Big ideas.
Once a week.
Subscribe to our weekly newsletter.
Are We Missing the Most Important Aspect of Health Care?
Physician Danielle Ofri argues that honest conversation is the most powerful mechanism for healing.

Danielle Ofri was confused the first time she heard the term ‘expired.’ The first-year medical student envisioned her family’s shabby air mattress used for camping trips in the Catskill Mountains. The revelation took a moment.
Now a veteran physician at New York’s Bellevue hospital, Ofri laughs at her earlier ignorance. Language, and more importantly communication, is at the center of her new book, What Patients Say, What Doctors Hear (Beacon Press). How doctors and patients interact plays a greater role in medicine than we might believe.
As the medical industry strives for a virtual world in which diagnoses are made and prescriptions rendered on a smartphone app, Ofri argues that successful conversation is the primary driver of healing. Sadly dialectics remain a longstanding elephant in the office: doctors enter with opinions, patients their own, the ticking clock on the wall in plain view of both parties.
This creates resentment in the patient, who, as it turns out, is interrupted by the doctor within twelve seconds on an average visit. Likewise the physician quickly grows impatient due to noncompliance: 50-75 percent of subjects do not adhere to physician advice. A vicious cycle commences in which neither side feels heard. Healing becomes difficult when anxiety rests at the foundation of this relationship.
This particular exchange is often fraught with problems from the beginning. A perpetual fear of litigation on one side and long wait times and snap judgments on the other create an insurmountable gulf. Marriage counselors recognize that by the time a couple seeks guidance it’s often too late. No comparable therapy exists for a patient that wants to break up with their doctor (or vice-versa).
Yet this mysterious distance is avoidable. Ofri writes that talking through emotional challenges alleviates tension for both parties. When physicians avoid the psychological and emotional aspects of illness the risk of nonadherence to medications triples. Factor in particularly stressful situations—unemployment, housing issues, romantic quandaries—and that risk is six-fold higher.
An inability to quantify conversation seems embedded in a system in which blood pressure and cholesterol levels are promptly displayed. But it’s not. One Canadian study showed that electrical stimulation for back problems resulted in a 45 percent reduction in pain. The other group received a sham treatment but talked extensively with their therapist. The result was 55 percent pain reduction.
It comes down to time. Doctors get caught on clinical hamster wheels; patients demand prompt answers to complex problems. Ofri believes this is mitigated when both parties take a deep breath. As she writes, “effective communication needn’t take an unconscionably long time; it just needs full and intense focus.”
Ofri’s narrative is not factual alone. Her personal experiences of bias, uncertainty, fear, and confusion are woven into the fabric of this challenging tale. She openly discusses her unconscious intolerance of obesity, avoidance of junkies, ethnic favoritism, the sheer emotional and cognitive magnitude of dealing with death and suffering on a daily basis. In the process she humanizes her profession, an essential step in reversing favoritism and bigotry in hospitals and clinics.
Delivering a death sentence, Ofri promises, does not become easier with practice. She’s broken down in tears on more than one occasion regardless of how together she tries to remain. She’s misread charts on long shifts and missed clear signs of domestic abuse. For an entire year she never realized one particularly challenging patient who never took the proper medication was illiterate.
Yet she argues that you can’t be a good doctor with a lousy bedside manner. Empathy matters. Spending six figures on an education makes some feel mighty, though research knocks such an attitude down. A study conducted at Waterbury Hospital in Connecticut revealed that while 73 percent of patients knew they had one primary care doctor during their visit, only 18 percent could name them. Incredibly, two-thirds of doctors believed their patients knew their name.
What if expectations shift? One of the most illuminating aspects of Ofri’s book is that expectations can be as influential as medication. The placebo effect works on such a premise. What we believe about a drug or doctor can actually block the biological effect of a pharmaceutical. This knowledge potentially shifts the patient-doctor relationship—so long as both parties recognize and act as if they’re in a relationship.
Which of course requires empathy. Ofri’s most potent revelation resides in its simplicity: the patient is not the same as the illness. In one racially-motivated study nurses offered less pain medication to African Americans than to white patients when instructed to use their best clinical judgment. When told to envision how pain affected their patients’ lives, dosages were more judicial. When they imagined feeling their suffering nurses complied with the Golden Rule.
My watch is currently telling me to take a minute to breath. Soon it might send my vitals to the team at UCLA, which would then text me should they notice worrisome discrepancies. A refill, diagnosis, even a kind word about my day might follow. Yet it could never replace the pantomimes and personality of a real human being. As Ofri argues in her insightful book, this remains the most important aspect of medicine.
--
Derek's next book, Whole Motion: Training Your Brain and Body For Optimal Health, will be published on 7/4/17 by Carrel/Skyhorse Publishing. He is based in Los Angeles. Stay in touch on Facebook and Twitter.
U.S. Navy controls inventions that claim to change "fabric of reality"
Inventions with revolutionary potential made by a mysterious aerospace engineer for the U.S. Navy come to light.
U.S. Navy ships
- U.S. Navy holds patents for enigmatic inventions by aerospace engineer Dr. Salvatore Pais.
- Pais came up with technology that can "engineer" reality, devising an ultrafast craft, a fusion reactor, and more.
- While mostly theoretical at this point, the inventions could transform energy, space, and military sectors.
The U.S. Navy controls patents for some futuristic and outlandish technologies, some of which, dubbed "the UFO patents," came to life recently. Of particular note are inventions by the somewhat mysterious Dr. Salvatore Cezar Pais, whose tech claims to be able to "engineer reality." His slate of highly-ambitious, borderline sci-fi designs meant for use by the U.S. government range from gravitational wave generators and compact fusion reactors to next-gen hybrid aerospace-underwater crafts with revolutionary propulsion systems, and beyond.
Of course, the existence of patents does not mean these technologies have actually been created, but there is evidence that some demonstrations of operability have been successfully carried out. As investigated and reported by The War Zone, a possible reason why some of the patents may have been taken on by the Navy is that the Chinese military may also be developing similar advanced gadgets.
Among Dr. Pais's patents are designs, approved in 2018, for an aerospace-underwater craft of incredible speed and maneuverability. This cone-shaped vehicle can potentially fly just as well anywhere it may be, whether air, water or space, without leaving any heat signatures. It can achieve this by creating a quantum vacuum around itself with a very dense polarized energy field. This vacuum would allow it to repel any molecule the craft comes in contact with, no matter the medium. Manipulating "quantum field fluctuations in the local vacuum energy state," would help reduce the craft's inertia. The polarized vacuum would dramatically decrease any elemental resistance and lead to "extreme speeds," claims the paper.
Not only that, if the vacuum-creating technology can be engineered, we'd also be able to "engineer the fabric of our reality at the most fundamental level," states the patent. This would lead to major advancements in aerospace propulsion and generating power. Not to mention other reality-changing outcomes that come to mind.
Among Pais's other patents are inventions that stem from similar thinking, outlining pieces of technology necessary to make his creations come to fruition. His paper presented in 2019, titled "Room Temperature Superconducting System for Use on a Hybrid Aerospace Undersea Craft," proposes a system that can achieve superconductivity at room temperatures. This would become "a highly disruptive technology, capable of a total paradigm change in Science and Technology," conveys Pais.
High frequency gravitational wave generator.
Credit: Dr. Salvatore Pais
Another invention devised by Pais is an electromagnetic field generator that could generate "an impenetrable defensive shield to sea and land as well as space-based military and civilian assets." This shield could protect from threats like anti-ship ballistic missiles, cruise missiles that evade radar, coronal mass ejections, military satellites, and even asteroids.
Dr. Pais's ideas center around the phenomenon he dubbed "The Pais Effect". He referred to it in his writings as the "controlled motion of electrically charged matter (from solid to plasma) via accelerated spin and/or accelerated vibration under rapid (yet smooth) acceleration-deceleration-acceleration transients." In less jargon-heavy terms, Pais claims to have figured out how to spin electromagnetic fields in order to contain a fusion reaction – an accomplishment that would lead to a tremendous change in power consumption and an abundance of energy.
According to his bio in a recently published paper on a new Plasma Compression Fusion Device, which could transform energy production, Dr. Pais is a mechanical and aerospace engineer working at the Naval Air Warfare Center Aircraft Division (NAWCAD), which is headquartered in Patuxent River, Maryland. Holding a Ph.D. from Case Western Reserve University in Cleveland, Ohio, Pais was a NASA Research Fellow and worked with Northrop Grumman Aerospace Systems. His current Department of Defense work involves his "advanced knowledge of theory, analysis, and modern experimental and computational methods in aerodynamics, along with an understanding of air-vehicle and missile design, especially in the domain of hypersonic power plant and vehicle design." He also has expert knowledge of electrooptics, emerging quantum technologies (laser power generation in particular), high-energy electromagnetic field generation, and the "breakthrough field of room temperature superconductivity, as related to advanced field propulsion."
Suffice it to say, with such a list of research credentials that would make Nikola Tesla proud, Dr. Pais seems well-positioned to carry out groundbreaking work.
A craft using an inertial mass reduction device.
Credit: Salvatore Pais
The patents won't necessarily lead to these technologies ever seeing the light of day. The research has its share of detractors and nonbelievers among other scientists, who think the amount of energy required for the fields described by Pais and his ideas on electromagnetic propulsions are well beyond the scope of current tech and are nearly impossible. Yet investigators at The War Zone found comments from Navy officials that indicate the inventions are being looked at seriously enough, and some tests are taking place.
If you'd like to read through Pais's patents yourself, check them out here.
Laser Augmented Turbojet Propulsion System
Credit: Dr. Salvatore Pais
Do you worry too much? Stoicism can help
How imagining the worst case scenario can help calm anxiety.
Stoicism can help overcome anxiety
- Stoicism is the philosophy that nothing about the world is good or bad in itself, and that we have control over both our judgments and our reactions to things.
- It is hardest to control our reactions to the things that come unexpectedly.
- By meditating every day on the "worst case scenario," we can take the sting out of the worst that life can throw our way.
Are you a worrier? Do you imagine nightmare scenarios and then get worked up and anxious about them? Does your mind get caught in a horrible spiral of catastrophizing over even the smallest of things? Worrying, particularly imagining the worst case scenario, seems to be a natural part of being human and comes easily to a lot of us. It's awful, perhaps even dangerous, when we do it.
But, there might just be an ancient wisdom that can help. It involves reframing this attitude for the better, and it comes from Stoicism. It's called "premeditation," and it could be the most useful trick we can learn.
Practical Stoicism
Broadly speaking, Stoicism is the philosophy of choosing your judgments. Stoics believe that there is nothing about the universe that can be called good or bad, valuable or valueless, in itself. It's we who add these values to things. As Shakespeare's Hamlet says, "There is nothing either good or bad, but thinking makes it so." Our minds color the things we encounter as being "good" or "bad," and given that we control our minds, we therefore have control over all of our negative feelings.
Put another way, Stoicism maintains that there's a gap between our experience of an event and our judgment of it. For instance, if someone calls you a smelly goat, you have an opportunity, however small and hard it might be, to pause and ask yourself, "How will I judge this?" What's more, you can even ask, "How will I respond?" We have power over which thoughts we entertain and the final say on our actions. Today, Stoicism has influenced and finds modern expression in the hugely effective "cognitive behavioral therapy."
Helping you practice StoicismCredit: Robyn Beck via Getty Images
One of the principal fathers of ancient Stoicism was the Roman statesmen, Seneca, who argued that the unexpected and unforeseen blows of life are the hardest to take control over. The shock of a misfortune can strip away the power we have to choose our reaction. For instance, being burglarized feels so horrible because we had felt so safe at home. A stomach ache, out of the blue, is harder than a stitch thirty minutes into a run. A sudden bang makes us jump, but a firework makes us smile. Fell swoops hurt more than known hardships.
What could possibly go wrong?
So, how can we resolve this? Seneca suggests a Stoic technique called "premeditatio malorum" or "premeditation." At the start of every day, we ought to take time to indulge our anxious and catastrophizing mind. We should "rehearse in the mind: exile, torture, war, shipwreck." We should meditate on the worst things that could happen: your partner will leave you, your boss will fire you, your house will burn down. Maybe, even, you'll die.
This might sound depressing, but the important thing is that we do not stop there.
Stoicism has influenced and finds modern expression in the hugely effective "cognitive behavioral therapy."
The Stoic also rehearses how they will react to these things as they come up. For instance, another Stoic (and Roman Emperor) Marcus Aurelius asks us to imagine all the mean, rude, selfish, and boorish people we'll come across today. Then, in our heads, we script how we'll respond when we meet them. We can shrug off their meanness, smile at their rudeness, and refuse to be "implicated in what is degrading." Thus prepared, we take control again of our reactions and behavior.
The Stoics cast themselves into the darkest and most desperate of conditions but then realize that they can and will endure. With premeditation, the Stoic is prepared and has the mental vigor necessary to take the blow on the chin and say, "Yep, l can deal with this."
Catastrophizing as a method of mental inoculation
Seneca wrote: "In times of peace, the soldier carries out maneuvers." This is also true of premeditation, which acts as the war room or training ground. The agonizing cut of the unexpected is blunted by preparedness. We can prepare the mind for whatever trials may come, in just the same way we can prepare the body for some endurance activity. The world can throw nothing as bad as that which our minds have already imagined.
Stoicism teaches us to embrace our worrying mind but to embrace it as a kind of inoculation. With a frown over breakfast, try to spend five minutes of your day deliberately catastrophizing. Get your anti-anxiety battle plan ready and then face the world.
Jonny Thomson teaches philosophy in Oxford. He runs a popular Instagram account called Mini Philosophy (@philosophyminis). His first book is Mini Philosophy: A Small Book of Big Ideas.
Study: People will donate more to charity if they think something’s in it for them
A study on charity finds that reminding people how nice it feels to give yields better results than appealing to altruism.
How to get people to want to give you money, literal balls of cash not gaurenteed.
- A study finds asking for donations by appealing to the donor's self-interest may result in more money than appealing to their better nature.
- Those who received an appeal to self-interest were both more likely to give and gave more than those in the control group.
- The effect was most pronounced for those who hadn't given before.
Even the best charities with the longest records of doing great fundraising work have to spend some time making sure that the next donation checks will keep coming in. One way to do this is by showing potential donors all the good things the charity did over the previous year. But there may be a better way.
A new study by researchers in the United States and Australia suggests that appealing to the benefits people will receive themselves after a donation nudges them to donate more money than appealing to the greater good.
How to get people to give away free money
The postcards that were sent to different study subjects. The one on the left highlighted benefits to the self, while the one on the right highlighted benefits to others.List et al. / Nature Human Behaviour
The study, published in Nature Human Behaviour, utilized the Pick.Click.Give program in Alaska. This program allows Alaska residents who qualify for dividends from the Alaska Permanent Fund, a yearly payment ranging from $800 to $2000 in recent years, to donate a portion of it to various in-state non-profit organizations.
The researchers randomly assigned households to either a control group or to receive a postcard in the mail encouraging them to donate a portion of their dividend to charity. That postcard could come in one of two forms, either highlighting the benefits to others or the benefits to themselves.
Those who got the postcard touting self-benefits were 6.6 percent more likely to give than those in the control group and gave 23 percent more on average. Those getting the benefits-to-others postcard were slightly more likely to give than those receiving no postcard, but their donations were no larger.
Additionally, the researchers were able to break the subject list down into a "warm list" of those who had given at least once before in the last two years and a "cold list" of those who had not. Those on the warm list, who were already giving, saw only minor increases in their likelihood to donate after getting a postcard in the mail compared to those on the cold list.
Additionally, the researchers found that warm-list subjects who received the self-interest postcard gave 11 percent more than warm-list subjects in the control group. Amazingly, among cold-list subjects, those who received a self-interest postcard gave 39 percent more.
These are substantial improvements. At the end of the study, the authors point out, "If we had sent the benefits to self message to all households in the state, aggregate contributions would have increased by nearly US$600,000."
To put this into perspective, in 2017 the total donations to the program were roughly $2,700,000.
Is altruism dead?
Are all actions inherently self-interested? Thankfully, no. The study focuses entirely on effective ways to increase charitable donations above levels that currently exist. It doesn't deny that some people are giving out of pure altruism, but rather that an appeal based on self-interest is effective. Plenty of people were giving before this study took place who didn't need a postcard as encouragement. It is also possible that some people donated part of their dividend check to a charity that does not work with Pick.Click.Give and were uncounted here.
It is also important to note that Pick.Click.Give does not provide services but instead gives money to a wide variety of organizations that do. Those organizations operate in fields from animal rescue to job training to public broadcasting. The authors note that it is possible that a more specific appeal to the benefits others will receive from a donation might prove more effective than the generic and all-inclusive "Make Alaska Better For Everyone" appeal that they used.
In an ideal world, charity is its own reward. In ours, it might help to remind somebody how warm and fuzzy they'll feel after donating to your cause.
160-million-year-old ‘Monkeydactyl’ was the first animal to develop opposable thumbs
The 'Monkeydactyl' was a flying reptile that evolved highly specialized adaptations in the Mesozoic Era.
