- A hospital specialized for hernia surgery. Much better outcomes, much lower cost. The combination (better outcomes, favored by patients, and lower cost, favored by insurers) suggests this could spread, if patients plus insurers > doctors plus hospitals.
- Unlocking umami. I use koji salt, works really well. Comes in plastic squeeze container, which says “today’s newest seasoning”.
- More about the rise and fall of heart disease. This 1980 article considerably predates David Grime’s 2012 article on the same subject It is more methodologically sophisticated but reaches the same conclusion: The rise and fall is not explained by any popular theory (e.g., smoking causes heart disease, cholesterol causes heart disease). Because of this failure, using those theories to try to prevent heart disease (e.g., telling people stop smoking) makes little sense. Likewise, I doubt that experts know why dementia is decreasing, although they have theories.
- Hypochondriasis and self-tracking
Thanks to Alex Chernavsky.
I believe that hernia hospital was discussed in a chapter in on of Atul Gawande’s books. I remember that the doctors at the hospital were hired right after they finished their internship — as soon as they are legally allowed to practice medicine. They aren’t surgeons or trained in surgery. I remember being struck by the massive waste involved in doctor’s education — these hernia surgeons need not to have ever gone to medical school, but they do what they do far better than general surgeons. And — it would be insulting for a general surgeon, who spent four years in medical school, five years in residency, a few years as a fellow somewhere, to only do one specific surgery. And so the system serves physician’s egos and pocketbooks far better than it does patients.
Seth: Good points. Especially “such extreme specialization is discouraged by the massive amount of education that doctors receive”. I think a similar dynamic operates in science: After all that education, to do simple self-experiments would be insulting. Must do expensive research, whether that’s what is needed or not.
There are a lot of livelihoods that depend on popular theories of cardio-vascular diseases.
I think this sort of change is inevitable, it is just being resisted by the medical community.
Look at the model that made McDonalds successful;
-they concentrated on preparing variations of just one thing (i.e. burgers), and
-they split up the work into single task jobs that could be done by staff with a relatively low level of training (compared to a traditional chef).
It is easy to see how a clinic that specialises in just one thing can follow a similar model, and this already exists with many medical service business (pathology, lab testing etc).
And, of course, it already exists for cosmetic surgery – many places do this and nothing else.
The problem is/has been the front end – the doctors. You have to see a doctor, that costs probably $100 for a consultation, to get a test that may cost $20.
As we start to see more of these service businesses deal directly with people – no doctors required- the front end monopoly will start to crack.
A specialised surgery clinic is a bit more complicated than a pathology lab, but far less so than a hospital.
It is also much less bureaucratic, so we will see more innovation happening too.
Never heard of koji salt – thanks for the link.
LA Times has an article (your link is paywalled outside US):
https://articles.latimes.com/2012/aug/25/food/la-fo-koji-20120825
Cataract surgery in India is another example of this trend.
A wonderful collection of links. Many thanks.
heart disease and air quality.
https://forums.webmd.com/3/cholesterol-management-exchange/forum/1270
Grime didn’t even mention smoking in his article and this one clearly states the correlation between reduction of smoking and reduction of heart disease.
You seem pretty happy to accept some pretty week evidence in the face of the There arae literally hundreds of articles showing the link between smoking and CHD. Any chance you’ll be linking to any of those?
Seth: The article says that changes in smoking do not explain changes in heart disease. There is a correlation, yes, but the details contradict the idea that reduction in smoking caused the reduction in heart disease. Did I miss something? The only evidence I could find that smoking causes heart disease is the risk factor stuff — smokers are more likely to have heart disease than non-smokers. Obviously “smoking is unhealthy” and “heart disease is caused by doing unhealthy things” so this correlation by itself I don’t find especially persuasive — people who smoke probably do other unhealthy things. Millions of people suffer from heart disease who don’t smoke. For all I know smoking has a small effect. Something else has a large effect. The question raised by the article I cite is: what is that “something else”?
I have cooked with koji before. You can order dried, inoculated koji rice and use it to ferment your own soy sauce, miso, and to make amasake, a very sweet, delicious desert. Homemade amasake (as opposed to the store-bought stuff) is a bit of an acquired taste. Millet amasake is absolutely delicious.
However, I am now convinced that these are not particularly healthy foods. I eliminated all of them from my diet a few years ago and I feel noticeably better.
These foods are high in glutamate, and I’d rather err on the side of caution by not eating them. Dr. Baylock wrote extensively about this in “Excitotoxins: The Taste that Kills” a book I recommend. It is hard to refute that free glutamate causes brain damage in lab animals. Yes, it’s a naturally-occurring taste, and we have sensors all over our alimentary canals for it (which probably evolved for sensing protein levels in ingested food), but I see no point in adding any to food.
Seth: I’m pretty sure we can detect protein in food without glutamate detection. I think we like the taste of glutamate so that we will eat more aged/fermented protein — for example, aged meat. Surely you eat aged meat, which has much more glutamate than fresh meat. But I don’t disagree with your decision to stop eating all those fermented soy products. No doubt some people get too much glutamate — for example, people who suffer from MSG.