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Life Measured in NFL Memories

The tears were streaming down my face in 1963 as my father ushered us into his Oldsmobile and drove to my grandmother’s house in Brooklyn in stone-cold silence. My beloved New York Giants had just lost the NFL Championship to the Chicago Bears, ending a run of Championship games and to enter last place purgatory for years to come. “How could they lose with Sam Huff, Jim Katcavage, Y.A. Tittle, and Frank Gifford on the field,” I stammered, squeezing my Kyle Rote autographed football ever more tightly in the back seat.

Emotion and memory are forever linked in our national psyche and football has a tight grip on both. The exact street where I stood 1/2 century ago when I learned the Giants drafted the running back, Tucker Frederickson and later traded for QB Fran Tarkenton are branded into my senescent consciousness. Later, in college, watching on a black & white TV and manipulating the rabbit ears to get a clearer picture, I saw Roger Staubach come into view. My roommate, entered the living room after an all night Bridge tournament, told me to spread the rabbit ears wider, declared his intent to abandon professional card playing for a try at a veterinarian school at precisely the same moment that Staubach defeated the Miami Dolphins 24-3 in Super Bowl VI. 

Living in San Diego in the late 70’s and early ’80’s, I was caught up in Charger frenzy. Orchestrated by Coach Don “Air” Coryell, QB Dan Fouts, and receivers Charley Joiner and Kellen Winslow needed a minimum of 40+ points a game to have a chance to win. The Miami-Charger overtime gem in 1981, viewed in a bar in Pacific Beach with a gaggle of inebriated surfers, was an all time football high. I was hugging total strangers exhaling Miller High Life fumes and loving it. One week later the Chargers succumbed to Cincinnati in the infamous Ice Bowl and I fell into a deep fan abyss.

Football frenzy was destined to envelop my children. My older son was born on a day the Giants won. We exulted in the Giants two Super Bowl wins in the 21st Century and held on tight through Chargers wins and losses. My sons were there for the Charger playoff win over Indianapolis Colts, LaDanian Tomlinson’s record breaking rushing yardage game and the excruciating loss against the Jets in the 2010 first round playoff. 

As I tune into Super Bowl LVI this weekend, I will remember the rabbit ears, my father’s recall of QB Norm Van Brocklin and Elroy “Crazy Legs” Hirsch of 1950’s Ram fame, the players of my youth and hope that the current and future players held in esteem by my children and children’s children will bring them the joy of the NFL fan.

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The Real Genie in Genealogy

As new grandparents, we await the wondrous moments of human development to flow into our much loved grandson. It has also awakened our curiosity of what lies ahead during his lifetime after we are a forgotten footnote of family lore. Sensing our own sense of evanescence, my wife and I embarked on the worldwide pursuit of genealogy. Who are our ancestors? What were their struggles?  What can we learn about the past that we can pass on to the future members of our family?

I strolled through the American Museum of Natural History and came across the hominid tree. Australopithecus, Homo erectus, and Homo sapiens were primitive versions of modern man but broadly complex and contained too many branch points to fully understand and impossible, of course, to trace back to our grandson.  Lessons of life on the Serengeti may not be helpful in our grandson’s future. Consequently,  I narrowed the scope by 250,000 years by downloading MacFamily Tree 2019 and joining ancestry.com. 

Standing on the shoulders of prior family tree creators, I embarked on tracing my wife’s ancestors. A few clicks and I was back eight generations and landed in the 17th century in Scotland and Ireland. Her tree was historically stocked with five Revolutionary War heroes, an indispensable aide-de-camp of George Washington, and our 11th President, James Knox Polk. 

Documenting my dearly departed Ashkenazi Jewish brethren proved a more difficult challenge. I summoned wisps of memory from late relatives recalling a “Civil War soldier,”  an  “uncle with a battle injury,” and a “Wall Street merchant.”  The documents were sparse to non-existent until I summoned the meager Eastern European geography clues left in the U.S. census forms of my ancestors. One patriarch listed his origin as Poland Russia and emigrated to New York in 1865, returned to his native land and then returned again to the US in 1875 with a wife 30 years his junior. What were the circumstances that prompted this circuitous path? What made him leave the US so quickly after his perilous journey? Unlike my wife’s clearly documented centuries of ancestor life, including details of her Presidential cousin’s kidney stones in 1812, my great grandfather’s trail turned cold. Serendipitously, he showed up in a Civil War Archive as a private in the 41st Regiment in 1865. As a replacement soldier, he received $300 so that the wealthy could be spared the injury and death that the war bestowed upon its participants. His regiment consisted of European foreigners regaled in the New York press due to their “extensive experience” in wars fought in Eastern Europe. Their return to New York City in 1865, after 70% of the regiment had perished, was snubbed by the mayor who sent a city councilman to attend the ceremony. I could understand his return to  his native land and family after these events. But WHY did he return ten years later? History of Russian Poland filled in the explanation. Poland ceased to exist in 1795 and was carved up by the imperial powers of Russia, The Habsburg Monarchy (Austria) and Prussia. Numerous national uprisings against the occupying powers occurred in the 19th century. Russia was particularly brutal in suppressing the uprisings and singling out ethnic groups, especially Jews for punishment. The Pale of Settlement, enacted by Catherine the Great in 1791 and enforced by subsequent Tsars,  prevented Jews from migrating eastward to Russia and limited Jewish involvement in public life. Jews were forced to serve in Russian military service for 20 years and their children were coerced to participate in exchange programs with other ethnic families so that Jewish children could be “Russified” and  their Jewish heritage could be suppressed. With the assassination of the Tsar Alexander II in 1881, widespread pogroms that indiscriminately killed Jews were encouraged by the government.  Fascism, while not invented in Eastern Europe, thrived in the urban and rural areas.  This singled out the Jewish minority for the ills of society and excluded them from national life. Out of this maelstrom of terror and unrest came Jewish charity and unified cooperation amongst communities for survival and ultimately migration Westward.

With this background, my great-grandfather permanently emigrated to New York City. His children took jobs as clerks, shop girls, “fancy goods” peddlers and paper cutters.  One young relative was employed as a “lemon squeezer” in presumptively a bar. The family took in boarders to put food on the table. My great-grandmother, known to me when I was 8 and in the throes of advanced dementia, had many years earlier extricated herself from poverty and became a nurse-midwife.  Sacrifice for the family was evident when sifting through the detailed census information at the turn of the 20th century. Military records recorded service in the first and second World Wars with distinguished service and injuries incurred in battle.

Our hominid ancestors gave us upright walking, tools and reasoning. As my genealogy tree branched and diverted to other spurs, it became apparent that the accomplishments of my generation and my descendants had only been possible by the sacrifices and tribulations endured by my family. Gratitude, respect and knowing the inter-connectedness of the human condition is the take home lesson to  pass on to my new grandson who begins his story before our very eyes.

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Gasless in the Carolinas

Fayetville Gas

Roadtrip!” Visions of Chevy Chase in National Lampoon’s Vacation and John Belushi’s scream of “Roadtrip!” in Animal House jumped into my consciousness. The reality was a 1,300 mile car trip up the I-95 to a bat mitzvah in New Jersey. Armed with Google Maps, hotel booking websites,  speed trap detectors,  streaming music services, several bags of M and M’s and 14 gallons of gasoline filling the tank assured me of a well-planned trip that could not be marred with concern or interruption.  I guided the Subaru SUV onto the steaming Florida Highway Interstate and headed North. 

Rumbling past Jacksonville (Named for Andrew Jackson, who knew?) and over the St. Mary’s River into Georgia, the motels and the Loblolly Pines blurred together as we approached the South Carolina state line. A few hundred miles later, my smart car, uttered in a distinguished Bostonian accent, “your fuel levels are low, shall I search for a gas station?” I pushed mute, left the I-95 in Fayetteville and was ready for a quick fill up in the nearest Circle K. Soon enough, a station appeared that was empty of cars but thoughtfully the pump handles were ensconced with plastic. This was a nice Covid protection, I thought. As I squeezed the pump handle with ever increasing pressure, the fuel gauge failed to engage.  My wife stuck her head out of the passenger side of the window, and exclaimed in that know-it-all-tone, “The plastic on the handle means they are out of gas. I reminded you 200 miles ago that a computer hack shut down the Colonial Pipeline and gas would be scare in the Carolinas.”  “It’s a big town, we’ll find gas,” I stammered. Confident that all that fracking, gulf oil reserves and the assurances of Colonial Pipeline execs would lead to a full tank down the road. 

My swagger started to fracture after four empty stations and a “skull and crossbones” emoji appeared near the gas gauge. Limping into a Red Roof Inn on less than one gallon, I anticipated a long layover, minutes from Fort Bragg and the U.S. Army Special Operation Command. Was there a way out? Scrolling down GasBuddy, multiple stations appeared with a slash across the gas tank indicating dead pumps.   Logging off the internet and onto the sidewalk, we hiked a mile up to the nearest 7-11 in search of up-to-date information on gas shipments.  My wife brought a wad of 20s with her in case bribing would be required. “A tanker was spotted five miles away heading toward a Circle K,” the cashier said in a slow Southern drawl. We coasted to our destination and got in line with 50 other cars desperately fighting for fuel. The hour wait was filled with mathematics and history flashbacks. What is the fuel volume delivered by the standard tanker divided by the autos ahead of us?   Memories of the Arab Oil Embargo and waiting for my 1/2 tank of gas with my even license plate was a returning visual in my mind.  Now, 43 years later, I could not think of how I would tell my younger self that I would be gas deficient four decades later due to rogue computer hackers. The moment had arrived, the pump inserted and the sweet distilled hydrocarbon liquid flowed into the tank. I peered to the side and saw a guy in military fatigues pumping gas into his Mustang. Could Special Ops storm Russia and unplug every hacking computer network? Not so easy. Another thought entered my mind from my pumping experience: the leaf controlled the dinosaur kingdom millions of years ago and now oil and gas clearly controlled a trip up the Eastern Coast and dictated our potential absence or presence at a bat mitzvah.

We rolled out of the Carolinas the following morning while tracking the gas gauge every 50 miles and filling up before the fuel gauge got below 3/4. Never take gas for granted!  Shortages of gas delivery and panic buying is a real American response. Perhaps, I thought in a rare moment of self-reflection, i should listen to my wife (who did tell me in December 2019 that a global pandemic was about to occur from a virus found in Wuhan China) regarding human behavior and its defensive responses under pressure and fear. Finally, bring on the electric cars!

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COVID and Nasal Memories

Pizza in my Olfactory Dreams

The Door Dash delivery was on the top of the steps, delivered from a  pizza service in San Diego that claimed “New York Style Pizza.” After the ritual disinfection of the pizza carton, the lid was lifted and I was delivered into another time and place. Scotty, the owner of a Queens pizza restaurant 60 years ago, was ensconced in my olfactory memory. He was flipping the dough as his octogenarian mother was lovingly molding a veal parmigiana hero that could make a grown man cry. Melted mozzarella, oregano, sausage and mushroom fumes reawakened a gustatory experience that I experienced for the first time, many years ago. With hops entering my nostrils from my Dad’s 1965 Miller High life, I left the COVID virus prison and entered a happier time when New York City  was a palace of gustatory delights and my childhood garden was in full bloom.

Through my nose, to the ethmoid sinuses, onto the olfactory epithelium and 60,000 smell neurons directed my pizza delivery directly to the frontal lobes and limbic system where Scotty’s still lived in vivid memory. This ecstatic experience is being stolen from millions by a renegade virus which has shut down the world for the last year. Expunging the smell and taste in some of the 25 million who have had COVID, which may have long lasting and permanent damage of the olfactory system. Malnutrition, depression and the loss of warning symptoms to natural gas leaks or tainted foods may be the legacy of sufferers of nasal COVID injury.

The least regarded of the five senses, smell and taste have taken a back seat in medical training and in popular culture. Medical school has few lectures on the proper function and diseases of smell and taste. Medical history taking neglects inquiry of one’s nasal and lingual capabilities. Olfaction has been a butt of jokes for generations of comics from the Simpson’s “smell you later”, Hawkeye Pierce’s ridicule on food sniffing in M*A*S*H and  Mel Brooks flatulence scene in “Blazing Saddles.” 

The dismissal of this forsaken sense is belied by its prominent location. The olfactory nerve, the shortest of the cranial nerves, sits in the front of the brain and sends projections to multiple areas including the emotional hub, the limbic system. Our evolutionary ancestors and current mammalian brethren rely on scent to distinguish friend from foe and food from poison. Our beloved canine, Millie, the Jack Russell Terrier from times past would apply the sniff test and rarely made a bad decision on food or domicile choices.

Obscure medical jargon has entered the mainstream with anosmia (lack of smell), parosmia (smell that fails to correctly match the odor) and phantosmia (phantom smells) appearing on long hauler COVID social sites. “Everything smells like burnt coffee” I heard a patient exclaim. “No longer can I taste the citrus in my tea,” another laments. “I ate a hamburger and I miss the onion smell and taste.” Essential oil kits are hawked on Amazon in the hope that olfactory re-education may hasten recovery. While the long term outcomes are not apparent in so recent a disease, it appears that up to 5% of smell sufferers may not  regain perception at 6 months.

“Don’t it always seems to go that you don’t know what you’ve got ’til its gone,” Joni Mitchell’s ballad went in the ’60’s.  And so it goes with Scotty’s appetizing, fragrant pies from the same decade. Enjoy your senses and don’t forget to stop and smell the pizza.

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Media Distortion Syndrome: The Baby Boomer Edition

It was 1963, the Yankees were swept by the Dodgers in the World Series, the Kennedy assassination was to be a month later and the Jetsons were on network TV. My upstairs neighbor, a wise old soul, a year ahead of me in 5th grade, casually predicted the future as he was downing his second Twinkie. “By 2000, all of the Jetsons things will be there for us.” The flying cars, the robot maids, the vacuum transport to Europe and the 2 day work week. 

Fast forward to New Years Eve, 2000 as I anxiously turned on the TV to watch the Times Square Ball drop to usher in the new millennium. Car commercials came on, all terrestrial vehicles, United Airlines ads promising low fares to Europe at subsonic speed and no robots in sight in my Southern California home. How could Joel, my upstairs neighbor, be so wrong?  A case of media distortion syndrome, baby boomer edition, no doubt. 

Social media is replete with opinions and conspiracies that pass as truth and shape our world today.  My generation, spared from the early influence of the internet, was a product of broadcast television. The three networks (CBS, ABC and NBC) and local New York City stations, WNEW channel 5 and WPIX, channel 11, raised us through the ‘50s and 60’s and shaped our proclivities, biases and sense of reality. Through the writer’s scripts, we were raised on the magical, the ingenuity of the white male, the geological time slips, bigotry-lite, and anthropomorphisms. Here is a sampling of television education gone wrong:

  1. The Magical
    1. Bewitched: A corporate advertising executive who marries a witch that can twitch her nose and change reality.
    2. I Dream of Jeannie: An astronaut finds a magic lamp and releases an attractive genie who alters reality and discombobulates authority.
    3. The Flying Nun: Self explanatory.
  2. Ingenuity and Family Glue: The White Male
    1. Family Affair: A wealthy, N.Y.  bachelor engineer becomes surrogate father to two prepubescent 6 year olds and a female teenager, assisted by his English valet. No problem!
    2. Bachelor Father: Bachelor attorney adopts his adolescent niece and live happily ever after. 
    3. Sky King: Rancher and aviator raises his niece and extricates her from all sorts of perils.
    4. My Three Sons: Widowed engineer raises three sons with the help of his father-in-law and later invites his daughter-in-law to live with the extended family. No problem!
  1. Geological Mayhem
    1. The Flintstones: Stone age family lives in Bedrock with their pet sauropod dinosaur. Humans: Pleistocene epoch, Dinosaurs: died in Late Cretaceous: 65 million year gap; a rounding error to the networks.
    2. The Jetsons: Flying cars, humanized robots and push button jobs but no physicists consulting on the show..
  2. Anthropomorphisms
    1. Mister Ed: A debonair horse who only talks to his owner and has an egotistical streak.
    2. The People’s Choice: Politician’s basset hound makes wise cracks about the hi jinx experienced by his owner.
    3. My Mother the Car: Self Explanatory.
  3. Bigotry-Lite
    1. The Real McCoys: An Appalachian grandfather moves with his grandson, and his family to cast aspersions on California natives. Starring  Walter Brennan, a John Birch Society member and avowed racist. 
    2. All in the Family: A Queens cabdriver, Archie
      Bunker, spins prejudice at home but his persona softened by his work ethic and his financial and housing support of his liberal son-in-law.
    3. The Beverly Hillbillies: Appalachian family moves to California where rich, wealthy Californians belittle the rural immigrants. A mirror image of The Real McCoys.

What we digested from those 3 networks and local feeds was entertainment to some and truth and dogma to others. Twitch your nose, rub a lamp, consult your single male engineer/attorney about child rearing or converse with your horse or your loquacious canine and prepare for a blissful life.  As to our current world, with each more outrageous conspiracy theory espoused on cable and social media, the Senate ready to discuss disenfranchisement of  millions of voters I can only shake my head and utter the insightful and comforting words of an equine star of yesteryear, “Oh Wilbur.”

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Understanding Oxygen and the Apple Watch 6: A Primer on Oxygen Saturation 101

The tech world has had a hold on the imagination and pocketbook of Americans for decades, improving our day to day communication, entertainment and educational options, all contained in the device we hold in our hands. More recently, tech companies have entered the multi-billion dollar health and wellness market, claiming a roseate outlook on life quality by revealing a wealth of “health” data populated on our iPhone or Android phones for us to peruse. For those that majored in business, art, political science or philosophy in college, watched “Keeping Up with the Kardashians” instead of “Mr. Wizard” reruns and did not take a physiology or human biology course, these numbers may be bewildering. It is time to let some “air into this room” and provide a background for understanding tech and health devices.  After 4 decades around EKG’s and pulse oximeters attached to humans and a user of Apple products for almost as long, I will provide the introductory course on the latest Apple foray into health: oxygen saturation and the pulse oximeter.

Oxygen is a key to human health. Before it’s atmospheric debut, we had bacteria for a billion years with few tech inventions during this period, save for the flagella, a whip like structure that could take you a few inches across a scum filled pond. Queue the plants (algae and other photo-synthesizers) and oxygen enters the atmosphere allowing for multicellular organisms and ultimately us (now is the time to hug your house plant out of gratitude). What did oxygen do for us? It unlocked the ability to generate much more energy from food sources that allowed us to dig a ditch, launch a satellite or use your TV remote. As any biochemistry or medical  student knows, ATP, the powerhouse chemical we use to store and release energy, is manufactured 16 fold in the presence of oxygen (for the curious, see oxidative phosphorylation and electron transport chain for more details).

The engineering dilemma that evolution was faced with for us multicellular beings was a supply and distribution problem. How to get oxygen from the air to each of our cells?  To move a substance, you need a pressure gradient to drive the work and the atmosphere pressurizes oxygen to move from high to low pressure zones. But this does not get the prized element to deeper tissues. For that obstacle, we evolved the lungs, blood vessels, blood and heart to circulate oxygenated blood to tissues to bypass this problem. 

Yes, blood, that substance thicker than water. Oxygen can dissolve in blood but at very low concentrations. To improve on the quantity of oxygen, we inherited the red blood cell and its key constituent, hemoglobin. Hemoglobin is the main oxygen carrier in the blood and allows pick up and delivery of 02 to the tissues. Oxygenated blood is bright red (usually arterial) and less oxygenated blood (usually venous) is blue. We can exploit this light absorbing property to determine how much oxygen is bound to hemoglobin at a particular moment by shining a frequency of light at a blood vessel and checking how much is absorbed and reflected at one time in the heart beat cycle.  The ratio of oxygenated to  de-oxygenated hemoglobin is measured, and reported as  oxygen saturation.

Do you need a device that warns you of oxygen shortage? Shouldn’t you feel short of breath, breathe faster and get yourself into an emergency room in time? Not always, as your brain, highly dependent on oxygen, can go haywire with  confusion, lethargy and poor judgement as a consequence. This is why the flight attendant always directs you to put your oxygen mask on first before your children. What about turning blue (cyanosis) from low oxygen? Unfortunately, this is a late occurring sign which occurs when fully ⅓ of the hemoglobin is devoid of oxygen.

Is there an early warning device to warn us of oxygen deprivation?Cue the pulse oximeter:  oxygen saturation can be measured by a pulse oximeter, or more recently with tech watches that have similar technology. Healthy lungs at sea level usually allow for oxygen saturation over 95%. As with all technologies, certain pitfalls apply. If your hemoglobin is abnormal it may not be measured properly. Carbon monoxide poisoning, for instance, renders hemoglobin incapable of binding to oxygen but is not registered by the pulse oximeter. Yes, you can asphyxiate with a normal pulse oximeter reading. The sensors must be close to the skin and not moving or else a faulty reading could result. Even expensive devices can be subject to error. Many a time in the surgery center, a reading of 60% could appear in an awake, non sedated patient. Repositioning the sensor, recalibrating the device or wheeling a new machine into the OR solved the false reading.

So what can you glean from the result? High altitude can lower oxygen saturation due to lower oxygen pressures. Altitude sickness can result with headaches, shortness of breath and in extreme circumstances, flooding of the lungs with fluid. Severe pneumonia can lower oxygen saturation and in the case of COVID 19, may not result in air hunger which would normally warn you of severe lung infection. Severe asthma could also cause a drop in oxygen saturation. Apple has started a research trial examining the usefulness of the Apple Watch 6 in this circumstance.

 The most important use of this technology may be in screening for obstructive sleep apnea. This condition is quite common in the U.S with a prevalence up to 30% of males and 15% of females).  Celebrities such as Rosie O’Donnell, Shaquille O’Neal,  William Shatner, (aka Captain Kirk of Star Trek fame), Quincy Jones, Randy Jackson (of American Idol fame) are afflicted. Luminaries whose death may have been influenced by sleep apnea include William Howard Taft (former 27th President), Jerry Garcia (of the Greatful Dead), Justice Antonin Scalia, Carrie Fisher (of Star Wars fame) and James Gandolfini (of Sopranos fame). Sleep apnea has severe health consequences and has acceptable, effective therapy. With the increase in risk factors such as adult obesity and sedentary nature of the population, obstructive sleep apnea is becoming epidemic, resulting in upper airway obstruction at night with snoring, interruption of breathing and dangerous reduction in oxygen saturation. This condition often results in headaches, daytime fatigue, hypertension, acceleration of cardiac disease and premature death. A continuous positive pressure mask can ameliorate this condition. A convenient, readily available screening tool such as a reliable pulse oximeter for nighttime use could potentially save multiple lives by directing those into the office of sleep specialists for definitive diagnosis and treatment.

So should you climb on board the day and night pulse oximetry tech train?  With certain caveats (a device that has reproducible results and matched to gold standard testing, FDA approval and  that works for night-time monitoring) this metric may benefit you when hitting the ski slopes and when your significant other has had it with your snoring and asks you to “do something about it.” Take a deep breath and ponder that.

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The Battle Against Fake Science

The fates of Dr. Li Wenliang and Dr. Anthony Fauci will be irrevocably linked in our current times. Both physicians were muted by their respective political overlords:  Dr Wenliang sacrificed his life in the pursuit of warning the world of a deadly airborne virus originating in Wuhan, China and Dr Fauci, by the Trump Administration in thwarting his public health efforts in limiting morbidity and mortality. In these unsettling times, the assault on medicine and public health is not only lethal, but tolerated by industry, public opinion and political factions. 

When capitalism and profit intersect with human health, the American experience has often been in the favor of the former. American medicine in the 19th century was profit driven, fueled by several hundred medical schools that had no legitimate science curricula, no formal training programs and no criteria for competent professors. US medical students, desiring a top flight education, would journey to Paris to get state of the art instruction. Snake oil salesmen who peddled dangerous potions for multiple ailments thrived in the 19th century. 

The 20th Century provided some sanity and sanctity in the pursuit of science and healthcare. Abraham Flexner, an American educator, at the request of the Carnegie Foundation, reported in 1910 on quack medical training that resulted in the closure of multiple schools and began the scientific basis of medical education in the U.S. The Food and Drug Administration, established in 1906,  provided an oversight of drug therapy and provided a safety net to the general public.

Greed and the pursuit of profit in healthcare today still cannot be denied.  Popular entertainment reinforces the profit motive. Mr. Wonderful, on Shark Tank, when reviewing a vitamin and herbal supplement, gleefully queried the proprietor, “I don’t care if it works, what are your yearly sales?” Gordon Gecko, in the 1980’s movie “Wall Street”, uttered “Greed is good.”  Even in the 1950’s, Jim Anderson,  the iconic principled father in “Father Knows Best” sitcom during  the Eisenhower era, readily endorsed the Springfield snake oil salesman’s request for a business license because he was good to his dog and family. 

Congress got into the act of greed and greenbacks in response to a potential flood of pharmaceutical lobbyist money, further sacrificing the principles of science and public safety. Utah Senator Orin Hatch orchestrated potential legislative medical malpractice with The Dietary Supplement and Health Education Act of 1994 (DSHEA) which decreed that over the counter supplements and herbal products did not need to prove safety data prior to their release to the public and any complications would only need to be voluntarily reported. The supplement companies could not claim to treat a “disease” but misleading euphemistic claims such as “supporting health, “wellness,” or supporting a biologic system could be used in advertising without any scientific data to confirm the claim. What was the result? The OTC industry money profits increased from $9 billion to $50 billion,  Salt Lake City, Utah became a destination for the supplement companies. Hatch’s family became lobbyists for the industry and he and other members of Congress had a reliable flow of campaign donations.  What did the consumer get? The answer is clear: A flood of products that resulted in liver injury, life threatening drug interactions and occasional cardiovascular deaths. Product labeling was often misleading or wrong. Probiotics, living bacteria that can contribute to health, were often non viable or absent when analyzed by microbiologist/scientist scrutiny (R. Knight, UC San Diego). Families put themselves into financial jeopardy by spending hundreds of dollars per month on bogus supplements hawked by salesmen and health providers. This was a legislative fiat that legally supported medical quackery.

Now the technology industry is attempting to expand their profits by tapping into our health obsession and circumventing health law. Products that evaluate sleep hygiene, pulse and heart rhythm and oxygenation are entering watches, phones and bracelets. When developing a new technology, the rational response is to compare your experimental device to a gold standard that accurately measures the outcome you are looking at. For sleep analysis this is polysomnography, a medical test that looks at EEG, respiratory rates, eye movements among other data; oxygenation gold standard is the transmission pulse oximeter. Tech companies, such as Fit Bit and Apple, for instance, bypass the gold standard test and support their device results with an opaque “secret artificial algorithm.”  In the few studies that compare products to their gold standard, they are often shown to be inaccurate. The companies, unable to get FDA approval, then take guidance from the supplement industry by using “wellness” as the reason for the biometric. With no reproducibility and no public direction on the meaning and actionable explanation for the results, we are left with tech company advertising babble to encourage their purchase. 

It has been the pandemic of 2020 that has shown the stark reality of science deniers. Trump’s effort to undermine science and mask wearing and the infiltration and destruction of our beloved NIH, CDC and FDA autonomy has been an armageddon moment in healthcare. Pushing hydroxychlorquine, megavitamins and experimental medications that have not been fully vetted in randomized controlled studies as effective cures is unacceptable to the medical community and cannot be recommended as treatments to the public at large. Furthermore,  anti-vaxers, and proponents of the deadly “Herd Immunity” strategy are further evidence of our dilemma.

I am reminded of Dr. John Snow, a British obstetrician in the mid 19th century, who observed his London patient washing her infant’s diapers in a common water pump in town that spread cholera throughout the community. Snow’s work established the water-borne source of cholera and his urging of removing water pump handles. His pleas went unheeded by the public and scientists of his time leading to the death of thousands of additional victims in the cities around the globe. Accepting well designed investigations and their conclusions are our only way to avoid a “Dark Ages” outcome of health goals.

Our hope for the future lies in the investment of science teachers, high quality training of physicians and allied health providers, debunking and removing dangerous healthcare products on our social networks and providing the public with political leaders who want to move away from the past and into the evidenced based medical world of the present. 

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How Did Trump Happen?

As the key engaged the heavy deadbolt, a loud clank was emitted and the solid steel doors opened the locked ward of the LA County Psychiatric Hospital. That sound and the antiseptic smell of the unit still linger 35 years later, as I walked across the threshold, as a third year medical student, ensconced in my newly pressed white coat and brand new Washington Therapeutics manual.  A large muscular man was leaning on a table brooding and muttering to himself. The psychiatry resident pointed to him and asked me to take a psychiatric history. “He took a bus from Illinois and was arrested on the 405 Freeway while attacking cars on the off ramp with a crowbar.” After eliciting some grunting responses and “God directed me” responses to my clinical questions, I abandoned my medical questioning. “Send him to my office and I’ll demonstrate how to perform a psychiatric history,” my instructor demanded. Summoning the patient into the small office, I sensed a catastrophe in the making. Turning over the psychiatrist’s desk and chairs and uttering a string of expletives in rapid fashion, he stormed out of the room.  The resident paused for a minute and then observed, “That guy is dangerous. F**k the history. Double his haloperidol dose.”

This moment in my medical training recurs in my mind as I watched for the past 3 ½ years at the news correspondents’ quizzical looks as they tried to respond to Donald Trump’s ever increasing disjointed communication.  While my patient in the county psych ward communicated with violent behavior, he nonetheless was unable to express a coherent on-topic conversation that mirrors reality like Donald Trump.  As the evidence mounts of Trump’s psychopathology,  supported by Ivy League and family embedded mental health specialists, the parallel becomes more realistic.

How can you account for the election and sustained authority of a man that has no appreciation for reality, no empathy and no problem solving ability? Three concepts are critical, in my opinion: 1) The firewall of falsehoods that support politics and insulate the economic, profit motive for governance; 2) the pseudo-reality of 7 decades of television watching; 3) the inability of rational people to respond to a psychotic dialogue.

The political firewall of falsehood is particularly thick in our early education. We learn that Thomas Jefferson, the author of the Declaration of Independence and the third president of the United States is a great American, however educators skim over his ownership of slaves.  Andrew Jackson, our “people’s president” and victor over the British in New Orleans during the War of 1812, was also the architect of the forced removal and slaughter of the Cherokee from Georgia despite two Supreme Court rulings against its legality.  Various wars fought in the name of preserving the American way of life were often a subterfuge for economic gain. The latter was particularly relevant for me during the Vietnam War, as my generation was drafted and conducted the war at the bequest of past presidents, including the corrupt Richard Nixon. The firewall called the war effort to “prevent the spread of communism” and contain China and Russia from world domination.  These pseudo-facts were debunked by Southeast Asian historical scholars and disseminated in political science courses during my college years and validated by the subsequent arc of history.  Profits and employment opportunities in the U.S. were the nested reasons for this conflict. Lobbyists dominate political decision making and mask the true reason for congressional and presidential decision making. When one does break the firewall of mendacity and falls on the other side, the lure of profiteering can steer you back to the wrong side. No wonder, during my one Vietnam era protest in Washington, I was warned by relatives that this could harm my future employment in Wall Street financial firms. It was hard to contest the Trump supporter’s claim that “all politicians lie.”

Television was the final coup de grace that catapulted Trump into the White House. The lack of critical thinking is pervasive in our society and television has obliterated the lines of news and entertainment. Early television could still cling to morality and group cooperation (think Father Knows Best and Gilligan’s Island). “Reality” shows that masquerade as truth created a fictional narrative that viewers accepted without reservation. Without The Apprentice, Donald wouldn’t have had the political on-ramp he enjoyed.  While all who worked with Trump in the real world of construction and media declared him a fraud, he was on television and they must be mistaken.

In summary, rational people brought up on falsehoods, ensconced in Reality TV  for a number of years combined with protective self-talk when confronted with uncomfortable behavior from elected leaders, begin to accept and adapt to irrational discourse and actions. Consequently, they excuse or ignore it.

So the narrative goes as follows: Yes, he tells lies, but don’t all politicians do the same (the firewall of falsehood) and he’s a competent businessman, it says so on television. The psychosis element is dismissed by either: 1) not dealing with it (think of how many people avoid the homeless);  2) he couldn’t be in his position with a diagnosis of mental illness.

Mental illness that erupts into violent and dangerous behavior is easy to discern and react to swiftly with isolating the perpetrator from society.  That was easy to understand in my early days of training. Like the frog slowly boiled in hot water,  we have as a society built a firewall from truth, televised abnormal behavior into entertainment and have been trained to look away and excuse or normalize statements of question or actions by leaders when confronted with uncomfortable behaviors.  My Uncle Jack use to respond to all inexplicable government driven situations with, “It’s Fixed.”  I think he is correct, but it is up to us to fix the fix.

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Portland Exposed

Asian Dumplings from Afuri Ramen and Dumplings

Xylophone Recital at the Trailblazer Game

  • Food truck in Pioneer Square
  • Voodoo Donuts
Multnomah Falls

One of the perks of retirement is opening up a map, seeing a destination you’ve never been to and then booking it. I had never been to Portland and was curious if it’s reputation as a city of second chances, a foodie haven, a city planning Mecca or a hiking haven was reality. So with the help of Costco Travel Services, I journeyed to the Pacific Northwest for a fact finding mission. 

After touching down at the Portland Airport, the expected nightmare of big city surface transportation began. Would it be Uber/Lyft at a cost approaching the price of the plane ticket or a New York City Taxi $80-$100 price from JFK/Newark to Manhattan? To my surprise, the trip to the inner city involved use of the ubiquitous light rail (MAX). At $1.25 for a senior citizen and $2.50 for an adult it allowed a stress free ½ hour commute close to the doorstep of our hotel in downtown Portland. The light rail went about to every important destination in the city environs. The Embassy Suites was our destination abode. Formerly, The Multnomah Hotel, it had hosted the iconic Elvis Presley, Charles Lindbergh and all presidents from Teddy Roosevelt to Richard Nixon.

The sign “Keep Portland Weird” was a few blocks from the hotel and it wasn’t long before I encountered support for its message. It was on a subsequent rail experience, an elderly male with a thinning hairline and walker entered our car clutching a flask of vodka. “I honor the Ten Commandments but I can’t love my neighbor more than myself,” he exclaimed as he swigged from his flask. A dark haired man with an earring engaged him in debate of the Ten Commandments, later joined by a guy carting a bicycle on the train who also participated. As the vodka bottle was passed around to the discussants, I realized I was witnessing a Portland exclusive.

The cuisine in downtown Portland was eclectic but stellar. As craft beer had revitalized the brewing industry, Voodoo Donuts had the imprimatur of craft donuts. I went into dessert nirvana with “Old Dirty Bastard,” a donut with fudge and peanut butter capped with an Oreo-cookie dusting. The dumplings at Afuri Ramen and Dumpling, a Tokyo based Ramen restaurant were also divine. The noodle experience was accompanied with a peak into the future because artificial intelligent iPads substituted for waiters. 

To our delight, the Trailblazers were at home hosting the San Antonio Spurs in our second day in Portland. I had always wondered why my Lakers had such a difficult time in Portland, even when they had championship caliber teams. A trip to the Moda Center provided some clues. It was a Thursday night and the place was packed. A portly fan two rows up started a “Let’s Go Blazers” chant well before the singing of the national anthem. The crowd was warmed up with a swarm of 5th graders playing rhythm xylophone followed by the governor of Oregon presenting a certificate of appreciation to the team on its 50th year anniversary. The game was close and the fans were so vocal it felt like game 7 of the NBA Finals. On our light rail trip back to the hotel, a long term fan explained the phenomena in personal terms. “I’m a recovering alcoholic, been sober for 7 years and a ticket holder that long. The basketball team is all we have.” 

As a neophyte Portland tourist, the next stop was a popular destination, the Pittock Mansion. This was an early 20th century home built by Henry Pittock, the successful editor of the Oregonian. Overlooking the Williamette River and surrounded by Oregonian Pines, it was a beacon of 20th century ingenuity and a magnificent home. While I was wandering past the fine silks, wondered how a newspaper editor could amass a fortune. I came across a clue. Henry Winslow Corbett, the senator from Oregon, had provided a cash infusion to the paper in 1872 averting bankruptcy and temporarily taking control of the city newspaper. Corbett made his initial fortune by selling farm equipment and dry goods to the farmers and families newly arrived from the Oregon Trail. When the San Francisco merchants raised their prices during the California Gold Rush, Corbett was able to undercut their prices and achieve market share. You could say he was the Pacific Northwest Walmart of the 19th century! He used the paper’s influence to back  the successful campaign of Rutherford B. Hayes, the Republican candidate for President in 1876. With political influence, both Corbett and Pittock went on to amass a fortune in banking and real estate.

The Portland experience was not complete until we took an excursion down the Columbia River Gorge. Multiple waterfalls grace the shoulders of the Columbia River Scenic Highway. We stopped at the 627 foot Multnomah Falls, the largest waterfall in Oregon. It was spotted by Lewis and Clark in 1805 and does not disappoint. Hiking was challenging during the winter due to muddy trails but swathed in a conifer blanket, the ascent was still exhilarating.

If natural beauty, great food, a workable transit system and NBA basketball is your thing, I encourage you to seek out the Portland high.