James Hamblin spent years writing a book on hygiene beliefs and the new science of the skin microbiome. In it, he suggests that some people overuse cleansers and soaps, and may benefit from doing less.

But now there’s a pandemic, and he also really wants to remind people to wash their hands. Jim tries to explain the nuances of good cleaning and bad cleaning—and why he does not shower in the traditional sense.

On this episode of the Social Distance podcast, Katherine Wells asks Jim about that new book, Clean, and how to approach nuanced health discussions during a pandemic.

Listen to the episode here:

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What follows is an edited and condensed transcript of their conversation.

James Hamblin: I have a book coming out. It’s called Clean. It’s about the history of hygiene and sanitation and our beliefs about cleanliness.

Katherine Wells: You decided to study hygiene long before coronavirus. Why were you interested in hygiene?

Hamblin: Because I was interested in skin microbes. We did an episode, back in 2016, of If Our Bodies Could Talk, the video series, and talked to this company that was selling a skin probiotic. [The company encouraged] spraying bacteria onto your skin [under the] pretense of it getting better and improving your health. The idea is that we wash off all these microbes, some of which are healthy, some of which are fine, very similar to the gut microbiome. I started thinking after that, What if the answer is just to not wash off things so much?

And then I did a lot of research, and it turns out that there are a lot of dermatologists and people who study skin and the skin microbiome that say, “Yeah, actually, it would probably be good for a lot of people to just do less [washing].” Except for your hands. A lot of people are over-washing and over-applying things. You apply shampoo to remove oils from your hair and scalp and then conditioner to replace them. People use body wash all over and then use lotion or moisturizer to replace those oils. It’s this cycle of selling people products.

I researched the origins of that. The soap makers started with important, actual public-health interventions like hand-washing. One hundred years ago, people needed to know: You’ve got to wash your hands. You’ve got to stop the cholera.

Wells: And then the capitalist machine took over, and now it’s like, You must buy these things or else you’re disgusting. Your book has a complex message about how what began as a clear good-health intervention, soap and washing, has now become distorted into this sales machine where people are marketing you products you don’t actually need, or don’t need to use as much, with this health gloss over it.

Hamblin: Yes. We sold people so much soap that we had to start selling conditioner. And now we’ve sold people so many antimicrobial skin products, we’re going to start selling probiotics. It upends a lot of concepts about what it means to be clean if you’re supposed to have microbes on you.

Wells: But this is a hard message during a time when microbes are killing a bunch of people.

Hamblin: I started working on this five years ago, and it’s just now coming out. The text has not been updated to include the term coronavirus. But I think the book holds up. I’m very clear on hand-washing, very clear on this idea of targeted hygiene: doing things that actually prevent the spread of disease, and separating those from things that you just enjoy or that are social signifiers or culturally important.

I did this TV interview on a show called This Morning in the U.K., which is really a lovely show. The hosts were good and talked with me for about 10 minutes about all of this.

Wells: Did they ask you about coronavirus?

Hamblin: They did not specifically. But I was very clear that I have never stopped washing my hands, and that washing your hands is important. But some blogger at the Daily Mail tried to make me seem like I was a doctor out there telling everyone they’re wrong and I’m unhygienic. [The story has since] been changed because I complained to them.

Wells: This is the headline currently: “Doctor Who Hasn’t Used Soap in FOUR YEARS Leaves This Morning Viewers Baffled as He Insists He DOESN’T SMELL and Claims Products Are a ‘Waste of Money.’” Every paragraph is about how you’re insisting you don’t smell.

Hamblin: I think that was one sentence that I said because [the TV-show hosts] asked me, “Do you smell bad?” As you’re weaning yourself off of these [products], you do [smell bad], but then you stop smelling with any sort of regularity or frequency.

But there’s a reason you write 90,000 words about something like this. It needs to be a book for a reason: because it’s complicated. The initial headline was something like: “Doctor Says Washing Bad for Health.” If they want to make fun of me, I don’t care. But when they suggested that I’m countering this extremely critical public-health message right now, that was infuriating to me, because this is what I live for, to do the opposite of that. So I went to their site to report a factual inaccuracy, and just reported that I literally did not say the thing that they put in quotes in their headline. And they changed the headline to say I don’t use soap, which is still inaccurate.

Wells: This article initially suggested that washing was bad for your health, which was a very dangerous message at this time when washing is essential. Hand-washing, specifically, is essential to health. It says you haven’t use soap in four years. Is that true?

Hamblin: No, I use hand soap many, many times a day.

Wells: You’re very concerned that this might suggest that you are somehow endorsing not hand-washing at a time where it is essential for every person to be washing as much as possible.

Hamblin: Exactly. [People are] looking for clear messages, and one of the few clear messages the public-health community has been able to give is: Do wash your hands. Do wear a mask. Do social distance. There’s not a lot we can say for certain, but we know those things. Every time people try to throw a wrench in those gears just to be provocative or rile people up, it does actual damage.

Wells: This is complicated, though. Nuance does not work on the internet. This is the problem.

Hamblin: Every force drives you toward decontextualization.

Wells: I do feel like in several of these phone calls, I’ve been asking you about some headline I read, which is essentially decontextualized, slightly hyperbolic information, and I’m having to help you, like, deconstruct it for me. For instance, about vaccines, [I’ll read something where] it seems like we have a vaccine, but we don’t have a vaccine. We just have some very small study that showed some people were not harmed.

Hamblin: A headline is always too distilled. But most places do a decent job.

Wells: Is this just not the time to be talking about how, actually, for parts of your body [other than your hands], soap is really stripping and harsh? Is that just way too nuanced of a message right now?

Hamblin: No, I don’t think so. Because also, at the same time, this is a huge global industry. Sales are falling. People are changing their daily habits. They’re curious to know about what effect that has. It’s not life or death, but it’s part of our daily lives in which we spend time and money.

Your skin is an ecosystem. Now we’re getting a virus that’s like an invasive species. You don’t clear-cut a forest because of an invasive species. Ideally, you try to eradicate the invasive species. But that’s generally most of our approach [to hygiene]: Let’s just obliterate everything. Things get so simplified, and we have this tendency to want to distill things throughout health into “good” or “bad.”

Wells: I always want to know, do I do this or do I not do this? I can’t have a half-hour conversation about every possible health-related choice I could make in every day.

Hamblin: Then my advice is: Wash your hands as often as possible and wash your body and hair only when you’d like to.

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