Precision Medicine Quotes

There was a language specific to all things. The ability to learn another language in one arena, whether it was music, medicine, or finance, could be used to accelerate learning and other arenas, too.

Psychiatry, as a subspecialty of medicine, aspires to define mental illness as precisely as, let’s say, cancer of the pancreas, or streptococcal infection of the lungs. However, given the complexity of mind, brain, and human attachment systems, we have not come even close to achieving that sort of precision. Understanding what is “wrong” with people currently is more a question of the mind-set of the practitioner (and of what insurance companies will pay for) than of verifiable, objective facts.

Precision medicine is a data driven, knowledge driven, compassion driven, social intelligence driven, genetically compatible tailoring medical treatment and prevention systems for individual patients.

I am a sick man. ... I am a spiteful man. I am an unattractive man. I believe my liver is diseased. However, I know nothing at all about my disease, and do not know for certain what ails me. I don't consult a doctor for it, and never have, though I have a respect for medicine and doctors. Besides, I am extremely superstitious, sufficiently so to respect medicine, anyway (I am well-educated enough not to be superstitious, but I am superstitious). No, I refuse to consult a doctor from spite. That you probably will not understand. Well, I understand it, though. Of course, I can't explain who it is precisely that I am mortifying in this case by my spite: I am perfectly well aware that I cannot "pay out" the doctors by not consulting them; I know better than anyone that by all this I am only injuring myself and no one else. But still, if I don't consult a doctor it is from spite. My liver is bad, well--let it get worse! I have been going on like that for a long time--twenty years. Now I am forty. I used to be in the government service, but am no longer. I was a spiteful official. I was rude and took pleasure in being so. I did not take bribes, you see, so I was bound to find a recompense in that, at least. (A poor jest, but I will not scratch it out. I wrote it thinking it would sound very witty; but now that I have seen myself that I only wanted to show off in a despicable way, I will not scratch it out on purpose!)

In the post-Covid world, the mathematics of chaos theory will experience a greater relevancy as it is applied across a broader set of science disciplines, especially epidemiology, precision medicine and climate science. - Tom Golway

Mainly, though, the Democratic Party has become the party of reaction. In reaction to a war that is ill conceived, we appear suspicious of all military action. In reaction to those who proclaim the market can cure all ills, we resist efforts to use market principles to tackle pressing problems. In reaction to religious overreach, we equate tolerance with secularism, and forfeit the moral language that would help infuse our policies with a larger meaning. We lose elections and hope for the courts to foil Republican plans. We lost the courts and wait for a White House scandal. And increasingly we feel the need to match the Republican right in stridency and hardball tactics. The accepted wisdom that drives many advocacy groups and Democratic activists these days goes like this: The Republican Party has been able to consistently win elections not by expanding its base but by vilifying Democrats, driving wedges into the electorate, energizing its right wing, and disciplining those who stray from the party line. If the Democrats ever want to get back into power, then they will have to take up the same approach. ...Ultimately, though, I believe any attempt by Democrats to pursue a more sharply partisan and ideological strategy misapprehends the moment we're in. I am convinced that whenever we exaggerate or demonize, oversimplify or overstate our case, we lose. Whenever we dumb down the political debate, we lose. For it's precisely the pursuit of ideological purity, the rigid orthodoxy and the sheer predictability of our current political debate, that keeps us from finding new ways to meet the challenges we face as a country. It's what keeps us locked in "either/or" thinking: the notion that we can have only big government or no government; the assumption that we must either tolerate forty-six million without health insurance or embrace "socialized medicine". It is such doctrinaire thinking and stark partisanship that have turned Americans off of politics.

Even our behavior and emotions seem to have been shaped by a prankster. Why do we crave the very foods that are bad for us but have less desire for pure grains and vegetables? Why do we keep eating when we know we are too fat? And why is our willpower so weak in its attempts to restrain our desires? Why are male and female sexual responses so uncoordinated, instead of being shaped for maximum mutual satisfaction? Why are so many of us constantly anxious, spending our lives, as Mark Twain said, "suffering from tragedies that never occur"? Finally, why do we find happiness so elusive, with the achievement of each long-pursued goal yielding not contentment, but only a new desire for something still less attainable? The design of our bodies is simultaneously extraordinarily precise and unbelievably slipshod. It is as if the best engineers in the universe took every seventh day off and turned the work over to bumbling amateurs.

Pain is weakness leaving the body.” —CHESTY PULLER

If you have a smartphone, you have access to more computational power in your hand than most of the governments on the planet had just thirty years ago.

By this point, I had learned a couple of basic rules. First, detailed statistics are for research halls, not hospital rooms. … Second, it is important to be accurate, but you must always leave some room for hope. I came to believe that it is irresponsible to be more precise than you can be accurate. (essentially, - specificity/precision; + truthfulness/accuracy)

I am a sick man.... I am a spiteful man. I am an unattractive man. I believe my liver is diseased. However, I know nothing at all about my disease, and do not know for certain what ails me. I don't consult a doctor for it, and never have, though I have a respect for medicine and doctors. Besides, I am extremely superstitious, sufficiently so to respect medicine, anyway (I am well-educated enough not to be superstitious, but I am superstitious). No, I refuse to consult a doctor from spite. That you probably will not understand. Well, I understand it, though. Of course, I can't explain who it is precisely that I am mortifying in this case by my spite: I am perfectly well aware that I cannot "pay out" the doctors by not consulting them; I know better than anyone that by all this I am only injuring myself and no one else. But still, if I don't consult a doctor it is from spite. My liver is bad, well--let it get worse!

Think about it. Most people have a highway to stress and a dirt road to happiness. If you develop this new habit, you’ll reverse that—you can build a highway to happiness and a dirt road to pain.

Defining philosophy as “an activity, attempting by means of discussion and reasoning, to make life happy,” he believed that happiness is gained through the achievement of moral self-sufficiency (autarkeia) and freedom from disturbance (ataraxia). The main obstacles to the goal of tranquillity of mind are our unnecessary fears and desires, and the only way to eliminate these is to study natural science. The most serious disturbances of all are fear of death, including fear of punishment after death, and fear of the gods. Scientific inquiry removes fear of death by showing that the mind and spirit are material and mortal, so that they cannot live on after we die: as Epicurus neatly and logically puts it: “Death…is nothing to us: when we exist, death is not present; and when death is present, we do not exist. Consequently it does not concern either the living or the dead, since for the living it is non-existent and the dead no longer exist” (Letter to Menoeceus 125). As for fear of the gods, that disappears when scientific investigation proves that the world was formed by a fortuitous concourse of atoms, that the gods live outside the world and have no inclination or power to intervene in its affairs, and that irregular phenomena such as lightning, thunder, volcanic eruptions, and earthquakes have natural causes and are not manifestations of divine anger. Every Epicurean would have agreed with Katisha in the Mikado when she sings: But to him who’s scientific There’s nothing that’s terrific In the falling of a flight of thunderbolts! So the study of natural science is the necessary means whereby the ethical end is attained. And that is its only justification: Epicurus is not interested in scientific knowledge for its own sake, as is clear from his statement that “if we were not disturbed by our suspicions concerning celestial phenomena, and by our fear that death concerns us, and also by our failure to understand the limits of pains and desires, we should have no need of natural science” (Principal Doctrines 11). Lucretius’ attitude is precisely the same as his master’s: all the scientific information in his poem is presented with the aim of removing the disturbances, especially fear of death and fear of the gods, that prevent the attainment of tranquillity of mind. It is very important for the reader of On the Nature of Things to bear this in mind all the time, particularly since the content of the work is predominantly scientific and no systematic exposition of Epicurean ethics is provided.25 Epicurus despised philosophers who do not make it their business to improve people’s moral condition: “Vain is the word of a philosopher by whom no human suffering is cured. For just as medicine is of no use if it fails to banish the diseases of the body, so philosophy is of no use if it fails to banish the suffering of the mind” (Usener fr. 221). It is evident that he would have condemned the majority of modern philosophers and scientists.

Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.” —VIKTOR FRANKL, author, neurologist, psychiatrist, philosopher, and Holocaust survivor

Some people charge that Obama is a socialist. He isn’t a socialist in the precise sense of the word. He supports corporate medicine, central banking and international banking elites, the military-industrial complex, and, with great exuberance, the surveillance-industrial complex.

I am a sick man.... I am a spiteful man. I am an unattractive man. I believe my liver is diseased. However, I know nothing at all about my disease, and do not know for certain what ails me. I don’t consult a doctor for it, and never have, though I have a respect for medicine and doctors. Besides, I am extremely superstitious, sufficiently so to respect medicine, anyway (I am well-educated enough not to be superstitious, but I am superstitious). No, I refuse to consult a doctor from spite. That you probably will not understand. Well, I understand it, though. Of course, I can’t explain who it is precisely that I am mortifying in this case by my spite: I am perfectly well aware that I cannot “pay out” the doctors by not consulting them; I know better than anyone that by all this I am only injuring myself and no one else. But still, if I don’t consult a doctor it is from spite. My liver is bad, well — let it get worse! I have been going on like that for a long time — twenty years. Now I am forty. I used to be in the government service, but am no longer. I was a spiteful official. I was rude and took pleasure in being so. I did not take bribes, you see, so I was bound to find a recompense in that, at least. (A poor jest, but I will not scratch it out. I wrote it thinking it would sound very witty; but now that I have seen myself that I only wanted to show off in a despicable way, I will not scratch it out on purpose!)

It is well known that at the coronation of kings and queens, even modern ones, a certain curious process of seasoning them for their functions is gone through. There is a saltcellar of state, so called, and there may be a caster of state. How they use the salt, precisely--who knows? Certain I am, however, that a king's head is solemnly oiled at his coronation, even as a head of salad. Can it be, though, that they anoint it with a view of making its interior run well, as they anoint machinery? Much might be ruminated here, concerning the essential dignity of this regal process, because in common life we esteem but meanly and contemptibly a fellow who anoints his hair, and palpably smells of that anointing. In truth, a mature man who uses hair-oil, unless medicinally, that man has probably got a quoggy spot in him somewhere. As a general rule, he can't amount to much in his totality.

Like the DSM-V, the RDoC framework conceptualizes mental illnesses solely as brain disorders. This means that future research funding will explore the brain circuits “and other neurobiological measures” that underlie mental problems. Insel sees this as a first step toward the sort of “precision medicine that has transformed cancer diagnosis and treatment.” Mental illness, however, is not at all like cancer: Humans are social animals, and mental problems involve not being able to get along with other people, not fitting in, not belonging, and in general not being able to get on the same wavelength.

The Tree of Life was an ancient symbol of interconnection, fertility, and eternal life—precisely because of this legendary tree’s fruit. Fruit is part of our essence, a basic element of who we are. We cannot survive without fruit on this planet. It outweighs the nutrition of any other food. Yet the current “health” movement toward low-carb diets has put fruit on the endangered species list, with the goal of making it extinct. Is this denial? Ignorance? Foolishness? We’re not talking about uneducated people who are driving the trend. We’re talking about smart, highly intelligent professionals with advanced degrees in medicine and nutrition. If they’re advising patients to shun fruit, it must be because of their training, the misinformation out there, or their own selective interests. Have you heard of book burning? If the anti-sugar war keeps up its momentum, fruit trees will be next to go up in flames.

we have no good metrics for a place’s success in assisting people to live. By contrast, we have very precise ratings for health and safety. So you can guess what gets the attention from the people who run places for the elderly: whether Dad loses weight, skips his medications, or has a fall, not whether he’s lonely.

Psychologists often make a distinction between mistakes where we already know the right answer and mistakes where we don’t. A medication error, for example, is a mistake of the former kind: the nurse knew she should have administered Medicine A but inadvertently administered Medicine B, perhaps because of confusing labeling combined with pressure of time. But sometimes mistakes are consciously made as part of a process of discovery. Drug companies test lots of different combinations of chemicals to see which have efficacy and which don’t. Nobody knows in advance which will work and which won’t, but this is precisely why they test extensively, and fail often. It is integral to progress.

Men's rights activists tend to make a series of valid observations from which they proceed to a single, 180-degree-wrong conclusion. They are correct to point out that, worldwide, suicide is the most common form of death for men under fifty. It's also true that men are more likely than women to have serious problems with alcohol, that men die younger, that the prison population is 95 per cent male and that the lack of support for our returning frontline soldiers is a national disgrace. So far, so regrettably true. They are incorrect, however, to lay any of this at the door of 'feminism', a term which they use almost interchangeably with 'women'. [...] No, sir. No, lads. No, Daddy. That won't help us and it won't help anyone else. Men in trouble are often in trouble precisely because they are trying to Get a Grip and Act Like a Man. We are at risk of suicide because the alternative is to ask for help, something we have been repeatedly told is unmanly. We are in prison because the traditional breadwinning expectation of manhood can't be met, or the pressure to conform is too great, or the option of violence has been frowned upon but implicitly sanctioned since we were children. [...] We die younger than women because, for one thing, we don't go to the doctor. We don't take ourselves too seriously. We don't want to be thought self-indulgent. The mark of a real man is being able to tolerate a chest infection for three months before laying off the smokes or asking for medicine.

But “people” went beyond practice. How a doctor interacted with their patient was just as important in helping a sick person as the science and the cost, and so “people” includes that doctor’s personal imprint, or style. Graham’s style had pried out key information from Sam. It had allowed him to evaluate the diabetes with a more precise scientific lens. “People” was medicine’s art.

it is precisely their genius for interpretation that puts religious leaders at a disadvantage when they compete against scientists. Scientists too know how to cut corners and twist the evidence, but in the end, the mark of science is the willingness to admit failure and try a different tack. That’s why scientists gradually learn how to grow better crops and make better medicines, whereas priests and gurus learn only how to make better excuses.

Medicine was religion. Religion was society. Society was medicine. Even economics were mixed up in there somewhere (you had to have or borrow enough money to buy a pig, or even a cow, in case someone got sick and a sacrifice was required), and so was music (if you didn't have a qeej player at your funeral, your soul wouldn't be guided on its posthumous travels, and it couldn't be reborn, and it might make your relatives sick). In fact, the Hmong view of health care seemed to me to be precisely the opposite of the prevailing American one, in which the practice of medicine has fissioned into smaller and smaller subspecialties, with less and less truck between bailiwicks. The Hmong carried holism to its ultima Thule. As my web of cross-references grew more and more thickly interlaced, I concluded that the Hmong preoccupation with medical issues was nothing less than a preocupation with life. (And death. And life after death).

The weakest sufferers are precisely those who are least able to appropriate the future and its good things. If this be true of the weak, and if the strong find it irritating to be medicined with soft fictions, or presented with anything but sound truth, the popular method of consolation appears to be excluded altogether. If my own life were to be lived over again, I should, from the strength of this conviction, convert most of its words of intended consolation into a far more consolatory condolence. Never

Having a body, we have seen, does not entail knowing a body. Whereas a cow automatically eats whatever grasses supply needed nutrients, people must determine for themselves what to put into their bodies, with the result that there is room to make mistakes. Mistakes arise, in part, from ignorance. Yet ignorance is not the only problem produced by this arrangement. The fact that we are not compelled by our bodies' precise needs—understood as particular kinds of food and drink, rather than food and drink tout court—allows the formation of desires that have little or nothing to do with the needs on which bodily health depends.

[...] if he then should wish to perform rites belonging to many different forms, claiming to use them concurrently as means and ‘supports’ of his spiritual development, he will not really be able to combine them except ‘from the outside’, which amounts to saying that what he accomplishes will be nothing else than syncretism, which consists precisely in this kind of mingling of disparate elements that nothing really unifies. [...] This situation is similar to that of someone who, hoping to secure his health the more effectively, makes use at one and the same time of many different medicines the effects of which neutralize and destroy each other and sometimes even provoke unforeseen reactions harmful to his organism. There are things that are efficacious when used separately but that are nonetheless radically incompatible.

Among the most virulent of all such cultural parasite-equivalents is the religion-based denial of organic evolution. About one-half of Americans (46 percent in 2013, up from 44 percent in 1980), most of whom are evangelical Christians, together with a comparable fraction of Muslims worldwide, believe that no such process has ever occurred. As Creationists, they insist that God created humankind and the rest of life in one to several magical mega-strokes. Their minds are closed to the overwhelming mass of factual demonstrations of evolution, which is increasingly interlocked across every level of biological organization from molecules to ecosystem and the geography of biodiversity. They ignore, or more precisely they call it virtue to remain ignorant of, ongoing evolution observed in the field and even traced to the genes involved. Also looked past are new species created in the laboratory. To Creationists, evolution is at best just an unproven theory. To a few, it is an idea invented by Satan and transmitted through Darwin and later scientists in order to mislead humanity. When I was a small boy attending an evangelical church in Florida, I was taught that the secular agents of Satan are extremely bright and determined, but liars all, man and woman, and so no matter what I heard I must stick my fingers in my ears and hold fast to the true faith. We are all free in a democracy to believe whatever we wish, so why call any opinion such as Creationism a virulent cultural parasite-equivalent? Because it represents a triumph of blind religious faith over carefully tested fact. It is not a conception of reality forged by evidence and logical judgment. Instead, it is part of the price of admission to a religious tribe. Faith is the evidence given of a person’s submission to a particular god, and even then not to the deity directly but to other humans who claim to represent the god. The cost to society as a whole of the bowed head has been enormous. Evolution is a fundamental process of the Universe, not just in living organisms but everywhere, at every level. Its analysis is vital to biology, including medicine, microbiology, and agronomy. Furthermore psychology, anthropology, and even the history of religion itself make no sense without evolution as the key component followed through the passage of time. The explicit denial of evolution presented as a part of a “creation science” is an outright falsehood, the adult equivalent of plugging one’s ears, and a deficit to any society that chooses to acquiesce in this manner to a fundamentalist faith.

In network models of the interactome, these truncating mutations can be thought of as the removal of one node along with all its edges - a node removal. Nonconservative missense mutations of amino acids in the protein core that lead to major folding problems, protein aggregation, and premature protein degradation can also be modeled as node removals. At the other end of the mutational spectrum are small in-frame indels or missense mutations. These can preserve protein folding, but may modify the active site of an enzyme or affect the binding to another protein or macromolecule. In network models, these mutations, which specifically perturb a single molecular interaction, have been labeled as edge-specific or "edgetic". While investigation of the precise interaction defects associated with point mutations is of course not new, the term edgetic promotes a subtle yet meaningful archetype shift from conventional gene-centered models, which emphasize consideration of which specific edges are affected by a mutation, complement and extend classic gene-centric models, which ascertain only whether a gene product is present or not present and neglect less overt alterations of a given gene or gene product.

I want to convince you that intellectual property is important, that it is something that any informed citizen needs to know a little about, in the same way that any informed citizen needs to know at least something about the environment, or civil rights, or the way the economy works. I will try my best to be fair, to explain the issues and give both sides of the argument. Still, you should know that this is more than mere description. In the pages that follow, I try to show that current intellectual property policy is overwhelmingly and tragically bad in ways that everyone, and not just lawyers or economists, should care about. We are making bad decisions that will have a negative effect on our culture, our kids’ schools, and our communications networks; on free speech, medicine, and scientific research. We are wasting some of the promise of the Internet, running the risk of ruining an amazing system of scientific innovation, carving out an intellectual property exemption to the First Amendment. I do not write this as an enemy of intellectual property, a dot-communist ready to end all property rights; in fact, I am a fan. It is precisely because I am a fan that I am so alarmed about the direction we are taking.

Although these digital tools can improve the diagnostic process and offer clinicians a variety of state-of-the-art treatment options, most are based on a reductionist approach to health and disease. This paradigm takes a divide-and-conquer approach to medicine, "rooted in the assumption that complex problems are solvable by dividing them into smaller, simpler, and thus more tractable units." Although this methodology has led to important insights and practical implications in healthcare, it does have its limitations. Reductionist thinking has led researchers and clinicians to search for one or two primary causes of each disease and design therapies that address those causes.... The limitation of this type of reasoning becomes obvious when one examines the impact of each of these diseases. There are many individuals who are exposed to HIV who do not develop the infection, many patients have blood glucose levels outside the normal range who never develop signs and symptoms of diabetes, and many patients with low thyroxine levels do not develop clinical hypothyroidism. These "anomalies" imply that there are cofactors involved in all these conditions, which when combined with the primary cause or causes bring about the clinical onset. Detecting these contributing factors requires the reductionist approach to be complemented by a systems biology approach, which assumes there are many interacting causes to each disease.

If you can’t make a good prediction, it is very often harmful to pretend that you can. I suspect that epidemiologists, and others in the medical community, understand this because of their adherence to the Hippocratic oath. Primum non nocere: First, do no harm. Much of the most thoughtful work on the use and abuse of statistical models and the proper role of prediction comes from people in the medical profession.88 That is not to say there is nothing on the line when an economist makes a prediction, or a seismologist does. But because of medicine’s intimate connection with life and death, doctors tend to be appropriately cautious. In their field, stupid models kill people. It has a sobering effect. There is something more to be said, however, about Chip Macal’s idea of “modeling for insights.” The philosophy of this book is that prediction is as much a means as an end. Prediction serves a very central role in hypothesis testing, for instance, and therefore in all of science.89 As the statistician George E. P. Box wrote, “All models are wrong, but some models are useful.”90 What he meant by that is that all models are simplifications of the universe, as they must necessarily be. As another mathematician said, “The best model of a cat is a cat.”91 Everything else is leaving out some sort of detail. How pertinent that detail might be will depend on exactly what problem we’re trying to solve and on how precise an answer we require.

It should be clear by now that whatever Americans say about diversity, it is not a strength. If it were a strength, Americans would practice it spontaneously. It would not require “diversity management” or anti-discrimination laws. Nor would it require constant reminders of how wonderful it is. It takes no exhortations for us to appreciate things that are truly desirable: indoor plumbing, vacations, modern medicine, friendship, or cheaper gasoline. [W]hen they are free to do so, most people avoid diversity. The scientific evidence suggests why: Human beings appear to have deeply-rooted tribal instincts. They seem to prefer to live in homogeneous communities rather than endure the tension and conflict that arise from differences. If the goal of building a diverse society conflicts with some aspect of our nature, it will be very difficult to achieve. As Horace wrote in the Epistles, “Though you drive Nature out with a pitchfork, she will ever find her way back.” Some intellectuals and bohemians profess to enjoy diversity, but they appear to be a minority. Why do we insist that diversity is a strength when it is not? In the 1950s and 1960s, when segregation was being dismantled, many people believed full integration would be achieved within a generation. At that time, there were few Hispanics or Asians but with a population of blacks and whites, the United States could be described as “diverse.” It seemed vastly more forward-looking to think of this as an advantage to be cultivated rather than a weakness to be endured. Our country also seemed to be embarking on a morally superior course. Human history is the history of warfare—between nations, tribes, and religions —and many Americans believed that reconciliation between blacks and whites would lead to a new era of inclusiveness for all peoples of the world. After the immigration reforms of 1965 opened the United States to large numbers of non- Europeans, our country became more diverse than anyone in the 1950s would have imagined. Diversity often led to conflict, but it would have been a repudiation of the civil rights movement to conclude that diversity was a weakness. Americans are proud of their country and do not like to think it may have made a serious mistake. As examples of ethnic and racial tension continued to accumulate, and as the civil rights vision of effortless integration faded, there were strong ideological and even patriotic reasons to downplay or deny what was happening, or at least to hope that exhortations to “celebrate diversity” would turn what was proving to be a problem into an advantage. To criticize diversity raises the intolerable possibility that the United States has been acting on mistaken assumptions for half a century. To talk glowingly about diversity therefore became a form of cheerleading for America. It even became common to say that diversity was our greatest strength—something that would have astonished any American from the colonial era through the 1950s. There is so much emotional capital invested in the civil-rights-era goals of racial equality and harmony that virtually any critique of its assumptions is intolerable. To point out the obvious— that diversity brings conflict—is to question sacred assumptions about the ultimate insignificance of race. Nations are at their most sensitive and irrational where they are weakest. It is precisely because it is so easy to point out the weaknesses of diversity that any attempt to do so must be countered, not by specifying diversity’s strengths—which no one can do—but with accusations of racism.

Vitamin D3 boasts a strong safety profile, along with broad and deep evidence that links it to brain, metabolic, cardiovascular, muscle, bone, lung, and immune health. New and emerging research suggests that vitamin D supplements may also slow down our epigenetic/biological aging.29, 30 2. Omega-3 fish oil: Over the last thirty years or so, the typical Western diet has added more and more pro-inflammatory omega-6 polyunsaturated fatty acids versus anti-inflammatory omega-3 PUFAs. Over the same period, we’ve seen an associated rise in chronic inflammatory diseases, including obesity, cardiovascular disease, rheumatoid arthritis, and Alzheimer’s disease. 31 Rich in omega-3s, fish oil is another incredibly versatile nutraceutical tool with multi-pronged benefits from head to toe. By restoring a healthier PUFA ratio, it especially helps your brain and heart. Regular consumption of fatty fish like salmon has been linked to a lower risk of congestive heart failure, coronary heart disease, sudden cardiac death, and stroke.32 In an observational study, omega-3 fish oil supplementation was also associated with a slower biological clock.33 3. Magnesium deficiency affects more than 45 percent of the U.S. population. Supplements can help us maintain brain and cardiovascular health, normal blood pressure, and healthy blood sugar metabolism. They may also reduce inflammation and help activate our vitamin D. 4. Vitamin K1/K2 supports blood clotting, heart/ blood vessel health, and bone health.34 5. Choline supplements with brain bioavailability, such as CDP-Choline, citicoline, or alpha-GPC, can boost your body’s storehouse of the neurotransmitter acetylcholine and possibly support liver and brain function, while protecting it from age-related insults.35 6. Creatine: This one may surprise you, since it’s often associated with serious athletes and fitness buffs. But according to Dr. Lopez, it’s “a bona fide arrow in my longevity nutraceutical quiver for most individuals, and especially older adults.” As a coauthor of a 2017 paper by the International Society for Sports Nutrition, Dr. Lopez, along with contributors, stated that creatine not only enhances recovery, muscle mass, and strength in connection with exercise, but also protects against age-related muscle loss and various forms of brain injury.36 There’s even some evidence that creatine may boost our immune function and fat and carbohydrate metabolism. Generally well tolerated, creatine has a strong safety profile at a daily dose of three to five grams.37 7.

* Dov Weisglass said the Gazans would remain on a diet but not to make them die of hunger. Israeli experts determined precisely how many calories a day Garzans needed for bare survival while also depriving them of medicines and other means of a decent life.

Medical students undertook three years of training on the ward, followed by a year of internship. Their professors in the faculty of medicine became full-time instructors appointed by competitive examination (the concours) and employed by the state. Just as important, the Paris hospitals were suffused with a new set of values that promoted ability and merit rather than privilege, birth, and cronyism as the French Revolution provided a new dynamism and sense of open competition. The mottos of the French medical profession were “progress,” “reform,” “observation,” and “precision.” These values also included secularism as the revolution ended the hold of the church over the hospital system.

The US National Institutes of Health states: "There is a lot of overlap between the terms 'precision medicine' and 'personalized medicine.' According to the National Research Council, 'personalized medicine' is an older term with a meaning similar to 'precision medicine.' However, there was concern that the word 'personalized' could be misinterpreted to imply that treatments and preventions are being developed uniquely for each individual; in precision medicine, the focus is on identifying which approaches will be effective for which patients based on genetic, environmental, and lifestyle factors.

Since the 19th century, medicine has focused on specific disease states by linking collections of signs and symptoms to single organs.... Systems biology and its offspring, sometimes called Network Medicine, takes a more wholistic approach, looking at all the diverse genetic, metabolic, and environmental factors that contribute to clinical disease. Equally important, it looks at the preclinical manifestations of pathology. The current focus of medicine is much like the focus that an auto mechanic takes to repair a car. The diagnostic process isolates a broken part and repairs or replaces it.... Although this strategy has saved countless lives and reduced pain and suffering, it nevertheless treats the disease and not the patient, with all their unique habits, lifestyle mistakes, environmental exposures, psychosocial interactions, and genetic predispositions.

Over the course of 2021/2022 we will see the current transformation initiatives and innovation around supply chains being applied to the science of #epidemiology to track the journey and morphing of infectious diseases. #COVID19 #PrecisionMedicine - Tom Golway

I spend most of my Mondays with blood. I am a hematologist by training. I study blood and treat blood diseases, including cancers and precancers of white blood cells. On Monday, I arrive much earlier than my patients, when the morning light is still aslant across the black slate of the lab benches. I close the shutters and peer through the microscope at blood smears. A droplet of blood has been spread across a glass slide, to make a film of single cells, each stained with special dyes. The slides are like previews of books, or movie trailers. The cells will begin to reveal the stories of the patients even before I see them in person. I sit by the microscope in the darkened room, a notepad by my side, and whisper to myself as I go through the slides. It’s an old habit; a passerby might well consider me unhinged. Each time I examine a slide, I mumble out the method that my hematology professor in medical school, a tall man with a perpetually leaking pen in his pocket, taught me: “Divide the main cellular components of blood. Red cell. White cell. Platelet. Examine each cell type separately. Write what you observe about each type. Move methodically. Number, color, morphology, shape, size.” It is, by far, the favorite time of my day at work. Number, color, morphology, shape, size. I move methodically. I love looking at cells, in the way that a gardener loves looking at plants—not just the whole but also the parts within the parts: the leaves, the fronds, the precise smell of loam around a fern, the way the woodpecker has bored into the high branches of a tree. Blood speaks to me—but only if I pay attention.

When the electron vibrates, the universe shakes." Physicists now accept interconnectedness as a rule principle, along with many forms of symmetry that extend across the universe — for example, it is theorized that every black hole may be matt. Which sort of description will satisfy Bell's criteria for a fully integrated, non-local reality? It would have to be a quantum theory, because if gravity is present everywhere at the same time, if black holes know what white holes are doing, and if a difference of spin in one particle induces an equal but opposite transition immediately in its counterpart somewhere in outer space, it is clear that the information going from one location to another travels faster than the speed of light. In ordinary reality, that is not allowed either by Newton or Einstein. Contemporary theorists like the British physicist, David Bohm, who worked extensively with the implications of Bell's theorem, had to assume that there is an "invisible field" that holds together all reality, a field that has the property of knowing what is happening everywhere at once. (The invisible term here means not only invisible to the eye but undetectable to any measurement instrument.) Without going deeper into these speculations, one can see that the unseen environment sounds very much like the inherent intellect of DNA, and both behave very much like the subconscious. The mind has the property of holding all of our ideas in place, so to speak, in a silent reservoir where they are organized precisely into concepts and categories. By naming it "thought," we may be watching nature think through many different channels, one of the most fortunate of which our minds are, because the mind will construct and feel the physical truth at the same time. It may seem completely rational to observe a quantum phenomenon in the context of light waves, but what if quantum truth was just as apparent in our own feelings, impulses and desires? Eddington once expressed flatly his assumption as a scientist that "the world's stuff is mind-stuff." Thus the quantum mechanical system, as knowledge creation, has a possible position in non-local reality.

Skeptical Empiricism and the a-Platonic School The Platonic Approach Interested in what lies outside the Platonic fold Focuses on the inside of the Platonic fold Respect for those who have the guts to say “I don’t know” “You keep criticizing these models. These models are all we have.” Fat Tony Dr. John Thinks of Black Swans as a dominant source of randomness Thinks of ordinary fluctuations as a dominant source of randomness, with jumps as an afterthought Bottom-up Top-down Would ordinarily not wear suits (except to funerals) Wears dark suits, white shirts; speaks in a boring tone Prefers to be broadly right Precisely wrong Minimal theory, considers theorizing as a disease to resist Everything needs to fit some grand, general socioeconomic model and “the rigor of economic theory;” frowns on the “descriptive” Does not believe that we can easily compute probabilities Built their entire apparatus on the assumptions that we can compute probabilities Model: Sextus Empiricus and the school of evidence-based, minimum-theory empirical medicine Model: Laplacian mechanics, the world and the economy like a clock Develops intuitions from practice, goes from observations to books Relies on scientific papers, goes from books to practice Not inspired by any science, uses messy mathematics and computational methods Inspired by physics, relies on abstract mathematics Ideas based on skepticism, on the unread books in the library Ideas based on beliefs, on what they think they know Assumes Extremistan as a starting point Assumes Mediocristan as a starting point Sophisticated craft Poor science Seeks to be approximately right across a broad set of eventualities Seeks to be perfectly right in a narrow model, under precise assumptions

The period of disarray I lived through in the run-up to those choices is typical of the chaos that so often confronts women during menopause. At this time of our life, one way or another, and whether we choose eventually to go with its flow or insist on resisting its tide, chaos is going to come knocking at our door. As someone with an unreasonable need for control over my own life, I’ve always feared chaos; but chaos, it seems, was precisely what I needed in order to break free. Insight into the strong medicine that chaos brings comes from the word’s origins: it is derived from the Greek khaos, referring to the void which was said to exist before the cosmos was created. Chaos, then, contains the seeds of new life, the seething potential out of which an entirely new universe might be born. As Nietzsche said, “One must have chaos in oneself to give birth to a dancing star.”14 Chaos is the beauty of uncertainty; it unbinds us so that it can create us anew. In his book Timaeus, Plato declared in this context that chaos also incorporates the concept of chora: it is “a receptacle of all becoming — its wetnurse, as it were.” For me, this time was nothing if not a time of becoming. An old story had been consumed, and the ingredients for a new story were just beginning to assemble in the mixing bowl.

At the same time, some researchers wonder whether acetaminophen is impacting something as critical and fundamental as our emotions. One Ohio State researcher who examined this found that study participants who received acetaminophen versus a placebo had a harder time feeling “positive empathy” for strangers, which matters because the ability to experience empathy is associated with more stable romantic relationships and more successful careers. “Just like we should be aware that you shouldn’t get in front of the wheel if you’re under the influence of alcohol, you don’t take [acetaminophen] and then put yourself into a situation that requires you to be emotionally responsive—like having a serious conversation with a partner or coworker,” Dominik Mischkowski, an assistant professor at Ohio University who studies the relationship between pain and social behavior, told the BBC.

And remember, emotions can rule the physical body. One study showed that one five-minute angry outburst can impair your immune system for up to five hours.4 And so: learning to master your mind is essential to an extraordinary quality of life and extraordinary amounts of energy. We’ll explore more in depth the power of mindset and strategies for controlling it in the final two chapters of this book.

Guess what, Steve—your clock isn’t just a clock. It actually controls time!” (If you’re curious to know your own level of methylation and your epigenetic biological age, Sinclair’s team will soon be marketing a test based on a quick and painless cheek swab. It promises a turnaround time of just a few days and has a real cost of only a dollar.)

Sinclair’s supplement of choice is nicotinamide mononucleotide (NMN).

SEEING Seeing is one of human beings' highest features. It's an extraordinary experience that helps you to grasp your own vastness. There are, of course, different levels of vision. Our constant aim will be to escape the lower astral clear-sightedness of the trance-medium psychics and to step into the ‘vision of Truth’ or self-vision, which is like an eruption of all mental limitations. A key difference between these two ways of vision is that the pictures that stream into the consciousness are attached in the latter. On the other hand, one of the ways to achieve the sight of Truth is to become less interested in what you see and focus more on the act of seeing, enabling your state of consciousness to grow by seeing. Then you arrive at a completely different experience and comprehension of the world. One can never completely turn what is ‘seen’ into words because the perception transcends the mind's common logic. Therefore, real sight feeds the Spirit and dissipates the soul's false perceptions. ‘Seeing’ should not be seen simply as a device of interpretation, but as an experience that has in itself a transformative meaning. Seeing is an extended form of perception. It's an ‘ontological amplification,’ which means a way of being more. When you think in these terms of clairvoyance, you're much less likely to be deluded by the lower astral vision hallucinations. One of the common mistakes of beginners is to expect their normal vision and physical eyes to see celestial realities as if unexpectedly auras and supernatural entities were to be attached to the pictures of the world obtained through the brain. This cannot function because the normal cognitive perception is precisely the blind part of yourself. The first thing to do to start seeing is to get out of your head.

SEEING Seeing is one of human beings' highest features. It's an extraordinary experience that helps you to grasp your own vastness. There are, of course, different levels of vision. Our constant aim will be to escape the lower astral clear-sightedness of the trance-medium psychics and to step into the ‘vision of Truth’ or self-vision, which is like an eruption of all mental limitations. A key difference between these two ways of vision is that the pictures that stream into the consciousness are attached in the latter. On the other hand, one of the ways to achieve the sight of Truth is to become less interested in what you see and focus more on the act of seeing, enabling your state of consciousness to grow by seeing. Then you arrive at a completely different experience and comprehension of the world. One can never completely turn what is ‘seen’ into words because the perception transcends the mind's common logic. Therefore, real sight feeds the Spirit and dissipates the soul's false perceptions. ‘Seeing’ should not be seen simply as a device of interpretation, but as an experience that has in itself a transformative meaning. Seeing is an extended form of perception. It's an ‘ontological amplification,’ which means a way of being more. When you think in these terms of clairvoyance, you're much less likely to be deluded by the lower astral vision hallucinations. One of the common mistakes of beginners is to expect their normal vision and physical eyes to see celestial realities as if unexpectedly auras and supernatural entities were to be attached to the pictures of the world obtained through the brain. This cannot function because the normal cognitive perception is precisely the blind part of yourself. The first thing to do to start seeing is to get out of your head. Therefore, one of the constant reminders provided in this chapter will be: stop looking if you want to ‘see.’ Stop processing and analyzing images, in other words, as you are used to doing with your brain. Don't bother to see. And you work from your heart as you try. Let yourself switch into another state of consciousness and let ‘something else’ happen.

We forget how much cellphones used to cost. I actually had the first commercial model back in the 1980s, a Motorola that set me back $3,995—the equivalent of more than $10,000 today.1 It was more than a foot long and weighed nearly two pounds! The battery charged for six hours, and it only gave you thirty minutes of talk time. Today you can get the latest Apple iPhone for free with most cell service contracts—and it has one hundred times more computational power than the computer that took the Apollo 11 astronauts to the moon.

One of the central principles underpinning this book is that you need to function as the CEO of your own health. We can’t let anyone else determine our destiny, no matter how knowledgeable or caring they may be. Experts should be our coaches, but not our commanders.

Doctors can be sincere and sincerely wrong.

If you can’t measure it, you can’t improve it.” —PETER DRUCKER

Consider that optimal testosterone levels for a male can range widely from 250 to around 1,000 ng/dl (nanograms per deciliter). Here’s the problem: No one will tell you to seek out hormone replacement if you’re slightly above the base level of 250, but some men feel tired, listless, and lose their drive unless their levels are between 700 and 900 or higher. Tests to measure hormone levels and their impact on your life are essential to maintain strength along with optimal levels of mental and physical performance.

If there’s a heart attack looming in your future three, five, ten years down the road, this new AI-guided approach to CCTA—coronary CT angiography—called Cleerly can detect the warning signs so that you can take action to prevent it.

GRAIL arrived on the scene in the spring of 2021, and Fountain Life is one of the first places to offer this incredible test, which is part of its baseline testing for all members. Before GRAIL, it was possible to screen for just a few types of cancer, like breast, colon, cervical, prostate, and lung cancers. Prior to the GRAIL, we’ve been able to detect only 20 percent of cancers, which means that four of five cancers went undetected until they had grown and started causing trouble! Now as GRAIL is hitting the market, it has the potential to completely overhaul the field of cancer diagnostics. While GRAIL can search for more than 50 different types of cancer with a simple blood test, like any test it isn’t perfect.

Together, GRAIL and MRI full-body imaging can detect a complete spectrum of cancer at very early stages. And you know what that means, right? Early detection equals early treatment, less invasive treatments, and better survival rates overall.

A basic assessment of male hormonal health should include: total testosterone, free testosterone, dihydrotestosterone (DHT), estradiol (E2), sex hormone binding globulin (SHBG), and dehydroepiandrosterone (DHEA).

Now again, all of this may sound a bit overwhelming, but in reality, you could do all these tests—the CCTA test for heart disease, the MRI and GRAIL test for cancer, and the blood tests for metals and hormones in a few hours.

AN NAD+ BOOSTER BEING TESTED BY THE US SPECIAL FORCES When it comes to boosting NAD+, there may be a new game in town in the next two or three years and it goes by the code name MIB-626. MIB-626 is a proprietary, synthetically manufactured molecule that is similar to, but not identical to NMN. It’s being developed and tested by a company called Metrobiotech that Peter and I have invested in. Historically, when measured, the most NMN has been able to boost NAD+ levels intracellularly has been 40 percent, but recent studies in humans show that fourteen days of dosing with MIB-626 can raise NAD+ levels by as much as 200 to 300 percent! “We’ve discovered a way to reverse vascular aging by boosting the presence of naturally occurring molecules in the body that augment the physiological response to exercise,” said senior study investigator David Sinclair.

(If you’re curious to know your own level of methylation and your epigenetic biological age, Sinclair’s team will soon be marketing a test based on a quick and painless cheek swab. It promises a turnaround time of just a few days and has a real cost of only a dollar.)

Another useful tool to determine how your body utilizes carbohydrates and fats is a genetic test like the one my wife and I used from DNAFit.

But after two years, the participants in the ketogenic group began to gain their weight back as they struggled to stay consistent. Those who ate according to their genotype not only lost significantly more weight but also reduced total cholesterol, increased the beneficial HDL cholesterol, and improved fasting blood glucose levels.

It appears that humans from different ancestral backgrounds utilize carbohydrates and fats differently.

Companies like Viome, WHOOP, and Oura are leading us into a data-driven future that makes these individualized interventions possible. Increasingly, you and I will be able to optimize the way we eat, fast, exercise, rest, and sleep because we’ll know with more clarity than ever before what impact to expect when we fine-tune our behavior.

YOUR LONGEVITY HEALTH, FITNESS & LONGEVITY WEEKLY CHECKLIST 1. Hydrate. Drink half your body weight in ounces of water per day. Add some fresh lemon and a pinch of Celtic sea salt to optimize your hydration and electrolyte balance. 2. Eat foods closest to their natural source. Avoid processed carbs, and low quality processed meats. 3. Decrease Disease Risk. Consume at least one serving of cruciferous vegetables per day including broccoli sprouts, cauliflower, broccoli, brussels sprouts, or kale. 4. Commit to a structured eating window. Consume meals in an 8 to 12 hours and fast for 12-16 hour window each day. 5. Stay consistent with sleep. Go to sleep and wake up at about the same times each day. 6. Get strong. Perform three resistance training sessions per week. 7. Strengthen your heart, lungs, and build endurance with 3 cardiovascular exercise sessions of 20 to 30 minutes each session. 8. Consider the power of using heat and cold to use positive stressors to lower your blood pressure, reduce inflammation, reduce your risk of Alzheimer’s, and cut your risk of cardiovascular disease by up to 50%.

Train your brain with daily breathwork and meditation 5–20 minutes per day.

One helpful piece of technology that Peter uses religiously is a cooling mattress pad called a ChiliPAD. He sets it for sixty-five degrees—the same temperature as his bedroom air-conditioning.

In fact, research at Harvard Medical School shows a 45-minute treatment of NuCalm may give you the benefits equivalent to 2–5 hours of deep, restorative sleep by balancing your autonomic nervous system and restoring you to optimal health.

OsteoStrong takes its cue from static contraction, offering state-of-the-art machines that safely strengthen your entire musculoskeletal system in a workout that lasts less than ten minutes just once a week!

Opioids have so many negative potential side effects, from constipation, to altered consciousness, mood changes, and obviously addiction, and the list goes on. Toradol has none of these.

She pointed out in a recent study in Experimental Gerontology,19 saunas have been shown to stimulate the immune system, lower blood pressure, reduce inflammation, and improve cardiovascular function. Sitting in a sauna can also boost your heart rate in much the same way as medium-intensity exercise—but with far less effort! Plus, there’s the emotional bonus of taking time to relax, rejuvenating in peace on your own or in the company of friends and family. The

The regenerative medicine revolution is upon us. Like iron and steel to the industrial revolution, like the microchip to the tech revolution, stem cells will be the driving force of this next revolution.” —CADE HILDRETH, founder of BioInformant, a stem cell industry research firm

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.” —MARGARET MEAD

In fact, one of the most renowned lasers in these types of practices is the Thor laser, and after designing lasers for corporations, Dr. Casalini built increasingly complex and effective models of the Thor for 904 Laser, his group practice in Orange County, California, which specializes in anti-aging treatments and pain management.

The Game-Changer in Diabetes Management: Continuous Glucose Monitors Continuous Glucose Monitors (CGMs) have revolutionized diabetes management, offering real-time insights into blood sugar levels like never before. In this article, we'll delve into the significance of CGMs, their benefits, and why they are a game-changer for individuals living with diabetes. Understanding Continuous Glucose Monitors Continuous Glucose Monitors are wearable devices that constantly monitor glucose levels in the interstitial fluid, providing users with real-time data on their blood sugar levels. Unlike traditional finger-prick tests, CGMs offer a continuous stream of information, allowing for proactive management of diabetes. Benefits of Continuous Glucose Monitors Real-Time Monitoring: CGMs offer instant feedback on blood sugar levels, enabling users to make informed decisions about their diet, medication, and lifestyle choices. Early Detection of Trends: CGMs track glucose trends over time, allowing users to identify patterns and adjust their management strategies accordingly. Improved Diabetes Management: With continuous monitoring, individuals can better manage their blood sugar levels, reducing the risk of hyperglycemia and hypoglycemia episodes. Enhanced Quality of Life: CGMs provide greater freedom and flexibility, reducing the need for frequent finger pricks and offering peace of mind to individuals and their caregivers. Why CGMs Are a Game-Changer Precision Medicine: Continuous Glucose Monitors enable personalized diabetes management by providing individualized insights into glucose fluctuations and responses to various factors. Empowerment Through Data: CGMs empower users with valuable data, enabling them to take control of their health and make informed decisions in collaboration with healthcare providers. Continuous Innovation: Advancements in CGM technology, such as improved accuracy and connectivity features, continue to enhance the user experience and expand the capabilities of these devices. Integration with Digital Health Ecosystem: CGMs seamlessly integrate with mobile apps and other digital health platforms, facilitating data sharing, remote monitoring, and telehealth consultations. Conclusion Continuous Glucose Monitors represent a significant advancement in diabetes management, offering real-time insights, personalized care, and improved quality of life for individuals living with diabetes. As technology continues to evolve, CGMs will play an increasingly vital role in empowering individuals to live healthier, more active lives while effectively managing their condition.

In comparison with the mode of life of whole millennia of mankind we present-day men live in a very immoral age: the power of custom is astonishingly enfeebled and the moral sense so rarefied and lofty it may be described as having more or less evaporated. That is why the fundamental insights into the origin of morality are so difficult for us latecomers, and even when we have acquired them we find it impossible to enunciate them, because they sound so uncouth or because they seem to slander morality! This is, for example, already the case with the chief proposition: morality is nothing other (therefore no more!) than obedience to customs, of whatever kind they may be; customs, however, are the traditional way of behaving and evaluating. In things in which no tradition commands there is no morality; and the less life is determined by tradition, the smaller the circle of morality. The free human being is immoral because in all things he is determined to depend upon himself and not upon a tradition: in all the original conditions of mankind, 'evil' signifies the same as 'individual', 'free', 'capricious', 'unusual', 'unforeseen', 'incalculable'. Judged by the standard of these conditions, if an action is performed not because tradition commands it but for other motives (because of its usefulness to the individual, for example), even indeed for precisely the motives which once founded the tradition, it is called immoral and is felt to be so by him who performed it: for it was not performed in obedience to tradition. What is tradition? A higher authority which one obeys, not because it commands what is useful to us, but because it commands. What distinguishes this feeling in the presence of tradition from the feeling of fear in general? It is fear in the presence of a higher intellect which here commands, of an incomprehensible, indefinite power, of something more than personal there is superstition in this fear. Originally all education and care of health, marriage, cure of sickness, agriculture, war, speech and silence, traffic with one another and with the gods belonged within the domain of morality: they demanded one observe prescriptions without thinking of oneself as an individual. Originally, therefore, everything was custom, and whoever wanted to elevate himself above it had to become lawgiver and medicine man and a kind of demi-god: that is to say, he had to make customs a dreadful, mortally dangerous thing! Who is the most moral man? First, he who obeys the law most frequently: who, like the Brahmin12, bears a consciousness of the law with him everywhere and into every minute division of time, so that he is continually inventive in creating opportunities for obeying the law. Then, he who obeys it even in the most difficult cases. The most moral man is he who sacrifices the most to custom: what, however, are the greatest sacrifices? The way in which this question is answered determines the development of several divers kinds of morality; but the most important distinction remains that which divides the morality of most frequent obedience from that of the most difficult obedience.

You’ll meet the brilliant Dr. Mary Lou Jepsen, whose company, Openwater, is using red laser light and holography to measure the brain blood flow of a patient, in the ambulance, during that first critical three- to four-hour window to determine if tPA therapy is required and to diagnose every stroke.

Precision medicine is revolutionizing the healthcare industry, and ExactMeds is at the forefront of this exciting field. In this article, we’ll delve into what precision medicine is, why it matters, and how ExactMeds is playing a crucial role in improving patient outcomes. Introduction to precision medicine and its impact on healthcare. Explanation of how ExactMeds tailors treatment plans for individual patients. Real-world examples of success stories with ExactMeds’ precision medicine solutions. The future of precision medicine and how ExactMeds plans to continue innovating in the field.

I am a sick man... I am a wicked man. An unattractive man. I think my liver hurts. However, I don't know a fig about my sickness, and am not sure what it is that hurts me. I am not being treated and never have been, though I respect medicine and doctors. What's more, I am also superstitious in the extreme; well, at least enough to respect medicine. (I'm sufficiently educated not to be superstitious, but I am.) No, sir, I refuse to be treated out of wickedness. Now, you will certainly not be so good as to understand this. Well, sir, but I understand it. I will not, of course, be able to explain to you precisely who is going to suffer in this case from my wickedness; I know perfectly well that I will in no way “muck things up” for the doctors by not taking their treatment; I know better than anyone that by all this I am harming only myself and no one else. But still, if I don't get treated, it is out of wickedness. My liver hurts; well, then let it hurt even worse!

Talking of air, Mr. Tenby, I think you are a chemist. Have you paid attention to the recent experiments on the composition and resolution of air? Not? I am surprised at it; they are well worth your most serious consideration. It is now pretty well ascertained that inhaling gases is the cure for all kinds of diseases. People are beginning to talk of the gas-cure, as they did of the water-cure. The great foreign chemist, Professor Scaramouch, has the credit of the discovery. The effects are astounding, quite astounding; and there are several remarkable coincidences. You know medicines are always unpleasant, and so these gases are always fetid. The Professor cures by stenches, and has brought his science to such perfection that he actually can classify them. There are six elementary stenches, and these spread into a variety of subdivisions? What do you say, Mr. Reding? Distinctive? Yes, there is something very distinctive in smells. But what is most gratifying of all, and is the great coincidence I spoke of, his ultimate resolution of fetid gases assigns to them the very same precise number as is given to existing complaints in the latest treatises on pathology. Each complaint has its gas. And, what is still more singular, an exhausted receiver is a specific for certain desperate disorders.

The womb of the world births us. My filth comes from the same earthwork that gives rise to all stories. My interior light connects me with all the other creatures that inhabit this world of rocks, air, grass, woods, and water. My genetic code links me inextricably with all of nature. I enter the medley in the river of life with the ability to respond as life unfolds before my childlike eyes. My homemade medicinal poultice might not be of any benefit to other people. Nonetheless, we should each write our stories because each of us aims to attain a greater degree of awareness of our own authenticity. We owe a moral obligation to our family, friends, and ourselves as well as to the community to make a determined effort to wring the most out of life. We must applaud all efforts to investigate the human condition. Even if my writing amounts to nothing more than a clumsy attempt to travel the same tracks other people burnished with much more insight, clarity, precision, and style, it is an act of self-definition to ascribe to any philosophy. Philosophy represents a living charter; it is a life of action.

Ultimately, though, I believe any attempt by Democrats to pursue a more sharply partisan and ideological strategy misapprehends the moment we’re in. I am convinced that whenever we exaggerate or demonize, oversimplify or overstate our case, we lose. Whenever we dumb down the political debate, we lose. For it’s precisely the pursuit of ideological purity, the rigid orthodoxy and the sheer predictability of our current political debate, that keeps us from finding new ways to meet the challenges we face as a country. It’s what keeps us locked in “either/or” thinking: the notion that we can have only big government or no government; the assumption that we must either tolerate forty-six million without health insurance or embrace “socialized medicine.

John’s adolescence was marked by loss. When he was thirteen his father died, swiftly followed by his two sisters. Shortly after he turned seventeen his eldest brother, James, whose progress through his chosen medics, career had taken him to London, became unable to work due to ill health and returned to the farm, lying for days on one of the beds that pulled out from the walls of the two-roomed cottage like drawers, coughing himself to death at least while John watched or was nearby; and I find it hard to imagine, now, when death is largely hedged about with treatment plans, when it does not often come senseless out of nowhere, but can be postposted, or if not, then at least explained, what grief must have been like when that boundary was a curtain you could put your hand through. It is easy to think that when death could be so quickly turned to, a matter of mistral and all families counted lost children in their numbers, that loss must have been a blunter thing- that having so much practice, they must have been better at it, or inoculated, that it cannot have been for them such devastation, this laying waste- as the birth of a tenth child might be of less account in a busy week than the loss of a pair of, so that the date of it was not looked for until later, when it was found to have been forgotten. It is easy to think that in an age without anaesthetics, when legs might be hacked off on kitchen tables, teeth pulled sigh pliers taking gobbets of jaw and gun away with the , that pain must have been somehow a less precise, less devastating thing, the alternative being unthinkable- that it was just the same but persisting, could only be endured, to universal to allow concession; and so John Hunter watched the bodies of those he loved carried out of the tiny farmhouse one by one, making their last journey to the church, and afterwards he went about the business of his day, he went to school or to the fields, and then at last, summoned by William, the sole surviving brother he barely remembered, he went to London and, did not return.

The paper subsequently written by Amos with Redelmeier* showed that, in treating individual patients, the doctors behaved differently than they did when they designed ideal treatments for groups of patients with the same symptoms. They were likely to order additional tests to avoid raising troubling issues, and less likely to ask if patients wished to donate their organs if they died. In treating individual patients, doctors often did things they would disapprove of if they were creating a public policy to treat groups of patients with the exact same illness. Doctors all agreed that, if required by law, they should report the names of patients diagnosed with a seizure disorder, diabetes, or some other condition that might lead to loss of consciousness while driving a car. In practice, they didn’t do this—which could hardly be in the interest even of the individual patient in question. “This result is not just another manifestation of the conflict between the interests of the patient and the general interests of society,” Tversky and Redelmeier wrote, in a letter to the editor of the New England Journal of Medicine. “The discrepancy between the aggregate and the individual perspectives also exists in the mind of the physician. The discrepancy seems to call for a resolution; it is odd to endorse a treatment in every case and reject it in general, or vice versa.” The point was not that the doctor was incorrectly or inadequately treating individual patients. The point was that he could not treat his patient one way, and groups of patients suffering from precisely the same problem in another way, and be doing his best in both cases. Both could not be right. And the point was obviously troubling—

Are [the arts and the sciences] really as distinct as we seem to assume? [...] Most universities will have distinct faculties of arts and sciences, for instance. But the division clearly has some artificiality. Suppose one assumed, for example, that the arts were about creativity while the sciences were about a rigorous application of technique and methods. This would be an oversimplification because all disciplines need both. The best science requires creative thinking. Someone has to see a problem, form a hypothesis about a solution, and then figure out how to test that hypothesis and implement its findings. That all requires creative thinking, which is often called innovation. The very best scientists display creative genius equal to any artist. [...] And let us also consider our artists. Creativity alone fails to deliver us anything of worth. A musician or painter must also learn a technique, sometimes as rigorous and precise as found in any science, in order that they can turn their thoughts into a work. They must attain mastery over their medium. Even a writer works within the rules of grammar to produce beauty. [...] The logical positivists, who were reconstructing David Hume’s general approach, looked at verifiability as the mark of science. But most of science cannot be verified. It mainly consists of theories that we retain as long as they work but which are often rejected. Science is theoretical rather than proven. Having seen this, Karl Popper proposed falsifiability as the criterion of science. While we cannot prove theories true, he argued, we can at least prove that some are false and this is what demonstrates the superiority of science. The rest is nonsense on his account. The same problems afflict Popper’s account, however. It is just as hard to prove a theory false as it is to prove one true. I am also in sympathy with the early Wittgenstein of the Tractatus Logico-Philosophicus who says that far from being nonsense, the non-sciences are often the most meaningful things in our lives. I am not sure the relationship to truth is really what divides the arts and sciences. [...] The sciences get us what we want. They have plenty of extrinsic value. Medicine enables us to cure illness, for instance, and physics enables us to develop technology. I do not think, in contrast, that we pursue the arts for what they get us. They are usually ends in themselves. But I said this was only a vague distinction. Our greatest scientists are not merely looking to fix practical problems. Newton, Einstein and Darwin seemed primarily to be seeking understanding of the world for its own sake, motivated primarily by a sense of wonder. I would take this again as indicative of the arts and sciences not being as far apart as they are usually depicted. And nor do I see them as being opposed. The best in any field will have a mixture of creativity and discipline and to that extent the arts and sciences are complimentary.

The program is grounded in 10 design principles, the aim of which is to create innovative solutions to intractable health problems....In other words, do not be content with the status quo. The remaining principles include several obvious but often overlooked themes in routine patient care: value each person, be human, be human-centered, codesign, facilitate connections, treat with dignity, and provide a stage from which the hardest, most important stories may be told.

In nature, ecosystems consist of fauna and flora, climatic characteristics, soil conditions, geologic features, and a host of other interacting influences. Similarly, the precision medicine ecosystem is made of many interacting components, including patients, clinicians, researchers, laboratory services, CDS software, genomic databases, smartphones, servers, claims data, mobile apps, biobanks to store clinical specimens, and EHRs. EHRs need to serve as gateways to this ecosystem. And for the EHR to become an effective conduit, it needs a way to organize these diverse sources in a way that lets clinicians and patients make more effective diagnostic and treatment decisions.

One consistent feature stood out: The samples all displayed a striking depletion of white blood cells within the lymph nodes and bone marrow, precisely the tissues that become packed with the feverishly dividing cells of lymphoma patients. Two Yale pharmacologists, Louis Goodman and Alfred Gilman, who had contracted to study the therapeutic effects of nitrogen mustard, made the connection. In a burst of imagination they entertained the possibility that the war gas possessed a dual nature, that it was a strange Jekyll-and-Hyde compound that could exist both on the battlefield and within a physician’s clinic.

An even stronger study on aging and the Transcendental Meditation program, performed with greater methodological precision, was conducted by researchers at Harvard and published in the Journal of Personality and Social Psychology in 1989. This study analyzed elderly people who were introduced to the Transcendental Meditation program. In a short time they showed numerous beneficial changes, and ultimately lived longer, on average, than patients in a control group that did not practice the Transcendental Meditation program. The positive results were noted to endure when a follow-up study was conducted more than ten years later.

The death of awe in our culture has left us with an oddly credulous cynicism. We are cynical, suspicious of established government, education, technology, and medicine. Yet our cynicism is the recycled remnant of dashed hopes and broken faith, precisely because, having lost sight of the God who is worthy, we have invested such trust in these institutions to save our civilization and us.

While Keith Taylor, then, might dismiss questions of "whether Vietnam 'belongs' to Southeast Asia or [North] East Asia" as "probably the least enlightening in Vietnamese studies," it could equally be argued that it is precisely Vietnam's historical, geographical, and cultural location at the frontier of different, identifiable, and historically sedimented cultural formations that makes its situation so distinctive and interesting.

SCIENTISTS HAD KNOWN since the late nineteenth century that tobacco smoke contains carbon monoxide. Victorian scientists had even been able to calculate the amount of gas in the smoke: up to 4 percent in cigarette smoke, and in Gettler’s own choice of tobacco, the cigar, between 6 and 8 percent. Gettler’s latest work theorized that chain smokers might suffer from low-level carbon monoxide poisoning. He speculated in a 1933 report that “headaches experienced by heavy smokers are due in part to the inhalation of carbon monoxide.” But his real interest lay less in their symptoms than in how much of the poison had accumulated in their blood, and how that might affect his calculations on cause of death. He approached that problem in his usual, single-minded way. To get a better sense of carbon monoxide contamination from smoking tobacco, Gettler selected three groups of people to compare: persons confined to a state institution in the relatively clean air of the country; street cleaners who worked in a daily, dusty cloud of car exhaust; and heavy smokers. As expected, carboxyhemoglobin blood levels for country dwellers averaged less than 1 percent saturation. The levels for Manhattan street cleaners were triple that amount, a solid 3 percent. But smokers came in the highest, higher than he’d expected, well above the nineteenth-century calculations. Americans were inhaling a lot more tobacco smoke than they had once done, and their saturation levels ranged from 8 to 19 percent. (The latter was from a Bronx cab driver who admitted to smoking six cigarettes on his way to Gettler’s laboratory, lighting one with the stub of another as he went.) It was safe to assume, Gettler wrote with his usual careful precision, that “tobacco smoking appreciably increases the carbon monoxide in the blood and cannot be ignored in the interpretation of laboratory results.”     THE OTHER NOTABLE poison in tobacco smoke was nicotine.

there is no guarantee that the time freed up by our newfound technological efficiencies will be made available for the human touch. A look at the modern history of industrial computerization would have one lay odds that this squishy stuff will be precisely what is sacrificed on the altar of productivity, particularly once every word, touch, and minute is measured, analyzed, and priced out.

In WMS, the temperaments are considered obsolete and therefore are rarely invoked as the causal agents of a disease. The humors have been replaced by precise molecules such as cholesterol, hemoglobin, and dozens of other measures that appear today on any routine blood work. So, the general health or sickness profile of the Unani concept, based on either dystemperament or humoral imbalance, or both, has been replaced by a series of single, isolated indicators as the basis for diagnosis and treatment. It is exactly here that the modern physicians fail to connect the details supplied to them by the remarkable achievements of modern science. And here the medicine of Avicenna offers a rationalization that is currently missing in modern medicine.

Interestingly, even though MinuteClinic employs no doctors in its clinics, it has never been sued for malpractice. The reason is that malpractice lawsuits arise primarily in cases of mis-diagnosis and flawed therapeutic judgment.16 Because MinuteClinic practices in the realm of precision medicine, its diagnoses are precise and its therapies predictably effective.

Most frustrating and important, Wilson said, assisted living isn’t really built for the sake of older people so much as for the sake of their children. The children usually make the decision about where the elderly live, and you can see it in the way that places sell themselves. They try to create what the marketers call “the visuals”—the beautiful, hotel-like entryway, for instance, that caught Shelley’s eye. They tout their computer lab, their exercise center, and their trips to concerts and museums—features that speak much more to what a middle-aged person desires for a parent than to what the parent does. Above all, they sell themselves as safe places. They almost never sell themselves as places that put a person’s choices about how he or she wants to live first and foremost. Because it’s often precisely the parents’ cantankerousness and obstinacy about the choices they make that drive children to bring them on the tour to begin with. Assisted living has become no different in this respect than nursing homes.

Now again, all of this may sound a bit overwhelming, but in reality, you could do all these tests—the CCTA test for heart disease, the MRI and GRAIL test for cancer, and the blood tests for metals and hormones in a few hours. The metals test and the hormone

genome.