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Two Cents about Renata Adler

Seth Roberts4 Comments

Renata Adler’s two novels, Speedboat (1976) and Pitch Dark (1988), have just been reissued by New York Review Books. I was pleased to see a recent New York article about her. Here is my two cents:

1. Gone: The Last Days of The New Yorker (2000) is one of my favorite books. It can be summed up like this: Genius corrupts. I first came across it in the Berkeley Barnes & Noble. I couldn’t stop reading it. When I left the store hours later my scooter had a parking ticket.

2. Her libel lawsuit is described here.

3. She wrote a book about the Bilderberg Group called Private Capacity. It was announced then cancelled.

4. During a panel discussion televised on C-Span, she took a phone call. It appeared to be from her daughter.

5. For several years she taught journalism at Boston University. A student said she told great stories.

6. In a book review, she said that Woodward and Bernstein’s Deep Throat was made up. Apparently she was wrong about that.

7. During a dinner I had with Aaron Swartz last summer, he praised her article attacking Pauline Kael (“The Perils of Pauline”, 1980).

8. When her article about Kael came out, a friend of mine said, Now she’ll be known as the person who attacked Kael. My friend was wrong. She is better known as the person attacked by eight articles in the New York Times when Gone was published. One short non-best-selling book, eight negative articles from the most powerful pulpit on earth.

9. Gone and some books by Jane Jacobs were the only books I took to China. I also adore Totto-Chan but I suppose I have memorized it. I mostly read books by men, so I am puzzled that all my most favorite books are by women. A Chinese friend of mine stayed in my Beijing apartment while I was gone. Her English isn’t very good but she praised Gone, which she called Lost.

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Thanks to Bryan Castañeda.

Who Is Listened To? Science and Science Journalism

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This book review of Spillover by David Quammen is quite unfavorable about Laurie Garrett, the Pulitzer-Prize-winning science journalist. Several years ago, at the UC Berkeley journalism school, I heard her talk. During the question period, I made a comment something like this: “It seems to me there is kind of a conspiracy between the science journalist and the scientist. Both of them want the science to be more important than it really is. The scientist wants publicity. The science journalist wants their story on the front page. The effect is that things get exaggerated, this or that finding is claimed to be more important than it really is.” Garrett didn’t agree. She did not give a reason. This was interesting, since I thought my point was obviously true.

The book review, by Edward Hooper, author of The River, a book about the origin of AIDS, makes a more subtle point. It is about how he has been ignored.

When I wrote The River, I did my level best to interview each of the major living protagonists involved in the origins-of-AIDS debate. This amounted to well over 600 interviews, mostly of two hours or more, and about 500 of which were done face-to-face rather than down the phone. Although the authors of the three aforementioned books (Pepin, Timberg and Halperin, Nattrass) all devote time and several pages to The River, and to claims that I definitely got it wrong, not one of them bothered to contact me at any point – either to challenge my findings, or to ask me questions. However, I have been contacted by someone through my website (a lawyer and social scientist) who asked me several questions, to all of which I responded. Later, this man read the first two of these three pro-bushmeat books and contacted the authors of each by email, to ask them one or two simple questions about their dismissal of the OPV hypothesis [= the AIDS virus came from an oral polio vaccine]. His letters to Pepin, Timberg and Halperin (which he later forwarded to me) were courteous and non-confrontational, and in two instances he sent three separate letters, but apparently not one of the authors could be bothered to reply to any of these approaches.

In other words, there is a kind of moat. Inside the moat, are the respected people — the “real” scientists. Outside the moat are the crazy people, whom it is a good idea to ignore. Even if they have written a book on the topic. Hooper and those who agreed with him were outside the moat.

Hooper quotes Quammen:

“Hooper’s book was massive”, Quammen writes, “overwhelmingly detailed, seemingly reasonable, exhausting to plod through, but mesmerizing in its claims…”

I look forward to the day that the Shangri-La Diet is called “seemingly reasonable”. Quammen and Garrett (whose Coming Plague has yet to come) write about science for a living. I have a theory about their behavior. To acknowledge misaligned incentives (scientists, like journalists, care about other things than truth ) and power relationships (some scientists are in a position to censor other scientists and points of view they dislike) would make their jobs considerably harder. They are afraid of what would happen to them — would they be kicked out, placed on the other side of the moat? — if they took “crazy” views seriously. It is also time-consuming to take “crazy” views seriously (“massive . . . exhausting”). So they ignore them.

Late Comment on Battle Hymn of the Tiger Mother

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Amy Chua wondered if all the pressure to practice (piano, older child, violin, younger child) she put on her two children was worth it. But then there were moments like these:

In a glass-windowed room overlooking the Mediterranean, Sophia played Mendelsohn’s Rondo Capriccioso, and got bravos and hugs from all the guests.

Which I found the most chilling sentence in the whole book. Her daughter’s recognition (“bravos and hugs”) made Chua very happy. But did it make Sophia happy? Chua doesn’t answer that question. She doesn’t follow the sentence I’ve quoted with “I could see how pleased she was” or “Years later she would say what a good time she had”. Nope, the chapter ends there.

“The Most Influential Tree in the World”

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The title comes from Andrew Montford’s new book Hiding the Decline (copy given me by author) about Climategate. From an introductory section:

When the figures were published the extraordinary lack of data underlying the blade of the Yamal hockey stick caused a minor sensation. In fact the high point at the end of the graph was shown to have been based on only four trees, and only one of these had the hockey stick shape. McIntyre dubbed it ‘the most influential tree in the world’.

Most of Hiding the Decline is about the inquiries that followed Climategate. I enjoyed reading about smug powerful people making fools of themselves and the fairy-tale-like consternation created by two unlikely events: 1. A non-scientist (Steve McIntyre) gets involved in the global warming debate. As in a fairy tale, McIntyre is free to speak the truth. In particular, he is free to question. Professional climate scientists cannot speak the truth for fear of career damage. 2. The release of the Climategate emails. As in a fairy tale, a sudden burst of truth about bad behavior previously hidden.

Hiding the Decline is as well-written as a book by a professional writer but this is a book no professional science writer could write due to its investment in an officially-wrong point of view. There are lots of badly-written books from tiny-minority points of view. The appearance of a well-written one, joining Montford’s earlier The Hockey Stick Illusion, is no small deal. How much free speech do we have? It depends on the medium. Maybe the sequence from less to more censored is: 1. Conversation. 2. Email and other private writing. 3. Blog post. 4. Poorly-written book. 5. Article in minor magazine. 6. Well-written book. 7. Article in prestigious magazine. 8. Textbook. From one step to the next (e.g., from conversation to email), views become less diverse. This book is disagreement with the official line high up the tree.

One reason we enjoy certain jokes is that they speak a forbidden truth. When you can’t usually say it, the truth is funny. The forbidden truth aspect of Hiding the Decline is another reason I enjoyed it so much.

Does the story have a happy ending? Montford thinks not:

As we look back over the ten years of this story, the impression we get is of a wave of dishonesty, a public sector that will spin and lie, and mislead and lie, and distort and lie, and lie again. . . . Despite the emails showing, apparently incontrovertibly, that FOI laws were flouted with the full knowledge of senior figures in university, there have been almost no discernible repercussions for anyone involved. . . . The response to [Climategate] was an extraordinary failure of the institutions and of the people who are paid to protect the public interest – a failure of honesty, a failure of diligence, a failure of integrity.

My view is different. The institutions (University of East Anglia, Penn State, and so on) and officials (e.g., Vice Chancellor of the University of East Anglia) “failed” only in their ostensible purpose. Their actual purpose centers on protecting the people who created or hired them (see The Dictator’s Handbook). At this they succeeded, but suffered a large loss of credibility. To me, Climategate is the story of how two people — Steve McIntyre and the hacker of the Climategate emails — both with zero official standing, had a huge effect on worldwide public discourse. (A Google search for Climategate returns about 2 million hits.) They exposed dishonesty in powerful and heretofore respected people (science professors) on a matter far more important than expense accounts. They pushed the rest of us a non-trivial distance toward seeing the truth. I didn’t know that was possible, and I’m glad it is.

Sleeping Pills are Very Dangerous

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Do you know how dangerous prescription sleeping pills are? I didn’t, and I do sleep research.

I came across Dr. Daniel Kripke’s book Dark Side of Sleeping Pills while finishing yesterday’s post on undisclosed risks of medical treatments. I had written an almost-complete draft a year ago. One line in the draft said “undisclosed risks of sleeping pills” with no additional information. I couldn’t remember why I’d written that so I googled “dangers of sleeping pills” and found Dr. Kripke’s book. I was unaware the evidence was so strong. I asked Dr. Kripke to tell the story of how he came to write it. He replied:

It is almost a life-long story.

As a young psychiatrist, I learned that the American Cancer Society had done a questionnaire survey of a million people which showed mortality related to long and short sleep. [People who sleep less or more than average have higher death rates.] In 1975, I asked if they would collaborate with me on a more complete analysis of the data on sleep length and insomnia. As a control variable, we included analysis of their one question about sleeping pill use. To my surprise, it looked like sleeping pill use was a strong predictor of early death, while insomnia was not (if you controlled for sleeping pill use by insomniacs).

There were many reasons why these results needed further study, so I asked if I could refine the questions for the new Cancer Prevention Study II (CPSII) which the American Cancer Society commenced in 1982 with 1.1 million participants. Imagine my surprise when I observed that sleeping pill use was associated with a comparable mortality hazard ratio as cigarette smoking! These studies, and about 20 more done all over the world with similar results, had two important limitations: in general, the studies did not identify the sleeping pills used and did not measure whether those taking sleeping pills at the start of the study continued the drugs, or whether those who were not taking sleeping pills (the comparison group) started taking them. So another study was needed.

Meanwhile, sleeping pills were never my main scientific concern. I was mainly interested in bright light treatment of depression and trying to understand how light worked. When I saw that patients needed information about light treatment, I wrote a very short book called “Brighten Your Life”, but it wasn’t long enough to publish, so I added information about sleeping pills to make it longer. When we found no publisher for the book, I made the information available at two web sites: www.BrightenYourLife.info and www.DarkSideOfSleepingPills.com. I found that the web site about sleeping pills was more popular than the advice about light treatment–indeed, one of the most popular sources about sleeping pills at Google. Therefore, over the years, I have worked to revise and update both web sites to try to help patients. It costs some money to program and maintain the web sites, but people write me to tell me how they have benefited. I see so much misinformation coming from the drug companies that I want people to have an alternative source.

Five or six years ago, my friend Dr. Bob Langer was working at the Geisinger Health Research Center, which had access to electronic health records about sleeping pill use from a large number of people. It took us five years to plan a study, obtain approval from ethics committees, retrieve the complex data from computer files in anonymized form, and analyze the very complex results. When these were published by the medical journal BMJ Open, the new information became available at https://bmjopen.bmj.com/content/2/1/e000850.full. It is an interesting web site which includes more data in a supplement to the main article and some comments and debate about the article. The interest in the article was world-wide, with stories on the BBC, at Agence France Press, in major newspapers in Japan, India, and China, and even mentions in far-off places like Myanmar and Ruanda. The new data showed that people taking drugs such as zolpidem and temazepam had about 4.6 times the mortality rate of people of the same age and sex who took no sleeping pills. The new data confirm that sleeping pills might cause as much death as cigarettes, and also some cancer, so I feel a big responsibility to make the information available. There may be hundreds of thousands of lives at stake. People need to know that sleeping pills are too risky to use, and I wish I had more help in telling people.

Recently we updated the Dark Side Of Sleeping Pills and Brighten Your Life and made them available together in a Kindle book, which is easy to purchase at Amazon and read off-line. The books have some new information which we have not yet had a chance to put in the web sites.

Even with, now, more than 20 scientific papers showing that taking sleeping pills is associated with more death and more cancer, many people don’t believe it. They imagine there is some other explanation, though nobody has been able to demonstrate an alternative explanation. Of course, statistical association is not quite the same thing as proof of causality, but if it is good enough for the American Cancer Society to advise avoiding cigarettes, it is enough evidence of risk to stay away from sleeping pills, in my opinion. The problem is that the drug companies have never done a controlled trial study large enough to prove one way or another whether the sleeping pills cause death and cancer, and I think they never will. The cigarette companies have never tried to prove that cigarettes are safe, and they know better than to try. It is the same. Whereas the FDA requires the very large studies for heart and diabetes drugs and so forth, the FDA has dropped the ball with sleeping pills. For more information about that, please see the Kindle book. There is, however, a new alternative to large, expensive, and dangerous controlled trials called a Mendelian randomization study, which uses the new genetic methods to determine causality when a genetic variation causes a risk factor such as sleeping pill usage. Since the genetic data already exist to do the Mendelian randomization studies, it is a matter of doing the difficult statistical analyses. I hope scientific colleagues will join in this task, because I can’t do it by myself. It is crucial to determine for sure the risks of sleeping pills. Too many lives are at stake.

Sleeping pills are astonishingly dangerous for something that is treated as more or less safe. In some cases, they are associated with a five-fold increase in death rate after only a few years of use. Cigarette smoking is associated with only a two- or three-fold increase in death rate after long use. And doctors don’t prescribe cigarettes. Is there anything else treated as safe that is associated with such a large increase in death rate? I can’t think of anything.

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Thanks to Dave Lull.

Interview with Doron Weber, Author of Immortal Bird, About What He Learned From a Hospital Tragedy

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Immortal Bird by Doron Weber, a program director at the Sloan Foundation, is about his son, Damon, who had a rare medical condition, and his son’s heart transplant operation (cost = $500,000) at New York Presbyterian/Columbia University Medical Center. Damon died after the operation. The post-operative care was so bad his father sued. “Three years into the lawsuit, the medical director [of the hospital] claimed Damon’s post-op records couldn’t be located,” said the New York Times.

How can such tragedies be prevented? To find out, I interviewed Doron Weber by email.

SETH Let’s say someone lives in a different part of the country — Los Angeles, for instance. What would you tell them about picking doctors to do a difficult expensive operation?

DORON I believe the key step before making any major medical decision is to gather as much information as possible. In my son’s case, we talked to everyone we knew at his regular New York hospital (New York Presbyterian) for their recommendation, and then we compared that information with experts at half a dozen other hospitals in New York and across the country who had a good reputation for his operation. I had established contacts at many of these hospitals, usually through physicians or scientists who I knew, either personally or professionally. But sometimes I would just get the name of a leading doctor and call him or her cold. They didn’t always respond but often they did, especially if you could make the case sound interesting. And I found that most doctors are very decent people who will try to share their knowledge, albeit succintly. I got the best results by being polite but determined and I didn’t require a long conversation–though some physicians were truly generous with their time–because in the end, you just want to know what they would do or who they would go see if it was their son or daughter.

I also traveled with my son to meet many of these experts at places like Children’s Hospital of Philadelphia, Boston Children’s, and the Mayo Clinic in Minnesota. During my son’s long illness, I found 3-4 key advisers–medical people who I respected and trusted, who would take my calls (one was my cousin, another the friend of a friend), and who were willing to work with me as my son’s case developed. These wonderful physicians would not just give intelligent medical advice seasoned by experience but they would send me the latest medical journals and articles for any possible leads. And they would direct me to other experts. Good people tend to know other good people.

If there was one mistake I made, it was to rely too much on data and statistics–they do matter, and they worked to extend and enhance my son’s life for several years–and not to listen to my own instincts. The physician whom I consider responsible for my son’s death–and against whom I have a still-pending lawsuit–was someone whom I had a bad feeling about from the start. (See Immortal Bird for examples.) But she had a great reputation, everyone kept extolling her and her hospital had the best outcome data for my son’s operation. Also my son wanted to stay at that hospital. So I suppressed my doubts and reservations and made the correct statistical calculation but a disastrous human one.

SETH What about screening doctors by asking about their legal record? For example, “Have you ever been sued for malpractice?” If so, going down the list of cases and learning about each one. And: “Have you ever been disciplined by a medical board?”

DORON Before my son’s wrongful death, despite all my information gathering, it never occurred to me to inquire about a physician’s legal record and whether he or she had ever been sued for malpractice. Now I know better. It would be very helpful to know if, and how many times, a physician has been sued before, even if it not definitive, because many doctors and hospital insurers settle out of court with strict confidentiality rules. But at least it gives you a preliminary context. And of course there are also frivolous lawsuits but if the same doctor was charged three times for the same alleged infraction, it is worth heeding. I have been most amazed at how many people, when I tell them about my medical lawsuit, describe how they or a loved one were horribly mistreated by a physician or hospital and came close to filing a lawsuit–but they didn’t go though with it because of the stress and the long, uphill battle and the years and expense involved. (Our own lawsuit has been active for six years but is on a contingency basis because we could not have afforded it otherwise.) Almost everyone has a personal hospital horror story–if a conversation ever flags, just bring up this subject–but most people shy away from challenging the hospital and the doctors with their big reputations and deep pockets. I also found people who did not understand that they had been mistreated because it was too painful to confront and they preferred to accept the hospital’s misleading explanation. I think beyond a record of being sued, every physician should have to post a record of all patient histories, which minimally would include diagnosis, length and type of treatment, and outcome for each case. In no other field does the consumer have less information on which to base a decision, and yet in no other field are the stakes so high.

SETH Based on your experience with your son, what are the first things we should change about our health care system?

DORON For me the greatest problem with our health care system is that it is no longer about health care but about the health business. Many hospitals have been taken over by private equity firms while even the non-profits are under pressure to reduce costs at the expense of patient outcomes. So I think we have to find a way to return the patient to the center of the health care system and ensure that everything else revolves around his or her well-being. Efficiency and controlling costs matters but health care is not just another business and should not be run by business managers. I like the Mayo Clinic model where doctors are under salary so can take their time and not worry about insurance and where physicians at the same hospital consult with one another and take a more holistic, multidisciplinary approach. I also think continuity of care is absolutely critical and each patient needs one assigned physician who will take full responsibility and oversight for his/her care and be held accountable, regardless of how many specialists or other doctors the patient sees.

Best Books of 2012

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In order of quality (best first):

1. The Dictator’s Handbook: Why Bad Behavior is Almost Always Good Politics (published 2011) by Bruce Bueno de Mesquita and Alastair Smith. The best book about political science I have read. A leader always needs supporters. The essential difference between dictatorships and democracies is how many. Full of data and examples that this view — the whole theory is a bit more complicated — explains. Econtalk interviews.

2. Antifragile: Things that Gain From Disorder by Nassim Taleb (copy sent me by author). Full of original ideas. It may be unprecedented that a serious thinker so anti-establishment has so loud a voice. Much of the book is about a generalization of hormesis, the observation that a small amount of Treatment X can be beneficial even though a large amount of Treatment X is deadly. For example, a small amount of smoking is probably good for you. Taleb goes beyond this to say that in some things, the hormetic benefit (the benefit from small amounts) is much larger than in other similar things. You can fulfill the same function (governance, banking, science) with a system where the entities benefit a lot from small shocks (which Taleb calls “anti-fragile”) or a system where the entities benefit not at all from small shocks. Systems where small shocks cause benefits tend to suffer less when exposed to large shocks. In my personal science, I have benefited a lot from day-to-day changes in my life (e.g., it led me to discover that butter improves my brain function and flaxseed oil improves my balance). In large science, day-to-day variation is only harmful. The core idea is that hormesis-like dose-response functions exist outside of the drug/poison/mice/rat/health experiments in which they were discovered.

3. Confessions of a Microfinance Heretic: How Microlending Lost Its Way and Betrayed the Poor by Hugh Sinclair (copy sent me by publisher). By “microfinance” he means microcredit. Sinclair convinced me that the belief that microcredit is a wonderful thing for poor people is one of the big delusions of our time. It is a wonderful thing only for the institutions that give it out (at exorbitant interest rates, usually). Sinclair sums it up like this (pp. 217-8): “Give a man a fish and he’ll eat for a day. Give a woman a microcredit loan to buy a fishing boat, and the CEOs of the MFI [microfinance institute] and the microfinance funds will eat for a lifetime.” Sinclair continues: “There is too much at stake [for the CEO’s] to allow any genuine scrutiny.”