Tuesday, July 1, 2014

Next Stop: Stanford University

In 1955, Albert Einstein was quoted that one should "learn from yesterday, live for today, hope for tomorrow. The important thing is to not stop questioning. Curiosity has its own reason for existing." Like Einstein, I have always believed in lifelong learning and satisfying my ever curious mind.
You may think that at the age of 55, with a medical school education, surgical training, a business degree, and a career that included founding, building, and eventually retiring from HealthDrive, a national health care company serving the extended care industry, my learning days and quest for more knowledge might be done. You might also think that after the shutdown of MDPrevent, (see my other post on what happened), my full throttle, but unsuccessful foray into life extension and disease prevention by lifestyle modification, my interests in longevity and preventive medicine would have waned. If you thought so, you would be incorrect on both accounts. That's because I believe if you don't succeed at first, try again.
About two months ago, I learned about a new program starting up at Stanford University called the Distinguished Careers Institute or DCI. The DCI, the brainchild of Philip Pizzo, MD, the former dean of Stanford’s Medical School, offers people who have had successful careers, but are eager to discover what comes next, an opportunity to expand their minds at Stanford by pursuing a scholarly pathway under the guidance of faculty mentors and advisers. When I read about the program in a press release, which I accessed through my daily Google alert on the keyword ‘longevity,’ the idea so excited me that I suspect I was the first person to apply online.
I am excited to announce that my application was accepted and I received an invitation to join the inaugural group (20 individuals) of Fellows to start the program in January 2015. Yesterday, I made the decision to accept the invitation after consulting with a number of professors at the Stanford Center for Longevity and the Stanford Prevention Research Center, including Doctors Pizzo and Kathy Gillam, the executive director of the DCI program, who all impressed me with their knowledge, friendliness, and willingness to help me identify my next career. Although I have always believed that success is the byproduct of one’s own hard work (and good luck), I have also learned the value of getting help from others. 
As a believer in making the most of one’s life until you can’t do no more and in doing well by doing good, I can’t believe there can be a better place for me than Stanford as the next stop on my life journey. Wish me luck.

Wednesday, June 11, 2014

Caveat Lector -- Let The Reader Beware!

A new study shows…

How many times have you heard that phrase followed by some new big revelation? It’s usually a new discovery because few scientists want to study and merely confirm what is already known. If they do, the confirmed results often don’t see the light of day. However, if they discover something new then watch out.

More importantly, the media doesn’t grab attention by generating headlines about widely accepted knowledge.  Often times, the new information creates a buzz because it conflicts with previously accepted science; not surprisingly, often these types of studies grab the most headlines. 

The problem with such studies and the headlines they generate is that no single study proves anything—it merely adds to our knowledge. That’s why people are cautioned to not accept any media science headlines at face value without knowing the full scope of the study reported and how its conclusions fit in with the greater body of evidence surrounding the topic.

At a recent wedding, three of my cousins approached me to ask nutritional questions. One even asked me during the meal if what he was eating was healthy.  Another commented that they should watch me to see what I eat to determine what was good for them.  That approach would be a horrible mistake.  A healthy diet should never be judged by one meal alone; healthy food should never be judged on the basis of isolated nutrients.

One would think that it is well understood that a healthy diet should be viewed holistically (in its entirety), but you could be forgiven for thinking otherwise when studies like the one recently published by the CDC hits the media circuit. The study, titled Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach attempts to clarify the value of consuming certain fruits and vegetables over others based on the levels of certain nutrients they contain.

As part of the study, Jennifer Di Noia, an associate professor of sociology at William Paterson University in Wayne, N.J., crafted a list based on the nutritional density of fruits and vegetables, using data from the U.S. Department of Agriculture. As the basis of determining nutritional value, she used 17 nutrients including potassium, fiber, protein, calcium, iron, thiamin, riboflavin, niacin, folate, zinc, and vitamins A, B6, B12, C, D, E, and K.
By her own admission, because she felt that since it was not possible “to include phytochemical data in the calculation of nutrient density scores, the scores do not reflect all of the constituents of a fruit and vegetable that may confer health benefits.” By phytochemicals, Dr. Noia is referring to all the antioxidants, like anthocyanins, polyphenols, carotenoids, etc., and other nutrients that naturally occur in fruits and vegetables; the same antioxidants that are believed to work synergistically with all the other nutrients in the fruits and vegetables to deliver the full nutritional value of a food item; the same naturally occurring antioxidants that are believed to play a role in neutralizing free radicals.

In addition, her qualification list only includes 17 nutrients while there are 13 vitamins, 15 minerals, two fatty acids, nine amino acids (she did include proteins, but did not clarify if they were complete proteins that by definition contain all 9 essential amino acids), and water, all of which are considered essential to human functioning. So even though there are 49 absolutely essential (as identified by current science—of course subject to future revision) nutrients, her list was based on only 17. Nevertheless, she concluded that they were apparently the most important.

What were her conclusions? Leafy green vegetables are good.  No big surprise. Raspberries, tangerines, cranberries, garlic, onions, and blueberries are essentially a waste of time when it comes to their nutritional soundness. Why? Because they didn’t have enough of the 17 nutrients she deemed important. Forget about what else they have in them; they just don’t make the cut. That’s just plain absurd.

An essential nutrient is an essential nutrient.  None is more important than another. Further, it’s renders her study meaningless when she leaves out phytochemicals.  If you followed Noia’s logic, you shouldn’t bother eating fruits and vegetables at all. Just pop a pill that includes the same amounts of her 17 key nutrients and call it a “Powerhouse Pill.” Shameless.

Nevertheless, I am very surprised, given the study’s limited utility, that the CDC published it in the CDC’s journal, Preventing Chronic Disease.  More importantly, until I read the actual study, I was baffled by its reported conclusions. Once I knew what criteria had been used, I also knew its true value—zero.  I disdain the use of “powerhouse” to describe any food as being more important than other foods contributing to an overall healthy diet. Using such a word is nothing more than an attempt at hype to grab more media attention. Uch.

For me it invoked once again the saying, Caveat Lector—let the reader beware!

Friday, June 6, 2014

Dr. Oz Show Canceled???

New York, NY. June 6, 2017 --After riot police were summoned, Harpoon Productions, the producers of the Dr. Oz Show bowed to public outcry and the rapidly growing crowd outside it’s studios that stretched down Manhattan’s Sixth Avenue, blocking traffic for miles in any direction, by announcing today the immediate cancellation of the syndicated television show that ran for ten years featuring Dr. Melvin Oz.    

The problems with the show had been steadily increasing due to mounting scandals plaguing Oz such as a lawsuit concerning burnt diabetic toes.  Another scandal involved Dr. Oz denying the fact that he and his family take no supplements and never have despite stating the opposite on many episodes.  In the face of incontrovertible evidence, Oz has continued to claim that he consumes dozens of supplements a day to prevent colds, hair loss and fungal infected toenails. However, the most troublesome revelation about Oz was the discovery that he is paid $1 every time he endorses a supplement. It is believed that Oz has joined the Forbes 300.
Problems for Oz and his show escalated on Wednesday when a group of several hundred morbidly obese women and men gathered outside the studio at Rockefeller Plaza in New York.  They came to protest against the show and its star. Waving banners that read, “You Did This To Us” and “Stop Feeding Fat Lies To Skinny People,” the protesters were presumably reacting to Oz’s now almost daily proclamations of new ways to lose weight, including his most recently touted  “One-Minute Rapid Weight Loss Plan” and “How To Lose Ten Pounds By Donating An Organ.“
These newfangled, unscientific, and radical plans were touted by Dr. Oz pursuant to what he declared was “recent research that showed they worked.”  In addition, these “quickie” weight loss plans, described by Oz as “miracles” had joined a long list of his other rapid weight loss schemes like Raspberry Ketones, Garcinia Cambogia, and Glucomannan.
One hefty protester by the name of Pop Goestheweasel, a 64 year old construction worker from Yonkers  said that he had enjoyed a 34 inch waist before watching the show based on his wife’s advice.  Goestheweasel,, who now appears to have ballooned to at least four hundred pounds, cut the interview short to snack on a pizza and milkshake Oz had recommended on a recent show as “a magical weight loss elixir.”  He also admitted that he was a sucker for Oz’s medical persona and until today continued to hope that the next Oz advice would be the one that finally restores his waistline.
Events really started to get out of hand when the original protesters were joined by thousands of once happy, but now neurotic women who joined the fray waving medical bills.  These bills estimated to total in the millions of dollars were the result of faithful viewers seeking immediate medical attention after Dr. Oz aired multiple episodes about the dangers of ignoring warning signs, such as sneezing once may indicate breast cancer, and an eye sty may be a sign of a heart attack.  
One woman in the crowd identified as Gota Migraine, a 47 years old housewife from Queens, revealed that she had seen five internists and thirteen specialists after hearing Dr. Oz tell his TV audience that fatigue may be due to Overexertion, a newly discovered illness.  After researching Overexertion on the internet, this lady was determined to seek appropriate medical attention to combat her life-altering condition. Despite numerous medical exams and tests, alternative medicine doctors she sought out after seeing them repeatedly featured on The Dr. Oz Show who had been unable to pinpoint why Overexertion was causing her fatigue. After being told to take no less than three thousand different supplement pills and nutritional foods, many of which had been emphatically endorsed on the Dr. Oz Show, Mrs. Migraine realized that her fatigue was due to carrying around hundreds of bottles containing her daily supplements.
The final straw for the Dr. Oz Show’s producers was when the crowd expanded to include hundreds of thousands of scalpel wielding doctors who traveled from all over the world to beg Oz to stop spewing pseudoscience to their patients.  In fact, it was noted that some doctors were actually breathing heavily from the burden of listening to their patients for years tell them that “Dr. Oz said this…and Dr. Oz said that.”  
The crowd, including the panic-stricken doctors, went into a frenzy when an announcement was made that Dr. Oz had issued a message for the crowd that “protesting against the Dr. Oz Show was bad for their health.”  Fortunately, the crowd quieted and was noted to have uttered a collective deep sigh of relief when news of the show’s cancellation reached them.  Even as the crowd began to dissipate, some doctors were noted to be tending to the morbidly obese men that had overdosed on Glucamannan and were suffering from intestinal blockage, while other doctors were seen comforting the neurotic women that everything would be okay now.
As for Melvin Oz, who could not be reached for comment, authorities report that he was taken into protective custody pending resolution of the incident. At the same time, it’s been announced that all his ubiquitous images on TV, magazines, internet, newspapers, and billboards have been removed to avoid inciting another mass protest.  It is clear the good doctor is no longer in.
This parody is meant as good fun. It is completely fictitious, as are all the characters and none of it has happened (at least not yet.) 
In addition, no real people were harmed in the writing of this parody, but it’s not certain that the same can be said for the viewers of the Dr. Oz Show.

Monday, May 26, 2014

Kayaking with Alligators and Other Calculated Risks

Jonathan Dickinson Park is a Florida State Park located in Martin County, Florida; the Loxahatchee River runs through it.

Last Friday, accompanied by my wife and another couple, I kayaked down the river to view pristine nature. Watching us from the sidelines were a number of alligators, with some appearing as large as ten feet long. One actually swam under my friend's kayak.

Stroking the water in my single kayak, I couldn't help but think what possessed me to go down a river surrounded by ferocious, life-altering creatures with my only defenses a paddle and a pocket-knife. Coupled with the knowledge that death had come to a young boy on this very same river from a similarly situated alligator only added to my puzzlement.

I am not a risk taker by nature, particularly when it comes to nature. True, I was a boy scout for three years, but supervised hikes in the woods was the extent of my trailblazing. Skydiving, motorcycle riding, hang-gliding, parachuting, bungee jumping etc. are simply not part of my repertoire and never have been. So what was I doing on that river? I was taking a calculated risk.

The Merriam Webster dictionary defines a calculated risk as "a hazard or chance of failure whose degree of probability has been estimated before some undertaking is entered upon." I think you will agree that boating down a river inhabited by alligators, one of which already killed someone, without any rescue in site in order to enjoy a unique patch of nature is by all means a calculated risk. Why did I do it and why should my adventure be of any concern to you?

Patients often told me that if they had to give up the foods they loved, there would be no reason to live. Clearly such people live to eat as opposed to eat to live. Even when faced with the risks of heart disease, cancer, stroke, diabetes, etc,, food means too much to them to give up. More importantly, they know there are no guarantees that if they actually gave up their pizza, cakes, burgers, french fries, milk-shakes, pasta, etc. that they would necessarily stay healthy or even live longer. For them, their calculated risk has their favorite foods trumping over potential health risks. 

Many people often make the same calculation about exercising regularly and managing their stresses more effectively. For example, if you spend one hour a day exercising for sixty years, you would have spent the equivalent of over three years of awake time (at an average of 17 hours a day) of your life exercising. It is estimated that people who exercise one hour a day, ignoring diet and other longevity factors, will on average live a few years longer. By some calculations, that seems like a wash. I say some, but not mine. 

When I think about the consequences of eating the right diet or staying physically active over the course of your life, I think in terms of both possible gains as well as losses. Although there are no guarantees that exercise will keep you alive longer, as Jim Fixx the runner proved by his passing, staying physically active has been clearly associated in every study I ever read with a healthier healthspan, the measurement of how long in life you feel well. So it's not just a matter of living longer, it's also about feeling better during the years you live. In addition, many studies also show that eating healthy when coupled with other healthy lifestyle choices is highly correlated with avoiding the chronic diseases often associated with aging. 

To eat what you want and to live a sedentary lifestyle is a calculated risk that you are free to take. It's your life after all. You may think that it is not as foolish as kayaking with alligators, but it's actually far worse given that millions of people have died prematurely from eating too much of the wrong foods while since the 1970s there are only twenty three recorded alligator deaths in the U.S. I prefer those odds. While alligators are a frightening topic and when they kill, they garner major headlines for the gruesomeness, the risk of dying early from an unhealthy lifestyle is far greater than death by alligator even when they are swimming nearby. So if you aren't brave (or stupid, depending on your perspective) enough to go kayaking with alligators, why do you keep eating the way you do? It's a calculated risk to eat unhealthy and the odds are not in your favor. 

Now that's something to chomp on (pun intended).

Friday, May 16, 2014

Is (The End of) Death Inevitable?

At a dinner party nearly two years ago, I made a passing comment about the inevitability of death. The host, an Israeli-Danish economics professor, took exception to my statement. He responded that one can only speak with certainty about what has happened, not what usually happens. At first blush, I thought he was either a wacko or was just being ornery. How could anyone assert that death was not a fact of life? How could anyone deny the inevitability of death?

After the dinner, I began to ponder his statement, and over the ensuing months gave it ever greater reflection. After reviewing the burgeoning body of research tackling anti-aging and longevity, I have reached my own conclusion. You may think I am also a bit looney, but please indulge me for a moment.

Car analogies are useful tools for explaining the function and longevity of the human body.  Everyone knows that the better you treat your car, the longer it will last.  However, despite utmost care, if the car is regularly used, at some point, the engine will need to be rebuilt, the tires replaced, the exterior retouched, etc. A car functions based on the quality of its fuel and replacing actual fuel with non-combustible liquids means the car can't function (except for electric cars, a scientific breakthrough in its own right).  Humans similarly need the right care and fuel to function.

However, car buffs will tell you that even though most cars are useable for at most a couple of decades, there are cars out there that are nearly a hundred years old and there are plenty of cars still functioning after many decades.  Yes, they need extra-special maintenance, but their useability is extendable indefinitely with continued care. Cars, like humans, also require the interoperability of multiple parts to be useful. Without a steering wheel, you can't meaningfully use the car even if you have a wonderful engine. Similarly, humans need their hearts, brains, livers, etc. to all function in unison and the failure of one is the failure of all.

Of course, cars analogies are of limited utility because the human body is far more complicated.
Unlike cars, replacing human parts is still a challenge. Yes, we can transplant some parts like hearts and livers, when they are even available, but parts like brains and thyroids still remain beyond our abilities. In fact, the human body is so complicated that many metabolic processes, parts of the microbiome (the bacteria, good and bad, that share our body space), and both human and microbiome genes and their related proteins have yet to be either fully understood or even identified. Even worse, when the body malfunctions like with auto-immune diseases and cancer, we are still mostly defenseless.

Nevertheless, what is unknown is ripe for the finding, analyzing and manipulating.  When smallpox was killing hundreds of millions of people, I am sure many wondered if a solution would ever be found. It was and the disease and the plague it caused are now mostly history. When the HIV virus was first discovered, the prognosis was sure death. Today, many live with the diagnosis due to effective interventions.

That is why I now believe that the difference between life and death is only a matter of undiscovered science. This means that the end of death as humans now understand it (another essay in its own right) will require scientific advances and breakthroughs that are only a matter of time. No one can tell you exactly when these life-altering discoveries will be made, but I suspect it will happen sooner than expected.  Why?  Because of the three "Ps": (Scientific) Progress, People and Purse.

Real progress is being made. Research into understanding what causes death is accelerating.  Universities across the U.S., Europe, Asia, and Israel are actively engaged in finding the root causes of death and related processes that accelerate and impede it.  Research into fruit-flies, worms, rodents and monkeys have already identified a number of gene variants whose presence and/or manipulation has been proven to extend life by as much as five times (in worms). Human gene studies have already identified multiple gene variants associated with super-centenarians, those aged above 110. Scientists recently created the first living semi-synthetic organism made from synthetic base pairs after long believing such a feat was impossible. As our ability to identify genes and proteins grows, so does the possibility for targeted gene therapies to control their actions. The accelerating progress to date offers the great promise of much more to come.

The solution to death will require great effort and that will require people capable of mustering such effort. Last year, Google announced the formation of a new company called CALICO, for California Life Company and hired Arthur Levinson, the former CEO and current Chairman of the pioneering Genentech, arguably one of the most successful and innovative biotechnology companies of all times. He is also Chairman of Apple, another technology bellwether. Levinson has begun assembling a team of leading scientists including recently adding Cynthia Kenyon, the UCSF molecular biologist and biogerontologist who has done the groundbreaking research into worm life extension. Not to be outdone, Craig Venter, the biologist and entrepreneur credited for winning the race to sequence the entire human genome, announced this year the formation of Human Longevity, a company dedicated to life extension. Human Longevity announced that it would first target cancer by collaborating with a UC San Diego Moores Cancer Center to sequence the genomes of between 40,000 to 100,000 cancer patients a year in order to find gene patterns amenable to novel gene therapies.

People like Aubrey de Grey, of the SENS Research Foundation, a non-profit funding work at universities across the world and at its own Research Center in Mountain View, CA,. have been getting much airtime about funding life extension by giving TED talks, writing extensively and circulating widely. Ray Kurzweil, the prolific writer, inventor, scientist, Google director of engineering, and futurist purports that the melding of humans and technology, what he calls the Singularity, will by itself propagate life indefinitely into a new era of Transhumanism, a perspective that argues that humans will enter a new stage of existence by using technology to greatly enhance intellectual, physical, and psychological capacities.  Of course, life and death as we know them today would be redefined under this scenario. Think beyond bionics and The Six Million Dollar Man and implanted circuitry and the current TV show Intelligence. Think nano- or even the much smaller femto-technology. Think semi-synthetic humans.

Perhaps the most intriguing persona in the longevity field is entrepreneur Laura Deming.  Admitted into MIT at the age of 14, child prodigy Deming, now 19, dropped out to found Longevity VC, a venture capital firm focused on identifying and funding research into life extension. Deming began researching longevity at the age of 12 in Cynthia Kenyon's UCSF lab.  With an early start into the field, Deming offers real promise. However, even great people usually need resources.

Scientific research is often expensive. To have any real hope for sooner than later anti-aging breakthroughs, purses must open and they have.  On the government front, the National Institute of Aging has been spending wisely. Recently, it announced a ten million dollar grant to University of Rochester, Albert Einstein College of Medicine and Harvard to fund such research. Craig Venter is purported to have raised fifty million for his venture, and Ms. Deming is funded to some extent by Peter Thiel, one of the co-founders of Paypal and a successful hedge fund manager.  Although Google has not publicly announced its investment in CALICO, it is estimated to be in the tens of millions.  By my estimates that easily places the current investment north of 100 million dollars. That may not be the billions needed, but its a good start.

So given the progress, people, and purse now engaged in the search for immortality, do you think that (the end of) death is inevitable? Maybe the economics professor was on to something...