Random Thoughts from a Restless Mind

Professor Robin Dunbar poses that the maximum number of individuals with whom a human can maintain social cohesion is 150. Hence, “Dunbar’s Number”. Essentially “social cohesion” means that you have some degree of awareness of who another person is beyond simply their name and their Twitter handle. Further research seems to show that we can follow 500 acquaintances (we know a bit more than just their name; for example, we might know to whom they are married), and we can match some 1500 faces to names. As I’ve written before we then cone down through various circles (friendly acquaintances, casual friends or “buddies”, close friends, and best friends), and there is a nearly constant movement in and out of all but the closest inner circles.

How has electronic communication altered this dynamic? It turns out that there is rather little change in the numbers involved. Weird, huh? You’d think that FB, Twitter, Snapchat, and Messenger would have increased the numbers but in fact Dunbar’s more scientific rationale–the size of the neocortex determines the number of contacts–holds true no matter what type of communication connects your network. Dunbar does have some thoughts on SM and its effect on relationships and they can be summed up thusly: remote connections maintained electronically crowd out the possibility of newer, closer friendships created locally and in real time.

My bet is that you can easily confirm this in your own groups as I did just the other day. A friendship 15 years in the making, one that was probably on the border between “buddies” and close friends, has been on the wane after a retirement and subsequent move south (and up), it’s gotta be 10 years ago now. A (very) brief interaction around a death in the family is the sum total of our engagement for a couple of years, yet I have managed to remain connected through occasional social media “engagement”. What remains of our friendship is my memories of times together, and perhaps warm feelings on both sides when those memories arise.

But Dunbar is right; mourning the friendship that was keeps that slot occupied and therefore unavailable for a more intimate, current, local friendship.

Key to all of this is the “how” of our interactions. Beth and I organized a spur-of-the-moment Happy Hour at a local bistro that turned into a raucous up too late bacchanalia with our inner circle. Cell phones were pocketed throughout (with the tacit agreement that we could text if our kids reached out) and we hugged each other, punched shoulders, and shared all manner of concoctions through the night. Yes, it all started with a group text, but that was simply the flint struck to light the campfire for the evening. We were together in the realest sense of the word.

How can we further combat this “crowding out” effect of modern electronic communication brought on by the availability afforded by our ubiquitous, irresistible smart phones? Easy. It’s in the name of the tool: phone. Short for telephone. Initially “cell phone” after the towers that were first erected to transfer…wait for it…telephone calls. VOICE! Voice, once taken for granted, has now become so exotic that I have been informed that I must first make an appointment to call someone on the phone. Indeed, the voice call is only slightly less rare (at least between friends) as a handwritten letter.

Therein lies the solution my friends. Your handheld computer is a telephone. It’s not even all that retro: Captain Kirk famously spoke into his communicator (“Beam me up, Scotty.”) in the future of Star Trek. Call your friends. If that seems a bit too anachronistic or archaic indulge in a video call. Hear them/see them between those occasions when you can shake hands or hug. More voice, fewer posts/texts/messages/snaps/tweets, especially for anyone in the “buddy” circle or closer.

Now, get off the internet. Go call a friend and make plans to get together for the Labor Day weekend.

Sunday musings…

1) Vicissitude. Fancy word for weather, especially if you need a particular weather pattern at any given moment.

2)) Hero. To be a hero one typically demonstrates courage in the face of personal danger, usually involving the selfless decision to put others before self. As a young man I find it hard to argue that this doesn’t describe John McCain. One could certainly disagree with the positions Mr. McCain took as a politician in the second phase of his life, but one would be hard pressed to argue that he hadn’t done enough in the service of his country over 60 some years.

RIP John McClain. Citizen. Patriot. Hero.

3) Health. CrossFit, Inc. has pivoted. Some among you will rejoice, for the direction that appears to be taken is in line with your own philosophy and goals. Those here who revel in the challenge of elite fitness will no doubt feel that this is a betrayal, a clear step backwards and toward mediocracy. I have a few friends who remain employed at CF, Inc. and they would doubtless like to hear me speak out in favor of this evolution. At the same time there are a few friends who are quite dear to me who would much rather I simply declare my days living in CF nation over and move on. CrossFit in all of its iterations has changed, and so, too, have I.

For many years I have written around this time of the year, just after the completion of the Games, about the peculiar and poorly understood triad that has comprised what we all know as “CrossFit”. It is a business, CrossFit, Inc., one that has as its charge the necessity to be self-perpetuating and to provide for the financial well-being of its owners. This should be self-evident, but over the years commentary has often come up that seeks to present CrossFit the business as some kind of public good. It is not, nor has it ever been. CrossFit, Inc. has succeeded over the years as a business, and in so doing it has made decisions that outsiders have both lauded and loathed. For many, how they interact with the company we call CrossFit is determined by who has been affected by these decisions and how. A pivot has occurred; you and I did not have a vote. CrossFit, Inc. will likely continue to prosper.

Second among the three traditional pillars of CrossFit is the Sport of Fitness. With the possible exception of aerobics competitions in the Denny Terrio age (the spandex!) and that old ABC series The Superstars (O.J. in a boat!), CrossFit likely deserved wears the mantle of the founders of fitness competition. Beginning with a friendly barbecue and leading up to a multi-day tiered competition shown on live network TV, there is no doubt that fitness competition is now here to stay. Early announcements suggest that the pivot will dramatically lower the direct involvement of CF in the competition season, but that CF will have the ultimate say at the highest level. No one you or I talk to has any real idea what this means, and supposition along those lines is wasted effort until we are all told exactly what CF has in mind by CF. The CrossFit Games have changed often over the years and they have changed again. Full stop.

Where most of us come in contact with CrossFit is in the third priority: fitness as a conduit to health. It surely seemed as if this was the least important of the three parts of CrossFit, at least until this past week, but it has always comprised the massively overwhelming majority of participants. Whether on CrossFit.com or in a local affiliate, almost everyone fell under this category;  most of those who thought they were part of the Sport of Fitness were fooling themselves at their own risk. With the creation of a CrossFit health movement and an L1 program for CrossFitting physicians, CrossFit, Inc. appears to be signaling that its public face will now be directed here. Note that I say “appears” because I am no more in the know about this than you or anyone else.

This is a good thing.  To de-emphasize the competitive aspects of CF is to re-emphasize the health aspects of CF that were outlined in “What is Fitness” in CFJ #2, the seminal thesis that brought so many of us here in the first place. I wish we could all go back and look at the threads on the old Message Board, 95% of which had to do with getting healthy. How will this affect the kind of CrossFit we see coming from CFHQ? Again, who knows. CVFMAHI has undergone countless lines of evolution outside of the direct umbrella of CrossFit. Individual trainers have gone out on their own and modified CrossFit in ways that reflect what they learned training people themselves (think James Fitzgerald, once known as OPT).  Entire movements with companies attached have been launched to provide clients with what they feel is a better way. A perfect example of this is The Brand X Method and the Martin family who are without a doubt the world leaders in youth fitness. Who will be right? Who will thrive?

Who knows?

In the end the entire conversation has changed over the last 10 years, and more people are sitting at the fitness table than ever. The line between healthcare and fitness continues to be a bright dividing line. Barriers continue to exist between the fitness world and both public health and public education. Will this pivot at CrossFit, Inc. start to blur those lines, or at least build bridges across them? Will we see some other organization, perhaps one that began within the CrossFit universe but now exists as a separate, growing galaxy like Brand X share the load or even take the lead?

The only constant in CrossFit in the years that I’ve been here is change. Change brings with it opportunity. My prediction: this turns out pretty well for CrossFit. The fitness world is much, much bigger than it was 10 years ago. One would do well to listen very carefully when CrossFit directly addresses this pivot publicly. This will also turn our pretty well for people who may have been part of the CrossFit world but are no longer associated with any of the 3 parts of CrossFit outlined above. One would also be well-advised to closely watch the direction taken by the Martins and others in the fitness world as well. There will be many benefits that come from that one, big original idea. They will come from many places.

After all the Theory of Relativity was simply the on ramp to what we now know as Quantum Physics. The highway of fitness progress is now fed by a growing number of on ramps that come from many directions.

I’ll see you next week…

–bingo

Sunday musings…

1) Bollocks. Testicles. Who knew? The whole kerfuffle over the Sex Pistols album title makes a ton more sense now.

2) Directed. “Use as directed.” I’m not sure who is more surprised. Mothers when their offspring open up some something or other and just fly into using it (and it works), or said offspring when they fail to check the directions and whatever it is they opened doesn’t work.

For the record this is also a problem in areas that are a bit less trivial than a tiny drone received as a birthday gift. Like medicine.

3) Knots. “Miles per hour plus the glamour of the open sea.” –Mark Childress.

Not terrifically accurate, but who’s gonna argue with that little bit of poetry?

4) Despair.  Why is it that so-called “great literature” always ends in despair? The boy never gets the girl and vice versa. Every family is rendered asunder whether or not they deserve that particular fate. Why?

Lettie Teague wrote about her summer reading, all of her books centered in some way around wine as a pivotal character. Upon reading the headline I was excited to have some fun, happy reading for a change. Yah. About that. Even the consumption of epic wines was spoiled by the despair that prompted the binge or that which ensued.

Jeez. Winston Churchill managed to help save the world when he drank. How come no one can write literature with a happy ending?

5) Change. Inspired by by near lifelong friend Bob.

I watch the ripples change their size
But never leave the stream
Of warm impermanence
And so the days float through my eyes
But still the days seem the same.  –David Bowie

Grand baby birthdays. Siblings and their offspring passing milestones. 40th high school reunions. There is no escaping the passing of time. Along with the ebbs and flows there has been but one, single constant: change. Each day seems so much like the one just passed, and yet a glance ever so slightly further back brings an awfully quick reality check. Change has been afoot. “You haven’t changed” is such a lovely thing to hear, yet it, too, cannot withstand even a passing glance in the mirror.

There is nothing new or even remotely weighty about noting change. What is significant, though, is the importance of both acknowledging and accepting change, however disruptive it may be physically or emotionally. One must be able to see change and react accordingly, no matter how difficult it may be for either an individual or for those who may be highly interested spectators. I think of my good friends from California, true pioneers in both the CrossFit movement and subsequently independently in the larger fitness world. They have looked at how their world, their lives have changed, and they have accepted the need to change as well. For them it begins with the closing of a beloved, iconic gym which is rightly famous worldwide, the loss of which has been met with an international tsunami of tears. Yet they have seen the change and have accepted that the time had come.

Some changes are so disruptive that they turn lives upside down even when you know they are on the way. Our friends Bob and Kathy begin the journey toward an empty nest as their only child begins his senior year in high school. So, too, my brother and sister-in-law must adapt to the changes brought by college graduation and their sons’ retirement from competitive sports. No longer will Randall and Joanne plan each week around their boys’ games. My sisters and their husbands are soon to follow. Will those changes be any less impactful given foreknowledge?

Someone, I’m not sure if they like me or not, once asked at what age I would choose to be frozen if such a thing was possible. How old would you choose to be, with all of the attributes of that age but no prospect of any further growth or development? It’s an impossible question, a cruel koan which cannot be solved. How can one possibly choose between the youthful feet attached to the running shoes that are so joyfully and maddeningly soaked by your child and the archless soles doused by a grandchild? Which is better, to have the agility to dance away from your son’s aim lest your shoes be ruined, or to happily submit to the realization that the laughter of your grandson is more than worth the fact that you can no longer save the shoes regardless.

Besides, the shoes have changed, too. They’re waterproof now.

Changes are happy and sad, big and small. We lose parents and friends. Special places like our friends’ gym close taking with them any chance they may change us for the better. Heck, it looks like I’ll be changing hips sometime soon, a change I for some reason thought I’d be the only one to escape. It makes me sad to hear parents tell a child “don’t change; stay like this forever” because that is one wish that will never be granted. Nor should it. After all, there is only one way to assure that change will never come.

I am not done changing
Out on the run, changing
I may be old and I may be young
But I am not done changing   –John Mayer

Change is life. To change is to be alive. Embracing change is to live.

I’ll see you next week…

–bingo

Sunday musings…

1) Krispies. All of my snaps and crackles now have pops.

2) Relevant. “Who wants to be relevant? It just takes a lot of work.” –Andie MacDowell

In this day of social media driving said relevance I think Ms. MacDowell is spot on. When relevance is measured by something as ephemeral and lacking in any type of substance as retweets and follows, her take is prescient.

True relevance is substantive. Or should be.

3)  Games. What are we to make of the massive gap between the top 5 men and women and everyone else? What is it that separates them so completely from the rest of the very best? Is it just me or is this fundamentally different from all of the other truly individual athletic sports?

4) Summer. For anyone with school-aged kids summer if officially over. August 1st has come and gone, the CrossFit Games are over, and football camps are open all across America. Heck, school starts in parts of Ohio on Wednesday, and didn’t I see kids heading to school last week on FB?

Sorry, that’s all wrong. School is meant to start after Labor Day. Too much work too soon for kids who aren’t taking part in feeding a family.

5) Screening. It appears that I am a health tracker recidivist. Why? Well, it certainly has nothing to do with the truly actionable nature off the information a tracker gives me, because to date only heart rate variability (HRV) has any value and at that it appears only in elite athletes. No, I’m just having some fun with mine, playing around to see if my little n=1 studies might come up with something that might move my needle for some reason or other.

That, and they are fun to write about.

Screening for health risks is potentially a big deal, the across the board lack of success thus far notwithstanding. The most recent best example of that coin is an article published this month in the NEJM on cardiac testing of elite soccer players in England. Performed at age 16 between 1996 and 2006 the screenings were undertaken to see if an EKG and Echocardiogram could predict cardiac events that led to early death in athletes who compete in sports with “strenuous exertion”. In all more than 11,000 athletes were tested, the vast majority of whom were declared healthy.

1 in 266 were found to have an underlying, silent abnormality that put them at risk for sudden cardiac arrest. Most of these were Hypertrophic Obstructive Cardiomyopathy (HOCM), the same entity that was responsible for the tragic death of Boston Celtic Reggie Lewis. 2/3 of those who were found to be at risk had surgical procedures which allowed them to safely return to play; it appears that they are all alive and well. Of the originally screens players 8 did in fact die from cardiac arrest, but here’s the kicker: only 2 of those 8 were assesses as being at risk. The other 6 went through the screening and passed. Overall the results equal a risk of 6.8 deaths per 100,000 athletes.

What does this mean in the greater context of health screening? In general the problem with health screening of all kinds (remember, I am in the midst of a classic American cardiac health risk screening process at the moment) is the combination of inaccuracy as noted above, coupled with a fraught cost/benefit ratio in almost all instances. Believe it or not, though, the cost of screening relative to the accuracy and ultimate effect may be the lesser of the problems inherent in screening. Two of the athletes screened and found to be at risk refused to give up soccer and were among the cardiac deaths. You might ask if they were mad to have continued to play, but I would counter that it is quite likely that all they had as a means to provide was soccer; to not play was to choose to go hungry. Imagine an inner city kid destined to be a Lottery Pick in the NBA screened and told they could no longer play the game that would surely set them up financially for life on their rookie contract alone?

Not to mention the deep psychological issues inherent in being told that you are no longer the one, single thing that you have self-identified since early childhood. That’s rough.

One of the very first diseases one used to learn about in med school was Huntington’s Chorea, an inherited disease in which the afflicted exhibit violent, uncontrollable movements (chorea) before eventually dying a rather unpleasant death  (any med students here? Is that still true?) Why? Well, partly because it’s such an interesting tale, equal parts detective story (the original cluster is in a tiny town in England) and history lesson (many of the townsfolk in England emigrated to Salem and were on the wrong end of the Salem witch trials). What makes this interesting in the context of screening is that Huntington’s Chorea is the first disease for which a single gene defect was identified, making it possible to screen with 100% accuracy to determine if you, like Woodie Guthrie and his siblings, would be so afflicted.

Would you want to know? Remember, even in this age of SPLCR technology there is still no cure for Huntington’s. Is there a difference between this and the cardiac risk of HOCM in athletes? How about the rather mundane and ridiculously common risk associate with elevated serum lipids? Given that there are things one can do to mitigate the risks in the latter one should probably answer “yes”, there is a difference. But emotionally, on an individual level, is there? That’s a really hard question to answer. I personally know families with Huntington’s and HOCM. Some family members get tested as a matter of course. Others, for any number of reasons, choose not to do so. In your life you know dozens of people who really need to be screened for diabetes and cardiac risk from elevated serum lipids who prefer the relative comfort of ignorance.

Who is to say who’s right?

In the end this is a question that is going to become more and more common as testing becomes both easier and less expensive. We are soon to see a lab test for HOCM which will be less expensive than an EKG/echocardiogram and more accurate to boot. The calculation will change as well because on the heels of this test is the likely approval of a gene therapy that will reverse the abnormality and presumably remove the risk. For some reason Huntington’s Chorea has defied this happy ending, but it has to be just a matter of time before it, too, is curable. Before any universal agreement is reached on screenings in general you can depend on tons of controversy which each new development. I shudder to think of the coming shit show that will be wrist-worn trackers that can detect afib in real time.

Who knows what kind of mischief I will manage to get into with my little HRV monitor?

I predict I’ll see you next week…

–bingo

Sunday musings…

1) Babies 2. Not gonna lie, still on a huge high from babies on the beach for the first time in 15 years. To top it off our last ‘baby” Ryan visited for a couple of days as he prepares for his senior year in high school.

All 6’5″ of him!

2) Highway. At the moment we are steaming along I-90 headed west to Casa Blanco, Beth at the helm. It never gets old, that feeling of awe that I can be connected to you all while I speed through the countryside of Western NY. I think this cellphone/internet thing is gonna make it, ya know?

This trip is often filled with hours of debriefing the events of extended White family’s week together crammed in our rented house on Cape Cod. Not this year, though. Nothing but a quiet, warm feeling as we work through the math necessary to accommodate what is likely to be a bigger crew next year as word gets out about how much fun we had.

3) Games.  This is the first year that CrossFit, Inc. has included sessions and events targeted specifically toward physicians who do CrossFit. It’s a good idea, albeit one that is rather late to the gate given Coach Glassman’s interest in the intersection of fitness and health. Still, better late than never. One of the best parts of the enterprise is the involvement of Dr. Julie Foucher. Waiting until now means that she is available to participate in the growth of the CrossFit MD movement as she, herself, grows as a physician.

Occasionally I stumble upon a post in the CF MD page on FB. Without meaning to offend, CF is so new to the majority of the MD’s participating that the space looks less like a collection of docs and more like some of the threads we all used to participate in back in the days of CrossFit.com v1.o and 2.0. This is not surprising, nor is it a knock on my medical colleagues. CF is exhilarating in the early stages; the newness of CF is the same for every new adherent. I feel like I am re-reading some of the best threads on the CrossFit Forum ca. 2010 or so.

Which makes me wonder: wouldn’t it be possible to accelerate the indoc (see what I did there?) if either the MDL1 course or the prep work included a review of some of those classic Forum threads? Think Eugene Allen on programming or Larry Lindenman on planned/cycled recovery. Robb Wolfe on Zone/Paleo nutrition. I remember one on scaling the load in a WOD based on your CrossFit Total (back for the first time since the very first Games in Aromas) rather than sex, height, or weight. Pretty sophisticated analyses from some of the OGs we no longer see anywhere around CF, but relevant and on point today as much as they were back in the day. You could accelerate the impact of having doctors engaged in functional fitness by leapfrogging them through the stages of self-discovery.

My take: make healthcare more like fitness rather than making fitness more like healthcare.

4) Reunion. Our return to Ohio is a day or two later than usual because we attended the 40th Reunion of one of my high schools (I moved after freshman year). Not a typo. 40 years. Doesn’t seem like yesterday; more like last week! One funny quirk: we all referred to each other as “kids”, as in “who’s that kid over there in the green shirt?” Every one of us did it. Attending was easy since it was my turn to bring my Mom home from the Cape and she still lives in the house I grew up in.

So? How was it? Was the Reunion a meaningful milepost? An event that will in some way alter the trajectory of any of us who attended? Probably not, but then again, is any Reunion really supposed to do that? No, what happened was a group of really nice people, many of whom still live in or around town, got together and spent a few hours being genuinely nice to one another. Oh sure, Tim (our Valedictorian) made fun of my senior picture outfit (definitely deserved), and some of the goofy stuff we wrote in each other’s yearbooks got a re-reading, but all in all everyone was quite gentle with one another. Heck, we could have spent all night ragging on me after Jane pulled out a pic I signed, but she was too kind to let it go down that way (for which I will be forever grateful!).

Heck, I’ll bet Dianne only got positive responses when she got folks to play the “who has changed the most” game (I wimped out and didn’t play).

No, Reunions are for remembering as many smiles as possible from days gone by, and for enjoying whatever threads there may be that tie us together, still. There were some crazy “it’s a small world” connections that were just a hoot to discover (like the Needham connection, right Lori?!) It was fun, and flattering as hell, to discover that some of my classmates have discovered my ramblings here and elsewhere and liked them. For the record they all seem to agree that Beth is AT LEAST my Better 95%! Tim and Tom came from California to RI and got trumped by Yukio who surprised us from Tokyo. That’s just cool. No revelations, no epiphanies, just a few hours to remember that we were privileged to have known each other in whatever small way, then and now.

I had so much more fun than I expected to, from the first hugs (thanks Kit, Jackie, and Sue) to the last handshake (great party Steve), I’m so very happy to have been a part. Think “yes” the next time you get an invitation.

I’ll see you next week…

–bingo