Month: December 2007

Omega-3 and Depression

Seth Roberts2 Comments

From the abstract of a 2003 article titled “A Double-Blind, Placebo-Controlled Study of the Omega-3 Fatty Acid Docosahexaenoic Acid in the Treatment of Major Depression”:

Thirty-six depressed patients were randomly assigned to receive DHA, 2 g/day, or placebo for 6 weeks. Response was defined a priori as a >=50% reduction in the score on the Montgomery-Åsberg Depression Rating Scale. Thirty-five participants were evaluable; 18 received DHA, and 17 received placebo. RESULTS: Response rates were 27.8% in the DHA group and 23.5% in the placebo group. The difference in response rates between groups did not reach statistical significance. CONCLUSIONS: This trial failed to show a significant effect of DHA monotherapy in subjects with major depression.

This study is unusual in that it used DHA rather than EPA. EPA studies have been more successful. Excerpt from an overview:

One meta-analysis combined all the studies involving adults with unipolar or bipolar depression reported above, in which omega-3 fatty acids were used to augment existing treatments or as monotherapy. Best-case and worst-case analyses were carried out, and omega-3 fatty acids were found to produce a statistical improvement compared to placebo under both scenarios (best-case p = 0.02, worst-case p = 0.03). A second review including the same data has also suggested a benefit of omega-3 fatty acids in major depression. However, as the authors of both reviews point out, there is significant heterogeneity among the included trials, and this undermines the reliability of the combined results.

Here is the conclusion from another review article:

Trial evidence that examines the effects of n–3 PUFAs on depressed mood is limited and is difficult to summarize and evaluate because of considerable heterogeneity. The evidence available provides little support for the use of n–3 PUFAs to improve depressed mood.

A weak effect, in other words. I would be surprised if omega-3s helped a lot with depression. My self-experimentation pointed to a different cause of depression — seeing faces too little in the morning and/or too much at night.

The Twilight of Expertise (part 13: ICU doctors)

Seth Roberts2 Comments

The other shoe drops. A year ago Atul Gawande wrote in The New Yorker about the Apgar score, a low-tech measurement of newborn viability that led to vast improvements in obstetrics. That’s the “how to improve?” side of things. Now Gawande has written about something equally simple and powerful on the “here’s how to improve” side of medicine: the use of checklists to improve ICU treatment. The first article was called “The Score”; this one is called “The Checklist”.

Checklists are the idea of Peter Pronovost, an ICU doctor at Johns Hopkins Hospital. His first checklist, in 2001, was designed to prevent infections on tubes inserted into patients. Nurses made sure that doctors followed the checklist. It’s like the Ten Commandments: the top and bottom getting together to improve the behavior of people in the middle. Checklists involved the empowerment of nurses (bottom) by hospital administrators (top) to improve the performance of doctors (middle). No coincidence, I’m sure, that the Apgar score also involved female empowerment: Virginia Apgar was one of the first powerful women in medicine.

Pronovost told Gawande:

The tasks of medical science fall into three buckets. One is understanding disease biology. One is finding effective therapies. And one is insuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.

Not to mention a sick person’s perspective. I completely agree. Several years ago I heard an industrial designer give a talk to an interface design group. He said that new high-tech products go through three stages: (a) used only by gadgeteers and professional engineers (e.g., the first home computers); (b) used by experts (e.g., billing software for lawyers); and (c) mass market (e.g., cell phones). The discipline of engineering, he said, was good at designing for the first two stages but not the third.

The similarities suggest a common explanation. I think one reason goes back to Veblen: It is low status to do useful work. It may also have to do with male dominance of medical research and engineering. When balancing status versus usefulness, men may weigh status more highly.

More innovation in the delivery of medicine: house calls. No kidding. More about Peter Pronovost.

The Value, Not So Hidden, of Blogging

Seth Roberts4 Comments

The evolutionary sequence is:

1. Facial expressions and vocalizations.

2. Language (speech and writing).

3. Blogging.

Each makes clearer to everyone else what is inside us. Human nature being what it is — closely tied to occupational specialization — it should be no surprise that blogging is very useful in getting a job, as Penelope Trunk says. To get a job you need a skill. Your skill is inside you; blogging makes it much more apparent. Blogging shows not only that you have a skill but that you have an emotional attachment, too: Bloggers write about what they care about. Not only does blogging help you get a job, it helps you get a job you want.

There should be software that creates networks of blogs based on similarity. I wish I knew which blogs were most like mine, for example.

Gary Taubes’s Berkeley Talk

Seth Roberts13 Comments

Gary Taubes spoke at Berkeley a few weeks ago; the title of his talk was “The Quality of Calories: What Makes Us Fat and Why No One Seems to Care” (webcast). Did you know that the last edition of Dr. Spock’s baby book advocated a vegan diet? One of many fascinating details. Also this:

There’s a group at the University of Cincinnati that did an Atkins vs. low-fat study and they found that the Atkins people lost twice as much weight and they liked the diet much better. I was interviewing the dietitian who did the study. She had agreed to talk to me but she was very hesitant — she didn’t offer up any information. Finally, at the end of the interview, the one thing she offered freely: I asked her who funded it and she said the American Heart Association.

I said, “Well, I have to give them credit for funding it.”

She said, “Don’t. They funded it because we proposed it as a study that would refute the benefit. And when we found that the Atkins diet really worked and worked better than the low-calorie diet, now we’re trying to get money to look further into it and they won’t give it to us.”

Thanks to Dave Lull.

Golden Handcuffs

Seth Roberts1 Comment

In The Innovator’s Dilemma, Clayton Christensen gives many examples of how industry-leading companies lost their lead, often so badly they went out of business. As I’ve said before, this is something I’ve studied in rats writ large. In a great talk about the beginnings of the PC industry, Mitch Kapor describes meeting Ken Olsen, the CEO of Digital Equipment Corporation (DEC), a $15-billion-sales-per-year company destroyed by the PC.

“Meeting the needs of people who had never previously used computers was the foundation of this entire [PC] industry,” says Kapor. “Even after we [Lotus] had started to become successful, this was still not clear to some people.” This is what Christensen says, too: Disruptive innovations begin downmarket, among users not previously thought worthy of notice. For example, hydraulic-powered shovels started in sizes appropriate for digging ditches. The pattern Christensen saw was that the industry-leading companies ignored this market until it was too late. DEC was no exception. Olsen wanted to meet Kapor, who was flown by DEC helicopter to DEC headquarters. When they met, Olsen complained for 15 minutes about the flimsiness of the PC case.

“The stuff that made him smart was the stuff that was now making him incredibly dumb,” says Kapor. “They didn’t understand that they needed to stop doing all the things that had made them successful in order to have a chance to succeed.” I would put it differently. Our experiments with rats made one thing clear: The more successful you are — and DEC was very successful — the harder it is to try new ways of doing things.

Comment on another Kapor talk.

The Power of Prayer

Seth Roberts5 Comments

From Nassim Taleb:

I truly believe that it was rational to resort to prayers in place of doctors: consider the track record. The risk of death effectively increased after a visit to the doctor. Sadly, this continued well into our era: the break-even did not come until early in the 20th Century. Which effectively means that going to the priest, to Lourdes, Fatima, or (in Syria), Saydnaya, aside from the mental benefits, provided a protection against the risks of exposure to the expert problem. Religion was at least neutral –and it could only be beneficial if it got you away from the doctor.

This gives placebo effect a whole new meaning. And it defends religion in a new and reasonable way.

A belief similar to Taleb’s is why I began the long-lasting self-experimentation that led to my paper “ Self-experimentation as a source of new ideas“: I didn’t want to see a doctor about my sleep problem (I awoke too early in the morning and couldn’t fall back asleep). I was sure that what the doctor would prescribe (sleeping pills) would do more harm than good.

Everyday Humor (part 1)

Seth Roberts1 Comment

I returned vol. 3 of Not Only the Best of the Larry Sanders Show to my public library but forgot to include the DVD. I got a phone call about it. I returned with the DVD, which I had put in a paper envelope.

Here it is, I said. As I was leaving, the librarian asked if I wanted my envelope back. “In case this happens again,” she said. Everyone laughed.

Type of joke: veiled not-serious deprecation.

Blood donation, weight loss, and humor. More on humor.

Everyday Hedonics

Seth Roberts3 Comments

Conversation on a Berkeley lawn:

Andrew Gelman: You’d think we prefer an upward spike in pleasure — we’re happier for a while, then return to normal — to a downward one, but the evidence isn’t clear.

Seth: I know someone who woke himself up so he could enjoy falling asleep.

Andrew: Really?

Seth: Yes, really.

Andrew: Was that you?

Seth: No, it wasn’t me.

Andrew: If I heard about someone doing that, I’d think it was you.

Phil Price: That’s brilliant, actually.

Leonard Mlodinow, author of Euclid’s Window (about geometry), Feynman’s Rainbow, and a forthcoming book on probability and chance, and co-author with Stephen Hawking of A Briefer History of Time, was the brilliant sleeper. (Not Montaigne.) He might have woken himself up while he was a grad student at Berkeley (in physics). After Berkeley, he became an assistant professor of physics at Caltech. He left Caltech to become a writer. As unorthodox in a big way as waking yourself up so that you can fall asleep is in a small way.

Jane Jacobs and Art

Seth Roberts2 Comments

painting of big flat building

The Cleveland painter Michelle Muldrow was a musician for ten years before becoming a painter — although she got a BFA (Bachelor of Fine Arts) before that. From an unusual background, an unusual creative process:

Interviewer: Describe your working process when creating a new work.

MM: Usually I begin reading about environmental issues, urban development, really anything touching on the subjects of land use, as well American history and fiction. I guess I sort of consider myself a sponge at the beginning stages of work, then usually some travel helps and I take tons of source photos. From there I organize my photos into different obsessions, be it the artificial horticulture and landscaping in the modern developments, or the death of inner ring suburbs, subdivisions, etc, at that point I look for what I am most interested in painting. It’s sort of like all my intellectual obsessions still must go through a filter of how I feel, and that is an important element to my work- nostalgia. I suppose I attribute that to the rootlessness of my childhood, I am always trying to make sense of my landscape and home. Then I begin the body of my work. I tend to approach my work as a series or body rather than as individual images. I always prep, underpaint and paint at least 4-5 paintings all at once, never one at a time. I freehand draw, then do a monochromatic underpainting, and from there, I paint.

Painting, in other words, resembles blogging: You can blog about anything, you can paint anything — so long as you care about it.

One of her favorite writers is Jane Jacobs. She used to live in San Francisco, where there seemed to be no upper limit on the value of property. In Cleveland, with boarded-up homes everywhere, there seems to be no lower limit.

painting titled LA Wires