If you consider yourself a divinity, a deity, a godlike entity replete with genius and brilliance and the reification of perfection, in all likelihood, you are a narcissist and you suffer from a cognitive distortion, delusional in nature, known as grandiosity. That is, of course, unless you're a pharaoh or a Roman emperor or Jesus Christ himself. In all other cases, you'd better see a therapist. So grandiosity is a way, a method, a strategy, a mechanism to falsify the world, to falsify or reframe the perception of reality so that it conforms to the narcissist's inflated, fantastic, self-aggrandizing self-image and self-perception. Narcissist believes himself to be all these things because he is trying to compensate for a brittle, fragile, vulnerable state of mind. But grandiosity is only one cognitive distortion of many. Narcissist's reality testing is totally compromised and impaired. Narcissists are no longer with us. They are in a fantastic paracosm. They have gravitated and emigrated to a realm to which none of us has access, luckily for you. And the narcissist suffers from multiple cognitive distortions but also from multiple biases. And today I'm going to discuss two or three of them. There are many, many others. And you can search my channel. I have discussed other distortions and biases in other videos. But let us today deal with a few more. Start with what is known as the recency bias. Human memory is fallible. We all make mistakes. We all commit errors when we try to revisit the past in our minds. Actually science says that there's no such thing as memory. What happens is, when we are asked to remember something, we put together hastily all kinds of elements, emotions and smells and images. We put them together and we concoct a memory. That's why eyewitness memory and personal recall and autobiography are not reliable. Not reliable at all. So we are all fallible, as I said. We all make mistakes. And one of these mistakes is that we experience current problems more acutely than past problems. We recall past difficulties, past crises, past vicissitudes, past problematics. We recall them as if they were less onerous, less challenging, less taxing, less demanding than the problems we are faced with today. So there is a waiting error. There's an error in assigning weights to the past and to the present. The present has a larger weight than the past. And a problem in the past would look minuscule, small, manageable, compared to the very same problem in the present. We tend to think better of experiences in retrospect. We are, in other words, nostalgic. We tend to idealize the past and to devalue the present. And this is known as recency bias. When you see make America great again, this yearning for the supposed good old days, that's a recency bias. Now it's a cognitive bias and it favors recent events over historic ones. Favors them not necessarily positively. It simply regards them as more pertinent, stronger, more intense, more relevant, and so on and so forth. It's, in short, a memory bias. A greater importance is assigned to a recent event than to a previous event or to an event in the past. Now this should not be confused with other types of biases, which I will discuss momentarily, like anchoring and recency effect and so on and so forth, although recency bias is related to what is known as a serial position effect or the recency effect. Again I will discuss it in a minute. It's also not related to the recency illusion, which again I'm going to discuss momentarily. While all people, normal and healthy people, and even people with mental health issues, all people have a recency bias which is common to all humanity. All people tend to regard the past as more benign than the present, even if they say otherwise by the way. Psychological tests and experiments and studies have demonstrated that even when people say the past was much worse than the present, actually they assign an emotional weight to the past that is affirmative, that is positive, they are nostalgic, they hark back to olden times. The narcissist is the only exception, as usual, whereas most people regard the past as more positive than the present, the narcissist regards the past as way more negative than any possible present or future. The narcissist has a reverse recency bias. The old days are bad, the old days are challenging, the old days were humiliating, the old days were horrible and evil and wicked and the old days are best-gun and the narcissist needs to falsify reality this way because it supports his victimhood stunts. The old days are the days that gave rise to the narcissist's victimhood. He has been victimized in the past. In order to claim victimhood in the present, the narcissist needs to cast the past as a period of victimization, of abuse, of maltreatment and mistreatment, of discrimination, of hatred and mitigated hatred towards him, of the envy of others and so on and so forth. The narcissist needs to paint the past as a period in which he has been the target of malign intent, malicious designs and malevolent actions. So the narcissist is her reverse recency bias because he needs to consider himself a victim. The narcissist's world of narrative is a morality play. The narcissist, like any mythical hero, overcomes ostensibly insurmountable obstacles and prevails from zero to hero. The good, which is the narcissist, the good prevails over evil. There's a victory here. There's a triumphant storyline to enhance, to amplify, to emphasize the enormousness of this victory, the miraculousness of this triumph. The narcissist needs to really exaggerate the evils of the past. How he fell prey to predators and evildoers and schemers and cunning people and psychopaths and so on and so forth. So he paints the past as a very dark period with no redeeming feature. And having survived it, he acquires the etiquette. He acquires the label of a survivor and a victim. This not only supports his victimhood status, his victimhood claims and grievances, but it also renders him a superhuman hero, a superhero. Okay, so there's a reverse recency bias in narcissism. This is also common among people whose identity consists of their victimhood. People who regard victimhood as a form of identity, identity politics maybe.  Fight with other victims, elevate themselves above their abuses morally and otherwise.  People whose victimhood defines them, directs them, guides them, imbues their life with meaning, serves to explain their personal history. These kind of people also suffer a reverse recency bias where the past is all bad and then there's a period of triumph and prevailing and then there's a present and in the present there's a victim, but a victim who is also endowed with superhuman qualities. For example, super empathy among the empath community. Empaths are of course covert narcissists. Another example of a bias is the anchoring effect. The anchoring effect is when you judge or decide something based on a reference point or an anchor and the reference point or anchor could be completely irrelevant. Completely irrelevant. When you're given a piece of information and you're given some data you would tend naturally to compare other data to the data that you already possess. The data that you possess provide you with a sense of safety, stability, orientation. You can navigate. It's like a compass. So you would tend to compare all future incoming data to the data that you already possess. You already have. This would massively influence your decision-making process, the choices that you alight on. This is known as anchoring. So for example, if you want to buy a car you would compare the price of the car to the price of another car next to it. And if the price of the car you are contemplating is lower than the price of the car next to it, you would automatically, reflexively consider the second car cheap. This is an example of an anchoring bias. And this applies not only of course to numbers such as prices or it applies to other types of data and information, historical data, gossip, rumors, conspiracy theories and so on so forth. There is anchoring is a basic feature of human cognition. We tend to latch onto information we already have as an island of stability around which we can construct a fortress to cope with the roiling oceans of the unknown, more or less. That's more or less a definition of anchoring. The narcissist suffers from extreme anchoring bias. Anchoring is very problematic because it distorts and deforms the perception of reality in ways which are insidious and very difficult to discern. Now the narcissist is anchoring all his behaviors and especially his self-valuation. The narcissist anchors his self-perception, self-image in a way that is biased. So he would use specific data, he would select specific data from the environment to allow him to compare himself to this data in ways which affirm and buttress and uphold and support his grandiose inflated self-image. Narcissists engage therefore in what I would call selective anchoring bias. They don't react just to any random piece of data. They react to selected groups of information and they choose this information so as to aggrandize themselves. It's kind of relative positioning, kind of elevating yourself by comparison. Now anchoring is one of the mechanisms in operation during the devaluation phase when the narcissist compares himself to you, the devalued persecretary object and feels superior. But narcissists always feel superior to others. They always believe themselves to be supreme in the top echelon. So they are always engaged in anchoring, they always compare and they always compare favorably to themselves and unfavorably to others. And this anchoring bias is at the core of the cognitive distortion of grandiosity. It distorts reality and this distortion is what we call grandiosity. In short we could say that grandiosity is a form of anchoring bias but much more complex because grandiosity includes not only an anchoring bias but other biases. Grandiosity is a compendium of biases in effect. So the narcissist goes around comparing himself all the time to other people. Comparing his accomplishments to other people's accomplishments, comparing his situations to other people's situations etc. Always comparing. It's a comparison machine all the time.  It's the same with the narcissist, he collects virtual likes in his mind and he positions himself all the time. This comparison allows the narcissist to convince himself of his own perfection and genius and brilliance and omniscience and omnipotence and so on and so forth. Of course if you choose a low enough benchmark anyone would be a genius. Anyone would be more accomplished and so on. And this is what the narcissist does in his anchoring, selective anchoring bias. He chooses benchmarks that aggrandize him, makes him look good in comparison. And he would tend, for example, to socialize with people who are much less intelligent than him, much less good-looking than him, much less accomplished than him. So as to feel superior, he would tend to surround himself with the yes men and otherwise intellectually challenge the dubious people. He would always create environments which would allow him to engage in positive anchoring in saying to himself, compared to this anchor, compared to this piece of information, compared to this person, I'm God-like, I'm definitely God-like, no question about it. Anchoring is a serious problem, serious distortion of reality. It allows you to mis-perceive even ostensibly objective things like the price of a car or the orbit of the planet of Mars. There was an experiment by Sherif and others in 1958, there's assimilation and effects of anchoring stimuli on judgments and they demonstrated how people misjudge the orbit of Mars because they compare it to the orbit of Earth. So it could lead to serious problems in judgment and appraisal and evaluation, even in the sciences. In the case of the Nazis, there's only anchoring bias, like anchoring bias is always on, together with all the other biases. The Recency Illusion is the belief or the impression that something you've just learned is recent, it's new. It's new to you, but you would tend to assume or to think or to believe that it's new period. Since you haven't heard of it before, it must be new. And this is known as the Recency Illusion. This is a term coined by Arnold Swicky, he was a linguist and he dealt with language and so on and so on, but he defined it as the belief that things you have noticed only recently are in fact recent. And this is created, this is an outcome of something known as selective attention. Now the Nazis does this a lot. He comes up with an idea so he says it's a new idea, no one has thought about this idea before, or he learns something and then he goes around and he says, I am super updated, I'm cutting edge, I'm bleeding edge, I've just learned this amazing, totally new concept. I'm a harbinger, I'm a pioneer, even though the concept he has just learned is 58 years old or something. So there is a time distortion here, all these biases involve time distortions. There's a time distortion here.  Everything that crosses the narcissist mind must be new, as the narcissist is an engine of innovation and a genius of transformation. So anything, even the most mundane pedestrian thoughts of the narcissist are treasures, precious things that should be valued and recorded for posterity. And so there is this recency illusion. The narcissist also likes to consider himself as super up to date, a constant pioneer, someone who shows the way to others, someone who engages in what is known as creative destruction, creative disruption, an innovator, an inventor, an explorer, a leader, a guide, a mentor, a guru, and so on. So anything the narcissist learns, he would tend to ascribe to the recent past. He would say, this is so new, no one has heard of it. So I'm the one who is teaching everyone else about this new concept. Even though I have not invented it, even though I'm not the one who came up with it, I am the one who is popularizing it. I am the one who is educating and edifying and teaching everyone.  It's the first time. He is the inventor. He is the discoverer. And so the narcissist lies to himself and to others about all kinds of ideas and concepts and theories and theorems and discoveries and claims that they're his, that he came up with them when, in effect, he picked them up somewhere. He picked them up from other people, he picked them up from the internet, he picked them up from books, he read while he was a child, he picked up things and then he recycles them and he claims that they're his. He came up, it's his concept, his idea, his invention, his theory. And so this is the recency illusion. The serial position effect is a tendency to recall the first and the last items in a series, but the first and the last items are recalled the best. Because vividly, while anything in between and everything in between is vaguely remembered and this is known as a serial position effect. This was first described by Herman Ebbinghaus. He performed studies on himself and later on others and he found out to his amazement that recall accuracy varies as a function of the item's position in a list. He found out that the first item on release, the last one, he remembered clearly, unequivocally, but he was not quite sure about the items in between and this is called free recall. This ties in with the recency effect and ties in with something called the primacy effect. But coming back to narcissism. The narcissist would try to position himself as either the last or the first. I am the first to have done this, I am the first to have come up with it, I am the first to have thought about this, I am the first to have innovated, I am the first to have used this method or process, I am the first. Or he would position himself as the culmination, as the epitome, as the last item on the list, beyond which there is no need to proceed. He would position himself as the compendium of everything that came before him. It's a little reminiscent of Islam where the messenger Muhammad says that he is the last of a line, there is a line of prophets and he is the last and there will be no other prophet or messenger after him. He concludes the list, he closes the list. So narcissists do the same, they say, I am the last, in me reside all my predecessors, all their knowledge, all their discoveries, all their experience, all their wisdom are deposited in me, I am the repository of all these things and so I am the culmination and reification and representation and embodiment of everything that came before me. Or I am the pioneer, I am the first, there hasn't been anyone before me who has been doing this, etc. I initiated the whole thing, I started the whole thing and that is a serial position effect bias of the narcissist. As you see, narcissists have a very convoluted and conflicted relationship with time and with truth and when they combine the two, they distort reality, they distort the perception of time and then they derive from these distortions and from these biases information that they claim to be the truth. You see where the problem arises, you see why narcissists are widely considered wrongly as liars. They are not liars, they are confabulators and they suffer from enormous cognitive biases. They don't perceive reality the way you do. As far as they are concerned, their fantasies are totally real. Every thought, every idea that crosses their mind must be real. Why? Because it crossed their mind that they are Godlike. They are infallible, they never make mistakes. So if anything crosses a narcissist's mind, it must be true. And so there's a situation here where the narcissist constantly shapeshifts himself and reality and himself in relation to reality, recasts the past in order to emphasize the present and then falsifies the present in order to conform to a grandiose self-image and it's a mess. It's a mess. You can't reverse engineer the narcissist's process of thinking because it doesn't lead anywhere and it doesn't start anywhere. It's a reflexive reaction to the need to reframe reality, falsify history and recast the present in order to support a totally imaginary, fantastic, fictitious, grandiose self-narrity, known as the false self and because it's false, because it's fantastic, because it's a paracosm, because it's a movie, essentially. You can't expect veracity, it's not a documentary, Naz's life is not a documentary. It's a feature film and as you would not expect to study history from a feature film, you would not expect to study, not expect to learn anything meaningful about the narcissist from the way he talks or reports about his life, about his past, about his accomplishments, about his thoughts, about his ideas, about his goals. None of this is true, not in the malevolent or malicious sense of lying, there's no lying here. None of it is true because all of it is rewritten and reframed, a little like the Communist Party in Russia that used to brush out or retouch personalities from editions of the Bolshoi encyclopedia. The narcissist rewrites the same book time and again and again and no edition is similar to the previous one.


And so what I have to say is really not new. In fact, I'll be mentioning things that others have discussed in a lot more detail during earlier talks. But I hope that by offering what might be considered something of a consumer perspective, I can help synthesize and integrate what we've been hearing about today into the larger picture of our knowledge of how genetics and environmental factors contributed to human health and disease. Now this is a slide from the Department of Energy's public slide gallery, which was made available early on in the Human Genome Project. And the title says, Gene Chips Reveals Susceptibilities. If only it were that easy, because what they really reveal is data. And through by-dent of effort and cleverness and high technology, we can transform those data into information. This is the very same image that Teri showed earlier of results of a genome-wide association study in type 2 diabetes. But we don't really want information either. We really want is knowledge, and this is what's being touted as the key to personalized medicine. So where's the knowledge? That's what we really want. Right now, what we mostly have is a lot of data. We have more data than any other thing. We have more data than information, and certainly more than we have knowledge. So in trying to offer some comments on synthesizing and integrating the results of genome-wide association studies, I'm going to first review a little bit of the experience in replicating genetics associations in general. And in doing so, I'll make a contrast in the aims of such studies between identifying novel associations and measuring their effects and populations and mention a few methodologic issues that pertain to genome-wide associations. Then I'll describe some network approaches, many of which have already been discussed in great detail by other speakers. I'll focus on the Human Genome Epidemiology Network, which is a network of epidemiologists actually, and is the one that I work on, and I'll give a few other examples. And finally, I'm going to discuss two important results that are well known as success stories in genetic association studies to try to show how the results of candidate gene and genome-wide association studies can fit together. So thanks to that wonderful scientific resource PubMed, we can actually monitor the growth of science in this area. And these data are from a database that we have produced from PubMed on an ongoing basis since 2001 by conducting a sweep weekly of the new scientific publications added to the PubMed database and identifying the ones that are genetic association studies, mostly of unrelated persons. And you can see that the number of published gene disease association studies has grown tremendously just over the last five or six years to the point that we now have over 5,000 such publications entered into PubMed annually. Studies of genetic association that actually examine some other factor from the environment have grown at a much slower pace. Those are in green, the green subset. And then there's also a small but growing number of meta-analyses to synthesize the results of these candidate gene association studies. Now, as early as 2001, it was clear that there were problems in replicating the results of genetic association studies of candidate genes, and this is a rather famous graphic from a paper by John Ioannidis that was published in Nature Genetics in 2001 showing that often the first publication of a particular gene disease association had the most extreme outcome or odds ratio, and that over time, as the same association was studied by other investigators, the effect tended to converge either to a very small or to a null result. And John Ioannidis called this the Proteus Phenomenon after the Greek god who could metamorphose himself into many different shapes. And so basically, you know, there's been a lot of jousting with results of these scattered, non-replicating genetic association studies. And in this article John, who has written extensively on the topic, recommended a systematic approach using meta-analysis. Now, around the same time, we established what is known as the Human Genome Epidemiology, or huge net collaboration, which now has four coordinating centers. In addition to the one at CDC, there's a huge net Canada headquarters at the University of Ottawa, also in Cambridge, the UK, and the University of Ioannida for obvious reasons. And the main functions of this particular network are the published literature scan and review that I mentioned, the production of systematic reviews, methodologic work to strengthen reporting of associations, and also to promotion of network collaboration. And just a schematic to show how we have pursued this. I have here something that's a figure that was published in January 2006 in a commentary that described our approach. And the first workshop that we had to discuss this model was to focus on a network of networks, which I'll describe in a minute. That was in November of 2005. Since then, we've had others that, first of all, devised standardized procedures for reviewing and conducting meta-analysis of such associations. There's an online handbook that was published in 2006, and an addendum is being developed currently for genome-wide associations, a result of genome-wide association studies. I mean, a workshop last summer in Canada focused on strengthening the reporting of genetic associations with some guidance. Last fall, there was another group that met to discuss. This says grading, but basically the evaluation of evidence for an association. And in Atlanta next year, we hope to gather people back together to discuss this model and the body of evidence today. Now, reasons why replication of genetic associations has been challenging can be divided roughly into three categories. First of all, there's heterogeneity that we've discussed quite a bit already today. And there are many different reasons why heterogeneity may occur within the context of different studies, including differences in phenotypic measures, perhaps differences in true differences in underlying genetic factors. But there are also many unmeasured factors, including exposures that might play an important role. The second major category has to do with statistical uncertainty, and basically the usual problems, including type I error, which can occur just based on sampling variability when many, many comparisons are made, and also the problem of low power, which many of the early studies were quite small. And even genome-wide association studies may be too small to detect small effects. And this is another reason that's already been presented for pooling data and collaborating and analysis. And finally, there are biases that can affect the results, including all the usual epidemiologic biases, and perhaps particularly important in this field, publication bias, where another very likely explanation for this protease phenomenon is that positive results are, especially initially, are much more likely to be published than those that are negative. So how do these concerns differ when we're talking about genome-wide association studies? They're still, the same problems are still there. There are perhaps a few advantages here and there, and additional kinds of information one can use to get at some of them. For example, as has already been discussed quite extensively here, we can address at least one of the unmeasured factors, which is the different genetic background, especially among different ethnic groups that could result in population stratification. With respect to sampling variability, a number of statistical techniques are being explored for addressing this. And in terms of low power, there's the use of meta-analysis that David Hunter already showed several large ones, and the use of prior information from candidate genes, which can be used to inform the analysis. Now, we still have all the usual epidemiologic biases, but to the extent that the data collection methods and protocols can be made available for other investigators to peruse, the greater transparency can at least provide insight into what those biases might be. So having that kind of information available, for example, in the dbGaP resource, along with the study data, really has great potential to address, at least provide some information to address the problem. Publication bias, of course, still remains a problem. Although by enhancing access to data, as has just been discussed through either dbGaP or other data sharing mechanisms, people will be able to perhaps interrogate these other sources for the same association and demonstrate variation in the results of that. So as I mentioned, our particular network has done some work in the area of systematic reviews and meta-analysis and has made this handbook for systematic reviews available online. I'm providing the CDC link, although it actually resides on the University of Ottawa website. We also maintain a database of systematic reviews and meta-analyses, which we currently have sponsored about 50 such reviews that are published in collaboration with about 10 journals that allow us to publish those reviews simultaneously online. And we also have a citation database of about 550 meta-analyses that have been conducted so far. Also in progress are some guidance for reporting association data and publications, and as I mentioned, criteria for evaluating the evidence. And more information about all of these things can be found on the huge-net website. So is synthesizing information from genome-wide association studies any different from that and collected in candidate gene studies? Well, one thing to mention, I think, is that the priorities of such studies may differ. I mean, an important goal of the genome-wide association studies is to identify novel associations. Whereas at least now a predominant goal of candidate gene studies is to measure the size of the effect. Now, in principle, you know, both approaches can be used for both things, but currently a lot of the excitement about the genome-wide association study results stems from the discovery of novel associations that remain to be tested. Most differences between these types of studies are really a matter of degree. We still have to consider type one error. We have to consider type two errors. We still have the issue of harmonization among studies, especially of phenotypic information. Also among different genotyping platforms, this has already been discussed quite a bit, and there are methods to deal with all of these things. Likewise, population stratification is still an issue. So the more information is available about each of the studies, the more transparent they are, the better the information obtained from synthesis. So what's the purpose of conducting meta-analysis of data from genome-wide association studies? We've seen some examples. This approach can improve the power to measure small effects, to assess heterogeneity among genome-wide association studies. There are methodological challenges also discussed earlier, such as the use of different genotyping platforms, the harmonization of data, especially when different criteria are used to define phenotype of interest, and also the treatment of replication samples that are within the same genome-wide association study, a phenomenon that is quite typical. But I think, you know, to me anyway, that meta-analysis has its limits. I mean, it's definitely a good way to start, but it really is not the end all of data integration, because it's really only good for synthesizing data in one dimension. So this is just a draft of some proposed evaluation criteria for considering individual gene disease associations, and I guess a proposal rather than guidance. And basically there are five main categories that tend to span not only validity, but I guess to a certain extent utility of the discoveries. And they are effect size, the amount of evidence and replication, protection from bias, biological plausibility, and relevance to health conditions. And really only the first two can be addressed by meta-analysis, and the other things are somewhat subtle in many ways and can't be assessed in any automatic way. So I may have failed to point it out, but at the center of my big wagon wheel image was the expression network of networks. Why network of networks? What's the utility of this approach? Well, the way we think of this as a way to bridge cottage industry with big science, to quote Bob Hoover who talked about this at SCR last year. And a way to, prior to trying to combine everything and one final repository like DBGAP, there's really a great deal that can be done by investigators working together within a particular domain. And we've already heard numerous examples of that, because people who are working on the same problem tend to share not only specific knowledge and for example there are within fields groups that devise phenotypic criteria that can be used to standardize the collection of clinical data and phenotypic data and epidemiologic studies. So there's specific knowledge, there's awareness of current research problems so that the publication of the results provides a feedback mechanism to the research agenda and they tend to share funding sources. So you see for example in the National Cancer Institute which has had a consortium model in place for many years, this network of networks idea is already in place. And in other places, as Andy Singleton mentioned in his talk, you know there are various kinds of consortia and collaborations that can come together for a single purpose in an ad hoc way or for a prolonged collaboration in a research area. And many networks already exist, some of these were mentioned earlier, the first two are NIH sponsored. There are also international collaborations that tend to overlap with some of the NIH funded projects, some are independent. There are big ones like this one on genetic susceptibility to environmental carcinogens but then there are also very small ones, nascent ones that have been formed to address smaller topics such as the pre-bic collaborative to study preterm birth. Okay. Now, here's a crazy network image but I do love it because it shows just what can be done when data are made available. This is actually based on OMIM, a network model that connects genes that have been studied in association with diseases and where associations have been found and the top one is disease centered and the bottom one is gene centered and you can see these are not random. Of course to a certain extent it's looking under the light post phenomenon but there probably are true relations in there and this is based entirely on data and OMIM and was done by physicists by the way. So here's another model of the network that I think is worth showing. It's the ALTS gene database which is embedded in the Alzheimer Research Forum which is a collaborative group to promote research on Alzheimer disease and again the data are obtained by sweeping PubMed for publications and are curated in this database which can also perform online meta-analyses. Lars Bertram at Harvard is the founder and curator of that. Here's the P3G Observatory from Montreal where they are also trying to create a repository of questionnaires and comparison tools that have compiled a number of them from 11 studies in the U.S. and other countries. I think they should connect up with TBGap. So in two minutes I may not have time to tell my tale of two associations. You don't believe me, it's 340. I don't believe you, no. But anyway, okay, I'll hit the buttons fast and you will get an impressionistic image. Okay, so this association between CAR 15 and Crohn's disease is a huge success of the candidate gene era. In 2001 and as we've already heard the complement factor H and age-related macular degeneration is a huge success of the genome-wide association study era. Here's the natural history of the big discovery. The pink is CAR 15. Lots and lots of replications. It's an early success. It has offered key insights into pathogenesis and phenotype but six years later we're not entirely sure how to use this. It hasn't replicated in all populations and it was hoped at the time that it would be useful in identifying patients who could benefit from infliximab which at the time was a big new treatment intervention but it didn't work. However, genome-wide association has been helpful and since I don't have time to discuss it I would suggest that everyone who hasn't looked at this do so. It is a commentary by Lon Cardin following the publication of the IL-23R association with Crohn's disease which shows just how a genome-wide association in combination with candidate gene data can be used to expand the knowledge horizon. This is the macular degeneration. You see CFH dropped on the scene in 2005, been replicated many, many times and there already have been three meta-analyses. Another early success provided great insight into pathogenesis and progression. There's a recent study examining interaction with smoking and BMI. Directions for translation isn't clear. It doesn't currently have any utility for screening and in fact there was no interaction in that same environmental factors study with the treatment assignment and the ARIDS trial although I was very disappointed even though the author said there was no interaction I was very disappointed the data weren't presented. Isn't that the thing you would most want to know? You need to finish up, Marta. Okay, so I won't repeat this. Instead I'm going to use Terry's slide and this, you know, she called it the wave, that's good. Waves can be good or bad. I've heard it called it tsunami. Let's not call it that. It's a rising tide that lifts all boats. That's what we want, right?


I'm Sam Vaknin and I'm the author of Malignant Self-Love, Narcissism Revisited. In a court of law, the narcissist acts convincing. It captivates judge, jury and audience. So how can you expose the lies of the narcissist? Well, you should distinguish the factual pillar from the psychological pillar of any cross-examination of a narcissist or any deposition made by him. It is essential to be equipped with absolutely unequivocal, first-rate, thoroughly authenticated and vouched for information. The reason is that narcissists are superhuman in their capacity to distort reality by offering highly plausible alternative scenarios which feed most of the facts, however damning. It is very easy to break a narcissist, even a well-trained and well-prepared one. But you have to know how to do that. You have to find the chinks in the narcissist's armor. You have to penetrate. You have to inflict pain and to use, to leverage the narcissist's underabilities, frailties, weak spots and underline inferiority complex.  Any statement of fact which seems to contradict his inflated perception of his grandiose self. Any criticism, disagreement, exposure of fake achievements, belittling of talents and skills which the narcissist fantasizes that he possesses. Any hint that he is subordinated, subjugated, controlled, owned or dependent upon a third party. Any description of the narcissist as average, common, indistinguishable from many others, boorish, boring. Any hint that the narcissist is weak, needy, dependent, deficient, slow, not intelligent, naive, gullible, susceptible, not in the know, manipulated, a victim, an average person of mediocre accomplishments. The narcissist is likely to react with rage to all these hints and allusions and allegations and in an effort to reestablish his fantastic grandiosity, he is likely to expose facts and strategies that he had no conscious intention of exposing. The narcissist reacts indignantly with wrath, hatred, aggression or even overt violence to any infringement of what he perceives to be his natural entitlement. Narcissists believe that they are so unique and that their lies are of such cosmic significance that others should defer to their needs and cater to their every whim without a do. The narcissist feels entitled to interact or be treated or questioned only by unique individuals. He resents being doubted and ridiculed by run-of-the-mill advocates or attorneys, let alone by you. An insinuation, hint, intimation or direct declaration that the narcissist is not special at all, that he is average, common, not even sufficiently idiosyncratic to warrant a fleeting interest, all these inflame the narcissist. He holds himself to be omnipotent and omniscient, contradict this and he will unravel. Tell the narcissist that he does not deserve the best treatment, that his desires are not everyone's priority, that he is boring or ignorant, that his needs can be catered to by any common practitioner, medical doctor, accountant, lawyer, psychiatrist, that he and his motives are transparent and can be easily gorged, that he will do what he is told, that his temper tantrums will not be tolerated, that no special concessions will be made to accommodate his inflated sense of self, that he is subject to court procedures like everyone else, etc., and then the narcissist will likely lose control of himself. He will make a public scene. The narcissist believes that he is the cleverest, far above the madding crowd, and the great and most. So contradict him often, disagree with him, criticize his judgment, expose his shortcomings, humiliate him, berate him, tell him you are not as intelligent as you think you are, or who is really behind all this, it takes sophistication which you don't seem to possess, or so you have no formal education. Or you are and then make mistake his age, or make him much older, or what did you do in your life, did you study anything, do you have a degree, did you ever establish or run a business, would you define yourself as a success, or would your children share your view that you are a good father, or you were last seen with a certain this and this, who is a stripper or some other demeaning profession. I know that many of these questions cannot be asked outright in a court of law, but you can insinuate them, you can hurt them at the narcissist during the breaks, inadvertently during the examination of the position phase. You can lose control of yourself and say these things, make sure that he is confronted with these truths, he cannot stomach truth. His whole precariously balanced personality is built on false foundations, on a false self, and on the acceptance of this false self by everyone around him, narcissists hate innuendos even more than they detest direct attacks, good luck.


Well, good morning. I am at the gym. It is raining here in sunny Arizona and we're actually expecting thunderstorms. It is 505 a.m. bootcamp starts at 5 a.m. so clearly that is canceled due to the rain and the thunderstorms but I'm not using that as an excuse not to get my workout in so I just actually pulled into the gym. I'm going to do the elliptical for 30 minutes and I have not done the elliptical in oh gosh six months or more. I am not a structured cardio person. I actually don't do any cardio outside of boot camp. I walk a lot but that's exercise more than it is cardio so I'm going to do structure cardio 30 minutes on the elliptical and then I'm going to do upper body. I was here yesterday doing push motion upper body so today I'm going to do pull motion upper body and get in a strength workout get in some cardio and still get in my workout even though it is raining and boot camp was canceled.  I'll finish that when I get home and get ready for the day. I have a really busy day today I have lots to share with you guys it's gonna be a good day so let's go ahead and head on into the gym and get our workout for the day done. I am home from the gym I just finished up my protein coffee and girls hungry I'm really really hungry I burned quite a few calories at the gym between the elliptical and lifting weight so I'm going to put together some breakfast then we're gonna talk about my outfit. I have a little I bought it so you don't have to situation we're gonna talk about that next but for breakfast this morning I am going to pack in the protein have some healthy carbs and get in my greens for the day so I'm going to do three-quarters of a cup of the good culture cottage cheese a serving is a half of a cup so I'm actually going to do more than that it's 110 grams so I'm going to do 165 grams that way I get in a little bit extra protein and then I'm going to top it with some pineapple this is leftover from my meal prep need to eat this up so I'm going to top it with some pineapple and then I'm going to toast up a Western alternative bagel these are the cinnamon spice there's 8 grams of protein so you can't beat it in a bagel so I'm going to toast this up put a teaspoon of Kerry gold real butter on there and have a bagel alongside my cottage cheese I do have a 10% discount for Western bagel I'll link it down below for you and then I'm going to mix up my greens I actually just got this in the mail I used up all of the motivate peach greens and I just got this new container I have been taking greens every day and have noticed some really outstanding results especially when it comes to my gut and my gut health I don't have that discomfort in my gut anymore I feel like everything flows a little bit more smoother it also helps maintain proper blood sugar throughout the day and just gives you tons of vitamins and minerals and of course gets your greens in every single day so this is the full tub motivate actually has a tangerine and a peach I have them both I like them both I reorder the peach because I do still have some of the tangerine and then they also have these little sample packs or travel packs this is going to come in very handy because I actually have a trip coming up here in a couple of weeks and I'm going to just take these packets with me you get two peach and two tangerine and they are just there are one serving little packet so it's really convenient on the go whether you're traveling or you're someone who's maybe on the go or in the car a lot you can just leave these in your purse in your desk store in your car pop them into your water and you have your daily dose of motivate greens and it's also a great way to try out the peach and the tangerine flavor so I'm going to go ahead and mix up some peach greens with this morning's breakfast and I will link motivate down below I do have a 20% off discount sitewide you know I love motivate I use pretty much everything from them their burn a lot of their supplements and of course their greens so for my greens I'm using my motivate temperature controlled shaker bottle I love this because it has the shaker component in the lid so I just add one scoop of my greens I fill it with water add some ice shake it up and I have my greens for the day so here is my breakfast I have my western bagel at three quarters of a cup of cottage cheese some fresh pineapple this looks so incredibly good I'm going to get in just a ton of protein some fiber some healthy carbs huge win for breakfast so I just finished breakfast and like I said I want to sit down and talk to you about my outfit for the day and I don't know about you but I've been seeing Halara all over Instagram all over YouTube all over Facebook and it has tempted me more than once to pick up a few items from the line and then I always talked myself out of it but I finally decided to pick up a few pieces there is a little top that I have been eyeing for literally about a year and then I've always wanted to try out their dresses because I've heard really really good things about their whole wannabe dress line so I went shopping and I bought a skirt a pair of pants that cute top I've been eyeing and three dresses including the one that I'm wearing today I was curious about the quality is the quality worth the price not that Halara is expensive because it's not and is it going to be a dress a pair of leggings a top a skirt that I can not only wear to work out but can wear in my day to day life I really appreciate a piece that is versatile and I was pleasantly surprised with how many options and how many different pieces they have on the Halara website I really had a good time shopping so I wanted to share with you everything I picked up starting with again the dress that I'm wearing today this is the everyday cloud full backless two-in-one flair workout dress this is one of their wannabe dresses I love this I will say that I order to size large I definitely could a size down to a medium however I do feel like the built-in broad does offer a good amount of support I am not wearing another broad with the dress and I feel like that I'm getting the support that I need the pads are removable and what I really appreciate with the dress is that it has adjustable strap I always have to adjust the straps on my shoulders and what I really really love about it is how easy it is to wear this dress and use the restroom because that is a problem with dresses that have built-in shorts is it's a pain in the you know what to use the restroom and this one actually has a detached waist of the short so that it's easy to keep the dress on use a restroom and be comfortable this particular dress comes in about 10 different colors and all the way up to size 3x so very very size inclusive and all of the pieces came in these little bags I like to show these because I love these for travel I use these for my socks and underwear for what bathing suits they do have the resealable zip closure this dress is buttery soft super super comfortable and then I have to get a dress in pink you know I love Barbie pink you guys are always commenting and saying how good I look in pink so I really appreciate that it's actually one of my favorite colors to wear I love bright bold colors and this is a little different style dress than the green one that I'm wearing this is the cloud full fabric backless two-in-one flare workout dress this one comes in about 20 different colors and all the way up to size 4x now I picked mine up in a size large again it fits me but I definitely could a size down to a medium if you're in between sizes definitely size down and there is a size chart on the Halara website this one also has the kind of cute strappy back it does have removable pads the built-in shorts love that there's a spot for your cell phone your keys whenever I hike to Mamak Mountain or I walk to and from the gym I always have to wear something with pockets so that I can take my phone and take my workout gloves and take my key and I always like to hang out usually take sunscreen or lip balm so I love that this includes the built-in pocket in the shorts that's actually underneath the dress of the skirt so you don't even notice it even if you load the pocket up with your keys and your phone this is so nice and thick and again that really buttery soft material I also very much appreciate the length I am 5' 8' in this dress falls at the perfect length I also love this color you know I love orange and again this is that kind of bright coral color perfect for summer and this is a different style of the wannabe dress I wanted to order three different styles to try them out to see what style I like better in spoiler alert I love all three of them I can't wait to wear them all I actually was thinking this would be the perfect dress to wear to pickleball so I'm going to wear this on Saturday when I go play pickleball again we have the adjustable straps the removable cups the shorts built in with the phone holder and one side note about the shorts is they fit beautifully they're not too tight and they're very very comfortable this is the fabric backless two-in-one flare activity dress longer length wannabe dress this one comes in about 10 different colors and goes up to sizes 3x I just can't get over how smart and genius it is to have a built-in pocket in the shorts and what I also really like about these dresses is because they have that little bit of a flare bottom they're very very figure flattering and they hide everything tummies back fat thighs they hide it all super super flattering and again so incredibly comfortable in something that not only I could wear to work out like pickleball but I would even wear this to the grocery store so this top right here is the one that I've seen all over Instagram ads and on YouTube that has always caught my attention because I think the style of this is so unique and so fun I'm so happy to finally have this in my collection because I truly love it I definitely will be picking up some other colors this is the hooded drawstring cutout casual hoodie it actually it comes in about 10 different shades in regular length and longer length if you don't like the cropped length and it actually goes up to size 4x I love that it has draw strings that it has a hood and I just love this little cut out detail with a sweatshirt vibe it is so battery soft a really nice thick material love this jewel toned red color perfect for fall perfect for the holidays perfect for winter I did get the regular length I think next time I'm going to purchase one in the longer length this kind of sits right at my waist and again I am 5'8 so if you're shorter it'll be a little bit longer but I love this this was like I said this is what had caught my attention from Halara and I'm so happy I bought her and I'm definitely buying a few more and then I grabbed some flare leggings now I don't own any flare leggings and I absolutely loved this crisscross design of these and I love a good flare leg I think it's very flattering especially if you have a little bit bulkier legs the flare leg can really give you that long line tall sleek spelt look I picked my leggings up in a size medium and they are the perfect fit for me they hug just in the right places and they flow beautifully on the legs these are the high-waisted crossover flare yoga leggings they come in about 15 colors in regular and petite and all the way up to a 4x so again I do have mine in a medium like I said they fit beautifully the quality of these mind blown I mean they are so thick and high quality that seems to be the trend with Halara everything I purchased is extremely extremely high quality and again you could wear these to the gym you could wear these a day-to-day you could wear these lounging around the house I absolutely love them and last but not least is the skirt now let me tell you this skirt you guys it is the most flattering comfortable amazing skirt ever and that is this little guy right here this is the color fig so it's kind of this plum purple color this skirt looks so good it literally hides everything this is the high-waisted bodycon side pocket two-in-one mini ruched skirt it comes in about 15 different colors and goes all the way up to a size 4x I am obsessed with the ruching on the side it really really flatters the figure there is built-in shorts again with the pocket which is absolutely amazing and the length of this skirt is perfection I even love the waistband because if you did wear a shorter shirt or crop shirt you would see this waistband and it kind of drops down and gives you that longer torso which is very slimming and very figure flattery now I picked mine up in a large I could have definitely sized down to a medium I wasn't sure how the fit of Halara was and I would say overall it's either true to size or maybe even fits on the big side I can definitely wear this it fits me if I wanted like a little tighter fit I would go with a medium or that bodycon style I'm a hundred percent going to buy some more of these again great for working out great for pickleball tennis walking because it does have the built-in shorts I could wear this to the gym boot camp and again even to the grocery store date night girls night this is so cute and I can't believe how amazing it flatters the figure so overall Halara is pretty incredible I can see myself purchasing several more pieces from the brand I really like the quality for the price just the quality overall is exceptional everything fits absolutely beautifully I will link the Halara website down below I'll link all of the pieces that I shared with you and a 15% discount code so off the already affordable prices you can save an extra 15% I always use codes I don't care whose code it is I'm using a code to save some money but I am beyond impressed and so glad I finally tried out Halara. So in Prompto car ride we are actually headed to Sam's Club it is time for me to do my massive grocery haul go to Sam's Club stock up we ran out of quite a few things just over the last couple of days that are Sam's Club staples and I was looking over my schedule for the week and today is the only day that I'm able to make it to Sam's Club and my coaching call this afternoon had to reschedule so it actually worked out perfectly so I hopped in the car we're going to Sam's Club brought my water with me and a snack it is already 10 30 and I have not had a morning snack and I want to make sure that I eat something enough that will tide me over until I get home I probably will wait till I get home to eat lunch we'll just kind of have to see where the day takes us but I did bring a healthy eating all the time in go bar this is the peanut butter protein bar this actually has 15 grams of protein the ingredients in these bars are clean as clean can be really good macros as well so I'm going to eat this on my way to Sam's Club again hoping that this will tide me over until I can have lunch when I get home or maybe we'll pick something up along the way like I said we'll just see where the day takes us Sam's Club is about a 40 minute drive one way for me it's actually really close to Lola's chemo so I'm going to have my snack I do have a 10% discount for healthy eating I'll link it down below for you and let's go to Sam's Club I don't know if you guys heard that but one of the typical homeless guys I see in this parking lot there's quite a few in the Sam's Club parking lot was asking for money I don't have any cash so I just told him I hope he has a good day had he asked for food I probably would have given him something but speaking of food this is something I like to buy when I come to Sam's Club it's colby jack cheese cheddar cheese these are the little crunch master rice crackers and pepperoni it's just a really good snack you can kind of do a cheese pepperoni cracker vibe so I'm going to have some of these as lunch today it's already after 12 I'm not going to get home until one o'clock and I'm really hungry and I wanted to buy all the snacks at Sam's Club because I'm hungry and I did buy a few snacks but this is going to be my lunch today I'll go ahead and put up here on the screen points calories all the information for you I'm obviously not eating this whole thing I'm going to just have a few crackers few pieces of cheese and a few pieces of pepperoni so Troy and I are about to start cleaning the house and I'm going to make myself a protein shake tide me over before dinner so of course I'm going to use my clean simple eats protein this is actually the chocolate peanut butter cup I really like this one definitely gives me Reese's vibes you can actually add some regular peanut butter or powdered peanut butter to this it'll amp up the protein if you do especially add some powdered peanut butter and really amp up the peanut butter taste I like it just as is so I'm going to do one packet of the clean simple eats chocolate peanut butter protein and then eight ounces or one cup of my fair life chocolate milk and then I throw in a few ice cubes it's amazing it's 33 grams of protein and you guys know how much I love clean simple eats I eat clean simple eats every day in some fashion sometimes multiple times a day so I will go ahead and link it down below with a discount so here's my chocolate peanut butter protein shake topped it with a little bit of whipped cream I'm so excited for this speaking of whipped cream these guys always get whipped cream are you ready oh yeah she can barely wait for it to come out of the container it's almost gone so it like seeps out oh lola for dinner tonight I'm making southern chicken pot pie this is a super super easy recipe so let me show you what you'll need you're going to need an egg light sour cream oregano two cans of low-fat cream of chicken soup a big of frozen mixed vegetables you could probably use canned too shredded chicken puff pastry sheet and an onion so I went ahead and added my entire container of sour cream to a bowl I'm going to add my bag of steamed mixed vegetables two cans of cream of chicken soup one egg oregano I shredded chicken and a small diced up onion and then mix that all together this is the filling for our pot pie I think I'm also going to add some salt and pepper the original recipe said rotisserie chicken which is going to be seasoned I just used unseasoned shredded white chicken from Sprout so I'm going to pop in a little salt and pepper to add some seasoning I went ahead and sprayed a 16 by 9 baking dish with non-stick cooking spray add your chicken pot pie filling I was also going to point out that you could probably use plain non-fat yogurt in place of the sour cream that'll definitely lower the points in calories well maybe not the calories so much but definitely lower the points I thought about that after I use sour cream but I'm okay using sour cream in the pot pie then we are going to take our puffed pastry sheet you could also use a pie crust dough either one would work and we're going to place that right on top go ahead and cut just a few slits in the top just to allow the crust to vent the egg was supposed to be used as a wash not into the chicken pot pie it's fine I added an extra egg a little extra protein so I'm going to take the egg and brush it on top to get that nice golden crust we're putting this into a 400 degree oven for about 30 minutes so the southern chicken pot pie is out of the oven it looks absolutely delicious this entire pan makes only eight servings so let me plate up a serving and I'll be back to share points calories and macros I just plated up a dinner there is one serving again it makes eight servings total all of the information is here on the screen for you it is the end of the night I'm about to go wash my face put my pajamas on I have a night today fiance to catch up on with Lola and I think for dessert tonight I'm going to make a yogurt bowl I've been eating a yogurt bowl every day for a long time I love them and sometimes it's a snack sometimes it's a dessert tonight it's a dessert I want to show you exactly how I put together my yogurt bowl like I said I eat this every day I change it up my yogurt bowl changes every time I eat it I use different toppings I use different fruit I use different yogurt I want to go with like a cinnamon toast kind of vibe tonight so let me flip you down and let's make my dessert on today's what I eat in a day on WW I hope you enjoyed coming along with me today seeing all the good food tonight's dinner recipe was really good kind of that comfort food vibe don't forget to check out Motivate and Halara down below I'll link everything I shared with you today as well as nutrition coaching highly recommend macros and calories this is how I've lost and maintained my 140 pound weight loss as well as one-on-one coaching for accountability or to ask your questions links and discounts to my other favorite things and come join our Facebook group we would love to have you thank you so much for watching friends happy Wednesday and I'll see you in the next one bye