THE DOCTOR WEIGHS IN

TOP 10 TRENDING HEALTH STORIES

OF ALL TIME

THE DOCTOR WEIGHS IN

TABLE OF CONTENTS

Exercise Before Breakfast to Boost Its Benefit on Weight

Are You Feeling Depressed or Having Depression?

Infidelity: Did Your Genes Make You Do It?

To Treat Sore Muscles: Heat or Cold?

The Best Way to Remove Earwax

The Biologic Clock of Aging

What Do Women Really Want When It Comes to Men?

What Turns Him On? How You Look or How You Smell?

How Much Money Do U.S. Doctors Make?

Consciousness: The Most Baffling Problem in the Science of the Mind

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By Dov Michaeli, MD, PhD

I start my day by rolling out of bed and drinking a tall glass of orange juice before I go to my home gym. I then do about 30 minutes or so of moderate aerobic exer-cise, followed by yoga stretches, and then strength training on alternate mornings (dumbbells, push-ups, and pull-ups). [Here is video of my exercise routine.]

Only after I have finished my workout, do I sit down for a hearty breakfast. I found this regimen is perfect for outwitting my brain’s infinite capacity to find excuses t skip exercising, “just today.” It also gives me a sense of well-being that lasts the whole day. And, I also found out something that is a subject of debate among exercisers and sport physiologists: I could easily lose excess weight when my bathroom scale warned me that the previous night’s dinner was too indulgent.

This regimen has worked great for me over the 15 years that I have been following it. I have never gained, or lost, more that 2-3 pounds from my preferred weight of 145 lbs. I know, this is an N of 1. But, trust me, it is based on solid science.

How do we burn calories with exercise?

The two most important sources of energy used by muscles when exercising are carbohydrates and fats. Protein can also be a source of energy for exercise, but its contribution is minor (about 6%), and it is used only if the carbs and fats are getting depleted or when the exercise is extreme.

Now, here is a key point. When we get up in the morning, we are basically in a

fasting state because we haven’t eaten all night—muscle glycogen and blood sugar levels are low. Insulin levels are low as well. During the day, as we feed, we elevate our blood glucose level—insulin levels rise and muscle glycogen stores are replenished. Further, insulin works as a brake on fat mobilization from adipose tissue and subsequent breakdown into fatty acids. That means, during the fed state, muscles preferentially use glucose for energy. As a consequence, glycogen can supply energy for as long as two hours before the muscle has to resort to fatty acids for energy supply.

So what happens if we exercise before we eat breakfast? With glycogen stores depleted overnight and fat mobilization facilitated by the low insulin levels, muscles are forced to utilize fatty acids as a source of energy.

Well, you can see where I am going. If you want to get rid of more fat, it makes sense to exercise before you replenish your muscle glycogen stores by eating.

But wait, there is more.

You don’t have to kill yourself

Trained athletes are a class by themselves. Their exercise regimen is high-intensity; most of the rest of us exercise moderately or lightly.

Exercise intensity can be expressed as a percentage of VO2 max (maximum oxygen consumption). Low intensity such as fast walking would be 30-50% of VO2 max. Jogging can demand 50-80% of VO2 max depending on the intensity, and sprints can require from 85-150% of VO2 max (with the added 50% coming from short-term anaerobic energy production).

This difference in intensity has profound metabolic consequences. At low to moder-ate intensity, muscles prefer fatty acids over glucose as a source of fuel. Why?

Because at lower VO2 max, there is less oxygen available for oxidation. It so happens that a molecule of glucose requires more oxygen for its complete oxidation than a molecule of triglyceride (fat). Add to that the fact that gram of fat provides 9 calories of energy and a gram of glucose only 4 calories. You can see then why, in order to maintain the low to moderate level of exercise, it would be more efficient to break down fat.

So if you exercise before breakfast, you are getting a twofer: low levels of insulin, low blood sugar, and facilitated mobilization of fat. How can you pass up such a deal?

Makes a lot of sense. But as we know in biology and medicine, what makes sense is not necessarily true. We need an experiment.

Finally, a real experiment

Gretchen Reynolds reported in the NYT on a 2010 study, in which researchers in Belgium persuaded young, healthy men to stuff themselves for six weeks with a

diet consisting of 30% more calories and 50% more fat than the men had been eating previously. Some of the volunteers remained sedentary while gorging. Others began a strenuous, mid-morning exercise routine after they had eaten breakfast. The third group followed the same workout regimen, but before they had eaten anything.

At the end of the six weeks, the sedentary group predictably was supersized and unhealthy, having gained about six pounds each. They had also developed insulin resistance and larded their muscles with new fat cells. The men who exercised after breakfast had also packed on pounds, about three pounds each, and developed insulin problems. But the men who had exercised first thing in the morning, before eating anything, had gained almost no weight and retained healthy insulin levels. Their bodies were also burning more fat throughout the day than were the other men.

Of course, the early-morning exercise prevented weight gain, which is not the same thing as inducing weight loss. Obviously, we would have been happier if the experiment was designed to demonstrate weight loss rather than prevention of gain, but the hormonal and metabolic mechanisms at play here are the same: low insulin, low blood sugar, and preferential utilization of fat as a source of fuel.

So whether you just like to walk, or jog, or swim, or even lift weights—do it first thing in the morning. You’ll get a lot more out of it. I guarantee it!

By Helen M. Farrell, MD

What do you think about when you hear the word “depression”?

Many people resonate with this term. Having a bad day is a common experience—whether it’s triggered by an argument, loss of a job, or simply a product of a rainy day. For many people, such experiences leave them saying things like, “I feel depressed.” But in fact, not many people are aware that there is a major difference between feeling depressed and having depression.

Feeling depressed vs clinical depression

The difference is important because depression is a major mental illness. It’s not just a normal temporary feeling of sadness. That’s something we all experience by virtue of the fact that we are human. Clinical depression is different. It accounts for the leading cause of disability...in the world! It’s that significant. It causes that level of impairment.

And most importantly, depression won’t go away, just because you want it to.

Of the 10% of Americans who struggle with depression, many will go untreated and suffer in silence. It’s possible to suffer in silence because depression, like many mental illnesses, is a master at disguise.

“What is depression?” video

Partnering with TED-Ed on the animated short-film, “What is depression?” has allowed this once stigmatized and daunting concept to be better understood on the world stage. And it's a good thing, too, because depression is very treatable!

The overwhelming number of views the film received, shortly after its launch, is atestament to the fact that people are curious about depression. And despite many public campaigns aimed to increase awareness and reduce suicide, people are still confused over what depression really means.

Few sufferers look like tattered souls—homeless, loitering on the streets, and in-cessantly talking to themselves. In fact, they look like you and me.

Symptoms

There might not be specific blood work or a biomarker (yet) that can d finitively diagnose depression, but the symptoms tend to manifest in a number of different ways. Frequent crying spells or fluctuations to one’s mood that oscillate between sadness to extreme irritability are tell-tale signs, for example. Loss of interest in

https://www.youtube.com/watch?v=z-IR48Mb3W0

former hobbies, decreasing energy, and trouble sleeping or concentrating are also warning sings. Many people experience depression as having low self-esteem. Others will notice changes in their appetite or feeling restless or slowed down. In extreme cases, depression can lead to the most dangerous of symptoms: suicidal thoughts.

Treatments

But just like hypertension or diabetes, depression is a chronic condition that can be treated. There might be flare-ups over time but it is possible for symptoms to sub-side. For example, healthy diets, regular exercise, and open communication are all vital to success. In some cases, talk therapy with a professional is beneficial along with medication management. And in extreme cases, people can go to the hospital for more intense treatments that run the gamut from enhanced supports to electro-convulsive therapy.

Depression is not a weakness or a personality trait. It is a disorder and should be treated as such openly without fear of stigma. Caring communities have the power to transform stigma into hope and acceptance. What works for one individual might be different for the next, but the point is that there is always hope!

By Dov Michaeli, MD, PhD

Marital infidelity, it seems, has been the province of sensational journalism, politi-cians, and celebrities—major, minor, and wannabes. But an article in the New York Times reports that lots and lots of us common folks are willing “sinners” as well.

As Richard A. Friedman, Professor of Psychiatry at Weill Cornell Medical College in NY, reminds us, 91% of Americans find marital infidelity morally wrong. et, the rate of infidelity has been pretty constant over the past two decades at around 21% for married men according to a 2013 Gallup poll. It’s between 10-15% for married women, according to the General Social Survey at the University of Chicago’s independent research organization, NORC.

Ashley Madison

You don’t have to be a whiz in statistics to notice that the numbers don’t add up. But even these numbers don’t tell the whole truth. Noel Biderman, the founder and former CEO of the infamous website, Ashley Madison, [you most likely remember it from the high profile hacking and release of confidential data that had many of its members quaking in their boots] that is dedicated to extramarital affairs, was quot-ed on CNBC saying,

“It hasn’t been easy to study infidelity before the Internet—cheaters don’t put their hands up. I’m sitting on a lot of big data. I sign up 35,000 people a day. I get 120

million visitors a month. There are 1.2 million communications sent on my platform every day!”

Is this an American phenomenon? “Not at all,” says Biderman. “It turns out infideli-ty is global! There’s no country you can point me to where it doesn’t exist. Even in places where it’s punishable by death! How many things would you risk your life for right now?”

Not only is the practice widespread (Ashley Madison boasts having “over 43,645,000 anonymous members!”), but it has deep roots in human history. Six hundred years before Moses intoned “thou shalt not covet your neighbor’s wife”, the Babylonian king Hammurabi, “the King of Righteousness,” included in his law codex a section on marital infidelit . The Code listed different punishments for men and women for this transgression. Men were allowed to have extramarital relation-ships with maid-servants and slaves, but philandering women were to be bound and tossed into the Euphrates along with their lovers.

But wait, doesn’t the fact that infidelity is so ancient, so common, and practiced at the risk of losing one’s life tell us that it is not just a momentary moral indiscretion, but rather something more fundamental to our humanity? In fact, it goes even beyond that because even animals do it.

Birds do it, bees do it, let’s fall in love

Studies suggest that only about 10% of the birds and mammals that seem to mate for life are actually faithful to their partners, according to studies that suggest that infidelity may be nature’s way. This is another way of saying that sexual infidelity is favored by natural selection. Animal parents may gain important benefits for the future of their species this way, research shows. A female may stray to pick up the best genes possible for her offspring while males may be driven by an impulse to father as many offsprings as possible. Some males go overboard ensuring that their DNA, and only theirs, survives. Male lions and mountain gorillas kill their fe-male’s offspring sired by another male. And, to make doubly sure—they eat them.

My hormones made me do it

The paradigm of oxytocin, the “love hormone,” as promoting social bonding got its start with the remarkable discovery of the sexual behavior of two very similar rat-like rodents: the prairie vole and the montane vole. The male prairie vole becomes socially monogamous once it mates with a female. His cousin, the montane vole, is more the “love-em-and-leave-em” kind.

And, what’s the difference between them? Turns out that they both secrete oxyto-cin and the structurally related vasopressin, but the oxytocin, as well as the vaso-pressin-secreting cells, in the prairie vole are located in the ventral forebrain and the adjacent reward center (the nucleus accumbens). In the montane vole, the cells are located in the amygdala, an area of the brain that has to do with fear, anx-iety, and rage. There, they activate an inhibitory system, reducing the normal fear and anxiety response. So our philandering montane vole apparently does it not only without any warm and fuzzy feelings, but also without any pangs of conscience.

But, what about us humans?

These, you might argue, are all animal stories. What about us and our complex behaviors? Can hormones provide a biological explanation?

When nasally administered to humans, oxytocin has been reported to reduce fear, possibly by inhibiting the amygdala, just like the montane vole. But oxytocin/vaso-pressin help us go beyond FDR’s exhortation that “the only thing we should fear is fear itself”; it actually enhances trust. In a risky investment game, experimental subjects given nasally administered oxytocin displayed “the highest level of trust” twice as often as the control group. Subjects who were told they were interacting with a computer showed no such reaction.

Disclosure of emotional events is a sign of trust in humans. When recounting a negative event, humans who receive intranasal oxytocin share more emotional details and stories with more emotional significance. Judging by the popularity of our reality TV shows, we must be blessed with an overabundance of the stuff.

Humans also find faces more trustworthy after receiving intranasal oxytocin. In a study, participants who received intranasal oxytocin viewed photographs of human faces with neutral expressions and found them to be more trustworthy than did those who did not receive oxytocin.

So, is oxytocin the biological basis of Isaiah’s 11:6 vision of

“The wolf will live with the lamb, the leopard will lie down with the goat, the calf and the lion and the yearling together; and a little child will lead them?”

Although this quote is quite inspirational, it poses severe difficulties with our understanding of evolution and its tool, natural selection.

How could such indiscriminate action of the “love hormone” be adaptive? What about a competing tribe usurping your grazing grounds? Are you going to sing Kumbaya with them?

A paper in Science examines this conundrum. In three experiments using dou-ble-blind placebo-controlled designs, male participants self-administered oxytocin or placebo and made decisions with financial consequences to themselves, theirin-group, and a competing out-group. Results showed that oxytocin drives a “tend and defend” response in that it promoted in-group trust and cooperation and de-fensive, but not offensive, aggression toward competing out-groups. So, oxytocin doesn’t make us gullible. It makes us “love,” but not indiscriminately—only our in-group.

Is oxytocin all there is?

We would be naïve to think so. Not only does our veneer of culture and social mores “interfere” with a purely hormonal deterministic mechanism, even the biology is bound to be much more complex. How do we explain the different degrees of hormonal effects? There’s got to be more complexity to such basic mechanisms of natural selection as sexual attraction, love, and yes, infidelity. Indeed, it is more complex. Here is one example.

Dopamine, the feel-good neurotransmitter, is associated with a variety of behav-ioral actions, including enhancement of oxytocin and vasopressin activity. It raises the question: Could the unsubtle action of oxytocin/vasopressin be fine-tuned by the dopamine receptor? This is not a wild guess. There are several subtypes of this receptor, but one of them, DR4, is of particular interest because it mediates a variety of behaviors associated with sensation-seeking. The gene contains a region in which 48 base pairs repeat themselves between 2 and 11 times. Recep-tors that contain 7 or more repeats (dubbed the 7R polymorphism) show reduced number of receptors in the reward structures of the brain, as well as reduced do-pamine binding affinity. Humans that possess this long version of the gene display behaviors associated with ADHD, alcoholism, financial risk-taking, impulsivity, and sexual behavior. So, it should come as no surprise that subjects who carried the 7R dopamine receptor subtype were 50% more likely to report sexual infidelity.

Is biology destiny?

So, are carriers of the 7R version of the dopamine receptor simply “bad seeds,” doomed to moral and social failure? Or, more generally, are we slaves to our genes? Not at all. Unlike other animals, we do have morals, the philosophy of ethics, and a conscience. Some of us are burdened with some pretty bad genes. All it means is we’ve got to work harder to overcome them. In the final analysis, it is in our hands.

By Dov Michaeli, MD, PhD

Wonder if you should use heat or cold for your sore mus-cles? Well, the answer is…it depends.

When you get two different answers to a question, sometimes even diametrically opposed, you can assume that there is no convincing evidence for either. One example is the seemingly age-old question: Shall I use heat or cold to treat muscle soreness? My answer is: It depends.

What does cold treatment do? First, it numbs the local pain neurons, so the sense of relief is immediate. It also reduces the local tissue temperature, which in turn reduces inflammation and swelling. The mechanism for that is by vasoconstriction, which reduces the blood flow and the release of inflammatory mediators into the site of injury. In the case of serious tissue injury, you want to reduce swelling and inflammation. This is not only reasonable, but also works for muscle strains. If you get a shooting pain during or immediately after an exercise, you have a muscle strain.

But what if we are not dealing with injuries like muscle or tendon tears or strains? What about the run of the mill post-exercise muscle soreness?

Muscle soreness after exercise, otherwise known as delayed onset muscle sore-ness or DOMS, can hinder both your exercise routine and daily activities. If you feel a dull soreness starting about 8 hours and lasting for a few days after an in-tense bout of physical activity, it is likely that you are suffering from this common condition. What’s the treatment for it? Some “experts” say a cold bath or a cold compress. Others advocate a hot bath or warm compresses. Some cover all bas-es: Do cold first,and follow with heat. Confused?

Don’t do it - Injury guaranteed

If you check the internet, you’d find so much nonsense that I can’t blame you for being confused. Here is an example of advice given in Fitness Magazine [Update: We noticed they removed the article]:

Question: “Will a hot bath help prevent muscle soreness after a workout?”

Answer: “Cold water is a better bet,” says Marty Jaramillo, CEO of the I.C.E. Sports Health Group. “Immersing yourself in chilled water is like an ice pack for

your entire body,” he says.

“When you exercise, your blood vessels open wider and stay that way for at least an hour afterward. Soreness occurs when waste products like lactic acid

settle in your muscles through these dilated vessels. Colder temps constrict ves-sels, limiting the amount of waste product that accumulates,” explains Jaramillo.

You got it backward, Mr. Jaramillo. Lactic acid is not dumped by the circulation into the muscle—it is generated by the muscle and is removed from it by the blood ves-sels. So, constricting the vessels would actually accomplish the exact opposite of

what is desired—it would reduce the rate of lactic acid removal. Besides, the theory that lactic acid causes the soreness has been proven wrong.

The soreness we experience after vigorous exercise is the result of micro-injuries to muscle fibers, and the repair process results in stronger muscles; precisely the reason why we exercise. So, a certain degree of soreness is actually good for you.

Like any healing, a certain amount of inflammation is required to repair the exercised muscle. White cells, rushing to the site of the injury, remove injured and dead tissue and release peptides, called cytokines and growth factors (fibroblast growth factor, epithelial growth factor, and platelet-derived growth factor, to name a few), that, in a marvelously orchestrated fashion, go about repairing the damage. So why would you impede their access to the injury site with cold? It makes more sense to dilate the vessels to better allow the cells to reach the site and do their job.

Another reason why a cold bath or compress doesn’t make sense: After exercise, a muscle is contracted and only gradually does it return to its pre-exercise state. Cold will impede the relaxation. Heat relaxes the muscle and thus contributes to faster relief of the soreness.

Where is the evidence?

Amazingly, with all the hot/cold controversy, you’d expect somebody would do the study. I couldn’t find one (please send references, if you know of one). Such a study should be quite easy to do, you don’t even need human volunteers.

Run rats on a treadmill for a pre-determined period to induce micro-injuries in the quadriceps' muscles. Then treat one group with heat, the other with cold, and a third untreated. Then take periodic blood samples to measure lactic acid and inflammatory mediators, as well as muscle biopsies, at different times after the exercise to document the histology of the injured muscle and its rate of repair. Any sports scientist reading this?

So what’s to be done?

Until such an experiment is done, we need to just use common sense. So here is my routine:

I usually warm up before exercise by doing some stretching and light exercise, lasting about 10-15 minutes. After exercise, I stretch again and then take a hot bath for about 20 minutes. I used to regularly incur running and weight-lifting inju-ries. But through trial and error, and some common sense, I now manage to avoid injuries and heal faster using this simple recipe.

Bear in mind, though, this is a sample with N of 1. But at least for this experimental subject, it is 100% effective.

By Marsha Garcia

Ear wax sounds funny, but impacted ear wax is a serious problem. In fact, ear wax complaints send millions of patients to the medical office each year for professional ear cleaning. Millions more head to the drug store seeking over-the-counter rem-edies. Other individuals resort to dangerous home remedies such as using sharp objects, cotton swabs, and ear candling to remove annoying ear wax at home, often with disastrous results.

But ear wax isn’t evil. It actually provides a number of benefits to the ear. It helps clean and lubricate the ear canal. It helps trap and keep foreign substances from reaching the inner ear. The acidity of ear wax even helps prevent ear infections by killing bacteria.

So ear wax is good—in the right amounts. But like most things in life, too much of a good thing can be bad for you. The same applies to ear wax. When ear wax builds up, the impaction can cause miserable symptoms, including pain, pressure, dizzi-ness, and itching. But these symptoms are just the start.

As Baby Boomers enter middle age, and as a result of increased exposure to noise pollution, hearing aid usage has increased. Hearing aid usage blocks the natural flow of ear wax through the ear canal, leading to ear wax impaction. Unfortunately, ear wax is the number one cause of hearing aid failure. So, it is important for hear-ing aid wearers to keep their ears clean to extend the life of their hearing aids.

Finally, in addition to the annoying symptoms already mentioned, ear wax impaction is a major cause of temporary hearing loss. When wax fills the ears, sound waves

can’t get in; this limits the ability to hear. Sometimes, the loss of hearing due to ear wax impaction comes on gradually. Other times, the onset is sudden. Now, not all hearing loss is caused by ear wax. When ear wax is not the problem, only a visit to a hearing specialist can determine the cause of hearing loss.

What should you do if you have impacted ear wax?

DO visit your medical professional if you suspect you have more than wax, such as an infection or injury to your ear drum. [Severe pain, fever, or the pres-ence of blood or pus can be signs of infection or rupture.]

But, if you are SURE your symptoms are caused by built up ear wax and you do NOT have ear tubes in place, you can clean your ears at home using the same method professionals use as described in the next section.

DON’T use cotton-swabs (such as Q®-Tips), or other objects, such as ear picks, to remove wax. These can be dangerous and push wax further in.

DON’T use ear candles. Scores of internet videos have demonstrated that ear candling is not only a hoax but can lead to serious burns.

The preferred method of ear cleaning

According to the American Academy of Otolaryngology, irrigation is the preferred method to safely clean ears, using 3 simple steps:

1. Pre-soften ear wax prior to cleaning2. Irrigate ears with very warm water3. Re-acidify the ear to prevent infection after cleaning

Individuals can easily perform these three steps at home with the right tools.

For irrigation, never use water pic devices, designed for cleaning teeth, to clean ears. The pressure from such devices may damage the ear. An “ear washer,” [i.e. a device specifically designed for irrigating ears] is the right tool to use when cleaning ears. The ear washer should be filled with very warm water [not hot or cold water]. Using hot water can scald the ear. Using water that is cooler than body temperature can cause dizziness. Think of Goldilocks and always use water that is just right—very warm water! Now, flush the ears with the ear washer until the ear is clean. Sometimes, with stubborn ear wax, this can take repeated tries.

Finally, it is important to re-acidify the ear canal after cleaning. Remember, the acidic property of ear wax helps prevent ear infections. Cleaning out ear wax reduces the acidity in the ear canal. So after washing, it is important to rinse with a solution that approximates the pH of the ear.

Our home-use product, the Wax-Rx pH Conditioned Ear Wash System, contains everything needed for each of these 3 steps: pre-treatment wax softening drops; an easy to use, specially designed ear washer; and a post-wash pH conditioned rinse.

For softening the wax, specially formulated wax removal aid drops or olive or mineral oil can be used several minutes before cleaning. Studies show pre-softening ear wax before irrigation improves the ease and effectiveness of the treatment.

Preventing wax impaction

Of course, it’s great to be able to clear ear wax impaction when it occurs, but, if you find you experience chronic ear wax build up, you can prevent impaction with a regular ear washing routine. Irrigate your ears every 6-12 weeks using the 3-step method to prevent future impaction.

By Dov Michaeli, MD, PhD

What we have learned about the biologic clock of aging goes beyond satisfying the curiosity of how long we are destined to live.

In a previous post, “How is Your Biologic Clock Ticking?,” we discussed the two types of biological clocks that govern our daily lives. There are the ones that are present in most cells, whose periodicity is about 12.2 hours. And, there is the one located in the brain that rides herd over them, forcing them to conform to a 12-hour period of wake/sleep, through the action of the hormone melatonin.

Scientists have long suspected that there must be another clock—one that determines not our daily life, but our overall longevity. Where would be a likely location for such a clock? The “obvious” answer would be in our DNA. After all, it is common knowledge that if you selected your parents wisely, you are almost guaranteed to live to the same ripe old age that they did. And, if you maintained a healthier lifestyle than they had, you may even be able to exceed it.

The boomer generation, the post-war wave of kids who grew up having it all (and demanding even more), expect to live the good life as long as biology would allow—and perhaps even more. Scientists, many of them boomers themselves, have been eager to oblige.

Telomeres – the chromosome stabilizers

TTAGGG. No, this is not a stuttering finger trying to print TAG,nor is it a typo. This is a sequence of the nucleotides thymine, adenine, and guanine (or T, A, G, re-spectively). At both ends of each chromosome, this sequence repeats itself about 2500 times, forming caps that keep the structure of the chromosome stable. You can think of it as analogous to the metal cap at the end of a shoelace.

When cells divide, their chromosomes undergo duplication so that each daughter cell gets the full complement of genes of its mother cell. The only one catch? The telomeres don’t duplicate. This results in the telomeres getting shorter with each cell division. Eventually, when they get short to the point that the stability of the chromosome is compromised, cell division stops. This occurs in order to protect the organism from the metabolic and genetic chaos of unraveled chromosomes.

This explains why every cell can undergo only a certain number of divisions before entering a phase of senescence. With time, senescent cells accumulate mutations and lose most of its normal functions, eventually dying.

Since we are basically the sum of our cells, you can see how the process of telomere shortening translates into life-shortening. Stated differently, telomeres determine our longevity.

Indeed, certain diseases characteristic of aging, such as autoimmune diseases, are associated with truncated telomeres. Cancer incidence also rises with age. But here, the opposite thing happens. The telomeres don’t truncate; they actually elongate due to the activity of an enzyme called telomerase, thus keeping the cancer cell essentially immortal, which is the very essence of cancer.

The longevity clock

It appears almost inevitable that telomere length and its rate of shortening would predict longevity, right? Indeed, many studies looked into this tantalizing possibil-ity. Just imagine. If we could control the enzyme that lengthens it, telomerase, we could prolong life, or, at the very least, avoid the diseases that make aging an unappealing prospect.

Like everything in nature, nothing is as it seems. There are always 'confounding factors', or as Donald Rumsfeld of Iraq war infamy might say, "the unknown unknowns."

The evidence suggesting telomere length as a biomarker of aging in humans is equivocal. Indeed, the correlation between age and the length of telomeres is less than 0.5. More and more, researchers in the field developed a consensus that a single biomarker of aging doesn’t exist. If a biomarker exists at all, it must be multifactorial. That’s where things have stood since the discovery of the telomeres in 1978. [Historical note: Elizabeth Blackburn, Carol Greider, and Jack Szostak were awarded the 2009 Nobel Prize in Physiology or Medicine for the discovery of how chromosomes are protected by telomeres and the enzyme telomerase.]

The Gilgamesh project

An unusual article appeared in the April 8, 2014 issue of the usually dry, “just the facts, ma’am” journal Nature. It describes, in entertaining personal detail, the discovery of a marker of aging that really works. Here’s the story:

Three German teenagers, Steve Horvath, his identical twin Markus, and their friend Jörg Zimmermann formed ‘the Gilgamesh project’, which involved regular meetings

where the three discussed mathematics, physics, and philosophy. The inspiration for the name, Horvath says, was the ancient Sumerian epic in which a king of Uruk searches for a plant that can restore youth. Fittingly, talks at their meetings often turned to ideas for how science might extend lifespan. Now, how more nerdy can you get?

The only one who remained faithful to the Gilgamesh project was Horvath. He supplemented his Ph.D in mathematics with a doctorate in biostatistics. In 2000, this led to a position in the genetics department at UCLA.

Now, an untenured assistant professor cannot undertake such a risky project as discovering a longevity clock, since failure rarely leads to tenure. But in 2006, after working and publishing on other projects, Horvath received tenure. It was now safe for him to embark on the Gilgamesh project again.

The astounding discovery

Horvarth reasoned that environmental influences play a major role in the rate of our aging. These factors vary widely and can range from hormonal and dietary to stress, lifestyle and even pollution.

They exert their influence through chemical and structural modifications made to the genome without altering the DNA sequence. The changes are made y adding a methyl group to the nucleotide sequence CpG (C and G are nucleic acid bases, cytosine and guanine; the p stands for the phosphate group that connects them).

These methylation reactions are called epigenetic modifications. As cells age, the pattern of the epigenetic alterations shifts, and some of the changes seem to mark time. To determine a person's age, Horvath explored data for hundreds of far-flung positions on DNA from a sample of cells and noted how often those positions are methlyated.

It sounds simple until you realize that a typical human genome contains more than 28 million CpG sites. How do you even begin to tackle such an improbable task?

As in many breakthroughs in science, lady luck came to the rescue. Horvath found success with a simple statistical model, which looked at how many cells in a drop of saliva have DNA methylated at just two particular CpG sites.

The index roughly paralleled participants' ages with a correlation of 0.85, or 85%, and an average accuracy of about 5 years. As if this was not incredible enough—such an accurate prediction based on 2 CpG sites only—Horvath looked at even more sites and increased the predictive power of his method. But his manuscripts were rejected, because "they were too good to be true."

By December 2012, his methylation database spanned 51 types of non-cancerous tissue and cells, plus 20 kinds of cancer. The age estimator had grown to include 353 CpG sites. And the accuracy? An astounding 99.5% (or a

correlation of 0.995). Bear in mind that, normally, biomarkers have a correlation of 0.6-0.7, and the telomere hypothesis had a correlation of less than 0.5.

The clock's median error was 3.6 years, meaning that it could guess the age of half the donors to within 43 months for a broad selection of tissues. That accuracy improves to 2.7 years for saliva alone, 1.9 years for certain types of white blood cells, and 1.5 years for the brain cortex. The clock shows stem cells removed from embryos to be extremely young and the brains of centenarians to be about 100.

Horvath's paper was finally published in 2013. It unleashed a veritable avalanche of confirmatory studies.

Why is it important?

Horvath's method has many potential applications. Criminal investigators, for example, might find an epigenetic clock handy for establishing the age of a victim or an assailant by analyzing any biological residues left behind.

But the most interesting use of the clock will be to detect 'age acceleration'—discrepancies between a person's epigenetic and chronological ages, either overall or in one particular part of their body.

Such discrepancies could be signs that something is awry. For instance, analyzing methylation data collected on more than 2,100 men and women aged 40 to 92 as part of the Framingham Heart Study, the researchers concluded that for every five-year increase in age acceleration, the risk of dying from any cause during the study jumped by 15%.

Researchers are also comparing the ages of different tissues from the same individual, in the hope of identifying more accurate, less invasive ways to

diagnose disease or gauge the risk of future illness. Last year, Ideker and his collaborators reported that the epigenetic ages of breast, kidney, lung, and skin cancers were 40% older, on average, than the patients from which they were removed.

Distortions in epigenetic age seem to parallel other diseases more closely. Horvath says that recent work has found that people with HIV who have detectable viral loads appear older, epigenetically, than healthy people or those with HIV who have suppressed the virus.

Another study, not yet published, observes that some tissues show significant age acceleration in morbidly obese people. In the coming months, Horvath will be mining the vast Women's Health Initiative database for more links. The database includes thousands of methylation profiles gathered as part of this 20-year, 160,000-person study spearheaded by the National Heart, Lung and Blood Institute (NHLBI).

A tour de force

This tour de force was accomplished by analysis of 'big data', using statistical methods. The investigator is not even a trained biologist, rather he is a double Ph.D in math and statistics.

What has been accomplished goes beyond satisfying the curiosity of how long we are destined to live. It promises to develop into a platform that will rapidly decipher the mechanisms of diseases, their environmental causes, and their potential therapy. Three for the price of one. Amazing!

By Dov Michaeli, MD, PhD

A couple of months ago, I posted a blog about a politically sensitive subject: What’s going on inside the brains of Trump supporters. Specifically, I wondered aloud about women enthusiastically supporting a manifest bully who had displayed his attitude toward the fair sex as sex objects. As I might have expected, I received some hostile responses, a few of them ad hominem, from Trump supporters. What was less expected is the vehemence of women’s attacks. So, where did that come from? Was this a reaction to the cognitive dissonance they must be feeling watching their presidential candidate behaving like a schoolyard bully? Could it be a manifestation of the Stockholm Syndrome, when a captive identifies with his/her kidnapper?

Some psychologists believe that women who choose to stay in abusive relationships suffer from this syndrome. Maybe, except that there is no objective evidence to that effect. Those Trump adoring women are not captives, neither are they coerced in any way. To the contrary, at least, the TV images show genuine enthusiasm.

To try to figure this out, I turned to literature to see what science has to say about what women want when it comes to men? It turns out, it says a lot, but also very little. What do women really want when it comes to men? Check it out on the web and you’ll be overwhelmed by books, scientific papers, faux-science articles, blogs, and advocacy screeds. So, let me distil it into 2 interrelated main lines: evolutionary and psychological.

Evolutionary psychology

The evolutionary psychologists David Buss and Todd Shackelford of the University of Texas have published widely on the subject of sexual attraction between the sexes. They concluded that women desired men with traits in the following four dimensions:

Good genes: Men who were more masculine, physically attractive, good look-ing, fit, and high in sex appeal

Good investment ability: Men with high potential income, good earning capacity, educated, and older than the woman herself.

Good parenting: Men who want a home and children, who are fond of children and like them, who want to raise them well, and are emotionally stable and mature.

Good partner: Men who want to be a loving partner. It is not hard to see the common thread in those criteria; the evolutionary desire to maximize survival odds of the offspring.

The Israeli scientists Sigal Tifferet and David Kruger dug a bit deeper. They decided to investigate whether the “terminal investment hypothesis,” which had been demonstrated in non-human primates, applies to humans as well. The hypothesis states that in species showing an age-related decline in reproductive value, repro-ductive effort should increase with age.

They surveyed 1,365 women from 11 countries, ranging in age from 14 to 68, about their preferences in a male partner and found that women generally preferred the “dad” type man for a long-term partner and the “cad” type man for a short-term sexual affair. Preferences varied by age: Young women were more likely to consider brief sexual affairs, particularly with the cad. This effect of age is perfectly understandable if we consider that young women are more fertile and are unconsciously more likely to have a relationship with an attractive man, bearing “good” genes. Older women, in contrast, prefer mating strategies that are related to higher paternal investment.

A short comment on the field of Evolutionary Psychology

According to Wikipedia, Evolutionary Psychology is a theoretical approach in the social and natural sciences that examines psychological structure from a modern evolutionary perspective. The word “theoretical” is important. In essence, practitioners of this approach are finding a causal relationship between our evolution as a species and human behavior. But this alleged connection is based on generally accepted, but unproven, assumptions about our archaic ancestors. One example is humans, like all other species, are supposed to try and maximize the survival of their DNA. Pretty solid evidence for that. From there to the statement made by some scientists that rape is based on that imperative sounds quite sensible, albeit less supported by evidence. From there to the fraught conclusion that rape is “natural”, as in “boys will be boys,” is a skip and a hop.

In case you think this is far-fetched, just Google it. The Internet is polluted with many hundreds of entries on the subject, with only a few based on research and actual data. Of course, the conjecture on rape being adaptive may be true or it may not. To draw such a conclusion is to ignore what we call “confounding factors.” Could a raping intruder be killed by the head of the band, as happens in some apes species? Could the newborn issuing from such an act be killed by the alpha male of the band, as lions are known to do? Hence, such behavior would have been maladaptive and eliminated by natural selection.

My point is, such ‘sensible’ assumptions and retrospective inferences should be taken with a healthy dose of skepticism. There is no substitute for collecting data obtained from carefully designed and controlled experiments with real, live humans. Their interpretation in the context of natural selection is intellectually satisfying (to them) but still, these are only conjectures.

The physiological evidence

Previous research has shown that in the week near ovulation, women become attracted to sexy, rebellious, and handsome men, like George Clooney or James Bond. In fact, this is not limited to looks only; being an all-around “bad boy” is a big plus.

Why on earth would women choose bad boys at their prime reproductive age? Because their hormones make them. Studies have shown that an ovulating woman’s hormones influence who she sees as good potential fathers, and they specifically pick sexier men over obviously more dependable men.

Kristina Durante, at the time at the University of Texas, San Antonio, had women view online dating profiles of either a sexy man or a reliable man during periods of both high and low fertility. Participants were asked to indicate the expected paternal contribution from the men if they had a child together based on how helpful the man would be caring for the baby, shopping for food, cooking, and contributing to

household chores. Near ovulation, women thought that the sexy man would contribute more to these domestic duties. Durante concluded,

“Under the hormonal influence of ovulation, women delude themselves into thinking that the sexy bad boys will become devoted partners and better dads. When

looking at the sexy cad through ovulation goggles, Mr. Wrong looked exactly like Mr. Right.”

Bottom line

We started this journey puzzling over what goes on in the brains of women who support the Donald, an archetypical “bad boy.” I could find lots of science on the subject—some of it very good. It is easy to understand why he is doing so poorly among women, in general, and college-educated, in particular. What is more difficult, and much more interesting to me, is to understand why some women are drawn to him. Despite all the learned research, I am still puzzled. Were these women ovulating at the time they made their choice? Or, are they looking for cads? Just kidding (or not).

What Turns Him On? How You Look or How You Smell?

By Dov Michaeli, MD, PhD

The behavior of many animals is controlled by a symphony of odors…are humans any different?

You must have lived under a rock for the last 50 years if you haven’t heard about those chemical text messages called pheromones. Just look around you. No, truly observe. Dogs can’t resist the urge to mark their territory as they patrol the neighborhood. Laboratory mice cower in the corner of their cages when exposed to the smell of cat urine. And, we all know about those pesky mosquitoes drawn to your breath CO2 and body heat.

What we can learn about pheromones from Drosophila

Here is something puzzling and instructive at the same time. The male Drosophila fruit fly emits a volatile substance called CVA (11-cis-vaccenyl acetate) which works its magic on the female fly and makes her enthusiastically submit to his advances. But whatever residue of the aphrodisiac lingers on her body turns off an approaching male and he beats a hasty retreat. It’s the same chemical substance but it has opposite effect. From a natural selection point of view, it makes perfect sense. The impregnated female and the horny male don’t need to waste energy on pointless sex.

Is there a human sex pheromone?

In short, the behavior of everything around us is controlled by a symphony of odors. So is it any wonder that investigators have been on the hunt for the elusive human pheromone for the past 50 years? Just Google “human pheromones” and you’d get hundreds of thousands of hits.

Why this intense interest? Because there is money in it. Just go to the perfumes section of any department store and you’ll see the chemical warfare arsenal designed to lure you (if you are a male). Or check out the man-toiletries area of the store where products are hoping females will be captivated by the musk scents of the after-shave lotions. But, does it really work?

Pheromones will improve your sex life, a common sales pitch goes. But despite decades of research and untold millions of dollars, not one chemical has been identified that causes the release of a behavioral pattern. Which brings us to a bit more sophisticated understanding of pheromone effects. The pheromone hitting the female fruit fly's antennae caused the release of her receptive behavior; nothing romantic, nothing volitional. It’s all automatic and hard-wired. This type of behavior is uncommon in mammalians. More common are priming effects, in which the physiology of the recipient of the pheromone is changed, without immediate behavioral changes. For this kind of effect, evidence does exist.

We’ve lost our pheromone sense

In a study of menstrual cycle synchronization, a team led by Martha McClintock at the University of Chicago, collected body secretions from women at different times in their menstrual cycles and presented the substance under subjects’ noses. The test subjects either accelerated or slowed their cycles to synchronize with the donors’, even without conscious perception of the odor. However, more recent studies challenge this study, and the phenomenon of menstrual synchronization is disputed, even when women are living together.

The whole idea of human pheromones becomes even more problematic because the machinery that mediates pheromone effects on the brain of Drosophila and mice is barely present in humans. In non-humans, the organ that senses the pheromones is called the VNO (Vomernasal organ), which in humans is vestigial. Which raises the question: Why would natural selection allow the loss of such an important organ?

The answer is quite fascinating. Recent research showed that at about the same time our primate ancestors gained color vision, they also lost the genes for the VNO receptors. In other words, we switched from experiencing the world through a bouquet of odors wafting up our noses to the symphony of colors imprinted on our retinas.

Which is better? I suspect if you asked fruit flies, they would tell you they are quite happy, thank you. For myself, I am very happy to watch a beautiful young woman playing tennis, sans her armpit smell.

How Much Money Do US Doctors .Make?

By Patricia Salber MD, MBA

How much money do U.S. doctors make? And, does it make them happy? The results of the 2016 Medscape Physician Compensation Report

For the 2016 Medscape Physician Compensation Report, physicians were asked to provide their annual compensation for patient care including salary, bonus, and profit sharing if employed, earnings after taxes, and deductible business expenses (but before income tax) if in private practice. Here is what they found.

Who earns the most?

Orthopedic surgeons are the top earners in the 2016 survey, coming in at $443,000 up from $421,000 in last year’s survey—I guess all that unnecessary back surgery really pays off. (Just kidding! Or not!). Cardiologists came in 2nd place earning $410,000 per year (up from $376,000 last year). Plastic surgeons come in 8th from the top (down from 5th place last year) at $355,000—essentially unchanged from 2015. This is pretty interesting, considering a large percentage of cosmetic surgery is paid for out-of-pocket. Could it be that people are opting for fillers instead of facelifts?

At the low end of the totem pole are the primary care docs, you know the ones we need a whole lot more of. Pediatricians’ average compensation is $204,000 (up from $189,000 last year), family physicians $207,000 (up from 195,000), and inter-nists $222,000 compared with $196,000 last year. The specialists who take care

of some of the most numerous and complex patients in the country, the diabetes doctors and endocrinologists, are also down at the bottom at $206,000 (up from $196,000).

When comparing 2016 to the prior year, it appears most docs got a raise, but two specialties—allergy and pulmonology—experienced a significant decline and twospecialties’—plastic surgery and pathology—incomes were flat. Although all of the categories of primary care (pediatricians, family docs, internists) earn more this year compared to last—internists by 12%—it didn’t help move them off of the bot-tom part of the income list.

Breaking it down by region, state, gender, and more

The highest earnings were in the North Central and South East regions of the United States with mean incomes of $296,000 and $287,000, respectively. At $348,000, physicians incomes were highest in North Dakota due to demand driven by North Dakota’s oil boom. New Mexico was the lowest-earning state at a measly $272,000.

Screenshot from 2016 Medscape Physician Compensation report

A little over two-thirds of physicians are employed as opposed to being in private practice. This is despite the fact that employed physicians ($207,000 primary care, $274,000 specialists) make less (in terms of cash compensation) than self-employed docs ($229,000 primary care, $348,000 specialists). Noteworthy is that employed PCPs had the highest increase in earnings at 10% compared with self-employed PCPs (8%) and all specialists (6%).

Women continue to earn less than men (as they have in all of the Medscape Phy-sician Compensation surveys to date) although the difference has shrunk because women’s earnings increased more than men between 2012 and 2016.

Screenshot from 2016 Medscape Physician Compensation report

Who is the happiest of them all?

One of the most interesting parts of the survey are the questions that reflect physicians’ satisfaction with their lot in life. In an answer to a question about fair compensation, ≥60% of dermatologists, emergency physicians, and pathologists said they were fairly compensated.

Despite their stratospheric compensation ($443,000 per year!), only 44% of ortho-pedists said they were fairly compensated…what??? How much do they think they should make? And, speaking of high earners, what about the plastic surgeons—only 47% of them say they feel fairly compensated. Helping aging boomers appear young and beautiful is certainly important (and becoming even more so as gravity and the sun continue to take its toll), but surely they can scrape by on $355,000 per year.

Screenshot from 2016 Medscape Physician Compensation report

It is fascinating that more than half of one of the lowest paid specialties, the pedia-tricians, feel fairly compensated. But perhaps it isn’t so surprising when we remember that these are the doctors that have sock puppets in their pockets and toys in their waiting rooms. Playing with kids is priceless, no?

When it comes to overall satisfaction with their chosen profession, dermatologists are at the top with 66% meeting the criteria for overall satisfaction in this survey (Medscape averaged the percentage of physicians who would choose medicine again, those who would choose their specialty again, and those who thought they were fairly compensated.)

Sixty-six percent of dermatologists were satisfied with their income, 53% would choose medicine again, and 74% would choose their specialty again. Nephrologists were the most unsatisfied with a 47% overall satisfaction rating (44% happy with income, 62% would choose medicine again, and 35% would choose their specialty again).

The tyranny of the 15-minute office visit

The survey confirms that short office visits are the norm for primary care. More than half of physicians report spending 16 minutes or less seeing patients, and only 11% of male and 15% of female doctors report spending 25 minutes or more. Over half of physicians (54% of self-employed and 59% of employed) spend 10 or more hours per week doing paperwork and administration. Nine percent of self-employed and 12% of employed doctors say they spend an astonishing 25 or more hours doing so. That time has to come from somewhere—it is eating into time with patients and eroding time with family and friends. Is it any wonder that physician burnout is now considered a major problem for the profession.

The bottom line

When it comes to income, physicians, even the lowest paid primary care docs, are doing pretty well compared to the rest of Americans—the average income in 2014 was $44,600. On the other hand, even the highest paid of the specialists aren’t making anywhere near what the super rich are making. According to CNN Money, Dara Khosrowshahi, the CEO of Expedia, was the highest paid CEO in 2015 with an income of $94.6 million. His cash compensation was a mere $3.8 million with stock while his options worth $90.8 million made up the rest. I guess he must have done a spectacular job helping us with our travel because his 2015 income was 881% higher than in 2014.

On the other hand, the survey results make it clear that money alone does not bring happiness…or satisfaction. Only 11% of physicians said that “making good money at a job I like” was the most rewarding aspect of the job. In this survey, gratitude and relationships with patients as wells as being good at the job, finding answers, and making diagnoses were what drove satisfaction.

Factors like masses of paperwork, the dreaded EHR, reduced face-to-face time with patients, long hours, night call, loss of autonomy, lack of the previous exalted place in society, and other annoyances of day-to-day practice may all serve to dilute satisfaction of practitioners of a profession that was once one of the most highly sought after in the U.S.

Should we be worried? Probably. But I am an optimist and am hopeful that changes in medical education, practice models, and reimbursement may help with physician satisfaction as may digital health technologies and do-it-yourself health care. Of course, it remains to be seen. __________________________________________________________________*Survey Methodology:

Sample size: 19,183 U.S. physicians across 26 specialties met the screening criteria

Recruitment period: November 17, 2015 – February 9, 2016

Data Collection: Via third-party online survey collection site

Sampling error: The margin of error for the survey was +0.68%

Consciousness: The Most Baffling Problem in the Science of the Mind

By Dov Michaeli, MD, PhD

Here is a thought that occurred to me as I was walking Sherman, my big Black Lab: Does he know that he is a dog? Did it ever enter his mind to ask: ‘Who am I? What’s my purpose in life? Just eat and chase the ball?‘ I asked him, but he just looked at me, as if to say: ‘Are you nuts? You expect me to have what you people call consciousness?’

Wait a minute, you might think, dogs are far removed from us humans, genetically speaking. Okay, so what about the mother gorilla I observed in the Impenetrable Forest of Uganda? She was grooming her babies just like any human mother would. But did she contemplate for a minute what the future holds for her young offspring? Did she make any long term plans for them? Was she even aware that her time on earth is finite and eventually she’d die? Bear in mind, this gorilla shares 99% of her genes with us!

So, why do we think about things like that?

Since antiquity philosophers have been grappling with this age-old conundrum: What is consciousness? Then along came René Descartes, the famous 17th-century philosopher who said that the mere capacity to think about these questions proves our existence as…thinking human beings. That is what he meant when he famously said, “I think, therefore I am.” Forgive me, my dear René, if I detect a bit of circular reasoning here. Be it as it may, like many other philosophical musings, it poses the question but it offers no answer.

David Chalmers, a philosophy professor and Director of the Center for Consciousness at the Australian National University, is a rare breed of a mathematics and physics-trained philosopher. He made the observation that “consciousness poses the most baffling problem in the science of the mind. There is nothing that we know more intimately than conscious experience, but there is nothing that is harder to explain.”

The soul

In most religions, consciousness is equated with the notion of ‘soul’. It is considered to be something that animates our feelings, as in ‘soulful music’, something that is beyond our physical being, as in Marc Chagall’s images floating above their ‘real’ physical beings.

The soul in Jewish tradition (Neshama) shares the same root, and close meaning, with breath (Neshima). When one gives out his last breath, his soul still survives in the ether. Christianity evolved similar concepts. In Hindu religion, the soul even precedes, not just survives, the physical being. And animists all over the world

(Africa, Asia, Oceania) believe that their ancestors’ spirits are watching over them and require constant offerings.

Every time I have tried to persuade somebody that consciousness must reside in the brain, I would get the skeptical query: “Yes, but how do you explain this something extra, the ‘soul’?” The answer is, it’s tough. And here is why.

Where is the seat of consciousness?

Kristoff Koch and Francis Crick, the molecular biologist who famously helped dis-cover the double-helix structure of DNA, hypothesized that a region called the claustrum might integrate information across different parts of the brain, like the conductor of a symphony. What an inspired speculation. Recently, researchers discovered that the claustrum indeed acts as a kind of on-off switch for the brain. When they electrically stimulated this region, the patient became unconscious instantly.

Does this describe the physical location of consciousness? Only to the limited extent of describing the state of being conscious and losing consciousness. This is akin to a light switch controlling the presence or absence of electrical light. But it falls far short of describing the experience of the ‘warm light’ of the impressionists or the ‘cold light’ of a Hopper painting that evokes a sense of extreme loneliness. Obviously, consciousness is more than the opposite of unconsciousness.

Apparently, there is no “seat of consciousness” in the brain. Even if we examine a ‘simple’ trait such as face recognition, we find that recognition of the face in outline form resides in one area—that structural details of the face are recognized in another. To make things even more complicated, facial movement is tracked in two other areas of the brain and the emotional content of our reaction to a face is subserved by yet another area. All these areas send their messages to yet another area, which filters out ‘noise signals and integrates the strong (hence, important) signals, and then sends that message on to the prefrontal cortex, which renders a judgment: "I like this person" or "He gives me the creeps."

Could the detailed understanding of the working of one ‘simple’ function, such as face recognition, give us a clue about the workings of an infinitely more complex trait as consciousness?

How can we explain it without resorting to magical thinking?

Here, we come to the realm of theories.

Several theories of the brain look at it as an incredibly complex computer. The brain has about 86 billion neurons, and about 10,000–100,000 connections of each neuron to other neurons. But this enormous jumble of interconnected neurons is far from chaotic.

Neurons form networks and sub-networks. And, these are not static networks. They can be part of a larger mega network at one point, and then become part of another network an instant later. They are dynamic!

This incessant, restless electrical activity in different areas of the brain, such as when we read a novel, has been demonstrated by placing electrodes on the reader’s head. So, one theory is that consciousness ‘simply’ draws on the vast number of neuronal networks, coordinating their activities into a coherent outcome, very much like the face recognition task, only vastly more complex. That makes a lot of sense but is unsatisfying. The same type of organization can be seen in a super-computer, yet, these machines are not self-conscious, suggesting that something else is needed.

Indeed, we see the creation of this ‘something extra’ all around us. Look at an ant colony. Each individual is functioning according to pre-set rules of behavior, collecting food, guarding the nest, feeding the larvae. Each activity in itself still does not amount to a functioning society. But put all these activities together in a coordinated fashion, and you get a living, breathing colony. Or, put differently, a higher order of organization.

Or take something that we do every day without giving it a second thought: Communicate through language. Consider the meaning of the words “compare”, “summer”, “day”. Each word has a well-defined, circumscribed meaning. But put together these words in a certain order, and you get Shakespeare’s evocative “Shall I compare thee to a summer’s day?”

Such qualitative transformations occur in science as well. Scientists make tedious progress by making incremental advances in the field. But all those seemingly disparate observations, most seeming quite inconsequential in themselves, come together at one point, and lo and behold: A scientific revolution occurs—what we call a paradigm shift. Newton’s Laws of Mechanics, the laws governing the motion of stars formulated by Kepler, along with the mathematics developed by Leibniz, all existed in isolation for hundreds of years and shaped the way we viewed the world. But then came Albert Einstein, who mixed that brew of sciences and from it created a brand new view of the world, a higher order of understanding the universe, a scientific revolution called the Theory of Relativity.

What does all this have to do with the brain and consciousness?

All these neurons, sub-networks, networks, interacting networks ever creating, shifting, dissolving in order to create new ones become a generative system. That is to say, their disparate, even contradictory actions, come together to generate something bigger than the sum of the parts—something that we may call consciousness.

I like this theory because it doesn’t posit a brand new phenomenon; we see it all around us. It is not based on magical thinking (e.g. the existence of metaphysical spheres of being) but rather on physical matter (the brain) and its known functions. And finally, it fulfills the necessary condition of any scientific theory—it is testable.

In the final analysis, neither the pontification of philosophers, nor the rhapsodies of dreamy poets, nor the fervent beliefs of the religiously-inclined will solve the mystery of the conscious self. Science will.