I’ve been making it in 2-quart jars. Doing little experiments, I’ve figured out that
1. 4 tea bags is better than 6. I’ve been using Tetley’s low-cost black tea. Each teabag supposedly has 33% more tea than usual. In Wild Fermentation, Sandor Katz suggests 4 teabags for 2 quarts.
2. 3/4 cup of sugar is better than 1/2 cup of sugar. The Wild Fermentation recipe says 1/2 cup of sugar for 2 quarts.
Ankylosing spondylitis is a kind of arthritis with puzzling symptoms all over the body. Its main symptom is back vertebrae fusing together; ankloysis is stiffening or fusion of a joint. To read Wikipedia you’d think it can only be treated with dangerous drugs that don’t work very well.
I recently learned from someone with the condition that it got much better after he cut out all refined carbohydrates, especially sugar, an idea he got from Dr. Bruce West. He describes his regimen as “avoid processed foods [= food with lots of additives], such as fast foods, and especially refined carbohydrates, such as high fructose corn syrup.” After he started this, he felt better in three days. He can eat fruit, but not bread or soft drinks or desserts. He’s never tried eating more fermented foods; he barely knew what they were.
Is the idea spreading? I asked. No, he said. Curious, in this day of forums and patient-centered websites.
More A reader noted that the same advice is given here.
Today I had a hangnail. I realized I hadn’t had one in months. I used to get them all the time — say, once a week. The only big change in my life in the last few months is all the fermented food I now eat. I find it hard to believe there’s a connection but I can’t remember another time in my life when they went away.
There is nothing new about large industry leaders, such as General Motors, going bankrupt; in The Innovator’s Dilemma, Clayton Christensen gives many examples and an explanation: complacency, also called smugness. We’re doing well, why shouldn’t we continue to do things our way? They fail to innovate enough and less-complacent companies overtake them, often driving them out of business. Complacency is human nature, true, but it’s the oldest mistake in the economic world. (I’ve studied a similar effect in rats and pigeons.) In the 1950s, complacency was surely why the big American car companies rejected the advice of quality expert Edward Deming. In less-complacent Japan, however, his ideas were embraced. This doomed the US car industry. Much later, Ford was the first American car company to take Deming seriously, which may be why Ford is now doing better than GM or Chrysler.
The further away you are I suspect the more clearly you see complacency for what it is — a failure to grasp basic economics (innovate or die):
“Chinese financial assets [in America[ are very safe,” [Treasury Secretary Tim] Geithner said. His response drew laughter from the [Peking University] audience.
- Congratulations: You’ve become a New Yorker staff writer by Dan Baum
- History written by the losers by Nassim Taleb
- Amazon reviews aren’t as trustworthy as you may think
- Vast high-quality audio and text for learning foreign languages, including Chinese
Thanks to Ben Casnocha.
Atul Gawande might be the best medical writer ever. He is the best medical writer at The New Yorker, at least, and the best one I’ve ever read. He consistently writes clearly, thoughtfully, and originally about the big issues in medicine. That is why his recent article about health care costs (my comment here) and his graduation speech at the Univesity of Chicago are so telling. And not in a good way, I’m afraid.
The graduation speech starts off with an excellent story:
The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.
So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.
Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.
Bill Gates, Jeffrey Sachs, are you listening? Gawande goes on to say that to improve medicine, there needs to be the same sort of study of “positive deviants”. Here is his first example:
I recently heard from one such positive deviant. He is a physician here in Chicago. He’d invested in an imaging center with his colleagues. But they found they were losing money. They had a meeting about what to do just a few weeks ago. The answer, they realized, was to order more imaging for their patients—to push the indications where they could. When he realized what he was being drawn to do by the structure he was in, he pulled out. He lost money. He angered his partners. But it was the right thing to do.
No kidding. The contrast between mothers who figure out creative iconoclastic new ways to feed children on tiny amounts of money and a doctor who merely refuses to be a scumbag could hardly be greater. But Gawande uses the same term (“positive deviant”) for both! This is the depth to which a writer and thinker of Gawande’s stature has to descend, given the straitjacket of how he thinks about medicine. Gawande thinks that doctors will improve medicine. He’s wrong. Just as farmers didn’t invent tractors — nor any of the big improvements in farming — neither will doctors be responsible for any big improvements in American health. The big improvements will come from outside. I’m sure they will involve both (a) advances in prevention and (b) patients taking charge of their care.
When these innovations happen, where will doctors be? Helping spread them or defending the status quo? That’s what Gawande should be writing about. One big advance in patients taking charge was home blood glucose testing. It came from an engineer named Richard Bernstein. Best thing for diabetics since the discovery of insulin. Doctors opposed it. When I invented the Shangri-La Diet, and lost 30 pounds, my doctor didn’t ask how I lost all that weight. Not one question. Like all doctors, he had many fat patients; the notion that I, a mere patient, could know something that would help his other patients didn’t cross his mind. When I was a grad student I did acne experiments on myself that revealed that antibiotics (hugely prescribed for acne) didn’t work. My dermatologist appeared irritated that I had figured this out. That’s a little glimpse of how doctors may react to outside innovation involving patients taking charge. Of course doctors, like dentists, cannot do good prevention research.
If Gawande took the first story he told to heart, he might realize it is saying that the improvements to health care won’t come from doctors, just as the improvements to the health of those village children didn’t come from experts. As I said earlier, doing my best to channel Jane Jacobs, a reasonable health care policy would empower those who benefit from change. That’s what the village nutrition program did. It empowered mothers who were innovating.
I want to measure, day by day, how well my brain is working. After I saw big fast effects of flaxseed oil, I realized how well my brain works (a) depends on what I eat and (b) can change quickly. Maybe other things besides dietary omega-3 matter. Maybe large amounts of omega-6 make my brain work worse, for example. Another reason for this project is that I’m interested in how to generate ideas, a neglected part of scientific methodology. Maybe this sort of long-term monitoring can generate new ideas about what affects our brains.
So I needed a brain task that I’ll do daily. When I set out to devise a good task, here’s what I already knew:
1. Many numbers, not one. A task that provides many numbers per test (e.g., many latencies) is better than a task that provides only one number (e.g., percent correct). Gathering many numbers per test allows me to look at their distribution and choose an efficient method of combining (i.e., averaging) them into one number. (E.g., harmonic mean, geometric mean, trimmed mean.) Gathering many numbers also allows me to calculate a standard error, which helps identify unusual scores.
2. Graded, not binary. Graded measures (e.g., latencies) are better than binary ones (e.g., right/wrong).
Every experimental psychologist knows this. What none of them know is how to make the task fun. If I’m going to do something every day, it matters a great deal whether I enjoy it or not. It might be the difference between possible and impossible. People enjoy video games, which is a kind of existence proof. Video games have dozens of elements; which matter? Here’s what I figured out by trial and error:
3. Hand-eye coordination. Making difficult movements that involve hand-eye coordination is fun. My bilboquet taught me this. Presumably this tendency originated during the tool-making hobbyist stage of human evolution; it caused people to become better and better at making tools. Ordinary typing involves skilled movement but not hand-eye coordination. This idea has worked. I led me to try one-finger typing (where I look at the keyboard while I type) instead of regular typing. And, indeed, I enjoy the one-finger typing task, whereas I didn’t enjoy the ordinary typing tasks I’ve tried.
4. Detailed problem-by-problem feedback. Right/wrong is the crudest form of feedback; it doesn’t do much. What I find is much more motivating is more graded feedback based on performance on the same problem.
5. Less than 5 minutes. The longer the task the more data, sure, but also the more reluctant I am to do it. Three minutes seems close to ideal: long enough for the task to be a pleasant break but not so long that it seems like a burden.
Experimental psychology is a hundred years old. Small daily tests is an unexplored ecology that might have practical benefits.
In this post Jasper Lawrence describes a trip to Cameroon to infect himself with hookworms. Here’s how it begins:
As my asthma got worse I became increasingly reliant on inhalers, pills and antihistamines as well as upon the oral steroid prednisone to stay out of hospital. I tried all the drugs and therapies available. As it was by the time I was in my late 30s I was a frequent visitor to the emergency room. As anyone who has experienced a severe asthma attack can tell you they are terrifying.
My use of prednisone increased, and as you may know the side affects of prednisone are quite horrible, particularly with long-term use. I started to suffer from some of these side affects, particularly obesity, and despite all this these drugs were only marginally effective in controlling my asthma.
Soon I was denied health insurance and so now I had the added burden of paying for all my medical care.
On a trip in the summer of 2004 to visit relatives in England I learned of a BBC documentary about the connection between a variety of intestinal parasites and various autoimmune diseases.
In Cameroon:
Cameroon has no tourism infrastructure, its people being so poor (your pocket change represents two or three months wages) and the insane corruption make for a very challenging environment for a western traveler, particularly a conspicuous white one. You are a walking pile of cash, a visitor from another, much wealthier, planet. One feels very vulnerable and exposed. It can be very wearing and the danger of being robbed is constant. . . . With the driver’s help (I told everyone of my quest) I was able to visit a variety of villages and with practice learned to identify where the locals would defecate.
Rajiv Mehta of Zume Life, a company that helps patients follow treatment regimes, told me that he’s been doing the Shangri-La Diet with some success — he’s lost 3 pounds in a month. Now and then he tells others about the diet. There are two types of reactions. Those who are outside the field of obesity prevention/research are interested. Those inside the field, obesity professionals (e.g., a Stanford professor), uniformly reject it: “Impossible,” they say. Can’t possibly be true.
Or, at least, how safe do the people who prescribe and give them think they are? Jock Doubleday has an interesting way of finding out: Offer money to drink the ingredients, adjusted for body weight. The offer, which began in 2001, is currently $200,000 to “an M.D. or pharmaceutical company CEO, or any of the relevant members of the ACIP [the CDC’s Advisory Committee on Immunization Practices] now including liaison representatives, ex officio members, chairman, and executive secretary” who will do this.
More The person who accepts this offer needs to fulfill a contract posted here. However, it isn’t clear what the “Agreement-in-Full” mentioned in the contract consists of. So it isn’t clear if the person can know what he or she is getting into before putting $5,000 at risk. If the Agreement-in-Full cannot be examined now, this is a meaningless — too vague to be understood — offer. I have written to Jock Doubleday to find the Agreement-in-Full.
And more Mr. Doubleday says he has the Agreement-in-Full but he would not show it to me nor apparently to anyone else not on the list of those eligible for the offer. So the whole thing is a tribute to the magic of web pages.