In this case, Weiss says what he really thinks by repeating what someone told him:
She can never bring these ideas up with her Jewish relations, they go haywire. She never talks about these ideas in company.
But Weiss can express them without breaking a sweat. This is amazing.
Speaking of empowering patients, this is incredibly important.
He clicked on baclofen, and the Web site informed him that nearly 200 patients registered at PatientsLikeMe were taking the drug. He clicked again, and up popped a bold bar graph, sectoring those 200 across a spectrum of dosages. And there it was. Contrary to what his neurologist told him years ago, 10 milligrams wasn’t the maximum dose. In fact, it was at the low end of the scale. “They’re taking 30, 60, sometimes 80 milligrams — and they’re just fine,” Small recalls. “So it hits me: I’m not taking nearly enough of this drug.” A few days later, Small asked his neurologist to up his dosage. Now Small takes 40 milligrams of baclofen a day. His foot drop isn’t cured — there are no miracles in M.S. — but he has found that after 14 years, he can walk to his car without sinking into quicksand.
Long ago diabetics did not have access to blood-glucose meters. Doctors resisted this innovation, now considered the greatest advance in the treatment of diabetes since the discovery of insulin.
Thanks to Tyler Cowen.
I asked Bryan Caplan what effect his blogging had had. It made his first book a success, he said. Or helped make it a success. He had started blogging about two years before it appeared. Other bloggers wrote about his book as if they knew him. They knew him from his blog.
I am visiting George Mason University. Yesterday, as I was answering email, I heard a class in progress on the other side of the partition by my desk. It was Robin Hanson lecturing about the economics of health care to 20 undergraduates. It was so interesting I ended up listening to about 90 minutes of it. “Do your students know what a great class they’re getting?” I asked Robin during a break. “I don’t know myself,” Robin replied.
I have heard hundreds of professors lecture. I had never heard anything like this. It wasn’t the usual stuff. It wasn’t the usual stuff made entertaining with cartoons or demonstrations or jokes or war stories. Instead, it was a straightforward look at how the medical profession operates, and a lot of it was about how it operates to empower doctors, reduce the power of patients, and reduce health care innovation. Robin traced the history of the profession from the 1800s until today. “What separates a trade from a profession?” he asked his class. Professionals have ethics, he said. Doctors devised a code of ethics. At the top was “first, do no harm.” What does this mean in practice, he asked his class. If a patient dies, does the doctor feel shame? No. If a patient wants a medical procedure that isn’t recommended, does this mean the doctor doesn’t do it? Apparently not. In contrast to the remarkable vagueness of “first do no harm” the rest of the doctors’ ethics code was quite clear: no practice without a license, no advertising, and so on — each item with clear economic implications.
Robin also discussed how little doctors are supervised. A British doctor managed to kill over 200 people before anyone noticed; he was finally caught only because he forged a will. A nurse at a local hospital was assigned to measure how often doctors wash their hands. They’re supposed to always wash their hands but many do not. The nurse did the survey, and, as requested, correlated hand-washing compliance with death rates. It turned out that the doctor who washed his hands the least had the highest death rate. The nurse reported this. The exceptional doctor had her fired.
On and on like this. Several books cover bits of this territory. A Sacred Trust by Richard Harris, very well written, is about how the AMA fought public health legislation. Overtreated by Shannon Brownlee, which Robin assigned, is a recent overview. The nice thing about Robin’s critique is that it was very accessible and at the right level of detail — I didn’t have to spend 10 hours reading a book to learn what Robin said in 20 minutes — and it was very wide-ranging. During my last visit to GMU, Robin had told me about the RAND study that found groups with different access to health care had the same health. Uh-oh. This was a much broader, more narrative look at same thing — how well is our health care system working? — and was a kind of explanation of the results of the RAND study.
A friend living in Holland writes:
I found this word [beleg] in my Dutch/English dictionary today.
Definition 1: to declare martial law. Definition 2: sandwich filling.huh?
Speaking of ignorance, after all this time, we don’t understand the effects of artificial sweeteners. Excellent health journalism by Jill Adams. The Shangri-La Diet shows we didn’t understand the effects of sugar. (Universally believed to be fattening, even by Gary Taubes, it turns out to be extremely slimming under some conditions.) Which we have been eating even longer.
Thanks to Dave Lull and Andy Pattantyus.
Understanding and investment go together: The more you understand something, the more you should invest in it. On Friday, Bear Stearns owners thought their stock was worth $30/share; they were utterly wrong, it turned out.
In this sense, self-experimentation — research so cheap it can be done as a hobby — is a statement of complete ignorance. Because it is so cheap, you can test a hundred absurd ideas. If you use more expensive research methods, you cannot afford to test ideas you think are absurd. You must search a smaller solution space. If you are not correct about where the answer to your question will be, the region of possibilities that contains it, your research will fail to find it.
My self-experimentation about why I was waking up too early revealed that I was almost completely ignorant about what I was studying. Two of the causes I found — eating breakfast and not standing enough — were not on my list of possibilities when I started. The Shangri-La Diet is outside the range of weight-loss methods that obesity researchers consider reasonable; without self-experimentation, it would never be tested.
Nathan Yau has posted results from the first two weeks of a self-experiment about procrastination. He tried
1. making a to-do list every evening for the next day
2. blocking the sites he wastes the most time at.
The results were not what he expected.
I’m impressed:
This is the story of Olivier Ameisen, a brilliant physician and cardiologist who developed a profound addiction to alcohol. He broke bones with no memory of falling. He nearly lost his kidneys; he fractured ribs and suffered a hemopneumothorax that left blood and air in the sac around his lungs. He gave up his flourishing practice and, fearing for his life, invested himself in Alcoholics Anonymous and, later, rehab. Nothing worked.So he did the only thing he could: he took his treatment into his own hands. Searching for a cure for his deadly disease, he discovered baclofen, a muscle relaxant that had proven effective in curing rats addicted to every substance from nicotine and alcohol to cocaine and heroin. Ameisen prescribed himself the drug and, over a two-year period, experimented with the dosage until he reached a level high enough to leave him free of any craving for alcohol. That was four years ago.
Background. I took 4 T of flaxseed oil during the day (instead of just before bedtime) and measured its effect with a cursor test. The test was how accurately I move the cursor from one point to another with a single movement. The result was a sharp improvement — some of which lasted, some of which didn’t. (Just to be perfectly clear: what’s varied is not my daily amount of flaxseed oil. It’s the time of day I take it. I’m varying the time between a short-lived peak in omega-3 concentration, which happens shortly after ingestion, and doing the cursor test. Usually they are far apart. The interesting data are what happens when I move them close together.)
New data. I tried the same thing again. Here are the results.
The green line shows when I took 4 tablespoons of flaxseed oil. I took the oil at 8:30 am. The first test after that, at 9:30 am, showed the improvement. (In previous measurements of the short-term effects, it has taken closer to 2 hours to see the maximum effect.)
Here is a longer view, which emphasizes the constancy of the pre-test baseline.
For comparison, here are the earlier results.
Conclusions. When I take 4 T of flaxseed oil, it creates for a few hours a higher-than-usual concentration of flaxseed oil in my blood. I’m pretty sure the active ingredient is omega-3. This has two effects: