The Roseto Effect

Yesterday at work I was discussing ways of reducing health disparities (differences in health outcomes between groups) in the Medicaid population. A brilliant colleague brought up Malcom Gladwell’s “Outliers” which describes the Roseto effect.

Roseto, Pennsylvania, originally a small town of Italian immigrants, shed light on external influences that impact health. Dr. Stewart Wolf noticed that the town’s incidence of heart attacks was much lower than the national average. So began a long-term study on the residents of Roseto! They were known for smoking, drinking alcohol, lack of exercise, obesity, and eating copious amounts of animal fats and sweets, all of which contribute to heart disease. Yet Roseto residents were healthier than most Americans! Why? After obtaining lab tests and histories from town residents, Dr. Stewart Wolf hypothesized that their close social connections had a protective effect on heart disease. Before the 1970s, the town residents maintained a unique culture of a close-knit community with high levels of civic engagement, community support, multigenerational homes, and social gatherings. In fact, Dr. Stewart ruled out other causes such as genetic effect by proving that Roseto residents who moved to other communities had a higher incidence of heart disease. Not only did Roseto residents have better health, they had low rates of suicide, alcoholism, drug addiction, crime, and welfare assistance. The Roseto effect theory strengthened after the 1970s when the town became more Americanized and close-knit social ties broke down, contributing to increased heart attacks.

I sometimes wonder why billions of dollars are spent by modern medicine to treat symptoms of chronic diseases. Studies like the Roseto effect offer a root cause analysis approach. Go after the causes, not the effects!

Stress, loneliness, and helplessness are HUGE factors that contribute to poor health. Being able to trust and confide in other people and receive support during difficult times are crucial to human survival. We are emotional beings! In my opinion, love and spirituality are just as important as a statin or antidepressant medication in improving our wellbeing.

Public health and governmental agencies are finally accepting that other factors besides medical care contribute to good health. Social determinants of health (stable housing, access to healthy food, access to nature), cultural influences, adverse childhood experiences, and social connectedness are hot topics in government right now. In Medicaid, there are many pilot projects that focus on improving a person’s mental health, housing issues and social support in addition to physical health.

My colleague wanted to use the Roseto model to look at health disparities:  analyze why certain groups are healthier than others and share this knowledge to promote changes in groups who are not as healthy. Understandably genetic factors are hard to change, but changing one’s lifestyle or social support is an achievable goal. Or is it?

We live in the time of Millennials, constant screen time, multiple Facebook checks, and decreasing in-person socialization. How can we maintain close-knit social ties when technology is forcing us to do otherwise? I don’t know the answer to this question. As a pseudo-nomad ─ having lived in Houston, Dallas, Los Angeles, and Sacramento ─ with few close friends, I myself have not been able to maintain social connectedness where I currently live.

My dream? Live in one city for an extended period of time and cultivate a close community of friends and family who spend time with each other on a regular basis and help each other out.

A girl can dream, right?  🙂

Check out the video below that explains the Roseto effect.



Toni Morrison’s Views on Work

The New Yorker Magazine can go to extremes to appease its well-educated and slightly stuffy audience.  In depth articles on plant behavior, lingerie in the Middle East, and Bob Marley’s life can get overly complicated. But sometimes they publish pieces that are generous in their simplicity and authenticity, allowing one’s heartstrings to be pulled as if a harp is being strummed for a Celtic tune.

The following New Yorker excerpt by Toni Morrison, which describes her father’s advice about her childhood job, is one of those moving bodies of words that washes away built-up grime.

Advice that Toni Morrison received from her father:

  1. Whatever the work is, do it well—not for the boss but for yourself.
  2. You make the job; it doesn’t make you.
  3. Your real life is with us, your family.
  4. You are not the work you do; you are the person you are.

In the words of Toni Morrison herself:

“I have worked for all sorts of people since then, geniuses and morons, quick-witted and dull, bighearted and narrow. I’ve had many kinds of jobs, but since that conversation with my father I have never considered the level of labor to be the measure of myself, and I have never placed the security of a job above the value of home.”

A big thank you to Toni Morrison’s father for arguing against the career-driven, individualistic American way of life. He stressed the importance of family and home and core identity which are unrelated to one’s work. When I left a career in medicine and was jobless, I had no clue who I was outside of my identity as a doctor. What did I value? What hobbies did I have? Who did I enjoy hanging out with?

To be honest, it was that value of home that saved me from losing my sense of self. It was my friends and family members (and dog!) who lifted me up to try harder,  be better, and smile brighter. My family accepted me despite setbacks with my career because they knew all along that my core would never change. I learned that jobs can come and go but your support system never leaves you.

I am extremely grateful to my family for their unconditional love, and I must also thank myself for discovering who I was at my barest moment.

This New Yorker piece also applies to those entering retirement as they will be challenged to create a meaningful life without a career. I hope you can learn from Toni Morrison’s experience and spread this simple yet powerful wisdom!



Questions for Tomorrow.

Do you change to thrive or do you thrive to change?

Are bus drivers actually angels sent from above to help the mentally ill?

Is a perfect roommate even better than the perfect soulmate?

Why do the menstrual cycles of different women sync up easily but political parties never come to a consensus?

Why worry about saving for a future house you don’t want to purchase?

Why does it feel utterly comforting when your building’s security guard smiles at you?

Can people completely change their true natures?

Why do high school friends remember details about you that you’ve long forgotten?

Why is it so hard to connect with others even though we are hard-wired to be social, attached beings?

Do mothers lose a sense of self? Do single women lose a sense of meaning?

In 100 degree weather, why do buildings run air conditioning to the point of hypothermia?

Why do some people who gorge on sweets never develop diabetes?

How can animals understand the depths of your soul better than you can?

Why do loud people get all the credit when humble silent people do all the work?

When will the medical community admit that Trump is mentally unfit for office?

When will I come to terms with myself?

How many licks does it take to get to the center of a tootsie pop?  🙂





A Day in the Life of Devs

Cocoa therapy:

Chocolate swirls and cocoa whirls,

marshmallows oozing on top,

the finest chocolate in the city

can’t replace what was lost


Not satisfied with the chocolate,

I open the heavy wooden door to the trendy and pricey restaurant.

All I see is a sea of white.

I am the only person of color in this establishment.

I eat the fancy pizza nervously with my head down, perusing my favorite magazine.


A toddler with clear blue eyes and golden hair comes up to me

“Ask the lady if she’s an attorney,” says his father.

The toddler continues to stare at me.

“She’s reading the New Yorker magazine. She must be an attorney.”

I turn to the father and explain that I’m a doctor, not a lawyer.

After they leave, I crack a smile. I love breaking stereotypes!

Maybe I was an attorney in my last life.  🙂


Eulogy Virtues Part II

Two years ago, I wrote about David Brook’s piece in the New York Times ( It’s funny what can happen in 2 years. I feel I’m farther away from my goals than I ever imagined!

Austrian poet Ranier Maria Rilke’s words come to mind:  “Have patience with everything unresolved in your heart and to try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given to you now, because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer.”

Although my questions did not lead to answers, they did lead to personal growth. And maybe this growth is more important than my goals which is exactly what David Brooks is trying to convey in his Ted Talk on eulogy virtues.

Let’s be clear here. David Brooks is not the most entertaining speaker. His style is the opposite of the current President’s. On a side note, I’m not sure how a yellow-haired loud-mouthed populist who lacks competency as a moral human being, or even a moral ape, can be an influential speaker. Yet Brooks puts together a great argument: find your weaknesses and turn them into a life of love.

In the Ted Talk, this quote by American theologian Reinhold Niebuhr stands out:

“Nothing that is worth doing can be achieved in our lifetime; therefore we must be saved by hope.Nothing which is true or beautiful or good makes complete sense in any immediate context of history;therefore we must be saved by faith. Nothing we do, however virtuous, can be accomplished alone;therefore we must be saved by love. No virtuous act is quite as virtuous from the standpoint of our friend or foe as from our own standpoint. Therefore we must be saved by that final form of love, which is forgiveness.”

Forgiveness as a form of love. Such a great thought to ponder on. Ponder away folks! Let these concepts simmer within you like a pilot light in a 1940’s gas wall heater (one of the perks of living in a house built in the 1920’s…lead poisoning here I come!).


The Flow of Words



Parts of me dwindle down, allowing my former self to peek out into the scary abyss.

Don’t be afraid Humor, jump into the world where you are Missed.


The dog’s silky hair, free time, sunshine, mom’s food, my brother’s off-putting yet cozy smell, the yellow stains on the ceiling from the water leak, the friends who don’t Pity me


You don’t go out to eat on the weekends? You don’t have any friends or family in town? You moved here without knowing anyone? You’re single? Wow, that’s Brave.


Bravery leads the way, as the other parts follow blindfolded

Stumbling through a dark forest, twigs crunching below their feet

Lengthy hazing ritual for a new beginning

Now open your blindfolds, look at each other, and hold hands

The the most difficult part is about to start!


The Wisdom of Jewel’s Journey

It’s rare to find a podcast episode that awakens your inner heart. James Altucher’s interview of the singer Jewel opens your universe. For those going through a struggle, reinvention, or midlife crisis, Jewel’s journey from homeless girl to a mindful artist provides a guide on how to thrive during uncertain times.

As a child of divorce living in Alaska with her father, Jewel had a unique upbringing. On one hand, she was a homesteader─living off the land in a sustainable way─and grew up in a barn. On the other hand, she and her dad routinely sang at bars which allowed her to express and nurture her musical talents. Jewel’s father was abusive which complicated matters even further. When most kids her age were goofing off, she struggled with “nature vs nurture” questions. Am I doomed to an abusive life where I will abuse others or can I cultivate a mindset that allows me to change my situation?

“Could I re-nurture myself?”

She chose to change her destiny and at the tender age of 15, Jewel enrolled at a high school for the arts and moved by herself to Michigan. What insight from such a young person!

Jewel moved to San Diego to be closer to her mother once she graduated from high school. After being propositioned by her boss and refusing to have sex with him, Jewel found herself jobless and living out of her car. During this period of her life she became sick multiple times from kidney infections. She was so sick and febrile at one point, she walked into a hospital in a daze but was refused medical care for not having insurance! Luckily an “angel” doctor found her and provided her with free medical care and antibiotics. Yet things got worse when someone stole her car, the one place she called home. In an instant, Jewel was homeless and living on the street at the age of 18!

“It was one of the most transformative experiences of my life. It’s a very demoralizing thing to be in that type of position where you’re just stuck on survive mode.”

While living in this animalistic mode with no hope and no money, she decided to shoplift a dress from a store. She stopped when she saw her reflection in the mirror. Is this really who I want to be?  At that moment she recalled a quote by the Buddha, “Happiness doesn’t depend on who we are or what we have, it depends on what we think.” Yet again she used her resiliency skills to create a positive outlook during a dark time. Mind over matter! First, she learned about her own fear and anxiety.

“Fear is this thief, and it takes the past and projects it into the future. It robs you of the only moment you have to create any change in your life”

Then Jewel started noticing her hands. They were always clenched or held tightly to her body. So she let them go: she used her hands to to shake others’ hands and to open doors for people. Finally, she brokered a deal with a coffee shop to increase their customer base by receiving payment to sing. At the age of 19 while still living on the streets, she was offered a $1,000,000 deal to sign to a record label!

Any homeless 19-year-old would have signed immediately. Not Jewel! She had the foresight to read up on record deals and knew she would not be able to sell enough records to meet the requirements of the contract. She decided to sign a much smaller deal which allowed her to express her authentic style of music─the type of music that was vulnerable and didn’t actively seek out an audience. Jewel learned from nature to cultivate herself to be a hard-wood tree instead of a soft-wood tree.

“Hard wood grows slowly.”

Yet hard-wood trees think long-term and are able to survive life’s upheavals due to a solid foundation.

“Shortcuts lead to soft-wood trees that fall over quickly.”

Despite Jewel’s huge success in the music industry, she still faced challenges later in life such as a divorce and mismanagement of her earnings by her mother. Each time she encountered a new challenge, Jewel reinvented herself by working HARD and nourished her inner happiness rather than focusing on external outcomes.

“What if it’s not that I’m broken? What if there’s a part of me that exists whole at all times? I just have to do a very loving archaeological dig back to my whole self.”

She followed the map of her inner self and her inner values, not the map of others. Jewel concentrated on the goals that were speaking to her soul. As a physician who quit my practice, I know firsthand how difficult it is to listen to your inner voice because of the distracting sounds of society’s expectations.

Jewel’s journey proves that success is a mindset. It doesn’t matter if you have only $50 in your bank account because you are capable of improving your situation by altering your thoughts. For those who think it’s too late to reinvent yourself, think again. Life is about change! Change your goals, change your lifestyle, and change your mindset to become the true person you were meant to be.

If there’s one podcast episode you listen to, let it be this one! Click on the link below to play or download the podcast.


Gratitude and the Forest of Authenticity

It only takes a few people to show you new ways of thinking, new ways of being. Wild methods of living that allow for enriching experiences. Why live in an apple orchard when you can dance in the rainforest? My life as a robot is officially over and my cup of gratitude toasts those who guided me to new horizons. Thank you to the handful of friends in California who helped me question everything, the money, the career, the expectations, the false relationships. I even question myself. What is my purpose? What is my joy? Escaping the brainwashing and lies was my greatest accomplishment, and now I look forward to going deeper into the forest of authenticity, my true home.


Teaching Children Useful Emotional Skills

When I dabbled in the education field, I observed what kids were being taught. Math and science, critical thinking, reading comprehension. Yet the curriculum does not cover topics like perseverance, self-improvement, and community-building, which may be more useful than any other subject.

Kids are not taught how to deal with difficult future situations: academic struggles, unemployment, crime, bullying, death of a family member, health problems, domestic violence, divorce, poverty, and racism. Children who do encounter problems often work with school counselors on an individual basis. But there is no universal curriculum on resilience.

Why is resilience so important? Here is why (from my personal perspective):

For my entire life up until the age of 31, I had never encountered any severe problems. I failed one test in high school and I took a leave of absence during medical school (due to intense stress from the competitive environment). Other than those two things, my life was okay. I set goals and always reached them despite enduring daily stress and unhappiness in the medical field. I became a doctor and found a great job. No major struggles came my way. So when an unexpected death in the family shattered my heart and my optimism, I completely fell apart.

After leaving the practice of medicine to grieve and explore other careers, I felt bitter and hopeless. Honestly, I felt the entire world was against me despite being a high functioning physician one year earlier. Unemployment and confusion about my next career path turned me into a negative person, and I didn’t have the skills to fight off feelings of despair.

I had never failed before so I didn’t have practice using resilience. If I went through this ordeal as a physician with a supportive family, imagine what struggles kids from low-income neighborhoods encounter! I have seen all kinds of people become hopeless due to lack of resilience, which puts them at risk of depression, homelessness, drug abuse, and crime. The lesson I have learned is that resilience requires PRACTICE and needs to be taught in childhood or adolescence!

Here are useful tools to improve outcomes during difficult emotional times:

Deep breathing and meditation exercises

Networking skills


Simple cognitive-behavioral exercises (such as triaging problems and finding solutions)

Being able to share shame, anxiety, and fear with others

Communication skills to resolve interpersonal conflicts


Maintaining a stable self-esteem

Eating healthy and exercising

Supporting an internal locus of control (you have control over your life instead of environmental factors having control)

Seeking out academic help

Learning from mentors and surrounding yourself with positive/motivated people

Transforming negative thinking into positive thinking (what positive lessons did you learn from a traumatic event?)

Seeking out appropriate social services (including help for mental health, housing, and employment issues)

Writing in a journal or diary

Celebrating every small step of improvement.

Finally, having the knowledge that things will get better as long as you keep trying. In the words of Galaxy Quest, “Never Give Up! Never Surrender!” These are all skills that can be taught in a classroom!

If we take time to teach high schoolers how to apply to college and study for the SAT, let’s also give them the emotional tools they’ll need to succeed in all aspects of life by making them resilient in the face of obstacles.


If you have time, check out Angela Lee Duckworth’s Ted Talk on the effects of grit in the school system:


And here’s an inspiring clip from Galaxy Quest: