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Want the Best Sunscreen? What You Need to Know
5 ways to make sure your sunscreen is safe and effective

By Mehmet C. Oz, MD, and Michael F. Roizen, MD

Summer's here. And who isn't cheering? But before you spin vintage Beach Boys vinyl or park your towel in a sunny spot, we have a public service announcement: Pick up some sunscreen, pronto. There's a rock-solid reason to coat your body with this healthy stuff.

An Australian study confirmed a message we hope you'll memorize: Slathering on sunscreen daily makes you 50% less likely to develop melanoma, the most deadly kind of skin cancer, and 70% less likely to develop invasive melanoma, the worst of its kind. You couldn't ask for more convincing evidence. The volunteers were from a part of Australia that has the highest rates of skin cancer in the world. (Know the danger signs? Do a skin cancer self-examination.)

We're hoping that will light a fire under your flip-flops if nothing else has. Because, despite years of sun-safety campaigns that make stop-smoking advocates look like slackers, melanoma rates have shot up 45%. And two less risky types of skin cancer (squamous cell and basal cell) are up 16%. Yes, genes play some role in this, but sun exposure (including tanning beds) is responsible for 65% of melanoma.

"Okay," we hear you saying, "but which sunscreens are safe and effective and not goopy?" Smart question. Here's what you should buy this year.

Avoid controversial sunscreen ingredients. Some (not all) researchers have raised red flags about two absorbable sunscreen ingredients: oxybenzone and retinyl palmitate (a form of vitamin A). Both are found in hundreds of sunscreens. The concerns? Very briefly, oxybenzone, which has been used in sunscreens as a partial UVA/UVB shield since 1978, has been called a hormone disrupter that mimics the effects of estrogen in lab studies. Retinyl palmitate has triggered genetic mutations when exposed to sunlight in the lab. In other words, one or both might have a cancer connection. The dangers of these ingredients have been disputed by the American Academy of Dermatology and others. We think: Until the research is clear, we're sticking with sunscreens that use micronized zinc oxide or titanium dioxide to block UVA/UVB rays. They work instantly and stay put, and, unlike chemical sunscreens, neither is absorbed. The tiny micro-sized particles help prevent a chalky look. We actually prefer micronized zinc because, if you sweat the way Dr. Oz does, even microparticles of titanium dioxide make you look ghostly. (Check out these anti-aging foods that make your skin glow!)

Beware of SPF "inflation." There's a decent case to be made that the sun protection factor (SPF) numbers on many sunscreens may be too high and create a false sense of security. But even if they're accurate, few people apply sunscreen perfectly or use nearly enough. So squirt on a lot and go high, not low. Although technically an SPF 30 filters out only 4% more UVB rays than an SPF 15 (97% versus 93%), if you go with an SPF 30 (higher if you burn easily), you also get better protection against UVA rays. They're the kind that penetrate deeper and cause skin damage that leads to wrinkles and cancer. We say: An SPF 30 is the bare minimum you should use.

Don't forget UVA protection. That familiar SPF number only measures protection from burning UVB rays. Despite years of wrangling and thumb-twiddling, the Food and Drug Administration still doesn't require sunscreen makers to list UVA protection levels. So you have to scour the ingredients list for UVA blockers. For the record, these include avobenzone, dioxybenzone, ecamsule, meradimate, the aforementioned oxybenzone, sulisobenzone -- and, yep, zinc dioxide and titanium dioxide. We like: You guessed it, sunscreens that use micronized zinc oxide. It creates an instant physical barrier against UVA/UVB rays.

Save money on sunscreen. You can easily plunk down $20 or more for a fancy brand, but spending a bundle could backfire because you're likely to use it sparingly. Fact is, adults need to apply at least 1 full ounce (a shot-glassful) and then reapply it every few hours or after swimming or sweating. We bet: That's lots more than you're using. Buy inexpensive brands so you spread it on thickly and repeatedly.

Skip goopy sunscreen. Excuses for skipping sunscreen (sticky, smelly, greasy, chalky, stings your eyes) are disappearing faster than souvenir teacups commemorating Kate and William's royal wedding. Drugstores are jammed with choices: fragrance-free or scented; tinted or transparent; oil-free or creamy; sturdy enough for sweaty sports or gentle enough for tiny tots; anti-acne or anti-aging. All you have to do? Choose it and use it.

Rita Levi-Montalcini, Nobel Prize-winning neuroscientist, dies at 103

by Emily Langer, Published: December 30

Rita Levi-Montalcini, a Nobel Prize-winning neuroscientist who began her seminal research on cell development while dodging bombs and fleeing Nazi persecution during World War II, died Dec. 30 at her home in Rome. She was 103.

Gianni Alemanno, the city’s mayor, announced her death in a statement to international media. The cause was not disclosed.

Dr. Levi-Montalcini was widely regarded as one of the most influential scientists of her generation, and her accomplishments were particularly notable because of the handicaps and obstacles faced in science by women throughout the world when she began her career.

Her rise to the highest reaches of scientific achievement was made even more difficult because she embarked on her career under the fascist regime of Benito Mussolini, who expelled her and her fellow Jews from the Italian academic world.

She shared the 1986 Nobel Prize in medicine for her discovery of a substance known as the nerve growth factor, a naturally occurring protein that helps spark the growth of nerve cells. She launched that groundbreaking research in a makeshift bedroom laboratory during the war and deepened it in the 1950s at Washington University in St. Louis, where she worked alongside her co-Nobelist, the American biochemist Stanley Cohen.

In essence, Dr. Levi-Montalcini’s discovery helped explain how embryonic nerve cells grow into a fully developed nervous system and, more broadly, how a damaged nervous system might be repaired. Cohen was credited with the identification of the epidermal growth factor, a similar substance that helps regulate the growth of skin and other cells.

Together, those advances “opened new fields of widespread importance to basic science,” the Nobel Assembly at the Karolinska Institute declared in awarding the prize to the two scientists. The nerve growth factor is considered a foundation for modern research into treatment of Alzheimer’s disease and has also influenced research on cancer, Parkinson’s disease and muscular dystrophy.

Writing in the journal Science in 2000, Dr. Levi-Montalcini attributed her success to “the absence of psychological complexes, tenacity in following the path I reputed to be right, and the habit of underestimating obstacles.”

Rita Levi-Montalcini was born April 22, 1909, in the northern Italian city of Turin. Her mother, Adele Montalcini, was a painter; her father, Adamo Levi, was an engineer and subscribed to the then-prevailing view that women were best suited to the domestic life.

“It was he,” Dr. Levi-Montalcini wrote in an autobiography, “who had a decisive influence on the course of my life, both by transmitting to me a part of his genes and eliciting my admiration for his tenacity, energy and ingenuity; and, at the same time, by provoking my silent disapproval of other aspects of his personality and behavior.”

She discovered her affinity for science in her early 20s and gravitated toward medical research because she had lost a beloved governess to cancer. Dr. Levi-Montalcini received a medical degree in 1936 from the University of Turin, where her classmates included the future Nobel laureates Salvador Luria and Renato Dulbecco.

A chemical found in red meat helps explain why eating too much steak, mince and bacon is bad for the heart, say US scientists.

A study in the journal Nature Medicine showed that carnitine in red meat was broken down by bacteria in the gut.

This kicked off a chain of events that resulted in higher levels of cholesterol and an increased risk of heart disease.

Dieticians warned there may be a risk to people taking carnitine supplements.

There has been a wealth of studies suggesting that regularly eating red meat may be damaging to health.

In the UK, the government recommends eating no more than 70g of red or processed meat a day - the equivalent of two slices of bacon.

Saturated fat and the way processed meat is preserved are thought to contribute to heart problems. However, this was not thought to be the whole story.

Continue reading the main story
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I would strongly recommend that unless you're a vegetarian or vegan, there is a potential risk from taking L-carnitine, lecithin, choline or betaine supplements in an attempt to ward off cognitive decline or improve fat metabolism ”

Catherine Collins
Dietitian
"The cholesterol and saturated fat content of lean red meat is not that high, there's something else contributing to increases in cardiovascular risk," lead researcher Dr Stanley Hazen told the BBC.

I used to take vitamin supplements almost every day. Taking vitamins seemed like a good idea: after all, we know that vitamins are essential for life, and vitamin deficiencies can definitely hurt you. I always thought that vitamins were an inexpensive way to get a little bit healthier.

Millions of Americans apparently agree with me. Close to half of the population in the U.S. takes vitamins, with multi-vitamins being the most popular.* Vitamins are sold in virtually every grocery store, ranging from mega-markets like Wegmans to the organic Whole Foods chain.

The vitamin and supplements industry, which is immensely profitable, relies on the intuition that if a little bit of something is good for you, a bit more can’t hurt. Right?

Wrong. If you don’t have a serious vitamin deficiency, taking supplemental vitamins doesn’t provide any benefit, in almost all cases that have been studied. What’s even more surprising is this: routinely taking mega-doses of vitamins might actually harm you.

So here are the top 5 vitamins that you should not take (unless your doctor recommends it):

1. Vitamin C. Perhaps the most popular single vitamin supplement, vitamin C occurs in plentiful amounts in many fresh fruits and vegetables. In the early days of global exploration, sailors often died from scurvy, caused by the lack of vitamin C. Way back in the 1700′s, Scottish doctor James Lind famously conducted an experiment that proved that citrus fruit cured scurvy, although vitamin C itself wasn’t discovered until the 1930s.

Vitamin C gained its current popularity through the woefully misguided efforts of Linus Pauling, who published a book in 1970 recommending mega-doses of C to prevent the common cold. Although Pauling was a brilliant chemist (and Nobel laureate), he was completely wrong about vitamin C, as Paul Offit explains in detail in his new book, “Do You Believe in Magic?”

Vitamin C doesn’t prevent or cure colds. This question has been studied exhaustively: a review in 2005 covering 50 years worth of research concluded that

“the lack of effect … throws doubt on the utility of this wide practice.”

Although Vitamin C is generally safe, megadoses of 2000 mg or more can increase the risk of kidney stones, which can be excruciatingly painful.

2. Vitamin A and beta carotene. Vitamins A, C, and E are all anti-oxidants, which have been promoted for their supposed anti-cancer properties. The evidence doesn’t support this: for example, in a large study supported by the National Cancer Institute*, smokers who took vitamin A were more likely to get lung cancer than those who didn’t.

Vitamin A plays an important role in vision, but too much vitamin A can be toxic, causing multiple serious side effects. Perhaps the most famous cases of vitamin A toxicity occurred in early polar explorers, who ate the livers of their sled dogs, not realizing that the livers had excessively high amounts of vitamin A. Antarctic explorer Douglas Mawson barely survived, and his companions died, probably of vitamin A poisoning.

3. Vitamin E. Long touted as an anti-cancer agent, vitamin E is a very popular supplement. A large study last year, of 35,533 men, looked at vitamin E and the risk of prostate cancer. The authors found that the risk of cancer increased for men taking vitamin E. In an even larger review done at Johns Hopkins University, Edgar Miller and Lawrence Appel found that the overall risk of death was higher in people who took vitamin E. The Mayo Clinic summarizes the evidence this way:

“Evidence suggests that regular use of high-dose vitamin E may increase the risk of death from all causes by a small amount.”

4. Vitamin B6. The B vitamins, including B6 and B12, are present in many foods, and deficiencies are rare. But taking B6 supplements for a long time can be harmful, as NIH’s website explains*:

“People almost never get too much vitamin B6 from food. But taking high levels of vitamin B6 from supplements for a year or longer can cause severe nerve damage, leading people to lose control of their bodily movements.”

5. Multi-vitamins. This is the big one. With nearly 40% of Americans taking a multi-vitamin, they must be good for you, right? But a huge study that I wrote about last year, looking at 38,772 women over 25 years, found that the overall risk of death increased with long-term use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper. Death, one must admit, is a pretty bad outcome.

On the evidence, supplementing your diet with any of these 5 vitamins carries little or no benefit, and may cause you harm. This is why we do science, people. Our intuitions aren’t always right: just because a little bit of something is good for you does not mean that a lot of it is even better.

Vitamins don’t “boost your immune system,” they don’t promote joint health, they don’t reduce stress, and they don’t help prevent colds or other common ailments.

So what should one do? Ignore the marketing, and treat supplements like you would any other medicine: take them with caution. If you are taking regular vitamin supplements, or thinking about it, ask your doctor before doing so.

And by the way, 100 grams of spinach has healthy amounts of vitamins A, C, E, K, several B vitamins, and essential minerals including iron and calcium.

The evidence against supplements continues to pile up.

Recently I created a list of The Top 5 Vitamins You Shouldn’t Take. Now I’m expanding that list to include vitamin D, which is taken by almost half of older adults. Now, two new studies in latest issue of The Lancet show that most of these people are wasting their money.

The first study is a large review by Philippe Autier and colleagues, who found that taking supplemental vitamin D has no effect on a wide range of diseases and conditions. After looking at over 450 studies, the authors conclude:

“The absence of an effect of vitamin D supplementation on disease occurrence, severity, and clinical course leads to the hypothesis that variations [in vitamin D levels] would essentially be a result, and not a cause, of ill health.”

So it appears that we’ve been getting cause and effect backwards, at least as far as vitamin D is concerned. Autier looked at non-skeletal disorders, including heart disease, weight gain, mood disorders, multiple sclerosis, and metabolic disorders, all of which have been linked to lower vitamin D. In trial after trial, supplemental vitamin D had no beneficial effect on any of these conditions. Autier et al concluded that:

“associations between 25(OH)D and health disorders … are not causal. Low 25(OH)D [vitamin D] could be the result of inflammatory processes involved in disease.”

Instead, the researchers found, in study after study, that low vitamin D was the result of poor health, not the cause.

The Autier study didn’t look at the biggest supposed benefit of vitamin D: protection against osteoporosis. We’ve long known that vitamin D is associated with bone health. Fortunately, in the same issue of The Lancet, Ian Reid and colleagues looked closely at this question. They reviewed 23 studies with 4082 participants, all designed to determine at whether supplemental vitamin D improves bone density. Their findings? It doesn’t help. They concluded:

“Continuing widespread use of vitamin D for osteoporosis prevention in community-dwelling adults without specific risk factors for vitamin D deficiency seems to be inappropriate.”

Vitamin D supplements, to put it plainly, are a waste of money.

(For those concerned about osteoporosis, the widely used drug alendronate (Fosamax®), has been shown to increase bone density by about 5%, as explained in a 2011 article by Dr. Sundeep Khosia. But Fosamax has side effects.)

It’s pretty easy to get enough vitamin D in a normal diet. Or, as Dr. Mark Gillinov explained in the Huffington Post last week, just 10 minutes of sunlight gives you about 4 times your daily recommended vitamin D requirement.

So here’s my expanded list of the Top Six Vitamins You Shouldn’t Take, with the newest entrant at the end:

Vitamin C
Vitamin A and beta carotene
Vitamin E
Vitamin B6
Multi-vitamins
Vitamin D

You can read more about the first five, some of which can be downright bad for you, in the original list.

What’s left? Well, if you don’t have a deficiency, there’s no reason to take any supplemental vitamins at all. As my Hopkins colleagues Eliseo Guallar, Lawrence Appel, and Edgar Miller wrote last month in the Annals of Internal Medicine : “Enough is enough: stop wasting money on vitamin and mineral supplements.” As they wrote, after looking at three more large studies just published last month,

“most supplements do not prevent chronic disease or death, their use is not justified, and they should be avoided.”

Save your money. Or better yet, if you must spend it, buy a bit more fresh fruit. You’ll be healthier for it.

[Addendum: Although routine supplementation is unnecessary, if you think you have a vitamin deficiency, consult with your doctor. Deficiencies might be the result of other health problems that your doctor can help you address. Treatments for specific conditions or diseases may include vitamins.]

Man Saves Wife’s Sight by 3D Printing Her Tumor
When his wife was misdiagnosed, Michael Balzer used 3D printing and imaging to get her well

Print Your Own

Want to print your medical image? Ask your doctor for your DICOM files and download 3D Slicer (slicer.org). Then use the Region Growing tool to segment the image. Extract a 3D mesh of the surface, save as an STL, and use ParaView (paraview.org) to simplify it to a manageable number of triangles. To see more details, check out Make: volume 42, page 83, or visit makezine.com/ projects/3d-print-your-medical-scan.

Cognitive Bias 6:01 AM Feb 17, 2015
Your Brain Is Primed To Reach False Conclusions

By Christie Aschwanden

Paul Offit likes to tell a story about how his wife, pediatrician Bonnie Offit, was about to give a child a vaccination when the kid was struck by a seizure. Had she given the injection a minute sooner, Paul Offit says, it would surely have appeared as though the vaccine had caused the seizure and probably no study in the world would have convinced the parent otherwise. (The Offits have such studies at the ready — Paul is the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and author of “Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.”) Indeed, famous anti-vaxxer Jenny McCarthy has said her son’s autism and seizures are linked to “so many shots” because vaccinations preceded his symptoms.

But, as Offit’s story suggests, the fact that a child became sick after a vaccine is not strong evidence that the immunization was to blame. Psychologists have a name for the cognitive bias that makes us prone to assigning a causal relationship to two events simply because they happened one after the other: the “illusion of causality.” A study recently published in the British Journal of Psychology investigates how this illusion influences the way we process new information. Its finding: Causal illusions don’t just cement erroneous ideas in the mind; they can also prevent new information from correcting them.

Helena Matute, a psychologist at Deusto University in Bilbao, Spain, and her colleagues enlisted 147 college students to take part in a computer-based task in which they each played a doctor who specializes in a fictitious rare disease and assessed whether new medications could cure it.

In phase one of the study, the student volunteers were divided into two groups — a “high illusion” one that was presented with mostly patients who had taken Drug A and a “low illusion” one that saw mostly patients who hadn’t taken the drug. Each student volunteer saw 100 patients, and in each instance, the students were told whether the patient had recovered. The student volunteers weren’t told that the drug didn’t work — the recovery rate was 70 percent whether or not patients took the drug. Yet, as expected, people in the high illusion group were more susceptible to erroneously concluding that it had an effect.

Presumably, because the student volunteers in the low illusion group had more opportunities to see the syndrome resolve without the drug, they were less prone to assuming that recovery was linked to it. Previous studies have shown that simply seeing a high volume of people achieve the desired outcome after doing something ineffective primes the observer to correlate the two.

Phase two of the study is when things got interesting. The experiment was repeated, except this time some patients simultaneously received two drugs — the ineffective one from phase one and a second drug that actually worked. This time, volunteers from both the high and low illusion groups were presented with 50 patients who’d received the two drugs and 50 who received no drugs. Patients in the drug group recovered 90 percent of the time, while the group that didn’t get meds continued to have a 70 percent recovery rate. Volunteers in the “high illusion” group were less likely than participants in the “low illusion” group to recognize the new drug’s effectiveness and instead attributed the benefits to the drug they’d already deemed effective. The prior belief in the first drug’s potency essentially blocked acquisition of the new information.

“You have to be sure before you’ll destroy what you already know and substitute it with something new,” Matute told me.

This finding might seem like nothing more than an interesting psychological quirk if it didn’t make us so vulnerable to quackery. Many so-called “alternative” remedies exploit the illusion of causality, Matute said, by targeting conditions that naturally have high rates of spontaneous recovery, such as headaches, back pain and colds. Quack cures remain popular in part because they bestow a sense of empowerment on people who are feeling miserable, by giving them something to do while they wait for their problem to run its course.

But not every dicey claim is made by a charlatan. Some credentialed clinics advertise platelet-rich plasma (PRP) as a “revolutionary” treatment for sports injuries even though the data on these therapies remains mixed. While writing about PRP last year, I was surprised to learn that none of the doctors I interviewed were tracking their outcomes. Because many people who get PRP seek it after they’ve tried everything else, doctors who provide the treatment are likely to see a lot of patients who are already on their way to recovery, as their condition finishes its natural course.

And that means it’s probable that these doctors are essentially replicating the first part of Matute’s study — priming themselves to find a correlation between PRP and recovery that isn’t there. We won’t know until they start tracking their results and comparing them to similar patients who didn’t get the treatment. (An easy way to protect against the causality illusion is to pay attention and count.) Physicians don’t have a great track record for self-assessment. A 2006 study published in The Journal of the American Medical Association found that doctors are poor judges of their own performance.

In this respect, doctors are only human, and so it’s not so surprising that the medical profession is filled with practices that have been disproved. Even when the evidence for or against a treatment or intervention is clear, medical providers and patients may not accept it. In some cases, the causality illusion is to blame, but usually the reasons are more complex. Other cognitive biases — such as motivated reasoning (all of us want to believe that the things we do make a difference), base rate neglect (failing to pay attention to what happens in the absence of the intervention), and confirmation bias (the tendency to look for evidence that supports what you already know and to ignore the rest) — also influence how we process information. In medicine, perverse incentives can push people in the wrong direction. There’s no easy fix here.

One thing seems clear, though. Simply exposing people to more information doesn’t help. Last year, political scientist Brendan Nyhan at Dartmouth and his collaborators published a randomized trial of four different approaches to influencing attitudes about vaccines among parents. The study’s 1,759 participants were split into groups, and each subset was presented with information about why vaccines are important — everything from why the diseases that a measles, mumps, and rubella vaccine could prevent are worth avoiding to images of children stricken with those diseases and a heart-felt story about an infant who nearly died of a case of measles. None of these efforts made parents more likely to vaccinate their kids.

Matute and her colleagues recently tested a different approach. Instead of trying to counteract false associations through information, they experimented with ways to improve the way people think. In a study published in science journal PLoS ONE, they invited a group of teenagers to test a wristband with a metal bar. Using language deliberately filled with jargon and pseudoscientific concepts, the researchers explained that the metal strip could improve physical and intellectual abilities, and the students were invited to test out the product while performing written tasks like solving a maze or number exercise. All the while, the researchers primed the volunteers to find a benefit from the band by raving about how previous users had noticed its alleged properties. By the end of the demonstration, many participants said they’d be willing to buy the magical ferrite strip.

Next came the twist — the researchers stepped out of their huckster roles and guided the teens through an analysis of what they’d just seen. They pointed out the holes in the evidence for the band’s powers, introduced the students to the causality illusion, and emphasized that to assess whether the product had improved their performance, they needed to have a baseline score for comparison. The objective of this second part of the intervention was to teach the teens to think critically about causality.

Afterward, the researchers ran the students through a computer test similar to the one used in the study on the causality illusion. They were shown a series of fictitious patients and given the opportunity to administer a fake (and, unbeknownst to them, ineffective) drug with the goal of figuring out whether the medication worked. Participants who’d learned about the challenges of establishing causality ran more trials without the medication (a necessary step to measuring the drug’s effectiveness) and made more accurate assessments of the drug’s efficacy.

It’s a promising result, but whether such an intervention could, say, prevent NFL players from buying up deer-antler spray or Olympians from taking risky supplements remains to be seen. Nyhan cautions against assuming that this educational approach can eliminate the causality illusion. Many psychological studies have shown promising improvements in belief accuracy when it involves matters that participants don’t care about, Nyhan told me. “But the lesson of controversial political, health and science issues is that people don’t apply their critical-thinking skills in the same way when they have a preference for who’s right.” Studies by law professor Dan Kahan at Yale show that even highly numerate people are prone to cognitive traps when the data contradicts the conclusion most congenial to their political values.

So where does this leave us? With a lot of evidence that erroneous beliefs aren’t easily overturned, and when they’re tinged with emotion, forget about it. Explaining the science and helping people understand it are only the first steps. If you want someone to accept information that contradicts what they already know, you have to find a story they can buy into. That requires bridging the narrative they’ve already constructed to a new one that is both true and allows them to remain the kind of person they believe themselves to be.

Filed under Cognitive Bias, Illusion of causality, Vaccines
CHRISTIE_CONTRIB
Christie Aschwanden @cragcrest

Christie Aschwanden is FiveThirtyEight’s lead writer for science. Her work has appeared in the New York Times, the Washington Post and Discover.

Peer-reviews on everything I write below are greatly appreciated. I want to make sure I understand this equation.

io9 has a pretty down-to-earth [io9.com] explanation of the equation:

FIT Treadmill Score = %MPHR + 12(METS) - 4(age) + 43(if female)

You can get your MPHR for your age here [empr.com]. I found a chart of METS [brianmac.co.uk] here for various exercises.

So, if I'm understanding this correctly. If I reach a 160 heart rate out of 179.0 MPHR predicted for my 41 years of age while running 12 minute miles worth 8.5 METS. My score would be:

83.7 + 12(8.5) - 4(41) = 21.7

The same heart rate for my age running 8 minute miles:

83.7 + 12(8.5) - 4(41) = 69.7

If I am understanding this correctly, it really looks like you could easily improve your score with a few lifestyle choices (push yourself harder when you work out, eat healthier). This equation could be a great metric for people concerned about their health