“Thou Shalt Not Testify Against Another Doctor”

Seth Roberts2 Comments

First do no harm . . . As Robin Hanson has said, what does that mean? In contrast, the rule illustrated by this story, from Bryan Castañeda, who works for a Los Angeles law firm, is quite clear:

At the old firm I used to work at, I was talking to one of the senior attorneys and the topic of medical malpractice cases came up. He said he avoids them. Why, I asked. He said — I’m paraphrasing here — “Because you won’t find a doctor who will testify against another doctor in open court. They may advise you in private, ‘Oh yeah, so-and-so definitely screwed up,’ but you won’t get them to say that on the stand. They all protect each other.”

Judging by this story, if your doctor makes a mistake, the only person who will suffer consequences is you. Thank heavens the rest of us have more power than ever before. A recent survey of doctors found that “more than a 10th (11.3%) admitted to telling patients something that was not true.” The survey did not ask about lies of omission (when silence is misleading); unwillingness to testify that someone else made a mistake is that sort of lie. The survey also showed that doctors (at least, those who took the survey) have a self-serving interpretation of the term not true. Although only about 10% said they had said something “that was not true” — meaning something that they knew wasn’t true — “more than half had described a patient’s prognosis more optimistically than warranted.” Apparently they consider such descriptions not instances of “not true”.

In Systems of Survival, Jane Jacobs described two moral systems (lists of rules/values): The guardian syndrome and the commercial syndrome. In certain areas of life (e.g., military), the guardian syndrome prevailed; in other areas (e.g., small business), the commercial syndrome prevailed. Loyalty (e.g., “never testify against a fellow doctor”) is a guardian value — indeed, the main guardian value. In contrast, honesty is the main commercial value. Jacobs said that the two syndromes corresponded to two ways of making a living: taking and trading. Doctors do not represent themselves as predatory (= taking). But, according to Jacobs, this sort of rule (“never testify against a fellow doctor”) puts them squarely in that camp.

I asked Jim Jacobs, one of Jane Jacobs’s sons, for comment. He replied:

Exactly right. Jane experienced this herself, unfortunately. It’s really a major problem. I see the very same behavior among medical researchers too.

Vitamin D3 in Morning: Mixed Evidence From PaleoHacks

Seth Roberts5 Comments

Paleo Hacks has a thread about timing of Vitamin D3. Better in morning (my and several other people’s experience) or evening (Robb Wolf’s experience)?

This answer supports morning:

I prefer taking it in the morning. I think it helps set my circadian rhythm.

This answer supports night:

I prefer it at night. I find I sleep better.

This answer supports morning:

I had trouble sleeping when I started Paleo and was taking my D3 at night before bed. Was nervous and couldn’t seem to settle down. No problems since I went to morning, I have them with my fish oil right after breakfast.

By the time you read this there will probably be more evidence.

Thanks to Melissa McEwen.

Coconut Oil Cures Foot Fungus

Seth Roberts12 Comments

About ten years ago my doctor pointed to a thin white line on my foot: That’s fungus, he said. Huh. He prescribed an antifungal medicine, previously available only by prescription, that had recently become over-the-counter (OTC). I tried several OTC remedies from my drugstore. None worked. According to the directions, they were to be applied twice per day. My doctor said the reason for the failure was that I hadn’t precisely followed the directions. This reminded me of a doctor who said that fat people know what to do about being fat (eat less) and simply fail to do it.

Years later I discovered that socks matter. With a much larger number of socks, my foot fungus got much better. Apparently the fungus died if it didn’t come in contact with my foot within a week or so. (I had it only on one foot.) With a large number of socks, my foot fungus never got really bad. But it did not entirely go away.

I discovered that tea tree oil works. When my foot fungus got noticeable I would put on some tea tree oil and it would get better.

In January I went back to Berkeley for a month. Without doing anything, my foot fungus seemed to vanish. Apparently being away from my apartment for 4 months was enough to get rid of the fungus. When I returned to Beijing in February, the fungus returned within a day or two. The shape of a particularly bad spot matched exactly where a plastic sandal touched the upper part of my foot. A sandal I’d worn in the shower to prevent foot fungus.

All this is to show how little I know about foot fungus in spite of having it for years.

In November (3 months ago) a reader of this blog named Chuck Currie wrote me:

Sometime in the spring I noticed that I was getting what looked like a rash around the large toe of my right foot. It began spreading, first under and between my toes and then across the top and then under my foot. There was a definite line with little bumps that showed it progression. And, it itched really bad – like bad athlete’s foot.

In July I was prescribed Nystatin and Triamcinolone Acetonide cream. [I tried this — Seth] I was told to put it on twice a day, which I did. Because I wear flip flops all summer, I didn’t need to cover it. The cream did not work at all. It actually seemed to make it worse.

I have been interested in coconut oil since going paleo, even though I can’t eat it, or coconut milk – they really upset my stomach. I was reading an article on coconut oil that mentioned its anti-fungal properties and I remembered reading this before. So I thought I would give it a try on my foot.

After showering, I cover my foot with coconut oil, place a plastic bag over my foot (the kind you put produce in) to keep it from being wiped off and then place a sock over the bag to hold it on. I leave it on for two or three hours and then take everything off and lightly wipe my foot with a paper towel and go to bed.

I do this three or four nights a week and have been doing it for three months. I knew immediately that it was doing something. My foot became very warm, almost like it was on fire, the first time I did this. It didn’t have this effect the second time. My fungus/rash started to retreat. My skin would dry out and flake off between sessions, like I was using an exfoliate.

Then I noticed that my [toenail fungus] started to clear up and I could see the nail growing from the cuticle on my big toe was clear, not yellow and thick. By now the line has progressed two thirds of the way up my toe. At this rate, it should be completely clear in another couple of months.

I still get small flare ups of the rash/fungus on my foot, but it has almost completely cleared up. You can still see where it had been. The skin is dryer and lighter in color than the rest of the foot.

I think if I had done this every night the progress would have been faster. I’m now starting to put a small amount of coconut oil on the top of my foot in the morning and letting it air out for a while before putting on my socks and shoes. When the fungus was on the bottom of my foot this was not possible, but now that it only seems to be on the top, this works and I think this will speed up the process. The best thing is there are no bad effects. I use extra virgin, cold pressed, unprocessed coconut oil. My understanding is that heat processed coconut oil does not have the same anti-fungal properties.

Pretty convincing, huh? In Berkeley I bought Whole Foods house brand coconut oil (cold-pressed). Edible was cheaper than non-edible. In Beijing, after my foot fungus had gotten quite noticeable, I started to use it. At bedtime, I rub it all over my foot, put my foot in a thin plastic bag, and put on a sock. When I get up, I take off the sock and the plastic bag.

After doing this once, my foot was much better. After five applications, I couldn’t detect any fungus. Application is pleasant (without trying, I don’t miss a night) and, as Chuck says, obviously safe — I could eat what I am spreading on my foot. It costs a few dollars/month. Tea tree oil works, too, but it wasn’t easy to spread all over my foot, wasn’t pleasant to apply, wasn’t edible, and cost $15/tiny bottle. On the internet you can find many home remedies, such as soaking your feet in apple cider vinegar. Apparently they work. This is much easier.

If you try this, please tell me your experience, whether it works or not.

Tucker Max on How to Eat an Egg

Seth Roberts22 Comments

A few months ago I blogged that a rat had persuaded me to eat more eggs. This particular rat liked scrambled eggs. Rats are omnivores, like humans. Unlike humans, they ignore advertising, nutrition fads and disinformation. Related to this, Tucker Max emailed me:

Have you thought about eating your egg raw? It sounded weird to me at first, but after looking extensively into it, there was a lot of good evidence that cooking an egg destroys a lot of the beneficial nutrients/enzymes in it. Once I started doing this, I noticed a HUGE increase in energy from the egg. It was like I almost eating a different food. In fact, the very first time I did it was at night, like 9pm, and I couldn’t get to sleep until 3am I had such a huge burst of energy. It’s not quite like that anymore, but I take it about an hour or two before I work out, and its like taking a red bull (I may be a bit vitamin B12 deficient, which would explain this).

As to how I do it, I just crack the egg into a coffee cup, and swallow it whole. It has pretty much no flavor. I also only do it with organic pasture-raised eggs. I don’t think I’d do this with normal, crappy store bought eggs.

I replied:

On my blog I said that butter and egg were in that way different from other foods — butter or at least milk must be a complete nutrient since it is the only food the baby gets. Other foods are under no such evolutionary pressure.

Tucker replied:

Which is why its SO important to get raw milk/butter from grassfed cows. Almost a completely different food than normal grocery store milk.

Yeah. When I get back to California I will compare raw and cooked eggs. In Beijing I eat mainly fermented eggs.

Personal Science and Varieties of DIY

Seth Roberts2 Comments

How does personal science (using science to solve a problem yourself rather than paying experts to solve it) compare to other sorts of DIY?

Here’s an example of personal science. When I became an assistant professor, I started to wake up too early in the morning. I didn’t consider seeing a doctor about it for several reasons: 1. Minor problem. Unpleasant but not painful. 2. Doctors usually prescribe drugs. I didn’t want to take a drug. 3. Sleep researchers, based on my reading of the sleep literature, had almost no idea what caused early awakening. They would have said it was due a bad phase shift of your circadian rhythm. They often used the term circadian phase disorder but never used the term circadian amplitude disorder — apparently they didn’t realize that such a thing was possible. I decided to try to solve the problem myself — an instance of DIY. Except that, if I made any progress, that would be better than what the experts could provide, which I considered worthless.

There are thousands of instances of DIY, from fixing your car yourself to sewing your own clothes to word processing. Here is one dimension of DIY:

1. Quality of the final product. Better, equal, or worse to what you would get from professionals. Richard Bernstein’s introduction of home blood glucose testing led him to much better control of his blood glucose levels than his doctors had managed. Same as my situation: DIY produced acceptable results, the experts did not.

In contrast to Bernstein, who reduced his blood glucose variability within months, it took me years to improve my sleep. That is another dimension:

2. Time needed. Personal science, compared to other DIY, is orders of magnitude slower.

Here are some more dimensions:

3. Training needed. I don’t know how much training personal science requires. On the face of it, not much. I had acne in high school. I could done self-experimentation at that point. It just didn’t occur to me. On the other hand, I think effective personal science requires wise narrowing of the possibilities that you test. For most health problems, you can find dozens of proposed remedies. How wise you need to be, I don’t know.

4. Commercialization. Some forms of DIY are entirely the creation of businesses — cheap cameras, home perms, IKEA, etc. Bernstein’s work happened because of a new product that required only a drop of blood. The company that made it wanted doctors to do DIY: measure blood glucose levels in their office (fast) rather than having the measurement made in a lab (slow). When I started to study my sleep, no business was involved. Now, of course, companies like Zeo and the makers of FitBit want users to do personal science.

5. Price. My sleep research cost nothing, which in the DIY world is unusual. The term DIY is almost entirely a commercial category: Certain books and goods are sold to help you DIY.

6. Customization possible. Some kinds of DIY give you the tools to build one thing (e.g., IKEA, home perms). Other kinds (e.g., Home Depot, word processing) give you the tools to build a huge range of things. This dimension is variation in how close what you buy is to the finished product (Ikea = very close, word processing = very far). Personal science allows huge customization. It can adjust to any biology (e.g., your genome) and environment (your living conditions).

7. Benefit to society. If I or anyone else can find new ways to sleep better — especially safe cheap easy ways — and these solutions can be spread, there is great benefit to society, by comparison to DIY that allows non-professionals to reproduce what a professional would create (e.g, IKEA).

You might say that personal science isn’t really DIY because, compared to other DIY, (a) it is much slower and (b) the potential benefit to society is much greater. But those features are due to the nature of science. Any form of DIY has unique elements.

My mental picture of DIY is that there are two sides, producers and consumers, and in many domains (health, car maintenance, word processing, etc.) they creep toward each other in the sense that what producers can make slowly increases and what consumers are capable of slowly increases. When they meet, DIY begins. In some cases, the business has done most of the changing; the DIY is very easy (e.g., Ikea). In other cases, the consumer has changed a lot (literacy — not easy to acquire). Either way, the new DIY causes professionals who provided that service or good for a living to lose business.

Assorted Links

Seth Roberts2 Comments

Thanks to Ryan Holiday, Matt Cassel, Tom George and Dave Lull.

Carl Willat Suffers From the Willat Effect

Seth Roberts6 Comments

Carl Willat, for whom the Willat Effect is named, wrote to me:

I had two cartons of half and half in the fridge, neither had reached its expiration date but one was three days newer. I wondered if I could taste the difference between them, and I found that I could. Neither was sour, but one tasted fresher. I made a batch of vanilla ice cream out of each of them, figuring that together with the other ingredients I was adding (vanilla, egg yolks, cream, salt and sugar) the difference in taste would be less noticeable. After putting both mixtures through the ice cream freezer I tasted them [side by side] and one tasted a lot better. I gave a friend of mine a spoonful of each and she immediately noticed the difference. She correctly identified the good one and described it as tasting fresher and lighter. I can’t bear to eat the less good batch and I don’t know what to do with it. I don’t want to give it away for fear someone will think it representative of what my ice cream tastes like. I’m sure in the past I’ve made plenty of ice cream of this same quality that I and everyone else thought was perfectly acceptable, even delicious.

The fascinating part is “can’t bear to eat the less good batch”. Same thing with me and tea: In the last half year or so, I’ve made hundreds of side-by-side comparisons of tea. I now throw away cups of tea I don’t like. I never used to do that.

The DIYization of Beer Brewing and Innovation

Seth RobertsLeave a comment

The key point — as far as I’m concerned — in this article about the DIYization of beer brewing comes in the middle of a paragraph:

Home brewing is part of a broad spectrum of DIY activities including amateur astronomy, backyard biodiesel brewing, experimental architecture, open-source 3-D printing, even urban farming. . . . Many of these pastimes can lead to new ideas, processes, and apparatus that might not otherwise exist.

Likewise with the DIYization of science: It will produce new ideas, solutions, etc. The Shangri-La Diet is an example.

Thanks to David Archer.

Vitamin D3 in Morning: 4000 IU Better Than 1000 IU (Story 20)

Seth Roberts10 Comments

Daniel Lemire, a Canadian computer science professor, left the following comment here

I have irregularly taken 1000 UI in the morning for years with no noticeable effect.

For about two years, I have had poor sleeping patterns characterized mostly by the fact that I tend to go to bed at 1am or later (and I get up around 7:15 am [woken up by an alarm clock]). Whenever I would try to go to bed earlier, I would simply fail to fall asleep.

After reading this blog, I increased my intake of D3 to 4-5,000 IU. I’m now falling asleep about an hour earlier. This could be a placebo effect, of course, but I consider it a very significant improvement.

It is unclear whether I have more energy. I don’t know how to measure such an effect. I expect that I’m less irritable, but that’s a side-effect of getting more sleep.

I asked him for details.

Tell me about yourself.

I’m in my 40′s. I enjoy a flexible schedule and often work from home.

You write: “For about two years I have had poor sleeping patterns characterized mostly by the fact that I tend to go to bed at 1 am or later (and get up around 7:15 am [woken up by an alarm so that he can eat breakfast with his family and walk his kids to school]). Whenever I would try to go to bed earlier, I would simply fail to fall asleep.” You mean you are still tired when you get up? You want to sleep longer but are unable to?

I was getting about 6 hours of sleep, and yes, I was still tired when I got up. I’m less tired now that I am getting around 7 hours of sleep.

“I tend to go to bed at 1 am or later”. What was the average (median) time of going to bed? When you went to bed at this time (“1 am or later”), how long would it take you on average (median) to fall asleep?

The median is 1 am. I fall asleep immediately. I don’t go to bed unless I know I will soon fall asleep: I tried to go to bed earlier, but it made me feel worse about my insomnia and I did not get better sleep. I tend to stay up until I feel like I must go to bed.

“After reading this blog, I increased my intake of D3 to 4-5,000 IU.” How many days have you been at the new dosage?

2 weeks +/- 3 days.

Was this the only change?

Yes. As far as I can tell. The time did not change. It is around 7:30 am. Soon after I get up. Before coffee.

“I’m now falling asleep about an hour earlier. ” What time (median) is that? How long (median) does it take you to fall asleep? What time are you now waking up?

I now fall asleep around midnight. I just instantly fall asleep. So I am getting approximately 7 hours of sleep.

“I expect that I’m less irritable.” You’ve noticed that you’re less irritable?

Yes. I feel less irritable.

What brand and formulation (e.g., capsule, gelcap, tablet) of D3 do you take?

Walmart house brand (“equate”). Tablets, 1000 IU/tablet. I take 4, sometimes 5. (Median is 4.)