Month: March 2012

Assorted Links

Seth Roberts2 Comments

Thanks to David Cramer, Jahed Momand and Nancy Evans.

The Value of Moodscope

Seth Roberts4 Comments

In 2007, Jon Cousins started tracking his mood to help NHS psychiatrists decide if he was cyclothymic (a mild form of bipolar disorder). After a few months of tracking, he started sharing his scores with a friend, who expressed concern when his score was low. Jon’s mood sharply improved, apparently because of the sharing. This led him to start Moodscope, a website that makes it easy to track your mood and share the results.

I was curious about the generality of what happened to Jon — how does sharing mood ratings affect other people? In January, Jon kindly posted a short survey about this. More than 100 people replied.

Their answers surprised me. First, in a survey about sharing your mood — not about tracking your mood — most respondents did not share their mood. It is as if, in a survey about being tall, most respondents were not tall. Second, although Jon’s mood sharply rose as soon as he started sharing, this was not the usual experience. Sharing helped, some people said, but other people said sharing hurt. For example, one person said her mood was used against her in arguments. Finally, the respondents gave all sorts of persuasive reasons that rating their mood helped them. To me, at least, the value of mood rating isn’t obvious. I can list a dozen hypothetical benefits but whether they actually happen is unclear to me. I rated my mood for years and did it only to learn about the effects of morning faces. MoodPanda, another mood-rating site, gives a few brief vague unenthusiastic reasons to track your mood. And their site is all about mood rating.

In contrast, Moodscope users were clear and enthusiastic about the value of tracking. Here are some reasons they liked mood-tracking:

It is useful to look back sometimes to help you find ways of ‘keeping up’ a positive mood/outlook.

My mood range has definitely narrowed since starting mood stabilizers, so using Moodscope has given me solid evidence that the treatment is working well. I also run statistical analyses of my mood charts against variables like sleep, medication use, and alcohol consumption. The correlations were not particularly meaningful using a 9-point Likert-like scale from a standard mood chart. When I used my Moodscope scores instead, I suddenly found that some of the correlations are (ridiculously!) statistically significant, which also made me feel more certain about what I need to do and change to better manage my mental health.

I could express my miserableness in total safety, without leaning on anybody else. It has proved wonderful. My profile has risen from a score of 7 on day 1 (11 months ago) to the 90s now. Being able to track my reasons for feeling better or worse has been part of this. The patterns are visible, ditto the triggers that send me up or down.

The great benefit of Moodscope has been to confirm the advantages of my own lifestyle management for coping with bipolar disorder. It has shown that what I felt was bad for me, is indeed bad, and what I felt was good for me, is indeed good. (I know that I have to take the meds.)

It helps that I can post things about sleep hours in the comments and see the correlation to the chart.

I have found the tool immensely helpful in gaining insight into how my own behaviour and thoughts can impact upon my mental health. I have gained more control.

It helps me to gain insight into my moods, take responsibility for them and steer a calmer, more productive course through life.

It allows me not to panic when I am low as I can see that ups and downs are all part of life.

Pre-Moodscope, I would not realize i was on the way down until 10 or so days had passed, and so I had done nothing. But with Moodscope, I can see if it’s a trend and do something immediately. It means I deliberately intervene earlier.

I use my scores, and comments, to understand what triggers my low mood and take steps to stop it getting lower, in so far as I am able.

I view it as a diary of sorts, private for my own contemplation.

I want to catch myself before I make a deep plunge and stay down too long. I do use the info with my doctor. I love having something concrete to show and talk about.

It has helped me feel like there is a greater safety net there, and given me a greater awareness of when I’m slipping back into my treacle pit; I now know that any score between 20 and 30 means I am in dangerous territory and need to take some remedial action, and if I get below 20 then I’m really in a bad way.

Moodscope has helped me identify incidents in my life with my mood. For example if I have to assert myself strongly with someone, I feel exhilarated and very proud of myself for about two day then gradually my mood will lower and a week later I will feel apathetic and down. I love that it is helping me make sense of my emotions and as a result I am not judgmental of them.

I’ve found Moodscope really useful in finding out what influences my moods. I am bipolar and after 20 years on lithium I’m managing without any meds. Don’t worry, I came off it slowly, under medical supervision!

I use Moodscope as a sort of diary of how I am feeling. Looking back I can see what really pushed my mood down and oddly it’s not always the major things that you’d imagine. In my case depression is brought on more by physical health problems – I am a CFS sufferer.

I sum up their reasons like this: 1. Helps understand causality (what causes mood to be low or high?). 2. Immediate guidance (should I take action to raise it?). 3. Self-expression (similar to diary). 4. Reassurance (low moods are “part of life”). Alexandra Carmichael wrote about the value of mood-tracking and mood-sharing. Her experience did not repeat Jon’s: She found little initial benefit of sharing, but great eventual benefits (“a kind of deep, healing therapy”). This was the main benefit of tracking for her — that it allowed this sharing. Kari Sullivan also tried Moodscope. She didn’t share her mood. The benefits she list fall under the heading of Reason #1 (helps understand causality). For example, she learned “most social interaction lowers my mood,” which surprised her.

Not everyone liked tracking:

My girlfriend . . . stopped using Moodscope. In her words, “I don’t want Moodscope to remind me how terrible I’m doing.”

She has now decided to give up on taking the test as it just reinforces her feelings of general greyness and sometimes despair.

At a website devoted to collecting new ideas about health, Moodscope ranked #1 out of about 500 ideas.

When I started my self-experimentation I didn’t get anywhere for a long time (after initial success with acne). After 1990, however, I was astonished at the progress I made. One useful discovery after another — how to lose weight, sleep better, be in a better mood, and so on. Over the next 20 years, I improved my health considerably more than all the other scientists in the world put together. I came to see what was happening as a kind of catalysis. The useful information was already there; my personal science was the catalyst that turned it into something useful. (Lack of people like me was why the discoveries were so abundant — a counter-example to Tyler Cowen’s lack-of-low-hanging fruit explanation for stagnation.) Professional scientists were too restricted in what they did.

The Moodscope story is similar. Psychologists have been studying and measuring mood for a long time. The Profile of Mood States is an important result of their research. But no psychologist saw it as an agent of change. It was simply a research tool, albeit a popular one. Only when Jon Cousins started using it for his own selfish purposes did it become clear how useful it could be. He was the catalyst.

Both my story and Jon’s are examples of what I say about DIYization of science: It gets tools into the hands of a larger and more diverse group of possible innovators, who are less “stuck” — less committed to old ways of doing things — than the professionals. They are also more motivated to do something useful than the professionals, who are weighed down with other big concerns — about status, job security, money, and so on.

Vitamin D3 in Morning: 7000 IU Improves Sleep (Story 21)

Seth Roberts5 Comments

Someone who wishes to be anonymous wrote me:

I had been taking 400 IU D3+calcium morning noon and night for years. I usually fell asleep fitfully. My sleep was rarely uninterrupted throughout the night.

After reading your blog, I started taking all three pills in the morning. Getting to sleep was easier, but sleep was still usually fitful.

After more reading of your blog, I stopped the D3+calcium and switched to 7000 IU of D3 every morning. Within a couple days, my usual pattern became that I fell asleep quickly and slept soundly through the night.

It is now three weeks, and I continue to enjoy excellent sleep. I noticed no changes in energy or mood.

I asked some questions.

Tell me about yourself.

I’m an academic (professor of decision sciences), 52 years old. I live in Philadelphia.

What you mean by “I fell asleep fitfully”?

Even if I was tired, sleep did not come easily. I had no worries, so it wasn’t that.

How long did/does it usually took/take you to fall asleep under the three conditions?

Original 400 IU D3+ calcium 3 times/day: 1/2 hour was usual.
All 3 are taken in morning: 15-30 minutes, but still awakening in the night frequently
7000 IU in morning: 10-15 minutes, and sleeping like a log.

What time do you wake up? What time do you take the 7000 IU?

I usually wake between 7 and 7:15. Sometimes I head straight for the kitchen (where the vitamins are stored) and I take them immediately. Other times I head for the shower and then to the kitchen, whereupon I take the vitamins.

What brand of Vitamin D3 do you take now?

Vitamin Shoppe

 

How Accurate are the QuackWatchers? Mercury Amalgam Fillings

Seth Roberts10 Comments

From Amalgam Myths and Facts (amalgam here means mercury-containing amalgams used by dentists):

Myth 10: Amalgam has been banned in Germany and Sweden and therefore should be banned in the United States.

Fact 10: Dental amalgam has not been banned in any country in the European Union.

From a 2009 press release:

The [Swedish] Government today decided to introduce a blanket ban on mercury. The ban means that the use of dental amalgam in fillings will cease.

In response to the Swedish ban, the American Dental Association put out a press release that said such a ban was “not necessary” in America because dentists do such a good job recycling the amalgam that doesn’t go into your mouth. Moreover, “a recent economic impact study published in the journal Public Health Reports indicates dental care costs in the U.S. would increase up to $8.2 billion in the first year alone if amalgam use was discontinued.” I don’t know what “up to” means. Perhaps it means that dental care costs would increase by a trivial amount “up to” $8.2 billion. Mercury-containing amalgam fillings are about half mercury.

Soon after I had two mercury fillings removed, I slowly became faster at arithmetic.

Assorted Links

Seth Roberts6 Comments
  • In praise of Rush Limbaugh.
  • Shangri-La Diet experience (“Bottom line: I lost three pounds in a week and a half”) of an artist named Elizabeth Periale.
  • Long interview with Tucker Max. “His fridge . . . is in one way very different: where you’d expect the six-pack of cold ones waiting for the game, instead you’ll find rows and rows of kombucha, the fermented health beverage.”
  • End of college campuses. Megan McArdle imagines a world in which college is replaced by distance learning. “95% of tenure-track jobs will be eliminated.” Jane Jacobs, in Systems of Survival, divided jobs into taking and trading. Teaching is trading if the student really wants to learn the subject. Teaching is taking if the student is forced to take (and pay for) the class. Scary thought: Every college student is asked about every class: would you take this class if you didn’t need to (and didn’t need to take other classes)?

More About the Lawsuits Against Law Schools

Seth Roberts5 Comments

New York magazine has just published a long article about the lawsuits against law schools for deceptive reporting of job prospects. This is the most radical (in the sense of challenging what “every reasonable person knows”) article I’ve seen in a major magazine in a long time. Gary Taubes’s article (“What if It’s All Been a Big Fat Lie?”) is a good example of such an article. It was published in 2002. Long long ago The New Yorker published a series of articles by Paul Brodeur (published as a book in 1989) arguing that power lines cause cancer. So long ago that Brodeur has retired. Unlike what Taubes and Brodeur wrote, the New York article is not investigative journalism. It was much easier to write. But that does not change the similarity of basic message — that powerful respected people have been lying to us.

Beyond the sheer existence of this article, it’s also interesting that nobody interviewed for the article said the allegations were false. For example, here’s a dean at New York Law School, one of the defendants:

“We teach critical thinking, and writing, and so forth,” Buckler said. “And that’s always been the case, and those skills have always been useful. I guess I would say that it’s never been a good reason to go to law school or any grad school, because you think there’s a guarantee at the end. Whether that was twenty years ago or ten years ago or this year.”

In other words: It doesn’t matter if we publish false or misleading data because (a) we teach useful skills and (b) the data don’t matter — right-thinking people ignore such data (“it’s never been a good reason to go to law school” because you think it will provide a job). Recent graduates of New York Law School do an even worse job of defending the school:

“Mathematically, it’s a ton of graduates, yes, and no, there aren’t enough jobs for them,” Daniel Gershburg, a 2006 graduate of NYLS and an attorney with a successful practice in Manhattan, says. “At the same time, what are schools supposed to say? ‘No, no, don’t come here! Run for your lives! . . . ’” [That is: Of course they lied.] Julia Shapiro, who graduated from NYLS in 2007—and who works as a lawyer in Los Angeles—puts it this way: “Suing the school is not going to help them find a job. I would not put my energy into wallowing in my sorrows.” [That is: Get over it.]

In contrast, it’s easy to make a case that the schools intentionally deceived prospective students. One of the lawyers behind the lawsuits said:

“NYLS [New York Law School] has to put students in seats,” Strauss said. “That’s the system they set up for themselves. They’ve got a huge new building, gleaming classrooms, but they’re cutting corners on transparency. They’ve created this reality where the only way they can put [enough] people in seats is by misleading them.”

A commenter put it like this:

Over the past 20+ years (since the advent of the U.S. News Rankings, really), the non-elite law schools have perpetrated a pervasive and dynamic fraud aimed at luring unsuspecting college students to throw away their financial futures [due to] reliance upon utterly fraudulent salary-and-employment data. The goal is obvious: to keep the student-loan teat gushing into administrative pockets.


As I said earlier, there’s an old joke: Why do students go to law school? They’re bad at math. Apparently law school administrators are also bad at math. The existence of this story suggests that average reader of New York magazine is not inclined to forgive them.

An Example of Predatory Medicine

Seth Roberts7 Comments

I recently posted about how doctors act like predators, in the sense of having what Jane Jacobs called “guardian values” (e.g., loyalty to other doctors is more important than honesty to patients). Here is an example of medical behavior that coming from an ordinary business would be shocking:

On February 21 [2012], I had my evaluation for a kidney transplant at a university-affiliated medical center about 100 miles from where I live. The way this institution operates, it takes about 8 months to get from initial referral to evaluation and there are all kinds of diagnostic tests in between (see previous blogs for more details). Once you are an approved transplant candidate and an organ becomes available, you go to the hospital and have surgery. The average stay for a kidney transplant is about 3 days and then you are discharged to a local hotel for 5-7 days. During that time, you return to the hospital every day for blood work, monitoring of the immunosuppressive medications and patient education. Also, you must have a full-time caregiver. That can be a friend, family member, stranger off the street corner, but they must be with you at all times to ensure that you are eating, taking meds, bathing, etc. Also, driving is prohibited until about six weeks post-transplant so the caregiver is also a chauffeur and attends the educational activities as a back-up in case the patient becomes incapacitated or symptoms of rejection appear.

In short, your caregiver must be able to put their own life on hold for about two weeks with as little as two hours notice. When you think about it, that’s a pretty tall order to fill. I have a caregiver, he happens to be a member of this forum. He is a dear, dear friend and always will be if only for the fact that he is willing to undertake this role with only the merest of acquaintance. He is more than willing to put himself and his home at my disposal if necessary. I won’t call him out by name, he obviously knows of whom I speak, but I truly feel as though Karma has smiled on me since our paths have crossed.

So the evaluation finally rolls around. Caregivers must be present during the evaluation. We check in at the medical center and are shown to an exam room. We are seen by a barrage of clinicians; dietician, nephrology resident, nephrology attending (the doctor in overall charge of my medical care while at the transplant unit), and the transplant surgeon. There are physical exams (kind of interesting since my caregiver knows me pretty well, but not THAT well), an EKG and a side trip to the lab. At the lab, the phlebotomist doesn’t pay any attention to my advice about using a butterfly catheter and proceeds to draw 20 (count ‘em, 20) vials of blood for type, cross match, antigen levels, etc, etc through a Vaccutainer. About halfway through, my vein collapses and she has to switch to the other arm, this time with a butterfly. After that, a chest x-ray. Back up to the 9th floor for our final meeting of the day; the social worker.

Up until this time, everything had been encouraging. I can’t say enough good things about the clinical staff, they were all wonderful, professional, warm, willing to answer questions, etc. My transplant surgeon looks like he should be on a TV medical drama, he can unzip me any time! The good vibes ended the minute we sat down with the social worker. She informed me that I would be required to have a second caregiver, a backup so to speak. WTH? People that can call a halt to their lives don’t grow on trees. Talk about hitting a brick wall. Here’s a sample of the conversation:

Social worker: What will you do if you are discharged to home and you can’t take care of yourself?
LadyDoc: Well, if I can’t take care of myself then I guess I shouldn’t be discharged, should I?
Social worker: Well, you could always go into a nursing home.
LadyDoc: Over my dead body.

And there you have it, the standoff. I have looked through every single printed word and email that I have ever gotten from this institution (and I keep very good records) and there is NOT A SINGLE WORD about having a second caregiver. The only family I have in the area is my daughter and she has two little boys under the age of five at home, so I can hardly ask her. My circle of friends is painfully small, many are disabled and not up to the challenge and the others have lives of their own.

The social worker called me a few days later to see if I had changed my mind and it suddenly began to sound like a sales pitch. She was touting all the advantages of this particular institution but I just don’t see it. I am now turning my attention to medical centers where the inpatient stay is closer to 5-7 days and then the patient is discharge directly to home, none of this stay-in-a-hotel stuff. I can’t think of too many places where germs and nastiness run more rampant than a hotel. I am so frustrated, I feel as though the last 7 months of my life have been an utter waste of time. Furthermore, the evaluation day was wasted; if we had met with her first we could have simply gotten up and walked out and said “Thank you for playing, please try again”.

In case you needed any convincing that customers for health care differ from customers for other services. (The difference: they are more desperate.) Think of this example if you are sure that government-run health care must be worse than the current system. You can learn what happened next at the link.

The Parable of the SAMe

Seth Roberts4 Comments

SAMe is a drug well known to help depression. For example, “a popular dietary supplement called SAMe may help depressed patients who don’t respond to prescription antidepressant treatment, a new study shows.” But there’s something important few people know about SAMe.

While talking to a Seattle woman about how Vitamin D3 first thing in the morning helped her with depression, she told me the following story:

When I was 47, I just wanted to be healthier. I kept gaining weight. I knew what foods are healthy. I just didn’t seem to eat them. A naturopath suggested SAMe. I tried it — Twin Labs SAMe. That was really fabulous for me. For the first time I got a glimpse of what being not depressed was like. Cravings weren’t there any more. Went from a size 24 to a size 14. Lost 70 pounds. I’m 5′ 8″. I didn’t feel deprived. I was eating plenty of food. going to yoga. Feeling really great.

Then Twin Labs discontinued it. It was made in Japan. I tried every other SAMe out there, eight different brands. None of them worked. I gave each of them a month. I tried different dosages.

I started slipping back into depression. Not being able to cope. I was sleeping more. Sugar cravings returned.

[why did Twin Labs stop making it?]

It wasn’t a good seller for them. So fucking wrong. I wrote letters to try to get them to start making it again. I did a campaign. People found pockets of what was left in the country and sent it to me. But it finally ran out.

The moral(s) of the story? 1. So much for word of mouth. You might have thought it would make the good SAMe sell well, better than the bad SAMe. Apparently not. 2. So much for the placebo effect. 3. Clinical studies (e.g., of SAMe) may higher-quality versions of what they are testing than the versions available to the rest of us. 4. So much for quality control in the supplement industry — except maybe in Japan. There can be substantial quality variation among supplements, undetected by the industry. I have to believe the companies selling the useless SAMe didn’t realize it. Surely they thought that good SAMe would be a better product for them than bad SAMe.

This resembles the Vitamin D3 story I have been telling. Tara Grant said she’d heard countless times that Vitamin D is good. She hadn’t heard once that it must be taken in the morning. I’ve heard countless times that SAMe is good. This was the first time I heard about huge quality control issues. In both cases individual self-observation uncovered a crucial truth that an industry had overlooked. They didn’t want to miss it. The Vitamin D Council didn’t want to miss the time-of-day effect. They just did.

This also resembles what I said about ultrasound machines: A lot of them are broken, unbeknownst to their operators and the people (often pregnant women) being scanned. The countless “experts” (doctors) who recommend ultrasound don’t seem to know this.

Which is why personal science (trusting data, not experts) is more valuable than experts want you to think.

“Thou Shalt Not Testify Against Another Doctor”

Seth Roberts2 Comments

First do no harm . . . As Robin Hanson has said, what does that mean? In contrast, the rule illustrated by this story, from Bryan Castañeda, who works for a Los Angeles law firm, is quite clear:

At the old firm I used to work at, I was talking to one of the senior attorneys and the topic of medical malpractice cases came up. He said he avoids them. Why, I asked. He said — I’m paraphrasing here — “Because you won’t find a doctor who will testify against another doctor in open court. They may advise you in private, ‘Oh yeah, so-and-so definitely screwed up,’ but you won’t get them to say that on the stand. They all protect each other.”

Judging by this story, if your doctor makes a mistake, the only person who will suffer consequences is you. Thank heavens the rest of us have more power than ever before. A recent survey of doctors found that “more than a 10th (11.3%) admitted to telling patients something that was not true.” The survey did not ask about lies of omission (when silence is misleading); unwillingness to testify that someone else made a mistake is that sort of lie. The survey also showed that doctors (at least, those who took the survey) have a self-serving interpretation of the term not true. Although only about 10% said they had said something “that was not true” — meaning something that they knew wasn’t true — “more than half had described a patient’s prognosis more optimistically than warranted.” Apparently they consider such descriptions not instances of “not true”.

In Systems of Survival, Jane Jacobs described two moral systems (lists of rules/values): The guardian syndrome and the commercial syndrome. In certain areas of life (e.g., military), the guardian syndrome prevailed; in other areas (e.g., small business), the commercial syndrome prevailed. Loyalty (e.g., “never testify against a fellow doctor”) is a guardian value — indeed, the main guardian value. In contrast, honesty is the main commercial value. Jacobs said that the two syndromes corresponded to two ways of making a living: taking and trading. Doctors do not represent themselves as predatory (= taking). But, according to Jacobs, this sort of rule (“never testify against a fellow doctor”) puts them squarely in that camp.

I asked Jim Jacobs, one of Jane Jacobs’s sons, for comment. He replied:

Exactly right. Jane experienced this herself, unfortunately. It’s really a major problem. I see the very same behavior among medical researchers too.

Vitamin D3 in Morning: Mixed Evidence From PaleoHacks

Seth Roberts5 Comments

Paleo Hacks has a thread about timing of Vitamin D3. Better in morning (my and several other people’s experience) or evening (Robb Wolf’s experience)?

This answer supports morning:

I prefer taking it in the morning. I think it helps set my circadian rhythm.

This answer supports night:

I prefer it at night. I find I sleep better.

This answer supports morning:

I had trouble sleeping when I started Paleo and was taking my D3 at night before bed. Was nervous and couldn’t seem to settle down. No problems since I went to morning, I have them with my fish oil right after breakfast.

By the time you read this there will probably be more evidence.

Thanks to Melissa McEwen.