Month: June 2011

Health Care Stagnation

Seth Roberts38 Comments

In December, the Los Angeles Times reported — very briefly — that from 2007 to 2008, life expectancy in the United States declined by 0.1 year. It should have been the lead story of every newspaper in the country with the largest possible headlines (“ LESS LIFE“). Did 9/11 reduce life expectancy this much? Of course not. Did World War II? Not in a visible way — American life expectancy rose during World War II. I can’t think any event in the last 100 years that made such a difference to Americans. The decline is even more newsworthy when you realize: 1. It is the continuation of trends. The yearly increase in life expectancy has been dropping for about the last 40 years. 2. Americans spend far more on health care than any other country. Meaning vast resources have been available to translate new discoveries into practice. 3. Americans spend far more on health research than any other country and should be the first to benefit from new discoveries.

Maybe I’m biased (because my research is health-related) but I think this is the biggest event of our time. It is the Industrial Revolution in reverse — progress grinding to a halt. For no obvious reason, just as the Industrial Revolution had no obvious reason. Health researchers have been given billions of dollars to improve our health, the whole system has been given tens of billions of dollars, and the result is … nothing. Worse than nothing.

No journalist, with the exception of Gary Taubes, seems the least bit aware of this. It is a difficult story to cover, true. But several journalists, such as health writers for The New Yorker (Atul Gawande, Michael Specter, and Jerome Groopman) are perfectly capable of covering it. They haven’t. With a few exceptions, they write about progress (e.g., Peter Provonost’s checklists). It is like only reporting instances when Dirk Nowitzki missed a free throw. Each instance is true but the big picture they create — he misses all free throws — is profoundly false.

Among academics, the stagnation has received a tiny amount of attention. In a recent paper (gated), two University of Southern California professors, considering a wider time period, point out that there has been some improvement in how long you live after you get sick, but no improvement in how long you live before getting sick. Here is how the discussion section of their article begins:

There is substantial evidence that we have done little to date [meaning: from the 1960s to the 1990s] to eliminate or delay disease or the physiological changes that are linked to age. For example, the incidence of a first heart attack has remained relatively stable between the 1960s and 1990s and the incidence of some of the most important cancers has been increasing until very recently. Similarly, there have been substantial increases in the incidence of diabetes in the last decades.

Here is my explanation of the paradox of: 1. Enormous and increasing health care costs. 2. Vast amounts spent on research. 3. No better health. Health researchers, such as medical school professors, shape their research to favor expensive treatments, such as expensive drugs. In fact, the best treatments would cost nothing (e.g., the Shangri-La Diet). To make the expensive treatments seem worth studying, they invent utterly false theories and claim to believe them. For an example (research about depression), see The Emperor’s New Drugs by Irving Kirsch. Because health researchers are forced to worship absurd theories, they are incapable of good research. Absence of good research is why there is no progress. The health care supply chain — everyone between you and the research, such as doctors, nurses, drug company employees, hospital employees, alternative medicine practitioners, medical device makers, and so on — is happy with the situation (useless research) because it ensures that little will change and they will continue to get paid. They are the supposed experts — and remain silent.

It is human nature that everyone in the supply chain remains silent. They are protecting their jobs. But the silence of the journalists is The Emperor’s New Clothes writ large. To explain why smart journalists fail to notice the stagnation, I think you have to go back to studies of conformity. When everyone you talk to — people in the supply chain — says black = white (i.e., that progress is being made), you say the same thing.

Why is personal science, the main subject of this blog, important? Because it is a way out of this stagnation.

The Medtronic Scandal

Seth Roberts2 Comments

In August 2010, John Farber, a reporter at the Milwaukee Journal Sentinel, wrote an article about how a medical device called Infuse, used for spinal surgeries, “went from revolutionary advance [2002] to public health alert [2008].” Bad side effects were common when Infuse was used, far more common than when it wasn’t used. Infuse is a hugely profitable product of Medtronic, the largest medical device company in the United States.

How did the high rate of bad side effects go unnoticed? Farber went on to find that there were unreported conflicts of interest in the journal articles about Infuse. The authors of the articles had received (before and after publication of the articles) large payments from Medtronic, on the order of $5 million per person. The articles themselves greatly underreported side effects. Moreover,

Evidence has accumulated suggesting that the superior clinical results reported by doctors with financial ties to Medtronic have not been replicated when the device was used by doctors who receive no payments from Medtronic.

A whole issue of The Spine Journal has been devoted to the problem and a Senate committee is investigating.

Thanks to Zachary Hamaker.

Mercury Damage Revealed by Brain Test

Seth Roberts20 Comments

For several years I have been doing simple daily tests to measure my brain function. I got the idea when I noticed that a few capsules of flaxseed oil improved my balance. Flaxseed oil also improved other measures of brain function, such as digit span. I wasn’t surprised I could do better; what was surprising was how easy it was. It revealed a big gap in our understanding of nutrition. I do the daily tests not only to improve brain function but also to improve the rest of my body. I think the brain is like a canary in a coal mine — especially sensitive to bad environments. Learning what environment was best for the brain would suggest what environment is best for the rest of the body. When I started taking an optimal amount of flaxseed oil, my gums turned from red (inflamed) to pink (not inflamed), supporting this assumption.

I tried six or seven mental tests and eventually settled on a test of arithmetic (how fast I could do simple problems such as 5-3). I hoped that now and then my score would change (in either direction, faster or slower) and that these changes would point to new things that control brain function. No one had/has done such a thing. I had no idea if unexpected changes would show up or, if they did, how often. I didn’t know what the score changes would look like (their size and shape) nor, of course, what would cause them. Would all of them involve diet? Would all of them make sense in terms of what we already know? (Flaxseed oil makes sense because the brain contains lots of omega-3.)

The first two surprises were these: 1. My score suddenly improved a few days after switching from Chinese flaxseed oil to American flaxseed oil. This made sense: It is easy to destroy omega-3 if flaxseed oil is kept at room temperature. 2. My score suddenly improved when I switched from pig fat to butter. This was counter-intuitive: pig fat is more paleo than butter.

Last fall, there was another surprise: My score greatly improved since the summer. I was much faster than ever before. At first I thought the improvement was due to moving to Beijing. I had moved from Berkeley to Beijing in early September. My Beijing life differed in a thousand ways from my Berkeley life. I had three ideas about which differences might matter. 1. Walnuts. Perhaps I ate more walnuts in Beijing. Walnuts are supposed to be good for brain function. 2. Heat. It was much hotter in Beijing than Berkeley. Maybe that improved brain function. 3. Vitamins. I took less vitamin supplements in Beijing. Maybe they harmed brain function.

I tested these possibilities. 1. I stopped eating walnuts. My arithmetic score did not clearly change. 2. Winter came, it got much colder. The improvement did not go away. 3. I took the same amount of vitamins I’d taken in Berkeley. My arithmetic score didn’t change. So all of these ideas were wrong.

Because they were wrong, I considered a fourth possibility: The improvement was due to removal of two mercury amalgam fillings on July 28, 2010. They were replaced with non-amalgam fillings. I’d had them removed for precautionary reasons. I wasn’t suffering from any signs of mercury poisoning. Hair tests had repeatedly shown mildly high amounts of mercury in my hair (75th percentile of an unspecified sample). Measurements of the mercury in my breath had come out higher than usual but it was hard to be sure the machine was working correctly.

I looked again at my data. It showed something I hadn’t noticed: the improvement started before I went to Beijing. It started very close to July 28. That was good evidence that the mercury explanation was correct. Now the evidence is even stronger. I’ve returned to Berkeley and thereby made my life quite similar to the situation when my scores were much higher than now. The improvement has remained.

The evidence for causality — removal of mercury amalgam fillings improved my arithmetic score — rests on three things: 1. Four other explanations made incorrect predictions. 2. The improvement, which lasted months, started within a few days of the removal. Long-term improvements (not due to practice) are rare — this is the only one I’ve noticed. 3. Mercury is known to harm neural function (“mad as a hatter”). As far as I’m concerned, that’s plenty.

A long Wikipedia article describes evidence on both sides of the question of whether mercury amalgam fillings cause damage. In 2009, the American Dental Association stated in a press release “the overwhelming weight of scientific evidence supports the safety and efficacy of dental [mercury-containing] amalgam.” As recently as 1991, Consumer Reports told readers “if a dentist wants to remove your fillings because they contain mercury, watch your wallet.” (Dental insurance will pay most of the cost of removing my remaining amalgam fillings.) In an essay last revised in 2006, Stephen “Quackwatch” Barrett explained at length why mercury toxicity is a “scam”. According to Barrett, “there is overwhelming evidence that amalgam fillings are safe.”

Ask your dentist some pointed questions.

 

 

 

 

 

 

 

 

 

Assorted Links

Seth Roberts2 Comments

Thanks to Anne Weiss.

Albert Einstein: Out-of-Touch Theorist

Seth Roberts19 Comments

Martin Wolf relays what passes for wisdom:

Albert Einstein is reported to have said that insanity consists of doing the same thing over and over again and expecting different results.

Which, if true, shows that Einstein was a theorist.

Call me insane. Based on many years of data collection, I believe scientific progress has a power-law distribution. You sample from this distribution when you collect data. You collect data again and again — “doing the same thing over and over again”. Almost all the data you collect produces little progress; a tiny fraction produces great progress. The secret to scientific progress is doing the same thing over and over — and being wise enough to grasp that the results will vary greatly. (Nassim Taleb understands this.) In the short term, it seems like you are getting nowhere.

I learned this lesson from my sleep research. For ten years I tried various solutions to my problem of early awakening. Nothing worked. All my ideas were wrong. Eventually I got “lucky” but actually I made my own luck by persisting so long.

Once you realize the distribution of progress, you grasp that the secret of success is making the cost per sample as low as possible. Few scientists, in my experience, have figured this out. They prefer expensive experiments because larger grants signal higher status. Won’t fancy equipment tell me more? they rationalize. Grant givers, also failing to understand the basic point, are happy to oblige the status-seekers: Much easier to administer one $200,000 grant than 10 $20,000 grants. And progress slows to a crawl.

More Rita Mae Brown is a more likely source of this saying than Albert Einstein.

Marcia Angell on Psychiatry: A Train Wreck

Seth Roberts11 Comments

Marcia Angell, a former editor of JAMA, may be the most prominent critic of drug companies. The most recent two issues of the New York Review of Books contain a two-part critique by her of psychiatry. I liked Part 1 because she described the excellent work of Irving Kirsch (The Emperor’s New Drugs). Part 2, however, is a disaster.

She goes on and on about the evils of the DSM s — the diagnostic manuals of psychiatry. Improving the reliability of diagnosis is playing into the hands of the drug companies, she seems to say. She complains that the number of diagnoses is increasing. Well, yes, all diagnostic systems get larger over time. This is a good thing; if you don’t have a name for a problem, it is hard to do cumulative research about it and hard to communicate research results to everyone else. She complains, apparently, that new categories are being added:

There are proposals for entirely new entries, such as “hypersexual disorder,” “restless legs syndrome,” and “binge eating.”

She does not say why this is bad. Maybe she thinks it’s obvious. It isn’t obvious to me. Diagnostic categories help researchers and doctors and the rest of us communicate. For example, Dennis Mangan’s research shows why it is a good idea for the term restless legs syndrome to have an agreed-upon meaning.

She complains that the DSM doesn’t have enough “citations”:

There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies. (There are four separate “sourcebooks” for the current edition of the DSM that present the rationale for some decisions, along with references, but that is not the same thing as specific references.)

Please. This is clueless. A diagnostic manual is a dictionary. It assigns meanings to diagnostic categories. You can make a useful dictionary without “citations of scientific studies”. Long before you can do scientific studies about the best way to define dog you can come up with a definition of dog that is better than nothing.

She ends her review with this:

Above all, we should remember the time-honored medical dictum: first, do no harm (primum non nocere)

Gag me with a spoon. Time-honored? Doctors — with the support of JAMA, not to mention the rest of the health-care establishment — continually prescribe drugs with bad side effects and high prices and suppress innovative alternatives. (Not only that. My own surgeon recommended a dangerous surgery of no clear value.) How they can claim to do no harm escapes me.

Sure, psychiatry is awful. For a long time psychiatrists rallied around a transparent intellectual fraud (Freud and his offshoots). Now they rally around a less transparent intellectual fraud (neurotransmitter theories of mental illness). Psychotherapists and their wacky theories and no-more-effective treatments are no better so I wouldn’t blame the drug companies for the underlying problem. I put the problem like this: Our health care system consists of a very large number of people, many with very large salaries, who must get paid. Being human, they strongly oppose any progress that would reduce their salary or influence or, heaven forbid, eliminate their job. Because of them, many promising lines of research, such as prevention via environmental change or cure via nutrition, are completely or almost completely ignored. This is the fundamental reason Angell’s critique is so bad: She is part of the problem. She is very smart, but she’s been brainwashed (“ primum non nocere“!). She utterly ignores the fact that we don’t know what causes depression, what causes schizophrenia, what causes autism, and so forth. Only when we learn what causes these and other mental disorders will we be in a good position to improve our mental health.

 

 

 

The Torchlight List by Jim Flynn

Seth Roberts8 Comments

In college and afterwards, I tried to educate myself by reading well-written stuff. At first, I went through back issues of The New Yorker in the Caltech library. Later I stuck with books. For example, I learned about molecular biology by reading The Eighth Day of Creation. The Torchlight List by Jim Flynn (discoverer of the Flynn Effect, the slow increase in IQ scores) has the same underlying philosophy: a good way to learn is to read books you enjoy.

The Torchlight List describes 200 books in pleasant narrative prose that Flynn both enjoyed and found educational. Here are the first three:

  1. The Story of Language by C. L. Barber
  2. The Greek World edited by H. Lloyd-Jones
  3. The Decipherment of Linear B by John Chadwick

Indeed, I read the Chadwick book and enjoyed it. I have yet to find a well-written book about language evolution (although I liked John McWorter’s lectures on the subject) so I look forward to the Barber book.

More people should write books like this; the underlying idea is very good. I found one important gap in Flynn’s categories of books (Science and Early History, American History, America Broods, The Human Condition 1, …): Books That Caused Discomfort (and are fun to read). There are not many such books. Robert Moses was intensely discomforted by Robert Caro’s The Power Broker. (A recent enjoyable TV series that caused discomfort was The Kennedys.) Lolita was discomforting, far more than Nabokov’s other books. First prize in this category goes to The Man Who Would be Queen by Michael Bailey.

 

 

Assorted Links

Seth Roberts3 Comments

Self-Tracking as a Source of Political Power

Seth Roberts2 Comments

The more certain you are the more power you have to convince others and convince yourself. You may want to convince them that change is needed — e.g., that a polluting factory should be shut down or cleaned up. China has a huge problem with industrial pollution, as this report describes. Children are especially at risk.

The danger to those in power posed by self-tracking — in particular, blood tests that measure lead — is shown by this quote from the report:

Even parents who were able to access [lead] testing for their children reported difficulties in obtaining the results of the tests conducted. Many parents in Yunnan and Shaanxi reported that test results from their children’s lead tests were withheld completely. Some parents in Yunnan and Shaanxi told Human Rights Watch that they never saw any test results. Others were allowed to see the results from initial testing but were prevented from seeing the results from follow-up testing.

My daily arithmetic tests (how fast can I do simple arithmetic, such as 3 + 5) have the same purpose as the lead tests: to assess the quality of the environment. If my scores get worse, it may reflect poisoning. Comparison with a blood test for lead highlights strengths and weaknesses of my arithmetic test.

Strengths

1. Sensitive to many things. Can detect any bad influence on the brain, not just lead.

2. Free in the sense that the cost is zero (so long as you have a laptop).

3. Unrestrictable. No one can deny you access.

4. Fast. You get the results immediately.

5. Great sensitivity. You can test yourself as often as you want. The more tests you do the more easily you can detect a change.

6. Variability known. By looking at a graph of your data (score vs. day) you can judge the natural variability — essential for judging the importance of a deviation. With lab tests, the variability is rarely known to the person whose blood was tested or the doctor that reviews the results.

7. Measures what you care about. You care about health. Brain health is part of that. Sure, high levels of lead are bad, but what about low levels? Is there a hormetic effect? The dose-response function isn’t obvious.

Weaknesses

1. Unconventional. A lead test is easier to understand.

2. Unspecific. If a score is bad (= if I get slower) it isn’t clear why. If you have too much lead in your blood the cause is likely to be obvious (e.g., polluting factory, lead in food).

3. Sophistication needed. The arithmetic test is sensitive to hundreds of environmental factors, I’m sure, so identifying the cause of any change inevitably requires sophistication. For example, perhaps you need to control the time of day. Another example is that you need to control/allow/adjust for practice effects.

If the Chinese parents were able to measure their children’s brain functions themselves, they might be far more outraged — and therefore far more powerful.

Tucker Max on Omega-3 and Writing Ability

Seth Roberts15 Comments

Re-reading an old post recently, I found this comment by Tucker Max:

I took four tablespoons [of flaxseed oil] a few hours ago, instead of the regular two, thinking that maybe I could load up and it might help me get back to normal quickly. The pain is pretty much the same, and I just brushed and my gums bled, so obviously the flaxseed oil takes more than a few hours to affect those problems. But–and I haven’t measured this with reaction tests like you do–I feel considerably more mentally alert right now. I don’t know if I felt like this before, and maybe I didn’t notice it because it came on slowly, or maybe I need four tablespoons at once to see a difference, but I really do feel the difference.

By coincidence I had noticed the same thing the day before: I was distinctly sharper than usual a few hours after drinking flaxseed oil (two tablespoons), as measured by my arithmetic test. I had noticed the same thing twice before — years earlier — but had decided not to study it in detail because it was much easier to study the long-term effects of flaxseed oil.

I wrote Tucker to say he had been right. He replied:

Yeah, there’s zero doubt in my mind now that fish oil/omega 3 is crucial to brain function. If I don’t take it, I can’t write effectively.

That’s very interesting. Sure, drugs have short-term effects. If you ingest caffeine, for example, it will make you more awake for a few hours. But drugs are dangerous. The notion that a necessary nutrient has benefits that last only a few hours is new. (The notion that a necessary nutrient can make us distinctly sharper will also be new to most people, but not to readers of this blog.) Perhaps we should eat omega-3 every few hours. You’ve heard of RDAs (Recommended Daily Allowances). Perhaps the future will contain RHAs (Recommended Hourly Allowances).

If you haven’t been reading this blog for several years, see these posts for background. Flaxseed oil also will make you smarter long-term, e.g., the next day. The short-term effect is in addition to the long-term effect.