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Book Review: Good to Go, by Christie Aschwanden

This is a book review. It is by Phil Price. It is not by Andrew.

The book is Good To Go: What the athlete in all of us can learn from the strange science of recovery. By Christie Aschwanden, published by W.W. Norton and Company. The publisher offered a copy to Andrew to review, and Andrew offered it to me as this blog’s unofficial sports correspondent.

tldr: This book argues persuasively that when it comes to optimizing the recovery portion of the exercise-recover-exercise cycle, nobody knows nuthin’ and most people who claim to know sumthin’ are wrong. It’s easy to read and has some nice anecdotes. Worth reading if you have a special interest in the subject, otherwise not. Full review follows.

The book is about ‘recovery’. In the context of the book, recovery is what you do between bouts of exercise; or, if you prefer, exercise is what you do between periods of recovery. The book has great blurbs. “A tour de force of great science journalism”, writes Nate Silver (!). “…a definitive tour through a bewildering jungle of scientific and pseudoscientific claims…”, writes David Epstein. “…Aschwanden makes the mid-boggling world of sports recovery a hilarious adventure”, says Olympic gold medal skier Jessie Diggins. With blurbs like these I was expecting a lot…although once I realized Aschwanden works at FiveThirtyEight, I downweighted the Silver blurb appropriately. Even so, I expected too much: the book is fine but ultimately rather unsatisfying. It is fairly interesting and sometimes amusing, but there’s only so much any author can do with the subject given the current state of knowledge, which is this: other than getting enough sleep and eating enough calories, nobody knows for sure what helps athletes recover between events or training sessions better than just living a normal life. The book is mostly just 300 pages of elucidating and amplifying that disappointing state of knowledge.

The author, Aschwanden, went to a lot of trouble, conducting hundreds of interviews, reading hundreds of scientific or quasi-scientific or pseudo-scientific papers, and in some cases subjecting herself to treatments in the interest of journalism (a sensory deprivation tank! Tom Brady’s magic pajamas! A cryogenic chamber!…) If the subject of athletic recovery is especially interesting to you then hey, it’s a fine book, plenty of good stuff in there, $30 well spent for a two or three hours of information and amusement.

For readers of this blog — and maybe for everybody — the first couple of chapters are the best ones, because they provide some insights that can apply to many areas of science and statistical analysis. The first chapter explains what happened when Aschwanden became interested in whether beer is good, bad, or indifferent as a ‘recovery drink.’ She has a friend who was a researcher at a lab that researches human performance and when she brought the question to him he was enthusiastic about studying this issue, so they did. They designed and performed a study that is typical (all too typical) of studies that address this kind of issue: only 10 participants, with tests spanning a couple of days. Do some hard exercise, then drink regular beer or non-alcoholic beer. The next day “run to exhaustion” (following a standard protocol) and afterwards drink whichever beverage you didn’t drink the previous day. The next day, run to exhaustion again. Quantify the time to run to exhaustion at the specified level of effort. The study found no ‘statistically significant’ difference between real beer and fake beer for the contestants as a whole, or for male participants, but for women there was a statistically significant difference, with performance better after real beer! And for men there was a difference large enough to be substantively important if true, but not statistically significant. Fortunately, Aschwanden is no dummy. She doesn’t mention the ‘garden of forking paths’, but does recognize some other major methodological problems with the study. As she puts it: “There was only one problem: I didn’t believe it. Trust me — I wanted our study to show that beer was great for runners, really, I did. Yet my experience as a participant… left me feeling skeptical of our result, and the episode helped me understand and recognize some pitfalls that I’ve found to be common among sports performance studies.” And then she gives a few paragraphs that do a great job of illustrating why it is really hard to get objective measures of human performance for a study like this, and why it matters. The upshot is that in this study the researchers are fitting noise. And the problems that came up in this study are common, indeed nearly ubiquitous, in this sort of research. Disappointingly, even this chapter doesn’t show any data or any hard numbers. There’s not a plot or table in the book.

The second chapter discusses hydration (and over-hydration), starting off with a discussion of the creation and marketing of Gatorade and going on from there. As with every chapter, Aschwanden mixes anecdotes, history, and results from scientific studies, and pulls everything together with her own evaluation. It’s a good formula and makes for a readable book. The hydration chapter is typical in that it illustrates the extent to which marketing and a smattering of scientific research led to a widespread perception among athletes that later turned out either not to be true or to be more nuanced than was first thought. In fact, according to Aschwanden and backed up by many studies she cites, in contrast to what many athletes and coaches have believed over the past thirty years or so our bodies can tolerate moderate dehydration with very little problem, and optimal hydration for a many athletes and many activities turns out to involve a lot less drinking than most people (including most athletes and coaches) thought for decades. And it’s probably better to be rather dehydrated than to be rather over-hydrated.

I can’t resist adding my own little hydration story. A couple of years ago, on a very hot day I rode my bike on a hilly route to our local mountain (Mount Diablo), rode up it and back down, stopped at the bottom for food, and then rode back home. The ride was about 100 miles and the temperature was in the high nineties. Each time I stopped for water, I filled and chugged one of my water bottles, then filled both of them and continued on, draining both bottles by the time I got to the next water stop. Knowing the capacity of my bottles and the number of times I stopped, it’s easy to count how much I drunk that day. I also had a large milkshake and a coke at my lunch stop, as well as something like a pound of food. On that day I drank 17 pounds of fluid. I weighed myself when I got home and found that I had lost 8 pounds. I had not urinated during the day, and didn’t do so for several hours after I got home. What’s the point of telling you this? I dunno; I just think it’s really interesting. In one long day I sweated or exhaled more than 25 pounds of water! I still find it hard to believe..although it does jibe with one of Gatorade’s early marketing campaigns, which promoted the idea that athletes should drink 40 ounces per hour, and not necessarily on a brutally hot day. But Aschwanden has both anecdotes and studies in which successful athletes drank much less, and about some athletes getting in bad medical trouble by drinking too much.  The point isn’t that endurance athletes shouldn’t drink, it’s that they shouldn’t obsess about drinking as long as they don’t get too thirsty. Aschwanden says it has long been conventional wisdom that in an athletic event you should drink before you’re thirsty, and drink enough that you never become thirsty, but there’s actually no evidence that that leads to better performance than simply drinking when you feel like it.

Another chapter covers the current fad for ice baths, cryogenic chambers, ice-water compression boots, and so on. No real evidence they help, no real evidence they hurt.

Another chapter covers the current fad for infrared treatments (heat baths, saunas, ‘infrared’ saunas, Tom Brady’s magic thermal underwear, etc.) No real evidence they help, no real evidence they hurt. Oh, and not only have the claims about thermal underwear not been evaluated by the Food and Drug Administration, they’ve apparently never been evaluated by a physicist either, because they’re ridiculous. If you buy the underwear you deserve to be mocked, and you should be. If no one else will do it for you, send me an email and I’ll do the mocking.

Massage? No real evidence it helps, no real evidence it hurts. That said, I intend to continue to get occasional massages from my next door neighbor, Cyrus Poitier, who is an elite sports masseur. He travels with the men’s national wrestling team and the women’s swim team, and is one of the US Olympic Team’s masseurs. Like most of Cyrus’s clients, I don’t go to Cyrus for feel-good massages — in fact they are usually quite painful — but instead I go when I have some soreness or tightness that I haven’t been able to get rid of on my own, and I do think his massages help. But do they really, in the sense of helping me perform better athletically, and, if so, how much? According to Aschwanden there’s no evidence, or only weak evidence, that they help at all. But I would swear they help me! And he has many elite athletes as clients. So are all of us wrong? Well, maybe we are, or maybe we’re right that the massages help but the effect is rather small. Or maybe they help the performance of those of us with some musculo-skeletal issues but harm the performance of people with other issues. The right way to answer this is with data, and according to Aschwanden the existing data aren’t adequate to the task.

Every ‘recovery modality’ in the book has a bunch of proponents, including some elite athletes who swear by it. Every one of the modalities has a bunch of individuals or companies promoting it and telling people it works, usually buttressed by questionable studies like Aschwanden’s beer study.  And just about every one of the recovery methods or substances has some skeptics who think it’s all hype.

And ultimately that’s the problem with Aschwanden’s book, though it’s not her fault: at the moment it’s impossible to know what works, and how well. She says this herself, towards the end of the book: “After exploring a seemingly endless array of recovery aids, I’ve come to think of them as existing on a sort of evidence continuum. At one end you’ve got sleep — the most potent recovery tool ever recovered (and one that money can’t buy). At the other end lies a pile of faddish products like hydrogen water and oxygen inhalers, which an ounce of common sense can tell you are mostly useless… Most things, however, lie somewhere in the vast middle — promising but unproven.” For someone like me, that’s a good reason to ignore just about all of the unproven stuff: even if something would improve my performance fairly substantially — let’s say a 5% increase in speed on my hardest bike rides — that wouldn’t change my life in a noticeable way. But for a competitive athlete, even 0.5% could be the difference between a gold medal and being off the podium, or being a pro vs an amateur who never quite breaks through. So there are always going to be people promoting this stuff, and there will always be athletes willing to give it a try.

Although firm conclusions about effectiveness are hard to come by, there’s plenty of interesting stuff in the book. For example, one of the many anecdotes concerns sprinter Usain Bolt. At the 2008 Olympics in Beijing, Bolt wasn’t happy with any of the unfamiliar food available to him at the athletes’ cafeteria, so he went to McDonalds and ate Chicken McNuggets. Every day. For lunch and dinner. (He also ate a small amount of greens drenched in salad dressing). According to Bolt’s memoir, he ate about 100 nuggets every 24 hours, adding up to about 1000 chicken nuggets over the course of the ten days he competed in the 100m, 200m, and 4x100m relay (with multiple heats in each, plus the finals). He won gold medals in all of them. As Aschwanden says, “Those chicken nuggets were adequate, if not ideal, fuel to power him through his nine heats, and to help him recover his energy in between them. Feeling satiated and not worrying about gastrointestinal issues are surely worth a lot to an athlete preparing for his most important events of the season. Would Bolt have performed better eating some other recovery foods? Maybe. The better question is: How much difference would it make?”

By the way, a popular saying among the kind of people who read this blog is “The plural of ‘anecdote’ is not ‘data.'” I liked that saying too, the first time I heard it, but the more I think about it the less I agree with it. Of course it’s literally true that ‘data’ is not the plural of ‘anecdote’, since the plural of ‘anecdote’ is ‘anecdotes.’ But each (true) anecdote does provide a data point of sorts. A sprinter won three gold medals on a diet consisting almost entirely of Chicken McNuggets, and his 100m time was a world record even though he didn’t run all the way through the tape. That really does set an upper limit on how deleterious a week of Chicken McNugget consumption is, at least to Usain Bolt. As far as data go, that anecdote is probably more informative than the quantitative results of Aschwanden’s 10-participant beer study, no matter how carefully the study was conducted.

One of the good things about Aschwanden’s book is that she puts the pieces together for us. She’s smart, she’s a former elite athlete herself (a professional cross-country skier), she talked to hundreds of people, she read lots of scientific studies, and she formed well-informed beliefs about everything she writes about. Only a tiny portion of those interviews and studies can fit in the book, but I trust her judgment well enough to think I’d probably reach most of the same conclusions she did, so I appreciate the fact that she does summarize her beliefs. A few key ones are: (1) ‘recovery’ involves both mind and body, and stress of all kinds — physical, mental, and emotional — hurts recovery of both mind and body. (2) Sleep is especially important to recovery; relaxation is too. If an athlete’s recovery routine is itself a source of stress, it’s counterproductive. (3) Under-eating is bad, and is worse than eating non-optimally. (4) The timing of food intake is unimportant unless you have a short break between events. If you finish an event and you have another one in a few hours, eating the right thing at the right time is critical. But if you aren’t competing again for 24 hours or more, there is no ‘nutrition window’, there’s a nutrition ‘barn door’, in the words of one researcher she quotes. (5) Other than getting enough sleep and enough relaxation, and eating enough to replenish glycogen supplies and calories in time for your next event, nearly nothing else is definitively known to be beneficial compared to just living an ordinary life between events. (6) Overtraining is real thing, with both physical and mental components, and overtraining can be worse than undertraining. (7) With regard to specific ‘recovery modalities’: Massage might or might not help; ice baths might or might not help (and in fact might harm recovery a little); various food supplements might or might not help; heat in various forms might or might not help; ibuprofen and other anti-inflammatories probably do a little physical harm in most people, but most athletes refuse to believe it; stretching probably doesn’t help most people. (8) Different things work differently for different people, so following the same recovery routine as your sports idol might not work for you; (9) Some recovery methods, maybe a lot of them, really do help some people simply due to the ‘placebo effect’, and there’s nothing wrong with that: if it helps, it helps.

If any of these points seem odd or wrong or questionable to you, then I suggest reading the book, because Ashwanden explains why she has adopted her viewpoint. If you agree with all of them but want support for them, that’s another reason to read the book. If you agree with them all, shrug, and say “yeah, that’s pretty much what I figured” then you can skip the book unless you are interested in some interesting stories like the one about Bolt.

30 Comments

  1. Kyle C says:

    I know it has come into vogue, but I rue that use of “placebo effect.” “Placebo” is (was!) a useful term for something that *has no therapeutic effect* and thus can be used as a dummy marker to measure non-specific reversion effects. A “placebo” that specifically “works” is not “really” a placebo, despite the journalistic meaning of the term. P.S. I am fun at parties.

    • Brent Hutto says:

      It is my understanding that “placebo effect” refers to the usual pattern where some small portion of the group receiving the placebo perceive a benefit because they believe they received the non-placebo treatment.

      Placebo is the thing. “Placebo effect” is an effect often observed due to the thing. Different concepts.

      • Steve says:

        No. It is just a bias. If patients believe they are on the therapy or not on the therapy, they may act differently. Report more problems or less. Having one group being given a therapy and the other group no therapy breaks the blind and may bias the results. It doesn’t mean that the placebo actually does something. Placebos are chosen so that they have no therapeutic effect. What we see in studies without placebos is typically an effect in the treatment group even if the treatment does nothing. I agree with Kyle. The term “placebo effect” is really confusing because it leads people to think that placebos have an effect, when really we are talking about a spurious treatment effect.

        • Brent Hutto says:

          In common usage, the phrase “placebo effect” is used as the label for one specific spurious treatment effect. I’ve never known anyone to use it otherwise (meaning anyone among researchers in public health, nursing or medicine). It’s just an acknowledgement of a quantity that will arise in analyzing data using a placebo randomization condition.

          • Brent Hutto says:

            One last comment then I’ll leave it alone.

            The “placebo effect” is of course larger when the outcome is some perception or self-reported behavior or symptom. It is smaller or even too small to notice when the outcome is objectively measured by observation, blood test, etc.

            If you give someone either headache pill or a placebo, it is entirely plausible that some placebo receivers will experience headache relief simply by (wrongly) believing they received the real headache pill. There is not much plausible mechanism for placebo receivers seeing their blood lipids reduced due to belief alone (although it’s possible they change their behavior in some lipid-reducing way due to that belief that’s pretty far-fetched).

          • Kyle C says:

            But Phil might say, “If it works, it’s not spurious.” Search for the article “Rebranding placebo” in Knowable magazine for researchers using it my way.

    • Phil says:

      Kyle,
      One of the researchers quoted in the book avoids “placebo effect” for the reasons you mention, preferring the term “anticipation effect” or something like that. Aschwanden notes the terminologies and even agrees with some of the sentiment — as I said, if it works, it works — but she generally uses ‘placebo effect’ and so do I. I think most of this blog’s readers understand what it means, and any other term would require explanation.

      Aschwanden mentions a basketball team — Philadelphia, I think — that offers its players a choice of recovery options after each game: massage, ice bath, infrared sauna, maybe something else. They just tell the players “you’re welcome to try any of these, lots of players find them helpful.” There are some studies that suggest that if you let people choose their own treatment, they find it more beneficial. But it doesn’t seem to matter (measurably, in studies performed so far) which one they pick.

    • TB says:

      Right, there’s all these articles about the “power of placebo” where a journalist thinks that the improvement of the subjects in the control group receiving sugar pills must be due entirely to the sugar pill as opposed to, say, their immune system.

  2. Steve says:

    But … Tom Brady?

  3. Koray says:

    Is the book all about cardio, or is weight training also covered?

    • Phil says:

      Almost all of the examples I recall are from endurance sports or high-aerobic-intensity sports (basketball, soccer, marathon, ultra distance, middle distance, skiing, etc etc.) Weight training came only once that I recall, I think in the context of when to eat protein. The answer is: pretty much any time. There have been claims that you are primed to build muscle especially well if you eat protein within some fairly narrow window of time after working out, but that seems to not be true, you have hours. If there’s an optimal time it’s a very broad plateau, not a sharp peak.

      Other than that there’s nothing I recall about weight lifting. That said, there’s a large strength component to lots of sports that come up, like football.

      • David J. Littleboy says:

        Ha! Thanks for doing my homework for me! (I’d read it if (a) it had scientifically valid helpful results and (b) was relevant to my concerns (I do weights, not cardio), but is sounds like not. Sigh.).

        I’ve been having nasty problems with DOMS after my twice-monthly sessions with my personal trainer, and the only thing that seems to help is doing squats and push-ups religiously (the Mormon connection) between sessions. If I goof off, I have trouble walking for the next 3 days. My SO, a world-ranked (amateur, age-bracketed) competitive swimmer has no sympathy. Life is hard on aging wimpy nerds.

        • Martha (Smith) says:

          Use it or lose it. This aging wimpy nerd does bar fitness twice a week, yoga once a week, individual gym workouts three times a week, individual hand weights once a week, and yard work whenever weather is dry enough at available times. And my triceps were amazing sore after Tuesday’s bar fitness — and when I told the instructor today, she said, “Good!”.

          • Kyle C says:

            It sucks! But I agree. We need to prepare the young — when you hit middle age, your default needs to be to work out Every. Dang. Day.

            • Martha (Smith) says:

              Confounding the problem: If you have poor instruction, you can injure yourself, and then you need to find exercises that help but don’t exacerbate the injury.

              • Tom says:

                Doms is a scam by personal trainers to make you think you’re ‘using muscles you haven’t used before’. Just make people do eccentric exercises, preferably slowly.
                Do a punch of negative pullups, slow as you can. 2 days later you won’t be able to comb your hair. No performance benefit though.

          • David J. Littleboy says:

            Use it or lose it is for real: in my second language, I spent 25 years full tilt translating, but not reading literature, and the vocabulary I built up in the years around grad school is rusty. Oops. But it’s coming back, albeit with work.

            But science is depressing. The bottom line from the science on exercise is that no matter how much you do, there’s always something to be gained from exercising harder: more is always better. Oscar Wilde had it wrong: science is _not_ always making wonderful improvements in things. (I’m happy doing an hour of squats, pushups, free weights every day plus occasional rounds juggling three 3-kg balls.)

            • Chris Wilson says:

              “The bottom line from the science on exercise is that no matter how much you do, there’s always something to be gained from exercising harder: more is always better.”

              Disagree strongly, although it really depends how you look at it. Within a session, you want sufficient intensity to serve as whatever stimulus you are going for (a bit circular, I know, but not misleading). Same goes for volume. In endurance leaning events, the almost universally accepted approach by every national team in every event from rowing to running is profoundly polarized – lots of easy volume, plus a modest amount of ^really^ hard work (say 10-15% of total volume). It seems to be the *density* of high quality sessions over time (weeks to months, strategically periodized leading to an event) that builds phenomenal performances on competition day. You can’t get that density without a robust base, and killing yourself in one session so you need a week to recover properly is directly antagonistic to density.

              Powerlifting training is similar when you strip it down, there is a lot of ‘easy volume’ accrued in warm-up, accessory lifts, practice lifts, and then a small dose of “drive it home” intensity in your heavy work sets (usually not accumulating more than 15-25 reps for a given lift at this intensity in a given workout).

              Of course, the elephant in the room with all this, and directly relevant to recovery, is the omnipresence of PEDs at all levels of competition. Insane volumes of high intensity can only be sustained by well-prepared genetically gifted individuals for short periods of time. Unless they are on gear. In which case, lots of high intensity is a parlor trick. If you are on T, HGH and EPO, you can do a metric f-ton of high-intensity sessions, and always be bouncing back like an energetic 18-year old…

              • Martha (Smith) says:

                I also disagree with “more is always better” — since quality is important: more of poor quality exercise can be worse than less of it. (For example, poor quality exercise often leads to injury, which then restricts ability to exercise without further injury.)

            • Phil says:

              David, you should read the book! As I said in my short summary, “(6) Overtraining is real thing, with both physical and mental components, and overtraining can be worse than undertraining.” There’s really no question about this. How much is too much depends on both the sport and the athlete but there’s no question that you need time to recover. Most of the methods that are discussed in the book can be thought of as ways to recover faster so you can train more or harder. Nobody, really nobody, questions that recovery is needed.

              But perhaps you were making a weaker claim, at least implicitly: that for people like you (or me), more training is better. Depending on the sport, this could be right. Last year I got hurt in a bike crash just as I was starting to train for my annual bike trip with a friend. By the time I was healed enough to ride I only had about five weeks to train, and I was starting from way below my usual baseline. Fortunately, I had enough flexibiltiy in my work to just ride a lot, so although I started the trip in the worst shape of any of my trips, I wasn’t all _that_ far behind. Most days involved at least one “beyond category” climb or at least a couple of “category one” climbs, and added up to at least 8500 feet of climbing. I had the interesting experience of starting each day fitter than the day before, but also more fatigued. I don’t know quite how to quantify this but it really is what I felt was happening.

              Even some Tour de France riders used to talk about ‘riding theselves into shape’ during the first week of the Tour. The theory was that if you start the tour in peak condition, then by the third week you’ll be exhausted..and the third week is often the decisive one. Note that they’d be exhausted because they weren’t getting enough recovery. Everybody needs recovery. But also note that they felt that they were getting in better shape in that first week, which involves consecutive days of 120+ miles at high tempo.

              So, David, if what you’re saying is that a typical person who is only going to exercise one to two hours per day can find a type of exercise for which “the more the better”, I probably agree with that. But as a more general statement, “the more the better” isn’t true.

              • David J. Littleboy says:

                Yes. I was talking about the typical person who has a real life other than training.

  4. jd says:

    Nice review.

    Couple comments – hydration is pretty important (as you discovered in your personal anecdote; very interesting, BTW!). As someone who raced road bikes and who trained racers, I have looked through literally thousands of files from power meters (power, HR, cadence, etc), and one of the more interesting things to see is cardiovascular drift. This is best seen from a file where the rider rode at a submaximal effort for an extended time on a trainer in a hot environment and kept the cadence and power similar across the ride. The HR trends up dramatically over time as the power stays the same. Compare this file to the same ride and rider in cooler weather and the HR doesn’t trend much at all. I would bet that some people do not drink enough if they are just going on thirst, but this is probably individual.

    The Usain Bolt anecdote doesn’t really seem very surprising or informative… 100m dash doesn’t require much in terms of energy (just the phosphagen system for the most part for 10sec, right?) so eating chicken nuggets for a few days wouldn’t seem to make much difference. Now, if Chris Froome had only eaten chicken nuggets to win the Tour de France, or if Bolt had only eaten chicken nuggets in the year of training leading up to the Olympics, then that would be more surprising.

    The summary points at the end seem kind of expected.

  5. Chris Wilson says:

    Haha yea, much of this rings true to my experience. About the only things that reliably matter for my recovery ability: sleep; eating enough and well (i.e. protein, veggies, healthy fats and starches); relaxation and enjoyment. Things that tank it: not sleeping enough or well, too much other stress, not eating enough or well. I feel like occasionally some other things seem to help – massage, hot/cold, creatine and/or protein supplements. But I suspect that’s where variability across individuals and time reigns supreme, and the low-N studies that are the norm in this kind of thing are never gonna be useful…
    Oh, one final thing, getting the ‘overload’ just right in whatever exercise modality you are doing seems to me to matter a lot. You want enough intensity-X-volume to activate all the signaling pathways that provoke cellular and physiological improvements, but not a whole lot more. Past a modest threshold, all you are doing is tapping out your reserves, hence ability to recover and to ‘live to fight another day’.

  6. I’ll make time to read the book. I would love to see her debate Dr. Joe Mercola, who features many fitness and post-workout recovery regimes experts on his website. mercola.com.

    I’ve benefitted from taking Dr. Mercola’s advice I’ve been able to prevent major sports injuries, therefore.

    Specifically, massage and stretch exercise very therapeutic for me. It takes a fair amount of trial and error to see what works for any of us.

  7. Manoel Galdino says:

    300 hundred pages in 3h? Is it only me or this is a really fast pace reading? In my native language (Portuguese) I’m considered a very fast reader by a lot of people, but I don’t think I can read 300 pages in 3h in general. Maybe I’m not a fast reader as I thought?

    • Correct me if I’m wrong. The singular of ‘data’ is ‘datum’. The plural of ‘anecdote’ is ‘anecdotes’.

      I speculate we are going through a period of greater skepticism about treatments and more broadly about expertise.

    • Phil says:

      Aha, something that is subject to quantification!

      There are actually only 256 pages of regular text, followed by about 40 pages of endnotes and then an index. Once or twice I looked at the endnotes but basically that’s 40+ pages I didn’t read. So, not really 300 pages.

      About 300 words per page. One of these pages takes well under a minute at my normal reading speed. I’m a fast reader, I think, but I don’t try to rush or to read faster than seems natural to me.

      I do think 3 hours is about right, but I read it in two long sessions plus some little snippets so it could have added up to 3.2 or even 3.5. On the other hand it could also have been 2.9. I guess it’s more likely to have been a bit more than three hours than a bit less.

      So, Manoel, maybe 256 pages in 190 minutes seems less surprising? It was probably something like that.

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