The Power of Habit:Why We Do What We Do In Life and Business

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Charles Duhigg

We cannot change behaviors – including visual behaviors – without changing habits. Habits are behaviors which have become so automatic that they require little or no conscious thought. We can override a habit through conscious attention but this exhausts our available working memory. We have all experienced the errors that we tend to make when our working memory is taxed, such as not being able to remember why we opened the refrigerator. Continue reading

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Grit

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We can hypothesize that John Irving may have undiagnosed and untreated visual problems which contribute to his dyslexia but that is not the most important message in the following excerpt from Grit by Angela Duckworth. Our patients who have worked successfully to remediate their visual problems have some advantages over those who have found everything to be effortless to this stage in their lives. If you wonder about grit, I suggest that you read this well-written story.

“Garp was a natural storyteller.”

This is a line from John Irving’s fourth novel, The World According to Garp. Like that novel’s fictional protagonist, Irving tells a great story. He has been lauded as “the great storyteller of American literature today.” To date, he’s written more than a dozen novels, most of which have been best sellers and half of which have been made into movies. The World According to Garp won the National Book Award, and Irving’s screenplay for The Cider House Rules won an Academy Award.

But unlike Garp, Irving was not a natural. While Garp “could make things up, one right after the other, and they seemed to fit,” Irving rewrites draft after draft of his novels. Of his early attempts at writing, Irving has said, “Most of all, I rewrote everything…. I began to take my lack of talent seriously.”

Irving recalls earning a C- in high school English. His SAT verbal score was 475 out of 800, which means almost two-thirds of the students who took the SAT did better than him. He needed to stay in high school an extra year to have enough credits to graduate. Irving recalls that his teachers thought he was both “lazy” and “stupid”.

Irving was neither lazy nor stupid. But he was severely dyslexic: “I was an underdog…. If my classmates could read our history assignment in an hour, I allowed myself two or three. If I couldn’t learn to spell, I would keep a list of my most frequently misspelled words.” When his own son was diagnosed with dyslexia, Irving finally understood why he, himself, had been such a poor student. Irving’s son read noticeably slower than his classmates, “with his finger following the sentence – as I read, and I still read. Unless I’ve written it, I read whatever ‘it’ is very slowly – and with my finger.”

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Since reading and writing didn’t come easily, Irving learned that “to do anything really well, you have to overextend yourself…. In my case, I learned that I just had to pay twice as much attention. I came to appreciate that in doing something over and over again, something that was never natural becomes more second nature. You learn that you have the capacity for that, and that it doesn’t come overnight.”

Do the precociously talented learn that lesson? Do they discover that the capacity to do something over and over again, to struggle, to have patience, can be mastered – but not overnight?

Some might. But those who struggle early may learn it better.

Dr. Gary J. Williams

DrWilliams@GWilliamsFamilyEye.com

 

 

Amblyopia and Neuroplasticity

Neuroplasticity – our brain’s ability to develop throughout our lifetime – is now understood, but neuroscientists did not accept neuroplasticity in the human brain until it was confirmed 50 years ago by David Hubel and Thorstein Wiesel through their research on the visual cortex of the brain. Over the last 50 years, research on neuroplasticity has continued to focus on vision. Continue reading

ADHD Nation Children, Doctors, Big Pharma, and the Making of an American Epidemic

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Alan Schwarz

ADHD Nation is as important for understanding the evolution of the diagnosis and treatment of attention disorders, the role of Big Pharma, and how attention disorders have been mismanaged as are the books NeuroTribes and In a Different Key for understanding the evolution of our understanding of autism.

Alan Schwarz is an award-winning investigative journalist whose work made public the seriousness of concussions in the NFL. Like concussions in sports, the potential side-effects of ADHD medications have been largely ignored. Big Pharma and the scientists they support have been complicit in this omission.

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ADHD medications have the potential to improve attention, motivation, and energy which is not dependent on having ADHD. When used properly, the drugs can help many people and the side-effects are minimized. But the statistics make it clear that the condition is being over-diagnosed in this country. The drugs are also being used (and misused) by many high school and college students and by others who feel that they need a boost and have never been diagnosed. The causes of their problems are not being investigated nor are other possible means of treatment. Consider the following…

In the 1930s, a drug was developed with the goal of treating asthma or nasal congestion which, serendipitously, was found to make people feel good. Smith, Kline, & French “licensed it before knowing exactly what medical condition the stuff might actually treat. Finding out was a lot easier then than it is today: Lax federal regulations did not require any proof of safety, let alone efficacy, before a drug was released for public experimentation. So SKF sent boxes of what it called ‘Benzedrine sulfate’ to any doctor willing to try the drug on patients with various ills, from asthma to postpartum depression.”

Due to known problems with amphetamines, a close cousin to amphetamines was developed to have the same effects with fewer side effects. “CIBA termed the chemical formulation of this drug ‘methylphenidate’. The company released it to the American market in 1956 as Ritalin, a treatment for narcolepsy, chronic fatigue, depression, and erratic behavior caused by senility. (Again, only in adults; the medication was untested in children.)”

Dr. Keith Connors, author of the Connors Rating Scale, is the best-known researcher in the field of ADHD. “Connors needed no questionnaire to assess the effects of Ritalin on himself. Late one afternoon, following an exhausting day in the lab, he had to attend an eight-p.m. lecture by Harry Harlow, a behavioral psychologist famous for locking young monkeys away from their mothers and studying their emotional demise. Knowing he’d never stay conscious for the whole thing, Connors found the tub of Ritalin capsules so generously donated by CIBA and took one. Within thirty minutes he snapped awake and thought to himself, ‘This is fantastic!’ He kept working until eight. He skipped dinner. He zoned in on the lecture, chatted with folks afterward, and stayed up until three in the morning. Just one dose felt so beguiling, that he never tried the stuff again for the rest of his life.”

In the early 1990s, Obetrol was an amphetamine which was prescribed for weight control but it was not a financial success. After a pediatrician discovered that it worked for some children who did not respond well to Ritalin, Obetrol was remarketed as Adderall.

“Psychiatry journals teemed with more than a thousand studies on ADHD conducted by Biederman, Barkley, and other pharma-sponsored scientists. The Food and Drug Administration relied on them when green-lighting medications as safe and effective. Their findings served as the backbone for the lectures that drug companies’ key opinion leaders delivered on world tours. The whirlwind created a self-affirming circle of science, one that quashed all dissent.”

“While almost all other developed nations immediately closed the loophole that Metadate had exploited – expressly banning direct-to-consumer advertising of controlled substances, usually through legislation – the United States sat back and let the market take over. To this day, the United States is only one of two developed nations that allow advertising of ADHD medications to the general public.”

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“Appallingly, some children have heightened anxiety interpreted not as a side effect of medication, meaning the drug should be reconsidered, but a new condition needing additional treatment…. Diagnosing young children with several overlapping psychiatric conditions became de rigueur in the 2000s, resulting in what some call a ‘medication cascade’. No doctor was more responsible for the trend than Joe Biederman up at Harvard, who evaluated dozens of drugs on behalf of his Big Pharma benefactors and almost invariably declared them safe and appropriate for children with multiple diagnoses like ADHD and bipolar disorder. Yet neither he nor anyone else tested the performance or risks of these drugs in combination – no pharmaceutical company would ever sponsor such a study, considering it too risky to their product’s reputation.”             “Adderall and methylphenidate have always been among the most addictive substances in medicine. Weird as it may sound, stimulants are dangerous by being not dangerous enough – the drugs have found a sweet spot in which their advantages are more common and immediately obvious than their more latent risks, lulling all involved into complacency.”

“Today, misuse of ADHD medications by high school students is far more widespread that most anyone realizes. About a million high school kids nationwide use Adderall, Concerta, Vyvanse, and others without a doctor’s prescription, getting them either from friends or from dealers for a few dollars a pill.”

“Dozens of studies since the 1990s have estimated that about 8 to 35 percent of undergraduates take stimulant pills illicitly to try to improve their grades; a reasonable estimate among high-pressure colleges is probably 15 to 20 percent. Most students, of course, don’t experience terrible outcomes – if they did, the dangers would already be better recognized. But many do. One 2006 study found that about one in ten adolescents and young adults who misused ADHD medications became addicted to them, with some of them becoming psychotic or suicidal.”

“A different study found that teachers suspected ADHD far more often in elementary school children whose birthdays made them one of the youngest in their grade – just a tick over six, say, when the rest of their classmates were nearing seven. Therefore, many kids were being diagnosed merely because they were born in the wrong month: ‘The youngest children in fifth and eighth grades,’ it concluded starkly, ‘are nearly twice as likely as their older classmates to regularly use stimulants prescribed to treat ADHD.”

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At the end of his working career, Dr. Keith Connors sent a letter to a colleague and closed with the following: “Beware the simple & sovereign explanation.” That is good advice to all of us.

Alan Schwarz includes in the book a mock doctor/patient interview from a certified continuing education program purported to teach physicians how to diagnose ADHD. From the start of the conversation to the writing of the Rx was six minutes. Also, it was not revealed that there was a possible conflict of interest but the following was discretely printed at the end: “Supported by an independent educational grant from Shire.”

http://www.psychologytoday.com/tests/health/adhdattention-deficit-disorder-test

There are many possible causes for ADHD behaviors other than primary “brain dysfunction”. Since there is no litmus test for ADHD like blood work or imaging, ADHD is primarily a diagnosis of exclusion. Other possible causes of ADHD should be investigated and ruled out prior to considering medication. Visual problems are one of the possible causes of these signs and symptoms but so are the accelerated curriculum, fewer recesses in school, less time playing outside, more stimulation from video games, more organized activities which reduce free time, instant communication and responses, less sleep, and more pressure. Children whose problems are not primarily due to attention, may also do better with medication, but their underlying problems are not being addressed and they may be being medicated unnecessarily. “The human brain has evolved over many thousands of years, yet only in the last hundred, a blip on that time line, have we demanded that each and every young one sit still and pay attention for seven hours a day.”

MONASTRA VIDEO

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https://www.cdc.gov/ncbddd/adhd/index.html

 

Body by Darwin

Jeremy Taylor

This book presents the growing evidence that we cannot continue to make progress in health care unless we consider the influences of our evolutionary past. Jeremy Taylor addresses seven areas:

  • Our immune system;
  • Issues regarding fertilization, pregnancy, and childbirth;
  • The effects of upright posture;
  • The development of the eye and macular degeneration;
  • The challenges of cancer;
  • Coronary artery disease; and
  • Dementia.

Each chapter stands on its own. I have chosen excerpts from his discussion of our immune system because these disorders affect such a large (and growing) number of our patients. “It is impossible to get to the root of the very peculiar human immune system and design really effective cures for allergies and autoimmune diseases without a fresh understanding of how the immune system evolved and for what reasons.” p. 7

“The world of our ancestors was a much dirtier place than it is now. Evolution took the expedient route, since microorganisms in prehistory could not be eradicated, of allowing humans to live with them rather than continually fight them. The great collateral cost of self-inflicted damage to our tissues caused by permanently raging immune systems was avoided by handing over the regulation of our immune systems to the microbes inside us, so that we ended up tolerating them. Evolution could not foresee a world where public hygiene, antibiotics, and chemicals that kill 99.9 percent of all household germs has so depleted this microbial population inside all of us that our immune systems no longer mature properly or are properly regulated, giving rise to dramatic increases in allergy and autoimmunity.” p. 8

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The author reviews volumes of research and shares a number of anecdotes including one about a boy with autism whose behavior was so uncontrollable that he had to be institutionalized. Soon after institutionalization, he had a complete reversal in behavior which was caused by chigger bites. To perpetuate his recovery, his immune system is now being treated with infusions of pig whipworms, without which his behavior regresses. This case supports the “hygiene hypothesis which links the bacteria, fungi, and helminths (parasitic worms) in our guts, on our skin, and in our airways and vaginas, with a host of autoimmune and allergic diseases. There is mounting evidence that the composition of all these organisms, living on and inside us – collectively known as our microbiota – can offer protection against a formidable list of autoimmune diseases, including the inflammatory bowel diseases Crohn’s disease and ulcerative colitis, type 1 diabetes, rheumatoid arthritis, multiple sclerosis, and, as we have seen, mental health.” p. 17

“Of all the autoimmune diseases, type 1 (or early-onset) diabetes is rapidly becoming the main scourge of life in the modern, hygienic Western world. Karelia is a large northern European landmass that used to belong to Finland but was partly ceded to Russia during World War II. As a result, the country has been partitioned. Although Russian and Finnish Karelians have the same genetic makeup, including the same susceptibilities to diabetes, the differences in their socioeconomic status and health could not be more stark. One of steepest standard-of-living gradients in the world exists at the border between Russian and Finnish Karelia, with the latter having eight times the gross national product of the former. Yet the incidence of type 1 diabetes, and a host of other autoimmune diseases, is far higher on the Finnish side. Finnish Karelians have six times the incidence of diabetes, five times the incidence of celiac disease, six times more thyroid autoimmunity, and much higher allergy levels than Russian Karelians.” p. 21

“The baby is born with a gut that is almost completely sterile and must be populated immediately with bacteria. If it is breast-fed, it starts to receive one of the most extraordinary products in the natural world. Human breast milk contains a complex array of fats and sugars – fast food – but it also contains immunoglobulin A, an antibody that protects the lining of the human gut and prevents pathogens from attacking and perforating it. It has also been estimated that a breast-fed infant receives over 100 million immune cells every day, including macrophages, neutrophils, and lymphocytes, together with a host of cytokines, chemokines, and colony-sustaining factors – molecules that signal between cells of the immune system and promote their growth. Over seven hundred species of bacteria have been found in human breast milk. It also contains oligosaccharides which the baby is totally incapable of digesting. It is present to feed the bacteria from the breast milk which are colonizing in the baby’s gut”. p. 24

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“Within a week or so after birth, the infant gut, originally sterile, has become colonized by up to 90 trillion microbes. The number of microbes in our guts eventually exceeds the total number of cells in our bodies by a factor of ten. Scientists now refer to the existence of a meta-genome to represent the combined genomes of human and microbiota, a superorganism in which we humans are the junior partner and without which we could no longer exist.” p. 27

“Our resident gut microbiota – the mass of over two thousand bacterial species identified as frequent, long-term inhabitants inside us – is extremely complex. Our relationship with them is so close and intertwined that many of the metabolic signatures that can be identified in human blood, sweat, and urine actually come from our commensal bacteria, not us.” P. 34

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“The gut has been called the ‘second brain’ and has its own dedicated nervous system embedded throughout the gut wall. It is becoming increasingly clear that our gut molecules can communicate directly with our brains, and they are implicated in brain development, brain chemistry, behavior, and mental illness.” pp. 36 – 37

This is support for the importance of children getting outside to play in areas that have a variety of foliage comes from a different perspective – as long as we check carefully for tics.

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The Power of Play

Let Them Eat Dirt

Gut: The Inside Story of Our Body’s Most Underrated Organ

Grain Brain

 

A for Effort

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There is an article in the June 18, 2017 edition of the New York Times Magazine which reports research that children who were in an exercise program for one hour a day after school improved on academic testing and had less visceral fat*. In the second phase of the study, the control group will have the same program as the research group.

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While I laud the research and the results, the whole situation causes me to sit back and shake my head. In the whole history of the United States, would anyone have even thought of this study until the last 25 years? The study also states that most children in our country do not have an hour of activity a day. This is a huge change compared to the childhoods of most of their parents and grandparents.

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The exercise in this program was active play such as playing tag. While the article focused on the change in visceral fat, it also stated that the exercise group performed better on tests of attention, processing information, and controlling their impulsivity. What else is involved with playing a game like tag other than running? Attention? Planning? Cooperation to distract the person who is it? Not being impulsive? Having fun as a group?

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Are children’s choice of out of school activities significantly influencing their current lives and their futures? Are the changes in recreational activities and the accelerated curriculum contributing to some of the problems that children are having such as attention disorders, hyperactivity, undeveloped sensory integration, immature visual motor skills, and visual problems?                                                           I strongly believe that they are.

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The Power of Play

Let Them Eat Dirt

Balanced and Barefoot

The Pressure to Learn to Read Early

*Visceral fat is body fat that is stored within the abdominal cavity and is therefore stored around a number of important internal organs such as the liver, pancreas and intestines. … Storing higher amounts of visceral fat is associated with increased risks of a number of health problems including type 2 diabetes.

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