Great military strategists have told us that the outcome of a battle is determined before a single shot is fired. This is not clairvoyance but an astute insight into ways in which the future is inextricably tied to the present.
Might I extrapolate even further from this idea? We know that heavenly bodies like the sun and the moon exert a gravitational force on all surrounding planets, asteroids, and comets, based in part on their length, width, and depth, the famed three dimensions. Yet what about the fourth dimension, time? Could there be forces at work that draw us inexorably closer to our personal, professional, and pathological fate? Is there, in other words, a gravitational pull of the future?
For most academic physicians, this concept isn’t really too far-fetched. Take, for example, chronic illnesses such as diabetes, high blood pressure, or circulatory problems. Once these have taken root within a given individual’s body, a new course is chartered, as if a ship’s captain has rerouted his craft according to a different set of nautical maps. “Without firing a single shot,” so to speak, an ailment like diabetes recharts the destiny of the person’s heart, arteries, brain, and kidneys. Unfortunately, diabetes is known to cause microvascular changes 5 to 10 years before blood sugar begins to rise—the seeds of future, possibly fatal health crises begin to work their mischief long before the person or the physician have a clue that something is wrong.
To this we can add many other factors, particularly those associated with DNA, the unique “hard drive” that is embedded in every single living human cell—yours is yours alone, unshared with anyone else in human history. Let’s not worry about the specifics of genotype, phenotype, karyotype, histocompatability antigens, and the like; you can read about these in Star Magazine at your leisure. Simply put, you may have an increased risk of cancer, ulcerative colitis, high cholesterol or even acne (from an inability to fight skin bacteria, in case you’re wondering) based on your genetic makeup—your future may be partially predetermined by these mysterious and highly complex molecules.
Of course, your daily routine of selfcare is neither mysterious nor complex. Do you exercise effectively, if at all? Do you eat with isocaloric balance in mind--namely, keeping your weight healthy and stable? Are you developing rewarding and profitable relationships that may flower eventually into financial stability and personal happiness? Are you continuously learning newer skills that enhance and solidify your self-confidence? Is improvement in itself on your “to-do” list?
Or have you convinced yourself by means of delusional personal mythology and/or self-validating beliefs that it makes no difference how much you weigh, what your blood tests represent, or how high your blood pressure is? You might feel that your appearance is adequate, even if your clothing choices and posture telegraph a negative message to the outside world. How much are you in touch with what others see and think, as well as the “first impression” you make at school, work, or a social event?
These insights will also partially determine your future, and, conversely, given your present lifestyle choices in appearance and behavior, your future may evolve as a consequence of how you are acting right now. The “gravitational force” of disease, disability, antisocial behavior,and other negative entities might be pulling you inexorably towards a scenario of incapacitation, frustrated dreams, and unhappiness.
However, unlike unchangeable genetic codes, your lifestyle choices are exquisitely sensitive to change—better skincare, hairstyles, outfits, nutrition, and physique are helpful to anyone at any time, even by glamorous celebrities who continually reevaluate and recreate their image.
Whether “the future” is interpreted as next month, next year, or decades from now, there is always something you can do to make it better. Look in the mirror at your own three dimensions—length, width, and depth (or calculate your Body Mass Index, essentially the same thing). Then consider the fourth dimension, time, and its role in the outcome of your life. Fortune tellers might look at your palm, tea leaves, or a crystal ball in order to divine your fate. But using your own honest powers of self-observation, you can do this in a more predictable and cost-effective way—and, through the enjoyable process of self-reinvention, pave the pathway for yourself to a happier and healthier tomorrow.
Friday, August 22, 2008
Saturday, August 2, 2008
A Lifetime of Transitions
Summer is usually not a time for philosophical reflection, but 2008 is different for me. As I prepare for a series of publicity-related events to promote The Park Avenue Diet, my thoughts have taken me backwards and forwards in time—reflecting on the past and anticipating the future. “This is a transitional time for you,” my friend and mentor Dr. Stanley Krippner noted a few months ago. Agreed, but as I pondered his overview, I began to think of the entire arc of life, in itself, somewhat inflexibly, a series of stages not unlike a grand railway journey with multiple stops.
No matter who you are, where you live, or what surrounds you, you too will experience a social, academic, and professional environment that is continually being reshaped and redefined. How will you be able to manage these multiple transitions seamlessly and painlessly? The answer will depend to a large extent on your ability to redefine your image, an amalgam of visible behavioral and physical characteristics that reflect your philosophical beliefs.
Are you the same person you were a few years ago? Probably not, although you might wish to believe that your current relationships, appearance, and health are permanent—at least the positive aspects. But physicists teach us that “the only thing constant is change.” So prepare yourself for a roller-coaster ride that might last 80 years by learning to adapt, to upgrade your image, and to develop an evanescent trait called “inner strength.” Otherwise, your roller-coaster ride may be a bumpy one.
I have had many life-defining experiences over the past few years, moments of unbelievable happiness and moments of painful heartache, and so have you. But in looking back even further, I’ve been blessed with a most circuitous and surprising pathway that has brought me to this point—and into your life. I’ve been a shy high-school student, an idealistic Yalie, a frazzled medical student, an overworked intern, a colorful emergency room physician, an associate of a famous diet-doctor, and now an author and media personality—all of these without knowing the next chapter of the story.
At each point of transition, my image changed, but not in some vague spiritual way. Building upon one knowledge base after another, I improved my weight, bodily physique, skin, apparel, hairstyle, interpersonal skills, and self-confidence to match my new responsibilities and hopefully impress my new colleagues. However you look today, good, bad, or indifferent, it’s not a permanent state of affairs. Your ability to reevaluate yourself periodically—and honestly—is not a superficial onceover. It is a survival technique that you will need to call upon repeatedly if you want to develop the resilience necessary to endure, thrive, and excel.
Let’s take as an example your weight. It may seem adequate or at least tolerable to you (66% of American adults are either overweight or obese according to recent CDC statistics) but what will someone else think?--someone such as a college admissions interviewer, a potential employer, a new friend. Their first impression of you, a phenomenon that my fashion expert colleague Helene Hellsten estimates as taking three seconds to formulate, may negate your chances of academic advancement, job placement, or romance. Weaknesses in interpersonal skills may mean nothing to you, but they might convince the gatekeepers of your future that you “haven’t got it all together.”
On the other hand, mastering the various components of appearance and behavior—and upgrading them periodically to present yourself as continuously fresh and interesting—allows you to move from one stage of life to another as seamlessly as possible. People who ignore this learning technique are often described as being “in a rut” or stagnant. You may need to transition from school to an office environment, from living with your parents to coping with your own apartment, from solitude to an intimate relationship. Transitions are as complex and multifaceted as the people that they affect, so don’t try to predict the future—instead, prepare yourself for a series of reinventions, opportunities for creativity, redesign, and productive introspection.
Whether you know it or not, this is a transitional time for you too, just as it is for me. You may not know when the next chapter of your life will begin or who will be the principal characters—but change is inevitable, like the change of seasons we experience every year. Nature makes it happen to trees, insects, and weather patterns, and people make it happen with kaleidoscopic social dynamics and relationships. Your armament against these powerful forces is not merely self-knowledge but the ability to reinvent yourself, after careful reappraisal and inventory of your appearance and behavior. It’s an important and necessary skill, and you can have fun doing this with the proper input from experts such as the team assembled for The Park Avenue Diet.
This is not just a transitional time for me…or you. We all lead a lifetime of transitions.
No matter who you are, where you live, or what surrounds you, you too will experience a social, academic, and professional environment that is continually being reshaped and redefined. How will you be able to manage these multiple transitions seamlessly and painlessly? The answer will depend to a large extent on your ability to redefine your image, an amalgam of visible behavioral and physical characteristics that reflect your philosophical beliefs.
Are you the same person you were a few years ago? Probably not, although you might wish to believe that your current relationships, appearance, and health are permanent—at least the positive aspects. But physicists teach us that “the only thing constant is change.” So prepare yourself for a roller-coaster ride that might last 80 years by learning to adapt, to upgrade your image, and to develop an evanescent trait called “inner strength.” Otherwise, your roller-coaster ride may be a bumpy one.
I have had many life-defining experiences over the past few years, moments of unbelievable happiness and moments of painful heartache, and so have you. But in looking back even further, I’ve been blessed with a most circuitous and surprising pathway that has brought me to this point—and into your life. I’ve been a shy high-school student, an idealistic Yalie, a frazzled medical student, an overworked intern, a colorful emergency room physician, an associate of a famous diet-doctor, and now an author and media personality—all of these without knowing the next chapter of the story.
At each point of transition, my image changed, but not in some vague spiritual way. Building upon one knowledge base after another, I improved my weight, bodily physique, skin, apparel, hairstyle, interpersonal skills, and self-confidence to match my new responsibilities and hopefully impress my new colleagues. However you look today, good, bad, or indifferent, it’s not a permanent state of affairs. Your ability to reevaluate yourself periodically—and honestly—is not a superficial onceover. It is a survival technique that you will need to call upon repeatedly if you want to develop the resilience necessary to endure, thrive, and excel.
Let’s take as an example your weight. It may seem adequate or at least tolerable to you (66% of American adults are either overweight or obese according to recent CDC statistics) but what will someone else think?--someone such as a college admissions interviewer, a potential employer, a new friend. Their first impression of you, a phenomenon that my fashion expert colleague Helene Hellsten estimates as taking three seconds to formulate, may negate your chances of academic advancement, job placement, or romance. Weaknesses in interpersonal skills may mean nothing to you, but they might convince the gatekeepers of your future that you “haven’t got it all together.”
On the other hand, mastering the various components of appearance and behavior—and upgrading them periodically to present yourself as continuously fresh and interesting—allows you to move from one stage of life to another as seamlessly as possible. People who ignore this learning technique are often described as being “in a rut” or stagnant. You may need to transition from school to an office environment, from living with your parents to coping with your own apartment, from solitude to an intimate relationship. Transitions are as complex and multifaceted as the people that they affect, so don’t try to predict the future—instead, prepare yourself for a series of reinventions, opportunities for creativity, redesign, and productive introspection.
Whether you know it or not, this is a transitional time for you too, just as it is for me. You may not know when the next chapter of your life will begin or who will be the principal characters—but change is inevitable, like the change of seasons we experience every year. Nature makes it happen to trees, insects, and weather patterns, and people make it happen with kaleidoscopic social dynamics and relationships. Your armament against these powerful forces is not merely self-knowledge but the ability to reinvent yourself, after careful reappraisal and inventory of your appearance and behavior. It’s an important and necessary skill, and you can have fun doing this with the proper input from experts such as the team assembled for The Park Avenue Diet.
This is not just a transitional time for me…or you. We all lead a lifetime of transitions.
Friday, August 1, 2008
A Modest Weight-Loss Proposal
As a practicing physician it never ceases to amaze me when an overweight patient doesn’t follow my advice. After a Yale University liberal-arts education, a degree in psychology, four years of medical school, an Internal Medicine residency, four years of emergency room work and more...where did I go wrong?
Usually people respond positively to my gravitas and depth of knowledge. The recommendations I give can make an enormous difference...after all, we are talking about life-shortening, debilitating chronic illnesses, the ones precipitated and worsened by overweight.
Why don’t most overweight or obese Americans slavishly follow the warnings of the medical community? It’s certainly not from lack of publicity: every newspaper and television show seems to have an article or segment devoted to health issues. Yet only 5-10% of dieters keep the pounds off permanently and never revert to their former bad habits. What’s wrong with the other 90%? Aren’t they afraid of death?
Somewhat sheepishly I have often posed to colleagues the hypothesis that there is only one diet that would really work wonders. I call it The April 15th Diet. Don’t bother to look for the recipe book, spin-off products, or in fact any nutritional information. On The April 15th Diet you can eat unlimited portions of anything that you want for almost 365 days. Sounds terrific, no?
Then on April 15th of every year you will report to the local post office. After your retina scan and DNA sample pass inspection, you will hand the clerk a notarized copy of your previous year’s income tax returns. You will then step onto a special scale that will measure height and weight, immediately calculating your Body Mass Index. A bar-code sticker will be printed and affixed to your tax return. Then you are done for the day.
Several months later you will receive an envelope from the Internal Revenue Service. They will have audited your tax return and calculated your refund. This amount, however, will be adjusted downwards for every unit of Body Mass Index higher than ideal. Only people who demonstrate sufficient personal responsibility, self-control, and successful results will qualify for a full refund. Incomplete efforts, “trying” or total neglect will lead to incrementally increasing deduction from the funds. Parents are also penalized for the behavior and overweight of their children.
The money saved by instituting this program would be incalculable. Since overweight and obese American will eventually divert money from the healthcare system to pay for their insulin injections, cardiac surgery, dialysis treatments and seeing-eye dogs, it is economically wiser to extract some sort of pre-payment beforehand. Illnesses that affect all people equally (cancer, influenza, broken bones) should be “paid for” by all citizens since they are all more or less at identical risk. However, the concerned citizen of the future might ask his obese neighbor: “You pay for your own ice cream. Why should I share the cost of your medication, hospitalization and nursing care?”
Americans share only two things in common: death and taxes. The fear of premature death is not sufficient to motivate people to lose weight. The possible loss of disposable income, on the other hand, would certainly change hearts, minds and bellies very quickly. Memberships in health clubs would sky-rocket, especially in March. Nutritionists, rather than accountants, would have to work around the clock in early April. Cobwebs and tumbleweeds would surround fast-food stores, and long lines would form at salad bars at the crack of dawn.
Get angry, stamp your feet, write a Letter to the Editor! I know that The April 15th Diet is the worst diet that you ever heard of...but boy would it work!
Usually people respond positively to my gravitas and depth of knowledge. The recommendations I give can make an enormous difference...after all, we are talking about life-shortening, debilitating chronic illnesses, the ones precipitated and worsened by overweight.
Why don’t most overweight or obese Americans slavishly follow the warnings of the medical community? It’s certainly not from lack of publicity: every newspaper and television show seems to have an article or segment devoted to health issues. Yet only 5-10% of dieters keep the pounds off permanently and never revert to their former bad habits. What’s wrong with the other 90%? Aren’t they afraid of death?
Somewhat sheepishly I have often posed to colleagues the hypothesis that there is only one diet that would really work wonders. I call it The April 15th Diet. Don’t bother to look for the recipe book, spin-off products, or in fact any nutritional information. On The April 15th Diet you can eat unlimited portions of anything that you want for almost 365 days. Sounds terrific, no?
Then on April 15th of every year you will report to the local post office. After your retina scan and DNA sample pass inspection, you will hand the clerk a notarized copy of your previous year’s income tax returns. You will then step onto a special scale that will measure height and weight, immediately calculating your Body Mass Index. A bar-code sticker will be printed and affixed to your tax return. Then you are done for the day.
Several months later you will receive an envelope from the Internal Revenue Service. They will have audited your tax return and calculated your refund. This amount, however, will be adjusted downwards for every unit of Body Mass Index higher than ideal. Only people who demonstrate sufficient personal responsibility, self-control, and successful results will qualify for a full refund. Incomplete efforts, “trying” or total neglect will lead to incrementally increasing deduction from the funds. Parents are also penalized for the behavior and overweight of their children.
The money saved by instituting this program would be incalculable. Since overweight and obese American will eventually divert money from the healthcare system to pay for their insulin injections, cardiac surgery, dialysis treatments and seeing-eye dogs, it is economically wiser to extract some sort of pre-payment beforehand. Illnesses that affect all people equally (cancer, influenza, broken bones) should be “paid for” by all citizens since they are all more or less at identical risk. However, the concerned citizen of the future might ask his obese neighbor: “You pay for your own ice cream. Why should I share the cost of your medication, hospitalization and nursing care?”
Americans share only two things in common: death and taxes. The fear of premature death is not sufficient to motivate people to lose weight. The possible loss of disposable income, on the other hand, would certainly change hearts, minds and bellies very quickly. Memberships in health clubs would sky-rocket, especially in March. Nutritionists, rather than accountants, would have to work around the clock in early April. Cobwebs and tumbleweeds would surround fast-food stores, and long lines would form at salad bars at the crack of dawn.
Get angry, stamp your feet, write a Letter to the Editor! I know that The April 15th Diet is the worst diet that you ever heard of...but boy would it work!
Friday, June 27, 2008
Book Launch- June 17
Have you ever been to the launch party for a new book? Neither have I until recently, when The Park Avenue Diet made its debut at a lavish, four-story penthouse on (where else?) Park Avenue. Over a hundred colleagues, friends, celebrities, and revelers converged at 6 p.m. as flashbulbs popped, wine flowed, and general merriment abounded.
It was a special thrill to welcome my mentor, Dr. Stanley Krippner, to this exciting and momentous event. He is one of the world’s most distinguished humanistic psychologists, and I have been privileged to be his friend for 40 years—but until now we had never worked together on a book. He flew in from California just for the book launch, then returned for graduation ceremonies at Saybrook Institute. Here he is with my personal assistant, Kristina, and another colleague, Debbie Ellis.
Chef Marie-Annick Courtier and her husband made a rare visit to New York City to join us for the launch of The Park Avenue Diet. Her recipes and wisdom are intrinsic to the message of the book, and I had the unique pleasure of thanking her for her brilliant work by giving her a culinary tour of the East Village, Chinatown, Little Italy, and Soho. The next day, she flew to France to cook at a lavish wedding in a chateau in Burgundy. Salut a la France!
Let’s walk around so I can introduce you to some of the celebrity consultants, whose contributions to The Park Avenue Diet make it the unique and revolutionary book that it is. Of course you know Tinsley Mortimer, the glamorous and charitable socialite! She was followed by camera crews and reporters from Access Hollywood and German television, as well a dozen journalists from such publications as W, Elle, and The New York Observer. Tinsley’s empathetic, humanistic, and brilliant insights into interpersonal skills are the epicenter of the book, but you’ll be reading them at a later time.
Here are two other contributors to The Park Avenue Diet, who also sent photographers and reporters into a tizzy: Bernadette Penotti, a personal trainer/fitness expert par excellence, and Helene Hellsten, the distinguished and stunning Swedish fashion expert of international renown.
It was a special thrill to welcome my mentor, Dr. Stanley Krippner, to this exciting and momentous event. He is one of the world’s most distinguished humanistic psychologists, and I have been privileged to be his friend for 40 years—but until now we had never worked together on a book. He flew in from California just for the book launch, then returned for graduation ceremonies at Saybrook Institute. Here he is with my personal assistant, Kristina, and another colleague, Debbie Ellis.
Chef Marie-Annick Courtier and her husband made a rare visit to New York City to join us for the launch of The Park Avenue Diet. Her recipes and wisdom are intrinsic to the message of the book, and I had the unique pleasure of thanking her for her brilliant work by giving her a culinary tour of the East Village, Chinatown, Little Italy, and Soho. The next day, she flew to France to cook at a lavish wedding in a chateau in Burgundy. Salut a la France!
Here’s the real star of the event, the book itself. All of the copies were gone by the end of the launch, as were all of the wine and sushi appetizers. The guests stayed on, having met new friends and having enjoyed watching a revolutionary new book gets its first media attention.
Some other assorted photos follow. You know everyone by now, so walk around, enjoy yourself, and thanks for being here!
Wednesday, April 2, 2008
David Grob, M.D.
Last week I received the news that my greatest teacher, Dr. David Grob, had passed away. We first met in the mid-1970's when I was a medical student at Maimonides Hospital and he was the Director of Medical Education, as well as the chairman of the Department of Internal Medicine.
Dr. Grob was an internationally renowned expert in myasthenia gravis as well as a professor with impeccable academic credentials. To me, however, he was simply the most inspiring healer and teacher of a lifetime. Dr. Grob charted my entire academic pathway after medical school, giving me priceless opportunities to learn clinical medicine on the wards of Maimonides Hospital. From 1978 onwards for five years, I was immersed in patient care as an extern, intern, and resident, spending approximately 108 hours per week mastering the diagnostic and technical skills needed to help critically ill patients.
What made learning from Dr. Grob so very memorable was not merely his orderly and encyclopedic knowledge of the basic health sciences--in addition, he seemed to present medicine as a holy art, marveling at the intricacies of the human body and showing enormous empathy for the suffering individual. At times, while he was examining patients with the manual dexterity of a piano virtuoso, he would close his eyes, as if communing with Hippocrates or healing spirits.
One session of morning rounds in the intensive care unit featured five patients with myasthenia gravis, each one with a different set of signs, symptoms, and response to therapy. He instilled in us that day a great respect for the infinite mysteries of the human body, wherein even an extremely rare disease can unfold in multiple, different ways.
A brilliant practitioner of physical diagnosis, a lost art in itself, Dr. Grob would map out the outline of a patient's liver by percussing the surface of the abdomen, then draw an outline on the bemused person himself (patients enjoyed this as much as the students, by the way). On other occasions, he would lie a pencil down on the left ribcage directly over the "point of maximum impression" [where the heartbeat is most easily felt] and we would watch the pencil bobbing up and down with every heartbeat.
In another impressive display of physical diagnosis, Dr. Grob showed me how to "feel" atrial fibrillation, a sensation resembling a "bag of worms" writhing under my hands. Who else would have taught us how to estimate a blood pressure by touching the wrist artery? I still use this skill almost every day, and several times in Cabrini Emergency Room it was actually of crucial importance.
I hope that you too will have your life enriched and ennobled by brilliant teachers and mentors. Dr. Grob represents to me a Golden Age of healthcare--the technology and information were not as extensive as they are today, but the empathy, sense of wonder, and ability to inspire will last me a lifetime. Thank you, Dr. David Grob. Hail and farewell!
Dr. Grob was an internationally renowned expert in myasthenia gravis as well as a professor with impeccable academic credentials. To me, however, he was simply the most inspiring healer and teacher of a lifetime. Dr. Grob charted my entire academic pathway after medical school, giving me priceless opportunities to learn clinical medicine on the wards of Maimonides Hospital. From 1978 onwards for five years, I was immersed in patient care as an extern, intern, and resident, spending approximately 108 hours per week mastering the diagnostic and technical skills needed to help critically ill patients.
What made learning from Dr. Grob so very memorable was not merely his orderly and encyclopedic knowledge of the basic health sciences--in addition, he seemed to present medicine as a holy art, marveling at the intricacies of the human body and showing enormous empathy for the suffering individual. At times, while he was examining patients with the manual dexterity of a piano virtuoso, he would close his eyes, as if communing with Hippocrates or healing spirits.
One session of morning rounds in the intensive care unit featured five patients with myasthenia gravis, each one with a different set of signs, symptoms, and response to therapy. He instilled in us that day a great respect for the infinite mysteries of the human body, wherein even an extremely rare disease can unfold in multiple, different ways.
A brilliant practitioner of physical diagnosis, a lost art in itself, Dr. Grob would map out the outline of a patient's liver by percussing the surface of the abdomen, then draw an outline on the bemused person himself (patients enjoyed this as much as the students, by the way). On other occasions, he would lie a pencil down on the left ribcage directly over the "point of maximum impression" [where the heartbeat is most easily felt] and we would watch the pencil bobbing up and down with every heartbeat.
In another impressive display of physical diagnosis, Dr. Grob showed me how to "feel" atrial fibrillation, a sensation resembling a "bag of worms" writhing under my hands. Who else would have taught us how to estimate a blood pressure by touching the wrist artery? I still use this skill almost every day, and several times in Cabrini Emergency Room it was actually of crucial importance.
I hope that you too will have your life enriched and ennobled by brilliant teachers and mentors. Dr. Grob represents to me a Golden Age of healthcare--the technology and information were not as extensive as they are today, but the empathy, sense of wonder, and ability to inspire will last me a lifetime. Thank you, Dr. David Grob. Hail and farewell!
Saturday, March 8, 2008
Honi Soit Qui Mal Y Pense
Human beings have a wide range of belief systems, techniques of reasoning, and methods of problem solving. Some of them are logical. The issue at hand is not how one confronts complex geopolitical or sociological challenges that affect the planet. On the contrary, to paraphrase Mark Twain: “Man is the only animal that lies about its health or needs to.”
In numerous, unintentionally funny studies, experimenters derived statistics about weight loss from telephone conversations with the involved participants. The researcher would discuss height, weight, eating patterns, and exercise regimens with a disembodied voice on the other end of the telephone line. Was proof offered? Was there visible, objective evidence of these statements, perhaps provided by a digital optical device linked to an e-mail address? Or did the researchers rely on scientific noblesse oblige, a blind faith in the honesty and integrity of those being studied?
You already know the answer: many people lied. Interestingly, men lied about their height, hoping that their weight would seem better to the researcher if distributed among extra imaginary inches. Women who were less than contrite would give their weight in high school. Another study, even more mirthful than this one, added another step: the arrival at the experimental subject’s home of a small van with a scale in the back. Oops! The scale’s readings often didn’t match the reported poundage. But the deception these people attempted was minor compared to their self-deception, namely that the vital statistics involved were inconsequential—to the medical study, to the researchers, and to themselves.
Self-deception takes many forms, but the most potentially lethal ones concern health. “I don’t need to get a checkup because I feel okay.” “I read numerous health-related websites daily, which means that I have great insight into my own body.” “I take numerous vitamin supplements—so I don’t need to worry about cancer or heart disease.” “There are many studies that show no correlation between weight and human illness—please pass the chocolate syrup.”
Self-validation is a method used by self-deceptive individuals to rationalize their questionable behavior patterns. Albert Ellis called it “crooked thinking.” Dr. Stanley Krippner has written extensively on “personal mythology.” But I think it sounds better in French: honi soit qui mal y pense. Which I translate somewhat loosely as: “Whatever you say.”
May I offer some medical examples? A diabetic might tell me: “I can eat whatever I want—I just have to take extra insulin.” A hypertensive might offer: “I don’t need to follow a low salt diet. I’m taking a water pill.” An overweight person might step to the counter and order a low-fat muffin with a large orange juice. It’s right because I say it’s right!
The original French expression originally appeared in an entirely different context. It was a reproach to people who think that something relatively innocent is shameful and scandalous (namely, the accidental slipping of a leg garter while a woman was dancing in front of British royalty). I’ve brought the expression into modern times with its converse meaning—it isn’t scandalous because I say it isn’t scandalous.
“I’ve had a hard day at work, so I deserve to eat anything I want, especially at dessert time.” “My children aren’t overweight. That’s baby fat, and they will outgrow it eventually.” “March is the perfect time of year to go on a diet. I needed all that extra padding during the winter to protect me against the flu.” Do any of these sound familiar? Is there anything remotely logical in these statements? Have you heard (or thought) anything similar recently?
If so, go to the mirror, look at yourself, smirk, and repeat after me: honi soit qui mal y pense. And then, stop trying to fool yourself.
In numerous, unintentionally funny studies, experimenters derived statistics about weight loss from telephone conversations with the involved participants. The researcher would discuss height, weight, eating patterns, and exercise regimens with a disembodied voice on the other end of the telephone line. Was proof offered? Was there visible, objective evidence of these statements, perhaps provided by a digital optical device linked to an e-mail address? Or did the researchers rely on scientific noblesse oblige, a blind faith in the honesty and integrity of those being studied?
You already know the answer: many people lied. Interestingly, men lied about their height, hoping that their weight would seem better to the researcher if distributed among extra imaginary inches. Women who were less than contrite would give their weight in high school. Another study, even more mirthful than this one, added another step: the arrival at the experimental subject’s home of a small van with a scale in the back. Oops! The scale’s readings often didn’t match the reported poundage. But the deception these people attempted was minor compared to their self-deception, namely that the vital statistics involved were inconsequential—to the medical study, to the researchers, and to themselves.
Self-deception takes many forms, but the most potentially lethal ones concern health. “I don’t need to get a checkup because I feel okay.” “I read numerous health-related websites daily, which means that I have great insight into my own body.” “I take numerous vitamin supplements—so I don’t need to worry about cancer or heart disease.” “There are many studies that show no correlation between weight and human illness—please pass the chocolate syrup.”
Self-validation is a method used by self-deceptive individuals to rationalize their questionable behavior patterns. Albert Ellis called it “crooked thinking.” Dr. Stanley Krippner has written extensively on “personal mythology.” But I think it sounds better in French: honi soit qui mal y pense. Which I translate somewhat loosely as: “Whatever you say.”
May I offer some medical examples? A diabetic might tell me: “I can eat whatever I want—I just have to take extra insulin.” A hypertensive might offer: “I don’t need to follow a low salt diet. I’m taking a water pill.” An overweight person might step to the counter and order a low-fat muffin with a large orange juice. It’s right because I say it’s right!
The original French expression originally appeared in an entirely different context. It was a reproach to people who think that something relatively innocent is shameful and scandalous (namely, the accidental slipping of a leg garter while a woman was dancing in front of British royalty). I’ve brought the expression into modern times with its converse meaning—it isn’t scandalous because I say it isn’t scandalous.
“I’ve had a hard day at work, so I deserve to eat anything I want, especially at dessert time.” “My children aren’t overweight. That’s baby fat, and they will outgrow it eventually.” “March is the perfect time of year to go on a diet. I needed all that extra padding during the winter to protect me against the flu.” Do any of these sound familiar? Is there anything remotely logical in these statements? Have you heard (or thought) anything similar recently?
If so, go to the mirror, look at yourself, smirk, and repeat after me: honi soit qui mal y pense. And then, stop trying to fool yourself.
Sunday, March 2, 2008
The Observer Effect
Principles of science can be useful tools, especially when you watch or read promotional material from the weight-loss industry. For the past 40 years, The Dark Ages of Dieting, Americans have been offered a wide range of ineffective therapies, all purportedly having innate logic and objective validity. Pharmaceutical corporations-- although themselves the subject of much controversy and scrutiny-- are exemplary models of ethical rigor when compared with supposedly trustworthy “nutritional” sources.
Let’s not discuss, for the moment, whether or not grapefruit, cabbage, red peppers, unlimited protein, the glycemic index, macadamia nut oil, or salmon is the unique cure for obesity—or why these epiphanies were reached by individuals, as opposed to physicians at the Mayo Clinic or the Pasteur Institute. Several years ago, I had the unique pleasure of congratulating a voluptuous television star on her new weight-loss vitamin line--I was being polite, and you would have too. Did she design the formulations from her own research into biochemistry and physiology? Could she spell?
Scientific research, a discipline totally unknown to a majority of Americans, includes certain “checks and balances” that ensure the integrity of the findings and their interpretation. One safeguard is protecting against the observer effect, a phenomenon somewhat tangentially related to the Heisenberg uncertainty principle. Here’s an easy example: students will behave differently if their exams are proctored by several teachers—observation of their behavior (by watchful monitors) will affect their actions (avoiding cheating). Do you drive more carefully when police cars, hidden cameras, or speed traps might be present? Observation of your behavior, whether visible or possible, makes you much more likely to follow the rules of the road.
How about a television spokesperson for a weight-loss program? Is he or she totally motivated by health concerns, idealistic beliefs, or the need to lower cholesterol? On the contrary, the mere fact that this individual is being observed (and, of course, paid) affects his or her own food choices, exercise schedule, and wardrobe contents. This doesn’t happen if the spokesperson is trying to sell you home insurance, power drills, or lawn furniture. Are you impressed when that spokesperson “sticks to the program” and is photographed in smaller-sized clothing?
A fascinating weight-loss study reported in the British Medical Journal several years ago described two groups of experimental subjects. The first group was given precise caloric guidelines by medical personnel and nutritionists. The second group, the “controls”, were simply told that they were in a weight-loss study but given no instructions of any kind. Not surprisingly, both groups lost weight, although the first group did slightly better. The observer effect was responsible for this unusual outcome. When people become aware that their weight is being watched by others—no matter what the reason—behavioral changes can occur, even if not specified or supervised.
How does the observer effect play a part in your daily life? That’s at the epicenter of The Park Avenue Diet, since one’s image—which is a projection into society of a lifestyle pattern—is by definition the only thing other people can observe. Upgrading appearance and behavior can enhance this phenomenon, leading to better relationships, job opportunities, and health. How the outside world perceives us is extraordinarily important—so let the observer effect become your strategic partner, not a mechanism of distortion and misinformation.
Let’s not discuss, for the moment, whether or not grapefruit, cabbage, red peppers, unlimited protein, the glycemic index, macadamia nut oil, or salmon is the unique cure for obesity—or why these epiphanies were reached by individuals, as opposed to physicians at the Mayo Clinic or the Pasteur Institute. Several years ago, I had the unique pleasure of congratulating a voluptuous television star on her new weight-loss vitamin line--I was being polite, and you would have too. Did she design the formulations from her own research into biochemistry and physiology? Could she spell?
Scientific research, a discipline totally unknown to a majority of Americans, includes certain “checks and balances” that ensure the integrity of the findings and their interpretation. One safeguard is protecting against the observer effect, a phenomenon somewhat tangentially related to the Heisenberg uncertainty principle. Here’s an easy example: students will behave differently if their exams are proctored by several teachers—observation of their behavior (by watchful monitors) will affect their actions (avoiding cheating). Do you drive more carefully when police cars, hidden cameras, or speed traps might be present? Observation of your behavior, whether visible or possible, makes you much more likely to follow the rules of the road.
How about a television spokesperson for a weight-loss program? Is he or she totally motivated by health concerns, idealistic beliefs, or the need to lower cholesterol? On the contrary, the mere fact that this individual is being observed (and, of course, paid) affects his or her own food choices, exercise schedule, and wardrobe contents. This doesn’t happen if the spokesperson is trying to sell you home insurance, power drills, or lawn furniture. Are you impressed when that spokesperson “sticks to the program” and is photographed in smaller-sized clothing?
A fascinating weight-loss study reported in the British Medical Journal several years ago described two groups of experimental subjects. The first group was given precise caloric guidelines by medical personnel and nutritionists. The second group, the “controls”, were simply told that they were in a weight-loss study but given no instructions of any kind. Not surprisingly, both groups lost weight, although the first group did slightly better. The observer effect was responsible for this unusual outcome. When people become aware that their weight is being watched by others—no matter what the reason—behavioral changes can occur, even if not specified or supervised.
How does the observer effect play a part in your daily life? That’s at the epicenter of The Park Avenue Diet, since one’s image—which is a projection into society of a lifestyle pattern—is by definition the only thing other people can observe. Upgrading appearance and behavior can enhance this phenomenon, leading to better relationships, job opportunities, and health. How the outside world perceives us is extraordinarily important—so let the observer effect become your strategic partner, not a mechanism of distortion and misinformation.
Thursday, February 21, 2008
Albert Ellis
The journey to my current professional position has taken me down many exciting and challenging intellectual pathways. I had always wanted to be a physician but became unusually fascinated by human psychology while still in high school. My first exposure to the field was a summer project at Western Michigan University studying the precepts and experiments of B.F. Skinner—a behaviorist whose philosophy was diametrically opposed to the florid and mysterious inner world conjured up by Jung and Freud.
Then came four years of specialized studies at Yale covering, among other topics, abnormal psychology, physiological psychology, dream research, and orthomolecular psychiatry. I attended numerous national and international conferences, read scholarly articles prolifically, and even conducted research on nutritional treatments for hyperactive children. There were many psychological superstars at the time, brilliant pioneers whose take on human thought and behavior was insightful and dazzling—but one stood out above the rest: Albert Ellis.
Albert Ellis felt, as most psychologists do, that thought influences and shapes behavior. But to Ellis, there were no murky subterranean levels of human consciousness such as those proposed by Sigmund Freud: the ego, the id, and the superego—primitive controlling forces inaccessible to our conscious minds. For Ellis, explanation of our daily actions lays quite close to the surface, making introspection and therefore change much easier. What interested me most about him was the pragmatic approach that he advocated, one that involved isolating philosophical errors, repatterning behavior, and subsequently arriving at a different worldly attitude.
He called the philosophical errors “crooked thinking”, a concept best explained by the master himself in an outburst I witnessed at one of his free-wheeling seminars. The moment an audience member said “I feel sad when…” he rejoindered with “I make myself sad when…” This is quite a distinction: the latter allows for the possibility that we can gently reprogram our thinking patterns in more positive and productive ways.
The current term “personal mythology” owes much to these revolutionary ideas. It defines an individual’s unique system of values, some productive, others counterproductive, and yet others delusional. As a physician I have seen many patients whose health care hangs tenuously in the balance but “don’t need to get a check-up because I feel okay.” The rules they are following are self-made, and their rationalization is always self-validating: this is beautifully rendered in French as honi soit qui mal y pense. The road to ill-health and nutritional self-destruction is often paved with these philosophical errors, and it was Albert Ellis who showed me that “crooked thinking” can have both psychological and physical repercussions.
I add another layer of meaning to his philosophy, namely that how we look (our weight, our bodily physique, our hair, clothing, and skin) and how we behave (our self-confidence and our interpersonal skills) are also amenable to change—not just how we think. External characteristics, rather than merely being superficial window-dressing, can influence our emotions—and therefore we need to affect change in two directions: inside-out and outside-in. This is an expansion of the approach Dr. Ellis mastered, and I am honored to have been profoundly influenced by this unique genius.
Then came four years of specialized studies at Yale covering, among other topics, abnormal psychology, physiological psychology, dream research, and orthomolecular psychiatry. I attended numerous national and international conferences, read scholarly articles prolifically, and even conducted research on nutritional treatments for hyperactive children. There were many psychological superstars at the time, brilliant pioneers whose take on human thought and behavior was insightful and dazzling—but one stood out above the rest: Albert Ellis.
Albert Ellis felt, as most psychologists do, that thought influences and shapes behavior. But to Ellis, there were no murky subterranean levels of human consciousness such as those proposed by Sigmund Freud: the ego, the id, and the superego—primitive controlling forces inaccessible to our conscious minds. For Ellis, explanation of our daily actions lays quite close to the surface, making introspection and therefore change much easier. What interested me most about him was the pragmatic approach that he advocated, one that involved isolating philosophical errors, repatterning behavior, and subsequently arriving at a different worldly attitude.
He called the philosophical errors “crooked thinking”, a concept best explained by the master himself in an outburst I witnessed at one of his free-wheeling seminars. The moment an audience member said “I feel sad when…” he rejoindered with “I make myself sad when…” This is quite a distinction: the latter allows for the possibility that we can gently reprogram our thinking patterns in more positive and productive ways.
The current term “personal mythology” owes much to these revolutionary ideas. It defines an individual’s unique system of values, some productive, others counterproductive, and yet others delusional. As a physician I have seen many patients whose health care hangs tenuously in the balance but “don’t need to get a check-up because I feel okay.” The rules they are following are self-made, and their rationalization is always self-validating: this is beautifully rendered in French as honi soit qui mal y pense. The road to ill-health and nutritional self-destruction is often paved with these philosophical errors, and it was Albert Ellis who showed me that “crooked thinking” can have both psychological and physical repercussions.
I add another layer of meaning to his philosophy, namely that how we look (our weight, our bodily physique, our hair, clothing, and skin) and how we behave (our self-confidence and our interpersonal skills) are also amenable to change—not just how we think. External characteristics, rather than merely being superficial window-dressing, can influence our emotions—and therefore we need to affect change in two directions: inside-out and outside-in. This is an expansion of the approach Dr. Ellis mastered, and I am honored to have been profoundly influenced by this unique genius.
Fanfare for the Common Malady
After several decades of medical practice and an eclectic education in the science and art of healthcare, this physician/philosopher can truly say "I've seen it all." Of course, strictly speaking, that's not true, since Harrison's Textbook of Internal Medicine is several thousand pages long--there's enough pathology to last a lifetime, so to speak. Would you like to hear about some of the esoteric and exotic things I've seen? Of course, you would.
In 1965 I was a teenage volunteer at Maimonides Medical Center, working as a clerk in the dialysis unit. When the brilliant nephrologist in charge (Dr. Donald Snyder) learned that I wanted to be a physician, he took it upon himself to teach me how to take a blood pressure. In those days, we used a sphygmomanometer, an antiquated device with a column of mercury and an inflatable cuff. After listening to Dr. Snyder's careful instruction, I was told to take the blood pressure of the first patient to come into his clinic. "Pump it all the way up" he added. I did what I was told and recorded a blood pressure of 300 over 130. "You'll never see that again" Dr. Snyder remarked, and he certainly was correct. Fortunately, after dialysis, the patient's blood pressure normalized.
As long we're on the subject of astronomical elevation of vital signs, might I also mention the fastest respiratory rate I ever witnessed? 24 times per minute, due to an aspirin overdose. Or the most rapid heart rate? 240 beats per minute, part of a "thyroid storm," fortunately a rarity. Normal blood glucose is approximately 80-100; my all-time record was approximately 2700 (due to a hyperglycemic, hyperosmolar coma). The most spectacular and frightening cardiac arrhythmia I witnessed was torsade des pointes, an out-of-control spiraling of the EKG that looks like a DNA double-helix.
Lest you think that these startling experiences were merely passive observations, allow me to tell you about the first clinical skill I ever performed. Most medical students begin their hospital training by learning how to obtain a blood sample or start an intravenous infusion. This lucky student, during his first overnight shift, happened to walk by a room where attempted CPR was unsuccessful but the supervisory professor still wanted the interns to learn an extremely dramatic last resort--administering adrenalin through an eight-inch intracardiac needle. If you've seen John Travolta and Eric Stoltz perform this procedure on Uma Thurman in Pulp Fiction, you know what it looks like. If you haven't, I won't upset your stomach. The professor pointed to me, said "Let him do it", and I did what I was told--several days before I learned how to attach EKG electrodes.
Rare infectious diseases? How about tularemia, an extremely rare bacterial infection a Brooklynite caught from his pet rabbit? Or disseminated meningococcemia? "You'll never see this again" I was correctly told in 1977. Scarlet fever? I never saw it--I had it! Even on a vacation in Morocco, medical rarities fascinated me: I followed a leper around the Marrakech marketplace, stunned at his characteristic facial features and what I refer to as "the terrible power of illness". This was also evident on the single occasion I saw a patient with neurofibromatosis (incorrectly called the "Elephant Man's disease") and another individual with dextrocardia (not really an illness, since organs that develop as "mirror images" usually function normally.)
Why discuss these extraordinarily rare conditions? Perhaps to gain a sense of perspective on common maladies such as hypertension, diabetes, and heart disease. These chronic illnesses are most definitely debilitating and life-shortening, yet many people minimize their "terrible power" because they are so prevalent. Being overweight or obese invites over 20 serious illnesses into your body, and even one can change your life plans drastically. Medical rarities seem exotic and interesting, like tropical orchids or spectacular comets. Common illnesses, no matter how mundane they may seem to you, are the real problem, especially when you have the power to diminish or avoid them.
In 1965 I was a teenage volunteer at Maimonides Medical Center, working as a clerk in the dialysis unit. When the brilliant nephrologist in charge (Dr. Donald Snyder) learned that I wanted to be a physician, he took it upon himself to teach me how to take a blood pressure. In those days, we used a sphygmomanometer, an antiquated device with a column of mercury and an inflatable cuff. After listening to Dr. Snyder's careful instruction, I was told to take the blood pressure of the first patient to come into his clinic. "Pump it all the way up" he added. I did what I was told and recorded a blood pressure of 300 over 130. "You'll never see that again" Dr. Snyder remarked, and he certainly was correct. Fortunately, after dialysis, the patient's blood pressure normalized.
As long we're on the subject of astronomical elevation of vital signs, might I also mention the fastest respiratory rate I ever witnessed? 24 times per minute, due to an aspirin overdose. Or the most rapid heart rate? 240 beats per minute, part of a "thyroid storm," fortunately a rarity. Normal blood glucose is approximately 80-100; my all-time record was approximately 2700 (due to a hyperglycemic, hyperosmolar coma). The most spectacular and frightening cardiac arrhythmia I witnessed was torsade des pointes, an out-of-control spiraling of the EKG that looks like a DNA double-helix.
Lest you think that these startling experiences were merely passive observations, allow me to tell you about the first clinical skill I ever performed. Most medical students begin their hospital training by learning how to obtain a blood sample or start an intravenous infusion. This lucky student, during his first overnight shift, happened to walk by a room where attempted CPR was unsuccessful but the supervisory professor still wanted the interns to learn an extremely dramatic last resort--administering adrenalin through an eight-inch intracardiac needle. If you've seen John Travolta and Eric Stoltz perform this procedure on Uma Thurman in Pulp Fiction, you know what it looks like. If you haven't, I won't upset your stomach. The professor pointed to me, said "Let him do it", and I did what I was told--several days before I learned how to attach EKG electrodes.
Rare infectious diseases? How about tularemia, an extremely rare bacterial infection a Brooklynite caught from his pet rabbit? Or disseminated meningococcemia? "You'll never see this again" I was correctly told in 1977. Scarlet fever? I never saw it--I had it! Even on a vacation in Morocco, medical rarities fascinated me: I followed a leper around the Marrakech marketplace, stunned at his characteristic facial features and what I refer to as "the terrible power of illness". This was also evident on the single occasion I saw a patient with neurofibromatosis (incorrectly called the "Elephant Man's disease") and another individual with dextrocardia (not really an illness, since organs that develop as "mirror images" usually function normally.)
Why discuss these extraordinarily rare conditions? Perhaps to gain a sense of perspective on common maladies such as hypertension, diabetes, and heart disease. These chronic illnesses are most definitely debilitating and life-shortening, yet many people minimize their "terrible power" because they are so prevalent. Being overweight or obese invites over 20 serious illnesses into your body, and even one can change your life plans drastically. Medical rarities seem exotic and interesting, like tropical orchids or spectacular comets. Common illnesses, no matter how mundane they may seem to you, are the real problem, especially when you have the power to diminish or avoid them.
Sunday, February 17, 2008
Universal Health Care
What is universal health care? And why is it the subject of so much debate during a presidential election?
This purposely vague, somewhat-utopian concept takes the earthly form of access to medical consultations, testing, and treatments—regardless of an individual’s ability to pay and his or her current health status. Sounds like a plan, so be sure to vote for the candidate whose double-talk and blather most closely resemble your own views on the subject.
Can we deconstruct this term before proceeding further? Health, as defined by the World Health Organization in 1948, is “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” Health care, according to UNICEF in 2001, embraces “preventive, curative and palliative interventions, whether directed to individuals or to populations.” Universal, as defined in the aforementioned political debates, refers solely to the United States, not, thankfully, to the entire solar system and distant galaxies.
Universal health care represents an effort to minimize the cost of office visits, medication, surgery, and hospitalization to the individual consumer. Because the threat of injury and illness seemingly affects all people equally, a one-size-fits-all system appears ideal. Of course, logic needs to be temporarily suspended for this idea to resonate: drivers, smokers, mountain climbers, and diabetics all have varying risks to different body parts.
Part, if not all, of the appeal of universal health care is that the term presupposes that health care is something that is done to us. We, seemingly, are passive entities upon whom physicians, nurses, their assistants, pharmacists, and psychologists bestow their wisdom and experience. Of course, they might recommend weight loss, exercise, smoking cessation, or serious introspection, but these are unnecessary when there is an endless amount of money to cover any subsequent medical expenses.
Even in the somewhat “universal” area of infectious diseases, disparity exists despite a human desire for homogeneity. Does the influenza virus affect all of its victims uniformly? Contrast the able-bodied businessperson with a nursing-home resident who might easily develop a secondary bacterial pneumonia. Who will decide which patient to vaccinate, or is universal access to vaccines also “guaranteed”?
Health care, in contradistinction to its current misdefinition, is something that is done primarily by us. A country where 66% of the adult population is overweight or obese is an unlikely place for grand, utopian medical initiatives to flourish. Perhaps 2009 will see the transformation of the United States into Shangri-La—the mythical kingdom where no one ages. If it doesn’t happen that way, be sure you redefine health care as a personal issue, delineated by the boundaries of your own body—and unaffected by mountebanks of any political party.
This purposely vague, somewhat-utopian concept takes the earthly form of access to medical consultations, testing, and treatments—regardless of an individual’s ability to pay and his or her current health status. Sounds like a plan, so be sure to vote for the candidate whose double-talk and blather most closely resemble your own views on the subject.
Can we deconstruct this term before proceeding further? Health, as defined by the World Health Organization in 1948, is “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity.” Health care, according to UNICEF in 2001, embraces “preventive, curative and palliative interventions, whether directed to individuals or to populations.” Universal, as defined in the aforementioned political debates, refers solely to the United States, not, thankfully, to the entire solar system and distant galaxies.
Universal health care represents an effort to minimize the cost of office visits, medication, surgery, and hospitalization to the individual consumer. Because the threat of injury and illness seemingly affects all people equally, a one-size-fits-all system appears ideal. Of course, logic needs to be temporarily suspended for this idea to resonate: drivers, smokers, mountain climbers, and diabetics all have varying risks to different body parts.
Part, if not all, of the appeal of universal health care is that the term presupposes that health care is something that is done to us. We, seemingly, are passive entities upon whom physicians, nurses, their assistants, pharmacists, and psychologists bestow their wisdom and experience. Of course, they might recommend weight loss, exercise, smoking cessation, or serious introspection, but these are unnecessary when there is an endless amount of money to cover any subsequent medical expenses.
Even in the somewhat “universal” area of infectious diseases, disparity exists despite a human desire for homogeneity. Does the influenza virus affect all of its victims uniformly? Contrast the able-bodied businessperson with a nursing-home resident who might easily develop a secondary bacterial pneumonia. Who will decide which patient to vaccinate, or is universal access to vaccines also “guaranteed”?
Health care, in contradistinction to its current misdefinition, is something that is done primarily by us. A country where 66% of the adult population is overweight or obese is an unlikely place for grand, utopian medical initiatives to flourish. Perhaps 2009 will see the transformation of the United States into Shangri-La—the mythical kingdom where no one ages. If it doesn’t happen that way, be sure you redefine health care as a personal issue, delineated by the boundaries of your own body—and unaffected by mountebanks of any political party.
Saturday, February 9, 2008
Extra Caramel
Midtown Manhattan is not spared the presence of several famous fast-food franchises, one of which happens to be across the street from my home. On a recent cold morning, I decided to try their coffee, avoiding the synthetic admixtures that resemble bagels, donuts, and croissants.
Imagine my surprise when my neighbor on line, a young overweight adolescent, ordered her breakfast: “a caramel mocha latte, with extra caramel.” Thoughts raced through my head: “To this we’ve come.”-- “What hath God wrought?”—“Yick.” Recent houseguests, two German naturopaths, had prepared for me a breakfast of curried vegetables and millet. From the sublime to the ridiculous, you say?
Allow me to transport you back a few years, when I was asked to give nutritional advice on Breast Cancer Awareness Day for a major network news show. What foods would be the best choices to lessen the risk for this dreaded disease? This is as foolish a question as exists, since the answer, for most Americans, is less food.
As repeated studies have demonstrated, visceral fat, an “organ” deep inside the abdomen, is responsible for abnormal production of estrogenic hormones. Weight correlates with breast cancer risk, a fact well known to the American Cancer Society. Therefore, unless I missed something when studying logic at Yale University, the best way to minimize this risk is to lose weight.
This was too sensitive an issue for the television producers, and my appearance was cancelled. Certainly you’ve seen more controversial material on the air, whether mind-numbing violence, hysterical political blather, or inappropriate sexual content. Is it a badge of honor to be censored because of a statement in the textbook of internal medicine?
Or is it better to allow free reign to individuals who want an extra boost of caramel in the morning to start their day? Vitamins? Minerals? Amino acids? Who needs them when you’ve got corn syrup, thickening agents, and emulsifying additives?
A recent bill proposed in Mississippi recommended that obese people should be denied service at state-licensed restaurants: http://www.thesmokinggun.com/archive/years/2008/0201081fat1.html
Yea or nay? How much micromanagement would you be willing to allow? “Sorry, sir, we cannot allow you to have salt or catsup with your burger.” “Ma’am, it’s a salad or nothing.” “Put down that slice of pizza and step away from the counter.”
Is it an inalienable right to make unwise food choices? Would communities be more responsible if they policed their residents’ health-related affairs? Should I have said something to the young woman who asked for extra caramel? If the latter case, you know the answer: she might not have enjoyed her morning drink but instead poured it over my head.
Imagine my surprise when my neighbor on line, a young overweight adolescent, ordered her breakfast: “a caramel mocha latte, with extra caramel.” Thoughts raced through my head: “To this we’ve come.”-- “What hath God wrought?”—“Yick.” Recent houseguests, two German naturopaths, had prepared for me a breakfast of curried vegetables and millet. From the sublime to the ridiculous, you say?
Allow me to transport you back a few years, when I was asked to give nutritional advice on Breast Cancer Awareness Day for a major network news show. What foods would be the best choices to lessen the risk for this dreaded disease? This is as foolish a question as exists, since the answer, for most Americans, is less food.
As repeated studies have demonstrated, visceral fat, an “organ” deep inside the abdomen, is responsible for abnormal production of estrogenic hormones. Weight correlates with breast cancer risk, a fact well known to the American Cancer Society. Therefore, unless I missed something when studying logic at Yale University, the best way to minimize this risk is to lose weight.
This was too sensitive an issue for the television producers, and my appearance was cancelled. Certainly you’ve seen more controversial material on the air, whether mind-numbing violence, hysterical political blather, or inappropriate sexual content. Is it a badge of honor to be censored because of a statement in the textbook of internal medicine?
Or is it better to allow free reign to individuals who want an extra boost of caramel in the morning to start their day? Vitamins? Minerals? Amino acids? Who needs them when you’ve got corn syrup, thickening agents, and emulsifying additives?
A recent bill proposed in Mississippi recommended that obese people should be denied service at state-licensed restaurants: http://www.thesmokinggun.com/archive/years/2008/0201081fat1.html
Yea or nay? How much micromanagement would you be willing to allow? “Sorry, sir, we cannot allow you to have salt or catsup with your burger.” “Ma’am, it’s a salad or nothing.” “Put down that slice of pizza and step away from the counter.”
Is it an inalienable right to make unwise food choices? Would communities be more responsible if they policed their residents’ health-related affairs? Should I have said something to the young woman who asked for extra caramel? If the latter case, you know the answer: she might not have enjoyed her morning drink but instead poured it over my head.
Friday, February 1, 2008
The Truth Will Set You Free !
"You can't handle the truth" shouted the angry officer memorably portrayed by Jack Nicholson in A Few Good Men. I've sometimes had the same thought in my quest to deliver objective, life-saving information to patients, friends, and media audiences. Let's stipulate that in matters of art, music, and food, there are usually no right or wrong choices: de gustibus non disputandum est, as they said in ancient Rome.
In the world of academic medicine, however, proper logic, statistical analysis, and reasoned extrapolation are indispensable components of scholarly opinions. This was my environment from 1975 to 1983, the years I spent as a medical student, extern, intern, and resident at Maimonides Medical Center in Brooklyn, New York. My professors included pioneering cardiologists like Sterling Jonas, David Dresdale, and Adrian Kantrowitz. Dazzlingly brilliant clinicians such as Norman Brunner and Nathaniel Plotkin seemingly knew every word in the textbooks of internal medicine.
It was not enough for students to have the answer to every question asked on morning rounds or the noon conference; often, a direct citation of a particular study, medical article, or editorial was necessary--chapter, verse, and word, as it were, not unlike the duties of a biblical scholar.
May we contrast this education with the sensory bombardment you endure every day, listening to "advice" from "health reporters" whose hospital experience may be limited to watching bedpans emptied on a popular medical/soap-opera television show? How about the unsolicited "pop-ups" on your Internet browser that give you the latest "nutritional" information? Stop by your local bookstore and count the number of "health books" written by television personalities, whose unique qualifications make such trifles as a college diploma, medical degree, and hospital experience totally unnecessary.
Sad to say, scientific reality is very much a part of human illness--and therefore a set of basic truths, whether we are willing to face these or not. "Where ignorance is bliss, 'tis folly to be wise"--except if you are an overweight diabetic, in which case retinal hemorrhages, dialysis, and impotence might become part of your daily routine. The "truth" that "you can eat whatever you want" with no consequences will eventually become a distant memory.
How do you know that a particular "diet" works well? From promotional advertising? From the testimonials of a few well-paid "patients"? From the mere fact that the products are sold in your local box-store or pharmacy? Do you also believe the claims of every car manufacturer? Do you see every movie released because there are a few good reviews cited in the ads? On Election Day, do you break the handle in your voting booth as you cast your ballot for every candidate? How could you disbelieve any of them?
When I discuss the "success rate" of various famous "diet" programs in a radio interview--as reported by the Journal of the American Medical Association, the British Medical Journal, the Annals of Internal Medicine (none are available at your supermarket check-out counter)--I watch the host's facial expression change into that of a child who has just discovered the truth about the Easter Bunny. The disconnect between the perceived "reality" and the actual truth is a chasm wider than Grand Canyon, even though the data is easily found on the Internet or in any medical library.
If knowledge is power, Americans have a steep learning curve as far as health matters are concerned, especially regarding weight loss. There is enough misinformation to fill several [incorrect] textbooks. Perhaps we should resurrect an expression from the 1960's: "Everything you know is wrong." Yet the more we look for the truth, particularly where our lives are at stake, the better and longer are lives can be. Critical thinking will pay off more when it is applied to critical issues--and there is nothing more important than your own health, safety, longevity, and happiness--all of which are bound inextricably to each other...and to the truth.
In the world of academic medicine, however, proper logic, statistical analysis, and reasoned extrapolation are indispensable components of scholarly opinions. This was my environment from 1975 to 1983, the years I spent as a medical student, extern, intern, and resident at Maimonides Medical Center in Brooklyn, New York. My professors included pioneering cardiologists like Sterling Jonas, David Dresdale, and Adrian Kantrowitz. Dazzlingly brilliant clinicians such as Norman Brunner and Nathaniel Plotkin seemingly knew every word in the textbooks of internal medicine.
It was not enough for students to have the answer to every question asked on morning rounds or the noon conference; often, a direct citation of a particular study, medical article, or editorial was necessary--chapter, verse, and word, as it were, not unlike the duties of a biblical scholar.
May we contrast this education with the sensory bombardment you endure every day, listening to "advice" from "health reporters" whose hospital experience may be limited to watching bedpans emptied on a popular medical/soap-opera television show? How about the unsolicited "pop-ups" on your Internet browser that give you the latest "nutritional" information? Stop by your local bookstore and count the number of "health books" written by television personalities, whose unique qualifications make such trifles as a college diploma, medical degree, and hospital experience totally unnecessary.
Sad to say, scientific reality is very much a part of human illness--and therefore a set of basic truths, whether we are willing to face these or not. "Where ignorance is bliss, 'tis folly to be wise"--except if you are an overweight diabetic, in which case retinal hemorrhages, dialysis, and impotence might become part of your daily routine. The "truth" that "you can eat whatever you want" with no consequences will eventually become a distant memory.
How do you know that a particular "diet" works well? From promotional advertising? From the testimonials of a few well-paid "patients"? From the mere fact that the products are sold in your local box-store or pharmacy? Do you also believe the claims of every car manufacturer? Do you see every movie released because there are a few good reviews cited in the ads? On Election Day, do you break the handle in your voting booth as you cast your ballot for every candidate? How could you disbelieve any of them?
When I discuss the "success rate" of various famous "diet" programs in a radio interview--as reported by the Journal of the American Medical Association, the British Medical Journal, the Annals of Internal Medicine (none are available at your supermarket check-out counter)--I watch the host's facial expression change into that of a child who has just discovered the truth about the Easter Bunny. The disconnect between the perceived "reality" and the actual truth is a chasm wider than Grand Canyon, even though the data is easily found on the Internet or in any medical library.
If knowledge is power, Americans have a steep learning curve as far as health matters are concerned, especially regarding weight loss. There is enough misinformation to fill several [incorrect] textbooks. Perhaps we should resurrect an expression from the 1960's: "Everything you know is wrong." Yet the more we look for the truth, particularly where our lives are at stake, the better and longer are lives can be. Critical thinking will pay off more when it is applied to critical issues--and there is nothing more important than your own health, safety, longevity, and happiness--all of which are bound inextricably to each other...and to the truth.
Saturday, January 26, 2008
20 Years Ago
In 1988, after four years of intense work as an emergency room attending physician at Cabrini Medical Center, I had made no future plans for my academic career. That January, I was working in a small clinic in Downtown Manhattan with several distinguished cardiologists, surgeons, and other specialists. One of the cardiologists told me that a famous doctor needed an excellent internist to join his practice and that I should apply; he gave me no details but kept recommending an interview. I refused several times.
Finally, more to appease my colleague, I offered to meet him at his office and then we would take a cab to this physician's office-I still had no idea where I was going. And on a snowy January afternoon, we indeed got into a cab, and my cardiologist colleague told the driver "400 East 56th Street" which was, in fact, my home. I assumed that the cardiologist had made a mistake--but as we pulled up my driveway, he told the cab to stop not at the front door but at the nearby medical practice--The Atkins Center.
At precisely 6 p.m. I met the person who had arranged the interview, someone I knew from books and television, the most famous "diet-doctor" ever. His offer to join his practice was certainly a surprise: I didn't accept immediately, and in fact it took several months of persistent phone calls by Dr. Atkins himself--and then a visit to Maimonides Medical Center, the hospital of my internship and residency. I asked Dr. David Grob, to this day the greatest physician and teacher I have ever met, what I should do. To my great surprise, he said "Take the job." I couldn't believe my ears, but because I felt that Dr. Grob was wise and brilliant, I followed his advice.
Twenty years later, I have handed in the draft manuscript for The Park Avenue Diet, a "diet" book unlike any other in publishing history, a veritable lifestyle manual. My thoughts have evolved considerably since 1988, especially about the relatively straightforward therapy we call weight loss. And the nutritional landscape has also changed, not for the better. We will be exploring topics of interest in this blog, following the latest scientific stories, and finding a pathway to better health and longer life. I hope you will be entertained, enlightened, and lightened!
Finally, more to appease my colleague, I offered to meet him at his office and then we would take a cab to this physician's office-I still had no idea where I was going. And on a snowy January afternoon, we indeed got into a cab, and my cardiologist colleague told the driver "400 East 56th Street" which was, in fact, my home. I assumed that the cardiologist had made a mistake--but as we pulled up my driveway, he told the cab to stop not at the front door but at the nearby medical practice--The Atkins Center.
At precisely 6 p.m. I met the person who had arranged the interview, someone I knew from books and television, the most famous "diet-doctor" ever. His offer to join his practice was certainly a surprise: I didn't accept immediately, and in fact it took several months of persistent phone calls by Dr. Atkins himself--and then a visit to Maimonides Medical Center, the hospital of my internship and residency. I asked Dr. David Grob, to this day the greatest physician and teacher I have ever met, what I should do. To my great surprise, he said "Take the job." I couldn't believe my ears, but because I felt that Dr. Grob was wise and brilliant, I followed his advice.
Twenty years later, I have handed in the draft manuscript for The Park Avenue Diet, a "diet" book unlike any other in publishing history, a veritable lifestyle manual. My thoughts have evolved considerably since 1988, especially about the relatively straightforward therapy we call weight loss. And the nutritional landscape has also changed, not for the better. We will be exploring topics of interest in this blog, following the latest scientific stories, and finding a pathway to better health and longer life. I hope you will be entertained, enlightened, and lightened!
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