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.

A new study published this week in the Journal of the American Medical Association found that:

Occasional and low cumulative marijuana use was not associated with adverse effects on pulmonary function.

The study involved 5115 men and women over a twenty year period.

We’re still unsure why marijuana has so little effect on the lungs as compared to cigarettes.

I love this Kickstarter project:

Many of the 12 million Americans living in recovery have found cooking to be a powerful ritual in their commitment to recovery. However, since the only effective treatment for alcoholism is total abstinence, cooking with wine is not an option. So the challenge is this: create a non-alcoholic cooking wine that retains the color, flavor, and aroma of wine without the alcohol.

They did it. Nice work. Let’s back them.

(Source: kickstarter.com)

Are you a doctor in NYC?

I’m starting a new company called Sherpaa. 

We’re hiring exceptional doctors. Let’s work together. 

My best of health 2011.

One of the questions I ask doctors is “In the past 10 years, what is an innovation that has revolutionized medical practice?” Most of them can’t answer. So, with that in mind, I’ve tried to choose the most important health concepts from the past 12 months. Some of them are from other people. Some of them are my own thoughts. Some of them are simply important moments in my own personal health. In no particular order:

Trials and Errors: Why Science is Failing US

Although the scientific process tries to makes sense of problems by isolating every variable—imagining a blood vessel, say, if HDL alone were raised—reality doesn’t work like that. Instead, we live in a world in which everything is knotted together, an impregnable tangle of causes and effects. Even when a system is dissected into its basic parts, those parts are still influenced by a whirligig of forces we can’t understand or haven’t considered or don’t think matter.

How Doctors Die

The nation’s “best” hospitals aren’t even in the top 400 list of safest hospitals.

In the latest advance for health care accountability, the country’s leading hospital accreditation board, the Joint Commission, released a list on Tuesday of 405 medical centers that have been the most diligent in following protocols to treat conditions like heart attack andpneumonia. Almost without exception, most highly regarded hospitals in the United States, from Johns Hopkins in Baltimore to the Mayo Clinic in Rochester, Minn., did not make the list.

Food Stamps Are Now Worth Double at Farmer’s Markets in Michigan

Real Food is Cheaper than Junk Food

The Easy Way to Stop Smoking

The Hazards of the Couch

The Hot Spotters

A Food Manifesto for the Future

Most Health Solutions Aren’t Medical, They’re Social

Weighing the Evidence on Exercise:

It is extremely unlikely that using exercise or a diet alone will lead to long-term weight loss.
Exercise makes you hungry because your body wants to maintain its current state. Guard against eating more because you’re exercising. 
Start eating real food and less calories— understand that this is how you will eat from now on.
Start exercising. Once you hit your weight goal, continue exercising. Don’t stop.
If you don’t change anything about your life, you’ll never weigh less than you do now.

What Happens to Doctors Who Think Outside the Box?

Family Planning as a Cost-Saving Preventive Health Service

The cost of one Medicaid-covered birth in the United States (including prenatal care, delivery, postpartum care, and infant care for 1 year) was $12,613 in 2008, according to estimates from the Guttmacher Institute. The national per-client cost for contraceptive care the same year was $257. In 2008, an estimated $1.9 billion was spent on publicly funded family-planning care — an investment that resulted in an estimated $7 billion in Medicaid savings for the cost of unplanned births.

Coffee vs. Migraines

RIP Dr. Kevorkian

RIP Jack LaLanne

A Measure of My Days: The Journal of a Country Doctor:

Health is not a commodity. Risk factors are not disease. Aging is not an illness. To fix a problem is easy, to sit with another suffering is hard. Doing all we can is not the same as doing what we should. Quality is more than metrics. Patients cannot see outside their pain, we cannot see in, relationship is the only bridge between. Time is precious; we spend it on what we value. The most common condition we treat is unhappiness. And the greatest obstacle to treating a patient’s unhappiness is our own. Nothing is more patient-centered than the process of change. Doctors expect too much from data and not enough from conversation. Community is a locus of healing, not the hospital or the clinic. The foundation of medicine is friendship, conversation and hope.

Wild Food: A tumblr I started because most people have no idea what their food looks like as it’s growing.

Buddycare vs. Humancare

Vaccines Save Lives. End of Story. Part 1 and Part 2.

Everything in Your Environment is Set Up for the Way You Were Before

Introducing my new company, Sherpaa. Launching in just a few weeks.

Doctors of the Future:

We’re a tribe of forward-thinking creative doctors.
And we know that the future of healthcare depends on us.
We’re the leaders of this revolution.
Intrigued? You should be.

One of the best things to happen to me.

Photo by me from many years ago on New Years Eve at Madison Square Garden while listening to Wilco ring in the new year.