Month: May 2012

How Common Are Medical Errors? A Horror Story

Seth Roberts6 Comments

In this post a contract artist who calls himself Wolverine gives a long list of life-threatening medical errors that happened to him. I hope that he will eventually add dates so that the rate of error becomes clearer [more: all the errors happened within a 14-month period] but even without them the stories suggest that life-threatening errors are common. (As does the effectiveness of surgical checklists.) Medicine is a job where if you make a mistake only the customer suffers not you. Surely this is why the error rate is so high. Wolverine was operated on by a surgeon who, because of a fatal error, had lost his license to practice in California. He changed states, was hired again, and made the same error on Wolverine.

I learned about this from Tucker Goodrich, who has been corresponding with the author and told me something remarkable:

He’s eating a paleo with raw milk diet. The other transplant patients he knows are all eating the modern American diet and dying of infections; he’s been infection-free for two years.

 

Beijing Quantified Self?

Seth Roberts2 Comments

I recently had lunch with Richard Sprague, an engineer at Microsoft Beijing. He raised the possibility of starting a Quantified Self Meetup group in Beijing. The meetings could be held in one of Microsoft’s two brand new buildings, which are in the exact center of Zhongguancun. If you might attend, please let me know (e.g., by commenting on this post).

Climate Science Humor: What if Your Model Predicts Wrongly

Seth Roberts5 Comments

After noting that James Hansen’s 1988 climate model predicted too much warming in the subsequent 22 years, someone at Skeptical Science concluded:

The main reason Hansen’s 1988 warming projections were too high is that he used a climate model with a high climate sensitivity, and his results are actually evidence that the true climate sensitivity parameter is within the range accepted by the IPCC.

There is no consideration of the possibilities that (a) one or more other parameters were wrong or (b) the model — aside from parameter values — is wrong (e.g., it oversimplifies). Surely you are joking, Mr. Skeptical Science.

Thanks to Phil Price.

 

Drug Companies Release More Data From Drug Trials

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Drug companies, in a few cases, have recently started to release much more data from drug trials. Unsurprisingly, analysis of the new data by outsiders — people who have nothing to gain from positive results — has often contradicted the drug company analysis of the same data.

One example involves the flu drug Tamiflu. The new analysis suggested that “Tamiflu falls short of claims—not just that it ameliorates flu complications, but also that the drug reduces the transmission of influenza.” Another example involved Prozac. The new analysis “ended up bucking much of the published literature on antidepressants. . . . [It]found no link between Prozac and suicide risk among children and young adults . . . Prozac appeared to be more effective in youth, and antidepressants far less efficacious in the elderly, than previously thought.”

Another reason to believe in the value of this new data is the work of Lisa Bero at UCSF. She looked at the efficacy of nine drugs using unpublished FDA data. “Nineteen of the redone analyses showed a drug to be more efficacious, while 19 found a drug to be less efficacious. The one harm analysis that was reanalyzed showed more harm from the drug than had been reported.”

I hope that the FDA will eventually require that all raw data from drug trials be publicly available as a condition of approval. (The same should also be true of journal articles, as a condition of publication.) It is abundantly clear that drug company analyses are often misleading — which harms the public.

Morning Faces Therapy for Bipolar Disorder: What One User Has Learned

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A friend of mine has been using morning faces therapy to improve his mood — he suffers from bipolar disorder — for 15 years. He is the first person I told about it. I recently asked him how his use of it has changed over the years. He replied:

I began the morning faces therapy in April, 1997. I can think of only two significant changes over the years in my use of the therapy: 1) I use a mirror instead of videotapes, and 2) I accept that once or twice a week I’m too tired to start as early as I’d like (so I get more sleep instead). To elaborate:

1) When I restarted the treatment in 2006 after having been hospitalized, I was too depressed to deal with videotaping. In fact, I was too depressed to get out of bed so early. The mirror solved both problems, because I could easily prop it on my mattress top. After a few days I was able to get up, allowing me to listen to music, use bright lights, etc., during the treatment.

2) Whether for lack of discipline or the proper genes, I simply can’t go to sleep early enough so that I can get up early every morning. (Granted, I haven’t tried everything, but for the sake of the argument, let it stand.) This shortcoming used to bother me a great deal. Then on October 6th, 2011, I read in this blog about someone else who didn’t always start the treatment early, because he was “too tired to get up early”. Well! It didn’t seem so bad if someone else had the same problem. Over the years I’ve found that starting 30-60 minutes late once or twice a week doesn’t seem to perturb my mood enough to cause great concern.

I asked how the therapy has helped him. He replied:

The benefits of the morning faces therapy have been both 1) quantitative and 2) qualitative.

1) I have had bipolar disorder for 27 years. With the therapy, I’ve been medication-free for 6 years, and I was on much reduced doses of medication for about 7 years. So it’s fair to say the therapy has reduced the severity of the illness by around one half. Also, the lithium that I took in part caused kidney disease, whereas, obviously, there are no side effects from looking at faces in the morning.

2) The qualitative difference seems far more important to me. I am basically content with life; I am comfortable in my own skin. I’ve never felt like this before, and life without this is empty.

Note to skeptics: you might think, well, bipolar disorder is known to go in remission, and maturity often brings contentment. But this fails to explain why stopping the treatment brings back both the illness and the essential sadness.

Three Days in May: Sex, Surveillance, and DSK

Seth Roberts6 Comments

Nicholas Sarkozy must be kicking himself. Sometimes a bird in the bush is worth more than a bird in the hand. If only I’d waited… He struck too soon. If only he’d waited until Dominique Strauss-Kahn (DSK) became his main opponent and then created a DSK scandal. The opposition would not have had time to regroup. DSK was careless, creating opportunities for his opponents. Edward Jay Epstein’s new book, Three Days in May: Sex, Surveillance, and DSK , makes clear that DSK was being monitored, presumably via his cell phones. A first-rate intelligence organization, says Epstein, can turn on your cell phone and listen to you. At one point a French journalist is given a transcript of a call that DSK made. How was this possible? the journalist asked. The answer given is that by freakish coincidence “DSK’s speaker phone was accidentally left on while his line was somehow connected to a French phone that was legally under surveillance.” Why the speaker phone should matter is not explained.

Such means of surveillance — available to those in power, but not to the rest of us — make those in power more powerful, harder to unseat. However, Epstein’s book also shows the effect of lower-tech new recording devices, especially CCTV recordings, cell phone records, and key-entry logs. They make it harder to lie. DSK’s accuser, Nafissatou Diallo, was lying, no doubt. The district attorney’s office got to “Version 3″ of her story before giving up. The discrepancies between what she said happened and the key-entry records reveal her lies beyond doubt. The new recording devices also pull two people into the story who otherwise might have remained out of it: a security guard and the head engineer at the hotel, who went into a private loading-dock area and did a kind of victory dance shortly after 911 was called. The 911 call made the matter public, which effectively destroyed DSK’s chance of elective office. They claim to not remember what they were celebrating. If it had nothing to do with the 911 call, it is exceedingly strange — another freakish coincidence — that it happened at exactly the same time.

Three Days in May is a new kind of investigative journalism in the sense that it is based on detailed electronic records (such as CCTV tapes and key-entry records) that weren’t available until recent years. Stories and movies are often set in remote locations or times to give the story a kind of freshness. Here freshness derives from the information being used. Epstein assembles hundreds or thousands of facts from these records into his story. I was interested to see a kind of power-law distribution of information value, the same thing I see in my self-experimentation: almost all of the facts tell us just a little, a very tiny fraction of them tell us a lot. Although electronic surveillance is usually considered a government tool (“Big Brother is Watching”) Epstein’s book makes a more subtle point. These records make false accusations more difficult to sustain and conspiracies more difficult to carry out without detection — and who does that help? In any case, Three Days in May is a fascinating true crime story — and the criminal is not DSK.

Overtreatment in US Health Care

Seth Roberts1 Comment

In April there was a conference in Cambridge, Massachusetts, about how to reduce overtreatment in American health care. Attendees were told:

The first randomised study of coronary artery bypass surgery was not carried out until 16 years after the procedure was first developed, a conference on overtreatment in US healthcare was told last week. When the results were published, they “provided no comfort for those doing the surgery,” as it showed no mortality benefit from surgery for stable coronary patients.

One participant said that overtreatment cost one-third of US health care spending. As far as I can tell, no one said that “evidence-based medicine” underestimates — in the case of tonsillectomies, almost completely ignores — bad effects of treatments. This failure to anticipate and accurately measure bad effects of treatments makes the overall picture worse. Maybe much worse.

Assorted Links

Seth Roberts6 Comments

Thanks to Melissa McEwen and Bryan Castañeda.