Macular Degeneration

There is a lot of nonsense written about nutrition, often related to the sale of products. In contrast to these fads and quick weight loss programs, the books How Not to Die and The China Study make dietary recommendations to improve health based on the large body of research that is now available. Absolute proof is illusive in health, nutrition, medicine, and surgery. Sometimes, very high degrees of correlation is the best that can be done.

Nutrition has a significant influence on the diseases of affluence that are prevalent in our society compared with people of the same age in other societies. Eating a plant-based, whole foods diet with less animal protein and dairy has a positive effect on many conditions and has the potential to reverse cardiovascular disease, cancer, and diabetes. Isolating individual substances and taking supplements is less effective than eating the plant sources from which these substances were derived. The plant sources contain other beneficial factors and facilitate beneficial interactions.

The China Study reports the results of two studies that involved multiple ophthalmological eye disease research institutions. One evaluated the correlation between diet and the preservation of vision. The other assessed the correlation between nutrients in the blood with the preservation of vision.

“The study on dietary intakes compared 356 individuals fifty-five to eighty years of age who were diagnosed with advanced macular degeneration with 520 individuals with other eye diseases. Five ophthalmology medical centers collaborated on the study. Researchers found that a higher intake of total carotenoids was associated with a lower frequency of macular degeneration. Carotenoids are a group of antioxidants found in the colored parts of fruits and vegetables. When carotenoid intakes were ranked, those individuals who consumed the most had 43% less disease than those who consumed the least…. Spinach and collard greens conferred the most protection. There was 88% less disease for people who ate these greens five or more times a week when compared to people who consumed these greens less than once a month.”

“The second study compared a total of 421 macular degeneration patients with 615 controls. Five leading clinical centers specializing in eye diseases and their researchers participated in the study. The researchers measured the level of antioxidants in the blood, rather than the antioxidants consumed. Risk of macular degeneration was reduced by two-thirds for those people with the highest levels of carotenoids in their blood, when compared with the low-carotenoid group.”

We recommend supplements because their benefit is also supported by research. We also recommend eating more broccoli, carrots, spinach or collard greens, winter squash and sweet potatoes. This isn’t difficult to do, especially when you are worried about your vision. These foods taste good, and they provide health benefits to more than your eyes.

Why We Sleep

Matthew Walker

The benefits of sleep sound exaggerated. If sleep was a drug, it would be considered a miracle drug. The first question on our Quality of Life questionnaire for patients in vision therapy is: “Do you get adequate rest?” If the answer to this is “no”, we are unlikely to improve the patient’s visual comfort and efficiency until they improve their sleep. When their sleep is improved prior to initiating therapy, the person will still have visual problems, but their symptoms are likely to be reduced. I hope that the following excerpts from Why We Sleep motivate you to start improving your sleep-related behaviors.         

Tragically, one person dies in a traffic accident every hour in the United

States due to a fatigue-related error.

Melatonin helps regulate the timing of when sleep occurs by systematically signaling darkness throughout the organism. But melatonin has little influence on the generation of sleep itself. Your twenty-four hour circadian rhythm is the first of two factors determining wake and sleep. The second is sleep pressure. At this very moment, a chemical called adenosine is building up in your brain. It will continue to increase in concentration with every waking minute that elapses. The longer you are awake, the more adenosine will accumulate.

Be aware that de-caffeinated does not mean non-caffeinated. Depending on the decaffeination method and the bean that is used, one cup of decaf can have between 3 to as high as 10 percent of the dose of a regular cup of coffee.

The practice of biphasic sleep is not cultural in origin. It is deeply biological. All humans, irrespective of culture or geographical location, have a genetically hardwired dip in alertness that occurs in the midafternoon hours.

Mere seconds before the dreaming phase begins, and for as long as that REM-sleep period lasts, you are completely paralyzed.

That humans can never ‘sleep back’ that which we have previously lost is one of the most important take-homes of this book.

REM sleep increases our ability to recognize and therefore successfully navigate the kaleidoscope of socioemotional signals that are abundant in human culture, such as overt and covert facial expressions and major and minor body gestures.

Infants and young children who show signs of autism, or who are diagnosed with autism, do not have normal sleep patterns and amounts…. Autistic individuals show a 30 to 50 percent deficit in the amount of REM sleep they obtain.

Neither society nor our parental attitudes are well designed to appreciate or accept that teenagers need more sleep than adults, and that they are biologically wired to obtain that sleep at different times.

Poor sleep is one of the most underappreciated factors contributing to cognitive and mental ill health in the elderly, including issues of diabetes, depression, chronic pain, stroke, cardiovascular disease, and Alzheimer’s disease.

Related to vision therapy to develop ocular motor skills: Rather than a transfer from short-to long term memory required for saving facts, the motor memories had been shifted over to brain circuits that operate below the level of consciousness. As a result, those skill actions were now instinctual habits. They flowed out of the body with ease, rather than feeling effortful and deliberate.

Ten days of six hours of sleep a night was all it took to become as impaired in performance as going without sleep for twenty-four hours straight… When participants were asked about their subjective sense of how impaired they were, they consistently underestimated their degree of performance disability.

After being awake for nineteen hours, people who were sleep-deprived were as cognitively impaired as those who were legally drunk.

There is no major psychiatric condition in which sleep is normal. This is true of depression, anxiety, post-traumatic stress disorder (PTSD), schizophrenia, and bipolar disorder (once known as manic depression).

From a metabolic perspective, the sleep-restricted participants had lost their hunger control. By limiting these individuals to what some in our society would think of as a “sufficient” amount of sleep (five hours a night), Van Cauter had caused a profound imbalance in the scales of hormonal food desire. By muting the chemical message that says “stop eating” (leptin), yet increasing the hormonal voice that shouts “please, keep eating” (ghrelin), your appetite remains unsatisfied when your sleep is anything less than plentiful.

Sleep fights against infection and sickness by deploying all manner of weaponry within your immune arsenal, cladding you with protection. When you do fall ill, the immune system actively stimulates the sleep system, demanding more bed rest to help reinforce the war effort.

The scientific evidence linking disrupted sleep-awake rhythms and cancer is now so damming that the World Health Organization has officially classified nighttime shift work as a “probable carcinogen”.

Humans are primarily visual creatures. More than a third of our brain is devoted to processing visual information, far exceeding that given over to sounds or smells, or those supporting language and movement…. Accurately reading expressions and emotions of faces is a prerequisite of being a functional human being. Facial expressions represent one of the most important signals in our environment. There are regions of your brain whose job it is to read and decode the value and meaning of emotional signals, especially faces. And it is that very same essential set of brain regions, or network, that REM sleep recalibrates at night.

Data aggregated over the past century from more than 650,000 schoolchildren aged five to eighteen reveal that they are sleeping two hours fewer per night than their counterparts were a hundred years ago.

A new report has discovered that medical errors are the third-leading cause of death among Americans after heart attack and cancer. Sleeplessness undoubtedly plays a role in those lives lost.

Why are we not designing NICUs and their care systems to foster the very highest sleep amounts, thereby using sleep as the lifesaving tool that Mother Nature has perfected it to be?

Drowsy driving is responsible for more accidents than either drugs or alcohol and is more deadly. Fatigue impairs judgment causing people to underestimate their degree of impairment and their ability to compensate. The more tired we are, the more likely it is that we will experience microsleeps, a short instance in which all of our senses and processing cease. This cannot be overcome by willpower or caffeine.

While we cannot make ourselves sleep, scheduling time to sleep and setting the stage to sleep needs to be planned like the other parts of the day, not just something left over when everything else is done. It also should not be the first thing to give up when something needs to be done or there is something that you want to do. Drugs do not provide the quality and phases of sleep which are required to repair our bodies, brains, and attitudes in preparation for the next day. Cell phones and other digital screens have further complicated the challenge of getting adequate rest.  

How Not to Die:

Discover the Foods Scientifically Proven to Prevent and Reverse Disease

Michael Greger with Gene Stone

This book is not about not dying. It is about reducing our risks of dying from preventable diseases. It is the most fact-based book on the effects of food that I have read to-date. Every statement has a reference and the sources are reputable. Dr. Greger presents the information, with salesmanship, but knows from experience that everyone will make decisions within their current comfort zone. With more knowledge, and feeling better, our comfort zones may change over time.

Most of us have improved our lifestyle over time. This book is a resource for continuing change in a positive direction. While the dietary recommendations are mainly preventative, they also helps us feel better now, like brushing our teeth. The following are all directly from the book without editorializing. Many of the facts are new to me, especially about poultry and dairy. I was surprised by my misconceptions caused by how foods have been modified.  The poultry that we ate in our childhood is not the poultry that we purchase in the store today. If I read a comparable book that is 40 years old, it would be different. Foods have changed and the knowledge provided through science continues to develop. Please consider the following excerpts.

For most of the leading causes of death, the science shows that our genes often account for only 10 – 20 percent of the risk.

According to estimates from the U. S. Department of Agriculture, 32 percent of our calories comes from animal foods, 57 percent from processed plant foods, and only 11 percent comes from whole grains, beans, fruits, vegetables, and nuts.

As Dr. Walter Willett, the chair of nutrition at Harvard University’s School of Public Health put it: “The inherent problem is that most pharmacologic strategies do not address the underlying cause of ill health in Western countries, which are not drug deficiencies.”

The lowest validated rates of Alzheimer’s disease in the world are found it rural India, where people eat traditional, plant-based diets centered on grains and vegetables. In the United States, those who don’t eat meat (including poultry and fish) appear to cut their risk of developing dementia in half.

The FDA estimates that 80 percent of the antimicrobial drugs sold in the United States every year now go to the meat industry…. Nearly every major medical and public health institution has come out against the dangerous practice of feeding antibiotics for farm animals by the ton just to fatten them faster. Yet the combined political might of agribusiness and the pharmaceutical industries that profits from the sale of these drugs has effectively thwarted any effective legislative or regulatory action.

Research has clearly shown that as the amount of fat in your diet becomes increasingly lower, insulin works increasingly better.

Reducing belly fat may be the best way to prevent prediabetes from turning into full-blown diabetes…. Eating legumes was shown to be just as effective at slimming waistlines and improving blood sugar control as calorie cutting.

The EPIC-PANACEA (European Prospective Investigation into Cancer – Physical Activity, Nutrition, Alcohol, Cessation of Smoking, Eating Out of Home, and Obesity) which found that meat consumption is associated with weight gain even independent of calories, identified poultry as potentially the most fattening meat…. According to the U. S. Department of Agriculture, about one hundred years ago, a single serving of chicken may have contained only sixteen fat calories. Nowadays, one serving of chicken may have more than two hundred calories of fat…. That’s more than ten times more fat. Chicken now contains two to three times more calories from fat than from protein…. As the beef industry is proud of pointing out, even skinless chicken can have more fat, and more artery-clogging saturated fat, than a dozen different cuts of steak.

Three-quarters of the salt in a typical American diet comes from processed foods, not the saltshaker…. Which of the following has been reported to contain the most sodium: a serving of beef, a serving of baked all-natural chicken, a large McDonald’s French fries, or a serving of salted pretzels? Chicken. The poultry industry commonly injects chicken carcasses with salt water to artificially inflate their weight, yet they can still be labelled “100 percent natural”.  Consumer Reports found that some supermarket chickens were pumped so full of salt that they registered a whopping 840mg of sodium per serving – that could mean more than a full day’s worth of sodium in just one chicken breast.

In a prospective, double-blind, placebo-controlled, randomized trial, ground flaxseeds may work two to three times better than the most powerful antihypertensive drugs, and they only have good side effects. In addition to their anticancer properties, flaxseeds have been demonstrated in clinical studies to help control cholesterol, triglyceride, and blood sugar levels; reduce inflammation, and successfully treat constipation.

In the United States, eleven different types of phosphate salts are allowed to be injected into raw meat and poultry, a practice that’s long been banned in Europe.

The National Cancer Institute has identified heterocyclic amines (HCAs), as “cancer producing substances, chemicals formed when muscle meat, including beef, pork, fish, and poultry, is cooked using high-temperature methods”.

While intake of green tea and soy might account for a twofold reduction in Asian women’s breast cancer risk, it doesn’t fully account for the disparity between Eastern and Western breast cancer rates…. Asian women also eat more mushrooms…. Eating mushrooms and sipping at least half a tea bag’s worth of green tea each day was associated with nearly 90 percent lower breast cancer odds.

No matter what the setting – whether subjects were alone or in a group – exercise appeared to work about as well as drugs at bringing depression into remission.

The blood of those eating the standard American diet does fight cancer – if it didn’t, many of us would be dead! – but the blood of people eating plant-based diets was shown to fight cancer about eight times better.

Research has shown that flaxseeds can be used to treat BPH (benign prostatic hypertrophy). Men given the equivalent of about three tablespoons of flaxseeds a day experienced relief comparable to that provided by commonly prescribed drugs such as Flomax or Proscar – without the drugs’ side effects such as lightheadedness or sexual dysfunction.

 The only thing potentially worse for prostate cancer than eggs was poultry.

2012 research from the University of California – Davis found that chemicals and heavy metals in children’s bodies from the foods they ate were indeed found to exceed safety levels by a larger margin than in adults. Cancer risk ratios, for instance, were exceeded by a factor of up to one hundred. For every child studied, benchmark levels were surpassed for arsenic and the banned pesticide dieldrin. They were also too high for DDE, a by-product of DDT. The number-one food source of arsenic was poultry among preschoolers and, for their parents, tuna. The top source for lead? Dairy. For mercury? Seafood. Those concerned about exposing their children to mercury-containing vaccines should know that eating just a single serving of fish each week during pregnancy can lead to more mercury in their infant’s body than injecting them directly with about a dozen mercury-containing vaccines. You should strive to minimize mercury exposure, but the benefits of vaccination far exceed the risks. The same cannot be said for tuna.

It took years for nearly five hundred researchers from more than three hundred institutions in fifty countries to develop the 2010 Global Burden of Disease Study. Funded by the Bill & Melinda Gates Foundation, it is the largest analysis of risk factors for death and disease in history. In the United States, the massive study determined that the leading cause of both death and disability, was the American diet, followed by smoking. The worst aspect of our diet was determined to be not eating enough fruit.

The dietary factor found best able to boost DNA repair was citrus fruit.

Dark-green, leafy vegetables are the healthiest foods on the planet. As whole foods go, they offer the most nutrition per calorie.

Sweet potatoes can be considered a superfood. They are ranked as one of the healthiest foods on the planet.

Thirty-four vegetables were tested for their cancer-fighting abilities. Since they do not all perform the same for different types of cancer, the conclusion is that eating a variety of vegetables is best. Those with the most cancer preventing potential fall into two groups: cruciferous vegetables and the allium veggie family, including garlic and onions…. The same garlic dose that blocked nearly 80 percent of cancer cell proliferation appeared to have no effect whatsoever against normal cells, and similar results were found for the other allium and cruciferous vegetables.

The Global Burden of Disease Study calculated the not eating enough nuts and seeds was the third-leading dietary risk factor for death and disability in the world, killing more people than processed meat consumption. The PREDIMED (Primary Prevention of Cardiovascular Disease with a Mediterranean Diet) is one of the largest interventional dietary trials ever performed. It concluded that people who ate more than three servings of walnuts per week appeared to cut their risk of dying from cancer in half. A review of the scientific literature concluded that “the far reaching effects of a plant-based diet that includes walnuts may be the most critical message for the public.”

Over the last twenty-five years, about half of new drug discoveries have come from natural products.

Spices don’t just make food taste better; they make food better for you.

A double-blind, randomized, controlled clinical trial was performed comparing the efficacy of ginger for the treatment of migraine headaches to sumatriptan (Imitrex), one of the top-selling, billion-dollar drugs in the world. Just one-eighth of a teaspoon of powdered ginger worked just as well and just as fast as the drug (and costs less than a penny).

I have digested these statements (sorry) and others in the book and some of them sound impossible, but they are well-documented. Implementing these changes requires a significant change in the thinking of most of us and differs from what we have seen and read advertised. We have initiated changes that are in our comfort zone to enhance and prolong our quality of life. Here’s to our health.

Digital Addictions are Drowning us in Dopamine

By Anna Lembke

This article appeared in the September 14, 2021 issue of the Wall Street Journal. Anna Lembke is a psychiatrist and professor at Stanford University. The article is adapted from her new book, Dopamine Nation: Finding Balance in the Age of Indulgence. Evolution has left us with the potential for addictive behavior. When doing the same thing over-and-over no longer causes the same degree of pleasure through the release of dopamine in the brain, we could stop, but another option is to continue to ramp it up to get the pleasure we had before. This is dopamine addiction. Stopping now will cause withdrawal symptoms.  Pleasure and pain are processed in the same part of the brain. However, if we withdraw from the activity for an extended period of time, the brain will rebalance its sense of pain and pleasure. Modest use of the digital device will again provide pleasure, but the use must be limited or the cycle will be repeated.

“Our brains evolved this finetuned balance over millions of years in which pleasures were scarce and dangers ever-present. The problem today is that we no longer live in that world. Instead, we live in a world of abundance…. Digital products are engineered to be addictive…. Yet despite increased access to these feel-good drugs, we’re more miserable than ever before. Rates of depression, anxiety, physical pain and suicide are increasing all over the world, especially in rich nations.”

On the same day that this article appeared, I finished reading the book How Not to Die by Michael Greger, who writes: “The food industries bank their billions by manipulating the pleasure centers of our brains, the so-called dopamine reward system…. This natural response has been and continues to be perverted for profit…. Given our new understanding of the biological basis of food addiction, there have been calls to include obesity as an official mental disorder.”

The public has been deceived. It is difficult to find trustworthy sources of information and, even if you do, none of us has the time to become well-informed on every important topic. Our best hope is to know those scientific facts that are the most important, knowing that some of what is known now will change in the future. That may be because the abilities of technology and scientists have changed, but it also can be because the world is changing. Do we all remember when we went outside and didn’t worry about the sun and didn’t worry about tics? The first was due to the scientific knowledge of the time. The second is due to conditions changing. Depression, anxiety, and its consequences may have slipped under the radar for the last year or so due to COVID, but they are continuing to increase.

Using Information from Evolution and Science to Improve our Lives

First Steps: How Upright Walking Made Us Human

Jeremy DeSilva

Projections: A Story of Human Emotions

Karl Deisseroth

The interests that we share on our blog focus on vision, child development, wellness, mental health, and science. These two books address all of these from different starting points. Both scientists are compelling writers. I recommend both books for their primary messages but have chosen the following due to what they have to say about our primary concerns.

From First Steps

Evolutionary importance of visual skills. “Australopithecus moved in large groups, eyes constantly scanning for any subtle movement in the tall grass.”

Natural drive for visual motor development. “Babies move for the joy of it.” “How do you learn to walk? Thousands of steps and dozens of falls per day.”

Another value of active play. “As children develop, their bones do not just increase in size. They change shape in response to the daily stresses kids put them through.”

Genes or environment? “Our skeletons are the product of nature and nurture working together in a complicated dance that results in the human form.”

Value of walking. “Walking is our default. Throughout history, if we wanted to eat, we had to walk. What is new is not walking.” “A decade’s worth of data on 650,000 people found that those who did the exercise equivalent of a twenty-five-minute daily walk – as long as they were not obese – lived close to four years longer than those more immobile counterparts.” “Research on over 300,000 Europeans discovered that inactivity caused twice as many deaths as obesity.” “A 2016 study of nearly 1.5 million people found that moderate exercise lowers the risk of developing thirteen different cancers.” “Scientists have now discovered over a hundred molecules that our muscles make and release when we walk that reduce inflammation and attack cancer cells.” “In addition to preventing some cancers and reducing the risk of dying from cardiovascular disease, a daily walk can prevent autoimmune diseases and can help ward off type 2 diabetes by lowering blood sugar levels. It improves sleep and lowers blood pressure. It decreases circulating cortisol levels, which helps reduce stress. In a study of almost 40,000 women over forty-five years old, a thirty-minute daily walk reduced the risk of stroke by 27 percent.” “Walking does not help just with the hippocampus and memory. There is some evidence that it helps relieve symptoms of depression and anxiety.” “Research demonstrates that, for our mental health, we should walk where there are trees, birds, and the soft whispers of the wind.”

Questions from evolution:

From First Steps: Why has evolution left humans with such difficult and dangerous births?

From Projections: Why has evolution left us with psychiatric disease?

From Projections

Vision development. “The coordination between the eyes is a lovely thing when it works, when they join to face the world together in primates like us. Both receive the same instructions from the brain, to follow the ball thrown from Dad in the darkening chill. But the two eyes, each with slightly different shapes and angles, are not connected with each other. Much has to be perfectly tuned for the two to move together, to not create double vision with offset views of the scene…. Two sensors, two eyes, are balanced together on the finest edge of time…. Early in life, before we become aware, double vision serves as that error signal sent back – and then our brains mend the error, adjusting the signals sent down cranial nerves to the eye muscles, aligning and tuning with care, until the offset disappears, and we see the world as one.”

The importance of science, communication, openness, and a humanistic outlook. “Truth is the best tool that we have. Truth that we can get to, as soon as we can get to it, though the open conversations that we know, of free argument and creative discovery…. Science is a conversation with the past and the future, and with a public. Scientists are not recluses shouting data into the void, not automatons filling drives with bits. We seek truth, but truth to communicate in ways that we think and hope will matter. The meaning in our work comes from the human partners we imagine and direct our voice toward, with awareness that these conversations will not be one-way…. In unformed open spaces that bring no judgment or posturing, our path forward is that of a patient in talk therapy, where insight is achieved only through engaging freely and frankly, and without possibility of penalty. Otherwise immature defenses are the resort; walls built because honest and free conversation, engaging all human family members, has not been prioritized. We need to be what we might be, so we can discover who we are.”

Vision Development: Ocular Motor

An irony of ocular motor development is that it is often overlooked. Efficient ocular motor skills keep eyes aligned at all distances of gaze, maintain clear vision, track a moving object smoothly, maintain visual attention, and accurately jump eyes to the next object or word. Vision development does not have obvious milestones such as rolling over for the first time or saying the first word, but it is just as dependent on engaged practice. The thousands of hours that children spend moving, reaching, climbing, and imitating may not be recognized for what they accomplish. Like other skills which must be developed, ocular motor skills are roughly prewired. They are refined and tuned through years of intentional movements and play.

It is common for the eyes of a newborn to wander independently. The coordinated movements required to align the eyes and to maintain their precise alignment must develop from visual feedback. The newborn’s visual acuity is limited, particularly at a distance. Binocularity is driven by the coordination of the visual fields of both eyes so that the spatially synchronous retinal receptors of each eye receive information from the same object and send signals to the same receptors in the visual cortex.

When people consider sight, what comes to mind is seeing clearly, recognizing objects and the ability to read. These are skills of our focal visual system, but our ambient, peripheral, primarily subconscious visual system is just as important. Our focal visual system is dependent on our ambient visual system to maintain eye alignment. The ambient system also directs our eye movements, senses our motion and the motion of objects around us, stabilizes the image we perceive of the world (particularly as we move), and contributes to our balance. These may be dysfunctional due to faulty development, can be severely impaired by head injuries and must be recalibrated as we adjust to new glasses.

The speed, accuracy, and coordination of eye movements is unique. Eye alignment is accurate to within hundredths of a degree and misalignments of as little as 1o create significant noise in the system. In reading, a 1o misalignment of the eyes cause them to be looking at different letters. In most of our motor systems, being off by 1o is trivial and does not interfere with function.

 Our nervous system functions through a balance between the amplification and depression of signals, so it is natural that when the information from the eyes conflict and do not augment visual function, information will be suppressed. This is beneficial to reduce confusion, but also reduces visual potential, compromising the input and the processing of visual information. Persistent suppression can cause amblyopia.

Since almost no children are born with a turned eye, the description for an eye turn in the first year of life has changed from congenital to infantile. While there may be genetic predispositions, the loss of control is primarily due to faulty development. There is a tendency for some children’s eyes to turn inward around three years of age as they are becoming increasingly interested in detail and small differences. This often correlates with being farsighted. It has also been observed to correlate with children who are precocious and whose activities and interests are outdistancing their visual development.

When children are brought into the office due to visual difficulties in school such as a convergence insufficiency or loss of place when reading, it is not effective to try to train those skills in isolation. Convergence and tracking to read are due to a combination of perceptual and ocular motor skills as is the ability to handle visually crowded spaces and pages. They emerge from the development of a hierarchy of visual skills including: planning and guiding movement, being aware of where we and our body parts are in space, being aware of where things are around us, exercising meaningful and accurate eye movements in our surroundings, being able to visually multitask (see more than one object at a time), and assist balance.

We are concerned about the accelerated visual demands in school which exceeds the visual development of many children. Not all children are visually ready to read in kindergarten. Many children are not ready to handle crowded pages of reading or math problems, write on the line, or copy from the board. We are creating unnecessary stress with no evidence that pushing children to read who are not ready will improve their lifelong reading skills or enhance their interest in reading. Visual development, and other areas of development, are stimulated by going outside to play with peers (made easier by not having homework).

Extra Life

Steven Johnson

One of man’s amazing accomplishments is doubling life expectancy over the course of a century after it was stable for thousands of years. It is the result of many events and coordinated efforts, some of which appear in this book. They are largely unknown because they evolved over time. This is not like reporting a pandemic, flood, or fire. It is reporting the pandemic that did not happen, “the dog that didn’t bark in the nighttime”.

Each development is an interesting story which demonstrates the importance of the cooperation of hope, imagination, science, and advocacy. I will list some of the subjects of some of the stories, but I am not going to summarize them. The important aspects will be lost in summary. Sound bites are inadequate. I encourage you to read them yourself. I will list the categories and add some excerpts as teasers. It is a good time to read about overcoming challenges as the news is about the pandemic, fires, floods, drought, air pollution, political discord, and international tensions. We used to joke about ignoring Mother Nature, but it is an example of black humor.

This book begins with these two simple but astonishing facts: as a species we have doubled our life expectancy in just one century, and we have reduced the odds of that most devastating of human experiences – the death of a child – by more than a factor of ten.

We have absurd conspiracy theories about Bill Gates planting microchips via mass vaccination or outright hostility directed at simple acts like mask-wearing in part because we have forgotten, as a culture, how much science and medicine and public health have improved the quality (and the length) of the average human life over the past few generations.

Thomas Hobbes’ view of life as “nasty, brutish, and short” offered a sobering prospect: despite all our achievements, we had remained trapped beneath the long ceiling of thirty-five years of life expectancy, with a third of all children dying before adulthood. Human beings had spent ten thousand years inventing agriculture, gunpowder, double-entry bookkeeping, perspective in painting – but these undeniable advances in collective human knowledge had failed to move the needle in one critical area. Despite all those accomplishments, we were no better at warding off death.

The healer’s role in variolation was not to supply some kind of magic element that would cure patient’s ills; instead, the intervention merely unlocked powers that were latent in the patients themselves. There is a pleasing symmetry in contemplating the discovery of variolation from the vantage point of twenty-first century health care. The most exciting new breakthrough in medicine – immunotherapy, using the body’s natural defenses to tackle chronic diseases like cancer or Alzheimer’s – relies on the same basic mechanism that enabled the first great breakthrough in the history of extending life.

The popular awareness of smallpox eradication pales beside that of achievements like the moon landing, despite the fact that eliminating this ancient scourge had a far more meaningful impact on human life than anything that came out of the space race…. The comparison between smallpox eradication and the space race is intriguing for another reason: because in many ways the battle against variola major was a triumph of global collaboration rather than competition, despite the fact that it took place during the Cold War.

Pasteurization did not become a standard practice in the milk industry until 1915, a full fifty years after Pasteur developed the technique. The lag from discovery to implementation might well have cost millions of lives around the world. The lag happened because progress is not merely the result of scientific discovery. It also requires other forces: crusading journalism, activism, politics. Science alone cannot improve the world. You also need struggle.

When you ask people to list the great innovations of the early twentieth-century, they invariably list planes, automobiles, radios, television – not pasteurized milk or chlorinated water. But think of all the unimaginable suffering that was avoided by those two interventions: all the parents who didn’t bury their children, all the infants who got to grow up and have their own children in turn.

 A planet carrying twenty-three billion chickens is also running a massive and unprecedented experiment in inadvertently breeding new strains of avian flu. The H1N5 virus that provoked the global panic in 2007 was partially transmitted by chickens. If another pandemic emerges in the coming years with even more devastating effects than COVID-19’s, the immense population of chickens on earth – and the systems of factory farming that produce them – is likely to be a point of origin for the outbreak.

 We face the global crisis of climate change not just because we adopted an industrial lifestyle, but also because we figured out new techniques to keep people from perishing in mass famines or living at the very edge of starvation, but their ultimate impact is almost beyond comprehension: billions of lives lifted out of hunger and starvation, and a planet struggling to manage the secondary effects of that runaway growth.

The following are some of the reasons why the average person born today is expected to live 20,000 days longer than they would have if they were born a century earlier: immunization, safe drinking water, safe milk, safer automobiles, less lead, less smoking, cleaner air, medications that have been tested for safety and efficacy, and an increase in nutrition.

Why Trust Science?

Naomi Oreskes

Science historian Naomi Oreskes reviews the strengths and weaknesses of science over the last two centuries in her new book, Why Trust Science? She analyses what makes science trustworthy and how to judge when we should have reservations about new scientific claims. News tends to distort science. News is presented to attract our interest and stimulate our attention. Results of repeatable scientific studies that have achieved a consensus of experts is highly likely to be trustworthy. Gaining a consensus among scientists is not easy and the increasing diversity of our scientists has enhanced the rigor of this process. Questioning how studies are done, the use of statistics, and its conclusions are part of the scientific process. There is no one scientific method that applies to all areas of investigation. When the consensus of experts is questioned, it is important to know who is doing the questioning. Is it other scientists, and if so, do they have potential conflicts of interest? Oftentimes those who are arguing against the conclusions of science are not scientists. That does not mean that they cannot have questions, but we need to be aware of their agenda. Much more than science is involved when opinions are formed, and decisions are made. Think of the decades-long battle over smoking and who was involved.

Even when there is a strong consensus amongst scientists, there are other factors to be considered before actions are taken. These include moral, political, economic, and social issues. In the past, it was thought that scientists should not be open about their values because their objectivity may be questioned. A more enlightened perspective is to recognize that we all have values and, by exposing them, potential biases may be avoided by making the process more transparent.

There are few instances of pure science, discovery for discovery’s sake. Goals are usually involved; feeding more people, improving the environment, improving health, improving education, discovering ways to reduce conflict, or ways to create profit. To achieve these goals, science must be integrated with technology, engineering, and culture. Science is studied more easily when the scope is narrowed, but the application is better when the scope is widened. The world is complicated, and science and scientists do not work in isolation. They consult with others as they work and before papers are accepted for publication. Papers are then reviewed by peers in the same and associated fields increasing the scrutiny through diversity. In recent decades, there have been concerted efforts to cause the public to distrust science. Decisions should be made based on the best information available including a projection of the intended and unintended outcomes, not just on someone’s feelings and intuitions.

We all have reasons to be humble. As an individual, we cannot know everything, and we cannot take all factors into consideration. History provides reasons to be humble. There is much that we don’t know now that will be known in the future and some of what we know now will be demonstrated to be incorrect. There will also be technology available that we are unable to imagine at this time. Comparing and contrasting the responses to COVID-19 with the 1918 Influenza is an excellent example. Safe and effective vaccines for COVID-19 were developed within months with technology that did not exist 100 years ago, but we did not have comparable progress in communication and humanistic issues. We missed an exceptional opportunity to join together to battle an outside threat but failed. Politics did what it does best, it divided us.

The pandemic made obvious the disparities in healthcare in our country and its consequences. Life expectancies had declined in the United States for three consecutive years prior to the pandemic for the first time since the 1918 Influenza. This was due to the epidemic of opioid overdoses and suicides. The book, The Body Keeps the Score, has been on the NY Times non-fiction best-seller list for years which is one of many red flags about our national mental health. As I write this, many people are choosing not to work. This has implications far beyond the economy. It is not a good sign for reviving our mental health.

How the Body Shapes the Mind

Sean Gallagher

Patients with challenging problems, statements by Annie Murphy Paul in Extended Mind, and statements made by Sue Barry in Coming to Our Senses caused me to look back at this book which I read a number of years ago. The other books are very readable, but perhaps it is because Sean Gallagher is a philosopher, How the Body Shapes the Mind is more challenging. He brings together information from a variety of scientific disciplines to explain how the body shapes the mind and he continues to dismantle the assumption of the separation between body and mind that was dominant in Western science and medicine until the last few decades. Most of what follows is my translation of his gems with a couple of verbatim excerpts at the end.

When we observe the development of motor skills in an infant, we are not just seeing signs of intelligence, we are observing intelligence. We are wired from birth to have a unified perception of the world. They senses are separated by researchers to simplify our understanding, but that is not how children process the input.  The refinement of movement observed not only demonstrates developing motor organization, it also demonstrates the developing organization of the entire individual, the developing identification of self, and the emerging ability to communicate with others and how to live in the world into which the have been born. Movement shapes the mind and both movement and the mind become more refined with the development of visual motor skills and visual perception which provide more accurate and consistent information.

It was recognized by astute observers decades ago that practicing certain natural movements correlated with more advanced and sophisticated development, including the growth of visual skills. Gallagher specifically references crawling which has been observed for decades to correlate with the ability to cross the midline and the refinement of binocular coordination.

Children’s posture and motor development are part of their sense of self and correlate with their ability to attend to and inhibit extraneous movements. Their ability to mimic (most babies can mimic tongue movements at six weeks of age) relate to how they will get along with others.

Most movements and the awareness of our body and its spatial relationships with our surrounding become automatic and we become less clumsy. To the degree that this requires conscious attention, it compromises our cognition and our attention. When a conscious decision is made, like moving to another room, the execution should become increasingly efficient and subconscious.

The following are verbatim excerpts.

As a reader, I am not at first conscious of my posture, or of my eyes as they scan the pages. Rather, totally absorbed in my project, I begin to experience eyestrain as a series of changes in the things and states of affairs around me. Gradually, the perceived environment begins to revise itself; the text seems more difficult, the lighting seems too dim, the body shifts itself closer to the desk, etc. In the end I discover the true problem – the fatigue, the headache. The eyes that have been reading have been anonymous eyes, doing their work, without my reflective awareness of them. I was not conscious of my eyes at all. Now, however, my attention is directed to my eyes. They suddenly emerge out of prenoetic (subconscious) anonymity and become explicitly owned. My pain now becomes my present concern, and my body in general gets in the way of my reading comprehension.

The importance of extraocular muscles that are undergoing constant modifications in the performance of vision, along with vestibular information essential for the maintenance of balance should not be underestimated. In normal subjects, extraocular eye muscles are essentially integrated with a more holistic body schema and their constant modifications work to coordinate balance and movement.

Coming to Our Senses:

A Boy Who Learned to See, A Girl Who Learned to Hear, and How We All Discover the World

Susan R. Barry

In Coming to Our Senses, Susan R. Barry uses the stories of two people, one with a visual deficit and one with a hearing deficit to help us understand how input from these senses develops into perceptions of the environment through interactive experience. One of these people had very little vision until he was 15-years-old at which time he had surgeries which provided clearer images to his retinas and aligned his eyes. The other person had very little hearing until she was 12-years-old when she received a cochlea implant which bypassed her ear and directly stimulated her auditory nerve. He had not learned to see. She had not learned to hear. The stories are about how difficult it is to develop these perceptions when you are not starting from infancy.

“Since understanding what we see and hear seems so natural to most of us, we assume that, in infancy, our vision and hearing developed spontaneously. But nothing could be further from the truth…. Active exploration and experimentation were required…. As babies, we, to a large extent, taught ourselves. But teaching yourself to see or hear as an adolescent or adult is not so instinctive and automatic.”

Sue Barry has shared the personal story of her vision and how it influenced her life in Fixing My Gaze. Her eyes were not aligned as a child. They aligned better after three eye muscle surgeries but she did not use them together and did not experience stereoscopic vision. Sue had difficulty learning to read as a child due to her vision problems, but went on to get her doctorate from Princeton University. She had her own visual transformation at age 48, learning to align and use her eyes together and to develop stereoscopic vision through optometric vision therapy. Sue is a neuroscientist who taught at Mount Holyoke College. Optometric vision therapy challenged the previously accepted scientific understanding of neuroplasticity and its critical periods. This demonstrates the importance clinical observations which often stimulate clinical research. Established knowledge resists change, but change is accepted when there is adequate knowledge to demonstrate that the prior model was flawed. As a result of Sue’s experience, many optometrists have gotten to know her as she has shared her story. She has been an exemplary bridge between basic science and clinical application. Sue has also generously consulted with many people who have questions about their vision.

Although neuroplasticity decreases as we age, the brain maintains plasticity throughout our lifetimes. We continue to have the ability to learn and change. This does not mean that it is easy. The success of optometric vision therapy requires the patient to be motivated, their neuroplasticity needs to be stimulated, techniques need to be employed which provide the patient with conscious and subconscious feedback, and focused rehearsal is required to develop automaticity so vision does not have to be a conscious process. The patient must learn to attend with a balance between tension and relaxation.

“When people tense up, they lose their view of the visual periphery, concentrating more on what is front and center. This reduction in the area that they see may focus their attention on what is most important at the time, but it does mean losing a view of the ‘big picture’ or the context of the scene.” “Our perception is shaped not just by our eyes and ears but by the whole of our experience.” “How we attend to the world influences not only what we perceive but who we are.” “Whether we are conscious of it or not, we all have our own set of perceptual biases, our own perceptual style, which both guides and limits what we sense and do. Perception is a personal act.”          

Most people have visual problems and auditory processing challenges which are much less severe than those of these two individuals, but these stories aid our understanding the process of development and how it can be stimulated. “Coming to our senses” and our balance between detail and perspective applies to more than hearing and seeing. Just as visual and auditory stimulation can be overwhelming, the rate of change and the stimulation and unnaturalness of contemporary life can be overwhelming. Both of these individuals were overwhelmed in congested artificial environments and found relief, resilience, and perspective in nature.