Walmart sells a kit for home measurement of HbA1c (brand name ReliOn) that costs $9 and provides results by email. It’s sold only at Walmart. I have been paying $30 for the same measurement at a test center (about 30 minutes away). If you use insurance, copay might be $15. Without insurance, a doctor’s office test might cost $90. The reviews suggest the test has roughly the same variability and average as a lab test. A few people had trouble getting enough blood on the dots but at $9 there is plenty of room for repeat testing.

My blood sugar improved when I started to walk an hour per day and when I started intermittent fasting (eating about half as much as usual every other day). I noticed the effects with blood sugar tests but frequent HbA1c tests (say, once/week) would have been much better.

Diabetes has become an enormous problem in China, where 10% of adults have Type 2 diabetes, roughly the same as in America. Americans often think obesity causes diabetes but this doesn’t explain why smoking — which makes people thinner — is associated with diabetes. People get diabetes who don’t smoke and aren’t fat. Whether anyone who walks an hour/day gets diabetes is less clear.

Thanks to Shant Mesrobian.

A year ago, Eric Lander, who identified himself as “President and Founding Director of the Broad Institute of Harvard and MIT [and] one of the principal leaders of the Human Genome Project, directing the largest center in the international project” did a Reddit AMA (Ask Me Anything). One of the questions did not go as expected:

Question As an advisor to the President, what is being done or do you think will be done to increase the attractiveness of students finishing PhD programs in science?

Lander We need to shorten the time for getting a PhD and for a first faculty job. Young people should get out into the scientific world early, when they have lots of fresh ideas. We should encourage grants to young scientists and should encourage them to take big risks. When you’re taking big risks, science is amazingly fun.

The response to this answer was very negative.

With all due respect, this is a ludicrous statement. . . The true problem is the way in which you fund science. You fund projects and proposals. In order to get these projects funded, the preliminary data has to be essentially the whole project being done. Then you fund at a 6% percent line. It leads to cronyism in the peer review process and a general sense of despair in scientists. How about you radically change the funding system for PIs?

I too am disappointed with Dr. Lander’s response to possibly THE most important question here regarding training basic scientists.

Do you truly believe this? . . . There is no reason to encourage more students to go into science if there is not enough government funding to support their careers.

Alas, this is not important. It just pleased me that someone questioned Dr. Lander’s absurd claims, which he makes often. “We should encourage young scientists to take big risks”. Yes, I agree, does he really believe this? Do he really believe that someone coming up for tenure should take big risks?

A recent Bloomberg News article looked into why Mt. Sinai Hospital in New York did a very large number of heart procedures, making its cardiologists very well-paid. One reason, the journalists discovered, is that patients had been told to lie:

On a pair of representative Sundays in 2012, 10 patients told ER workers they’d been instructed to arrive there before their cath-lab appointments, according to internal hospital correspondence. Two of them said they’d been coached to say they were having acute symptoms of heart disease, according to the exchanges.

Even more remarkable, the journalists found, was that many patients had cardiology appointments before they showed up at the emergency room:

Certain patients who showed up at Mount Sinai Hospital’s emergency room on Sunday mornings stood out [because] they already had appointments. Each was scheduled for a procedure at Mount Sinai’s catheterization lab, where cardiologists thread wires and tubes into blood vessels to detect disease and insert cardiac stents. The New York hospital’s cath lab has regularly scheduled such emergencies-by-appointment, according to three doctors and another medical professional, all of whom said they had direct knowledge of the practice.

Larry Husten, a medical columnist at Forbes, argues that this is an example of a widespread problem.

I have blogged many times that bedtime honey improves sleep. I learned this from Stuart King, an Australian musician. He also pointed out we eat dessert with dinner more than with other meals. which others who have described the honey effect have not said. The dessert observation suggests that other sweets, not just honey, improve sleep. After I repeated the dessert observation, a friend said I of all people should know it isn’t universal. The Chinese don’t eat dessert, she said. Yes, I said, but where I lived in Beijing there seemed to be lots of sweets eaten in the evening, and lots of street vendors selling fruit in the evening.

The honey-sleep connection helped me improve my sleep in other ways. I found my sleep got better if in addition to bedtime honey I ate fruit (e.g., banana) an hour or so before bedtime. My sleep got even better if I ate something sweet, such as Yakult, an hour or so before that. Both observations implied that honey improved sleep because of the sugar. Nowadays I usually eat three sets of sweets: soon after dinner, mid-evening, and bedtime. I sleep very well every single night, better than ever before. These findings make sense if glycogen (stored glucose) is very important for sleep. My way of eating (three sets of sweets slightly spread out) may produce more glycogen at bedtime than similar ways of eating (e.g., eating the same sweets spread throughout the day).

Recently I realized that Stuart’s observation about dinner and dessert made a prediction: the word dessert should be better associated with the word dinner than the words breakfast and lunch. (A lot of talking/writing consists of describing reality.) I used Google to test this prediction. I counted the hits returned when I searched “dessert dinner”, “dessert breakfast”, and “dessert lunch”. The prediction turned out to be true: “dessert dinner” had a lot more hits than the other two combinations, even though breakfast, lunch and dinner are almost equally common.

I checked about forty other food words: Were they more associated with one meal than others? I found several interesting things.

1. It wasn’t just dessert. Honey and fruit were associated with dinner more than breakfast or lunch. The size of the association was very similar in the three cases. For almost all other food words I tested there was little or no association.

Here are examples of little or no association.

2. There were some surprising associations, shown here.

No surprise that tea is associated with breakfast but why is potato associated with lunch? French fries? Why is nuts associated with dinner? Do nuts contain something that improves sleep?

For each food I computed a “dinner effect” meaning the log(dinner count) minus the average of log(breakfast count) and log(lunch count). Here is a kind of histogram of those values.

The outlier status of nuts, fruit, honey and dessert is clear.

These findings support (a) the original idea (because the original idea led to them), (b) the importance of the original idea (because the association is so clear) and (c) use of Google to learn what people do. Word associations are influenced by many things, no doubt; these results suggest actual behavior is a strong influence. Use of Google to study behavior is free, public, fast, and convenient.

I was surprised the results were so clear. I suspect the explanation is that sweets taste better closer to bedtime. Dessert, honey and fruit differ in many ways; the similarity of size of association suggests that the association is due to what they share (sugar).

I hereby give you permission to eat dessert with dinner.

• Magnesium associated with reduced arterial calcification
• Sarno method for treating muscle pain compared to other methods. “My surgeon who had been an NBA team physician assured me I had a 90% plus chance of returning to my life as it had been. However, eight weeks after the surgery I was WORSE.”
• Are old people in Great Britain living shorter lives because of prescribed drugs?
• Some cancers detected by mammograms apparently disappear without treatment.

Thanks to Steve Hansen.

According to the headline of a Yahoo News article, “the dawning of the age of genomic medicine” is upon us. There has been little impact of genomics but “that is finally changing,” says Julie Steenhuysen, the author of the article.

I was curious how this would be argued. Here’s how:

Sambrookes had been very athletic as a young teen, but as she matured, she noticed a heaviness in her legs. By age 20, running left her tired. At 40, she needed a pacemaker, just like her mother did at that age.

“I started thinking there is something to this,” said Sambrookes, now 56, who lives in Michigan City, Indiana.

After some dead ends, she found McNally, who cast a wide net, testing for more than two dozen genes that could account for Sambrookes’ heart and muscle problems.

The culprit turned out to be a mutation in a gene called Lamin that causes Limb-girdle muscular dystrophy. The disease can cause weakness and wasting of the muscles between the shoulders and knees. The mutation can also cause electrical disturbances of the heart.

McNally recommended Sambrookes replace her pacemaker with an implantable cardiac defibrillator that could protect against sudden cardiac death.

That proved to be the right call. Last August, Sambrookes’ heart stopped three times. Each time, the defibrillator shocked her back to life.

“She literally tried to die three times,” McNally recalls of her patient. “It still takes my breath away.”

Because someone recommended a pacemaker be replaced with a defibrillator, genomic medicine is a good idea. The benefits of genomic medicine must remain elusive if you have to use such a poor example to support it.

• progress on narcolepsy. It is an auto-immune disease. A vaccine against the H1N1 (swine flu) virus apparently caused narcolepsy in France.
• Was Angleton right? New book by Edward J Epstein.
• Vivaldi’s business plan. “It ­doesn’t depend on pity; it doesn’t begin with scarcity. It starts with people’s talents and promise, not their neediness and suffering. It doesn’t assume that the people with money have the answers and the solutions while the people without money have the problems and the tragedy.” Another excellent post by the same author (Samuel Wells).
• Is the problem gluten or something sprayed on wheat? (Here is a unconvincing rebuttal.)

Thanks to Patrick Vlaskovits.

There were many funny things about Leah Goodman’s claim in Newsweek that a California engineer invented bitcoin. One was her observation that he put two spaces after a period — just like the inventor of bitcoin. Another was her observation that his relatives said he was “brilliant”, without giving any examples. His brilliance had remained perfectly hidden – until now. A third was her conclusion that he was obsessed with secrecy and distrusted government – just like the inventor of bitcoin (according to her). Felix Salmon was quite wrong when he said there are some very strange coincidences and the pieces of her argument “fit elegantly together”. Actually, her argument is worthless from top to bottom. Salmon was right, however, when he said that the engineer’s English shows he couldn’t possibly have invented bitcoin. As Salmon says, Goodman ignored this itty-bitty problem.

Who is the inventor of bitcoin? I’m sure it’s Nick Szabo, a former law professor at George Washington University. This idea first surfaced a few months ago in an anonymous blog post based on textual analysis. Szabo used certain phrases in the original bitcoin description far more than a bunch of other possible candidates. That is real evidence. The hypothesis that Szabo is the inventor passes several other tests as well:

1. Right time zone. The original bitcoin postings appeared to come from the Eastern (United States) time zone. Szabo lives near Washington, D. C.

2. Prior to bitcoin, he had similar ideas. As far as I can tell, his previous ideas were the closest of anyone’s.

3. Yet the original bitcoin proposal didn’t reference his work. The usual reason for not mentioning a predecessor’s work is that you want more credit. Yet the creator of bitcoin didn’t want credit. Failure to mention Szabo’s work is so strange it may have been Szabo’s way of telling insiders he’s the inventor. In other words, this fact makes sense if Szabo is the inventor. It remains unexplained if anyone else is.

4. Szabo failed to get excited when bitcoin emerged. It was based on his work (more or less). Like everyone, including me, Szabo had been told countless times that his ideas were worthless, crazy, stupid and so on. (“Money just doesn’t work like that, I was told fervently and often.”) Because of that treatment, I greatly enjoy pointing out confirmation of my ideas. It’s such a fundamental pleasure there’s a word for it: glee. If he wasn’t the inventor of bitcoin, Szabo should have gleefully followed its progress, pointing out over and over how this showed his original ideas were right. He didn’t do this. Again, this makes sense if he was the inventor — he didn’t want to draw attention to how close bitcoin is to his published ideas. It remains unexplained if anyone else is.

5. The clincher, for me, is that he wrote an article about the emergence of money that is compatible with my theory of human evolution. His article says money emerged from collectibles. Collectibles are an important part of my theory. I say they emerged because they helped skilled artisans, who were innovators, make a living. For most people, collectibles are trivial, whereas I’ve written often about the Willat Effect, which I believe is the psychological rule that created them. It isn’t easy to be consistent with my theory. I’ve read dozens of theories about human evolution. Whenever they explain the same things as mine (e.g., evolution of language), they have been inconsistent with my theory. Two examples are Jared Diamond’s ideas and Daniel Dennett’s ideas. Szabo’s essay is the only the second example I have seen of ideas that fit mine. The aquatic ape theory, which is about what happened before the events of my theory, also fits; Szabo’s ideas are about what happened after the events of my theory. Szabo’s ideas about the emergence of money are very non-obvious (especially because you have to realize the centrality of collectibles) and are compatible with a theory he cannot have heard of. I doubt anyone agrees with me that compatibility with my theory is a great plus but it is obvious that if you understand how money began, you are in a much better position to invent a new form of money than if you don’t. The difficulty of mining bitcoins corresponds to the difficulty of making collectibles. You could randomly pick anyone, including cryptographic experts, and the probability would be extremely low they have a good theory of how money began. Yet Szabo does.

I ignore the coincidence of initials: NS and SN (or NS).

Szabo’s achievement is good news for me because we have a similarity. He was a law professor. They are not supposed to invent new and useful things. No law professor before Szabo invented anything remotely as new and potentially important as bitcoin. I am a psychology professor. They are not supposed to make useful discoveries about health. I have made discoveries/inventions about health that are certainly new and might some day be important, such as the Shangri-La Diet and the underlying theory, the effect of morning faces on mood and daily brain testing.

After I say that Nobel Prize in Medicine is usually given for research of little or no proven value, one counterexample I’ve heard is the 2008 prize for the discovery that cervical cancer is caused by the human papilloma virus (HPV). This should allow us to reduce cervical cancer via vaccination.

There are several things wrong with this example:

1. The predicted improvement has not been observed. The average age at which a woman is diagnosed with cervical cancer is 48 years old. To assess the effect of HPV vaccination — usually given to young girls — on cervical cancer you need to wait thirty years. Thirty years haven’t passed. The history of medicine is full of examples where treatments that supposedly worked — such as tonsillectomies, given to millions — when tested turned out to not work. The history of medicine is also full of examples where supposedly wonderful treatments (e.g., frontal lobotomies) turned out to have side effects so bad the treatment was stopped.

2. Cervical cancer is not a big source of death. In the United States, it kills perhaps five thousand women per year. Heart disease kills hundreds of thousands of people per year; so do all forms of cancer taken together. And pap smears, which cost little, actually work. “Cervical cancer is 100% curable if detected early,” says one website.

3. Because pap smears work well, it isn’t clear there is room for improvement. To find out you’d want to compare two groups: (a) pap smears plus HPV vaccination and (b) pap smears alone.

4. It isn’t clear the vaccine will work, even if HPV infection does cause cancer. There are at least 100 varieties of HPV; the vaccine protects against two. Does vaccination against two varieties increase infection by other varieties (because different viruses compete for the same niche)? Hard to rule this out. Again, there are many examples in medicine where actually helping people turned out to be far harder than experts had predicted, even when the initial idea wasn’t nonsense. An example is the oncogene theory of cancer, which also has a Nobel Prize associated with it.

In summary, not a counterexample.

A few years ago, a Korean friend of mine spent a college year abroad in Tanzania. In South Korea, access to information about North Korea on the Internet was blocked. In Tanzania, it wasn’t. Impressed by what she learned, she cut-and-pasted some of it into an email to her sister.

After she sent the email, she remembered that in South Korea it was illegal to cut-and-paste from a website. She called her mom to tell her sister not to read the email. The message was successfully conveyed and her sister deleted the email without reading it.

In the last year, however, the South Korean government has changed its policy and is now trying to educate citizens about life in North Korea. Information is no longer blocked. Now and then people escape. They are put on show and tell about North Korean life many times. The intention is to prepare for the coming reunification. Special committees have been formed to discuss how to solve the anticipated problems.

We are used to hearing about the advantages of dividing one country into two, but my friend had no trouble explaining why the South Korean government wanted reunification. One reason was that the war with North Korea was very expensive. Another was that families had been divided. A third was that since North Korea has nuclear weapons, reunification will mean that South Korea has them. (My friend had not read a certain newspaper article the day she said that.) This article suggests that the real reason cannot be said out loud. It is that reunification will allow South Korea to take advantage of the land and people freed by the collapse of North Korea.

“What have you learned from the reunification of Germany?” I asked.

“There will be chaos for a long time,” she said.