Friday, December 21, 2007

'Bullshit' artist

The following was excerpted from an essay called 'Silly Bullshit' in 'Strong Enough? Thoughts from Thirty Years of Barbell Training,' by Mark Rippetoe:

What is it that drives the dissemination of silly bullshit? The drive comes from the commercial interest (obviously) and ego (amazing!). Donna Smith could use the money; so can I, so I appreciate the motivation. The magazine people want you to keep buying them, and to buy from their advertisers, and if they make sure to hire writers that have ‘CSCS’ beside their names, they have covered their asses. The fine folks who bring you HipHop Abs, the Ab Roller, and Cortislim are counting on the fact that you will probably fail to do your homework. On the other hand, Dr. Mirkin probably isn’t in a jam for cash, so he just likes the idea of being a Fitness Expert in addition to a doctor (and, for all I know, maybe a very good one in his actual specialty). The orthopod who tells you that full squats are bad for the knees and they’ll stunt your growth, and that you need to just do lighter weights and use higher reps because “they do the same thing,” doesn’t expect you to pay him for this advice; he’s throwing it in for free. He knows he’s qualified because after all he is a doctor. The exercise science people have qualified themselves. And the media don’t care who’s qualified; they just need to fill 45 seconds.

The problem is simple. It is incumbent on you, yes You, to educate yourself to a sufficient extent that you are in a position to evaluate information issued from a position of authority. You are supposed to be able to recognize silly bullshit when you hear it. And I’m sorry if it’s hard to have to think all the time but the consequences of placing your responsibility to do so in the hands of others can result in a closet full of Thigh Masters, which will make it necessary to find somewhere else to hang your shirts – like on your Bowflex.

Tuesday, December 18, 2007

Lagging behind

When I was in college I spent bored afternoons sitting in the terminal at Logan airport with grounded feet and a soaring imagination. Really I should have been studying for my astronomy class which required extra diligence considering that spectroscopy bored me silly and Dr. Kamal’s incomprehensible Indian accent required a skill of rapid translation that I didn’t possess. In International Departures I was leaving all of that behind me and instead playing Margaret Mead solving mysteries of sociology such as why would any couple purposely wear matching track suits. At this point, if I ever marry, I’ve decided it will be the first Christmas present that I’ll buy my spouse (MY husband would think that was funny which might explain why such a man is so hard to find).

The mysteries just get more interesting as I recently sat next to a gentleman on a flight back to Seattle who managed to combine two classic haircuts – the Mullet and the Caesar – for a look uniquely his own. It’s clear that Caesar wouldn’t have sanctioned that though it had strong potential to scare an enemy. Such a puzzling choice would have dominated all my analytical processes had he not also chosen to wear flip flops with tube socks. The stimulus overload caused my cerebrum to crash into my cerebellum and I had to reboot. I was torn between building the case study and the cost of opening the Pandora’s Box of prattle. If you start chatting to your plane-mate, you have to be prepared to maintain the conversation for the full duration of the flight if he or she decides to keep keeping on. Barring the user-friendly and well-illustrated escape from the well-market exit door, there’s really no place else to go. In the long run, I’d really much rather make an interest-only payment on my ever accumulating sleep debt. This debt has only one useful side effect: when it causes what feels like jet-lag every day of the week, you really don’t feel jet lagged even after you’ve been prattled at cross-continent.

Jet lag is a particular challenge for many people this time of year when the misery of ‘lagging’ is added to the misery of awkward family gatherings that require a heightened readiness to pounce on your own internal edit switch. Thank goodness for Carl Ellison’s trip to Budapest in which he test drove the advice Dr. Singh gave during the talk in September. I’ll let Carl explain:

"Dr. Singh advised me to take 10 mg Melatonin at 4:00 a.m. destination time. I was planning to ease into Budapest time from Pacific over 5 days – maybe 1 or 2 time zones per day – leading up to taking off on Friday morning. I was delayed in that, so I took my first dose of Melatonin on Monday night at 7:00 pm Pacific (4:00 am Budapest). I puttered around and got in bed at about 8:00 pm. At midnight, my eyes were wide open. I was awake and ready to start my day. It never occurred to me that the circadian rhythm reset would happen that fast. So, for the rest of that week, I ran on Budapest time, more or less (lost some sleep in the process – partly from setting an alarm to wake me at 7:00 pm Pacific to take more Melatonin). I believe now (although I haven’t checked with Dr. Singh) that I should have taken only one dose – the day I was flying (or the night before, in this case).

"On the way back from Budapest to Seattle, I did that – took only one dose at 4:00 am Pacific time. I had just boarded the plane in Frankfurt for the leg to Washington Dulles – so I got a glass of water from the flight attendant and took the pills at about 13:00 Frankfurt time. I stayed away long enough to get the meal they served on the airplane – and then put on my eye shades and dozed some from Frankfurt to Dulles. This was max 5 hours of sleep – maybe 4. We changed at Dulles to a flight to Seattle and I didn’t sleep at all on that flight. When we landed in Seattle, it was about 9:30 pm and I felt as I usually do at 9:30 – not really tired but able to go to bed. I got into bed at about 11:00 pm – and had a normal night’s sleep.

"At both ends – Budapest and Seattle (on return) – I had no jet lag. Normally, I have terrible jet lag going East and minor jet lag going West. I’m sold. My thanks to Dr. Singh.”

Don’t try to skip the prep and opt for sleep aids. As this site cautions, ”Some people use sleeping tablets to try to alleviate jet lag. This is a dangerous approach as sleeping pills induce a comatose state with little or no natural body movement, and it is well known that prolonged immobility during flight can lead to fatal blood clots (deep vein thrombosis). This was reported as far back as 1988 in the Lancet, which said it was estimated "that over three years at Heathrow Airport, 18% of the 61 sudden deaths in long distance passengers were caused by clots in the lungs." Picture the leg veins as bags of blood. When this blood doesn't circulate there is a risk that it will clot. In addition, many so-called sleeping pills are variants on anti-histamines and they tend to dehydrate significantly, adding to the already significant problem of in-flight dehydration.”

When I told Dr. Singh about Carl’s results he offered the following, “Thanks for the feedback. I am glad he was able to benefit from the forum. Melatonin is most effective if used under dim light conditions and about 8 hours before the core body temperature minimum. Phototherapy, hypnotics and alertness facilitating agents may also be useful adjuncts. Take care.” Hmmmm, phototherapy, hypnotics – sounds like the same astromony class.

Tuesday, December 11, 2007

Swerving off the path

I only read Oprah books on Airplanes and then once I get over the novelty, I start to wonder why even then. I think it’s only to lament that my neurosis is not the flavor-of-the-week kind. The most recent book I bought on the way to San Francisco was about a woman who couldn’t find herself - other than on the top of the best sellers list. The tale of her journey in which she gives up her antidepressants in favor of a three month carb coma of pasta carbonara is beneficial to me only in regards to the caloric expense of flinging the book and then chasing it down to fling it again. I actually bought it after seeing the author on Oprah whom I was watching as a means to pass time while my toenail polish dried. I can now see that my initial impression may have been a result of huffing top coat.

My trip to San Francisco for a two-day stint in a communication seminar was a handy way to answer the question ‘How many days does it take to unravel a personal trainer?’ Take it easy Will Shortz, This isn’t a riddle. Given that I traveled without my emergency bomb shelter supplies – the very thing I’d tsk tsk a client for not packing – it was clear I was in trouble. It means I was dependent on my hunter gatherer skills on a very tight schedule. I landed Friday night, and had my butt planted in a chair designed by the same man responsible for refining the technique of water boarding, by Saturday morning at 9 a.m. With two thirty minute breaks until dinner, I needed to track down protein prepared with limited amounts of antibiotics, hormones and preservatives, that weren’t wrapped in, served over or in a committed relationship with wheat, excess carbs or sugar. I’d have greater success heading for the alley, cornering a sewer rat and eating it sashimi-style whole, hold the rice.

Given the health implications of all the wheaty, carby stuff and the likelihood that consuming it would make me fall asleep or leave me wandering through a food fog unable to focus on the seminar I paid for, I elected to ‘fat fast’ on creamy cups of coffee. Yes, half and half is not a great source of nutrition but a few doses in fairly small amounts won’t hit me with a lot of chemicals and the neutral impact of fat on my blood sugar will allow me to stay awake. Plus, the caffeine is an appetite suppressant.

In short, I threw my adrenals under the bus. It’s not a good plan and it’s a lot like answering the question, ‘So, where would you like that paper cut?’ Somewhere out there Dr. Carlston dropped what he was doing and exclaimed, ‘Krikey, someone’s adrenals are in trouble!’ I picture him rescuing abused adrenals and bottle feeding them back to health like baby birds. He’d be really excited about it, too and he’d reach that level of animated concern that would make injured adrenals feel safe. It’s important to note that if I could reach his natural level of enthusiasm, I wouldn’t need the coffee. I can hear Dr. Carlston replying, ‘but without the coffee, Heather, you could probably reach that level of enthusiasm naturally.’ He’d say it with an exclamation point. And damn you get out of my head. There’s my exclamation point.

At the seminar, there were eyebrows raised at my second cup of coffee and some inquiry into whether or not I was going to eat anything. These inquiries were made by fragile women smugly nibbling performance bars that they thoughtfully packed as bomb shelter supplies. In my head I played a coldhearted game of ‘which cancers will that cause,’ before answering ‘I’m fine.’ Everyone knows that’s a blatant cry for help. The answer in my head went something like, ‘no worries. Without protein, my body will happily snack on my biceps. Thanks for asking.’ I smiled a little broader mainly because, in a communication course, I feared clairvoyance. It’s no surprise to me that I was attending a class about communication considering how clear it was that my internal conversation was far richer than anything I was willing to let fly.

During the real meal break in the evening, I was consumed by a singular mission of refueling. I ordered fish stuffed with fish and wrapped in fish with a side of fish. Stuffed to the gills with protein, I salvaged my nutrition at least a little. It didn’t stop me from meandering into every convenience store on the walk to Reza’s where I was staying so that I could pretend to buy snacks. The marketing implies that food can be found in such places and that was blatantly untrue. I bought nothing though trying to remember what a Pringle tasted like was food for thought. I remained alert however as I approached Reza’s neighborhood. To say he lived at the gates of hell would be to imply that hell was the kind of gated community in which the influential feared joy riders casing the neighborhood and breaking into cars. Nope, hell has no gates and its contents leaked to Reza’s doorstep.

The next day I spent in recovery, entrenched in pjs catching up on e-mail. I abandoned the second cup of coffee and replaced it with a handful of chocolate truffles I bought at Godiva when I went out to forage the first cup. It was mildly celebratory since I was no longer trapped on a hard chair after two days of abuse and mildly reactive to two days of bad nutrition. What it became, however, is the answer to the question, ‘how do you give yourself a splitting headache in two easy steps?’ (By the way, it runs in the family. When I told my Dad about the truffles he told me that the last time he ate chocolate he fell off his porch. It’s something to look forward to in my sixties.)

With debauchery behind me, I started my day with a 5:15 wake-up call for the 6:00 a.m. CrossFit San Francisco class. I arrived, filled out my paperwork and answered that ‘yes’, I have some experience with this CrossFit stuff. Anyone with a background in Martial Arts will tell you never enter somebody else’s Dojo with a swagger. I didn’t make loud noises, stare down the locals or exaggerate my warm-ups with standing back flips or a six pack of muscle ups. Partly because I can’t do either. When the coach who was helping me determine the appropriate weight for six sets of ten back squats said, “Your one-rep-max is over 200 pounds? That’s heavy,” I replied in an ‘I suppose so’ kind of way. I was there as a student not as a stop on my victory tour.

Ah, back to all that's good and pure! After an exhilarating return to reality, I swung by Starbuck's for a cup of coffee.

Monday, December 3, 2007

Agriculture Supported by Customers— not by the Government

George Vojkovich
and a side order
from Skagit River Ranch

If you become complacent about the quality and the source of your food, you won't have the choices we have today. And with industrial organic, we barely have any access at all to animal products and produce cultivated under proper conditions. As the demand for organic increases, we find more and more ways to reduce the quality in order to increase the profit until the word organic becomes meaningless. The Farmer's Market isn't just a way to salvage nutrient density, it's a way to preserve the wisdom in the natural order of things that defies mass production and for very good reasons. When I was buying eggs on Saturday, I asked George if I could reprint this post from his website:

It is said by year 2020, we will have 1.2 billion more people in the world. Yet, do you know in 2005, the world produced less food for human consumption than it did in 1984? The agricultural productivity is going down, not up. Why? Two thirds of the natural resources in the world are used up. Our past ignorance and greed are destroying the plant support system; ocean, rivers, forest, atmosphere and lakes. I am convinced more than ever that if we are to have a future for our children, we all have to grow “nutrient dense” food through sustainable, non-toxic farming that would produce more yield than the conventional method. There was a sustainable system of agriculture called “Terra Preta” that supported millions of people in Brazil before the mid-16th century. “Sustainable” farming is nothing new, and will work for us today if we try. Economically, spiritually and environmentally, food must be produced sustainably if we expect to leave this earth in tact for our future generations, and the right choices must be made today.

Sadly, here is the U.S. agricultural policy in a nutshell. You hear politicians talk about the Farm Bill? The Farm Bill was supposed to protect farmers, but it actually hurts small farmers like us. Each year, something like $24 billion goes to subsidize farms in the mid-west that grow corn for a few Mega Agri corporations. 75% of the U.S. agriculture is raising feed corn (and now ethanol) in the mid-west. Now that the corn price doubled in 2006, these farmers are making the biggest profits ever. They need no subsidies, but with government’s free flowing money, secured by the powerful agri-corporations, they have no incentives to change their chemical driven farming methods to more sustainable, less harmful ways. Their subsidized feed is so cheap-- “below” cost of production, making it impossible for small farmers like us to compete on a level playing field. Now we, west coast farmers are now competing not only with foreign countries, but also with subsidized U.S. farms. So how do we survive?

The only way that I can think of is to have customers who understand the situation, share the same desire to make this earth a little better place for our children, and are willing to pay the higher price for clean, locally & sustainably grown organic food. When I was listening to Michael Pollan speak about his new book, “The Omnivore’s Dilemma” last fall, he said that where we spend our “food” dollars is not yet regulated by the government while everything else seems to be. And he is right. As a tax payer, I don’t have a right to prevent my tax dollars going to big Agri-corporations without going to jail. But the government won’t arrest you for supporting a farmer like me through your purchases. So, Eiko and I thank you, all of our faithful customers, for your support and making this style of farming possible.

Here is the newest article by Michael Pollan on “Farm Bill”…. Please read it and tell others… Nobody can explain it better than he can .

Sunday, December 2, 2007

Seriously, There's a Point . . .

I watched an entire marathon of ‘What Not to Wear’ while continuously combing the cat I agreed to ‘sit’ while my friend was out of town. I made threadbare the one good coat the cat was wearing while I promised to no one in particular that if I could just make it to the store in these sweats without ending up on the next episode, I’d sacrifice them to the slob gods as soon I got home. And borrowing most of the cat’s coat thanks to the mindlessly excessive maintenance I subjected it to wasn’t making either of us look any more chic. On an up note, I always thought my tragic fashion sense would some day qualify me for handicap plates in a neighborhood with no legal parking. I never guessed that a crippling social disorder would ultimately win pole position in that race.

The disorder became obvious just last week while on a mission of mercy. Michael asked me to get him beans at Vivace - the best coffee in my neighborhood and everybody else’s’. Since my days are always perfumed with the brew, I understood the urgency. If any independent coffee house in Seattle appreciated that people only breeze in at 5:30 a.m. when they have someplace to be, I’d be spoiled with exceptional coffee but since they all act as if I have all the time in the world while they busy themselves making sweet love to the beans, I go instead to the corporate colossus of coffee. I stood in line and savored the pretense that I was the kind of person who sauntered into Vivace because the world can wait for me to caffeinate and still I worried that I stank of a lowbrow grind.

As I stood in line, the man in front of me turned around and then turned again. I pondered whether it impressed him that I was in line at Vivace before I remembered that so was he. We chatted like northwesterners while I beat down the instinctive northeasterner suspicions that pushed me to data dodge by way of bullshit. I was a confident, successful business woman having a casual conversation until he asked if I wanted to join him for coffee. Immediately I became a nervous ninth-grader still holding tightly to my mother’s warnings about strangers. My eyes went wide, I jammed my hands into my pockets and mumbled something about having to go home and go to bed. For the love of God please tell me I didn’t just tell a grown man that I couldn’t stay out because it was past my bedtime!

So I understand that as a segue to a conversation about sleep, this was terrible but, as my sister points out, I write this blog because I amuse the heck out of myself and the fact that I can spar with a man but sharing coffee with one scares the bejeebers out of me – well, that’s just laugh-out-loud funny. Or tragic – depending on whether or not you’re my ovaries.

I’ve been collecting data about sleep since I asked Dr. Singh about napping. I was looking for solutions to my sleep deprivation and he told me that naps longer than twenty minutes can cause sleep inertia. Ah, yes. I nodded knowingly. What I knew, however, is that I had no real idea what he was talking about so I looked it up. Following are studies that I compiled in my quest, but first, a definition of sorts:

Sleep inertia

Sleep inertia is a transitional state of lowered arousal occurring immediately after awakening from sleep and producing a temporary decrement in subsequent performance. Many factors are involved in the characteristics of sleep inertia. The duration of prior sleep can influence the severity of subsequent sleep inertia.

Although most studies have focused on sleep inertia after short naps, its effects can be shown after a normal 8-h sleep period. One of the most critical factors is the sleep stage prior to awakening. Abrupt awakening during a slow wave sleep (SWS) episode produces more sleep inertia than awakening in stage 1 or 2, REM sleep being intermediate. Therefore, prior sleep deprivation usually enhances sleep inertia since it increases SWS. There is no direct evidence that sleep inertia exhibits a circadian rhythm. However, it seems that sleep inertia is more intense when awakening occurs near the trough of the core body temperature as compared to its circadian peak.

A more controversial issue concerns the time course of sleep inertia. Depending on the studies, it can last from 1 min to 4 h. However, in the absence of major sleep deprivation, the duration of sleep inertia rarely exceeds 30 min. But all these results should be analysed as a function of type of task and dependent variables. Different cognitive functions are probably not sensitive to the same degree to sleep inertia and special attention should be provided to dependent variables as a result of the cognitive processes under review. Finally, sleep disorders represent risk factors which deserve new insight in treatment strategies to counteract the adverse effects of sleep inertia.

H SAYS: For all of those folks who dozed half way through that you should pause to marvel all the evil implications. Four hours of sub-par function behind your desk equals low productivity which then means later hours to catch up. Plus, as Dr. McCleary points out, lack of sleep actually shrinks the hippocampus which means you'll never remember that I told you how dangerous sleep deprivation can be because that's what the hippocampus is supposed to do. Spending the first couple of hours at work trying to remember where you're supposed to be, what you're supposed to be doing and where you put you're coffee mug isn't getting you promoted during this review period (that should keep you up at night). Just saying.

Effects Of Sleep Inertia As Bad Or Worse Than Being Legally Drunk, Say Researchers

A new University of Colorado at Boulder study shows that people who awaken after eight hours of sound sleep have more impaired thinking and memory skills than they do after being deprived of sleep for more than 24 hours.

The study showed test subjects had diminished short-term memory, counting skills and cognitive abilities during the groggy period upon awakening known as sleep inertia, said CU-Boulder Assistant Professor Kenneth Wright, lead study author. The new study has implications for medical, safety and transportation workers who are often called upon to perform critical tasks immediately after waking, since cognitive deficiencies following 24 hours of sleep deprivation have previously been shown to be comparable to the effects of alcohol intoxication, he said.

The study appears in the Jan. 11 issue of the Journal of the American Medical Association. Study authors included Wright and Adam Wertz of CU-Boulder's integrative physiology department and Joseph Ronda and Charles Czeisler of Brigham and Women's Hospital in Boston, which is affiliated with Harvard Medical School.

"This is the first time anyone has quantified the effects of sleep inertia," Wright said. "We found the cognitive skills of test subjects were worse upon awakening than after extended sleep deprivation. For a short period, at least, the effects of sleep inertia may be as bad as or worse than being legally drunk."

Following six nights of monitored sleep lasting eight hours per night, the study participants were given a performance test that involved adding randomly generated, two-digit numbers, said Wright. Based on the results, the researchers concluded the subjects exhibited the most severe impairments from sleep inertia within the first three minutes after awakening, he said.

The most severe effects of sleep inertia generally dissipated within the first 10 minutes, although its effects are often detectable for up to two hours, according to the study authors.

Studies conducted by Dr. Thomas Balkin and colleagues at the Walter Reed Army Institute of Research in Washington, D.C., have shown cortical areas of the brain like the prefrontal cortex take longer to come "on-line" following sleep than other areas of the brain, Wright said. The prefrontal cortex is thought to be responsible for problem solving, emotion and complex thought.

The CU-Boulder study has implications for medical professionals who are often called on to tend patients in crisis on a moment's notice, often at odd hours, Wright said. Medical residents, for example, who may work 80 hours or more per week and who "catnap" at times, could be prone to make simple math mistakes when calculating dosages of medicine during bouts of sleep inertia, he said.

The results also have implications for emergency medical technicians and firefighters who may be hastily awakened and called upon to drive a vehicle to an emergency scene, putting themselves and others at risk, said Wright. The study also has implications for commercial truck drivers, who frequently pause for quick naps in their vehicles' sleeping berths during cross-country excursions, he said.

Wright and his colleagues said further studies are needed to measure the effects of nap interruption and "recovery sleep" in on-call, sleep-deprived individuals.

The study also illuminates the challenges faced by everyday people who are forced to make crucial decisions following abrupt awakening. "If a person is awakened suddenly by a fire alarm, for example, motivation alone may be insufficient to overcome the effects of sleep inertia," he said.

The paid study volunteers, nine of whom were included in the sleep inertia study, slept eight hours per night during the month leading up to the study, had no medical, psychiatric or sleep disorders and were free of medication including alcohol, nicotine, recreational drugs and caffeine. The subjects also spent several hours each day during their six-day, in-patient stay practicing the math test used to quantify sleep inertia.

"These were very healthy people who had performed the test hundreds of times, making the results even more profound," said Wright. Located at Boston's Brigham and Women's Hospital, the sleep lab used in the study contained infrared video cameras, audio equipment and physiological recorders that monitored sleep patterns of participants through the night, he said.

The More You Sleep, The Longer You Live

Dr. Keith Humphreys
Sunday, September 2, 2007

It's done in bed, it feels great and most Americans don't get enough of it. It's sleep, of course, the most undervalued contributor to optimum health and performance.

Did you know that sleep had anything to do with success in sticking to a diet? Get to know leptin and ghrelin. They sound like a Hungarian comedy act, but they are hormones that regulate appetite. Ghrelin is produced in the stomach and signals the brain when it's time to eat. Leptin is secreted by adipose tissue (i.e., fat) and has the reverse effect, telling your brain when you are full. Chronic lack of sleep increases ghrelin and decreases leptin, leading you to feel hungry when you don't really need to eat and to keep eating after you have gotten the calories you need.

Hitting the weights at the gym? Good sleep will bring you the results you want more quickly. The body repairs itself, including rebuilding your sore biceps, during the deepest phase of sleep. That's why a good night's sleep will not only make your workouts more productive but will also boost your immune system in general.

Despite these and other benefits, including greater mental alertness, improved concentration, better mood - even lower risk of car accidents - sleep remains underrated when it comes to health promotion. Maybe people can't believe that something as mundane as consistently getting seven or eight hours of sleep a night can have such a positive impact on their health. Or maybe, in a culture of double cappuccinos and Ambien, sleep deprivation goes unrecognized in the first place.

If you get stuck in a period of weeks or even months where sleep is hard to come by (e.g., new baby, a big work deadline), pay off your sleep debt with extra sleep as soon as you can and you should suffer no long-term ill effects. But don't make sleep deprivation a lifelong habit. A study of almost 7,000 Alameda County residents, over a nine-year period, found that people who routinely slept six or fewer hours a night had about 70 percent higher risk of dying than did people of similar age who slept seven or eight hours a night.

H SAYS: Again, dying - not a good strategy for promotion during this review cycle.

There are many common sense ways to make it easier to get to sleep, including keeping to a consistent schedule and avoiding big meals, caffeine and intense exercise just before bed. A full list of strategies is available from the National Institutes of Health.

The Institute's strategies for better sleep are useful, but they work only if you make sleep a priority, which many people in the compulsively busy Bay Area do not. If you think you don't have time to sleep enough, remember that survey research shows that most people grossly underestimate how much time gets away from them in the evenings when they are idly surfing the Net or half-watching TV. If you feel tired, turn off the machines and go to bed. And if you believe you absolutely must see the next episode of "Big Brother" or a rerun of "Gilligan's Island," remember that TiVo and VCRs were invented so that we can watch such programs later, when we are rested enough to appreciate their nuanced messages and enduring contributions to our culture.

Keith Humphreys is a professor of psychiatry at Stanford University. He does research in addiction treatment and national mental health and drug policy. He has written for the New York Times and other publications.