Acne Cured By Self-Experimentation

In November, at Quantified Self Europe, Martha Rotter, who lives in Ireland, gave a talk about how she cured her acne by self-experimentation. She summarizes her talk like this (slides here):

When I moved to Ire­land [from Seattle] in 2007, I began to have skin prob­lems. It began gradu­ally and I attrib­uted it to the move, to stress, to late nights drink­ing with developers and cli­ents, to travel, to whatever excuses I could think of. The stress was mul­ti­plied by the anxi­ety of being embar­rassed about how my face looked, but also because my new job in Ire­land involved me being on stage in front of large audi­ences con­stantly, often sev­eral times a week. A year later my skin was per­petu­ally inflamed, red, full of sores and very pain­ful. When one spot would go away, two more would spring up in its place. It was a tough time. I cried a lot.

Frus­trated, I went to see my homet­own der­ma­to­lo­gist while I was home for hol­i­days. He told me that a) this was com­pletely nor­mal and b) there was noth­ing I could do but go on anti­bi­ot­ics for a year (in addi­tion to spend­ing a for­tune on creams and pills). I didn’t believe either of those things.

I was not inter­ested in being on an anti­bi­otic for a year, nor was I inter­ested in Accu­tane (my best friend has had it mul­tiple times and it hasn’t had long term res­ults, plus it can be risky). What I was inter­ested in was fig­ur­ing out why this was hap­pen­ing and chan­ging my life to make it stop. I refused to accept my dermatologist’s insist­ence that what you put in your body has no effect on how you look and feel.

I began sys­tem­at­ic­ally cut­ting things out of my diet to see how I reacted. First chicken and soy, based on a recom­mend­a­tion from a food aller­gist. Over the course of a year I cut out sugar, glu­ten, carbs, starches, caf­feine, meat, fish until finally the magical month of Decem­ber 2010 when I cut out dairy. My skin was my own again by New Year’s day this year.

It took a year to fig­ure it out. It was com­pletely worth it. There’s noth­ing wrong with Irish dairy, it just doesn’t work for me. I drink Amer­icanos instead of lattes now, I don’t eat cer­eal; none of that is a huge deal. For what it’s worth, I can drink goat’s milk.

A great example of the power of self-experimentation compared to trusting doctors. One quibble: I’ll be more sure “there’s nothing wrong with Irish dairy” if she finds that American dairy also causes skin problems. The evidence so far (she didn’t have skin problems until she moved to Ireland) suggests that at least for her American dairy (i.e., dairy where she lived in America) is better than Irish dairy. I have heard Irish dairy praised. They sell Irish butter at Beijing stores near me. I won’t be buying it.

At the end of her post she makes a very important point:

Quan­ti­fied Self isn’t for every­one, but every­one should feel they have the power to change things in their body and their life for the better.

I agree. By learning about examples of people who have done just that — such as Martha — we will come closer to having that power. Right now, as far as I can tell, most people feel helpless. They do what doctors or other experts tell them to do, even if it doesn’t work very well.

Long ago, hardly anyone could read. This left them in the grip of those who could. But eventually came mass literacy, when the benefits of reading finally exceeded the costs (e.g., because more books were available at lower prices). Reading is primitive science: if you read about things that happened, it is information gathering. It resembles doing a survey. Nowadays, almost everyone (in rich countries) reads, but almost no one does experimental science. This leaves them in the grip of those who can do experimental science (e.g., drug companies). I think my work and Martha’s work suggest we are close to another turning point, where, for nonscientists, the benefits of doing experiments exceed the costs.

Thanks to Gary Wolf.

The Continued Existence of Acne Reveals the Perverse Incentives of Modern Medicine

Yesterday I wrote how Alexandra Carmichael’s headache story illustrated a large and awful truth about modern healthcare: It happily provides expensive relief of symptoms while ignoring investigation of underlying causes. If we understood underlying causes (e.g., causes of migraines), prevention would be easy. Let people get sick so that we can make money from them. There should be a name for this scam. In law enforcement, it’s called entrapment.

Sensible prevention research would start small. Not by trying to prevent breast cancer, or heart disease, or something like that: They take many years to develop and therefore are hard to study. Sensible prevention research would focus on things that are easy to measure and happen soon after their causative agents. One example is migraines. Migraines happen hours after exposure. The fact that Chemical X causes migraines means it is likely that Chemical X is bad for us, even if it doesn’t cause migraines in everyone. This is the canary-in-a-coal-mine idea. Migraines are the canary.

Acne is another canary. Acne is easy to measure. Figuring out how to prevent it would be a good way to begin prevention research. To prevent acne would be to take the first steps toward preventing many more diseases. A high-school student could do ground-breaking research — research that would improve the lives of hundreds of millions of people — about how to prevent acne but somehow this never happens. In spite of this possibility, grand-prize-winning high-school science projects, from the most brilliant students in the whole country, are always about trivia.

A just-published review in The Lancet reveals once again the unfortunate perspective of medical school professors. The abstract ends with this:

New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.

Actually, finding out what causes acne is all that’s needed.

To figure out what causes acne (and thereby how to prevent it) three things are necessary: (a) study of environmental causes, such as diet, (b) starting with n=1, and (c) willingness to test many ideas that might be wrong (because it’s far from obvious how to prevent acne). All three of these things are exactly what the current healthcare research system opposes. It opposes prevention research because drug companies don’t fund it. It opposes n=1 studies because they are small and cheap, which is low-status. To do such a study would be like driving a Corolla. It opposes studies that could take indefinitely long because such studies are bad for a researcher’s career. Researchers need a steady stream of publications.

High school students, who aren’t worried about status or number of publications, could make a real contribution here. You don’t need fancy equipment to measure acne.

Thanks to Michael Constans.

Dangerous Acne Medicine

Treatment of acne with isotretinoin is associated with suicide attempts, according to a new study. A puzzle is that suicide attempts started to rise before the treatment started. They sharply declined to baseline after treatment stopped.

Acne is an good target for self-experimentation because it is easy to measure and is surely related to diet. My discovery of the value of self-experimentation happened with acne: I discovered that of the two drugs my dermatologist had prescribed, one (benzoyl peroxide) worked, the other (tetracycline) didn’t. I had believed the opposite, that tetracycline worked and benzoyl peroxide didn’t work.

Tsinghua Student Life

The Chinese government sets limits to the number of acceptable student suicides per year at every college. If the number is exceeded, the college is punished — perhaps by a reduction in administrator salaries. Although colleges conceal suicides from their own students, they dare not conceal them from the government. At Tsinghua (with about 12,000 students) the annual limit is six. (So far this year, there have apparently been none.) In the electrical engineering department recently, more than six students were thought to be considering suicide. Because of this, a psychology professor gave the EE majors a talk about looking at the bright side of things.

A newly-formed Tsinghua student club has a Chinese name that means Sing Your Heart. It is for students who want to volunteer to teach in poor rural areas. The club has a special song that they sing at every meeting. They are remarkably ambitious: They want to set up a training program to train students to teach in these areas.

The School of Humanities and Social Sciences has a debate competition every year. This year’s topic is: Should the Fuwa (the Beijing Olympic mascots) have genders?

Acne Treatment Statistics

Cure Together has acne treatment statistics: Comparisons of the effectiveness of about a dozen treatments. Only two treatments rate high for effectiveness and both have only a few raters. Neither of the high-rated treatments (Roaccutane and Dr. Hauschka Skin Care) was part of Stone-Age life. Because of the absence of acne in at least a few groups of people living more Stone-Age-like (stoneagesque?) lives, it is likely that something about modern life causes acne. When whatever that is is figured out, it should be possible to eliminate acne cheaply and safely.

Regardless of the future, this table is a big step forward in dealing with the problem. It is the first unbiassed look at the effectiveness of different treatments I have seen and it tests a lot of everyday treatments (e.g., face-washing). Academic papers on the subject usually study prescription drugs and the authors usually favor one of the treatments being studied.

Acne.com versus Acne.org

Acne.com, a website paid for by the drug company behind Proactiv, a common acne medicine, has the following:

Acne Myths & Claims: Certain foods cause acne. No, those french fries you had yesterday didn’t give you new zits today. In fact, scientists have been unable to find ANY substantial connection between diet and acne. So all the foods you’ve been afraid of — pizza, french fries, chocolate — are fine. Of course, that doesn’t mean you should binge on your favorites whenever you want — a healthy diet will help your body have the strength to help you in your fight against acne. So use your common sense, but don’t be afraid to indulge now and then.

“All the foods you’ve been afraid of are fine”? This is much too certain-sounding. T he studies that failed to find a diet/acne connection were poor. Other research suggests that acne may well have a dietary cause. The false certainty is self-serving. Because foods don’t cause acne don’t bother trying to figure out which ones; just take our medicine! It resembles my surgeon claiming there was evidence that the surgery she recommended and would profit from was a good idea when there wasn’t any such evidence.

In contrast, acne.org has this:

Myth: Diet and acne are related. Reality: The bottom line is we need more research. We do know that people in some indigenous societies do not experience [any] acne whatsoever across the entire population. This is in stark contrast to the widespread presence of acne throughout all modern society. It leaves us to ponder the question of whether the indigenous people’s diet contributes to their acne-free skin. Discovering a dietary way of preventing acne may be a future reality, however, we may live so differently from our hunter/gatherer ancestors that it has become close to impossible to replicate our ancestral diet. But let’s see if we can work together to come to some consensus from our own experiences. If you feel that you have cleared your acne using a particular diet, or if you are planning on attempting a diet of some kind, please post your method on the Nutrition & Holistic health message board.

That’s reasonable and helpful. The website that couldn’t hire expensive experts had better information.

Reviews of Proactiv on acne.org.

What Else Causes Acne?

Previous posts have implicated Western Civilization and face-washing with soap in the etiology of acne. What else might be involved? A reader writes:

My girlfriend suffered from acne for years. She went to a dermatologist, tried every fancy soap and skin cleansing system, but nothing worked. She was also a Diet Coke fanatic. Every morning while she was getting ready for work, like a coffee drinker, she’d have one. It was her daily jolt of caffeine.

When I read about your diet modification, part of which included giving up soda, and your subsequent acne disappearance [I found that Diet Pepsi caused acne], I of course told her about it. “No, it has nothing to do with my diet, it’s hormones and bacteria.” She was not about to give up her beloved Diet Coke! How else could she function in the morning? In the meantime, she would periodically get upset at what she called the “open sores” on her face.

About 9 months ago, she decided to go on a detox diet — not with the aim of treating her acne, but just to lose a couple pounds. It required her to eliminate as many artificial chemicals and preservatives from her diet as possible. Out went the Diet Coke. Within days, her skin cleared up. She hasn’t had a major breakout since.

Yet more evidence that acne is due to lifestyle factors and can be completely cured by lifestyle changes, often dietary. There should be a list somewhere, ordered from most to least likely, of lifestyle causes of acne. If you have acne you just go down the list eliminating each one in turn until you find the culprit.

Acne Self-Experimentation: Why It’s Promising

This article reports that there was no acne whatsoever among the Kitava Islanders in Papua New Guinea and the Ache hunter-gatherers in Paraguay. Here is the abstract:

BACKGROUND: In westernized societies, acne vulgaris is a nearly universal skin disease afflicting 79% to 95% of the adolescent population. In men and women older than 25 years, 40% to 54% have some degree of facial acne, and clinical facial acne persists into middle age in 12% of women and 3% of men. Epidemiological evidence suggests that acne incidence rates are considerably lower in nonwesternized societies. Herein we report the prevalence of acne in 2 nonwesternized populations: the Kitavan Islanders of Papua New Guinea and the Aché hunter-gatherers of Paraguay. Additionally, we analyze how elements in nonwesternized environments may influence the development of acne. OBSERVATIONS: Of 1200 Kitavan subjects examined (including 300 aged 15-25 years), no case of acne (grade 1 with multiple comedones or grades 2-4) was observed. Of 115 Aché subjects examined (including 15 aged 15-25 years) over 843 days, no case of active acne (grades 1-4) was observed. CONCLUSIONS: The astonishing difference in acne incidence rates between nonwesternized and fully modernized societies cannot be solely attributed to genetic differences among populations but likely results from differing environmental factors. Identification of these factors may be useful in the treatment of acne in Western populations.

This implies that acne isn’t inevitable. It’s almost surely caused by something environmental — perhaps diet, perhaps something else (such as washing your face with soap). That’s why self-experimentation about acne is promising: By changing your environment in various ways, you may be able to figure out what’s causing your acne.

Acne Gone Thanks to Self-Experimentation

A year ago I told students at my friend’s Mohamed Ibrahim‘s school that a student of Allen Neuringer’s had gone on a camping trip and found that her acne went away. At first she thought it was the sunshine; but then, by self-experimentation, she discovered that the crucial change was that she had stopped using soap to wash her face.

Now Mohamed writes:

I told my classes about your friend who went camping without her face products only to discover that the face products were contributing to her acne, and that from that point on she only washed her face with water. It turns out that two of my students wash their faces with water! And their skin looks great! I started “washing” my face with water about a month ago, and [now] my face is acne free and soft as a pair of brand new UGG boots. [He had had acne for years.] The only additional thing I do is wipe my face with a napkin throughout the day to remove any excess oil.

So one cause of acne is using soap to wash your face.

Acne really matters. And it’s common. It now turns out that it has a pathetically easy solution, in at least some cases. Dermatologists don’t know this. Apparently hardly anyone knows it. Somehow the entire healthcare establishment, to whom we entrust our health in many ways, missed this. Dennis Mangan’s discovery that niacin can cure restless-leg syndrome is another example of a pathetically easy solution missed by experts. Likewise, the Shangri-La Diet is very different than anything an obesity expert has ever proposed.

What else has been missed?

More Imagine a med student in a dermatology class. The student raises his hand and asks a question. “I read in a blog that acne goes away if you stop using soap. What do you think about that?” What would the instructor say — after telling the student not to believe everything he reads on the Web?

The American Health Paradox: What Causes It? (continued)

Atul Gawande might be the best medical writer ever. He is the best medical writer at The New Yorker, at least, and the best one I’ve ever read. He consistently writes clearly, thoughtfully, and originally about the big issues in medicine. That is why his recent article about health care costs (my comment here) and his graduation speech at the Univesity of Chicago are so telling. And not in a good way, I’m afraid.

The graduation speech starts off with an excellent story:

The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.

So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.

Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.

Bill Gates, Jeffrey Sachs, are you listening? Gawande goes on to say that to improve medicine, there needs to be the same sort of study of “positive deviants”. Here is his first example:

I recently heard from one such positive deviant. He is a physician here in Chicago. He’d invested in an imaging center with his colleagues. But they found they were losing money. They had a meeting about what to do just a few weeks ago. The answer, they realized, was to order more imaging for their patients—to push the indications where they could. When he realized what he was being drawn to do by the structure he was in, he pulled out. He lost money. He angered his partners. But it was the right thing to do.

No kidding. The contrast between mothers who figure out creative iconoclastic new ways to feed children on tiny amounts of money and a doctor who merely refuses to be a scumbag could hardly be greater. But Gawande uses the same term (“positive deviant”) for both! This is the depth to which a writer and thinker of Gawande’s stature has to descend, given the straitjacket of how he thinks about medicine. Gawande thinks that doctors will improve medicine. He’s wrong. Just as farmers didn’t invent tractors — nor any of the big improvements in farming — neither will doctors be responsible for any big improvements in American health. The big improvements will come from outside. I’m sure they will involve both (a) advances in prevention and (b) patients taking charge of their care.

When these innovations happen, where will doctors be? Helping spread them or defending the status quo? That’s what Gawande should be writing about. One big advance in patients taking charge was home blood glucose testing. It came from an engineer named Richard Bernstein. Best thing for diabetics since the discovery of insulin. Doctors opposed it. When I invented the Shangri-La Diet, and lost 30 pounds, my doctor didn’t ask how I lost all that weight. Not one question. Like all doctors, he had many fat patients; the notion that I, a mere patient, could know something that would help his other patients didn’t cross his mind. When I was a grad student I did acne experiments on myself that revealed that antibiotics (hugely prescribed for acne) didn’t work. My dermatologist appeared irritated that I had figured this out. That’s a little glimpse of how doctors may react to outside innovation involving patients taking charge. Of course doctors, like dentists, cannot do good prevention research.

If Gawande took the first story he told to heart, he might realize it is saying that the improvements to health care won’t come from doctors, just as the improvements to the health of those village children didn’t come from experts. As I said earlier, doing my best to channel Jane Jacobs, a reasonable health care policy would empower those who benefit from change. That’s what the village nutrition program did. It empowered mothers who were innovating.