Month: October 2009

The Price of an Unnecessary Operation

Seth Roberts2 Comments

A few years ago, a Berkeley surgeon named Eileen Consorti, to whom I was referred by my primary-care doctor, recommended that I have an operation to repair a hernia so small I couldn’t detect it. I have already written about how she kept saying there was evidence such operations were beneficial but as far as I can tell no such evidence exists. (Dr. Consorti has yet to provide the evidence she still seems to think exists.) Okay, she overstated benefits. What about costs?

During a conversation about whether the operation was a good idea, I said operations are dangerous. I didn’t want to have one unless there was a clear benefit. She replied that nobody had died from anesthesia during one of her operations. But of course death is only one of the things that can go wrong. It turns out the general category of bad things happening during anesthesia is called undesirable events and the rate of undesirable events has been measured. In this study, the rate was 100-150 undesirable events per 1000 hours of anesthesia. My operation was simple; I estimate it would have taken one hour. So my chances of having something bad happening to me as a result of an operation without any clear benefit to me — but considerable financial benefit to Dr. Consorti — was about 10%!

In a discussion of the costs and benefits of the operation, she didn’t tell me this.

Beijing Air

Seth Roberts1 Comment

Yesterday was really windy. Lots of bikes fell over, including mine. I thought my sheets, hung to dry outside my apartment window, had blown away. I searched for them around the building. I eventually found them — in my closet. I got a piece of dirt in my eye that I noticed for several hours. It was my first significant bad encounter with Beijing air this time around (since August). I was in Beijing last fall, too, and then the dirty air really bothered me. I felt better after I got an air filter for my apartment.

When I was a freshman at Caltech, Richard Feynman came to our dorm for dinner. I asked the first question: “What do you think of the air?” He looked at me as if it was a stupid question. I think his answer was, “You get used to it.” After living in Beijing last year, I said over and over I liked everything except the air. Now I find it hard to complain about the air. In my apartment I have one big air filter per room that runs constantly; they are quiet and turn red if the air is dirty. They hardly ever turn red. Last year, after a week without dusting, you could write “lung cancer” in the fine black dust that had accumulated. Now it isn’t there. Through my window the visibility is usually pretty good; I can see the lights of buildings in the distance.

Yesterday someone told me Beijing air has gotten much much better. “Ten years ago your hair would get filthy” from coal dust, he said. The hutongs had coal-burning heaters. Now they are gone. Measures of air quality have even improved since last year, I think he said. I met someone recently arrived who was bothered by the air but she felt much better after I gave her an air filter.

Overall, I think four things have changed: 1. The air in my apartment, where I spend most of my time, is much better (compared to unfiltered). 2. Outside air is somewhat better. 3. Due to fermented foods, my overall health is better. 4. Due to learning about hormesis, I don’t worry about a small amount of air pollution.

James Fallows on How I Survived China. The bottled water at a Buddhist restaurant came from a garden hose.

More About Faces and Mood

Seth Roberts5 Comments

A friend with bipolar disorder writes:

When I wrote in your blog that I use your discovery daily, it means that every day I look in a mirror for an hour, starting at approximately 6:30 a.m. I have the mirror about 20 inches from my face because I have read that a mirror image is half the size of the object reflected. [Life-size faces appear to work best. Using a mirror means the face you see is perfectly life-size, allowing for distance. TV faces can be larger or smaller than life-size.] To keep from being bored while looking at my face in the mirror, I mostly listen to tapes of C-SPAN programs. Sometimes I listen to music. Once or twice a week I may just think, or plan my day. That does get boring after about 30 minutes.

Sorry, I definitely was exaggerating when I wrote “doctors are amazed”. “My doctors” refers only to my psychiatrist and psychotherapist; at best, they seem “impressed” by my condition. My therapist regularly says that I’m doing “great”(variously referring to social relations, self-awareness, and general functioning) — “especially considering my situation“ and my psychiatrist once exclaimed that my bipolar disorder was in “complete remission”, albeit when we were composing an online personal ad. I do think both of them are at least mildly surprised that I seem to be doing alright on half the standard therapeutic dose of Depakote, and a low dose of Prozac.

There was an actual experience that weakly supports my claim about practitioners having no interest in utilizing your idea. I once asked my therapist to suspend his disbelief, and just imagine that your treatment does work as a strong antidepressant. Then would he mention the treatment to his other patients, or give a talk at a conference, or write up a report, or tell his colleagues? In all cases, he said “no”. Although he agreed that ideas for clinical trials have to come from somewhere, evidently that somewhere was not part of his concern.

I stress that my therapist is compassionate and reasonably intelligent, and he has helped me deal with many important practical problems. And of course in your blog even you have admitted that your idea, on the face of it, sounds way too crazy. It’s to my therapist’s credit that he claims to believe your treatment works to some degree — adding positively, “whatever works for you”. Unfortunately, that addition implies that your treatment is somehow working “psychologically” for me (e.g., as a kind of meditation) rather than working “biologically” in a way that, presumably, would work for most people.

If my doctors were following my particular case as closely as they pretend to, then they ought to be amazed. Instead, my sense is that they see me through the lens of their diagnosis. Without actually dismissing the sheer statistical improbability of my having been off of drugs and without a hospitalization for four years, they do seem to forget that fact when we discuss drug therapy. When I mention those four years, they sometimes play the skeptic, offering up alternative possibilities: it was a fluke, or I was in remission anyway, or something else. I don’t try anymore to persuade anyone, not even family, about the treatment — it’s not worth the effort.

I suppose the bigger picture is that there is little credibility to the testimony of a bipolar person who has experienced psychosis. (Perhaps my case is not helped by dramatic pronouncements of mine such as, “History will judge you. People will wonder, “why didn’t they listen to him?”) Too, I’m not paying my doctors enough to get lengthy consultations. If I were paying enough, and if I made the case with details to my psychiatrist, she might be persuaded that there is a big effect. She has a high opinion of you; in fact, she’s the person who told me of the report in The SF Chronicle (5/30/06) about the SLD diet. And, she gives some credence to Dr. Stoll’s results with omega-3 for treating bipolar. Nevertheless, for what it’s worth, I would stand by my original opinion about her not changing her practice.

Secrets of Infomercials

Seth Roberts11 Comments

Here is a long list of reasons, by Steve Dworman, who makes them for a living, why infomercials are the way they are. One big reason is data: you can easily do an experiment that compares two different versions of the same commercial. It is much harder to measure the effectiveness of other forms of advertising. (The lack of data involved in most advertising choices is easy to see on Mad Men.) Self-experimentation has the same advantage: It’s so much easier to test an idea.

One of his points is about the use of celebrities: It must work, or else they wouldn’t do it. (Because there is data behind how things are done.) I think this points to something hard-wired: We want to learn from other people. That’s the default. If we have a question, we search for someone who will answer it. Learning from our own experience — such as self-experimentation — is a last resort. It feels wrong, we don’t like it. I remember feeling this way when I bought a camera. Sure, I could do extensive research about which camera is best. But that would be hard. Better to ask a friend. And then the purchase would be a link between us.

How to Eliminate/Prevent a Skin Infection and What It Means (continued)

Seth Roberts15 Comments

A brief summary of my previous post is all I needed to do to cure/prevent a skin infection was buy more socks. Instead of buying 5 pairs every 6 months, buy 20 pairs every two years. That’s all. Costs nothing. No drugs. No special treatment of the socks. No special cycle on the washing machine. No following a hundred (or ten) instructions about how to avoid infection. Like my depressed friend, I had the reaction: Why didn’t my doctor tell me this? He didn’t tell me because he didn’t know, I realize. Why he didn’t know . . . is a harder question.

The whole practice of health care is called medicine, so focused is it on cure rather than prevention. There are medical schools, which turn out doctors. Schools of public health are the closest thing we have to schools based on prevention but they don’t even train nutritionists. Nor do they do experiments, in most cases. (They do little data collection besides epidemiology.) And they get much less money than medical schools. Scurvy and Vitamin C are the first examples of the new way of dealing with illness I’m talking about — finding the environmental deficiency and fixing that, which is inevitably extremely safe and extremely cheap. After the discovery of Vitamin C, similar examples were discovered and the broader term vitamin was coined. But I think there is a need for a similar term that includes non-vitamins. It would mean aspects of everyday life, food and non-food, that we need to be healthy.

Like Vitamin C, my discovery that more socks eliminates skin infection points to a cure/prevention agent that is perfectly safe and extremely cheap. So do all my posts about fermented foods. It costs basically nothing to let food ferment. You lose nothing and gain a lot. Yet bacteria are not vitamins — and it isn’t all bacteria we need, just the 99.999% that are harmless. (And other foreign stuff, like bee venom, can substitute for bacteria.) I began thinking there are non-food vitamin-like things (things we need to be healthy) when I discovered the effects of standing on sleep and morning faces on mood. So we need several things to sleep well, including morning light, and at least one thing for proper mood regulation. Insomnia and depression are non-infectious problems, like scurvy. We think of vitamins as preventing/curing non-infectious problems, so the analogy was obvious. And these examples (sleep and mood) involved the brain. So there were vitamins for the brain, you could say. But the socks/foot infection example and the fermented foods/many illnesses example both do not involve the brain and do involve infectious diseases and auto-immune diseases (which, although non-infectious, are quite different from scurvy). So the idea that there are bunch of extremely cheap, perfectly safe things we need to be healthy expands to cover more of health.

Vast amounts of money are spent on health research, much much more on the consequences of poor health, and truly incalculable suffering comes about because we don’t know what these things are. (Depression alone causes vast suffering. Now add to that poor sleep, autoimmune problems, much infectious disease . . . ) Yet because studying these things (a) will make money for no one, (b) won’t produce a steady stream of published papers and (c) is useful (= low status), they are nearly impossible to study.

How to Eliminate/Prevent a Skin Infection and What It Means

Seth Roberts32 Comments

Several years ago, during a routine checkup, my primary-care doctor pointed to some white lines on my right foot. (Curiously only one foot had them.) Fungus, he said. I had a fungus infection. What should I do? I asked. He suggested over-the-counter anti-foot-fungus medications, sold in every drugstore.

I tried a few of them. They didn’t work. The problem persisted.

A month ago I noticed the problem had gotten much worse. Yikes. What had gone wrong? I realized that in the previous few weeks I had changed two things:

  • Instead of putting my wash through an extra wash cycle without soap (to rinse it better), I had started doing my wash the way the rest of the world does it. I had stopped doing the extra cycle because I was no longer worried about becoming allergic to the soap.
  • I had bought 5 new pairs of socks and had been cycling though 4 of the new pairs again and again (washing them between wearings, of course), ignoring the rest of my socks.

This suggested a theory: My skin infection was due to my socks. The infectious agents get on my socks and are not completely removed by the washing machine. They survive a few days on the shelf. To wear socks with the infectious agent already present gives the infection a boost. Maybe my new socks supported the infectious agent better than the socks they replaced.

Based on this theory, I did three things:

  • Resumed putting my wash through an extra cycle without soap.
  • Took off my socks earlier in the evening.
  • Bought 12 new pairs of socks and made sure every sock went a long time (e.g., 3 weeks) between wearings.

I saw improvement right away. (The morning after I wore new socks.) A month later, the infection, present for at least several years, is entirely gone. It took about a month for it to clear up completely.

The essence of my discovery is that the infectious agent could survive my socks being washed conventionally (in a washing machine) and live for a few days without contact with my feet. Whereas a few weeks away from my skin killed it. I have been unable to find this info anywhere else. A very minor discovery, but unlike the work that won the most recent Nobel Prize in Medicine, useful right now. Cost: zero. I would have had to buy new socks anyway.

In Cities and the Wealth of Nations, Jane Jacobs tells about a reporter interviewing someone in an oil-rich Middle East country (Iran?). During the interview the interviewee tries to cut an apple with a knife. The knife breaks. We can’t even make knives, the interviewee says. That’s how backward our economy is. To develop economically, MIT professors had advised his country’s government to build a dam, at great expense. The MIT advisors thought that building a dam would be good for economic development. They were wrong, it turned out. Jacobs thought it was telling that after all that money invested, the local economy still couldn’t make something as basic as a good knife. Many industrial processes require cutting tools.

This is the same thing. Preventing and eliminating infection is at the core of medicine, just as cutting is at the core of manufacturing. My discovery reveals that my doctor — and by implication, the whole health care establishment — failed to know something basic and simple about this. If they understood what I figured out, there would be no need for anti-foot-fungus medicine. A gazillion dollars a year is spent on medical research, medical schools and research institutes around the world are full of faculty doing research — and they haven’t figured out something as basic and simple as this.
Gatekeeper Drugs. How to Avoid Infection: Something I Didn’t Know.

The Monster Is Asleep

Seth Roberts2 Comments

This old comment made me laugh me when I reread it recently:

It was slightly embarrassing when friends would ask how long I had been on [the Shangri-La Diet]. I lied and said a day – it had only been eight hours but, hey, without SLD, I normally would have done a great deal of damage in those 8 hours. It’s now been a week and I’ve lost three pounds. I love the luxury of choosing finer foods now that I’m no longer compelled to eat everything in sight when dinnertime comes around. The Monster has been rocked to sleep

Book Recommendations: Hedges, Yes, Dalai Lama, No

Seth Roberts19 Comments

Thumbs up: Chris Hedges, Empire of Illusion. Hedges writes about how Americans are delusional in their beliefs about how wonderful their country is and how rich and powerful they are. One of his targets is academia, which he says turns out graduates who are far too respectful of authority. (He doesn’t mention molecular biologists, but they’re another example.)

Thumbs down: His Holiness the Dalai Lama and Howard Cutler, The Art of Happiness in a Troubled World. Two words: runaway serfs.

Modern Biology = Cargo-Cult Science?

Seth Roberts15 Comments

At first I thought the title of this article was “Taking Back The Nobel Prizes”. My eyes widened. Someone at the New York Times has a radical thought, it appeared. I was wrong. The title is “Taking Back Nobel Prizes”; the article is about the less-than-radical idea that Henry Kissinger did not deserve a Peace Prize. Then I thought it was too bad that Richard Feynman isn’t alive. If he were, I would ask him if modern biology — the sort that wins Nobel Prizes — is an example of what he called cargo-cult science in a famous graduation speech. I would be a good person to ask that question, I thought, because he considered rat psychology cargo-cult science. Yet I used rat psychology to come up with the Shangri-La Diet, which has helped many people lose weight in counter-intuitive ways.

Cargo-cult science, according to Feynman, was activities that have the superficial trappings of science but don’t actually accomplish anything. You do all the right things, or so you think, but the planes don’t land. The sort of biology that wins Nobel Prizes has a long history of this. This year’s prize went to research that found that telomeres shorten with age. The press release, forced to say how this is useful (the Nobel Prize is supposed to be for research that benefits mankind), says

These discoveries had a major impact within the scientific community. Many scientists speculated that telomere shortening could be the reason for ageing, not only in the individual cells but also in the organism as a whole. But the ageing process has turned out to be complex [shocking!] . . . Research in this area remains intense.

. . . It was therefore proposed that cancer might be treated by eradicating telomerase. Several studies are underway in this area, including clinical trials evaluating vaccines directed against cells with elevated telomerase activity.

Some inherited diseases are now known to be caused by telomerase defects, including certain forms of congenital aplastic anemia, in which insufficient cell divisions in the stem cells of the bone marrow lead to severe anemia. Certain inherited diseases of the skin and the lungs are also caused by telomerase defects.
In conclusion, the discoveries by Blackburn, Greider and Szostak have added a new dimension to our understanding of the cell, shed light on disease mechanisms, and stimulated the development of potential new therapies.

Shameless. Note the utter absence of even one disease in one person cured or prevented. Not one. And this is supposed to be the most beneficial discovery in medicine. It’s the top prize in medicine and biology! Last year the prize was given for HIV. Do we have an HIV vaccine? No. The year before that, HPV. Do we have an HPV vaccine? No. A few years before that, the discovery that a certain bug “causes” stomach ulcers — the award that showed that the medical community and the Nobel Prize committee have a weak grasp of the concept of causality. The biologists think they do everything right — but the planes don’t land. The biologists who do this research aren’t able to solve actual problems. (Some people do — those who discovered that smoking causes cancer, for example — but they don’t get Nobel Prizes.) Could something important be missing from their view of the world? I think so.

Cargo-cult activities aren’t worthless, so long as you learn from your mistakes. The cargo cultists could see that the planes didn’t land and eventually figure out that something was missing. That’s actual knowledge, humble but useful. Feynman’s criticisms of rat psychology were reasonable. Those doing rat psychology learned from their mistakes, I think, and eventually the field improved and produced the research behind the Shangri-La Diet. Modern biology isn’t worthless, just as cargo cults aren’t worthless. Obviously “useless” knowledge can eventually become useful, as has happened many times. But these overblown claims for the value of modern biology truly cost the rest of us — a great deal, I believe. Because the first step in getting somewhere, as Feynman liked to say, is to confront reality. At least in their public statements about the value of their research, modern biologists are living in a dream world. It’s always “potential” this and “future” that and “insight into disease mechanisms” — without ever curing or preventing a disease.

Thanks to Eric Meltzer.

Yogurt and Seasonal Allergies

Seth Roberts3 Comments

This comment on a previous post deserves emphasis:

For the past 3 years or so, a co-worker and I would suffer spring allergies together. We seemed to be allergic to the same thing, because we’d start and stop at the same times. This year, we both got whacked hard late April. Desperate, I started eating yogurt (Breyers mostly, some Danactive and Stonyfield) every day, sometimes twice, after reading your blog and doing some research. About 8 – 10 days later, I noticed I had no symptoms. My friend had light symptoms, so I thought maybe it was just a lull. Then about 2 weeks later, my friend got pummeled by allergies again, very badly; he could hardly work. I had NO symptoms. I didn’t even realize it was a bad day for allergies until he showed up to work. I haven’t had any allergies since.