Facts and ideas from anywhere

WATER

As Bill Bryson has so elegantly described,¹ our bodies consist mainly of water—with about 60% comprising oxygen and about 10%, hydrogen. Ironically, while these two gases are two of the lightest things in nature, when combined they form one of the heaviest, namely water, which makes up about 70% of our bodies.

William C. Roberts, MD.

Erin Brockovich recently published Superman’s Not Coming: Our National Water Crisis and What We the People Can Do About It.² The second chapter of this splendid book is entitled “It began in Hinkley … and it’s everywhere now.” That is the book’s theme. In 1991, Erin Brockovich, a 31-year-old single mom with three little kids, was living in Los Angeles, 3 hours from Hinkley, a tiny Southern California community located in the Mojave Desert. She was working as a legal clerk and discovered that a carcinogen called hexavalent chromium (also known as chromium-6) had contaminated the water in Hinkley. When she first arrived in the town, Erin noticed that the water was lime green. She had never seen water like that. Then she noticed frogs with two heads and others lying lifeless on the surface of the water. The trees were dying. Wildlife was missing. The cattle had hundreds of visible tumors over their bodies. She learned that nosebleeds, multiple miscarriages, and cancer were common among this rural town’s people. Brockovich pondered: What’s the one thing that trees, animals, and people rely on? It is water, the source of life. Brockovich’s father had taught her that “deception is the root of all problems.” In Hinkley and everywhere since, Brockovich opined that “the problems I work on start with a lie.” If our water is green or brown, it is our job to do something about it. We need nothing more than our eyes, ears, nose, and a little common sense to see that an environmental catastrophe has occurred. She emphasized that Hinkley was a microcosm of what’s happening throughout the world today. She stressed that neither the Environmental Protection Agency, started by President Richard Nixon, nor other politicians are going to save us.

The utility PG&E had a large plant in Hinkley. Erin and her colleagues eventually learned that chromium-6 seeped into the groundwater from one of its gas compressor stations. It was originally used to stop rust from forming in cooling towers and pipes and then later discharged into unlined holding ponds during the 1950s and 1960s, eventually leaching into the soil and contaminating the aquifer that supplied the town’s drinking water. Groundwater in Hinkley tested as high as 80 ppm in the 1990s. No level is acceptable. It is now estimated that it will take at least 150 years to clean up the mess. The class action lawsuit against PG&E was filed in 1993, and the case resulted in the largest medical settlement lawsuit in history. Hinkley now is a ghost town. The company had put profits above public health. PG&E had the resources, the technology, and the manpower to clean up its own mess and yet chose to lie, cheat, sue, intimidate, falsify documents, and outright bully anyone trying to protect the rights of water-drinking consumers. In 2014, California became the first state in the nation to regulate this substance and establish a maximum contaminant level of 10 PPB for chromium-6 in drinking water.

In 2000, Brockovich became famous with the movie Erin Brockovich starring Julia Roberts, who won an Oscar for her performance. The movie was an instant hit and Erin Brockovich thereafter started receiving hundreds of emails (www.ErinBrockovich.com) every month. PG&E, of course, was not pleased when the movie came out exposing the dangers of chromium-6.

Throughout the book, Brockovich emphasizes that sound science is the basis for all legislation and policy decisions to protect public health, and she warns that large companies can influence the scientific process and conceal their own studies to avoid or postpone regulations. Brockovich has emphasized that environmental pollution is not easy to detect or prove. It may take years to build a scientific case to prove the harmful effects that certain chemicals have on our health. Asbestos was used to insulate homes for decades before it was finally banned. One of the biggest hurdles in the Hinkley litigation was establishing whether or not ingestion and skin exposure to chromium-6 could cause harm to residents. Even after PG&E lost the Hinkley case, it did not back off its pursuit to downplay the effects of hexavalent chromium. Because it is difficult to remove this chemical from the water to meet the stricter standards, it was worth the company’s time and resources to find science to ensure it wouldn’t have to get involved with the cleanup.

Environmental pollution is occurring all over the world. A report from the Environmental Working Group found that by 2016, about two-thirds of the US population—218 million people—were drinking water contaminated with potentially unsafe levels of chromium-6. Many of the chemicals have latency periods of 10, 20, or 30-plus years. In some cases, like Flint, Michigan, symptoms start showing up after only a few months. Brockovich now responds to requests for help in contamination complaints in all 50 states and in other countries. She emphasizes that there is no agency on the ground having door-to-door conversations and identifying residents who may be affected by contamination in their area. As a result, many people have lost faith in the federal government’s ability to investigate what’s making people sick in their communities. That’s one reason they now turn to Brockovich. Not only would Brockovich get emails and letters describing communities’ drinking water situation, but residents would send pictures of the water coming out of their faucets, ranging from yellow to green to black. These contamination cases, as a rule, are uninteresting to elected officials. Most lawyers will not touch these cases, and senators and representatives do not generally respond either. That’s what makes Brockovich so popular in this arena. She started a map of the USA, and whenever she would get a call about water contamination in a community, she would place a dot on her US map. It gradually became a sophisticated software project, and anyone can access it online (www.communityhealthbook.com). The online address was launched in 2017 and now has thousands of people reporting.

Among the biggest pollution areas in the USA are its military bases, probably the worst polluters in the world. The US Department of Defense is bigger than any corporation. It has spread toxins across 40 million acres of American soil. The Environmental Protection Agency has identified at least 149 current and former military bases with groundwater contamination. The drinking water and soil at these bases have been polluted by a range of dangerous chemicals left from military activities, including jet fuel, cleaning products, degreasing solvents, firefighting foams, and explosives. John D. Dingell, the longest-serving member of Congress in US history, told Newsweek in 2014, “Almost every military site in this country is seriously contaminated.”

The most contaminated military base in the USA is the US Marine Corps Base Camp Lejeune, located in Jacksonville, North Carolina. It is the largest Marine base on the East Coast, supporting a population of >100,000 Marines, their families, and civilian employees. The Agency for Toxic Substances and Disease Registry, a federal public health agency, completed a public health assessment of drinking water at the base and concluded that the people living and working at the base were exposed to “contaminants of concern” in their drinking water from 1953 through 1987. These chemicals included trichloroethylene, tetrachloroethylene, dichloroethylene, vinyl chloride, and benzene. Health issues associated with exposure to trichloroethylene and tetrachloroethylene include infertility, cancer (including a huge cluster of breast cancer in men), and neurobehavioral effects, among others. So many babies born at Camp Lejeune in the 1960s and 1970s died that a nearby cemetery had a section that parents called “Baby Heaven.” Children were born without craniums and with neural tube defects, such as spina bifida and anencephaly. Leukemia and lymphoma were common. Camp Lejeune closed most of the contaminated water wells in 1985, 5 years after the pollution was first discovered. Camp Lejeune is considered by scientists and federal investigators to be the worst and largest water contamination site our country has ever seen!

In August 2012, President Barack Obama signed a bipartisan-supported bill called Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012. The bill provided hospital care and medical services through the Department of Veterans Affairs for veterans and family members who resided at the base for >30 days between January 1957 and December 1987 for up to 15 health conditions that scientists linked to the contamination: lung cancer, breast cancer, bladder cancer, kidney cancer, leukemia, esophageal cancer, multiple myeloma, renal toxicity, miscarriage, myelodysplastic syndrome, female infertility, scleroderma, hepatic steatosis, non-Hodgkin’s lymphoma, and neurobehavioral effects. Hundreds of other bases, forts, munition stations, annexes, depots, centers, and unnamed facilities in the US are also dealing with similar pollution issues.

A number of chemicals pollute our water, and hurricanes and major storm events also deteriorate the water quality, threatening human health and the environment. This is particularly true in Florida. Such storms, of course, generate large volumes of flood water, causing sewer and septic systems to fail, and flush large quantities of sewage and pollutants into oceans, bays, rivers, and lakes. Nutrients, pesticides, fecal bacteria, heavy metals, petroleum products, industrial chemicals, and many other contaminants in our waterways make them unsafe for swimming or fishing. Major storm events and associated pollution can significantly impact local fisheries, tourism-based economies, and the people and livelihoods that depend on them, often taking months or years to recover. Regional water issues such as those going on in Florida go beyond this one state. The Great Lakes are a mess. The Sacramento Delta is a “toilet bowl.” The Ohio, Missouri, and Mississippi rivers are laden with toxins. We need more people and resources focused on solutions for our country’s waterways!

Early in 2018, the deputy mayor of Cape Town, South Africa, announced a cap on the amount of water that could be used by each person in the city, and that limit was 13 gallons of water each day. That is not much. That’s enough daily for a 90-second shower, a half gallon of drinking water, a sink full to hand wash dishes or laundry, one cooked meal, two hand washings, two teeth brushings, and one toilet flush. (The 13-gallon cap is the United Nations guideline for a human being’s minimum daily requirement.) In contrast, the US federal government estimates that the average American uses 100 gallons of water each day! Cape Town is a vibrant coastal city of 4 million people, a place that hosts tourists in the millions every year. It is the home of world-class art museums and great dining. Cape Town named the day that the city would entirely run out of water “day zero,” meaning that Cape Town would run dry. City officials made it illegal to use a water tap to wash your car, fill a pool, or water a garden. Shipments of bottled water sold out as soon as they hit store shelves. The remarkable efforts of Cape Town’s citizens did not avert day zero. They only pushed it further into the future. The problem has not gone away. It has only been delayed. For the first time in human history, a city of millions of people came within a hairs-breath of running out of water completely. Day zero is still coming.

What happened in Cape Town? The same thing that threatens many cities around the world. The population of the city increased rapidly. Its government deferred building sewage-recycling plants to increase the usable water supply, and it waited too long to implement aggressive conservation policies. Above all, the environment that produced the city’s water changed entirely. Cape Town had hotter weather, less rainfall, emptier streams—all of which led to a shortage that got worse over time. Then, starting in 2014 there were 3 years of drought, which emptied Cape Town’s reservoirs and led to the 2018 near-zero moment.

Cape Town is not alone. The 21 million people who live in Mexico City regularly have their domestic supplies of running water cut off. The same thing has happened in São Paulo, Brazil. In 2015, their city’s water reserves hit terrifying lows, and some of the trucks brought in to help were looted. By one estimate, São Paulo had only 20 days of water left. Bangalore, Beijing, Istanbul, Moscow, Cairo, Jakarta—these cities of millions of people could be at serious risk for running out of water soon. Melbourne, Australia, a city on the edge of an expanding desert, is expected to have its day zero within the next decade. Los Angeles and San Diego recently emerged from a record-breaking 5-year drought and were down to less than a year’s supply of water in their reserves. Miami and Salt Lake City are also at risk. Thus, not only is the quality of water important but the quantity obviously is essential. As Brockovich emphasizes, there would be no looming day zeroes from China to California without global warming.

The year 2018 was the fourth hottest year on record, and the last 5 years have been the hottest climate researchers have observed. The year 2018 also was the wettest year in the last 35 years. Scientists attribute the higher rainfall to a warmer atmosphere, which causes more evaporation, along with warming oceans, which add to the intensity of storms and hurricanes. “Climate change,” as Brockovich states, “is an umbrella term for a global set of processes taking shape in innumerable, interconnected ways, ranging from the dwindling of glaciers in the Andes to the increased outbreaks of prairie fires in the American Midwest, to the increasing prevalence of disease-carrying mosquitoes.” Climate change is reducing the amount of drinkable water on the earth’s surface. In October 2018, the United Nations Intergovernmental Panel on Climate Change released a report arguing that we had a dozen years left to keep temperatures in check or else we would face drastic consequences. Unchecked, temperatures could lead to worse forest fires, massive food shortages, and the death of many coral reefs around the world. In 2007 the panel issued its special report, Global Warming of 1.5°C. We are already 1°C above preindustrial levels!

There is much more in this book.

TEEN PREGNANCY

When babies raise babies, we all suffer. Of the girls who have a child before they turn 18, 38% drop out of high school, making it nearly impossible for them to get a good job and a financially secure future.³ Dallas County spent almost $12 million paying for teen births (girls aged 15–19 years) in 2014. Teenage mothers tend to score lower on school readiness assessments. Although teen births are declining nationwide, the rates in Dallas and Texas in general are well above the national average, in some areas 4 times higher. We must reduce the teen pregnancy rates!

DIABETES MELLITUS IN DOGS AND HUMANS

Dogs who live with people with diabetes are more likely to develop diabetes, compared with dogs whose human companions do not have diabetes.⁴ The reverse is also true. People whose dogs have diabetes are more likely to get the disease themselves. The reason, apparently, is that people tend to pass their eating habits onto their companion dogs, putting them at risk for the same diseases that unhealthful eating causes in humans.

SHARK BITES

Shark attacks are rare. In 2019, there were only 64 shark attacks worldwide, with just two fatalities. In a recent piece in The Dallas Morning News, Amanda Foreman gave some historical perspective on shark bites.⁵ Herodotus recorded how, in 492 bc, a Persian invasion fleet of 300 ships was heading toward Greece when a sudden storm blew up around Mt. Athos. The ships broke apart, tossing some 20,000 men into the water. Those who did not drown were devoured by sharks.

The Age of Discovery introduced European explorers to a new species of shark far more dangerous than the ones they had known back home. In a narrative of his 1593 journey to the South Seas, the explorer and pirate Richard Hawkins described the shark as “the most ravenous fish known in the sea.”

It is believed that the first deadly shark attack in the US took place in 1642 in an inlet on the Hudson River, north of Manhattan. Anthony Van Corlaer was attempting to swim across to the Bronx when a giant fish was seen to drag him under the water. The first confirmed American survivor of a shark attack was Brooke Watson, a 14-year-old sailor from Boston. In 1749, Watson was serving on board a merchant ship when he was attacked while swimming in Cuba’s Havana Harbor. Fortunately, his crewmates were able to launch a rowboat to pull him from the water, leaving Watson’s right foot in the shark’s mouth. Despite having a wooden leg, Watson enjoyed a successful career at sea before returning to his British roots to enter politics. He ended up serving as Lord Mayor of London and becoming Sir Brooke Watson. His miraculous escape was immortalized by his friend, the American painter John Singleton Copley, in Watson and the Shark.

The American relationship with sharks changed irrevocably during the summer of 1916. The East Coast was gripped by both a heat wave and a polio epidemic, leaving the beach one of the few safe places for Americans to relax. On July 1 of that year, a man was killed by a shark on Long Beach Island off the New Jersey coast. Over the next 10 days, sharks killed three more people and left another severely injured. The Jersey Shore attacks served as the inspiration for Peter Benchley’s bestselling 1974 novel Jaws, which was turned into a blockbuster film the next year by Steven Spielberg. Since then, the shark population in US waters has dropped by 60%, in part due to an increase in shark fishing inspired by the movie. Appalled by what he had unleashed, Benchley spent the last decades of his life campaigning for shark conservation.

SNAKE BITES

According to the World Health Organization, there are approximately 550,000 snake bites each year around the world, and approximately 140,000 (25%) of the victims die.⁶ Another 400,000 people survive, some with amputated limbs and other permanent disabilities. About 95% of the deaths occur in poor, rural communities in developing nations. One of the worst-hit locations is sub-Saharan Africa, where up to 30,000 deaths from snake bites are believed to occur each year. Some snake bite experts say the true toll may be double that.

A major factor, according to a piece in the National Geographic, is a shortage of antivenom that neutralizes the toxins of dangerous snakes. Complicating matters is that many victims, for a lack of money or transportation, or because of distrust of Western medicine, do not go to hospitals or do not get there in time. The staff at many health centers are insufficiently trained to treat snake bites and, even if the drug is on hand, it is too expensive for many victims. Additionally, most of the reliable African antivenoms need to be kept refrigerated to stay stable and effective. With frequent power cuts, even in cities, keeping them cold can be nearly impossible.

To draw attention to the snake bite crisis and to attract funding for research and treatment, in 2017, the World Health Organization added snake bite envenomation to its roster of neglected tropical diseases, which include rabies, dengue, and leprosy. Elevating snake bites to this level of concern hopefully will serve as a wake-up call to Africa’s health ministers.

Most African snake bite victims are farmers who work in remote fields barefoot or in sandals. Once a venomous snake strikes, a race against the clock begins. Transport to the nearest hospital can take hours, even days. By then it may be too late. The venom of an elapids, a family of snakes that include mambas and cobras, can kill within hours. Their neurotoxins rapidly paralyze respiratory muscles, making breathing impossible. The venom of vipers, however, can take several days to kill, interfering with clotting and leading to inflammation, bleeding, and tissue death.

Once the victim is at a treatment center, survival depends on two factors: is a reliable antivenom available, and if so, does the medical staff know how to administer it? Often in sub-Saharan Africa, the answer to both is no. Some people are not taken to a hospital at all. Families may seek help instead from a traditional healer who may apply leaves or ash from burned animal bones or tie a tourniquet around the bitten limb, which can dangerously restrict blood flow. Some botanical treatments do ease pain and reduce swelling, but that cannot save a victim’s life. Fortunately, about half of the bites from venomous snakes are “dry,” with no venom injected. These patients get well, and the traditional healer believes that he or she has healed the patient.

Producing antivenom is a long, expensive process, and because most people who need it live in developing countries, such drugs are not big moneymakers. In 2014, Sanofi discontinued production of its antivenom Fav-Afrique, a drug effective against the venom of 10 of Africa’s most dangerous snakes. It discontinued production because the medicine was not profitable. Antivenom production requires actual venom. That comes from labs that may house thousands of snakes in captivity; they are milked about once a month for their venom. Depending on the species, venom can cost a pharmaceutical company up to several thousand dollars a gram, and then the venom—in amounts too small to have deleterious effects—is injected into horses or other large animals whose blood develops antibodies. Blood is drawn, and lab technicians separate out the antibodies and purify them to make antivenoms. Even with a high-quality antivenom, treating snake bites can be hit or miss: the chemical makeup of venom and its effects can vary from snake to snake, even within species. Sometimes antivenoms that are supposed to treat certain species do not work in some areas. The puff adder’s venom can change from one area to another.

In 2013, a company in Mexico, Inosan Biopharma, began marketing a new antivenom, one that could neutralize the toxins of at least 18 snake species—more than any other available antivenom in Africa. The drug, Inoserp Pan-Africa, also is advantageous and is not freeze dried. Not needing refrigeration is a game changer. For all its effectiveness, Inoserp is not being produced in sufficient quantities. There is a severe shortage of antivenoms more broadly; the number of vials in circulation is <5% of the 1 to 2 million needed yearly in sub-Saharan Africa. And even if Inoserp were widely available, rural Africans, whose earnings are no more than a few dollars a day, could not afford it. Hospitals and pharmacies might charge $80 to $120 or more per vial, and most snake bite victims require several vials. Less expensive antivenoms are available but are often unreliable.

Preventing snake bites, of course, is better than having to treat them. Public awareness campaigns in several African countries push wearing shoes when walking in places likely to have snakes and push use of flashlights at night.

WEALTH IN THE USA

At the end of 1989, according to Federal Reserve data, the top 1% in the US held 23% of all wealth.⁷ The bottom 50% held 3.7%. Thirty years later, at the end of the first quarter of 2019, the top 1% held 31% of all wealth, and the bottom 50% held 1.3%. The rich got richer and the poor got poorer. The top 1% had more wealth than the bottom 90%, and that was in 2019!

THE SUPERRICH

These are individuals with a net worth of at least $30 million.⁸ New York City has the most of these superrich citizens (nearly 10,000); next is Hong Kong, with nearly 9500, followed by Tokyo, Los Angeles, Paris, London, Chicago, San Francisco, Washington, DC, and Dallas, with just over 3000. North America has a 36% share of the world’s ultra-high-net-worth population. The world, consisting of >7 billion people, contains just over 290,000 individuals with ultra-high net worth.

CHARLES PONZI

The year 2020 is the 100th anniversary of Charles Ponzi’s indictment for his postal arbitrage scheme in Massachusetts.⁹ In a classic Ponzi scheme, a con artist offers investors outsize returns based on an intriguing but somewhat mysterious money-making venture. Earnings are hard to verify, but few care because the business seems to produce such big payouts. Rather than using investments to produce profits, however, the con artist simply pays off earlier investors with money from later ones enticed by the promise of lavish returns. These earlier investors find the recent return so compelling that they often let their earnings ride and for a while at least their duplicitous maestro compounds them. In Ponzi’s case, he promised investors a 50% return every 45 days, ostensibly by using international postal reply coupons to leverage the strength of the dollar vs the Italian lira and other currencies. He was soon thronged by investors—40,000, by one estimate, including many Boston police officers—but there were not enough coupons in the world to soak up all their money. It was easier to use the growing cascade of new money to pay off earlier funders. Ponzi’s adventure lasted less than a year. Like many subsequent schemers, he was a perceptible outsider plagued by status anxiety, and when the money started rolling in, he used it to fund a wealthy lifestyle.

Although Charles Ponzi gave his name to such scams, he did not invent them. In Boston in the 1870s, Sarah Howe launched a bank for women promising 8% a month on deposits. Money poured in. Like many such later schemes, Howe’s was exposed by newspaper reporters. Ponzi was done in by the Boston Post.

Similar frauds continue to abound. Early in 2020, Jeff and Paulette Carpoff, a California couple, admitted that their solar company and its alluring tax credits were a Ponzi scheme. Investors included Berkshire Hathaway (Warren Buffet’s company). The biggest Ponzi scheme in American history was that of Bernard Madoff, who went to prison in 2009 for securities fraud that cost investors more than $17 billion.

Some economists have noticed that even some legal business activities can look awfully Ponzi-ish. When a firm has to borrow to meet interest payments or governments have to borrow to meet pension obligations to retirees whose own pension contributions have been paid out to predecessors, that’s Ponzi-ish.

MEGA CITIES

A recent article stressed that the US needs to increase its population to 1 billion people to stay competitive in the world.¹⁰ Some countries are now past that number, and they have many large cities. Today, there are >30 cities worldwide with a population of at least 10 million, including 1) Tokyo, 37.4; 2) Delhi, 30.3; 3) Shanghai, 27.1; 4) São Paulo, 22.0; 5) Mexico City, 21.8; 6) Dhaka, 21.0; 7) Cairo, 20.9; 8) Beijing, 20.5; 9) Mumbai, 20.4; 10) Osaka, 19.2; 11) New York-Newark, 18.8; 12) Karachi, 16.1; 13) Chongqing, 15.9; 14) Istanbul, 15.2; 15) Buenos Aires, 15.2; 16) Kolkata (Calcutta), 14.9; 17) Lagos, 14.4; 18) Kinshasa, 14.3; 19) Manila, 13.9; and 20) Tianjin, 13.6. All of these megacities will have problems providing clean water to their inhabitants.

RESTAURANTS SERVING VEGETARIAN OPTIONS

Wallethub.com provides a list of the best cities for following a plant-based diet.¹¹ Of the top 20 cities, New York was number 1. Three California cities were in the top 10 (San Francisco, Los Angeles, and San Diego). Austin, Texas, was number 13, and Houston, number 14. Dallas did not make the top 20. About 55% of restaurants in New York City have vegetarian options. New York City also has the most salad shops (34 times more than Laredo, Texas, the city with the fewest).

COMMUTING TO WORK

I hear the phrase a lot, “stuck in traffic.” I live only 3 miles from Baylor University Medical Center and the transit time is <15 minutes. Many of my workmates live 25 miles or more from the hospital. Compared to other large cities in 2016, Dallas traffic moves fairly well.¹² Inrix during March and April 2017 analyzed hot spots—defined as areas with repeated traffic jams—in 25 major US cities. The number of traffic jams was as follows: Los Angeles, 128,000; New York City, 113,000; Washington, DC, 50,000; Atlanta, 58,000; Dallas, 45,000; Chicago, 40,000; San Francisco, 30,000; Houston, 35,000; Miami, 60,000; Boston, 27,000. A previous study released in February 2017 based on 2016 data by Inrix calculated that traffic congestion costs US drivers an average of $1400 per driver each year, mostly the cost of time and fuel.¹³ Dallas lags on use of public transit. The share of workers using public transit in our major cities in 2016 was as follows: Washington, 36%; Boston, 33%; Chicago, 28%; Atlanta, 10%; Los Angeles, 9%; Denver, 6%; Dallas, 4%; Austin, 4%; Charlotte, 3%; and Nashville, 2%.

QUEEN ELIZABETH’S 10 LIFE LESSONS

Queen Elizabeth II, now 94 years of age, still follows her 10 daily rules.¹⁴ 1) Recharge your willpower. Willpower is akin to a battery that requires routine recharging. Tea time is that crucial interval for the queen, a sacred break in her day when she rests for a quiet hour with a cup of tea. 2) Stick to a schedule. From her first day as queen, she has ended each day by writing in her journal. 3) Develop your sense of purpose. The queen lives for something larger than herself: her country. 4) Serve others. She is the patron of hundreds of charities. She believes that giving herself to good causes can do as much as anything to put her worries into perspective. 5) Sweeten the self-talk. She tries to put things out of her mind that are disagreeable. The trouble with gloom, she opines, is that it feeds upon itself. 6) Brush aside vanity. She can, with a complete lack of vanity, comb through a daily onslaught of personal stories in the tabloids and remain detached and a frequently amused spectator. 7) Never stop playing. She takes time almost every day to play as she loved to as a child, especially with horses. Doing so has kept her muscles active and her mind remarkably agile. 8) Keep the faith. The queen attends church every Sunday and prays every night before bed. Whatever worries the world throws at her, she believes there is a higher throne on which to lay them. 9) Be open to change. At any age when many find it hard to accept altered conditions, the queen has never stopped learning and adapting. Change has become a constant. “The way we embrace it defines our future.” 10) Cherish your crowning years. Elizabeth smiles more nowadays and is more warmly approachable than ever. All of this supports the scientific phenomenon known as the “U-bend of life”: the discovery that the world’s happiest people tend to be those who are in their 80s and beyond.

William C. Roberts, MD

January 8, 2021