Introduction
In our modern world, we've become obsessed with cleanliness. We shower daily, use countless skincare products, and constantly sanitize our surroundings. But what if this extreme hygiene is actually doing more harm than good? In his book "Clean: The New Science of Skin," James Hamblin explores this provocative idea, challenging our long-held beliefs about cleanliness and health.
Hamblin, a medical doctor turned journalist, embarked on a fascinating journey to understand the science behind our skin and its relationship with the microbial world. He spoke with microbiologists, dermatologists, and historians to uncover the truth about our cleaning habits and their impact on our health. The result is a thought-provoking exploration of hygiene, the skin microbiome, and the complex relationship between humans and the microscopic organisms that live on and in us.
The Great Shower Experiment
Hamblin's investigation into cleanliness began with a radical personal experiment: he stopped showering. For five years, he ditched all personal care products and only washed his hands and occasionally got his body wet. This "existential audit" was initially motivated by a desire to save time and money after leaving his secure job as a doctor to become a journalist.
The results of this experiment were surprising. After a few months of adjustment, Hamblin noticed that his skin became less oily, and he experienced fewer eczema breakouts. While he didn't smell like a field of daisies, his girlfriend described his scent as simply smelling "like a person."
This personal experiment led Hamblin to discover that many skin researchers also take a minimalist approach to showering habits. It turns out that our modern obsession with cleanliness might be doing more harm than good.
The Evolution of Cleanliness
To understand how we arrived at our current hygiene practices, Hamblin takes us on a journey through the history of cleanliness. Our reasons for cleaning ourselves have changed dramatically over time, influenced by cultural, religious, and scientific developments.
Ancient Bathing Practices
In ancient Rome, bathing was more about socializing and relaxation than hygiene. The famous Roman baths were places for entertainment and general wellness, with actual washing coming last. The water in these baths was rarely changed, creating a less-than-hygienic environment by today's standards.
Religious practices also played a role in cleanliness rituals. In ancient Jerusalem, people washed themselves to avoid spiritual contamination. Hebrews required hand and foot washing before entering the Temple and before and after meals. Similarly, Islam requires ritual washing five times a day before prayer, leading to the development of complex water systems in Arabic countries long before Europeans.
Christianity and Hygiene
In contrast, early Christians viewed excessive bathing as a sinful luxury. This attitude towards hygiene contributed to the spread of diseases like the Black Death in 14th century Europe, which killed one in three Europeans.
The Birth of Germ Theory
It wasn't until the mid-19th century that the link between living conditions and disease was discovered. John Snow, a London physician, traced a cholera outbreak to a contaminated well in 1854. However, it took another 30 years for his work to be corroborated by German physician Robert Koch, who observed cholera-causing microbes under a microscope.
The emergence of germ theory revolutionized our understanding of disease and hygiene. Governments began investing in preventative infrastructure like water treatment facilities and sewage systems. Social norms shifted, and being ungroomed became associated with being dangerous. Cleanliness became an indicator of social status, creating a huge market for soap.
The Rise of the Soap Industry
The late 19th century saw a soap boom in America and Britain. Companies like Lever Brothers led the charge, not through innovative soap-making techniques, but through groundbreaking advertising strategies.
Innovative Marketing
William Lever, the mastermind behind Lever Brothers, was one of the first to realize the potential of selling to every household as the middle class emerged. His company, which produced Sunlight Soap, became the world's largest soap distributor thanks to aggressive and innovative marketing techniques.
Lever's approach to advertising was revolutionary. He "painted the world with his brand," placing ads everywhere and even founding a newspaper and publishing a healthcare book, both carrying his brand name. This approach set the stage for modern advertising practices.
Soap Operas and Marketing Jargon
Soap companies didn't just run ads; they revolutionized broadcasting. They created the genre of daytime serials, which came to be known as "soap operas" due to their sponsorship by soap manufacturers. These programs were targeted at housewives, the primary consumers of household products.
The soap industry also pioneered the use of marketing jargon. Companies like Colgate & Company advertised their products as "hard milled" and "safer," even though these terms had no real meaning. Palmolive invoked recommendations from unnamed doctors, a practice that continues in advertising today.
Expanding Product Lines
As soap became ubiquitous in households, companies needed to expand their product lines to maintain growth. They cleverly marketed new products to solve problems supposedly caused by soap use. For example, if soap gave you dry skin, you needed to buy moisturizer. This strategy set the stage for the emergence of vast skincare empires.
The Modern Skincare Industry
Today, the skincare industry is a multi-billion dollar behemoth, with both mainstream brands and "indie" companies vying for consumers' attention and dollars. The current trend in skincare marketing emphasizes words like "clean," "cruelty-free," and "pure," often highlighting specific "new" ingredients.
The Blurring Line Between Cosmetics and Medicine
One concerning trend in the skincare industry is the blurring line between cosmetics and medicine. Many companies use scientific-sounding terms and make claims that tread dangerously close to medical promises. This makes it difficult for consumers to distinguish between medical fact and cosmetic fiction.
For example, collagen products are widely marketed as firming and plumping for the skin, despite the fact that collagen molecules are too large to penetrate the skin when applied topically. Meanwhile, retinoids, which do have some scientific evidence supporting their ability to stimulate collagen production, are sold both as prescription drugs and over-the-counter cosmetics.
Regulation and Consumer Trust
Unlike the pharmaceutical industry, which is heavily regulated and requires years of trials before introducing new drugs, the skincare industry operates with much more freedom. In the United States, it's legal to make almost any claim about a cosmetic product as long as you're not promising to cure a disease.
Interestingly, many consumers tend to be more trusting of skincare products than of drugs. This may be due to a sense of disillusionment with the medical establishment, leading people to seek alternatives. The skincare community often relies on shared personal experiences to determine which products are effective, creating a sense of empowerment and control over one's health and appearance.
The Importance of Microbes
While the skincare industry has been pushing for ever-increasing cleanliness, scientists have been uncovering the vital role that microbes play in our health, particularly when it comes to our skin.
The Amish Study
A groundbreaking study in 2016 compared two genetically similar communities: the Amish and the Hutterites. The key difference between these groups was their level of exposure to the microbial world. Amish children, who regularly accompanied their parents to communal farms, had significantly lower rates of asthma and allergies compared to Hutterite children, who had less exposure to soil, animals, and microbes.
This study suggested that early exposure to a diverse microbial environment could be beneficial for our immune systems.
Understanding the Immune System
To grasp why exposure to microbes is important, we need to understand how the immune system works. Immune cells circulate through our blood and lymphatic systems, constantly on the lookout for foreign particles (antigens). When they detect these antigens, they trigger an inflammatory response to protect us.
However, sometimes the immune system can misfire, attacking harmless particles or even our own cells, leading to autoimmune diseases. One way to prevent these mistakes is to "train" the immune system by exposing it to a variety of bacteria, especially early in life.
The Importance of Early Exposure
This microbial exposure begins at birth. During vaginal delivery, babies pick up some of their mother's microbes. Breastfeeding further contributes to the development of the infant's microbiome. As children grow, they continue to form their microbiome through everyday contact with family members, dirt, animals, and even other children's toys.
The Overuse of Antibiotics
While exposure to diverse microbes is beneficial, our society has become increasingly focused on eliminating bacteria through the use of antibiotics and antimicrobial products.
The Rise of Antibacterial Soaps
The trend of antibacterial products can be traced back to the late 19th century when Lever Brothers introduced Lifebuoy soap, claiming it could cure fevers and colds due to its antiseptic ingredient, carbolic acid. This marketing strategy played on the newly discovered germ theory and people's fears of invisible microbes.
Later, the concept of "body odor" or "B.O." was introduced as another marketing ploy, suggesting that bacteria caused unpleasant smells that could only be eliminated with soap. This fear-based marketing was highly effective, leading to a boom in antibacterial products.
The Dangers of Antimicrobial Ingredients
Over time, soap makers began adding antibiotics to their products. In 1948, Dial soap was introduced, containing the antibiotic compound hexachlorophene. However, studies later revealed that this chemical could penetrate the skin and affect the nervous system.
Manufacturers then switched to another microbe-killing compound, triclosan. Recent studies have shown that constant exposure to triclosan can promote tumor development, alter hormone function, and possibly cause allergies. Despite these risks, by 2009, three in four Americans had triclosan in their urine.
Regulation and Shifting Trends
In 2013, the US Food and Drug Administration asked soap makers to provide evidence that antibacterial soaps were more effective than plain soap and water in fighting disease. When companies failed to provide substantial evidence, regulators banned triclosan, hexachlorophene, and 17 other antimicrobial ingredients from soaps.
Interestingly, the latest skincare trends are now moving in the opposite direction, with many brands selling products containing probiotics and prebiotics to foster microbial growth on the skin. This shift reflects a growing understanding of the importance of a diverse and healthy skin microbiome.
The Skin Microbiome and Health
Recent research suggests that our skin microbiome may hold important information about our overall health. This idea is supported by studies involving dogs trained to detect various diseases through smell.
Dogs Detecting Disease
In 2009, researcher Claire Guest was working on a study about dogs' ability to smell cancer when her own dog, Daisy, began acting strangely around her. This behavior prompted Guest to check herself, leading to the discovery of a small lump in her breast that turned out to be cancerous.
Since then, dogs have been trained to detect various health conditions, including high blood sugar levels and early signs of Parkinson's disease. These dogs are picking up on small changes in the complex mixture of chemicals we emit, known as volatiles.
The Microbiome Connection
Researchers are now exploring whether these detectable changes in our smell are linked to alterations in our skin microbiome. If this theory proves correct, it could lead to new methods for early disease detection and treatment.
For example, a study in Gambia used dogs to detect malaria by smelling socks worn by schoolchildren. The dogs correctly identified socks worn by infected children in seven out of ten cases. This suggests that the compounds produced by our skin are not random but may contain valuable health information.
Finding Balance: Hygiene and Microbial Exposure
The history of human cleanliness has swung between extremes. From the open-air approach of Florence Nightingale in 19th-century military hospitals to the sealed, sterile environments of modern medical facilities, we've seen dramatic shifts in our approach to hygiene and health.
Lessons from History
Florence Nightingale's work in Crimea during the 1800s demonstrated the importance of fresh air and cleanliness in reducing hospital death rates. Her approach of opening windows and improving air circulation led to a significant decrease in mortality.
However, with the advent of germ theory, hospitals shifted towards more closed, sterile environments. While this approach has its merits, we may have lost some of the benefits of Nightingale's more balanced approach.
Maintaining Microbial Diversity
Recent studies suggest that maintaining microbial diversity is crucial for our health. A 2017 study from the University of Waterloo found that people who live together develop similar microbiomes and have greater microbial diversity. The same is true for people who have pets, drink less alcohol, and exercise outdoors.
These findings suggest that some level of exposure to diverse environments and organisms is beneficial for our microbiome and overall health.
Global Hygiene Imbalance
While some parts of the world have embraced extreme cleanliness, often to their detriment, other regions lack access to basic hygiene necessities. More than 30% of the global population doesn't have the means to wash their hands at home, and billions still die from preventable infections.
For example, after the 2010 earthquake in Haiti, 8,000 people died of cholera, a disease that could have been prevented with access to clean water and good hygiene practices.
Conclusion
James Hamblin's "Clean" challenges our modern notions of cleanliness and hygiene, suggesting that our obsession with sterility may be doing more harm than good. While basic hygiene practices like handwashing remain crucial for preventing the spread of infectious diseases, we shouldn't take cleanliness to extremes.
The book argues for a more balanced approach to hygiene, one that recognizes the importance of our skin's natural microbiome and the benefits of exposure to diverse microbial environments. This doesn't mean we should all stop showering, but it does suggest that we might benefit from a less aggressive approach to personal cleanliness.
Hamblin's work encourages us to question long-held beliefs about hygiene and to consider the complex relationship between our bodies and the microbial world around us. By cultivating a diverse microbiome through exposure to the outside world, we may actually improve our health more than through excessive cleaning and product use.
As we move forward, it's important to strike a balance between maintaining good hygiene practices and allowing our bodies to interact naturally with the microbial world. This approach not only benefits our individual health but also has implications for global health initiatives and the equitable distribution of hygiene resources.
Ultimately, "Clean" invites us to reconsider our relationship with cleanliness and to embrace a more nuanced understanding of what it means to be truly healthy in our modern world. It's a call to look beyond marketing claims and arbitrary standards of personal care, and to make informed decisions based on scientific evidence and a holistic view of health.
By opening up conversations about hygiene beliefs and practices, we can challenge arbitrary standards and make more informed decisions about our personal care routines. As we continue to learn more about the intricate relationship between our bodies and the microbial world, we may find that when it comes to cleanliness, less is often more.