Martin Ford’s popular 2015 book, Rise of the Robots, only came to my attention with the extra reading time offered by current stay at home policy. I’m sorry I hadn’t read it before and would love to see it updated to 2020.

The extent of AI’s impact on our economy, job markets and income disparity was already much greater in 2015 than I suspected was true now. The impact on factory workers and other rote physical work is well recognized and, in many areas, already fait accompli. Office work, including much now done by college graduates, and even computer and software jobs are quickly disappearing. In the last 20 years the investment business has realized greatly increased profits while employing many fewer people; legal work formerly done by young attorneys is done faster, more accurately and far more cheaply by computer; programming and computer system analysis is likewise often better done by machines.

Young people making educational and career decisions would be well advised to read this book. Ford views much education related debt to be wasted, never to retrieved.

A long chapter examines robots and AI in health care. New jobs will be abundant in health care but most will be menial and low paid such as elder care. Certain professional areas will be almost entirely replaced: pharmacy; radiology film reading; pathology slide reading. Optimal treatment plans in oncology and some other areas will replace current professional decisions. Ford feels there will be a need for many nurse practitioner type jobs: a professional who can interact with patients and input information from the patient into the system. Most basic acute problems and much chronic disease follow up can be handled at this level, replacing the primary care physician, a field most MD’s avoid anyway.

In the course of the book Ford digresses into societal problems. He reviews our dysfunctional medical system controlled by for profit decisions which are often dangerous to health and which divert huge amounts of money into profits for drug companies, specialty physicians and medical centers. Specific issues of abuse include billings of twenty times or more Medicare allowable; drug and equipment advertising; no negotiated drug prices by Medicare; the conflict of interest in fee for service medicine where the medical center or physician profits from extra studies and procedures. The result is that new technology often is greatly overused with lots of expense but little patient value.

He recognizes that American society is not ready for Medicare for All even though many analysts conclude it is the best system. A simple viable alternative is successful in several European countries: the government sets all-payer maximum rates (he suggests 120% of Medicare.) but this still does not resolve drug prices and fee for service abuses. He would ban advertising (as does most of the rest of the world) and set drug prices.

Incremental change to a poor quality, hugely overpriced American medical system may soon be off the table. If the economic consequences of COVID are as dire as many predict there will be no money for this wasteful approach. Medical, and to be fair, other hugely profitable businesses have shown little altruism in the past and have manipulated government and a gullible public. I think they will fight to keep as much as they can. Amusingly, and I am not a Bernie fan, his policies might be what would allow America to best endure the upcoming years.

The COVID-19 epidemic has taken front stage. Health experts have filled print, TV and internet with advice on travel, masks, personal hygiene.

Consensus is that this virus is highly contagious; some have said that virtually everyone will get it. There are probably many asymptomatic cases, but these people might still pass the virus to others. Estimates of mortality vary from less than 1% to almost 3%. So far mortality seems less than the average flu epidemic. It also differs from the flu in that infants are less likely to die. The flu pandemic of a little more than 100 years ago disproportionately killed healthy young adults; this is not so for COVID-19 which is most serious for the elderly and those with chronic disease.

Lifestyle will be critical to avoid serious illness or death in this epidemic since the immune system determines disease outcome in infections like COVID-19. The immune system is dependent on a high nutrient diet- lots of whole plant foods- and sufficient rest. Many parents who raise their children on a whole food plant based diet report no childhood colds or flus. Eating processed foods and lots of animal products are proven ways to depress the immune system. Lack of sleep will also do it.

If estimates that most or all will be infected are correct the only recourse is healthy lifestyle to minimize severity of the disease. Amazing how all roads lead back to the same answer for health.

Research and training institutions have been enamored with drugs and procedures for decades. That’s where the money is for salaries, labs and, recently, sharing patent rights. As a result we have medical professionals who know little else. Life has been extended; many serious chronic diseases can be managed, if rarely cured. The result: lots of sick, miserable seniors whose life is survival without joy.

When I discuss lifestyle with people I often hear “I want to enjoy my life, not eat vegetables and fruit. I don’t care when I die as long as I enjoy my meals.” But now ‘modern, scientific medicine’ won’t let you die; instead you get 10-30 years of pain, suffering, hospital and doctor visits at the end of your days.

Mainstream medicine is starting to acknowledge this. A recent article from the prestigious British Medical Journal is reviewed:

Just How Much of a Benefit Do We Get from a Healthful Lifestyle?

Anthony L. Komaroff, MD reviewing Li Y et al. BMJ 2020 Jan 8  https://doi.org/10.1136/bmj.l6669

A long-term analysis suggests that adopting such a lifestyle at midlife might add as long as 10 years of disease-free life.

And they’re talking about modest changes- no smoking or drugs; only moderate alcohol; a little exercise; more fruits and veggies. Eat mainly whole plant foods and benefits multiply. Start earlier in life and these diseases almost vanish. Evidence for this is overwhelming but undermined daily with fake news by food businesses, big Pharma and the medical industry-business complex.

In the last month I’ve given the revised The China Study by Campbell to several people who expressed an interest in healthy eating. Since it had been over ten years since I read and reread the book I thought I should read the new version. It’s as good as ever! And it should be read by anyone interested in health; nutrition; how big business, government, academics and organized medicine work together to make money, often not in the best interests of health-seeking individuals.

Campbell’s delightful synopsis of a Plato dialogue between Socrates and Glaucon is remarkable for its similarity to the present day situation. My summary:

Socrates- People should eat barley, wheat, boiled vegetables with relishes; desserts of figs, peas, beans, berries, nuts; and wine in moderation, passing their days in tranquility and sound health, probably living to an advanced age.

Glaucon- Yours is a diet fit for swine. People should recline on couches eating a modern rich diet including meat.

Socrates- Everyone will suffer from inflammation and we will need many doctors. (Glaucon agreed.)

Socrates- this luxurious city will be short of good land because of all the acreage needed for livestock. People will take land from others leading to war and violence. Many of the best will rush to become doctors and lawyers in this city of sickness and strife.

Wow! Socrates had it figured out almost 2500 years ago. He and Plato are revered as the greatest of wise men to this day, but when was the last time you’ve heard about this dialogue?

Most people, certainly most reading this, want to have good lifestyle habits so that they will enjoy life with optimal health. These blogs offer my analyses about eating and exercise to achieve this goal. But knowledge is not enough. It’s easy to skip exercise and tempting to indulge in unhealthy food and drink.

As I reflect on my own behavior and observe others it’s clear that poor choices multiply as the day moves into evening. For me, a major cause is fatigue: I find it easy to exercise and eat only healthy foods when I’m not tired and my observations and reading confirm this is true for many others as well.

This is not an easy issue since social time is often evenings when we can be with family and friends who may not have our lifestyle knowledge and goals. My strategies-

Exercise early in the day.

Eat a substantial breakfast and lunch which consist entirely of whole plant foods and whole grains.

Eat dinner at home as much as possible since you have control of the food supply. The corollary is don’t have unhealthy food in your refrigerator or cupboards.

Take a late afternoon nap if very tired.

I would love to hear from others about their experiences and strategies for coping with “good habit fatigue.”

Andy Polansky, a friend and former radiology colleague, suggested the book False Positive by Theodore Dalrymple. This book consists of the author’s comments on a year of the New England Journal of Medicine, one of the most respected medical journals. Dalrymple is British and, I suspect, classically educated since his writing is elegant and filled with classical and Shakespearean references.

One of his comments is on an article discussing rates of certain common cancers in the United States. He notes that, compared to African-Americans, Americans of European heritage have 50% more diagnoses of breast, prostate, colon and melanotic skin cancers, but the death rates from each of these cancers is approximately the same between blacks and whites.

What can this possibly mean? Dalrymple’s conclusion is the same as mine: many cancers are not clinically important, but screening, much more common in affluent people, leads to diagnosis and often treatment of cancers that will never kill you. The anxiety, complications and cost of these unnecessary treatments is enormous.

Screening in medicine is a huge, profitable business, advocated by almost all medical organizations and taught to medical students as gospel. Certain screenings are of well proven value: blood pressure in western countries or any population with a western lifestyle (societies with a mainly whole plant food diet have a very low rate of hypertension.) Screening for cancer (this does not mean looking for cancer in those who have signs or symptoms or a reason they have a high chance of a specific cancer) is problematic at the least. My personal choice was to have one colonoscopy in my late 50’s and to see a dermatologist since I am fair skinned, had a lot of sun exposure, and have had multiple skin cancers.

Over the past months I’ve started to write about a subject for this site several times. Each time before starting I reviewed what I had written in past years and discovered that I had covered this or a very similar topic in past years: there isn’t that much to healthy eating and lifestyle- eat mainly whole plant foods (as Michael Pollan told us so well); get at least a moderate amount of exercise most days; avoid tobacco, illegal drugs and excess alcohol. Add in a good night’s sleep, cultivate relationships and community, make use of meditation or other relaxation techniques. Most who do these simple, common-sense things will be happy, healthy and have the much better likelihood of avoiding premature death and chronic illness.

Our local grocery store on Kauai makes tasty vegetarian and fish sushi on site daily. This is a staple for many neighbors and we enjoyed it too until we read the ingredients listed in very fine print on the label. They find it necessary to include lots of things which we never suspected including “wheat protein” (gluten). Since I have celiac disease I can’t eat this. Presumably, one of the commercial sauces they use for binding includes gluten and several other unusual ingredients. Fortunately a local food truck makes similar, even better, vegan sushi without all the chemicals.

The food industry loves complexity including a wide variety of chemicals for preservation and flavor enhancement. Review of the contents of most popular, commercial, “healthy” whole grain breads typically shows 25-30 ingredients, many of them chemicals of some sort. I don’t know health effects of each of these chemicals but I’d be amazed if at least some of them aren’t bad for you. Healthy eating habits require a magnifying glass while grocery shopping outside the produce aisle.

After finishing a large steak last night I decided that it was so good I should have another.

Here’s the recipe (from Dr. Fuhrman):

Roasted Cauliflower Steaks

Serves: 2

Slicing a head of cauliflower into large “steaks” is a elegant way of serving this tasty cruciferous vegetable. Season and roast until tender, then serve with a flavorful garbanzo bean puree.

INGREDIENTS:

1 large head cauliflower1/2 teaspoon ground turmeric1 teaspoon Dr. Fuhrman’s MatoZest or no-salt Italian seasoningground pepper, to taste1/4 cup pine nuts or chopped walnuts1/2 cup no-salt-added or low sodium vegetable broth or more as needed1 large shallot, chopped1/4 cup raisins1/2 cup cooked garbanzo beans1/4 cup chopped parsley

INSTRUCTIONS:

Preheat oven to 350 degrees F. 

Cut cauliflower vertically into 1/2-inch thick steaks. You should end up with 2-3 steaks and some extra pieces. Rinse lightly with water and season on both sides with turmeric, no-salt seasoning and pepper. Place steaks and small pieces on a lightly-oiled baking dish, cover with foil and bake for 25-30 minutes or until lightly browned and tender, turning after 15 minutes. Remove small pieces of cauliflower and return steaks to the oven with the heat turned off to keep warm.

Meanwhile, in a saute pan, saute pine nuts or walnuts until lightly toasted. Remove from pan and set aside. Add shallots to the pan along with 2 tablespoons of vegetable broth and saute for 2-3 minutes or until starting to become translucent. Add raisins and cook until raisins become plump, adding broth as needed to keep them moist.

In a high-powered blender, blend the small cauliflower pieces, 1/2 of the pine nuts or walnuts, 1/2 of the raisin mixture, the garbanzo beans, 1/2 of the parsley and enough broth to provide a smooth puree.

Transfer puree to a serving platter, place cauliflower steaks on top of puree and garnish with the remaining nuts, raisin mixture and parsley.

Calories 361; Protein 15 g; Carbohydrates 53 g; Sugars 22 g; Total Fat 14.1 g; Saturated Fat 1.2 g; Cholesterol 0 mg; Sodium 173 mg; Fiber 13.7 g; Beta-Carotene 389 ug; Vitamin C 215 mg; Calcium 151 mg; Iron 5.3 mg; Folate 337 ug; Magnesium 141 mg; Potassium 1702 mg; Zinc 3.1 mg; Selenium 4.5 ug

When discussing celiac disease I mentioned that the book Grain Brain by Perlmutter advocated no gluten or whole grains for anyone, celiac or not. David Katz commented that this was ridiculous since the medical literature strongly confirms health benefits for whole grains. Because this book continues to be widely read and cited by low carb advocates I purchased a copy and read it. The following is the review I sent to Amazon:

I have rarely read a book that made me so angry.

It’s probably good to say who I am: a retired physician (diagnostic radiologist) whose retirement project has been studying nutrition and its effect on health for the past 15+ years.

The message of this book is that a low carbohydrate, high fat diet promotes brain and overall health primarily by keeping blood sugar and insulin low and controlling systemic inflammation. The diet advocated will help most people manage blood sugar and decrease inflammation for most who are eating a standard American diet (SAD).

Sugar and processed carbs are vilified; no argument since they are not healthy. But unrefined grains and whole plant food starches are given the same label. Interesting, since epidemiological studies uniformly find that large groups of people whose major calorie source is these foods live the longest and have the least chronic disease. The absolutely proven healthy diet is one that is exclusively or mainly whole plant foods including whole grains.

Since this diet avoids processed carbs and starches it will be calorie restricted for most people who will lose weight and have less inflammation. Perlmutter tells his readers that they can usually get their CRP (a commonly used lab test measuring inflammation) to less than 3 after a month or so. On a whole food plant based diet (WFPB) mine is 0.4 which is about par for people eating this way.

Many eating the Grain Brain diet will end up with high serum cholesterol but the author tells us that this is not only OK but good, citing some irrelevant references (too detailed a topic to cover in a review.)

Atherosclerosis, which causes most heart attacks and strokes, is barely covered, on one page mentioned as something everyone gets no matter what the diet. This is absurd which I’m sure the author must know. Many people do not get atherosclerosis- those who have eaten a WFPB diet their whole lives. Those who change to this diet reverse atherosclerosis. A WFPB is the only well-proven way to treat atherosclerosis, still the number one killer of Americans.

Cancer gets a few passing references. Since overweight people get more cancer the author assumes they will get less cancer in spite of many studies associating animal protein consumption, a mainstay of a Grain Brain diet, with more cancer.

The book does advocate eating non-starchy vegetables which is undoubtably a good idea but is unlikely to make up for the other bad advice.

It’s frightening to contemplate the number of people whose health has been damaged by this best selling book. I do understand that the author has made a lot of money from the book and other related projects: the American dream (nightmare) to create a very profitable business no matter the effect on health or societal welfare. 

There’s been a lot of interest about fiber and I was asked how to decide how much psyllium to take.

I prefer a simple end point- you are getting enough when you have at least one good-sized soft bowel movement a day. Be sure to drink plenty of water with and after the psyllium and during the day.