Planet Lance

A Nike commercial in 2001that is a prophecy for Lance’s future 2013

Two things scare me. The first is getting hurt. But that’s not nearly as scary as the second, which is losing.
Lance Armstrong

We are still in the orbit of planet Lance. He is a weighty fellow and, for better or worse, he still attracts us.  Recently the International Swimming Federation banned him from masters’ competition, US Postal is suing him for $40 million, and Hollywood has at least 3 movies about him in the works, with lurid titles such as The Cycle of Lies, Seven Deadly Sins and The Secret Race. The spectacle of his fall from grace is irresistible.

As many know, it all started when the US Antidoping Agency (USADA) website posted its 202 page report. The document was a damning indictment against Armstrong and his legacy. It methodically interviewed everyone in Lance’s circle, and eventually breached Lance’s wall of secrecy. And that, in itself, was not enough. The USADA did not simply dismantle Lance’s wall, they needed an exhausting inventory of each and every brick. Who at USADA did Lance piss off (as only he can), because there is vindictiveness in the report that goes beyond accountability? USADA’s report wasn’t about cleaning up sport, it was a vendetta.

I have to ask – Did hard-core cycling fans deny that performance-enhancing drugs fuelled Lance’s 7 Tour victories, or did they suspect cheating and watch the spectacle anyway?  Professional cycling is a drug culture and the Tour de France, since its inception, has been rife with drugs. Back in the beginning amphetamines and opioids were the drugs du jour.  Anabolics had their day, only to be supplemented by EPO in the 90’s. Now noninvasive tDCS, (trans cranial direct current simulation where you electrically zap the part of the brain that tells the body to slow down, and bypass the redline puke and die stage every racer experiences), is on the horizon. Who knows what the future holds? As long as there is fame and money to be had, as long as races are grueling events that millions watch, there will be cheats and there will be drugs. Almost every top contender in the Tour has been busted. Did anyone think that Lance would be spared?

Whether you love him or hate him there is only one Lance. He has never deviated from whom he is to gain public approval. There was an appetite for a superhero and Lance was glad to oblige. It was a win-win situation – he got to win, we got a hero. We ignored the personality traits he revealed because they were incongruous in the man we wanted to see. Now the winds of public opinion have shifted. Everyone is furious that our Lance Armstrong, (the mythical, super human, heroic version) never existed. USADA has forced us to look at all of Lance and see him as he is, and what we see, unfortunately, has made us unhappy.

Early on, I questioned, Who is Lance Armstrong?  I read his books to find some answers (My conclusion: What a jerk!). Since the start of his meteoric rise, I was at first, awed by his raw talent and his laser- like drive to succeed. These are qualities that I admire.  And, I confess, I stood for hours on the shoulders of Mt Ventoux during the 2009 Tour, just to see him pass. I envied his quick wit and quirky language, his ability to spar with the press, deal with the naysayers, and say something definitive after every Tour stage. He was smart, charismatic and Lance was good TV. I was bewitched, but as time went by, I was no longer fooled. Lance simply could not be that good for that long, because, well, no one is. This is a fact that every cyclist knows. As a doctor, I tend to look for a diagnosis, a pattern of behavior to explain what I see. I paid attention to what Lance revealed in his actions and behavior. In short, I tried to see the whole man and he was quick to reveal his coldness, fury towards those in his crosshairs, strict control of all of those in his service and above all, his monstrous ego. He does what he needs to do, to remain the top dog no matter the price. There has never been room for anyone else in the rarefied atmosphere of planet Lance.

Martha Stout in her book The Sociopath Next Door states that 1 in 25 ordinary Americans are sociopaths with an antisocial personality disorder and what qualifies these individuals is a lack of conscience. She defines a lack of conscience as a state where the individual experiences no feelings of guilt or remorse no matter what they do, no limiting sense of concern. This state leaves the sociopath free to participate in society without being hampered by the fussy concept of right and wrong. If morality is absent and conscience does not come into play, then whatever decision is right for you, is the right solution.  There is a tendency for the public to think sociopaths are criminals but the vast majority is nothing of the sort.  They are ordinary citizens. When they possess great talent, strength or intellect they are our heroes and idols.

In my career I have interacted with many patients who were sociopaths. When an MD is presented with a patient, the Diagnostic and Statistical Manual of Mental Disorders (or DSM: fifth revision) helps to classify the difficult personality. The DSM-5 lists 5 personality types and gives criteria for each. For example, the antisocial personality type requires the individual to display a trait from each of the ABCD categories below.

  • A Criteria is defined as either; Egocentrism, (self esteem derived from personal gain, power or pleasure) OR goal setting based on personal gratification, absence of internal standards associated with culturally normal ethical behavior



  • B Criteria is either a lack of remorse OR exploitation as a primary means of relating to others, including by deceit or coercion, the use of dominance or intimidation to control others



  • C Criteria is a personality showing antagonism either by;


  1. 1.     Manipulation (frequent use of subterfuge to influence or control others, use of seduction, charm or glibness or ingratiation to achieve ones ends) or
  2. 2.     Deceitfulness –dishonesty and fraudulence, misrepresentation of oneself,
  3. 3.     Callousness –lack of guilt or remorse about the negative effects of ones actions on others, aggression or
  4. 4.     Hostility –persistent or frequent angry feelings, anger or irritability in response to minor slights and insults; mean, nasty or vengeful behavior



D Criteria includes irresponsibility, impulsivity or risk taking behaviors

 Robert Hare, at the University of British Columbia, concurs that the Antisocial personality may be valued for audacious leadership, and that these individuals are adaptive to a highly competitive environment because they gets results for the individual or/ and the corporations who employ them. Often these individuals will cause long term harm, both to their co workers and the organization as a whole, due to their manipulative, deceitful, abusive and fraudulent behavior. Hare describes this personality as intra- species predators who use charm, manipulation, and intimidation among other things, to satisfy their personal needs. Because they lack conscience and empathy, there is no guilt or remorse. Further, Martha Stout states that the best way to identify such a person is that they will always seek our sympathy and often unwittingly, we forgive.

 Lance has the criteria for this diagnosis. He has never hidden from us. He was always in full view. We just did not want to see him. The characteristics of his personality that made the USADA want to vilify him, to make him pay, are also the ones that have made him iconic. Lance Armstrong is one of the most fascinating figures in modern sport. He is the guy who beat the odds with cancer only to comeback from near death to win the most difficult sporting event in the world, not once, but seven times. He never quits, gives in, or admits defeat. He put flesh on the American dream.  We like that. He dominated his sport utterly, completely, and ruthlessly because that is his personality. We pretend to like that, but now, not so much.

Some may ask: What happens for Lance now? He will do as he has always done. He will keep his yellow jerseys because, as he will justify, everyone else on the podium with him and beyond has been caught doping at some time or other. Victory sustains him, and he will perform and beat everyone for as long as he can, even if it is just in a pool training session. He will reinvent himself, write another book and do personal appearances. Now we will come for his notoriety, or our curiosity. Others will come because he is charismatic, smart, a good speaker and he came back from cancer to win seven Tours. Although he won’t ask for sympathy, time will be the balm that leads us to forget and perhaps, forgive.


Chocolate as Food for Thought


The First Thinker…


Thinking about chocolate

The Aztecs used it to enhance strength in their warriors; the Spanish viewed it as a cure-all, and hid it from the rest of Europe for a hundred years; the 17th century British physician Dr. William Hughes thought it useful in pregnancy “since it nourishes the embryo and prevents fainting fits”; Thomas Jefferson sang it’s praises and the Swedish taxonomist Carl Linnaeus named it Theobroma Cacao (food of the gods). Yes, I’m referring of course to, chocolate.

In its base form, cacao powder is rather bitter, but once sugar and a few other goodies are added, chocolate becomes less a medicinal elixir and more the delicious and rather addictive confectionary we know it as today.  What can we say about its purported medicinal properties? We know that cocoa products are rich in flavonoids – antioxidants – that may be beneficial to overall health. Does that translate into tangible benefits? A new paper in the New England Journal of Medicine suggests the answer may be yes!

In his paper Chocolate Consumption, Cognitive Function, and Nobel Laureates, Dr. Franz Messerli reports a rather curious correlation between a country’s chocolate consumption and its ability to produce Nobel laureates. The Swiss, as one would expect, lead the pack in both chocolate consumption (a whopping 12 KG per person per year) and, somewhat less predictably, in Nobel laureates (34 per 10 million population). The Danes aren’t far behind. Canada’s chocolate consumption on the other hand, is a mere 4 KG per person per year and we, lamentably; produce a correspondingly low number of Nobel laureates at only 6 per 10 million population.  Dr. Messerli’s paper, it should be noted, was delivered somewhat tongue-in-cheek, but there exists an undeniably strong correlation between the two variables.

So what is going on here? Does eating generous quantities of chocolate boost brainpower? There has been some suggestion that flavonoids (also found in green tea, red wine and some fruits and vegetables) improve blood flow and may therefore improve cognitive ability among other health benefits.  A 2009 article in the Journal of Nutrition, suggests a strong correlation between brain function, as measured by a battery of cognitive tests, and the intake of flavonoids in the diet. So how does that relate to Nobel laureates?  Perhaps smart people just like to eat chocolate, or maybe the Swiss produce Nobel laureates because of some other reason and their enthusiastic chocolate consumption is a coincidence – just something they like to do.

The bottom line is chocolate, particularly dark chocolate (without too much added sugar), along with other flavonoids, can be part of a healthy diet when consumed in moderation. Be wary of the calories though – one ounce of dark chocolate packs about 150 calories, which, for the average person, would require about 1 ½ miles or 30 minutes of walking to burn off. Also, beware of highly sweetened chocolate or candy bars as they are more likely to enhance your waistline than your brainpower. Even if eating chocolate doesn’t increase your odds of winning a Nobel Prize, it might just put a smile on your face and that is a prize unto itself.

Rum Balls: My favorite chocolate recipe…I usually make these as a double batch and give away on trays at Christmas, or I freeze them, separated in layers, in cookie tins. When I have company I remove enough to fill a plate and serve with fruit . They last all year in the freezer.

12 oz. semi sweet chocolate chips, melted in microwave at 50% power

½ cup almond paste, crumbled into small bits

1-cup sour cream

8 cups graham wafers, ground up in food processor

3 cups icing sugar

2/3-cup cocoa

1 1/2 cups white rum

1 ½ cups melted butter

2 cups pecans ground in food processor

1 tsp. salt

chocolate shot(round balls)  or vermicelli(rod shaped). I like these better as are softer.

Combine all the wet stuff in one bowl, e.g. melted chocolate, butter, sour cream, rum, almond paste. Stir into wet slurry.

Combine all the dry stuff in a bigger bowl. I use a big plastic ice cream bucket with a lid.

Mix the wet into the dry to form a gooey paste.

Refrigerate till firm or overnight, covered.

Use a tbsp. to get an amount of the mixture and roll it into a ball. I put Pam on my hands to stop it from sticking as it warms. If you get it on your hands, scrape it off and put back into the dough.

Roll the ball in the chocolate shot. You can use ground-toasted pecans if you prefer.

Assemble on trays in small decorative paper cupcake liners or put in cookie tins in layers with saran/wax paper in between and freeze.

(adapted from Diane Clement)