Manifold Podcast #20: Betsy McKay (WSJ) on Heart Disease and Health

Steve and Corey talk to Betsy McKay, senior writer on U.S. and global public health at The Wall Street Journal, about her recent articles on heart disease. Betsy describes how background reporting led to her article linking the recent drop in life expectancy in the United States, often attributed to the opioid crisis or increases in middle age suicides due to economic despair, to the increasing prevalence of heart disease, driven by the rise in obesity. The three also discuss current public health recommendations on how to reduce heart disease risk and on the use of calcium scans to assess arterial plaque buildup. Steve describes boutique medical programs available to the super-rich that include full body scans to search for early signs of disease. Betsy elaborates on how she approached reporting on a new study linking egg consumption to higher cholesterol and increased risk of death, a result at odds with other recent findings and national recommendations that two eggs a day eggs is safe and healthy. Finally, they consider whether people are wasting money on buying fish oil supplements.

[ At about 20m I discuss how I got on the keto diet... ]

Transcript

Death Rates Rising for Young, Middle-Aged U.S. Adults

How to Reduce Your Risk of Heart Disease

New BP guidelines that set elevated BP as above 120mmHG/80 and Stage 1 hypertension is 120-130/80-90, Stage 2 140/90 or above.

New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension

Heart Attack at 49—America’s Biggest Killer Makes a Deadly Comeback

Study Links Eggs to Higher Cholesterol and Risk of Heart Disease

Fish Oil: Hunting for Evidence to Tip the Scales

Don’t Use Bootleg or Street Vaping Products, C.D.C. Warns


man·i·fold /ˈmanəˌfōld/ many and various.

In mathematics, a manifold is a topological space that locally resembles Euclidean space near each point.

Steve Hsu and Corey Washington have been friends for almost 30 years, and between them hold PhDs in Neuroscience, Philosophy, and Theoretical Physics. Join them for wide ranging and unfiltered conversations with leading writers, scientists, technologists, academics, entrepreneurs, investors, and more.

Steve Hsu is VP for Research and Professor of Theoretical Physics at Michigan State University. He is also a researcher in computational genomics and founder of several Silicon Valley startups, ranging from information security to biotech. Educated at Caltech and Berkeley, he was a Harvard Junior Fellow and held faculty positions at Yale and the University of Oregon before joining MSU.

Corey Washington is Director of Analytics in the Office of Research and Innovation at Michigan State University. He was educated at Amherst College and MIT before receiving a PhD in Philosophy from Stanford and a PhD in a Neuroscience from Columbia. He held faculty positions at the University Washington and the University of Maryland. Prior to MSU, Corey worked as a biotech consultant and is founder of a medical diagnostics startup.

Neuroenhancement

Hmm... do we need drug testing for neuroenhancers?

I wouldn't be surprised to find that there are individuals who naturally function in the kind of state induced by Adderall or Provigil. Think of those hyper-productive people who start companies, write lots of books and papers and still manage to have hobbies and a social life. If a little pill helps the average guy achieve that level of capability, why not?

Provigil (modafinil) is used by the militaries of several countries, for example by fighter and bomber pilots.

New Yorker: ...The BoredAt Web sites—which allow college students to chat idly while they’re ostensibly studying—are filled with messages about Adderall. Posts like these, from the BoredAtPenn site, are typical: “I have some Adderall—I’m sitting by room 101.10 in a grey shirt and headphones”; “I have Adderall for sale 20mg for $15”; “I took Adderall at 8 p.m., it’s 6:30 a.m. and I’ve barely blinked.” On the Columbia site, a poster with an e-mail address from CUNY complains that her friends take Adderall “like candy,” adding, “I don’t want to be at a disadvantage to everyone else. Is it really that dangerous? Will it fuck me up? My grades weren’t that great this year and I could do with a bump.” A Columbia student responds, “It’s probably not a good idea if you’re not prescribed,” but offers practical advice anyway: “Keep the dose normal and don’t grind them up or snort them.” Occasional dissents (“I think there should be random drug testing at every exam”) are drowned out by testimonials like this one, from the BoredAtHarvard site: “I don’t want to be a pusher or start people on something bad, but Adderall is AMAZING.”

...Zack, who has a book being published this summer, called “The Neuro Revolution,” said, “We live in an information society. What’s the next form of human society? The neuro-society.” In coming years, he said, scientists will understand the brain better, and we’ll have improved neuroenhancers that some people will use therapeutically, others because they are “on the borderline of needing them therapeutically,” and others purely “for competitive advantage.”

Zack explained that he didn’t really like the term “enhancement”: “We’re not talking about superhuman intelligence. No one’s saying we’re coming out with a pill that’s going to make you smarter than Einstein! . . . What we’re really talking about is enabling people.” He sketched a bell curve on the back of a napkin. “Almost every drug in development is something that will take someone who’s working at, like, forty per cent or fifty per cent, and take them up to eighty,” he said.

...Paul Phillips was unusual for a professional poker player. When he joined the circuit, in the late nineties, he was already a millionaire: a twenty-something tech guy who had started off writing software, helped found an Internet portal called go2net, and cashed in at the right moment. He was cerebral and, at times, brusque. His nickname was Dot Com. ...Most unusual of all, Phillips talked freely about taking prescription drugs—Adderall and, especially, Provigil—in order to play better cards.

He first took up the game in 1995, when he was in college, at U.C. San Diego. He recalled, “It was very mathematical, but you could also inject yourself into the game and manipulate the other guy with words”—more so than in a game like chess. Phillips soon felt that he had mastered the strategic aspects of poker. The key variable was execution. At tournaments, he needed to be able to stay focussed for fourteen hours at a stretch, often for several days, but he found it difficult to do so. In 2003, a doctor gave him a diagnosis of A.D.H.D., and he began taking Adderall. Within six months, he had won $1.6 million at poker events—far more than he’d won in the previous four years. Adderall not only helped him concentrate; it also helped him resist the impulse to keep playing losing hands out of boredom. In 2004, Phillips asked his doctor to give him a prescription for Provigil, which he added to his Adderall regimen. He took between two hundred and three hundred milligrams of Provigil a day, which, he felt, helped him settle into an even more serene and objective state of mindfulness; as he put it, he felt “less like a participant than an observer—and a very effective one.” Though Phillips sees neuroenhancers as essentially steroids for the brain, they haven’t yet been banned from poker competitions.

Last summer, I visited Phillips in the high-desert resort town of Bend, Oregon, where he lives with his wife, Kathleen, and their two daughters, Ivy and Ruby. Phillips, who is now thirty-six, seemed a bit out of place in Bend, where people spend a lot of time skiing and river rafting. Among the friendly, faithfully recycling locals, he was making an effort to curb his caustic side. Still, when I first sent Phillips an e-mail asking him to explain, more precisely, how Provigil affected him, he couldn’t resist a smart-ass answer: “More precisely: after a pill is consumed, tiny molecules are absorbed into the bloodstream, where they eventually cross the blood-brain barrier and influence the operation of the wetware up top.”

In person, he was more obliging. He picked me up at the Bend airport driving a black convertible BMW, and we went for coffee at a cheery café called Thump. Phillips wore shorts and flip-flops and his black T-shirt displayed an obscure programming joke. “Poker is about sitting in one place, watching your opponents for a long time, and making better observations about them than they make about you,” he said. With Provigil, he “could process all the information about what was going on at the table and do something about it.” Though there is no question that Phillips became much more successful at poker after taking neuroenhancers, I asked him if his improvement could be explained by a placebo effect, or by coincidence. He doubted it, but allowed that it could. Still, he said, “there’s a sort of clarity I get with Provigil. With Adderall, I’d characterize the effect as correction—correction of an underlying condition. Provigil feels like enhancement.” And, whereas Adderall made him “jittery,” Provigil’s effects were “completely limited to my brain.” He had “zero difficulty sleeping.”

...Drugs like Ritalin and Adderall work, in part, by elevating the amount of dopamine in the brain. Dopamine is something you want just enough of: too little, and you may not be as alert and motivated as you need to be; too much, and you may feel overstimulated. Neuroscientists have discovered that some people have a gene that leads the brain to break down dopamine faster, leaving less of it available; such people are generally a little worse at certain cognitive tasks. People with more available dopamine are generally somewhat better at the same tasks. It makes sense, then, that people with naturally low dopamine would benefit more from an artificial boost.

...Zack Lynch, of NeuroInsights, gave me a rationale for smart pills that I found particularly grim. “If you’re a fifty-five-year-old in Boston, you have to compete with a twenty-six-year-old from Mumbai now, and those kinds of pressures are only going to grow,” he began. Countries other than the U.S. might tend to be a little looser with their regulations, and offer approval of new cognitive enhancers first. “And if you’re a company that’s got forty-seven offices worldwide, and all of a sudden your Singapore office is using cognitive enablers, and you’re saying to Congress, ‘I’m moving all my financial operations to Singapore and Taiwan, because it’s legal to use those there,’ you bet that Congress is going to say, ‘Well, O.K.’ It will be a moot question then. It would be like saying, ‘No, you can’t use a cell phone. It might increase productivity!’ ”

...Paul McHugh, a psychiatrist at Johns Hopkins University, has written skeptically about cosmetic neurology. In a 2004 essay, he notes that at least once a year in his private practice he sees a young person—usually a boy—whose parents worry that his school performance could be better, and want a medication that will assure it. In most of these cases, “the truth is that the son does not have the superior I.Q. of his parents,” though the boy may have other qualities that surpass those of his parents—he may be “handsome, charming, athletic, graceful.” McHugh sees his job as trying to get the parents to “forget about adjusting him to their aims with medication or anything else.”

...Of course, the idea behind mind-hacking isn’t exactly new. Fortifying one’s mental stamina with drugs of various kinds has a long history. Sir Francis Bacon consumed everything from tobacco to saffron in the hope of goosing his brain. Balzac reputedly fuelled sixteen-hour bouts of writing with copious servings of coffee, which, he wrote, “chases away sleep, and gives us the capacity to engage a little longer in the exercise of our intellects.” Sartre dosed himself with speed in order to finish “Critique of Dialectical Reason.”