Another Unintentionally Revealing Response From the American Medical Association

Seth Roberts5 Comments

A few weeks ago I blogged about the lame response of the American Medical Association to HealthTap, a website that solicits doctors’ answers to medical questions. Their criticism was so weak it amounted to praise.

More recently, the AMA was asked about its position on doctor rating websites. Here’s what happened:

Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.” This, however, is almost exactly the same statement it provided to its own publication, American Medical News, in 2008, when it was attributed to Dr. Nancy H. Nielsen, the president-elect of the A.M.A. at the time.

Such plagiarism is more consistent with what Jane Jacobs in Systems of Survival called guardian values (where honesty is unimportant) than commercial values (where honesty is very important). When you grasp that doctors follow guardian values rather than commercial ones their behavior becomes far more predictable — and plainly in need of control by outsiders. That doctors are allowed to charge for their services resembles allowing policemen to write as many parking tickets as they like and pocket the fines.

Thanks to Bryan Castañeda.

The Hunger Games

Seth Roberts11 Comments

I recently read The Hunger Games and liked it a lot. I finished it in a few hours — couldn’t stop reading. In contrast, I read a few pages of the first Harry Potter and stopped. When I was ten years old, I read The Hobbit, The Fellowship of the Ring (the first book of The Lord of the Rings trilogy), and stopped halfway through the second book. I never went back and have not seen the movies. I have never read a book by Stephen King, John Grisham, Robert Patterson, Anne Rice, Stephanie Meyer, and so on. None of them appealed to me. The Hunger Games is different than other books that have sold huge numbers of copies. When it came out, Stephen King reviewed it in Entertainment Weekly and gave it it a B. The second book in the trilogy, reviewed by someone else, got a C.

Sentence by sentence, even scene by scene, The Hunger Games is mediocre. It is not quotable. There is no vivid writing. The characters are barely interesting. It is not Jonathan Franzen, much less Vladimir Nabokov. But it does a wonderful job of supplying the four basic elements of a good story: a hero, a villain, making you care about the hero, and putting the hero in jeopardy.

Beneath the surface, also, is something I rarely find in novels: the author feels strongly about her subject matter. Collins, the author of The Hunger Games, has said she is writing for teenagers about war. Her father, who was in the Army, cared deeply about this and taught his children about it. “A family trip to a castle, which [the 13-year-old Collins] imagined would be “fairy-tale magical,” turned into a lesson on fortresses [given by her father],” says an article about Collins. Did Vladimir Nabokov know this much about child molesters (Lolita)? No, it was a literary device. Did Tolstoy or Flaubert have the events of Anna Karenina or Madame Bovary drilled into them in childhood? Unlikely. Both novels are built on basic novelistic subjects (actually, the same subject — infidelity). Somehow Collins’s deep connection comes through. I have no idea if you can write a good book simply because you love something. But you can definitely write a good book if you hate something: The Devil Wears Prada.

 

Gary Shteyngart is a Very Funny Guy

Seth Roberts1 Comment

I heard Gary Shteyngart (latest book Super Sad True Love Story) at the Beijing Bookworm. No better job of authorial self-promotion have I seen. He was born in Leningrad in 1972, he grew up hearing jokes from his parents. For example: The 1980 Summer Olympics were in Moscow. At the time, Brezhnev was in charge. He was going senile. At an Olympic ceremony, he gave a speech. His hands shook holding the text of his talk.

“Ohhhhhh…..” he read.

He paused.

“Ohhhhh…….”

He paused.

“Ohhhhh……”

An apparatchik ran up to him. “Senior Comrade Brezhnev, those are the Olympic Rings!”

The moderator asked Shteyngart what he thought of Putin’s plan to require every Russian teenager to read a specified 100 great books by graduation. “These things never work,” said Shteyngart. “American cities have done this. Everyone’s supposed to read a certain book, usually To Kill a Mockingbird. Never tell someone what to read.” However, he said one of his favorite authors is Karen Russell. (For a New Yorker podcast, he read a story by Andrea Lee.)

I asked about his favorite TV shows. He mentioned The Sopranos, The Wire, and Breaking Bad. “Who would have guessed that TV would become a great art form?” He is writing a show for HBO about Brooklyn immigrants.

I learned that he was interviewed by a magazine called Modern Drunkard. The interviewer — not Shteyngart — mentions an Russian saying: “The church is near, but the road is icy. The bar is far away, but I will walk carefully.” How true.

 

 

 

Flavour, a New Scientific Journal

Seth Roberts2 Comments

A new online open-access journal called Flavour has just started publication. The first issue has three articles and an editorial.

The journal

encourages contributions not only from the academic community but also from the growing number of chefs and other food professionals who are introducing science into their kitchens. . . . often in collaboration with academic research groups.

The first set of articles has an example of a collaboration between chefs and professional scientists — how to get a strong umami flavor from Nordic seaweed. Then you add the flavor to ice cream. Which reminds me of dessert at a friend’s house where he poured expensive balsamic vinegar on vanilla ice cream.

Thanks to Melissa McEwen.

Assorted Links

Seth Roberts3 Comments

Thanks to Anne Weiss.

“Seth, How Do You Track and Analyze Your Data?”

Seth Roberts5 Comments

A reader asks:

I haven’t found much on your blog commenting on tools you use to track your data. Any recommendations? Have you tried smart phones? For example, I have tried tracking fifteen variables daily via the iPhone app Moodtracker, the only one I found that can track and graph multiple variables and also give you automated reminders to submit data. There are other variants (Data Logger, Daytum) that will graph one variable (say, miles run per day), but Moodtracker is the only app I’ve found that lets you analyze multiple variables.

I use R on a laptop to track and analyze my data. I write functions for doing this — they are not built-in. This particular reader hadn’t heard of R. It is free and the most popular software among statisticians. It has lots of built-in functions (although not for data collection — apparently statisticians rarely collect data) and provides lots of control over the graphs you make, which is very important. R also has several programs for fitting loess curves to your data. Loess is a kind of curve-fitting. There is a vast amount of R-related material, including introductory stuff, here.

To give an example, after I weigh myself each morning (I have three scales), I enter the three weights into R, which stores them and makes a graph. That’s on the simple side. At the other extreme are the various mental tests I’ve written (e.g., arithmetic) to measure how well my brain is working. The programs for doing the test are in R, the data is stored in R, and analyzed with R.

The analysis possibilities (e.g., the graphs you can make, your control over those graphs) I’ve seen on smart phone apps are hopelessly primitive for what I want to do. The people who write the analysis software seem to know almost nothing about data analysis. For example, I use a website called RankTracer to track the Amazon ranking of The Shangri-La Diet. Whoever wrote the software is so clueless the rank versus time graphs don’t even show log ranks.

I don’t know what the future holds. In academic psychology, there is near-total reliance on statistical packages (e.g., SPSS) that are so limited perhaps they can extract only half of the information in the usual data. There are many graphs you’d like to make that it is impossible to make. SPSS may not even have loess, for example. Yet I see no sign of this changing. Will personal scientists want to learn more from their data than psychology professors (and therefore be motivated to go beyond pre-packaged analyses)? I don’t know.

Vitamin D3 in Morning: Moving D3 & Fish Oil from Evening to Morning Improves Sleep (Story 22)

Seth Roberts3 Comments

A few weeks ago I got an email from a reader named Alexander Vinther:

I take Vitamin D3 (2000 units) in the morning (between 7 and 9 am) together with fish oil. My sleep is deeper and I don’t wake up at odd times during the night. I tried increasing my intake 3-fold [= to 6000 IU] but felt too energetic/restless when going to bed (regardless of the time). I stopped taking Vitamin D3 (the regular dose) for a while to check my results only to start waking up in the night (or waking up early). Before this, my intake of D3 and fish oil was usually in the evening (everybody seems to recommend taking vitamins in the evening). The change from evening to morning was with both fish oil and D3 (I have always been taking them simultaneously) with huge improvement in sleep.

This is especially interesting because he made the evening-to-morning change long before I blogged about it. I asked for details.

Tell me about yourself.

Male, 24 years old. I live in Denmark and study philosophy. I exercise a lot (6 times a week, crossfit).

What were your sleep and energy like before you started taking D3 and fish oil in the morning?

My energy levels during the day would change a lot, sometimes with a huge surge in energy in the evening making falling asleep difficult. This would lead to few hours of sleep or a general feeling of not having slept at all (this in comparison to what I feel now, the feeling of “deep” sleep). [This is what happened when he was taking D3 and fish oil in the evening. –Seth]

Have you tried other D3 dosages?

I started out with 1400 units of Vitamin D3. I now take a multivitamin which has a small amount of D3, hence the 2000 units. I didn’t notice a difference between 1400 and 2000 units, but 6000 made me giddy/restless for the first week, which is for as long as I tried that particular dosage. 4000 units seems to have the same effect as 2000 units, but it is a dosage I haven’t taken for more than a week.

How long have you been taking Vitamin D3 in the morning?

I switched the time (from evening to morning) of my D3 intake about a year ago. Stumbling upon your blog confirmed my belief in or underlined the evidence for a difference in morning/evening intake.

How soon after you started D3 and fish oil in the morning (instead of the evening) did you notice better sleep?

I would say I see improvements in my sleep 3-4 days after D3 intake

What brands of Vitamin D3 and fish oil do you use?

My D3 brand is Danish: Naturdrogeriet D Mega. My fish oil brand is Biosym EPA-GLA+. I take 2 capsules containing a total of 1200 mg fish oil (DHA, EPA, GLA), 600 mg Borago oil and 700 mg soyalecithin.

Genomics Confidential: Iceland Not So Wonderful

Seth Roberts7 Comments

Many people think that personal genomics will change medicine. Doctors will choose treatments based on your genome, learning your genome will tell you what diseases you are at high risk of so you can take precautions, and so on. One person who believes this is Eric Topol. In his new book, The Creative Destruction of Medicine, he writes:

The biggest leap came in the first decade of the twenty-first century. The six billion bases of the human genome were sequenced, and this led to the discovery of the underpinnings of over one hundred common diseases, including most cancers, heart disease, diabetes, autoimmune disorders, and neurologic conditions.

Here is the founder of a company that makes sequencers: ““I believe that the impact on the medical community of whole human genome sequencing at a cost comparable to a comprehensive blood test will be profound.”

I disagree. I have seen nothing that suggests genes make a big difference in any common disease and plenty that suggests environment makes a big difference. My self-experimentation led me to one powerful environmental factor after another, for example. Biologists have invested heavily in the study of genes for reasons that have nothing to do with practical applications, as Thorstein Veblen would be the first to point out.

In 1999, New Yorker staff writer Michael Specter wrote an admiring article about a neurology professor named Kari Stefansson. Stefansson had returned to his native Iceland to take advantage of Iceland’s genetic homogeneity to find genes for common diseases. “In the past, drugs were discovered almost by chance,” Specter wrote, as if this would soon change. The wishful thinking involved is indicated by passages like this:

[Stefansson] and Gulcher selected the five per cent of Icelanders among the hundreds of thousands in their genealogical database who had lived the longest— most of them over ninety. The database allowed the two scientists to seek an answer to a simple question: Are these people who live so long related to each other more often than the average in Iceland? The answer quickly became apparent. People over ninety are much more closely related to each other than people in the general population are, and their children are more likely to live longer than the children of others. That provides strong evidence that the trait is inherited.

“Strong” evidence? The “people over ninety” observation is strong evidence that longevity is inherited only if relatives share nothing but genes. The “their children are more likely” observation is strong evidence of genetic control only if parents pass on to their children only genes. Both assumptions are highly unlikely. For example, surely an Icelandic person lives closer to his relatives than to randomly selected Icelanders.

The article quotes no one with my view (geneticists are overstating the practical value of their work), but it does say that “Stefansson set out to raise capital at a time [1996] when investors had become skeptical about the many unfulfilled promises made by companies claiming that genetic research would solve the ills of humanity.”

Will reality overtake hype? Here is an indication this is happening:

Kari [Stefansson], a neurologist, was a Harvard professor when he co-founded deCODE in 1996. Two years later, Iceland’s parliament gave deCODE access to one of the country’s unique resources—health records of the genetically homogenous population. DeCODE debuted on the NASDAQ stock exchange in 2000, and it made dramatic discoveries of genetic factors associated with cancer, heart disease and other conditions. But the company never turned a profit and filed for bankruptcy protection in 2009.

 

Assorted Links

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  • Kombucha news: new scientific studies. Plus an expert says: ““When diets are fads, they never seem to last long.”
  • University of Pennsylvania clears medical school professors of ghost-writing. “‘It’s important to note,” [said the Penn report,] ‘that the results of the study were negative to the sponsor’s product [and] were so characterized in the publication’ . . . But Lisa Lehmann, the director of the Center for Bioethics at Brigham and Women’s Hospital in Boston, notes that the study’s findings were not unequivocally negative. ‘Penn noted that the study was negative and seems to imply that diminishes concerns about bias, but this is not entirely true. There is a segment of the population, those with low serum lithium levels, for whom the study recommends the medication.’ “
  • Jeffrey Sachs apparently believes in AGW (Anthropogenic Global Warming). He also believes, according to Felix Salmon, “that development is easy, we know how to do it, and that given enough money, it’s relatively trivial to spend that money in an effective way to reduce poverty around the world.” Results from the Millennium Project do not support his beliefs.
  • 5 years of success with the Shangri-La Diet

Thanks to Alex Chernavsky.

More About the This American Life Retraction

Seth Roberts12 Comments

Mike Daisey had a perfectly good point about the shallowness of Steve Jobs. Too bad he took “dramatic license”. The more interesting part of the story for me is why This American Life (TAL) producers were fooled by Daisey and how they reacted when this became clear.

Suppose I make a short film in which Michael Jordan misses ten free throws in a row. Ten separate free throws, spliced together. Every detail is true, but the whole is false. Mostly he made free throws. You are never going to learn how false my film is by fact-checking it. Because every fact is true. That was the first big mistake made by TAL producers. They assessed Daisey’s story by fact-checking. In their retraction they say nothing about this point and seem unaware of it. Had they assessed it more broadly they might have become aware of the exaggerations.

The second big mistake made by TAL was to accept the standard journalistic view that you should get “both sides” of a story. If Person X claims Y, try to find someone who disagrees. If a Democrat says such-and-such, find a Republican to comment. In the Daisey story broadcast in January, the TAL producers took Daisey to be saying “Chinese factories are bad” and countered this, in standard journalistic practice, by finding someone who would defend Chinese factories: New York Times columnist Nicholas Kristof, of all people. Yeah, the salaries are low but they are better than rural jobs, said Kristof. I could have said that. Kristof knows almost nothing about Chinese factories — that was perfectly clear. Thinking they needed “the other side” confused TAL producers and wasted their time. Instead, they should have asked someone who knows a lot about Chinese electronics factories to comment. Again, if they had done this they might have realized that Daisey was not telling the truth. Most journalists know not to demonize. But many of them haven’t learned not to polarize.

From the retraction broadcast it is obvious that Ira Glass is furious. He lied to us! was the dominant note. Given how furious he is it is perfectly understandable that he and the rest of TAL didn’t manage to reach even one interesting conclusion the entire show. They simply wanted to set the record straight quickly, which is fine. If there are more stories about this, in-depth ones, I am afraid Glass is going to conclude We wanted to believe. That is going to be his deepest comment on this. I hope I’m wrong. I don’t agree with that assessment. I think the real problem is We wanted things to be simple. In particular, they wanted (and still want) the simple-minded view of the world taught in journalism school to be correct. The one in which experts can be trusted, every story has two sides, and truth can be ascertained by fact-checking.

A medium-sized scandal in American journalism is the mainstream journalistic view of global warming — of course humans have caused it (= AGW). To say otherwise is “anti-science”. The question has complexities (e.g., how models are tested, how scientists distort stuff) that journalists ignore. I don’t think journalists “want” to believe anything about global warming. I think what they really want is simplicity. It makes their jobs easier. A considerably larger scandal is the free pass given to medical schools and drug companies and their first, let them get sick attitude. The recognition that that this is horrible and there are alternatives seems beyond the thinking of most journalists who cover the subject. Again, the notion that our health care system is predatory is complex. Much simpler to believe it is good and not question basic assumptions. Both scandals — AGW and health care — are well in evidence at The New Yorker, an even more respected outlet than TAL, where Elizabeth Kolbert blindly accepts AGW and Atul Gawande, Michael Specter, and Jerome Groopman accept the first let them get sick way of doing things.