Category: Diseases, Injuries, and Dying

How 99 Ways to Die Might Save Your Life-a book review

In this post I review “99 Ways to Die and How to Avoid Them.” Dr. Ashely Alker, an emergency physician, humorously outlines various health risks and preventive measures. Combining personal anecdotes with medical insights, she emphasizes the importance of awareness in avoiding fatal incidents and advises readers to prioritize health habits over misinformation, and seeking medical care as soon as possible.

99 Ways to Die

And How to Avoid Them

by Ashely Alker, M.D.

Published January 2026 by St. Martin’s Press

Thank you, NetGalley and publisher, for sending this book for review consideration.

Why would a medical doctor write about ways to die? Aren’t they supposed to keep people alive?

Yes, and that’s why Dr. Ashely Alker, a “death escapologist”, wrote 99 Ways to Die. As an emergency medicine specialist, she says this book is bad for business. Reading it, and following her advice, may keep you out of her emergency room. Better yet, it may save your life.

Dr. Adler briefly shares her pre-medical life and education, including overseas study for a master’s degree in public health. She relates personal experiences with illness and the healthcare system, which led her to medical school and residency.

The table of contents reads like a textbook of emergency medicine, in that it includes both illnesses and situations that can lead to illness. Some of them you have no doubt heard of.

  • Heart Attacks
  • Cancer
  • Ebola virus
  • Nuclear blast radiation

But have you heard of

  • Schistosomiasis,
  • Mad Cow disease,
  • Venomous agent X,
  • Takotsubo cardiomyopathy

And you’ve heard of but may not believe can be deadly.

  • Influenza,
  • Measles,
  • High Blood Pressure,
  • Pregnancy,
  • Health Influencers (yes, she really wrote this)

She devotes ample discussion to infections, both bacteria, viral, fungi, and even parasites. One whole chapter is on vaccine-preventable infections (obviously, she advocates vaccination)

One of the top five frequent causes of death is accidental trauma, which is often overlooked in discussions of preventive medicine. Not Dr. Adler. She details the ways things like drugs, animals, vehicle crashes, crime, sports, weather, and war can harm and kill us. And don’t forget the dangers of food and water!

You may be thinking this book must be highly technical. She does use scientific names and terms, which she explains in simple language. Her tone is engaging and conversational. She is blunt, sometimes humorous, but always perfectly serious.

She shares stories of her own patients with these conditions; details changed for privacy. Is some of it gory or scary? Maybe, depending on your comfort level and how much you want to know about the human body and how it can be misused and abused.

Disease and death affect all of life and history, as she points out in discussing the impact of the influenza epidemic of 1918 and the COVID-19 pandemic of 2020. I found her discussion of the atomic bombs dropped on Hiroshima and Nagasaki, Japan in World War II particularly poignant.

The initial blasts killed over 200,000 civilians, with many more dying later from radiation illness. In her review of biological and chemical warfare, she suggests we consider carefully who we put into power.

 From this book, you will learn that health is more than knowing your blood pressure and cholesterol. Our risk of disease is more due to where and how we live, and our socioeconomic status. The most important number for your health may be your zip code in the United States.

None of us expect to die from an automobile collision, hypothermia, homicide, drowning, tornado, poisoning, insect bite, or war, but we might and she explains how to avoid it. Common sense things-wear a seat belt, dress for the weather, apply insect repellent, don’t believe medical misinformation you read online. Learn CPR and save someone else’s life.

I’m a physician and worked in ERs, but I still learned from her book. So, I believe you will also. Her main takeaway is to value and care for your body, you only have one. As she wrote in her dedication

May we all be alive this time next year.

Dr. Ashely Alker

Read an excerpt

Note: She does not intend this book to replace advice from your own personal physician. References to CDC recommendations are to those issued before January 1, 2025.

The Author

Ashely Alker, M.D., M.Sc., is an emergency medicine physician on a mission to improve public health. While completing her master’s degree, Dr. Alker studied at Harvard School of Public Health’s multinational institute in Cyprus. She lived near the United Nations Green Zone and worked in humanitarian affairs at the Unit for the Rehabilitation of Victims of Torture.

After graduating from the George Washington University School of Medicine, Dr. Alker served as a healthcare advisor for a member of the US Congress. During her residency in emergency medicine at the University of California, San Diego, Dr. Alker became a technical consultant and medical screenwriter, improving medical accuracy on over twenty shows, including TV and film for Netflix, Hulu, HBO, and Disney.

Her nonprofit, Meaningful Media, connects writers, artists, and reporters with certified public health experts to develop scientifically accurate messaging.

Images in this Post

The book image and Dr. Alker’s photo are from her website.

What do you think?

What do you think about a physician writing a book about dying?

What is the most unusual, bizarre, or unexpected cause of death that you know about?

How will reading this review and/or the book impact your idea of what will cause your own death?

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Use this search box for related posts on this blog or other topics of interest to you.

Dr. Aletha

The Surprising Benefits of Vaccines for Older Adults

In this post I share updates about the numerous off-target benefits of vaccinations for older adults, highlighting their potential to reduce risks of cardiovascular diseases and dementia. It emphasizes the importance of vaccinations like flu, shingles, and RSV, while noting that many older adults remain unvaccinated, missing out on these protective effects.

This information is current as of the date of original publication or update but may have changed by the time you read this. Do not use this information for diagnosis or treatment purposes. Before making health decisions, discuss with a qualified healthcare professional.

I think I am officially “older”. I qualify for Medicare and have reached my full retirement age. I receive the senior discount at restaurants. I remember many events that younger people have only heard about.

I find many advantages to having reached this age and in this article from KFF Health News I learned about more. The vaccines I have received to prevent infections may also protect me from cardiovascular disease and dementia.

I’m sharing this information with you here now, courtesy of KFF Health News.

VACCINE-PREVENTABLE DISEASES
This is not a complete list of all available vaccines.

Vaccines Are Helping Older People More Than We Knew

by Paula Span, January 14, 2026

Let’s be clear: The primary reason to be vaccinated against shingles is that two shots provide at least 90% protection against a painful, blistering disease that a third of Americans will suffer in their lifetimes, one that can cause lingering nerve pain and other nasty long-term consequences.

The most important reason for older adults to be vaccinated against the respiratory infection RSV is that their risk of being hospitalized with it declines by almost 70% in the year they get the shot, and by nearly 60% over two years.

And the main reason to roll up a sleeve for an annual flu, influenza, shot is that when people do get infected, it also reliably reduces the severity of illness. However, its effectiveness varies by how well scientists have predicted which strain of influenza shows up.

photo of a display at the Museum of Natural Science in Washington, DC, from Dr. Aletha

Off-Target Benefits



But other reasons for older people to be vaccinated are emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.

The list of off-target benefits is lengthening as “the research has accumulated and accelerated over the last 10 years,” said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Some of these protections have been established by years of data; others are the subjects of more recent research, and the payoff is not yet as clear. The first RSV vaccines, for example, became available only in 2023.

Still, the findings “are really very consistent,” said Stefania Maggi, a geriatrician and senior fellow at the Institute of Neuroscience at the National Research Council in Padua, Italy.

She is the lead author of a recent meta-analysis, published in the British journal Age and Ageing, that found reduced risks of dementia after vaccination for an array of diseases. Given those “downstream effects,” she said, “vaccines are key tools to promote healthy aging and prevent physical and cognitive decline.”

Dr. Aletha inspecting her arm after a COVID-19 shot

I rolled up my sleeve for a COVID vaccination.



Yet too many older adults, whose weakening immune systems and high rates of chronic illness put them at higher risk of infectious diseases, have not taken advantage of vaccination.



The Centers for Disease Control and Prevention reported last week that about 31% of older adults had not yet received a flu shot. Only about 41% of adults 75 and older had ever been vaccinated against RSV, or respiratory syncytial virus, and about a third of seniors had received the most recent COVID-19 vaccine.

The CDC recommends the one-and-done pneumococcal vaccine for adults 50 and older. An analysis in the American Journal of Preventive Medicine, however, estimated that from 2022, when new guidelines were issued, through 2024, only about 12% of those 67 to 74 received it, and about 8% of those 75 and older. (The pneumoccal vaccine protects against disease from the bacteria Streptococcus pneumonia. )

Prevalence of High Level Penicillin Resistance in Streptococcus pneumoniae, United States.
This image was produced, by the Centers for Disease Control and Prevention (CDC) in 1997, It lists the percentages of penicillin resistant S. pneumoniae infections, during 1987, 1991, and 1993-94, based on data collected by both the Morbidity and Mortality Weekly Report (MMWR), The Journal of Infectious Diseases. Note how over this 8-year period, there was a steady increase in the occurrence of high level penicillin resistance. public domain

Benefit for Heart Disease Prevention



The strongest evidence for off-target benefits, dating back 25 years, shows reduced cardiovascular risk following flu shots.

Healthy older adults vaccinated against flu have substantially lower risks of hospitalization for heart failure, as well as for pneumonia and other respiratory infections. Vaccination against influenza has also been associated with lower risks of heart attack and stroke.

Moreover, many of these studies predate the more potent flu vaccines now recommended for older adults.

Could the RSV vaccine, protective against another respiratory illness, have similar cardiovascular effects? A recent large Danish study of older adults found a nearly 10% decline in cardiorespiratory hospitalizations — involving the heart and lungs — among the vaccinated versus a control group, a significant decrease.

a preserved human heart, from a museum exhibit
photo by Dr. Aletha at the Denver Museum of Natural Science



Lowered rates of cardiovascular hospitalizations and stroke did not reach statistical significance, however. That may reflect a short follow-up period or inadequate diagnostic testing, cautioned Helen Chu, an infectious disease specialist at the University of Washington and co-author of an accompanying editorial in JAMA.

“I don’t think RSV behaves differently from flu,” Chu said. “It’s just too early to have the information for RSV, but I think it will show the same effect, maybe even more so.”

Possible Dementia Prevention?



Probably the most provocative findings concern vaccination against shingles, aka herpes zoster. Researchers made headlines last year when they documented an association between shingles vaccination and lower rates of dementia — even with the less effective vaccine that has since been replaced by Shingrix, approved in 2017.

Nearly all studies of off-target benefits are observational, because scientists cannot ethically withhold a safe, effective vaccine from a control group whose members could then become infected with the disease.

That means such studies are subject to “healthy volunteer bias,” because vaccinated patients may also practice other healthy habits, differentiating them from those not vaccinated.

Although researchers try to control for a variety of potentially confounding differences, from age and sex to health and education, “we can only say there’s a strong association, not a cause and effect,” Maggi said.



But Stanford researchers seized on a natural experiment in Wales in 2013, when the first shingles vaccine, Zostavax, became available to older people who had not yet turned 80. Anyone who was 80 and older was ineligible.

Over seven years, dementia rates in participants who had been eligible for vaccination declined by 20% — even though only half had actually received the vaccine — compared with those who narrowly missed the cutoff.

“There are no reasons people born one week before were different from those born a few days later,” Maggi said. Studies in Australia and the United States have also found reductions in the odds of dementia following shingles shots.

In fact, in the meta-analysis Maggi and her team published, several other childhood and adult vaccinations appeared to have such effects.

Comparing a Healthy Brain with a brain affected with Alzheimer’s Disease; Credit: National Institute on Aging, National Institutes of Health

“We now know that many infections are associated with the onset of dementia, both Alzheimer’s and vascular,” she said.

In 21 studies involving more than 104 million participants in Europe, Asia, and North America, vaccination against shingles was associated with a 24% reduction in the risk of developing dementia. Flu vaccination was linked to a 13% reduction. Those vaccinated against pneumococcal disease had a 36% reduction in Alzheimer’s risk.

The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for months. It was associated with a one-third decline in dementia.

Other researchers are investigating the effects of shingles vaccination on heart attacks and stroke and of COVID vaccination on cancer survival.

Preventing Damage from Chronic Inflammation



What causes such vaccine bonuses? Most hypotheses focus on the inflammation that arises when the immune system mobilizes to fight off an infection. “You have damage to the surrounding environment in the body, and that takes time to calm down,” Chu said.



The effects of inflammation can far outlast the initial illness. It may allow other infections to take hold, or cause heart attacks and strokes when clots form in narrowed blood vessels. “If you prevent the infection, you prevent this other damage,” Chu said.

Hospitalization itself, during which older patients can become deconditioned or develop delirium, is a risk factor for dementia, among other health problems. Vaccines that reduce hospitalization might therefore delay or ward off cognitive decline.

Will Anti-Vaccine Public Policy Cause Missed Vaccinations in Adults?



Health officials in the Trump administration have assailed childhood vaccines more than adult ones, but their vocal opposition may be contributing to inadequate vaccination among older Americans, too.

Many will not only miss out on the emerging off-target benefits but will remain vulnerable to the diseases the vaccines prevent or diminish.

“The current national policy on vaccination is at best uncertain, and in instances appears anti-vaccine,” said Schaffner, a former member of the CDC’s Advisory Committee on Immunization Practices. “All of us in public health are very, very distressed.”




This story also ran in The New York Times
Shared without charge under a Creative Commons License by KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you transform challenges into opportunities for learning and growth.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Use this search box for related posts on this blog or other topics of interest to you.

Dr. Aletha