Iron Horse

 They said it was a record that would never be broken.  Ever.  Lou Gehrig was a Hall of Fame first baseman for the New York Yankees from 1923 to 1939.  He was twice voted as Major League Baseball's Most Valuable Player, played in the World Series seven times (winning six times), won the Triple Crown (awarded to the player who finishes first in batting average, RBI's, and home runs), and was an All-Star seven consecutive years in a row.  He had a career .340 batting average and hit 493 home runs.  He is one of only 20 players to ever hit four home runs in a single game.  He was elected to the Baseball Hall of Fame in 1939 and was the first player to have his uniform number retired by a team, when his number 4 was retired by the Yankees.  But he is perhaps most remembered for his durability, which earned him the nickname "Iron Horse".  Gehrig played in 2,130 consecutive games.  

Gehrig's consecutive game streak ended on May 2, 1939.  His consecutive game record would stand for for 56 years, broken by another Hall of Famer, Cal Ripken, Jr, who would go on to break Gehrig's consecutive game record in 1995.  Gehrig stunned fans and teammates alike when he voluntarily took himself out of the line-up due to an undiagnosed ailment.  He would later be diagnosed with the incurable neuromuscular disease amyotrophic lateral sclerosis (now sometimes referred to as "Lou Gehrig's Disease").  He officially retired shortly after removing himself from the line-up, and the New York Yankees - and really all of baseball - honored him with "Lou Gehrig Appreciation Day" on July 4, 1939.  Gehrig ended the day with his now legendary farewell speech, in which he stated, "Fans, for the past two weeks you have been reading about the bad break I got.  Yet today I consider myself the luckiest man on the face of this earth."  

Gehrig's final words in the speech are incredibly poignant, "So I close in saying that I may have had a tough break, but I have an awful lot to live for."  Call it luck if you want, but Gehrig also chose to view all of the positives in his life instead of the negatives.  He had every reason to be angry, or even depressed.  His disease had robbed him of his career and perhaps everything that made him great.  His disease dramatically changed his life and would eventually rob him of that too.  Yet, he still looked back on his life and felt he was lucky.  He felt that he was fortunate.  Life was good.

We can learn a lot from Lou Gehrig.  Even if we may never be faced with a serious or even fatal illness, how Lou Gehrig chose to live out the rest of his life is something that we can all learn from.  You only have one life to live, so make it a good one.  Count your blessings.  Stay positive, even if or when things all around you are falling apart.

Is the Flint Water Crisis finally over?

I read an online news story a couple of days ago that said that the city of Flint, Michigan recently completed the replacement of almost all of the lead pipes providing water to the people living there.  The project was ambitious in scope, and long overdue, lasting almost 10 years from start to finish.  While the lead pipe replacement project closes one chapter of this story, the long-term public health impact of this incident is far from clear.  

I wrote about the Flint Water crisis in a brief editorial for the journal Current Treatment Options in Pediatrics in 2016.  I wrote then, "For its entire history, the city of Flint's fortunes have been closely tied with the fortunes of the automobile industry."  The automobile manufacturer General Motors was founded in Flint, and both the company and the city grew considerably during World War II and beyond.  However, when General Motors declared bankruptcy in 2008, so too did the city of Flint fall into hard times.  The city ranks near or at the bottom of the state of Michigan in almost every social (unemployment, domestic violence, violent crime, drug abuse) and public health (preterm birth, infant mortality, life expectancy) statistic.  However, it was after then Governor Rick Snyder declared a state of financial emergency in 2011 that Flint's problems with lead in the water began.  Governor Snyder appointed an Emergency Manager who was charged with cutting costs and reducing the city's $15 million budget deficit.

Flint previously obtained its water from the city of Detroit, whose source of water was nearby Lake Huron and the Detroit River.  The cost of water had nearly doubled by 2013, prompting Flint's city council to approve a proposal to switch to the Karegnondi Water Authority on March 25, 2013, which would allow the city to obtain its water directly from Lake Huron, bypassing Detroit (essentially, they were cutting out the middle man in the deal).  While the new deal would save the city approximately $19 million over an 8-year period, the new proposal would require completion of a new regional water pipeline, which would not be completed until 2016.  At the same time, the Detroit Water and Sewerage Department gave the Flint city council a one-year termination of contract notice.  The city council scrambled and signed a contract to use the water from the nearby Flint River until the new regional pipeline could be completed.

Almost immediately after the switch occurred in April, 2014, Flint residents began to complain and express concerns about the color, taste, and odor of their water.  Notably, the water from the Detroit Water and Sewerage Department was far less corrosive than the water from the Flint River.  City officials had failed to apply corrosion inhibitors to the water, possibly in yet another cost-cutting move.  In fact, General Motors had recently stopped using the Flint River water at one of their nearby engine assembly plants because the water quickly corroded the engine parts.  The corrosive water leached lead from the city's aging network of lead-based waterpipes, which had two adverse effects.  First, the lead levels in the water rose to dangerous levels.  Second, the lead and other heavy metals inhibited the chlorine-based disinfectants in the water, causing bacterial contamination.  Just four months after the switch, the city government put out a warning to residents to boil their water due to high levels of E. coli and Legionella.

As detailed in two outstanding books, The Poisoned City: Flint's Water and the American Urban Tragedy by journalist Anna Clark and What the Eyes Don't See: A Story of Crisis, Resistance, and Hope in an American City by pediatrician Mona Hanna, MD, MPH, local pediatricians started to report increased blood lead levels in children under 5 years of age, with neighborhoods with the highest water lead levels reporting the greatest number of cases.  Lead's neurotoxic effects can adversely impact a child's motor and cognitive development, so the disturbing increase in blood lead levels was a public health nightmare.  Dr. Hanna was instrumental in helping to make the connection between the increase in lead concentrations in the city water supply and the increase in the number of lead poisoning cases in Flint's pediatric population (notably, there were at least three separate studies establishing this link).

Somewhere between 6,000 to 14,000 children were exposed to drinking water contaminated with high levels of lead.  Children are particularly susceptible to the long-term effects of lead poisoning, so we will likely not know the true impact of this incident until several years from now.  Dr. Hanna, who is currently the Associate Dean for Public Health and and C. S. Mott Endowed Professor of Public Health at Michigan State University College of Human Medicine was  named one of Time magazine’s 100 Most Influential People in the World and recognized as one of USA Today’s Women of the Century for her role in uncovering the Flint water crisis and leading recovery efforts.  She stated, "Investment in our children's future, and in their health, is not just an economic necessity, but it is the bedrock of public health and a just society."

After nearly $400 million in both state and federal spending, the city of Flint has finally secured a clean water source and laid modern, safe, copper-based pipes to nearly every home in the city.  The late Reverend Allen C. Overton of Concerned Pastors for Social Action, one of the plaintiffs in the subsequent federal lawsuit said, "Thanks to the persistence of the people of Flint and our partners, we are finally at the end of the lead pipe replacement project.  While this milestone is not all the justice our community deserves, it is a huge achievement."

For me, the story of the Flint water crisis perfectly illustrates the critical linkage between public health and medicine.  As the health economists David Cutler and Grant Miller suggested in an article published in the journal Demography in 2005 ("The role of public health improvements in health advances: The twentieth century United States"), "clean water was responsible for nearly half the total mortality reduction in major cities" during the late 19th and early 20th century.  Similarly, Marcella Alsan and Claudia Goldin published an article in the Journal of Political Economy in 2019 ("Watersheds in child mortality: The role of effective water and sewerage infrastructure, 1880-1920") and concluded that one-third of the decline in child mortality from 1880 to 1920 was directly related to investments in clean, safe water.  As I have stated many times in the past, health delivery is not just about health care.  The so-called social determinants of health account for anywhere between 30-50% of reported health outcomes, particularly mortality.  As these studies - and the Flint water crisis - prove yet again, you can't drive improvements in health by focusing only on health care.  

The world is changed...

I am going to borrow the Elvish queen Galadriel's opening monologue to the 2001 movie The Fellowship of the Ring (the first movie in Peter Jackson's epic masterpiece trilogy, The Lord of the Rings):

The world is changed.  I feel it in the water, I feel it in the earth, I smell it in the air...Much that once was is lost, for none now live who remember it...

Okay, perhaps the last part is a bit of an exaggeration, as most of the changes that I am going to talk about in today's post are not all that old.  Apparently, the Gallup Poll has been asking the same question every year since 1939: "Do you have occasion to use alcoholic beverages such as liquor, wine, or beer, or are you a total abstainer?"  You can tell that the question was first written in 1939, as we wouldn't ask that question in the same way in 2025.  What is surprising is that the number of Americans who say that they do "have occasion to use alcoholic beverages" hit an all-time low of 54% in this year's survey, which came out earlier this month.  Just as important is that the decreased consumption coincides with a growing belief that moderate alcohol consumption is bad for one's health, which is a majority view for the first time in the history of the survey.

Alcohol consumption, even among young adults, has been steadily declining since 2023, when 62% of Americans reported drinking alcohol, which decreased to 58% in 2024.  The trend towards decreased alcohol consumption coincides with the latest research reporting that, contrary to previous opinions, any degree of alcohol consumption may negatively affect health.  Importantly, the decline in alcohol consumption does not appear to be caused by a shift towards other drugs, such as recreational marijuana, which is now legal in about half of U.S. states.

The alcohol consumption patterns among those Americans who do drink are also shifting.  A record low of 24% of alcohol drinkers say that they had a drink in the past 24 hours, while 40% say it has been more than a week since they last consumed alcohol (the highest percentage since 2000).  The average number of alcoholic drinks consumed over the past week has decreased to 2.8 drinks/week, which is the lowest reported since 1996 (and decreased from 3.8 drinks/week in last year's survey).  

Americans appear to prefer beer over liquor and wine, which is consistent with the pattern over the last six years.  Wine remains in third place, though there are differences in age and gender.  For example, in general, men prefer beer over wine and liquor, while women generally tend to choose wine over beer. This is perhaps surprising given the so-called "French Paradox" and prior research suggesting potential heart-healthy benefits to wine consumption (see my post, "Raitis tammikuu").  

The French population, as a whole, consumes a diet that is much higher in saturated fats (think of all the cheese and butter that they consume compared to Americans - one blogger basically said, "They eat butter like it's a food group...Their cheese selection could stock a small grocery store."  Yet,  compared to the French, Americans have much higher rates of heart disease and obesity.  The classic explanation has been that the anti-oxidants in wine, specifically compounds known as polyphenols (including one called reservatrol), are "heart healthy".  However, Dr. Kristie Leong recently wrote a blog on Medium ("Why French people eat butter and stay lean (the paradox that broke nutrition science)") that suggested other factors are responsible for the "French Paradox".  Dr. Leong says that the explanation isn't what the French people are eating, but rather how they are eating:

1.  French meals average 22 minutes compared to 14 minutes for Americans.  Eating slower gives our brains time to tell our stomachs that we are full.

2.  French portions are 25% smaller than American servings, yet satisfaction levels are identical.  Dr. Leong says that a typical French dinner plate is about 9 inches in diameter compared to a typical American dinner plate, which has a diameter of 12 inches.  That three inch difference translates to a 44% increase in surface area available to pile food on the plate for Americans.  

3.  French people stop eating when they feel satisfied, while Americans stop when their plate is empty.  Given the differences in plate sizes mentioned above, Americans are just going to eat more, regardless of whether they feel full or not.

4.  French food culture prioritizes ingredients over convenience.  They eat a lot less processed foods compared to Americans.

5.  Americans eat an average of 2.2 snacks per day.  The French?  Less than one.  

6.  French culture prioritizes leisure in ways that seem almost alien to Americans (lunch breaks are sacred, vacation time is mandatory, and work-life balance isn't just a buzzword).  Less stress leads to better health.

7.  French wine consumption averages one glass per day, typically with meals.  Americans tend to binge drink, and alcoholic beverages tend to have a lot of calories.

As I've stated previously, more recent research suggests that "no amount of alcohol is safe", which is becoming the majority belief, at least according to the Gallup survey.  More importantly, there is a lot more to the "French Paradox" than just wine consumption.  The French have better dinner habits than Americans, which according to Dr. Leong is playing the most important role here.

It will be interesting to monitor the trend towards decreased alcohol consumption in the future.  I suspect that we will start to see studies reporting on the economic impact of decreased alcohol consumption very soon.  And perhaps we will also see a consolidation in the beer, wine, and liquor industry?  Time will tell.  But clearly, the world is changed...  

Blue Lights

You tend to hear all kinds of crazy stories (and believe them) when you are young!  When I was growing up in Indianapolis, we used to hear about a haunted house known as "The House of Blue Lights".  The house was the former residence of an eccentric local millionaire and philanthropist named Skiles Edwards Test, who died in 1964.  The story goes, at least the way that I heard it, Test kept the house decorated with blue Christmas lights all year round.  That doesn't seem too eccentric, but I also heard that he kept his deceased wife in a glass coffin inside the house, also surrounded by blue lights.  While the former story was mostly true, the latter was definitely not.  Incidentally, the house at the northeast side of Indianapolis had nothing to do with the popular boogie-woogie blues song that was released by, among others, Chuck Miller, Chuck Berry, and George Thorogood. 

Well, it was exactly the story of "The House of Blue Lights" that came to mind when I read a recently published article in The New York Times.  Journalist Caroline Hopkins Legaspi wrote an interesting article that summarizes a lot of research on the effects of blue light on sleep (see "Why do screens keep you up? It may not be the blue light.").  Smart phones primarily use blue light for their displays, and there are all kinds of studies out there suggesting that using your smart phone before going to bed is the absolute worst thing that you can do, primarily because of the adverse effects of blue light on circadian rhythm.  Blue light has a shorter wavelength and higher energy than other colors, which allows for better visibility, particularly with bright ambient light.  Blue light is naturally emitted by the sun and plays a role in regulating our body's natural sleep-wake cycle (the technical term for which is called our circadian rhythm).  Blue light helps us feel alert and awake during the day, though too much blue light at night has been reported to inhibit the release of melatonin, which is a hormone that helps us sleep.

Caroline Hopkins Legaspi suggested that the relationship between blue light and sleep is not as straightforward as we think .  She reported research by Lauren E. Hartstein, an assistant professor of psychiatry at the University of Arizona that suggests that the content of what's on the screen before bedtime is probably more important than the type of light used by the smart phone.  Some of us are perhaps more sensitive to blue light than others, while others just don't seem to be affected by blue light.  Finally, Dr. Hartstein questions whether it is appropriate to generalize findings from sleep studies performed in a laboratory versus what actually happens when those same individuals are at home.

So, what can we conclude from the available research?  First, scrolling through social media or playing video games before bedtime probably aren't helpful for our circadian rhythms.  Second, many of us just can't seem to "calm our brains" at night, and reading a book (not a suspense or murder mystery) or watching a television show (again, not a murder mystery) could actually help in these situations.  Third, if you aren't having any trouble falling asleep, even if you are checking things on your smart phone, the smart phone is probably not causing any problems.  As Dr. Hartstein says, "If you are able to fall asleep quickly, you sleep well throughout the night, and you feel rested the next day, then that's great.  You don't need to constantly adjust your behaviors."  In other words, if you want to bask in the glow of blue light, just like ole Skiles Edwards Test did, it's probably okay to do so.  Just don't put your dead wife in a glass coffin, and definitely don't listen to haunted house stories before bedtime!

The "Walkman Effect"

The psychologist Stanley Milgram wrote an essay in the journal Science in 1970 called "The Experience of Living in Cities".  In the essay, he talked about the concept of overload from systems theory, which refers to a system's inability to process inputs from the environment when there are too many inputs for the system to cope with.  He wrote, "City life, as we experience it, constitutes a continuous set of encounters with overload, and of resultant adaptations...One adaptive response to overload is the allocation of less time to each input."  He then referred to the sociologist, Georg Simmel, who pointed out as long ago as 1903 that individuals who live in cities come into contact with so many other individuals that in order to conserve their cognitive attention, they largely keep to themselves or maintain only superficial relationships with their acquaintances compared to those individuals who live in more rural areas.  

We've known for a long time that individuals who live in cities tend to keep to themselves, at least when compared to those individuals living in rural areas (see my recent post, "The Quiet Commute").  One of my high school friends wrote a novel called East Fifth Bliss.  The author says of the protagonist in the novel, Morris Bliss, "Morris rarely converses with the neighbors.  A greeting, good morning, or 'Hey, how are you?' at most.  Rarely more.  A crowded city is often isolating."

While cognitive overload is an important factor, particularly when it comes to living in a crowded city, what's also clear is that technology has also had an adverse impact on how we interact with one another.  The writer Jonathan Haidt in particular writes about the dangers of social media and the adverse impact that social media has had upon society today in his book, The Anxious Generation.  Haidt's book is still relatively new (it was published in 2024), but the concerns about technology's adverse impact on society are not - look no further than the Sony Walkman, a portable cassette player first introduced in the late 1970's.  

At the time it was first introduced, the Sony Walkman was revolutionary in concept.  Shuhei Hosokawa published an essay about the Walkman and its impact on society in the journal Popular Music in 1984 entitled "The Walkman Effect".  Hosokawa claimed (and I think he was correct) that the Walkman created a private auditory space within public spaces, allowing users to detach from their environment and mentally withdraw into a private world of music.  

Of interest, the original model of the Walkman played cassette tapes and included a second earphone jack as well as an extra set of headphones.  There was a curious orange button labeled "Hot Line" that when pushed, allowed the two users to speak to each other through a microphone.  According to Akio Morita, one of the Sony co-founders, the company was anxious about the solitary nature of their new product, and they included the orange button to provide an emergency "share" feature.  

In other words, the company that released the Sony Walkman was concerned enough that the new technology would further isolate its users that they created a feature to try to create "togetherness".  Ironically, the orange button was soon removed and the Sony Walkman became hugely popular, primarily because of its solitary nature (hence, the "Walkman Effect").  

I remember when the Sony Walkman first came out.  As a matter of fact, I owned a later model of the Walkman and used it literally all the time.  What's clear to me (again) is that our tendency for self-imposed isolation is not a new phenomenon.  It was there before social media, the smart phone, and the Internet.  And to be honest, we've been talking about these issues since the time of the ancient Greeks (see my recent post, "Today's Phaedrus moment").  I even bet that the earliest humans were once sitting in a cave, lamenting a younger generation of cavemen and cavewomen who were spending too much time alone drawing pictures on the cave walls.

Technological advances often bring welcome changes to society.  However, as with just about everything else, there can be drawbacks to technological change too.  I don't pretend to have all the answers here, but I do think that we need a more balanced discussions about the pro's and con's of technology, particularly social media, the smart phone, and the Internet.

One more time on the elites...

I wanted to finish off the discussion on elite individuals from my two previous posts last week, "What makes elite individuals elite?" and "The 40% rule", hopefully generating less controversy (see "Controversy") than the last time.  Specifically, I wanted to re-visit the topic on whether elite athletes are born with elite skills and physiologic tools that make them markedly superior to everyone else or whether they develop those elite skills and physiologic tools with practice and training.  In other words, is it "nature" or "nurture".  There is also a third possibility that it's a combination of both "nature" and "nurture".  The author David Epstein wrote a fascinating book on this exact subject called The Sports Gene: Inside the Science of Extraordinary Athletic Performance, which I've mentioned a few times in related posts from the past (see "What makes a champion?" and "Peak").

It would be helpful to start out with a brief discussion on something that is known as the mammalian dive reflex.  I first learned about the so-called dive reflex during one of my undergraduate biology courses (I think it was a class called "Comparative Animal Physiology").  The dive reflex is a normal and protective physiologic response to water submersion.  It's found in almost all mammals, which includes, of course, humans.  When mammals (or humans) dive underwater, they have to hold their breath, which causes the concentration of oxygen in their bodies to decrease.  That's usually not good!  However, the body responds to being submerged in water by lowering the heart rate (bradycardia), slowing down or even stopping the normal breathing reflex (bradypnea or apnea), and shunting blood flow from the arms and legs to the brain, heart, and kidneys to preserve the body's core functions (increased peripheral vascular resistance).  All of these responses decrease the body's consumption of oxygen, allowing mammals (and humans) to survive, for at least a time, underwater without a source of oxygen.

As you will no doubt acknowledge, some mammals are much better at diving underwater than humans (think about how long whales and dolphins can hold their breaths underwater compared to humans).  These mammals evolved, through natural selection, bodily mechanisms to help them dive underwater for much longer periods of time.  As it turns out, some humans are better at diving underwater than others.  Dolphins and whales developed a robust dive reflex over thousands of years, but what about humans?  As it turns out, two distinct populations of humans have appeared to develop remarkable adaptations over time that allow them to hold their breath underwater for much longer than most of us.  These populations are the Bajau people of Southeast Asia (known as "sea nomads") (see "Physiological and genetic adaptations to diving in sea nomads") and the Haenyeo people of Korea (see "Genetic and training adaptations in the Haenyeo divers of Jeju, Korea").  Both populations have appeared to develop over thousands of years genetic modifications that allow them to dive underwater for long periods of time.  In the first study, the Bajau people were shown to have increased spleen size, providing a reservoir of oxygenated red blood cells during diving.  In addition, they appear to have inherited a specific gene modification that affects the so-called dive reflex.  The second study showed that the Haenyeo women divers also have developed a superior dive reflex (pronounced bradycardia) compared to everyone else who lives in Korea.

The scientists in both studies suggest that their results provide convincing evidence that the Bajau and Haenyeo divers evolved their remarkable adaptation to diving underwater over thousands of years.  I find these results incredibly remarkable, as it suggests that "nature" is playing a major role in their abilities.  However, the studies I mentioned in the two posts last week ("What makes elite individuals elite?" and "The 40% rule"), as well as a number of studies mentioned in David Epstein's book The Sports Gene: Inside the Science of Extraordinary Athletic Performance suggest that "nurture" plays a major role as well.  In other words, rather than an either/or when it comes to the "nature versus nurture" debate, it's a both/and!  Elite athletes are the result of great genes and practice, practice, practice!

I mention all of this, as one of the most frequently debated topics in leadership and management is whether leaders are born with a unique ability to practice the art of leadership, or do they develop those skills with practice and training?  Most of the studies and articles on leadership that I've read strongly suggest that great leaders develop their skills over time with extensive education and training.  That's certainly reassuring, but given the discussion on elite athletes above, I am still left to ponder if we will ever find a so-called leadership gene.  Stay tuned for more!

A Kodak "moment"...

Pay close attention over the next few days on what is happening with the Eastman Kodak Company.  I've read a couple of news stories suggesting that the 133 year-old company's demise is imminent.  Just this past Wednesday, media outlets such as CNN and MSNBC reported on the company's ongoing financial struggles, specifically pointing out statements that company representatives made in a quarterly earnings report that the company didn't have "committed financing or available liquidity to meet debt obligations coming due within 12 months."  

If these reports are true, it would be a tragic end to a company that was once one of the stalwarts of American industry.  Kodak was the fourth most valuable brand in the U.S. (after Disney, Coca-Cola, and McDonald's) with just over $15 billion in revenue as recently as 1996.  The company declared bankruptcy in 2012 (see the graphic below from The Economist magazine).

Following declaration of bankruptcy in 2012, the company shifted from the photographic film business and focused on commercial printing, packaging, and advanced materials and chemicals (including pharmaceuticals).  The company sold off most of its businesses and patents.

Kodak has been the subject of countless business articles, case studies, and graduate theses on disruptive innovation (see, for example, the Harvard Business Review article, "Kodak's Downfall Wasn't About Technology").  Kodak's core business was selling photographic film.  Once cameras went digital, people became less interested in film.  And when cell phones became cameras, digital cameras became much less popular.  

The ironic twist in all of this was that an engineer at Kodak actually invented the digital camera.  Kodak's response at the time was to focus on their core business.  Therein lies the reason for all of the articles and case studies!  It's a classic example of Clayton Christensen's "disruptive innovation", how a smaller company with a new, often simpler product, can initially target low-end, niche markets, gradually improve, and ultimately displace leading companies.

The company recently issued a press release that countered the claims made in the last few days, stating that it had no plans of ending operations or filing for bankruptcy.  Whether this is true or not, remains to be seen.  I will be watching with great interest to see how this all plays out.