’s terrain pg. 1).”
This book could have been entitled The Body Keeps the Score, but that title was taken!
“The term ‘addiction’ is reserved for behaviors we consider dangerous or stigmatized. But cancer cells do not respect those distinctions. They do not care whether the behavior is socially accepted. They care about the environment in which they are allowed to grow (pg. 3).”
Ultimately, we end up with “molecular scars: changes that are chemical, hormonal, immunologic, and epigenetic in nature…silently shaping the risk of disease long before a diagnosis ever arrives (pg.1).”
I’m pleased that Cuomo’s perspective, that addictive behavior is a major component of daily life for everyone, aligns with mine:
“Addiction has become embedded in the architecture of daily life…these behaviors rarely register as addictions. But biologically, they engage the same systems of reward, repetition, and escape (pgs. 15-16)…craving is not just emotional, but cellular… what we repeat becomes who we are, both in how we feel and how our bodies function (pg. 29).”
Cuomo describes the scars that accumulate when the body, through many repetitions of unhealthy behaviors, has been pushed out of balance. These activities include eating refined sugar, trans fats, and processed additives, pushing oneself to accomplish or enjoy without regard to the internal signals for rest, preferring sedentary activities to movement, engaging compulsively with screens, mistaking shallow connection with others (perhaps online) with genuine connection, not getting out in nature enough, and others. You have probably seen similar lists, but Cuomo explains in detail the kinds of scars that develop, and the health implications.
Cuomo is looking well beyond preventing cancer simply by avoiding carcinogens and having regular screenings. Although these actions are important “they are incomplete. They overlook the terrain in which disease develops. They address threats while missing the underlying conditions (p.105).” Although cancer is his focus, he touches in other diseases also.
This 114-page book has 10 chapters:
- Molecular Scars
- The Addicted Society
- Craving is Chemical
- Inflammation Nation
- Food as a Drug
- Digital Dopamine
- Nicotine, Alcohol, and the Usual Suspects?
- Beyond the Individual
- Biology Can Change
- The New Prevention
If I were asked to shorten this book, I would not know what to cut. I have attempted here to provide some of the powerful ideas in this book, but this review will not replace a reading. Almost every sentence or paragraph (sometimes needed to place a sentence in context) is quotable. Major themes are returned to and built upon, so there is repetition, but it is meaningful.
Some of the most eloquent writing is in the chapter “Digital Dopamine:”
“The device is built to capture attention, stir motion, and sustain engagement… it trains the brain to see novelty (pg. 60)… the brain is not satisfied. It is activated. The body, in effect, responds to the digital environment as if it were a source of constant threat and novelty. It prepares to act, but there is no physical action to take. The stress accumulates (pg.61)…Social threat is not just a psychological concept. It is a biological event (pg. 65).”
This book is atypical in that it has no references or footnotes. This is a bold choice for an academic. I admire it. The credibility of a book without references will partly depend on the credibility of the author. In this case we have a highly credible author:
https://profiles.ucsd.edu/raphael.cuomo
Credibility will immediately be established for anyone familiar with the accomplishments required to gain his academic rank at a major US research university. Both this rank and the awards Cuomo has received confirm that he is well-respected by scientists.
Furthermore, with the electronic resources now available, it is easy to investigate a sentence like this one:
“People who feel socially supported recover faster from surgery, respond better to vaccines, and experience fewer complications from illness. These effects reflect real physiological responses shaped by social conditions (p.97).”
An advantage of the no-reference style is that the text flows easily. I assume that the general reader, who is more curious about conclusions and implications than the set of studies supporting them, will find this reading experience satisfying. Many “popular science” books these days go from study to study, presenting details meaningful to scientists and the author, but not necessarily to the reader. I’m curious to see whether this no-reference style catches on. It seems well-suited to the electronic resources now available to us.
This book is a manifesto for public and individual health. It clearly describes what changes need to be made. For the individual there is sufficient information on what to do, why to do it, and how to do it. We could wonder whether even Dr. Cuomo lives up to his ideals, but he is clear that it is not the occasional indulgence but the consistent pattern that we need to be concerned about.
At the public health level, the book does not present much detail about how to accomplish these changes. Such a book would be very different, certainly political, perhaps Machiavellian (as in, the ends justify the means). Nevertheless, Cuomo hints at the difficulty of the political task: “entire industries, from food to media to pharmaceuticals, are structured around maintaining a population that is constantly craving, reaching, and consuming (pg 15).” These industries (and the others that could have been mentioned) will not go gently into a public health perspective. Beyond corporations, public policy (“housing policy, food accessibility, labor conditions, and educational opportunities (pg. 108)” will need to change also.
Unfortunately, the individuals, healthcare administrators, legislators and others most needing this book may not read it. Nevertheless, I am writing this review because this book deserves wide circulation.
Cuomo is a passionate mid-career scientist. We may be receiving insights from him for decades to come. I hope so.
Liked this book review of The Hidden Biology of Addiction and Cancer by Raphael E. Cuomo, Ph.D.? You might also be interested in: Undoing Drugs: A review by Tom Horvath, Ph.D.
