- Nassim Taleb makes a good point about treating high blood pressure. Only when systolic blood pressure is above 180 is there a big increase in risk of death. Giving people lower blood pressure dangerous drugs could easily do more harm than good.
- The Annals of Unsolved Crime, forthcoming book from Edward Jay Epstein
- Should you go to graduate school in literature? by Ron Rosenbaum
- Steve Levitt’s 50-year-old sister dies of a rapidly growing brain cancer. His father, a doctor, “was shocked at how impotent — and actually counterproductive — her interactions with the medical system turned out to be.” In a hospital, she was prevented from sleeping.
Thanks to Dave Lull.
My wife wonders about her BP so if anyone can direct me to a graph like Taleb’s, but for women, I’d be grateful.
The Levitt piece is revealing. “Three hours later, we are still at the hospital. It is difficult to set up home oxygen on the weekend, and the pharmacy apparently has difficulty filling a prescription for a common drug”: you can get service like that on the NHS, free.
“In this era of molecular biology, the most valuable medication was morphine, a drug that has been available for almost 200 years.” Many British doctors believe that American doctors cause – or rather permit – a great deal of unnecessary pain for their patients by underprescribing morphine.
Anyway, once it had been determined that the poor woman was riddled with cancers, perhaps palliative care might have been the wise thing to do from the beginning?
https://www.newswithviews.com/Howenstine/james181.htm
https://www.dailymail.co.uk/health/article-2211442/I-want-enjoy-days–waste-having-chemo-Doctor-Kate-Granger-tells-shes-stopped-treatment-prolong-life.html
Seth: Dr. Levitt might have written this: “In this era of molecular biology, and 100 years of Nobel Prizes in Medicine, the most valuable medication turns out to be morphine, a drug that has been available for almost 200 years.”
With regard to graduate school for literature:
About ten years ago, there was a wonderful essay written by a disillusioned young woman who (foolishly) went to Yale to get a PhD in literature. Here’s how the article starts:
See, “Letter from Yale“, by Helena Echelin.
Regarding sleep in hospitals . . .
Several years ago I had a reaction to the anesthesia used during an operation. They investigated me for days to determine what had happened. That first night they woke me every two hours to take a blood sample. Plus I listened all night to the random beeps from medical machines and the sounds patients made in adjoining rooms due to a severe flu outbreak. The next morning I felt sleepy. Then the day nurse came in, introduced herself, and lectured me on how tired I looked and how I should be getting my sleep.
@dearieme,
You might find this paper about BP of use: https://www.math.ucla.edu/~scp/publications/mortality.PDF .
Seth: Thanks for the blood pressure reference. I sent it to my mom, who takes blood pressure medicine.
@Kirk: fascinating – I am in your debt. I was taken not only by the fact that common guidelines for systolic bp are/were too high, but the way that this became clear by applying just three bits of common sense, namely (i) using all-causes death as their measure of merit, (ii) categorising the data by age and sex, and (iii) exploiting percentiles as a ‘natural scale’ for bp. (I say “common sense” in the reasonably precise sense of “that’s what an engineer or physicist would do”).
I was also taken by their discussion of the benefits that some bp-lowering drugs afford by mechanisms distinct from the actual lowering of bp. Many statin-sceptics suspect something similar – that the category of patients for whom statins bring a benefit are gaining from effects of their statin distinct from its effect in lowering cholesterol.
By the by, apologies for being greedy, but can you by any chance provide a copy of the “commentary on page 159″ referred to at the foot of the paper? Anyway, I repeat my thanks.
other studies than framingham seem to indicate that mortality goes up at lower blood pressure values – you can google this as well as i can. a brief survey of this makes me think though that 140 is not an important number.
@dearieme
I stumbled on that article by a lucky web search. Sometimes authors of articles published in paywall journals have obtained an agreement with the journal to allow the author to place the paper on a personal website (or, ahem, think they have the right but haven’t read the fine print). The Lancet is a paywall journal. If you have a local university system which indulges the local taxpayers, you might be able to borrow that issue from them.
Medical school libraries sometimes allow public access to their journals and books. That’s true of the University of Rochester. I’ve been there many times.
This is tragic story.
“Overnight admission to the hospital is recommended for “observation” and rest prior to the trip home. Fifty years of experience have taught me that admission to an academic hospital is not restful. I have stopped counting the patients who want to be discharged to get some rest.”
I don’t want to descend into hyperbole but based on the my recent experiences with hospitals and rest (lack thereof), namely, the birth of my son and my appendectomy — I contend that lack of restful sleep post-intervention has MASSIVE iatrogenic effects and is weakening (killing?) people.
As Robb Wolf says: “If someone sleeps well, you can’t kill them; if they sleep badly, you can’t keep them alive.”
The night after my appendectomy I, like Kirk (above), was woken up and checked up on ceaselessly, ostensibly for my benefit. Not to mention torture by the the hideous and inhumane cacophony of monitoring devices beeping away mercilessly.
The next morning, I, literally, begged them to allow me to sleep without interruption for a few hours so I gain enough strength to go home and heal through sleep.
Our experience with the birth of my son was not dissimilar — post-birth all through the night, nurses came in to “check” on my wife and son ceaselessly, again, ostensibly, for our benefit. Result, none of us slept and all three of us were exhausted.
We opted out of another night in the hospital and went home.