Author: Seth Roberts

Creating More Diversity

Seth Roberts10 Comments

Like Tyler Cowen, I found this interview with Harvard professor of genetics George Church bizarre, in the sense of un-self-aware. Here is the most telling part:

SPIEGEL: Wouldn’t it be ethically problematic to create a Neanderthal just for the sake of scientific curiosity?

Church: Well, curiosity may be part of it, but it’s not the most important driving force. The main goal is to increase diversity. The one thing that is bad for society is low diversity. This is true for culture or evolution, for species and also for whole societies. If you become a monoculture, you are at great risk of perishing.

“The main goal is to increase diversity”. Fine. Yet in Church’s own classes — if he is like 99.9% of professors I know — he treats all the students the same (same lectures, same assignments, same tests, same grading scheme), apparently not understanding that such treatment decreases diversity.

When I was a graduate student, I had lunch (along with other graduate students) with Richard Herrnstein, another Harvard professor (of psychology). Herrnstein was on Harvard’s admissions committee. The perfect candidate, he said at lunch, would be a flute-playing football player with perfect SAT scores. Jane Jacobs describes an equally dispiriting lunch with a Harvard professor of urban studies.

What is it about Harvard professors? As Ron Unz says, “the elites they have produced have clearly done a very poor job of leading our country.”

Personal Science = Insourcing Your Health

Seth Roberts3 Comments

I recently blogged about undisclosed risks of medical treatments. For example, sleeping pills are associated with a big increase in death rate. Patients are rarely (never?) told this. One reason risks are undisclosed is ignorance: Your doctor doesn’t know about them. Another likely reason is that you and your doctor have different goals. If a treatment harms you, your doctor is not harmed, in all but a few cases. If you refuse a treatment (such as a surgery), your doctor may make less money. This pushes doctors to overstate benefits and understate costs.

This is the simplest case for personal science: You care more about your health than any expert ever will. The experts have advantages, too (such as more experience with your problem) so it is not obvious that personal science will be better than expert advice — you have to try it and find out. When I started to study my acne, I was stunned how easy it was to improve on what my dermatologist had told me.

A recent article in The Atlantic (“The Insourcing Boom”) describes a similar revelation at General Electric. GE executives wondered if they could build a certain water heater (the Geospring) just as profitably in America as in China. They looked at it carefully:

The GeoSpring in particular, Nolan says, has “a lot of copper tubing in the top.” Assembly-line workers “have to route the tubes, and they have to braze them—weld them—to seal the joints. How that tubing is designed really affects how hard or easy it is to solder the joints. And how hard or easy it is to do the soldering affects the quality, of course. And the quality of those welds is literally the quality of the hot-water heater.” Although the GeoSpring had been conceived, designed, marketed, and managed from Louisville, it was made in China, and, Nolan says, “We really had zero communications into the assembly line there.”

To get ready to make the GeoSpring at Appliance Park, in January 2010 GE set up a space on the factory floor of Building 2 to design the new assembly line. No products had been manufactured in Building 2 since 1998. . . .

“We got the water heater into the room, and the first thing [the group] said to us was ‘This is just a mess,’ ” Nolan recalls. . . . “In terms of manufacturability, it was terrible.” . . . It was so hard to assemble that no one in the big room wanted to make it. Instead they redesigned it. The team eliminated 1 out of every 5 parts. It cut the cost of the materials by 25 percent. It eliminated the tangle of tubing that couldn’t be easily welded. By considering the workers who would have to put the water heater together—in fact, by having those workers right at the table, looking at the design as it was drawn—the team cut the work hours necessary to assemble the water heater from 10 hours in China to two hours in Louisville.

In the end, says Nolan, not one part was the same.

So a funny thing happened to the GeoSpring on the way from the cheap Chinese factory to the expensive Kentucky factory: The material cost went down. The labor required to make it went down. The quality went up. Even the energy efficiency went up. . . . The China-made GeoSpring retailed for $1,599. The Louisville-made GeoSpring retails for $1,299.

That’s what happened when designers and manufacturers were no longer so far apart. As far as I can tell, the designers at GE had no idea such big improvements were possible, just as I was shocked how easy it was to do better than my dermatologist.

There are dozens of ways to bring the incentives of doctor and patient closer together but that would be like trying to bring the Chinese workers and GE designers closer together. Personal science is much easier. No one besides you needs to change. It corresponds to insourcing: insourcing responsibility for your health.

Best Introduction to the Shangri-La Diet?

Seth Roberts7 Comments

A long thread at Mark’s Daily Apple may be the best introduction to the Shangri-La Diet. It is dramatic (people object, people say the diet is crazy), varied (many voices, many sorts of data), responsive to feedback (questions and objections are answered) and no doubt more convincing than my book (because it isn’t by me). The helpful elements include:

1. An introductory success story (from a woman named heatseeker) that I have already blogged about.

2. Someone makes a common Paleo objection — it works because of macronutrient ratios. “You have stumbled on the perfect macro ratios for you!” Heatseeker says this is unlikely because she barely changed her macro ratios. She answers many other questions and objections (e.g., “how do you choke down the coconut oil?”).

3. Someone says it didn’t work for them (“neither did anything else”).

4. Link to a talk by me (“You Had Me at Bacon”) that puts the diet in the context of my other work, such as the effect of pork fat on sleep.

5. Link to Alex Chernavsky’s results, which are most impressive in context.

6. Emphasis that the flavorless calories can be anything so long as they are flavorless (i.e., have no smell, which can be achieved by eating them nose-clipped). As heatseeker says, she lost weight via flavorless fat, I lost weight via flavorless sugar, so the success cannot be due to the fat. It is more complicated than that.

7. A confident naysayer: “I started eating less and now I’m lean for life. It really is that simple.”

8. Link to a scientific paper by me about the underlying theory.

9. Heatseeker says: “I would say that after four years of eating according to TPB [The Primal Blueprint by Mark Sisson], and 2-3 years of really strict adherence, absolutely every promise made by Mark came true–EXCEPT the fat loss.” That Diet X works better than a credible alternative (in this case, TPB) is more interesting than the observation that it works better than nothing.

10. A link to me talking about “ what food makes my brain work best“. More context.

11. “Has been incredibly easy to follow, even while at work,” says someone who is not heatseeker.

12. Independent discovery: “38 years ago our gym teacher had one of the overweight girls (we had 2) in gym class doing this! By the time we hit our Christmas break she had lost most of her pudge!! This is a true story. I remember because the girl’s parents were not informed and the gym teacher almost got fired for ‘experimenting’ on the said pupil. What saved her was people finding out that the girl had been caught by the teacher barfing up her lunch in an effort to lose weight (bulimic) so to keep her from going down that path and to gain her trust as a confidant etc she helped her by showing her a method she herself had used to control hunger which was eating a fat source between meals. Fantastic eh??? I had never heard anything quite like this until I read this thread.”

13. Bonus side effect: “Last night I slept through the night! Completely! I did not even slightly stir for any reason. . . . I have not slept through the night in YEARS!!!!!!” More reason to think that lack of certain fats impairs sleep.

14. Psychological effect: “What is happening here with the SLD? I feel calm and neutral to food.” You may remember research that suggested self-control is like a muscle. One similarity is the more you use it the stronger it gets. Several people have said that as soon as they started SLD, they were able to overcome other addictions, such as smoking and coffee. Maybe this is because years of struggling with food, day after day, had left them with very strong self-control. Before SLD, their self-control was exhausted pushing away urges to eat. As soon as SLD got rid of those urges, their very strong self control made it easy to quit smoking or whatever.

15. Two reluctant yea-sayers: “I coincidentally started trying this as a gesture of support for a desperate friend of mine . . . The whole concept is ludicrous and it’s probably just placebo effect . . . I’m kind of embarrassed to admit that this has worked for me. 10 lbs down” (Person 1). “If there weren’t so many people saying this works for them, I’d think it was the stupidest thing in the world” (Person 2).

 

Fecal Transplant Roundup

Seth Roberts12 Comments

A new study has found that fecal transplants work better than antibiotics for clearing up a common and dangerous infection:

Such transplants cured 15 of 16 people who had recurring [= difficult-to-get-rid-of] infections with Clostridium difficile bacteria, whereas antibiotics cured only 3 of 13 and 4 of 13 patients in two comparison groups.

Clostridium difficile infections often result from antibiotic treatment. It is a big step forward for modern medicine to manage to grasp that the bacteria in our bodies protect us from infection. Here is a blog about the value of fecal transplants; here is another blog.

The comments contain many interesting details:

I spent Thanksgiving of 2012 in ICU and almost died from C-Diff. It was a harrowing experience for both me and my family. It required two months of care, recuperation and doses of vancomycin. My hospital bills are outrageous. [Fecal transplants are much cheaper — Seth] I am praying it doesn’t return, having just finished my last dose of vancomycin. I had a dental implant and was on clyndamycin for two weeks and that was the culprit. Dentists should be required to inform patients that C-Diff could be a reaction to that specific antibiotic. I was not warned about this being a possible side effect.

Our mother was hospitalized at a major university hospital and came down with C. diff. The antibiotics they gave her to fight the infection finally destroyed her kidneys and hearing and she decided that life was not worth living in that condition.

We have using this “treatment” for years and years in horses with difficult intestinal issues which didn’t respond to other medications. We pass a slurry of fecal material from a heathy horse ( often mixed with electrolytes and baking soda) directly into the stomach of the sick horse. It works in almost all cases.

After my gut microflora was destroyed by 9 months of antibiotics for Lyme disease, I got C. diff this past June. Was flabbergasted that NONE of my doctors, ALL of whom prescribe antibiotics, ( & hopefully read the NYT or the INTERNET) [knew] about fecal transplants! I ditched my Lyme doctor (who said along with my GI & GP): “Take Flagyll” (which didn’t work) and then Vancomycin. No thanks. Wasn’t going to wait around for the C. diff to corrode my guts or till I was almost dead, so I went right to Dr. Brandt for a transplant and in ONE day the symptoms were gone.

I had recurring c diff for 12 months.Tried a myriad of antibiotics and a colon cleanse.Nothing worked. I was getting sicker and weaker by the day, not to mention very depressed. I was “beyond” desperate. My husband (an internist) performed a fecal transplant (using my brothers stool–close DNA donor) at home (hanging the saline/stool bag from the ceiling fan!) 3+ years ago. I have been healthy ever since.

[A doctor:] This important study . . . is a big step in the right direction, however the study is quite small. [A doctor who doesn’t understand statistics even after it is explained in plain English. The evidence from this “small” study is very strong. In case you didn’t understand the numbers, the article says it in words: “the antibiotic groups were faring so poorly compared with the transplant patients that it was considered unethical to continue”. — Seth] A larger RCT is needed before this becomes standard of care [implying that his or her lack of understanding of statistics is the norm — Seth]. Since no one is currently in position to reap monopoly profits from this treatment, I predict the study will be a long time coming. [Which, if true, implies that doctors’ lack of understanding of statistics will kill a lot of people.–Seth]

The majority of cases of C. difficile infection occur in the hospital where they were usually brought on by use of broad-spectrum antibiotics destroying the natural balance of intestinal flora in the gut. A great many people outside the hospital setting walk around healthy colonized by C. difficile without becoming infected. Others become colonized while in the hospital, a virtual surety if you stay long enough. Broad-spectrum antibiotics wipe out bacteria that normally out-compete C. difficile at different niches within the intestinal ecosystem. [In other words, gross overuse of antibiotics has created a new ecosystem — modern hospitals — where C. difficile thrives. — Seth]

After a reaction to an antibiotic caused C Diff which lasted almost a year, was treated with multiple antibiotics of which Vancomycin was the only one that kept it at bay, having had a number of courses without success, meanwhile weight was down 25 lbs and health was deteriorating as in my opinion Vancomycin also presented some problems of its own, teeth browning, lethargy etc. C Diff ruins body and soul. After a lot of research was lucky to have found a doctor who checked out the fecal transplant history/procedure and performed the transplant. The feces donor was my brother having first had blood & feces testing. The transplant was a success, after suffering C Diff for almost a year my quality of life is great – normal.

The [squeamish] tone of this article is enraging. [It begins “The treatment may sound appalling”. The headline calls it “This, er, Option”. — Seth] I contracted ulcerative colitis when I was fifteen, and the squeamishness of my parents and doctors in my small town prevented me from accessing real care. More concerned with being grossed out than dealing with the problem at hand, I was allowed to go a year without receiving proper care. As a result, I ended up with such extreme internal bleeding that I was sent unconscious to the intensive care unit at Swedish Hospital in Seattle, three hours away from home, where a surgeon removed my entire colon. He chided my parents and local doctors for not seeking help from a specialist sooner; had they done so, I would not have been in such dire condition. I spent the next year of my childhood in the hospital. All this is to say: get over feeling grossed out by the human body and consider any possible treatments that might work. If this one does, great. Ditch the whole “ew” reaction because it stands in the way of saving lives.

I was plagued for decades with room-clearing gas and stomach cramps. Yogurt and probiotics didn’t stand a chance against the established bad bugs. Then I went for my first colonoscopy (which gave me a whistle-clean gut.) I was told I could have anything I wanted. First thing, I drank a full quart of organic kefir. I haven’t had a problem since. [Very interesting. Before a colonoscopy, you take something special to clean out your gut.–Seth]

Thanks to Alex Blackwood and Karen Goeders.

Assorted Links

Seth Roberts8 Comments

 

No Stagnation in My Kitchen

Seth Roberts12 Comments

Stagnation of innovation is often illustrated with kitchens. In 1996, Paul Krugman wrote, “I live in a house with a late-50s-vintage kitchen, never remodeled. The non-self-defrosting refrigerator, and the gas range with its open pilot lights . . . it is still a pretty functional kitchen.” (Illustrating, at least, his lack of change.) Tyler Cowen said “if he were to introduce his grandmother to a modern American kitchen, it wouldn’t be all that earth-shattering for her.” David Brooks mentioned lack of innovation in many things, including “appliances”. Last week, the Economist said:

Take kitchens. In 1900 kitchens in even the poshest of households were primitive things. . . . Fast forward to 1970 and middle-class kitchens in America and Europe feature gas and electric hobs [= burners] and ovens, fridges, food processors, microwaves and dishwashers. Move forward another 40 years, though, and things scarcely change.

For a long time I wanted to go to the giant kitchen and housewares trade show in Chicago every summer, until this article convinced it would be the same old stuff with tiny variations.

In contrast, my kitchen has changed greatly in the last ten years. Here’s how:

1. Tea-brewing equipment. Soon after I started practicing the Shangri-La Diet (calories without smell), I started drinking lots of tea (smell without calories).

2. Electric tea kettle (heats water for tea better than microwave).

3. Kitchen scale (for tea and flaxseed). I discovered that flaxseed oil and, later, ground flaxseed improved my brain function and gums.

4. Noseclips. For the Shangri-La Diet.

5. Yogurt maker. I believe that fermented foods are essential for health.

6. Kombucha brewing tools (e.g., glass jars).

7. Spice grinder (for flax seed).

8. Soup cooker (for pork belly and miso soup). Eating lots of pork belly improved my sleep.

I would like to make more fermented foods. I hear that in South Korea I can get a machine that makes both natto and yogurt.

My kitchen changed because my ideas about health changed. My ideas about health changed because of my research. I found a new way to lose weight. I had a new explanation of why we like foods with complex, sour, and unami flavors (so that we will eat more fermented food). Self-experimentation convinced me that I was seriously omega-3-deficient, thus the flaxseeds. I discovered that if I eat a lot of animal fat, I sleep better.

I believe kitchen stagnation reflects stagnation in our thinking about health. Every October, I point out that the Nobel Prize in Medicine has again been given to research that is so far useless. “Molecular medicine has come nowhere close to matching the effects of improved sanitation,” says the Economist. Could mainstream health researchers be trapped by their desires to show off (no cheap equipment), to be respected (no “crazy ideas”), and to produce a steady stream of publications (no time to test implausible ideas)? Could having goals other than the truth (such as respectability) make it harder to find the truth? People who have written about stagnation in innovation do not seem to have considered these possibilities.

“The Most Influential Tree in the World”

Seth Roberts2 Comments

The title comes from Andrew Montford’s new book Hiding the Decline (copy given me by author) about Climategate. From an introductory section:

When the figures were published the extraordinary lack of data underlying the blade of the Yamal hockey stick caused a minor sensation. In fact the high point at the end of the graph was shown to have been based on only four trees, and only one of these had the hockey stick shape. McIntyre dubbed it ‘the most influential tree in the world’.

Most of Hiding the Decline is about the inquiries that followed Climategate. I enjoyed reading about smug powerful people making fools of themselves and the fairy-tale-like consternation created by two unlikely events: 1. A non-scientist (Steve McIntyre) gets involved in the global warming debate. As in a fairy tale, McIntyre is free to speak the truth. In particular, he is free to question. Professional climate scientists cannot speak the truth for fear of career damage. 2. The release of the Climategate emails. As in a fairy tale, a sudden burst of truth about bad behavior previously hidden.

Hiding the Decline is as well-written as a book by a professional writer but this is a book no professional science writer could write due to its investment in an officially-wrong point of view. There are lots of badly-written books from tiny-minority points of view. The appearance of a well-written one, joining Montford’s earlier The Hockey Stick Illusion, is no small deal. How much free speech do we have? It depends on the medium. Maybe the sequence from less to more censored is: 1. Conversation. 2. Email and other private writing. 3. Blog post. 4. Poorly-written book. 5. Article in minor magazine. 6. Well-written book. 7. Article in prestigious magazine. 8. Textbook. From one step to the next (e.g., from conversation to email), views become less diverse. This book is disagreement with the official line high up the tree.

One reason we enjoy certain jokes is that they speak a forbidden truth. When you can’t usually say it, the truth is funny. The forbidden truth aspect of Hiding the Decline is another reason I enjoyed it so much.

Does the story have a happy ending? Montford thinks not:

As we look back over the ten years of this story, the impression we get is of a wave of dishonesty, a public sector that will spin and lie, and mislead and lie, and distort and lie, and lie again. . . . Despite the emails showing, apparently incontrovertibly, that FOI laws were flouted with the full knowledge of senior figures in university, there have been almost no discernible repercussions for anyone involved. . . . The response to [Climategate] was an extraordinary failure of the institutions and of the people who are paid to protect the public interest – a failure of honesty, a failure of diligence, a failure of integrity.

My view is different. The institutions (University of East Anglia, Penn State, and so on) and officials (e.g., Vice Chancellor of the University of East Anglia) “failed” only in their ostensible purpose. Their actual purpose centers on protecting the people who created or hired them (see The Dictator’s Handbook). At this they succeeded, but suffered a large loss of credibility. To me, Climategate is the story of how two people — Steve McIntyre and the hacker of the Climategate emails — both with zero official standing, had a huge effect on worldwide public discourse. (A Google search for Climategate returns about 2 million hits.) They exposed dishonesty in powerful and heretofore respected people (science professors) on a matter far more important than expense accounts. They pushed the rest of us a non-trivial distance toward seeing the truth. I didn’t know that was possible, and I’m glad it is.

Assorted Links

Seth Roberts3 Comments

Thanks to Patrick Vlaskovits.

What Should Your Cholesterol Be?

Seth Roberts9 Comments

According to the Mayo Clinic website, lower levels of cholesterol are better. For total cholesterol, says the Mayo Clinic, below 5.2 mmol/L (= 200 mg/dL) is “desirable”. A level from 5.2 to 6.2 mmol/L is “borderline high”, and above 6.2 mmol/L (= 240 mg/dL) is “high”.

A 2011 study from Norway, based on 500,000 person-years of observation, found drastically different results. For both men and women, the lowest levels of total cholesterol (below 5.0 mmol/L) were associated with the most death. For men, the best level was intermediate — what the Mayo Clinic calls “borderline high”. For women, the safest levels were the highest.

If high cholesterol causes heart disease, as we are so often told, the pattern for women makes no sense. For a long time, experts have told us to limit egg consumption because eggs are high in cholesterol. However, a new study shows that egg consumption has no association with heart disease risk.

Via Malcolm Kendrick. I also like his post about whether statins cause muscle pain.

The First John Maddox Prize

Seth Roberts5 Comments

The panel that chose the winners of the first John Maddox Prize — Colin Blakemore, a British psychologist, Tracey Brown (Sense About Science), Phil Campbell (Nature), and Brenda Maddox — deserve a prize for Most Contentious Award. The Maddox Prize is supposed to be awarded to people who have excelled at:

any kind of public activity, including all forms of writing, speaking and public engagement, in any of the following areas:

  • Addressing misleading information about scientific or medical issues in any forum.
  • Bringing sound evidence to bear in a public or policy debate.
  • Helping people to make sense of a complex scientific issue.

The first winners, announced in November, were Simon Wessely, a British psychiatrist, and Fang Shi-min, a Chinese journalist. Criticism of Fang is here. Criticism of Wessely is here (in the comments) and here. One of his papers is here. Wessely is best known for promoting the use of cognitive behavioral therapy (CBT) to treat people with chronic fatigue syndrome (CFS). In particular, “he and his colleagues demonstrated substantial overlap in symptoms between chronic fatigue syndrome and clinical depression. . . . He subsequently developed a treatment approach using cognitive-behavioural therapy techniques, which in many cases brought about substantial improvement.”

The puzzle is that this is considered significant. Maybe people with CFS are depressed because they have CFS? Maybe this is why CBT helps them? A statement explaining the reward does not answer this objection. As for Fang, I have no idea if he deserves the prize. I would be surprised if members of the prize committee could judge for themselves the accuracy and value of his work.