Author: Seth Roberts

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Thanks to Bryan Castañeda.

Drug Companies Hide Unfavorable Evidence

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Ben Goldacre, a British epidemiologist and newspaper columnist (“Bad Science”), who used to attack homeopathy (trivial), has now written about something important: drug companies hide vast amounts of unfavorable evidence. I already knew this but many details were new to me.

I liked some of the comments:

We live in France and used a traditional GP for five years. Every time one of us went [to see him] he or she would come back with prescriptions for three or four medicines. Over that time he prescribed our family of five an estimated 60-80 medicines. We only ever took one, and everyone always got better without using these medicines. . . .This same GP also would refer us to thoroughly incompetent specialists. A few years ago I had a frozen shoulder. I went to see a ‘specialist’ who yanked my arm and shoulder about, clearly having no idea how an arm actually moves, and he then suggested operating. . . . Instead I looked on the Internet for info and found some exercises I could do and also underwent some Bowen technique treatment. A year later I was fine.

As a business consultant, I was approached many many years ago by a company who wanted help to set up an independent research institute evaluating farm pesticides. They’d found the doses prescribed for actual application were many times the amount actually needed (for obvious profit reasons), sometimes efficacy was in doubt, and loads of hideous ecological side effects were buried.

Speaking of “many times the amount actually needed”, I attended a talk about lighting standards in office buildings in which the speaker said the standards were too high (e.g., desks were better lit than necessary). His explanation was that the more lighting there is, the more air conditioning you need. The more air conditioning, the more cost, and architects are paid a fixed percentage of the cost. One of his slides showed that someone in the industry wrote down this rationale.

My GP often says the pharmaceutical industry wants to see everybody on prescription. He does prescribe tests, a lot of them, but drugs very rarely, and most of his recommendations are targeted at patients’ lifestyle: diet, exercise, work, relationships. When he does prescribe drugs, if it is an antibiotic or an antifungal, you have to come back after 1 week so that he can see if the treatment has worked/is working. If you need longer term treatment, for example physiotherapy and painkillers for back pains, or if you have a long term condition such as diabetes, he insists on seeing every month, to check that you are treatment compliant. . . . I have to thank him for a lot. Until fairly recently, I was stuck in a really unhealthy work environment, and could not find another job. I had done a Psychology course which had nothing but praise about antidepressants, so I asked him if he would prescribe me one of the newest tricyclic ones. He was extremely angry, told me I needed a new job, not tablets, and that if I ever got that drug elsewhere and he found out, he did not want to see me again (he would probably have found a blood test to check up I was ‘clean’). So I did not go down the tablet route, and he was right: all I needed was to change job.

Two or three years ago, I was working in Germany and went to see a German doctor. He looked at the list of daily medications my British doctor had prescribed (5 different drugs), ostensibly to help me survive middle age. He looked shocked, and told me that the British medical profession is dominated by the pharmaceutical industry, and he advised I stop taking three of the drugs prescribed. Now, having come back to the UK, every time I visit my GP, I am bullied once again to take this or that. If I try to resist, I receive very patronizing lectures about this or that risk.

Thirty years of bi-polar disorder taking virtually every possible anti-depressant over time, and at times when hospitalized, forced to take them under the duress of threatened sectioning under the Mental Health Act. Throughout those years I told the psychiatrists that the drugs didn’t work beyond an initial “placebo effect” lasting about 2 weeks, and that the side effects were often awful. Now it seems I may have been right all along. . . . Big Pharma, [you] made a difficult life a lot worse.

Maybe Goldacre will someday grasp that “evidence-based medicine”, which he often praises, also hides a vast amount of unfavorable evidence.

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  • American-Afghan detainee dispute. “The conflict over the Americans’ insistence that some detainees should continue to be held without charge had [become] public.” Via Ron Unz.
  • Hydrogen therapy
  • How to improve doctor performance. “Without telling his partners, Dr. Rex began reviewing videotapes of their [colonoscopy] procedures, measuring the time and assigning a quality score. After assessing 100 procedures, he announced to his partners that he would be timing and scoring the videos of their future procedures (even though he had already been doing this). Overnight, things changed radically. The average length of the procedures increased by 50%, and the quality scores by 30%. The doctors performed better when they knew someone was checking their work.”
  • Pistachio miso and other unusual fermented foods.

Thanks to Tyler Cowen, Alex Chernavsky, Patrick Vlaskovits, Chuck Currie and Bryan Castañeda.

Last Weekend’s Quantified Self Conference

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Last Saturday and Sunday there was an international Quantified Self Conference at Stanford. I attended. In Gary Wolf’s introductory talk, he said there are 70 Quantified Self chapters (New York, London, etc.) and 10,000 members. I was especially impressed because I recently counted about 50 chapters. One new chapter is Quantified Self Beijing. It has its first meeting — in the form of a day-long conference — in nine hours and I haven’t quite finished my talk (“Brain Tracking: Why and How”). Please indulge me while I procrastinate by writing about the Stanford conference.

Here are some things that impressed me:

Office hours. A new type of participation this year was “office hour”, meaning you sit at a table for an hour. My office hour, during which two people showed up, was the most pleasant and informative hour of the whole conference for me. I thank Janet Chang for suggesting I do this.

Robin Barooah used a measure of how much he meditated, which he collected via an app he made, to measure his depression. When he was depressed, he didn’t meditate. Depression is half low mood, half inaction. It is very rare that the inactive side of it is measured. It is so much easier to ask subjects to rate their mood, but this has obvious problems. Robin inadvertently found a way to measure level of activity over long periods of time. He also found that participation in an experiment that tested a PTSD drug caused long-lasting improvement, another idea about depression I’d never heard before. At dinner, Robin told me that his partner, when they’re at a restaurant, has sometimes said “God bless Seth Roberts” for allowing her to eat butter without guilt.

Steve Jonas, from QS Portland, told me that he spent a long time (many weeks) doing some sort of mental test. During one of those weeks, he consumed butter a la Dave Asprey, in coffee. Much later he analyzed the results, computing an average for every week, and noticed that during the week with butter his performance was distinctly better than performance on other weeks. I hope to learn more about this. Steve also gave a talk about learning stuff using spaced repetition. He noticed that learning new stuff increased his curiosity. After he used spaced repetition to learn stuff about Mali, for example, he became more interested in reading news stories about Mali. I think this is an important conclusion about education, the way rote learning and encouragement of curiosity are not opposites but go together, that I have never heard before.

Larry Smarr, a computer science professor at UC San Diego, gave a talk called “Frontiers of Self-Tracking” centered on his Crohn’s disease. I was struck by what was missing from his talk. He began self-tracking before the Crohn’s diagnosis and clearly the self-tracking helped establish the diagnosis. However, you don’t need to self-track to figure out you have Crohn’s disease, roughly everyone who has gotten this diagnosis did not self-track. I couldn’t figure out how much the self-tracking helped. Crohn’s is generally associated with frequent diarrhea, which is exactly the opposite of hard to notice. Larry said nothing about this. Later he talked about massive amounts of personalized genetic data that he was getting. I couldn’t see how this data could possibly help him. Isn’t self-tracking supposed to be helpful? If I had a serious disease, I would want it to be helpful. At the same time, judging from his talk, he seemed to be ignoring the many cases where people have figured out how to better live with their Crohn’s disease. I would have liked to ask Larry about these gaps at his office hour but I had an eye problem that caused me to miss it.

I asked Nick Winter, cofounder of Skritter, what he thought of the recent Ancestral Health Symposium at Harvard (August 2012), which we both attended. He didn’t like it much, he said, but it more than justified itself because Chris Kresser’s talk about iron led him to get his iron checked. It turned out be off-the-charts high. Partly because oysters, partly because of red meat. I think he said he has since donated blood and it came down. I hadn’t previously heard of this danger of eating red meat. Again I discussed with Nick why he found that butter had a bad effect on his cognitive performance, the opposite of what I found. One possibility is that the butter slowed digestion of his lunch, thus reducing glucose in his blood at the time of the cognitive tests. But this does not explain why a certain drug eliminated the effect of butter.

In his talk, Paul Abramson, a quant-friendly San Francisco doctor, said that mainstream medicine is “riddled with undisclosed conflicts of interest”. I hope to learn more about this.

Jon Cousins contributed a neat booklet about what he had learned and not learned from starting Moodscope. What he hadn’t learned was how to make a sustainable business out of it. I suggested to him that he might be able find professors who would apply for grants with him that would use Moodscope as a research tool. The grants would pay Jon a salary and might include money for software development. Mood disorders are a huge health problem — depression is sometimes considered the most costly health problem of all, worldwide — and Moodscope is a new way to do research about them. Paying Jon a salary for a few years would cost much less than assembling a similar-sized sample (Moodscope has thousands of users) from scratch. I wonder how professors who do research on mood disorders will see it.

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Does Too Little Vitamin K2 Cause Prostate Cancer?

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People with unusual genomes often resemble canaries in a coal mine: More sensitive than the rest of us to bad environments. This is illustrated by a new study of prostate cancer/genome associations.

Repeating earlier work in Europeans, they compared the genetic profiles of Japanese groups of prostate cancer sufferers with non-sufferers. . . . The joint numbers included 7,141 prostate cancer sufferers and 11,804 non-sufferers. The most recently identified loci are on chromosomes 11, 10, 3 and 2. . . .The locus on chromosome 2 is linked with GGCX, a vitamin K-dependent [actually, vitamin K2] enzyme that regulates blood clotting [Vitamin K2 does not regulate blood clotting], bone formation and cancer biology. Japanese foods such as natto and seaweeds are rich in vitamin K, which is thought to protect against cancer. Interestingly, the association of this SNP with prostate cancer was significant in all populations except for the Japanese in the USA, indicating that environmental factors, such as diet, are involved.

Here is the paper. Why would the correlation not show up for Japanese in the USA? Maybe because Japanese in the USA all get too little Vitamin K2.

Neither the press release nor the article make clear what I am saying: These results make it a lot more plausible that Vitamin K2 protects against prostate cancer. A lot of mainstream nutritional advice is based on epidemiology. The K2/prostate cancer connection is especially interesting because it does not suffer from the usual problems of epidemiology: difficulty measuring intake (do you have any idea how much K2 you consume?) and vast confounding (Vitamin K2 intake is probably correlated with many other things).

Unaccountable by Marty Makary

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The not-yet-released book Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care by Marty Makary, a professor of surgery at Johns Hopkins, may or may not make good arguments — I haven’t read it — but it certainly begins with a good story:

Harvard surgeon Dr. Luctan Leape at a national surgeon’s conference . . . opened the gathering’s keynote speech by looking out over the audience of thousands and asking the doctors to “raise your hand if you know of a physician that you work with who should not be practicing because he or she is dangerous.”

Every hand went up.

The author, Marty Makary, asked the same question at his talks and got the same response. Both of them — Leape and Makary — should have started asking “What fraction of the surgeons you work with are unfit to practice?”

I wonder how the rest of us can identify those unfit-to-practice surgeons. My experience has taught me not to trust a surgeon who says I need surgery.

Early Immune Warning System: A Bit of Evidence

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I have proposed that three things — a tendency to touch each other (e.g., shake hands), a tendency to touch near our mouths, and our tonsils — together form an early warning system for our immune system. The early warning system helps the immune system get tiny exposure to microbes circulating in the community. It performs self-vaccination. Like ordinary vaccination, exposure to tiny amounts of Microbe X protects against exposure to a large amount of Microbe X.

In Daniel Everett’s anthropological study of the Pirahã people (Don’t Sleep, There are Snakes: Life and Language in the Amazonian Jungle, 2009) he says the Pirahã “all touch one another frequently” (p. 85). “They loved to touch me too.” He has never seen kissing but “there is a word for it, so they must do it.” This supports the idea that a tendency to touch others is widespread.

If this theory is true, reducing microbe exposure to zero (e.g., sterile food) is a seriously bad thing. It’s been proposed that the polio epidemics of the first half of the 1900s were caused by cities becoming too clean.

Evidence from ants.

 

The Terry Deacon Affair

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Terrence Deacon is a professor of anthropology at the University of California Berkeley — at the moment, chair of the anthropology department. (Deacon, like me, is interested in the evolution of language.) How unfortunate for the department, especially his graduate students, that he has recently been accused of using vast amounts of another person’s work without giving her credit. It isn’t easy to see the overlap, maybe because Deacon is a terrible writer (“by far the most unreadable book I have ever encountered” said a reviewer of one of his books), but there appears to be no doubt of the similarity and Deacon’s exposure to the work he is accused of not citing. Deacon says he doesn’t remember it.

When I brought unquestionable examples of plagiarism by Leslie Iversen, an Oxford professor, to the attention of Julie Maxton, the Registrar of Oxford University, she dismissed them (“honest error” — appearing to say that Iversen didn’t know that word-by-word copying is wrong). In this case there is no word-by-word copying but the failure to cite is far more upsetting to the persons not cited. What may have been copied is more abstract (“deeper”, you could say) and therefore more important.

At first, the complaint was dismissed. “I have concluded that the information available to me does not warrant appointment of an Investigative Officer under our campus faculty disciplinary procedures. The conduct you have alleged would not constitute a violation of the University of California’s Faculty Code of Conduct,” wrote Janet Broughton, Vice Provost, on May 27, 2011.

Later (December 12, 2011), Robert Price, Associate Vice Chancellor for Research, responded, ” The fact that certain concepts or phrases used by Dr. Deacon in the article you provided are the same or similar to concepts that appear in chapters from your book is not evidence of plagiarism, as these concepts may not be unique to your work. Perhaps the way you use these concepts is unique, which then would constitute plagiarism.” This understates the evidence, which is a long series of similarities.

Finally, the fact that outsiders find the claims (of failure to give credit) credible appears to have convinced Price that something must be done. “The continuing public dispute that your claims have generated lead me to believe that such an investigation [of the claims] is necessary in order to “clear the air””, wrote Price. After being successfully pressured to investigate, Price, a political science professor, in a September 3, 2012 letter reveals a lack of understanding of social pressure:

I wish to make crystal clear to you, your associates, and to all those to whom you are communicating that the University of California, Berkeley has not found that Professor Deacon has engaged in any form of research misconduct. The sole reason for undertaking an investigation are the claims made by you and your associates. [Contradicting what he said earlier — that the “continuing public dispute” led to the investigation.] . . . The idea that you would use my communications with you [“use” in the sense of posting on a website] and the ongoing examination of your allegations by UC Berkeley as part of what increasing strikes me as a vendetta against Professor Deacon is reprehensible.

My letter to Alicia Juarrero [who complained] ends with this paragraph: “Our University policy on research misconduct, as well as the federal regulation on which it is based, require that all stages in the research misconduct investigation procedure are treated as strictly confidential. (UCB “Research Misconduct: Policies, Definitions and Procedures,” item IC and Federal Regulation 45CFR93.108). I expect that you will adhere to this requirement.” Rather than adhere to the stated requirement of confidentiality, Dr. Juarrero shared the letter with you and you, in turn, posted it on your website. What purpose is being served other than to make it appear that Deacon is guilty of something before even a single one of your claims has been validated? This sort of tactic will be familiar to those who remember the history of Joe McCarthy.

“What purpose is being served”? Uh, making the accusations harder to ignore? As for McCarthy, he made accusations without supplying evidence (“In this envelope [which he didn’t open] I have the names of 80 Communists in the State Department”). That is not happening here.

Why Alicia Juarrero Got Mad at Terry Deacon. New Terry Deacon Website.

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Thanks to Tucker Goodrich and Allan Jackson.