Archive for September 2018


Habit is probably the most powerful tool in your brain’s toolbox. It is driven by the basal ganglia at the base of the cerebrum. It is so deep- seated and instinctual that we are not conscious of it, though it controls our actions.

If you do just about anything frequently enough over time, you will form a habit that will control you.

Good habits are those that get you to do what your “upper-level you” wants, and bad habits are those that are controlled by your “lower-level you” and stand in the way of your getting what your “upper-level you” wants.

You can create a better set of habits if you understand how this part of your brain works. 

For example, you can develop a habit that will make you “need” to work out at the gym. Developing this skill takes some work.

The first step is recognizing how habits develop in the first place. Habit is essentially inertia, the strong tendency to keep doing what you have been doing (or not doing what you have not been doing).

Research suggests that if you stick with a behavior for approximately eighteen months, you will build a strong tendency to stick to it nearly forever.

The three-step “habit loop.”

The first step is a cue—some “trigger that tells your brain to go into automatic mode and which habit to use.” Step two is the routine, “which can be physical or mental or emotional.” Finally, there is a reward, which helps your brain figure out if this particular loop is “worth remembering for the future.”

Repetition reinforces this loop until over time it becomes automatic. This anticipation and craving is the key to what animal trainers call operant conditioning, which is a method of training that uses positive reinforcement.

For example, dog trainers use a sound (typically a clicker) to reinforce behavior by pairing that sound with a more desirable reward (typically food) until the dog will perform the desired behavior when it merely hears the click. In humans, rewards can be just about anything, ranging “from food or drugs that cause physical sensations, to emotional payoffs, such as the feelings of pride that accompany praise or self-congratulation.”

Habits put your brain on “automatic pilot.” In neuroscientific terms, the basal ganglia takes over from your cortex, so that you can execute activities without even thinking about them.

If you really want to change, the best thing you can do is choose which habits to acquire and which to get rid of and then go about doing that.

Write down your three most harmful habits.     Now pick one of those habits and be committed to breaking it. Can you do that? That would be extraordinarily impactful. If you break all three, you will radically improve the trajectory of your life. Or you can pick habits that you want to acquire and then acquire them.

 The most valuable habit I’ve acquired is using pain to trigger quality reflections. If you can acquire this habit yourself, you will learn what causes your pain and what you can do about it, and it will have an enormous impact on your effectiveness.

Single dose of new drug can shorten flu duration by a day

A single dose of a new influenza drug can significantly shorten the duration of the illness in teens and adults, according to a study. The article reports the results of two multi-centre, double-blind, randomised clinical trials.

Both found that the drug, baloxavir marboxil, shortened the duration of flu symptoms by about one day and more quickly cleared virus compared with placebo in otherwise healthy teens and adults. The larger, phase 3 trial also found that baloxavir’s effect on symptoms was similar to that of a five-day course of oseltamivir but that baloxavir had significantly greater antiviral potency. The studies identified no important side effects.

“Baloxavir shows remarkable antiviral potency in uncomplicated influenza, and if approved by the US Food and Drug Administration (FDA), it would be an important addition to our treatment options for influenza,” said researcher Dr Frederick G Hayden, of the University of Virginia School of Medicine. “Of note, because baloxavir has a novel antiviral action in inhibiting the endonuclease of the virus, the drug is inhibitory for influenza A and B viruses including those that may be resistant to currently available drugs.”

The first trial was conducted in Japan in 2016 and evaluated the drug’s safety and effectiveness in 389 adults, ages 20 to 64. Study participants received either the drug or a placebo. Median flu symptom duration among those who received the drug was 23.4 to 28.2 hours shorter than among participants who received the placebo. (Baloxavir, developed by drug company Shionogi, was approved for use in Japan in children and adults in February 2018.)

The second study was conducted in the US and Japan in the 2016-17 influenza season. It compared baloxavir with both a placebo and an approved drug, oseltamivir, in 1,064 otherwise healthy study participants ages 12 to 64, with proven influenza. The median time to resolution of flu symptoms was 26.5 hours shorter among those who received baloxavir than the 80.2 hours reported among those who were given placebos. Baloxavir and oseltamivir produced similar reductions in symptom duration, but baloxavir required only a single dose compared with the standard five-day oseltamivir regimen.

“Single-dose baloxavir was without evident safety concerns, was superior to placebo in alleviating influenza symptoms and was superior to both oseltamivir and placebo in reducing the viral load one day after initiation of the trial regimen,” the researchers note in their paper.

In both trials, the rate of adverse events reported by study participants was similar regardless of whether participants had been given a placebo or baloxavir.

To become available in the US, baloxavir would need approval from the FDA. The drug was accepted for priority review by the FDA in June, so that a decision is expected by 24 December at the latest.

The drug was tested for its safety and effectiveness among flu sufferers with a higher risk of complications during the past influenza season, but the results of that testing have not yet been formally presented.

Studies of its effectiveness in hospitalised influenza patients, likely in combination with other influenza antivirals, and in preventing transmission of influenza virus are planned.

Background: Baloxavir marboxil is a selective inhibitor of influenza cap-dependent endonuclease. It has shown therapeutic activity in preclinical models of influenza A and B virus infections, including strains resistant to current antiviral agents.
Methods: We conducted two randomized, double-blind, controlled trials involving otherwise healthy outpatients with acute uncomplicated influenza. After a dose-ranging (10 to 40 mg) placebo-controlled trial, we undertook a placebo- and oseltamivir-controlled trial of single, weight-based doses of baloxavir (40 or 80 mg) in patients 12 to 64 years of age during the 2016–2017 season. The dose of oseltamivir was 75 mg twice daily for 5 days. The primary efficacy end point was the time to alleviation of influenza symptoms in the intention-to-treat infected population.
Results: In the phase 2 trial, the median time to alleviation of influenza symptoms was 23.4 to 28.2 hours shorter in the baloxavir groups than in the placebo group (P<0.05). In the phase 3 trial, the intention-to-treat infected population included 1064 patients; 84.8 to 88.1% of patients in each group had influenza A(H3N2) infection. The median time to alleviation of symptoms was 53.7 hours (95% confidence interval [CI], 49.5 to 58.5) with baloxavir, as compared with 80.2 hours (95% CI, 72.6 to 87.1) with placebo (P<0.001). The time to alleviation of symptoms was similar with baloxavir and oseltamivir. Baloxavir was associated with greater reductions in viral load 1 day after initiation of the regimen than placebo or oseltamivir. Adverse events were reported in 20.7% of baloxavir recipients, 24.6% of placebo recipients, and 24.8% of oseltamivir recipients. The emergence of polymerase acidic protein variants with I38T/M/F substitutions conferring reduced susceptibility to baloxavir occurred in 2.2% and 9.7% of baloxavir recipients in the phase 2 trial and phase 3 trial, respectively.
Conclusions: Single-dose baloxavir was without evident safety concerns, was superior to placebo in alleviating influenza symptoms, and was superior to both oseltamivir and placebo in reducing the viral load 1 day after initiation of the trial regimen in patients with uncomplicated influenza. Evidence for the development of decreased susceptibility to baloxavir after treatment was also observed.

A Japanese Technique for Overcoming Laziness

Do you know why most people set goals but fail to accomplish them? Many people try to set goals, especially in the New Year period; many come up with their New Year resolutions, but unfortunately, most of them never set out to achieve according to their plans.

Most people started out strong. They are motivated and are determined to achieve their goals in the beginning. However, as time goes by, people lose their steam; they lose their motivation and get distracted by the business of their lives. As a result, they procrastinate and their laziness kicks in and they give up on their goals.

The main reason people fail to accomplish what they have set out to achieve is that they are trying to achieve too much and too fast.

It is true that people want to be rich, to become a millionaire, to build a multi-million dollar business, and to be successful as quickly as possible, but doing so requires tremendous effort to break the old habit.

Habits can be difficult to change, especially bad habits that have been ingrained deeply in you. Thus, if you are trying to achieve something too fast and trying to do too much in the early phase, you will suffer a drastic habit change. And this is not a good approach to achieve what you want in life.

Most people cannot cope with a drastic habit change. They quickly feel tired and exhausted. For example, if you used to wake up at 7AM each day, try to get up at 5AM from tomorrow on. Your body cannot cope with the change and you are not used to it. You will feel tired, sleepy, and difficult to concentrate and cannot get much done even if you wake up early and have more hours to do things.

This is why most people find it difficult to achieve what they have set out for. Eventually, they will choose to procrastinate and let their laziness take over their lives. Never let this happen to you.

The Technique to Overcome Laziness

In Japan, there is a powerful and effective technique that anyone can use to overcome their laziness and get things done.

It is called the Kaizen technique, which can also be known as the one-minute principle. This technique is so powerful that it is used by most leaders in managing their businesses in Japan.

In Japanese, the word “Kaizen” comprises of two single words, “Kai”, which means change, and “Zen”, which means wisdom. In other words, the Kaizen technique suggests people cope with change slowly and wisely. This technique was invented by Masaaki Imai. When it comes to achieving what you desire in life, you should act on it slowly and wisely, not spontaneously.

Why the Kaizen Technique Works

The Kaizen technique is based on the one-minute principle for improvement. In other words, it says that if you want to achieve something, you should practice it every day for a minute at the same time, and no more.

This is extremely important because anyone can do it for just one minute a day. In the western culture, the majority will think that this technique is ineffective and many are doubtful because they believe that people can only achieve success through pouring in enormous effort and time.

On the contrary, when you try to pour in tremendous effort and put in a huge chunk of your time into doing something, it will exhaust you and makes you burnout. This is definitely not a good way to start any project or goal.

Besides that, when you apply this technique, you will need to break down your goals into smaller chunks of actionable steps because the technique requires you to work on it for just one minute.

Kaizen technique turns your big audacious goals into smaller actionable steps that you can do each day. More importantly, this principle allows you to see your progress. You will know if you are following through or you are falling behind. And for most people, acting on their goals for just one minute a day will not be an issue at all. No matter what you are trying to accomplish, be it push-ups, writing an article or reading a book, start by doing it for just one minute. When you do it for one minute, you will see your progress, you will experience a sense of victory and success, and this will motivate you to move forward. From one minute of action becoming five minutes. And from five minutes of actions evolving into 15 minutes and then more. The key is to start small and grow. Most people try to tackle their goals and do everything all at once, and this is what causes them to fail.

Anyone can achieve their goals, live their dreams and accomplish what they want in life. First, you must understand what it is that you want to achieve. And then do it for just one minute a day. Practice the principle of Kaizen and start small. When you do it for just one minute a day, it will take you no energy and it does not require much of your motivation, and anyone can do it if it is just for a minute. Plus, you will be able to see yourself making the progress and start seeing small victories. This will boost your motivation and encourage you to go forward even more. Furthermore, this one-minute technique helps you develop the right habit that you need to achieve success in life. As what Lao Tzu said, “The journey of a thousand miles begins with one step.” Therefore, apply the Kaizen technique into every area of your life and see how it can help you overcome laziness and change your life forever.



Do You Have It? 

What Can You Do?

Are you burning out?

Are you worried about yourself, both in your work, and in your personal world..?

Do you feel a little brittle, and a lot “on the edge”?

It seems appropriate, in the early part of a week, to pose these questions, and to offer you three sure-fire signs that you may be heading for a bit of trouble. And a few powerful strategies to “catch it” while you still can.

At some point, earlier on in my career, I did some work for an Executive Wellness clinic. Corporate executives would come in for an holistic wellness-screening day, and get assessed on all facets of general well being (nutrition, exercise, blood markers, etcetera).  And they would see me, to assess, primarily, the extent to which they are managing the demands of their lives, without being at risk of burnout.

For this purpose, we used “The Maslach Burnout Inventory”, which is a simple but robust series of self-report questions, and, on completion, yields a risk profile. This psychometric assessed for three indicators of burnout risk, and it is these that I want to share with you, briefly, now.

Specifically so that you can check in with yourself, and reflect on how you are faring.


  1. Emotional Exhaustion

Emotional exhaustion is more than just garden-variety tiredness.  This is fatigue in your soul… Yes, there is most certainly a physiological component. But when we speak about emotional exhaustion, we’re talking about a “profound spiritual and psychological flatness”, a de-motivation, and a general sense of “I couldn’t be asked”. It’s an energy issue. It’s almost as though one has unwittingly “sprung a leak”, and is hemorrhaging the will and courage to go on.

And it’s dangerous.

It’s dangerous because sleep doesn’t really help. The “usual reliefs” don’t touch sides. Everything, no matter how innocuous, starts to feel like a drain on you, and it leads to social and professional withdrawal and shut down. Left untended, it can start to skew perspective, and lead to faulty cognitive processing and therefore poor decision-making. An otherwise sane and rational person starts to come apart at the seams…

  1. Cynicism

 I really don’t like cynicism.  Not in myself, nor in others. (Sure, a humorous, satirical diatribe can relieve stress, but that’s not what I’m talking about). Cynicism is a thief. And it’s the hallmark of a very, very injured person. And this saddens me.

When I see true cynicism, I see a part of a human that has been really badly burnt. Cauterized, if you will, to stop the bleeding. Bleeding, from the wound of just NOT winning… From the wound of trying with all your might, but going nowhere slowly. From the wound (perhaps) of your best just not meeting the demands of the moment. And so, faced with this on a chronic level, the belief emerges that we are rigged to fail… That succeeding isn’t possible. And that energetic and energized peers are naive, idealistic and have imbibed the KoolAid. The stupid KoolAid :-).

And so we start to see only the darker sides of life… of people… of possibilities.  We may even feel that we know a truth that others don’t know. And, in a sense, there’s truth in this – because non-cynical people won’t and don’t embrace such truths about futility and nihilism and the inevitability of failure. (And thus this is mostly not their experience).

And it’s dangerous.

It’s dangerous, because we give up. Not necessarily consciously. But somewhere deep in our soul, we stop trying, because there’s no point.

  1. Reduced Sense of Professional Efficacy

 Ai, the age-old Loss of Confidence.  I’ve seen it in my clients, and I’ve seen in myself. It seems to creep up out of nowhere.  We go from feeling “in the zone” and “in flow” (on top of our game, and professionally “on fire”), to wondering if we have any value at all… (Or even any grey matter between our ears). Tasks that were previously really effortless suddenly feel profoundly challenging. We second-guess our every move and motive. We become desperately insecure, and genuinely concerned about being exposed as a fraud. I’ve even worked with people who almost appear to have incurred a head injury, through burnout, in the sense that they are literally less capable than they were before (it doesn’t have to last – recovery is possible – but it’s tangible!).

And this is dangerous.

Because, as with all facets of burnout, a little begets a lot, and it spirals, escalates, grows teeth and takes on a life of its own. Confidence is such a precarious issue; “whether you think you can, or you think you can’t you’re right…’.  So truly, perception of performance determines performance, and so on.

DO YOU RELATE? WHAT NOW? Catch it while you can!

 So perhaps you’ve scrolled through my list, and feel settled that you’re mostly actually ok…

But perhaps a little more of this has resonated, than you strictly would like… What now?

Simply REALISING this is a large part of the battle won… It means that you have come up for air sufficiently even to have been “hooked” by this article. The mere fact that you are reading it is useful, and testimony to an inner wisdom that wants to “catch it before it lands”. “Catching it before it lands” is a metaphor I use quite a lot, almost instinctively, in my private practice.  I have a mental image of a ball or bomb or grenade hurtling at a person, but a swift hand manoeuvre managing to literally halt the destruction, in its tracks, through skill and foresight. Perhaps I watch too much fantasy TV, and too little science.

But nonetheless, my reader is emotionally exhausted, cynical, and has lost faith in his/her ability to be professionally excellent.  What now?


 Conventional wisdom says, “take leave”, “take a break” etcetera. And, in some senses, conventional wisdom is correct. However, I have too often worked with people who have activated such a “mental health holiday” for themselves, only to return sluggishly to work, feeling that they are resuming their burnout right where they left it several weeks earlier.  (Think of the common response to “how was your holiday” – “lovely, thank you, but I already feel like I never went”.

So “leave” is not necessarily the answer. But REPLENISHMENT is… Replenishment is finding what people and activities sooth you, and restore your soul, and learning, with discipline, to incorporate these into your normal daily life. Regularly. Always.

Most drug rehabilitation centers teach their patients that, every morning, they should set two goals: a physical one, and a spiritual one, and be sure to attend to both in the course of each waking day. This is useful for many reasons, not the least of which are to have a sense of purpose and accomplishment, and to stay grounded in one’s own process.


What PEOPLES’ company nourishes you, and restores your soul..?

What ACTIVITIES make you feel like you can breathe again, and “come up for air”?

Are you prioritizing a healthy amount of sleep? (I find that SO MANY ISSUES start with a lack of quality sleep, and I’m a firm proponent of the use of whatever reasonable and managed aids assist in getting enough of this very basic human need).

If you are feeling burnt out, rather than taking mindless days off, apply MINDFUL consideration to the replenishment of your soul more regularly. I believe daily journaling, if that’s your thing, would go further to rejuvenate than two weeks at home. Ditto, a regular evening walk with a good friend and confidante… Ditto the practice of meditation, or yoga, or 30 minutes in a boiling bubble bath on a daily basis. Ditto the application of work-life boundaries, or taking 10 minutes at teatime to listen to a podcast or a favorite playlist.

REPLENISHMENT is key. It’s bigger that rest.


In my work with burn(ing) out people, I am very often aware that the initial problem emerged from an issue which clashed with their values. Something happened, and caused them to feel a sense of cognitive dissonance. (Cognitive dissonant is a rather exhausting condition, which involves one’s beliefs and one’s behavior being at odds with each other). Sometimes this can be due to a Serious Issue, like being complicit to fraud or negligence. But often, it’s even the result of a restructure, an organogram shift, or a change in reporting lines. The point is that the change creates an environment which no longer feels “right”, nurturing or peaceful. We know that each individual is driven and motivated fundamentally by one or two guiding “professional values”, and if the environment changes, away from their preference, this can set up an inner angst which, untended, can result in a burnout.

So my advice to burning out people is to assess what the initial point of impact was, that served as a turning point and critical moment in where you now find yourself. My sense is that you would not have to dig too deep… Once you’ve pinpointed this, you may wish to then do some self-work to determine what is, and isn’t possible, within the situation that feels untenable.

Can you live with it? Yes? Then RESOLVE to live with it, and GET ON with living with it…

Does LIVING WITH IT serve a bigger life goal or value for you (like financial/family peace), and should you then FIND A WAY to LIVE WITH IT?

Do you need to find creative strategies to make the environment kinder and more palatable..? Is it perhaps a courageous conversation with key players in your turmoil? A desk change?

My biggest advice in THIS portion is to DO SOMETHING… Not just to let the circumstance and sentiment build and dominate you, as though you were completely at its mercy. We are NEVER completely at its mercy. There is ALWAYS something creative that can be done, to navigate through a precarious situation. And we know that anxiety is reduced by action, and that action is important as it restores our sense of power and agency.