The Benefits of Dangerous Travel

How do you know when you're in danger?  Sometimes it seems perfectly clear:  a truck barreling down on you as you cross a street;  hiking on a narrow ledge with a 500-foot fall;  a nervous mugger pointing a gun at you; an angry mob around you chanting anti-American slogans when you are in a foreign country.  In these examples the imminence of harm and the source of the threat are certain and unambiguous.

But many times assessing danger requires making an inference, an attribution, or an interpretation that isn't so clear.  As we begin to cross a street, we make inferences regarding the local norms involving drivers versus pedestrians and the likelihood a car or truck will yield to us.  When we encounter a high ledge while hiking we look at its riskiness based our assessment of our physical abilities and experience in comparable situations.  In planning a trip abroad we judge the likelihood of being the target of resentment or anger in a foreign country based on current news reports and personal accounts of other travelers.  We usually feel confident that we have correctly determined the threat or danger -- that we know whether we are in danger -- but in truth we have only really guessed.

I wrote last February that my wife and I were considering going ahead with our plans to visit the Middle East, despite the turmoil there (see my blog of February 15th) .  We did indeed make the trip, and recently returned from a month in Jordan, Syria, and Egypt.  We were there from April 12 to May 12, during the regional upheaval journalists and politicians have now dubbed the "Arab Spring"  or "Arab Awakening" (I suppose these are appropriate labels, but in this case Springtime and Awakening are associated with bullets, tanks, and firebombs).  We certainly hadn't planned to be involved in these momentous events, and new developments along the way forced us to assess danger far more than normal in our travels:  protests in Syria intensified and so did the brutal government crackdown on them;  just as we were about to enter Syria, the Jordan/Syria land border was closed, though it was still possible to fly between countries, which we did;  shortly after entering Syria the U.S. State Department issued a warning advising U.S. citizens to leave the country immediately (we didn't);   in Libya the UN stepped up its military action against the government; about halfway into our trip Osama Bin Laden was killed by U.S. forces; while we were in Egypt there were violent clashes between Christian and Muslim groups.

Were we in danger?  You might infer from the list of events above that we were standing in the middle of the street with a truck barreling down on us -- the clearly harrowing situation I suggested at the beginning.  And to be honest, if all these things happened right before we left home we might have cancelled.  But we're now convinced that would have been a mistake, that we were in fact not in significant danger, and that whatever level of risk present was far outweighed by the positive benefits of the trip.

We weighed the information we received from news sources and from the State Department along with our own direct observations, which contrasted sharply. Everywhere we went people of all walks of life, ages, and social position were genuinely welcoming and friendly -- particularly when they found out we were Americans.  Although we stood out like sore thumbs (it is not possible to blend in there, especially when you're two of only a handful of tourists), we never felt like targets of resentment or anger.  Naturally our inferences might have been wrong, but the probability of our misjudgment has to be considered in the context of 40 years of mostly independent travel that has exposed us to a variety of social situations and interactions requiring us to assess the sincerity and honesty of people's motives.  Based on that experience, we have to regard this as one of the safest trips we have ever taken and probably one of the most enjoyable.

Some of you reading this may wonder why we would travel to a place where there is even a chance of danger -- what's the great attraction that makes the inconvenience and potential hassles worthwhile?  This is tough to answer. In response to a good friend who challenged our motivation for this trip, I said that our rewards for travel here were the same as they always have been for us:  acquiring a deeper understanding of different cultures, including those under the thumb of notorious, disgusting regimes; seeing first-hand the layers of history embodied in the art and architecture of past civilizations and current societies;  appreciating the ecology and geology of other parts of the world.

Paul Theroux put it a bit more eloquently in a recent NYT article on traveling during turbulent times, and I'll close with his words:

"In the bungling and bellicosity that constitute the back and forth of history, worsened by natural disasters and unprovoked cruelty,  humble citizens pay the highest price. To be a traveler in such circumstances can be inconvenient at best, fatal at worst. But if the traveler manages to breeze past such unpleasantness on tiny feet, he or she is able to return home to report: 'I was there. I saw it all.' The traveler’s boast, sometimes couched as a complaint, is that of having been an eyewitness, and invariably this experience — shocking though it may seem at the time — is an enrichment, even a blessing, one of the life-altering trophies of the road. 'Don’t go there,' the know-it-all, stay-at-home finger wagger says of many a distant place. I have heard it my whole traveling life, and in almost every case it was bad advice. In my experience these maligned countries are often the most fulfilling."

Jogging the Memory of a Geezer

[**Warning**  This blog is another in my "Geezerhood" series.  Past entries have included "Embracing Your Inner Geezer," "How to Compress Your Morbidity," "The Power of Negative Thinking," and "So, What Do You Do All Day?".   Those readers who have decided they are immune from Geezerhood may find this material irrelevant and are urged to use discretion in reading further.]

As the saying goes, "Growing old isn't for whimps."  Besides the challenge of coping with physical changes, as discussed in my blog of  2/1/11, there is also the challenge of possibly losing your mind, or at least not being  able to remember where you put it.  Sad personal reminders of this are several academic colleagues of mine who are now in various stages of Alzheimer's, a disease made all the more tragic for these people because they were all bright, well-educated intellectuals with incisive minds. 

Alzheimer's is the most prevalent form of dementia, followed by dementia produced by strokes.  And it is indeed prevalent. According to the Alzheimer's Association, 5.4 million Americans have the disease.  At age 65 the estimated lifetime risk of developing Alzheimer's or some other form of dementia is 20% for women and 17% for men.  For those who make it to 85, the risk is much higher -- 43%.   And it is indeed deadly.  Alzheimer's is currently the 6th leading cause of death in this country, 5th for those over 65.  It is estimated that 61 percent of people with Alzheimer’s at age 70 will die before age 80 compared with 30 percent of people at age 70 without the disease.

An optimistic take on these grim statistics is that most geezers won't be stricken by Alzheimer's or other forms of dementia during their "golden years" -- if  20%  are afflicted, then the other 80% won't be, right?  While this optimism is justified in the strictest sense,  there is now a substantial body of scientific evidence that even "normal" geezers will experience some degree of cognitive decline due to changes in neurological processes and brain structure that are an inevitable result of aging.  These physical changes will likely be manifested in difficulties in learning, reasoning, decision making, cognitive task performance, and memory.   The evidence also shows, though, that there is a wide range among individuals in the type and degree of difficulties they experience, even among those with the same degree of  neurological degradation.  A more realistic approach then, is to ask "how much cognitive decline will I experience and is there anything I can do about it?"

The most recent research bearing on these questions has been nicely summarized and evaluated by Christopher Hertzog in a monograph published by the Association for Psychological Science (Hertzog et.al., 2008).  Hertzog's analysis of the available data suggests that there are a number of identifiable factors that influence a person's degree and rate of decline, and that there are certain interventions that can -- within limits -- alter an individual's position within the possible range of functioning.

It is important to note that the evidence for some of these "enrichment effects" is not very strong or is controversial, while for other factors the research seems much clearer and stronger.  For example, it is somewhat surprising that the common sense idea of staving off cognitive decline by leading an intellectually active lifestyle (the "use it or lose it" hypothesis) -- while it has received consistent empirical support -- must be tempered by the fact that the strength of the effect is not as strong as it is for other factors and may be open to alternative explanations  (Hertzog et. al., 2008).  Nonetheless, research over the last 10 years indicates that continued engagement in mentally stimulating activities (reading books, attending plays, playing chess, writing, playing a musical instrument, attending public lectures, taking courses, etc.) can reduce the debilitating effects of "normal" cognitive decline, and even lower the risk of dementia and Alzheimer's disease (Wilson et. al, 2007).

Another approach to cognitive enrichment is based on what might be called the "mental pushup" model., where older people are exposed to interventions that involve specific training in memory, reasoning, or problem solving.  For example,  in a study by Ball et al. (2002), 2500 participants over 65 went through training sessions in one of three cognitive domains:  memory, reasoning, or visual search.  The results showed marked gains for each training group that persisted over a 5-year follow up period.  As encouraging as these results seem, it was also found that the enhancement effects didn't transfer to performance-based measures of everyday problem solving or everyday speed of processing -- in other words, the benefits were restricted to the specific training domains and didn't generalize to other kinds of tasks.   A number of other studies have reached the same conclusion -- very little generalization of the cognitive gains achieved by training specific skills or processes (Hertzog et al., 2008).

However, there have some very recent attempts to develop training strategies involving more complex mechanisms that do show generalization.  One example is training in quickly switching between different tasks or between different sets of cues relevant to the same task,  both of which are abilities involving cognitive control that usually decline significantly with age.  In a study by Karbach & Kray (2009)  this type of intervention not only significantly improved older adults' task-switching performance,  but also produced generalized improvements in verbal and spatial memory, and reasoning skills.

Another promising new approach is "metacognition"  training.  "The essential feature of metacognitive interventions is to train individuals to assess processing demands of task contexts and to select, implement, and evaluate strategies during performance" (Hertzog et al., 2008, p. 20).  For example, one metacognitive approach trains people on using mnemonic memory techniques coupled with self-testing to determine when material has been learned well enough to permit later retrieval (Dunlosky et al., 2007).  Research indicates that the generality of this technique enables older people to apply it to everyday situations outside the experimental context.

As promising as some of these training strategies are, there is one type of intervention that recent research shows is hands down the most effective in lessening cognitive decline associated with aging:  physical activity.  It even seems to "compress cognitive morbidity" so that the period of diminished mental capacity is shorter, even among those with Alzheimer's and other forms of dementia (I discussed compression of morbidity regarding physical aspects of aging in an earlier blog).

The fitness fanatics out there no doubt are vigorously nodding their heads in agreement as they read this before their spinning class or after their 15-mile run.  But the real news in this research is that (a) the level of physical activity required to achieve significant benefits is really quite modest, and (b) beneficial effects can be achieved even when the physical activities are initiated later in life. This is particularly encouraging for those geezers who have physical limitations or injuries that prevent them from engaging in high impact aerobics, or for those who weren't physically active in their younger years.

For example, in a study by Kramer et al. (1999) older adults who were in good health but sedentary were randomly assigned to either a training condition in which they walked briskly for 1 hour per day 3 days a week for 6 months, or a condition in which they performed stretching and toning exercises for the same amount of time.  Those in the walking condition but not the stretching and toning condition showed generalized improvement in various aspects of cognitive functioning, including the ability to selectively process task-relevant information while ignoring irrelevant information, the ability to override inappropriate responses, and the ability to switch rapidly between multiple tasks.

In another example, the activity levels of 6,000 women aged 65 and older were assessed (e.g, blocks walked per week, flights of stairs climbed per day, frequency and duration of  various exercise and sports activities) and then levels of cognitive functioning were measured 6-8 years later (Yaffe et al., 2001).  Those who were more active were 30% less likely to show cognitive decline, even after adjusting for education level, health status, and other rival explanations.  Interestingly, walking distance was related to cognitive functioning whereas walking speed was not, suggesting that even moderate levels of activity have a beneficial effect.

Finally, a number of studies have found that modest physical activity and exercise can reduce the probability of severe cognitive problems in later life.  Rovio (2005), for instance, found that physical activity in middle age consisting of as little as 20-30 minutes twice per week of exercise vigorous enough to produce breathlessness and sweating reduced the risk of dementia 20 years later by 52%. 

After evaluating all of the available research regarding cognitive functioning in older adults, including the studies focusing on physical activity, Hertzog et al. (2008) offers this optimistic conclusion:

"What is most impressive to us is the evidence demonstrating benefits of aerobic physical exercise on cognitive functioning in older adults. Such a conclusion would have been controversial in the not-too-distant-past, but the evidence that has accumulated since 2000 from both human and animal studies argues overwhelmingly that aerobic exercise enhances cognitive function in older adults.  The hypothesis of exercise-induced cognitive-enrichment effects is supported by longitudinal studies of predictors of cognitive decline and incidence of dementia, but also by short-term intervention studies in human and animal populations.  The exercise-intervention work suggests relatively general cognitive benefits of aerobic exercise but indicates that cognitive tasks that require executive functioning, working memory, and attentional control are most likely to benefit."  (p.41)

Geezerhood is tough.  But thanks to increases in our scientific understanding of aging, we are seeing some real advances in practical ways to come to terms with it.  Cognitive decline may be inevitable, and for some us it will be devastatingly severe.  But thankfully there are ways we can lessen the degree to which the quality of our lives are impacted by the relentless march of time.



References:

Ball, K., Berch, D.B., Helmer, K.F., Jobe, J.B., Leveck, M.D., Marsiske, M. (2002.  Effects of cognitive training interventions with older adults:  A randomized controlled trial.  Journal of the American Medical Association, 288, 2271-2281.

Dunlosky, J., Cavallini, E.,  Roth, H.,  McGuire, C.L., Vecchi, T., & Hertzog, C. (2007).  Do self-monitoring interventions improve older adults' learning?  Journal of Gerontology: Psychological Sciences, 62B (special issue I), 70-76.

Hertzog, C., Kramer, A.F., Wilson, R.S.,  & Lindenberger, U. (2008).  Enrichment effects on adult cognitive development:  Can the functional capacity of older adults be preserved and enhanced?  Psychological Science in the Public Interest, (9).

Karbach, Julia, & Kray, Jutta (2009). How useful is executive control training? Age differences in near and far transfer of task-switching training.  Developmental Science,  978-990.

Kramer, A.F.,  Hahn, S., Cohen, N.J., Banich, M.T., McAuley, E., Harrison, C.R., et al. (1999).  Aging, fitness and neurocognitive function.  Nature, 400, 418-419.

Rovio, S., Kareholt, I., Kelkala, E.I., et al. (2005).  Leisure time physical activity at midlife and the risk of dementia and Alzheimer's disease.  Lancet Neurology, 4, 705-711.

Yaffe, K., Barnes, D., Nevitt, M., Lui, L.Y., & Covinsky, K. (2001).  A prospective study of physical activity and cognitive decline in elderly women.  Archives of Internal Medicine., 161, 1703-1708.


Wilson, R.S., Scherr, P.A., Schneider, J.A., Li, Y., & Bennett, D.A. (2007).  The relation of cognitive activity to risk of developing Alzheimer's disease.  Neurology, 69, 1911-1920.

It's a Guy Thing

My sister recently forwarded me a story that has been circulating on the internet for quite some time, though I have never seen it before.   I'll quote it below, then make some comments about whether it is true or not.  Right now, though, you should know that I was gasping for breath from laughing when I read it.  In short, you have been forewarned that this is my kind of humor (see What, Me Worry? for an analysis of what makes me laugh):

Pocket Tazer Stun Gun, a great gift for the wife. A guy who purchased his lovely wife a pocket Tazer for their anniversary submitted this:
Last weekend I saw something at Larry's Pistol & Pawn Shop that sparked my interest. The occasion was our 15th anniversary and I was looking for a little something extra for my wife Julie. What I came across was a 100,000-volt, pocket/purse-sized Tazer.

The effects of the Tazer were supposed to be short lived, with no long term adverse affect on your assailant, allowing her adequate time to retreat to safety...??

WAY TOO COOL! Long story short, I bought the device and brought it home... I loaded two AAA batteries in the darn thing and pushed the button. Nothing! I was disappointed. I learned, however, that if I pushed the button and pressed it against a metal surface at the same time, I'd get the blue arc of electricity darting back and forth between the prongs.

AWESOME!!! Unfortunately, I have yet to explain to Julie what that burn spot is on the face of her microwave.

Okay, so I was home alone with this new toy, thinking to myself that it couldn't be all that bad with only two AAA batteries, right?

There I sat in my recliner, my cat Gracie looking on intently (trusting little soul) while I was reading the directions and thinking that I really needed to try this thing out on a flesh & blood moving target.

I must admit I thought about zapping Gracie (for a fraction of a second) and then thought better of it. She is such a sweet cat. But, if I was going to give this thing to my wife to protect herself against a mugger, I did want some assurance that it would work as advertised.

Am I wrong?

So, there I sat in a pair of shorts and a tank top with my reading glasses perched delicately on the bridge of my nose, directions in one hand, and Tazer in another.
 The directions said that:
a one-second burst would shock and disorient your assailant;
a two-second burst was supposed to cause muscle spasms and a major loss of bodily control; and
a three-second burst would purportedly make your assailant flop on the ground like a fish out of water.

Any burst longer than three seconds would be wasting the batteries.

All the while I'm looking at this little device measuring about 5" long, less than 3/4 inch in circumference (loaded with two itsy, bitsy AAA batteries); pretty cute really, and thinking to myself, 'no possible way!'

What happened next is almost beyond description, but I'll do my best.

I'm sitting there alone, Gracie looking on with her head cocked to one side so as to say, 'Don't do it stupid,' reasoning that a one second burst from such a tiny lil ole thing couldn't hurt all that bad.. I decided to give myself a one second burst just for heck of it.

I touched the prongs to my naked thigh, pushed the button, and...

HOLY MOTHER OF GOD. WEAPONS OF MASS DESTRUCTION. WHAT THE... !!!

I'm pretty sure Hulk Hogan ran in through the side door, picked me up in the recliner, then body slammed us both on the carpet, over and over and over again. I vaguely recall waking up on my side in the fetal position, with tears in my eyes, body soaking wet, both nipples on fire, testicles nowhere to be found, with my left arm tucked under my body in the oddest position, and tingling in my legs! The cat was making meowing sounds I had never heard before, clinging to a picture frame hanging above the fireplace, obviously in an attempt to avoid getting slammed by my body flopping all over the living room.

Note:
If you ever feel compelled to 'mug' yourself with a Tazer,
one note of caution:

There is NO such thing as a one second burst when you zap yourself! You will not let go of that thing until it is dislodged from your hand by a violent thrashing about on the floor!
A three second burst would be considered conservative!

My bent reading glasses were on the mantel of the fireplace.

My triceps, right thigh and both nipples were still twitching.

My face felt like it had been shot up with Novocain, and my bottom lip weighed 88 lbs.

I had no control over the drooling.

Apparently I had crapped in my shorts, but was too numb to know for sure, and my sense of smell was gone.

I saw a faint smoke cloud above my head, which I believe came from my hair.

I'm still looking for my testicles and I'm offering a significant reward for their safe return!

PS: My wife can't stop laughing about my experience, loved the gift and now regularly threatens me with it!
 

If you think education is difficult, try being stupid!!!!

This story has been circulating since 2004, and although it has never been determined for sure that it is just a wildly funny made-up tale, there are strong hints that it is just that.  Most telling is that the story has changed over the years by being updated and expanded -- for example, in the original story it was Jessie Ventura who was the pro-wrester instead of Hulk Hogan.  You can compare the version above with the original available on  Snopes.com, my favorite site for researching stuff like this.  Despite the strong possibility it didn't really happen, it is still very funny indeed.  Oh, and a little quick Googling reveals that such devices do, in fact exist.  For example,  at BestStunGun.Com you can buy one for about $70 that is the size of a pen, generates 800,000 volts, and requires just two small 3-volt CR2 batteries.

Incidents that really have happened and which showcase human (usually male) stupidity are collected and presented at another of my favorite sites, The Darwin Awards.  The Darwin Awards "...salute the improvement of the human genome by honoring those who accidentally remove themselves from it..."   Here's just one example, called Dying to Go:

Dying To Go
2009 Darwin Award Nominee
Confirmed True by Darwin

(12 April 2008, Florida) Traffic was moving slowly on southbound I-95. Shawn M. had recently left a Pompano Beach bar, and now he was stuck in traffic. As the saying goes, you don't buy beer--you just rent it, and Shawn couldn't wait another moment to relieve himself. "I need to take a leak," he told his friends. Traffic was deadlocked, so the waterlogged man climbed out, put his hand on the divider, and jumped over the low concrete wall... only to fall 65 feet to his death. "He probably thought there was a road, but there wasn't," said a Fort Lauderdale police spokesman. The car was idling on an overpass above the railroad lines. His mother shared her thoughts. "Shawn didn't do a whole lot for a living. He got along on his charm, just like his father." Though his death was tragic, Shawn's downfall proves the old adage: Look before you leak!

Definitely more of my kind of humor.

Watching The World From Cyberspace

Movietone News. Remember?  This was how many people got a chance to see images of current events before the days of T.V. news, YouTube, webcams, and smartphone video transmissions.  I remember as a kid going to a movie theater and before the feature film began watching a cartoon and then an episode of Movietone News.  I was fascinated by the filmed depictions of  people, places, and events that I had previously read or heard about.  The lag on these films was at least a couple of weeks, but it really didn't seem to matter -- things moved more slowly back in those days.

Fast forward to the last few weeks.  It would be hard to imagine a clearer illustration of how internet technology has changed the way we acquire knowledge of the world and the way we relate to people, places, and events than the role of technology in covering (a) the popular uprisings in the Middle East,  (b) the earthquake and tsunami in Japan, and (c) closer to home, the sudden change in the ongoing eruption of Kilauea Volcano in Hawaii.

Unlike the days of Movietone News,  from anywhere in the world you could watch the demonstrations and confrontations in Egypt live , as they were happening, thanks to webcams streaming video images to internet sites.   Or you could access YouTube clips uploaded minutes after events happened.  Interpreting the meaning of what you were seeing was perhaps problematic,  but there was nevertheless a feeling of immediacy that was unmistakeable, and a feeling of being connected  to the people in this far away place.  For those providing the images there was no doubt a feeling of connection as well, and also a feeling of empowerment and influence.

The video coming from Japan has been a stunning, near real-time display of the destructive power of nature and the fragility of human existence.  I've seen movies and still photos of tsunamis before, but the current depictions have had an effect on me at much higher level of magnitude.  I think this is due to the range of video sources, the immediacy of the images, and to their internet accessibility.  As with the popular uprisings in the Middle East,  my empathy seems stronger because the images are depicting the events right now, not as they were sometime in the past.

My third example is the role of internet technology in covering the recent change in the eruption of Kilauea Volcano, about 90 miles from where I live here on the island of Hawai'i.   The current eruption has been going on for over 20 years, but it has changed in character several times during that period.  For the past couple of years the main activity has been from a side vent of Kilauea, which feeds lava to a system of tubes that carry it several miles to the ocean.  Although the side vent is in a remote part of Volcanoes National Park and volcanic gases make hiking to it very dangerous, real time images of it have been available from a webcam placed on the rim of the vent.  A webcam is also positioned over the summit caldera in a spot accessible only to geologists, and until just recently the summit camera showed fascinating images of a lava lake just below the rim. 

These live views of an erupting volcano, available to anyone in the world with access to the internet, illustrate my point very nicely.  But even clearer is the role of internet technology in providing an immediate experience of the change in the eruption which happened a couple of weeks ago.  Suddenly all activity at the summit and the side vent ceased,  and lava began fountaining from a crack near the vent.  Within hours the geologists had placed additional cameras near the crack to provide spectacular views of the event.  In this case technology allowed a real-time experience of something happening that would be too dangerous and too difficult to observe in any other way.  Like the tsunami, witnessing this event via the internet deepened my appreciation of the power and unpredictability of nature in a way a Movietone News clip could never have done.

It is certainly debatable whether constant connectivity with events around  the world is a good thing in all cases.  But there is little doubt that this technology has irreversibly altered our relationship to each other and to the world around us.

Tax Tips for Tea Time

Ah, the joys of spring. Snow melting. Birds nesting. Flowers blooming. Warmth & sunshine. The promise of renewal, growth, and better times.

And getting your income tax refund.

The average refund is about $3,000.  Last year the total was $328 billion paid to 109,376,000 taxpayers, well over 50% of those filing. Note that this is more than 5 times the total budget cuts recently proposed by the Republican/Tea Party controlled House of Representatives. I find it a smidge interesting that those who regard themselves as fiscally astute and critical of government spending would be willing to give the government a $328 billion interest-free loan. As Roberton Williams, a senior fellow at the Tax Policy Center puts it,

"While the majority of Americans receive refunds and many taxpayers look forward to getting that check in the mail, it's sometimes easy to forget that it's your own money to begin with. All you did was overpay the government during the year. In one sense people like to get a refund because it's nice to know that refund is eventually coming -- they can file their taxes and not think about it again. But really, it's just an interest free loan to the government."

So tip number one if you're upset about taxes is don't overpay them by $328 billion! During the year that the Fed has your money interest free you could better use it to, say, pay your mortgage, buy food, or reduce your high-interest credit card debt.   By paying just the taxes actually owed and no more, the average taxpayer would have an extra  $250 available per month ($3000/12).  Of course, there would be no pseudo-windfall in April. But instead of giving the Fed an interest free loan, you could be avoiding paying  a high-interest loan yourself.

Tip #2: Become a CEO. Most have negotiated their contracts so that their taxes are paid by the company.

Tip#3: Become a witch. Actually, for some Tea Party members, like Christine O'Donnell, this wouldn't be much of a stretch. Although O'Donnell hasn't engaged in witchcraft since high school (according to Fox News), she could probably brush up in short order. Those tax-and-spenders in Congress could then be cursed and hexed into line, as witches in Romania did last January: "Everyone curses the taxman, but Romanian witches, angry about having to pay up for the first time, hurled poisonous mandrake into the Danube River on Thursday to cast spells on the president and government" (NYT).

Tip #4: Calculate your effective tax rate. This is very simple. Take your total income and divide it into your total tax bill.  You may find this is much lower than the marginal rate which gets higher as you have more income. People often forget that the higher rates don't apply to all of your income, only the portion that exceeds certain limits -- for most of us only a small chunk, if any, gets taxed at the higher rates. It is true, of course, that for CEO's in the U.S., who receive an average of $4 million per year in compensation, a much higher portion falls into the upper brackets. But see Tip #2.

Tip # 5: As you steam and burn at having to pay taxes that go to fund programs "X" and "Y," remember that there are some people who are quite happy to pay for those, but who don't want to pay for "W" and "Z," which just happen to be the only things you think government ought to be providing.....

Some Thoughts on Egypt's Revolution

The revolutionary events in Egypt over the past few weeks have been extraordinary in terms of their global repercussions. They also have implications for me personally -- the first demonstration in Cairo's Tahrir Square took place the day after my wife and I had put down a deposit for a week's tour of upper Egypt in May.

We've been in Egypt before. We visited about 30 years ago, shortly after the historic Camp David Accords had been signed. We remember the optimism and hopefulness of the people at that time, and the positive regard they had for the U.S., particularly for President Carter. We were treated very, very well during that trip, and it certainly was one of the best we have ever taken. Unfortunately for the Egyptan people, Anwar Sadat was assassinated not long after he signed the accords, and the reign of Mubarak snuffed out their optimism and hope for the future.

Our first visit to Eqypt was a great trip with one exception. We arrived in Cairo very tired and extremely jet-lagged. I think it was late in the afternoon, and we transferred to our hotel, a brand new Holiday Inn near the Great Pyramids of Giza where we stayed for a few nights before heading south. We were on a TWA tour which was very thorough, well organized, and which wasted no time in getting to the good stuff. Our first morning after arriving was to be one of the highlights of the trip -- visiting the Great Pyramids, the Sphinx, and some important sites outside of Cairo. Unfortunately our alarm failed to wake us at the appointed hour and the hotel wake-up call never came. We finally got a call from our tour leader asking if we weren't going to join the group for the day? We threw on some clothes and rushed to the waiting bus with only a few candy mints for breakfast, not even a cup of coffee. Needless to say, we can barely remember what we saw that day.

Our goal this year was to revisit some of those monuments, this time while wide awake, and also spend some time in historic Alexandria, which we did not see on the first trip. We scheduled this week in Eqypt at the end of a longer trip to Jordan & Syria -- note, no possibility of jet-lag while viewing the Sphinx! Also, rather than being on a lock-step group tour, we've arranged for a car, driver, and local guide to take us to those places on our own personal itinerary.

We haven't canceled any of our plans in Eqypt, nor in Jordan & Syria, and we won't unless it seems absolutely necessary.

When we describe this to people we get pretty strong reactions. Some are wide-eyed that we would even consider going to the Middle East at all, let alone after the recent developments. Others are very encouraging, and think that it would be an excellent time to visit these places, assuming some stability and lack of violence, because the people will once again be optimistic and hopeful. Given the economic dependence of many common citizens in these countries on tourism, they are likely to welcome visitors very warmly -- in fact, going ahead with our trip is perhaps the most direct way of helping people and showing support for them. Americans in particular should perhaps show support, given the democratic goals of the protestors. [Please feel free to weigh in on this with your own comments -- anonymously if you prefer.]

We'll see what happens in the next several weeks. We certainly live in interesting times, don't we?????

How to Compress Your Morbidity

Let's talk about dieing. I don't mean death itself, which has all kinds of philosophical and religious issues attached to it, but rather the physical and mental processes leading up to death, which involve more factual, scientific issues.

All of us will die and nobody knows exactly when. Despite the uncertainty as to the timing of death, most of us have an idealized model of how we want to die: continued high level of physical and mental functioning for as long as possible and then rapid decline just before the end. This period of decline in which we are infirm, diseased, disabled and/or demented is called morbidity, and we wish it to be as short as possible, followed by a quick and painless death.

About 30 years ago a gerontologist by the name of J.F. Fries proposed what he called "the compression of morbidity hypothesis." According to Fries, there are natural limits on how long humans can live, and improvements in health care, life style, and reductions in the effect of environmental risks are steadily progressing us to a maximum life expectancy, which he believed at the time was about 85 years. He proposed that the same factors that produce a longer life would also produce a "compression" of morbidity because they would lead to a lower incidence of chronic disease and a higher age of onset of chronic disease.

The compression of morbidity hypothesis is certainly attractive because it fits our idealized model of dieing, and it would be great if it were correct. Unfortunately the gerontological research over the last 30 years seems to indicate that Fries was wrong on two counts. First, life expectancy in at least one country (Japan) has now exceeded Fries' proposed limit of 85, and is still increasing almost linearly in most countries (Christensen et. al, 2009), though there is perhaps some leveling off in the U.S. (Crimmins & Beltrán-Sánchez, 2010):

Large declines in mortality rates in recent decades have translated into sizable increases in survival at older ages. For example, in the United States, the probability of a 65-year-old surviving to age 85 doubled between 1970 and 2005, from about 20% in 1970 to about 40% in 2005 (Bell & Miller, 2005). Similar or greater increases in survival at older ages have been reported in most developed countries among people aged 80 years or older since the 1970s (Kannisto, 1994, 1997; Vaupel, 1997). As life expectancy has increased, the modal age at death has steadily increased so that death in low-mortality countries most frequently occurs to people in their late 80s and 90s (Robine, 2010). Even death rates among people above age 100 have declined significantly in recent years leading to an increasing number of centenarians (Kannisto, Lauritsen, Thatcher, & Vaupel, 1994; Robine, Saito, & Jagger, 2003; Vaupel, 2010). This steady rise of life expectancy even at the oldest ages indicates that humans are not yet pushing up against a fixed limit, one that cannot be exceeded, which is a central tenet underpinning the compression of morbidity hypothesis." (Crimmins & Beltrán-Sánchez, 2010)

Although this may seem like good news -- we're living longer -- the data also show incidence of disease and disability has increased, not decreased in elderly populations, contrary to the compression of morbidity hypothesis (Christensen et. al, 2009; Crimmins & Beltrán-Sánchez, 2010). With respect to physical mobility problems, for example, data from the National Health Survey compared the percent of people in different age groups in 1998 and 2006 who reported being unable to perform at least one of the following: walking 1/4 mile, walking up 10 steps, standing or sitting for 2 hr, and standing, bending, or kneeling without using special equipment. The results show no support for a compression of this kind of morbidity:

For a number of other sources of morbidity, like cardiovascular disease, stroke & heart attack, diabetes, & cancer, the research comparing 1998 and 2006 indicates "There is no hint of a declining prevalence of disease over these eight years....The most striking change over the ten-year period is the increase in all the CVD conditions among older males; for females, the increase among the oldest group only occurs in the prevalence of stroke. Older men and women show an increased prevalence of cancer. Diabetes increases are seen through much of the adult age range" (Crimmins & Beltrán-Sánchez, 2010). Since mortality rates in older age groups have been decreasing during the same period, this means the number of survivors of these diseases has generally increased, often with decreased functioning associated with the management of the disease.

Now that you're suitably depressed, let me point out that the studies reviewed above deal with population trends and don't negate the possibility of individual factors that might contribute to compression of morbidity. Indeed, there is data showing that life-style choices (diet, exercise, weight control, preventative health-care, etc.) may compress morbidity for specific individuals, though more studies along this line are needed to be more definitive. In one study, 418 people were followed over 12 years (1986-1998) in terms of how their lifestyles (smoking, exercise, weight) related to morbidity patterns. Those with healthier lifestyles showed either a slight increase in morbidity over time with no acceleration of disability before death, or only a brief period of accelerated morbidity before death (Hubert, et. al., 2002), consistent with the idea of morbidity compression. In short, it is certainly possible to have some degree of control over your own individual morbidity pattern.

Another more optimistic point is that even if we must live with disease or disability in our later years, there are more ameliorative resources available all the time. As Christensen et. al. (2009) have noted, the rising use of assistive technology and improvements in housing standards, public transport, accessibility of buildings, changes in social policies, shifting gender roles, and the social perception of disability may loosen the link between disease and functional limitation of disability. Of course, these things are somewhat dependent upon governmental policy and therefore the political climate. Given our current health care debates in the U.S. we may find ourselves well behind other developed countries in offering preventive and ameliorative resources.


References

Christensen, K., Doblhammer, G., Rau, R.Vaupel, J.W.(2009). Ageing populations: the challenges ahead. Lancet. 2009 October 3; 374(9696): 1196–1208

Crimmins, E.M., & Beltrán-Sánchez, H. (2010). Mortality and morbidity trends: is there compression of morbidity? Journal of Gerontology: Social Sciences, 66B(1), 75–86.

Fries, J. F. (1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303, 1369–1370.

Hubert HB, Bloch DA, Oehlert JW, Fries JF. (2002) Lifestyle habits and compression of morbidity. J Gerontol A Biol Sci Med Sci. 2002 Jun;57(6):M347-51.