How Do You Think?

The use of Video Conferencing to teach young children is a new challenge for everyone involved.  In order for it to work, YOU and the teacher or therapist (instructor) MUST FIRST TEACH YOUR CHILD HOW TO LEARN IN THIS NEW WAY.  Teaching this new skill will likely be the first thing the instructor will want to work on.  Without the ability to attend to and participate in instruction, your child will not likely benefit from video conferencing.  The acquisition of this new skill requires careful planning and thoughtful instruction. 

Strategies that will help make this work:

1. Set the Environment Up for Success. There are several extremely important objectives here:
   1. The instructor must be very clear with you about their goals, objectives, and expectations. You will be the instructor’s eyes, ears, and hands, so if you need help or support – please ask for it!
   2. Work through the technological barriers FIRST. Download the necessary apps and/or programs as guided by the instructor and be prepared to practice with the instructor before your child is asked to participate.  Getting the technology set up and working can be the most challenging step in this entire process.  Patience is important.  You should also know in advance what device will be used, how it will be used, and where it will be used.   
   3. Set up the environment in order to eliminate competing distractions. The specifics of this will depend on your child and your home, but your child will need a good learning environment (e.g., a quiet room, no siblings watching TV or playing nearby, and minimal access to distracting toys, etc.).
   4. The instructor may suggest using visual schedules, When-Then contingencies, and preceding the session with sensory activities that increase focus. The instructor should help you get these things set up.
2. The Instructor will likely want to start slowly and focus on making it fun. Once the technology is working, you know what to expect, and the environment is set up for success, the instructor will likely start by having fun with your child.  They will minimize demands so that your child learns that this video conferencing thing is fun and that their instructor is just as fun on the screen as in person.  The early sessions may be kept short (perhaps very short).  This will require pre-planning – you will likely have to help the instructor know what your child enjoys at home so that they can tap into those interests.
3. Use Positive Behavioral Strategies. The instructor will want to work out a plan for ongoing reinforcement of appropriate attending and participating behavior during the session.  You may be asked to provide those reinforcers during the session.  They may also suggest that you follow the session with a special activity, toy, or treat to reward their hard work (even if it was just play).  This too will require advanced planning and ongoing communication with the instructor.  Please understand that these rewards are for success during the session and that they are important tools in teaching this new skill set.
4. Demands will be placed gradually. The instructor will SLOWLY start folding in small demands as your child’s attending and participation skills improve.  The instructor should initially prioritize making your child feel successful during this new type of instruction.
5. Be Attentive. Both you and the instructor should continually attend to the child’s level of interest in the activities, his or her level of focus, and how conducive the environment is to learning.  It may be necessary to adjust and modify expectations throughout the session.  The instructor will try to end the session before the child’s interest and motivation disappears.  Also they will want to end it on a positive note.  Talking about how the session went, at the end of the session, will be important to the ongoing success of this approach. 
6. Continually Adjust Strategies and Expectations. It will be important to continually assess, adapt, and adjust the strategies, as well as everyone’s expectations throughout each session.  The same is true regarding the quality of the learning environment and the use of reinforcers. 
7. Have Fun & Make it Fun! Brainstorm games, the use of favorite toys, stories, and songs, as well as activities (including physical movement) that can be implemented while video conferencing.  Be creative, be silly, and remember that rule number one is: Have Fun!

Developed by Dr. Gerald T. Guild, PhD, Licensed Psychologist and Behavior Specialist at The Children’s League in Springville, New York and by Kimberly Guild, MS, SLP-CCC, Speech Language Pathologist at Cattaraugus-Allegany BOCES in Olean, NY

The use of Video Conferencing to teach young children, particularly those with disabilities, is fraught with many NEW challenges.  In order for it to work, the instructor MUST FIRST TEACH THE CHILD HOW TO PARTICIPATE ADAPTIVELY.   It is essential to prioritize gaining the instructional control of the student over implementing other IEP objectives.  Consider instructional control in this context, as a new skill-set that is foundational: necessitating careful planning and thoughtful instruction. 

Key Strategies:

1. Set the Environment Up for Success. There are several extremely important objectives here:
   1. Be explicit with caregivers about your goals, objectives, and expectations – they are your key allies and instructional assistants in this process (i.e., your eyes, ears, and hands) and you absolutely need them to work with you to make this happen. This is new to them too, so you must teach them how to teach, and you must keep them on your side.  They will need your guidance, support, and compassion. 
   2. Work through the technological barriers FIRST. Help the caregivers acquire the necessary apps and downloads, and learn the procedures necessary to video conference BEFORE attempting to meet with the child. Practice with the caregiver first, as these challenges must not be underestimated.
   3. Teach the caregiver how to set up the environment in order to eliminate competing reinforcers and distractions. The specifics of this will depend on the child and the resources within the home, but you must discuss with the caregiver what device will be used, how it will be used, where it will be used, and they must understand that their child absolutely needs a conducive learning environment (e.g., a quiet room, no siblings watching TV or playing nearby, and minimal access to competing reinforcers, etc.).  
   4. Also consider the use of visual schedules, When-Then contingencies, and prior to the session, sensory activities that will likely increase the child’s level of focus.
2. Start Small and Focus on Pairing with Reinforcers. Once the technology is working, the caregiver understands what to do, and the environment is set up for success, start by having fun with the child.  Minimize demands at first and just focus on making sure that they have fun with you.  Teach them that this video conferencing thing is fun and that you are just as fun on a screen as you are in person.  Remember to keep it short (perhaps very short).  This will require pre-planning, knowing what the child enjoys at home, and tapping into their inherent interests.
3. Use Positive Behavioral Strategies. Work out a plan for ongoing reinforcement of appropriate attending and participation during the session and follow the session with a contingent highly potent activity, toy, or treat.  This will require advanced planning and ongoing communication with the caregiver as they are the likely providers of the tangible reinforcers.
4. Carefully Approach Demands. Once you have a happy participant (which may take many short and fun visits), SLOWLY start folding in small demands – addressing skills they have already mastered at school.  It will be important to prioritize making them feel successful in order to maintain the child’s motivation.
5. Be Attentive. Continually attend to the child’s motivation, focus of attention, the environment, and the needs of the caregiver as you “work” with the child. Adjust and modify your expectations as the session evolves, try to end it before the child’s interest and motivation disappears (end it on your terms AND on a positive note), and debrief with the caregiver following the session. 
6. Adjust Your Strategies and Expectations Continually. Always assess, adapt, and adjust your practice, your expectations, the environment, and your use of reinforcers. 
7. Have Fun & Make it Fun! Brainstorm games, the use of favorite toys, stories, and songs, as well as activities (including physical movement) that can be implemented while video conferencing.  Be creative, be silly, and rule number one: Have Fun!
8. Ramp Up Demands Slowly and Carefully. As Grandfather Guild always said “The hurrier I go, the behinder I get!”

Developed by Dr. Gerald T. Guild, PhD, Licensed Psychologist and Behavior Specialist at The Children’s League in Springville, New York and by Kimberly Guild, MS, SLP-CCC, Speech Language Pathologist at Cattaraugus-Allegany BOCES in Olean, NY

Very little is normal today and it can be very hard, even for the youngest among us.  Perhaps the hardest thing for your children is the departure from the regular routine of going to school and being with their friends and teachers.  Even harder still may be the pressure on you to provide for your family’s safety and well-being – oh, and keeping the kids happy and learning.   Some children will respond to these times with increased behavioral challenges, sleep problems, toileting regression, and heightened general agitation.  Sound familiar?  Here are TEN TIPS to help you get through this.

1. TAKE CARE OF YOU! – Your children need you – not only in the home, but also your strength and reassurance. This means you need to stay healthy both physically and emotionally.  Do the things that promote physical and emotional well-being (e.g., avoid the virus, exercise, get adequate sleep, avoid excessive screen time, and focus on the positive things you can control).  If you are struggling to cope with all this, contact the Substance Abuse and Mental Health Disaster Distress Hotline at 800/985-5990 or and the Crisis Text Line, an anonymous texting service available 24/7. Starting a conversation is easy. Text GOT5 to 741741
2. MAINTAIN REGULAR ROUTINES – Although going to school is no longer an option, it is important for your children to have some predictable NEW ROUTINES. Keep bedtime routines the same everyday, build some structured learning time into their day, and perhaps most importantly, actively play with your child everyday – at regularly scheduled times. Consider talking with your child’s Teacher and/or Speech Therapist – they may be able to help you build a daily visual schedule.
3. PROVIDE REASSURANCE – Your children may need to be reassured – although they may not comprehend the full scope of what is going on, they do know that something is different. They may also absorb your stress – so try to keep your cool in their presence, listen to them, speak kindly, and assure them that you are doing all that you can do to keep them safe.
4. PAY LOTS OF ATTENTION TO THE BEHAVIORS THAT YOU LIKE – Often children use the most efficient strategies to get your attention, regardless of whether it’s positive praise or getting yelled at. If they are seeking lots of negative attention – try to refocus your attention on the good things they do – making it easier for them to get your positive praise and attention – and ignore (to the degree you can) the negative attention seeking – making undesirable behavior a less efficient way to get your attention.
5. PLAY WITH AND READ TO YOUR CHILDREN – These are very powerful educational tools that also help manage behavior – use them a lot. Make it part of the routine.  As I say at the preschool where I work: “Rule #1 – Have fun with the kids.”  Silly play routines are also engaging and FUN.
6. RUN ‘EM RAGGED – Physical exercise is another powerful tool to decrease anxiety and promote good sleep routines. This is true for you as well.  For kids, this means active physical play (e.g., chase play, supervised outdoor play, scheduled and supervised jumping and climbing activities).
7. LIMIT SCREEN TIME – Media coverage of COVID-19 is extensive and overwhelming. Check into the news two times a day and entirely avoid exposing your children to it.  Also, avoid using excessive screen time to entertain your children or escaping yourself when you could be positively attending to your children.
8. PRACTICE GOOD HYGIENE – Lots of information out there on this – wash your hands a lot – routinely avoid unnecessary social contact – disinfect frequent contact points – teach good hygiene – model good hygiene
9. BE A GOOD ROLE MODEL – Stay calm – Focus on what you can control – Your children will follow your lead.
10. HAVE A CONTINGENCY PLAN – Develop a plan in case you or someone in your family gets the virus.

We are all together in this – but not.  Although you may not be able to get face-to-face support at this time, there are other ways to get support from the Substance Abuse and Mental Health Disaster Distress Hotline at 800/985-5990 and the Crisis Text Line, an anonymous texting service available 24/7. Starting a conversation is easy. Text GOT5 to 741741                 

Remember tip number one: TAKE CARE OF YOU!    

Compiled by Dr. Gerald T. Guild, PhD, NYS Licensed Psychologist and Behavior Specialist.  This information was drawn from reputable sources like the CDC, WHO, The National Child Traumatic Stress Network, and the American Academy of Pediatrics.

Although I did not make a substantial number of posts in 2013, the traffic to my site remained relatively vigorous.  Throughout 2013 my blog had 24,007 hits from 21,042 unique visitors, accounting for nearly 30,000 page views.  I had visitors from every state in the US and 158 nations around the world.  Visitors from the United States accounted for the vast majority of those hits, but the UK, Canada, Australia, India, China, and Germany also brought in large contingents.

Of my posts published in 2013, none made it to this year’s top ten list: five were from 2010,  four were published in 2011, and one was from 2012.  This year the top ranked article (The Moral Instinct) was a 2010 review of a very popular 2008 New York Time’s article by Steven Pinker.   This perennially popular piece ranked 5th last year, 4th in 2011 and 3rd in 2010.   Its bounce to the top this year is more of a testament to Pinker and the popularity of his piece that explores the universality of morals.  In that piece I wrote:

Pinker delves into the neurological factors associated with morality and the evolutionary evidence and arguments for an instinctual morality. He reviews several important studies that provide evidence for these hypotheses. But, he argues that morality is more than an inheritance – it is larger than that. It is contextually driven. He notes: “At the very least, the science tells us that even when our adversaries’ agenda is most baffling, they may not be amoral psychopaths but in the throes of a moral mind-set that appears to them to be every bit as mandatory and universal as ours does to us. Of course, some adversaries really are psychopaths, and others are so poisoned by a punitive moralization that they are beyond the pale of reason. ” He further contends “But in any conflict in which a meeting of the minds is not completely hopeless, a recognition that the other guy is acting from moral rather than venal reasons can be a first patch of common ground.

This article may have also remained popular because of its relevance with regard to the state of affairs in today’s political arena and the application of Jonathon Haidt’s increasingly popular work on the Moral Foundations Theory.  

The 2013 number two ranked piece Nonmoral Nature: It is what it is, is a review of one of Stephen Jay Gould’s most famous articles where he argued that there is no evidence of morality in nature, that in fact “nature as it plays out evolution’s dance, is entirely devoid of anything pertaining to morality or evil. We anthropomorphize when we apply these concepts. Even to suggest that nature is cruel is anthropomorphizing. Any true and deep look at the struggle for life that constantly dances in our midst can scarcely lead to any other conclusion but that nature is brutal, harsh, and nonmoral” (Gould).  Historically this has been a controversial topic and remains so in certain circles today.  This piece has remained popular over the years – ranking 4th last year and 2nd in 2011 and 2010.

Brain MRI

Brainwaves and Other Brain Measures – the 3rd ranking post this year ranked 2nd last year and 1st in 2011. This very popular piece takes a pragmatic, comparative, and colorful look at the various ways of measuring brain activity.  My 2012 article Happiness as Measured by GDP: Really?  is finally getting some attention.  Although it ranked 10th last year, it has climbed into the number four slot this year.  I contend that this is perhaps one of the most important articles I have written.

Proud as a Peacock By Mark Melnick

My critical article on the widely used Implicit Associations Test ranked 5th this year, 6th in 2012, and 4th in 2011. Last year’s number one piece on Conspicuous Consumption and the Peacock’s Tail  is one of my favorite pieces.  It addresses our inherent drive to advance one’s social standing while actually going nowhere on the hedonic treadmill.  It delves into the environmental costs of buying into the illusion of consumer materialism and its biological origins (the signaling instinct much like that of the Peacock’s tail).

I am excited to report that Poverty is a Neurotoxin is also finally gaining some traction.  Published in 2011 it has never achieved a top ranking; although, in my humble opinion, it is no less important.  Rounding out the top ten of 2013, my Hedgehog versus the Fox mindset piece ranked 8th this year, 9th last year, and 10th in 2011. One of my all time favorite posts from 2010,  What Plato, Descartes, and Kant Got Wrong: Reason Does not Rule made it back to the top ten list this year coming in 9th.  It was 7th in 2011 and 8th in 2010.  My 2011 post Where Does Prejudice Come From? ranked 10th this year, 7th last year, and 5th in 2011.

So here is the Top Ten list for 2013.

1. Moral Instinct  (2010) 4182 page views since published – All time ranking #5
2. Non Moral Nature: It is what it is (2010) 4616 page views since published – All time ranking #3
3. Brainwaves and Other Brain Measures (2011) 7941 page views since published – All time ranking #1
4. Happiness as Measured by GDP: Really? (2012) 1719 page views since published – All time ranking #8
5. IAT: Questions of Reliability and Validity  (2010) 2572 page views since published – All time ranking #6
6. Conspicuous Consumption & the Peacock’s Tail (2011) 7677 page views since published – All time ranking #2
7. Poverty is a Neurotoxin (2011) 960 page views since published – All time ranking #18
8. Are you a Hedgehog or a Fox?  (2010) 1702 page views since published – All time ranking #9
9. What Plato, Descartes, and Kant Got Wrong: Reason Does not Rule (2010) 1381 page views since published – All time ranking #12
10. Where Does Prejudice Come From?  (2011) 1625 page views since published – All time ranking #10

Rounding out the top ten All Time Most Popular Pieces are:

• Wicked! Things are NOT as they Seem (2012) 4485 page views since published – All time ranking #4
• Attribution Error (2010) 2263 page views since published – All time ranking #7

These top ranking articles represent the foundational issues that have driven me in my quest to understand how people think.   This cross section of my work is, in fact, a good starting point for those who are new to my blog.

There are several other 2013 posts that ranked outside this year’s top ten list; regardless, I believe they are important.  These other posts include:

1. Mind Pops: Memories from out of the Blue
2. Who Cheats More: The Rich or the Poor?
3. Crime, Punishment, and Entitlement: A Deeper Look
4. Cheaters
5. American Exceptionalism: I’m all for it!
6. Partisan Belief Superiority and Dogmatism as a Source of Political Gridlock

Maintaining relevance is an article, published in 2012, The Meek Shall Inherit The Earth: Our Microbiome, pertains to the collection of an estimated 100 trillion individual organisms (bacteria for the most part) thriving in and on your body that account for about three pounds of your total body weight (about the same weight as your brain).  These little creatures play a huge role in your physical and mental well being and we are just beginning to understand the extent of their reach.  Modern medicine in the future, will likely embrace the microbiotic ecosystem as a means of preventing and treating many illnesses (including treating some mental illnesses).  I have continued to update this piece with comments including links to new research on this topic.

Children of high socioeconomic status (SES) show more activity (dark green) in the prefrontal cortex (top) than do kids of low SES when confronted with a novel or unexpected stimulus. (Mark Kishiyama/UC Berkeley)

Although, not among the most popular articles this year, my pieces on the pernicious affects of poverty on child development from 2011 warrant ongoing attention.  If we truly wish to halt the cycle of poverty, then we need to devote early and evidenced based intervention services for children and families living in poverty.  As it turns out, poverty is a neurotoxin.  Knowing the information in this series should motivate us, as a society, to truly evaluate our current political and economic policies.

• Parenting May Matter: For Infants and the Economically Deprived 

• The Effects of Poverty on Brain Development 

• The Economic, Neurobiological, and Behavioral Implications of Poverty 

• Halting the negative Feedback Loop of Poverty 

• Poverty Preventing Preschools 

• Poverty is a Neurotoxin 

The bottom line:

The human brain, no matter how remarkable, is flawed in two fundamental ways.  First, the proclivities toward patternicity (pareidolia), hyperactive agency detection, and superstition, although once adaptive mechanisms, now lead to many errors of thought.  Since the age of enlightenment, when human-kind developed the scientific method, we have exponentially expanded our knowledge base regarding the workings of the world and the universe.  These leaps of knowledge have rendered those error prone proclivities unessential for survival.  Regardless, they have remained a dominant cognitive force.  Although our intuition and rapid cognitions (intuitions) have sustained us, and in many ways they still do, the subsequent everyday illusions impede us in important ways.

Secondly, we are prone to a multitude of cognitive biases that diminish and narrow our capacity to truly understand the world. Time after time I have written of the dangers of ideology with regard to its capacity to blindfold its disciples.  Often those blindfolds are absolutely essential to sustain the ideology.  And this is dangerous when truths and facts are denied or innocents are subjugated or brutalized.  As I discussed in Spinoza’s Conjecture:

 

“We all look at the world through our personal lenses of experience.  Our experiences shape our understanding of the world, and ultimately our understanding of [it], then filters what we take in.  The end result is that we may reject or ignore new and important information simply because it does not conform to our previously held beliefs.

Because of these innate tendencies, we must make additional effort to step away from what we believe to be true in order to discover what is indeed true.

The Hand of God as an example of pareidolia.

It is often argued that the United States is exceptional with regard to its capabilities and responsibilities.  With respect to its military prowess, and defense budget, it is certainly exceptional.  I am curious however.  To what extent is the US exceptional in other important ways?  Is the US the envy of the world with regard to its educational system and its healthcare?  How safe are Americans?  Further, does America prove exceptional with regard to issues such as equality, democracy, and opportunity?  I for one, am all for being exceptional.  Shouldn’t we strive for superiority in all these areas?  Is not a person’s character judged based on variables other than one’s physical strength?  Are not issues such as kindness, fairness, and morality given important consideration when we evaluate each other?  I suggest that nations too should be judged on these issues.  We as a people certainly judge other nations based on these attributes.

So, how does the US compare to other wealthy and developed nations on these important issues?  Let us take a closer look.  By far, the best accessible and concise analysis of this question is contained in The Measure of a Nation by Howard Steven Friedman.  Dr. Friedman is a prominent statistician and health economist at the United Nations and he teaches at Columbia University.  Measure of a Nation was named by Jared Diamond (author of Pulitzer Prize winning Guns Germs and Steel) as the best book of 2012 in an interview published in the New York Times.  I have to agree with Diamond’s opinion.  Friedman’s book is a data driven assessment of 14 nations, each meeting specific criteria for population (at least 10 million) and wealth (mean GDP at least $20,000).   Friedman methodically and carefully analyzes data from each nation and creates a relative ranking system whereby each nation is evaluated on diverse issues such as Health, Safety, Education, Democracy, and Equality.  The comparison countries include: UK, Canada, Germany, Spain, Portugal, France, Belgium, Italy, Greece, Netherlands, Australia, Korea, and Japan.

Friedman’s book constitutes an ambitious undertaking and he is careful to be clear about the pitfalls associated with the measures and analyses used.  In the end however, as a skilled statistician and economist, he was able to pull together a clear and concise  comparative ranking system that factually answers the question – “Is America Exceptional?”

He are the rankings:

Data is from The Measure of a Nation, by Howard Steven Friedman

I don’t know about you, but I was appalled by these findings.   The US comes up with a last place ranking on a majority of very important quality of life variables with regard to health, safety, democracy, and equality.  It gets worse when you look at all the comparisons drawn in Friedman’s book.  I included only those measures that could easily be put in a table without the need for deeper explanation.   And with regard to education, we are in the middle and bottom third of the rankings, except when it comes to years of education and percent of the population getting secondary education.   Our literacy rankings are unacceptable.

Neither Friedman or I are driven to bash the United States.  Instead, he and I both are motivated by a desire for exceptionalism across all these measures.  Friedman makes recommendations about how we as a people, and a nation, could improve on all these important variables.   The subtitle of his book is How to Regain America’s Competitive Edge And Boost Our Global Standing.  The problem is one of over-confidence and unquestioning nationalism.  To boldly contend that America is exceptional in every way is both unsubstantiated and untrue.  How I wish it was otherwise.

It is time to step back, look deeply at these issues, accept the reality that we can do better, and then devote our efforts to making it so.  We are arguably the richest and most powerful nation in the world with a vast capability for excellence.  It comes down to priorities and hubris.  If “we the people” demand excellence in these areas, and stand-up and make our voices heard, politicians will have to respond.  If however, we bombastically proclaim “We’re #1” regardless of what the evidence suggests, we will continue to languish.   Should not the measure of a nation, with such capabilities,  be the best?

Spread the word, get and read Friedman’s book.  Let’s start changing the dialogue in this country away from the current divisive and unproductive rancor, and begin focusing on what really matters.  It starts with knowledge and it ends with a healthier, safer, smarter, and more fulfilled populace whose politicians truly represent them and actually address important issues.

◊

For other discussions and data points on US rankings relative to other nations see:

We’re # 37! USA! USA! USA! A look at the US Healthcare System

A 2010 US Department of Education report releasing the 2009 Program for International Student Assessment (PISA) scores indicated that 15-year-old students from the US scored in the average range in reading and science, but below average in math.

Happiness as Measured By GDP: Really?

There is no doubt that violent crime in the US is a major problem.  Murder is certainly not a uniquely American act, but as in other things, we Americans excel at it.  The U.S. murder rate is nearly three times the rate that it is in Canada and more than four times the rate that it is in the United Kingdom.

We humans like to think of ourselves as strong and dominant forces.  Why shouldn’t we?  After all, we have conquered many of our natural foes and reign supreme as rational and commanding masters of our destiny.  That is what we like to think.  But this may be an illusion because as it turns out, we share our bodies with an unimaginably vast array of organisms that seem to play a substantial role in our well-being.

In and on your body, there are ten microorganisms for every single human cell.  They are invisible to the naked eye – microscopic actually.  For the most part they are bacteria, but also protozoans, viruses, and fungi.  This collection of organisms is referred to as the microbiome and it accounts for about three pounds of your total body weight: about the same weight as your brain.  In all, there are an estimated 100 trillion individuals thriving on your skin, in your mouth, in your gut, and in your respiratory system, among other places.  And it is estimated that there are one to two thousand different species making up this community.⁽²⁾

Image of Microscopic Bacteria

Since wide spread acceptance of the Germ Theory, in the late nineteenth century, we have considered bacteria as the enemy.  These organisms are germs after all, and germs make us sick.  This is accurate in many ways: acceptance and application of the germ theory vastly extended the human life expectancy (from 30 years in the Dark Ages to 60 years in the 1930s).   Other advances have since increased that expectancy to about 80 years.

But, as we are increasingly becoming aware, this microbiome plays a crucial role in our ability to live in the first place.  There are “good” and “bad” microbes.  But this dichotomy is not so black and white.  Some good microbes turn problematic only if they get in the wrong place (e.g., sepsis and peritonitis).  But what we must accept is that we would not survive without the good ones.  We are just beginning to learn of the extent to which they control our health and even our moods.

For example, some of our nutritive staples would be of very limited value if it wasn’t for Baceroides thetaiotaomicron.  This microbe in our stomach has the job of breaking down complex carbohydrates found in foods such as oranges, apples, potatoes, and wheat germ.  Without this microbe we simply do not have the capability to digest such carbohydrates.⁽¹⁾  And this is just the tip of the proverbial iceberg.

The “beneficial” bacteria in our guts are clearly very important.  They compete with the harmful bacteria, they help us digest our food, and they help our bodies produce vitamins that we could not synthesize on our own.⁽³⁾  Surprisingly, these microbes may play a significant role in our mood.  A recent study looking at the bacteria lacto bacillus, fed to mice, resulted in a significant release of the neurotransmitter gaba which is known to have a calming affect.  When this relationship was tested in humans we discovered a relationship between such gut bacteria and calmness to a therapeutic level consistent with the efficacy of anti-anxiety pharmaceuticals.⁽²⁾  This alone is amazing.

But wait, there’s more.  Take for example Helicobacter pylori (H pylori) whose job seems to be regulating acid levels in the stomach.  It acts much like a thermostat by producing proteins that communicate with our cells signaling the need to tone down acid production.  Sometimes things go wrong and these proteins actually provoke gastric ulcers.  This discovery resulted in an all out war on H pylori through the use of antibiotics.   Two to three generations ago more than 80% of Americans hosted this bacteria.  Now, since the discovery of the connection with gastric ulcers, less than 6% of American school children test positive for it.⁽¹⁾  This is a good thing! Right?

Perhaps not.  As we have recently come to discover, H pylori plays an important role in our experience of hunger.  Our stomach produces two hormones that regulate food intake.  Ghrelin (the hunger hormone), tells your brain that you need food.  Leptin, the second hormone, signals the fact that your stomach is full.  Ghrelin is ramped up when you have not eaten for a while.  Exercise also seems to boost Ghrelin levels.  Eating food diminishes Ghrelin levels.  Studies have shown that H pylori significantly regulates Ghrelin levels and that without it your Ghrelin levels may be unmediated thus leading to a greater appetite and excessive caloric intake.⁽¹⁾  Sound like a familiar crisis?

The long and the short of this latter example is that we really do not understand the down stream consequences of our widespread use of antibiotics.  Obesity may be one of those consequences.  When we take antibiotics, they do not specifically target the bad bacteria, they affect the good bacteria as well.  Its not just medical antibiotics that cause problems – we have increasingly created a hygienic environment that is hostile to our microbiome.  We are increasingly isolating ourselves from exposure to good and bad bacteria, and some suggest that this is just making us sicker.  See the Hygiene Hypothesis.

We have co-evolved with our microbiome and as such have developed an “immune system that depends on the constant intervention of beneficial bacteria... [and] over the eons the immune system has evolved numerous checks and balances that generally prevent it from becoming either too aggressive (and attacking it’s own tissue) or too lax (and failing to recognize dangerous pathogens).”⁽¹⁾   Bacteroides fragilis (B fragilis) for example has been found to have a profoundly important and positive impact on the immune system  by keeping it in balance through “boosting it’s anti-inflammatory arm.”  Auto immune diseases such as Chrones Disease, Type 1 Diabetes, and Multiple Sclerosis have increased recently by a factor of 7-8.  Concurrently we have changed our relationship with the microbiome.⁽¹⁾ This relationship is not definitively established but it clearly merits more research.

Gaining a better understanding of the microbiome is imperative, and is, I dare say, the future of medicine.  We humans are big and strong, but we can be taken down by single celled organisms. And if we are not careful stewards of our partners in life, these meek organisms may destroy us.  It is certain that they will live on well beyond our days.  Perhaps they shall reclaim the biotic world they created.

Author’s Note:  This article was written in part as a summary of  (1) Jennifer Ackerman’s article The Ultimate Social Network in Scientific American (June 2012).  Information was also drawn from (2) a Radio Lab podcast titled GUTS from April of 2012 and (3) a story on NPR by Allison Aubrey called Thriving Gut Bacteria Linked to Good Health in July of 2012.

The year 2011 proved to be a challenging year.  A number of serious health issues in close family members took center stage.  The frequency of my posts declined in part due to these important distractions but other factors also played a major role.  Although I published fewer articles, the number of visits to my blog increased substantially.

Over the course of the year, I had 18,305 hits at my website by 15,167 unique visitors, accounting for over 25,000 page views.  I had visitors from every state in the Union and visits from people from 140 nations around the world.  Visitors from the United States accounted for the vast majority of those hits, but the UK, Canada, and Australia also brought in a large contingent of visitors.

One article in particular far outpaced all other posts.  My post on Brain Waves and Other Brain Measures accounted for as many visits as the next three most popular posts combined.  Of my posts published in 2011, only four made it to this year’s top ten list.  The other six were published in 2010.  Of those six from 2010, four were also on the top ten list last year.

Great interest persisted in my post entitled Nonmoral Nature: It is what it is.  This review of Stephen Jay Gould’s most famous article sustained a number two ranking for a second straight year.  I had also reviewed in 2010 a very popular New York Time’s article by Steven Pinker entitled The Moral Instinct.  This article moved up a notch this year, ultimately ranking number three.  My critical article on the Implicit Associations Test ranked number four this year, versus a number six ranking last year.  And my Hedgehog versus the Fox mindset piece ranked number ten this year, compared to a number seven ranking last year.

So here is the Top Ten list for 2011.

1. Brainwaves and Other Brain Measures (2011)
2. Non Moral Nature: It is what it is (2010)
3. Moral Instinct  (2010)
4. IAT: Questions of Reliability and Validity  (2010)
5. Where Does Prejudice Come From?  (2011)
6. Cognitive Conservatism, Moral Relativism, Bias, and Human Flourishing  (2011)
7. What Plato, Descartes, and Kant Got Wrong: Reason Does Not Rule.  (2010)
8. Intuitive Thought  (2010)
9. Effects of Low SES on Brain Development  (2011)
10. Are you a Hedgehog or a Fox?  (2010)

It’s interesting to me that this list includes the very foundational issues that have driven me in my quest.  And each was posted with great personal satisfaction.   This encompassing cross section of my work is, in fact, a good starting point for those who are new to my blog.  There are several popular 2011 posts that ranked outside the top ten but ranked highly relative to other posts published in 2011.  These other posts include:

• Tribal Moral Community
• Schadenfreude
• Narrative Fallacy
• What not to say to someone with cancer: And what helps
• Parenting Style May Matter for Infants & the Economically Deprived
• Narrative Fallacy: A “Sign” of Cognitive Maturation

One article I published late in 2011 has attracted significant attention.   I believe that it is perhaps one of the most important posts I’ve written.  As I was writing this retrospective, Conspicuous Consumption and the Peacock’s Tail was far outpacing all other posts.

The most emotional and personally relevant articles pertained to significant problems in healthcare in the United States and my wife’s battle with breast cancer.  These articles include: (a) What not to say to someone with cancer: And what helps; (b) Up and Ever Onward: My Wife’s Battle With Cancer; (c) Cancer, Aging, & Healthcare: America, We Have a Problem; (d) We’re Number 37! USA USA USA!; and (e) Tears of Strength in Cancer’s Wake.  The latter pertains to perhaps the proudest parental moment of my life.

Another very important issue that I wrote a fair amount about includes the pernicious affect of poverty on child development.  Clicking here takes you to a page that lists all of the articles on this topic.  Knowing the information in this series should motivate us, as a society, to truly evaluate our current political and economic policies.

One of my favorite articles tackled my long standing curiosity about the geology of the place I live.  The article itself did not get a lot of attention, but I sure loved writing it.

This two-year journey, thus far has resulted in perhaps unparalleled personal and intellectual growth.  It has changed the way I look at life, the world around me, and my fellow human beings.   It is my sincerest hope that those who have seen fit to read some of my material have experienced shifts of perception or at least a modicum of enlightenment.

The bottom line:

The human brain, no matter how remarkable, is flawed in two fundamental ways.  First, the proclivities toward patternicity (pareidolia), hyperactive agency detection, and superstition, although once adaptive mechanisms, now lead to many errors of thought.  Since the age of enlightenment, when human kind developed the scientific method, we have exponentially expanded our knowledge base regarding the workings of the world and the universe.  These leaps of knowledge have rendered those error prone proclivities unessential for survival.  Regardless, they have remained a dominant cognitive force.  Although our intuition and rapid cognitions have sustained us, and in some ways still do, the subsequent everyday illusions impede us in important ways.

Secondly, we are prone to a multitude of cognitive biases that diminish and narrow our capacity to truly understand the world. Time after time I have written of the dangers of ideology with regard to its capacity to blindfold its disciples.  Often those blindfolds are absolutely essential to sustain the ideology.  And this is dangerous when truths and facts are denied or innocents are subjugated or brutalized.  As I discussed in Spinoza’s Conjecture:

“We all look at the world through our personal lenses of experience.  Our experiences shape our understanding of the world, and ultimately our understanding of [it], then filters what we take in.  The end result is that we may reject or ignore new and important information simply because it does not conform to our previously held beliefs.

Because of these innate tendencies, we must make additional effort in order to discover the truth.

I have little tolerance for unabashed patriotism. When you look closely at the facts with regard to important quality of life indicators, the good ole US of A falls short in many areas.  Life, liberty, and pursuit of happiness and unalienable rights seem to apply more to corporate entities than they do to we the people. And freedom now has more to do with economic opportunity in other countries than it does with civil liberties for our own citizens.  Don’t get me wrong, I am happy to be an American.  Thanks to my brave and industrious parents and their forefathers, I have had a steady launching pad and subsequently have done moderately well for myself.  However, I am very fortunate not to have been born Gay, a minority, or poor.  To paraphrase an old Seinfeld episode “Not that there is anything wrong with being any of these,” but the reality is that these folks suffer at disproportionate levels in this country.  And I suggest that this is a direct result of social and economic policies.

Somehow, patriotism has become the exclusive domain of those on the Right who through Conservative policy support deregulation, free markets, hawkish military doctrines, government downsizing and subsequent cuts in social services and regulatory agencies.  Even the Democrats have shifted to the right and this has been particularly true since the Clinton Administration. These policies certainly bolster corporate interests and the financial portfolios of the very wealthy.  But those gains have come at the expense of the vast majority of Americans.  The income divergence between wealthy Americans and the rest of us is no secret.  Charts and graphs, easily accessible, have uniformly detailed the relative economic flat line that most of us have endured for decades while those in the top 1% show skyrocketing and seemingly geometric growth rates.  Meanwhile, policies that may level the playing field for most Americans, have somehow been castigated as “Socialist” and “Anti-American.”  This latter thinking is wrong on so many different levels.

Regardless of the real world consequences, nearly half of Americans latch onto and support the Conservative – pro-business policies that are clearly at odds with their well being.  One important way this plays out is in healthcare.  When it comes to life expectancy, the USA ranks number 37 in the world.  That’s right 37!  There are 36 nations that, as a people, take better care of each other than we do.

In a recent study published in Population Health Metrics on life expectancy in the United States, data regarding life expectancies in every county from 2000 to 2007 shows how U.S. mortality compares with that from other wealthy nations.  The results indicate that life expectancy in the United States has not kept pace with other nations.  In fact, the data suggests that life expectancy has fallen in many counties, particularly in Appalachia and the deep south.   Women in such settings have fared far worse than men.

Here are some of the highlights from the study.  The highest life expectancy for women in 2007 turned out to be in Collier County near Naples, Florida – where women lived on average for 86 years.  In contrast for women from Holmes County, Mississippi the average age at time of death was 73.5 years.  That is nearly a 13 year discrepancy.  Further it was indicated in the report that:

In 2007, life expectancy at birth for American men and women was 75.6 and 80.8 years, ranking 37th and 37th, respectively, in the world. Across US counties, life expectancy at birth ranged from 65.9 to 81.1 years for men and 73.5 to 86.0 years for women (Figure 1a). Geographically, the lowest life expectancies for both sexes were in counties in Appalachia and the Deep South, extending across northern Texas. Counties with the highest life expectancies tended to be in the northern Plains and along the Pacific coast and the Eastern Seaboard. In addition to these broad geographic patterns, there are more isolated counties with low life expectancies in a number of western counties with large Native American populations. Clusters of counties with high life expectancies for males and females are seen in Colorado, Minnesota, Utah, California, Washington, and Florida.

What accounts for this gap and the lower relative ranking among our fellow longer living earthlings from other nation states?   On June 16th, 2011, Melissa Block from NPR – Talk of the Nation discussed the results of this study with Dr. Ali Mokdad, a global health professor at the Institute for Health Metrics and Evaluation at the University of Washington.   Dr. Mokdad noted that: “there are four factors – three are equally affecting men and women in this country.”   He then indicated that the three equal opportunity factors included:  (1) socioeconomic status;  (2) access to healthcare/health insurance or no insurance; and (3) quality of medical care.  In other words, if you’re poor, you don’t have medical insurance, and you live in remote areas with poor medical facilities, with less proficient professionals, you are more likely to die early.  On the other side of the coin, it is true that we have the best quality medical care in the world, BUT, many Americans do not have access to this Tier 1 level of care.  It’s only true for certain pockets of the population who are relatively affluent and living near major medical institutions.

The fourth factor, preventable risk factors (e.g., smoking, obesity, poor diet, lack of physical activity), affects both genders but women and particularly poor women disproportionately.  The study points out that in more than 300 counties in the United States, life expectancy declined over 20 years for women.

It is time to wake up America!  These statistics are appalling and embarrassing.  Look at the the real world human costs of economic policies that create and sustain such divergence.  The most recent recession, clearly the result of financial deregulation and unfettered free market greed, has had catastrophic global consequences that have reshaped the landscape.  Budgetary discussions center around deep government cuts to education and social services – further compromising the very people who have been hurt the worst.  Elimination of continued tax breaks to the richest Americans is absolutely off the table.  And now the Conservative agenda is to abolish “Obama Care?”  Look at the evidence people – its all around you.  Before you buy into an ideology – look at the real world consequences – look at the evidence, and ask yourself how you and your loved-ones are affected.  It scares me that such callus disregard for our fellow citizens is the new chic.

I find myself in an unfortunate spot.   Both my mother and father are suffering from seemingly intractable health problems and my wife was just diagnosed with breast cancer.  My parents, each suffering for years with chronic pain have been victimized by aimless care in an over burdened, understaffed, and misguided healthcare system.   The maladies of a healthcare system driven by economists has left us with a patient care system that is often just mediocre and sometimes atrocious.  More evidence for this has played out in the sequence of events that has left cancer undiagnosed and unabated inside my wife’s breast for six months after she first detected a lump.

What I have personally witnessed over the last year has left me appalled.  There is not enough time, space, or reader interest, I suppose, to take you through these respective journeys.  And my anecdotes, as deeply meaningful as they are to me, tell only a minute fraction of a complicated story.   Multiple factors have coalesced to degrade healthcare, and these forces have been primarily dictated by the motive for profit, austerity, or the quest for financial viability.  These interests have seemingly superseded the drive for quality care.

When I had my own private practice (as a Licensed Psychologist) the reimbursement schedules set up by insurance companies provided financial incentives for care provision that were incompatible with my training and my personal and ethical care standards.  Viability as a service provider demanded either compliance or unsustainable practices.  In large part due to these realities I chose a different career path.  This is all too common.  Two of the best medical doctors I’ve known have left the field because of similar issues.  When you can’t do what’s right and you feel like you have to thin your care to stay in business, the whole patient care scenario becomes compromised.

Medical care for run of the mill ailments seems adequate (if you are fortunate enough to have health insurance); however, when issues are complex or they involve multiple body systems, the quality of care seems to break down.  My father, for instance has many health issues.  His care, when any of these issues becomes acute, pits one specialist against another and thus one body system against another.   Just recently his acute pulmonary difficulties landed him in the ER and there, the care, as prescribed by an ER Doc, resulted in an adverse reaction necessitating yet another ER visit that resulted in a worsening response necessitating admission to the hospital.

His care has been so fragmented and communication so compromised that he experienced in this circumstance, a doctor induced overdose.  Looking back over the last several months, he has experienced intolerable amounts of pain and suffering – the likes of which no one should have to experience.

While in the Hospital after his initial diagnosis of pneumonia, he fell and injured his back causing significant and persistent pain that was initially misdiagnosed as pleurisy.  Months of pain and misdiagnoses left lingering unresolved pain. My mother likewise has an idiopathic issue that results in protracted and unimaginable pain.  The poor women has experienced dumbfounded docs and care that resulted in multiple re-admissions and ultimately no resolution of the issue.   We have traveled to distant cities to see experts with hopes that we can get her issue under control.  An appointment just this week left even the Doctors at Cleveland Clinic shrugging their shoulders in ignorance.  Idiopathic pain unresolvable by the best.  This isn’t anyone’s particular fault, but it leaves my mother wondering when the next episode will incapacitate her with pain. That is no way to live. She now needs experts in pain management.

My parents are strong, independent, self-reliant, humble and unassuming people who do not have a bone of entitlement in their make-up.  They have worked hard throughout their lives as solid contributors to society.  They are careful and cautious people trying to do what is right.  What they have gone through in their golden years is tragic.  And some of it, certainly not all of it, lies at the feet of modern health care.

Now, we have cancer care on the immediate horizon. I cannot and will not tolerate the mediocrity that pervades the healthcare system in pursuit of my wife’s recovery.  We will advocate for the best possible care available, and will not accept less than best practices should our insurance company attempt to compromise my wife’s care to save a buck.  This will not be easy and perhaps not cheap, but life and time are precious.  Far more precious than the material possessions that surround us.  I keep saying that if Lance Armstrong can survive the extensive cancer he had and go on to win a record number Tours de France, than we can beat this.  The only question is – will we get Tier 1 level of care?

Clearly there are three tiers of healthcare in the United States.  There is the reactive or non-existent care received by the poor and those at the lower end of the SES spectrum who cannot afford insurance.  Then there is the care for those of us with health insurance – adequate for run of the mill ailments – but stressed by complexity.  Then there is Tier 1 care for those with no financial restraints.  Money talks and it can buy you the best care in the world.

We do not have limitless resources or the fame and backing that Lance had, but but we do have resolve, determination, and the best breast cancer surgeon in Western New York.  I laid it out on the table when we met with her doctor:

“Only the best for my wife! I don’t want an insurance bureaucrat making medical decisions for us.  I’ll sell my house if I need to – Tier 1 Care – nothing less!”

And so the journey begins. We have a lot to learn and a formidable opponent. Cancer can be tough too.