Qigong: A Breath Of Fresh Air?
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Qigong: Breathing Is Good (Magic Remains Unverified)
In Tuesdayâs newsletter, we asked you for your opinions of qigong, and got the above-depicted, below-described, set of responses:
- About 55% said âQigong is just breathing, but breathing exercises are good for the healthâ
- About 41% said âQigong helps regulate our qi and thus imbue us with healthy vitalityâ
- One (1) person said âQigong is a mystical waste of time and any benefits are just placeboâ
The sample size was a little low for this one, but the results were quite clearly favorable, one way or another.
So what does the science say?
Qigong is just breathing: True or False?
True or False, depending on how we want to define itâbecause qigong ranges in its presentation from indeed âjust breathing exercisesâ, to âbreathing exercises with visualizationâ to âspecial breathing exercises with visualization that have to be exactly this way, with these hand and sometimes body movements also, which also must be just rightâ, to far more complex definitions that involve qi by various mystical definitions, and/or an appeal to a scientific analog of qi; often some kind of bioelectrical field or such.
There is, it must be said, no good quality evidence for the existence of qi.
Writerâs note, lest 41% of you want my head now: Iâve been practicing qigong and related arts for about 30 years and find such to be of great merit. This personal experience and understanding does not, however, change the state of affairs when it comes to the availability (or rather, the lack) of high quality clinical evidence to point to.
Which is not to say there is no clinical evidence, for example:
Acute Physiological and Psychological Effects of Qigong Exercise in Older Practitioners
âŚfound that qigong indeed increased meridian electrical conductance!
Except⌠Electrical conductance is measured with galvanic skin responses, which increase with sweat. But donât worry, to control for that, they asked participants to dry themselves with a towel. Unfortunately, this overlooks the fact that a) more sweat can come where that came from, because the body will continue until it is satisfied of adequate homeostasis, and b) drying oneself with a towel will remove the moisture better than itâll remove the salts from the skinâbearing in mind that itâs mostly the salts, rather than the moisture itself, that improve the conductivity (pure distilled water does conduct electricity, but not very well).
In other words, this was shoddy methodology. How did it pass peer review? Well, hereâs an insight into that journalâs peer review processâŚ
âThe peer-review system of EBCAM is farcical: potential authors who send their submissions to EBCAM are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job. It goes without saying that such a system is prone to all sorts of serious failures; in fact, this is not peer-review at all, in my opinion, it is an unethical sham.â
~ Dr. Edzard Ernst, a founding editor of EBCAM (he since left, and decries what has happened to it since)
One of the other key problems is: how does one test qigong against placebo?
Scientists have looked into this question, and their answers have thus far been unsatisfying, and generally to the tune of the true-but-unhelpful statement that âfuture research needs to be betterâ:
Problems of scientific methodology related to placebo control in Qigong studies: A systematic review
Most studies into qigong are interventional studies, that is to say, they measure peopleâs metrics (for example, blood pressure, heart rate, maybe immune function biomarkers, sleep quality metrics of various kinds, subjective reports of stress levels, physical biomarkers of stress levels, things like that), then do a course of qigong (perhaps 6 weeks, for example), then measure them again, and see if the course of qigong improved things.
This almost always results in an improvement when looking at the before-and-after, but it says nothing for whether the benefits were purely placebo.
We did find one study that claimed to be placebo-controlled:
âŚbut upon reading the paper itself carefully, it turned out that while the experimental group did qigong, the control group did a reading exercise. Which is⌠Saying how well qigong performs vs reading (qigong did outperform reading, for the record), but nothing for how well it performs vs placebo, because reading isnât a remotely credible placebo.
See also: Placebo Effect: Making Things Work Since⌠Well, A Very Long Time Ago â this one explains a lot about how placebo effect does work
Qigong is a mystical waste of time: True or False?
False! This one we can answer easily. Interventional studies invariably find it does help, and the fact remains that even if placebo is its primary mechanism of action, it is of benefit and therefore not a waste of time.
Which is not to say that placebo is its only, or even necessarily primary, mechanism of action.
Even from a purely empirical evidence-based medicine point of view, qigong is at the very least breathing exercises plus (usually) some low-impact body movement. Those are already two things that can be looked at, mechanistic processes pointed to, and declarations confidently made of âthis is an activity thatâs beneficial for healthâ.
See for example:
- Effects of Qigong practice in office workers with chronic non-specific low back pain: A randomized control trial
- Qigong for the Prevention, Treatment, and Rehabilitation of COVID-19 Infection in Older Adults
- Impact of Medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients: a randomized controlled trial
âŚand those are all from respectable journals with meaningful peer review processes.
None of them are placebo-controlled, because there is no real option of âand group B will only be tricked into believing they are doing deep breathing exercises with low-impact movementsâ; thatâs impossible.
But! They each show how doing qigong reliably outperforms not doing qigong for various measurable metrics of health.
And, we chose examples with physical symptoms and where possible empirically measurable outcomes (such as COVID-19 infection levels, or inflammatory responses); there are reams of studies showings qigong improves purely subjective wellbeingâbut the latter could probably be claimed for any enjoyable activity, whereas changes in inflammatory biomarkers, not such much.
In short: for most people, it indeed reliably helps with many things. And importantly, it has no particular risks associated with it, and itâs almost universally framed as a complementary therapy rather than an alternative therapy.
This is critical, because it means that whereas someone may hold off on taking evidence-based medicines while trying out (for example) homeopathy, few people are likely to hold off on other treatments while trying out qigongâsince itâs being viewed as a helper rather than a Hail-Mary.
Want to read more about qigong?
Hereâs the NIHâs National Center for Complementary and Integrative Health has to say. It cites a lot of poor quality science, but it does mention when the science itâs citing is of poor quality, and over all gives quite a rounded view:
Enjoy!
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What are heart rate zones, and how can you incorporate them into your exercise routine?
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If you spend a lot of time exploring fitness content online, you might have come across the concept of heart rate zones. Heart rate zone training has become more popular in recent years partly because of the boom in wearable technology which, among other functions, allows people to easily track their heart rates.
Heart rate zones reflect different levels of intensity during aerobic exercise. Theyâre most often based on a percentage of your maximum heart rate, which is the highest number of beats your heart can achieve per minute.
But what are the different heart rate zones, and how can you use these zones to optimise your workout?
The three-zone model
While there are several models used to describe heart rate zones, the most common model in the scientific literature is the three-zone model, where the zones may be categorised as follows:
- zone 1: 55%â82% of maximum heart rate
- zone 2: 82%â87% of maximum heart rate
- zone 3: 87%â97% of maximum heart rate.
If youâre not sure what your maximum heart rate is, it can be calculated using this equation: 208 â (0.7 Ă age in years). For example, Iâm 32 years old. 208 â (0.7 x 32) = 185.6, so my predicted maximum heart rate is around 186 beats per minute.
There are also other models used to describe heart rate zones, such as the five-zone model (as its name implies, this one has five distinct zones). These models largely describe the same thing and can mostly be used interchangeably.
What do the different zones involve?
The three zones are based around a personâs lactate threshold, which describes the point at which exercise intensity moves from being predominantly aerobic, to predominantly anaerobic.
Aerobic exercise uses oxygen to help our muscles keep going, ensuring we can continue for a long time without fatiguing. Anaerobic exercise, however, uses stored energy to fuel exercise. Anaerobic exercise also accrues metabolic byproducts (such as lactate) that increase fatigue, meaning we can only produce energy anaerobically for a short time.
On average your lactate threshold tends to sit around 85% of your maximum heart rate, although this varies from person to person, and can be higher in athletes.
In the three-zone model, each zone loosely describes one of three types of training.
Zone 1 represents high-volume, low-intensity exercise, usually performed for long periods and at an easy pace, well below lactate threshold. Examples include jogging or cycling at a gentle pace.
Zone 2 is threshold training, also known as tempo training, a moderate intensity training method performed for moderate durations, at (or around) lactate threshold. This could be running, rowing or cycling at a speed where itâs difficult to speak full sentences.
Zone 3 mostly describes methods of high-intensity interval training, which are performed for shorter durations and at intensities above lactate threshold. For example, any circuit style workout that has you exercising hard for 30 seconds then resting for 30 seconds would be zone 3.
Striking a balance
To maximise endurance performance, you need to strike a balance between doing enough training to elicit positive changes, while avoiding over-training, injury and burnout.
While zone 3 is thought to produce the largest improvements in maximal oxygen uptake â one of the best predictors of endurance performance and overall health â itâs also the most tiring. This means you can only perform so much of it before it becomes too much.
Training in different heart rate zones improves slightly different physiological qualities, and so by spending time in each zone, you ensure a variety of benefits for performance and health.
So how much time should you spend in each zone?
Most elite endurance athletes, including runners, rowers, and even cross-country skiers, tend to spend most of their training (around 80%) in zone 1, with the rest split between zones 2 and 3.
Because elite endurance athletes train a lot, most of it needs to be in zone 1, otherwise they risk injury and burnout. For example, some runners accumulate more than 250 kilometres per week, which would be impossible to recover from if it was all performed in zone 2 or 3.
Of course, most people are not professional athletes. The World Health Organization recommends adults aim for 150â300 minutes of moderate intensity exercise per week, or 75â150 minutes of vigorous exercise per week.
If you look at this in the context of heart rate zones, you could consider zone 1 training as moderate intensity, and zones 2 and 3 as vigorous. Then, you can use heart rate zones to make sure youâre exercising to meet these guidelines.
What if I donât have a heart rate monitor?
If you donât have access to a heart rate tracker, that doesnât mean you canât use heart rate zones to guide your training.
The three heart rate zones discussed in this article can also be prescribed based on feel using a simple 10-point scale, where 0 indicates no effort, and 10 indicates the maximum amount of effort you can produce.
With this system, zone 1 aligns with a 4 or less out of 10, zone 2 with 4.5 to 6.5 out of 10, and zone 3 as a 7 or higher out of 10.
Heart rate zones are not a perfect measure of exercise intensity, but can be a useful tool. And if you donât want to worry about heart rate zones at all, thatâs also fine. The most important thing is to simply get moving.
Hunter Bennett, Lecturer in Exercise Science, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Iâve been diagnosed with cancer. How do I tell my children?
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With around one in 50 adults diagnosed with cancer each year, many people are faced with the difficult task of sharing the news of their diagnosis with their loved ones. Parents with cancer may be most worried about telling their children.
Itâs best to give children factual and age-appropriate information, so children donât create their own explanations or blame themselves. Over time, supportive family relationships and open communication help children adjust to their parentâs diagnosis and treatment.
Itâs natural to feel you donât have the skills or knowledge to talk with your children about cancer. But preparing for the conversation can improve your confidence.
Preparing for the conversation
Choose a suitable time and location in a place where your children feel comfortable. Turn off distractions such as screens and phones.
For teenagers, who can find face-to-face conversations confronting, think about talking while you are going for a walk.
Consider if you will tell all children at once or separately. Will you be the only adult present, or will having another adult close to your child be helpful? Another adult might give your children a person they can talk to later, especially to answer questions they might be worried about asking you.
Finally, plan what to do after the conversation, like doing an activity with them that they enjoy. Older children and teenagers might want some time alone to digest the news, but you can suggest things you know they like to do to relax.
Also consider what you might need to support yourself.
Preparing the words
Parents might be worried about the best words or language to use to make sure the explanations are at a level their child understands. Make a plan for what you will say and take notes to stay on track.
The toughest part is likely to be saying to your children that you have cancer. It can help to practise saying those words out aloud.
Ask family and friends for their feedback on what you want to say. Make use of guides by the Cancer Council, which provide age-appropriate wording for explaining medical terms like âcancerâ, âchemotherapyâ and âtumourâ.
Having the conversation
Being open, honest and factual is important. Consider the balance between being too vague, and providing too much information. The amount and type of information you give will be based on their age and previous experiences with illness.
Remember, if things donât go as planned, you can always try again later.
Start by telling your children the news in a few short sentences, describing what you know about the diagnosis in language suitable for their age. Generally, this information will include the name of the cancer, the area of the body affected and what will be involved in treatment.
Let them know what to expect in the coming weeks and months. Balance hope with reality. For example:
The doctors will do everything they can to help me get well. But, it is going to be a long road and the treatments will make me quite sick.
Check what your child knows about cancer. Young children may not know much about cancer, while primary school-aged children are starting to understand that it is a serious illness. Young children may worry about becoming unwell themselves, or other loved ones becoming sick.
Older children and teenagers may have experiences with cancer through other family members, friends at school or social media.
This process allows you to correct any misconceptions and provides opportunities for them to ask questions. Regardless of their level of knowledge, it is important to reassure them that the cancer is not their fault.
Ask them if there is anything they want to know or say. Talk to them about what will stay the same as well as what may change. For example:
You can still do gymnastics, but sometimes Kateâs mum will have to pick you up if I am having treatment.
If you canât answer their questions, be OK with saying âIâm not sureâ, or âI will try to find outâ.
Finally, tell children you love them and offer them comfort.
How might they respond?
Be prepared for a range of different responses. Some might be distressed and cry, others might be angry, and some might not seem upset at all. This might be due to shock, or a sign they need time to process the news. It also might mean they are trying to be brave because they donât want to upset you.
Childrenâs reactions will change over time as they come to terms with the news and process the information. They might seem like they are happy and coping well, then be teary and clingy, or angry and irritable.
Older children and teenagers may ask if they can tell their friends and family about what is happening. It may be useful to come together as a family to discuss how to inform friends and family.
Whatâs next?
Consider the conversation the first of many ongoing discussions. Let children know they can talk to you and ask questions.
Resources might also help; for example, The Cancer Councilâs app for children and teenagers and Redkiteâs library of free books for families affected by cancer.
If you or other adults involved in the childrenâs lives are concerned about how they are coping, speak to your GP or treating specialist about options for psychological support.
Cassy Dittman, Senior Lecturer/Head of Course (Undergraduate Psychology), Research Fellow, Manna Institute, CQUniversity Australia; Govind Krishnamoorthy, Senior Lecturer, School of Psychology and Wellbeing, Post Doctoral Fellow, Manna Institute, University of Southern Queensland, and Marg Rogers, Senior Lecturer, Early Childhood Education; Post Doctoral Fellow, Manna Institute, University of New England
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Is ADHD Being Over-Diagnosed For Cash?
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Is ADHD Being Systematically Overdiagnosed?
The BBCâs investigative âPanoramaâ program all so recently did a documentary in which one of their journalistsâwho does not have ADHDâwent to three private clinics and got an ADHD diagnosis from each of them:
- The BBC documentary: Private ADHD Clinics Exposed (28 mins)
- Their â5 Minutesâ version: ADHD Undercover: How I Was Misdiagnosed (6 mins)
So⌠Is it really a case of show up, pay up, and get a shiny new diagnosis?
The BBC Panorama producers cherry-picked 3 private providers, and during those clinical assessments, their journalist provided answers that would certainly lead to a diagnosis.
This was contrasted against a three-hour assessment withâŻan NHS psychiatristâsomething that rarely happens in the NHS. Which prompts the questionâŚ
How did he walk into a 3-hour psychiatrist assessment, when most people have to wait in long waiting lists for a much more cursory appointment first with assorted gatekeepers, before going on another long waiting list, for an also-much-shorter appointment with a psychiatrist?
That would be because the NHS psychiatrist was given advance notification that this was part of an investigation and would be filmed (the private clinics were not gifted the same transparency)
So, maybe just a tad unequal treatment!
In case youâre wondering, hereâs what that very NHS psychiatrist had to say on the topic:
Is it really too easy to be diagnosed with ADHD?
(weâll give you a hintâremember Betteridgeâs Law!)
âSince the documentary aired, I have heard from people concerned that GPs could now be more likely to question legitimate diagnoses.
But as an NHS psychiatrist it is clear to me that the root of this issue is not overdiagnosis.
Instead, we are facing the combined challenges of remedying decades of underdiagnosis and NHS services that were set up when there was little awareness of ADHD.â
~ Dr. Mike Smith, Psychiatrist
The ADHD foundation, meanwhile, has issued its own response, saying:
âWe are disappointed that BBC Panorama has opted to broadcast a poorly researched, sensationalist piece of television journalism.â
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The Best Form Of Sugar During Exercise
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Itâs Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where weâve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future tooâthereâs always more to say!
As ever: if the question/request can be answered briefly, weâll do it here in our Q&A Thursday edition. If not, weâll make a main feature of it shortly afterwards!
So, no question/request too big or small đ
âWhat is the best form of sugar for an energy kick during exercise? Both type of sugar eg glicoae fructose dextrose etc and medium, ie drink, gel, solids etcâ
Great question! Letâs be clear first that weâre going to answer this specifically for the context of during exercise.
Because, if youâre not actively exercising strenuously right at the time when youâre taking the various things weâre going to be talking about, the results will not be the same.
For scenarios that are anything less than âI am exercising right now and my muscles (not joints, or anything else) are feeling the burnâ, then instead please see this:
Snacks & Hacks: Eating For Energy (In Ways That Actually Work)
Because, to answer your question, weâre going to be going 100% against the first piece of advice in that article, which was âSkip the quasi-injectablesâ, i.e., anything marketed as very quick release. Those things are useful for diabetics to have handy just in case of needing to urgently correct a hypo, but for most people most of the time, theyâre not. See also:
Which Sugars Are Healthier, And Which Are Just The Same?
HoweverâŚ
When strenuously exercising in a way that is taxing our muscles, we do not have to worry about the usual problem of messing up our glucose metabolism by overloading our body with sugars faster than it can use it (thus: it has to hurriedly convert glucose and shove it anywhere itâll fit to put it away, which is very bad for us), because right now, in the exercise scenario weâre describing, the body is already running its fastest metabolism and is grabbing glucose anywhere it can find it.
Which brings us to our first key: the best type of sugar for this purpose is glucose. Because:
- glucose: the body can use immediately and easily convert whateverâs spare to glycogen (a polysaccharide of glucose) for storage
- fructose: the body cannot use immediately and any conversion of fructose to glycogen has to happen in the liver, so if you take too much fructose (without anything to slow it down, such as the fiber in whole fruit), youâre not only not going to get usable energy (the sugar is just going to be there in your bloodstream, circulating, not getting used, because it doesnât trigger insulin release and insulin is the gatekeeper that allows sugar to be used), but also, itâs going to tax the liver, which if done to excess, is how we get non-alcoholic fatty liver disease.
- sucrose: is just a disaccharide of glucose and fructose, so it first gets broken down into those, and then its constituent parts get processed as above. Other disaccharides youâll see mentioned sometimes are maltose and lactose, but again, theyâre just an extra step removed from useful metabolism, so to save space, weâll leave it at that for those today.
- dextrose: is just glucose, but when the labeller is feeling fancy. Itâs technically informational because it specifies what isomer of glucose it is, but basically all glucose found in food is d-glucose, i.e. dextrose. Other isomers of glucose can be synthesized (very expensively) in laboratories or potentially found in obscure places (the universe is vast and weird), but in short: unless someoneâs going to extreme lengths to get something else, all glucose we encounter is dextrose, and all (absolutely all) dextrose is glucose.
Weâd like to show scientific papers contesting these head-to-head for empirical proof, but since the above is basic chemistry and physiology, all we could find is papers taking this for granted and stating in their initial premise that sports drinks, gels, bars usually contain glucose as their main sugar, potentially with some fructose and sucrose. Like this one:
A Comprehensive Study on Sports and Energy Drinks
As for how to take it, again this is the complete opposite of our usual health advice of âdonât drink your caloriesâ, because in this case, for onceâŚ
(and again, we must emphasize: only while actively doing strenuous exercise that is making specifically your muscles burn, not your joints or anything else; if your joints are burning you need to rest and definitely donât spike your blood sugars because that will worsen inflammation)
âŚjust this once, we do want those sugars to be zipping straight into the blood. Which means: liquid is best for this purpose.
And when we say liquid: gel is the same as a drink, so far as the body is concerned, provided the body in question is adequately hydrated (i.e., you are also drinking water).
Here are a pair of studies (by the same team, with the same general methodology), testing things head-to-head, with endurance cyclists on 6-hour stationary cycle rides:
CHO Oxidation from a CHO Gel Compared with a Drink during Exercise
Meanwhile, liquid beat solid, but only significantly so from the 90-minute mark onwards, and even that significant difference was modest (i.e. itâs clinically significant, itâs a statistically reliable result and improbable as random happenstance, but the actual size of the difference was not huge):
Oxidation of Solid versus Liquid CHO Sources during Exercise
We would hypothesize that the reason that liquids only barely outperformed solids for this task is precisely because the solids in question were also designed for the task. When a company makes a fast-release energy bar, they donât load it with fiber to slow it down. Which differentiates this greatly from, say, getting oneâs sugars from whole fruit.
If the study had compared apples to apple juice, we hypothesize the results would have been very different. But alas, if that study has been done, we couldnât find it.
Today has been all about whatâs best during exercise, so letâs quickly finish with a note on whatâs best before and after:
Before: What To Eat, Take, And Do Before A Workout
After: Overdone It? How To Speed Up Recovery After Exercise
Take care!
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Cross That Bridge â by Samuel J. Lucas
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Books of this genre usually have several chapters of fluff before getting to the point. You know the sort:
- Let me tell you about some cherry-picked celebrity stories that overlook survivorship bias
- Let me tell you my life story, the bad parts
- My life story continued, the good parts now
- What this book can do for you, an imaginative pep talk that keeps circling back to me
âŚthen there will be two or three chapters of the actual advertised content, and then a closing chapter thatâs another pep talk.
This book, in contrast, throws that out of the window. Instead, Lucas provides a ground-up structure… within which, he makes a point of giving value in each section:
- exercises
- summaries
- actionable advice
For those who like outlines, lists, and overviews (as we do!), this is perfect. There are also plenty of exercises to do, so for those who like exercises, this book will be great too!
Caveat: occasionally, the book’s actionable advices are direct but unclear, for example:
- Use the potential and power of tea, to solve problems
Context: there was no context. This was a bullet-pointed item, with no explanation. It was not a callback to anything earlier; this is the first (and only) reference to tea.
However! The book as a whole is a treasure trove of genuine tips, tools, and voice-of-experience wisdom. Occasional comments may leave you scratching your head, but if you take value from the rest, then the book was already more than worth its while.
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Immunity â by Dr. William Paul
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This book gives a very person-centric (i.e., focuses on the contributions of named individuals) overview of advances in the field of immunologyâup to its publication date in 2015. So, it’s not cutting edge, but it is very good at laying the groundwork for understanding more recent advances that occur as time goes by. After all, immunology is a field that never stands still.
We get a good grounding in how our immune system works (and how it doesn’t), the constant arms race between pathogens and immune responses, and the complexities of autoimmune disorders andâwhich is functionally in an overlapping category of diseaseâcancer. And, what advances we can expect soon to address those things.
Given the book was published 8 years ago, how did it measure up? Did we get those advances? Well, for the mostpart yes, we have! Some are still works in progress. But, we’ve also had obvious extra immunological threats in years since, which have also resulted in other advances along the way!
If the book has a downside, it’s that sometimes the author can be a little too person-centric. It’s engaging to focus on human characters, and helps us bring information to life; name-dropping to excess, along with awards won, can sometimes feel a little like the book was co-authored by Tahani Al-Jamil.
Nevertheless, it certainly does keep the book from getting too dry!
Bottom line: this book is a great overview of immunology and immunological research, for anyone who wants to understand these things better.
Click here to check out Immunity, and boost your knowledge of yours!
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