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Sunday musings 4/16/17

Sunday musings…

1) Easter. On this, the most holy of Holy Days in all of Christendom, Happy Easter to all

2) Fitness. I find that I have become something approaching a ceremonial fitness adherent. It is not an attractive look, sadly. Fitness is a habit, one that I’ve drifted away from of late.

Time to dial it back in.

3) Tracker. The MIO Slice is the 4th fitness tracker I have now tried. And abandoned. The attraction for the slice was its “always on” measurement of PAI or Personal Activity Intelligence metric. Based on the degree and duration of exercise that elevated your heart rate above your resting rate, the PAI has been validated as a health measure that directly relates to longevity in Swedes. For a measurement geek like me, it was simply irresistible.

One sticky little issue, so common to all the other trackers extent: the damn thing doesn’t work.

Listen, if you’re gonna create a measurement that depends on tracking heart rate, it stands to reason that you should be able to…you know…measure heart rate. The Slice can’t, at least not on my wrist. 60 minutes after a WOD in which I got up to ~100% of my age-adjusted max predicted HR, my little tracker dude was still reading a pulse of 115/minute. Feeling pretty fresh and relaxed I was skeptical. Two fingers to my carotid, a $15 Casio and a 0:15 investment of time revealed that my gadget was off by a scant—wait for it—100%. My pulse was 58.

While it may turn out that the PAI is, indeed, a valid measure of fitness/health (though it skews way too far in emphasizing aerobic exercise IMO), the MIO Slice is just one more example of the folly of fitness trackers in general. They are, at best, an amusing diversion only slightly more complex than a toy. The notion that an employer can assess the health (and therefore insurability) of an employee by using a fitness tracker is ludicrous. The best one I’ve used so far basically just made crap up, but the Nike Fuel Band and its silly Fuel Points was still the most fun of the bunch.

Maybe I can score one on Amazon.

4) Invisible. A family member is about 95% of the way to being diagnosed as having Celiac Disease. This is what you have when the ingestion of gluten, a protein found in grains, incites an inflammatory reaction in the lining of your intestines. This process has prompted Clan bingo to take a deep dive into the science of this disease, and it has exposed us to some interesting patterns of behavior in our society.

You can’t see Celiac disease, and this is where the societal observations come into play. It’s not unlike diabetes, or most of the more common mental illnesses that plaque us. People who suffer from all of these look pretty much exactly like people who don’t. Same thing with folks who have Celiac disease. I won’t bore you with the science, but suffice it to say that over time the damage done to the intestinal tract from exposure to gluten in those afflicted is as severe and threatening to health as one sees in heart disease. Like all of these examples, one only knows if you are talking with someone who has Celiac disease if you are told so.

It’s astonishing how hard folks work not to believe you.

At the moment I am at 36,000 feet, flying home with Mrs. bingo from a visit with Lovely Daughter in the Low Country of South Carolina. We saw everything from “I can’t guaranty that there’s no cross-contamination in that batch of ice cream” (saving a possible insult to the gut) to “Really? Subbing rice for the noodles ruins that dish” (leavening the meal with guilt). Funny how some diseases prompt incredulity, even judgment, isn’t it? Think back a bit to our discussion about depression and suicide for another example.

One need not immerse oneself in learning the details of every “hidden” malady in order to prepare yourself for the inevitable interactions you will have. Sometimes having a specific checklist for every eventuality is simply not feasible. Here it is probably better to simply develop a kind of emotional expertise, one that allows you to accept what you are hearing as true and move to accommodation as your first response. It’s just another example of how a “kindness reflex” makes things easier.

It’s Easter. What better day to start.

I’ll see you next week…

Your “Who” Is More Important: Masters Sunday musings

Master’s Sunday is the day I think I miss my Dad the most. We’d be on the phone dissecting the action, second guessing each decision and reminiscing about our respective visits to Augusta National (sadly, neither one of us ever played there.). In many ways the game of golf was the tie that bound my Dad to my brother and me. In Jr. High School he invited us into his world; we did whatever it took to stay there.

The older I get the more important my “who” becomes. Thinking about golf today has really brought this home for me. I walked away from golf 9 years ago because I couldn’t stand to be average, let alone not very good. Doing so put way, WAY too much emphasis on the “what”, on the golf itself. It was entirely reasonable for me to take a break from golf after my injury because it literally hurt to swing a club. But 9 years?

Let me be really clear: I don’t miss the game of golf. I played in high school and a bit in college, and I’ve played literally thousands of rounds on some of the most famous courses in America. The game of golf doesn’t owe me anything at all. What I do miss, though, is being in the company of other people (mostly men, I’ll admit) who are doing something that makes them happy. More than that, since you almost always get to choose who you’re playing with, you are always in good company.

It’s been a wonderful day to remember that “who” is so much more important than “what”. I am part of a bunch of middle-aged knuckle-heads who met as fathers of pre-schoolers and then bonded on some of the most God-forsaken dogpatch golf courses imaginable. No matter. We were together. We celebrated the 60th birthday of one of our pals at breakfast where my guys regaled me with side-splitting tales of this year’s golf trip to South Carolina. If they’ll have me, next year my “new game” is likely to produce a few follies that we can laugh about during a breakfast to come.

My brother is an extraordinary golfer, as is my best friend of 40 years. My sister’s husband, too. My son will eventually become a very good golfer; his pride will accept nothing less. Lil’bingo and “Lovely Daughter’s” husband are both eager to play as well. My game will sadly fail to match up, but that’s no matter. How I play is a “what”. It always was, even though it took me an awfully long time to figure that out. What I now hope to get, and what I hope to give each time I get a chance, is to be part of a group that understands that the “what” they are doing is so much less important the “who” that they are doing it with. All of these men have asked me many times to join them, and this year I will finally do just that.

Golf, CrossFit, Cards…whatever. “Who” is the reason you are there.

 

Optimizing Effort/Outcome=Minimal Effective Dose

Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health (CrossFit). A quick mention of Eva T in Outside magazine and the program she uses with her clients sounds a lot like MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. The rate limiting factor here is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from WODs/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control.In the end no outcome worth getting happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in CrossFit and elsewhere.

Tyranny and the Culture of Grievance.

Thomas Sowell, an American sage, laments the “huge degeneration” in America toward “the grievance culture”. Indeed, I have written on this before. The near reflex response to be aggrieved, to be offended first, and to ponder and reflect later, if at all. There is a certain and definite lack of goodwill, a reluctance or refusal to extend goodwill, or the assumption of goodwill, on the part of others. Rather, the culture of grievance mandates that we impugn malintent in the deeds and actions of others, especially if in some way those others (them others) have values or beliefs that don’t completely and consistently line up with those of the aggrieved.

On CrossFit.com, especially in a prior “Wild West” era, this phenomenon could be seen every 4th day with the publication of a libertarian-leaning article, or something that ran counter to the progressive drumbeat in the halls of academia or government. The simple act of speaking against the orthodoxy of a group sent said group into a paroxysm of aggrievement. This is no different from what we see in the now limitless wilderness of the internet and social media. Context is irrelevant. Intent is irrelevant. The provenance of the offering is irrelevant. Once unleashed the only thing that matters is the bleating of the aggrieved, however large or small their numbers might be, however trivial the insult, if it can even be called an insult at all.

While away at a professional meeting this weekend a new ad campaign for a product in my professional world dropped. It is irreverent and funny, and it was conceived and created by members of the same group that is on the receiving end of the joking. There were three reactions, as is probably typical of something like this. One group thought it was clever and funny, and realizing that it was the first in a series this group looked forward to seeing where the campaign was headed. By far the largest group saw the humor, realized what the intent of the campaign was, acknowledged that the humor was harmless and without intent to harm, but cringed at what was a rather large misstep. Seemingly in love with the joke both the creators of the campaign and the company that authorized its launch failed to see that, while funny, it was in very poor taste. This second group shook its collective head at how tone deaf the company was.

The third group was mortally wounded by offense. The aggrievement was existential. A firestorm was unleashed upon the company. The agency and its employees were excoriated despite their inclusion in the group supposedly aggrieved, saved only by their anonymity as individuals from a very public shaming among an influential cadre of the advertised company’s customers. That ire was directed at the CEO of the company, an exec known quite personally by a majority of his/her customers. The attacks were pyrrhic and personal despite an obvious lack of malintent. There appears to be no amount of shame that can possibly atone for the sin of humor without intent to offend that misses its mark and does just that, regardless of the size of the cohort offended.

The grievance culture allows progressively smaller and smaller numbers of individuals who care about narrower and narrower issues to hijack larger and larger institutions and paralyze them. One need only look at the tragicomedy that played out 2 weeks ago at Middlebury College in Vermont to get a sense of what this means. A (pseudo-) scholar was invited by a conservative student organization to speak. Mind you, this speaker’s ideas have been so roundly disparaged that even the members of that conservative club did not support them; they invited him in order to have an opportunity to debate the ideas. Alas, other members of the Middlebury community were offended by the mere presence of on campus of one who could hold ideas that are so antithetical to their own. This group declared that their grievance superseded any and all rights and privileges of every other individual or group, including the group that invited the speaker and whose members largely shared the opinion (but not the aggrievement) of the offended.

This small minority drove the speaker from the stage. They attempted to drone out an internet broadcast of his speech with repeated pulling of fire alarms. In the ultimate expression of their grievance they assaulted a faculty member who was driving the speaker out of town after the event, sending her to the hospital. It is particularly instructive that the group of the aggrieved chose this course because the speaker’s ideas and positions have been so roundly and completely debunked that it would probably have taken less effort and have been more effective to simply simply hoist him on his own petard on the stage and watch him swing.

I find myself in group 2 in my professional example (amused but somewhat astonished that experienced business people could be so tone deaf) and similar to the group that invited the faux-controversial speaker (contemptuous of pedagogy that cannot be supported with anything other than belief). Mr. Sowell is a true A-list man of ideas and letters, while I am a C-lister with B-list aspirations. Nonetheless I share with him his sorrow at this degeneration of American culture, this insistence that a difference of ideas begets a grievance that supersedes not only the rights of those who disagree, but also the very possibility that other ideas might exist. Replacing a culture of ideas and ideals with a culture a grievance is a step backward for society, perhaps for civilization.

The tyranny of the minority begins with a tyranny of ideas, waged with the weaponry of grievance.

 

Sunday musings: Opiate Overdoses and American Health

To the victors go the spoils. History is written by the victors. Truer words, eh?

I find myself turning off all manner of information outlets of late because they are all just so many repeats. The other side of that victor coin is that the vanquished simply repeat the lines of the victor when s/he was losing. Look no further than the kerfuffle about the Accountable Care Act. If you remove time stamps and the naming of characters what one hears or reads is essentially unchanged today from what was said or written some 7 years ago.

Try it.

My sense of ennui is so strong that it is fairly paralyzing. Is there no one out there who is willing or able to propose something that is truly new? Can we not even even come up with new or original complaints and criticisms? Must we be doomed to this endless cycle of sameness about seemingly everything?

It’s almost as if the vanquished do not so much fail to learn from history but that they work very hard to faithfully replay history in exquisite detail, dooming us all.

We are looking at a true health crisis in the U.S. In 2016 some 40,000 Americans died from opiate overdoses. This is more than the number of deaths by firearms by a factor of 4, and is similar to the number of deaths in automobile accidents. This morning I read a startling statistic: 7 million working age men are out of the employment market, and 1/2 of them take painkillers on a daily basis. Crazy, huh?

On CrossFit.com we agree that there is a general crisis of health in the American populace stemming from over-consumption of calories (most of which are high glycemic index carbs) and under-consumption of physical activity. Another equally startling story in this week’s news is the growing acceptance of excess body weight fat as some kind of new normal, a normal that should somehow be institutionalized.Total capitulation, that.  In this discussion one must add the over-consumption of alcohol, because countless studies have shown that this legal substance is responsible for all kinds of negative health effects, both direct and indirect. (As an aside, it does give one pause when one considers the possibility of legalizing another neuro-depressant, marijuana). As if this isn’t enough, we now must add to this toxic recipe the ingestion by any route of opiates.

The U.S. is regularly taken to task for its failure to sit at the top of the world’s life expectancy leader board despite spending the largest amount per capita on healthcare in the world. This criticism becomes more and more unreasonable as we dive further into what it is that actually drives statistics such as life expectancy. Deaths from overdoses are illustrative of the folly of conflating health and healthcare: there is nothing in the healthcare system of treatment that drives this statistic, and the death of these primarily young people has a disproportionate effect on the life expectancy statistic in which it is years lived that we are counting (and losing).

What, then, is to be done, especially in the setting here of health-conscious individuals? It behooves each of us to take a bit of personal responsibility in the discussion and pledge that we will utilize accurate nomenclature, and in turn demand that everyone else in the conversation do likewise. Health and healthcare are not synonyms. Likewise, healthcare and health insurance (itself somewhat of a misnomer) are not the same; one does not lose healthcare when one does not have health insurance, and for certain the ownership of a health insurance policy does not guarantee one access to healthcare. Indeed, because the outcome was inconvenient to the majority of entrenched healthcare interests, the landmark study of Oregon Medicaid recipients that showed no improvement in health outcomes in those with Medicaid compared with those without has been mostly ignored and purposely forgotten. We need to engage in this conversation, but do so with strict fidelity to meaningful terms.

From there we should lead in whatever way we can. This effort is not at all about the treatment of disease, at least not as far as we here are concerned, but rather one of Public Health. There are quite specific areas to be addressed if we wish to effect change. Each area must be subjected to a root cause analysis. Over-consumption of low-quality carbs is near and dear to CrossFit, Inc., and the battle against “Big Soda’s” influence has been engaged. Other influences such as agricultural subsidies should have a similar bright light shined in their direction. How is it that the dramatic reduction of drinking and driving has failed to render deaths from drunken driving a statistical anomaly? Perhaps someone can convince one of those know-better do-gooder billionaires globe-trotting in search of a trendy problem to throw money at to look a bit closer to home when they apply their famous intellect to new thinking about old problems.

As to the tragedy that is opiate overdose deaths, can we please have someone with no skin in the game be given no-risk access to any and all applicable data and just turn them loose? Some guy did a deep dive into the issue of scrubbing the internet of all vestiges of child pornography using a combination of massive computing power and an outsider’s view. Give someone like that the ability to examine the entire opiate ecosystem to uncover some of the hows and whys so that we can make some decisions of the whats of our response with more than just our typical SOP of some self-designated, conflict-of-interest-infected expert who declares that his/her solution should work because of what they are sure must be going on. This seems to be a new thing, after all, and rather young, too. Prior opiate societal infestations surely share some aspects with our present crisis, but I don’t recall the opium dens in the days of the Crusades so routinely offing their customers.

Anything that can be measured can be analyzed. Anything that can be analyzed can be altered utilizing the results of that analysis. What is needed is the double-edged sword of courage to uncover an unpleasant truth, and strength to set aside all manner of short-term personal gain in favor of a long-term solution for societal benefit.

We ought not let 40,000 lives representing hundreds of thousands of years not lived to be lost in vain.

CrossFit Programming and the CrossFit Open

CrossFit Open workout 17.2 will be announced tonight. This is a good time to reflect on the different aspects of CrossFit. There is a tension that exists between CrossFit, the strength and conditioning program and CrossFit, the Sport of Fitness.This tension is usually expressed in the guise of criticism of various versions of CrossFit programming. What’s very interesting is the lack of tension on this topic among the truly elite CrossFit athletes. If you look at their programming it looks like they are training to become…wait for it…really good at CrossFit.

Weird, huh?

What does that mean, anyway? Good at CrossFit? This is a perfect time for you to both re-read the seminal article “What is Fitness” in CFJ #2 and to recommend it to anyone who is either curious or unsure as to what constitutes CrossFit, and for the sake of this musings, CrossFit programming.

CrossFit is the pursuit of a broad, inclusive general fitness where fitness is defined as work capacity across broad time and modal domains. In the vernacular, CrossFit trains and tests us to move larger loads further over a longer period of time. In order to do this Coach has identified 10 Essential characteristics of Fitness as so defined, each of which needs to be equally expressed. Cardiovascular/Respiratory endurance; stamina; strength; flexibility; power; speed; coordination; agility; balance; accuracy.

Fitness as defined by CrossFit and Coach Glassman includes a precisely balanced degree of each of these 10 elements, with no one element being more of less important than any other. The CrossFit Games, and the athletes who take part, are simply an expression of the farthest right side reaches of the fitness Bell Curve. Look carefully and you will see that the events ask for equal competence in all 10 Elements; the athletes are simply better than the rest of us across the board. They get there because they do more work on all of the 10 Essential Elements.

While we here, and most folks in Affiliate gyms, can assume agreement on the benefits of seeking Fitness as defined by CrossFit, this is not to say that either our definition of fitness or our particular way of seeking it (expressed through our CrossFit programming) is appropriate for every individual. Some people just like to run really long distances, while others are happiest when they lift really heavy stuff. Still others are interested only in the appearance of their body, and their entire fitness program is geared toward achieving a particular vision or visual. There is nothing inherently wrong with any of these desires, nor anything inherently wrong with the programming necessary to achieve these outcomes.

It just may not be CrossFit.

Because of this, the issue of programming is always on the table. Is there an optimal version of CrossFit programming? People take turns at supporting and denigrating the programming on the Main Page and in Affiliate gyms. For example, I think there are legitimate criticisms that can be leveled against gyms that do not emphasize proper movement. Countless efforts are made to “improve” on the model you see here on .com. Some of these alternatives make sense, while others IMO are not really alternative CrossFit programming but alternatives to CrossFit itself. Most of these, indeed most of the conversations in general, have to do with strength and strength training. Are you (is anyone) strong enough? Will CrossFit.com or another version of CrossFit make you strong enough?

The 10 Essential Elements found in CFJ #2, “What is Fitness”, are also posted on 030530 ( ironically on a day when heavy Deadlifts were prescribed). Pretty much all of the conversations noted about programming revolve around the premise that strength is somehow more important than other elements of fitness. Reasonable people can disagree on this point, but as a premise in discussing CrossFit the notion that strength is a, or the, primary element of fitness has no standing. There are 10 elements of Fitness, each no more and no less important than any other if we are seeking a broad, inclusive general physical preparedness that we call “fitness”. Full stop.

Whoa, wait a minute there Mr. bingo, aren’t you the guy who co-wrote an article called “Strong Medicine” introducing a programming alternative called “CrossFit Strength Bias”? Didn’t your home gym programming have supplemental strength training per CFSB principals since the time it opened? Isn’t that statement there just a bit, oh, duplicitous? Forked-typing?

Nope. Not at all. You see, if you read the original article you will see that CFSB is one way to address a DEFICIT in strength relative to the other 9 Essential Elements, not a program meant to gain strength at the EXPENSE of the other 9. As such it, like some others, is a program for the masses, for a CrossFitter who perceives a hole in his/her fitness that needs to be addressed, not at all unlike a CrossFitter who does supplemental work on balance or flexibility. Additional Element-specific work, be it strength or agility or whatnot, that drives continued balance and improvement in all 10 Elements is very much CrossFit. All versions of CFSB (I am now using the  newest protocol, v3.2) are designed to be one way to address this imbalance. There are others that you may enjoy more (Wendler, Westside, etc.), and just like having personal goals, there is nothing inherently wrong with another supplemental strength program as long as it works without the need to sacrifice other competencies.

Whether you are looking at members of a CrossFit Box or competitors at the CrossFit Games, CrossFit is outcome based. The outcome desired is a broad-based fitness comprised of equal quantities of each of the 10 Essential Elements. What goes into the left side of the hypothetical Black Box should produce Work Capacity Across Broad Time and Modal Domains if the Black Box is a CrossFit athlete of any type. An increase in your Deadlift brought about by concentrating on strength training at the expense of cardiovascular/respiratory endurance will be accompanied by a decrease in your 5K run time and vice versa. This may be precisely in line with your goals, but it is not CrossFit as defined by Coach Glassman and expressed at its limits by CrossFit Games athletes.

Programming for CrossFit should be aimed first and foremost at CrossFit outcomes. What you find on CrossFit.com, and what you should probably expect to find as the primary goal in an Affiliate gym, is programming that seeks to balance all 10 of the Essential Elements of Fitness, increasing all of them in an effort to produce increased work capacity across broad time and modal domains.

A demonstration of CrossFit programming will be available online tonight. It can be used as a workout or a test.

 

Sunday musings 2/26/17: Information Offloading

Sunday musings…

1) Hinnie. A mule/horse cross used for work in hillside vineyards in Portugal. Hardy and sure-footed.

Even Beth didn’t know that.

2) Modernity. Synonym for progress. Or not.

3) Business. “Business is never just business.” The Godfather.

It’s amazing how true this is. How false rings the phrase: “It’s just business.” Business, like politics, is ALWAYS personal. Someone wins; someone loses. Someone is brought along to victory without making a contribution, given a gift. Someone is collateral damage. Somewhere along the line the Hinnies go to work, but the ox gets gored.

4) PAI. Personal Activity Intelligence. This is a new fitness measurement from the company Mio Global that proposes that one can measure fitness through a proprietary formula that takes into account variability in your heart rate associate with activity. It owes its claim to Scandinavian data over some 40 or so years that shows an increased longevity associated with a higher PAI.

I put my sensor on yesterday and will embark on a bit of an exploration. As anyone who has read my stuff knows, I am actively in the process of developing a single metric for health, one that includes Fitness, Emotional Well-Being, and traditionally Western health measures. Call it the OHI or Objective Health Index. A serious challenge to any such measurement is that it must be accessible to the overwhelming majority of people anywhere. Any successful effort must also be simple and relatively easy to understand as well. Heart rate is all of that.

After a single session in my classic CrossFit garage gym it is evident that PAI is not an adequate stand alone proxy for fitness. Like almost every such proposal it is only really an effective measurement of cardiovascular fitness. While we would all agree that this is a critical element of fitness, we in the CrossFit universe would–and do–scoff at the notion that all one needs to do to be fit is run or bike long distances. This measurement, like all others, will need a companion integer that allows us to add strength to our Fitness variable.

Still, this stands to be interesting.

5) Offloading. Why do I write? Why do I sit down and use time that could otherwise be put to use in the gym, or in the office, or even just hanging with the Man Cub? As a long-standing lover of language I am always on the lookout for the best vocabulary to explain concepts I sometimes struggle with. Offloading is a term that is used in this case to describe what it is that humans do with information that they do not need to keep on hand in “useful memory” space.

This is what I do with ideas when my “wetware” memory is full.

This is hardly new. Indeed, the sturm und drang associated with the mega-trends in education, etc. associated with our massive information/recall apparatus that is the internet actually has its origin in the Greek era of Socrates and the transition from an oral tradition to one in which teachings were written. (HT to Frank Wilczek). Prominent adherents to the oral tradition such as Socrates and Simonides argued forcefully that the advent of the written transfer of information would weaken the mind and produce an inferior type of intelligence. In a fascinating and delicious ironic twist, all we know of either of these men we know because someone else wrote down what they recalled hearing.

In my day job we are still encased in a paradigm in which information is transferred from teacher to student and then tested to see if that information has been committed to memory. Imagine, with the explosion of data now available in the world of medicine we test (and test, and test…) both new doctors and established ones to see if they remember a certain percentage of facts, regardless of how often those facts come into play in the act of practicing medicine. The CrossFit analogy is to test a trainer on the precise moment that the obturator engages in the deadlift. One neither needs to know this to teach the deadlift, nor does one need to have memorized this in order to have it on hand in the gym. So, too, in medicine.

Please don’t get me wrong, I still enjoy knowing a bunch of stuff and being able to call up that stuff without needing to use my Google-Fu. The reality is that we have made a move from memory in written form to memory in digital form that is just as profound and disruptive as that from oral to written. We have only to remember where it is we have stored our memories, our books and our music and our musings.

And our passwords. We still need to remember our passwords.

I’ll see you next week…

–bingo

Sunday musings: Think for Yourself

Sunday musings…

1) Aperitivo. 6:00 PM in Italy means retreating to a soothing spot for a drink and a small snack of some sort. Saying it that way really doesn’t do “aperitivo” justice in much the same way one would insult a siesta by calling it a nap.

One doesn’t have a slice of pizza and a Bud Light for Aperitivo.

2) Blend. In the wine world there is an age-old conflict over which is better: single vineyard or blended wines. It is no different in the wider spirits community that includes whiskey (or whisky, if you will) of any and all sorts. What the question boils down to is a simple one in which we are asked to determine if we value a unique, somewhat difficult to produce experience more or less than one that is reliably consistent. Is a wine produced entirely from the famous To Kalon vineyard more special than one that uses To Kalon grapes as part of a blend meant to be consistent year after year? Is single malt scotch which varies over the years a more pleasing experience than, say, Johnny Walker blends?

And what, for Heaven’s sake, does this have to do with fitness?

Of late I have found myself working a bit of supplementary work into my CrossFit training. This additional work is not on top of my CrossFit–I’m kinda old and additional volume just crushes me now. Rather, it is inserted between WOD’s for the dual purpose of continually working on the weaker links in my 10 Essential Areas of Fitness, and it is not really varied at all. I have come to liken Crossfit when constantly varied as akin to that single vineyard red wine: you get what the vineyard gives you in any given growing season and make the best wine you possibly can in that year. “Fran” comes up on a day when I am doing CrossFit and I feel young and strong, so I do it As Rx’d, for example.

My supplemental work comes at regular intervals and is quite planned and predictable. Longer, slower, lower intensity workouts in the oxidative pathway are easier on my joints, and they have the added benefit of allowing me the luxury of higher order cognitive engagement during the workout. Who among us is able to use anything but our reptilian brain during a full-on, high intensity CrossFit WOD? The latest version of CFSB provides me with a consistent schedule of full-body, functional movements that I am hopeful will allow me a lifetime of unassisted elevation off the loo. More along the lines of Opus One, the famed Napa Valley blend that aims for a consistent character each year.

The point, of course, is that neither is inherently better, though either may be the better choice at a given time and under given circumstances.

3) Commentary. How do you feel about celebrities of any sort offering up commentary on issues that are far afield from the activities that made them famous? While I confess that I am about to boycott any and all manner of reporting on what someone in power has said but not done, or might/could do but has not yet done, this is not an inquiry into what is opined so much as who is doing the opining. Does the fact that one is famous give one permission to speak on issues outside your direct sphere of influence, and if it does, are we to give more weight to the opinions of the famous simply because of their fame?

Why, for example, does anyone care about what George Clooney thinks about, well, anything?

I’ve long found it fascinating that talent and achievement in sports and entertainment seems to give both the famous and their followers the notion that a familiar name in, say, football makes one an expert in, oh, environmental policy. To be fair there are some celebrities who use their hard-won free time and riches to become experts in something that is far afield from their day jobs. Matt Damon and his efforts to provided potable water in developing countries comes to mind. Since it is not possible for a black man to no longer be black once he has reached a pinnacle in sports or entertainment it is entirely reasonable and appropriate for him to comment on social issues such as race, discrimination, and social mobility if he so chooses. Here I think of LeBron James and his increasing engagement in this kind of discussion.

What I am thinking about is more the question of whether celebrity ought give the speaker more gravitas, more influence in the discussion. Why should I care what the flavor of the day in Rap music thinks about immigration policy? Or that quarterback who is constantly being interviewed about reproductive rights? There isn’t an airsickness bag big enough to contain my reaction to the braying of the glitterati on both sides of the aisle in our last presidential election cycle. Why does anyone care who Tim Robbins or Kid Rock will be voting for and why?

Listen, I’d love to tell you that I am famous, and that this little rantlet is a classic pot calling the kettle black thing, but there are about 11 people who really read my drivel and 10 of them think I’m full of shit. No, what I’m saying here is really, really simple: think for yourself. Celebrities have a passkey to the bully pulpit, but they rarely have anything other than their fame that allows them to stake their claim to the podium. Seek out the thoughts and opinions of people who may be smarter than you are in a particular area and listen to what they have to say. Consume and digest views that are different from your assumptions, just realize that this dish should be consumed based on its quality, not the fame of the chef. Neither beauty nor fame nor fortune bestows upon the fortunate anything but an audience.

You don’t need the opinion of a celebrity. Think for yourself.

I’ll see you next week…

–bingo

Clutter

In the never-ending battle for supremacy on the countertop, my wife Beth and I are ever engaged in a tug-of-war over clutter. Though we were until very recently unaware that this is a THING. Like, with a guru thing, one that people engage in quasi-worship and for which they pay real money. Some “Kon Marie” or something like that. Totally news to us. You?

The anti-clutter thing, such as it is, is dramatically more than the comical little game that Beth and I have going on. Adherents think there is a true spiritual goal, an attainable endpoint that must be reached and then maintained. And not just on the kitchen counter mind you. No, no…on every counter, real or virtual, in every “room” of your life. Now, don’t get me wrong, there is certainly a place for a bit of order in a life, and we could all stand to be a little lighter when it comes to our stuff, but the fervor and the zeal with which adherents of this THING take it is spooky. Weird bordering on abnormal. It reminds me of the kitchen drawer in the house owned by Ben Affleck’s character in The Accountant: one fork, one spoon, one knife.

There’s only one person living there, after all.

Like everything else we can find merit on both sides of the clutter coin. For example, my workouts in the Casa Blanco garage gym have been of much higher quality since a little construction project was completed and the Men With No Last Names cleared out along with all of their stuff. My cleans have been much better now that they are performed in a clean garage. The pleasure that Beth gets from seeing a clean kitchen counter would be comical if it wasn’t so genuine, and frankly my pleasure at seeing her so happy is pretty significant, too. (Note to self: Beth will be home in 2 hours; get cracking at clean up).

There’s a flip side, though. Apparently there is research that validates my little slice of the countertop: people are more creative if they are surrounded by a bit of clutter. As I muse my computer peeks out from a pile of old newspaper clippings, magazines and books, and various chochkies from our life as it is today. Oh, and there would also be the Man Cub’s toys. They are apparently to Kon Marie what kryptonite is to Superman. Though we now live in a tiny cottage, a life that has us in a constant state of “purging” our things, what remains is not so much clutter as it is a measure of our lives and our loves. A clean surface around my keyboard leads to a blank screen. One woman’s clutter is another man’s muse.

I guess this is really just one more essay on the concept of “enough”. The monastic pursuit of any unreachable, unachievable outcome is one that must be accompanied by some degree of unhappiness in my opinion. What joy is there in the perfectly uncluttered closet complete with one pair of perfectly ironed and folded socks if all your eye sees is the possibility of going to work barefoot?

It all makes me think of an essay I read last month about clutter. Have you ever noticed, as did the author, that the arch villain in every movie you’ve ever seen lives in a perfectly ordered home, devoid of any clutter whatsoever? The hero, on the other hand, can hardly find her feet, let alone her socks, as she wades through the clutter of her tiny little hovel. That villain has a plan, meticulously laid out and ready to be put in play with single-minded zeal. Funny thing, though: the hero always seems to make her breakthrough with creativity, flexibility, and something she finds among the clutter, right where she knew it had to be. Every single time.

Now that I think about it, we do have pretty impressive swaths of countertop that are as devoid of clutter as the desert in Lawrence of Arabia. No villains around here, though. I have my tiny little corner of the kitchen table, and as long as you don’t move my “cheese” I know where pretty much everything is. That doesn’t make me the hero, though.

Can we talk about my wife’s closet?

Equality is the Enemy of Enough

“Life’s not fair.” –Scar

What does equality mean? What does it mean to be equal? This came up this week in my day job. A study was done that proports to show that male and female eye doctors are paid unequally. The conclusions are false at the outset in this particular case because by law, services in this particular arena are paid exactly the same no matter who performs them, when or where. Unfortunately, the sensational lede taps into all kinds of notions of fairness, and all kinds of perceptions about what people assume must be true, that women make less than men for equal work. There is no question that this is the case is some walks of life, but interestingly the data (some of which the authors ignore in their quest to prove their preconception) proves otherwise in medicine. An opportunity to examine real differences in how men and women practice medicine is thus lost in the pursuit of an examination of the spiritual quest to combat inequality, even where none exists.

Is this the unicorn of equality? Is payment under government programs the only place where equality actually exists? Heck if I know. What interests me is the fact that the first assumption is that inequality is present. Inequality is the default setting. That there is an inherent degree of unfairness in pretty much any and every setting. Know what I think? Equality doesn’t exist. It cannot exist if we are to have an ever-improving world. There is nothing unfair about that in the least.

A just civilization establishes a floor below which allowing people to live is ethically wrong. For example, in healthcare it is my contention that we have a moral obligation to see that every citizen has access to care when they are sick. Inherent in this contention is that there is a basic level of care that meets this moral obligation by ensuring the same outcome as any other level of care. One could apply this same concept to food, clothing, and housing without missing a beat. We can think of the rights enshrined in the U.S. Declaration of Independence as a proxy for this baseline if you’d like. Life, liberty, and the pursuit of happiness make a very fine baseline.

One’s right to “life” necessarily includes a right to be fed, would you agree? Equality would mean that if one among us dines on Beef Wellington, than each among us must do so as well. This is where unthinking and unquestioning fidelity to “equality” brings you. In so doing it forces everyone to expend energy protesting “inequality” better put toward fulfilling the moral obligation to see that no one goes without protein. In healthcare we see all kinds of protests againts the inequality of care demonstrated by the horror of a VIP of some sort or another recuperating from a procedure in a luxury suite, while the proletariat must recover in the equivalent of a Hotel 6. The reality is that the outcomes will be equal; the moral obligation has been fulfilled. Above a basic level in pretty much any domain you wish to examine, equality does not exist. Sorry. Scar is right. Life’s not fair.

Is he really though? Saying that it’s not fair is the same as saying that inequality above that level at which everyone has a right to live is wrong. Here is where I part company with those who hew to this viewpoint. What does it matter that someone drives a Cadillac while another drives a Kia? Do both not get you to work on time? Or that Beef Wellington again: do you not get the same amount of protein from a hamburger? The example I am using in another conversation about equality in healthcare is similar: if a medicine is effective taken 4 times a day, is the fact that someone can pay more for a version that must only be taken once a day a measurement of unfair inequality? I vote “no”.

My strong feeling is that energy spent in some way protesting “equality” is energy that is not expended on the much more important task of fulfilling the moral obligation of raising everyone to that acceptable basic level. In may, in fact, work against that effort. That constitutes unfairness in my opinion. Advocacy and protest should be directed there, toward making sure that everyone has that most basic obligation covered. Once universal entry is accomplished across all applicable domains, the next task is to continually raise that basic level for everyone, no matter how far the gulf may be between that level and whatever the “sky’s the limit” level might be. One need only look at “poverty” or “hunger” and how the bar has moved ever upward there to see how this might work.

We have a moral obligation to see that true rights are available to all. It is unfair to those who have not yet achieved that most basic level when efforts to help them are diverted to the pursuit of an unachievable conceptual goal that neither feeds nor clothes nor cures those in need: equality.

 

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