Auburn, Al. (Special to Informed Comment) – Peter Attia, M.D. received his medical degree from Stanford University School of Medicine and trained at John Hopkins Hospital in General Surgery and worked at the NIH as a surgical oncology fellow at the National Cancer Institute focusing on immune-based therapies for melanoma. Bill Gifford, a veteran journalist, authored the N.Y. Times bestseller Spring Chicken: Stay Young Forever (or Die Trying). Each of us will one day die. There are two aspects to longevity: first, your chronological lifespan and two, your “healthspan” or how well you live. Most people die as result or effect of the “Four Horsemen,” or chronic diseases, viz., heart disease, cancer, neurogenerative disease (or type 2 diabetes) and related metabolic dysfunction.

Peter Attia (P.) argues that there are three periods or eras in medical history. Medicine 1.0 lasted two thousand years after the death of Hippocrates and dealt with observation and guesswork. Medicine 2.0 has seen its finest hour with fighting COVID-19 yet has made meager progress against what P. names the four Horsemen (heart disease, cancer, metabolic dysfunction, and metabolic syndrome including diabetes and neurodegenerative diseases like Alzheimer’s). Medicine 3.0 suggests that we have an early screening for various diseases. For example, we need to deal with cancer on three fronts: early prevention, more defective and targeted treatments, and accurate and comprehensive detection. The problem is this: we know very little about how cancer begins and why it spreads. In sum, cancer is not one, simple disease, but a condition with “mind-boggling complexity.”  Yet, despite hundreds of billions of dollars spent on research on cancer, death rates have barely moved. We are intervening at the wrong point in time, i.e., well after the disease has progressed. Most diseases have been in our body for several years before they have been detected.  

The main question in this book is this: how can we reduce our risk for disease and death, plus upgrading the quality of our lives as we age? In evaluating new patients, P. asks these basic questions: do we take in too many or two few calories? Are we adequately muscled or under muscled? Are we metabolically healthy or not? If we want to live a long life, we need a tactical plan. P. suggests these five dimensions: exercise, nutrition or diet, sleep, techniques to improve our emotional health, and various supplements, drugs, and hormones or molecules we take in from outside our body. Limitations of space allow me to speak to only three of these dimensions, viz., exercise, nutrition and sleep.

Exercise has the greatest power to determine how one will live out the rest of one’s life. Why so? Exercise retards the onset of chronic diseases, reverses physical decline, gives one more energy, and reverses cognitive decline. Doctors measure cardio-respiratory fitness in terms of VO2 max which is the maximum rate at which one uses oxygen. The good news is this: VO2 max can be increased by training. It’s especially important to strengthen one’s muscles. As a diabetic, I lift weights at the gym four times a week. I also walk vigorously seven days a week and avoid sugar and avoid eating pasta, rice, and heavy carbs. I take no medicine to control my diabetes. The last time I checked my HbA1C score was 5.9. At age 82, I can do twenty-five pushups and can walk with a forty-pound dumbbell in each hand for five minutes. Exercise acts like a drug in that it tells one’s body to produce its own endogenous drug like chemicals. Having strong muscles delays death because it preserves “healthspan” (or the quality of one’s life), as opposed to one’s life span.

Peter Attia with Bill Gifford, OUTLIVE: THE SCIENCE & ART OF LONGEVITY, (New York: Harmony Books, 2023). Click here.

Nutrition has several easy rules. One must eat essential fats, obtain the vitamins and minerals one needs, avoid fructose heavy foods (that likely cause blood- glucose spikes), eat fish, cut down on calories, and avoid pathogens like E. coli and toxins like lead or mercury. No dose of alcohol is healthy; hence I drink one or two bottles of Budweiser Zero Alcohol daily. One should also eat 50 grams of fiber each day. Foods high in protein like eggs have no effect on blood sugar. There’s no one diet for everyone. It depends on one’s health and one’s individual needs. Excess calories contribute to heart disease, cancer, metabolic disorders like diabetes, and Alzheimer’s disease.

Sleep is undoubtedly the best medicine for one’s brain. Our brain works well when we are unconscious as we process memories, thoughts and emotions, hence dreams. Sleep influences one’s memory, cognitive function, and emotional equilibrium. Sleep also staves off Alzheimer’s disease. P. suggests we sleep between seven and a half to eight- and one-half hours a night. One night of bad sleep has a negative effect on our physical and cognitive performance and wreaks havoc on our metabolism. Sleep deprivation increases insulin resistance by up to a third. Higher stress levels make us sleep poorly and cause glucose to be released from the liver. Less than six hours of sleep is associated with a 20 percent higher risk of a heart attack. Chronic bad sleep causes dementia and Alzheimer’s disease. P. notes that alcohol impairs sleep quality more than any other factor. Trazadone works well to help one sleep. The exact dose depends on the individual. Fifty milligrams or even less improves one’s sleep quality without grogginess the next day.

In sum, I give high marks to this study by P. He gives us forty pages of references and a helpful index. In sum, this book took my breath away. Highly recommended!

The decision of the Biden administration to wage total economic war and to use the Ukrainian army to defeat Russia completely even if it takes years has larger global consequences, however, which should temper enthusiasm for this enterprise. The war in the Ukraine has displaced more than 12 million people in Ukraine and its neighboring countries, caused huge shortages of grain in the Middle East in countries like Egypt, Lebanon, and famine in Yemen, high energy costs in Europe, soaring unemployment world-wide, and higher gas prices and inflation in Europe and North America.

There exists a history to the war between Russia and the West going back to the end of the Cold War and the reunification between East and West Germany. When Thomas Friedman asked George Kennan, (the architect of the US Cold War strategy of containment), what he thought about NATO expansion, Kennan said: “I think it is a beginning of a new Cold War. I think it is a tragic mistake. There was no reason for this whatsoever. No one was threatening anybody else.”

In 1999, the Czech Republic, Hungary, and Poland became members of NATO and in 2004, Slovenia, the Slovak Republic, Romania, Lithuania, Estonia, and Bulgaria joined NATO. Though not formally a member of NATO today, Ukraine is a de facto NATO ally. In a speech in December 2021, Putin remarked that “military contingents of NATO countries have been almost constantly present on Ukrainian territory under the pretense of exercises. The Ukraine troop control system has already been integrated into NATO.”

At the World Economic Forum in Davos on June 1, 2022, Former Secretary of State, Henry Kissinger remarked that the war between Russia and the Ukraine might totally reshape the world today. He added that we should aim for a long-term peace solution between Russia and the West. Both Russia, the Ukraine and NATO may be forced to make concessions in order to bring about world peace. For Kissinger, the outcome of the war and the peace settlement will be decisive whether Russia and Ukraine, added by NATO, will be adversaries forever, or whether they will work together and reach a compromise within an international framework. In an article in 2014, Kissinger felt that the best outcome would be that Ukraine became a neutral state and act as a mediator or bridge between Russia and Europe. Kissinger also noted in 2022 that peaceful negotiations should resume in the next two months.

It seems reasonable for Putin to be anxious that if Ukraine joined NATO since that would give NATO the ability to launch a nuclear first-strike on Russia. The US should have de-escalated the situation by removing Tomahawk missiles from Romania and Poland, negotiating Ukrainian neutrality, and removing troops and bases near Russia. Remember this: when the Soviet Union put nuclear weapons on Cuban soil in 1961, the US set in motion a naval blockade around Cuba and forewarned Cuba to remove these weapons at once, which they did.

There are many in-theater reasons why there must be a diplomatic solution rather than an ongoing proxy war between Russia and the West that goes on indefinitely According to Gen. Mark Milley, Chair of the Joint Chiefs of Staff for the US, Ukraine has had 1,000 casualties per day in the Donbas region of Ukraine. On average 200-500 Ukrainians are killed each day and many more wounded. For its part, circa 32,950 Russian troops have lost their lives in battle since the invasion began, according to the Ukrainian General Staff. It should be noted that in wartime, these figures may not be entirely correct because each side often has its own statistics that are not always exact.

It is not even clear that a protracted struggle with Russia is in the interests of the US and its allies. The National Security Strategy states that China represents the number one adversary of the US. China is without a doubt the strongest manufacturing powerhouse on the planet. Russia remains the second largest producer of oil and gas in the world. For its part the proxy war in Ukraine by the US brings Russia closer to China which is definitely not in the strategic interest of the US. China has recently increased its stockpile of its nuclear weapons to defend itself against America’s updating its nuclear arsenal.

Maximalist goals may get in the way of ending the war. The US has in no uncertain terms told Germany that it should never open the Nord Stream 2 gas pipeline to Russia. It would be better used as a bargaining chip. Russia has put over 11 billion dollars into this gas pipeline and holding out the prospect that Europe will return to using Russian gas as a stopgap until green energy replaces fossil fuels entirely may be a huge way of getting Russia to make concessions to Ukraine and to the West.

The US has given powerful artillery weapons to Ukraine. This decision should be reconsidered. If Ukraine uses these weapons to attack Russian soil, we may have a nuclear war in which the entire planet loses. Also, it will cost between $500 billion and $1 trillion to rebuild Ukraine. Presently, Ukraine has an old, inefficient infrastructure that should be rebuilt so that it’s carbon-neutral.

In sum, Putin is entirely wrong in invading Ukraine. In the end, neither Russia nor Ukraine can win this senseless war on a purely military basis. Eventually, the struggle will move into the arena of diplomacy. Rather than rigidly mapping out maximalist positions, both sides should be talking even now.

Guillén is the Zandman Professor in International Management at the Wharton School of Penn and an expert on global market trends. This book has eight chapters, a conclusion, and a Postscript on the impact of COVID-19 on trends in 2030. This book acts as a roadmap to navigate the next decade, since today’s world will change by 2030. The world is changing so fast that folks are nervous about what the future has in store for all of us. One of the biggest changes by 2030 will be technological ones, such as 3-D printing, artificial intelligence, and nanotechnologies.

Technology will generate creative solutions but also create problems, e.g., as a result of autonomous vehicle technology about three million truck drivers may lose their jobs. Autonomous vehicles have a bright future since a computer can adapt to road and traffic conditions, and figure out a complex trip. A single robot in the manufacturing section can displace five to six workers. By 2030 there will be more robotic arms than human ones, more computers than human beings, and more sensors than eyes. Artificial intelligence (AI) can perform tasks that human brains do, such as make decisions, recognize speech, and utilize visual perception.

Today, it takes about a decade of higher education and years of training to become a first-rate surgeon. Yet in 2016, the Smart Tissue Autonomous Robot (STAR) used its own intelligence, tools, and vision to stitch together the small intestine of a small pig. It did a better job than human surgeons who had the same task. The robot’s stitches were more consistent and less resistant to leaks than the sutures of the human surgeons. And an added bonus: robots are neither temperamental nor judgmental.

New 3D printers can create a three-dimensional figure or object by printing very thin sheets in sequence. They then stack them on top of each other to create a three-dimensional shape. By using only the exact amount of material needed to make a dental piece or human replacement tissue, waste is reduced. Less carbon will be put into the atmosphere as fewer goods are made with less material. The clincher is this: companies will need much less shipping as mini-factories and printer farms are constructed that are closer to customers. Companies are learning to manufacture items to real-time demand, instead of storing their supplies in warehouses since freight transportation makes up 25% of all carbon emissions in affluent nations.

Cities can use 3-D printed seawalls to counter flooding and storm surge. The company, Branch Technologies, uses Cellular Fabrication (C-FABTM), that is, industrial robots, complex algorithms, and freeform, extrusion technology that allows material to become solid in free space. This same company is perfecting a new construction product that’s stronger, lighter, faster on-site and with ten times greater design freedom using a waste-free process. This company built the largest 3-D structure in the world, viz., a bandshell at a park in Nashville. China uses 3-D printing to print entire homes that may aid in recovering from natural disasters like earthquakes and cyclones.

Nanotechnologies can go a long way in arresting climate change. The clothing industry accounts for circa eight % of total carbon emissions. Nanotechnologies can design particles as small as one billionth of an inch manufacturing cheaper, stronger, and more environmentally friendly materials that are programable, i.e., material endowed with the capability of changing their shape, conductivity, density, or optical properties in response to sensors. Researchers have discovered a material that tightens in cold weather to provide warmth and yet provides relief from heat in summer. We now have nanomedicine. We can deliver drugs to cancerous cells with enormous precision. Nanotechnologies can detect ovarian cancer when the disease is affecting one hundred cells. Nanorobots are able to be programmed to transport molecular payloads and cause on-site tumor blood supply blockages that can lead to tissue death and shrink the tumor.

Women in the US, Europe, and East Asia are having fewer children yet there’s a baby boom in Africa. Its population of 1.3 billion people will grow to 2 billion by 2038. One might surmise that Africa couldn’t survive such a growth in population, but that’s not the case. The landmass of Africa is humongous, i.e., about as big as India, China, Japan, the US plus Western and Eastern Europe combined. Will Africa be able to feed its increased population? The World Bank says that by 2030 Africa’s agriculture may well become a trillion-dollar sector, thus transforming the entire global economy.

Though today Africa imports food, its positioned to become an agricultural and industrial revolution. It must cultivate 500 million acres of land that’s about the size of Mexico, while greatly improving productivity by growing and processing a vegetable named cassava the third chief source of carbohydrates after rice and maize in the developing world. Over 300 million people in sub-Saharan Africa use cassava for their daily dietary needs since it contains less sugar than wheat.

This is a remarkable book, one that I cannot do justice to in a short article. The author has certainly done his homework in writing this book, e.g., it contains 27 pages of notes that enlighten the reader. I have difficulty praising this book too highly.

The Strange Case of Donald J. Trump by Dan P. McAdams [click]

McAdams is a pre-eminent expert in personality theory and the Henry Wade Rogers Professor of Psychology at Northwestern University who does research on how people change over time. He argues that people build evolving narratives of themselves that give their lives unity and purpose. In the above-mentioned book, the author uses sophisticated, scientific research in personality theory, developmental and cognitive psychology that he relates to the life of President Trump. This book gives readers a “psychological reckoning” of Mr. Trump. “Reckoning” means coming to terms with someone, that is, it involves analysis, or, in this case, making sense of what makes Donald Trump tick. In doing so, McAdams gives an evidence-based, fair-minded portrait of Mr. Trump to the degree that that is possible, since we’re all human and have our views.

The author makes a crucial distinction between the language of medicine that speaks of sickness and health as opposed to the language of personality that concerns itself with such notions as goals, motivation, self-concept, narrative identity, values, temperament, and the dynamics of attachment. The disciplines of psychiatry and clinical psychology deal with the language of medicine, whereas McAdams uses the language of human personality in focusing on Donald Trump. The author believes that neither psychiatrist nor psychologists should diagnose political figures in accordance with the Goldwater Rule that forbids psychiatrists from diagnosing mental illnesses in public officials. Hence the author, to his credit, simply endeavors to understand “who Donald Trump is and how he came to be.”

McAdams points out that Donald Trump lacks a compelling narrative or story to spin “about himself.” Trump has no story to tell about who he is, came to be, and will be in the future. He lives in the moment without regard to his past or future. He sees himself as a thing, akin to a comic-book superhero, living from one episode to another. The author calls him “episodic man,” similar to a “volcano” or “wild beast.” Most people have a tool called “autobiographical reasoning.” This tool enables one to have a life story that shows one’s uniqueness, gives meaning to one’s past, thus describing how one came to be. As a person gets older and moves into their 20s, 30s, and 40s, one’s autobiographical reasoning becomes more apparent and more sophisticated. Trump seems to lack insight into his life since he does not appear to have autobiographical reasoning. He has absolutely no perspective on himself, though he talks about his fantastic accomplishments, ad nauseam.

Trump, an episodic man in a Hobbesian universe, looks upon the world as a dangerous place. It’s all about winning and defeating one’s enemies at all costs. The world consists entirely of winners and losers or “suckers.” An episodic person does not have to be truthful or moral, since only one goal remains important: absolute victory. McAdams argues that Trump’s goal in 2016 was to win the election. That was more important to him, than governing the country. Surprisingly, Trump filed papers in order to be a candidate for the presidential campaign in 2020 on his first day in office in January, 2017. Today, Trump aims to be re-elected President for a second term and nothing or no one will keep him from attaining that goal. Otherwise, he will have failed miserably and the word, “fail” doesn’t exist in Trump’s vocabulary. Trump perpetually describes himself as a “winner” even when he fails.

One may ask “Is Donald Trump one of the greatest deal-makers in the history of US Presidents?” To this question one must give a resounding “No.” Why so? For example, during his presidency from 2017 to the spring of 2019, Trump destroyed more deals than he did creating new ones. He took the US out of the Paris climate accords that were adopted by almost 200 nations. Trump breached the Iran nuclear agreement or JCPOA made during the Obama administration between the UN Security Council (China, France, Britain Russia and the US) plus Germany, and Iran . He also refused to sign the Trans-Pacific Partnership (TPP) trade deal.

There are five basic steps to deal-making according to Mr. Trump. First, one must fill a human need, that is, cater to what the other person desires and then presenting oneself as the ideal person to meet that person’s need. Second, bend the rules and defy the norms by using “truthful hyperbole.” Innocent exaggerations and white lies are fine and desirable in certain settings. For this reason, hundreds of lawsuits have been brought against Mr. Trump for tax evasion, sexual assaults on women, and dubious financial practices. Third, put on a show. Trump’s deals are similar to performance art or a musical on Broadway. For Trump the benefits of being written about are much greater than the downside, even if the publicity is bad. It amounts to free publicity. Fourth, one should exert maximal pressure. It helps to look big, i.e., be intimidating and fearless. Bargain hard over every inch of the deal and make far out demands one after another, thus wearing out the opposition. Five, win always. Between 1984 and 1995, Trump’s core businesses lost $1.7 billion, more than any other US taxpayer. Trump did have to give up three casinos, his $30 million yacht, the Trump Shuttle, and the Plaza hotel, plus was forced to limit his expenses to $450,000 a month. Despite these losses, Trump considered himself a “winner’ since the banks had to save Trump in order to save themselves.

Trump considered deals with foreign countries on a par with a real estate transaction. Yet in foreign policy (including trade deals) the parties involved are “repeat players.” If one takes advantage of another country, they will, like the proverbial elephant, never forget it. There must be long-term trust between the various parties in a trade deal, otherwise there will be “revenge diplomacy.” That’s the reason why the US and China cannot agree on a trade deal, since President Xi does not, for good reason, trust Mr. Trump nor his negotiators, like Treasury Secretary, Steven Mnuchin and US Trade Representative, Robert Lighthizer, who take their orders from President Trump.

Personality psychologists agree on five fundamental elements of behavior variability. They are (1.) Extraversion: enthusiasm, gregariousness, reward-seeking behavior, and social dominance, (2). Neuroticism: emotional instability, negative emotions and depressive tendencies, (3). Openness: receptivity to new ideas, imagination, curiosity; (4). Conscientiousness: abidance to rules, discipline, organization, organization; and (5) Agreeableness: kindness, compassion, care for others, warmth, modesty. These elements or dimensions are on a continuum from very high extraversion to very low introversion. Trump is outstanding in two of these traits, viz., he’s off the charts relative to extraversion and rock bottom in terms of agreeableness. Donald Trump may be one of the most extraverted persons who ever walked the planet. Extraversion shows itself via words, bodily movements, facial expressions, such as smiling, and other non-verbal signs. Enthusiasm engenders enthusiasm and Trump’s energy ignites a crowd of onlookers who on the campaign trail are won over, regardless of what Trump actually says. Trump won the 2016 election without any platform whatsoever. He won it on the basis of his strong personality and animal magnetism.

Simultaneously, Trump has a huge downside. He fails on the trait called agreeableness that asks the question “how nice one is.” The author calls Trump “a tsunami of disagreeableness.” We see this on Twitter where Trump belittles his enemies such as journalists, the media, Democrats, Republicans like the late Sen. McCain, cabinet members, immigrants, blacks, Latinos, athletes. In sum, his venom is spit out against anyone who disagrees with him. Trump is an authoritarian person and would like to be President of the US forever. Yet President has a fondness for violent men like Vladimir Putin who can neither see nor do any evil. Trump demands absolute loyalty from his entire administration yet he himself would not support anyone who turns on him like Michael Cohen.

With all his faults, how did it come to pass that President Trump has a fervent base of millions of followers? First, Trump supporters deny that he lies or claim he doesn’t lie very much. Others dismiss the allegations that Trump lies, blaming it on the Democrats and the leftist press. Second, some of his followers remark that Trump “tells it like it is.” His heart is in the right place though he may lie “about the details.” Third, some supporters say Trump’s claims could be true. When Trump lied about the size of the inauguration crowd, Kellyanne Conway responded that horrible weather kept his followers away. Fourth, Trump may be a con man, however, he’s our con man. This may account for the number of Republican senators and representatives who know that Trump bends the truth, but they must support him for fear of losing their next election.

Five, some supporters argue that Trump is a different kind of person whose rules do not apply to him. For some, Trump has superhuman powers that allow him to do what other politicians do not dare. Would George W. Bush or Barack Obama have survived their presidency if they had bragged on camera that they grabbed a woman’s genitals or stated they trusted Vladimir Putin more than their own intelligence agencies? A number of white evangelical Christians like Jerry Falwell Jr. see Trump as a kind of savior sent to save the country from radical Muslim terrorists and the erosion of Christian values.

This book is profound, insightful, and evidence-based. It’s the summation of the academic research on personality that McAdams has done over his entire lifetime. I feel entirely comfortable recommending it to readers of all stripes. Strongly recommended.

In college I considered myself an ultraconservative Republican. I subscribed to the conservative journal the National Review and looked upon William Buckley as my hero. I also wanted Barry Goldwater to become our President. I believed Secretary of Defense, Robert McNamara in claiming we needed to go to war with Vietnam based on the ‘domino effect.’ This theory meant that if South Vietnam fell to the Communists, other Asian nations like Cambodia and Thailand would also succumb to communist ideology.

My worldview changed dramatically when I went abroad for my graduate education at the universities of Innsbruck, Würzburg, and Munich. For example, I met students from Egypt who questioned me why the U.S. gives billions of dollars to Israel while doling out a small pittance of money to Egypt, a much larger country. I had no good answer to give my peers from Egypt. Those who live outside the U.S. for nine years, like I did, view American differently than they would have, if they had remained in America? Living abroad for many years makes one more cosmopolitan, as one observes how the rest of the world lives and acts.

Does not President Trump’s mantra “Make America Great Again,” create a ‘fortress mentality’ of “us,” (America) against “them,” (other countries like Iran, Iraq, North Korea, China)? This mentality overlooks the fact that “us” and “them” are two sides or faces of the same coin, particularly in a globalized world. The question of the day boils down to this: What can be done positively to get beyond disparate ideologies so there can be peace on earth?

In his book, Friendship in Islamic Ethics and World Politics (Ann Arbor, Michigan: University of Michigan, 2019) the editor, J. Mahallati, suggests that intrastate and interstate friendships may be the path to bring about a more peaceful world. Friendship and love of neighbor as emphasized in the major religious traditions may be the key to bring the world closer together. Friendship might well be the sole answer to the military and economic wars without end, violations of human rights, and unilateralism by individual countries.

In the same book mentioned above, Seyyed Hussein Nasr, remarks that Sam Huntington did the world a disfavor with his theses about a ‘clash of civilizations’ between the West and other civilizations. Wouldn’t it be better to speak about friendship between the West and the Islamic world? After all, Judaism, Christianity, and Islam are called the Abrahamic religions, since they all claim their lineage goes back to the same patriarch, Abraham. Moreover, these three desert religions agree that God is one. They are also called, “People of the Book,” since each of these religions recognize the Hebrew Scriptures.

Finally, wouldn’t it be a better world if the various nations lived in peace, rather than fighting endless military and economics wars, in which there are no winners, but only losers? For friendship to exist between cultures and nations, there must be mutual respect, rather than simply concern for one’s own self-interest. Does it make sense for the three superpowers, China, Russia, and the U.S. to pour trillions of dollars into buying fighter jets, aircraft carriers, and nuclear weapons that are unshootable, morally speaking, since they would devastate the planet?

The political scientist, Dr. Ted Becker, suggests that China, Russia, and the U.S. need to join forces together to fight global climate change in order for Mother Earth to survive. Now that we have the coronavirus (that some scientists predict may break out every winter), shouldn’t the richer nations help poorer nations to deal with the coronavirus? Finally, we may never know the answer to this question, but has global climate change brought about the coronavirus? I’m not a biologist, but don’t viruses change over time in response to changes in the physical world? These are the questions that Ted Becker and Paul Szep raise in their book on Amazon, titled “The Three Kings of Chaos: The Apocalyptic Geopolitics of the 21^st Century.” It’s available on Kindle and will take your breath away.

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Bonus Video added by Informed Comment:

Stockholm Environmental Institute: “Responding to a global challenge”