Author: Seth Roberts

A Second Opinion: You’ve Been Poisoned by Your Doctor

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In a wonderful profile of master diagnostician Dr. Thomas Bolte, this especially pleased me:

Many of the patients Bolte sees are victims of iatrogenic, or doctor-caused, illness. Simply put, they have been misdiagnosed, overmedicated to the point of sickness, or given treatment inappropriate to their conditions. On occasion, this has led to shouting matches with more conventional docs, like the dermatologist colleague who burst into Bolte’s office one day and harangued him—in front of another patient—for telling the mom of an acne-ridden teen to stop feeding her child so much junk food. There’s no evidence that diet has anything to do with acne, the dermatologist shouted. Bolte begged to differ and cited the literature. “The pharmaceutical industry has trained even doctors to believe that there’s a pharmaceutical answer to everything,” he says, shrugging.

A large fraction of Bolte’s patients have been poisoned. They get better when the poison is stopped. The mother of a friend of mine was near death — so near that her children decided to put her in a hospice. By mistake her six or seven medicines were stopped. And she recovered! Her medicines were what had been killing her.

The technical term for such horrors is drug interaction.

Thanks to Dave Lull.

Charles Nemeroff Under Scrutiny

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For most of its existence, there was no letters section in The New Yorker. A big mistake, which Spy pointed out and made fun of by running Letters to the Editor of The New Yorker. The current version of The New Yorker has letters, of course, but no comments on the web. Another big mistake.

Because those comments can be incredibly good. In its Health Blog, the Wall Street Journal website recently posted news about Charles Nemeroff, the Emory University psychiatry professor who failed to disclose about a million dollars from drug companies. The news itself wasn’t anything special but the comments told me important stuff I hadn’t known:

  • What his defenders say. (Not easily summarized.)
  • The nature and quality of his research. “Regarding Dr. Nemeroff’s contributions to science, although he has published many papers, a large proportion have dealt with the hypothesis that the adrenal hormone cortisol plays a major role in the etiology of depression. This hypothesis has its proponents, but has not gained widespread support from experimental or clinical data. Drugs designed to inhibit cortisol have been disappointing as treatments for depression. Hence, regardless of any ethical issues surrounding his career, his publications have been numerous, but with low impact on advancing science and on actual clinical outcomes. Actually, it’s a sad commentary on how really difficult it is to understand the biology of mental illness that individuals such as Dr. Nemeroff who conduct rather mediocre scientific work are considered major contributors to the field.” You can read a thousand outraged editorials and blog posts about Nemeroff and not find something this revealing. Without anonymity, it is very hard to say something like this.
  • Complete refutation of one of Emory University’s comments. “Emory said its review supports Nemeroff’s contention his lectures weren’t product specific.” WHAT….I worked in pharma sales years ago specifically selling SSRI’s. Nemeroff was WELL known for SPECIFICALLY selling Paxil in his presentations. He was GSK’s Paxil hit man.” So much for Emory’s credibility.
  • A surprising suggestion. “Disclosure alone is not going to do that. These are amounts of money that even if Nemeroff had properly disclosed would be unethical -it can’t be right that a Prof is paid 300 K a year for a full time job and get 500 K in addition from drug companies – even IF it was disclosed. Patients will do well in asking their physician to post or tell them about such additional moneys – and should vote with their feet since there are many honest people, though less powerful, in the field as well.”
  • A comment on the real cost of people like Nemeroff. “Anon asks, “Who among the bloggers is familiar with his work, conversant with his research, actually read his papers?” I have, and I don’t trust much about what he says in any of his pharma-related articles. Indeed, I have challenged his findings in letters to the editor. The saddest part of this entire scenario (Nemeroff and others) is the wreckage they have strewn throughout our scientific literature in the past 10-15 years.”

Supporting what I said about letters to the editor. The truth about Nemeroff’s research (and by extension a vast swath of psychiatric research) was in the letters to the editor. But a letter to the editor is just one person — and usually these letters can’t be anonymous. This discussion is many people, it’s a discussion, it’s anonymous, and it’s easily available. The emotion expressed — because people can comment quickly and informally — makes the whole thing easy to read.

This is a wonderful age we are living in, that so much nuanced and well-informed comment is available. Never before, not even close. Merry Christmas!

Another Link Between Better Sleep and Better Health

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Much of my self-experimentation has been about improving my sleep — in particular, not waking up too early. I found that avoiding breakfast and standing a lot made a big difference. Currently I am studying the effect of stressing the leg muscles in other ways and will soon have more to say about this.

Now comes more evidence this matters: People who slept too little had a higher risk of coronary artery calcification.

JAMA abstract.

100 Paper NY Times = 1 Heavy Textbook

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Alana Taylor, a journalism student at NYU, blogged about one of her classes:

Quigley [the teacher] tells us we have to remember to bring in the hard copy of the New York Times every week. I take a deep sigh. Every single journalism class at NYU has required me to bring the bulky newspaper. I don’t understand why they don’t let us access the online version, get our current events news from other outlets, or even use our NYT imes app on the iPhone. Bringing the New York Times pains me because I refuse to believe that it’s the only source for credible news or Pulitzer Prize-winning journalism and it’s a big waste of trees. . . I am taking the only old-but-new-but-still-old media class in the country.

Yeah. The same thing goes on all over campus where students are required to buy a heavy glossy textbook that costs about a semester of paper New York Times. As if the same info wasn’t free on the Web.

Long ago, textbooks were a fantastic bargain because they cost so much less than private tutors. And private tutors disappeared.

After Taylor’s unflattering piece, her thin-skinned professor, who had said “it’s essential for journalists to blog”, banned blogging about the class.

Careful with the Sushi

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I once lost about 12 pounds by eating lots of sushi. I didn’t think was a good long-term idea, however, because sushi was expensive and might have too much mercury. Now Jeremy Piven, best known as Ari in Entourage, has found that eating lots of sushi can indeed raise your mercury levels a significant amount. According to New York,

Dr. Carlon Coker went on record with Entertainment Tonight to confirm that Piven has six times the amount of mercury in his system that a healthy person should have, apparently a result of Piven’s insatiable appetite for sushi.

As a result he quit his role in David Mamet’s Speed the Plow. Mamet’s response:

I talked to Jeremy on the phone, and he told me that he discovered that he had a very high level of mercury. So my understanding is that he is leaving show business to pursue a career as a thermometer.

What a jerk.

Life Imitates Art School (part 2)

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Tsinghua University includes an art school added six or seven years ago. An art school elsewhere in Beijing moved to the Tsinghua campus; a big building was built for them. Two of my Chinese teachers are art students. I told them about the San Francisco art school where every department looks down on another department. This got a big laugh. The same thing happens in their school, they said. It is divided into fine arts and design. The fine arts students look down on the design students because the design students are working for money; the design students look down on the fine arts students because they aren’t practical.

The more curious interaction is between the art students and the rest of the school. Students in the rest of Tsinghua, which resembles MIT, often ask the art students their score on the national exam that high school students take to get into college. It is incredibly difficult to get into Tsinghua by that route; maybe 1 in 10,000 is successful. Art students have lower scores on this test but must also pass a test of artistic ability. One of my teachers, who is now a graduate student, said she’d been asked her exam scores at least 10 times. Here is one context. My teacher has just helped another student with his bike.

Student who has just been helped: What’s your major?

My teacher: Art.

Student: What was your score on the national test?

And she is big and strong, she said, so potential questioners may have been afraid of being hit. Other art students are asked more often.

Experimental Journalism

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By which I mean journalism that involves doing an experiment. In this example, two New York journalists measured reaction to two versions of strawberry milk. The low-rent version did surprisingly well.

A friend and I were once thinking of writing newspaper articles about parking illegally in various places in San Francisco and measuring how long until we got a ticket. News you can use.

The Twilight of Expertise (part 16: opticians)

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These glasses can help everyone, not just the poor:

The wearer adjusts a dial on the syringe to add or reduce amount of fluid in the membrane, thus changing the power of the lens. When the wearer is happy with the strength of each lens the membrane is sealed by twisting a small screw, and the syringes removed. The principle is so simple, the team has discovered, that with very little guidance people are perfectly capable of creating glasses to their own prescription.

[Josh] Silver [a retired professor of physics] calls his flash of insight a “tremendous glimpse of the obvious” – namely that opticians weren’t necessary to provide glasses

Speaking of not needing opticians and making glasses more affordable, a year ago I discovered by accident something extremely useful: Wearing one contact lens is better than wearing two.

Wearing just one contact lens, I get good distance vision from the lensed eye and and good close-up vision from the unlensed eye. Wearing two contact lenses, I have poor close-up vision. Another benefit of one rather than two contact lenses is that one eye is contact-lens-free for a long time. And I go through contact lenses half as fast. I wear lenses that last one month so I switch monthly which eye has the lens.

No optician told me this. No optician has even figured this out, as far as I know.

Are You Having Trouble Getting Grants?

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A few weeks before I left Berkeley, I ran into one of my psych-department colleagues in a supermarket. He said — this was before the financial crisis — that the grant outlook was terrible. The success rate for NIH grants was about 7%. He had had two grants; now he expected to have none. “Self-experimentation is looking better and better,” he said.

Today I got an email that began like this:

If your department’s economic outlook is looking bleak, like the rest of our economy, then we have some help available for you! Regardless of the nation’s economic condition, the federal, state, local, corporate and private foundation grant system in the US is quite healthy and can provide substantial supplemental relief to your budget woes. Grant money for equipment, training, vehicles and other needs is still available in substantial amounts and remains unaffected by the current economic crisis. Competition for this available funding is becoming more intense with more agencies than ever applying. You need an edge to win; we offer that edge!

CHIEF and 5.11 Tactical have teamed up for 2009 to offer our nationally recognized grant consultant, Kurt Bradley and his national grant writing seminars, for the affordable price of $149.00. Kurt and 5.11 will be in Las Vegas, NV on January 6th and 7th to instruct public safety agencies how to capture their share of this money. Chief Grants has turned hundreds of departments into successful applicants and winners for these funds, assisting agencies, just like yours, in obtaining more than $100 million dollars.

I was on the 5.11 Tactical mailing list because I had bought some pants that police officers often buy.

In Systems of Survival, Jane Jacobs wrote that there were two systems of morality, corresponding to two different ways of making a living: taking and trading. The first values loyalty more than honesty, the other values honesty more than loyalty. Police are firmly in the taking morality system, which pervades government. Science should value honesty, of course; but you can see that a dependence on grants pushes everyone involved toward a loyalty-based morality: If we tell the truth we might lose our grant. Modern science is indeed almost completely dependent on grants, which means results don’t really matter. What really matters is getting the next grant. One reason my self-experimentation was effective was it didn’t depend on grants. No matter what I found, no matter how strange or upsetting or impossible or weird the results might be, I could publish them and continue to investigate them.

Chocolate is Good For You (part 4)

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From the January 2008 Journal of Nutrition:

In a cross-sectional study, we examined the relation between intake of 3 common foodstuffs that contain flavonoids (chocolate, wine, and tea) and cognitive performance. 2031 participants (70—74 y, 55% women) recruited from the population-based Hordaland Health Study in Norway underwent cognitive testing. A cognitive test battery included the Kendrick Object Learning Test, Trail Making Test, part A (TMT-A), modified versions of the Digit Symbol Test, Block Design, Mini-Mental State Examination, and Controlled Oral Word Association Test. . . . Participants who consumed chocolate, wine, or tea had significantly better mean test scores and lower prevalence of poor cognitive performance than those who did not.