Thanks to Ken Feinstein and Dave Lull.
My New Yorker subscription runs out in July. In February I got a letter from the magazine that said “We Need Your Instructions At Once”. Renewal price: $49.99 (1 year) or $79.99 (2 years). In May I got a similar letter that said “Renewal Confirmation”. Renewal price: $29.99 (1 year) or $49.99 (2 years).
I recently got a flyer from my HMO. “Feel better soon . . . without antibiotics!” said the front page. “Antibiotics do not kill viruses” said the second page. Apparently the point of the flyer is to reduce antibiotic usage. I am surprised that doctors need protection from patients asking for antibiotics for viral diseases.
Antibiotic resistance is a problem, yes, but the bigger problem is how those who run our health care system ignore the immune system. Here are examples:
1. The historical solution to the problem of antibiotic resistance has been to develop new antibiotics. The problem has not stimulated research into how to strengthen the immune system. Here is a 1992 editorial in Science: “Mechanisms such as antibiotic control programs, better hygiene [= more handwashing], and synthesis of agents with improved antimicrobial activity need to be adopted in order to limit bacterial resistance.” Nothing about improving immune function. A 2012 World Health Organization report about the problem does not contain the word immune.
2. The idiocy of tonsillectomies. Forty years after researchers figured out that tonsils are part of the immune system, tonsillectomies remain common. Removing tonsils because of too many infections makes as much sense as removing part of the brain because of memory loss. I have never encountered a doctor who appears to understand this.
3. Epidemiologists have yet to systematically study what makes the immune system more or less powerful. For example, this epidemiology textbook does not contain the word immune. Nor does this review of 25 epidemiology textbooks.
4. A respected professor of pharmacology at the University College London named David Colquhoun left the following comment on this blog: “Talking of made up theories, the corniest of all has to be “stimulating the immune system”. There is [not], and never has been, any evidence that it happens — it is the eternal mantra of every quack who is trying to sell you their own brand of implausible therapy.” Here is an example of the evidence he says doesn’t exist. Professor Colquhoun is a Fellow of the Royal Society.
5. I know very little about the immune system. I barely know what a T cell is. My job (psychology professor) has nothing to do with it. Yet I have come up with three ideas related to it: 1. Tonsillectomies are idiotic. 2. We need regular intake of microbes to be healthy — in part to stimulate the immune system. 3. We need exposure in small amounts to the germs around us for our immune systems to best protect us. (So it’s not obvious that outside of hospitals more handwashing is a good thing.) Only because these ideas are obvious (#1 and #3) or semi-obvious (#2) was someone as ignorant as me able to think of them. That one ignorant outsider thought of three of these things before the hundreds of thousands of health researchers did suggests how little they think about the immune system.
Someday the people in charge of our health care — or the rest of us, ignoring them — will figure out how to make our immune systems work much better. We will sleep much better, eat much more fermented foods, take enough Vitamin D at the right time of day, and so on. Perhaps we will wash our hands less and kiss more. Antibiotic usage will go way down, selection for resistant microbes will become much less intense, and antibiotic-resistant microbes will become much less common. The problem will disappear.
A new study of a quarter million Copenhagen residents found that those with Vitamin D blood levels of 40-70 nmol/L [16-28 ng/ml] had the lowest death rate. People with lower and higher amounts had higher death rates, in other words. The death rate versus blood level function has a reverse-J shape, i.e., too little is worse than too much. About 1% of the sample had levels above 140 nmol/L [56 ng/ml], for practical purposes a “high” level.
Because Vitamin D3 seems to have a big time-of-day-dependent effect on sleep (Vitamin D in the morning improves sleep, Vitamin D in the evening makes sleep worse) it is plausible that people with high Vitamin D levels were more likely to take it in the evening than those with moderate levels and this is why they had higher mortality. Likewise, it is plausible that those with moderate levels were more likely to take Vitamin D in the morning than those with low levels and better sleep explains the lower mortality. Although epidemiologists adjust for smoking in studies like this, they don’t yet adjust for sleep quality. It is also plausible that people who were more sick took more Vitamin D — hoping it would improve their health.
I think I have a better way to decide how much Vitamin D3 to take: choose the minimum amount that produces the best sleep. Sleep is so strongly connected with health that I wouldn’t want to choose worse sleep over better sleep simply because of epidemiology. At the same time that I greatly improved my sleep, I stopped getting easy-to-notice colds. Apparently my immune system was doing a better job of fighting them off.
There is evidence that Vitamin D improves immune function independently of its effect on sleep. A 2009 survey found that “those with less than 10 nanograms of vitamin D per milliliter [25 nmol/L] of blood, considered low, were nearly 40 percent more likely to have had a respiratory infection [over what period of time?] than those with vitamin D levels of 30 ng/ml [75 nmol/L] or higher.”
So those three studies (epidemiology, lab, epidemiology) taken together make a good case that my Vitamin D levels should be at least 25 ng/ml. I will have my Vitamin D level measured soon and it will be interesting to see how much an approach based purely on self-measurement (find the minimum amount of Vitamin D that optimizes sleep) agrees with this.
Thanks to Chase Saunders.
More. In an earlier version of this post I confused ng/ml with nmol/L.
This series of posts about a proposed Alan Turing conference at Stanford left me wondering about the best academic novels I had read. Pnin is good, but not very academic. Gone by Renata Adler is fantastic but about office politics. I didn’t like Changing Places nor Lucky Jim. I doubt a novel could be better than this:
A couple of days later we received a note from Lester Earnest to say he was withdrawing from the committee. Since Les was underwriting the event this was a blow; we had lost our funding.
I wrote to Les asking him what had happened, knowing that the exchange with [Jennifer] Widom [chair of the Stanford CS department] over the December holiday was surely sufficient to deter and depress anyone.
A few hours later Ed Feigenbaum wrote to the committee saying that he had not spoken to Les but that he would withdraw from the committee himself. This puzzled both me and Les because Les had just told me that Ed that had talked him out of supporting the conference.
Is there a blog about academic politics?
Thanks to Brian Horrigan.