Vol. 214 June 1, 2019 JUULING AND SCHOOLING

June 1, 2019

“Nicotine addiction begins when most tobacco users are teenagers, so let’s call this what it really is: a pediatric disease.”
-David Kessler, MD. Commissioner of FDA, 1995

 


When I was a young parent my kids’ souls were threatened by the dangers of  “sex, drugs, and rock ‘n roll”. THEIR kids are facing a new triple threat, “marijuana, video games, and vaping”. Vaping? (pronounced with a long ”a”) Really? (pronounced with a short “a”)

How can inhaling flavored water vapor with either no or just a touch of nicotine be dangerous? Let Jonathan Winickoff, MD, MPH, Professor of Pediatrics at Harvard Medical School and Director of the MGH Tobacco Research Treatment Center list the reasons:

First of all, there is no water in vaping solutions. Vaping is NOT inhaling water vapor. It is inhaling particulate matter of numerous chemical compounds in mostly propylene glycol and glycerin. When heated these compounds degrade to formaldehyde. The vapor also contains carcinogenic organic and inorganic chemicals, cytotoxic nano-sized metallic particles from the heater coil, silicates (like in sand), and ALWAYS nicotine. All vaping solutions contain nicotine despite the label that says “contains no nicotine”, or even more cleverly “contains no nicotine tar”, which means of course “no tar”. Currently there are no FDA regulations about labeling vaping solutions. Companies can label and market anyway they wish without any accountability.

Vaping solutions are flavored to lure teens into using because teen age vaping does lead to dependency on nicotine and a significant percentage of teenage vapers go on to smoking cigarettes (“combustible tobacco”). This assures a continued revenue stream for tobacco companies. Mint, menthol, and mango are apparently the favorite vaping flavors (gives new meaning to “3M” doesn’t it). Flavors in cigarettes were banned by federal law in 2009 except for “menthol and mint”, but the federal ban specifically did not apply to e-cigarettes. There are over 8,000 vaping flavors available.

Juul (jewel) is the most successful vaping company owning about 75% of the market. Juul is so successful that it has become a verb, as in “Do you Juul?, Lets Juul.”

A Juul pod of vaping solution contains about 200 “hits” or puffs which is the equivalent of a pack of 20 cigarettes. Pods are used in devices that previously looked like cigarettes, hence the term e-cigarette, but now vaping devices can look like pens, superhero figures, a miniature coke can, and, most  commonly, a computer thumb drive. One middle school kid laughed at his father’s confusion by saying, “We don’t use thumbdrives any more. Every thing is in the Cloud. If you see a kid with a thumb drive, he is vaping.”

Taking 300-400 hits a day is common. Unfortunately taking an occasional hit as an “experimental rite of passage” can progress to increased use and an unrecognized dependency. JuuLing periodically on the week ends can lead to withdrawal symptoms of anxiety, distraction, and increased body movements on non-use school days. Those are the same symptoms of ADHD.

A popular device, a Sourin Drop, is available in many different colors and is small enough to hold (“conceal”) in the palm of your hand/ It is a refillable device (unlike a JuuL pod which you buy pre-filled) that lets you mix flavored vaping solution and marijuana (THC) so that they can be inhaled together as a mixture.

Juuls are much easier to use than cigarettes to use; you don’t need a match, there is very little aroma, there is no butt to get rid off, they can be used in NO SMOKING zones, and there is certainly no tell-tale stain on your fingers.

A pod cost about $4 and can be bought online easily without proof of age despite the requirement to be over 18.. Needham, MA was the first town in America to ban sales to those under 21, and Hawaii was the first to establish a state-wide ban. Fourteen states have now followed Newton’s example and prohibit stores from selling vaping solutions to those under 21.

Tobacco companies are investing heavily in e-cigarettes. They know that the younger a person is when nicotine is introduced the more likely they will become a life-time tobacco user. They deliberately, purposefully, and relentlessly market vaping to young people. Nearly 40% of high schoolers and nearly 15% of middle schoolers have vaped at “least once”. Use of vaping in places where smoking is prohibited also helps produce a second income stream for tobacco companies.

A lot of this “threat-to-teen-agers-talk” does sound like old hat to some of us old guys , but vaping has the potential of some serious unattended future consequences for our youths. Most of us did survive the dangers of sex, drugs, and rock’n roll after all, and what will be the inevitable triple threat for future teen agers : “space dust, AI simulations (‘feelies’), and audio-visual implants?”

Action plan:

  1. Call your Massachusetts statehouse representative to support the passage of H. 1902 which bans the sale of “all flavored tobacco products” in Massachusetts.
  2. Lobby in your own town to ban the sale of flavored tobacco products to anyone under 21 years of age.
  3. Let your kids and grandkids read this blog.

Vol. 213 May 15, 2019 Fake Nutritious Foods

May 15, 2019

        “Food packaging can be very confusing”

                           -Whitney Linsenmeyer, Ph.D, R.D., St. Louis University

In case you haven’t noticed, the widespread proliferation of nutritious sounding labels in food marketing continues; as in “natural”, “local”, “fresh”, “farm-to-table”, “organic’, and even “gluten-free”. Consumer Reports On Health has tracked food marketing and packaging trends for years. Its June 2019 issue highlights “8 foods that seem healthier than they really are”.

Veggie Sticks – Even if not always green, what could be more nutritious than vegetables?
A professor of nutrition at Boston University calls them “produce pretenders”. Made with potato flour and starch, oil, salt, and just enough vegetable powder to give it color, it is “not much better nutritionally than a potato chip”. A better choice: 4 cups of air-popped pop corn with less calories and much more fiber. Hold back from adding salt and butter.

Rice Cakes– Even the whole-grain brown type of rice lacks fiber and, like other rice products, may contain arsenic.
Flavored varieties can load up on sugar and salt. If you are going to use a rice cracker/cake at least put peanut butter, sliced banana, or humus with a tomato slice on it for more protein and fiber.

ARSENIC!? – It has been known for years that rice picks up arsenic from the soil in which it grows. Arsenic (chemically a “heavy metal” ) is a natural element in the soil. It’s truly “natural”, as in “found in nature”. It is found in trace amounts in all types of rice.  Brown rice can have 80% more arsenic than other types.  The region also makes a difference with Texas rice at the high end and California rice at the lower end. Can it poison you? NO. The FDA permissible arsenic level in drinking water is 10 parts per billion (ppb). One brand of rice cake grown in Mexico tested at 17 parts per billion, and the FDA directed the U.S. company importing it to change its manufacturing process.

Spinach Wraps – That healthy-looking green hue is often just due to food coloring.
The amount of spinach in it can be negligible. Most wraps are made with refined white flour so have very low fiber content.

Protein Powder – Most Americans consume enough protein in their daily food. No supplement is necessary.
The downside of these powders is that some brands have been found to have significant levels of heavy metals and other toxins. Peanut butter in your smoothie is a more reasonable way to add protein if you wish.

Turkey Burgers – They may be no more nutritious than regular beef burgers. Wait a minute, is nothing sacred?!
“Butterball ground turkey” has the same calories and saturated fat amount of a beef burger because of the inclusion of dark meat and skin, but “Butterball ground turkey breast  has about one-tenth the saturated fat.

Bran Muffins– Here it is a matter of size. Muffins are often cupcakes.
The Au Bon Pain raisin bran muffin weighs in at 5 ounces and packs 430 calories and 31 grams of sugar. If really desiring more bran, go with all-bran cereal.

Granola – How can a mixture of oats, fruit, and nuts not be good for you?
It’s the calories of the added sugars, fat, or whey protein concentrate. Better choice: make your own with shredded wheat cereal with some sugar and almonds added.

Instant Oatmeal – It is so “instantly” digested that it can give you a spike in your blood sugar and a shorter period of hunger satisfaction.  Packets flavored with brown sugar or maple syrup can contain more than 9 grams of added sugar. Cooking “steel-cut” oats (round kernels) or microwaving “rolled” oats (steel-cut oats crushed flat) and serving with fruit, a little fruit butter, or cinnamon is a better choice.

Obviously its the added sugar, salt (sodium) and/or saturated fat that belies the “nutritious” label. A recent report from the National Academy of Medicine recommends that the maximum adult daily sodium intake should be 2,300 mg. The average daily sodium intake of Americans is above 3.400 grams.

Now that restaurants are listing calorie counts in their menus you may think you are home-free in striving to eat healthy, BUT Applebee’s Cedar Salmon has only 370 calories AND 19 grams of sugar and 1530 mg of sodium, Chipotle’s Vegetarian Bowl has a whopping 11.5 grams of saturated fat and 1830 mg. of sodium, while even Panda’s Express “Black Pepper Chicken” has close to one-half of the daily requirement of salt.

Reading food labels can be difficult . . . confusing. . . and time-consuming.

PS: A couple of my kids and their kids are not going to like this blog since some of these foods are their favorite “healthy snacks.”


Vol. 212 May 1, 2019 MMR Vaccination Updated and DTaP Explained

May 1, 2019

YET ANOTHER STUDY PROVES THAT MEASLES VACCINE DOES NOT CAUSE AUTISM
An eleven year study of 657,000 Danish children showed that those who received the MMR vaccine had no increased incidence of autism. In fact, the girls who received the vaccine had a 5% reduction in their risk for autism. In Denmark all vaccinations are free of charge and voluntary. When 95% of children in a community are vaccinated against measles the 5% of unvaccinated children are protected through “herd-immunity” due to the reduction of exposure to the highly contagious measles virus.

Measles was declared “eradicated” in 2000. Since then we have had unexpected U.S. measles outbreaks in 2014 and presently we are breaking all records for new cases (78 cases just this very week). Since January 1, 2019 the U.S. has had 465 cases in 19 states. Recent U.S. measles outbreaks in Brooklyn, NY, Portland, Oregon, and Rockland County, NY were caused by unvaccinated visitors to an annual Jewish pilgrimage in the Ukraine returning to their unvaccinated orthodox Jewish communities in the U.S.

Surrounded by states with nearly 700 new measles cases Dayton, Ohio is voicing concern about a measles outbreak in their city. Of the 9 counties in Ohio 8 have measles vaccination rates between 90 – 93%. Montgomery County, Dayton is the county seat, has a rate of only 88%. Remembering that herd immunity is achieved at 95%, Ohio, which requires proof of vaccination within 14 days of school attendance, is considering rewriting their current reasons for exemption (about 9% in Montgomery County) of “religious, medical, or reasons of conscience.”

THERE IS NO HERD-IMMUNITY FOR TETANUS
The “T” in the DTaP vaccine stands for tetanus. Tetanus is not a contagious disease like measles. It is caused by wound contamination with a bacteria that causes intense, painful muscle spasms, clenched jaw (“lockjaw”), and extremely unstable vital signs.  The tetanus vaccine is the only protection against tetanus.  It is rare because most children receive the tetanus vaccine. Oregon in 2017 reported its first case of tetanus in thirty years. An unvaccinated 6 year old sustained a cut on his forehead while playing on a farm and developed tetanus. His 2 month hospitalization cost $800,000. The total bill for his care including rehab services and transportation exceeded $1 million. Upon discharge the parents continued to refuse any immunizations for him  including a tetanus vaccine booster to complete their child’s protection!

PERTUSSIS (“WHOOPING COUGH”) OUTBREAKS HAPPEN IN THE SPRING
The “P” in DTaP immunization stands for pertussis and the standard recommendation is to get 4 DTaPs before age 18 months ,starting at 2 months, with a booster at 6 years and as a teenager. Our periodic pertussis outbreaks can not be blamed wholly on anti-vaxxers who refuse immunizations because the pertussis vaccine is not as effective as other vaccines in maintaining protection; the immunity created by the vaccine wanes over time. The little “a” in front of the “P” stands for “acellular”. The acellular vaccine has less of the side effects of injection site pain, temporary fatigue, and a fever than the earlier vaccine that contained cells of the bacteria. But, this newer vaccine (introduced in the late 1990s) produces a smaller increase in and a shorter duration of immunity. “P” vaccinated people can get pertussis, but unvaccinated children and adults are 8 times more likely to get pertussis.

Pertussis immunization is now recommended for all pregnant women since protective antibodies pass through the placenta to the unborn child affording protection to the infant in the first months of life. Pertussis can be diagnosed in some one with a persistent cough by a simple nasal swab done in the office, and it can be treated effectively with antibiotics.

WHAT ABOUT THE “D” IN DTaP?
Diphtheria is a bacterial disease with a terrible sore throat. When severe it can form a membrane in your throat that blocks off your air and sometimes it produces a toxin that attacks the heart, causing death.  In 1921 the U.S. had 206,00 cases of diphtheria with 15,420 deaths.  The diphtheria vaccine is so effective that such cases are extremely rare in the U.S. Herd immunity is important in diphtheria. The CDC estimates that 94% of kindergarten pupils in U.S. are immunized against it. The Soviet Union, India, and Yemen remain areas with large numbers of diphtheria cases.

“Good ole” Montgomery County, Ohio had one of the last reported U.S. diphtheria cases; a teen age girl with a bad sore throat in 2014. That rare event got lots of press coverage which might be why Montgomery County is a particularly skittish about a possible measles outbreak in 2019.

Diphtheria can be treated effectively with antibiotics and anti-toxins. Any contacts of the person with diphtheria can also be treated to prevent spread of the disease. A simple skin test (Schick test) identifies people with no immunity to diphtheria, so efforts to control its spread can be highly targeted.

MY MODEST PROPOSAL MAY NOT BE THAT “FAR OUT”
My previous blog suggesting that one way to change the behavior of anti-vaxxers would be to sue the parents of an unvaccinated child for neglect to recover the cost of the medical treatment, loss of wages of caretakers, loss of school performance, continued rehabilitation of complications, etc. of any person who then got measles from the unvaccinated case. Perhaps that might send an effective message to anti-vaxxers of a personal financial risk where scientific data holds no sway. What if the parents of the Oregon tetanus-afflicted child were sued by tax payers in Oregon to “recover” the medical care costs of nearly a million dollars presumably borne by Oregon’s tax payers?


Vol. 211 April 15, 2019 A Modest Proposal To Eradicate Measles In The U.S.

April 15, 2019

Measles was declared “eradicated” in 2000. Since then we have had unexpected U.S. measles outbreaks in 2014 and presently we are breaking all records for new cases (78 cases just this very week). In 2014 there were 667 cases of measles in Amish country of Ohio. Since January 1, 2019 the U.S. has had 465 cases in 19 states.

For those of us who are used to hearing big numbers every day—size of the national debt, baseball player salaries, number of immigrants pounding on our door, etc.—these numbers don’t sound very compelling. BUT, measles is a preventable disease. One measles vaccine shot protects the recipient 93% of the time. When you add the second shot years later the individual’s protection goes to 97%. 

 Measles, the most infectious disease we know, can cause debilitating encephalitis (brain swelling), pneumonia, and, very rarely in the U.S., death in both infants and adults. Madagascar is not so lucky. Because of its poverty Madagascar has a vaccination rate of only 58% despite the population’s desire for vaccination. They had 1200 deaths in the115,000 who got measles last year. Europe had 41,000 measles cases in 2018. A community vaccination rate of 90-95% is necessary for effective “herd immunity” in which the vaccinated keep the un-vaccinated safe just be reducing their chances of exposure.

You are not likely to be exposed to a case of Madagascar measles, but if you happen to be in the Williamsburg section of Brooklyn, or Rockland County, NY, or  Portland, Washington, or near Sacremento, California, you may be exposed. These four hot spots of current measles outbreak apparently share an unintended consequence of easy-access global travel.  Unvaccinated Orthodox Jews returning from the September annual Hasidic Pilgrimage from Israel to Uman, Ukraine unexpectedly brought measles back to their unvaccinated, ultra-orthodox Jewish U.S. communities.

There is no aversion to vaccination in the Bible, the Quran, or even Sanskrit texts. It is speculated that these communities have low measles vaccination rates because of “anxiety about science”, “concern about risks of new technology”, and, especially in Soviet emigres, “distrust of the government”. 

In 1896 a Jewish man in Britain refused vaccination contending that it was against his religion. The prosecutor, also Jewish, asked the opinion of the Chief Rabbi of Britain who answered, “Hogwash.” The London court agreed.

Anti-vaxxers don’t respond to facts, They reject scientific data. They are apparently immune to dreaded stories about sick, dying children but appear to believe dreaded stories of assumed vaccine reactions. The mayor of New York City has declared a public health emergency and wants to fine any Williamsburg orthodox Jew who refuse the measles vaccine $1000. He has threatened to even close non-compliant Yeshivas. Rockland County tried to bar unvaccinated persons from public places including . . . gasp, . . . malls! A judge with a cooler head put that on hold.

After reading about the British 1896 court case a modest proposal just sprang out of my head: We should sue an anti-vaxxer, the parent of an unvaccinated child, for civil damages!

It has been recently and repeatedly affirmed that one way to get things done in America, to effect change, is to sue somebody—your spouse, your neighbor, the police, the National Enquirer, the President, whomever. 

So, all we have to do is wait until an unvaccinated child with measles exposes a vaccinated child. Since we know that the measles vaccine is not truly 100%  effective, the vaccinated child has a small chance (probably 3% – 7%) of getting measles. If the vaccinated child now with measles develops the more common complication of pneumonia, or the rare one of encephalitis, or the even rarer one of death, his or her parents could sue the unvaccinated child’s parents for all present and future medical bills, loss of school days, future loss of income due to brain damage, loss of companionship, and other compelling emotional stresses dear to personal injury lawyers. If encephalitis were the complication, the huge jury award would be enough to get the attention of even the most adamant anti-vaxxers. They would learn that their stance is not just a risk to society; it could be a large monetary risk to them personally.

References:
1. “A Modest Proposal”, Jonathan Swift, 1729 


Vol. 210 April 1, 2019 Alzheimer’s: There’s an App For That.

April 1, 2019
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Dr. Atul Gawande, CEO of Haven, the new healthcare-innovation company formed by Amazon, Warren Buffet, and J.P. Morgan, has announced that their first “new model of care” is an app for patients with Alzheimer’s. The app’s name is “FIGAWI”, after that ancient Indian tribe that gets lost in the fog almost every Memorial Day weekend on Cape Cod.

The app will provide a number of programs meeting the anticipated needs of Alzeihmer’s patients including:

WMC – Where’s My Car?
When exiting a store and realizing that you forgot where you parked the car, you just have to say WMC? . . . or WTFMC!?, depending on your sense of frustration and degree of patience.
1. The app will immediately access your state’s RMV Dept. database to collect your car’s make, year, and color,
2. then it will scan your credit card charges to find in which near-by store you had just made a purchase. (If you are near a complex of stores or in a mall, you can speak the name of the store into your phone, or if you have been in multiple stores, the program will search your credit card database for the last 10 store charges in order to identify the relevant parking lot.),
3. then it will get a Google satellite picture of the parking lot nearest to you and place a pin on it marking your car’s location.
4. If your phone’s GPS fails to record you moving toward the car within 3 minutes, the app will activate your car’s horn and flashing head lights to aid in its detection.
5 . If you fail to reach your car to turn off the alarm warning system within 12 minutes, the app will call either your emergency contact person in your contact list or 911, depending on your position (vertical or horizontal) as indicated by your phone’s orientation.
6. As an added bonus, if you open and start your car within 15 minutes, the app will show you any current outstanding parking tickets and remind you about the date and amount of your next car loan payment.

WT – Who’s That?
When meeting a person who you know, but can’t remember his or her name, you just have to say WT? or WTFT!?, depending on your sense of urgency. The app will immediately:
1. take a picture of the person approaching you,
2. compare it to pictures of your friends and families stored in your contacts and photo library (If you do not have a picture of that person in your contacts or photo library, the program will access Facebook, Instagram, WhatsApp, the RMV, your local police database, TSA, and the FBI in sequence to seek a match using built-in face recognition software.).
3. The matched name will appear on your phone’s screen along with the date you last saw them, the person’s nickname, spouse’s name (if any), and names of all their children listed by decreasing birth dates.
4. If facial recognition can’t find a match, the phone screen will light up with the following message, “Say hi and take a picture of this person. Ask the person how to spell his or her name so ‘I can get it right for my contact list’, then say, ‘So glad to see you ______________(insert name)’.”

WDISIT – What Day Is it?
The app immediately calls up and displays your calendar, highlights the day and time , and lists the last two places you were in and for how long, as well as where you are expected next.

WIG – Where Am I Going?
Not quite ready for prime time; still under development. Unfortunately our AI program for reading minds currently works only for people who have indwelling brain electrodes or cochlear implant devices masquerading as same.

WAIH – Why Am I Here?
As in “Why did I come into this room?” – (see above WIG) But this function is currently operational based on scans of your house’s floor plan in your town’s Assessor’s Office which is integrated with the time of day, day of the week, and the next two days of appointments on your calendar.

HDIGT – How Do I Get There?
Just say ‘How do I get there?” or “How the f… do I get there?” (almost a shout). The app will discern your different voice volume and tones. If your voice volume threshold exceeds “almost a shout”, the app screen will immediately flash “CALM YOURSELF, and repeat the request please.”
If the volume threshold is exceeded on the repeated request, the screen will show, “OK, TAKE A DEEP BREATH AND COUNT TO 10 — the number of all your fingers, and try again please.”
Please note that this App is separate from Siri, Alexa, and Google so you may choose one of over a dozen app voices which will respond in kind to your sense of urgency and voice volume on a scale of 1 to 10, just like pain.
Once you have respectfully gained the app’s attention, merely say the name of the place you wish to go: as “Super Stop and Shop”, “”Post Office”, “Doctor Smith’s office”, or “The Dump” (also recognized as the “Transfer Station” or “Recycling Center”).
If you can’t remember a specific name, you can say “where I usually buy groceries”, “where I go to Yoga classes”, “nearest liquor store”, or “where I ate Thanksgiving dinner last year”, and the app will bring up the relevant map and directions after scanning your contact list, your most frequent credit card charges, and both yours and national holiday calendars for the past 5 years.
You can also ask the App to give directions with ONLY right hand turns for your safety, if you wish. Of course, “Take me home” will work without any other directions every time and every where.

These seamless cyber connections are all included in the basic FIGAWI App package. Confidential personal notes about your family members and friends can be included at an additional price in the advanced package, as long as you agree to Facebook’s, Amazon’s, Apple’s, Yelp’s and Google’s privacy policies. The app is available in Russian as well as the usual English, Spanish, Hip Hop, and Rap.

Future upgrades of the App will include integration with car ignition breath analyzer devices, if appropriate (the app can scan court data bases and local newspaper “police blotters” for judgements and allegations). The emerging 5G network will also allow this App to connect with other existing helpful apps like: Find my phone, Find my keys, alerts for CD maturing dates, due dates for oil changes and tire rotations, automatic “I’ve fallen and I can’t get up” calls, time to take your pill alerts, “Did I leave the toaster (iron, radio, thermostat ) on?”, etc. Eventually the App will integrate with self-driving cars, so you can find it after it parks itself in the parking lot.

The password for the App is “No Password” or “I Can’t Remember S**t!” whichever the user feels is most appropriate. The App will accept either one depending on the note of frustration and volume of your voice.

One does not actually have to have the diagnosis of Alzeihmer’s (easily confirmed or ruled out by a scan of your primary physician’s EMR) to get this app. The differences between Alzeihmer’s and cognitive impairment of old age is subtle enough to confuse our current AI program, . . . and some physicians.

The FIGAWI App is available to anyone over 65. Despite AARP’s active lobbying we are not offering it to people just over 55.

I was going to list the website where you can order the app, and its price, but I can’t remember either.

HAPPY APRIL FOOLS DAY.


Vol. 209 March 15, 2019, Jargon Update

March 15, 2019

Jargon: “special words or expressions that are used by a particular profession or group and are difficult for others to understand.”

PIV
“Penis In Vagina” intercourse.  Researchers into the sexual activities of people over 65 yo. are using this term to more accurately define a specific sexual act . . .  because they are documenting a wide variety of sexual practices without penile insertion in this age group.

Elderly” is OUT
This term is currently way out of favor. Few “older adults” want to be considered elderly. “Seniors” is acceptable, even though it implies that those under 65 are “juniors”. It may be the association of that word with “discount” that keeps it current. “Perennials”, suggested as a response to the “millennials”, has the connotation that one has to be replanted every spring so it’s failing to stick. “Olders”, “gerontos”, and “third-agers” are distant possibilities. “Older adults” has been adopted by the American Geriatric Society. The American Association of Retired Persons began referring to itself simply as AARP in the late 1990’s . . . about the time it started sending membership invitations to 50 year olds. The Boston Commission on Affairs of the Elderly just changed its name to the Age Strong Commission. (The best candidate for “Best New Politically Correct Term of the Year” award.)

GM/GF
Genetically engineered wheat that contains far less gluten for gluten-free bread that tastes and feels more like real bread has been created using CRISPR gene modifying technology. When it does reach the marketplace it will undoubtedly cause a real purchasing dilemma for a select group of tree huggers.

“Organic”, “natural”, “healthy”
All still remain relatively undefined by the U.S.  Department of Agricultural so any company can put those labels on almost any food. The USDA and the National Organic Standards Board have opposite opinions on the “organic-ness” of carrageenan, a seaweed derived thickening agent. The USDA Organic label does indicate no synthetic pesticides and fertilizers, no genetically modified crops, no chemical processing aids, and no artificial ingredients. A proposed Food Labeling Modernization Act hopes to set uniform, definitive standards in the U.S.

Computer vision
A growing domain of artificial intelligence using “deep learning”, a “type of machine learning that uses multilayered neural networks whose hierarchical computational design is partly inspired by a biologic neuron’s structure.” (1) (Took the words right out of my mouth.) Computer vision can analyze medical images like pictures of skin lesions as well as the work flow in operating rooms or the progression of patient mobility in the ICU.

Moral injury
This is a substitute term for “burn out” in describing what is happening to our physicians.  “The increasingly complex web of medical providers’ highly conflicted allegiances. . . results in the moral injury . . . of not being able to provide high-quality care and healing in the context of health care. . . . Electronic health records track productivity and business metrics, but significantly reduce face-to-face interactions.” (2)

Cisgender
Having a gender identity that is aligned with one’s sex assigned at birth. The opposite of transgender. . . usually, but some transgender persons identify with both genders or neither! (on to the next jargon item.)

Nonbinary
Identifying as neither male or female, having multiple gender identities, or having none; “a more expansive concept of gender.”

Sexual orientation
“Who you go to bed with. Gender is who you go to bed as.”

High-end lobster
Offered by a Maine seafood restaurant that pumped marijuana smoke through the tank water to sedate lobsters before throwing them into the pot. The practice was stopped by order of the state Department of Health for “dispensing of marijuana without a license.”

Standing desks are OUT
A deeper look into the 2015 research of the health benefits of standing vs. sitting while working at a desk indicates that there is little actual health benefit to standing. “Workers should not fool themselves into thinking that standing is a form of exercise.”

Pasture-raised chicken
“Cage-free” chickens may still be raised in packed buildings with no outside access. “Free-range” chickens have outside access but there is no government standard for amount of available space. “Organic” chickens are cage-free, are fed only organic feed, and have outdoor access, but it may be just a small concrete porch. “Pasture-raised” chicken require 108 square feet per bird of outdoor space to earn that label as well as the “Certified Humane” label. (3)

Geroscience
This emerging field of scientific research of longevity hopes to gain the Federal Drug Administration’s attention for reviewing drugs to retard the aging process, which recognizes aging as a natural process (outside their purview) not as a disease (within their jurisdiction for review of new drugs).  A newly formed Boston-based Academy for Health and Lifespan Research will lobby various governments world-wide to support development of drugs and other age-slowing therapies.

“Safe-school officer”
Former combat veterans wearing body armor while carrying a 9mm Glock handgun and a sawed-off automatic rifle hired to roam the halls of the Manatee School for the Arts in Palmetto, Florida. The principal hired the combat veterans because “I don’t want this to be the first time they’ve had someone shooting at them.”

References:
1. NEJM 378;14 April 5, 2018
2. Drs. Talbot and Dean, Boston Globe 8/15/18
3. Consumer Reports On Health, February 2019


Vol. 208 February 15, 2019 Sex, Love, and Attachment . . .

February 15, 2019

. . .  an appropriate headline for the day after Valentine’s Day, don’t you think?

All three “drives” or urges, sex, love, and attachment, arise from the same part of the brain according to Helen Fisher, neuroscientist and anthropologist, author of The Anatomy of Love. She states that these three brain neuropathways interconnect and interact to produce together the feeling of romantic love. This occurs in the most primal part of our brain which also generates feelings of hunger and thirst. The three pathways can operate independently, obviously one can have sex without love or attachment, but all three have to be working together to produce “romantic love”; think about the lyrics, “Will you still love me tomorrow?” (presumably during a night of sex).

That same part of the brain is the source of dopamine, the neurochemical stimulant associated with our “craving and reward” mechanisms.  Dopamine causes release of endorphins, neurochemical messengers,  and oxytocin, a hormone, both of which are opiate-like. Oxytocin, sometimes called the “love drug”, is released when a mother nurses her infant which promotes their strong attachment, and so is also called the”bonding drug”.  Interestingly, just petting and cuddling your dog has been shown to cause oxytocin release.  The most potent release of oxytocin is associated with orgasm. Dopamine and other “feel good” neurochemicals are known to make the decision-making parts of the brain less active; think of “Love is blind” or “Madly in love” or somebody texting a picture of their genitalia.

In the 1970’s two graduate student psychologists, married to each other, started experimenting with a program to try to promote “personal closeness” in a non-romantic relationship between two strangers. They found that a series of 48 escalating, self-revealing questions that random pairings of people asked of each other, followed by staring silently into each others’ eyes for four minutes, produced “friendships” of strangers that lasted for months in 35% of the pairings. This procedure became known as the Arons Protocol, named after its two developers. (1)

In 2015 the writer of a love column, Mandy Len Carton, decided to try the Arons Protocol, now pared down to 36 questions in three sets, on one of her dates. She promptly fell in love, and described the experience in her Modern Love column, “To Fall in Love With Anyone, Do This”, her most widely read column according to the NY Times.

There are 2500 social network “dating websites” in the U.S. alone. Most ask questions of subscribers in hopes of identifying common compatibilities that will make “a good match”. One of the first sites, eHarmony launched in 2000, boasts that its 150 questions (pared down from the original 450) were scientifically developed by a clinical psychologist to ensure a better “match” of personalities and values; a better match would lead to more “attachment” and long-lasting romantic love. Tinder, not so much.

Most agree that romantic love is not simply something we can talk ourselves into, or game ourselves into, and that it can also occur very quickly as in  “love at first sight”.  Much research shows that many factors, perhaps even including unknown, unidentified pheromones are involved in generating that feeling of love. Deep down most of us don’t want to believe that the mystery of human love can be explained by genetic maps and certain chemical levels in the brain or blood. Alfred Einstein, when asked if he ever thought of trying to have “the perfect child”  with Marilyn Monroe said, “I would be afraid that the child might have my looks and her brains.” Einstein might have had the last word on the relationship between science and love when he said, “Gravity is not responsible for people falling in love.”

Using some of the suggested “attraction” elements for the development of love: Imagine a six-foot, wide-shouldered, licorice-sucking man wearing a lavender sweater over a 2-day old T-shirt driving a Lotus through busy city traffic picking up a hitchhiking, ovulating blonde with a very symmetrical face, eating a doughnut above her C cup bra, and carrying a bouquet of spicy flowers  . . . sounds like a movie . . . wait . . . it IS a movie . . . they already made it . . . but, Julia Roberts is taller than Richard Gere!

Or better yet, imagine using the Aron Protocol to reduce our current society’s polarization. Why not set up Aron Protocol meetings of couples for police and black community members, white and black college students, capitalists and socialists, or even Trump supporters and Trump opponents! Arthur Aron has said, “We never designed [the Aron Protocol] for use in the real world . . . but people are looking for ways to be close to others.” (2)

References: 
1. Aron, A., Melinat, E., Aron, E. N., Vallone, R. D., & Bator, R. J. (1997). The experimental generation of interpersonal closeness: A procedure and some preliminary findingsPersonality and Social Psychology Bulletin, 23(4), 363-377.

2. “The Science of Love,” Linda Rodriguez McRobbie. Boston Globe, Feb. 10, 2019, K1


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