Category: health care

Assorted Links

Seth Roberts3 Comments

Thanks to Brent Pottenger, Phil Alexander, dearime, and Casey Manion.

No Cheap Remedies: A Guiding Principle of Modern Health Care

Seth Roberts21 Comments

I blogged earlier that a guiding principle of our health care system is first, let them get sick. Show no interest in prevention or environmental causes, thus ensuring that people will get sick and become desperate for remedies, which you (health care provider) can charge lots of money for. An example of the disinterest in prevention is that schools of public health, which do considerable prevention research, get a tiny fraction (1%?) of the money spent on medical schools, which never do prevention research. As they say, an ounce of prevention is worth a pound of cure — and the government and other powerful players invest exactly the opposite of what this common-sense wisdom implies. You know the term war profiteering. Modern heath care is sick profiteering.

It is profiteering, not ignorance, because another guiding principle of modern health care is no cheap remedies. Along with zero interest in prevention, there is zero interest in cheap remedies, such as dietary ones. Doctors usually prescribe drugs or surgery. Both are expensive. Surely doctors are intelligent, but this principle makes them look stupid: They ignore or dismiss cheap remedies, no matter what. At Boing Boing I wrote about two examples. Sarah suffered from frequent migraines. Her doctors wanted to try one drug after another and do expensive tests. No matter how useless the tests and drugs — Sarah tried 30 drugs — her doctors acted unaware of other possibilities, such as looking for environmental triggers. Reid Kimball, who had Crohn’s Disease, found a diet that worked. He told a UCSF doctor how well it worked. I don’t think you can manage Crohn’s with diet, said the doctor. As if he hadn’t understood what Reid had said.

My self-experimentation is a reaction to this state of affairs. It is a way to test cheap remedies. I started self-experimentation about sleep (I woke up too early) because I knew a doctor would simply prescribe a drug. I didn’t want to take a drug for the rest of my life. You cannot easily do self-experimentation on prevention (e.g., compare how many colds you get with Regimen A versus Regimen B) but, no surprise, there is great overlap between cheap remedies and prevention. I found various cheap safe ways to sleep better — and I stopped getting colds. Not only does omega-3 make my brain work better, it prevents gum disease. I eat butter to make my brain work better, and I suspect it prevents heart attacks. What’s that? Someone told you butter is evil? That’s another consequence of our deeply messed-up health care system: When the people at the center of the system, the ones with the most power and prestige, promote twisted self-serving ideas (e.g., Harvard psychiatry professor Joseph Biederman and his advocacy of giving powerful drugs to six-year-olds), these ideas spread outward to everyone else, who believe and repeat them. I was no different. When my self-experimentation starting reaching conclusions utterly different than what I’d been told (e.g., I found that breakfast is bad and sugar can cause weight loss, I was stunned. I’d heard a thousand times that breakfast is good and sugar is fattening.

Gatekeeper syndrome.

Assorted Links

Seth Roberts2 Comments

  • Interview with me on Jimmy Moore’s Livin’ La Vida Locarb
  • This article about natto helped its author win a prize for best newspaper food column
  • great QS talk about self-measurement by John Sumser. “It all started when I quit smoking. Bad idea. Since I quit smoking in 2004, every quarter for 7 years it has rained shit on me.”
  • In a QS talk, I compare the Quantified Self movement and the paleo movement.
  • Chinese high-school students in America: Not what was promised. Lack of “rigor” has benefits, as I have blogged: “Dismayed by the school’s [poor] college placement record, Chen considered transferring. Instead, he began to enjoy himself. Because his courses were undemanding, he had time for friends and outside interests. He took four Advanced Placement tests on his own.“I’ve developed my personality a lot,” Chen said. “Everything turned out for the best.””
  • If you read The China Study by T. Colin Campbell, a pro-vegetarian book, you may remember the big role played by some casein experiments with rats. Rats that ate a low-casein (= low animal-protein) diet were supposedly in better health than rats that ate a high-casein (= high animal-protein) diet. In this article Chris Masterjohn shows how misleading that was. “One thing is certain: low-protein diets depressed normal growth, increased the susceptibility to many toxins, killed toxin-exposed animals earlier, induced fatty liver, and increased the development of pre-cancerous lesions when fed during the initiation period of chemical carcinogenesis.”

Thanks to Janet Chang.

Grandmother Knows Best About Crohn’s Disease

Seth Roberts24 Comments

On Boing Boing a post by me tell about a man who cured himself of Crohn’s Disease mainly by following what is called The Specific Carbohydrate Diet. He got the idea from his grandmother, who heard about it on the radio. The diet is about eighty years old. The version he used appeared in a book published in 1994 — 17 years ago. Still no clinical trial.

As I’ve said, if you have managed to cure yourself of a serious medical condition please let me know. I would like to learn from your experience and help others learn from it.

Let Them Get Sick (running)

Seth Roberts14 Comments

I wrote recently about how our health care system resembles a protection racket. In a protection racket, you or someone else threatens people so that you can make money protecting them. Modern health care, especially in America, ignores prevention. It says let them get sick. Let the general public get sick so that we (health care providers) can make money treating them.

The profitability of let them get sick is illustrated by some numbers in Run Barefoot Run Healthy, a new book by Ashish Mukharji (who gave me a copy). Ashish has run several marathons. Before he started running barefoot, running caused all sorts of problems. To deal with them was costly:

  • Two or three pairs of orthotics (a type of insole): $200-$300 each.
  • One MRI, for what turned out to be ITBS (Iliotibial Band Syndrome, a thigh injury): around $1,000.
  • Twenty or more deep-tissue massage treatments for ITBS: around $80 each.
  • Corns removed (twice): $500 per treatment.
  • Twenty or more sessions of physical therapy for ITBS and Achilles tendonitis: $100-$250 per session.
  • Several visits to orthopedists and podiatrists: $150 per visit.
  • Cortisone injection for plantar fasciitis: $200.

Since he started barefoot running (3 years and 2 marathons ago), he has incurred no (zero) running-injury expenses. Interviews with other barefoot runners convince him this is typical. Long ago a runner friend of mine told me everyone who runs eventually hurts themselves. The truth of this was confirmed many times by runners I met after she said this. Now it appears she was right because all the runners she and I knew wore shoes.

I started barefoot running/walking on my treadmill a year ago. I have never had running injuries (probably because I walk — uphill fast — much more than run). Going barefoot saved time. During the first few months, I got four or five cuts (actually, splits) on the sides of my feet. The skin was split by downward pressure. The cuts made ordinary walking (in shoes) a little unpleasant. I did nothing about them. They healed and have not recurred.

A better health care system would have discovered the damage caused by running shoes long ago. We are lucky to live when personal scientists such as Ashish can figure out the truth themselves and tell others.

Cheap Safe Remedies: Oatmeal (Cholesterol) & Deep Breathing (Blood Pressure)

Seth Roberts7 Comments

A friend who lives in New York City writes:

The doctor I had when I lived in San Diego believed in always trying the gentlest and simplest remedies before resorting to anything as drastic as drugs or surgery. My cholesterol was high and she suggested I try lowering it by eating oatmeal for breakfast every day, saying it didn’t work for everybody but a lot of her patients had been able to avoid going on statins that way. “But I hate oatmeal,” I whined, like a sulky child. She said perhaps I would get used to it; wouldn’t it be better than being dependent on medications for the rest of my life? So, reluctantly, I bought some Quaker Oats and gave it a try. The results were dramatic — my cholesterol numbers were “perfect” the next time I had a blood test. Dr. Yu was right about getting used to oatmeal, too — I actually like it now, and look forward to my daily bowl.

Perhaps inspired by my success with the oatmeal, I also lowered my blood pressure myself, through breathing exercises. A friend who is into alternative medicine had told me about being advised by several of her alternative-medicine practitioners to try lowering her blood pressure in that way, so when mine was high, I just googled about lowering it until I found a site that offered free demo clips of a kind of breathing exercise geared to music — you can choose whether classical or new age. As it said on the site, they don’t work for everybody, and most people have to do them for twenty minutes daily for a couple of weeks before the benefits begin showing up at all, but some lucky folks see an immediate and drastic drop in blood pressure the first time they try. I turned out to be one of the lucky ones. For months, I did the breathing exercises daily, cued to inhale and exhale by their demo tapes, and my blood pressure stayed down. Eventually i even sprang for the CD set they were selling on the site, just because I got sick of hearing those same melodies on the free demo clips over and over. Now I’ve internalized the rhythms so I don’t need any music at all to cue me, and I can do the exercises anywhere, while doing other things, and my blood pressure has remained low. I do notice that if I ever neglect the exercises, when my life gets busy and I just forget to do them, it starts creeping up again — which is good incentive to keep them up. Basically, the exercises just consist of inhaling to a slow count of 8 and exhaling to a slow count of 16, and doing that for about 20 minutes every day. My blood pressure was around 160/90 before I started the exercises. Now it’s 120/80, just as it should be.

I also find the breathing exercises very soothing, in general. When I’m upset about something like, say, being stuck on a slow bus that is crawling through traffic while I’m in danger of being late to something and am surrounded by screeching children, I find that doing those exercises enables me to be reasonably serene and philosophical instead of miserable and angry and anxious.

Notice that by measuring her blood pressure regularly my friend (a) learned how to control it and (b) collected excellent evidence that breathing exercises help. Because individuals can easily collect such evidence — my friend did so by being lazy — a good response to “where’s the double-blind randomized trial?” is Mark Frauenfelder’s: Big Brother loves you.

First, Let Them Get Sick

Seth Roberts18 Comments

In Cities and the Wealth of Nations, Jane Jacobs tells how, in the 1920s, one of her aunts moved to an isolated North Carolina village to, among other things, have a church built. The aunt suggested to the villagers that the church be built out of the large stones in a nearby river. The villagers scoffed: Impossible. They had not just forgotten how to build with stone, they had forgotten it was possible.

A similar forgetting has taken place among influential Western intellectuals — the people whose words you read every day. Recently I wrote about why health care is so expensive. One reason is that the central principle of our health care is not the meaningless advertising slogan promoted by doctors (“first, do no harm”) but rather the entirely nasty first, let them get sick. Let people get sick. Then we (doctors, etc.) can make money from them. This is actually how the system works.

It is no surprise that doctors and others within the health care system take the first, let them get sick approach. It is wholly in their self-interest. It is how they get paid. If nobody got Disease X, specialists in Disease X would go out of business. What is interesting is that outsiders take the first, let them get sick attitude for granted. It is not at all in their self-interest, just as it was not at all in the self-interest of the Carolina villagers to think building with stones impossible.

An example of an outsider taking first, let them get sick for granted is a recent article in the London Review of Books by John Meeks, an excellent writer (except for this blind spot). The article is about the commercialization of the National Health System. Much of it is about hip replacements. How modern hip replacements were invented. Their inventor, John Charnley. How a hospital that specialized in hip replacements (the Cheshire and Merseyside NHS Treatment Centre) went out of business. And so on. Nothing, not one word, is said about the possibility of prevention. About figuring out why people come to need hip replacements and how they might change their lives so that they don’t. Sure, a surgeon (John Charnley) is unlikely to think or say or do anything about prevention. That’s not his job. But John Meeks, the author of the article, is outside the system. He is perfectly capable of grasping the possibility of prevention and the parasitic nature of a system that ignores it. Long ago, people understood that prevention was possible. As Weston Price documents, for example, isolated Swiss villagers knew they needed small amounts of seafood to stay healthy. But Meeks — and those whom he listens to and reads — have forgotten.

Why is Health Care So Expensive?

Seth Roberts21 Comments

Because health care costs have been increasing faster than other costs for a long time. Everyone knows that. But why is that happening? Not so clear. This excellent article (via Marginal Revolution) says that health care is not subject to the same pressures as industries where costs have come down. Off-shore manufacturing is one such pressure. For example, a cell phone used in California can easily be made in China. In contrast, the health care a person in California is likely to want (e.g., X-rays, check-ups) must be supplied locally.

Let me suggest other reasons:

1. A large fraction of medical school professors are co-opted by industry. They get lots of money from health care companies. The companies have no interest in cutting costs. They fund research by medical school professors for exactly one reason: to sell more product.

2. The average medical school professor has little idea how to do research. Recently I mentioned a study in which they threw away half of their data. An article about the Potti scandal revealed that Potti’s main co-author, Dr. Nevins, essentially confessed he didn’t understand the research in the papers he had co-authored with Potti. As far as I can tell, medical school professors usually know so little statistics they cannot analyze the data from the studies they do. If you don’t understand how to do research, innovation will be difficult.

But I think the bigger and less obvious reasons are these:

3. The health-care supply chain is long. Some medical school professors can innovate — Peter Provonost, for example. But they face a special problem: the enormous health-care supply chain. It includes doctors, nurses, hospital workers, drug company employees, health insurance employees, medical equipment manufacturers, alternative medicine practitioners, psychotherapists, X-ray techs, health food store employees, and on and on. No other industry is like this. No one in the supply chain can innovate, yet all of them can block innovation. Everyone in the health-care supply chain must be paid. They care enormously about being paid. They hate to take a pay cut. Any innovation — unless it increases the cost of health care — threatens their paycheck. So there is a huge bias in favor of change that increases cost and a huge bias against change that decreases costs.

4. Let them get sick. If a man is not afraid, you cannot sell him protection. This is why protection rackets have two parts: (a) threat followed by (b) offer of (expensive) protection. Modern health care workers understand a similar truth: If a person is not sick, you cannot sell him (expensive) health care. Modern health care workers do not actively make people sick, they let a dysfunctional research system do that. (E.g., cluelessness about how to stimulate the immune system.) Then they pounce — and the money starts to flow. Once the money starts flowing, political power builds up. In a sane world, schools of public health, which care about prevention, would receive vastly more money than medical schools, which ignore prevention. In fact, the opposite is true.

This is why personal science will be so important: It is a way around our massively-dysfunctional health-care system — dysfunctional, that is, for everyone outside it.

 

Assorted Links

Seth Roberts16 Comments

Thanks to Peter Spero and Alex Chernavsky.

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

Seth Roberts16 Comments

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.