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Dr. Jonathan Edlow

Dr. Jonathan Edlow is the author of the new book Bull's Eye: Unraveling the Medical Mystery of Lyme Disease. In the book he chronicles the emergence of the disease, how scattered clues led to the cause — bacterium Borelia burgdorferi, and then to the deer tick that spread it. The search for the cause began in the late 1970s when people around Lyme, Conn., began suffering from unexplained arthritis, swelling, circular rashes, fatigue and other symptoms. Edlow is vice chairman of the department of emergency medicine at the Beth Israel Deaconess Medical Center and assistant professor of medicine at the Harvard Medical School.

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Other segments from the episode on August 13, 2003

Fresh Air with Terry Gross, August 13, 2003: Interview with Jonathan Edlow; Review of Rod Levitt's reissued first album; Interview with Jeremiah Tower; Review of Jacqueline Winspear’s debut novel,…

Transcript

DATE August 13, 2003 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Analysis: Dr. Jonathan Edlow discusses the early beginnings of
Lyme disease, what is known about it today and the treatments
available
BARBARA BOGAEV, host:

This is FRESH AIR. I'm Barbara Bogaev in for Terry Gross.

The tick-borne illness which infects more than 18,000 people a year in this
country is known as Lyme disease, but its story began nearly a century ago
across the ocean from Lyme, Connecticut. In his new book, "Bull's Eye:
Unraveling the Medical Mystery of Lyme Disease," Dr. Jonathan Edlow reveals
that as early as the 1880s, medical researchers in Europe had identified
rashes and confusing neurological syndromes caused by tick bites. But it
wasn't until the early '70s when separate clusters of baffling cases of skin
rashes and arthritis started showing up in Connecticut that doctors assembled
the big picture. When deer ticks bite humans, they transmit a
corkscrew-shaped bacterium known as a spirochete, which causes symptoms that
vary widely from person to person.

Dr. Jonathan Edlow has practiced emergency medicine in Boston for more than 20
years. He teaches at the Harvard Medical School and he's been tracking Lyme
disease since reports first surfaced. I asked him to tell us about the first
cluster of Lyme disease cases in this country.

Dr. JONATHAN EDLOW (Author, "Bull's Eye"): There were two Navy doctors at the
submarine base in Groton, Connecticut, back in the mid-'70s. And during the
summer of 1975 into the internist's office, Bill Mass(ph), a patient came with
a rash and a fever and sore joints. And he didn't know what it was, so he
sent him to the dermatologist, Bill Burroughs, who was stationed on the base.
He didn't know what it was, but it seemed like something that probably should
be treated with an antibiotic. And back then, they selected penicillin.

Over the course of that summer of '75, they collected four patients with the
exact same syndrome--a big rash, fevers. And they went through the
literature. They knew about Rudolph Surimenti's case report from 1970. They
knew about some of the European data. And Bill Burroughs was the
dermatologist, had a habit of going to the Yale Department of Dermatology
grand rounds each Wednesday morning, and he presented these cases, because he
still didn't know what it was. And one of the European doctors in the
audience suggested that this was a disease that had been seen in Europe,
erythema migrans.

BOGAEV: Now pretty much at the same time, families in Lyme, Connecticut, were
falling ill with similar symptoms, right? And you describe the case of Polly
Murray. She was devastated by undiagnosed symptoms for years in Lyme. What
did doctors make of her case, and did they have any communication with these
other doctors in nearby Groton, Connecticut?

Dr. EDLOW: Well, initially, they didn't have any communication. Initially,
Mrs. Murray and other members of her family, even the dog of the family, had
been having all kinds of symptoms--joint symptoms, neurologic symptoms, skin
symptoms--for many, many years. They saw dozens of doctors, but they
never--and they were given many diagnoses, but there really was no diagnosis
that sort of fit. And at one point, they even suggested that Mrs. Murray was
a little bit psychologically unstable. She finally persisted and in October
of 1975 called the State Department of Public Health in Connecticut.

BOGAEV: And at this point, did all of the doctors hook up and did all the
information end up in one place, or what happened?

Dr. EDLOW: No, this was, you know, before medical records were computerized
and--but what did happen is that one town over, in Old Lyme, Connecticut,
there was another woman, Judy Mensch, whose daughter, Ann(ph), had a joint
arthritis. And she was taken to the hospital. She was diagnosed with having
juvenile rheumatoid arthritis, which is a fairly uncommon disease. And Mrs.
Mensch had grown up in Manhattan, had known lots and lots of people, had never
heard of juvenile rheumatoid arthritis. And within her one country block in
Old Lyme, Connecticut, there were five children with that diagnosis. And this
seemed just incredulous to her. So she started talking to doctors and then
she finally, about one week after Mrs. Mensch, she called the Department of
Public Health in Connecticut as well.

BOGAEV: Sociologists talk about a theory of a tipping point for social
phenomenon in which it launches--something launches into the public
consciousness or, in the case of an epidemic, into the consciousness of the
medical community. So was there a point with this story of Lyme at which all
of these factors came together and tipped the balance for Lyme?

Dr. EDLOW: Well, I certainly think that 1975 would--would be that year. You
have the Navy docs at the Groton sub base reporting their four cases. You've
got Mrs. Mensch and Mrs. Murray calling the State Department of Public Health,
and initially they were blown off. They were told by the person answering the
phone that, `Arthritis is not a reportable disease and, therefore, there's
nothing we can do.' Fortunately, that person took some written messages and
left them for the person who was the acting communicable diseases chief, a man
named David Snydman. And when Snydman came back from vacation--he was in
Europe at the time--he had these two messages about these two women reporting
clusters of arthritis. He had been trained at the CDC in epidemiology, and to
him, rather than just blowing these women off, he was intrigued, and he wasn't
bothered by the fact that, you know, there was a round peg in a square hole.
And he got curious. He called the women up, and he realized that something
was going on.

BOGAEV: How did the medical community then arrive at the conclusion that it
was tick-borne?

Dr. EDLOW: Well, the tick part had to do with a couple pieces of evidence.
One of them was that, as they began looking at the evidence, they realized
that this skin rash, erythema migrans, had first been discovered--or
described, rather, in 1909 by a Swedish dermatologist. And he had described
with that original case that it was associated by a tick bite. So that was
one line of evidence from Europe. The second was that both Mrs. Mensch and
Mrs. Murray in their initial interviews had, I guess, a mother's intuition or
a hunch that there had been a lot more ticks in the area over the last few
years and just sort of wondered aloud whether it could be ticks. And then the
third line of evidence was a specific epidemiologic study that the departments
of medicine and epidemiology at Yale undertook, which is they looked at the
communities on the west bank of the Connecticut River, which were Lyme
and--all of Lyme and East Haddam, and they compared the rate of erythema
migrans and the amount of ticks on mice and deer to that of the cities on the
west bank of the Connecticut and found that it was, like, 13 times higher. So
the same side of the river, the east bank had more erythema migrans and also a
lot more ticks, like 13 times more.

So there are all three of those lines of evidence. And I guess the fourth one
is that when you looked at the patients who were sick, there was almost never
patients who lived in the city centers. It was all patients that lived more
out in the woods and in the suburban areas.

BOGAEV: Now how does the tick transmit the disease? And I understand this
involves tick spit.

Dr. EDLOW: It involves tick spit, tick saliva. They're disgusting little
creatures, and basically, when these ticks bite people, they feed for several
days, sometimes as long as a week. And the bacteria, the spirochetes migrate
from the intestine of the tick into the saliva and get injected into the skin,
essentially.

BOGAEV: Now I'm thinking there are plenty of deer in this country. Why did
this syndrome or this disease surface in Lyme, Connecticut?

Dr. EDLOW: Well, it's a good question. I'm not sure that I have the answer
to that. Certainly in place where there are a lot of deer and there are a lot
of mice and there are this particular kind of tick, it sort of brought all the
elements in the environment necessary for Lyme disease to develop. There were
certainly--and the other thing I should mention is that the deer herds are
actually bigger now than they were, say, 30 or 40 years ago. And the reason
that the deer are important is that adult phase of the tick spends the winter
on the deer--that's their preferred animal--and they mate on the deer. So the
more the deer, the more ticks. And, in fact, the deer herds have been
increasing in the northeastern United States for many decades.

BOGAEV: Now there is a prevailing view of Lyme that it's a disease born of
the growth of the suburbs, that there are more and more highly populated
suburban areas in close proximity to rural areas, and that means more and more
deer in close proximity to human beings, which mean more deer ticks on our
skin and more Lyme.

Dr. EDLOW: That's exactly correct.

BOGAEV: And that scenario has held true.

Dr. EDLOW: That's true. And the same thing happened in Europe. You know,
after World War II, a lot of the forests had been bombed, a lot of the deer
had been hunted for food, a lot of the wooded areas had been chopped down for
the rebuilding of Europe after the war. And in Western Europe, these Old
World forests began to regrow and with it the deer herds, and therefore, the
same sort of thing happened in Western Europe.

BOGAEV: Now how does Lyme generally present? What are the symptoms? And
does it present differently in different people--children, adults?

Dr. EDLOW: Well, the sym...

BOGAEV: And I realize we're wandering into something very controversial
already.

Dr. EDLOW: Yeah. Well, the symptoms for the most part--and this is if you
were to open a textbook of medicine right now and read about the symptoms of
Lyme, it would tell you that after tick bite, if you get Lyme disease--and
only about 3 or 4 percent of people bitten by a tick will actually get
Lyme--the most common symptom is this unusual rash that's called erythema
migrans. We'll just call it EM for short. And this rash often looks like a
bull's-eye or a target lesion, but not always. It can just be a big, flat red
rash, and approximately 80 percent of people who contract Lyme disease will
have this skin lesion.

BOGAEV: What if you don't get the rash? How would you know you have Lyme
disease?

Dr. EDLOW: Well, that's a good question, and some people will have just a
plain old flu-like illness, and by that, I just mean a fever and chills and
muscle aches and joint pains without any rash. And as you might imagine,
there's probably 100 diseases that would fit that description, and one might
not be thinking about Lyme disease. It's also important to recognize that
only about 20 to 25 percent of patients with Lyme disease will remember having
been bitten by a tick. So if you haven't had the tick bite, which would put
you in the majority, and you have just a fever and chills, you know, Lyme
disease is not the first thing that comes to mind. In addition, some people
are bitten, infected but don't develop any symptoms, and some of these
patients might develop symptoms later on down the line.

BOGAEV: Whenever there's a controversial disease that people have theories
about or people are unsatisfied with the recommended conventional therapies,
they come up with alternative therapies, and you trace a kind of fascinating
sidebar to this story, which is that in at least one case, someone tried
something called malaria therapy, which was once...

Dr. EDLOW: Right.

BOGAEV: ...applied to syphilis.

Dr. EDLOW: Correct. It's an interesting story. This man got a call from his
daughter that she was going down to Mexico to purposely contract malaria in
order to treat her Lyme disease. And, you know, he thought she was nuts until
he begun looking into it. In fact, she was responding to a letter to the
editor in no less than the New England Journal of Medicine from a physician
who's well-known to everybody, Harry Heimlich, the thoracic surgeon who
invented the Heimlich maneuver. And Dr. Heimlich had been watching a
television program one night about Lyme disease, and he said, `This sounds a
lot like syphilis,' and began advocating malaria therapy.

Well, the history of that goes back to--at the turn of the century, the turn
of the last century, that is, syphilis was a huge public health burden in--in
Western Europe and here. And a large percentage of patients in mental
institutions had late stages of syphilis because many of the symptoms were
primarily psychiatric, and people would die within four to five years of this.
There was no treatment at the time. They were treated by psychiatrists. And
an Austrian psychiatrist named Jauregg Wagner actually noticed that some of
his patients who were early in the course of late syphilis, when they had a
severe fever from some other illness, actually seemed to get quite a bit
better.

So he began giving patients malaria. He would take blood from an infected
patient, give the patient with late syphilis malaria. They would develop very
high fevers, and he found that a large percentage of them got much better, and
some of them actually had complete recoveries and went back to their jobs and
work. This was unheard of. This was like having something, you know, for HIV
infection these days that totally cured them. So he won the Nobel Prize. I
can't remember if it was 1926 or 1927, but something that seems fairly
outlandish to us right now was something that won this man the Nobel Prize in
medicine less than a century ago.

BOGAEV: So this woman, did she contract malaria and how did it go?

Dr. EDLOW: Well, she did. She actually--the description of this was by her
father, who said that one night she was sitting by a river bank in Belize for
several hours at dusk and got a few hundred mosquito bites but didn't contract
malaria. She actually went back to Mexico a few times and finally was
injected with the blood of a child that had malaria. They used a child
because they wanted to minimize the risk of other blood-borne infections. She
did get malaria, she did have high-spiking fevers, but unfortunately, her
symptoms did not get better, the symptoms that had been attributed to the
chronic Lyme disease. But I think it shows you the degree of desperation that
one may go to when one is having chronic symptoms.

BOGAEV: I'm talking with Jonathan Edlow. He's the author of "Bull's Eye:
Unraveling the Medical Mystery of Lyme Disease." He's an assistant professor
of medicine at Harvard Medical School.

Let's take a break and then we'll talk some more. This is FRESH AIR.

(Soundbite of music)

BOGAEV: If you're just joining us, my guest is Dr. Jonathan Edlow. His new
book is a medical history of Lyme disease. It's called "Bull's Eye."

Lyme disease is generally described as having three stages. What are the
three stages and what are the symptoms of each stage?

Dr. EDLOW: Yeah, they're sort of defined as follows: The early localized
stage means when the disease, the spirochete is localized into the skin, it
hasn't spread anywhere. And that's where you get the rash, erythema migrans,
or fevers and chills, maybe a swollen nymph gland.

The second stage is called early disseminated Lyme disease, and that's when,
in the early stages, the early weeks to months after the spirochete getting
into the bloodstream, it causes symptoms. And those symptoms can be in the
neurologic system--for example, a meningitis that's usually fairly mild, a
Bell's palsy where the facial nerve becomes paralyzed and half of the face is
paralyzed. Sometimes it's cardiac symptoms where you get an extremely slow
pulse rate. Occasionally, you can get arthritis. And sometimes it's just
multiple skin rashes, the spirochete goes throughout the bloodstream and you
get 20 erythema migrans lesions instead of one.

The latest stage is called late disseminated, and most of those symptoms are
either joint problems with arthritis or neurologic problems, and they fall
into two categories. One is cognitive problems where your concentration is
off and your sleeping is off and you have a tremendous amount of fatigue,
memory is poor. And then the other is what's called peripheral neuropathy,
where you get either numbness or pains in the hands and the feet due to Lyme
disease within the brain and spinal cord and peripheral nerves.

BOGAEV: What's the currently recommended treatment of Lyme? And this has
been really controversial and gotten politicized in the last decade. And
there are basically two camps. There are people who advocate long-term
antibiotic therapy to avoid these long-term symptoms, and others who say there
might be no such thing as long-term symptoms and that taking antibiotics for
long periods of time is not necessary. So what's the thinking on this now?
Is there any consensus?

Dr. EDLOW: Yeah. Well, we should break it down into several categories.
First of all, I think most people would agree that early diagnosed Lyme
disease, meaning the first couple few months, is fairly easy to treat with
antibiotics and that antibiotics for most early presenting patients, two to
three weeks is adequate. And for those that are diagnosed in the first weeks
to months, sort of a middle stage, a second stage, that three to four weeks is
almost always enough. Most people would agree with that, not everybody. The
second piece is that it's not true that people don't have chronic symptoms. I
think everybody would agree--both what I call the alternative camp and the
conventional camp would all agree that patients who have had Lyme disease,
that some of them, people who are late to be treated, will have chronic
symptoms. The question is, what are those symptoms being caused by? And
that's where a lot of the controversy comes in.

People who believe in long-term antibiotic therapy, and by that I mean months
and sometimes years, believe that there are still live spirochetes in the
patient and it's the live spirochete that's causing these symptoms. There are
other potential causes for the symptoms, and the conventional camp believes
that it's one of those other causes, and there are different ones. It could
be that there's already permanent tissue damage from the original infection,
and the symptom is just due to cells that have died and are causing symptoms.
It's possible that there are symptoms due to an untreated co-infection. It's
possible that, after the original infection, the immune system has been revved
up and that it's the immune system that's causing the ongoing symptoms. It's
possible that the Lyme disease has triggered some other second separate
disease, like fibromyalgia or chronic fatigue syndrome, and obviously, you're
going to treat each of those differently. And it's also possible that some
patients have multiple mechanisms of disease or that some of the mechanisms
are true in one patient, but other mechanisms are true in another patient. So
again, it gets really complicated.

BOGAEV: Let's talk about removing a tick. How do you do it? What's the best
way? What's the recommended way?

Dr. EDLOW: Well, the recommended way is to take a tweezers or a forceps that
are very, very thin and try to get as close to the skin as possible where the
tick is and kind of pinch a little bit and then lift upwards sort of firmly,
and over about, you know, 35 to 40 seconds, most ticks will lift off. What
one should not do is put alcohol or turpentine or a burnt match or Vaseline,
because sometimes that will make the tick kind of squeeze the infectious
contents into the person rather than not.

BOGAEV: Well, Jonathan Edlow, I enjoyed talking with you today. Thank you.

Dr. EDLOW: Thank you very much.

BOGAEV: Jonathan Edlow's new book is "Bull's Eye: Unraveling the Medical
Mystery of Lyme Disease." I'm Barbara Bogaev, and this is FRESH AIR.

(Soundbite of music)

(Credits)

BOGAEV: Coming up, fried Sonoma goat cheese with arugula and pesto. We talk
with Chef Jeremiah Tower about the origins of California cuisine. His new
memoir about his three decades as a chef and restaurateur is called
"California Dish." Kevin Whitehead reviews the dynamic sound patterns of the
Rod Levitt Orchestra. And Maureen Corrigan reviews the debut novel "Maisie
Dobbs."

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Reissue of trombonist Rod Levitt's first album
BARBARA BOGAEV, host:

This is FRESH AIR. I'm Barbara Bogaev.

In 1960 trombonist Rod Levitt was a veteran of Dizzy Gillespie's and Bill
Evans' big bands, and was working in the orchestra at Radio City Music Hall
when he formed an octet to play his original music. That band eventually made
four albums for Riverside and RCA. In recent years, a few critics have
clamored for their re-release. The first of these albums has now been
re-issued. Jazz critic Kevin Whitehead has an appreciation.

(Soundbite of "His Master's Voice")

KEVIN WHITEHEAD reporting:

"His Master's Voice" by Rod Levitt, the master in question being Duke
Ellington. Levitt catches the flavor of his bright woodwinds and wa-wa brass,
the shifting textures, concise solos and rhythmic drive. The tribute is
doubly impressive as Levitt's octet was half the size of Duke's 15-piece band.
These days, an Ellington impression that good could win you a Pulitzer, where
back then even Duke couldn't get one. And anyway, Levitt had other good
ideas.

(Soundbite of "Holler")

WHITEHEAD: Playing in other folks' bands, Rod Levitt never cared much for the
plunger mute. But when he put his own group together, he kept hearing that
wa-wa sound in his head. He named that piece we just heard "Holler," thinking
of slaves' field hollers. That's such an inspiration could seize a dentist's
son from Portland, Oregon, says a lot about the dynamic nature of American
culture. We all crib from each other.

(Soundbite of jazz music)

WHITEHEAD: Rod Levitt's musicians came from Broadway shows, Stokowski's
Symphony of the Air and big bands from Gerry Mulligan's to Ellington's.
Trumpeter Rolf Ericson was, in fact, working with Duke when he recorded this
music. It comes from the CD "The Dynamic Sound Patterns of the Rod Levitt
Orchestra" on OJC. One reason the octet could pass for an orchestra is that
Levitt rehearsed them like mad, revising and discarding pieces and trying to
coax or trick them into playing less politely. He liked blaring harmonies and
primary colors, and liked to keep things moving. That's George Marge in
English horn.

(Soundbite of jazz music)

WHITEHEAD: Counter all the quick-change material, Rod Levitt was also fond of
taking a simple motif and stretching and developing it over the course of a
piece, like his "Upper Bay," meant to depict competing activities in an Air
Force barracks, including a noisy card game and a band rehearsal.

(Soundbite of "Upper Bay")

WHITEHEAD: Buzz ran on alto saxophone. Rod Levitt made three more albums
after this one in the mid-1960s. The critics liked them, but they didn't
catch on with the public. Levitt got discouraged, disbanded and went into
advertising, where he wrote catchy jingles for One-A-Day vitamins, The New
York Daily News and others. So millions of people finally did get to hear
some of his music, but I still like the non-commercial stuff best.

(Soundbite of jazz music)

BOGAEV: Kevin Whitehead writes for the Chicago Reader and the Chicago
Sun-Times. He reviewed the re-issue "The Dynamic Sound Patterns of the Rod
Levitt Orchestra."

Coming up, the American culinary revolution. This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Jeremiah Tower on the evolution of his approach to
cooking
BARBARA BOGAEV, host:

Thirty years ago you couldn't walk into your local supermarket and find baby
spinach or extra virgin olive oil or jars of sun-dried tomatoes and mango
salsa. It took a culinary revolution known as California cuisine to bring
this about, which also brought with it endless individual pizzas with goat
cheese and pesto and, arguably, the rise of the celebrity chef. Jeremiah
Tower was there at the creation, and he makes a case for that with his new
memoir, "California Dish." In it, Tower reminisces about his first job as a
professional chef in the early 1970s at Alice Waters' restaurant, Chez
Panisse, in Berkeley, California. Tower eventually became a co-owner of Chez
Panisse. In the '80s and '90s he ran several other successful restaurants in
the Bay Area, including Santa Fe Grill and Stars. He's the author of two
cookbooks, "Jeremiah Tower Cooks" and "Jeremiah Tower's New American
Classics," which won a James Beard Award. I talked with him recently about
the evolution of his approach to cooking.

You describe in your book that you'd work at Chez Panisse for a while and you
were searching for your identity as a chef or the mark that you were going to
make with this bistro food, and you had an epiphany at one point on a rare,
rare vacation in Mexico that you had to do big, outlandish, non-traditional
things based on traditional impulses. So what did that mean to you and where
did that lead you?

Mr. JEREMIAH TOWER (Chef/Author): Well, I loved the old food, but I realized
that, you know, we'd been doing regional--I mean, I had the idea to do
regional festivals. So we started with the country food of the regions of
France. And then when we ran out of regions and we were talking about Corsica
and things like that, and I thought, `That's really pushing it,' you know, and
I just realized that we were sitting in the middle of the most wonderful
region of all called California and we should just use those ingredients, or
the Monterey prawns that we'd drive down and get fresh, there was just the
beginning of goat cheese, there were oysters from Tomales Bay, sometimes the
live lobsters from the Mexican coast. And I just thought we should develop
our own kind of cuisine using California ingredients, but using the principles
from the past, of all the great dishes of the past as well.

BOGAEV: There are some great descriptions in the book about what lengths a
chef has to go to to get the freshest and the best ingredients. And you
describe The Oakland, an Italian butcher, and that you'd get shoulder deep
into drums filled with the blood and liver of calves to buy your stuff. What
were you looking for in those drums?

Mr. TOWER: Well, you know, that was an amazing place, because they were just
receiving these calves that were going down--hanging up from the truck,
whizzing down into the warehouse. I used to stand there with a pail and grab
the veal sweetbreads as they went by, because within half an hour they're
going to be in boxes and put in the freezer. So the only way for me to get
fresh things was to stand there and grab them out of the carcasses as they
went by.

And with the livers, they came in a big barrel and it was full of calf's
blood, I mean. And I wanted the blond one, so I had to roll up my sleeves and
dig in there to find them. Of course, the people that worked there thought I
was absolutely crazy. I probably was.

BOGAEV: You wanted the blond livers 'cause they're better? What? They
taste better?

Mr. TOWER: Yeah. The blond livers of veal--they're milder, closer to foie
gras in a sense.

BOGAEV: Now it sounds as if two things were happening at once in the '70s in
California, this idea that you should use the very freshest locally grown
unique-to-California food and also that you should--or that a restaurant
offers more than food, it also offers entertainment.

Mr. TOWER: And that we learned that entertainment was very important, as
well as the food. When we did for the champagne dinner, blue trout, and
that's one of the three menus in "California Dish." And we brought these trout
up from Garrapata, where I had remembered they were since I was a child, and
my grandfather took me down there. So we brought up these live trout in tanks
and had bathtubs and pails and everything all over the kitchen with
compressors putting air into the water. And every time there was an order, I
would grab a trout and kill it and shove it in the cabezone(ph). But the
first trout slipped out of my hands, went flopping across the floor just as a
waiter was coming into the kitchen, so it went out into the dining room and
ended up on some dowager's ankles, and then there were shrieks all over the
restaurant. And that really made the evening. Everyone came piling into the
kitchen to see what we were doing. Then I knew that theater was at least half
the story.

BOGAEV: Now you do write in the beginning of your book, though, that
California cuisine would never have become discovered if it weren't for a few
pushy French chefs. And this involves a promotional event for Ocean Spray
cranberries in Newport, Rhode Island. So what's the story behind that claim?

Mr. TOWER: Cranberries, yes, believe it or not. But it was an event that the
agency for Ocean Spray was doing called Innovations. So they invited Guy
Savoy, who was the Young Turk in France at the time, to come to the United
States and put on a dinner in front of a hundred American food journalists to
try and see, you know, what this so-called sauceless cuisine or sort of
nouvelle cuisine, as it was developing in France, was really like. Then they
invited a couple of us California kids to come and do, you know, a funny
little lunch to keep everybody's strength up.

As we got to the mansion, we were in the kitchen, and the French arrived and
they said, you know, `Out, out, out.' You know, `We're the important ones
here, and we need the kitchen.' So I looked around for a place to cook, and
the only place--remembering a sense of theater, of course--that we put up a
kitchen of grills and tables right in front of where the journalists were
going to have lunch, and we cooked in front of them. And that's the first
time they had ever seen grilling and salsas and things like that. It was
certainly the first time we ever saw cooking dessert on the charcoal grill as
well. And it just caught their imagination. And that was when the term sort
of `California cuisine' and what it meant, meaning charcoal grilling and
salsas and everything, was plastered across every food section in America.
And that...

BOGAEV: So you do a lot of grilling in California cuisine, or you did back
then, but you did it then because of necessity?

Mr. TOWER: Yes. Well, of course, we did a lot of grilling afterwards because
that's what the press said California cuisine was, you know. But, you know,
the only heat source we had out there were these two six-foot-long grills and
mesquite charcoal. So we had to cook everything on that. And the dessert was
actually a fruit ragout. And we just lined up all the saute pans, put the
fruit in with the sugar syrup and a pinch of salt and just, in unison, tossed
it around until it was warm because we were serving it with coconut ice cream.
So that the sight of, you know, six of us, each with a saute pan in our hands
and tossing them all in sequence, it was just wonderful to watch, great
theater.

BOGAEV: Now another icon of California cuisine became the little individual
pizza with goat cheese and tomatoes and pesto or whatever. And it sounds as
if there's also a kind of funny `born of necessity' story to how you first
started serving those.

Mr. TOWER: But so many of the things in the restaurant business that become
legendary or great or most successful are born out of necessity. I mean, you
can sit around for hours or weeks, even, trying to come up with a brilliant
idea, but in my experience, you know, it's the brilliant ideas because you're
under pressure and you need something in five minutes. And that's exactly
what happened with the individual pizzas. It was the third birthday of Chez
Panisse, and I had written this menu. And I'd seen in a book in the south of
France these things called panisses. And I thought, `Well, that's it; that's
perfect, you know.' But of course, I didn't look to see what they were; I just
quickly glanced over the recipe and saw they were little round things. And
when it got closer to the event, I made them and they were absolutely
disgusting because they were made out of chickpea flour.

BOGAEV: But they were already on your menu, your printed menu.

Mr. TOWER: I know, so I had to do something. So I just told everybody, you
know, `Oh, panisses are just little pizzas kind of things,' and everyone was
happy. So we made them.

BOGAEV: Now eventually California cuisine--a backlash was created, and I'm
thinking of a few quotes that you point out in your book from classically
trained French chefs, from food critics. One of my favorites is from a French
chef in 1998 who writes that--or he said that, "California cuisine consists of
things you don't normally hear of going together, like alligator fritters with
a parsnip sauce. The alligator tastes like chicken, and the parsnip tastes
like turnips. It's frightening." (Laughs)

Mr. TOWER: Sounds frightening to me. (Laughs)

BOGAEV: So how aware were you of the backlash, and had you already moved on
to a new kind of cooking by the time this came around?

Mr. TOWER: Well, of course, what the backlash against was California cuisine
redux. I mean, it was the people who didn't really understand it who thought
it was all about chic ingredients rather than perfectly controlled, simple,
wonderful ingredients. So when people started putting kiwi fruit on top of
squab and then balsamic vinegar on the plate and raspberries and lemongrass
that they thought had to be chopped up rather than made into an infusion, I
mean, it just got impossible. You couldn't even eat the food after a while.
So we never went there; I never went there and also, you know, so that I
distanced myself a little bit from all of that. We called it new American
cuisine, or the Eastern press called it new American cuisine.

BOGAEV: Now I'm thinking that the ingredient revolution that was started by
the California cuisine movement in the '70s and the '80s has really worked in
this country. You can get boutique farm and baby vegetables, lettuces and
organic wild rice and hothouse herbs and all of that pretty much everywhere.
What's left for chefs to work with in terms of innovation or--you know, does
that make it harder? Does that raise the bar?

Mr. TOWER: It does raise the bar. I mean, at the end of "California Dish," I
say, you know, `The revolution hasn't worked,' because you can go to Texas and
see those amazing central markets or you can be driving in Marathon, Florida,
on the Keys and see another amazing supermarket. And all the farmer's markets
all over Union Square in New York and Philadelphia, everywhere. The
revolution has worked, and it's all about ingredients. But the challenge now
is not to find the ingredients so much, though that's still a huge part of any
great chef's work. I think the innovation now with the chef in America is to
step back and let the food, let the ingredients really speak rather than
saying, `This is the food of a famous chef.' I mean, look at--the biggest
influence now on chefs in America is Spain, and those wonderfully crazy chefs
in Spain sometimes put just one little ingredient on a plate. Of course, it's
amazingly perfect and full of flavor and intriguing at the same time. So
that's the challenge. It's not so much doing something new, but it's doing
something new for yourself, which is to step back, let the food be famous.

BOGAEV: Well, Jeremiah Tower, I want to thank you so much for talking with
us. It was fun.

Mr. TOWER: Thank you for inviting me on the show.

BOGAEV: Jeremiah Tower. His new memoir is "California Dish."

Coming up, a review of the new novel "Maisie Dobbs." This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Jacqueline Winspear's debut novel, "Maisie Dobbs"
BARBARA BOGAEV, host:

British writer Jacqueline Winspear grew up listening to her grandparents'
stories of life in Britain and on the battlefield during World War I. She's
woven their recollections into her first novel, called "Maisie Dobbs." But
book critic Maureen Corrigan says "Maisie Dobbs" mixes in a heavy dose of New
Age therapies with its nostalgia.

MAUREEN CORRIGAN reporting:

Jacqueline Winspear's debut novel, "Maisie Dobbs," is a quirky literary
creation. If you cross-pollinated Vera Brittain's classic World War I memoir,
"Testament of Youth," with Dorothy Sayers' Harriet Vane mysteries and a dash
of the old PBS series "Upstairs, Downstairs," you'd approximate the peculiar
range of topics and tones within this novel. Neither flora nor fauna, fish
nor fowl, it also behaves by turns like a romance, a tale of terror, an
historical novel and a primer on holistic health.

Personally, I'm ready for a dose of the eclectic. So far, this season's big
books have been the new "Harry Potter," which is a wondrous but, after all,
familiar phenomenon, and Hillary Clinton's autobiography, which I've dipped
into at random and found to be as measured and monotonous as the annual report
of some non-profit agency.

"Maisie Dobbs" takes too many risks to be flawless. In particular, the
coincidences that structure its plot are too whopping. But overall, its
intelligent eccentricity offers relief from the dopey doldrums of most other
so-called summer books. Part of the fun of reading "Maisie Dobbs" is
connecting the dots, figuring out how the daughter of a London
costermonger--that is, vegetable seller--came to launch herself as a private
investigator and psychologist. For that's how the 30-something Maisie
advertises herself when the novel begins in the spring of 1929.

As we readers learn through a teasing series of flashbacks, Maisie at age 13
was placed in service to Lady Rowan Compton, a famous London suffragist. The
young Maisie worked by day as a scruffy in-between maid. By night, however,
she revealed herself to be a brilliant autodidact, sneaking into Lady Rowan's
library to teach herself Latin and the collected works of Kierkegaard.
Naturally she's discovered one night by Lady Rowan, who, instead of sending
the trespassing Maisie packing, eventually sponsored her studies at Girton
College Cambridge. Lady Rowan also introduced Maisie to a physician and
mystic named Maurice Blanche, who tutored Maisie in science, philosophy and
what he calls the forensic science of the whole person. World War I, however,
disrupted Maisie's singular education. She enlisted as a nurse, was sent to
France and fell in love with a young doctor whose fate remains obscure until
the very end of the novel.

Past and present intersect in Maisie's first big case. A client hires Maisie
to check up on his wife, whom he suspects of infidelity. Through entertaining
narrative twists and turns that take readers all over late 1920s London and
the countryside, Maisie discovers an odd place called The Retreat. It's a
kind of commune for servicemen whose disfiguring facial injuries have made
them into figures of revulsion to the society they served. In order to ferret
out the evildoings at the retreat, Maisie has to confront her own still gaping
psychological war wounds.

In "Maisie Dobbs," Winspear has concocted what's essentially a class-conscious
feminist fairy tale about a woman without advantages finding autonomy.
Winspear shores up this engaging vision with plenty of solid historical
detail. For instance, she vividly describes the pre-dawn fireplace cleaning
rituals Maisie once performed as a maid and, later, off the battlefield, the
routine she executes of disinfecting wounds with garlic juice. As befits a
fairy tale, the cast of offbeat, benevolent secondary characters in the novel,
like Lady Rowan and Maisie's noble vegetable-hawker father, are very winning.
But it's Maisie herself who is the most bizarre draw here. She's part
clairvoyant, part intellectual, part New Age therapist. When she's
questioning hesitant witnesses, she'll discreetly practice the art of touch or
invite them on a walk in the park to relax their muscles and therefore their
tongues.

To the extent that it is a mystery, "Maisie Dobbs" tackles a big philosophical
subject that has preoccupied so many other serious mystery novels; that is,
how do human beings really come to know the truth. Unlike champions of pure
reason like Sherlock Holmes, Maisie also relies on the wisdom of yoga, Freud
and feng shui to diagnose and heal a troubled world.

BOGAEV: Maureen Corrigan teaches literature at Georgetown University. She
reviewed "Maisie Dobbs" by Jacqueline Winspear.

(Soundbite of music)

(Credits)

BOGAEV: For Terry Gross, I'm Barbara Bogaev.
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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