©March 2008

Seeking an antidote for aging has been a dream of humans since before Ponce de León searched in vain for the Fountain of Youth in Florida, followed centuries later by hordes of retirees from New York.  In fact, led by advances in sanitation, housing, and subsequently by the vaccination and antibiotic era, humans have enjoyed a fair amount of success by increasing life expectancy from 47 years to about 80 years over the past 150 years in developed nations.  While it is unfortunate that these successes have not generally been shared with countries left behind by modern advances, the World Health Organization and certain private foundations are currently seeking to more evenly distribute these achievements.  The challenge facing developed countries, in addition to helping to correct the disparity in public health resources between the wealthy and poor, is to continue to increase longevity while at the same time assuring that this increased quantity of time includes the promise of quality of life.  The fields of research are studded with disappointments, but also with some exciting new discoveries.

There have been several recognized changes in cells that occur as we age.  Many of these changes have been attributed to damage resulting from byproducts of the operations of our cellular machinery.  We know that a particular “handle” on our DNA, called the “telomere,” seems to shorten as a cell divides over and over again, leading eventually to cellular death.  We know that exposure to certain unstable molecules within the cell causes damage to cellular materials by oxidation, and thereby lead to shortened cellular life span.  This contributed to a search for “antioxidants” as a solution to aging, and resulted in the emergence of many advocates of mega-doses of certain vitamins.  However, recent research has not confirmed the promised benefits of high dose Vitamin E and Beta carotene supplementation.  While a number of genetic markers have been recognized as promoting longevity, the practical application of this knowledge to public health is only theoretical.

On the other hand, there are reasons for some hopeful optimism in this quest for longevity.  Work done in 2006 with the fruit fly and certain worms uncovered an enzyme system which not only extends life span, but also reduces the frequency of several diseases of aging, such as type 2 diabetes.  A search is underway for other molecules that stimulate the “sirtuin” enzyme system and several candidates have come to light, but much research is needed before any conclusions can be practically applied to humans.

Through research done with rhesus monkeys and other species, one intervention has been repeatedly demonstrated to have a positive impact on longevity.  Animals that consume a calorie-restricted diet live longer.  It is in keeping with Nature’s sense of humor that exactly the behavior most averse to affluent populations is the behavior which appears to have the greatest impact on increasing life span.  While solutions other than limiting food intake are being sought to extend lifespan, for the time being calorie restriction appears to be the most accessible option, if not the most marketable.

While these thoughts have not addressed the critical issue of quality of life, it is important that we flavor any increased duration of life with satisfaction.  We are again left with the task of deciding for ourselves what balance between time and quality provides us with the rewards we seek.

©July 2007

To question what it means to be human may not sound like a public health issue.  However, suicide, as narrowly defined, is a behavior that is distinctive only to humans.  Therefore, to scrutinize what it is about humans that accounts for this uniquely human tragedy may bring us to a better understanding of the phenomenon of suicide and contribute to minimizing its occurrence in our communities.

It is clear that other creatures will engage in behavior that results in the self-imposed death of the individual.  A scorpion will sting itself, a spider may lose its life upon mating, a mammal may die defending their young against impossible odds, and higher animals may die of starvation after the loss of a mate or die as a result of self-injury upon captivity.

However, as far as science can determine, none of these examples represent actions by otherwise healthy individuals that are chosen with the specific purpose of ending the life of the individual.  So what singularly human capacities make such a decision possible?

It is generally accepted that humans enjoy intellectual powers that provide us with unique perceptions.  This includes the ability to conceive of life span, life expectancy, and mortality – most notably our own.  People understand abstract concepts like taboo behavior, popularity, ethics, and cultural norms.  We inevitably construct some sort of self-image of ourselves by measuring how we perform against the norms that regulate the societies in which we live.  Unfortunately, when our own self-assessment leads us to perceive ourselves as falling far short of our own expectations or society’s expectations, mental anguish is a frequent outcome and the mechanisms of mental illness frequently follow.  Self-awareness of the factors that influence our behavior provides the basis for widely embraced and successful forms of psychological treatment, such as Cognitive Behavioral Therapy and Dialectical Behavioral Therapy.

To maintain a healthy mental state, one must have an adequate supply of socially acceptable coping mechanisms (rational arguments, self-confidence, meaningful employment, a sense of humor, spiritual beliefs, etc…) with which to manage the negative or positive self-perceptions one encounters, to greater or lesser degrees, during life.  One theory considers that the abyss of suicide in an otherwise healthy individual represents a breakdown of these coping mechanisms relative to one’s negative self perceptions and/or world perceptions.

A recent article in the New England Journal of Medicine points out that it is possible to detect in young people when the failure of coping mechanisms begins to push a young person towards a sense of hopelessness.  There are even indications that physical, genetic factors may in some instances influence our ability to develop and exercise adequate coping skills.

Herein lays the public health message.  Prominent risk factors for suicide include Native American and White ethnicity, residence in a rural community, access to firearms, substance use disorders, male gender, sexual assault victimization and recent personal loss.  “Red flag” trigger factors include recent exposure to personal tragedy, intoxication, loss of interest in favorite pastimes, ease of access to a suicide method or legal problems.  If you or someone you know displays such behavior and admits to thoughts of suicide when you ask, call or have them call 1-800-273-TALK immediately.  For a local number to access emergency mental health care for thoughts of suicide, call your local Behavioral Health Department.

Self-perceptions are naturally distorted by our own biases.  Recognizing early when those perceptions – guided or misguided as they may be – are leading us to thoughts of hopelessness may be all the incentive we need to seek professional counseling services.  Such services can and do save lives.

©December 2008

Recently Americans have shared an identity crisis of extraordinary proportions.  Without dwelling upon the confidence-rattling events of the past several years, the emergence of a national state of depression seems to threaten one of the great strengths of our nation: a sense of humor.  Therefore, in the interest of taking a break from the fury of the battle, it appears to be a timely opportunity to explore the mysteries of laughter.

If we stick with a scientific dissection of laughter as a behavior, we discover that it actually involves very complex neurophysiologic mechanisms.  First, there is the cerebral recognition of irony in the joke itself.  Then there is the contraction of the oral muscles which bears the teeth, the spasms of the diaphragm which cause brisk movements of air, the array of sounds generated by contraction of the vocal chords, and in a real guffaw, gasping for air and closure of the eyes!

In many forms of dementia, the sense of humor is one of the first cognitive functions to go.  A very revealing test that a doctor can do in the course of a physical exam is to tell a joke, and see if the patient responds.  Of course, if the physician is a biostatistics professor this test is nearly impossible to conduct.

Through neuroimaging techniques and mapping of the cerebral cortex, scientists have pointed out that laughter is generated from the same anatomical sites in the brain that produce growling in other primates and lower mammals.  The consequential behavior – bearing of the teeth accompanied by the emission of guttural sounds – certainly is reminiscent of laughter, although true laughter is curiously unique to humans.  On the other hand, a certain amount of satisfaction might be achieved by growling while watching the evening news, since giggling might be socially unacceptable.

The recognized health benefit of laughter has led to the development in India of “Laughter Clubs”, in which individuals join in communal laughter without the benefit of comedy.  Like yawning, laughter has a subliminal infectious quality.  Ergo, “sit com” producers saturate the sound tracks of their shows with tracks of laughter which in real life would warrant referral for group psychotherapy.

In this country, one can only speculate about the consequences if the pharmaceutical companies, recognizing the health benefits of humor, were to obtain patents on the latest jokes.  Would it be necessary for companies to prove the positive effects of certain jokes by performing controlled studies, in which the control group would be forced to listen to ice skating commentary?  Would certain jokes only be available by prescription, accompanied by warnings for patients suffering from incontinence?  Would there be certain jokes that should never be told together to a particular patient because of the risks of interactions?  Would insurance companies deny coverage to Comedy Clubs that were not Preferred Providers?

While our health care system is plagued with many problems, we should console ourselves that some of the healthiest things we can do are free, and within our reach.  A walk in the woods, a swim in the ocean, or a reminder to not take oneself too seriously may all be on that list.  It’s a funny thing.

©September 2007

When was the last time you took time away from work to enjoy a vacation?  While taking time off, did you relax?  It might actually be a very astute public health recommendation to advise our friends and families to “go fly a kite.”

According to a study by the International Labour Organization, Americans take fewer days off of work each year than any other industrialized country.  Twenty five percent of Americans do not receive paid vacation.  In addition, those employees in the U.S. who are provided the benefit of paid vacation days typically fail to take an average of one to two of those days per year.

Workers in Germany average 30 days of paid vacation time per year, and in France it averages 38 days.  Americans average about half that.  Even among the industrious workers of Japan, vacations are more extensive than in the U.S.

Now, it should be made clear that there is nothing wrong with dedication to work and a strong work ethic.  This is the classic parental montra.  However, it is also dangerous to accept the notion that we can maintain maximum health and benefit to our families when we forfeit every last morsel of free time in favor of work.

Research has explored the characteristics of work that contribute most significantly to work related stress.  It turns out that the occupations that generate the most anxiety on the part of employees are those jobs in which the employee has the least ability to influence their work responsibilities.  Such an insight may help explain why work within the U. S. Postal Service or in positions with repetitive mundane responsibilities are so hard on some employees.

Literature is rife with speculation about why Americans are so obsessed with work.  Economic pressures, Puritanical roots and corporate influences have all been suggested as major contributors.  However, Websters Dictionary alludes to the fact that the Latin root of the word “vacation” includes references to the cocept of “freedom.”  Restraints are equally effective, whether they be physical or self imposed and economic, and neither is conducive to good health.

Consider planning a vacation this next year.  And remember that a vacation does not have to be expensive.  Time off to go camping, or a bike trip might be just the ticket.

It is worth reminding ourselves that spending restful time with our families and friends is an important way to keep a healthy perspective on the trials of work.  Such an outlook makes for a more enjoyable life and ultimately a more productive employee.