Month: May 2011

Assorted Links

Seth Roberts3 Comments

Thanks to Paul Sas and Gary Wolf.

Six Signs of Profound Stagnation in Health Care

Seth Roberts19 Comments

In a recent interview, Tim Harford, the Underground Economist, said,

That’s what makes medicine such an effective academic discipline.

By “that” he meant certain methodologies, especially randomized experiments. I disagree with this assessment. My opinion is that health care is in a state of profound stagnation, unable to make much progress on major problems.

Here are six signs of the stagnation in health care (by which I mean everything related to health):

1. The irrelevance of Nobel Prizes. Year after year, the Nobel Prize in medicine is usually given for research that is so far useless (e.g., teleomere research) or irrelevant to major health problems.

2. The obesity epidemic. Starting in 1980, obesity rates climbed fast. Thirty years later, doctors seem to know no more about how to cure obesity than in 1980. Low-fat diets, popular in the 1980s, are still popular! Low-carb diets are ancient — the Banting diet became popular in the 1860s.

3. Ancient treatments for depression still popular. SSRIs were introduced in 1988. Cognitive-behavioral therapy began in the 1980s, combining earlier ideas. Neither works terribly well — and notice how different they are.

4. The high cost of ineffective care. Americans pay much more for health care than people in other rich countries, yet American health is no better. All that new technology that Americans are paying for isn’t helping. In an article complaining about our education system, Joel Klein, the former head of New York City schools, wrote, “unlike in health care . . . in education, despite massive increases in expenditure, we don’t see improved results.” Actually, that’s exactly what we see in health care when we compare America to other countries. Tyler Cowan makes this point in The Great Stagnation.

5. Statins. A defender of modern medicine would claim that statins were an important innovation. They are heavily prescribed, yes. Yet in recent tests they have been stunningly ineffective — so much so that the earlier favorable evidence has been questioned.

6. The stagnation has become invisible — the normal state of affairs. Allowing Harford to make that comment. Harford, like Dr. Ben “Bad Science” Goldacre (whom Harford praises), believes you judge science by whether it follows certain rules. By making various rules (e.g., the need for placebo controls) and then following them, medical researchers have drawn attention — at least Harford’s and Goldacre’s — away from lack of progress. They’re making progress, they say, because they’re following self-imposed rules. Well, what if the rules make things worse? (For example, placing high value on placebo controls may draw attention away from non-pill treatments.) Better to judge by results.

What do you think are the clearest signs of health-care stagnation — if you agree with me about this?

Percentile Feedback Workspace Available

Seth Roberts3 Comments

I have put a requested R workspace on my website so that you can download it. The percentile feedback workspace compares your productivity (time spent working/time available to work) today to previous days. When I started using it, I became more productive. Here is an introduction. Here are all posts about it.

This is not for everyone. You need R installed to use it (of course) and you’ll need to know at least a little R. You must edit a function called save.ws so that the workspace is saved in the right place. I have used it under Windows XP.

Comment on “Morning Faces Therapy For Bipolar Disorder”

Seth Roberts7 Comments

In yesterday’s post, a friend of mine with bipolar disorder told how he used my faces/mood discovery. It allowed him “to enjoy life and relate to others in ways that I never could my entire life,” he wrote. Partly because it allows him to stop taking the usual meds prescribed for bipolar disorder, which have awful side effects.

What do I think about this?

To begin with the obvious, I am very happy that something I discovered has helped someone else. Practically all science has no obvious use. (A tiny fraction is eventually helpful.) In experimental psychology, my field, I can’t think of a single finding that’s helped many people. Because of this background, managing to help someone via science seems like a fairy tale. It’s too soon to say the story has a happy ending — it isn’t over — but it is beginning to have a happy ending.

Thank heaven for blogs. Something like my faces/mood discovery is difficult to publicize, yet without accumulation of evidence it will go nowhere. It wouldn’t be easy to publish in a psychiatric or psychotherapeutic journal because I’m not a psychiatrist or psychotherapist. Even if published, the chances of interesting psychiatrists and psychotherapists are low because it doesn’t involve a treatment you can make money from (gatekeeper syndrome). It should greatly interest persons with bipolar disorder but they are not the typical readers of the scientific literature on mood disorders. However, like all sufferers, they search the Internet.

In my internal calculus, the story provides what I think of as “ industrial strength” evidence. Industrial-strength evidence is evidence that something works in practice, not just in the lab. In a laboratory setting, which to some extent includes me studying myself, you try to keep things constant. You want to reduce noise. Noise reduction makes signals clearer. An effect you can see easily in a lab experiment, however, may be too small to matter outside the lab, where more powerful forces push people around. Whether your lab experiment — in which you have managed to control Force X — has practical value depends on the size of Force X relative to other forces at work outside the lab. An example is the theory behind the Shangri-La Diet. Does that theory tell us anything useful about why people are fat? Does it explain the obesity epidemic, for example? I knew the theory had plenty of truth because it had led me to several new ways of losing weight and had helped me lose considerable weight and keep it off forever. But that was far from showing (a) it was the only thing that controls weight or even (b) one of the big things. Lab experiments can’t do that. It’s been claimed that obesity is due to a virus. Experiments support the idea. Yet the idea is irrelevant to everyday life, I’m sure. No one has written How to Lie With Laboratory Science but it could be written. The only way to find out if a “true” idea explains enough of reality to be useful is to use that idea in real-world situations. Which is what my friend did.

But that isn’t the biggest thing. The biggest thing, from my point of view, is that what my friend has done helps keep this idea alive. When it comes to ideas, grow or die. My friend’s story keeps the idea alive by expanding it. It gives it a new and personal dimension. It isn’t just about mood measurements, it’s about living a reasonable life. I’ve given talks about this idea, but this story makes it much easier to talk about to a general audience.

 

 

 

 

Morning Faces Therapy for Bipolar Disorder

Seth Roberts4 Comments

In 1995, I discovered that seeing faces in the morning improved my mood the next day. If I saw faces Monday morning I felt better on Tuesday — but not Monday. The delay was astonishing; so was the size of the effect. The faces not only made me cheerful, they also made me eager to do things (the opposite of procrastination) and serene. This is the opposite of depression. Depressed people feel unhappy, don’t want to do anything, and are irritable. Eventually I found that the mood improvement was part of a larger effect: morning faces produced an oscillation in mood (below neutral then above neutral) that began about 6 pm on the day I saw the faces and lasted about a day. As strange as this may sound, there was plenty of supporting data — the connection between depression and insomnia, for example.

After I had observed the effect on myself hundreds of time, I urged a friend with bipolar disorder to try it. Recently he wrote me about how it has helped him.

Here is the very short story of my experience with this treatment.

I have used your treatment since 1997. As an indication of its effectiveness, from 1999 to 2003 I was completely off of medications, and now I’ve been off again since August of last year.

I was severely ill when I began the treatment. I was first hospitalized in 1985 for manic psychosis, and I was hospitalized later for suicidal thoughts and then again for psychosis. In 1997 I was 46 years old, taking Prozac, Depakote, and Moban (an anti-psychotic), and I was barely functioning.

The initial reaction, after three days of the treatment, was astonishing. It felt like a giant headache was just lifted off me. But the [new] clarity of mind enabled me to see my awful condition, and I had acute suicidal thoughts for a day or two. After that initial bounce, the improvement in mood was more subtle, but definitely correlated to how early I started looking at faces.

The early years of the treatment were often rocky. You were still working out some of the kinks in the treatment. The biggest surprise came when you found that exposure to fluorescent lights at night cancelled the effect of the faces. Another problem, also having to do with fluorescent lights, arose when I added early-morning bright-light therapy: the start-time and duration had to be adjusted by trial-and-error. At least six times I was one step away from becoming delusional, and then the treatment would pull me back within 48 hours. You were indispensable during those early years because I could call you and you would give me advice and the will to pull through.

By 2003, I had made some good progress. I had moved back to Berkeley, I was living with “normal” roommates instead of with other bipolar guys, and I had even been able to work for short periods. But along the way I had accumulated several minor pains. Back pain and stress made it difficult to get more than 4 hours of sleep. Sleeping pills did not solve the problem. I was scared that I would have to return to the mental health system; I would be a failure at the only thing I ever cared about [using the face treatment to stay out of the mental health system]. I made a pathetic attempt at suicide and wound up back in Herrick Hospital.

It was back to the crappy life—dulling medications, the psychiatrist and the psychotherapist, the support group, a volunteer job. Then, in 2006, the publicity for your diet book motivated me to try the “faces in the morning” treatment again. By that time, you had found that using a mirror was as effective as using videotapes [such as C-SPAN Booknotes recordings], which greatly simplified the process.

By 2009 I had reduced my doses of Prozac and Depakote to only 10 mg and 250 mg, respectively. (I hadn’t needed Moban since 1999.) In August of 2010, dissatisfied with my low energy level, I decided to go off medications completely again. Getting off of Prozac and Depakote gradually was tricky, because Prozac, which can induce mania, has a plasma half-life of about 10 days, while Depakote, which is anti-manic, has a half-life on the order of only 10 hours.

Today, most people would no doubt say that I’m still a loser. No matter, I’m able to enjoy life and relate to others in ways that I never could my entire life. I’m a Total Believer in the treatment. I don’t proselytize, though. People automatically reject the idea, and in any event I don’t want to be (directly) responsible if the treatment doesn’t work for someone. (Example: My nephew has clinical depression; he also has guns. If he tried this treatment, went off of medications, and then for some reason killed himself, my sister would never speak to me.)

The most difficult aspect of the treatment for me has been simply going to bed early. Even though I feel better the earlier I go to sleep, 10:45 pm is the best I can do on a regular basis.

To sum up, I believe you have discovered a powerful anti-depressant treatment that, in my case, has been effective for severe bipolar disorder. As a complete substitute for medications, however, it has entailed serious risks, and it requires substantial discipline to maintain. It is also important to note that “face therapy” is not the only alternative therapy that I use. In addition to the bright-light therapy that I mentioned above, I currently take 3 grams of omega-3 per day in the form of fish oil capsules.

There are a few more details and observations in these blog posts:

https://sethroberts.org/2007/05/06/life-size-faces/#comment-10539

https://sethroberts.org/2007/07/31/more-about-faces-and-mood/

https://sethroberts.org/2009/10/15/more-about-faces-and-mood-2/

Tomorrow I will comment on this.

The Signaling of Economists

Seth Roberts19 Comments

I like this essay by Brad DeLong about the failure of economics professors. They didn’t just fail to predict the recent economics crisis but they have failed, as far as he can tell, to learn from it. If you are naive, of course this is astonishing — but DeLong is not naive. Yet he is “astonished”. That’s interesting.

It’s hard to imagine DeLong doesn’t know what I am about to say. I imagine anybody with any academic sophistication is aware of it — especially economists. As Thorstein Veblen (an economist) pointed out in The Theory of the Leisure Class (1899), a great deal of what professors do, including economics professors, is about signaling high status. In economics, this is done by being highly mathematical. (Same in statistics. In art history, it is done by using big words. In engineering it is done by being theoretical. In many areas of science, it is done by using expensive equipment and having a large lab. In many fields it is done by being useless — e.g., preferring “pure” research over “applied” research.) This is no mystery. Economists think a lot about signaling. Michael Spence wrote an influential paper (which included Veblen’s phrase “conspicuous consumption”) and book about it, for example, for which he won a Nobel Prize. (More examples from economics.) But DeLong ignores the signaling of economists. Let me propose why economists haven’t taken the steps DeLong is astonished they haven’t taken: Because it would make them more useful and less mathematical. Thereby signaling lower status.

Why is signaling so common? It is basic biology, yes. But it is also convenient. Here is what Veblen didn’t say: It is so much easier to signal than to make progress. Among animals, it is much easier to signal you will win a fight than to actually win one. Among professors, it is easier to use big words than to write clearly. DeLong wants economists to choose progress over signaling. Shouldn’t an economist not be astonished when the lower-priced option is chosen?

The Future of China

Seth Roberts5 Comments

Recently I had dinner with two Tsinghua students I advise.

ME Do you know what “science fiction” is?

BOTH OF THEM Yes.

ME I have an idea for a science-fiction story. Five years from now, Tsinghua and Beida [Beijing University] students get together and decide to change the government. What do you think?

They were amused by this idea. However, here’s what they said:

BOTH OF THEM Where’s the science?

I explained that science fiction often takes place in the future.

 

Seth Roberts Interview About Self-Experimentation

Seth Roberts1 Comment

For an article about self-experimentation and self-tracking to appear in Men’s Fitness UK this summer, Mark Bailey sent me several questions.

In what ways have the results of your self-experimentation directly affected your daily life e.g. health / work / lifestyle changes?

  1. Acne. My dermatologist prescribed two medicines. I found that one worked , the other didn’t.
  2. Weight. Found new ways to lose weight (e.g., nose-clipping).
  3. Sleep. Found new ways to sleep more deeply, avoid early awakening (e.g., one-legged standing).
  4. Mood, energy, serenity. Found that morning faces make me more cheerful, more energetic, and more serene.
  5. Productivity. After I started to track when I was working, I discovered that a certain feedback system made me work more, goof off less.
  6. Inflammation. Self-experimentation led me to take flaxseed oil. In the right dose — which I determined via self-experimentation — it greatly reduces inflammation. As a result, my gums are pink instead of red. They no longer bleed when I floss.
  7. Balance, reflexes. Flaxseed oil improved my balance and quickened my reflexes — I catch what I would have dropped.
  8. Blood sugar. I found that walking a lot improves my blood sugar level.
  9. Mental clarity. I found that flaxseed oil and butter improve how well my brain works in several ways.

Changes 1-6 are/were obvious. The rest are more subtle.

How long have you been self-experimenting?

About 35 years.

What are the main advantages of self-experimentation e.g. yields results specifically relevant to the individual and engages them directly in the process of finding solutions?

My self-experimentation has had three benefits:

1. Find new ways to improve health. Ways that no one knew about. I mentioned most of them earlier: New ways to lose weight, sleep better, be in a better mood, and so on. I find them to be much better (safer, cheaper, more powerful) than what was already available.

2. Test health claims made by others. I’ve done this many times. My interesting self-experimentation started when, as I said earlier, I measured the efficacy of two acne medicines my dermatologist had prescribed. I found that Treatment A worked and Treatment B did not worked, which was the opposite of what I had believed. It’s been claimed that drinking vinegar causes weight loss. I tried that, it didn’t work. Many people say that exercise improves sleep. I found that aerobic exercise made me fall asleep faster but did not reduce early awakening. The most dramatic “test” of health claims made by others came when I discovered that butter improved my arithmetic speed — which meant it was likely that butter improved overall brain function. I took this to mean that butter was good for the rest of the body — in contradiction to the official line that saturated fats are bad for us.

3. Find best “dose” of a treatment. Many people have claimed that flaxseed oil is beneficial. I found they were right. I tested different amounts/day and found the dosage that produced the most benefit. The best dose (2-3 tablespoons/day) was much larger than you would guess from the size of flaxseed oil capsules and the suggested dose on bottles of flaxseed oil capsules.

What do you consider are the potential weaknesses e.g. lack of clinical precision / possible placebo effect?

Is too-high expectations a weakness? You could spend a lot of time and not learn anything useful. Which isn’t so much a weakness as a fact of life.

In my experience, useful self-tracking and self-experimentation are slow. Other people’s self-tracking projects often strike me as too ambitious — doing too much too soon. For example, they are tracking too many things. Or worrying too much about placebo effects. Because they are doing too much — carrying too much, you could say — they may get tired and stop before they have learned something useful.

From a psychological perspective, why is the use of data / numbers, as in self-tracking, so much more powerful and engaging than merely ‘setting a goal’?

For one thing, it’s more forgiving. When I set goals for myself, I often fail to meet them. That can be so unpleasant I give up. When you simply measure something, it much easier to succeed — all you have to do is make the measurement. For another thing, it’s more informative. By studying my data I can learn what controls what I’m measuring (e.g., sleep). Setting a goal doesn’t do that.

Why, in a world dominated by numbers / statistics, has it taken so long for us to use data to learn about ourselves, our lives and our bodies?

You seem to be asking why has it taken so long to apply something so useful elsewhere (“numbers/statistics”) to ourselves? I have a different starting point. I think it is science — which is more than numbers and statistics — that has been useful elsewhere. Numbers/statistics by themselves are little help. I also think health scientists (e.g., med school professors) have used numbers/statistics to learn about ourselves — with little success.

In my experience, you need four things to make useful progress on health: 1. Good tools. Computer, numerical measurement. 2. Experiments. You need to systematically change things. 3. Knowledge of what others have learned. You can’t do experiments blindly, there are too many possibilities. You have to choose wisely what to change. 4. Motivation. You have to really care about finding something useful.

Professional scientists have Numbers 1-3 (tools, experiments, knowledge). Lacking Number 4 (motivation), they haven’t gotten very far. Self-trackers have Number 1 (tools). If they have a problem, something they want to improve, they have Number 4 (motivation). Most self-trackers have Numbers 1 and 4. Without Numbers 2 and 3 (experiment and knowledge) they aren’t going to get very far. What’s so important about the self-quantification movement is they might get Numbers 2 and 3. They might learn to experiment. They might learn to study what everyone else has already learned. When that happens, I think they will make a lot of progress. They will discover useful stuff that professional scientists have missed. And the whole world will benefit.

What developments will need to occur before self-tracking can really grow in the future e.g. better analysis / devices etc?

More successful examples. More examples where self-tracking led to improvement. They will teach everyone how to do it usefully. I think these examples will show that self-tracking alone is not nearly enough, as I said. But maybe I’m wrong. We need examples to find out.