This is your brain on drugs

Plus the omicron update and reflections on another pandemic year.

Dear friend,

I’m not as regular on social media as I was before— more on that a little bit further down in this newsletter. I realize that some of you may only be following this email for updates on the omicron variant. I’ll cut to the chase first and then proceed with my end-of-year and musings on the title of this newsletter.

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The Omicron update.

• As I’ve noted in articles and newsletters written over the past five weeks— and as corroborated by real world data from Israel, Europe, Hong Kong, South Korea, United States and elsewhere omicron is likely many times more infectious than delta.

• Multiple mutations in the spike have lowered prior immunity from vaccines and previous infection

• A research paper just published in Nature a few minutes ago corroborates what preprints have said earlier. I’ll briefly summarize the findings in bullets below—

  • Two doses of Pfizer or Moderna were 23-fold and 42-fold lower in antibody neutralizing capability with the omicron compared to with the wild-type or beta variant.

  • Three doses of Pfizer were 7.-5-fold lower and three doses of Moderna were 16.7-fold lower against omicron.

  • Previous infection plus two vaccine shots or three vaccine shots was reduced but better than three vaccines alone.

  • The authors conclude that ultimately omicron-specific vaccines may be needed.

  • However, the current study did not test for cellular immunity or protection against transmission or severe disease.

  • All in all, this is solid work by noted immunologist Florian Krammer’s group at Icahn School of Medicine at Mount Sinai (NY).

• A wide number of articles in the popular press contain sound bites such as the following—

  • “Omicron is not the same disease as the previous virus” which was widely reported.

    • This is great as a soundbite, but ultimately it lacks nuance. Omicron may be more transmissible and milder, but it spreads the same way, infects the same cell receptor, and is vaccine-preventable. It is the same virus. Let’s be honest even COVID-19 caused by the original strain didn’t cause one single disease in everyone. I’ve written a few chapters about this in my book.

  • Everyone will get infected by omicron regardless of vaccination status.

    • No, everyone does not have to. Prevention is about risk mitigation. I understand the fatalism creeping in two years into a pandemic, but we should also strive for accuracy.

  • Omicron will make the virus endemic, so that’s actually a good thing.

    • Two years into the pandemic, I’m not going to make any predictions about the variant-of-the-month. Anyone who has done that has found that it has come to bite them in the back. Although, to be honest, no one remembers what anyone says anyway.

  • Omicron is a lot like the common cold.

    • Omicron may be milder, but many of us are vaccinated and/or infected once. It is still a variant of SARS-CoV-2 and unlike the human coronaviruses that cause common colds. Maybe after a few years of the arms race between virus and immune systems it will join cold causing viruses, but it is too early to make that prediction.

Now, back to what I was saying…

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So long, 2021.

And so it ends.

Some of us may have fared better than others during the pandemic. We must mourn what we have lost, but also be grateful for what we have. It has been a rough year. Thank you for listening to me.

We may have had goals in early 2020 that remain unfulfilled to this day. But we have also come to realize that goals are not everything. The past two years have made us reflect on what is important in each of our lives.

Ask people who they are and they will tell you their job, where they studied, or how much they got on exam. Climbing Everest, making money, buying a house: these are milestones. They have endpoints. Love and honesty are values, they are endless.

Through the twenties and early thirties there are many personal milestones- education, job, marriage, kids, travel, and house and snazzy things for many of us. But the truly breathtaking milestones diminish over time for most. This is the unspoken, underlying truth of life.

The key, in my view, is to find what challenges and motivates us. Obedience only gets us so far. After a point, the standard societal trappings leave a hollow feeling. Everyone must find their own path and their own fulfillment. Becoming an adult involves figuring out what parts of yourself and the world you can accept and what parts you cannot.

We must also reflect our our purpose in life and our values. We must decide what matters to us. Life is fleeting and we are on this planet for only a short duration.

How would we approach life if we knew that we had only a few years left?

I think we must find the causes where we can make a difference and the people to whom we matter. We must live the experiences that give us joy (as ephemeral as it may be) when we have the opportunity.

To do this we must actively contemplate what makes us happy. It’s not simply a matter of removing the sources of unhappiness.

To someone that happiness might be finding out one small thing that no other human knew before. To someone else it might be to create something new or something better. Or to make someone happy. Or to make a tiny difference in a life.

We may spend the days writing and replying to emails. We may tell people our made-up job designations. But at the end of the day, we will be someone to somebody. Hopefully, they will be inspired by our values and look up to us.

What would we regret if we were nearing the end of life?

Palliative care workers have asked this question to people who are terminally ill.

People say things like “I wish I had the courage to be true to myself.” Or “I wish I hadn’t worked so hard.” Or “I wish that I had the courage to express my feelings.”

People regret things not done, roads not taken, friends not cherished. That is because in our minds we can create parallel realities of “what-if” where things turn out differently.

Let us consider that we are at that point now at the fork in the road and we have that choice to make that change and consider that “what-if” right now. What would we do?

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May you be filled with hope and awe and curiosity. May you have good health and good thoughts. May you be kind to others and to yourself. May you find peace inside of you.

We'll take a cup o' kindness yet
For auld lang syne!

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Facing up to our addictions

Towards the end of Anna Lembke’s Dopamine Nation: Finding Balance in the Age of Indulgence I came across a paragraph that described how I had been feeling for the past few years.

I find it difficult at times to stop myself from working once I’ve begun. The “flow” of deep concentration is a drug in itself, releasing dopamine and creating its own high. This kind of single-minded focus, although heavily rewarded in modern rich nations, can be a trap when it keeps us from the intimate connections with friends and family in the rest of our lives.

I felt as if the author knew me very well.

In my last newsletter I mentioned the top popular science books of 2020 (excluding the one I wrote myself). A strong contender for book of the year is Dr. Lembke’s Dopamine Nation.

I covered this book and my thoughts about dopamine and addiction in my column for Hindustan Times this week.

We are currently facing an attention, anxiety, and addiction crisis driven by easy access to physical and behavioral drugs. Right now, there are people walking across streets or sharing meals in their homes oblivious of one another because they’re mesmerized by their smartphones…

The gambling, shopping, game, and social media apps on our phones are addictive. Using them is stimulating and we form repetitive patterns. These patterns become habits. After a while, they become routine. People no longer know when or how many times they pick up their phones. The glow of the phone is the last thing they see at night and the first thing in the morning. But these activities don’t make them happier or less anxious. In fact, there’s even a term for the repetitive action of going down a timeline and absorbing bad news – doomscrolling.

About a decade ago, I wrote a short perspective piece for a scientific journal that described work scientists had done in animals that found that compulsive overeating was like drug addiction. While there are some differences with different kinds of addictions, the same reward circuit was found to be involved.

I urge you to read my column, and also to pick up the book. There’s a useful framework for rebalancing dopamine levels in the brain that starts with observing a compulsive behavior to abstinence for 2-4 weeks.

After that abstinence period, comes a phase of mindfulness and deliberate awareness. What are the patterns of use (if any) someone wants to go back to? Exercise can also rebalance the pain side of the pleasure-pain balance.

One other point that Dr. Lembke mentions in her book is that taking cold showers can raise dopamine levels temporarily making us feel good, as well. There’s a natural dopamine spike that remains elevated for a few hours. But it’s important not to get addicted to cold showers either.

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The world is too much with us; late and soon,

Getting and spending, we lay waste our powers…

— William Wordsworth

The modern electronic world is designed to get us hooked. In fact, that’s the business model. We’re the product being sold.

Companies like Twitter and Facebook make money if we're hooked and spend more time on their sites triggering the dopamine reward pathway. It's in the basic design.

The Netflix documentary The Social Media uncovered many tactics that social media companies use to keep us hooked to their apps.

Ever wonder why the bell icon showing how many notifications you have shows up a moment later than the tweets home icon? It's deliberate: by delaying gratification and increasing anticipation by a moment, Twitter is using a slot-machine method to get us coming back.

A pity then that Netflix did not mention many of the tricks they use to keep people binging abnormal amounts of video content in one sitting! People can get addicted to watching streaming video too. In fact, Netflix also wants you to be consuming their content instead of walking in nature, reading a book, or having a conversation.

When we read a physical book or newspaper or watched a television show in the past, there was a logical stopping point. Now, we can binge an entire eight show season in one night, tweet about it, and move on to the next thing.

Many high-level tech company executives have banned the devices and apps that they helped create from their own homes. So what exactly are these former Google, Amazon, Facebook, and Twitter employees who are warning about social media and technology doing to stem the problem they helped create?

They're giving well paid tech talks, creating series for web platforms, and launching new start-ups. Some of them are creating new apps.

It seems that we need apps to help us concentrate because of all the other apps that keep us distracted…

OK. Enough ranting. Here’s my point—

I’m not a Luddite and I’m certainly grateful for the many meaningful conversations I have online. I’ve met some really awesome people through social media and I get to send out a newsletter to complete strangers who are willing to hear me rant. How cool is that? :-)

But these are powerful tools, so powerful that even their designers don’t know exactly how they compel us to spend time online. And over time, overuse can cause a surge in anxiety, crankiness, insomnia, and inattentiveness.

Gresham's law which states that "bad money drives out good" can be applied to social media. All things being equal, the more valuable commodity will gradually disappear from circulation.

There’s valuable time I’m spending writing this, and you’re spending reading this. That’s time we could be doing something else. Let’s not lose sight of this. Let’s spend our time online deliberately and mindfully.

If you find social media overwhelming but don't want to quit, treat it like a trip to the grocery store in the midst of the omicron surge.

Know what you want. Get in. Get out. Also, wear a mask and socially distance.