Category Archives: Longevity Medicine

Patel, Kashyap. Dying Without Fear: The Pursuit of Eternity. Penguin Random House India; 2020.

Yes, I can defi nitely share my journey with you. I will also sharesome of my other patients stories with you, if you believe theywill help.When do you want to begin?

Maybe we can meet once a week at lunch time, here under thisbeautiful copper dome. Could we start tomorrow?

So beings a series of conversations which unfold in the captivatingrelationship between Harry Falls, a former pilot with theBritish Royal Air Force and later a fl ight instructor in the UnitedStates, and Kashyap Patel, MD, author of Dying Without Fear,which will be available soon from Penguin Random House India.Production delays due to coronavirus disease 2019 will require theApril 2020 launch date to be rescheduled. (See Cover.)

Readers of Evidence-Based Oncology (EBO) will recognizePatel as an associate editor and contributing author. Patel is amedical oncologist/hematologist and the chief executive officerof Carolina Blood and Cancer Care Associates, based in RockHill, South Carolina. Having grown up in India and practicedmedicine on 3 continents, he has devoted tremendous personaltime and travel to nourish his interest in world religions andculturesparticularly to gain insight into the universal humanexperience of death.

Falls, married to one of Patels colleagues, died within months ofa diagnosis of lung and liver cancer. Yet, amid the challenges of hisillness, Falls was incredibly fortunate. He had the rare opportunityto discuss his questions about death with Patel, a physician andfriend who was exceptionally well-equipped to help Falls prepare for what the aviator called his ultimate and infi nite journey.Throughout the last months of Falls life, the pair met weekly toexamine death from multiple vantage points: physical, emotional,relational, cultural, and spiritualreligiousphilosophical. Theirencounters provide the foundation of Dying Without Fear.

Patels medical facility was well-designed for conversationswith Falls. The doctor explains, My clinic, Carolina Blood andCancer Care, was founded on a holistic approach to the treatmentof cancer. We constructed the building with a U-shaped designthat allowed all patients to look out onto a healing garden witha gazebo topped by a golden dome. When weather permitted,patients could receive their chemotherapy treatments outside onthe patio or under the dome. It wasnt just for the patients comfort.During difficult discussions, a quick glance at the garden in bloomor the smile of a patient resting in the sun grounded me, put lifein perspective, and reminded me of my mission of service.Patelsclinic was an early adopter of the patient-centered cancer caremodel designed to serve holistic needs of patients, with a focuson palliative care.1 As described previously in EBO, Carolina Bloodand Cancer Care Associates has been one of the most successfulpractices in the country in executing alternative payment models(APMs), which gives practices more support to help patientswith advanced care planning.1,2 But when Patel and Falls were having their conversations years ago, these ideas were still new,and support systems like the one that Patel created for Falls wereharder to find.

The healing garden is the recurring setting where readers ofDying Without Fear will vicariously accompany Falls along hisjourney toward death. Pondering his grim diagnosis, Falls decidesnot to pursue chemotherapy or any other treatments, becausethey would involve diffi cult adverse eff ects and would be unlikelyto prolong his life significantly. After evaluating where I standand how Ive lived all these years, I feel it would be best for me tostart packing my bags for the ultimate and infinite journey. God blessed me with a life that I have noregrets over Lets face it, Doc. From everythingyouve told me, treating my cancer is like trying tosave an exploding plane in mid-air. Chances areits not going to happen. I think of it like Ive justreceived an upgrade on a long fl ight. Ive collectedso many miles that God has granted me a charterflight to a destination unknown. Now the only issueis the waiting time.

Doctors have debated for more than 20 yearson how to engage cancer patients in the decision-making conversation once they have reachedthe terminal stage.3 The culture of care in theUnited States suggests that Falls is an exception,with language around treatment calling onpatients to fight cancer even when it cannot be cured. A 2019 study of 20 women with metastaticbreast cancer found that patients definitionof a good compassionate doctor was one whogives positive news and leaves room for hope.4Another study published last year found that 28%of patients with imminently fatal colorectal cancerreceived treatment , even though this can preventpalliative care.5

Patel writes, Even when I was seeing patientswith very advanced cases where I knew they werebetter off dying peacefully than going through thepains of chemotherapy, which bought them maybe afew more weeks, almost every patient I came acrosswas adamant about hoping for a miracle. But Harrywas different.

Falls decides he will not pursue extraordinarymeasures to avoid death, but he has an extraordinarycuriosity about the dying process, which Patelstrives to appease. Upon receiving his terminaldiagnosis, Falls says, Doc, Im not a religious orritualistic individual. Im somewhere between anon-believer and an agnostic. But I have somefundamental existential queries that are hauntingme. I want to know how death has been definedall these millennia. How do people die? Did ourancestors understand death in a similar fashion toour understanding? How did they treat the bodiesafter death? How was this diff erent across cultures?What about the afterlife? What is a good death, orrather, what does it mean to die well? I can handle amid-air somersault and navigate the worst turbulence.But I am totally incapable of even remotelyimagining my own mortality and afterlife.

Patel responds, I wish everyone facing death,which is in fact everyone someday, would spendtime thinking about these questions.

Patel comes to the conversations with immensecross-cultural knowledge. The reader is drawn in bypoignant stories of a doctor and his terminal cancerpatients, which stimulate Falls discernment abouthow to spend his final days meaningfully, and aboutdisposition of his body after death. For example,Patel introduces the Indian custom of a funeralpyre, and describes how he fulfi lled the traditionalceremonial role of igniting his brothers funeralpyre. He explains beliefs and rituals associated withdeath in ancient Egypt, Greece, Rome, and Australia,and in Hinduism, Buddhism, Judaism, Catholicism,evangelical Christianity, and Islam. He delves intotopics not normally covered in a physicians training,such as the human soul, possibilities for an afterlife,and the meaning of suffering.

Although his cancer is not cured, Falls satisfieshis human need to prepare for a peaceful death.Readers will not want to put the book aside until they learn how Harrys story ends.

Patels purpose for writing Dying WithoutFear, described in an interview with EBO, is toprompt communal and personal preparation for aprofound human experience that is unavoidable,yetparadoxicallytoo seldom a subject of openconversation. Patel thinks humans will have moremeaningful and comfortable experiences of deathif their community does not treat death as a taboosubject, or an event to be delayed through extreme,often painful measures that yield meager improvement in longevity or quality of life. He writes:

I see it every day; patients in their last few daysenduring horrifi cally painful therapies when wehave already informed them that the end resultof that dreadful suff ering will be maybe twoor three more weeks of life spent in agonizingpain. The pain and the therapy do not allowthem to spend time with their loved ones or enjoy the comforts of life. Those few weeks are spentchained to a hospital bed. We are too willing, itseems, to bargain away quality time with thosewe love and freedom from debilitating pain inexchange for fourteen to twenty-one more dayson earth. And in that last leg of the marathon,instead of preparing and planning for a graceful and pain-free departure surrounded by those wehold dearest, we prefer to ruin those last, mostprecious moments in pursuit of a farfetched cure,ensuring that the fi nal days we spend on earthare the most miserable of our entire lives. It isthis fate that, as a physician who has been at thedeathbed of countless numbers of my patients, Iwant to help people avoid.

As Patel shares stories of his deceased patients,its evident that they have benefi ted from a highlyattentive physician. He accepts their calls to hiscell phone at all hours; he visits their homes;he attends their funerals. Readers who havestruggled to schedule appointments with theirphysicians may be astonished at the generosity of the time spent with Falls. Yet, from an ethicalperspective, Dying Without Fear raises serioussystemic concerns about empowering patients toexercise genuine informed consent. How much isinformed consent for end-of-life decisions underminedor impossiblefor countless patientswho begin the dying process as Falls did, but neverhave the opportunities for education and reflectionthat he received?

Read the rest here:
BOOK REVIEW: One Oncologist's Journey With a Patient to the Outcome We All Face - AJMC.com Managed Markets Network

Human evolution is complicated, to say the least.

It's complicated by love, which makes us want to keep people alive. It's complicated by science and technology, which give us the power to do so. It's complicated, sometimes, by politics. And it's complicated by our environment, which is relatively stable, meaning we haven't needed many significant adaptations for thousands of years.

But what happens when that changes? What would happen to a population of humans - generations of humans - who left Earth to find new lives in the vast wonder of space?

The environment out there, beyond the protective environment of our home planet, is very different from the one we've evolved in for millions of years. It's quite conceivable that our species would become something altogether different.

For decades, this potential transformation of humanity has been fertile ground for speculative fiction.

In James S. A. Corey's wildly popular The Expanse series, and Robert Heinlein's The Moon is a Harsh Mistress, away from the strictures of gravity we see humans evolving to be unnaturally tall, brittle-boned creatures.In Becky Chambers' To Be Taught If Fortunate, we see the reverse - bones thickening on high-mass exoplanets, to support a higher body mass.

We see a lot of longevity as imagined technologies extend our lives. Iain M. Banks' Culture novels are a brilliant example of this, wherein humans develop the ability to live for centuries, and become cosmic dilettantes. In Bruce Sterling's Schismatrix, humans have genetically engineered themselves to such an extent, they're pretty much a new species.

While the specific outcomes and pathways vary quite wildly in science fiction, the concept itself - human metamorphosis away from Earth - isn't that far-fetched. It may not seem like it, but as we go about our day-to-day lives, humans are still evolving.

Scott Solomon, an evolutionary biologist at Rice University, has written a book on the continuing human evolution, and spent a lot of time thinking about how we might evolve in the future. According to him, migrating away from Earth is bound to change us.

"For evolutionary change to occur, you need genetic variation and you need natural selection," he told ScienceAlert.

"When you have those two things for a population that's facing a very big change in environment, evolution can happen quickly. We will have all the pieces in place if we move to, say, Mars."

Environmental pressures are going to be a huge part of our transition from an Earth-bound species to a space-faring one. That's already evident. Just a temporary jaunt in space physically changes people. Astronauts, even after a few months in space, can take years to restore the bone density lost in microgravity. Some changes occur even faster.

Kira Bacal is a medical scientist and practising physician at the University of Auckland in New Zealand. But she spent several years working at NASA's Johnson Space Center working in aerospace medicine.

"There are some things that happen on an extremely rapid timeline," she told ScienceAlert.

There is, for example, the baroreceptor reflex. It regulates our blood pressure, keeping it at a constant level in response to external changes. It's the reason you don't faint when you stand up, keeping your blood from pooling in your feet due to gravity. In microgravity, this reflex is immediately impaired because you don't need it.

Changes also happen in the vestibular system - the finely tuned mechanisms that help us keep our balance and control eye movements, along with the brain processing involved.

"Suddenly you're in a situation where if you drop something from your hand, it doesn't go anywhere," Bacal explained.

"So the whole expectation of what's going to happen, the processing of the sensory inputs you're getting, the way it feels to move through space, no pun intended, is very different."

Other changes that take place over time in microgravity include the loss of bone density; without the constant stress gravity places on your bones, they lose density at about 10 times the rate of osteoporosis. There are also anatomical changes to the eye, microstructural changes in the brain, and even changes in the gut microbiome.

Although these physiological changes give us some idea of the environmental pressures that could shape the evolution of space-faring humans, they only affect individuals to different degrees, and seem to revert to normal when the astronaut returns to Earth, even if it sometimes takes a few years.

So, how fast could we expect to see permanent evolutionary adaptations in Homo galacticus? To understand the timescales involved, terrestrial precedent can help us once again. Two recent examples, detailed inSolomon's book Future Humans, are disease resistance and adaptation to the lower oxygen levels of high altitudes.

In the tropics, where malaria is most common, there's also a higher incidence of sickle cell anaemia. That's because sickle cell, a hereditary disease, involves a gene that protects against malaria - so people most likely to survive malaria and reproduce are also sickle cell carriers. And different populations of people living at high altitudes have developed different adaptations to cope with low oxygen levels.

Both of those are relatively recent, taking place over the last few tens of thousands of years - practically an eyeblink in evolutionary terms.

But it's not just the environment that shapes the path of our evolution. Culture - the way we live and the choices we make - also plays a role, and it can speed things along quite substantially.

"We can see things that have happened even in just the last several hundred years," Solomon said. "For example, quite a few studies have found that the timing of reproduction is evolving in modern human populations, and it's evolving in ways that are often surprising to people."

In the case of the French-Canadian population of le aux Coudres, for instance, detailed church registers dating back to the 18th century showed a curious trend - the average age at which women gave birth to their first child went downfrom 26 to 22 in a 140-year span. This reproductive age seems to be heritable, and women who reproduce younger have more children that also reproduce younger, coming to dominate the population. That's natural selection.

But in other places, that age of first reproduction is rising, as women choose to delay having children for various reasons, now that those regions have readily available means to do so. That's culture - and technology - at work.

"This is a good example of natural selection and culture in society having sort-of tug of war over the same characteristics," Solomon said. "Some people have gone so far as to say that [culture] has replaced natural selection, but I think it's quite clear that it hasn't replaced natural selection, it's just changed it."

Culture, technology and natural selection will be important for space-faring humans, too. Will there be artificial gravity or not? Science fiction puts forward that lack of gravity will result in bird-boned, brittle humans, but Solomon believes otherwise - simply because of the strain childbirth puts on our bones.

Not only is the birthing process hard, but minerals to grow the baby are often taken from the mother's bones, resulting in lower bone density. So the women more likely to survive pregnancy and childbirth in space might have denser bones to start with, allowing them to live to have more dense-boned children. Technology and natural selection could both play a role there.

Will there be radiation shielding? How strong will it be? Because radiation can drive mutation (and cancer), and being exposed to it could produce some unexpected evolutionary pathways. But darker skin is more resistant to dangerous radiation, so that could play a role, too.

These - and other, smaller influences - are all going to have varying effects, sometimes playing tug of war with the same trait to shape a human optimised for their space environment.

By and large, we can't really predict what our space-faring descendants will look like, because we don't know all the factors that are going to come into play.

Even with all those unknowns, decisions made before those pioneers set off into the infinite final frontier - decisions we might see made in our lifetimes, in fact - will have more of an impact than we might know.

As Solomon explains, it's yet another effect we've already watched unfold on Earth - the founder effect.

"The people that are the founders will have a very significant influence on the long-term makeup of the human population in space," he said.

"It plays out on Earth all the time. Every time a new island pops up out of the sea there are going to be some plants and some insects and other species that will eventually make their way there. And whatever characteristics and traits they happen to have are going to be the characteristics that are going to be present in that population."

We can already see hints of how it might play out for spacefaring humans. Earlier this year, NASA put out a call for astronaut applications - and one of the requirements is a Masters degree. That means people who are wealthy enough to be highly educated. That means, in America at least, probably white people.

Not every country has the resources for a human space program, or can train astronauts. Sometimes the decisions on who gets to go to space may be politically motivated.

People can also get selected based on physical traits, which is starting to sound a bit too much like eugenics, if the plan is to travel space for multiple generations.

"A lot of how we develop and what we develop is affected, not so much by 'is there gravity' or 'isn't there gravity', but by who they decide make acceptable astronauts," Bacal said.

A mid-point as a test case, she points out, is the notion of the commercialisation of space. Miners, for instance - spending stretches in low gravity, returning to Earth in between jobs.It takes much longer to regain bone density than it does to lose it, so it could be possible that space miners never gain enough time to fully recover, resulting in early-onset osteoporosis.

"That could - as it already is in terms of the astronaut corps - impact who gets to work there or who gets chosen for your 10-generation generation ship. You might say, 'look, we're going to choose people who are less likely to be susceptible to bone density loss'," she said.

"That has ethnographic implications. It has gender implications." And these will need to be considered very carefully if we want to avoid a situation where specific groups of people are barred from space because of their race or gender.

We may never become a true space-faring species. It's possible we'll never leave the Solar System. But we're also not likely to stay here on Earth forever.

Space agencies are already making plans for at least one permanent base on the Moon. We've sent several robotic missions to Mars, and plans for a crewed mission are underway. A permanent Mars colony isn't out of the question, either.

These are harsh, literally alien environments, with low gravity and intense radiation. They're entirely different from our home planet, where we've been evolving for millions of years. These places will inevitably have an impact on the human body.

So will the technology we have available, how we travel, and the decisions we terrestrial humans make about who gets to go. But not all differences are visible to the eye.

"You know, there are people that are better at coping with radiation here on Earth. You can't tell by looking at them, but they might live longer than the rest," Solomon said.

"I think a lot of the changes are things that will take place inside the body. I think there would be some outward changes, but a lot of more subtle, internal changes."

In the end, those future humans, the inheritors of the stars, may not look as different from us as we might expect.

See more here:
Homo Galacticus: How Space Will Shape The Humans of The Future - ScienceAlert

After a few moments of chatting, it's clear that Kelly McCreary and the brilliant cardiothoracic surgeon she plays on Grey's Anatomy aren't terribly different. From the moment she answers the phone ahead of this year's season finale, she is warm and friendly. She is the kind of person who uses first names in a way that seems like she's known someone forever. She's also anxious. Seriously. Literally 29 seconds into our discussion, she admits the current COVID-19 pandemic has set her on a bit of an emotional roller coaster.

"Every other day I'm going absolutely nuts inside. One day I can be a little bit productive and focused. The next day, I can be drowning in anxiety and depression," she says with an nervous laugh. McCreary, who joined the series at the end of its 10th season, has a charming candor reminiscent of the emotionally honest characters who define the series on which she stars. In a time when the perils of real medical trauma are scarier than scripted medical trauma, there's something strangely comforting about a Grey's Anatomy doctor being worried, too.

In her onscreen world, McCreary's character, Dr. Maggie Pierce, has had quite a taxing few months herself. Throughout Season 16, tragedy and misfortune have plagued Dr. Pierce's personal and professional lives. The mid-season finale left the fate of Dr. Pierce's career in question after she missed a crucial step in an important surgery. Because of production issues related to COVID-19, the April 9 episode will serve as the season's finale. In the episode, Dr. Pierce has rebounded only to have the fate of her biological father, Dr. Richard Webber, hang in the balance. In short, both McCreary and Pierce could use a break from the insanity.

Jessica Brooks

Although this global pandemic put a rush order on Grey's Anatomy's final episode, Season 16 ends in classic Grey's Anatomy fashionwith a twist and a bang. McCreary spoke with Esquire about the big finish and what's to come for Grey Sloan Memorial.

For this to be a finale the series didn't have in mind for this season, the conclusion was so, so strong. Congratulations on such a successful year.

Well, honestly that was kind of just pure luck. So that was episode 21 out of what was supposed to be 25, but when that episode was produced we had no idea what was coming. We actually wrapped production in the middle of the next episode, so the episode wasn't finished and it was just lucky that [episode] 21 happened to have these elements that wrapped up a storyline and left us with really great juicy cliffhangers. I guess it's just how the writing has been over the course of the entire season. We've been able to take people on these waves again, like these roller coaster rides. We haven't been holding back waiting for mid-season finale and the finale, it's all drama all the time. So we just got kind of lucky.

That's so crazy. It felt so purposefullike a real classic Grey's Anatomy finale.

That's so awesome to hear because obviously they had other plans in the writer's room. I don't even know myself what all was entailed for the finale of this season, but I'm so glad that it's a satisfying story for the audience, that's all I ever want to do is, tell some good stories, so I'm really glad that it feels that way.

I've been so excited for you and your character this season because this is Maggie's sixth full season, I believe.

That's a whole first grader! Maybe even a second grader.

The way that Grey's Anatomy has persisted, there is potential that a current first grader is going to come up to you in 15 years and say, "I've been watching you since I was in first grade," because the show just persists. What is it like to be a part of that?

Sometimes I become aware in these moments... like, there was no social media and streaming and all of that stuff when I was coming up as a kid and in my early professional days, so I couldn't have imagined the longevity. You know how there are some shows that are classics: I Love Lucy and Mash. People still talk about and reflect on [those shows] firmly but it's not as like bequeathed and available for generations of people the way that Grey's Anatomy is. I couldn't have imagined the stickiness of this job. I'm smacked with this idea that for some people I will always be Maggie Pierce forever.

I'm so intrigued by this season because I've been waiting on a season where Maggie really has a reckoning and she's had I feel several in one season, particularly with her medical expertise being questioned.

I definitely think that she is coming out of it stronger with time. Personally, I'm a big believer that every breakdown is an opportunity to have a breakthrough and sometimes it takes stillness and self medicating with television and whatever people need to do to sort of like be able to receive the lesson of the moment, be able to take out the time to figure out what the next great step is.

I think it's only interesting to watch somebody be great at something all the time for so long. Even in your own life, even when you're sort of going along succeeding, everybody looks for ways to be challenged and find a way to grow and see if they can be better. That's been so much fun to play. I love seeing her coming out on the other side of it as a better teammate, even more critically thinking doctor, as a member of this community who can relate to her peers on an even deeper level now.

Is there anything that you hope that Maggie gets a chance to do or encounter that maybe she hasn't yet? Are you looking for your big explosive, oh gosh, what happened to Maggie moment?

This season wasn't enough of a big explosion? [laughs] It was so much fun to shoot the episodes where Maggie's got to have her love at first sight momentthis romantic comedy experience. Maggie is a perfectionist, and I can relate. People who are perfectionists sometimes miss out on being in the moment when they're looking so hard at analyzing the moment. So that was a real thrill. I'm looking forward to seeing whether and how that progresses in the next season.

I have to ask you a silly question, especially in these times. How often do you get solicited for actual medical advice?

Oh God, I don't. But sometimes I give it out for some reason. Like, I don't know what I'm thinking. I've still practiced at speaking with authority about medicine on the show that I am very quick to offer my opinions to friends and some family. Oh no, you can take this supplement and make sure you see your doctor about that. And like, what do I know?

In a different world, how do you think the doctors of Grey's Anatomy would handle the situation we're currently in?

Oh man. I'm sorry, because when you say that, I get this image in my head of all the things I've seen on the news and reports I've read and heard from medical professionals. They're so tired and they're so scared and they're so under resourced and yet they are still pushing through. They're isolated from their families sometimes. I think about the sacrifice that they're making and it literally goes through to my eyes every single time.

I like to think that the doctors of Grey Sloan Memorial would be like them, and the doctors at Grey Sloan are also for some reason all total prodigies at solving major problems. So hopefully they'd be able to figure out the problem of the resources and come up with some inventions that could help. Use the might of the Catherine Fox Award and the wealth at that hospital to find a vaccine.

I would hope that they would be leading the charge for this, but at the very least, I would hope that they would be as good as the people who are out there in New York City and Michigan and all these places where it's so scary and unrelenting right now.

Read more:
Grey's Anatomy's Kelly McCreary on That Surprise Finale and How Grey Sloan Might Handle COVID-19 - Esquire

The pictures of the empty streets in New York City taken during the coronavirus crisis gave a strange feeling to everybody. For those who saw or experienced the traffic jams on the main avenues of the city and the crowdedness of Times Square, the photos were unfamiliar. An odd and bizarre sense of emptiness, a peculiar atmosphere of desolation and at the same time a perplexing and puzzling beauty made millions view these pictures again and again.

In fact, this unusual scene of abandoned New York streets has been in several different movies. It was always as a background for an eerie, ghostly, mysterious or dreamy situation. In the movie "The Devils Advocate" (1997), one of the most suspenseful scenes was Kevin Lomax (Keanu Reeves) walking on the deserted East 57th street, to confront John Milton (Al Pacino). In another movie "Vanilla Sky" (2001), this time David Aames (Tom Cruise) was driving his car from uptown Central Park West to Times Square, seeing the streets and Times Square totally empty. It was a dream, a nightmare to be more precise. In both movies the protagonists were shocked and confused to see the emptiness of the streets in New York. It was unusual not only for these two protagonists who had their offices in the busiest parts of Manhattan. For the millions of viewers of these movies as well, it was a sign of abnormality, irregularity and oddity. New York City has always been identified with its chaos, complexity, crowds and orderly disorder.

In the last few weeks, we have seen a sufficient number of these pictures and photos which satisfied our awe and made many around the world feel somehow blue, gloomy and melancholic. The scenes that we used to see in fiction scenarios have become real. It has been happening in the midst of a pandemic and outbreak of the coronavirus. This added another layer of unusualness to the situation. For Hollywood producers, New York has always been a primary target for the outside forces who would harm humanity. In "Independence Day" (1996) aliens in a giant spaceship attacked the city. In "Deep Impact" (1998) it was a meteor that generated major tidal waves that destroyed the city. In "The Day After Tomorrow" (2004) New York had become a victim of global warming. Even the monsters, including "King Kong" (2005) and "Godzilla" (1998) targeted the city. This time the city was attacked by invisible viruses and for real.

New epicenter

The epicenter of the coronavirus is not Wuhan or Milan anymore, for the last two weeks New York City is considered the real hot spot of the deadly outbreak. The urgency of the situation is obvious from, now regular, press conferences of the governor of New York state and the mayor of New York City. Gov. Mark Cuomos press conferences have been followed all around the world by people who want to understand the true extent of this pandemic. As of today more than 180,000 people in New York are infected with the deadly virus and 9,000 people lost their lives, almost three times the casualties of the 9/11 attack.

Nineteen years after the horrible terrorist attacks aimed at the World Trade Center, we have seen New York as the center of the worst pandemic of the last several decades. The scenes from the overcrowded hospitals and mortuaries are circulating all around the world. The burial of the unclaimed bodies of pandemic victims to Hart Island in New York gave chills to millions of people. The Big Apple, the finance capital of the world, that hosts the United Nations, the biggest corporations, the most expensive real estate and the most magnificent museums in its territory during this crisis showed the frailty of human lives and limitations of technology and medicine to fight against some small viruses.

The outbreak of the virus in the city now reminds many people of the beginning of the crisis in the city of Oran from Albert Camuss "The Plague," which has become one of the best sellers again 73 years after its publication during the days of the coronavirus. In the novel, first the dead rats in the streets and then an increasing number of people with fevers in the hospitals signaled the emergence of something unusual. There was always a fear of a plague but nobody, including the leading character of the novel Dr. Rieux was willing to admit the true nature of the threat the city was facing.

The novel raised the issue of how people failed to really prepare for a threat such as a plague. Each and every time it is considered as a surprise, something like an earthquake. In a memorable quote of the novel, it was stated that "'Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky. There have been as many plagues as wars in history; yet always plagues and wars take people equally by surprise. In New York, the situation was not that different. This time the warnings and red flags were not coming from the history books or the stories of the elder residences of the town. According to the experts, the spread of the coronavirus first throughout Asia, then throughout Europe raised the risk of a potential outbreak in the U.S. in the coming weeks. The most likely target was, of course, the most significant and cosmopolitan city of the U.S. But again everybody, including New Yorkers, took it as a surprise when in March the virus shocked people with the speed of its spread.

Some of the administrators of New York were not different from the high level bureaucrats of Oran. They knew what could go wrong during the epidemic, but it was impractical to alarm everybody. In Oran there was a reluctance to call it a plague, and administrators took draconian measures. In New York, it was already known that it would be a host of the coronavirus outbreak, but the problem was how to take action against it. The mayor of New York was among the people who did not want to seem alarmed. Mayor Don DeBlasio asked New Yorkers to go about their lives and to go about their businesses in the midst of the outbreak in the world. He said that one cannot get this virus in a subway or stadium or in a conference. He claimed that if someone is under 50 and did not have an underlying medical condition it will not be a major threat. He seemed to be very much against the school closures in the city. It turned out that the motivation of the administrators have always been more or less the same, a) fear of a false alarm b) a desire to avoid disruption to everyday life of citizens and c) to provide the continuation of economic and social activity in the city. In Oran people believed that these forms of epidemics were just like bad dreams that will pass away; in New York the expectation of many was that it can be managed and it would go away like a regular cold for many people. President Donald Trump, for instance, a New Yorker himself, believed that it would miraculously go away.

But it was not only the administrators, citizens also made similar mistakes during the beginning of the outbreak in both Oran and New York. The narrator in the novel explains how the residents of Oran failed to take precautions despite warnings. Thus the blame fell on them as well. According to him, they forgot to be modest... and thought that everything was still possible for them, which presupposed that pestilences were impossible. They went on doing business, arranged for journeys and formed views. How should they have given a thought to anything like plague, which rules out any future, cancels journeys, silences the exchange of views. They fancied themselves free... Following the stay at home order issued there were pictures of New York parks and streets on social media with a lot of people continuing with their routine. Cuomo had to warn people multiple times about the danger that this behavior poses for New Yorkers.

In a press conference he warned young people by saying that "'So you're not Superman and you're not Superwoman; you can get this virus. And you can transfer the virus and you can wind up hurting someone who you love or hurting someone wholly inadvertently. This is a public health issue and you cannot endanger other people's health." Later his tone got tougher when he saw the continuing presence of the people on the streets. This time he called the crowds wholly inappropriate and stated that its insensitive, its arrogant, its self-destructive, its disrespectful to other people, and it has to stop, and it has to stop now and added that it is not a joke and he is not kidding. "He reminded New Yorkers that this is not life as usual. It took this much warning and thousands in the hospitals overcrowding the wards and ICU units for New Yorkers to understand the extent of this threat.

It is sad. It is unprecedented for many people in this generation to see a pandemic causing this much damage to a city and its residents. It is sometimes inconceivable to understand how an epidemic cannot be contained even by the most advanced nations. It is sometimes hard to believe the amount of harm that a virus can give to societies and economies around the world. For a moment or for years we have believed that pandemics were something that belong to history textbooks. We woke up with the coronavirus. The residents of Oran and New York and indeed the people in the world need to understand the fact that the epidemics will be around for a long time. There will be fighting, there will be casualties. Epidemics and pandemics have been the part of lives of many generations and it seems that it will continue to be that way. The number of casualties, the longevity of the battle and the nature of fighting will depend on the level of preparedness of humankind for these kind of diseases. As the narrator of the novel stated about the end of the plague in Oran, there will not be a definitive victory. It will just be the end of another battle. The virus, just like the pandemic in "The Plague" will stay dormant, until it rises again.

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Camus, New York and unending wars of pandemics - Daily Sabah

Dear Nonie,

Thank you for the recipes last week! Im interested to know what is understood up till now about treating coronavirus holistically. Suzanne from East Gwillimbury

Dear Suzanne,

I wrote an article on March 15 about boosting immunity holistically for coronavirus preparedness and I would first like to point you to that.

The answer to your query is tricky. We dont have studies on natural therapies, except high dose IV vitamin C, as of yet. You can read more about the therapy here. The protocol is based on similar treatments in people with the coronavirus in Shanghai, China, where The patients who received Vitamin C did significantly better than those who did not get vitamin C, according to the lead physician, Dr. Andrew G. Weber (pulmonologist and critical care specialist). Dr. Weber went on to say, It helps a tremendous amount, but it is not highlighted because its not a sexy drug. Corroborating reports on the vitamin C therapy can be found in The New York Times and The Dr. Wrath Health Foundation.

Readers may not know this is actually orthomolecular medicine. The term was coined by Linus Pauling. Pauling was an American chemist, biochemist, peace activist, and more. He theorized about the importance of vitamin C in high doses for optimal human health. The megavitamin therapy was taken up and developed clinically by Canadas Dr. Abram Hoffer (biochemist, physician, psychiatrist). Dr. Hoffer is the person who first introduced me to nutrition and vitamin therapies for mental health conditions. Those interested can read more about orthomolecular medicine here.

The problem with finding data on holistic therapies for COVID-19 is twofold: the virus is new and the current structure of the medical establishment does not support research for the sake of research as well as it should. I am sure I dont need to tell you, medicine is business in todays economy.

A common denominator in cases of mortality from COVID-19 to date is the presence of pre-existing, serious health conditions, of which diabetes / insulin resistance are preeminent. There seems to be a twofold increase in the number of patients in intensive care having diabetes and mortality seems to be threefold higher in people with diabetes, according to data out of China (1). According to CDC coronavirus reports, patients with type II diabetes and metabolic syndrome may have up to 10x greater risk of death from COVID-19 (2).

Insulin resistance explains both metabolic syndrome and diabetes II and it can present clinically even in the absence of type II diabetes. The symptoms are:

A diagnosis of type II diabetes happens after this disease state has progressed quite far, so a number of people without the actual diagnosis may also be at greater risk, which may lead some naysayers to claim the correlation isnt that high, but it is. And, as you can see, this would explain why the elderly are so hard hit by this virus, since these diagnoses are themselves epidemic in the elderly.

Type II diabetes and metabolic syndrome are caused by a diet high in processed foods and carbohydrates and can be managed and even reversed in many cases, by simple dietary interventions and nutrition education.

So if you want to know how to protect yourself from COVID-19, my best advice is first and foremost to take this time to create healthier dietary habits. These habits will help you not just with COVID-19 risk management but in creating better health outcomes overall. And what else can you do with your time at home that will so change the trajectory of your health and longevity?

Ill continue this next week by sharing the top 10 foods that cause insulin resistance and the 10 substitutes you can use to avoid them. If you want to learn even more and take this opportunity to learn how to turn your health around, Im offering a variety of live cooking and nutrition classes every week during the lockdown. You can read more and sign at hopenotdope.ca/events.

Namaste!

Nonie Nutritionista

This article is intended for information purposes only and should not be considered medical advice, for which you should see a licensed medical practitioner. Follow all ministry of health and government guidelines for the appropriate ways to handle COVID-19.

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Eating healthy more important than ever now - NewmarketToday.ca

Fast food is a hallmark of modern living, and while it may be convenient, it's not doing us any favors.

A new study from Penn State, West Virginia and Michigan State universities suggests it's one of several factors contributing to a decline in American life expectancy.

The research, published this week in the journal Social Science & Medicine, found that people living in communities with more fast-food restaurants are living shorter lives. Another major factor found to negatively impact life expectancy was the number of people in a community with jobs in the extraction industry, which includes mining, quarrying and natural gas production. A third key factor was a community's population density, with people living in rural areas having a longevity edge over those in more urban environments. In this case, more people is not necessarily merrier.

Life expectancy defined as the length of time a person born in a specific year can expect to live is one of the most critical ways to gauge a society's overall health. But, after making steady gains over the previous decades, American life expectancy flat-lined in 2014 and then began reversing. From 2014 to 2017, the average years in an American life rolled back from 78.9 to 78.6 years.

"American life expectancy recently declined for the first time in decades, and we wanted to explore the factors contributing to this decline," lead author Elizabeth Dobis of the Penn State-based Northeast Regional Center for Rural Development explained in a press release. "Because of regional variation in life expectancy, we knew community-level factors must matter."

For the study, the team looked at how life expectancy in 2014 has changed from a 1980 baseline on a county-by-county basis. They ended up combing through data from more than 3,000 counties enough to build a comprehensive statistical model that weighed the impact of 12 community variables. They were also able to control for personal variables that are already established as factors on lifespan, including sex, race, education and alcohol use.

"By analyzing place-based factors alongside personal factors, we were able to draw several conclusions about which community characteristics contribute most strongly to this variation in life expectancy."

Their findings? People who lived near fast-food restaurants are having time shaved from their lives.

But that factor wasn't the only thief of time. People who worked in "extraction industries" i.e. mining and oil and gas extraction were also dying younger than those who did not. The population density of a community also had an adverse impact on lifespan. Indeed, the researchers found people living in less dense, rural communities lived longer lives, on average.

It seems at least a few of the reasons why people move to the city conveniences, jobs, and simply to be around more people are also bad for their health.

How bad, exactly?

"For example, for every one percentage point increase in the number of fast-food restaurants in a county, life expectancy declined by .004 years for men and .006 years for women."

Expanding on that grim arithmetic, for each 10 percentage point increase in the number of fast-food restaurants took a 15- to 20-day hit on life expectancy. Researchers found a similar relationship between oil and gas jobs and how long people lived.

"Another interesting finding was that lower population density, or living in more rural areas, is associated with higher life expectancy," study co-author Stephan Goetz adds. "This suggests that living in large, densely-settled metropolitan areas, with all of their amenities and other advantages, comes at the expense of lower life expectancy, at least in a statistical sense."

One thing that stood out to researchers, regardless of a community's density, was how strongly people living there acted like an actual community. Factors like access to doctors and how well people supported each other were seen as having a positive impact on life expectancy.

"We were surprised by the strong positive contribution of social capital to life expectancy within communities," says coauthor Goetz. "Places with residents who stick together more on a community or social level also appear to do a better of job of helping people in general live longer."

What does proximity to fast food have to do with longevity?

A new study looks at the community factors behind the dip in American life expectancy.

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What does proximity to fast food have to do with longevity? - Mother Nature Network