Guidance and A Good Example

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Do you teach students? Do you manage employees? Are you setting a good example for those who will come after you? Last week, I heard Jamie Dimon, the chief executive of J.P. Morgan, discuss the importance of cultivating a bench of good people from which the board of directors could select a worthy successor. A truly wise leader in any organization thinks like that. Of course, in order to think and plan on that level, one needs tremendous maturity, discipline, humility, and prudence.

Many people today are too insecure and self-obsessed to train their own replacements. They’re more worried about who might threaten their power and position. But history is a good teacher. Socrates trained Plato, and Plato trained Aristotle. Jesus picked 12 apostles and numerous disciples. Sir William Osler trained an elite cadre of young physicians to follow in his footsteps at Johns Hopkins.

Superior leaders surround themselves with first-rate people, and these leaders cultivate several key attributes and skills. Whether you are a senior partner, a professor, or a parent, here are some of the qualities that are essential to your ultimate success as you pass the baton:

  • A deeply ingrained sense of right and wrong. Many people focus on what they can get away with. Moral relativism is not the secret to greatness or even long-lasting success.
  • A willingness to accept personal responsibility for success or failure. Expressions like “It’s not my fault,” “It’s not my job,” do not make for an acceptable mindset.
  • The ability to speak and act with courage. This one is tough in the age of social media nonsense and nastiness. The vast majority of people in board rooms and conference halls are afraid of what someone might say, so they hide behind the commonplace and comfortable. There is no honor in cowardice.
  • The wisdom to encourage and inspire others. Mediocre-management types make excuses. Top notch people bring out the best in others. When you have a great parent, teacher, coach, or boss, you can’t bear the thought of disappointing your hero.
  • The capacity to engage in independent thought and creative problem solving. The world is full of lemmings, parrots, copycats, and complainers. It takes a secure, confident leader to inspire real leadership in others.

Whether you work in a huge medical center, a small office, a corner pharmacy, or at home, someone is looking to you for guidance and a good example. Don’t be afraid to set the bar high.

The Keto Craze

Posted on Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

By Dr. Laura Pawlak

Unlike any time in history, Americans are faced with an obesity epidemic.  The sensible weight-loss guidelines of a mere decade ago appear to be failing.

“The best foods to eat on a diet?  The best foods to eat to keep weight off?  The same foods you should eat when you are not on a diet, but just less of them.”  Dr. Frank Sacks, Harvard School of Public Health, 2009.

The above statement was based on the study of 48 popular diets. All diets failed to produce significant differences in sustained weight loss.

Fast-tracking to 2019, the American diet has drifted far from the standard of what should be consumed. The foods we eat are primarily processed, containing almost 90 percent of the diet’s added sugar.  Also, these foods contain too much salt, very little fiber, and lots of saturated fats.  Eating less of these foods may result in weight loss, but the body and brain remain unhealthy.

When it comes to dieting, today’s fast-changing lifestyle demands novel, quick fixes.  The hype in the latest keto diet craze is infectious:  Fast weight loss without exercise;  novel tools to measure rising ketone levels;  easy-to-find processed keto foods; and keto pills when the diet is too tough to follow.

You eat lots of fat (at 80 percent of calories), moderate amounts of protein (at 20 percent), and very few plant foods, sugar, or starch (at 5 percent).  The excess intake of calories from fat triggers metabolic, nutritional, and hormonal changes not meant to be sustained for long periods of time.  Guidance by a registered dietitian is definitely recommended.

The Atkins program proposes a moderate approach to the keto craze:  A choice of 20 percent or 40 percent of the diet as carbohydrates for a limit of one month — and progression toward more plant foods.

If weight loss is achieved on a keto diet, a major challenge still remains:  The need to maintain your lower, healthy weight with a diet that offers protection against disease — not a keto plan.

A 25-year study evaluating healthful longevity and diet, published in 2018, identified the foods you should eat for a long, disease-free life:  Consume approximately 50 percent of your calories as carbohydrates, primarily as whole plant food; eat proteins, mainly from fish and plants; and add healthy oils from olives, avocados, nuts, and seeds.


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renowned biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

Nuts About Nuts

Posted on Posted in Brain Science, Continuing Education, Homestudy, Nutrition, Seminars, Webinars

By Dr. Laura Pawlak

Americans love nuts. Their passion has led to an increased consumption by almost 40 percent in the last 15 years.

Contrary to the belief that nuts are fattening, nuts are nutritious foods categorized as superfoods.  Nuts offer a wide variety of nutrients especially protective for the brain and cardiovascular system.

A trio of nutrients in nuts — healthy fat, fiber, and protein — make them a satisfying snack that won’t affect your waistline, assuming the portion size is a handful each day.  In fact, researchers at the Harvard School of Public Health found that regular nut consumption was associated with a slightly lower risk of weight gain and Type 2 Diabetes than a diet devoid of nuts.

A caveat is noteworthy:  If the nut is adulterated, i.e. honey glazed or chocolate coated, the word fattening would be an appropriate description of the nut.

Although nuts vary slightly in nutrient content, all varieties are beneficial. Almonds are especially high in fiber.  The macadamia nut has the most fat, mostly as monounsaturated oil.  Brazil nuts are famous for their selenium content. Pecans and hazelnuts are loaded with a variety of antioxidants.  Pistachios contain more potassium than a banana.  Cashews excel in the nutrient, lutein, a protectant for your eyes.  Walnuts provide anti-inflammatory fats similar to fish oil.

The peanut, really a legume, is a valuable addition to the nut family, offering more protein than any nut.  Ground into a nut butter, this spread is a tasty alternative to butter or margarine.

Before purchasing a peanut butter, read the label.  Unnecessary emulsifiers may be added to prevent the separation of oil.  There’s no need to purchase peanut butter with added sugar even if you have a sweet tooth.  Spread plain or crunchy peanut butter on slices of a crisp apple.  Your sweet tooth will be as satisfied as your gut.

Has your doctor asked you to lower your intake of sodium?  A few brands of peanut butter are just ground, unsalted peanuts.  Here’s a suggestion for adapting your taste buds to salt-free peanut butter:  Mix a small amount of unsalted peanut butter with the regular salted version.  Over time, increase the amount of the salt-free spread until you reach 100 percent.

In my opinion, the best-tasting peanut butter is freshly ground.  Grocery stores often place a grinder and containers next to the bulk peanut supply.  Enjoy!


Dr. Laura Pawlak (Ph.D., R.D. emerita) is a world-renown biochemist and dietitian emerita.  She is the author of many scientific publications and has written such best-selling books as “The Hungry Brain,” “Life Without Diets,” and “Stop Gaining Weight.”  On the subjects of nutrition and brain science, she gives talks internationally.

Pop Quiz!

Posted on Posted in Brain Science, Continuing Education, Seminars, Webinars

By Mary O’Brien, M.D.

Quick!  What illness can cause fatal pneumonia, bacterial superinfection, meningitis, myelitis, encephalitis, acute thrombocytopenic purpura, transient hepatitis, or subacute sclerosing panencephalitis?  The answer is measles.  Each year nearly 20 million people are infected worldwide.  There are 200,000 deaths, most of which occur in children.  The anti-vaxxers are utterly unaware of these facts, but there has never been a shortage of ignorance in the world.

Measles is a highly contagious viral illness that typically strikes children. Unfortunately, more than 90 percent of susceptible people who are exposed will contract it.  Measles spreads mostly by aerosolized droplets from the nose, throat, and mouth during coughing.  The virus can survive airborne for two hours in closed areas like a classroom.  The vast majority of measles cases in the U.S. are transmitted by travelers and immigrants, with subsequent transmission to unvaccinated children and teens.

Measles has a 7 to 14-day incubation period.  The prodrome begins with fever, sneezing, watery eyes, conjunctivitis, and a hacking cough.  Koplik spots develop on the oral mucosa, opposite the first and second upper molars — before the rash develops.  Dental professionals take note.

A sore throat typically develops shortly before the rash, which is maculo-papular.  Macules erupt just in front of and below the ears, then migrate down the sides of the neck.  Papules begin to emerge as the rash spreads down to the trunk and extremities, including the palms and soles.

Peak severity is often marked by a fever above 40⁰C.  Many children have periorbital edema, photophobia, irritability, pruritis, and a hacking cough. These kids look and feel very sick for 3 to 5 days, at which point the fever subsides and the rash fades and desquamates.  Immunocompromised patients may be profoundly ill with severe, progressive pneumonia but no rash.

Mortality in measles is about 2 in 1000 cases in the U.S. and much higher in developing nations.  In the year 2000, measles was officially declared eradicated in the U.S. by virtue of the tremendously effective MMR (measles, mumps, rubella) vaccine.  Unfortunately, multiple outbreaks have recently occurred in California, Washington, Oregon, Utah, and New York.  Many outbreaks have been linked to unvaccinated children in Amish and Orthodox Jewish communities.  Currently, an outbreak of measles in Brooklyn, New York, has been declared.  There were 285 cases, a public health emergency.  Nationally, the figure stands at 465 cases documented in 15 states.

Scientific ignorance and paranoia on the part of some parents and stunning misinformation on the internet has led to clusters of unvaccinated children and rapid spread.  The original “study” claiming that vaccines cause autism was entirely fraudulent.  It involved 12 patients and was thoroughly debunked.  The author lost his medical license.  Legitimate studies of over two million children have demonstrated absolutely no relationship between vaccines and autism.  Autism has been linked to over 100 genetic mutations.  Many people today do not like to hear the word “genetic.”

A landmark study published several years ago in the New England Journal of Medicine revealed disrupted stratification of multiple cellular layers in the cerebral cortex early on in fetal development.  The stage for autism seems to be established before birth.

Making decisions based on misguided notions and emotions can be catastrophic.  Those of us in health care and education need to set the record straight.

Look At Me!

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology

By Mary O’Brien, M.D.

Let’s look at congestive heart failure (CHF), chronic traumatic encephalopathy (CTE), and chronic obstructive pulmonary disease (COPD).  We all have our abbreviations and acronyms.  Every discipline does.

Now, courtesy of incredibly foolish behavior sweeping the planet we have SRT – Selfie-Related Trauma.  People around the world are being injured or even dying by doing dangerous things while trying to take “selfies” (photographs, using a cell phone, of themselves and perhaps others who may be nearby).

Most, but not all of these cases involve students.  The top three countries for SRTs are India, the United States, and Russia.  Multiple traumatic injuries most often result from falls into rivers and canyons, from falls off of cliffs or trains, and from motor vehicle accidents.  Drownings and electrocutions complete the list.

The science of photography has changed the world.  For over 150 years, people took pictures of other people, exquisite scenery, major events, and touching moments.  Now, many people can’t get through the day without taking photos of themselves engaged in the most mundane or ridiculous situations.  Look at me in the kitchen.  Look at me at work.  Look at me on vacation.  Look at me by the Statue of Liberty or the Grand Canyon.

We now have two generations, possibly three, who have been conditioned to believe a picture is incomplete without ME.  This is not only pathetic, it is dangerous.

Not long ago, a young woman at a zoo learned an important lesson about the dangers of ignoring barriers to get a selfie.  She went into an area she should not have entered and breached a barrier.  Determined to get not merely a close-up of a jaguar, but a selfie with a wild animal, she turned her back on the animal to photograph herself in front of the jaguar.  The jaguar nearly captured her.  That’s what wild animals do.  Fortunately, the woman survived to recount her foolish behavior.

Barriers and warnings exist for a reason.  They’re there to protect people.  Jaguars are spectacular animals.  They can approach speeds of 80 miles per hour and, like all cats, they are fiercely territorial.  The desire to take a photo is understandable.  The photo should be of the jaguar, not yourself with the jaguar.

There are several lessons to be learned here:

  • Never ignore barriers, roadblocks, or warning signs unless you are the EMT (emergency medical technician) responding to the situation.
  • Appreciate the beauty or wonder around us but realize that we do not enhance the beauty or wonder.
  • Never, ever turn your back on a mountainside, cliff, bridge, canyon, or a wild animal.

If people are really that enchanted with themselves, there are these things called mirrors.

Lest Ye Be Judged

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It occurred to me the other day that I have a peculiar reason to appreciate “retirement.”  It has nothing to do with sleeping in a bit or taking an occasional nap.  It’s completely unrelated to dressing more casually or having a nice cup of tea whenever the mood strikes.  What I was truly enjoying was the notion I had been freed from the onerous task of evaluating other people.  But no!  Last week I had a Salvation Army pick up and the driver handed me an evaluation form.  I was supposed to rate the Salvation Army on promptness, friendliness, and efficiency — among other traits.  The Salvation Army!  I think we’re going overboard here.  I just wanted to donate some clothes.

No doubt anyone in healthcare, law, education, or business knows whereof I speak.  In fact, in recent decades this practice has reached ridiculous proportions.  Faculty evaluate residents who evaluate students who evaluate faculty.  Administrators evaluate managers who evaluate trainees who evaluate the whole system.  Every individual who speaks at a conference, seminar, or lecture is evaluated on everything from the tone of his (or her) voice to the title of his talk.  Filing cabinets and computer databases across America are bursting at their metal and electronic seams with evaluations.

The real question is:  Why do we need to judge one another?  I realize that some form of grading system is necessary through college and various training programs.  But over the past two decades we’ve gone far beyond grades.  We might have developed a national preoccupation with criticizing one another.  I genuinely enjoy giving people good evaluations.  But there are times when a negative evaluation is in order and, frankly, I’d just as soon undergo a root canal.  Every one of us has bad days, bad weeks, and sometimes even bad years.  Wouldn’t it be nice if we could be a bit more understanding?

The process of evaluation can be helpful when it’s geared toward encouragement, guidance, and improvement.  But when it reflects a harsh, critical spirit, nothing helpful happens.  Fighting the tide is not easy.  But I’d like to think that there’s hope.  A very wise man once said, “Judge not, lest ye be judged.”

I gave the Salvation Army people an “A.”

Some Timeless Investment Tips

Posted on Posted in Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s tax time again.  Those little pieces of paper that seem so important to the Internal Revenue Service are arriving in our mailboxes.  It’s a good time to review a few basic tips on money management and investing.  You know, the principles no one actually taught us during our many years of training to save lives.

What does money management or investing have to do with health care?  A lot. Financial worries, either personal or institutional, often compromise patient care.  People can act with “impure motives” if dollar signs cloud their thinking.  Everything we recommend to a patient, client, or student should be in his or her best interest.  Those of us in health care should keep our finances in order so that our motives are honorable.  Working with a fiduciary financial planner is similar.  Such a professional is obligated to do what’s best for his client, not himself or his company.

Keeping all of this in mind, there are some timeless investment tips that apply to almost all of us:

  • Saving and investing are different. Step 1 is to get out of debt. Step 2 is building up an emergency fund of at least three to six months of living expenses.  Then investing can begin.
  • Educate yourself and don’t invest in things that you don’t understand. In our culture you can earn an advanced degree and have no idea how to handle money. The first thing you have to invest is time.
  • Sign up for a 401(k) or 503B plan at work and fund it to the max. Investing each month (with money taken out of your paycheck before you see it) is the best path to security.
  • Watch out for management fees and fund expenses. There is a cost to investing, and awareness is key.
  • Take advantage of time and youth. Shocking numbers of people in their 20s, 30s, and 40s have no investments at all.  Modest, steady, monthly investments in your 20s and 30s can lead you to millionaire status in your 60s.
  • Whether you’ve been investing for six months or six decades, do not make decisions based on fear or greed. What separates most people from their money is emotional overreaction when markets tank.  Anyone who has worked in an ER (emergency room), OR (operating room), or ICU (intensive care unit) knows you cannot save a patient if you panic.  “Steady as she goes” sounds simple, but it’s tough when markets correct as they always do.  Stick it out.  The rebound always occurs.
  • Diversify investments and institutions. Depending on your stage in life, some mix of stocks, mutual funds, bonds, REITS (real estate investment trusts), and CDs (certificates of deposit) is prudent. Never put all of your eggs in one basket — or in one hen house.
  • Don’t fall for hot stock tips, free-dinner seminars, or charming financial sales people.
  • Don’t fuss or meddle too much. Some people cannot leave their investments alone. Occasional adjustments are warranted based on your personal situation and market conditions.  A giant oak will never reach its full potential if it’s transplanted every few months.
  • Be cautious and discipline yourself. People with significant financial assets often develop significant egos. Don’t let brokers take advantage of you by flattering your ego.  Remember the Bernie Madoff scandal.  Unscrupulous people can be master manipulators.

Some combination of hard work, discipline, prudence, and common sense helped you develop your career.  Those same principles can help you secure your financial future.

Don’t Do Anything Rash

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary  O’Brien, M.D.

Are you feeling upbeat and happy?  Have you looked at your end-of-the-year financial statements and credit card bills?  Most of us are feeling a bit tense and dismayed these days.  But take heart.  The markets have improved since Dec. 31, 2018 and your statements aren’t as bad as they look.

This is actually an excellent time to re-group financially and protect yourself from further chaos.  High frequency trading and complex algorithms contribute to frightening volatility on Wall Street.  A single comment from a government official can trigger 800-point swings on the Don Jones Industrial Average.

However, there are a few prudent principles that still work and may well save your sanity.

  • Get out of debt! This requires a daily commitment, but it’s worked in countless cultures for thousands of years.  Since financial security has a massive impact on health and emotional well-being, learning how to save money and reduce debt are crucial.
  • Don’t spend more than 25% of your monthly income on housing. No one “needs” or “deserves” top-of-the-line everything.  For 40 years, I’ve watched my fellow physicians fall into this trap.  And it is a trap.
  • Don’t even think of buying a house or condo if you can’t put at last 20 percent down. Aim for a 15-year mortgage.  It will not double your payments.  It makes no sense to end up house-poor because you’ve made a bank rich.
  • Stop buying or leasing new cars. Buy a used car or dealer-program car, take care of it, and drive it for 10 to 12 years.  I kept my last car for 22 years.  It was just fine.
  • Don’t be an impulse buyer. We can all live without much of what we have.  Consider the people who lived in Paradise, California, or the panhandle of Florida.
  • Don’t waste money on eating out or ordering restaurant food in until you’re completely debt free.
  • Stop wasting money on fancy coffee drinks and alcohol. Both your wallet and your waistline will benefit from these two steps alone.
  • Never buy anything to impress other people. If your friends are impressed by your Smartphone or your handbag, you need better friends.
  • Stop indulging yourself with excessive spending on hair, nails, facials, massages, etc. Many young women fall into this trap, especially if they pay attention to “beauty influencers” on social media.  You are capable of taking care of your own grooming.
  • Resist the temptation to go on vacations or indulge in entertainment until you have eliminated all debt. Millennials like spending money on “experiences.”  I recommend the experience of being debt-free.

Finally, use the money you save to build up an emergency fund of three to six months of living expenses.  Twelve months are better.  For most people, this should be at least $10,000.  Shocking numbers of people can’t afford to miss a single paycheck — just ask the folks affected by the partial government shutdown.

Next time, we’ll tackle some tips on investing wisely.  Until then, don’t do anything rash.

Not for Party People

Posted on Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

Another year is drawing to an end.  All across the country, folks are stocking up on beer and bubbly for their New Year’s celebrations.  Parties and parades, festivities and football will steal the limelight for a few short days.  But before long, the frivolity will fade and people will settle into their dreary routines.  New Year’s resolutions will be broken as quickly as they were born.  Soon another year will slip silently into oblivion.

All of this can get downright depressing if you really stop to think about it.  I mean — have you ever taken time at New Year’s to evaluate your life?  Are you accomplishing your goals and living your dreams?  Do you even remember what your goals and dreams are?  What wonderful things did you accomplish this year?  Are you a better person than you were 12 months ago?

I take these questions very seriously.  But then, I’m not a party person.  New Year’s has always been my time for taking a personal inventory, a self-assessment of growth and progress.  Having worked with older patients for decades, I’m convinced this exercise is not in vain.  People don’t stay in neutral long.  They either move forward, or they slide into reverse.  But the laws of physics hold fast.  Going in reverse is no problem.  It’s easy and requires no effort.  Going forward requires thrust or energy.  And each one of us must supply our own.

Conducting an annual self-assessment will not appeal to whiners and wimps.  And it’s probably not for party people.  It demands integrity, self-discipline, and drive.  After all, the whole point of this exercise is propelling oneself toward some pretty lofty goals.  Blaming others or the culture for one’s own faults and failures defeats the purpose.

Each of us has different challenges, circumstances, and goals.  My self-assessment questions have served me well over the years.  You may need to amend them, but see if they don’t get you thinking:

  1.  How many books have I read this year?  Did they really sharpen my thinking?
  2.  What are the most important lessons I learned?  Have I put them into practice?
  3.  Did I take good care of my body and health?
  4.  Did I give my family the time and attention it needed?
  5.  Have I learned a new skill or expanded my fund of knowledge?
  6.  Have I further developed a talent I already have?
  7.  Did I devote enough time to my spiritual life?
  8.  Did I try to make life better for others?
  9.  What did I do to invest in my future?
  10.  When I reap what I’ve sown, will I be happy with the results?

This New Year’s review may not be as scintillating as champagne or as fun as football.  But its effects will last a lot longer, and you won’t wind up with a headache!

It’s Almost Here!

Posted on Posted in Brain Science, Continuing Education, Psychology, Seminars, Webinars

By Mary O’Brien, M.D.

It’s almost here.  The lines in stores are growing longer and the traffic is becoming heavier.  Yes, it looks as if the annual Christmas crunch is upon us.  Before long, tired travelers will descend upon weary relatives and everyone will feign a friendly, festive front.  By the month’s end, bulging waistlines will battle burgeoning credit card bills for the top spot on the list of holiday headaches.

It seems to get worse with each passing year, and yet sensible solutions elude us.  Which customs would we cut?  Whose relatives would we not visit. What expenses should we forego?  Is it possible just “to say no?”

In recent years, I’ve learned to do precisely that.  After one too many miserable holidays attempting to accommodate everyone, I finally found a better solution.  I simply do what seems — sane.  Some might say my solution seems silly, but you can judge for yourself.  The following are my custom-made commandments for a calm Christmas.

  • Thou shalt not spend more than thou hast.
  • Thou shalt do thy Christmas shopping in September.
  • Thou shalt mail Christmas cards and packages early.
  • Thou shalt honor thy need for quiet time.
  • Thou shalt not be pressured to party.
  • Thou shalt not suffer the company of negative relatives.
  • Thou shalt read something inspiring each day.
  • Thou shalt eat less than thou wantest.
  • Thou shalt not covet thy neighbor’s decorations.
  • Thou shalt do something nice for thy neighbor each day.

I’m particularly partial to that last one.  How different would Christmas be, if everyone all over the world, did something unexpectedly nice for someone else everyday?  Something tells me that’s a lot closer to the true meaning of Christmas than overloaded credit cards and unrestricted appetites.  Silent night.  Holy night.  All is calm.  All is bright.  Maybe there’s a message in those simple lyrics.  I’d like to think so.