What really happens to our muscles as we age if we are chronically active?

These are MRI cross sections of leg muscles. Via this recently published study in the journal Physician and Sports Medicine. See also.

This looks great and it’s one of the most important health issues in our country. Glad to see there is more attention being given to why our cities and economy were designed to make health so hard.

A provocative new 4-hour series soon to air on public television, Designing Healthy Communities, examines the impact of our built environment on key public health indices, including obesity, diabetes, heart disease, asthma, cancer and depression. The series documents the connection between bad community design and burgeoning health consequences, and discusses the remedies available to fix what has become an urgent crisis.

Retrofitting Suburbia (by MPC)

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Good news from a study just published in Circulation:

Sex is the cause of less than 1% of all acute heart attacks, the review said. And autopsy studies suggest that only between 0.6% and 1.7% of sudden deaths are related to sexual activity.

(A word to the wise for cheaters, though: Of those who did die during the act, most were men having “extramarital sexual activity, in most cases with a younger partner in an unfamiliar setting and/or after excessive food and alcohol consumption.”)

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by Jessica Hische

A lovely, lovely song. Buy it here.

The War on Drugs, Come to the City. This record has been on constant rotation for the last 4 months or so. And then seeing them open up for The National at the Beacon Theater, well, they are just spectacular.

Christopher Lyles, 30, had tracheal cancer that had progressed so far it was considered inoperable. In November, doctors made him a new windpipe - or trachea - made out of tiny plastic fibers seeded with stem cells from his own bone marrow.

Two months after his successful operation, Lyles arrived home in Md. last week.

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The New York Times is reporting that the MTA is reassessing the width of its’ seats on public transit to account for our nation’s ever increasing backsides.

It’s interesting how our country is being redesigned for the new normal. Every industry is making their own rules— the airlines make obese people buy two seats for example. 

But the one thing that frustrates me about the airlines is the policy charging passengers for luggage based on weight:

Me: 159 pounds + 55 pound suitcase

Guy in front of me: 300 pounds + 45 pound suitcase

I get charged a hefty weight fine because my suitcase is 5 pounds overweight. If airlines are going to charge us for the weight of our luggage, they should assess our total weight, not just the weight of our luggage. It’s only fair.

I took a trip to Philadelphia yesterday to take a tour of Eastern State Penitentiary. It was built in 1829 and became known as the most influential prison in both design and strategy in the entire world. It was the first large building in the United States to have central heating and running water. Of course, neither worked really well— toilets were flushed by the guards only a few times a week. One guard could see down all seven of the hallways at one time due to it’s hub and spoke design and mirrors. It looks like a castle and was built 2 and a half miles outside of Philadelphia’s city center at the time. The spooky castle on a hill was designed to intimate the population into behaving well.

It housed 250 prisoners in 250 cells, in solitary confinement for typical sentences of 2 to 6 years. The most common crime was horse theft. The root word of penitentiary is penance. It was thought that if you put criminals in solitary confinement in a church-like setting, they will have nothing else to think about but remorse and Jesus. They also taught the criminals a trade, like boot-making, so when they got out they could be productive members of society. It even had its own hospital. Contraband was typically smuggled in from outsiders throwing hollowed out baseballs over the walls.

As time went by the penitentiary suffered from overcrowding, riots, disease, and encroachment by the city. It was finally shut down in 1971.

The designers of this prison tried to solve multiple societal problems— how to rehabilitate criminals, how to design a physical place that would foster rehabilitation, and how to prevent criminality. The person that designed this was a genius— not because of his theories on criminality, but because he actually got this thing built. The White House in 1829 didn’t even have running water. But the prison on a hill for 250 criminals outside Philadelphia did. Imagine the politics of that simple statement.

It’s almost 200 years later, and our solution is to throw 3% of our population in privatized prisons and expect that they’ll just get better. In 1829, the entire state of Pennsylvania had 1.35 million people. And only 250 people in its state prison, most doing time for horse theft. Given today’s rate of 3%, they should have built a prison for 40,500 people.

The issue that hit me the hardest was that in 1829 criminologists were dealing with the exact same issues as we are today— how best to rehabilitate criminals. We’ve got the world’s knowledge at our fingertips, but have very little idea how to fix crime. It’s a big fat hairy problem. And 200 years later, we’re really no closer to the solution than we were in 1829. In fact, it’s worse. The rates of criminality needing rehabilitation are astronomically higher.

How many other problems in our society will we be no closer to the solution 200 years from now? How to deliver equitable healthcare to a population of diverse people? How to educate our children? As an optimistic curmudgeon, I’ve always believed in humans’ ability to solve problems. But what if the last 20% of big fat hairy problems are unsolveable because they’re politically motivated human behavior problems? 

The real issue is that these issues can’t be solved with theories. They can only be moved along every so often with politics and cultural changes. Two hundred years, on the grand scale of things, isn’t that long. It’s a few generations. We, hopefully, all play our part in helping society progress. But our lives are just so, so short. I recently talked with someone who said, if you’re an entrepreneur, you should find an idea, build it out, and spend at least 5 years fully dedicated to that idea. At the end of five years, if the idea is working or not working, move on to the next big one. That means, if a typical person works 45 years, they have nine ideas they will work on in their lifetime.

Nine. It isn’t that large of a number. And of those nine, how many of your ideas will truly impact society for the better?  

Molecular visualizations of DNA. Stunning. Especially replication, which begins at 1:42.

Please read all of this, especially if you’re a parent.

How To Land Your Kid in Therapy:

MY FIRST SEVERAL patients were what you might call textbook. As they shared their histories, I had no trouble making connections between their grievances and their upbringings. But soon I met a patient I’ll call Lizzie. Imagine a bright, attractive 20-something woman with strong friendships, a close family, and a deep sense of emptiness. She had come in, she told me, because she was “just not happy.” And what was so upsetting, she continued, was that she felt she had nothing to be unhappy about. She reported that she had “awesome” parents, two fabulous siblings, supportive friends, an excellent education, a cool job, good health, and a nice apartment. She had no family history of depression or anxiety. So why did she have trouble sleeping at night? Why was she so indecisive, afraid of making a mistake, unable to trust her instincts and stick to her choices? Why did she feel “less amazing” than her parents had always told her she was? Why did she feel “like there’s this hole inside” her? Why did she describe herself as feeling “adrift”?

I was stumped. Where was the distracted father? The critical mother? Where were the abandoning, devaluing, or chaotic caregivers in her life?

As I tried to make sense of this, something surprising began happening: I started getting more patients like her. Sitting on my couch were other adults in their 20s or early 30s who reported that they, too, suffered from depression and anxiety, had difficulty choosing or committing to a satisfying career path, struggled with relationships, and just generally felt a sense of emptiness or lack of purpose—yet they had little to quibble with about Mom or Dad.

Instead, these patients talked about how much they “adored” their parents. Many called their parents their “best friends in the whole world,” and they’d say things like “My parents are always there for me.” Sometimes these same parents would even be funding their psychotherapy (not to mention their rent and car insurance), which left my patients feeling both guilty and utterly confused. After all, their biggest complaint was that they had nothing to complain about!

Portrait by me

Hostess, maker of Twinkies, files for bankruptcy.

Meanwhile, restaurants like Le Pain Quotidien and shares of Whole Foods and Lululemon are on the rise. This is capitalism at its best, and one of the main reasons why I’m optimistic about our nation’s health. You’ve got to fight capitalism with capitalism.