Chinese New Year - OX (my year)

 It wasn’t a year for the faint-hearted.  The unimagined alignment of COVID pandemic, BLM protests and electoral turmoil stripped the façade off American exceptionalism to expose the underbelly of structural racism and the third who are one paycheck away from disaster.  From cabin solitary to virtual huglessness to stir crazy depression.  Yet an opportunity to tap into the ‘adaptation and resilience’ lessons (oral histories) by nonagenarian Mémée (pediatrician mentor) and octogenarian Margaret (avant garde ink painter) gained from through the interminable WWII bombings in Hague/London and Chongqing respectively.

 

Family

I visited Rachel, John, Jack and Naomi and new addition Memee twice, including this past December courtesy multiple negative tests. Rachel placed a lot of energy into rendering virtual schooling home friendly, family-wide recesses outdoor fun, and amazingly, Jack and Naomi resumed 4.5 days of in-class this fall masked behind Plexiglass – with no transmitted cases!  Football and soccer persisted, virtual piano lessons played, and great hikes taken. 

Mendham crew with Memee

I was not able visit in person as planned in November, but FaceTimed Ben, Theresa, Flora and newbie Juna’s – Flora readily calls me Yeye.  Theresa has fashioned their home into a mini Montessori classroom.  Ben in his final year of fellowship was invited to remain as a physician-scientist.  Flora thrives in Montessori project mode and Juna though not crazy about the bottle is an avid on solids.  

The Denver crew

Halloweenies

Newbie foodie

Naturally I traveled and ate out one-fifth of that previously.  Yet, I was so fortunate to have extended family nearby – Steve, Mary, Becca/Josh/Korben/Garrett, Kat/Steph (wedding on Leap Day) – inside my bubble and after May 21^st saw them weekly.  We travelled together to Door County and their upper Michigan camp together.  After quarantining, I spent two weeks with a friend in Brooklyn and walked the Brooklyn Bridge … Coney Island, visited many

stunningly empty (appointment only) NYC museums and galleries, and ate in outdoors-only  heated curbside shelters.  

My highlight was the video birthday card for which Rachel gathered many of you.  Thank you! 

 

Keeping busy

It has been a healthy interlude for me despite the disruption, in part because of complete control over diet and absence of travel.  Instead of intermittent fasting begun in December 2015, in March I converted to 2 meals a day plan and trimmed 5 pounds.  As gyms closed, I began hiking in nearby Pheasant Branch conservancy – saw osprey, eagles, owls, wild turkey pheasants.  Sifu (master) Tam began telestrating Chen Tai Chi by Facebook and Zoom, resumed Zen (scoreless) tennis with Steve and took lessons, and rode the hilly county roads with Steve and new friend Jeff, a total 1656 miles, my most ever.  

I continued to do ‘fun’ academics of editing, mentoring, teaching, guidelines and organizing a 6-hour Telehealth Webinar with 23 energetic young faculty from NYC to SF.  

I read fewer pages but more than overcompensated by binge watching 400% (whoa) more non-sports movies/series episodes than ever – see below) and unexpectedly enjoyed internecine dynastic struggles among Crown Princes.  I became unaddicted to WordJam after completing all 6070 games to the very last word. Finally, it was a belated revelation to be able to connect the dots of structural racisim between housing segregation (in polluted environs), access to only unhealthy foods and lack of fresh foods, vast income/wealth disparity, eduational disadvantage, differential police enforcement/profiling/mass incarceration and finally as we so vividly saw resulting disparities in health and COVID mortality. We have to do better!   

Zoom provided the needed segue to the outside world of social activity, celebrations, planning meetings, courses, conferences, Theater, and my favorite ‘Old Farts’ group AKA ‘Grumpy old gastroenterologists’.

 

It was daily déjà vu, life interrupted, a year to remember (including those needlessly lost) and not to forget … 

 

Get your vaccine and see you when.

 

Addendum – some entertaining and thought-provoking mind candy:

Topical:  Second mountain David Brooks, The system Robert Reich

Health:  Lifespan (body) David Sinclair, Successful Aging (mind) Daniel Levitin, Breath James Nestor

Biographies:  Obama: a promised land, Van Gogh, Splendid and Vile Erik Larson

Biopics:  Be water: Bruce Lee, Michael Jordan, Tiger

Movies:  Bong Joon-ho: Parasite (Academy Award), Snowpiercer, Okja, Mother

Dynastic intrigue:  Rookie Historian (Korean heroine) – 20 episodes, Princess Wei Young (Chinese heroine) – 54, Rising Phoenix (Chinese) – 70, Longest Day in Chang ‘An (Tang dynasty) – 48 episodes

Mysteries:  Bosch (AP), Endeavour (PBS)

Asian American:  Minor Feelings Cathy Hong Park, Interior Chinatown Charles Yu, 

First Vote (movie):  niece Jennifer Ho as one of four main interviewees

Breath, the book

Another book recommendation for the Lunar New Year.  Question:  what do Yogis, Buddhist monks, functional oral surgeons and orthodontists, Stanford ENTs, opera coaches and deep (sea) divers have in common?  As James Nestor tells in his bestseller ‘Breath: the new science of a lost art,’ they are all ‘pulmonauts’ seeking health benefits through practice, study, and science of breathing.  This is a very readable, intriguing and life-provoking account of his journey of self-healing from skull-full catacombs of Paris to pulmonaut practitioners and scientists around the globe – many initially considered to be outside the mainstream.

 

Here are some fun facts:

-       We take 670,000,000 breaths during our lifetime and breathe 30 lbs of air per day.

-       85% of our weight loss occurs through the weight of expired CO₂ in the breath!

-       CO₂ maybe more important than O₂!  CO₂ enhances oxygen release from hemoglobin.

-       In a study of 1000+, the healthiest individuals had CO₂s of 6.5-7.5% whereas normal is considered 5%.  Conversely, the unhealthiest with multiple health problems were at 4%. Hypoventilate!

-       The perfect breathing rhythm – used by yogis, Buddhist chanters, Hindu khechari, Latin rosary, Native Americans, Taoists – was measured to be 5.5 sec inhales, 5.5 sec exhales or 5.5 breaths a minute!

-       Mouth breathing is very detrimental to health – within 10 days it can lead to sinus infections, increased stress (cortisols), snoring, sleep apnea as well as fatigue, anxiety and irritability.

-       Panic anxiety may be induced by CO₂ chemoreceptors in the amygdala – this is for my neuroscience friends.

-       Prolonged exhalation (Andrew Weil’s 4-7-8 inhale-hold-exhale count) increases heart rate variability and enhances the calming effect of the parasympathetic nervous system to counterbalance the sympathetic fight-or-flight system.

-       Today’s breathing problems (sleep apnea, snoring) and crooked teeth go lung-in-mouth, the cumulative effect of lack of mastication from our soft food diet – early man had and all other mammals have perfectly aligned teeth!  We are the humanoid exceptions.

-       Our diet and consequent lack of chewing induces a narrowed jaw and air passages – this can be reversed using gum chewing and palate expanders within a short period even past the age of 70 (documented by CT scans)!

 

So how about a summary:

Breathing/energy may be the unheralded missing pillar of health.  Improved breathing addresses many functional disorders of civilization including stress, anxiety, irritable bowel syndrome, sleep disorders, presumably through calming effects on the autonomic nervous system.  Although it cannot cure cancer, optimal breathing appears to have a beneficial effect on some diseases such as asthma, emphysema and ADHD.

 

Action points:

-       Shut your mouth and breathe through your nose – following 10 days of forced mouth breathing, resumption of nasal breathing resolved sinus congestion, high blood pressure, elevated stress/cortisol levels, snoring, sleep apnea etc.   

-       Exhale longer – Andrew Weil’s 4-7-8 inhale-hold-exhale practice can help one sleep and enhance the calming parasympathetic nervous system.  

-       Hold your breath – it retools your CO₂ chemoreceptors to help deliver oxygen to tissues more efficiently, a technique widely used by elite athletes.

-       Just breathe slower using the 5.5 sec inhale and 5.5 sec exhale (synchronizing apps are available) – 10 to 15 minutes of practice a day has been shown to reduce high blood pressure …

-       For crooked teeth, instead of braces, consider tongue exercises, gum chewing and palate expanders.

 

All in all, a breathtaking tome (couldn’t resist),

Another really good book on ... aging

This is another book ‘review’ for my friends, family and colleagues by Daniel Levitin (neuroscientist and professional musician) aptly entitled for us “Successful aging:  a neuroscientist explores the power and potential of our lives”.  The title sounded, well … but it is extremely well researched, well written, thoughtful and impactful for our age group as we prepare for the next phase(s).  The tome presents the latest findings on psychology and neuroscience from a developmental perspective and sprinkles in many anecdotes from active elders from our generation, Joni Mitchell, Steven Stills, Paul Simon, Pablo Casals, Jane Fonda, Dalai Lama, along with many older researchers as well.  It's dense but readable.

 

I enclose the outline, healthy practices to maintain intelligence, a definition of wisdom, and his ‘prescription’ for keeping the mind going.

 

Contents

1.     Continually developing brain

a.     Personality, Memory (sense of you), Perception, Intelligence (problem-solving), Motivation, Social, Pain

2.     Choices we make

a.     Internal clock, Diet (brain food), Exercise, Sleep (memory consolidation)

3.     New longevity

a.     Living longer, Living smarter (cognitive enhancement), Living better (telomeres etc)

 

Health practices to main intelligence

C – curiosity

O – openness

A – associations – engage with others

C – conscientiousness – follow-through (he thinks this is tantamount)

H – healthy practices (diet, exercise, sleep etc)

 

Definition of wisdom

1.     Social decision-making ability and pragmatic knowledge of life

2.     Prosocial attitudes and behaviors

3.     Ability to maintain emotion homeostasis (tendency towards positive)

4.     A tendency toward reflection and self-understanding

5.     Acknowledgement of and coping effectively with uncertainty

6.     Valuing of relativism and tolerance

7.     Spirituality

8.     Openness to new experience

9.     A sense of humor

 

Rejuvenating your brain 

1.     Don’t stop being engaged in meaningful ‘work’.

2.     Look forward, not backwards.

3.     Exercise, preferably in nature.

4.     Embrace a moderated and healthy lifestyle.

5.     Keep your social circle exciting.

6.     Spend time with people younger than you.

7.     See your doctor regularly, not obsessively.

8.     Don’t think of yourself as old.

9.     Appreciate your cognitive strengths (pattern recognition, crystallized intelligence, wisdom, accumulated knowledge)

10.  Promote cognitive health through experiential learning (traveling, g’children, new activities and situations)

 

Live on, live well!

   

Oh Canada, On Wisconsin

From national anthem to university fight song it illustrates where I could-a-been, would-a-been, should-a-been this summer of COVID-19 … to where I am.  It's ground hog day in Middleton, waking up in the same place for months for the first time decades.  And for the first time in 14 years it appears that due to ban on non-essential travel, I won’t make it up to the kinder, gentler north!

Comparative COVID cases in British Columbia and Wisconsin (5+ million both).  I thought BC cases were poised to explode due direct China traffic and the nearby Washington outbreak.  I was wrong.  BC began at 2/3^rd the number of WI cases in March and have fallen to 1/14 – a completely flattened curve!!!   From Vancouver friends to NY Times accounts this is directly due the leadership by provincial health minister Dr. Bonnie Henry.  It’s more than her policies, it has been her daily televised communiques where she provides the numbers, educates, reassures, empathizes and stresses civic responsibility.  This approach has led to a high degree of compliance with masking, social distancing, and contact tracing.  And no surprise what competent female leader can accomplish in a crisis.

So instead of metro Vancouver which has been a combination of summer Chinese immersion and Tai Chi boot camp, I’m ensconced in a mostly medium-sized, white, midwestern town of 38,000 adjacent to scenic Madison, the home of University of Wisconsin, the State Capitol interspersed between four large lakes.  Everything is so convenient, nature conservancy in the back for hiking, groceries 200 feet, Asian food store 0.5 and Costco 1 mile distant.

It has allowed a big time climb back into road biking, in 20-40 mile stretches several times a week replete with 15+% hilly grades (Tour de France) by myself, with Steve, and neighbor Jeff.  One of the unexpected delights is the abundance of bike only paths and being able to reach country blacktop within 0.5 mile of home.  I’ve been humbled by having to walk up the last quarter of two exceedingly steep climbs – and just retooled my rear cassette to give me two extra gears to ascend to the very top!  My favorites passageways meander downhill through tree-covered S-curved arbors at 30 mph.

The landscape explored by bike provides rural views from the hilltops not scalloped by glaciers.  From atop, I can view verdant expanses in a mosaic of green (8 ft corn) in perfectly aligned rows topped with amber (corn tassels), dark green (clover or soy beans), light green (hay), brown (plowed dirt) over rolling terrain with aroma of … fresh manure.  These pastoral vistas are sprinkled with groves of trees, patches of forests, streams and ponds, and dairy farms with black and white Holsteins while reaching skyward with silos, church steeples and wind turbines.  And the bike path is lined by purple and yellow wildflowers and white Queen Anne's lace suspended above.     

Not being able to visit immediate family and Ben’s newbie Juna, I do have extended family here with Steve & Mary and three generations and the Chun Clan here.  Given the time we spent together up at Mary’s modernized ‘camp’ in northern Michigan with all-new indoor toilets and hot water (!) playing games, constructing a hunt for buried treasure, swimming and boating, Korben age 7 in a very touching request asked me if he could have a sleepover with me!  And interviewing two nonagenarians for 3-4 hours a week each has woven a rich tapestry for me that has revealed to me how multiple displacements during WWII (and air raids), women struggling in a man’s world, toggling between east (China) and west (Europe and America), and always adapting to changing circumstances led to wisdom and artistic brilliance respectively.

Am in the best physical shape in 20 years and my two remaining neurons are still firing. 

So despite the constraints, life is full.  And, I'm thankful. 

 

B.S.  (Book Script)

 One quick and relevant read is Robert Reich’s (Clinton’s Secretary of Labor) “The System:  Who rigged it.”  In a nutshell, he delineates three systemic changes wrought by Ronald Reagan in 1980 that has led to the dramatic economic inequality, hollowing of the middle class, extreme concentration of wealth and simply put oligarchy, over the past 40 years.  And, he doesn’t let complicit liberals off the hook either.

1)    The shift from corporate governance from stakeholder governance (that included employees and public interest) to pure shareholder interests (basically profits)

2)    The shift in bargaining power from large unions to giant corporations with consequent reduction in relative wages and concomitant 15-fold rise in CEO compensation

3)    The unleashing of financial power of Wall Street through deregulation leading to stagnant wages, financial crises plus what he termed “socialism for the rich (bank bailouts) and harsh capitalism for the rest”

We are no longer in Kansas …

So said Dorothy to Toto.  On Feb 29, the auspicious leap date on which Steve’s daughter got married, I told good friends that we were about to enter the twilight zone, never fully realizing the extent of what would unfold.  And so, where in the world in Carmen SD … B Li?  A reasonable question as I was in Middleton only 28% of 2019.  But, of course, the question is moot in this twisted, twilight zone!  Friends and relatives of friends were severely affected by COVID-19 in NJ and NY with two succumbing, NYC colleagues experiencing the unimaginable.    

Baby Juna

Most importantly, Theresa and Ben’s second daughter Juna arrived just a day late on July 9^th!  As her Montessori school closed, Ben got up to study (master’s) at 4 am, then took care of  Flora from 7 am, while Theresa worked from home, and then they flipped in the afternoon.  Flora enjoyed the close attention and continued her self-directed, Montessori-style puttering from one activity to the next.  She said “Happy Birthday, Yeye” (paternal gramp) last week!

Big Sis Flora

Jack & Memee

Naomi

Jack and Naomi’s public school amazingly transitioned to daily 40 min Zoom classes, including gym and music, yet despite that effort Rachel noted a decline in learning.  Like all families, she bore the brunt of maintaining school and piano discipline, nutritional and mental health.  After a big sigh of relief, she is taking both swimming at a nearby recreationalized pond.  Fast Naomi has been invited to play on a travel soccer squad a year up.  And Rachel compiled video clips into the most wonderful recorded birthday card from many of you!  Best ever.

And so we adapt.  Flightless since returning from NYC on March 17.  Auto trips only to Milwaukee and to Mary and Steve’s northern Michigan camp.  Constricted in-person social circle but expanded tele-reconnects with family, high school, college, residency mates, former colleagues/mentees/mentor (Memee 90+) and AsAm medical students. Less reading (Van Gogh, Bruce Lee bios), more watching.  But without sports ... unexpectedly enjoyed Chinese and Korean dynastic series, “Rise of the Phoenixes, Rookie Historian, Princess Weiyoung, Last day in Chang-An” with strong heroines but … 50-70+ episodes.  Limited to two meals/day to control weight without exercise facilities.  Tai Chi by tele-teaching by Master Tam in Vancouver.  In spring, hiking/bird watching in the nearby conservancy with Steve.  And summer, tennis with Steve, biking with Jeff, now up to 50-60 miles/week.  Virtual dating.  In a throwback, I picked up the guitar after 40+ years with arthritic hands.  JT, here I creak and croak again.

And so we learn.  The myth of American exceptionalism.  Watched “13^th Amendment, Just Mercy, I am not Your Negro” that connect dots between slavery, Jim Crow, mass incarceration, social inequality and contemporary lynching (by authorities).  Caste by Isabel Wilkerson argues that it goes beyond race to a fixed, socially-constructed caste system.  Watching PBS’s “Asian Americans” with former schoolmate talking heads, Helen Zia and Gordon Chang and “First Vote” with niece talking head (on anti-Asian racism*,**) Jennifer Ho who is the Director of the Center for Humanities and the Arts at the U. Colorado – so proud!   Learning that Asian American health providers and medical students have been sadly and ironically (while others are feted) targeted by anti-Asian racism. 

And so we retire.  One sleepless night, tossed and turned up the idea that I should be contributing something … telemedicine?  I got approval and funding from our national organization, and within 5 weeks Zoom-organized 23 faculty into a 6-hour Telehealth Webinar with 500+ registrants.  Most importantly found two faculty to lead continuing Telehealth projects.  Cyclic vomiting syndrome (yes Suzanne) keeps me up(chuck) to date with guideline revisions, chapters, talks and research mentoring.  APAMSA prepared for next steps with an 8-hour strategic retreat by Zoom.  And I am interviewing artist Margaret Chang (Hong Xian) to collect materials for a possible small biography.  Hmm, I seem to be working.

"Floating without end" by Hong Xian

As Lois said in her birthday greeting, “count your blessings, not your candles.”  Said perfectly.

So as life is placed on pause, take some time to glimpse inwards while reconnecting virtually outwards … here’s a Coke zero with a twist of lime toast to adaptability (and positive changes to come) … 

REQUEST YOUR MAIL-IN BALLOT

*https://journalofethics.ama-assn.org/podcast/ethics-talk-spread-anti-asian-racism-and-xenophobia-during-covid-19-pandemic (interview with the AMA)

**Anti-Asian Racism & COVID19.pptx (can ask me for it)

Coronaville – our new home

Whether you are on staywork, furlough, staycation, self-isolation or quarantine .. it’s no longer Margaritaville. Aunt Terri (Teri’s sister) asked me to share my recent experience and thoughts with you.  

I visited NYC for Asia Week (largest Asian Art fair in galleries and museums) 2½ weeks ago as I had the past four years.  Just as chaos was erupting heralded by the closure of major museums and Broadway.  Susan and I dropped into empty art galleries, one opened just for us after my call – the owner wore a mask.  On Saturday night, Broadway was unprecedently deserted, we along in usually full restaurant and one of a handful at an off-Broadway whodunit.  We took the emerging CoVID concern seriously but not fastidiously seriously.  For example, we elbow bumped instead of hugged, but didn’t distance or mask even though not yet recommended.  Ben called me repeatedly, “Dad you’ve got to get out of NYC, it will the next epicenter!” (before it became so) and shared articles (on community acquisition) as well as his frontline experience.  Somewhat reluctantly, I shortened my stay and returned to a less exposed Middleton, Midwest.  A few days later Susan alerted me that our mutual friends both tested positive, and that she had spent four hours with them before onset of symptoms and that I had been secondarily exposed.  I then went into self-quarantine for 2 weeks.  Fortunately, both of us … remained healthy.  We dodged a bazooka.

What did I learn?  Despite burdensome anticipation from an indirect CoVID contact, I was relieved to be alive, and well.  I indeed had not fully pondered the early on risk.  Were it not for Ben, I would not have altered plans.  He acted pointedly like a parent for which I am truly grateful and thank-full.  I am concomitantly humbled as parent and physician.

Like you at home, I’ve had a chance to speak with numerous family and friends in the US and Canada.  I have read many articles, heard presentations, spoken to my retired from CDC classmate, listened to overwhelmed front-line (including Ben) physicians, and carefully followed my two CoVID + friends.  After an interminable two weeks of fever, cough, shortness of breath, low oxygen levels, their course finally turned.  Like all of you, I still worry for others.  

A few numbers and observations I wanted to share.  Some may be helpful.

1)    Infectivity, compared to influenza.  While a single case of influenza (which I had this spring) is estimated to potentially infect 400 others over a 2-month period, a single case of CoVID could similarly infect 100,000!  Like a California wildfire, it only takes one (ironically even at a funeral) to ignite a whole city.  And, CoVID is 20X more likely to cause mortality than flu.

2)    Spread by whom.  No longer just travelers and the obviously infected, it is in the community even spread by the asymptomatic (except for loss of taste and smell) infected persons.  It is running silently and ubiquitously in our communities.  And, in the absence of herd (previous) immunity it can run rampant, via direct cough droplets, via indirect surfaces (20 hours), in the air (3 hours) and possibly stool.

3)    Who.  Although 80% of cases are mild or moderate, 20% require hospitalization and 5% need ventilators and are at a significant risk of dying.  Serious cases appear to require almost a month in the ICU (much longer than usual) and overwhelms critical care and supplies.  Besides the chronic disease risk factors (especially hypertension due to ACE2 receptor?), it has a predilection for males (70% fatalities) especially over 80 years.  Yet in is not only the elderly as 40% of NYC in-patients are < 50 years.  What is causing deaths not the virus so much as the body’s immune overresponse (cytokine storm = systemic inflammatory response syndrome SIRS) leading to adult respiratory distress syndrome and multisystem organ failure.  And, who wins, and more importantly, who loses ventilator lottery? 

4)    Social isolation and distancing.  The countries where they have stopped CoVID cold, including Taiwan, Singapore, and in South Korea, have done so early self-distancing and isolation and by extensive testing, tracking all contacts of positives, and quarantining.  We don’t have that capability.  However, this flattened curve doesn’t mean you won’t eventually acquire CoVID but avoiding a CoVID mushroom cloud will relieve an overladened medical system and provide a better chance for survival later on.

5)    Medications.  Hydrochloroquine antimalarials do show promise in trials (controlled study from Wuhan), but it may be even better when coupled with azithromycin (Z-pack).  Remedesivir a failed IV anti-Ebola agent shows promise and is currently in trials here.  Tocilizumab an IV anti-inflammatory agent in one case report calmed the cytokine storm.  A vaccine is at least a year away.

So friends and family, take care and be safe.  Follow the guidelines especially washing your hands anytime your go out or return with regular soap and water for 20 sec up to your wrists.  And, if you should get symptomatic – fever, cough, shortness of breath, muscle aches, headaches + loss of taste, diarrhea – please get tested if available and self-isolate.  

Equinox unseen

under Corona glare

daffodils arise 

Three non-fiction bestsellers

Three impactful bestsellers all came in concomitantly from my library request list in the last two weeks and are worth a mention as tasteful food for thought in this Chinese New Year of the Rat.  

Talking to Strangers:  What we should know about the people we don’t know [how our interactions with strangers often go wrong] – Malcolm Gladwell

This is another Gladwellian foray into the maze running behind curious human behavior.  This book is apropos now when the world feels irretrievably polarized as it tries to examine ways we misinterpret or fail to communicate with one another, especially strangers.  It begins with death of Sarah Bland after an undeserved traffic stop spirals out of control, extends to those of numerous unarmed African Americans in police encounters and traverses all the way to blind spots at the root of historical tragedies.  How did Fidel Castro fool the CIA for a generation? Why did Neville Chamberlain think he could trust Adolf Hitler?  Why are campus sexual assaults on the rise?  Then onto wide-ranging front-page incidents involving the deceptions of Bernie Madoff, the trial of Amanda Knox, and the child-abuse scandal involving coach Jerry Sandusky.

Gladwell argues that the flawed tools and strategies we use to make sense of people we don't know invites misunderstanding and conflict with profound unintended consequences.  One of the misperceptions is that we autonomically default to is taking strangers at their word so-called ‘default to truth’ which was at the heart of a CIA double agent, sexual abuse of gymnasts and the unwarranted trust of Hitler.  He explains other types of miscommunications, especially when strangers’ actions that do not conform to accepted norms (“transparency”) and when a failure to recognize a connection between behavior and external factors (“coupling” or context) allows us to radically misinterpret the intended action.

At times the book felt a little too facile, too sensational, but it did explain why the overextension of police policy of geographical profiling and using incidental (tail light) infractions to stop ‘suspicious’ citizens (with the hope of finding contraband) led to unfortunate interactions that resulted in too many unwarranted deaths.  Sobering.

Life span:  Why we age – and why we don’t have to.  David Sinclair PhD

When I first saw this title, I thought it must the hyperbole of the fountain of youth.  But, after reading it, I learned a lot about mechanisms and treatment of aging (especially sirtuin system), some of which … could be life changing now!  Dr. Sinclair is an eminent Harvard geneticist who studies aging and is a strong proponent of studying aging as a disease, that is the core malfunction that underlies specific diseases – cardiovascular, metabolic (diabetes), cancer and neurodegeneration (Alzheimer’s).  He maintains that if we fully understand the aging process, we will be able to circumvent or substantially delay many of the known diseases and experience a markedly enhanced quality of life.  It seemed fanciful at first glance, but he is quite convincing.  

Indeed, many of the key mechanisms have already been elucidated by his and other laboratories – in worms and rodents – and can extend lifespan by 5-20%.  The main one is the ancient sirtuin protein that toggles back and forth between fertility vs. repairing damage.  Resveratrol (red grapes/wine yea!) and nicotinamide mononucleotide stimulate sirtuin and delays aging – the latter even restores fertility in aged mice (grandma become new ma?).  Rapamycin inhibits mTOR (even given at the end of life) in simple cells and metformin activates AMPK (mimicking fasting) with reduced dementia, CV disease, cancer and frailty in 41,000 humans!  A second is epigenetic reprogramming – the Yamanaka (Nobelist) factors – which in simple systems can reverse cellular aging as if hitting a reset button.  BUT, as of yet there is no definitive evidence that these will work in us and long-term side effects are yet unknown.  But as we speak, human trials have just started but may be years to conclusion.  

Dr. Sinclair to his credit, discusses the demographic, nutritional, climatic, social and moral implications of these momentous possibilities.  He and others project that our grandchildren will on average live to 100 years and that people will have 3 careers, a main one, plus two others lasting until the age of 90.  Accordingly, I’m aspiring to be a 90 sprightly Walmart greeter!  I also much appreciated the extent to which he gave credit to others in the field and especially his laboratory post-docs.

Lastly, despite the unknown, he has hedged his bet and reveals what he is doing to improve his own odds of aging gracefully.  He emphasizes lifestyle modification – intermittent fasting, low protein, plant >animal protein, exercise and sleep which we have discussed.  All grandma’s advice.  But he also takes metformin, resveratrol (100s glasses of red wine worth/day) and nicotinamide mononucleotide, an active metabolite of vitamin B6.  

This was fascinating and thought provoking and for me a life changer to find what is known and what one can do potentially do now for oneself.  And I’m going to hedge my bet as well.

Range: Why generalists triumph in a specialized world.  David Epstein (sportswriter)

What's the most effective path to success?  Epstein begins with Tiger’s terrible twos when he already knew he was going to become a golfer and after racking up hour after hour of deliberate practice he outpaced everyone without such a head start.  It turns out, even among elite athletes, early specialization and focus is the exception not the rule.

Having exposure to multiple sports, multiple types of creative arts, multiple academic disciplines, multiple jobs appears to help in several ways.  It allows the child to trial and find a match, it provides a breadth of background which informs unique problems, and it allows the problem solver to draw analogies from a wide range of experiences.  For example, too often it is I have a hammer and there is a nail therefore I … yet the stent-hammering cardiologist continues on despite the equivalent outcome of conservative treatment.  In fact, grit may be overvalued in many who simply change instruments, fields, or jobs due in truth to trying to find a better match rather than from lack of persistence.  So, while experts argue that anyone who wants to excel in a sport, an instrument, or a field should start early, focus intensely, and practice deliberately, data suggests otherwise.

At first, I thought Epstein, an award-winning sportswriter, was selecting data, perhaps even outliers.  But as he reviewed life stories and group analyses of top achievers, he discovered that early specialization is the exception and broad exposure is more the rule.  In domain after domain, from elite (Roger Federer) athletes to artists (Van Gogh), musicians and composers, inventors (of Nintendo, glitter, Apple), forecasters, scientists and Nobel Laureates (Cajal), this pattern seems to hold true.  In a complex and rapidly evolving world, generalists, who typically find their path later than earlier, rather than specialists solve/discover/invent the big and difficult ones. By balancing different interests, they appear to be more mentally agile and more able to make connections (analogies) across fields that narrow specialists cannot see.  The most impactful inventors and Nobelists often cross domains rather than plunge into a single area alone.

This book is one of the most insightful books about learning that ever I’ve read and is relevant to our kids, especially grand kids, teachers, professors … mid-career change.  For our grand kids, having to figure out the hidden rule rather than simply memorizing the short cut, failing a test, quitting a sport or instrument and taking up another appears to be in the long-run the best way to learn.  I realized belatedly how my dilettante-ism (interest in humanities – religion, psychology, medical anthropology) enabled me to delve into grey areas of functional mind-body GI disorders, develop diversity curriculum and understand Asian American medical students.  I came to view Ben’s 7-year walk-about differently as an experimental, matching and maturing phase in which his sociology studies, experience with underserved, goal of social justice, and humanities coalesced into his unique career path.