Hasta La Gadget!

Exactly one hundred and fifty years ago, on the 31st of January 1865, the United States Congress passed the 13th Amendment to the Constitution. The abolishment of slavery remains one of our country’s great moral triumphs, a crowning achievement of liberal, enlightened civilization. Unfortunately it was done too late, with too little real effect, and at a terrible price we did not have to pay.

No doubt this strikes a discordant note: dimly retained 5th-grade history seems to recall the abolition of slavery as one of a very few unblemished victories in our checkered national past. Not so.

Too Late:
I suspect that if you asked the Man on the Street (or me a week ago) where the United States fell in the timeline of nations abolishing slavery, they’d probably put it in the heroic forefront. It’s patriotic to believe the best of your country, so I’ll warrant it comes as a shock to hear that the United States, Land of the Free, came in just about dead last. Argentina abolished slavery in 1813, followed by Colombia, Chile, Central America, Mexico, and Bolivia by 1831. Slavery was made illegal in England in 1833, and the entire British Empire (i.e. most of the world) by 1840. Uruguay abolished it in 1842, followed by all French and Danish colonies, Ecuador, Peru, and Venezuela by 1854. In fact, the only nations to trail the United States were Brazil, Puerto Rico, and Cuba.

It’s worth noting, moreover, that in almost every single one of these instances, the abolition was done peacefully, and the countries quickly recovered from a sullied past.

Too Little Effect:
Not so in the United States. “Black codes,” vagrancy laws, Jim Crow, and other forms of white supremacy made a farce of the formal abolition of slavery, subjecting many blacks to quasi-slavery and de facto subjugation. As the writer Thomas W. Knox described, even the northern Reconstructionists were culpable: “The difference between working for nothing as a slave, and working for the same wages under the Yankees, was not always perceptible.” The bitter recriminations continued for a century, only really tempering with the Civil Rights Movement of the 1960s.

How is this possible? How could so much of the rest of world have resolved its issues of slavery with such relative ease and in such relatively short order? Why did we, who held that “all men are created equal,” have such a difficult time shedding such an execrable institution?

Too Great a Price:
I contend that the United States wrestled so ineffectively with slavery because it paid far too high a price for its abolition; an unjust war to maintain a reluctant union unwittingly subjected a nation and a race of people to well over a century of misery and holocaust.

Once again, this probably strikes a discordant note. Wasn’t the Civil War fought over slavery? Wasn’t Lincoln the Great Emancipator and the savior of southern blacks?

Unfortunately once again, not so.

Lincoln, the myth conveniently lets us forget, was no friend of the black slave. His own words, over and over again, prove this:

“I have no purpose to introduce political and social equality between the white and black races… I am in favor of the race to which I belong having the superior position. I have never said anything to the contrary.” Or: “Anything that argues me into [the] idea of perfect social and political equality with the Negro is but a specious and fantastic arrangement of words, by which a man can prove a horse chestnut to be a chestnut horse.” (1858)

William Lloyd Garrison, perhaps the staunchest friend of the black slave, and a true abolitionist, declared that Lincoln “had not a drop of anti-slavery blood in his veins.” Even more damning, Lincoln supported southern slave-owners’ claim to human property and said he “would give them any legislation for the reclaiming of their fugitives.”

Moreover, Lincoln wanted all blacks off American soil, a “glorious consummation” (1852), and advocated the peaceful “deportation” of blacks so that “their places be…filled up by free white laborers.” (1860)

These are tough words to swallow. It would have been one thing if Lincoln sent troops on a crusade to forcibly end slavery in the South. He would have had difficulty doing it–the draft riots of 1863 proved this when mobs of whites, violently opposed to fighting for black emancipation, rampaged and victimized blacks. But emancipation was not Lincoln’s crusade. The “Great Emancipator” issued his famous proclamation as a desperate military tactic in the defeated days after Fredericksburg. Tellingly, he did not emancipate a single slave (and there were many) under Union control.

No, instead Lincoln waged and conducted a traumatic war that killed nearly a million people in order to prevent the South from declaring independence. By directly contradicting the very Declaration he invoked, Lincoln set up a titanic collision of principle that fueled America’s biggest war. That war, and the toll it took, is what made slavery and black inequality such an impossibly hard thing to get over. Deep and perverse consequences, even if unintended and contrary to popular mythology, deserve a reckoning.

Racism and violence can never be excused, but understanding their roots can perhaps help to avoid feeding them. It is impossible to say how much of the white South tyrannized their black brethren in response to the tyranny of “northern aggression,” but it is a motive that simply cannot be ignored. Victims often seek victims, and the cycle of violence in the slaveholding South was only compounded, not reduced, by the outcome of the Civil War. White supremacist ideology, which gets no pass, undoubtedly fueled much of the racist atrocity. It is difficult to believe, however, that the South harbored a white slave-owning class any more brutal, ignorant, or entrenched than the white slave-owning classes of all those nations who preceded us in formal abolition. Something else was at play.

Indeed, it has been amply shown that slavery was on its way to a peaceful extinction in the run-up to the Civil War. It was in sharp decline in all the border states and the upper South as early as the 1840s. The economics of slavery were marginal at best by this time, and the trickle of fugitive slaves was becoming a torrent, further eroding the foundations of a moribund and inhumane establishment. Through gradual manumission and compensated emancipation (as in other nations), slavery could very well have ended sooner and certainly at far less sacrifice.

We lost our independence with Lincoln. In forcibly preventing voluntary disassociation, Lincoln not only betrayed American Independence, he also betrayed a long-suffering portion of our best Americans. By guaranteeing that the end of slavery be forever entwined with a simmering hatred of a great injustice, Lincoln (knowingly or not) loaded our nation with a brutal racial tension that we are only barely recovering from.

The 13th Amendment and the abolition of slavery is clearly worthy of celebration. Yet abolition did not have to take so long, do so little, or at such an awful cost. Jefferson famously noted of slavery: “we have the wolf by the ear, and we can neither hold him, nor safely let him go.” As the history of other nations’ abolition successes show, he was only partly right: the wolf was wounded and dying; its natural death was vastly preferable to our putting ourselves into his jaws for the final mouthful.

I wish to credit Professor Thomas DiLorenzo, of Loyola University, for his book, “The Real Lincoln” which provided the background setting for this essay. I bear full responsibility for tone and conclusions…

Modern medicine has some things in common with football — or maybe I just have the Super Bowl on the brain. Both, it seems to me, tend to foster our occasionally-overinflated hopes, leaving us at times to contend with a relatively, well, deflated reality.

Both are team sports, advancing courtesy of collective effort. And by and large, progress in each is predicated on prior progress. There is, in football, the occasional kickoff return for a touchdown, or a Hail Mary reception — and in biomedicine, the occasional “Eureka!” although most of those tales prove apocryphal on close inspection, Newton’s apple included. But in both, advance is generally achieved one arduous set of downs at a time.

Now, imagine if instead, football were more like biomedicine. Hold that thought, please — we’ll get back to it. First, let’s move the ball down the field.

There is value, to be sure, in advancing a “precision medicine” agenda, a priority affirmed in the president’s recent State of the Union address, and one garnering unusual bipartisan support. The proposition seems closely related to recent press highlighting new efforts to find genes that protect us from prevailing maladies.

But I confess I had some misgivings just the same. I’m sure that every other species has substantial inter-individual genetic variation, yet we seem to bank on the biological commonality of a species in how we care for them. Dogs, for instance, get dog food; cats get cat food; and horses get oats and hay. Biological commonality at times extends well beyond the bounds of just one species. Tropical fish, for instance, are many different species; yet it’s tropical fish food for the whole lot, if you happen to have them in an aquarium.

I am by no means suggesting that our interindividual variations are unimportant; their importance is self evident in innumerable ways. Nor am I suggesting reliance on standard-issue sacks of “Homo sapien” food, perish the thought. I’m not even asking us to get in touch with our inner fish.

But I am saying that we, too, as members of a common species are biologically more alike than different. And the pursuit of knowing what we can do about what differentiates among our metabolisms should not be at the expense of putting what we know about what we have in common to good use.

That was pretty much the sentiment expressed in a column in today’s New York Times, written as a precautionary rejoinder to the fast-track enthusiasm for the promise of precision medicine. The author, a physician at the Mayo Clinic, suggests this enthusiasm is misplaced and apt to leave us disappointed. Certainly that proved true in the early days of the genomic era, recently subject to an about face accordingly.

This also recalls another recent column, by Dr. Ezekiel Emanuel, suggesting abandoning the annual physical exam. While the traditional version of the physical exam is certainly obsolete, there is a real risk in this suggestion of tossing out the baby with the bathwater — because that encounter may be the only time for doctor and patient to meet other than at a time of crisis. Imagine, then, a world in which at such times of crisis, we have ever more perfect knowledge of a person’s genome, and ever less knowledge of that genome’s person. Call me a humanist, but that seems fraught with peril to me.

Precision medicine seems to call for a considerable allocation of money to learn things we don’t yet know. I support that in principle; it’s a classic example of investment and the promise of return.

But a case was made just this week in the New York Times that the return on investment for confronting the scourge of childhood poverty in the U.S. would be nothing short of dazzling — and that’s just in monetary terms. Poverty is a potent driver of diverse miseries, including much increased likelihood of the very diseases we would need precision medicine to treat more effectively.

Similarly, we have a robust body of knowledge about lifestyle practices consistently shown to slash rates of chronic disease and premature death by 80 percent. This reliable knowledge in no way obviates the need to ask new questions and generate new answers. But the pursuit of what we don’t yet know does not preclude effective use of what we do, either.

And yet, it does seem to be playing out that way. Even as we contemplate major new financial allocations to precision medicine, childhood poverty is left to languish. My friend and colleague, Dr. Derek Yach, and his co-authors recently pointed out that preventive medicine, despite its formidable and accessible promise, garners only a tiny, non-corresponding fraction of NIH biomedical research dollars. A preferential focus on learning what we don’t know does, indeed, seem to hinder action based on what we do.

Call that precision if so inclined, but it seems a lot like procrastination to me.

Or, with the Super Bowl on my mind, like a very odd game of football. What if football were more like modern medicine? Perhaps the only way to advance down the field would be to renounce all progress to date and start again each time at the 20-yard line. You never get to build on your prior gains. That seems a dubious game to me.

And yet there are signs that’s the playbook of modern medicine. For instance, I conducted the following exercise for purposes of this column. I searched Pubmed, the vast, online library of peer-reviewed biomedical publications, for papers with “chronic disease” in the title. That is, admittedly, a very simplistic search — but I thought it would suffice for my purposes. I simply wanted to see the publication trend over recent years. I used five-year increments, ending with the most recent full year, and here is what I retrieved:

1994: 575 papers

1999: 831 papers

2004: 1,430 papers

2009: 2,657 papers

2014: 4,190 papers

Taking this exercise just one step further, here is the percentage increase for each entry relative to the one before:

1999: 45 percent

2004: 72 percent

2009: 86 percent

2014: 58 percent

So, in general, not only is the fund of published knowledge about chronic disease growing dramatically, it is apparently growing, for the most part, at an accelerating rate. And yet, we have a global epidemiology study, overseen by the Lancet, and representing much the same period, showing an increasing burden of chronic disease. This isn’t exactly proof of a failure to use what we know, but at the very least it makes that concern an urgent one, deserving of scrutiny.

Whatever the potential benefits of “precision” medicine — whether we will hit the moon when shooting for it, or miss completely — how can it make sense to hope for a possible boon in the bush while squandering the one already in hand?

Precision is good, but procrastination is not. We should learn what we don’t know, but not at the expense of using what we do. Otherwise, it’s a disappointing game with lots of movement, but little progress — forever mired at the line of scrimmage.

-fin

David L. Katz, MD, MPH, FACPM, FACP lives in New England, and is rooting for the Patriots. Just the same, he’s not so sure the Seahawks should let them bring the balls, or the guacamole for that matter.

Director, Yale University Prevention Research Center; Griffin Hospital

President, American College of Lifestyle Medicine

Editor-in-Chief, Childhood Obesity
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Author: Disease Proof

During holiday break, my husband and I took our three daughters on a wintery Cape Cod trail hike. They were resisting us. They were cold. Tired. Just wanted to go back home after our visit to the coffee shop. We always do this to them. We always make them walk. We’re used to this kind of push back. And we’re used to the same result. We can handle a little bit of struggle, because we know once those legs get some space to run and climb outdoors, the crankiness shakes off and they can’t get enough. These trips are frequent and we often commit to them free from devices and distractions — even the adults — because we all benefit from being away. Even if it’s just around the corner from home, it’s enough to feel and appreciate the distance, the presence. This day went just as predicted.

After we made our way to the ocean, letting the wind whip our faces and the crisp salty air take our breath, we made our way around the backside of the trail. The sun was strong and direct. My middle girl, all ferocious and fast, was cruising ahead of us. When we opted to walk along the large rocks and jetties, she wanted to keep her pace. But she couldn’t. I watched as jumping from rock to rock became unpredictable. She had to steady herself and assess each move. She had to decide where to slow down and when she could open up a bit. At first she was frustrated, her one reliable speed was failing her. But I watched as she got her rhythm, walking and climbing sometimes, choosing to go over or under or around. Sometimes she needed help and sometimes she slipped and had to get up and try again. I couldn’t help but think of the metaphors seeping into this fiery girl, the lessons of life being taught to her by the wind and rocks.

Just after, we found a sandy, sunny reprieve and my oldest daughter ran up and scooped my hand into hers. She’s quiet and had been walking along with us for some time in silence. I feel her growing every day — up and away — so I love when she comes unprompted and reaches for me, just like this. She has questions. And they come pouring out: Who? Why? When? She’s looking at the water and the sand, the rocks and the trees. She’s feeling her divine place. She begs to know what I believe. It’s no mystery they only ask these questions when we’re out here, when we’re away from the things, the machines and messages, that are supposed to link us together. I believe in all of this, I tell her. I believe in living right here, with her hand in mine, and feeling the sun through the sting of the cold. She leans her head against me and I listen for her exhale.

I come here for answers too. I speak to the stones, pressing their sandy surface against my lips and tossing them into the tide as they wash my worries and share my wishes with the sea. I ask the sun to radiate through me, to fill me, so that I can shine out and fill others. It is the cleanest charge I know. At night, I feel the moon in my throat, buttery and whole, and I ask that my words come directly from that pure source. I want my girls to know this too. I want them to know which stick to lean on and which one will snap under their pressure. I want them to find their footing high in a tree, understanding what is certain and safe is up to them, that their bodies will tell them the truth if they are brave enough to listen.

I want them to nurture the space and the distance and each path. To create places to wonder and challenge, to bow and offer — to trust. Only then, when we touch it all, breathe it in, feel it — both the sharp rocks and the warm sandy corners — can we begin to understand, begin to see our true connection. Begin to know the source of our power.

Another day, another round of complaints about the FML experience that is assembling IKEA furniture.

Luckily, our frustration is understood far and wide, including Atlanta where four developers recently made a video game called Höme Improvisåtion that recreates just how difficult it is to assemble furniture, even in a virtual reality.

Spoiler alert: everything ends in a heap of random looking objects surrounded by neon “instructional” arrows.

And yet, despite the headache, we can’t tear ourselves away from the Swedish superstore (damn you, meatballs!). Thankfully, IKEA’s furniture assembly service is there to help. Or, you can always put in an order for this furniture that will assemble itself.

(H/T Curbed)

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I have a lot of clients who come to me complaining about their inability to achieve volume in their hair at home. When I hear this, I always provide them a mini tutorial and tips on how to achieve the sought after height and bounce on their own. Since you’re not in my chair though, I thought I’d provide you some helpful advice if volume is what you seek!

There are primarily two avenues that you can take to give yourself a good foundation of volume, and those are via the round brush or via velcro rollers. If you choose velcro rollers, keep in mind that the fatter they are, the more lift you’ll achieve.

If you are looking to achieve volume through your blow dry, make sure to prep wet hair with a volumizing product. Personally, I love CHI’s Magnified Volume Spray Foam, but there’s a ton of other body-boosting blow dry prep products out there.

Whether you choose to use a round brush or velcro rollers, many basic concepts are the same.

1) You need to over-direct the hair when blow drying with your round brush or when inserting your velcro rollers.

Over-direction simply means to pull the hair in the opposite direction from which it falls. With that in mind, you will take sections of hair and pull up and over in order to give the roots lift. Hold the hair with tension. The most important areas of the head to use your round brush or rollers is in front of and at the crown of the head and along your part line on both sides.

(Please disregard my horrific outgrowth! I know, I know, I’m due for highlights.)

If you are blow drying the hair, it should be about 80 percent dry by the time you start using your round brush. If you are using velcro rollers, you have the option to use them on damp hair, apply some heat on them with the blow dryer, and let them set, or you can put them in your hair when it is completely dry. Personally, I prefer the second option. If you do choose to put the rollers in your hair when it’s dry, spray with some flexible, but strong hold hair spray, shoot some hot air from the blow dryer on them in the direction they are rolled, and let them set and leave them in while you do your makeup. When you gently remove them, you will have great lift at the roots and a sexy sway and bounce to your hair. If you choose the round brush avenue, insert your brush at the root and continue to hold it in the over-directed position while applying heat in the direction of growth. Bring the round brush through to the mid-shaft and ends. A great trick is to shoot heat at your roots from underneath while holding the hair up. This ensures added volume.

Have I mentioned yet the importance of a focusing nozzle on your blow dryer? Why, I don’t think I have! You need one. A focuser helps you direct and concentrate your heat. You want to make sure that the heat you’re blowing follows the direction the hair grows/falls. If the heat is shooting in the opposite direction, it will cause unwanted frizz. Get a focuser!

Now that you’ve established great bounce and volume, we want to make sure it stays. You have the option to hairspray your hair and go OR tease/backcomb your hair, smooth, hairspray, and go. Since I’m a big fan of big hair, I always opt for at least a little backcombing. Again, lifting at the apex or crown of your head and at each side of your part and over-directing are essential to this process.These are consistent musts for creating voluminous locks. You will want to take thinner sections and at least two to three of them at each area of the head to create a solid roundness and foundation of volume. Lift each section and using either a tail comb or teasing brush, backcomb the hair underneath the section by combing down to the root starting from the root and moving through the mid-shaft of the hair. Do NOT comb or brush back and forth; this will add frizz and a little damage in for extra measure. Only backcomb in ONE direction. The reason I recommend a tail comb or teasing brush, as seen below, is that the ends of both provide you the ability to section the hair easily.

Once you’ve backcombed, gently lay the hair back down and smooth over with either your comb or brush. Give yourself a nice bath of hairspray, and you’re good to go. Go big or go home, baby! 🙂

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