Month: August 2011

The Continued Existence of Acne Reveals the Perverse Incentives of Modern Medicine

Seth Roberts16 Comments

Yesterday I wrote how Alexandra Carmichael’s headache story illustrated a large and awful truth about modern healthcare: It happily provides expensive relief of symptoms while ignoring investigation of underlying causes. If we understood underlying causes (e.g., causes of migraines), prevention would be easy. Let people get sick so that we can make money from them. There should be a name for this scam. In law enforcement, it’s called entrapment.

Sensible prevention research would start small. Not by trying to prevent breast cancer, or heart disease, or something like that: They take many years to develop and therefore are hard to study. Sensible prevention research would focus on things that are easy to measure and happen soon after their causative agents. One example is migraines. Migraines happen hours after exposure. The fact that Chemical X causes migraines means it is likely that Chemical X is bad for us, even if it doesn’t cause migraines in everyone. This is the canary-in-a-coal-mine idea. Migraines are the canary.

Acne is another canary. Acne is easy to measure. Figuring out how to prevent it would be a good way to begin prevention research. To prevent acne would be to take the first steps toward preventing many more diseases. A high-school student could do ground-breaking research — research that would improve the lives of hundreds of millions of people — about how to prevent acne but somehow this never happens. In spite of this possibility, grand-prize-winning high-school science projects, from the most brilliant students in the whole country, are always about trivia.

A just-published review in The Lancet reveals once again the unfortunate perspective of medical school professors. The abstract ends with this:

New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.

Actually, finding out what causes acne is all that’s needed.

To figure out what causes acne (and thereby how to prevent it) three things are necessary: (a) study of environmental causes, such as diet, (b) starting with n=1, and (c) willingness to test many ideas that might be wrong (because it’s far from obvious how to prevent acne). All three of these things are exactly what the current healthcare research system opposes. It opposes prevention research because drug companies don’t fund it. It opposes n=1 studies because they are small and cheap, which is low-status. To do such a study would be like driving a Corolla. It opposes studies that could take indefinitely long because such studies are bad for a researcher’s career. Researchers need a steady stream of publications.

High school students, who aren’t worried about status or number of publications, could make a real contribution here. You don’t need fancy equipment to measure acne.

Thanks to Michael Constans.

Alexandra Carmichael Almost Eliminates Headaches

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In this post, Alexandra Carmichael describes how she recently figured out what caused most of her headaches. She had suffered from frequent headaches for twenty years. One source was dairy. She confirmed this source when eating 1/4 stick of butter gave her a splitting headache. Another source was gluten. She got the idea that gluten might matter from the CureTogether list of migraine treatments. A final source turned out to be Febreze, as I mentioned in an earlier post.

You might marvel that conventional healthcare (e.g., doctors, the Mayo Clinic website, and so on) was no help. Or you might not. In the case of the woman I wrote about for Boing Boing, her conventional doctors actively got in the way of helping her find the source of her migraines. Alexandra takes ibuprofen for her headaches. So conventional healthcare (in this case, the makers of ibuprofen) has managed to profit from every one of her headaches but hasn’t done one useful thing to prevent them. A nasty state of affairs (provide expensive relief of symptoms, ignore prevention and underlying causes, thus ensuring that people continue to get sick and need relief) that is repeated a thousand places in our healthcare system (e.g., in depression, cancer, etc.).

At the First QS Conference, I gave a talk that included the following equation:

progress = resources*knowledge*time*freedom*motivation

I used this equation to explain why mainstream medicine was stagnating, but personal science was not. Personal scientists (individuals trying to improve their own health) seem tiny and insignificant compared to medical school professors with million-dollar grants and large labs. But the visible superiority of medical school professors — they have far more resources and knowledge than personal scientists, not to mention more prestige — masks an enormous hidden inferiority: Personal scientists have far more time, freedom, and motivation than medical school professors. And personal scientists are rapidly gaining more resources and knowledge. This is why, in terms of progress, they are catching up to and surpassing mainstream healthcare.

Alexandra’s story illustrates the pattern. In this case, personal science made progress (it eliminated most of her headaches), mainstream healthcare did not (it eliminated none of them). And the success of personal science depended on increases in resources and increases in knowledge. A new resource that helped Alexandra was a DailyBurn iPhone app that helped her track what she ate. From those records she noticed a curious pattern: that changes in how much dairy she ate caused trouble. Two new sources of knowledge also helped her. The accumulation of knowledge at CureTogether led to her to suspect gluten was one of her triggers. And my story in Boing Boing led to her to suspect that Febreze and other cleaning products were triggers.

 

Assorted Links

Seth Roberts3 Comments

Thanks to Anne Weiss.

The Rules of the Tunnel by Ned Zeman

Seth Roberts1 Comment

I loved Ned Zeman’s new book The Rules of the Tunnel, which I read during a long plane flight. Not only does it combine three of my favorite subjects — high-end magazines, bipolar disorder, and the crappiness of modern psychiatry — but it’s very well-written and revealing. I haven’t enjoyed a book so much in a long time.

Zeman once wrote for Spy, as did I. Long ago, I met him at a Spy party. I suppose I could have gotten a free copy of his book but I bought it. I wanted something great to read on the plane.

Sulfites in Wine May Cause Bad Dreams

Seth Roberts6 Comments

Eric Stroud, a web and marketing consultant, thought it would be nice to have a glass of wine an hour before bedtime. Wine is healthy, right?

But after seven or so nights of this, he began to have unpleasant dreams of a sort he’d never had before. They became more and more visceral, nightmarish, and anxiety-drenched. This continued four or five nights. Then he stopped drinking the wine. The bad dreams went away in one or two days. Something similar happened to one of his cousins.

He believes the bad dreams were due to the sulfites in wine. When he drank sulfite-free wine, he felt fine.

Tucker Max on Writing and the Importance of Understanding How You Differ

Seth Roberts24 Comments

I recently heard Tucker Max speak about writing books. He said he had succeeded because he told the truth about himself — including the unpleasant stuff. Most people don’t. That, plus an ability to make it entertaining, was what he could do that other people couldn’t. He was saying that “being yourself” — more precisely, building on how you are different — was the only good place to start. Imitating other people is not a good place to start. Jane Jacobs said the same thing about how cities should develop. She said it was pointless to try to imitate other cities — to imitate them by building a stadium or convention center, for example. Each city should figure out what its unique strengths are — what makes Springfield Springfield — and build on them. Amplify them.

I was pleased to hear Tucker’s remarks because I never hear such stuff said publicly (or privately), except from Jane Jacobs. When I was at Berkeley, now and then I’d tell other professors: It’s a mistake to treat all students in a class the same (by giving them the same assignments, the same tests, etc.). They’re not all the same. They differ greatly. A lot is lost by treating them all alike — a lot of self-esteem, for instance. My colleagues didn’t like hearing this. It was convenient to treat all students the same. And it was status-boosting. My fellow professors worked in a system where the dimension used to gauge success was something they were good at. The notion that there were many other useful ways to excel was undermining. If there is only one measure of success and I am #1 on that measure, I am #1 period. If there are thirty measures of success, all equally valid, and I am #1 on only one of them, my superiority is less clear.

Tucker’s presence at the Ancestral Health Symposium was criticized. Here is an email that the organizers (who include me) received:

One thing neither I nor my attendee friends can explain: Tucker Max as a speaker? Really? His claim to fame is having rough sex with drunk girls and then writing about it. I’m pretty sure the majority of his speaking gigs take place at bars and frat houses. From his own website:

“I get excessively drunk at inappropriate times, disregard social norms, indulge every whim, ignore the consequences of my actions, mock idiots and posers, sleep with more women than is safe or reasonable, and just generally act like a raging dickhead.”

If you have a chance, could someone please explain this choice of speaker? I’d love to support this conference in the future, and I’m all for challenging social norms, but not those that have to do with basic respect for other people.

I replied:

I wanted Tucker Max to come and went so far as to give up half my presentation time to allow him to speak.

Why did I want him to speak? Because he is a big supporter of paleo, because he had something fresh to say, because he would say it well (and he did), and because he is deeply respected by an audience it is crucial to reach — college students. Sure, some things he writes offend some people. I don’t think that means he doesn’t have something helpful to say.

I don’t think college students respect him so much because he writes about getting raging drunk, etc. I think they respect him because he speaks the truth about subjects where most people don’t speak the truth.

The connection between “being yourself” and speaking the truth about difficult subjects is simple: Being yourself inevitably involves being different and being different inevitably involves some people scorning you. As Tucker said things that caused people to scorn him. As some people scorn my self-experimentation. In a society where being yourself isn’t valued enough, the fear of scorn wins, people self-censor, and, as in the above email, they censor others. Everyone’s loss.

The effect of an educational lifetime of being treated the same — from kindergarten thru college — is that the notion that you are different and have something unique to add becomes less and less plausible to you. Because it becomes implausible, that possibility doesn’t enter into your calculations about what to do with your life — in particular, what job to choose. You begin to think that success = imitation of successful people, when that is misleading. Imitate successful people like you, yes, but most people aren’t like you. I chatted with Tucker after his talk. He said it isn’t enough to be different, you have to act on it, become better and better at exercising your unique talent. I agree. In a better world, you would do this starting young, like 10, and slowly become better so that by the time you needed to make a living you would have substantial skill. But our educational system, by treating everyone the same, or nearly the same, discourages this.

 

More About the Migraine Story Comments

Seth Roberts1 Comment

My post at Boing Boing about a woman who figured out the sources of her migraines attracted lots of comments, some of them preventive stupidity (e.g., “anecdotes are not evidence”). I asked the subject of the story what she thought of it. Here’s what she said:

I feel that many people entirely missed the point when reading the original article. I wasn’t trying to communicate that a) all doctors are evil/drug-pushing/uncaring or b) my ‘natural’ solution would magically cure everyone. I have to admit, I’m a little tired of both sides of that old ‘Real Science vs. Natural Healing’ argument anyway. In my case, at least, both extremes are obvious oversimplifications of years of my life that were a very trying, difficult struggle for me.

I am quite aware that the number of drugs I had been tried on was absurd (and layering them as was done: some to ‘prevent’, some to treat as needed, etc, definitely did not help. How can you distinguish what works? You can’t). The armful of drugs to “try until one works” left me dumbfounded for that very reason. At the same time, without the help of a doctor (who happened to be a naturopath, but that is beside the point) who was willing to take a look at my data and listen and apply what she knew, I’d never have reached the stable, much healthier point I’m at now. She hit on a pattern that made a significant difference. One that I wouldn’t have known how to help had I even seen it, because I’m not a doctor.

I believe the take-away message from my story ought to be simply: take charge of your health. I’m also well-aware that this isn’t a new message.
Nevertheless, if you have migraines, there’s only one person who wants them solved more than anyone else in the world, and that’s you. So tracking, I believe, is necessary.

As for my self-experimenting on removing harsh chemicals: so what? It made (and continues to make) a significant difference for me. Perhaps it is placebo, perhaps it’s a sensitivity. I have to say, the allegations that ‘spreading lies about how cleaners cause migraines cause doctors to have to clean up the mess’ strike me as particularly amusing because, with a touch of further digging, one quickly realises that switching to a fragrance-free, SLS-free, paraben-free cleaner isn’t exactly the kind of thing that lands people in the hospital.

I don’t care to argue about so-called natural living. Annie B. Bond’s story (and if I’m tooting horns for anyone, it’s her) and contributions to various websites made me start to wonder about the things I took for granted in the world around me and their impact on my health. If reading my story gave someone else a moment’s pause to consider what had changed in their environment along with the return or start of a health issue, well. I’m the first to admit that correlation is not causation. The science isn’t “perfect”: you don’t live in a lab. To my mind, that’s poor reason to give up before trying. It’s a terrible reason to give up before even considering. Critical thinking about your life, habits, environment, health, and how they intersect is not wasted thinking.

In any case, I have to admit, the only thing that surprised me is how willing people are to get into the arguments. I’ve commented on the natural-vs.-real-science bit above; the anecdotes-don’t-make-good-research theme is really an equally old and equally tedious argument to have with someone (my current faculty still tries to balance on the qualitative vs. quantitative data debate). For those who care, then, I hope they can come to consider this a piece of a much larger, multivariate puzzle of “everyone’s health”. Migraine sufferers, as far as I know, don’t have a “patients-like-me” site dedicated to them. Even if you get nothing else out of a story, you should get a sense of community. Other people are also going through what you’re going through- whatever the cause, whatever the outcome.

One person helped by the Boing Boing story. My comment on the comments.

Flaxseed Oil Reduces Healing Time

Seth Roberts12 Comments

A few days ago, Dominic Andriacchi, a 25-year-old law student living near Detroit, told me that he mentioned some of my self-experimentation (my discovery that postponing breakfast reduced insomnia) in an Amazon ebook (Law School Livin’) he’d just published. He added that something he read in this blog really helped him:

Thank you for introducing me to flaxseed oil. Recently, I re-injured my back (a injury that occurred during college football). While I’ve never seen a doctor for the injury, I did a little internet searching and figured that I had herniated a disk in my lower back. I also had pain in my leg due to, I presume, pressure on the sciatic nerve from the herniated disk.

He re-injured his back pulling a small tree uphill.

Usually, it takes at least a week for the pain to go away. I have trouble sitting, walking, and so forth. That day, because I [had] read the post of Tucker Max’s ankle injury and flaxseed oil, I immediately upped my flaxseed oil to a total of 15 1000mg capsules. The next day, there was nearly no pain at all. I could bend over and touch my toes with only the slightest pain. The day after that, I was back to normal.

Later he added some details:

I took 15 capsules of flaxseed oil [the day of the injury] to see what would happen. There was no immediate benefit that I felt that day, but the next day it was great. Even sitting or the slightest bending can cause a lot of pain, but I was able to bend over and nearly touch my toes. I took another 10 capsules that day as well. The day after that, I was completely pain free. I took more flaxseed oil capsules even though I was experiencing no pain at all. I expected the pain to come back, but it didn’t. From then on, I would just take my normal two flaxseed oil capsules [per day]. I was spacing them out, 5 at a time in between meals.