A Life Worth Ending

Michael Wolff wrote an incredibly honest essay over the summer about his mother’s last years in hospital beds, and having to endure endless sessions with doctors where no one was willing to confront the elephant in the room: his mother was a vegetable. Hers was a life worth ending. It’s a personal story I expect we’ll be hearing more frequently, as the rate at which we develop technologies to lengthen life outpaces the development of the corresponding ethics / norms / expectations within families and the healthcare system. Worth reading.

Book Review: Why We Get Fat

I found Gary Taubes’ Why We Get Fat to be provocative and persuasive. It challenged my long held assumption that the way to lose weight is to eat less and exercise more. Taubes’ hypothetical exposes the oddity of the “eat less, exercise more” maxim:

Imagine you’re invited to a celebratory dinner. The chef’s talent is legendary, and the invitation says that this particular dinner is going to be a feast of monumental proportions. Bring your appetite, you’re told—come hungry. How would you do it? You might try to eat less over the course of the day—maybe even skip lunch, or breakfast and lunch. You might go to the gym for a particularly vigorous workout, or go for a longer run or swim than usual, to work up an appetite. You might even decide to walk to the dinner, rather than drive, for the same reason. Now let’s think about this for a moment. The instructions that we’re constantly being given to lose weight—eat less (decrease the calories we take in) and exercise more (increase the calories we expend)—are the very same things we’ll do if our purpose is to make ourselves hungry, to build up an appetite, to eat more. Now the existence of an obesity epidemic coincident with half a century of advice to eat less and exercise more begins to look less paradoxical.

I also liked this sentence:

To ‘explain’ obesity by overeating is as illuminating a statement as an ‘explanation’ of alcoholism by chronic overdrinking.

The thesis of the book is that what you eat determines weight loss. Namely, what kind and how many carbohydrates. Taubes advocates the Atkins diet — low carb, high protein, high fat. Taubes is a science journalist, not a researcher himself, so he positions himself as a syntheizer of the literature. Here’s his recent podcast interview with Russ Roberts on Econtalk. For a more skeptical take, here’s a blog post from Scientific American.

I reccomend Why We Get Fat to anyone interested in nutrition, diet, and health. Thanks to Saar Gur and Tod Sacerdoti for the recomendation.

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Also from the book: diet and disease:

Eat Western diets, get Western diseases—notably obesity, diabetes, heart disease, and cancer. This is one of the primary reasons why public-health experts believe that there are dietary and lifestyle causes for all these diseases, even cancer—that they’re not just the result of bad luck or bad genes.

To get a feel for the kind of modern evidence supporting this idea, consider breast cancer. In Japan, this disease is relatively rare, certainly not the scourge it is for American women. But when Japanese women emigrate to the United States, it takes only two generations for their descendants to experience the same breast-cancer rates as any other local ethnic group. This tells us that something about the American lifestyle or diet is causing breast cancer.

Colon cancer is ten times more common in rural Connecticut than in Nigeria. Alzheimer’s disease is far more common among Japanese Americans than among Japanese living in Japan; it’s twice as common among African Americans as among rural Africans. Pick a disease from the list of Western diseases, and a pair of locations—one urban, say, and one rural, or one Westernized and one not—compare people in the same age groups, and the disease will be more common in the urban and Westernized locations and less common outside them.

The Fragility of Health

I came down with food poisoning last night. Twice during the night, I got out of bed, went into the bathroom, and threw up.

I bent over the toilet, hands on knees, and did the violent act for 45 seconds.

After the second time, I looked up from the toilet and faced the mirror in my bathroom. My eyes were bloodshot. Face grey. I was shivering all over. In that moment, I felt frail and vulnerable in a way I hadn’t felt for many years.

Today, I’ve been reflecting on how a single piece of bad food, in a matter of hours, could make me go from youthful, energetic, and ready to do anything, anywhere to bedridden, weak, depressed. My physical health is so good most of the time that I take it for granted.

Jimmy V’s classic ESPY speech from 1993, delivered two months before his cancer killed him, talks about cherishing every moment of good health. Obviously, a simple bout of food poisoning is not comparable to life-ending cancer, but his message, which I re-watched tonight, resonated anew. Hopefully it will stick for longer this time.

Mike Moritz is Chasing Daylight — The Adjustments He’s Making As a Result

Mike Moritz, one of the most successful VCs in Silicon Valley history, announced he’s been diagnosed with an incurable illness and has been told his quality of life will likely decline significantly in the next 5-10 years. Very sad. Moritz says he will continue to do investing but also make some changes in his life:

I will use twelve to fourteen weeks – sprinkled throughout the course of each year – for various pursuits, diversions and trivial indulgences.

Reading this sentence gave me pause and caused me to reflect.

Among other things, I was reminded of the classic 2005 Alex Tabarrok post about travel. To paraphrase: If someone told you you were going to live for 10 additional years (say, living until 110 instead of 100) and ask what you would do with that extra time, you would probably say (among other things), “I’d travel more.” If someone told you were you going to die in the next 5 years and ask what you would do with your time remaining on planet earth, you would probably say (among other things), “I’d travel more.” Those were Alex’s answers, and mine too. As Alex says, “Given that I would travel more if I was to live either less or more, the probability that I was at just that level of mortality that I should not be traveling now must be vanishingly small.” And so he set off for Peru.

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The phrase “chasing daylight” from the title of the post comes from the touching book by the same name. I finished the book in tears. My book review is here.

What Doesn’t Kill You Makes You Stronger?

Whether you think of Nietzsche or Kanye West when you hear the line "what doesn't kill you makes you stronger"–you probably think of it as true. Or at least I did. Short term struggle builds long term strength. Even life's toughest experiences have a redeeming quality inasmuch as it instructs or inspires or hardens or softens a person in the right away. Etc.

Christopher Hitchens is dying of cancer. He's undergoing radiation. In Vanity Fair he reflects on the maxim that I took as fact–and finds it false.

In the brute physical world, and the one encompassed by medicine, there are all too many things that could kill you, don’t kill you, and then leave you considerably weaker.

On the pain he felt:

To say that the rash hurt would be pointless. The struggle is to convey the way that it hurt on the inside. I lay for days on end, trying in vain to postpone the moment when I would have to swallow. Every time I did swallow, a hellish tide of pain would flow up my throat, culminating in what felt like a mule kick in the small of my back. I wondered if things looked as red and inflamed within as they did without. And then I had an unprompted rogue thought: If I had been told about all this in advance, would I have opted for the treatment? There were several moments as I bucked and writhed and gasped and cursed when I seriously doubted it.

He ends:

So far, I have decided to take whatever my disease can throw at me, and to stay combative even while taking the measure of my inevitable decline. I repeat, this is no more than what a healthy person has to do in slower motion. It is our common fate. In either case, though, one can dispense with facile maxims that don’t live up to their apparent billing.

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Here's a touching book trailer about dying. I've rarely seen someone on camera who appears truly at peace in life. Lee Lipsenthal does. He passed away a couple months ago. His book, Enjoy Every Sandwich, came out last month.

The Effects of Going Off the Grid and Exploring Nature

Is going off the grid and retreating into nature sure to be relaxing and rejuvenating? Not for Rob Horning, who spent some time in Idaho for a nature trip awhile back. He reports:

Contra Thoreau, retreating into nature, instead of bringing me back to myself, made me feel like less of a self and a bit more like one of the many undifferentiated bison one encounters out there. I don’t feel replenished for the assault on the backlog of posts I intend to read and write. Instead, as I was out hiking, I would think of this dormant blog and wonder how I’ll ever manage to catch upa nagging thought that filled me with vague, unshakable uneasiness.

Being adrift in the natural world had come to feel very unnatural; the serenity seemed like a taunt. This seems to me the inverse of the interconnected feeling I take for granted in the time I spend online, and I understood for the first time why people would do something as inane as Twitter their hikes from their iPhones or something. I tried to feed this anxiety by taking lots of pictures with the idea of sharing them later, but this only aggravated the feeling. I couldn’t possibly take enough pictures. Eventually I had to try the opposite tack and take no pictures at all.

There are two points here. The first is that if you take a vacation but spend the vacation time worrying about all the work that's piling up, it may cause more stress than you had in the first place. A valid point, which is why off-the-grid vacations need to be long enough so that you pass by that anxiety, so that you get you a point where so much work has piled up that you essentially say, "Screw it, time to relax." 6-7 days a couple times a year seems a good number for formal vacation; a couple days of stress, a few days of relaxation.

His second point is that being disconnected from technology–and out in nature–makes you feel adrift, perhaps lonely. I think this is a benefit from unplugging for stretches of time. Something that feels unnatural in the modern age is not necessarily a bad thing.

I wish I spent more time in nature and off-the-grid. That, and meditating, are two things I aspire to do more of in the year ahead in order to lower stress, improve health, and improve clarity of thought.

I Loved You, I Loved You, I Loved You

Derek Miller, a writer and technology thinker, passed away a couple days ago. He wrote a touching final post that was scheduled to publish upon his death:

Airdrie, you were my best friend and my closest connection. I don't know what we'd have been like without each other, but I think the world would be a poorer place. I loved you deeply, I loved you, I loved you, I loved you.

If you scroll through the most recent few entries (of his 10 year old blog), he writes about his decline with great eloquence, honesty, and clearheadedness.

It's a privilege (is that the word?) of the modern age to be able to read these types of blog posts — dying people documenting their decline in a public forum. There's something comforting in it, for me.

It's chilling when someone dies unexpectedly and their last blog post or tweet is especially banal or random.

Derek, long fighting cancer, prepared a thought-out goodbye post. Yet, a couple weeks ago he was tweeting about the the future of the iTunes store. He knew he was days or weeks away from dying…but in the meantime, why not link to a good commentary on whether iTunes will move to the cloud?

Perhaps it's not so chilling, after all, these sorts of seemingly trivial postings. Live each day of your life doing the things you like to do, tweeting about the things you always tweet about. Until there are no more days left to live.

RIP, Derek.

Live Together, Die Alone

As a follow up to my previous post on the Regrets of the Dying, a reader who worked in pallitive care wrote in to share an interesting anecdote: patients where she worked always seemed to die during the very brief moments when a family member or care worker stepped out of the room. This post on a Chicago Tribune blog contains similar anecdotes from a different hospice center:

In the 1990’s, Twaddle [chief medical officer at a pallittative and hospice center] and her colleagues noticed a strange phenomenon. "Families would be in vigil for days by a bedside, finally go to get some dinner, take a shower, and when they left, the person would die,” she said. "Then, racked with a sense of guilt, self-flagellation ensued as family members said 'I shouldn’t have left.' "

So they conducted an informal study and found that more than 80 percent of the time, Moms died alone. Dads, on the other hand, seemed to wait until everyone was there and died in the midst of the gathering, Twaddle said.

“Even when the family was in vigil, it was when they left that Mom died,” Twaddle said. “What does that perhaps indicate about 'wanting someone there?'”

Twaddle knows the study was scientifically flawed, but here's her larger point: “If there is a piece that is volitional in the death process, could it sometimes be in waiting for space, quiet, and aloneness for some?

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Here's Robin Hanson's skeptical take on list of regrets I linked to (emphases my own):

Deathbed folks are usually far from their analytical peak – they are often in great pain, and rather muddle-headed. So why would we think their comments especially insightful? I suspect we attach unrealistic significance to deathbed words because we are terrified to think about death, and eager to show our devotion to the dead and dying.

But if deathbed regrets are less than reliable descriptions of reality, where might they come from? One theory is that they are like the famous interview question “What is your main fault?”, which evoke answers like “I work too hard” or “I’m too much of a perfectionist.” These are obviously attempts to brag about a good feature, but call it a “fault.” All but regret #4 above fit this directly – they basically say “I sacrificed so much for you people.” Regret #4 similarly declares how much the dying cares about others.

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If all this talk of death is getting you down, here's a song from Glee that gave me goosebumps, and another one featuring Gwyneth Paltrow that got stuck in my head the moment I heard it. (You've been warned.)

Best Sign at the Rally for Sanity

This wins the award for the best sign (among many hilarious mock-signs) at Jon Stewart's political Rally for Sanity last weekend in Washington D.C.:

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How Seinfeldian: it identifies an issue everyone thinks about but rarely analyzes. Why do Mexican restaurants not provide more than three or four tortillas with a fajitas order? Order fajitas and you inevitably run out of tortillas before the meat and veggies are eaten.

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Last week I met with a friend who subscribes to this blog via Kindle. He pulled up to our meeting place, got out and stood in front of his car, and waved me over. He popped open the trunk. I looked. He had just come from picking up groceries. Plop in the middle was a full rotisserie chicken. I asked, "You read my post?" He smiled and nodded. I had a quiet moment, and reflected. To think my blogging has had that kind of impact — to know that more supermarket rotisserie chickens have made their way into the homes of hard working men and women, to know that said men and women will be enjoying not only warm chicken right away but also cold chicken leftovers for days to come…goosebumps, goosebumps. (Thanks to Jackie Danicki for turning me on to the wonders of inexpensive supermarket rotisserie chicken.)

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Here's my post on bread baskets, menus, and waiter eitquette. I talk about fish oil and supplements here. Here's my ode to the rice cooker. Paul Graham thinks the number of restaurants in a city that require men to wear a jacket and tie is an indicator of that city's potential as a tech center. Here are Michael Pollan's nine rules of thumb for good nutrition.

How to Cook Restaurant-Quality Food

Last year the always worthwhile Adam Gopnik wrote a great piece about cookbooks. Delightful reading for anyone unusually interested in cooking. For the rest of us, there was one big overarching practical nugget:

…hyper-seasoning, and, in particular, high salting, is a big part of what makes pro cooks’ food taste like pro cooks’ food….

Mark Peel, in his Campanile cookbook, comes near to giving the game away: “We chefs all lie about our mashed potatoes,” he admits. “We don’t tell you we’ve used 1½ pounds of cream and butter with 1¾ pounds of potatoes. You don’t need to know.” (Joël Robuchon, the king of his generation of French cooks, first became famous for a purée that had an even higher proportion of butter beaten into starch.)…

After reading hundreds of cookbooks, you may have the feeling that every recipe, every cookbook, is an attempt to get you to attain this ideal sugarsalt-saturated-fat state without having to see it head on, just as every love poem is an attempt to maneuver a girl or a boy into bed by talking as fast, and as eloquently, as possible about something else.

I've learned a bit about cooking over the past several months. Below, I add two points of advice to Gopnik's:

1. Add salt.

2. Buy rotisserie chickens from the supermarket.

3. Buy a rice cooker.