Premature advice about gene tuning

kw: book reviews, nonfiction, health, diet, genetics, epigenetics, self help

The title concerns me a little: Dirty Genes: A Breakthrough Program to Treat the Root Cause of Illness and Optimize Your Health. The author is Dr. Ben Lynch, a naturopath who for about a decade has been studying the effects of genetics and epigenetics on chronic disease, and susceptibility to disease in general. He developed a "Clean Genes Protocol" people can use who want to improve their health.

So, what is a "dirty gene", and how can dirty genes be "cleaned"? The reason we are all different from one another is that there are very slight genetic variations in all genes. There are numerous variants of every gene. The variants for a particular gene are called alleles. The differences among alleles are mostly in the small numbers of SNPs that each gene contains. We'll look at SNPs later on.

We can use eye color as an example. When I was young I learned the Mendelian explanation of inheritance for brown eyes and blue eyes. Somewhere in the genome is a gene with a few common alleles (variants) that controls eye color; call it BrownEye. One allele makes eyes brown by coding for a protein that produces the brown pigment; call it BrownEye+. Another allele makes eyes blue because it codes for the same protein in a form that won't operate correctly, so the pigment is not made, and the natural blue iridescence of the iris is seen instead; call it BrownEye-. These two sentences explain why brown eyes are considered dominant: We all have two copies of each gene. If someone has two copies of the same allele, of course their eye color will be the expected color, brown if the two copies are BrownEye+ and blue if the two copies are BrownEye-. What happens when someone has one copy of each allele? The BrownEye- allele produces a "broken" protein that can't produce pigment, but the BrownEye+ allele produces a working protein, so the pigment is made anyway; thus, that person will have brown eyes. Caution: this is very simplified. More than one gene is involved, and there are several kinds of "brown", plus "green" and "hazel" eye colors.

I don't know what it is that is different between these two alleles of BrownEye. There are several kinds of mutations, changes in our DNA, and we each accumulate a few hundred new mutations in the DNA of every cell in our bodies in our lifetime. The average rate is about 65 "per generation", based on a statement in this Wikipedia article. I presume that a "generation" is the 20-40 (average 33) years between our birth and the age at which we typically reproduce. We continue to accumulate mutations after that, but none of those are going to be found in our descendants.

Remember, we have two copies of our entire genome in each cell. By far the most common mutation—which can be caused by cosmic rays, environmental toxins, and the "stumbling" that the DNA copying machinery does on occasion—is the SNP. This means that, at the age we usually reproduce, each egg or sperm cell in your gonads will differ in about 33 locations from the DNA you were born with, and 90% of those will be SNPs.

Dirty Genes is all about SNPs, considering those that cause our DNA to operate different from the "optimal genome" (my term) to be "dirty"; the author doesn't say what kind of SNP is "dirty", not in any useful way. I think he is really writing about alleles, but there can be many more than the two I posited above, even for something "simple" like eye color.

With this lead-up, we can get a bit more practical. Getting your whole genome sequenced now costs something over $1,000, compared to the few billion dollars spent to produce the first total sequence. If you were to get your whole genome sequenced, and that of one of your parents or siblings, you would find on average about 10 million SNP differences between the two of you, scattered somewhat clumpily throughout each genome.

A SNP is a "single nucleotide polymorphism". A nucleotide is a 3-codon (3-"letter") sequence such as AGC. If in a particular place you have AGC and your father has ACC, that "G" is the SNP. This may or may not cause trouble for one of you. The following diagram will help:

Each copy of your genome contains 3 billion codons. You have two copies, and each has its own SNPs. Divide 6 billion by 10 million to get 600: There is on average one SNP each 600 codons. However, they are a little more concentrated in the non-coding and non-regulatory regions of the DNA, but I have not been able to find out the quantitative difference. So we'll assume no concentration for the moment. (Illustration credit: MansiG123 - Own work, CC BY-SA 4.0)

The coding DNA, the DNA that is used to make proteins, totals about 1.2% of the whole. So it contains at most 1.2% (probably somewhat less) of all the SNPs, or 120,000.

Regulatory DNA, that performs functions such as controlling the rate a particular gene produces protein, totals about 8% of the whole. So the number of SNPs found there adds up to another 800,000. The number of SNPs that can potentially "do something" is thus a little under one million. This squares with a statement by the author that we all have "a million" SNPs. But he doesn't explain it like I just did.

Now look at the diagram. We have to consider the section headed "coding region" to actually refer to coding DNA and regulatory DNA, or 9.2% of all our DNA. The "transfer table" used to convert DNA codons to amino acids in proteins has 64 codes. Three of these are used for start or stop (I think there are 2 "stop" codons). For the rest, 61/20 (there are 20 amino acids) is just over 3, and it means that the average amino acid has 3 codes that will request it in a pending protein synthesis.

A SNP that codes for the same amino acid as the DNA without that SNP is considered a "Synonymous" mutation. The protein isn't changed. So we can put 66% on the "Synonymous" box above, and 33% (or 34%) on the "Non-Synonymous" box. Below that, "Missense" means that the amino acid in the "different" protein will allow it to operate, but perhaps differently, while "Nonsense" means either that the "different" amino acid in that location will cause the protein to fold wrong and not work at all, or that the codon is a premature "stop" and the protein is cut short. "Nonsense" is more rare than "Missense", but I don't know by how much.

It comes down to this: About 300,000 of the SNPs in your DNA make it operate differently from whatever might be considered "optimal" or "standard". Since the actual distribution of SNPs is biased toward non-coding DNA, the number will be less. We have something over 20,000 coding "genes", maybe as many as 23,000. Each of them, then, contains a few SNPs; the average is about 14. So looking back at our BrownEye gene, the broken pigment that produces blue eyes is probably due to only one of the SNPs.

I infer that a "dirty gene" is one that has a Missense or Nonsense SNP, as compared to the "optimal" gene. Dr. Lynch is concerned with a combination of diet, exercise and other habits that support the proper operation of genes, as much as is possible based on the SNPs they contain.

The second genetic theme in the book is the methylation process that our cells use to actually accomplish gene regulation. Methylation is not yet well understood. It accounts for changes in gene expression; in particular, for example, the thousands of genes in a liver cell that are not needed for liver function are deactivated by being "coated" with methyl groups so they cannot be "reached" by the protein-producing machinery. Various levels of methyl "coating" are used for more fine regulation, such as the timing of certain proteins when they are needed or need to be temporarily slowed down or shut down. This is controlled by many of the "things" (we can't call them genes I suppose) that the regulatory 8% of your genome contains.

SIDEBAR: Hmm, I have seen the term "regulatory sequence" in a number of articles, and two abbreviations that may be synonyms: "regseq" and "refseq". These are both also used as software abbreviations, though, so I'll temporarily use "RS" for any of the "things" in the regulatory DNA.

The author's explanation of SNPs and "dirty genes" is directed quite differently from the above. I guess I expect more intelligence in those who read this, compared to his expectation for those who read his book.

Now I have to pan it. Ten years is a long time, and Dr. Lynch has given this a lot of effort, but he is up against a huge and hugely complex subject. What I think he has really done is to take the menu of recommendations that naturopaths have used for decades and give it a "new and improved" explanation with new buzz words. But certain fundamental knowledge is dramatically lacking. I'll pick one example that struck me early on.

No matter who you are, the Clean Genes Protocol begins with eliminating certain foods. Among them is gluten. This in spite that it is well known that only 1% of people suffer celiac disease, and thus cannot eat gluten. My former supervisor is one such, so I am familiar with it. Curiously, every time but one that gluten is mentioned in the book, it is a forbidden food. That one time, he throws a sop, telling us that one of his sons isn't bothered by gluten, but that he and the other son are very bothered by it. The term "celiac" is nowhere found in the book. That is shocking. Inexcusable.

A second example: The SNPs in a gene called the "methylation master gene", called MTHFR, are stated as a cause of Down Syndrome, along with a laundry list of lesser problems. Down Syndrome is caused by a very different kind of mutation, an extra Chromosome 21. I suppose you could call that 120 million SNPs. This is beyond belief!

I was only on page 24 when I saw that. I didn't read in detail much farther. I began to go through some of the recommendations—and found the gluten bungle—to see if it all might still make sense. It does not.

Compared to the recommendations of most naturopaths, the advice is actually a bit watered down. Though it is a fairly big book, he is trying to simplify the actual advice. But the reasons he gives for the recommendations do not make sense. "Dirty genes" is a catchy term. Maybe some day someone will define it more appropriately. But what is being "cleaned" from these "dirty genes"? Methyl groups. And you know, that is actually true, for the most part. The trouble is, this all has limited application. It is nowhere near as fine tuned as he claims.

The book is repackaged naturopathy with a shiny, new explanation for why things work or don't work, but the explanation doesn't explain enough. Our knowledge of the genome, the RS package (the "regulome"?), the proteome (all our proteins), and the saccharome (the different types of cellular sugars and simple carbohydrates, that outnumber proteins 20:1 or more), is very, very early and incomplete. Furthermore, instead of producing steps tuned to each individual's needs, the book's advice contains far too many broad brush recommendations will cause the majority of people to refrain from doing or eating things that don't matter, or that are perhaps better for them than not. In this case, a little knowledge can be quite a danger, indeed.

A must-read if you care about your internet presence

kw: book reviews, nonfiction, internet, privacy, security, self help

The subtitle of the book should catch your attention: "Are you naked online?". Are you? If so, what might you do about it? Ted Claypoole and Theresa Payton drew on broad experience in the online security arena, including Ms Payton's service in the White House, to write Protecting Your Internet Security: Are You Naked Online?. Start by reading this book.

Privacy as we once knew it is a thing of the past. The security of everything online is similarly threatened. It doesn't have to be. I took certain pieces of the authors' advice, and before noting the results, I should perhaps explain something that may be a little uncommon about me.

I decided from the time I started this weblog that I would go to certain lengths to divorce its identity from my own. There are a few clues here and there in my posts, so a persistent and diligent person could track me down. I tend to trust in "security by obscurity", as compared to more technical means. So these results might indicate how successful I have been.

Of course, the authors recommend that we all fire up a browser window in Private (or Incognito or Stealth or whatever) mode, and search our name. In my case, for historical reasons, there are six variants of my name, and two variants of this blog's name. But the search was not nearly as arduous as I expected. From the longest to the shortest ways to look up my name, always putting the entire thing on quotes (but none of those ways using a first initial rather than a first name):

• 4 text hits, 3 of them reporting my first marriage in various newspapers.
• 1 text hit.
• Though Google initially said 279, there were 17 actual hits, and 12 were about me. There was also one picture of an ancestor of mine in an Image search, but none of me. More briefly for the rest...
• 164 at first, then 19 of 21 text hits.
• 1,330 at first, then 31 of 35 text hits, plus 3 of about 170 images are actually me.
• 2 of 532 text hits are actually about me.

And for the blog names:

• "polymath07": 3,930 at first, but only 33 if you look at returns pages. Hundreds of pictures in the Image search, most from this blog, in which I frequently post pictures.
• "polymath at large": 7,590 at first, but only 26 actual hits. Many, many pix, nearly all from this blog.

All in all, the pages Google finds about me are nearly all positive, and of course the blog post returns are as I wish. I'd call that success.

Now, from an open browser page, I went to the Open Data Partnership "choices" page, which immediately ran a status check. It returned a long list of entities that either are or are not modifying ad choices based on my browsing behavior. Those who are, that I recognized, include Adobe Marketing Cloud, Amazon, Experian, Google and Microsoft. Some that are not doing so include LinkedIn and Ziff Davis (publisher of many magazines including PC Magazine, to which I once subscribed). One may easily opt out of all of their chicanery, but I have learned instead to do most searches for "stuff" in Private mode.

Private mode isn't perfect, so if you want to avoid, or at least confuse, advertisers and their tracking gimmicks, page 78 has a list of nine suggestions such as the Blur feature by Abine. You can also analyze your own online profile—the real one, not any of the ones you created yourself—using Spokeo, for example.

Why should all this be necessary? If you are old like me, it doesn't matter as much, but think of a teenager whose entire online presence is rife with teen attitude, complaints about parental restrictions, kidding and teasing (and worse) of "friends" and others, and the general sort of things you'd expect from kids who don't yet realize they are mortal. Fast-forward five years, when they are applying to a college, or ten years, when they are applying for a job. Colleges and prospective employers track down all the social media you've been using, and they are better at it than you think. Just changing your name on FaceBook or Twitter isn't enough. If your likeness appears anywhere, a single well-composed image of your face can turn up a lot through Image Search in Google, at the very least.

Or maybe you are a 35-year-old trying to build a business who has attracted the ire of a competitor. Will the competitor create an account somewhere in your name and use it to publish inflammatory and defamatory material that would drive away customers who stumble across it and think it is you? An entire industry of Reputation Management has arisen to address just such scenarios. Even if your competitor didn't do you dirt, maybe your teenage self did already, and unpleasant traces remain of someone you once were, but no longer are. The internet has a longer memory than a jilted spouse! To many folks, what you were then, perhaps you still are, under that polished veneer.

This naturally leads to a section on guiding your children through their early years as a digital native. It will be hard work to keep them from shooting their future self in the foot, but it is necessary.

Another notion occurred to me: Phase your life, and use a different online avatar and screen name for each phase. Upon entering Middle School, a preteen might post a sign-off in a soon-to-be-unused FaceBook account, saying "Goodbye, I'll go silent now. Catch everyone later, and elsewhere." Then she can use a new version of her name to start a new account, and gradually import old friends, but only after they have undergone a similar transition. Hard as it may seem, it is best to discard "friends" who don't see the value in this approach. The end of High School is a good time for a similar changeover. Other phases come to mind. Think it through.

Also, such a time is a good one to go through the abandoned account and delete posts that will cause trouble to the "new you". Of course, the Internet Archive will still have them in its "wayback machine", but you cannot cleanse everything. That's why it is best to keep your most private thoughts out of the ether entirely. When you are musing darkly, the Cloud is not your friend! The Google Docs app isn't totally secure; nothing online is.

A lot of this is like getting a better lock for the front door of your house and a better security system. It doesn't guarantee the house won't be robbed, but it makes you a harder target, so most thieves will pick someone less diligent to burgle. And that's the best advice for anyone concerned about their online privacy and security. Take a little forethought to be a harder-than-average target. It is worthwhile, and these authors are good guides to doing just that.

What might one learn from having cancer?

kw: book reviews, nonfiction, self help, cancer

When I saw The Cancer Whisperer: Finding Courage, Direction, and the Unlikely Gifts of Cancer by Sophie Sabbage, I wasn't sure what I would find, but I was hoping for a practical self help book. I think that is what this book is, but let me confess at the outset that I did not read the whole book: I read the Introduction and the first and last chapters in their entirety, and skipped here and there within the other 8 chapters.

I am certain this book is worth at least beginning to read, by anyone facing a new cancer diagnosis. You will know soon enough whether it suits your needs. I had cancer 17 years ago, died in the recovery room and had to be resuscitated, and fought a series of very different battles from those that Ms Sabbage describes. This was one reason I could not connect with the book's message.

The other primary reason I could not connect is that the writing style, though written in a self help style that is quite popular, simply puts me off. Sorry, Ma'am!

It is worthwhile to introduce the Compass concept, the subject of Chapter 1. In a diagram of an 8-point compass, the first item (the subject of Chapter 2) is at the top, and the subjects proceed clockwise around. They are, in order:

1. Coming to Terms – a matter of balancing feelings and facts, and setting the boundaries you wish to preserve (such as those around work and relationships).
2. Understanding Your Disease – learning all you can: more facts, the more the better. And here the author wisely tells (most of) us to avoid statistics, but I'll touch on this later.
3. Knowing Your Purpose – to decide what you want and why, and establish a plan toward obtaining it.
4. Stabilizing Your Body – prioritize actions such as changing eating habits.
5. Clearing Your Mind – including building the support network you need when your own control slips, as it will from time to time.
6. Directing Your Treatment – learn from your doctors, set your own priorities, and preserve your own integrity as a person not a disease. You may need help from your support network to lead your healing team, not just blindly following "what the doctors want". I'll have more on this below.
7. Dancing With Grief – embrace grief; there are automatic losses, including the possible loss of your future. 
8. Breaking the Shell – I am not totally sure, but this seems to entail "making friends" with your cancer to learn from it. Here we part ways. I am quite comfortable learning all I can from an enemy, all the while planning the most efficient way to totally eliminate it!

For many of us, the first in time will be 4…if we have time. In my case, I was working toward stabilizing a deteriorating situation for about two months before I had a cancer diagnosis. Once that occurred, I had no more than 8 days from diagnosis (Nov 22, 2000; the day before Thanksgiving!) to major surgery (Nov 30). I entered the hospital on Nov 27, and they took care of the stabilizing, because the doctor was not sure I could survive surgery. The bare facts:

• Stage 3+ colon cancer, with a major mass visible in the colonoscope, about the size of my fist (I have big hands).
• Nearly two months of enforced fasting due to intestinal blockage.
• Loss of 25 pounds during 2 months.
• Blood count of 8.5 and falling (15 is normal).

On Nov 27 I was placed in the hospice ward, and they began intravenous feeding. The normal "dose" is one 1-Liter bag of "lion milk" daily. I was given three bags daily. I was allowed a little walking around, steering my IV pole. I realized I was in the hospice when the message board outside all the other rooms said, "Comfort", while mine said "Comfort and Feed 3x". How many people do you know who spent 3-4 days in a hospice, and came out alive?

What led up to my diagnosis? I had a rather passive doctor. When I went to him with persistent pain that seemed to be near my stomach, he spent more than a month trying ulcer remedies and then an antibiotic. One day he said something like, "Maybe it would be a good idea to get a colonoscopy…at some point."—Appalling! At that point, I silently took charge (in the book's terms, I began directing my own treatment). I had been in the ER twice already with violent vomiting and bloody stools, and had overheard the ER doctor say, "There is a very high white blood count, but we can't find an organism." I was thinking, "Sounds more like cancer than an infection." Inside me I already had my diagnosis.

The next day, after the doctor had expressed puzzlement and made his immensely stupid statement, I went to the receptionist and innocently asked her, "He said something about seeing a gastroenterologist. Is there one he prefers?" She gave me a name. I had a fleeting thought that my inept doctor might have inept friends, but decided to give the man a try. In those days you needed a referral so I faked one. After a talk with that doctor's receptionist, she got me an appointment three weeks on. I'm not sure why I didn't immediately call some other GI doctors, but I didn't.

I made it through the 3 weeks (now it was 2 months since I had effective nourishment), and saw him on a Monday. He asked, "3 weeks? How'd you get in here so fast? My backlog is 3 months! Did you tell her you are bleeding?" I said, "Of course!" He said, "You're very pale" and took me right downstairs to a clinic that drew blood and determined my blood count was 8.5. He said, "Go to such-and-such a hospital at 7:00 AM on Wednesday and I'll meet you there." And on Wednesday the cancer was seen by my wife and me via the 'scope. But I was on Demerol and the memory didn't "take"; I had to be told about it after I came around.

Thanksgiving Weekend! What a time to suffer through telling my dear friends of my disease. They prayed for me. My wife and I had planned to go to a church conference for two days, so we went. It was just 2 hours away. There I told certain ones, who took the news to their churches so they could pray for me.

Early Monday I called my doctor. He called back saying he had a surgeon who would see me for "consultation" on Thursday. I hung up without a word, thought it over (chronic pain level had reached 8 and I had to think very slowly and thoroughly). I called him back and said, "I won't live that long." He said, "Go to the ER now. I'll call ahead that you are coming." Thus began 3 nights in a hospice, 9 days of IV feeding in 3 days, an an operation on the same Thursday that was going to be a "consultation." I was in the OR 5 hours. In the recovery room they put in an epidural to administer Morphine. It turns out I am over-sensitive to Morphine and I stopped breathing. My heart slowed to about 30/minute (any slower and it'll simply stall and stop). A nurse stood by with defibrillator paddles as another gave me mouth-to-mouth and then oxygen. Once the morphine wore off, they tapered off the oxygen and let my wife see me. After that I suppose I recovered as normally as one can.

That's enough on such a subject in this much detail. I followed up with chemotherapy. The GI doctor was frank enough to give me accurate statistics. In my case, being a mathematician, I knew exactly what they were telling me and what they were not telling me. He said, after the operation, I had a 15% chance of living for one year. After the "gold standard" chemotherapy for six months, that chance would improve to 35%. "Gold standard" is leukovorin plus 5-FU. 5-FU was originally developed as a "weapon of mass destruction", but was found, rather accidentally, to cure many cases of colon cancer. Leukovorin helps it work better.

And what does 35% mean? Survival rates in such cases follow the same statistics as failure rates in a transistor factory. Technically, it is a type of Weibull distribution. At some time 65% of the devices will have failed. The doctor's prediction put that point at one year, when 35% are still alive. Such a distribution has a very long tail such that, for example, about 10% survive for five years. In the case of colon cancer, there is very little chance of recurrence after five years, and different statistics come into play. Most folks who live for five years after colon cancer surgery will die of something besides colon cancer, 10, or 20, or 30-40 years later, depending on their original life expectancy. In my case, I was 53 at the time of my operation (pretty young for this kind of cancer), and now I am just a couple of months shy of being age 70. My father is alive, so I have some chance of living into my 90's, at least medically speaking. The last time I saw the GI doctor (he does a follow-up colonoscopy every 3 years), he called me "a trophy".

Looking back at the list above, I think I covered most of the bases of the Compass. The one thing I'd have added, perhaps as a part of "Dancing With Grief", or perhaps as a ninth point: "Laugh as much as possible". For some reason, the six months of my chemotherapy were the longest sustained period of great happiness of my life. Perhaps 5-FU has a side effect of being a superb anti-depressant (too bad about losing your hair if you are young; I didn't lose any). I also stumbled on AFV (America's Funniest Videos) on ABC, and have watched it pretty regularly every since. My kind of humor.

Considering that this is not a very popular blog, I conclude that few people think the way I do or like many of the things I like. So, while I was not so enamored by this book, I think it can help a great many people either to become cancer survivors, or to muddle their way through their cancer experience better than they might have done if left totally to their own devices.

We should ask John Lehr about this

kw: book reviews, nonfiction, dieting, self help, paleo diet theory

I've read and heard snippets about a "Paleo Diet", so I figured it is time to look into it. I read Your Personal Paleo Code: The 3-Step Plan to Lose Weight, Reverse Disease, and Stay Fit and Healthy for Life, by Chris Kresser. The thesis of this diet and self help movement is that we evolved for a million years or so eating a certain way, but in the past 10,000 years or so the agricultural revolution and then the industrial revolution have changed the kinds of foods we eat, and we aren't well fitted to the "modern diet".

Perhaps you've heard of the "no white stuff" diet: no bread or dairy, but eat lots of meats, fowl and fish, and all the fruits and greens you can stand. It seems to be a spinoff of the low/no-carbohydrate Atkins Diet. That is largely where the first section of the book is going.

The author tells us that hunter-gatherer peoples are healthier than we are, and that our ancestors were healthier still. We read that the grain-based diet in all agricultural societies is to blame for chronic illnesses such as heart disease and diabetes. Thus we need to eat more like our pre-agriculture ancestors.

It isn't really that simple, because, he explains, there was no single all-encompassing diet in the paleolithic era, which ended about 12,000 years ago. Those dwelling inland would eat quite different foods than seacoast peoples—who ate much more fish and shellfish—and the Arctic diet was about 90% blubber, as it still is.

He does point out that life expectancy at birth was about 22 years in 10,000 BC, but goes on to say that it fell to about 19 years a few thousand years later, based on archaeological studies primarily in the "Fertile Crescent", or Mesopotamia. I personally attribute that to a great increase in violence as people lived in groups larger than the typical gatherer group of 50-150 souls.

This is a bigger evolutionary adjustment: For millions of years, few members of any species in the genus Homo encountered non-relatives on any frequent basis. If they did, a fight to the death was the ordinary result. This is still true in parts of Papua New Guinea and Amazonia. Once agriculture came along, people began to live in larger and larger groups, and reflexes that were appropriate on the savannas became a problem. We are still learning to get along with strangers, and we're probably evolving more "civil" attributes. In most of the "civilized world", people are able to go about their daily activities without attempting to kill every stranger they see, because that would mean attacking nearly everyone encountered! This is attested by the steadily declining murder rate, documented pretty well for at least 1,000 years. I have written before that in Shakespearean England the murder rate was at least 10 times what it is in modern cities, and 100 times the rate in more rural areas.

Mr. Kresser does write that certain evolutionary changes have occurred as a result of agriculture; things such as tolerance for lactose and gluten. I don't know how many Cro-Magnons would have suffered celiac symptoms from eating wheat (or proto-wheat), but among modern populations of European origin, the rate of gluten intolerance is about 0.75% (1 in 133). Even among Asians, who are famously lactose intolerant, about one in three can drink milk, my wife included.

We really don't know whether any elderly Cro-Magnons had heart attacks, strokes, or cancer. I suspect "old" was closer to 40 than to 70, so they didn't usually live long enough to get "chronic" conditions. As I have also written in earlier posts, human evolution continues at a good clip. Wisdom teeth are on their way out, and another century or two could see a precipitous drop in rates of celiac disease and lactose intolerance, and possibly diabetes as well.

Anyway, for those who'd like to eat Paleo, this book is probably the best resource. The author is quite an enthusiast, but I would not call him a nutcase or fanatic. He is reasonable and persuasive. The second part of the book is advice about learning the kinds of foods you tolerate well, and the third is about building a life around your new/old (very old!) diet. He takes better account of human nature than authors of self-help books typically do, so his advice will be better followed by comparison. He also strongly stresses the need for more motion by all of us who are not professional athletes. I think all that walking has more to do with hunter-gatherer health than more or less meat or starch in their diet.

If I wanted to try the Part 1 diet, I'd find it hard to give up the starches I love: whole wheat bread and pasta, for example (My wife and I can both cook up a mean pot of spaghetti sauce or Stroganoff, though we tend to use ground turkey instead of beef). But I'd probably enjoy adding more steak or roast into my diet, compared to our present diet of chicken and fish, with only occasional beef or pork. Oh, and cheese! A Sunday evening favorite just before, or during, a "couch potato session" beginning with America's Funniest Videos, is a couple slices of bread topped with 6mm of cheese and microwaved; and I put cheese in any meat sandwich. A little tinkering around with his advice about macronutrient balance shows that my best calorie balance is 50% carbohydrate, 20% protein, and 30% fat. That's close to the way I eat now (whew!).

I began reading in a skeptical frame of mind, and came away with quite an appreciation for the author's insights into diet and activity (it's a better-received word than "exercise"). It is particularly appropriate that we learn to eat things that make us feel better hours or a day or two later, in preference to what might taste the best at the moment.

P.S. John Lehr? My favorite among the Geico caveman actors.

A French Woman's advice for the rest of us

kw: book reviews, nonfiction, self help, beauty, health, women

Did you ever wonder who is behind the Louis Vuitton brand? The former CEO of the luxury goods corporation, originally with Clicquot, is Mireille Guiliano, who has now taken up writing in what she calls Act 3.5. Her genre is self-help health and beauty for woman, her first book was French Women Don't Get Fat, and now her fourth is French Women Don't Get Facelifts: The Secret of Aging With Style & Attitude.

I had no idea what to expect when I began to read, but I figured it would be worth a peek into the author's mind, on the principle of Know Thine Enemy. I am not sure how to characterize the result: if one could say that my wife and I represent different planets (not necessarily Venus and Mars), here we have a voice from another galaxy.

Ms Guiliano deplores the term Aging Gracefully as a cop-out. She prefers her title phrase, Aging With Style and Attitude. Sort of a "Don't back down" or "Don't rain on my parade" approach to the passage of time. After a chapter on gravity, she tackles dress, skin and face care, grooming (both hair and skin), cosmetic use, exercise (she prefers it "invisible", not to break a sweat), and rest and play. Then we find three chapters on food and nutrition; her attitude towards supplements is, if you've been paying attention to this point, your diet needs no supplementation. Three more chapters wrap up matters not otherwise dealt with.

The writing is peppered with examples among her friends and acquaintances, of women not just "of a certain age" (from forty onward), but into their 70's to 90's, who live their lives a mere 60-year-old might envy. I was reminded of my grandmother, the original "Little Old Lady From Pasadena", who might have inspired the song "Go Granny Go", still getting stopped for speeding in her last year on Earth, and usually talking her way out of a ticket. Ms Guiliano closes with an honor roll of remarkable women, from Catherine Deneuve and Sophia Loren to Michelle Obama and Queen Elizabeth II.

I was amazed (perhaps I should not have been) at the list of self-care tasks she brings to a "normal" day or month. A woman following her suggestions needs a remarkable memory. I'd suggest that the first order of business is, "Pick the right parents". As an oil prospector might put it, "It is better to be lucky than good." Thus, my lovely wife uses no cosmetics, and in the last couple of decades, has declined attending the salon at all; she preferred teaching me to cut her hair into the longish bob she likes, which I do about monthly. She does have a couple of creams and moisturizers from Sesha and Nivea on hand, uses sunscreen on bright days, and that is it. She believes the best skin is clean skin. When I compare that with the string of daily tasks in the "Skin and Face" chapter of the book, I wonder when a French woman has time for anything else!

Gentlemen, here is the best beauty tip for the woman in your life, unless she is a rampant feminist (in which case, she probably already divorced you anyway): tell her she is lovely. Do so early and do it often. Uplift her spirits and it will uplift all else. Happiness begets loveliness. Oh, and to make her even happier? Do your share of the housework.

Reading the book didn't unlock the feminine mystique, but left me more mystified. That is OK. God didn't put men and women together to understand one another, but to love one another. Leave the understanding business to Him…and I am not sure He is much into that anyway.

Happy is as happy does

kw: book reviews, nonfiction, psychology, happiness, self help

Abraham Lincoln is quoted as saying, "Folks are usually about as happy as they make their minds up to be". If you take that notion, add the principle of hedonic adaptation—we get used to just about anything after a while—, and expand it all to book length, you'll get something like Sonja Lyobomirsky's new book The Myths of Happiness: What Should Make You Happy, but Doesn't; What Shouldn't Make You Happy, but Does.

Dr. Lyubomirsky has made a career of studying happiness, and her prior book The How of Happiness is one of a very few self help books with scientific backing (get it, I plan to). Myths goes further, focusing on the turning points of adult life: gaining or losing key relationships, getting or losing an occupation or a windfall, and the inevitable changes of getting older.

Many years ago, during a phase in which I allowed myself to think myself a victim, I was seeing a therapist about "depression", and he had me read the book Necessary Losses by Judith Viorst. It was a big help, and this book would have helped even more. My real problem was coupling the usual mid-life crisis that accompanies one's mid-40s with the stresses of having an infant in the home. Most 45-year-olds have only vague memories of the infant stage of their teen-aged (or older) kids. A few years later, seeing a therapist over a completely different issue (thankfully, relating to non-relatives!), at one point he asked me, "What do you do when you are feeling bad?" I said, "I do something I like." He replied, "Then you don't need me any more," and I haven't been to one since.

The biggest "attitude adjustment" I underwent came later, after I experienced dying of cancer, but was rescued at the last minute by a terrifically skilled surgeon. As Samuel Johnson said, "…when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully." Here is a before-and-after example. All my life I have been dogged by a tendency to over-submit to authority, and in particular, to quail when challenged. A few months after finishing chemotherapy, a manager (my boss's boss) assigned me something that was far and away outside my competence, in an area I had no interest in pursuing. I could see it was a recipe for failure, and sent a note, declining. She came storming to my office, pretty much trying to say, "Take it or else", and I said, "Look, I already died. What more can you do to me? Assign it to someone who is already good at that." For the rest of my career I operated as an equal partner with any supervisor or manager. And I was a lot happier!

The principle of hedonic adaptation is central to the book's approach, and is well studied. It is encapsulated in the proverbs, "Absence makes the heart grow fonder," and "Familiarity breeds contempt," as applied not just to relationships but to anything we might care about. For example: you have a bitter fight with a cherished friend, and there is a period in which the two of you do not communicate. You are alternately devastated and insultedly enraged, but you are definitely not happy. For a time, the matter consumes all your thoughts, but if this goes on for weeks or months, you have to go on with life, and you do. If someone asks you, "Are you happy?" you are likely to respond the way you would have the day before the blowup. Then you get the chance to reconcile, and the two of you forgive each other and resume the friendship. You are over the moon. Then in time, your general level of happiness returns. Over several weeks' time, your "mood meter" might go like this (ironing out lesser events):

Within limits, we get used to both the bad and the good. This goes for money also, for example. We are all happy to get a raise, but it doesn't seem to take very long to find ways to spend it, and we are no happier than before. Suppose it is a big raise, so you buy a boat (or name your favorite extravagance). You are tickled to pieces! A year or two later, you are wondering if you can afford an even bigger boat, or even worse, getting irritated at the amount of upkeep.

Now, what about aging? Can we really age gracefully? It seems we all know someone 5 or 10 or 20 or even 40 years older, who is still good looking and healthy and keeping busy with enjoyable things to do. We might wonder, can I do as well? Look around some more. It is also likely that you know someone of a similar age with this or that problem, and maybe coping with the tighter budget of a "fixed income" retirement, but who seems quite content…or not! If you have known that person a long enough time, do you remember his or her general mood half a lifetime ago? It was probably similar. This gets back to Lincoln's quote.

Externalities don't determine our "inner climate", though they do affect day-to-day moods, more or less severely. As in her earlier book, the author presents a number of methods to attain perspective. I find it akin to Stephen Covey's "circles of concern, circles of control" principle. He advises us to take a careful look at everything we worry about, to determine which we can control and which we cannot. In his view, to be both happier and more effective, we must do what we can to increase our circle of control and to decrease the circle of concern until, ideally, they match.

Dr. Lyubomirsky would agree, and each chapter ends with a section titled "The Prepared Mind" (based on Louis Pasteur: "Fortune favors the prepared mind."). If we have suffered a reverse in any area, and can step back, and expect to adapt to it, we can do so more quickly. If we have a pleasant (or ecstatic) surprise, and we can step back, and realize we will also adapt to that, we can perhaps avoid the negative swing that often occurs when we say to ourselves, "Well, that wasn't quite as good as I imagined, long term." Nobody can get what Lucy wanted in one of the Peanuts strips, when she said, "Why do there have to be ups and downs? I don't want any downs. I just want ups and Ups and UPS!!"

Don't we all. Not available, folks.

Using time well

kw: book reviews, nonfiction, self help

"Jack of all trades, master of none" has been morphed among my siblings and me into "Jack of all trades, master of several." We also sometimes say, "Talent on loan from God? Never felt the need to borrow any." Not that these are true, of course, but a little creative arrogance can do wonders to bolster optimism. However, there are very real problems with spreading effort into too many directions.

Item: When I started college, I thought, "Why do I have to pick a major? I want to major in everything!" That has a lot to do with it taking me seven years to finish a BS, with three minors. I eventually learned to focus, which led to a good career. The three minors came in useful much later, once I had mastered one field sufficiently.

Item: A friend once told me that the ideal house would have room for 10-20 long tables on which he could keep all the "stuff" needed for all of his hobbies, out and ready for use. That way, when he got tired or hit a snag with one endeavor, he could just find another project to work on for a while. This may explain why he never really finished anything.

On a different note, a famous pianist met a woman at a reception, who gushed, "Oh, I'd give my life to play like you do!" He replied, "I did." The message here is similar to a saying attributed to Arnold Schwarznegger: "Nobody likes to exercise. Everybody wants to 'have exercised'!"

I tell beginning guitar students, "With 10 hours of practice, you'll become comfortable with a chord or two. With 100 hours, you'll be able to play a number of tunes, and change chords easily. With 1,000 hours, you'll begin to focus on the music, more than on the instrument. With 10,000 hours, you'll be able to play anything in the styles you have been learning, and well enough to get paying gigs if you like."

In Robert Greene's new book Mastery, that notion is fleshed out with examples and exhortation intended to convince any lazybones who wants easy success, that there are no shortcuts. Greene first mentions the 10,000 hour threshold, then goes on to state that genuine mastery, sufficient to mentor others, often requires 20,000 hours. It takes a lot of passion for a subject to give it 10-20,000 hours of your time.

What does 10,000 hours represent? Working at a job 40 hours a week, with no vacations, yields 2,080 hours. Of course, nobody is "on task" for a full 8-hour day. Project planning in a technical discipline usually takes account of 35-36 "on-task weeks" in a work year, which accounts for vacations, illness, meetings, and even "pit stops". That comes to about 1,500 hours of "experience". In 5 years, then, one gains 7,500 hours, and can be expected to attain a total of 10,000 within the next 2-3 years. That is what is behind the statement found on many job descriptions, "5 years' experience required."

The Table of Contents of Mastery takes up 10 pages, with sufficient detail that you can use it for a cheat sheet after reading the book. Perhaps that is the point. The author makes heavy use of mini-biographies of masters in their field, from Leonardo da Vinci and Albert Einstein to Henry Ford to John Keats to Temple Grandin. In all cases, he emphasizes the long and strenuous preparation, the apprenticeship, whether formal or not (usually not), that each underwent. To many Americans, the Beatles came out of nowhere and took the nation by storm. Very few knew of their many 8-hour days (or mainly nights) of performing in the 7 years prior to 1964. I used to think of a 2-hour gig as a hard day's work! (Greene doesn't mention the band, but I know their history.) Few know of Einstein's long years of preparation for the insights that would lead to his theories of Special and General Relativity (plus elucidation of the photoelectric effect, which is what won him the Nobel Prize).

Time is not the only factor. A book like Ben Hamper's Rivethead shows that putting in the time on a hated task may make you very skilled, but doesn't lead to any world-shaking masterwork. In fact, Hamper is known because he labored to perfect a different skill, writing, in addition to putting a few million rivets into truck bumpers. Thus, one must have a passion, a feeling that something is your Life's Work. In addition, it takes some added skills and traits to produce a genuine Master: persistence in your search, humility to learn from mentors, social intelligence to help you slip around roadblocks, and willingness to look where others aren't willing to look. As to that last: I am most proud of a publication of mine, reporting a numerical modeling technique that combines astronomical and civil-engineering methods. Getting it published was harder than making the discovery because it was so outré. Luckily I had a good mentor to help me mollify the editor (I still need work on mollification skills).

This brings me back to the opening proverb. A true fanatic may be able to accumulate 10,000 hours of practice in a chosen discipline in less than 5 years, but to become a real "Jack of all trades, and master of all of them" isn't possible. Let's see: 50 years, perhaps 10 "masteries"? Unlikely. Even the proverbial Renaissance Man seldom excelled in more than 4-5 fields. However, you do need to develop more than your chosen passion. Greene holds up Ben Franklin as an example of one who studied the people around him as carefully as any biologist studies a favorite genus of moths or wasps. He didn't want a lack of social skill to hamper the effectiveness of his scientific or diplomatic endeavors. And the childlike attitude that leads to great creativity must be cultivated. Rare indeed is someone who comes by it naturally, and perhaps nobody does.

I came to the book thinking that the hype on the jacket blurb portended "You can move the Sun with your thoughts" sort of blather. I was pleasantly surprised. The book is well done, with useful examples and a demeanor much less preachy than most self help books. Its message is well thought out and presented in a useful order that accords with experience. Greene stresses again and again that there are no shortcuts. A Bluesman will say, "To play the Blues, you gotta pay your dues." True in any worthwhile field.

Getting ahead of the doctors - worth the work

kw: book reviews, nonfiction, medicine, self help, self defense

My grandmother had her first child in a hospital in 1918. She hated the experience, and had the rest of her children at home, delivered by my grandfather. In her eighties, she had a stroke, was taken to a hospital, and died the next day without regaining consciousness. My mother said, "If Mom had woken up in the hospital, she would have died, either of fear or fury."

Most people live through a hospital experience, or so the statistics say. Yet nearly all of us die in a hospital. At the standard rate of one death per person, it looks like a good place to avoid! My wife and I have each survived multiple hospital visits and surgeries. Considering that medical errors are now at least the second leading cause of mortality in the US, I reckon we were among the lucky ones.

Among the rising tide of books by doctors, either seeking to correct "the system" or offering advice on how to most safely negotiate it, a quite recent offering is Doctor, Your Patient Will See You Now: Gaining the Upper Hand in Your Medical Care, by Steven Z. Kussin, M.D. Doctor Kussin was involved in a very serious auto accident several years ago. He keenly observed the way he was treated, as compared to non-MD patients. After a long recovery, he wrote his book, impelled by the many serious lapses of the "care system".

The opening section introduces two styles of medicine, conveniently labeled "Old School" and "New School." The former, and currently less popular, style, is based on experience and relies on "experts". The latter, driven by young zealots and their mentors, is based on experiment and the "gold standard" of the double-blinded, randomized, controlled clinical trial, which we can abbreviate RCT. There are significant problems with both styles. It takes a genius to sift the useful nuggets out of RCT's, and sufficient skepticism of the process to be willing to do so, for your doctor to provide you optimal care. As the author explains, RCT's are at best a somewhat tarnished bronze standard. The second section, "A Medical Day", drills home the multiple pressures on your doctor to provide "slightly better than the worst" care.

The next major section of the book, then, helps you choose a doctor, not according to friends' recommendations (notoriously unreliable) or advertising (worse), but upon the single criterion that makes a difference: Brains. How to assess brains? Look at the diplomas. You may have to ask to see them. Was the MD degree conferred at Harvard or West Nowhere? How about the other degrees? Every MD has at least three diplomas, and you can bet that if they are from top institutions, they will be prominently displayed. If, in addition to having "top smarts" a doctor can communicate well, and actually cares how you feel, you have a gem! But go for smarts over bedside manner. You can influence the latter, but have no control over the former.

Half the book is about hospitals. Unless you die "on the street", you are going to spend time in a hospital sooner or later. A hospital experience will most likely save your life, but it just might take it instead, or leave you with an unnecessary, lifelong problem. The doctor offers advice about researching hospitals, so you'll have two aces up your sleeve: Firstly, the best among those nearby, and secondly, the best of the best if you need something specialized. For example, I live in an area with three local hospitals, one of which is highly rated for cancer care. But when my wife needed to have a rare tumor removed, we researched a little beyond the local area, and found a hospital where the doctors were very familiar with this kind of tumor. The doctor we chose showed us his scar from the same operation, and told us he was doing three or four such operations daily. The best local surgeon was doing a few yearly. That isn't good enough.

The book is full of suggestions for the best web sites and other resources. A bit too full, as it happens. It is overwhelming. The best overall free web site to research treatment options is UpToDate's Patient section. The same site has a paid section that can be a life-saver, but is costly: $440 per year. Fortunately, they offer a $20 package for one week of access, which is typically plenty of time to locate what you need. First spend time in the free resource to get used to the format and the search techniques. Once you know what treatment has the best chance of helping with the least chance of killing you, look for a hospital that offers it. The US News and World Report Hospital ranking is the best place to start. The same site lists all the doctors for a hospital, but it takes a bit of perseverance to find the best doctor for the condition you have and treatment that you need.

Now, when you go into the hospital, what do you do? Here the list of things you must know and requests you must make is long and overwhelming. Make a checklist, for you can't possibly remember it all. Also, have someone with you. Never go into a hospital alone. You need an advocate, preferably someone who has a "hard forehead", because that person (a group is better, so they can take shifts) will need to enforce hand washing practice, request cleaning up of the room and furnishings (or do it themselves), and make sure your medications are appropriate (start with a list of what you are taking now, a very detailed list!). You'll need to read these last chapters a few times to become clear. Ideally, so will your helper(s).

But it can be worth it. Consider this: ten to twenty times as many people die of errors committed in the hospital, as die on our highways. Many of us spend hundreds of hours weekly in our cars, and the result is a US death toll of about 40,000 yearly. But of the 20% of us who will spend a few days in a hospital this year, the number who will die improperly is a half million or more. An hour in the hospital is probably 100 times as risky as an hour in traffic!

As far as I can find out, the author does not have a product to sell (other than the book), and no hidden agenda, so I place a lot of weight on his writing. But it is a whole heck of a lot of advice, some of it difficult to follow even if you are healthy and well-oriented. When you are sick, on your back, and perhaps disoriented, just getting up the gumption to ask a question can be too much. I'll give you an example.

During the months that led up to my cancer surgery in 2000, I was in the emergency room twice. During the first visit, for projectile vomiting and diarrhea and pain, it was determined that there were huge numbers of white blood cells in my (very runny) feces, but they could not find a causative organism. I was lying there, hearing this, and I thought, "No germ? Then it must be cancer. I need a colonoscopy..." but I fell asleep at that point, and never stated my request. The colonoscopy that I had two months later discovered a fulminating carcinoma the size of my fist. In that two months it had probably more than doubled in volume. I am lucky to be alive. Had I at least whispered my concern to my wife, at the very least she could have reminded me about it before I was discharged, and I might have had the guts to demand the colonoscopy before being sent home.

A final note. There is a detailed discussion of the trend for hospital care to be in the hands of a "hospitalist". This person's primary allegiance is to the hospital's profit bottom line, and he or she will try to get you out the door before you are truly capable of home care. Discuss this with your doctor while you are healthy, and make sure your doctor, or the appropriate specialist, will undertake your care and buffer between you and the hospitalist. Do your best not even to go to a hospital that has a hospitalist in charge. Trouble is, this can be hard to find out. Sometimes the best way is to turn off your computer and pick up the phone. Ask, "Who is in charge of each patient's care?" Everybody has free calling to everywhere now. Take advantage of it.

Also, get this book. Read it more than once. It is a bit like the Bible: too much to take it all in on first reading. Keep it for a reference.

Dale is holding up remarkably well

kw: book reviews, nonfiction, self help

In the twelve years since I attended the Dale Carnegie Course, a lot has happened in my life. Not only did I start blogging, but I have Facebook and Google Plus, though I can't see the point of Twitter. It is hard to know how to manage relationships when I didn't grow up with these new media. E-mail is about forty years old, so I've learned best how to stay out of trouble with that (It is now 35 years since the last time an e-mail I sent brought someone raging to my office door…).

"The Course", when I took it, was still geared primarily toward face to face contact. Now new questions arise. Does Skype count? I have multitudes of colleagues and associates whom I never, or nearly never, see. I have fewer than 200 Facebook "friends", but I know a few people who have 500 or 1,000 or more. Broadcast publishing is the only way to reach most of them. Yet my son's preferred mode of communication is texting over our mobile phones (Talking takes too much time). When do we use what medium?

Dale Carnegie passed away nearly sixty years ago. His original best-seller is 75 years old. Is his advice still relevant? Reading the updated version, How to Win Friends and Influence People in the Digital Age, by the people at Dale Carnegie and Associates and Brent Cole, I find the basic principles are remarkably relevant. People haven't really changed, and their desires, hopes and dreams are different only in minor details. They still respond to a kind word, a smile, and a genuine listener. The trouble is, texting and e-mail are hard media; they are "cold". It takes ingenuity to engage someone using a cold medium.

The original How to Win Friends jump-started the entire genre of self help literature, which surprised Mr. Carnegie. He didn't think of it as self help at all. But now the genre contains tens of thousands of titles, and the challenge for the authors of the new book has been selecting from multitudes of good stories, and securing rights to repeat some of them.

When I began the book, I wondered if the authors would be able to match Carnegie's immensely readable style. I am happy to report that they did so. The reading is rapid and enjoyable. But now that I've read it, I find myself wanting to refer back to the examples and the exhortations. The lack of an index hampers this, but as there are 27 chapters in 230 pages, if I know the general subject, I can find the right chapter to look in.

The central issue in today's celebrity-driven culture (at least in America), is how to get attention while retaining self-respect. The noise level is incredible. This issue crops up in several chapters, and I find a notable quote at the end of the chapter Avoid Arguments: "Set yourself apart by being one who avoids the arguments that most jump into with both feet" (p 104). This is the opening chapter in the section "How to Merit and Maintain Others' Trust." This section alone is worth the cost of the whole book. Trust is the costliest currency, and never more so than now.

But how to be heard above the din? Here persistence pays off. The new media offer more ways to reach people than ever before. Broadcasting is sometimes useful, but is not always the answer. It still takes work to winnow a possible thousand or ten thousand "contacts" or "friends" down to the few dozen who might make a difference. Personal engagement with a few whose trust is worth winning is still the best way to have the most, and best, influence.

Near the end of the book (as it was in the 1936 edition) is the chapter, Give Others a Fine Reputation to Live up to. This is something I find personally hard. Encouragement doesn't come naturally to me, particularly encouragement that is based not on what I see today but on a person's potential (I am a lousy prophet). Yet I have, on occasion, overcome the tendency to say, "You should have done better," saying instead, "Let's put this behind us. I expect great things of you." It is not just some manipulation, but a heartfelt expectation, and I have seen very gratifying response. I'm still learning this lesson.

I have heard it said that Dale Carnegie's advice is "common sense." I don't find it that common. People who live these principles are exceedingly rare. The original book may have sold a few million copies—and I hope this edition sells millions more—, but a quick look around is all it takes to see that there is a long way to go. I need these principles, even after a dozen years of putting a few of them into practice. So do many others. I bought a few extra copies for colleagues of mine…

More ways to take charge of your health

kw: book reviews, nonfiction, medicine, self help

I long ago realized I'd have to be a very active participant in my own medical care and health, as I have written in several previous blog posts. My latest concern is about my wife's heart condition, or rather her lack of a condition. She has slightly high total blood cholesterol (TBC), around 230. A few years ago she was asked by the doctor to get a HeartCam test (see Philly HeartCam for the one out here). The test showed a few tiny spots of calcification in two coronary arteries, on the low side of "normal" for her age and sex. But based on that, the doctor prescribed a daily dose of 10 mg of Crestor. She doesn't like being medicated, and because this amount lowered her cholesterol quite a bit, she demanded to be prescribed a lower dose, so he prescribed 5 mg, a little grumpily. As it turns out, for Crestor specifically, the recommended starting dose is 5 mg for persons who are hypothyroid, over 65, or Asian. My wife is all three! Very recently, she began cutting the pills in half, so as to take 2.5 mg. Take it or leave it, Doc.

The literature makes it pretty clear: Crestor does increase life span for people with active, symptomatic heart disease, but it does not do so for people with no symptoms of disease. I discussed this matter with a friend who is a doctor, and he agreed, she has no symptoms; the HeartCam test indicates a very early stage in a process that proceeds slowly and she is likely to live into her 80s or 90s with no heart symptoms. We may decide to drop the Crestor entirely. And last year there was a study reported in Age and Aging, reported on page 151 in the book I'm reviewing, that states in older people, an optimum level of TBC is about 230! It seems my wife may be best left alone!!

The book is Top Screwups Doctors Make and How to Avoid Them by Joe Graedon and Teresa Graedon, a husband-and-wife team that has worked with hospitals for decades to improve patient safety. I read it at an uneven pace. I find it a bit of a downer to read so much bad news all at once, even though I learned a lot. For example, there is also a link between Crestor and its statin relatives and cataracts. My wife's family is already prone to cataracts, so perhaps it is best to avoid that added factor.

In Introduction is followed by twelve substantive chapters, each built around a Top Ten list. While there are many more possible items on each list, a list of ten major items will get you past the worst errors that are likely to be made. This is not a book that slams doctors. A few doctors deserve slamming, but most are at least conscientious. They are just overwhelmed. For example, there are more than 13,600 diagnoses in their arsenal, if any individual could manage to remember them all. My doctor friend confirmed that, even with computer help, it is hard to diagnose many conditions, or even to ask the right questions. Many doctors are too proud to look up stuff in a patient's presence, so we have to prod them to do so.

A key section of the book is a chapter detailing how the situation has changed regarding generic drugs. The authors were early promoters of generic medicines, but now that they are big business, and now that there are thousands of overseas labs making most of them, it is less certain that they are always the right idea. The FDA does not have the resources to monitor them, to be sure that the generic drug is medically identical to the branded drug or that it meets purity standards. Many times, "medically identical" does not mean "chemically identical", and the odd term "bioequivalent" used in FDA literature is even more troubling.

For example, if I want pain relief, I usually use Ibuprofen (branded as Advil or Motrin). The generic, Ibuprofen, is chemically identical to the branded products. But I can get the same level of pain relief if I take twice as much aspirin. The aspirin dose, by FDA rules, would be called bioequivalent. This in spite of the fact that it causes much more stomach bleeding than the Ibuprofen, and may cause dizziness at a high dosage.

There is a secondary problem. A certain substance may be off patent (such as Wellbutrin), but a timed-release version may be still under patent (as Wellbutrin XL). A generic using a different timed-release method may be released differently, causing more side effects, sometimes quite damaging side effects that the branded timed-release drug will not cause.

The authors contend that untimely death due to diagnostic errors, prescription errors, dosing errors, and unrecognized drug interactions may together reach at least 600,000 yearly in the U.S., making doctor-caused death the second leading cause of death. There is reason to believe the number is twice this, making doctors the leading cause of untimely death. Thus the reason for the book. Several doctors are quoted as saying or writing that there is on average one error committed per day per patient in U.S. hospitals.

If you are in the hospital, the best thing you can do for your own well-being is to have an alert helper with you as much of the time as possible, to double-check everything that is done to you while you are there. The helper(s) should not fear offending doctors or anyone else. They may be the only barrier between you and damaging or deadly errors.

The book contains several helpful resources. All the Top Ten lists are repeated in an appendix, and well explained in their respective chapters. There is a two-page listing of Dr. Beers' List of "bad drugs" on pp. 154-5. A Drug Safety Questionnaire is found on page 85. And there is another list of anticholinergic drugs (p. 164), because these are so ubiquitous and can interact with so many other medications.

An odd omission is an appendix listing web resources, so here are the major ones the authors mention:

The Cochrane Collaboration - Health experts evaluate what works, and what does not.
SkinSight - Insight from experts about treating and caring for your skin. It includes a self-help diagnostic tool.
American Geriatric Society - Includes a referral service to those rare geriatric specialists.
PubMed - A government sponsored resource for research documentation.
ConsumerLab.com - Independent evaluation of products, particularly OTC.

I probably used the book inappropriately by reading it all. It is a great resource, and is better used for looking stuff up.

Six ways to experience time

kw: book reviews, nonfiction, psychology, self help, time perspective

Self-help books have a certain format: Faith-building; Establishing the authors' authority; Setting the stage, via historical or global summary; and Offering help. For some books, the last step is mostly urging the reader to buy a product. For the better ones, real help is offered. The Time Paradox: The New Psychology of Time That Will Change Your Life, by Philip Zimbardo and John Boyd, is of the latter sort. But be warned, the subtitle ought to read "With this new psychology of time, you can change your life." You can, indeed, but it will take work.

Fairly early in the book (pp 53ff), one is offered the ZTPI (Zimbardo Time Perspective Inventory) and TFTPI (Transcendental Future TPI) questionnaires, and urged to complete and score them before continuing. I did so and had my wife do so. I chose a Radar plot to display our results:

What does this show? Each of us has an attitude toward the past, toward the present, and toward the future. Each attitude can be negative or positive, or some mix. Looking at the charts now, I probably should have re-cast them with the indicators in a different order, but they are still not hard to read: Both my wife and I tend to regret a lot of the past, and have relatively fewer happy memories. We both have a strong Future (meaning future positive, I could infer later) orientation, but an even stronger Transcendental-Future orientation. The latter item is logical for Christians. Where we differ (only a little, thankfully) is that she tends to be a little fatalistic about things ("I can't change that anyway") and less inclined to just enjoy life, while I am (moderately) the opposite.

I look at our chart as showing we are pretty well balanced, with a somewhat depressive tendency rooted in our negative outlook on the past, but an equally strong spiritual attitude. Now let us look at the information supplied by the authors about themselves, on a similar chart:


This shows two very compatible guys, who share a strong Future outlook (save for a rainy day; delay gratification), who have lots of happy memories, and who love enjoying life—put these together, and you have "work hard, play hard". They are distinctly not spiritual, and while they do not state it, are probably not religious at all.

It should come as no surprise that the authors promote this kind of profile as near-ideal. They spend quite a bit of space outlining the consequences of being too one-dimensional in any of the six traits.

Having established such a framework, they could present their answer to "What is the Time Paradox?" in extended form. The short answer is, we descended from apes that needed to find food, strove to avoid becoming food, and spent plenty of time either mating or fighting over mates and food. The most natural orientation was Past Negative (quicker reactions to danger), Present Hedonistic stronger than Fatalistic, and little need to plan for the Future. The world we live in today (in the First World at least), requires stronger Future skills than our distant ancestors had. In fact, for many of us, the world requires a time orientation that is the opposite of what we were born with.

The authors show how schools and other institutions are "Made for Futures", and frustrate those with a stronger Present or Past orientation. They show that too-strong a Transcendental orientation makes terrorism a perfectly logical response to oppressive environments that would induce Fatalism in others: Thus, suicide bombers aren't insane, but they are very differently oriented.

When it comes to helping oneself, the authors have plenty to offer. They have exercises throughout the book, such as the "Who am I?" worksheet: the question is repeated twenty times, and you are to reply differently to each one. There are similar worksheets that are more time-based (What was I?, What will I be?, etc.), and a gratitude exercise, for example. The kind of people who will find such changes the hardest to make are the Presents, both Fatalist and Hedonist. To them, the future is a nearly meaningless concept. It doesn't "fit in their heads."

A side note: I have an acquaintance with an addictive personality, the epitome of a Hedonist. It takes a real jackhammer experience to get him to pay attention to future needs, and then only for a short time. One would think that, after having his car stolen out from under him twice, having stared down the barrel of a gun, having been beat up by a drug dealer, he'd never return "there" again. But he is precisely what the Bible calls a "dog that returns to its own vomit." Sadly, I expect him to die young.

Which sparks a sort of proverb: Self Help is only for those with a Self to Help. Some folks don't have enough of a Self. But for most of us, simple skills like the Gratitude exercise (Quick, think of five things you're thankful for. Write 'em down. Repeat tomorrow and every day. Try not to do the same five every day.) can gradually adjust our Time orientation to make us a bit better than we were. Even if I have a different "ideal profile" in mind, it is an ideal the authors' tools can help me approach.

After life in the dark, even a candle is blinding

kw: book reviews, nonfiction, self help

There is no need for me to call Cathy Alter a potty-mouth. She calls herself that. She is also a potty-pen (or -keyboard). She has written Up for Renewal: What Magazines Taught Me about Love, Sex, and Starting Over. She may have hit bottom when she began a one-year makeover, for which she decided to use the advice from about a dozen women's magazines such as Glamour, Jane, Cosmopolitan and O.

For a conservative man, the book is certainly uncomfortable reading. She is the proverbial "scarlet woman" against which people like me warn our sons. But it seems she primarily consumed the attention of several scarlet men (until she turns things around), so she'd have had little energy left to corrupt any innocents.

For her, the value of the articles she attempted to follow lay in getting her out of her own comfort zone. That is the main requirement for growth of any kind. And she did grow. In the bargain, she rounded up an apparently quite suitable husband. The book culminates in their wedding.

I found it interesting to follow (when I wasn't skipping smut) the evolving thought processes of a person about 20 years my junior, raised by a lusty, perhaps promiscuous mother (her father is present and honored but firmly in the background), in a Jewish but rather irreligious home. And you know, she did grow. There's a lot less potty-mouth in the Cathy who closes the book.

As an aside, I am no saint, and have my own past, which I prefer to conceal. A poem I follow reads in part, "Living in Christ, no more shall be named/things of which now I am truly ashamed." 

I grew, with help from Christ and His people. Ms Alter grew, with help from an amazingly banal collection of pop culture publications, plus a number of stalwart friends. Growth is good.

One person's fat-to-fit journey

kw: book reviews, nonfiction, obesity, self help

I've worked with a man who usually weighed 400 pounds or more. It was compounded by his short statute, no more than five feet eight. Convert to metric and figure BMI: 181kg / (1.73m)² = 61. Considering that the "standard" defines BMI>40 as "morbidly obese", I was amazed that he'd lived nearly sixty years. I remember that he ate almost constantly. I suspect he didn't pay much attention. Yet he knew he was "really, really fat". It seems he'd long since given up "reducing", and did a lot of walking to keep in some kind of shape. Thus he was in better condition to be out in the world than was Susan Blech in her mid-thirties.

As she reports in Confessions of a Carb Queen: the lies you tell others & the lies you tell yourself, Sue Blech passed 400 pounds about the age of 35, and weighed just over 468 pounds (212kg) by age 38, when she entered a "fat farm" clinic in North Carolina. She never mentions her height, but if it is near the average for a Caucasian woman (65 inches or 1.65m), her BMI was about 80! She also reports that it was very hard to walk, and she seldom left her apartment. She was well on her way to becoming first a quarter-ton, then a half-ton homebody. The heaviest verified weights are 1200lbs (544kg) for a man and 1190 lbs (540kg) for a woman: both well over a metric half-ton and both bed-bound.

As the author, with her sister Caroline Bock's help, reports in her first eight chapters, she spent up to four hours daily going from BK to Wendy's to McD to various pizza places, eating meal after meal, and "grazing" almost constantly betweentimes. All the while, she would say she was "a little chubby", always "on a diet", forever promising herself to "do better" at some later date, usually the upcoming Monday. Finally, at age 38, she realized, "As I get bigger, my life gets smaller." Spurred by the fear that she will have a stroke and end up like her mother, incarcerated in a mental hospital after a stroke in her 40s, she went for help.

She entered a weight-loss clinic in Durham, North Carolina where, over two-and-a-half years she lost 250 pounds. It wasn't steady going, and she had binges once or twice. With the help of friends she continued to battle. She had those she could call when she got home to report that she was safe: "'Safe' doesn't mean that I wasn't in a car accident; 'safe' means that I didn't stop at Wendy's".

Some have written that lying is one thing, but when we believe our own lies, that's obsession. She had been obsessed. She is frank that she was very seldom hungry. She didn't eat from hunger. She ate for comfort, the comfort of a motherless child whose father comforted his children with food. Yet her three siblings didn't become obese. As the youngest, perhaps she felt most keenly the loss of her missing mother, still alive but still rarely aware as the book was published. She reports that the only way she could sleep was in a calorie-induced coma.

She herself doesn't know how she was able to sleep under the clinic's regimen of little more than rice, grits, and water. Initially, while getting used to it, it was probably only total exhaustion. But she also got a personal trainer, who patiently urged her to greater and greater efforts until she could sleep from genuine fatigue. She'd been an athlete and bodybuilder in her 20s, so whe knew how to exercise. As she reports, she found she needed a "boss", just like at any job.

The book opens with a small picture of her, an anxious-looking figure in front of a door. She is exactly as wide as the door. It closes with a larger picture of a much more slender woman, one who looks really good at 210lbs (95kg). She is a pretty woman at either weight, but is much more appealing as a "merely large" forty-year-old.

She makes it clear that she is no expert on weight loss, but only an expert on how she lost weight. Bread triggers her obsession. Total expulsion of bread from her menu is a major key to her success in losing weight. Each of us must clear-headedly figure out what our own obsession is, or we'll go through life never knowing how much we are deceiving ourselves. Sue Blech's inspiration is rooted in knowing that it is possible to recover from obsession, and thus recover from the symptoms that follow.

Here, try my specs...

kw: book reviews, self help

This isn't original with me, nor with Stephen Covey, from whom I heard it: Do your eyes trouble you? Having a hard time seeing sometimes? Here, try my eyeglasses. I can see perfectly with them. What, don't they help you? Strange...

Not so strange. If my eyes and nearsighted and yours are farsighted, or if we simply have quite different amounts of astigmatism, there's no way my glasses will do you much good...and vice versa. Some things are like that. My eyes are not your eyes.

Some are not. If you have a bad Strep throat, there are several antibiotics that ought to nicely clear it up. Of course, these days, the germ in question may be resistant to most antibiotics, so it may take a trial or two to find the one (or some combination) that will do the job. But, if the one causing your strep throat is one you caught from me, the same combination that works for me will work for you. One cause, one solution.

Are the emotional and mental quirks that we all suffer in the category of "one cause, one solution" or "my neurosis is not like your neurosis"? Hard to tell. Every self-help book I've read claims that this or that method or procedure will certainly work; it is all in the diligence you bring to it. That simply turns into a game of "blame the victim" when it doesn't work for someone.

So it is with the patterned behavior we all experience. I recently finished reading Make the Leap: a Practical Guide to Breaking the Patterns that Hold You Back by Farrell Silverberg, PhD. He has written a helpful book, if patterns are your problem. But what is a pattern?

We live by patterns. Most of us have a way we get to work, or church, or the grocery. We almost always go the same way. Whether we walk, drive, take the bus or train, we can do it without noticing; we are on autopilot. It is a useful pattern.

One day I was on the way to the library. The first half the way is the same roads I take to my son's school. I was nearly to the school before I broke out of autopilot, cussed, and turned back to the library. I was trapped by a pattern, if briefly.

Here is another, one that I cringe to recall. Like most school age boys, I had a few fights growing up. On a couple of occasions I was ambushed while sitting down. Many years later, when my son was 4 or 5, he dashed over to my chair and jumped on me. I hollered and thrashed, and he was flung across the room. Well, that was the first and last time he joyfully sprang into my lap. I was trapped by a pattern that hadn't been used for decades.

Some patterns are mild, some very strong. A very outdated, maladaptive pattern is what we call a neurosis. It is based on behavior that once helped, but doesn't do so any more. Now it harms us.

I'm not going to go into detail about the book. Dr. Silverberg is a very good writer, with useful methods to teach, but he makes no bones that it takes a lot of work on your part to see, understand, and break a pattern. It then takes more, much more, work to push it into permanent limbo.

I didn't find a pair of glasses that fit. But perhaps the things I remember will help me see any patterns that show up later. I happen to like my routines. I worked hard to set up many of them. I have reached the curmudgeonly state where I'd rather a few folks broke a pattern here or there, and left mine alone.