Cuban Data Refute Mainstream Health Beliefs

Seth Roberts30 Comments

A new BMJ paper looks at Cuban health before and after the economic crisis of 1991-1995, when the Cuban economy nose-dived. There wasn’t enough gasoline for cars. so bike riding greatly increased. In addition, people ate less. What effect did these changes (more exercise, less eating) have on health?

You know what is supposed to happen: Better health. Walter Willett, the Harvard epidemiologist, wrote a commentary about the study that concluded “The current findings add powerful evidence that a reduction in overweight and obesity would have major population-wide [health] benefits.” In other words, Willett said that what happened supports conventional beliefs.

But it didn’t. In several ways, what happened contradicts conventional beliefs.

1. A popular belief is that exercise causes weight loss. However, the percentage of “physically active individuals” doubled from 1985 to 2010 (from about 30% to 60%). In spite of this, the prevalence of obesity considerably increased (from about 13% to 18%) at the same time. Apparently exercise is considerably less important than something else. I have never heard a public health advocate say this.

2. A graph showing rates of heart disease, cancer, and stroke (the three main killers) over the period showed no change in rates of cancer and stroke. In spite of big changes in both exercise and obesity. The rate of heart disease stayed constant during the period when obesity went down. It steadily dropped during the period of time when obesity went up. Apparently the factors that control obesity and the factors that control heart disease are quite different (contradicting the usual view that exercise reduces both).

3. There is no simple connection between diabetes and obesity. During the economic crisis, when the prevalence of obesity went down by half (from 15% to 7%) and exercise greatly increased, the prevalence of diabetes slightly increased . Only after the crisis did the usual correlation (more obesity, more diabetes) emerge.

4. The only lifestyle factor to have its conventional effect: smoking. When you stop smoking, you gain weight is the usual belief (which I also believe). The data definitely support this connection. A huge reduction in the fraction of people who smoke (from 30% to 10%) did not reduce cancer but did coincide with a great increase in obesity.

5. Cubans are doing something right, as shown by the considerable decrease in heart disease and diabetes deaths. Apparently they are also more health-conscious, as shown by much higher rates of exercise and much lower rates of smoking. (Assuming that cigarettes did not become too expensive.) They are getting fatter, too, but apparently that is less damaging than we are told.

Willett and the authors of the study look at subsets of the data and use theories about “time-lag” to draw reassuring conclusions. In fact, large portions of the data are not easily explained by conventional ideas, as I’ve shown. You can look at the data many ways, but to me the study makes two main points. 1. During a period when everyone was forced to do what doctors recommend (exercise more, eat less), health did not improve. 2. During a period (post-crisis) when obesity got steadily worse, health improved (heart disease rates went down, cancer stayed the same, diabetes mortality went down). Cuba is too poor for the improvement to be due to better high-tech modern medicine. Taken together, these findings suggest we should be more skeptical of what we are told by doctors and health experts such as Willett.

Oral Rehydration Therapy For Diarrhea

Seth Roberts9 Comments

Oral rehydration therapy (ORT) is given to people (usually children) suffering from diarrhea, which before ORT was often fatal. It is very simple: The sufferer drinks water with sugar and salt ad libitum (as much as they want). You probably haven’t heard of ORT — at least, I hadn’t. Everyone has heard of antibiotics. Yet “ in 10 years [ORT] saved more lives than penicillin had in 40.” Infant diarrhea was once (and may still be) the main cause of death in poor countries.

A history of its discovery supports several things I’ve said on this blog. One is Thorstein Veblen’s point about the disdain among professional scientists for useful research:

ORT might also have been developed long before 1968 but for the attitudes of the dominant medical establishment toward practical experimentation, which the Cholera Research Laboratory and the National Institutes for Health shared. Nalin believes that “the people at the lab … got kudos for the extent to which [their] work was not practical. As soon as it became practical it was discarded like a soiled towel–it was too common, too hands-on… so the prestige went to people who measured trans-intestinal fluxes or electrical currents”.

No one who has attended an elite law school, medical school, or graduate program in education will be surprised by this.

Another is the great resistance among the medical establishment to cheap and effective solutions:

The formidable and persistent ignorance of the Western medical establishment, which continues over twenty-five years after the discovery of ORT, is phenomenal. While its refusal to advocate ORT may be due in part to the notion that ORT is only necessary for people in the developing world, its actions appear to be driven also by financial considerations. Most hospitals do not train physicians in the use of ORT since they have no financial reason to do so. [I think “since” overstates what is known — Seth] The use of intravenous therapy, which often involves keeping a dehydrated child overnight, assures [greater] insurance reimbursement. Sending children home with ORT would [reduce] profits. Furthermore, recent studies show that diarrhoeal illness among the elderly may incur even greater health care costs that could also be reduced by the use of ORT. At a time of heated discussion about cost-containment in health care, it seems all the more ironic and egregious that a superior, cheap, and proven therapy [fails to replace] a far more expensive one. Estimates based on the cost of hospitalizations and physician visits suggest that ORT could save billions of dollars annually.

As an example of the resistance of American doctors to a better therapy, an ORT researcher, who had used it on Apache reservations in America, told this story:

I had an anthropologist friend who adopted an Apache child from the [Arizona] reservation where we were working. He used to be the anthropologist on the reservation. And then he [left the reservation and] went to Arkansas to teach and the Apache child came down with severe diarrhea and he called me up and he said desperately, “Look, my son’s in the hospital and they’re giving him all sorts of intravenous fluids. The diarrhea’s not stopping, he’s losing weight, they’re not feeding him. I know that you did this work in Arizona [on the reservation] and it didn’t look like that. . . . Would you call this professor of pediatrics and just collegiately talk to him?” So I called up the professor and told him that in our experience with Apache children this is what we found and here’s the publication and so on. And he said to me, “Doctor, doctor, our [Arkansas] children are not the same as your [reservation] children”. He was treating an Apache child from the same reservation.

Shades of Downton Abbey (where Lady Sybil died because a London doctor was listened to instead of a rural doctor).

Assorted Links

Seth Roberts2 Comments

Thanks to Dave Lull and Ashish Mukharji.

Shangri-La Diet Success, Including Better Sleep

Seth Roberts3 Comments

Greg Pomerantz writes:

Over the Thanksgiving [2012] holiday, I suggested to a relative, Richard, that he try the Shangri-la Diet. At the time I had heard about it but did not know anyone who had tried it. I did not have any particular reason to think it would work, but since Rich had tried a number of other diets (including low carb, which he is still following for the most part) I thought it would be worth a shot.

He started the diet over the Thanksgiving holiday and has kept it up since then with a few breaks. He lost 13 pounds in the first month and another 6 pounds over the next two weeks. Altogether he lost a total of 32 pounds over the 16 weeks following Thanksgiving, an average of 2 pounds per week. During this period, he traveled a fair amount and was not able to maintain the diet every day. However, he reported that one of his favorite things about the Shangri-la Diet is how easy it is to restart after a lapse. He began using extra light olive oil but has switched to walnut oil.

There were two surprising results other than the weight loss (which I think is exceptional in its own right). First, his blood sugar control has improved, even compared to the low carbohydrate diet he was (and still is) consuming. Second, he has been sleeping better at night due to a reduction in his nighttime appetite. I believe the two may be related — one of his medications for type 2 diabetes greatly increases his appetite and causes weight gain. He has been using much less of that medication because of his improved blood sugar on the Shangri-la Diet. Therefore, reduced appetite from the diet plus a reduction in an appetite-increasing medication results in lower nighttime appetite and therefore better sleep.

Is Red Meat Dangerous?

Seth Roberts7 Comments

A recent paper from the Cleveland Clinic reports more than a dozen studies that add up, say the authors, to the conclusion that red meat and other meats cause heart disease at least partly by increasing trimethylamine-N-oxide (TMAO), which is made from carnitine by intestinal bacteria. Meat, especially red meat, is high in carnitine.

The results were reported all over the world, including the New York Times. There are several reasons to question the conclusion:

1. The association between meat and heart disease is weak. An epidemiological paper from the Harvard Nurses Study found estimated reductions in heart disease on the order of 10-20% when a “healthy” food was substituted for meat. Conclusions about causality (eating Food X causes Disease Y) based on the Harvard Nurses Study have predicted wrongly over and over when tested in experiments, so even this weak association is questionable. A 2010 meta-analysis found no association between red meat consumption and heart disease. The absence of any correlation is surprising because red meat is widely believed to be unhealthy. People who eat more red meat would presumably do more other “unhealthy” things. (Perhaps the error rate of the underlying epidemiology is high. Errors push associations toward zero.)

2. Within the Cleveland paper, the associations between carnitine and TMAO and heart disease are weak. For example, people with the greatest sign of heart disease (“triple” angiographic evidence of heart disease) had only slightly more carnitine in their blood (about 15% more) than people with the least sign of heart disease. (Maybe it is peak levels of carnitine rather than average levels that matter.)

3. A 1996 epidemiological study (via Chris Kresser) that looked at the correlates of various “healthy” habits among people especially interested in health (e.g., they shop at health food stores) found no detectable effect of being a vegetarian. For example, vegetarians had the same all-cause mortality as non-vegetarians. Other factors were associated with reduced mortality, including eating wholemeal bread daily and eating fruit daily. This study looked at a large number of people (about 11,000) for a long time (17 years), so I consider the lack of difference (vegetarians versus non-vegetarians) strong evidence against the idea that modest amounts of meat are harmful. (And I am going to start eating wholemeal bread in small amounts.)

I don’t dismiss the paper. Among people who eat more than modest amounts of meat, there may be something to it. Now and then epidemiology turns up a powerful risk factor — something associated with a risk increase by a factor of 4 or more (people at a high level of the risk factor get the disease at least four times more often than people at a low level of the factor). History shows that such correlations are likely to tell us something about causality. With weaker correlations (such as the correlation between red meat and heart disease), it is much more a guessing game.

To me, the important clue about heart disease is that it is very low in both Japan and France, much lower than in countries with high rates of heart disease. The two countries that have little in common besides the fact that in both people eat a lot more fermented food than in most places. In France, they drink wine, eat stinky cheese and yogurt. In Japan, they eat miso, pickles, and natto. Maybe fermented food protects against heart disease.

Lose Smell, Lose Weight: Evidence For the Theory Behind the Shangri-La Diet

Seth Roberts4 Comments

A friend of this blog writes:

What prompted me to try SLD: When I first went paleo I dropped 30 pounds with no exercise or food restriction, but my weight has been stable for about a year. In January and February [2013] I went through a bad allergy spell, with my nose congested all the time. I dropped six pounds in that time. When the seasonal allergy went away, the weight came right back. Calories without smell suddenly look like a big factor.

Here is a paper about the theory behind the Shangri-La Diet.

The Jenijoy La Belle Tenure Case at Caltech

Seth Roberts1 Comment

Jenijoy La Belle is a Professor of English at Caltech. Her tenure case, which started in the 1970s, is the main topic of this interview. Because of one person — Robert Huttenback — she was at first denied tenure. Amazingly, she managed to get tenure anyway. In the middle of the fight, which promised to become very embarrassing to Caltech, Huttenback became Chancellor of UC Santa Barbara.

Here is a related story from another interview:

One day on a Saturday or Sunday, I was in Baxter [Baxter Hall of Social Sciences and] picking up my mail upstairs. There was nobody else there but Huttenback and a young Turk— a young professor of economics, I guess, who is now of course a famous full professor somewhere, perhaps even retired. They were in the office that Jenijoy was going to have and next to it was the men’s toilet. And they were talking about playing a joke. The goal was to make the situation as uncomfortable—more than uncomfortable, offensive—for Jenijoy as possible. And I will not—I remember exactly what they were doing, but it is so crude that I will not tell you.

Here is one of La Belle’s comments:

In 1982, someone sent me a clipping from the Santa Barbara News and Review, from a column that sounded more like gossip than news. But it simply began: “Even in UCSB circles familiar with Chancellor Robert Huttenback’s perquisites of power, the situation has caused comment. Why do university cars and drivers transport Freda Huttenback, his better half, on personal business? Campus employees, from maintenance to clerical workers, tell us of receiving a Xeroxed map to the Huttenbacks’ home and directions to chauffeur her wherever she asks. These trips have reportedly included visits to a Ventura chiropractor. “Huttenback defends the practice by calling his wife a consultant to the university on interior design matters, saying that she occasionally needs a university car and driver for decorating business. Huttenback first denied he or his wife ever used the car for personal errands: ‘Whoever told you that must be someone I fired,’ was his reply.”

Huttenback was eventually convicted of fraud. He defends himself here.

New University of California: A Good Idea

Seth Roberts13 Comments

A California assemblyman named Scott Wilk has proposed a “New University of California” whose only purpose would be to provide certification tests — tests that show you have learned the material of this or that college class. Here is what his bill says:

(1) The New University of California shall provide no instruction, but shall issue college credit and baccalaureate and associate degrees to any person capable of passing examinations.

(2) The New University of California is authorized to contract with qualified entities for the formulation of peer-reviewed course examinations the passage of which would demonstrate that the student has the knowledge and skill necessary to receive college credit for that course.

This is not online education. You can learn the material however you want — for example, by reading a book.

An unsigned New York Times editorial called the idea “ particularly ludicrous” but did not say why. I think it’s a good idea. It gives students much more power: They can choose the learning methods and materials and times that fit them best (listening to lectures at work, for example), in contrast to the one-class-fits-all approach at almost all colleges. The cost in time and money will be much less than attending a typical university. The proposal helps employers because passage of these tests reflects a skill useful in many jobs: ability to learn on one’s own.

Compared to an ordinary college degree (say, from Berkeley), a degree or certification from the New University of California fails to show that you did well enough in high school to get admitted to Berkeley. This could be remedied by showing your prospective employer a letter of admittance to Berkeley.

Make Yourself Healthy Meetup: Underlying Ideas

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As I blogged earlier, I’ve started a Meetup group called Make Yourself Healthy. It is about doing better than expert advice. Doing better than taking prescription drugs for a problem, for example. The first meeting is Wednesday, April 24, 6:00 pm to 7:30 pm, in the meeting room of the North Branch of the Berkeley Public Library (1170 The Alameda).

I’ve found ways to improve on expert advice. I’ve found new ways to lose weight, sleep better, and so on. More to the point, many other people have done this. I wrote about some of them for Boing Boing. The specific things they learned about how to be healthy — for example, Dennis Mangan’s discovery (or confirmation of someone else’s discovery) that megadoses of niacin eliminated Restless Leg Syndrome — are not just important in isolation but also as part of a pattern: showing that such a thing is possible. Their solutions were vastly better than what their doctors recommended. This is counter-intuitive. We don’t see this in other areas of life. We don’t see amateurs building better cars than professionals, for example. But it’s happening.

I believe two things about this:

1. The solutions will generalize. What Person X discoveres improves her health turn out to help with other problems. I started drinking flaxseed oil because it improved my balance. It turned out to improve my brain function measured in other ways. And it turned out to improve my gums. I don’t have lichen planus or geographic tongue, which xylitol can cure, but I am taking xylitol because I believe (backed up by research) it reduces plaque.

2. The methods will generalize — what you do that finds a solution to Problem X is worth trying with other problems. With me, self-experimentation is an example. When studying my acne, self-experimentation showed how to better than my dermatologist’s advice. Later, it helped me improve my health on other dimensions (weight, mood, sleep, etc.).

The Make Yourself Healthy Meetup group can spread the solutions, the methods, and the knowledge that such a thing is possible. It can encourage people to try to improve on expert advice and help them do so.

How Things Begin: LightSail Energy

Seth Roberts2 Comments

LightSail Energy is a Berkeley company that makes compressed-air energy storage devices. It was started in 2008 by Danielle Fong and Steve Crane. A year later, they got significant funding. When I think of energy storage, I think of batteries or flywheels or pumping water uphill. Use of a quite different technology intrigued me. Compressed-air energy storage is sometimes disparaged (“ a lousy way of storing energy“).

Fong went to college (Dalhousie) when she was 12. She studied physics, computer science, math, economics, and philosophy. When it came time to apply to graduate school, she decided she wanted to work on something important. Energy was important. She had read and admired The Limits to Growth (1972). We are running out of convenient fossil fuels, she thought. We are running out of other things, too, such as arable land and aquifers, but solving these problems would require energy.

She decided to go to Princeton and study plasma physics, hoping to improve fusion technology. It was not what she expected. Her professors were brilliant, working on exciting things, such as compact magnetic confinement devices. In the background, however, “everyone’s jumping through hoops,” she says. Her professors were constantly writing grants. Their grant proposals were hard to understand. They went to “dark and foreboding” federal organizations, where they were misunderstood. Funding was cut “randomly and mercilessly” by forces outside the professors’ control. Among the graduate students, she found “a cadre” of interesting people but most of them, she thought, were overly concerned with finding something that had not been done before that meshed with a professor’s interest, in contrast to doing something important that they themselves found interesting. She also thought the other graduate students were not concerned enough with foundational questions. There were “too many good soldiers.”

Why rely on political whims I can’t control when I can create my own fortune and fund whatever research I want, she thought. If you were a mediocre physicist at any top graduate school, you could go to Wall Street and become a quant or go to Silicon Valley and build stuff. In 2007, she talked to Wall Street quants. “I was studying their derivative and option pricing theories,” says Danielle. “They assumed that price was given by an infinite series of small independent factors.” The independence assumption struck her as unlikely because much of the market relied on the same pricing theory. “This foundational assumption was poorly founded,” she says. It works, the quants said. The market collapsed three months later. Before it did, she decided to leave Princeton (after two years) and go to Silicon Valley.

She moved to the Bay Area and started couch surfing. During her first year there, she worked on several different projects with different cofounders and consulted for a variety of startups. Her “theory” was that she would learn how things work and find the right thing to do. She met Paul Graham and consulted for Y Combinator companies. She realized her “limiting factor” – what she needed the most – was a good co-founder. “Innovation is social,” she says. David McIntosh, a co-founder of Redux Games, “read [her] blog” and put her in touch with Max Crane. Max Crane is Steve Crane’s son. Steve was helping someone else start a video game company in Petaluma that needed a part-time programmer. Danielle was living in San Francisco at the time. Steve offered her the job and offered to drive her to Petaluma. “Every time we would drive up we would talk about different ideas,” said Danielle. “I had 50 different ideas for startups.” The one she kept coming back to, kept thinking about, was making a compressed-air-powered vehicle.

A friend, Nick Pilon, had asked her, “How far can you drive with the [solar] energy you could collect on a garage roof in a day? Is it enough to handle the average American commute?” To answer this, she had to provide a solution to the problem of making a practical, efficient vehicle. Batteries were a serious problem. They are expensive, heavy, and degrade relatively fast. Better energy storage would make a solar-powered vehicle more plausible. Several years earlier, her dad had sent her a link about a car that ran on compressed air. In that case, the CEO had been arrested for fraud. The car didn’t exist. However, MDI International in France had made some progress. (Well before Peugeot.) She suggested this possibility to Steve. It could be very inexpensive and fast to refill. They could make a scooter. Steve got really excited. “I’d love to help you get this funded,” he told Danielle. Eventually he put in $100,000 and joined Danielle as a co-founder. He left his other jobs to work with her.

The thermodynamics of air compression were discouraging. (So much so that in 2009 Berkeley researchers published a paper arguing that a compressed-air vehicle would not be viable any time soon. “The BEV [battery electric vehicle] outperforms the compressed-air car [CAC] in every category. Uncertainty in technology specifications is considerably higher for CACs than for BEVs, adding a risk premium.”) When air is compressed, it gets hot — and heat may leak away. When air expands, it cools — and cold air provides little pressure. Danielle realized that you could solve both problems by adding heat capacity to the air. This could be done by adding water (mist) during compression to absorb heat and using the stored heat to warm the air during expansion. If you could continuously supply the expanding air with heat, efficiency would increase from the low 20s to 70-85%. Such an engine – driven by compressed air – would be cheaper, lighter, and more powerful.

They spoke to Ed Berlin (whom Steve called “the most brilliant inventor I know”). Coincidentally, Ed had been working on a compressed-air hybrid vehicle. They joined forces. Ed introduced them to Keith McCurdy, who advised them about financing. At a party, Keith told Vinod Kholsa, the venture capitalist, about the idea. This led to a meeting with Ford Tamer, one of Kholsa’s partners, who specialized in two-wheeled vehicles. He was more excited about what they could do for the power grid (by storing excess power during times of low demand). They had a whole PowerPoint presentation about vehicles. They scrapped it and made another one.

Steve and Ed built the first prototype. Danielle measured its performance. “Ed had a machine shop in his garage and knew how to use it,” says Danielle.

An especially important early hire (Employee Number 6) was Kevin Walter, who became Vice President of Development (developing the engine that compresses the air). He had previously worked for one of the top racing car teams in the world and had developed many race-car engines. “We knew how to build engines in theory,” says Danielle, “but he had actually built them.” He knew, for example, where to drill holes so that oil would get to the right places. He also contributed a great deal of (psychic) energy, focus, and perseverance.

Being located in the Bay Area really helped. The Bay Area has many people (in the “low thousands”) who are good at making things. One LightSail employee (Liam McNamara) made a steam-powered automobile from scratch for Burning Man and won Junkyard Wars. Another (Keith Johnson) built electric cupcake cars and an electric pumpkin carriage. The Bay Area has “an atmosphere of possibility,” says Danielle. “The idea that when you have a great idea that is doable, you should do it. No one else is going to do it. Burning Man is a condensation of this. After people come, they feel they really can do something. And once they start, the deadline helps make sure they get it done.”