10/03/2018 – Financial Health • Solid article published in a pathology journal, advising residents (but applicable to students and anyone else) on financial health. Some take home points: be careful who you choose as an advisor, manage medical school debt early, buy enough insurance, ignore the Joneses, and buckle down and budget. Free full text at the link above.

10/03/2018 – What doesn’t kill you makes you stronger • Josh Mittledorf switched from physics to evolutionary biology years ago. His recent book Cracking the Aging Code is packed with dense but readable information related to aging and how we can avoid it. Aging is programmed into almost all animals. To go with the flow and allow what nature intended (usually a good “paleo” strategy) means to succumb to aging processes. In future newsletters we will cover some of the aging avoidance strategies proposed in the book, but today brace yourselffor an explanation for the science behind hormesis.
• Hormesis is “any process in a cell or organism that exhibits a biphasic response to exposure to increasing amounts of a substance or condition.” So something that in a very large amount would kill you (starvation, hypothermia, running for your life), actually improves health in a small dose (fasting, cold exposure, exercise). This is well known, all over the literature, and we have linked to a very cool website devoted to it. Though it is clear that hormesis is a thing, I had never seen an explanation for why humans work this way. 
• Humans are antifragile. Unlike a car or a building, we actually become stronger with stress exposure (bones, muscles, immune system). In fact, Mitteldorf didn’t say it in the book, but this repair function could be one way to define what life is. But why do we become stronger with stress? Why not just become stronger regardless of stress exposure? Why do we leave anything in the tank? The reason has to do with population flexibility and aging. 
• Picture two populations of organisms, A and B. Beings in population A have tons of food, do not have to chase any prey, have no extreme temperature exposures: they are living in abundance. Population B is struggling; they have cold winters, scant prey and therefore food supply, and are exercising a lot to chase down meals. If population A continues as it is, it will eat all of the prey, have a lot of offspring, and eventually deplete its resources. Population B on the other hand could run out of individuals due to death from starvation and exposure. 
• There exists what you could call a homeostatic population fix for these scenarios. Population A can kick in its aging genes, each organism can live a shorter life, and the population will not bust and become extinct. *Added bonus, aging and dying helps diversify the genetic pool. In fact, over thousands or millions of years, populations that did not evolve aging likely did become extinct, so they are gone (one example is the supepredator Rocky Mountain locust). Population B, in order to not become extinct, can slow down or turn off aging in its individuals. (Fertility is another modifiable factor and is addressed in the book). 
• These large scale processes occur in many different species and have been elucidated with complex mathematical models. This so called Demographic Theory of Aging relies on group selection, somewhat controversial in old school evolutionary circles that cling to the selfish gene paradigm. But it is becoming harder and harder to argue with Mittledorf’s publications and rationale. 
• The bottom line: Stressing your body in various ways signals your DNA to let you live longer, so your population doesn’t go extinct. Inversely, being in caloric excess, not moving much, and living in temperature controlled environments tells your body to age more rapidly, or else you will overpopulate. 
• Folks who are confused with the contradicting recommendations ask me what healthiest diet is. At this point in time, the most certain answer I have is that fasting is unequivocally healthy in the long-term. Intermittent fasting seems to carry the same benefits as prolonged calorie restriction, without many of the drawbacks. And winter is coming … get out in the cold and exercise.

9/26/2018 – Pain meds • Another interesting opioid piece. This one first hand account from a professional ethicist who became dependent on opioids after multiple orthopedic surgeries. He describes the withdrawal symptoms at every tapering step. Many do not realize withdrawal lasts weeks to months. We see a doctor who is not comfortable with opioid dependence.
• The problem is too large now to refer everyone to pain management. Great story showing that this can happen to anyone, and that it is possible to come out on the other side.

9/26/2018 – Braces • This interesting article looks at the link between snoring and braces. The assertion that braces somehow cause snoring does not make sense. The more believable scenario is that the same problem has led to braces AND to snoring. Since our dependence on farming, humans have been eating softer food in general. Small children used to chew gristle and fibrous vegetables, and now drink chocolate milk and eat ice cream.
• Many scientists have shown how this caused jaw and mouth size to decrease over time. Less room for teeth, therefore dental crowding and need for wisdom teeth removal. Less room for airflow so we get snoring. Snoring also comes from excess of soft tissue in the airway, compounding the small mouth. If you want to know more, check out this whole book on evolution of the human head.

9/12/2018 – Antilibrary • Umberto Eco doesn’t have a library, he has an antilibrary. Because home libraries should be about gaining knowledge, not showing off, one should have far more unread books than read.  • “The library should contain as much of what you do not know as your financial means, mortgage rates, and the currently tight real-estate market allows you to put there. You will accumulate more knowledge and more books as you grow older, and the growing number of unread books on the shelves will look at you menacingly. Indeed, the more you know, the larger the rows of unread books.” 
• I love the menacingly part. Definitely feel intimidated by the overflowing “to be read next” bookshelf. • Also check out brain pickings if you haven’t yet. Every one of Maria Popova’s posts open doors to numerous other books and ideas.

9/12/2018 – Coddling of the American Mind• 100 pages into a new book by Jonathan Haidt (and Greg Lukianoff). The premise (American [college] kids are being intellectually overprotected) rests on 3 main pillars of bad advice: 
1. What doesn’t kill you makes you weaker 
2. Always trust your feelings 
3. Life is a battle between good people and bad people 
• These “Great Untruths” fulfill three criteria of bad advice: contradict ancient wisdom, contradict modern psychological research on well-being, and harm individuals and communities who embrace them. More to come in next week’s PofW.

9/5/2018 – Psychology of Money• This long piece by Morgan Housel is absolutely full of wisdom on behavioral finance, personal wealth accumulation, and life in general. The beginning recounts stories of Grace Groner and Richard Fuscone. Grace was a secretary who ended up donating $7 million to charity when she died. Richard was a Ivy League educated investment banker who declared bankruptcy the same year Grace died. Housel points out that in no other field could something like this happen. The rest of the piece explains 20 flaws, biases and causes of bad behavior. A fun read, full of quotes and excellent advice.

9/5/2018 – Writing• Very cool article on the brain health benefits of actually writing. According to the author: All human cultures include speech, but not all have written language, and, even today, hundreds of thousands of people around the world never learn to write. One of my medical students spent a few weeks in India this summer, and he noted the main language spoken by his relatives there has no written component.  
• Writing is evolutionarily very new and quite beneficial: “’The practice of writing can enhance the brain’s intake, processing, retaining, and retrieving of information. Through writing, students can increase their comfort with and success in understanding complex material, unfamiliar concepts and subject-specific vocabulary.’ In other words, writing figuratively builds the brain’s muscles, which can then be used for all sorts of cognitive activity.”

9/5/2018 – Skepticism• Oliver Wendell Holmes was the father of Justice Oliver Wendell Holmes, Jr. The senior Holmes was a physician who reported on puerperal fever in 1843, two decades before the germ theory was elucidated. He introduced microscopy to North America, coined the term anesthesia, and criticized bloodletting and homeopathy before it was cool. He went on to become famous as a writer and novelist, but remained skeptical of medical dogma.  
• We should all take a few minutes a day or week to think about the (potentially many) mistakes we are making in treating patients. Half of what is taught in medical school is later proven wrong, we just don’t know which half.

9/5/2018 – US-China Conclusions• Destined for War ends on a mostly positive note, optimistic that we can avoid a military conflict with China.  
• Allison notes 4 possible strategies: accommodate (allow China to surpass us economically), undermine (attempt to subterfuge China from within), negotiate a long peace (work together to avoid conflict) or redefine the relationship (eg focus on major threats affecting both countries [nuclear armageddon, nuclear anarchy, terrorism, and climate change]).  
• Allison has 4 specific pieces of advice:  
1. Clarify vital interests: Is naval supremacy in the Pacific really a vital interest of the US? 
2. Understand what China is trying to do: Acknowledge China’s drive for the top spot in the Pacific. 
3. Do strategy: Listen to academics such as the author himself. 
4. Make domestic challenges central: Both countries have a lot to work on internally, political unrest in the US, excessive central control in China.