Tuesday, September 14, 2021

Time to instill integrity into vaccination verification


By Howard L. Smith, Ph.D.; David N. Gans, MSHA, FACMPE; Zung Vu Tran, Ph.D., FACSM, FSS; Nina Nichols; Brett Goldman; Ryan Hawkos; and Neill F. Piland, Dr.PH.

Even before COVID-19 vaccinations began to be widely disseminated, concerns were expressed about which agencies would document and monitor them. Just as quickly, the federal government took the position that it was not going to institute a system of passports. Those who were inoculated would receive a CDC vaccination card and that was the end of discussion at that time. Well, not quite. Wishful thinking on the part of our government to avoid vaccination documentation and verification has created a formidable crisis about the integrity of vaccinations at a pivotal juncture. 

Vaccinated and unvaccinated alike want to return to some semblance of normalcy that reflects any of the millions of ways that people work, play, pray or interact. This has become possible due to widespread immunization of the U.S. population coupled with prudent social distancing and mask use, which momentarily dampened COVID-19 case counts until variants proliferated. However, as long as a sizeable number of people avoid vaccination, the virus will find ways to thrive.

Increasingly, businesses, bars and restaurants, entertainment venues, sporting events, colleges, state and municipal governments, the Veterans Administration and federal agencies require proof of vaccination or continual tests. This has nurtured fertile ground for counterfeit cards. Anti-vaxers do not want to be prevented from partaking in such activities; plus, many people simply enjoy beating the system or proving that no one can make them do what they do not want to do regardless of the expense to their health or society. This self-centeredness is costing the United States some $2.3 billion in hospitalization for unvaccinated people during June and July 2021 alone.1

As we struggle to reopen our society and rejuvenate our economy, the long-ignored challenge of instilling integrity into vaccination documentation must be overcome. But does anyone really trust that the person sitting, standing or otherwise in their personal space has actually been vaccinated as they espouse or claim with a little sheet of paper? Remember, it only takes one exposure to acquire a virus that might kill you.

The preceding thoughts clearly underscore that it is past time for a viable and efficient vaccination verification system. Such a system would function much like the Good Housekeeping Seal of Approval or OSHA’s “Nationally Recognized Testing Laboratories,” in which valid third-party organizations with appropriate qualifications perform safety testing and certification of products. The CDC, or other health-related agency, could oversee a national vaccination verification system. For example, sources approved by the CDC (e.g., Nationally Recognized Verification Entities) could create highly recognizable electronic passports that substantiate COVID-19 vaccination. The technology and products already exist as private firms have looked ahead to now — when vaccination certification would be paramount to a functioning society.

Currently, the lack of a secure verification system is facilitating fraud as people falsify credentials, forge vaccination cards or hack digital certification tools to meet entry requirements for health facilities, mass gatherings and places of business. Physical and digital health records such as the CDC card and IBM’s Excelsior pass have been easily falsified.2

Cell phone-enabled vaccination verification should be an immediate reality. The world relies on cell phones to do most anything and everything. Verification needs to be easy to use at point of entry (e.g., into a restaurant, bar or entertainment venue), inexpensive, and widely recognized as one of the CDC-approved “Good Health Keeping Passports of Vaccination.” This will facilitate disease prevention, efficient use of health services and facilities and reduce healthcare costs, as well as invigorate economic activity and development.

It is time to quit stalling. All along we have known that there would be a need for bulletproof verification of vaccination to re-boot societal functioning. Let’s invest a modicum of resources in a reliable vaccine verification/certification system of high integrity as we have in developing the vaccines and confidently move onward and upward.

Sunday, September 12, 2021

The Physiology of Treading Water Efficiently

OUTSIDE magazine
Alex Hutchinson
Sep 9, 2021

A new study measures the physical and cognitive load of four different treading techniques. 
The key? Generate lift.  

On a canoe trip down the Spanish River in northern Ontario last month, my friends and I kept noticing an unusually high concentration of really, really big leeches lurking at the shores of our campsites. As a result, our pre-dinner swims involved paddling our canoes out to deep water then jumping in from there. 

This gave me lots of time to think about treading water: how long I’d be able to keep it up if necessary, if I was doing it properly, and whether that even mattered. Imagine my surprise, then, when I got home and saw this paper, just published in Frontiers in Physiology by Tina van Duijn of the University of Otago and her colleagues: “A Multidisciplinary Comparison of Different Techniques Among Skilled Water Treaders.” 

They put 21 volunteers, all experienced water polo players, synchronized swimmers, or competitive swimmers who self-identified as water-treading experts, through a series of physiological and cognitive tests while performing four different styles of treading. 

The verdict: some techniques really are substantially better than others. The four techniques are as follows: 

Running in the water: This one is pretty self-explanatory. Hands and feet are moving up and down in a running-like motion. 

Flutter kick: Your hands are sculling back and forth along the surface of the water, while your legs do a flutter kick. 

Upright breaststroke: Your hands are still sculling along the surface of the water, but your legs are doing the distinctive frog kick of the breaststroke. 

Eggbeater: It’s similar to the upright breaststroke, with the key difference that your legs are kicking one at a time instead of synchronously, producing an eggbeater pattern of alternating circles with each leg. 

Like pretty much everyone who took swimming lessons as a kid, I was taught the eggbeater. But as I floated down the Spanish, I realized that over the years I’ve settled into a comfortable upright breaststroke style as a default. In fact, I wasn’t really sure how to do the eggbeater anymore—which, as I thought back to an article I wrote a few years ago called “How to Survive 75 Hours Alone in the Ocean,” vaguely worried me. 

Was I working way harder than I needed to in order to stay afloat? It turns out I’m not alone in my habits. Among the expert water treaders in the study, 71 percent of them opted for eggbeater in their warm-up, but 14 percent each chose upright breaststroke and flutter kick. There were clear differences in how efficient the different techniques were, with running and flutter kick performing equally poorly, and upright breaststroke and eggbeater performing equally well. This pattern showed up in every outcome measure. 

For example, here’s the oxygen consumption (VO2) during the last portion of 3.5-minute test bouts, measured through a breathing mask attached to a snorkel: (Photo: Frontiers in Physiology) Oxygen consumption is roughly proportional to energy consumption, so the lower values for breaststroke and eggbeater mean they’re more efficient than the other two strokes. Aside: these values are adjusted based on the “wet weight” of each participant, which was measured by weighing them underwater. 

Normally VO2 measurements are adjusted for weight, since heavier people burn more energy—but in this case, wet weight was used to also account for differences in buoyancy. 

As a guy who sinks like a stone in water, I found this interesting! Similarly, heart rate was higher in running (140 beats per minute, on average) and flutter kick (147) than in breaststroke (129) and eggbeater (129). 

Same for perceived effort: 14 and 13 on the Borg scale from 6 to 20, versus 11 and 11, respectively. For cognitive load, they used the NASA-Task Load Index, which assesses things like effort, frustration, and perceived performance, and they tested reaction time in response to visual and audible signals. In both cases, breaststroke and eggbeater produced better results than the other two. 

There’s some interesting physics in the stroke comparisons. The two inferior techniques largely rely on pushing down against the water to move the body upward. This has two problems: water is too thin to provide much support, and even when the pushing works you get a lot of wasted up-and-down motion. The two better strokes, in contrast, involve lateral movements of the arms and legs: your cupped hand acts like an airplane wing or sailboat sail, generating lift forces perpendicular to the plane of motion. This is more efficient than pushing on the water, and produces less wasted vertical bobbing. 

 There’s one key difference between upright breaststroke and the eggbeater: in the former, your legs are kicking outward at the same time, while in the latter they’re alternating. This means that breaststroke produces some of that undesired up (when you kick) and down (between kicks) motion—and that effect is exacerbated if you stop sculling with your hands. 

In the eggbeater, there’s always one leg moving, so you get a smoother, more continuous lift that can keep you up even without your hands. The study didn’t test anything that required using your arms—but if you want to throw a water polo ball, strike a fancy pose during your synchro routine, or signal frantically to a passing ship that you need rescue, eggbeater looks like a much better bet. Next time I’m in deep water, I’m going to see if I can get the hang of it again.

Wednesday, September 8, 2021

Surprising ways you may be getting sun-damaged skin (From Kaiser-Permanente)

Make coffee. Eat breakfast. Brush your teeth. Take a shower.

This typical morning routine is missing an important step: Put on sunscreen.

Why should you wear it every day? Because sun-damaged skin may be sneaking up on you.

You know you and your family should wear sunscreen before spending a long afternoon outdoors, but sun damage is cumulative — short periods of unprotected sun exposure add up over time, eventually leading to visible damage to your skin and a higher risk of skin cancer.
What is sun damage?

Sun damage, or photoaging, is when ultraviolet (UV) light from the sun prematurely ages your skin. There are 2 kinds of UV light — UVA and UVB. UVA light damages skin at all levels, from the surface to the deepest layer, breaking down collagen and elastin fibers. UVB light damages the outer layer of skin and your DNA, which can lead to cancer. A simplified way to remember the difference is that UVA rays are aging and UVB rays are burning. If you have darker skin, it’s less likely to burn — but it can still be damaged by UVA rays.

Signs of sun-damaged skin include:
• Broken capillaries, usually around the nose
• Loss of skin elasticity
• Pigmentation changes, such as age spots and brown patches of discoloration (known as melasma)
• Red blotches
• Uneven skin texture
• Wrinkles

For a safer, healthier summer glow, try sunless tanning.

Surprising Ways you may be getting sun damage

Direct sun exposure occurs anytime you’re outdoors unprotected. Indirect sun exposure is when something is partially protecting you from the sun, like a window. If you’re not wearing adequate sunscreen, these exposures add up and lead to lasting sun damage.

“People are running errands — 5 minutes here, 10 minutes there — or walking their dog, and they’re not taking into consideration the cumulative, short bursts that they’re getting,” says Sarah Adams, MD, a dermatologist at Kaiser Permanente Southern California. “All of the sudden, they’ve been outside for an hour and a half and they haven’t worn any sunscreen or any sun protection.”

Some examples of surprising sun exposure include:
• Short trips outdoors, like walking from a parking lot to a building
• Being under shade, like an umbrella
• Clouds covering the sun
• Sitting next to a window — including in your home office, working at a drive-thru, or traveling in a car, bus, or airplane

And yes, you read that last one right — you should even wear sunscreen when you’re home all day if you’re near a window. Windows usually block UVB rays, but not UVA rays.

“When I see patients in clinic, I notice more photoaging — more dark marks, more pigmentation — often affecting the left side of their face,” Dr. Adams says. “I can often tell that someone was a driver versus a passenger because of the amount of sun damage that there is on one side of their face versus the other.”

Your skin can also become more sensitive to the sun if you’re on certain medications or skin products — so take extra care to protect yourself. Read the labels or check with your doctor if you’re using:
Acne medications like Accutane
Antibiotics, particularly tetracyclines
Some birth control pills
Some heart medications for arrhythmia
Topical skin products such as retinols, glycolic acid, and other alpha hydroxy acids
How to protect your skin from sun damage

Use sunscreen with SPF 30 or higher on yourself and your kids every day to prevent sun damage. Look for a broad-spectrum formula, which protects from both UVA and UVB light. Encourage your teens and older kids to use it daily, too.

Besides your face, be sure to apply sunscreen to commonly overlooked areas, such as your ears, the sides and back of your neck, the V of your chest, and the backs of your hands.

Get fast, easy coverage by wearing long-sleeved shirts and pants, a wide-brimmed hat, and sunglasses. Invest in clothes with UPF (ultraviolet protection factor) for extra protection.

Limit how much time you and your family spend outdoors between 10 a.m. and 2 p.m. when the sun’s rays are strongest. But remember, UV rays can be a concern anytime the sun is up. Use your smartphone’s weather app to check the current UV index — if it’s 3 or higher, you should protect your skin.

Some good news — you don’t need to reapply sunscreen throughout the day if you’re not sweating or swimming. Just make it part of your daily morning routine.

Monday, August 30, 2021

I Can’t Stop Thinking About This Subreddit That Collects COVID-19 Deniers Who Then Suffer the Worst

From Digg

On Reddit, there’s a forum called r/COVIDAteMyFace. It’s a sort of spin-off of r/LeopardsAteMyFace, which is a repository for news steeped in the repercussions of someone’s actions. “Revel in the schadenfreude anytime someone has a sad because they’re suffering consequences from something they voted for or supported or wanted to impose on other people,” reads the r/LeopardsAteMyFace description.

“Leopards Ate My Face” is a reference to a viral tweet from author Adrian Bott (@cavalorn) in October 2016, following the Brexit vote: “‘I never thought leopards would eat MY face,’ sobs woman who voted for the Leopards Eating People’s Faces Party.” I’ve been subscribed to r/LeopardsAteMyFace for a while, because, well, there is a certain kind of schadenfreude that results from seeing people realize that the terrible policies they vote for—often with callous or intentional disregard for other people—can hurt them, too.

But r/COVIDAteMyFace feels very different. After a friend sent me the link yesterday, I read through the posts there for hours and felt only sadness, shame for America, and a white-hot rage at those who knowingly peddle disinformation about the pandemic, along with the social media networks (primarily Facebook, but also increasingly places like TikTok) that have allowed awful COVID-19 memes and outright lies to spread.

Even after Facebook vowed to combat disinformation back in February, their own recent reports have shown that the most popular posts on the network cast doubt on vaccination. Many of the anti-mask and anti-vax Facebook screenshots shared by people r/COVIDAteMyFace were posted just days ago.

Again and again and again throughout the entries on r/COVIDAteMyFace, we see the same patterns. Someone has spent months sharing Facebook memes and status updates about medical “freedom,” not being a vaccine “lab rat,” conspiracies about the vaccine, relentlessly mocking apparent go-to boogeyman Dr. Fauci, the disparagement of masks and mask mandates, and more.

Alongside these screenshots, there are then follow-up posts from the same people or their family members reporting that they are now in serious condition in the hospital with COVID-19 and usually asking for prayers and “prayer warriors.” More often than not, there’s an additional post reporting that the COVID-19 denier and/or anti-masker/anti-vaxxer has died. With the rise of the wildly infectious Delta variant, the number of cases like this has skyrocketed.

There’s no satisfaction to derive from these posts. They’re a vast human tragedy told in the arc of screengrabs from social media. The subreddit also hosts article after article recounting further tragedies: the anti-vax parents who died weeks apart, leaving behind four children; a 34-year-old father who died after wanting to wait a year because social media made him feel uncertain about the vaccine; unvaccinated pregnant people and babies dying; endless testimonies from those hospitalized or on their deathbeds expressing regret that they did not get the vaccine.

If I read another story about people begging for the vaccine when they’re being intubated, I may scream. The pandemic was already a nightmare, but the rampant ignorance and active campaigns to make people afraid of highly effective, widely researched vaccines or to push back against the simple act of wearing a mask feel criminal at this point.

Who is responsible for making anyone think and believe that “this isn’t that real of a virus”? And why do people continue to believe this 18 months in, with more than 4 million people dead?

I am usually in diametric political opposition to many of the people whose stories are on r/COVIDAteMyFace. I am furious at anti-vaxxers and opportunistic politicians instituting laws against basic health protocols for political clout. But I grieve the death of every person lost to COVID-19—and every loss of human life is a catastrophe with ripple effects far beyond that person.

These people were often beloved spouses, lovers, parents, siblings, aunts, uncles, grandparents, cousins, friends, coworkers. Some were primary caregivers and breadwinners who will leave despair in their wake. They had vibrant lives that went far beyond political parties and bad memes.

Losing someone that you love, especially at a young age, is one of the most difficult things that will ever happen to those left behind. I know this personally. But I cannot even begin to imagine how it would feel to grapple with the knowledge that your loved one’s death could have been prevented with a free and immensely effective vaccine. Even from the outside, that knowledge feels crushing. Worldwide, at least two million children at minimum have lost a parent or a grandparent caregiver to COVID-19. It’s unfathomable to imagine the suffering that people will carry with them.

r/COVIDAteMyFace serves an important purpose. It documents for posterity how America’s response to COVID-19 went completely off the rails, and yes, it demonstrates how personal actions can have devastating consequences. If scrolling through the tragedies there makes even one “vaccine-hesitant” person get the vaccine, it will have served a great purpose.

Some of the commenters on this forum seem to revel in the outcomes as anti-vaxxers getting their due, and that can feel ghoulish. Yet many are also exhausted at fighting disinformation for more than a year, and rightfully upset about the impact COVID-19 deniers who then get COVID-19 can have on others. It can feel hard to extend sympathy to people who seem to be choosing Facebook medical advice over the combined endorsement of the majority of doctors and scientists around the globe.

Beyond the ramifications of death or serious illness to those in the person’s circle, these people can also infect others in their disregard for health measures. They can be responsible for more deaths or horrifying cases. They’re impacting the ability of businesses and offices to reopen. They’re making schools dangerous for kids, many of whom cannot yet be vaccinated. And the trauma experienced by the healthcare professionals who must care for and try to save everyone involved is already at a disastrous crisis point.

There are no easy answers, but what is starkly revealed when reading through r/COVIDAteMyFace is just how much social media has influenced people’s opinions amid the crass politicization of an international medical emergency. Social media networks, alongside politicians against mask mandates and “news” outlets that push vaccine skepticism and virus conspiracy theories, all have blood on their hands. In America, a lot of initial blame can be laid squarely at the feet of Donald Trump and the GOP for their constant downplaying of the virus and pushback against masks. But Trump is gone now and the misinformation has only dug in its heels.

Were Dante to write a modern-day Divine Comedy, I think there’d be a special layer of hell in “Inferno” for those who broker in pandemic disinformation for fun or profit. I imagine it as an infinite pediatric COVID ward where the only people you can speak to are the souls of once-vehemently anti-vax right-wing radio hosts who have died.

If anyone should feel the ramifications of their actions right now, it’s those who pushed others into the realm of fear and paranoia. It was found that just 12 people were responsible for generating a majority of “misleading claims and outright lies” about the pandemic on social media. It’s wrenching to consider the countless people suffering the consequences.

(via Reddit, image: Pexels, r/COVIDAteMyFace)

Tuesday, August 24, 2021

Telephone Disruption

 For reasons that we cannot discern, our primary line (301.421.4433) is not ringing through the switchboard. Our other numbers, which do not roll over, are working: 301.421.9529 and 301.421.0096 are working. You can choose an extension and leave a voice message any time of day. 

Wednesday, August 18, 2021

THOUGHTS ON AFGHANISTAN, from a senior military officer

I ask that you not use my name. I am a currently serving General Officer and what I have to say is highly critical of our current military leadership. But it must be said.

I don’t blame President Biden for the catastrophe in Afghanistan. It was the right decision to leave, the proof of which is how quickly the country collapsed without US support. Twenty years of training and equipping the Afghan army and all that they were capable of was a few hours of delay in a country the size of Texas. As for his predecessor, the only blame I place on President Trump was that he didn’t withdraw sooner.

We should blame President Bush, not for the decision to attack into Afghanistan following 9-11, but for his decision to “shift the goalposts” and attempt to reform Afghanistan society. That was a fool’s errand any student of history would have recognized. And yes, we should place blame on President Obama for his decision to double down on failure when he “surged” in Afghanistan, rather than to withdraw.

However, most of the blame belongs to the leadership of the US military, and the Army in particular. The Washington Post’s “Afghanistan Papers” detailed years of US officials failing to tell the truth about the war in Afghanistan, “making rosy pronouncements they knew to be false and hiding unmistakable evidence the war had become unwinnable.” That report was two years ago, and the stories within it began more than a decade before that. Afghanistan was, and always will be, “unwinnable”.

Of course, I blame President Biden for the disastrous retrograde operation still unfolding. But let us not allow that to deflect us from heaping even more blame on military leaders. They stonewalled President Trump rather than beginning deliberate preparations to exit the country when he told them to. They thought that they could outlast him and then talk sense to his successor. Then after the inauguration, they pressed the new president to reverse course. He wisely chose withdrawal. Then and only then did the generals begin their preparations in earnest. But it was too late to do it well.

The war in Afghanistan lasted more than twice as long as the Vietnam War. Although the cost in terms of American blood was thankfully far smaller, the mistakes are the same: America got involved in a long land war in Asia, in a peripheral region, in order to prop up a floundering and unreliable government, and at a time when there was a much bigger looming threat. In fact, Afghanistan was worse than Vietnam in that at least the Vietnam War was tangentially related to the effort to stop the global spread of communism during the Cold War. Afghanistan was worse than Vietnam in another respect: the military’s leaders of the Vietnam era had no precedent to dissuade them from a disastrous path. Today’s military leadership has the precedent of not just Vietnam, but also Iraq, Lebanon, Libya, Syria, and Yemen. That much obtuseness must be punished and removed from the system.

General Milley must resign. Not only is he the Chairman of the Joint Staff, prior to that he was the Chief of Staff of the Army. While all services share the blame, the Army is the land domain proponent. The 20 years of failure in Afghanistan is an Army failure. Scores of other generals also deserve a thorough evaluation; many of them are complicit in the lies to protect a decades-long failed strategy.

Secretary of Defense Austin also must be fired. The recently retired Army general and former CENTCOM commander was, and still is, part of the culture that is impervious to the fact that 20 years of trying it their way did not work.

Just as it did after Vietnam, the military, and especially the Army, must conduct a comprehensive review of why it exists. The purpose of the Army is to visit profound violence on our nation’s enemies; it is not to rebuild failed states. We have decades of experience: counter-insurgencies and nation-building does not work for America. We do not have the stomach for long wars of occupation—and that is a good thing. We are a nation of commerce, not conflict. A constellation of retired stars will tell you that the two can coexist. They are wrong. Retired Vice Chief of Staff of the Army General Jack Keane said only two months ago that because Afghanistan consumes just a small portion of the force, America “can afford the cost of fighting” there. What he does not see is that for 20 years, that “small portion” was the most important portion of the military. Everything else necessarily is subservient to the portion of the force in conflict. It has altered who the Army is and how it thinks. 

There exists only a handful of officers below the general officer ranks who served during the Cold War and who have lived through an era of great power conflict. From private through brigade commander, virtually every Army Soldier serving today has experienced little other than counterinsurgencies or nation-building while operating out of secure FOBs. Large-scale combat operations and insurgencies require different cultures and mindsets. In a resource-constrained environment, the same service cannot do both well. The Army today could not win a major war. Yet, winning a major war is the number one reason why an Army exists. It will take a generation to break bad habits, to think in terms of closing with and destroying the enemy versus winning hearts and minds. Keane sees raw numbers (and ignores the stark evidence that there was no progress over 20 years) and thinks that America’s Army can sustain that level of commitment. It cannot, and the opportunity cost to the culture of the force is much too great. Ignore him. Ignore Petraeus, McMaster, Stavridis, and the rest of their ilk.

Concurrent with its review of purpose, the Army must reevaluate its size and how it is organized. The active component is much too large. That makes it too eager to get involved in irrelevant theaters where failure is likely or even preordained. It should be very difficult for an American president to deploy the Army without the National Guard performing most combat operations. You argue that that takes time? Yes, that’s the point: it should take time to make the case to the American people that war is worth it.

The Marine Corps must provide the nation’s rapid response forces. It is a self-contained deployable multi-domain force. Some would argue that the service has both insufficient combat power and staying power. However, that is a feature, and not a flaw, as it forces the nation to rely on its Army—and hence its reserve components—before engaging in heavy combat or lengthy operations. The current Commandant of the Marine Corps, General Berger, already seems to recognize his service’s role—hence his decision to eliminate armor from the Corps.

Congress must reevaluate the authorities contained within Sections 12301 through 12304 of Title X. The president has too much latitude to, on his own authority, mobilize tens or even hundreds of thousands of Guardsmen and Reservists without congressional approval. It must be the policy of the United States that we do not place our service members in harm’s way without first making the case to the American people. This also means ending the 2001 and 2002 Authorizations for Use of Military Force as well as strengthening Congress’ role in the War Powers Act such that, absent an actual declaration of war, there can be no war.

Some would argue that such a constraint would limit the nation’s ability to respond to a Russian incursion in the Baltics or a Chinese attack on Taiwan. However, recent open-source studies conclude that the US military already is unable to defend against either attack. Pretending otherwise while not having the means to back up our assurances unnecessarily emboldens our partners and allies, making such an attack more likely. We lose nothing by making the law match the reality.

Let us not forget the intelligence agencies. They reported that Kabul was at risk of falling in as little as 90 days. That report was from last Thursday! The capital fell in less than 90 hours. Failure must be punished. And punishment in a bureaucracy means mass firings and a smaller budget—not more money so that they might be better the next time. Congress must consolidate and collapse our intelligence agencies. And when its reorganization is done, if the overall size of the nation’s intelligence apparatus is a quarter of what it is now, that still is too large.

And while we are on the topic of “too large,” DoD must be halved. There are too many flag officers, too many agencies, departments, and directorates. It is the only secretariat with independent but supposedly subordinate secretaries. There are too many Geographic Component Commands—each led by a 4-star virtual proconsul whose budget dwarfs what the Department of State spends in their regions. The result is a foreign policy that is overly military and underly diplomatic, informational, and economic. Congress must revisit the 1947 National Security Act and the 1986 Goldwater-Nichols Act. Both were good for their times, but after decades of experience, there clearly are new reforms necessary.

Unreformed, DoD is an inscrutable labyrinth that invites fraud, waste, and abuse. The excess attracts unscrupulous camp followers. Amazon did not choose Crystal City to locate its new headquarters because of low rents and ease of transportation access for its 25,000 employees. It chose the Arlington, Virginia neighborhood because it is two blocks from the Pentagon. That building controls the distribution of three-quarters of a trillion dollars every year. Most of it is wasted. The excess is apparent in the scores of class-A high rises housing defense contractors just blocks from the Pentagon. To end that waste, nothing so concentrates the senses as austerity.

Let me conclude with one last thought: the generals, the intelligence analysts, the defense contractors, and the pundits all leveraged America’s rarest resource: the American serviceman and woman. They are the ones who fought, and sweat, and bled, and died for what is now clearly a failed strategy and a doomed mission. Even after its failure was apparent to their leaders, they continued to enlist and reenlist, largely because their superiors—the experts—assured them that success was possible. It was not. It never was. Absent American support, Afghanistan collapsed over the length of a long weekend. That is proof enough that the last 20 years were in vain, and proof enough that the system is broken from within.

“Failure must be punished.” An idea so crazy it just might work.

What We Think We Know About Metabolism May Be Wrong

From the New York Times
A new study challenges assumptions about energy expenditure by people, including the idea that metabolism slows at middle age.
Aug. 12, 2021

Controlling for factors like body size and muscle mass, researchers found that there are basically four phases of metabolic rates and that a slowdown in adults doesn’t occur until after age 60. Desiree Rios for The New York Times

Everyone knows conventional wisdom about metabolism: People put pounds on year after year from their 20s onward because their metabolisms slow down, especially around middle age. Women have slower metabolisms than men. That’s why they have a harder time controlling their weight. Menopause only makes things worse, slowing women’s metabolisms even more.

All wrong, according to a paper published Thursday in Science. Using data from nearly 6,500 people, ranging in age from 8 days to 95 years, researchers discovered that there are four distinct periods of life, as far as metabolism goes. They also found that there are no real differences between the metabolic rates of men and women after controlling for other factors.

The findings from the research are likely to reshape the science of human physiology and could also have implications for some medical practices, like determining appropriate drug doses for children and older people.

“It will be in textbooks,” predicted Leanne Redman, an energy balance physiologist at Pennington Biomedical Research Institute in Baton Rouge, La., who also called it “a pivotal paper.”

Rozalyn Anderson, a professor of medicine at the University of Wisconsin-Madison, who studies aging, wrote a perspective accompanying the paper. In an interview, she said she was “blown away” by its findings. “We will have to revise some of our ideas,” she added.

But the findings’ implications for public health, diet, and nutrition are limited for the moment because the study gives “a 30,000-foot view of energy metabolism,” said Dr. Samuel Klein, who was not involved in the study and is director of the Center for Human Nutrition at the Washington University School of Medicine in St. Louis. He added, “I don’t think you can make any new clinical statements” for an individual. When it comes to weight gain, he says, the issue is the same as it has always been: People are eating more calories than they are burning.

Metabolic research is expensive, and so most published studies have had very few participants. But the new study’s principal investigator, Herman Pontzer, an evolutionary anthropologist at Duke University, said that the project’s participating researchers agreed to share their data. There are more than 80 co-authors in the study. By combining efforts from a half dozen labs collected over 40 years, they had sufficient information to ask general questions about changes in metabolism over a lifetime.

All of the research centers involved in the project were studying metabolic rates with a method considered the gold standard — doubly labeled water. It involves measuring calories burned by tracking the amount of carbon dioxide a person exhales during daily activities.

The investigators also had participants’ heights and weights and percent body fat, which allowed them to look at fundamental metabolic rates. A smaller person will burn fewer calories than a bigger person, of course, but correcting for size and percent fat, the group asked: Were their metabolisms different?

“It was really clear that we didn’t have a good handle on how body size affects metabolism or how aging affects metabolism,” Dr. Pontzer said. “These are basic fundamental things you’d think would have been answered 100 years ago.”

Central to their findings was that metabolism differs for all people across four distinct stages of life.

There’s infancy, up until age 1, when calorie burning is at its peak, accelerating until it is 50 percent above the adult rate.

Then, from age 1 to about age 20, metabolism gradually slows by about 3 percent a year.

From age 20 to 60, it holds steady.

And, after age 60, it declines by about 0.7 percent a year.

Once the researchers controlled for body size and the amount of muscle people have, they also found no differences between men and women.

As might be expected, while the metabolic rate patterns hold for the population, individuals vary. Some have metabolic rates 25 percent below the average for their age and others have rates 25 percent higher than expected. But these outliers do not change the general pattern, reflected in graphs showing trajectory of metabolic rates over the years.

The four periods of metabolic life depicted in the new paper show “there isn’t a constant rate of energy expenditure per pound,” Dr. Redman noted. The rate depends on age. That runs counter to the longstanding assumptions she and others in nutrition science held.

The trajectories of metabolism over the course of a lifetime and the individuals who are outliers will open a number of research questions. For instance, what are the characteristics of people whose metabolisms are higher or lower than expected, and is there a relationship with obesity?

One of the findings that most surprised Dr. Pontzer was the metabolism of infants. He expected, for example, that a newborn infant would have a sky-high metabolic rate. After all, a general rule in biology is that smaller animals burn calories faster than larger ones.

Instead, Dr. Pontzer said, for the first month of life, babies have the same metabolic rate as their mothers. But shortly after a baby is born, he said, “something kicks in and the metabolic rate takes off.”

The group also expected the metabolism of adults to start slowing when they were in their 40s or, for women, with the onset of menopause.

But, Dr. Pontzer said, “we just didn’t see that.”

The metabolic slowing that starts around age 60 results in a 20 percent decline in the metabolic rate by age 95.

Dr. Klein said that although people gain on average more than a pound and a half a year during adulthood, they can no longer attribute it to slowing metabolisms.

Energy requirements of the heart, liver, kidney and brain account for 65 percent of the resting metabolic rate although they constitute only 5 percent of body weight, Dr. Klein said. A slower metabolism after age 60, he added, may mean that crucial organs are functioning less well as people age. It might be one reason that chronic diseases tend to occur most often in older people.

Even college students might see the effects of the metabolic shift around age 20, Dr. Klein said. “When they finish college they are burning fewer calories than when they started.”

And around age 60, no matter how young people look, they are changing in a fundamental way.

“There is a myth of retaining youth,” Dr. Anderson said. “That’s not what the biology says. In and around age 60, things start to change.”

“There is a time point when things are no longer as they used to be.”