How Much Does your Soul Weigh?

On 10 April 1901 Duncan MacDougall together with four other physicians were waiting for six people to die. In a hospital in Dorchester, Massachusetts, each patients' entire bed was placed on an industrial sized Fairbanks scale that was sensitive within two tenths of an ounce (5.6 grams). After a few hours waiting, the patients died and something strange happened.

As soon as they died the scales dropped. They lost weight. The conclusion was that a human soul left the body and registered the loss of 21 grams. The weight of a mouse. Repeating the experiment with dogs resulted in no loss of weight, indicating that dogs have no soul to lose.

Since the soul was material, Duncan MacDougall reasoned that we should be able to measure it. Four years later the New York Times reported in a front-page story that MacDougall tried to take X-rays of the soul escaping the body at the moment of death. Then MacDougall died in 1920 at the young age of 54 leaving behind many questions and many charlatans to capitalize on his scientific legacy.

Following the publication of these experiments—both in the popular media as well as in academic journals—his colleague physician Augustus Clarke criticized the experiments. Clarke argued that the loss of 21 grams could be accounted for by expiration. Clarke noted that at the time of death as the lungs are no longer cooling blood there is a sudden rise in body temperature, causing a subsequent rise in evaporative sweating. Since dogs do not have sweat glands, and therefore cannot lose weight in this manner Clarke argued that the experiments were flawed.There was evidence to suggest that MacDougall knew of this alternate interpretation to his experiments beforehand.

Measuring is the scientific method. The medical historian Mirko Dražen Grmek wrote about the scientists Santorio Santorio (1561-1636) who diligently weighed and measured everything. In particular Santorio weighed all the food and drink that he ingested. He also measure all that come out the other end—feces and urine. After measuring his weight, the remaining weigh loss is due to something else. For every eight pounds consumed Santorio found that he only excreted three pounds. Five pounds of food and drink could not be accounted for.

It was not until 1862 that the infamous hygienist Max von Pettenkoffer constructed an insulated room designed to measure the exact amount of evaporative sweat and heat the body generated. As a hygienist, promoting good sewage and public health approach to health, Max von Pettenkoffer designed a machine—respiration calorimenter—for measuring heat given off by body’s chemical reactions and physical changes expended by a person at rest, standing and walking. He measured the weight of this metabolic energy use.

All the evidence was already there to suggest that our metabolism—the energy expanded in maintaining bodily functions—generates evaporative loss of weight. And MacDougall knew this. In his original paper he reports that: “He [dying patient] lost weight slowly at the rate of one ounce per hour due to evaporation of moisture in respiration and evaporation of sweat.” But he also addressed this loss as an explanation for the loss of weight when the patients died: “This loss of weight could not be due to evaporation of respiratory moisture and sweat, because…this loss was sudden and large…” It's undeniable that something else is taking place.

True science can only be conducted through experimentation. MacDougall’s theory, that there had to be “continuity” in life after death—a soul—was the incentive for his experimentation. The theory assumes that we know when people die. As strange as this question might seem there is no easy definition.

Our definition of death is a legal rather than a biological definition. In medicine it is a prognosis—predicting—rather than a diagnosis—confirming. Having no brain or heart activity indicates that the patient is unlikely to come back alive, it is by no means indicative of the body. Organs can still be harvested with the patient being dead. The legal definition of death does protect surgeons from liability when they are harvesting organs for transplantation.

In 1968—a year after the South African surgeon Christiaan Barnard performed the world's first human heart transplant—Stanford University surgeon Norman Shumway performed the first USA heart transplant from a brain-dead donor. These were nearly identical surgical procedures, except whereas Barnard’s surgery was received with adulation; in the United States, Shumway nearly ended up being prosecuted for conducting the operation. John Hauser, the Santa Clara County coroner, met Shumway with a threat of prosecution.  The infringement was that the donor did not have an autopsy performed to confirm that he was dead since performing an autopsy would have ruined the organs for transplantation.  Surgeons were being accused as killers. As a result of this threat of prosecution, organ donations stopped or slowed dramatically. Like an old Perry Mason TV series where the prosecutor is standing in front of the jury, pointing their right hand index finger at the transplant surgeon while declaring “Ladies and gentlemen of the jury, there is your killer. That surgeon killed my patient.”


If we are to use the Pope's language, that death needs to involve “decomposition,” “disintegration,” and “separation,” then it will truly stop all organ transplantation. Without the legal criterion of brain death, where the organs remain viable, there will be a dramatic deterioration in the quality of organs that can be harvested and transplanted. According to the World Health Organization, in 2014 120,000 solid organs were transplanted—more than 80,000 kidney, 26,000 liver and 6,500 heart transplants in 93 countries. After Austria, the United States has the highest per capita rate of transplants. Organ transplantation extends lives for a significant number of people.  But we cannot escape the fact that this is made possible by a legal definition of death and not a biological one. If organs are truly dead, they cannot be harvested and brought back to life again. However the reliance on a legal definition of death hinders a more scientific study of the biology of death.It is surprising to find how little we know about death.

The British researcher Sam Parnia argues that many people who can be classified as legally dead from heart attacks or blood loss could be resuscitated up to 24 hours after they "die". Parnia has been studying those who have no heart beat and no detectable brain activity for periods of time. While in this state the "dead" patients are given names of cities and when—sometimes, if—they recover patients are asked to ‘randomly’ name cities. They found that the patients are more likely to choose the same cities that they were exposed to while unconscious—legally dead. It seems that when we are dead we are still aware, although not conscious.

Pozhitkov and colleagues in 2017 found that death is not just a shutting down, but an orchestrated event. The authors found mRNA transcript profiles of 1063 genes became significantly more abundant after death. Even 9s hours after death. And this is not even, while most genetic activity increased 30 minutes after death, other activity increased only a day or two after death. These genetic activities are related to: stress, immunity, inflammation, apoptosis, transport, development, epigenetic regulation and cancer. We might be as ignorant of the biology of death is as much as we are ignorant of the creation of life.

As with the MacDougall studies there is a problem of small samples in these studies too. But such problems can eventually be overcome with better research design.
Weighing the soul might be complicated if we do not know when we actually die and the soul departs. There are increasing interest in both defining death and capturing the process. But evidence is scant and the methods used to examine death leave room for many errors and misinterpretations. Many publications exist of unsubstantiated reports of souls departing the body—Konstantin Korotkov, Eugenyus Kugis, Vitaliy Khromovaand and others—that purport to repeat the MacDougall’s findings, including photographic evidence. But none are published in scientific journals.

We have a great interest in “proving” things. The problem with science is that it is necessarily finicky with details and the problem with belief is that it is necessarily not. Science is just a method,without an answer. We are always refining the answer and the answer can never be completely correct. Belief, on the other hand,  is an answer without a method. It is always correct because we cannot test it and improve upon the answer.

Whenever we mix the two together—science and belief—both sides get muddled. But this space is where real science resides. In that uncomfortable area where we do not know what the outcome might be. Within this muddled space, soul searching might attain a new meaning.

© USA Copyrighted 2017 Mario D. Garrett

References

Grmek, M. D. (1952). Santorio Santorio i njegovi aparati i instrumenti. Jugoslavenska akademija znanosti i umjetnosti.

Kuriyama, S. (2008). The forgotten fear of excrement. Journal of Medieval and Early Modern Studies, 38(3), 413-442.

Pozhitkov, A. E., Neme, R., Domazet-Lošo, T., Leroux, B. G., Soni, S., Tautz, D., & Noble, P. A. (2017). Tracing the dynamics of gene transcripts after organismal death. Open biology, 7(1), 160267.

MacDougall, D. (1907). Hypothesis concerning soul substance together with experimental evidence of the existence of such substance, American Medicine, April 1907.

Parnia, S., Waller, D. G., Yeates, R., & Fenwick, P. (2001). A qualitative and quantitative study of the incidence, features and aetiology of near death experiences in cardiac arrest survivors. Resuscitation, 48(2), 149-156.

Medicare Cuts in the 2018 Budget

The new tax bill Congress is passing will increase the deficit. Although this might seem antithesis to the Republican doctrine, behind the obvious spindrift there lurks a clever ploy to trigger an automatic program that reduces funding to most social programs, including Medicare. Known euphemistically as PAYGO the Statutory Pay-as-You-Go Act of 2010, is a rule that requires any federal deficit to be paid for with spending cuts to social programs. With the exception of Social Security, unemployment benefits and food stamps, most mandatory spending programs—some 228 programs—will be cut or eliminated.  Specifically, Medicare will be cut by 4 percent a year. Medicare represents the most important program for older people after Social Security.

We got here because people, and some gerontologists, are ignorant of what really helps older adults and how we achieved a modicum of support for them. Without civic engagement and social protest, such laws breeze through without even a mention that Medicare is about to be cut.

Gerontology is full of experts. It is one of the richest disciplines, with academicians and researchers studying the whole spectrum from genetics to policy, from biology to geography, from architecture to neurology. They are all gerontologists. So it is common to find disagreements but we live happily in our own silos. How do we improve aging? We try and communicate the problems associated with aging in order to bring about change

Most communication techniques are embellishment of the 1954 Schramm's Model of Communication. Wilbur Schramm defined communication as a two-way street where both sender and receiver take turns to send (encode) and receive (decode) a message. We need messages that can be understood (decoded easier). And this what eight national aging-focused organizations tried to do when—AARP, American Federation for Aging Research, American Geriatrics Society, American Society on Aging, Gerontological Society of America, Grantmakers in Aging, National Council on Aging, and the National Hispanic Council on Aging—banded together and hired FrameWorks to create a strategy for helping the public understand aging issues. The result was a bible for an aging future. Like all bibles it is populated by don’ts:

1. Don’t lead with the story of demographic shifts.
2. Don’t talk about aging as a “civil rights issue.
3. Don’t use language that refers to older people as “other.”
4. Don’t overdo the positivity.
5. Don’t cross-contaminate efforts to build public will with “news you can use.”

FrameWorks simplifies scientific and societal messages to a point that the general public can understand in order for them to act positively on it.  The problem with simplification is that it is false. Changing attitudes does not necessarily change behavior. We believe that communicating a good message changes attitudes and brings about concrete changes. We therefore also believe that laws are enacted as an act of benevolence. But this is misguided, as we are witnessing right now with PAYGO. "Reframing Aging" and "Disrupting Aging" are a ruse because they simplify a process that is messy and volatile and exclude the participation of individuals in civil disobedience. Worst still these approaches deny the social activists their true worth in our political world. What changes and improves conditions for older adults are laws that are enacted, implemented and enforced. And these steps are accomplished by civic engagement (or lack thereof.)

A livable income remains the lynchpin of wellbeing among older adults. Income, especially in the United States increases access to affordable health care, housing, transportation and food at a minimum. And we got here through the single enactment of the 1935 Social Security Act. The act was not some kind of reframing aging, or disrupting aging. The act was enacted because there was civil unrest and a swell of support for alternate provisions. FrameWorks by focusing solely on ageism and seeing the problem as a public relations issue, misses out on one of the tenants of an aging reality: heteroscedasticity. As we get older, we as a group, become more varied and different from each other. A schism as wide as that between Donald Trump and Noam Chomsky. FrameWorks remain at a loss in representing these two extremes.

Reframing, disrupting, renewing, or any public relations exercise cannot address aging, understand the changes and needs, develop effective responses and tackle problems associated with aging—on an individual or at a community level. That thinking is nonsense. Neither Trump nor Chomsky complain of ageism. The obvious reason is that they are at their zenith. Their basic civic responsibilities seem to be provided for. Their other very vocal issues—however grave and important—have nothing to do with age. Aging becomes a policy issue ONLY when individuals are at their lowest—their azimuth.

The azimuth for older adults is similar to those for other ages. It includes provision for shelter, health, food and income. You cannot have other ambitions before meeting these basic requirements. Right now those basic requirements are unmet for an increasingly large minority of the older adult population. Social gerontologists focus on this vulnerable and abused group. The answer how to help them is not by reframing of issues, but by blue-color provision of services. And services are created through policy.

We have been here before. During these economic failures older adults are worst hit. The Great Depression of the 1930s followed previous economic collapses—1840s and again in the 1890s. Poverty among older adults grew dramatically so that by 1934 over half of older adults in America lacked sufficient income to be self-supporting. They needed charity to survive. State welfare pensions were non-existent before 1930, and for those that later developed State pensions only provided 65 cents a day for about 3% of older adults. Millions of older people were homeless, hungry and desperate. Millions more were unemployed. By some estimates more than two million adult men—referred to as hobos, travelling workers, the word likely derived from the term hoe-boy meaning "farmhand"—wandered aimlessly around the country. Banks and businesses failed. From this morass of civil depravity rose one of the most important piece of legislation. The 1935 Social Security Act that in 1965 spawned Medicaid and Medicare is the bedrock of services for older adults. No single act has ever-improved older adult’s wellbeing as much, or since.

Social Security Act

Social Security Act—passed by the President Franklin D. Roosevelt (FDR) administration in 1935—created a right to a pension in old age, and an insurance against unemployment. This legislation was not passed because of the benevolence of Congress, or that of FDR (who won in 1932 and 1936). The act was passed because there was civil unrest and a threat of further social upheaval.

Workers rose up, and although individual uprisings were ineffective, en masse this lead even the oligarchs of the time and the Supreme Court judges to back down. There are other interpretations of history. But a strong case can be made that civil uprising created dramatic political choices at the time. Characterized by worldwide turmoil that gave rise to communism, anarchist, fascism, and National Socialism—Hitler, Mussolini, Gandhi, Lenin/Trotsky/Stalin. Here in the United States it was Federalism as expressed through the many “alphabet agencies” created under the New Deal. Federalism emerged not in response to civic unrest but in competition. It managed to subdue it.

Before the Great Depression the poor already established a precedence of marching to Washington D.C. to express their ire.  The 1894 March of Coxey's Army after the industrialist Jacob Coxey organized tens of thousands of unemployed to march to Congress. Although this movement fizzled, Coxley later became an advocate of public works as a remedy for unemployment. But it was the Great Depression that awakened the masses. The story remains scattered among the literature. Six social movements have been etched in history and defined the New Deal, whether in competition or in promoting.

1.     With Every Man a King Governor and later Senator Huey Long wanted the Federal government to guarantee everyone over age 60 to receive an old-age pension while every family would be guaranteed an annual income of $5,000. He proposed to do this by limiting private fortunes to $50 million, legacies to $5 million, and annual incomes to $1 million. By 1935 the movement had 27,000 local clubs with 7.7 million members.

2.     The Long Beach physician Francis E. Townsend started the Townsend Movement. Long Beach in California was considered the “geriatric capital” of the United States at the time with over a third of its residents being elderly. After finding himself unemployed at age 67 with no savings and no prospects, Townsend proposed that the government should provide a pension of $200 per month to every citizen age 60 and older. The pensions would be funded by a 2% national sales tax. By 1933 there were 7,000 Townsend Clubs around the country with more than 2.2 million members.

3.     Fire & Brimstone movement takes its name from a radio preacher Father Charles E. Coughlin who rallied against the Social Security act as he did against FDR, international bankers, communists, and labor unions. In 1936, Coughlin, along with Townsend and the remnants of Huey Long's Share the Wealth Movement, would join to form a third party to contest the presidential election in the hopes of preventing President Roosevelt from being re-elected. They failed, but the preacher had some 35-40 million listeners.

4.     Upton Sinclair, a Californian novelist and social crusader, drafted a program called End Poverty in California (EPIC). In a 12-point program there was a proposal to give $50 a month pensions to all needy persons over 60 who had lived in California for at least three years. Using EPIC as his mandate, Sinclair was the Democratic nominee for governor in the election of 1934 that he lost.

5.     By 1938 there were approximately eighty different old-age welfare schemes competing for political support in California. The culmination of these different economic propositions was the Ham & Eggs movement. Named in response to a flippant put-down that this movement was for a common meal—Ham & Eggs was started by a radio personality Robert Noble. Based on the writings of Yale professor Irving Fisher, the movement demanded that the state issue $25 warrants each Monday morning to every unemployed Californian over the age of fifty. With more than 300,000 members with many more supporters it quickly grew into a movement. Although later the organization was co-opted by his two brothers advocating $30 every Thursday morning there remained a resilient support for this social program. Even after the passage of the Social Security Act in 1938 the successful Democratic candidate for governor Culbert Olsen openly supported the plan and an initiative was placed twice (1938 and 1939) on the ballot to adopt the Ham & Eggs plan as California state policy. Both propositions failed.

6.     In Ohio the Bigelow Plan named after Reverend Herbert S. Bigelow proposed a State amendment to guarantee an income of $50 a month ($80 for married couples living together) to those unemployed over sixty years of age. He proposed that funding would come from increased tax on real estate (2% increase on land valued at more than $20,000 an acre), and partly out of an income tax equal to one-fourth the federal income tax paid by individuals and corporations. This plan garnered nearly half a million voters before it was defeated.

All of these movements sometimes competed against the New Deal that FDR was pushing. There remains some resilient misunderstanding of the benefits of the New Deal. Most picture this as a battle between the good and evil, the benevolent against the greedy, the globalist against the small business. We have been here before. The true story is messier then as it is now.

When Kim Phillips-Fein, wrote Invisible Hands: The Businessmen's Crusade Against the New Deal the impression was that the New Deal was somehow transformative for the good. But at the time, the New Deal was anything but positive. Phillips-Fein has shown that unemployment during the New Deal remained high at around 17% (1934-40), and especially among African Americans and especially in the South, the economy was still depressed, federal income taxes were tripled, higher liquor taxes and (new) payroll taxes, high farm foreclosures (mainly African American farmers), and with more than 3,728 Executive Orders, the New Deal has been argued to have delayed recovery. It seems that the Social Security Act kept us lingering longer in depression. Only after the Second World War did the economy and public welfare improved. Despite this background, the 1935 Social Security Act, for the first time, provided a national safety net for older adults and transformed how we think about aging that still reverberates today.

The Social Security Act became a vehicle for social programs. In 1965, with the addition of Medicaid—health care for the poor and disabled—and then Medicare—healthcare for older adults—the social package was complete. Although Social Security is neither exclusively a social program nor an insurance program, so far is has resisted change. Until now.

What will protect and improve these services for older adults is not a reframing exercise, but a swell of civic protests and civic engagement that exposes and shames the architects of policy that will happily sell the future of our children (deficit increase), hit the poorest and most vulnerable members of our society (Medicare recipients) with only a murmur of protest from aging-focused organizations. Without protests to halt the cut to Medicare, no amount of reframing will ever reverse the damage done that will start over the next few months.



© USA Copyrighted 2017 Mario D. Garrett



Resources

Carlie, M. K. (1969). The politics of age: interest group or social movement?. The Gerontologist, 9(4_Part_1), 259-263.

Cushman, B. (1994). Rethinking the New Deal Court. Virginia Law Review, 201-261.

Phillips-Fein, K. (2009). Invisible hands: The making of the conservative movement from the New Deal to Reagan. Yayasan Obor Indonesia.

Driving While Old

In the United States there are more older-adults drivers on the road and as a result many will end-up in hospitals.

In 2015 there were more than 47.8 million licensed drivers ages 65 and older in the United States. The fastest growing driving population. With this increase we are also seeing more accidents. That same year 6,800 older adults were killed—compared to 2,333 teens ages 16–19—and more than 260,000 were treated in emergency departments for motor vehicle crash injuries.

A quick review of the National Institutes on Aging website on older drivers quickly provides a simplistic answer. The website that address older adults and driving includes such enlightened subheadings as: Stiff Joints and Muscles; Trouble Seeing; Trouble Hearing; Dementia; Slower Reaction Time and Reflexes; Medications. It is not surprising therefore to see that fatal crashes, per mile traveled, increases the older the driver is—particularly males. It seems that these physical diminished capacities have direct negative consequences when driving.

Despite this obvious conclusion—that diminished physiology results in more accidents—the evidence is not so clear-cut.

A 2015 report by the Insurance Institute for Highway Safety suggests that such increased fatalities are more likely due to increased susceptibility to injury and medical complications rather than the increased risk of crashing. Older people are more likely to be killed when in an accident. Frail bodies as well as driving older and less safe cars are to blame. There are a lot of older pedestrian deaths as well which does not involve them driving.

Older drivers might have impaired capabilities but they are not all impaired drivers. In fact they are safer than some younger groups. In general older drivers are more likely to use seat belts, tend to drive when conditions are safest and are less likely to drive while under the influence of alcohol. In comparison, teen drivers—at the zenith of their physiological prowess—have a higher rate of fatal crashes, mainly because of their immaturity, lack of skills, and lack of experience. It’s not all about biology.

Teenagers have taught us that driving a car requires more than just physical attributes. Even if we just focus on the most obvious, vision, the results are surprising.

Cynthia Owsley and her colleagues with the Department of Ophthalmology, University of Alabama, found that the best predictor of accidents was not visual acuity but a combination of early visual attention and mental status. Having 3-4 times more accidents (of any type) and 15 times more intersection accidents than those without these problems. Driving, it seems, primarily requires a sense of spatial awareness—knowing what is around you and predicting how objects and people are moving. This perceptual capacity is known as the “useful field of view”—the area from which you can take in information with a single glance.

The psychologist Karlene Ball and her colleagues with Western Kentucky University, reported that older adults with substantial shrinkage in the useful field of view were six times more likely to have a crash. What was surprising was that when compared with eye health, visual sensory function, cognitive status, and age—although these all correlated with crashes—they were poorer in predicting crash-prone older drivers. Our perception and how we can predict the immediate environment is more important than having excellent vision.

Our useful field of view narrows with age. We take in less of the visual field in front of us resulting in greater susceptibility for accidents. This is not a negative, although it has negative consequences. This is a result of years of excellent driving and training our brain that now we do not need to concern ourselves with peripheral events. We are such good drivers. As a result our peripheral view has become unimportant, and we have erroneously eliminated that aspect of driving at a time when it becomes important because we have started losing other sensory sharpness.

But luckily there are ways to enhance our perception. There are great computer-based tools for improving useful field of view and to retrain our brain to drive safer. As a result of training, these studies have shown that drivers make a third less fewer dangerous driving maneuvers, can stop sooner when they have to and feel greater mastery of driving in difficult conditions—such as at night, in bad weather, or in new places. All of which translates to a reduction in at-fault crash risk by nearly half. This is all good news that will ensure that older drivers can keep their license longer, and more importantly drive safer, despite having diminished physiological capacities.


© USA Copyrighted 2017 Mario D. Garrett 

References

Ball, K. K., Roenker, D. L., Wadley, V. G., Edwards, J. D., Roth, D. L., McGwin, G., ... & Dube, T. (2006). Can High‐Risk Older Drivers Be Identified Through Performance‐Based Measures in a Department of Motor Vehicles Setting?. Journal of the American Geriatrics Society, 54(1), 77-84.

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Atlanta, GA: CDC; 2017 [cited 2017 Nov 29]. Available from URL: https://www.cdc.gov/injury/wisqars/index.html

Insurance Institute for Highway Safety (IIHS). Fatality facts 2015, Older people. Arlington (VA): IIHS; November 2016. [cited 2016 Dec 21]. Available from URL: http://www.iihs.org/iihs/topics/t/older-drivers/fatalityfacts/older-people/2015

Owsley, C., Ball, K., Sloane, M. E., Roenker, D. L., & Bruni, J. R. (1991). Visual/cognitive correlates of vehicle accidents in older drivers. Psychology and aging, 6(3), 403.

-->