Human Limits

Exploring performance and health with Michael J. Joyner, M.D.

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Archive for the ‘Current Events’ Category

Aging: The Political Elite & Airline Pilots

The reemergence of former Vice President Dick Cheney in the CIA torture debate raises or re-raises all sorts of questions. One question that is not getting much attention is the health and age of key decision makers like Supreme Court Justices and high ranking elected officials.   I bring this up because Cheney has a long standing history of cardiac disease including at least four major open heart surgeries (two bypasses, an artificial heart and finally a heart transplant).   I also bring it up in the context of commercial airline pilots who are forced to retire at age 65 and prior to that are limited from working if they have significant medical problems. Additionally, depending on their age, they have to pass yearly or twice yearly physical exams to continue flying.

 

The Supremes

Currently, five of nine members of the Supreme Court are over 65 and would be ineligible for a commercial airline pilots licence based on age alone.   Justice Samuel Alito is knocking on the door and will be 65 on April 1st, 2015.

 

The Senate and House

The US Senate is an “old” organization with 40 of 100 members over 65. Harry Reid is 75 and Mitch McConnel is 72. I have no idea about the health status of Mitch McConnel, but Reid suffered strokes in 2013 and 2005. John Boehner is 65 and Nancy Pelosi is 74.

 

2016?

If Hillary Clinton were to be elected president in 2016 she will be 69, and she has a history of a venous blood clot in her brain. Vice President Joe Biden just turned 72 and has had brain surgery and also atrial fibrillation. Mitt Romney is 67, and at least as of 2011 was very rigorous about his diet and exercise regimen, but again as fit as he appears to be — he can run for president but can’t fly a commercial airline.

 

Does it Matter?

In the case of Dick Cheney there has been speculation dating from the middle 2000s that his medical condition(s) might have led to cognitive issues and clouded his judgement. There are also long standing concerns about the health of Franklin Roosevelt in the waning years of World War 2. He had a history of severe hypertension and other problems that almost certainly limited his ability to function late in the war.   Woodrow Wilson had a debilitating stroke in office that was largely covered up. Then there is the case of William Howard Taft who weighed over 300 pounds, was likely diabetic and clearly hypertensive with systolic blood pressures over 200. Taft also had sleep apnea.   After his presidency he served as Chief Justice of the Supreme Court and more or less acknowledged that he was having cognitive issues before he resigned and then died shortly thereafter at age 72. While we are at it, let’s not forget JFK, who was much younger but a medical train wreck.

 

Age Limits?

I am an advocate of healthy aging and believe that there should be no hard age limits for most jobs. However, I do believe that the health, especially the cognitive health of older decision makers needs to be evaluated and that those who show evidence of impairment should not be eligible for service. The other issue here is ongoing testing and evaluation of those already in office. Ronald Reagan was confused and rambling in one of his debates with Walter Mondale in 1984. Was it an early sign of his cognitive decline? A key elected leader or judge can make decisions that affect thousands of people in major ways with far more lives at risk than a full airplane. The president can embark on most military interventions with limited oversight. And don’t forget, there is a co-pilot on the plane.

 

 

A Holiday Gift For Your Athlete

I get a lot of questions about exercise equipment. What is the best exercise? How to workout on the road? What “should my kid be doing to improve” etc.   There is one simple answer to this question and it is also an ideal gift for almost anyone with fitness or athletic goals regardless of age who does not have too many orthopedic limitations. So what is the answer?

 

Get a Jump Rope and use it!

Jumping rope (or skipping rope) is outstanding for general conditioning. It can be used to generate an aerobic workout and you can things like minute on minute off intervals skipping rope. Skipping rope also develops footwork and balance. For younger athletes these are skills that carry over to almost all sports. For middle aged and older people these skills are critical to ward off things like frailty and falls.   Jump ropes are also cheap, portable, and don’t require a lot of space. The video clip below shows some classic footage of boxers jumping rope. Note especially the foot work and wild routine of the great Sugar Ray Robinson.   Later in the video you can see Bernard Hopkins who keeps fighting at age 50.

 

 

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What kind of rope?

I have a 40 year old Everlast leather jump rope with ball bearings that my mother got me sometime in the early 1970s. This is the type of rope the boxers use and it has stood the test of time. It is also a beautiful piece of functional industrial design. But almost any rope will do.

 

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No barriers

The specifics of skipping rope aside it is important to remember that you don’t need much if any equipment or space to develop an outstanding and effective whole body exercise routine. Skipping rope along with some simple calisthenics is free, can be done almost anywhere, and requires minimal equipment. The key requirements are simply self-discipline and motivation.

 

Football (soccer) Learning: 4 on 4 Beats 5 on 5!

David Epstein the author of the Sports Gene circulated this note to his e-mail posse:

“Mike, I’d totally read you blogging your thoughts about this: http://www.ministry-of-football.com/research-measuring-learning/.

The link is about optimizing skills acquisition and learning in football/soccer. The take home message is that for indoor versions of the game played by primary school kids there more learning goes on with 4 on 4 vs. 5 on 5 games. In other words more touches per player, more and better passing, and more periods of continuous play.

 

My Response: This is so Triangle!

David, this is so triangle offense. All old school basketball coaches break the game down into 2 on 2 and 3 on 3s. If you also look at fast break drills and other traditional b-ball drills they are all 3 on 2 with a trailer. The whole point of all of this is to; 1) generate spacing, 2) that passes are faster than running or dribbling, and 3) to “feel” the pressure from the defense and generate a mismatch.

This is why the Spurs win, why John Wooden said later in his life that the women’s game was better than the men’s, and why Pop hired Becky Hammon etc.

I have the Wooden/Sharman book of b-ball drills I picked up someplace and it is all in there.

This is also classic Soviet ice hockey and Herb Brooks as well.

 

David’s Response

See! Ha…I knew it. You should just post this…….

 

Obesity and Bargaining

A couple of weeks ago I floated the idea that for many problems facing the world a sort of collective grieving process is going on. In this post I want to pick up on that theme again as it applies to obesity. In general, for obesity I believe we have mostly moved beyond denial and are now “bargaining” about what to do about obesity both as individuals and society as a whole.

 

Costs of Obesity

Last week the big consulting firm McKinsey released a report on the global costs and consequences of obesity and what to do about it. Incredibly the report put the global costs of obesity at about 2 trillion dollars per year. This is about equal to the global costs of smoking and also the global costs of “armed violence, war and terrorism”. The report concluded that no single action is likely to solve the problem but that a range of policy options might work. The chart below is an example of what various anti-obesity interventions might do to obesity related years of life lost in Britain. My guess is that similar calculations would also apply to the U.S. and most countries where obesity is a serious problem. Of note I see at least three things missing from this chart:

 

  1. Taxes on high calorie foods or sugar sweetened beverages
  2. Higher insurance premiums for obese individuals
  3. Re-engineering the built environment

 

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Denial Not Gone

At the same time the McKinsey report was coming out, the U.S. CDC was being pressured to take down a website called “lean works” that included an obesity “cost calculator”. The concern was that such a tool might lead to workplace discrimination against obese individuals. So, perhaps denial that obesity is a problem and that something needs to be done about it is not totally gone.

 

Who Stays Lean?

Last month I was giving a talk in Denmark about what to do about physical inactivity and obesity. The talk was to a group of health care professionals who were uniformly lean and fit. Being Danes, many ride their bikes to work. So, at some level I was preaching to the converted. What occurred to me as well during the talk was that I was also talking to a group of highly educated people who all had a suite of behavioral characteristics that let them control their current behavior to prevent a future undesired outcome. In other words these people all had a sense of delayed gratification and conscientiousness. These traits likely permitted them to adopt and adhere to “healthy” lifestyles and remain lean in an obesogenic world. From what I can tell only a modest fraction of the population has a high level of these behavioral traits and skills. So what do we do in a world where so many people have so much trouble with what might be described as “self-control” and personal responsibility?

 

Beyond Personal Responsibility?

This brings me to the built environment and other big picture interventions to address the obesity and inactivity problem. The next chart shows how the battle against infectious disease was largely “won”. A lot of this had to do with things like sewers and clean water supplies. In other words, basic sanitation and civil engineering vs. medical care or medical interventions made a big difference.

 

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When big, dirty and disease ridden cities were being re-engineered and rebuilt in the 1800s and early 1900s, no one was telling the general public that clean water was their “personal responsibility”.  Instead slums were cleared and sewers and water works were built and things like cholera epidemics stopped. That having been said, I wonder how many people in today’s world would consistently boil their own water over days, months, and years in the absence of reliable clean water supplies. My guess is that over time only the most conscientious people would do it. At some level our current world is just as toxic and maybe larger scale interventions are needed.

 

Going Far Enough?

I applaud the McKinsey report, but does it go far enough? My guess is that many of the food policy recommendations will likely work if they can ever be implemented in a comprehensive way. However, I also have serious doubts about whether that can be done. I also believe (as cigarette taxes have shown) that humans are price sensitive and that economic tools have to be part of the solution to the obesity problem. There also probably needs to be a serious discussion about how car “unfriendly” the world needs to be if we really want to make a dent in the inactivity element of the obesity epidemic.  It is hard to imagine that our physical world might be redesigned in a way similar to what happened in cities 150 years ago, but perhaps it will happen. There are innovative proposals on the table in London to promote more bikes and fewer cars.

 

None of this will be easy, but the partial success of the anti-smoking movement in some countries shows that over time it is possible to change bad societal habits, but it takes more than simple personal responsibility.   So let the bargaining begin!

 

 

Jack Wilmore an Appreciation

My teacher, colleague and friend Jack Wilmore died last weekend at the age of 76.   He is survived by his wife of more than 50 years Dottie, their three daughters and families.

 

After graduating in the middle 1960s with his Ph.D. from Oregon, Jack taught at Ithaca College, Cal, UC Davis, Arizona, Texas, and Texas A&M. He was named Distinguished Professor at both Texas and Texas A&M. Given the rivalry (hatred?) between The University of Texas and Texas A&M, I wonder if anyone else has ever held such high academic rank at both places.

 

I was lucky enough to work in Jack’s exercise physiology lab at the University of Arizona as an undergrad and medical student from the late 70s through the middle 80s. While there are a million stories to tell, I think there is a three-fold “bigger narrative” about what Jack Wilmore accomplished and left for us all.

 

The Emergence of Exercise Science

The first part of the narrative is about how Jack and a few key colleagues around the country and world realized that physical education as known in the 1950s and 60s had to become more scientific and more intellectually rigorous. This led to a real flowering of what we now call Exercise Science or Kinesiology at essentially all of the big research universities and other academic institutions in North America, and the developed world.   This flowering led to the development of majors in related fields that have grown tremendously over the last 20-30 years. On many campuses these major are now among the most popular science majors. They are also key “pipeline” majors for undergrads interested in graduate or professional training in a number of health related fields. Very few people can say they participated in the broad based re-engineering of higher education on a worldwide basis; Jack Wilmore was a major player in this movement.

 

The Cutting Edge of Research

Jack was also at the forefront of a number of exercise related research themes starting in the 1960s. A short list includes:

  • A number of pioneering studies and books on body composition that among other things anticipated the “obesity epidemic” by several decades.
  • Early studies on female athletes.
  • Major contributions on topics related to adult fitness and cardiac rehab. Like the story for body composition and obesity, these contributions were several decades ahead of the current concerns about the health consequence of physical inactivity on the population as a whole.
  • The pioneering development of semi-automated and automated “metabolic carts” to measure oxygen consumption.   This really was the first wave of innovation in this area and again Jack anticipated what came decades later with the automated commercial systems that are used all over the world today.
  • Physiology studies that included topics like human performance, thermoregulation, the physiology of maximum oxygen uptake (VO2max), and the lactate threshold.
  • The genetics of training adaptations.

 

The other interesting thing is that Dr. Wilmore was a superb classroom teacher. You hear a lot about faculty at big universities being buried in the lab and uninterested or ineffective at undergraduate teaching.   Jack was the best classroom teacher I had as an undergrad. He was organized, engaged, and able to really transmit his interest and expertise to students.

 

All of his scientific and educational achievement was accomplished with an eye toward collaboration and what could be learned from others. Jack’s collaborative spirit brings me to the third element of the three-fold narrative.

 

Jack the Good Guy!

Over the last couple of days I have received all sorts of anecdotes about something helpful Jack did for someone. Things like a thoughtful and supportive question to a student at a conference, or a key letter for a younger colleague as they climbed the academic ranks. The comments from his many collaborators focus on his generosity and ability to put his ego aside while looking for solutions vs. having his way.

 

In Tucson, Jack had a sign on his desk that said “don’t let the urgent crowd out the important”.   When you combine that maxim with his ability to channel vs. suppress the energy of young people, his availability, and his ability to frame almost anything in a positive context you can see in retrospect how it all came together. Thus, there is a long, long list of people who benefited from and loved working with Dr. Wilmore. Nobody ever worked for him.

 

At the end of VO2 max tests on highly trained athletes, Jack had a knack for drifting out of his nearby office to the treadmill lab. As the test reached a climax with the runner going all out he would encourage us with a “beautiful job” just at the point of exhaustion. It was something we all wanted to hear but we never got to say it to him.

 

Beautiful job, Jack!…….

 

Grieving & “The Election”

The U.S. election a couple of weeks ago is being hailed as all sorts of things. However, if you look back over the last few elections it seems to me like the voters are pretty unsettled and that it more like a serve and volley between parties.   This has then led to a cycle of each side over-interpreting their “victories” as either a mandate for their world view, a repudiation of the other side’s, or both.   This over reading of things probably makes compromise on issues like entitlement reform, immigration, health care and energy policy harder rather than easier.   The lack of compromise then leads the voters to blame the party they see as in power and vote for the other side in the next election.   This summary may be an over simplification but it seems to me like it explains a lot of things.

 

Why is Compromise So Hard?

The standard answers to this question are about a politically polarized country, safe districts that reward uber-partisans, the 24 hour news cycle, and money in politics to name a few. However, is their a root cause of all of this? Could it be that both the political elite and general public are involved in a “grieving process” over the changes confronting the world and the challenges they are generating for the U.S. The steps in grieving include:

  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

 

My medical colleagues who do palliative care tell me that the process is not linear and that patients and families hopscotch from one stage to another but almost everyone ends up at acceptance over time.

 

Grieving About Change?

The aging population, globalization, and technology are leading to a transformation of human society on the order of that seen with the adoption of agriculture about 10,000 years ago and the emergence of the Industrial Revolution over the last 3-400 years. The only difference is that the current changes are happening in only a few generations vs. hundreds or thousands of years. Along these lines, many of the assumptions that underpinned U.S. economic and political “clout” and perhaps made compromise easier after World War II were things like.

  • Plenty of workers for every retiree
  • Life expectancy at age 65 on the order of 10 years (it is now closer to 20 years)
  • Plenty of medium skilled high wage jobs in manufacturing
  • A huge industrial base after WW II compared to the devastation everywhere else
  • A monolithic foreign policy foe in the Soviet Union

 

All of this is gone and I would argue that a political grieving process is in full swing. I would also argue that these factors explain most or part of all sorts of things ranging from the burgeoning national debt, income stagnation and inequality, to our uncertainty about how to respond to the mess in the Middle East.

 

An Example

I see a combination of denial, anger and bargaining particularly over issues like Medicare and Social Security reform. These are signature programs for the Democrats that they are loathe to change. They are also on the road to financial insolvency over the next couple of decades. Some seniors get angry when the topic of change comes up falsely arguing they have paid for their benefits. The Republicans are for reform until they get worried about the political fall-out of change or can attack a Democrat for advocating change.

 

This example is just one of many about how both the political elite (who are likely aware of the big trends I have outlined) and the general public are having trouble coming to grips with how the world is changing. Some people have moved beyond denial, anger and bargaining to depression – an acquaintance of mine was so depressed about the situation he seriously considered not voting figuring that it was essentially impossible to address the problems confronting the country. But the point is that we need a realistic discussion about a host of topics and possible solutions as we try to adapt to the changes that are coming.

 

Not the Only Example

In the next couple of posts I am going to use the “grieving” model to discuss other topics like why so few people follow health living guidelines as I try to understand the mismatch between what people understand and what they do.

 

How low can marathon times go?

 

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What Kind of Mind Game Will It Take to Run a 2-Hour Marathon?

 

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