Month: June 2008

The Ketogenic Diet

Seth Roberts3 Comments

Speaking of evidence snobs, this is from the TV movie … First Do No Harm (1997) about a family’s discovery of the ketogenic diet (a high-fat low-carb diet) for their severely-epileptic son:

DOCTOR The diet is not an approved treatment.

MOTHER But there have been a lot of studies.

DOCTOR Those studies are anecdotal, not the kind of studies we base sound medical judgment on. Not double-blind studies.

Later:

DOCTOR I assume you know all the evidence in favor of the ketogenic diet is anecdotal. There’s absolutely no scientific evidence this diet works.

The doctor prefers brain surgery. When the diet is tried, it works beautifully (as it often does in real life). “What could have gone so horribly wrong with this whole medical system?” the mother writes the father.

Less Carbs –> Better Sleep?

Seth Roberts6 Comments

I haven’t heard this before:

My insomnia seems to have gone. This may be something to do with my bold adherence to Nassim Nicholas Taleb’s low carb diet. I have not drunk and barely eaten a single gram of carbs for the last two and a half weeks. I am ten pounds lighter and I sleep like a baby. . . . I am attaining a steady seven and a half hours of unconsciousness nightly. This hasn’t happened in at least ten years, possibly more. I have also become optimistic, amiable and energetic.

Perhaps drinking less alcohol improved his sleep. This has nostalgic interest for me. A turning point in my self-experimentation came when I analyzed my data and saw that I started sleeping less exactly when I lost weight (by eating less processed food). In a complicated way this helped me discover that eating breakfast caused me to wake up too early.

Thanks to Dave Lull.

Jane Brody Misses Many Opportunities

Seth Roberts4 Comments

Jane Brody has written about health for the New York Times for a long time. Recently, a blood test indicated that her total cholesterol was 222 and her LDL was 134, which she believed was too high.

Missed Opportunity #1: She had no idea of the error in these numbers. It would have been better to get a second measurement to get some idea of the error. What if the second measurement of total cholesterol was 180?

She made various non-drug changes. She stopped eating cheese and lost a few pounds. She believed this would lower her cholesterol. It didn’t. A new test found total cholesterol was 236 and LDL was 159.

Missed Opportunity #2: She still had no idea of the error in these numbers.

Missed Opportunity #3: If the change from 134 to 159 was not random error, it was possible that cheese was lowering her cholesterol — the opposite of what she believed. She failed to consider this possibility — at least, she doesn’t mention it.

She made more extreme changes:

Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements.

Her cholesterol numbers got even worse — total cholesterol was 248 and LDL 171.

Missed Opportunity #4: She still had no idea of the error in these numbers.

Missed Opportunity #5: She again failed to consider the possibility that what she was told was wrong — that things she did to lower her cholesterol actually raised it.

Her doctor tells her: “Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.”

Missed Opportunity #6: She failed to consider what this says about her doctor. If her doctor believes this, why didn’t he or she say so earlier?

Missed Opportunity #7: She failed to ask her doctor the basis for such an extraordinarily broad claim (“nothing you do”).

Missed Opportunity #8: She failed to realize her own data called this statement into question. Her own data suggests that diet made a difference (if the random error is small enough). She changed her diet, her cholestrol changed.

My own self-experimentation started with the discovery that some of what my dermatologist told me was wrong. A certain antibiotic was supposed to reduce my acne; if anything it increased my acne.

The classic case of a self-experimenter failing to learn something he could have learned is Barry Marshall, the Australian doctor who won a Nobel Prize for showing that bacteria cause ulcers. He drank a flask full of the bacteria — this was the self-experiment. Results: 1. He didn’t get an ulcer. 2. He became infected and the infection went away after treatment with a drug later found to have no effect against the bacteria. Warren might have concluded that some people can successfully fight off infection from the bacteria and that the people who get ulcers are not those who are exposed to the bacteria (which is probably almost everyone) but those who can’t fight it off. Warren’s self-experimental results, like Brody’s, supported a conclusion quite different from the conclusion he started with, and he failed to notice — or at least mention — this.

Evidence Snobs

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At a reunion of Reed College graduates who majored in psychology, I gave a talk about self-experimentation. One question was what I thought of Evidence-Based Medicine. I said the idea you could improve on anecdotes had merit, but that proponents of Evidence-Based Medicine have been evidence snobs (which derives from Alex Tabarrok’s credit snobs). I meant they’ve dismissed useful evidence because it didn’t reach some level of purity. Because health is important, I said, ignoring useful information, such as when coming up with nutritional recommendations, is really unfortunate.

Afterwards, four people mentioned “evidence snobs” to me. (Making it the most-mentioned thing I said.) They all liked it. Thanks, Alex.

Lutein

Seth Roberts1 Comment

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Ever heard of lutein? If you have consider yourself well-informed. There is no Recommended Daily Allowance. But a study of monkeys fed a laboratory diet, presumably containing all necessary nutrients, found that they got macular degeneration eight years earlier than monkeys fed ordinary foods. The missing nutrient appears to be lutein, which is found in green leafy vegetables such as spinach. More info here.

One more indication that our knowledge of nutrition is incomplete even at the simplest (single nutrient) level.

Thanks to Martha Neuringer, who was one of the first researchers to study the brain effects of omega-3s.

FDA Acknowledges Risk of Teeth Fillings With Mercury

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The Food and Drug Administration has settled a lawsuit related to mercury in dental fillings. As part of the settlement, it will acknowledge that these fillings may harm some people. This is from an email by someone behind the lawsuit:

To change FDA policy, we tried petitions, Congressional hearings, state fact sheet laws, Scientific Advisory Committee hearings, and letters galore — to no avail. So in the great American tradition, we sued. The case came to a head this spring. On April 22, working with Johann Wehrle and Gwen Smith, I filed a motion for an injunction before Judge Ellen Huvelle. Three sets of briefs later, the government and I presented our oral arguments on May 16. In a crucial ruling, Judge Huvelle ruled that our 11 plaintiffs — the diverse group
listed below — have standing. She said FDA should classify, and invited the two sides to mediate. On May 30, before Magistrate Judge John Facciola, Bob Reeves (who flew in from Lexington KY) and I hammered out an agreement with FDAÂ officials and lawyers.

The impact of the re-writing of its position on amalgam can hardly be understated. [A curious mistake: the writer means overstated.] FDAs website will no longer be cited by the American Dental Association in public hearings. FDA shows awareness of the key issues involved. As it prepares to classify amalgam, FDA has moved to a position of neutrality. Indeed, having repeatedly raised the question of amalgams risk to children, young women, and the immuno-sensitive persons in its website, I find it inconceivable that FDA will not in some way protect them in its upcoming rule.

Mercury fillings were once very common and are still common. Unfortunate that it took a lawsuit to get the FDA to change. Judges have little or no relevant experience understanding scientific papers. Scientific advisory panels have much more relevant experience. However, they suffer from a “purity” bias – they are evidence snobs.

While They Slept

Seth Roberts4 Comments

From a review of Kathryn Harrison’s new book While They Slept, about a boy who murders his parents:

When Billy Gilley is 13, stealing cigarettes leads him to the Children’s Services Division, where the boy trustingly told a social worker about his family: the drinking, fighting, extreme verbal abuse in a family where customarily, after sentencing by his mother, his father would tie him to a tractor tire in order to immobilize him for beating with a rubber hose. He described for the social worker how his parents were, in Billy’s terms, “crazy and unfit.”

The child told his story, and the social worker’s response was to repeat it to those abusive parents. Furious, they demanded to speak with him in private, so that he recanted and said he had been lying. The parents threatened to sue the agency, which fired the social worker and destroyed the record of her conversation with Billy, leaving only the annotation that the child was a liar. . . .Having acquired literacy skills in prison, he writes and illustrates children’s books. In these books, large-eyed animals play an important role: children are in trouble or distress, and human adults cannot understand or help. The animals understand the children, and bring them to safety.

This reminds me of two things. Many years ago, such as in the 1920s, cancer was a terrible thing and a total mystery. People didn’t like to talk about it. Likewise the social worker’s actions are a terrible thing and a total mystery. What should be done about such behavior? Nobody wants to talk about it. The other thing this reminds me of is the Ten Commandments. Here is something else no one talks about: There is no commandment against child abuse. No stealing: yes. No murder: yes. No adultery: yes. No child abuse: no. Stealing is worse than child abuse? Huh?

Well, at least the review is titled “Speaking the Unspeakable.”

Murakami, Baseball, and Inspiration

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About ten years ago Haruki Murakami, the author, gave a talk at UC Berkeley. in which he said he had decided to try to become a writer during a baseball game — specifically, when someone hit a single to left field. I told this story as often as possible. My listeners were always puzzled. It made no sense. Was he kidding?

Now Murakami has told the story in print. Turns out it was a double, not a single. And I missed another crucial detail. Murakami was a “fairly devoted Yakult Swallows fan.” It was the Swallows lead-off batter who hit the double. Now the story makes sense. Something wonderful had just happened on the field. Surprising, too. Wonderful unpredictable things happen, Murakami realized. They could happen to him. “Something flew down from the sky at that instant,” he wrote, “and, whatever it was, I accepted it.”

How Things Begin (The Approval Matrix, part 8)

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ROBERTS Were there really some people that didn’t think that opera is highbrow and comics are lowbrow? Was that a hard thing?

NUSSBAUM The complicated thing is: why is opera considered highbrow and why is comics considered lowbrow?

ROBERTS That’s a different question.

NUSSBAUM We were trying to articulate this. Part of it is a mass versus elite thing. Part of it is a notion of the complexity of ambition of the thing. But that doesn’t really work.

ROBERTS That’s not quite fair.

NUSSBAUM You can have an opera that’s incredibly dumb and not very well thought through. And you can have a comic book that is the most ambitious thing ever in terms of its narrative or in terms of its artistry. The tricky thing is: what pulls something up or down? Also, I just couldn’t over the fact that people didn’t understand that lowbrow is not a bad thing. It’s not a bad thing for something to be mass and enjoyable. That’s why there are two different things. The visual is meant to literally suggest that highbrow and lowbrow are not same thing as brilliant and despicable.

ROBERTS I liked The Approval Matrix for that. I took it for granted.

NUSSBAUM I’m kinda chatterboxy today for lack of sleep.

ROBERTS That’s fine. You’ve helped a lot. The wonderful thing about The Approval Matrix is that in a small space it makes me aware of many new things I would like to find out about. It improves my world. It opens me up to lots of stuff. It opens me up to lots of art. It helps me find lots of great art.

NUSSBAUM That’s great!

ROBERTS Other magazines don’t do that as well. I think every magazine does that a little bit.

NUSSBAUM Not only is that very exciting to hear, it was one of the things when I was redesigning the section that was really difficult. When you read a section on culture it is generally divided into genres. So if you’re interested in visual arts, that’s what you end up reading about. If you’re interested in visual arts, you flip to the visual arts section. You’re likely to perhaps never read the book section or the TV section or something you’re not interested in. The thing about The Matrix is, because it’s a destination that sort of forces everyone to go to this place where it’s like a big bus station where everyone interested in everything is forced to hang out, I hope it has that service quality you’re talking about. Which is it opens your eyes to things you’d normally not have heard of, you’re forced to mingle with all art forms, to be very high-faluting about it.

ROBERTS That’s a good way to put it.

NUSSBAUM Are there other questions?

ROBERTS There’s aren’t any other pressing questions, no. You’ve done a wonderful job answering my questions. Thanks a lot, Emily.

Interview directory. Behind The Approval Matrix.