Tuesday, May 22, 2007

This Is Your Life (and How You Tell It)

Art by: Otto Steininger
Source: New York Times May 22th, 2007
Author: Benedict Carey


For more than a century, researchers have been trying to work out the raw ingredients that account for personality, the sweetness and neuroses that make Anna Anna, the sluggishness and sensitivity that make Andrew Andrew. They have largely ignored the first-person explanation — the life story that people themselves tell about who they are, and why.

Stories are stories, after all. The attractive stranger at the airport bar hears one version, the parole officer another, and the P.T.A. board gets something entirely different. Moreover, the tone, the lessons, even the facts in a life story can all shift in the changing light of a person’s mood, its major notes turning minor, its depths appearing shallow.

Yet in the past decade or so a handful of psychologists have argued that the quicksilver elements of personal narrative belong in any three-dimensional picture of personality. And a burst of new findings are now helping them make the case. Generous, civic-minded adults from diverse backgrounds tell life stories with very similar and telling features, studies find; so likewise do people who have overcome mental distress through psychotherapy.

Every American may be working on a screenplay, but we are also continually updating a treatment of our own life — and the way in which we visualize each scene not only shapes how we think about ourselves, but how we behave, new studies find. By better understanding how life stories are built, this work suggests, people may be able to alter their own narrative, in small ways and perhaps large ones.

“When we first started studying life stories, people thought it was just idle curiosity — stories, isn’t that cool?” said Dan P. McAdams, a professor of psychology at Northwestern and author of the 2006 book, “The Redemptive Self.” “Well, we find that these narratives guide behavior in every moment, and frame not only how we see the past but how we see ourselves in the future.”

Researchers have found that the human brain has a natural affinity for narrative construction. People tend to remember facts more accurately if they encounter them in a story rather than in a list, studies find; and they rate legal arguments as more convincing when built into narrative tales rather than on legal precedent.

YouTube routines notwithstanding, most people do not begin to see themselves in the midst of a tale with a beginning, middle and eventual end until they are teenagers. “Younger kids see themselves in terms of broad, stable traits: ‘I like baseball but not soccer,’ ” said Kate McLean, a psychologist at the University of Toronto in Mississauga. “This meaning-making capability — to talk about growth, to explain what something says about who I am — develops across adolescence.”

Psychologists know what life stories look like when they are fully hatched, at least for some Americans. Over the years, Dr. McAdams and others have interviewed hundreds of men and women, most in their 30s and older.

During a standard life-story interview, people describe phases of their lives as if they were outlining chapters, from the sandlot years through adolescence and middle age. They also describe several crucial scenes in detail, including high points (the graduation speech, complete with verbal drum roll); low points (the college nervous breakdown, complete with the list of witnesses); and turning points. The entire two-hour session is recorded and transcribed.

In analyzing the texts, the researchers found strong correlations between the content of people’s current lives and the stories they tell. Those with mood problems have many good memories, but these scenes are usually tainted by some dark detail. The pride of college graduation is spoiled when a friend makes a cutting remark. The wedding party was wonderful until the best man collapsed from drink. A note of disappointment seems to close each narrative phrase.

By contrast, so-called generative adults — those who score highly on tests measuring civic-mindedness, and who are likely to be energetic and involved — tend to see many of the events in their life in the reverse order, as linked by themes of redemption. They flunked sixth grade but met a wonderful counselor and made honor roll in seventh. They were laid low by divorce, only to meet a wonderful new partner. Often, too, they say they felt singled out from very early in life — protected, even as others nearby suffered.

In broad outline, the researchers report, such tales express distinctly American cultural narratives, of emancipation or atonement, of Horatio Alger advancement, of epiphany and second chances. Depending on the person, the story itself might be nuanced or simplistic, powerfully dramatic or cloyingly pious. But the point is that the narrative themes are, as much as any other trait, driving factors in people’s behavior, the researchers say.

“We find that when it comes to the big choices people make — should I marry this person? should I take this job? should I move across the country? — they draw on these stories implicitly, whether they know they are working from them or not,” Dr. McAdams said.

Any life story is by definition a retrospective reconstruction, at least in part an outgrowth of native temperament. Yet the research so far suggests that people’s life stories are neither rigid nor wildly variable, but rather change gradually over time, in close tandem with meaningful life events.

Jonathan Adler, a researcher at Northwestern, has found that people’s accounts of their experiences in psychotherapy provide clues about the nature of their recovery. In a recent study presented at the annual meeting of the Society for Personality and Social Psychology in January, Mr. Adler reported on 180 adults from the Chicago area who had recently completed a course of talk therapy. They sought treatment for things like depression, anxiety, marital problems and fear of flying, and spent months to years in therapy.

At some level, talk therapy has always been an exercise in replaying and reinterpreting each person’s unique life story. Yet Mr. Adler found that in fact those former patients who scored highest on measures of well-being — who had recovered, by standard measures — told very similar tales about their experiences.

They described their problem, whether depression or an eating disorder, as coming on suddenly, as if out of nowhere. They characterized their difficulty as if it were an outside enemy, often giving it a name (the black dog, the walk of shame). And eventually they conquered it.

“The story is one of victorious battle: ‘I ended therapy because I could overcome this on my own,’ ” Mr. Adler said. Those in the study who scored lower on measures of psychological well-being were more likely to see their moods and behavior problems as a part of their own character, rather than as a villain to be defeated. To them, therapy was part of a continuing adaptation, not a decisive battle.

The findings suggest that psychotherapy, when it is effective, gives people who are feeling helpless a sense of their own power, in effect altering their life story even as they work to disarm their own demons, Mr. Adler said.

Mental resilience relies in part on exactly this kind of autobiographical storytelling, moment to moment, when navigating life’s stings and sorrows. To better understand how stories are built in real time, researchers have recently studied how people recall vivid scenes from recent memory. They find that one important factor is the perspective people take when they revisit the scene — whether in the first person, or in the third person, as if they were watching themselves in a movie.

In a 2005 study reported in the journal Psychological Science, researchers at Columbia University measured how student participants reacted to a bad memory, whether an argument or failed exam, when it was recalled in the third person. They tested levels of conscious and unconscious hostility after the recollections, using both standard questionnaires and students’ essays. The investigators found that the third-person scenes were significantly less upsetting, compared with bad memories recalled in the first person.

“What our experiment showed is that this shift in perspective, having this distance from yourself, allows you to relive the experience and focus on why you’re feeling upset,” instead of being immersed in it, said Ethan Kross, the study’s lead author. The emotional content of the memory is still felt, he said, but its sting is blunted as the brain frames its meaning, as it builds the story.

Taken together, these findings suggest a kind of give and take between life stories and individual memories, between the larger screenplay and the individual scenes. The way people replay and recast memories, day by day, deepens and reshapes their larger life story. And as it evolves, that larger story in turn colors the interpretation of the scenes.

Nic Weststrate, 23, a student living in Toronto, said he was able to reinterpret many of his most painful memories with more compassion after having come out as a gay man. He was very hard on himself, for instance, when at age 20 he misjudged a relationship with a friend who turned out to be straight.

He now sees the end of that relationship as both a painful lesson and part of a larger narrative. “I really had no meaningful story for my life then,” he said, “and I think if I had been open about being gay I might not have put myself in that position, and he probably wouldn’t have either.”

After coming out, he said: “I saw that there were other possibilities. I would be presenting myself openly to a gay audience, and just having a coherent story about who I am made a big difference. It affects how you see the past, but it also really affects your future.”

Psychologists have shown just how interpretations of memories can alter future behavior. In an experiment published in 2005, researchers had college students who described themselves as socially awkward in high school recall one of their most embarrassing moments. Half of the students reimagined the humiliation in the first person, and the other half pictured it in the third person.

Two clear differences emerged. Those who replayed the scene in the third person rated themselves as having changed significantly since high school — much more so than the first-person group did. The third-person perspective allowed people to reflect on the meaning of their social miscues, the authors suggest, and thus to perceive more psychological growth.

And their behavior changed, too. After completing the psychological questionnaires, each study participant spent time in a waiting room with another student, someone the research subject thought was taking part in the study. In fact the person was working for the research team, and secretly recorded the conversation between the pair, if any. This double agent had no idea which study participants had just relived a high school horror, and which had viewed theirs as a movie scene.

The recordings showed that members of the third-person group were much more sociable than the others. “They were more likely to initiate a conversation, after having perceived themselves as more changed,” said Lisa Libby, the lead author and a psychologist at Ohio State University. She added, “We think that feeling you have changed frees you up to behave as if you have; you think, ‘Wow, I’ve really made some progress’ and it gives you some real momentum.”

Dr. Libby and others have found that projecting future actions in the third person may also affect what people later do, as well. In another study, students who pictured themselves voting for president in the 2004 election, from a third-person perspective, were more likely to actually go to the polls than those imagining themselves casting votes in the first person.

The implications of these results for self-improvement, whether sticking to a diet or finishing a degree or a novel, are still unknown. Likewise, experts say, it is unclear whether such scene-making is more functional for some people, and some memories, than for others. And no one yet knows how fundamental personality factors, like neuroticism or extraversion, shape the content of life stories or their component scenes.

But the new research is giving narrative psychologists something they did not have before: a coherent story to tell. Seeing oneself as acting in a movie or a play is not merely fantasy or indulgence; it is fundamental to how people work out who it is they are, and may become.

“The idea that whoever appeared onstage would play not me but a character was central to imagining how to make the narrative: I would need to see myself from outside,” the writer Joan Didion has said of “The Year of Magical Thinking,” her autobiographical play about mourning the death of her husband and her daughter. “I would need to locate the dissonance between the person I thought I was and the person other people saw.”

Saturday, May 19, 2007

Saturday, May 12, 2007

Tuesday, May 8, 2007

Genes Take Charge, and Diets Fall by the Wayside

Jules Hirsch, a research physician at Rockefeller University, conducted a simple but groundbreaking experiment on obesity nearly 50 years ago, changing the way scientists think about fat.

Photo by: Fred R. Conrad for the New York Times
Source: New York Times May 8th, 2007
Author: Gina Kolata


It was 1959. Jules Hirsch, a research physician at Rockefeller University, had gotten curious about weight loss in the obese. He was about to start a simple experiment that would change forever the way scientists think about fat.

Obese people, he knew, had huge fat cells, stuffed with glistening yellow fat. What happened to those cells when people lost weight, he wondered. Did they shrink or did they go away? He decided to find out.

It seemed straightforward. Dr. Hirsch found eight people who had been fat since childhood or adolescence and who agreed to live at the Rockefeller University Hospital for eight months while scientists would control their diets, make them lose weight and then examine their fat cells.

The study was rigorous and demanding. It began with an agonizing four weeks of a maintenance diet that assessed the subjects’ metabolism and caloric needs. Then the diet began. The only food permitted was a liquid formula providing 600 calories a day, a regimen that guaranteed they would lose weight. Finally, the subjects spent another four weeks on a diet that maintained them at their new weights, 100 pounds lower than their initial weights, on average.

Dr. Hirsch answered his original question — the subjects’ fat cells had shrunk and were now normal in size. And everyone, including Dr. Hirsch, assumed that the subjects would leave the hospital permanently thinner.

That did not happen. Instead, Dr. Hirsch says, “they all regained.” He was horrified. The study subjects certainly wanted to be thin, so what went wrong? Maybe, he thought, they had some deep-seated psychological need to be fat.

So Dr. Hirsch and his colleagues, including Dr. Rudolph L. Leibel, who is now at Columbia University, repeated the experiment and repeated it again. Every time the result was the same. The weight, so painstakingly lost, came right back. But since this was a research study, the investigators were also measuring metabolic changes, psychiatric conditions, body temperature and pulse. And that led them to a surprising conclusion: fat people who lost large amounts of weight might look like someone who was never fat, but they were very different. In fact, by every metabolic measurement, they seemed like people who were starving.

Before the diet began, the fat subjects’ metabolism was normal — the number of calories burned per square meter of body surface was no different from that of people who had never been fat. But when they lost weight, they were burning as much as 24 percent fewer calories per square meter of their surface area than the calories consumed by those who were naturally thin.

The Rockefeller subjects also had a psychiatric syndrome, called semi-starvation neurosis, which had been noticed before in people of normal weight who had been starved. They dreamed of food, they fantasized about food or about breaking their diet. They were anxious and depressed; some had thoughts of suicide. They secreted food in their rooms. And they binged.

The Rockefeller researchers explained their observations in one of their papers: “It is entirely possible that weight reduction, instead of resulting in a normal state for obese patients, results in an abnormal state resembling that of starved nonobese individuals.”

Eventually, more than 50 people lived at the hospital and lost weight, and every one had physical and psychological signs of starvation. There were a very few who did not get fat again, but they made staying thin their life’s work, becoming Weight Watchers lecturers, for example, and, always, counting calories and maintaining themselves in a permanent state of starvation.

“Did those who stayed thin simply have more willpower?” Dr. Hirsch asked. “In a funny way, they did.”

One way to interpret Dr. Hirsch and Dr. Leibel’s studies would be to propose that once a person got fat, the body would adjust, making it hopeless to lose weight and keep it off. The issue was important, because if getting fat was the problem, there might be a solution to the obesity epidemic: convince people that any weight gain was a step toward an irreversible condition that they most definitely did not want to have.

But another group of studies showed that that hypothesis, too, was wrong.

It began with studies that were the inspiration of Dr. Ethan Sims at the University of Vermont, who asked what would happen if thin people who had never had a weight problem deliberately got fat.

His subjects were prisoners at a nearby state prison who volunteered to gain weight. With great difficulty, they succeeded, increasing their weight by 20 percent to 25 percent. But it took them four to six months, eating as much as they could every day. Some consumed 10,000 calories a day, an amount so incredible that it would be hard to believe, were it not for the fact that there were attendants present at each meal who dutifully recorded everything the men ate.

Once the men were fat, their metabolisms increased by 50 percent. They needed more than 2,700 calories per square meter of their body surface to stay fat but needed just 1,800 calories per square meter to maintain their normal weight.

When the study ended, the prisoners had no trouble losing weight. Within months, they were back to normal and effortlessly stayed there.

The implications were clear. There is a reason that fat people cannot stay thin after they diet and that thin people cannot stay fat when they force themselves to gain weight. The body’s metabolism speeds up or slows down to keep weight within a narrow range. Gain weight and the metabolism can as much as double; lose weight and it can slow to half its original speed.

That, of course, was contrary to what every scientist had thought, and Dr. Sims knew it, as did Dr. Hirsch.

The message never really got out to the nation’s dieters, but a few research scientists were intrigued and asked the next question about body weight: Is body weight inherited, or is obesity more of an inadvertent, almost unconscious response to a society where food is cheap, abundant and tempting? An extra 100 calories a day will pile on 10 pounds in a year, public health messages often say. In five years, that is 50 pounds.

The assumption was that environment determined weight, but Dr. Albert Stunkard of the University of Pennsylvania wondered if that was true and, if so, to what extent. It was the early 1980s, long before obesity became what one social scientist called a moral panic, but a time when those questions of nature versus nurture were very much on Dr. Stunkard’s mind.

He found the perfect tool for investigating the nature-nurture question — a Danish registry of adoptees developed to understand whether schizophrenia was inherited. It included meticulous medical records of every Danish adoption between 1927 and 1947, including the names of the adoptees’ biological parents, and the heights and weights of the adoptees, their biological parents and their adoptive parents.

Dr. Stunkard ended up with 540 adults whose average age was 40. They had been adopted when they were very young — 55 percent had been adopted in the first month of life and 90 percent were adopted in the first year of life. His conclusions, published in The New England Journal of Medicine in 1986, were unequivocal. The adoptees were as fat as their biological parents, and how fat they were had no relation to how fat their adoptive parents were.

The scientists summarized it in their paper: “The two major findings of this study were that there was a clear relation between the body-mass index of biologic parents and the weight class of adoptees, suggesting that genetic influences are important determinants of body fatness; and that there was no relation between the body-mass index of adoptive parents and the weight class of adoptees, suggesting that childhood family environment alone has little or no effect.”

In other words, being fat was an inherited condition.

Dr. Stunkard also pointed out the implications: “Current efforts to prevent obesity are directed toward all children (and their parents) almost indiscriminately. Yet if family environment alone has no role in obesity, efforts now directed toward persons with little genetic risk of the disorder could be refocused on the smaller number who are more vulnerable. Such persons can already be identified with some assurance: 80 percent of the offspring of two obese parents become obese, as compared with no more than 14 percent of the offspring of two parents of normal weight.”

A few years later, in 1990, Dr. Stunkard published another study in The New England Journal of Medicine, using another classic method of geneticists: investigating twins. This time, he used the Swedish Twin Registry, studying its 93 pairs of identical twins who were reared apart, 154 pairs of identical twins who were reared together, 218 pairs of fraternal twins who were reared apart, and 208 pairs of fraternal twins who were reared together.

The identical twins had nearly identical body mass indexes, whether they had been reared apart or together. There was more variation in the body mass indexes of the fraternal twins, who, like any siblings, share some, but not all, genes.

The researchers concluded that 70 percent of the variation in peoples’ weights may be accounted for by inheritance, a figure that means that weight is more strongly inherited than nearly any other condition, including mental illness, breast cancer or heart disease.

The results did not mean that people are completely helpless to control their weight, Dr. Stunkard said. But, he said, it did mean that those who tend to be fat will have to constantly battle their genetic inheritance if they want to reach and maintain a significantly lower weight.

The findings also provided evidence for a phenomenon that scientists like Dr. Hirsch and Dr. Leibel were certain was true — each person has a comfortable weight range to which the body gravitates. The range might span 10 or 20 pounds: someone might be able to weigh 120 to 140 pounds without too much effort. Going much above or much below the natural weight range is difficult, however; the body resists by increasing or decreasing the appetite and changing the metabolism to push the weight back to the range it seeks.

The message is so at odds with the popular conception of weight loss — the mantra that all a person has to do is eat less and exercise more — that Dr. Jeffrey Friedman, an obesity researcher at the Rockefeller University, tried to come up with an analogy that would convey what science has found about the powerful biological controls over body weight.

He published it in the journal Science in 2003 and still cites it:

“Those who doubt the power of basic drives, however, might note that although one can hold one’s breath, this conscious act is soon overcome by the compulsion to breathe,” Dr. Friedman wrote. “The feeling of hunger is intense and, if not as potent as the drive to breathe, is probably no less powerful than the drive to drink when one is thirsty. This is the feeling the obese must resist after they have lost a significant amount of weight.”

This is an excerpt from Gina Kolata’s new book, “Rethinking Thin: The New Science of Weight Loss — and the Myths and Realities of Dieting” (Farrar, Straus & Giroux).

Correction: May 12, 2007

An article in Science Times on Tuesday about the role of genes in weight gain misstated the publication date for an article in the journal Science describing the biological controls over body weight. The article was published in 2003, not 2000.

Friday, May 4, 2007

Heart of Hawaii - Kaua'i

Photo by: Cory Lum
Source: New York Times, May 4th, 2007


THE Poomau Ditch Trail hugs a mountainside, and we hiked carefully, looking down at the path so as not to take a false step and fall hundreds of feet to eternity. Gnarly ohia lehua trees lined the side away from the chasm, and abrasive blackberry bushes — not native to Hawaii, but thriving here on Kauai like so many other invasive imports — reached out their scratchy canes. Everything around us was green: mountains, canyons, tree canopy.This was the Kokee Forest, a place of spectacular mountain crags, fertile valleys, treacherous hidden paths — and very few people. I've lived on Kauai for decades, but bird calls coming from the dense tropical woodland were new to me. When I mimicked them, sometimes there was a sonorous response. Off and on, we heard the rush of streams. Other times, there was no sound at all.

The trail switched back three times, leading into dank canyons and out to hot sun, and then emerged on a tip of land that seemed suspended in air over Poomau Canyon. An edge-of-the-seat view spread out before us: confluent valleys and a waterfall with double-dip pools draining from a swamp in what is one of the very wettest spots on Earth — Mount Waialeale, which averages 460 inches of rain a year. White-tailed tropicbirds with two-foot long tails cruised in the gentle wind. We were looking down on them.

Kokee (pronounced ko-KAY) is a Kauai that few tourists imagine — 20 or 30 miles from the white sand beaches that draw 1.2 million visitors a year, but wild and otherworldly, its cool, blossom-drenched inner reaches still reverberating with the ancient heartbeat of the Hawaiian Islands. Much of Kokee — the generalized name for the area including Kokee and Waimea State Parks — lies in Kauai's no-drive zone, the mountainous northwestern quadrant of the island that has few roads and no coastal highway. Even Kauai residents rarely penetrate far into it. When someone returns from a few days there and describes the trip, the neighbors' typical response is a low breath of respect and awe.

Kokee has not only remoteness and exotic beauty, but also a mystique — Kauaians think of it as the island's spiritual center, where natives traditionally went to find renewal and where beleaguered indigenous plants and birds still survive. Jack London, who used Kokee as the setting for “Koolau the Leper,” a grim allegorical tale of capitalism's invasion into Polynesia, described the place with magical atmospherics that still apply — an earthly paradise with “gorges among the jumbled peaks” and “fantastic draperies of tropic vegetation.”

Thomas Kaiakapu, wildlife manager for the Hawaii division of forestry and wildlife, described the significance this way: “All of the islands have a special place where locals go to do the gathering, to hunt pig and perform the hula. Kokee is where Kauaians go.”

Anyone willing to hike challenging trails and sleep in rustic cabins or sturdy tents can get to know Kokee. On a trip there this past winter, my wife, Chie, and I and another couple — all longtime Kauai residents — and a German visitor made it our mission to hike as many trails as possible in five days, while staying in one of the 10 barebones state cabins in Kokee State Park.

We walked amid cathedrals of magnificent koa trees; koa wood is treasured by furniture and musical-instrument makers. We examined weird mosses, huge mushrooms, colorful lantana and feathery ferns, and experienced the sounds of rare birds and the smells of exotic flowers and fragrant earth. We saw spectacular ocean and canyon vistas, and we felt at peace in a place that is both exhausting and totally refreshing.

We were lucky; the weather held out. It can rain for days straight in Kokee at any time of year, and vacationers who commit to going are wise to take along diversions. But the real magic must be experienced in Kokee's 24-hour cycle, from when the sun emerges and warms the cold morning air to the sunset over the forbidden island of Niihau, where only the descendants of the original Hawaiians may go. We kept on the move by day, warmed ourselves in front of the fireplace in the evening, and slept deeply in the chilled mountain air — temperatures can dip into the 30s in the winter months.

Kauai is like an artichoke: you must uncover it layer by layer. Most vacationers who spend at least a few days on the island venture inward from the outermost layer — the coast and its resorts — to the much visited Waimea Canyon and Kalalau lookouts — both can be reached by car on the Kokee Road, and the first two Waimea Canyon lookouts are accessible to tour buses. Weather permitting (that is, if rain and clouds don't intervene), the views from both of these lookouts are awe-inspiring, and the fresh air is perfectly clean and cool.

At the next layer, adventurers hike from the northwestern end of the coast road along an ancient, mountain-hugging Hawaiian trail to the beach and into the Kalalau Valley, where a stream flows until spilling out into the ocean from the sequestered Kalalau Beach. This 11-mile trek has often been featured in outdoor and hiking publications. It weaves in and out of canyons on a switchback trail that traverses the coastal cliffs.

We wanted to go deeper still into the 6,182 acres of Kokee and Waimea parks, with their thundering waterfalls, vast canyons, primeval mesic forest and unique high-altitude Alakai Swamp.

Our cabin was near what functions as downtown Kokee: an ethereal meadow, a quaint museum, a small restaurant (breakfast and lunch only) and two pay phones that provide the only lifeline to the outside world in this cellphone graveyard. We awoke to the screeching of wild chickens, a major element of Kauai wildlife. We hiked by day and returned to the cabin each night.

One memorable trail took us into the Alakai Swamp, a vast, green boglike area with stunted plants and endangered birds in the leeward shadow of Mount Waialeale. In the past, hikers there sometimes found themselves in thigh-deep mud as they slogged toward a magnificent vista of Wainiha Valley and Hanalei Bay, on the other side of the island and 75 miles away by road. Today, a grated-board trail makes walking easier.

The women in our group, Loutoa Zoller and Chie, have both practiced hula and felt a special attraction to the lush forest, where Laka, the Hawaiian goddess of the hula, dwells. The tourist-trade hula, or hula auana, with its smiling dancers and suggestive movements, is a far cry from the traditional hula kahiko, a sacred rite. Jo Manea, a hula dancer for more than 20 years and now an instructor, told us that we would find Kokee “full of Laka.”

“It's where people from all over come to gather the seven sacred plants of hula kahiko,” she said. “We adorn her and ourselves in the plants so we can honor her.”

We felt Laka amid the 40-foot koa trees, now protected by law, and the puffy red ohia lehua blossoms, and heard her along the babbling brooks. She can be inhaled in the fragrance of the maile vines and mokihana berries.

As the oldest of the main islands, Kauai has been etched away by wind and rain to create unique microclimates that are home to a variety of indigenous flora and fauna. For instance, Kokee is home to birds that still live because the mosquitoes bearing avian malaria and other diseases can't exist at its cool elevation. This environment, and dozens of native species of birds, are endangered by feral animals that chew and trample and wallow in the vegetation.

ONLY rarely in our days on Kokee's trails did we meet anyone else in the forest. On our most adventurous hike, deep in the woods, we strolled along a fairy-tale mountainside trail, picking and eating lilikoi (passion fruit), guava and other wild fruits, and were suddenly engulfed by a sea of tail-wagging retrievers. Close behind was Jim Cassel, a local hunter looking for wild pigs — a cross between pigs introduced by the Polynesians centuries ago and the European boar.

Hawaii suffers from many misconceptions on the part of outsiders, one being that it's a wonderful thing that most everything thrives and grows easily there. But the operative word is “everything.” Insects, rodents, invasive plants, molds and fungi have destroyed many of the original plants and birds. Wild goats, introduced in Kauai by Capt. James Vancouver in 1792, eat fragile plants to extinction. So do the blacktail deer first imported from Oregon in 1961.

The pig not only roots and digs, exposing virgin soil to invasive species, but disperses seeds from undesirable plants as it travels. It is this part of the “everything” growing here that must be culled if the native species are to have any chance of survival. The hunters are happy to help, finding the pigs fun to chase and good to eat.

Kokee is absorbed in a give-and-take about the future of the state parks. Locals chafed at early proposals for a 40-to-60-room hotel, a helicopter pad, more parking areas and wider roads to allow large buses. Proposals and public hearings continue.

The future is uncertain, but for now, aside from the damage inflicted by the imported plants and animals, much of Kokee still remains untouched, even occasionally dangerous. Hikers should never go off-trail. Even seasoned hikers have slipped, become lost or fallen through a hole under a fern bed and never been found. We were Kokee veterans, but we still needed constant mapping references and weather assessments.

Yet it was magical. This, we found, was a place to get high on life in some of its richest natural forms — and on the oxygen of unpolluted air in the middle of the Pacific Ocean. This was the domain of Laka.

Walks And Vistas: Using the Car Is Just the Start

KOKEE is accessible by car from the west side of Kauai, via the Kokee Road or the steeper Waimea Canyon Road. “Downtown,” the main visitor area of Kokee State Park, is reached from a driveway at Mile 15 of the Kokee Road. Guides and relevant information on trails and park conditions can be picked up there, at the Lodge at Kokee, which is a small restaurant open daily for breakfast and lunch and a gift shop, or at the rustic Kokee Natural History Museum next door, open daily from 10 a.m. to 4 p.m. More information is available at www.kokee.org.

The museum is an excellent primer for the area. Though small, it presents a number of scientific and natural exhibits, including a three-dimensional map of Kauai, and has a well-stocked book rack.

To rent a cabin (they start at about $95 a night and are best reserved well in advance), contact the Lodge at Kokee (808-335-6061; www.thelodgeatkokee.net). There are also four state campgrounds in Kokee and Waimea State Parks, and some hikers backpack and camp in the woods.

Many trails are best reached by hiking more than one day or by four-wheel-drive vehicles. Visitors who do not have their own trucks or S.U.V.'s will be limited by rental car companies' strictures against taking their vehicles off-road.

Thursday, May 3, 2007

Cervical Cancer

Photo by: Unknown
Source: MSN Health
Author: Anna Chan


Reality CheckWorldwide, cervical cancer is second only to breast cancer as a cancer threat to women.

This year an estimated 493,000 women across the globe will be diagnosed with cervical cancer, and more than half of them will die from the disease, according to the National Cervical Cancer Coalition. In the United States, the American Cancer Society estimates that about 39,000 women will be diagnosed with cervical cancer this year, and roughly 3,700 of them will die from it. The reason for the higher death rate in developing countries is due to limited access to Pap smears, tests that allow for early intervention by detecting precancerous cells in the cervix.

Reality Check
Where there’s cervical cancer, there’s genital HPV—usually.

Millions of women are infected with sexually transmitted human papillomavirus (HPV), which is a group of many viruses, some of which can cause genital warts. Researchers have discovered HPV present in approximately 90 percent of cervical cancer tissues, according to the American Social Health Association. Of the HPV types found in those patients, Types 16 and 18 were the most prevalent. These two high-risk strains don’t cause genital warts and generally don’t display other noticeable symptoms, which can make detection of these virus types trickier. Understand, you can have an infection of high-risk HPV and never develop cervical cancer; however, cervical cancer rarely exists without HPV.

Reality Check

How genital HPV is transmitted.

Of the roughly 150 known strains of HPV, about 25 percent are genital strains, meaning they are transmitted mainly via sexual contact. However, sexual contact that transmits HPV is not limited to only penetrative sex. Since HPV infects the skin, any skin-to-skin contact around the genital areas (including the thighs and buttocks) can lead to HPV transmission. In addition, HPV 16 has been found under the nails of males, according to Nancy Dorn, MN, ARNP.

But sexual contact is not the only way HPV can be transmitted. Although rare, a mother can pass on HPV Types 6 and 11 to her infant during vaginal delivery. These strains can cause respiratory papillomatosis, which may lead to benign growths in the respiratory tract. Currently, there is no data to support the idea that a Cesarean section may prevent this type of HPV transmission.

Reality Check
An annual Pap test is the best way to prevent cervical cancer.

With the introduction of the Pap smear by Dr. George Papanicolaou more than 50 years ago, the number of cervical cancer deaths has declined steadily in the U.S.

Although the Pap smear isn’t 100 percent accurate, today a patient with abnormal results can get a follow-up HPV test. This test can determine if HPV is present, and if so, if it’s one of the high-risk strains associated with cervical cancer. Regular screenings using both tests can detect precancerous changes in cervical cells, and with treatment, it is possible to prevent these cells from turning deadly.

Reality Check
Using condoms, not smoking and eating your veggies can help lower your risk for cervical cancer.

Reducing various risk factors can play a role in preventing cervical cancer. To begin with, practice safe sex. Using a condom can help block the transmission of HPV. But it is not a foolproof method, as the virus can be present on the skin around the genitals in areas not covered by the condom. But, again, having high-risk HPV does not mean that a woman will definitely develop cervical cancer. Researchers say that in addition to high-risk HPV, other factors (such as smoking, poor diet, sexual promiscuity, among other vices) are generally present before cervical cancer develops.

New research also suggests that women infected with multiple strains of HPV are 92 to 400 times more likely to develop high-grade cervical lesions that can lead to cervical cancer.

Reality Check
Cervical cancer is more deadly for the poor and certain racial groups.

In the U.S., the groups with the highest mortality rates from this disease are Hispanics living along the Texas-Mexico border, African-Americans in the South, Native Americans in the Northern Plains, Caucasians in Appalachia, Vietnamese-Americans and Alaska Natives. The cancer also usually affects women in middle age and older. The National Cancer Institute reports that these higher death rates may be due to poor access to health care and lower education and income levels.

Reality Check

New vaccines to protect tomorrow’s men and women.

Even though cervical cancer is one of the top cancer killers of women today, a new vaccine could change that. Gardasil has been found to be 100 percent effective against four HPV types, including the troublesome Nos. 16 and 18. The Food and Drug Administration (FDA) approved Gardasil on June 8.

Manufacturer Merck & Co. advises the vaccine be administered to young girls below the age of 15, as it would be most effective before girls become sexually active and are exposed to HPV. However, there is one potential obstacle that could block the vaccine’s ability to prevent the spread of HPV and thereby lower cervical cancer rates—cost. The anticipated price is between $300-$500 for the three shots during a six-month period.

For women older than 26 who do not qualify for Gardasil, GlaxoSmithKline is working on the vaccine Cervarix, which will protect against Types 16 and 18. Cervarix is effective in females ages 15 to 55, and the FDA is expected to review and approve the vaccine by year’s end. And although no HPV vaccine is available for men right now, two drug manufacturers are currently working on vaccines for the male half of the population.

“Reality Check” columns clear up misconceptions and offer fast facts on a broad range of health topics. To learn more about cervical cancer, see the American Social Health Association's National HPV & Cervical Cancer Prevention Resource Center.

Tuesday, May 1, 2007

Mental Abilities: ‘Sleep on It,’ It Appears, Really Is Good Advice

Photo by: Unknown
Source: New York Times May 1st, 2007
Author: Eric Nagourney


Sleeping on the job is not generally a good idea, but when it comes to the brain it may be another matter.

As people sleep, a new study suggests, their brains may be sorting through the information they have gathered, making connections that could lead to new insights. The study appears online in The Proceedings of the National Academy of Sciences.

Earlier studies found that people appear better able to remember things they have just learned if they are able to sleep soon after. In effect, they found, the brain appears to use sleep time to consolidate memories.

This study suggests that the process is still more complex, and that sleep helps people make inferences from bits of knowledge that may at first appear random, said one of the authors, Dr. Jeffrey M. Ellenbogen of Brigham and Women’s Hospital, the Harvard affiliate.

People make minor inferences all the time without sleeping first, of course, but those connections tend to be fairly straightforward. Sleep appears to play a role in helping people make “big picture” realizations, Dr. Ellenbogen said, like those involved in major scientific breakthroughs.

“Inferences are abundant in the world,” he wrote in an e-mail message. “Only a few are obvious. The rest need time and sleep to discover them.”

For the study, researchers asked 56 college students to study pairs of elaborately decorated ovals. They were told that in each pair, one oval won out over the other. But they were not told of a broader pattern in which all the ovals were part of a hierarchy.

The students were then broken into three groups.

The members of one group were tested to see how much of the hierarchy they could discern just 20 minutes after they studied the shapes. Another group was tested 12 hours later, with half its members having slept. Members of the third group were tested 24 hours later, after all had slept.

The first group did the worst, while those students who had been able to sleep did best.