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him, the book would simply have been a collection of anecdotes without a story. But the lightness papers over bigger issues. She mentions at one point that five PTs quit and weren't replaced, at the same time as the surge in Afghanistan overwhelmed the clinic with new patients. "That's practically a full caseload," said Jim, another PT, when five new patients arrived at the clinic. "Did we get a new physical thera- pist, too?" The answer, of course, is no. But Levine is too easy on manage- ment, working through lunch and staying late to complete charting. One wonders how things would be different if there'd been a union in place. Likewise, Walter Reed patients have a luxury civilians don't: a single-payer system that requires no pre-approvals and with no lim- its on new prostheses or treatment. People outside this system? Not a chance. I wanted to read more about the lessons Walter Reed has to teach us. What I got were goofy stories, sometimes without a point. Run, Don't Walk is a fun beach read, but don't expect any- thing more. —Heather Boerner Unnatural Selection: How We Are Changing Life, Gene by Gene By Emily Monosson Island Press, 2014 This fascinating and thought-provoking book details how human- developed evolutionary selection pressures—whether it be antibi- otics, the herbicide Roundup, or a river poisoned by the toxic byproducts of industry—have fast-tracked the rise of highly resistant bacteria, weeds, bedbugs, fish, and even cancer cells. Understand- ably, resistance tends to appear most quickly in organisms that reproduce quickly. Some resistance comes about by way of mutation, but often resistance is the result of a standing genetic variation that has long been lurking in the genetic background and suddenly proves advantageous given current circumstances. Monosson eloquently and in layman's terms describes how life is resilient and details case studies of organisms that have rapidly evolved to overcome whatever (usually chemical) ways of killing them we humans have concocted. As a result, we may soon be facing a world where we have little defense against these undesir- able foes. She doesn't really have an answer for what to do about it; really, no one does. But her book does make us aware of the situation and think more carefully about how we go about eradi- cating them, or even question whether total eradication is neces- sary. "Reducing selection pressure" should be an overall goal, she argues. Registered nurses will probably be most intrigued by the first several chapters that specifically discuss the rise of antibiotic-resis- tant bacteria, vaccine-resistant viruses, and treatment-resistant can- cer cells. In light of the current Ebola epidemic, the facts about how easily bacteria and virus cells reproduce, mutate, and can jump between animals and humans is sobering. For example, did you know that bacteria have an easy means of transferring DNA among one another and even between different types of bacteria? "While we humans hold tightly to our genetic stock, passing it like a carefully tended trust fund vertically from one generation to the next, bacte- ria pass plasmids [extra bits of DNA] from one cell to another like day traders on the stock-exchange floor," writes Monosson. Appar- ently, when bacteria are close to one another, they can extend a hair- like thread of cell membrane to another and pass around DNA. "This horizontal gene transfer provides bacteria with an unimagin- ably deep and interconnected gene pool." In the case of fighting cancer, Monosson details some new thera- pies and thinking about cancer. Since cancer cells are well known for developing resistance to various oncology drugs, Monosson puts forth certain scientists' novel, and undoubtedly controversial, idea that maybe the approach in the future should be "treatment, but with restraint." "Rather than aiming to eradicate cancer, treatment would strive to maintain a tolerable but susceptible population of cells," she writes. "These strategies, no doubt, will require a dramatic shift in how we think about treatment. Is it possible to make a sort of peace with such an aggressive and lethal opponent?" Monosson goes on to discuss the evolution of herbicide-resis- tant weeds and plants (and the spectacular success and subse- quent failure of the herbicide Roundup) and pesticide-resistant bedbugs and other pests. In her chapter "Natural Selection in an Unnatural World," she details the discovery by scientists of fish 24 N A T I O N A L N U R S E W W W . N A T I O N A L N U R S E S U N I T E D . O R G J U LY | A U G U S T 2 0 1 4