No, really...eat your ice cream!

As I mentioned in a recent post, I recently finished reading Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life by Ezekiel Emanuel.  Dr. Emanuel is a well-known medical oncologist, bioethicist, health policy researcher, and author of several books, though he is perhaps best known for being the chief architect of the 2010 Affordable Care Act. I heard him talk about his latest book about how to live a full and healthy life during a radio interview during my morning commute, and I was intrigued enough to order the book from my local public library.

I enjoyed reading Dr. Emanuel's book.  His central argument is that at some point around the age of 75 years, most people experience meaningful declines in creativity, productivity, and overall vitality.  Extending life far beyond that point can diminish the quality of life and seems counter to the purpose of living.  His approach to wellness emphasizes quality over quantity (living a healthy and meaningful life as opposed to simply focusing on extending the number of years lived).  Living a healthy and meaningful life is like ice cream.  It's meant to be enjoyed before it all melts away!

Dr. Emanuel argues against what he calls the "Wellness Industrial Complex", which  prescribes complicated regimens that often conflict, while at the same time promising us a longer and more productive life.  He argues that we spend too much time following "wellness" recommendations that may only add a few extra days or months to our life, and that we could better spend that time enjoying our life in the here and now.  Dr. Emanuel writes that "with so much health and wellness advice out there, it can be nearly impossible to differentiate the valid, reliable, and effective from the speculative, deceptive, and just plain stupid.  Even when the advice is scientifically sound, it's often extraneous, misrepresented, or misused."  

His approach is much simpler and can be summarized with six simple rules:

1. "Don't be a schmuck"

Dr. Emanuel defines "being a schmuck" as anyone who takes unnecessary risks.  He says, "One of the best and easiest things you can do for your wellness is not take stupid risks."  "Stupid things" include smoking, drinking alcohol, doing drugs, or not taking your vaccines.  He also adds to this list engaging in activities such as extreme mountaineering (e.g., climbing Mount Everest).  The risk of dying while climbing Mount Everest is on the order of 1 in 100.  The risk of death increases to 1 in 25 for climbers over the age of 59 years - "almost nothing can be schmuckier than that."

2. "Talk to people"

Dr. Emanuel writes, "It's important to cultivate family, friends, and other social relationships for a long, healthy, and happy life."  I've posted a lot about the so-called "Loneliness Epidemic" several times in the last year (see, in particular, my posts, "The Loneliness Epidemic", "To be of importance to others is to be alive...", and "We all need the human touch...").  There are now a countless number of studies that provide convincing evidence that fostering and maintaining close personal relationships through marriage, family, and friendships is one of the most important drivers of happiness and vitality.  The Harvard Study of Adult Development provides important evidence on this point.  Robert Waldinger, who has led the study for over two decades, states, "The surprising finding is that our relationships and how happy we are in our relationships has a powerful influence on our health.  Taking care of your body is important, but tending to your relationships is a form of self-care too. That, I think, is the revelation."

Relationships matter even more than one's heredity (see the article "Good genes are nice, but joy is better" in the Harvard Gazette or Waldinger's TED talk "What makes a good life" for more).  The psychiatrist George Vaillant led the Harvard Study from 1972 until 2004.  He said, "When the study began, nobody cared about empathy or attachment.  But the key to healthy aging is relationships, relationships, relationships."

Dr. Emanuel says that there are two great things about social relationships.  "First, unlike exercise, there's no strenuous exertion today for payback decades into the future.  Good social relations are good for you now.  [Second], initiating conversations is also generous.  It's good for you, and it's good for the people you talk to, so you can be virtuous just by starting a conversation."

3. "Expand your mind"

Dr. Emanuel recommends that we should stay mentally sharp through continuous learning, curiosity, and mental engagement.  He writes, "Be a mensch" and offers the American patriot Benjamin Franklin as an example.  "When I say, 'Be a mensch,' what I want to communicate is that the purpose of your life should not just be to live longer. It should be greater than that; it should be trying to make the world a better place. Benjamin Franklin said it best when he said, 'The noblest question in the world is, What good may I do in it?' That’s part of what being a mensch is."  At the age of 70 years, Benjamin Franklin crossed the Atlantic for the seventh time to serve as America's first ambassador to France.  During his Atlantic crossing, he mapped the Gulf Stream in order to improve the speed by which ships could travel across the oceans.  Once he arrived in France, he invented bifocals and developed the prototype for a new type of ship's anchor.  

There's an important caveat here though.  We shouldn't spend our time working through the daily crossword or Wordle.  Having a variety of intellectual pursuits is far more important.  We should try new hobbies, learn to play an instrument, or join a book club.  Dr. Emanuel suggests learning how to cook a new recipe - "This is a wellness trifecta.  It requires complex mental tasks as you plan the recipe, physical tasks as you go about the kitchen to organize the food, and then, if you invite friends over and have a meal together, it promotes social relationships."

4. "Move it"

We've all heard recommendation #4 before - regular exercise is critical to our overall physical and mental health.  Dr. Emanuel suggests that we focus on three types of exercise - aerobic exercise (like running or walking) for our heart and lungs, strength training for our muscles and flexibility, and balance training to maintain a healthy core.  Importantly, he suggests that "more is not always better" - there's no added benefit to vigorously exercising for more than 150 minutes a week.  He says, "The time you spend overexercising is time you could devote to more meaningful activities, like volunteering in your community or talking with your best friend as you walk through a forest."

5. "Eat your ice cream"

Recommendation #5 was the longest chapter in the book, and the one that I thought was the most interesting.  Dr. Emanuel says, "We have to do wellness behaviors for years and decades if they are going to do any good.  Constant deprivation requiring great expenditures of willpower are not the way to wellness.  Indeed, people who constantly diet with willpower fail at it and never lose weight."  Or worse (and the studies suggest that dramatic swings between weight gain and weight loss are really bad for your health), they gain all the lost weight back.  He suggest beginning by stopping the bad stuff - stop drinking sodas and other sugary drinks.  Similarly, cut down (or eliminate) salty snacks, packaged cakes, and cookies.  An occasional indulgence is acceptable, but we should try to limit our consumption of these items as much as possible.  

We should avoid processed foods.  Dr. Emanuel favors consumption of fermented foods such as yogurt (plain yogurt, not the kind with all the added sugar), kimchi, cottage cheese, miso, and sourdough bread.  These are all healthy foods which can maintain a healthy microbiome (all the beneficial bacteria that normally live in your gastrointestinal tract).

Dr. Emanuel also suggests limiting our alcohol consumption to one to two drinks per week and always with someone else.  He suggests that most Americans don't get nearly enough fiber, and he generally recommends against most, if not all, of the dietary supplements that have become far too popular in the last several years.  Finally, he reviews a few studies that suggest that eating ice cream can actually be healthy, but as in all things, with moderation (this was my favorite recommendation!).

6. "Sleep like a baby"

Sleep is not optional!  Most of us need around seven to eight hours of uninterrupted sleep per day.  Dr. Emanuel recommends against sleeping aids such as melatonin.  "There are other things you can do to sleep better: Sleep in a cool, dark room.  Don't look at your phone for the hour before.  The dinner glass of wine can disrupt your sleep.  Don't take a nap or consume caffeine after 2 pm."

Dr. Emanuel says, "Wellness is important, but it's not the end goal of life.  It is a way for you to live the kind of life that you want to live.  Wellness shouldn't be difficult. It's not about self-denial, being perfect, or trying some crazy biohack.  Don't waste valuable time chasing the latest fad just to add time later when, by the nature of aging, you won't be in optimal health anyway.  Remind yourself what makes life meaningful and joyful, and try to make the world a better place. That will help you live well..."

"Don't be a schmuck.  Be a mensch.  And really, eat your ice cream!"

Fortune favors the bold...

An interesting news article came by Chief Healthcare Executive came across my desk a few months ago announcing that "thousands of employees at hospitals and health systems have lost jobs in recent months."  Hospital leaders are citing mounting financial pressures, the impact of grant terminations from the National Institutes of Health, uncertainty in federal funding for graduate medical education, looming cuts in Medicaid programs, and increased supply chain expenses as reasons to cut labor costs, which is the largest expense for hospitals and health systems.  By cutting labor costs, hospitals can decrease pressure on their operating margins, at least in the short-term.  Whether this is the right move for the long-term future sustainability of these organizations remains to be seen.

Last year, I wrote a post about corporate lay-offs entitled "Nobody every cut their way to greatness...", in which I stated "There are actually a number of studies that show that lay-offs are frequently deleterious for the organization, with a so-called "dirty dozen" of detrimental effects.  I then cited one particularly well-known study from the aviation industry ("Airline downsizing and its impact on team performance") that provided concrete evidence of these twelve adverse effects to corporate lay-offs.  Given the current state of the world in which we live, I wanted to re-visit this topic and provide additional supportive evidence suggesting that in our VUCA world, organizations are better off if they "double down" and focus on growth and efficiency at the same time.

Ranjay Gulati, Nitin Nohria, and Franz Wohlgezogen studied 4,700 public companies during three past global recessions (1980-1982, 1990-1991, and 2000-2002), specifically analyzing their strategy and performance during the three years prior to the recession, the recession years themselves, and the three years after the recession (see "Roaring Out of Recession" from the March 2010 issue of Harvard Business Review).  Seventeen percent of the companies did not survive the recession - they either went bankrupt, were acquired, or became private.  Most of the surviving companies were able to partially recover, but the recovery was particularly slow.  Nearly 80% of the surviving companies had failed to regain their pre-recession growth rates for sales and profits three years after the recession.  Surprisingly, nine percent of the companies not only survived through the recession, they flourished afterwards, outperforming their rivals by at least 10% in terms of growth rates in sales and profits.  But again, it wasn't the companies that cut costs faster and deeper than their competitors that flourished - actually, these companies were the ones that had the lowest chance of surviving through the recession.

Gulati, Nohria, and Wohlgezogen described four different strategies that the firms they studied could employ during a recession:

1. Prevention-focused companies: Focus on avoiding financial losses and minimizing downside risks (i.e. primarily a defensive strategy)

Gulati, Nohria, and Wohlgezogen write, "Confronted by a recession, many CEOs swing into crisis mode, believing that their sole responsibility is to prevent the company from getting badly hurt or going under."  These CEOs work to reduce operating costs by eliminating discretionary spending, lowering head count, postponing new investments (including research and development, capital investments, and new lines of business), and preserving cash.  Unfortunately, these companies typically make across-the-board cuts ("Every department needs to reduce head count by 10%").  Rather than learning how to operate more efficiently, these organizations end up trying to do more with less.  Unfortunately, these cost-cutting measures often create pessimism and lower morale within the organization (see "Airline downsizing and its impact on team performance" mentioned above).  Employees lose trust in the organization and the leadership, which will take a long time to rebuild (if at all).  Few prevention-focused companies do well in the long run, and most do not even survive.  

2. Promotion-focused companies: Focus on making investments that maximize upside benefits (i.e. primarily an offensive strategy)

Some leaders pursue growth opportunities every chance that they get, even during a recession.  They use the recession as the proverbial "burning platform" in order to push through changes in the organization.  They continue to make strategic investments, and they often leverage the fact that many companies are cutting back on investments and talent acquisition to grow their own organizations.  Gulati, Nohria, and Wohlgezogen find that "Organizations that focus purely on promotion develop a culture of optimism that leads them to deny the gravity of a crisis for a long time."  In the end, these organizations are blindsided by poor financial results, as the changes required to become more efficient are implemented too late, or even not at all.  Only 26% of the promotion-focused organizations significantly outperform their rivals after a recession.

3. Pragmatic companies: Focus on making targeted investments (i.e. offensive play) AND minimizing downside risks to avoid financial losses (i.e. a defensive play)

The CEOs at pragmatic companies recognize that cost-cutting measures are necessary to survive through a recession, but they also know that strategic growth is equally important.  Balance is their goal - they try to decrease costs and increase revenue at the same time.  Gulati, Nohria, and Wohlgezogen found, "Companies typically combine three defensive approaches - reducing the number of employees, improving operational efficiency, or both - with three offensive ones: developing new markets, investing in new assets, or both."  Nine different combinations of approaches are therefore possible.  However, the most successful approach combines (1) improving operational efficiency with (2) developing new markets AND investing in new assets.

In other words, as Gulati, Nohria, and Wohlgezogen emphasize, "Companies that attend to improving operational efficiency fare better than those that focus on reducing the number of employees."  While layoffs reduce costs quickly, they undoubtedly make recovery more difficult later.  As I stated above, it's hard to earn back trust after layoffs, and the cost - both in terms of the trust factor and the actual monetary costs - are higher in the long run, as organizations often find themselves having to rehire new workers to replace the ones that they laid off during the recession.  

4. Progressive companies: Similar to the pragmatic companies, but focused on maximizing both financial upside benefits (through more than just targeted investments) as well as cutting financial losses

After a recession, companies that make investments in both existing and new businesses, while at the same time, focusing aggressively on operational efficiency, are usually the most successful organizations in the long run.  Gulati, Nohria, and Wohlgezogen write, "Companies that respond to a slowdown by re-examining every aspect of their business model - from how they have configured supply chains to how they are organized and structured - reduce their operating costs on a permanent basis.  When demand returns, costs will stay low, allowing their profits to grow faster than those of their competitors."

As Ranjay Gulati noted in a more recent follow-up article (see "Investing in Growth Through Uncertainty"), the combination of an offensive and defensive approach has been found over and over again to be the most successful strategy during an economic downturn.  Walter Frick adds ("How to Survive a Recession & Thrive Afterward"), "Some layoffs are inevitable in a downturn...However, the companies that emerge from crisis in the strongest shape relied less on layoffs to cut costs and leaned more on operational improvements."  Making targeted investments in growth, even during a time of uncertainty, is equally important.

Hell's Kitchen

There is a long-running and popular reality cooking show starring chef Gordon Ramsay that first aired on Fox on May 30, 2005 called "Hell's Kitchen".  Chef Ramsay is notoriously abrasive and demands perfection on the show, often yelling profanity at the contestants.  There's no doubt that his famous temper is used for entertainment value, and there are some reports that he is much nicer in private.  However, there's likely at least some truth on how he acts, and many in the culinary industry claim that his behavior is more often the norm than the exception, labeling it part and parcel of the "kitchen culture".

As I recently learned, the "kitchen culture" is actually part of the overall design of something known as the "kitchen brigade" (or "brigade de cuisine"), a system of organizing the kitchen staff and operations in order to maximize efficiency.  The system was first designed by the French chef and restaurateur Auguste Escoffier in the early 20th century.  It's a hierarchical and highly structured system that assigns specific roles to specialized staff in order to reduce chaos, ensure consistent quality, and allow for smooth operations, particularly when the restaurant is very busy.  There is a clearly defined chain of command, in which the executive chef ("Chef de cuisine") is responsible for the overall management of the kitchen.  The executive chef is responsible for creating the menu and new recipes (often with the assistance and/or approval of the restaurant manager), purchasing raw food items, training apprentices, supervising the rest of the kitchen staff, and maintaining a clean, sanitary, hygienic environment.  The "Sous Chef" is the second in command and receives orders directly from the executive chef, while all the remaining roles follow.

The executive chef serves as the "captain of the ship", and his or her orders are not to be questioned.  On most ships, the captain is ultimately responsible for everything that occurs on the ship, good or bad.  There was once a tradition of the captain "going down with the ship" in battle.  It's become a metaphor for any rigid, hierarchical system in which commands are issued from the top and meant to be followed without question.  When I was a medical student, the "captain of the ship" mentality was prevalent on most clinical teams, but particularly in the operating room, where the attending surgeon was deemed the "captain of the ship" (the "ship" being the operating room).  There was even a legal doctrine in the United States called "captain of the ship" doctrine, in which the attending surgeon was responsible - and legally liable - for every action of every other member on the operating team.  Thankfully, those days are long past.  Neither the legal doctrine nor the mentality of the attending physician as the "captain of the ship" is common today.  Those of us in health care have learned that a highly functioning team in which each and every member contributes and feels free to speak up ("psychological safety") is more engaging, more collaborative, and most importantly, leads to better outcomes.

So, it naturally begs the question that if surgical teams have figured out that a less hierarchical, rigid chain of command is better for patient outcomes, why can't those in the restaurant industry adopt the same mentality?  I've heard at least one chef say, "We all learned this way.  If it worked for us, why can it work for the next generation?"  Notably, I used to here that exact same rationale in medicine. 

Unfortunately, it's not just a "captain of the ship" mentality that is the problem.  The "kitchen culture" is downright toxic.  The New York Times recently featured a number of articles detailing the allegations of physical and mental abuse by Executive Chef Rene Redzepi at the world famous restaurant Noma in Copenhagen, Denmark.  The first article appeared on March 7th (see "Punching, Slamming, Screaming: A Chef's Past Abuse Haunts Noma, the World's Top-Rated Restaurant").  Just a few days later, the New York Times reported that Rene Redzepi had resigned after 23 years at the restaurant.

The toxic "kitchen culture" is not unique to Noma or to the fictional kitchen depicted in the television show, "The Bear".  Robin Burrow, a former lecturer in management and organizational behavior at Cardiff University in the United Kingdom has studied the toxic "kitchen culture" (see "Yes, Chef: Life at the vanguard of culinary excellence" and "Bloody suffering and durability: How chefs forge embodied identities in elite kitchens") and found that bullying and physical abuse are not only common, they are normalized as part of what someone has to go through in order to become an executive chef.  Burrow says, "Chefs who neglected to suffer had little claims to membership of the culinary community in the truest sense.  They were not true and proper chefs."

I wonder if haute cuisine could learn a few things from health care?  Better yet, it seems like the culinary community could learn some important lessons from high reliability organizations, such as the nuclear power industry, commercial aviation, or U.S. Navy aircraft carrier flight operations.  The stakes in a restaurant are certainly not "life and death" as in these other industries, but the stakes are just as important.  Operating a restaurant requires efficient and timely operations.  It's time that they abandon the toxic "kitchen culture" and focus on high reliability organization theory!

The fox, the hound, and the body...

Bear with me for just a moment.  I want to talk about two great films today.  The first film is the 1981 Disney full-length animated feature, "The Fox and the Hound".  The story is loosely based upon a novel by Daniel Mannix of the same name and tells the story of the unlikely friendship between a red fox named Tod and a hound named Copper.  As they both grow older, they struggle with the fact that they are meant to be enemies.  At one point in the story, they do in fact become enemies.  In the film's final minutes, Copper gets into a fight with a bear and is almost killed by it. Tod comes to his rescue and joins the fight, only to fall down a waterfall with the bear.  As Copper approaches Tod as he lies wounded in the lake below, his owner Amos, a hunter, appears, ready to shoot Tod. Copper positions himself in front of Tod to prevent Amos from doing so, refusing to move away.  Amos realizes that Tod had saved both his life and the life of his dog and decides to spare Tod.  As he walks away with Copper, Tod and his former best friend share one last smile before parting for good.  In the final scene, Copper lies down to take a nap, smiling as he remembers fondly the day he first met Tod.

As one blogger on Medium writes, "Friendships can be the cornerstone of our lives, providing support, joy, and companionship. However, not all friendships stand the test of time...Time marches on and always has a way of changing things, especially people. Sometimes the changes create chasms that can no longer be crossed and the challenges you were once able to tackle head-on with your friend become insurmountable."

The second film is the 1986 film "Stand by Me", a coming-of-age drama directed by the late Rob Reiner.  The film was based on a novella , The Body, written by Stephen King, and it's title comes from the song, "Stand by Me" by artist, Ben E. King.  The film (and novella) takes place in King's fictional town of Castle Rock on Labor Day 1959, although the film begins when author Gordon "Gordie" Lachance reads a newspaper article about the death of his childhood best friend, Chris Chambers in 1985.  The rest of the film is a flashback memory to when Gordie was 12 years old, and he (played by the actor Wil Wheaton) and his three friends (played by River Phoenix, Corey Feldman, and Jerry O'Connell) set out on an adventure to find the dead body of another missing boy.  "Stand by Me" is an enjoyable story, a great song, and an even better film!  It's one of my absolute favorites.

I have always remembered the film's ending, when Gordie (once again in 1985 and now played by the actor Richard Dreyfuss) talks about his childhood friendships with reverie.  When talking specifically about his best friend, Chris, who has recently died, he says, "Although I haven't seen him in more than ten years, I know I'll miss him forever. I never had any friends later on like the ones I had when I was twelve. Jesus, does anybody?"

Unfortunately, I too lost track of many, if not most, of my childhood friends.  I think that happens to most of us.  People do, in fact, change - for a variety of reasons.  Sometimes, as two friends (or even a group of friends) grow older, they grow apart.  Oftentimes, neither side is to blame.  It just happens.  According to a Dutch study published in the journal Social Networks, over a period of seven years the average size of personal networks is remarkably stable (see my posts, "Dunbar's number" and "It's a small world after all...").  However, during that same period of time, we replace the large majority of our close personal contacts and friendships with new ones.  We maintain only about 30% of our original casual contacts over those seven years and just under half of our close friendships.

I've posted a lot about the so-called "Loneliness Epidemic" in the last year (see, in particular, my posts, "The Loneliness Epidemic", "To be of importance to others is to be alive...", and "We all need the human touch...").  There's another scene about halfway through "The Fox and the Hound".  Tod's adoptive human mother, the Widow Tweed has realized that a fox is better off living in nature and not in captivity.  She drives Tod out to the forest and lets him go.  As she is driving back home, she recites the poem:

Remember how we used to play?

I recall those rainy days

The fire’s glow that kept us warm

And now I find, we’re both alone

Goodbye may seem forever

Farewell is like the end

But in my heart is a memory

And there you’ll always be

The key point here is that we should cherish the memories of friends long lost.  They will always be a part of our lives, and we should keep them in our hearts forever.  Just as important (and perhaps even more so), we shouldn't find ourselves alone because of those lost friendships.  Personal connections and friendships are important to our overall health.  As both the Widow Tweed and Gordie find out, while it's hard to move on, lost friendships can be replaced with new ones.  As Genesis 2:18 reads, "It is not good for man to be alone."  I will re-visit this topic in an upcoming post soon...

Happy Doctor's Day 2026

I wanted to take a moment to wish all of my fellow physicians a Happy National Doctor's Day!  Given that a number of our physicians are on Spring Break vacation this week, we will be celebrating Doctor's Day at our hospital next week.  However, it's still important to officially recognize our physicians on what has become their official day of recognition and gratitude!

National Doctor’s Day is celebrated every year on March 30th.  The first Doctor’s Day was observed more than 90 years ago, on March 30, 1933 by the Alliance to the Barrow County Medical Society in Winder, Georgia (a small town located just east of Atlanta).  Members of the Alliance selected the date to honor all physicians on the anniversary of Dr. Crawford W. Long’s first administration of anesthesia in 1842.  Of note, Dr. Long used ether during surgery to remove a tumor from the neck of James Venable.  The first Doctor’s Day was observed by sending cards to all the physicians and their spouses, and a red carnation flower was placed on the graves of deceased doctors.  

Through a series of resolutions in the years that followed, Doctor’s Day was widely celebrated throughout the southern United States, with sponsorship by the Southern Medical Association.  Eventually, a resolution was adopted and approved by both the U.S. House of Representatives and the U.S. Senate on October 30, 1990 and signed by President George H.W. Bush, designating March 30 as “National Doctor’s Day."  The red carnation remains as the symbol of Doctor’s Day.

I have never been more proud to be a member of this great profession.  We've all had a difficult past few years with everything that has been going on in our world.  Regardless, physicians have been at the forefront leading societal change during one of the most difficult periods in our history.  Importantly, our influence is due in large measure to the trust and respect that society has for our profession.  Physicians are still one of the most trusted of all professions.  As a matter of fact, physicians traditionally rank just below the nursing profession in trust surveys.

I can honestly say that if I had the chance to do it all over again, I would still choose medicine as my life's work.  Medicine has been my passion and my calling.  Being a physician has made me a better person, and I am incredibly proud to be a member of this esteemed profession.

To all Doctor's - thank you for what you do, each and every day!

"Shall we play a game?"

Several years ago, I posted (see "The only winning move is not to play") about the 1983 movie "War Games" starring Matthew Broderick, Ally Sheedy, and John Wood.  Broderick plays a teenage computer hacker named David Lightman who unwittingly accesses a United States military supercomputer called WOPR (War Operation Plan Response) programmed to simulate, predict, and execute global nuclear war against the Soviet Union.  At first, Lightman thinks he has found an as yet unreleased strategy game called "Global Thermonuclear War" and starts to play as the Soviet Union.  He and his friend, Jennifer Mack (played by Ally Sheedy) orders a number of nuclear missile strikes against U.S. cities, which triggers an actual warning at the North American Aerospace Defense Command (NORAD).  

Luckily, the military staff and computer programmers running WOPR figure out that the incoming missiles are not real and defuse the situation.  However, WOPR continues to "play the game" as it does not understand the difference between reality and simulation.  It continuously feeds false data, such as Soviet bomber attacks and submarine deployments to NORAD, prompting the military leaders there to further escalate the Defense Readiness Condition (DEFCON) level toward full-scale nuclear war.

David and Jennifer team up with WOPR's creator, Dr. Stephen Falken (played by John Wood), to stop the simulation.  Dr. Falken helps them realize the computer must learn that nuclear war is unwinnable.  They force WOPR to repeatedly simulate all the possible nuclear war outcomes based, each of which ends in total destruction.  The computer eventually reverts to tic-tac-toe, continuing to "learn" that no strategy for either global thermonuclear war or tic-tac-toe can win.  WOPR stops the launch sequence and declares, "A strange game. The only winning move is not to play."

As difficult as it is to believe now, no one back then could envision a scenario where artificial intelligence (because that's what WOPR essentially was in the movie) was used by the military to control our nuclear weapons.  Was artificial intelligence discussed frequently?  Yes it was.  Was the threat of nuclear war on everyone's minds?  Absolutely yes.  Was anyone thinking that artificial intelligence had advanced enough to be used by the military at that point or anytime in the near future?  Not really.

Well, guess what folks!?!  Artificial intelligence is here and likely is powerful enough to do most, if not all, of the things depicted in the movie "War Games".  In fact, Kenneth Payne, a professor in the Department of Defence Studies at King's College London recently released the results of a study in which he set three leading large language models (LLMs) – GPT-5.2, Claude Sonnet 4 and Gemini 3 Flash – against each other in 21 simulated nuclear crisis scenarios.  Dr. Payne's first three sentences in the paper are important and bear repeating, "As large language models (LLMs) are increasingly deployed in analysis and decision-support roles, it's imperative to understand more about how these systems reason about strategic conflict, particularly when the stakes involve catastrophic outcomes.  Defence ministries, intelligence agencies, and foreign policy establishments worldwide are already exploring how AI might augment human judgement in crisis decision-making, from pattern recognition in intelligence analysis to scenario planning for contingency operations.  Understanding how frontier AI models reason about escalation, deterrence, and nuclear risk is therefore a matter of AI safety..."

What happened?  As Dr. Payne admits, "Nuclear escalation was near-universal: 95% of games saw tactical nuclear use and 76% reached strategic nuclear threats."  Two of the models in particular (Claude and Gemini) treated nuclear weapons as legitimate strategic options, not as moral thresholds to cross.  While some LLMs limited nuclear strikes to military targets, a few of the others didn't necessarily avoid population centers (civilian targets).  Most concerning, unrestricted nuclear warfare didn't quite have the aura of a taboo that has restrained human decision-makers since the end of World War II, when the two atomic bombs were dropped on Hiroshima and Nagasaki.  

Likely all of us don't have to make decisions about whether to deploy nuclear weapons.  However, it's almost certain that all of us will be required to make decisions with imperfect information and in a crisis situation.  There's no question that AI will be a useful tool for helping us analyze the situation and make the best decision.  That possibility is a lot closer to us now than it was in 1983 when the movie "War Games" was so popular.  Therefore, it's just as important for us to understand how AI will help frame our choices and make decisions in the future.  The result of our decision probably won't lead to nuclear war, but the potential for an adverse outcome from our AI-driven decision-making could be equally concerning.

Eat Your Ice Cream

I recently started reading Eat Your Ice Cream: Six Simple Rules for a Long and Healthy Life by Ezekiel Emanuel.  Dr. Emanuel is a medical oncologist, bioethicist, health policy researcher, and author of several books, though he is perhaps best known for being the chief architect of the 2010 Affordable Care Act.  His latest book is all about how to live a full and healthy life.  Unfortunately, contrary to the title of the book, achieving wellness doesn't require eating a lot of ice cream!  Although he does cite a number of studies showing that ice cream has at least some health benefits, if consumed in moderation.

Dr. Emanuel argues against what he calls the "Wellness Industrial Complex", which  prescribes complicated regimens that often conflict, while at the same time promising us a longer and more productive life.  He argues that we spend too much time following "wellness" recommendations that may only add a few extra days or months to our life, and that we could better spend that time enjoying our life in the here and now.  Dr. Emanuel writes that "with so much health and wellness advice out there, it can be nearly impossible to differentiate the valid, reliable, and effective from the speculative, deceptive, and just plain stupid.  Even when the advice is scientifically sound, it's often extraneous, misrepresented, or misused."  

I would add that the evidence is often conflicting.  The best example here is the so-called French Paradox, which is based on the observation that people living in France have comparatively lower rates of coronary heart disease, including deaths, despite a higher intake of dietary cholesterol and saturated fat.  Back in the 1980's and 1990's, one popular explanation for the French Paradox was that people living in France also consumed higher amounts of red wine.  Red wine contains an anti-oxidant known as resveratrol, a compound believed to have anti-hypertensive effects and potential protective properties because of the ways it relaxes blood vessels.  Consuming moderate amounts of red wine could therefore offset the harmful effects of a diet high in cholesterol and saturated fat.  Unfortunately, as I've discussed in a couple of posts this past year (see "Raitis tammikuu" and "The world is changed..."), red wine consumption is no longer considered healthy!  The Office of the U.S. Surgeon General released a new advisory last year declaring that there is no safe level of alcohol consumption.  The advisory called out in particular the risks associated with several types of cancer, especially breast cancer in women and cancers of the digestive tract in both men and women.  The advisory states, "The more alcohol consumed, the greater the risk of cancer. For certain cancers, like breast, mouth, and throat cancers, evidence shows that this risk may start to increase around one or fewer drinks per day."  

So, red wine consumed in modest amounts was once considered healthy, but now that is no longer the case.  With that in mind, I recently read a study published in JAMA (the Journal of the American Medical Association) that found that greater consumption of coffee and tea was associated with a lower risk of dementia (see "Coffee and Tea Intake, Dementia Risk, and Cognitive Function").  The study followed over 130,000 individuals for up to 43 years of follow-up.  Detailed dietary records were collected about every 2 to 4 years, and the primary outcome of dementia was identified via death records or medical records.  After adjusting for a number of other lifestyle and health-related factors, higher caffeinated coffee intake was significantly associated with lower dementia risk and lower subjective cognitive decline.  Similarly, higher tea intake was also associated with lower dementia risk.  Decaffeinated coffee was not associated with a lower risk of dementia or cognitive decline.  The most prominent differences in dementia risk were observed with an intake of approximately 2 to 3 cups per day of caffeinated coffee or 1 to 2 cups per day of tea.

Well that's great news for me, as I drink about 2-3 cups of regular coffee (no sugar, no cream) every morning!  But it's hard for me to get excited about the results of this study, as I've read similar studies in the past about red wine consumption!  There's a good chance (better than average I'd say) that some future study will show that coffee consumption is bad for your health. 

I guess I like Dr. Emanuel's philosophy that "wellness shouldn't be so hard".  I think I've done a pretty good job of following his six rules (read the book!) so far in my life.  And I will likely continue to eat ice cream, drink my red wine, and continue my morning coffee ritual - all in moderation of course!