TV Recommendations

Seth Roberts5 Comments

TV is getting better and better.

1. Temple Grandin (HBO). I’d read Oliver Sacks’s story about her and seen a BBC documentary about her. This was far more moving.

2. Work of Art: The Next Great Artist (Bravo). A competition. Each week the contestants are given a task (make a portrait, make art from junk). The person who does the worst job is eliminated. Bravo’s great The It Factor followed actors in New York and Los Angeles and made you feel the constant rejection. This has the same vibe in the sense that much of what the contestants make is heavily criticized (“a middle-school art project”).

3. Undercover Boss (CBS). A head of a big company works at a low-level job in his company. Week after week, it has some of the most touching moments I’ve ever seen. When this or that employee learns that someone noticed their hard work or talent, they start crying. Because it relied on deception (“we’re making a documentary about entry-level jobs”), I wonder if there will be another season.

The Oncogene Theory of Cancer

Seth Roberts8 Comments

I am looking forward to reading Wrong: Why Experts Keep Failing Us — And How to Know When Not to Trust Them by David Freedman because of this sentence in an excerpt:

Cancer experts shake their heads today over the ways in which generations of predecessors wasted decades hunting down the mythical environmental or viral roots of most cancers, before pronouncing as a sure thing the more recent theory [that] cancer is caused by mutations in a small number of genes — a theory that, as we’ll see, has yielded almost no benefits to patients after two decades.

He’s referring to the oncogene theory of cancer, for which Michael Bishop and Harold Varmus won a Nobel Prize in 1989. I made a similar comment at a dinner:

Several years ago, at a big Thanksgiving dinner in an Oakland loft, I told the woman sitting next to me, a genetic counselor, what a travesty the Biology [Nobel] prizes were. The discovery that smoking causes lung cancer had improved the lives of millions of people, I said [yet the discoverers hadn’t gotten a Nobel Prize]; the discovery of so-called oncogenes hadn’t improved the life of even one person. She replied that she was the sister of [Harold Varmus]. The next day I learned she complained I had been rude!

I’m glad Freedman agrees with me. My low opinion of oncogene theory didn’t prevent Varmus from becoming head of the National Institutes of Health, whose recent budget was about $30 billion/year.

Thanks to Kathy Tucker.

Crazy Spicing Ice Cream

Seth Roberts6 Comments

Unfamiliar foods cause weight loss, says the theory behind the Shangri-La Diet. If you add enough spices to a food, it will become unfamiliar.An ice cream store in San Francisco called Humphrey Slocombe has some of the world’s strangest flavors, likely to be unfamiliar until you eat them many times.

Their flavors include Eight Ball Stout, Pink Grapefruit Tarragon, Carrot Mango, Russian Imperial Stout, White Chocolate Lavender. Here’s what happened when the owners ate a lot of them:

In the store’s first few months, Godby and his business partner, Sean Vahey, scooped from noon to 9 each night, ate nothing but ice cream, traded the leftover brownies for cocktails at a dive bar called Dirty Thieves and still lost weight. Since then they’ve hired eight employees and — hazard of the job — each gained back the 10 pounds they’d lost.

Thanks to Alex Chernavsky.

Homemade Yogurt Tip

Seth Roberts13 Comments

Mark Frauenfelder describes how he makes yogurt with a yogurt machine. Made by Hand, his new book, has a chapter about fermented foods.

Let me add my two cents. After several years of making yogurt, I finally figured out there are two crucial steps: 1. Denaturing (expanding) the milk proteins. 2. Growing the bacteria. They require different temperatures. The milk proteins, as far as I can tell, denature at temperatures starting around 130 degrees F. You want the milk to be in that range for an hour or so. Below that temperature, the milk proteins curl up again unless bacteria get in the way. The best temperature for growing the bacteria is said to be around 110 degrees F., although I’ve found that incubation at 92 degrees F. also works.

So the ideal process for making yogurt is something like this: 1. Keep the milk at 140 degrees for a few hours. 2. Add the starter bacteria. 3. Keep the milk at 110 degrees for a long time, say 12 hours. I have a yogurt maker that approximates the initial higher-temperature phase by having you add boiling water around the container. The first time I tried it I was surprised how well it worked (how creamy the yogurt was) because it was much simpler than the usual recipes where you boil the milk, let it cool, and so on — and which after all that produced mediocre results. It took me a long time to realize I’d get even better results with my yogurt maker if the milk was warmer when I started.

Assorted Links

Seth Roberts8 Comments
  • “ant tribes” near Beijing
  • What exactly is umami?
  • Is omega-3 an antidepressant? “Initial analyses failed to clearly demonstrate the effectiveness of Omega-3 for all patients taking part in the study. Other analyses, however, revealed that Omega-3 improved depression symptoms in patients diagnosed with depression unaccompanied by an anxiety disorder.” Are they fooling themselves? Maybe not. My research suggests that morning faces can reduce only depression but also anxiety disorders. So if you have depression without an anxiety disorder it may indeed have a different cause.

Thanks to Anne Weiss.

What Antidepressants Do

Seth Roberts28 Comments

After I complained about lack of outrage in Daniel Carlat’s Unhinged, Bruce Charlton pointed me to this essay (registration required) by Simon Sobo, a psychiatrist. Sobo says something I may end up repeating every time the subject of antidepressants comes up:

Rat pups that are isolated from their mother and littermates produce ultrasonic sounds that are indicative of stress. SSRIs [the most popular type of antidepressants] reduce these sounds (Oliver, 1994). Is a chemical imbalance being corrected? I doubt it.

That’s a nice summing-up. Prozac (an SSRI) really does something, but the notion that it returns to normal something broken is absurd. Sobo also gives an example of how the anti-anxiety effect of such drugs works in practice:

Mrs. L. had originally required 40 mg of Paxil (paroxetine) per day to recover from a postpartum depression. After 12 months on the medication, an incident happened that disturbed her. During her lunchtime, she was visiting her 1-year-old son at his day care center when one of the workers began screaming at another infant instead of picking her up. The next day Mrs. L. went shopping during her lunch break. Later that week a co-worker became tearful during the course of a conversation with Mrs. L. regarding her own child’s day care center. Only then did Mrs. L. wonder about her decision to go shopping the day after she had witnessed the day care worker’s inappropriate reaction. She wondered if her Paxil had made her indifferent when ordinarily she would have reacted and worried about such a thing.

My research about mood suggests that depression is due to defective entrainment of a mood oscillator. It’s caused by something missing from the environment. “Chemical imbalance” has nothing to do with it.


Fermented Food in Japan

Seth Roberts11 Comments

If you know anything about heart disease epidemiology, you know that Japan has the lowest rate of heart disease in the world. The usual explanation is high fish consumption. But other countries, such as Norway, also eat a lot of fish but don’t have low heart disease rates.

My visits to Japan suggest to me that Japanese eat far more fermented foods than people in other countries, including Norwegians. If heart disease is due to infection, then it’s clear that the immune stimulation provided by fermented foods helps fight infection. My umami hypothesis — that we like umami, sour, and complex flavors to encourage bacteria consumption, which we need to be healthy — began with a trip to Japan in 2008, when I noticed, in a food court, many types of miso for sale. Back in Berkeley, I started making miso soup. I was stunned how well it worked. All you needed was miso. No other flavorings. It was so easy and good I ate it every day. It was my first bit of evidence that fermented foods are different and better than other foods.

Here are some fermented foods that are easy to get in Japan:

1. Miso soup. Most Japanese eat this daily. In a few countries, such as France, many people eat yogurt daily. Koreans eat kimchi daily. In most countries, as far as I know, it’s hard to find a fermented food (apart from cheese and alcoholic drinks) that’s eaten daily by most people. Miso is also used to flavor fish.

2. Japanese pickles. The best pickles in the world. Some are pickled as long as as two years, developing noticeable alcohol. Other countries have pickles, of course, but as far as I know the only pickle restaurants are in Japan. Moreover there are pickle shops in big Japanese cities. The only other pickle shops I’ve seen are in New York City.

3. Pickled apricots (umeboshi). At a food court you have a choice of acidity, anywhere from 5% (slightly sour) to 25% (extremely sour).

4. Vinegar drinks. Tokyo 7-Elevens sell a black vinegar drink. Vinegar and water. In food courts you can buy special vinegars for this purpose. I’ve never seen vinegar drinks for sale anywhere else.

5. Natto.

6. Yogurt. The Japanese yogurts I’ve tried were sweetened but weren’t as sweet as the yogurts sold in Beijing.

7. Yakult. The fermented milk drink. It’s sold in such small packages it’s pretty clear it must appeal to people who think it improves their health. It doesn’t boost energy, quench thirst, or taste especially good. The manufacturer says it is good for health and that one bottle per day is all you need.

8. Beer and wine.

Because soy sauce is used in small amounts, it doesn’t count. At a Tokyo restaurant I met a nurse who said she thought you should eat fermented foods every day to be healthy. She said perhaps a third of Japanese believe this.

I’ve never seen high Japanese consumption of fermented foods noticed by epidemiologists. Individual fermented foods (such as miso), yes; the whole category, no. You can see how hard it would be to combine across foods: how much miso equals how much Yakult? Yet I’m sure fermented food consumption is extremely healthy.

Unhinged by Daniel Carlat

Seth Roberts7 Comments

Daniel Carlat, a Massachusetts psychiatrist, is the author of the excellent blog The Carlat Psychiatry Blog. He also wrote an excellent article in the New York Times Magazine about working on the side as a drug rep: He told other psychiatrists about new drugs. He quit (or was fired) because telling the truth wasn’t compatible with the job.

Unhinged, his new book (sent to me by the publisher after I asked for it twice — that’s how much I wanted to read it), covers the same ground. Its subtitle (or two subtitles) is/are The Trouble With Psychiatry — A Doctor’s Revelations about a Profession in Crisis. The contents were well-written, but none of it was new to me: the “chemical imbalance” theory of depression is a convenient myth, how drug reps work, how drug companies influence doctors, diagnosis difficulties, the cases of Charles Nemeroff and the like. (I did learn that Nemeroff was called “the boss of bosses” because of his prominence and power.) If any of his criticisms are new to you, this book is a great introduction. He uses many stories of patients to make his points.

Overall, I found the book too calm. What Nemeroff and others like him did I find outrageous but Carlat doesn’t sound outraged. Maybe he is, I have no idea, but his book is more reasonable-sounding than scornful and I would have preferred scornful. At one point he says he wrote an “angry” op-ed for the New York Times about something and I thought: good, some emotion!Â

The crisis of the subtitle (“A profession in crisis”) is enticing but is not borne out by the contents. Carlat dislikes aspects X, Y, and Z of his profession, but one person’s dissatisfaction does not equal crisis. I saw no signs he is part of a growing movement. My take on the trouble with psychiatry is that psychiatrists don’t understand what is wrong in almost every case they see and, due to lack of understanding, do a poor job of fixing the problem. Lack of understanding by doctors is nothing new and, until someone has a better understanding, doesn’t pose a professional problem. This basic truth goes unmentioned in Unhinged.

The David Healy Affair

Seth Roberts3 Comments

Bruce Charlton pointed me to this website full of information about how the University of Toronto rescinded a job offer to David Healy, a British psychiatrist, after he made negative comments about Prozac. Psychiatrists at the University of Toronto got a lot of money from Lilly, the maker of Prozac. Here’s something from a CBC documentary about it:

Although he refuses to interviewed, Dr. Nemeroff said through his lawyer that the [University of Toronto psychiatry] center asked for his opinion of Dr. Healy that day and he gave it. . . . Later that day he flew to New York where we do know he told a meeting of the American Foundation for Suicide Prevention exactly what he thought about Healy. One scientist who was there said Nemeroff’s attack was furious, angry, exercised, that the thrust was Healy was a nut.

If Charles Nemeroff calls you a nut . . .

Prenatal Ultrasound and Autism: Multiple Voices

Seth Roberts3 Comments

I previously blogged (also here) about Carolyn Rodgers’s idea that prenatal ultrasound may cause autism. It turns out that she isn’t the only person with this idea; researchers at the University of Louisville recently published the same idea.

I learned about the Louisville study from Anne Weiss, who said the connection has been plausible for a long time.

Ultrasound was introduced into obstetrics in the 1970′s and was generally restricted to high-risk pregnancies. By the 1980′s policy statements were issued by ACOG, the NIH and equivalent bodies in Europe and Canada stating that its use should remain limited to high-risk cases. Despite these recommendations, ultrasound technology became common in hospitals and doctors’ offices and routinely applied to low-risk populations. Within a short time the majority of pregnant woman were being exposed at prenatal visits, during multiple scans in hospitals, and during continuous monitoring during labour (which could mean 12 to 14 hours during childbirth alone). Skills and techniques used to monitor the fetus prior to the introduction of ultrasound (in utero and during the birth process) were slowly undermined by the technology and often underutilized. Iatrogenic effects from false positive readings, – unnecessary C- sections, inductions, instrumental deliveries etc. caused harm to moms and babies, especially in the early 1980′s.

Three important names in the 1980s were (1) Robin Mole, who presented a paper “Possible Hazards of Imaging and Doppler Ultrasound in Obstetrics” to the Royal Society of Medicine Forum on Maternity and the Newborn: Ultrasonagraphy in Obstetrics, April 1985. She was former director of the Medical Research Council Radiobiology Unit, England. Also the work of (2) M.E. Stratmeyer – Research in ultrasound. A public health view. Birth and Family Journal 1980 and (3) Doreen Liebeskind – still at Albert Enstein and a prof of radiology- presented at a symposium at Columbia in 1983.  She was concerned that ultrasound may be producing subtle changes in the fetal brain perhaps affecting behavioral mechanisms, possible changes in reflexes, IQ, attention span or some of the more subtle psychological, psychiatric or neurological phenomena. Referred to animal and lab studies that showed ultrasound may cause chromosomal damage, breakdown of DNA, etc. There are others who sounded the warning that this was not a benign technology but these voices were crowded out for varied reasons like threats of litigation, loss of the traditions skills of birthing etc.

There were also Japanese studies that raised concerns about ultrasound. Weiss continued:

Unfortunately the use of ultrasound in obstetrics has not declined, despite safety concerns and the lack of research to rule out serious neurological effects. It’s so entrenched in modern obstetrical practice.  Doctors use the machines to protect themselves from litigation – in the case of fetal abnormalities, undetected multiples, placenta previa, neurological or physical damage to the fetus during childbirth, stillbirth etc. It has almost become a form of entertainment – you can get photos and videos of baby’s ultrasound. It’s disturbing how benign it appears.

Within the context of the work I do, ultrasound is just one of many concerns I have with the over-management and medicalization of childbirth. My clients come to me to find ways to subvert this within the hospital setting or to prepare for a home birth with a midwife.  I also get referrals from doctors whose patients are dealing with difficult issues while pregnant.