On Econtalk, Russ Roberts recently interviewed Jeffrey Sachs, author of The End of Poverty and head of the Millennium Village Project (MVP). I enjoyed it but thought Roberts was too easy on Sachs. Here’s what I wished he had asked:

Your book, The End of Poverty — did you get anything wrong?

What mistakes have you made with MVP?

You say Nina Munk [author of The Idealist] chose a non-representative village. [Sachs said that Munk spent her time in the only village in “a war zone.”] Did you tell her that? If not, why not?

Munk was on your side when she began reporting, but changed her mind. Why is that?

Why was the project set up in such a way that evaluation is difficult? Why not pick ten villages and randomly select five for treatment?

You say the MVP project is successful because people are copying it — but those people are government officials. Is it plausible they are copying it because they see it as a good way to make money for themselves or improve their career? You must know many worthless medical treatments have been widely copied. Is this your best evidence of success?

No doubt your employees have often told you what you wanted to hear rather than the truth. What’s an example? What have you done to get honest assessments of how things are going?

What did you learn from Nina Munk’s book?

Roberts says he didn’t ask Sachs certain questions because there wasn’t enough time.

In Vitamin D and Cholesterol: The Importance of the Sun (2009) by David Grimes, an excellent book, I came across a 1977 study of healthy middle-aged men. The researchers measured their diet and watched them from 1966 to 1976. The question: What diets were associated with better health? There turned out to be associations with cholesterol (lower better) and systolic blood pressure (lower better), but these were less interesting than two strong dietary associations. One was between energy intake and heart disease. Men in the lowest third of energy intake had 23 cases of heart disease; men in the highest third had 7 cases. That’s probably due to exercise: the more you exercise the more you eat. We already know exercise is good.

The other association was with cereal fiber. Men in the lowest third of consumption (2-7 g/day) had 25 cases of heart disease; men in the highest third (8-34 g/day) had 5 cases. (A Wasa cracker has about 2 g cereal fiber.) You might dismiss this as healthy-person bias: healthy people do many healthy things, such as eat fiber. However, there was no association of heart disease and fiber from fruit and nuts. They’re healthy too. “The advantage of a diet high in cereal fibre cannot be explained [by us],” said the authors.

Later studies have found the same thing. For example, a 2006 review reached a similar conclusion: “There is an increasing body of evidence, including that from prospective population studies and epidemiological observational studies, suggesting a strong inverse relationship between increased consumption of wholegrain foods and reduced risk of CVD.” A study of health-conscious people — to reduce healthy-person bias — found a similar association: “Persons who habitually ate wholemeal bread had a lower mortality from cerebrovascular disease.” A 2002 review and a 2013 review provide even more evidence for the association.

Shant Mesrobian has emphasized the importance of fiber for health. Whereas paleo gurus usually say grains are bad. Here, for example, are “10 reasons to avoid grains”.

Edward Edmonds is an histologist at the Albany Stratton VA Medical Center, Albany, New York. He has been an histologist since 2002. Previously he worked at the Landstuhl Regional Medical Center, Landstuhl, Germany, the Ehrling Bergquist Hospital Offutt AFB, Nebraska, and the Armed Forces Institute of Pathology (now Joint Pathology Center), Washington D.C.

Recently he left an interesting comment on this blog:

When I train students I always expect that they will do things a little differently or that they will have new ideas, so . . . my first question is always show me what you have learned or show me how you’d like to do this procedure. In other words they went through the same training I did maybe at a different facility but there are a lot of different ways to approach things we do in the lab, so I let them develop their own “style”. Then after they do it in their own way I show them how I do it my way and I explain step-by-step why I’m doing it this way . . . The entire thing is an enjoyable experience. We are learning, and laughing, and undoing the dogma learned from the academic setting. . . . All of my students end up being excellent troubleshooters and problem solvers.

I asked how he came to this way of teaching. He replied:

Through experience. People like to feel good about themselves, no matter their status. If that person feels they have some sort of insight or knowledge that other people don’t have — when that person is queried about their knowledge or has an opportunity to discuss it, they light up, becoming a teacher themselves (regardless of the quality of the information). There is a level of confidence there.

What if someone came along and challenged the quality of that information? Let’s say the person challenging the information was an arrogant prick who did have better information but nonetheless put the ignorant person in their place? The quality of the information might be good, but nothing was actually learned that was relevant to the subject. Instead what was learned was how that prick made the other person feel and the prick feeling unchallenged felt empowered. If there were witnesses to the exchange the information learned was not bidirectional it was omni directional, everybody in the setting learned more about each others’ behavior but nothing relevant was retained because the environment was authoritarian. That is an extreme example but it happens in degrees and often it is subtle.

Now that person who was challenged might go home and for spite try to find things to improve the quality of their information. But the learning is motivated not by genuine interest but by spite which has a tendency to cloud judgment (as we can witness in heated academic debates). Are they learning (understanding) in that state of mind? Probably not.

That is partly where my teaching style comes from. It comes from recognizing the “state” in which learning occurs and that someone that learns well who is “smart, motivated, and capable” is so, not because they have some inherent grasp on a subject, but because they have confidence in their ability to learn. In other words they are smart because they recognized as being “smart, motivated, and capable of learning”. I want to learn from the students just as much as they want to learn. That really is key.

He also explained the difference between histologists and pathologists:

The histologists/cytologists are the people who develop the microscope slides you often see in studies with different “stains” we have a background in chemistry, biology, and anatomy, we do grossing (dissecting specimens), and autopsy, immunohistochemistry, electron microscopy, etc. A pathologist is some one who makes the diagnosis on the specimens we prepare. We work very closely together and in some facilities our disciplines overlap. However, they are actual doctors. There are also pathology assistants, they typically just gross and do autopsy. So whenever you have surgery or a biopsy it comes to histology to be processed, we do that and then the pathologist makes a diagnosis and puts their signature on it.

My sister sent me a link to an article (“Butter is Back”) by Mark Bittman, the New York Times food columnist, about a recent review that found saturated fat didn’t cause heart disease. I told my sister I had clicked on the link but had forgotten to read the article.

My sister was incredulous. How could you not want to say “I told you so”? she wondered. (In a 2010 talk I questioned the danger of butter.)

Here is the relevant passage, according to my sister:

A meta-analysis published in the journal Annals of Internal Medicine found that there’s just no evidence to support the notion that saturated fat increases the risk of heart disease. (In fact, there’s some evidence that a lack of saturated fat may be damaging.) The researchers looked at 72 different studies.

I told you so. But this part interests me more:

No study is perfect and few are definitive. But the real villains in our diet — sugar and ultra-processed foods — are becoming increasingly apparent.

Uh-huh. The experts were staggeringly wrong about saturated fat…but they couldn’t possibly be wrong about “sugar and ultra-processed foods”. That makes no sense, but that’s what Bittman wrote (“increasingly apparent”). To me, what is increasingly apparent is that nutrition experts shouldn’t be trusted.

I don’t know what “ultra-processed foods” are but I am beginning to believe the experts are utterly wrong about sugar, too. As far as I can tell, sugar in the evening improves sleep — by a lot, if you get the details right — and nothing is more important than good sleep. If you have read The Shangri-La Diet, you already know that sugar alone cannot have caused the obesity epidemic. It is more complicated than that.

• difficulties of personalized risk assessment
• Drugs cause falls in old people. When drugs were stopped, falls went down — in one case, by two-thirds.
• University of Western Australia, in response to a complaint, allows researcher to “investigate” himself.
• Food and mental illness
• “ I have stage 3 melonoma. . . . I have the ability to speed read . . . I found one very promising study.”
• Translator strikes back
• Masha Gessen, one of my favorite writers, on Pussy Riot

Thanks to Alex Chernavsky.

dearime asks:

Why do people fuss so much about paleo life? The population has grown so much since that it’s easy to believe that we’ve evolved a long way from then.

Jared Diamond wrote a paper about rapid evolution on an isolated island. When modern (factory) food was introduced to the island (in the 1940s?), there was a very high rate of diabetes, presumably due to the new food. Since then, the rate of diabetes on the island has gone way down, although they still eat modern food. Diamond took this to be due to evolution (people with diabetes-resistant genes had more offspring), supporting dearime’s point of view.

After the first Ancestral Health Symposium, Melissa McEwen commented how unhealthy many of the top people looked. On the other hand, Tucker Max commented how healthy the attendees looked in general. I agree with both observations. A paradox.

When I was an assistant professor, and wanted to sleep better, I believed wondering about paleo life was unhelpful because (a) we knew so little about it and (b) it must have differed in thousands of ways from modern life. Should I spend an hour trying to find out about paleo life and/or what paleo gurus recommend for bad sleep? Or should I spend an hour trying to find out how ordinary people have improved their sleep? My answer was the latter. I ignored paleo life.

Looking into how ordinary people improved their sleep did help. I eventually reached a non-trivial conclusion: Eating breakfast made my sleep worse. No paleo guru had said that — I had been right to ignore them. Yet it made evolutionary sense. Cavemen did not eat breakfast, I was pretty sure. (No refrigerators.) After that I paid more attention to what evolutionary thinking would suggest. This led to several discoveries: the effect of faces in the morning on mood, the effect of standing on sleep, and the Shangri-La Diet. It is incredibly hard to discover big new experimental effects (such as the effect of morning faces), especially in fields you know little about (my specialty in psychology was animal learning, not mood, sleep or weight control). I was impressed.

The effect of bedtime honey (more generally sweets in the evening) on sleep emphasizes the paradox or puzzle or whatever you call it. I found out about the honey effect by paying attention to what works. No paleo involved. Stuart King told me it improved his sleep. Here are three reasons to look at ordinary experience and avoid paleo theorists: 1. It turned out to help. 2. It’s a huge effect and very easy. 3. Paleo theorists have said the opposite: avoid carbs, avoid sugar. If you followed their advice, you would do the opposite of what helped Stuart and me. On the other hand, I increased my belief in the effect because it made evolutionary sense: 1. It makes sense of why we like sweets. 2. It makes sense of why our liking for sweets goes down when we are hungry (surely due to an evolved mechanism). 3. It makes sense of why we eat sweets more in the evening (presumably due to an evolved mechanism that makes sweets taste better in the evening).

The short answer to dearime’s question is that, in my experience, it is incredibly hard to learn anything about health. There are so many possibilities and evolutionary thinking helps choose among them — decide which to take the trouble to test.

A Vancouver drug center has started an unusual program: alcoholics bottle homemade beer.

The Drug Users Resource Centre, the Downtown Eastside non-profit famous for housing Canada’s first crack pipe vending machine, is also behind what may well be North America’s first program teaching severe alcoholics how to brew their own beer and wine.

Now the alcoholics just do bottling but the people behind the program intend to expand it to include other parts of the beer-making process, such as fermentation.

What’s interesting is that they are not treating severe alcoholics as passive or disabled — as recipients of treatment. At least not entirely.

This program reminds me of several things. Geel, a town in Belgium, treats people with mental illness as valued caregivers. Zeynep Ton says low-level retail employees should be treated as people who can learn many jobs, give good advice to both customers and management, make good use of free time, and so on. I treat my students as people who want to learn — who do not need to be scared into learning by threat of a bad grade — and are capable of inventing their own assignments.

Is there a general lesson to be drawn from these examples? (All are complicated, in spite of brief descriptions.) Could it be a good idea — as a default — to treat those you deal with as smart, capable and motivated? It is no great leap to treat alcoholics as motivated to make beer but it is a slight leap to treat them as capable of making beer. Is the next step is to treat them as smart?

What if doctors, before they saw a patient, told them: Please search the Internet for possible remedies. Bring a list of the ones you want to consider to our meeting. Is that crazy? The slightly subtle point is this may make the doctor happier.

 

 

 

 

 

 

Stuart King writes:

I was very hungry today at dinner and the thought of sweet food wasn’t appealing at all, but after filling up on some rice, chicken and coconut cream curry I immediately had ice cream and chocolate slice [= what Americans call a brownie], which had had no appeal 15 minutes or so before!

An everyday observation that anyone can make. Studies have shown what Stuart noticed: When you are hungry sweet foods are unappealing. This is why dessert is eaten after the rest of the meal.

The main way that psychologists explain an experimental effect — choose between explanations — is by finding out what makes the effect larger or smaller. For example, discovery of what makes learning more or less (what increases or decreases the effect of one learning trial) is the main way psychologists have chosen among different theories of learning. Different theories predict different interactions.

Why do we like sweet foods? The usual answers are that sweet foods are a “good source of energy” and they provide “quick energy”. But these explanations do nothing to explain what Stuart noticed. If sugar is a good (= better than average) source of energy, we should eat it before other foods (average sources of energy) when we are hungry (hunger signals lack of energy). The opposite is true. You may not want to call it a “contradiction” but there is no doubt the conventional view does not explain what Stuart noticed. Of course many nutrition experts, such as Weston Price, are/were entirely sure sugar is unhealthy.

As a tool for choosing among theories, Stuart’s observation is especially good because (a) it is very large (sweets go from unappealing to appealing) and (b) paradoxical (eating calories should make all calorie sources less appealing).

If you have been reading this blog, you know I explain Stuart’s observation by assuming that we need sugar in the evening to sleep well. Sugar (sucrose, fructose, glucose) eaten in the evening increases blood glucose, which increases glycogen. During sleep, glycogen becomes glucose, which the brain needs to work properly. Evolution shaped us to like sweet foods after a meal so that we will eat them closer to when we sleep. (The value of replenishing glycogen close to bedtime also explains why we eat sweet foods after dinner more than after breakfast or lunch.)

I can’t think of another case where what experts say is so out of line with what’s easily observed. For example, I’m sure cholesterol doesn’t cause heart disease, but there is no everyday observation that supports my belief.

I can’t think of another case where what experts say is so out of line with what’s easily observed. For example, I’m sure cholesterol doesn’t cause heart disease, but there is no everyday observation that supports my belief.

If sugar is helpful for sleep, why is it associated with diabetes? My guess is that sugar is almost always consumed in foods that taste exactly the same each time — what in The Shangri-La Diet I called ditto foods. For example, soft drinks. Ditto foods with sugar, because they have a strong precise CS (smell) and a strong fast US (calorie signal), produce an especially strong smell-calorie association. Such an association raises the body fat set point, thus causing obesity. Obesity causes diabetes. It’s also possible that eating sugar during the day — at the wrong time — hurts sleep. Maybe sugar during the day raises insulin and thus reduces the conversion of sugar to glycogen. Less glycogen causes bad sleep, bad sleep causes diabetes. My blood sugar levels clearly improved when I started eating sweets in the evening — opposite to what the sugar-diabetes link would predict.

• American Physical Society expresses uncertainty about AGW (anthropogenic global warming).
• Kyoko Miyake, talented documentary maker. I really liked Brakeless.
• Interview with Renata Adler. “The following thirty-two pages, in place of my essay–my most “controversial” essay, in some ways, closely argued–were from a cookbook.”
• The modern diet, in graphs. Note the huge increase in soybean oil. Sugar isn’t the only foodstuff to have increased a lot over the last 50 years.
• Blame doctors for the heroin epidemic. “Until recently, the system was rigged to encourage doctors and dentists to give out opioids with reckless abandon.”

Thanks to Casey Manion.

• Why I am anti-Komen. “Do you think individuals who donated to Susan G. Komen foundation knew their money would be used to sue other charities who want to raise money like Prom was doing? . . . Once national news shone a spotlight on Komen’s bullshit move, they backed off.”
• Cardboard standing desk
• Alex Chernavsky finds no effect of soy on brain speed
• Probiotic helps children. Notice that the study was done in Mexico City.

Thanks to Melody McLaren.