Category: health care

Winter Swimming

Seth Roberts8 Comments

In Jilin Province, where it gets very cold in the winter, the older residents engage in winter swimming. It’s good for their health, they say. Everyone knows this, a friend of mine who grew up there told me. On TV, she once saw an old woman say that she was having heart problems, but once she started winter swimming they got better.

When he was a grad student at Harvard, a friend of mine raised rats to be in learning experiments. He found that if he handled the rats — stressing them, essentially — they grew larger and healthier than unstressed rats.

The cosmic ray effect I mentioned earlier — that trees grow more when there is more cosmic radiation — occurred with older trees but not younger trees.

If you’ve ever designed an experiment, you know that both the treatment and the measurement need to be neither too high nor too low. With the treatment, that’s obvious. I suspect all three of these phenomena are examples of positioning the measurement appropriately. They suggest that everyone needs some sort of stress to be in the best health, but only in certain situations is it easy to see this.

How Effective are Flu Vaccines?

Seth Roberts4 Comments

An article in The Atlantic, based on research by Lisa Jackson, questions the conclusion that flu vaccines work. Here is the essence of her argument from a letter to the editor by Jackson and others in The New England Journal of Medicine:

In an 8-year study of a similar population of members of a health maintenance organization, we found risk reductions among vaccinated elderly persons during the influenza season to be essentially identical to those reported by Nichol et al. (Table 1).1 However, we also found even greater reductions before the influenza season.

Emphasis added. The lack of specificity suggests that those who get vaccinated are in better health to begin with than those that don’t. Other comparisons supported this conclusion.
Thanks to JR Minkel.

Interview with Professor David Jentsch about Not Taking Drug Company Money

Seth Roberts3 Comments

Dr. J. David Jentsch is a professor of psychology at UCLA; his research area is psychopharmacology. I contacted him because Aaron Blaisdell told me that he had decided to stop accepting research money from drug companies. This is unusual; I wondered why.

1. What is your research about? What portions of it have been funded by drug-company money?

My own research over the past 12 years has focused on the etiology of mental disorders (how genetic factors influence brain chemistry and behavioral functions) and how psychoactive substances work to normalize behavior through working on those very pathophysiological mechanisms. In particular, I study the brain systems and molecular pathways in control of cognitive functions, with a very specific focus on using that knowledge to generate insights about cognitive enhancement for schizophrenia, addictions and AD/HD. I study rodents and primates.

I have received funds from drug companies for two reasons. 1) The companies appreciated my work and funded efforts to discover new mechanisms that might inform what they ultimately did. 2) The companies provided funds to my laboratory so that I could investigate how novel potential candidate mechanisms that they developed influence cognition in laboratory models.

When one does work like I do, one wants to know that information learned is moving from the bench to the real world. That always requires a connection to a drug company — they make drugs/universities do not. That being said, I’ve always been of the opinion that having the best and most rigorous academic labs undertake these collaborations is in everyone’s best interest (the quality of the work is ensured). In my case, this was always a tiny part of what I did; therefore, the quality was good, my objectivity was unquestionable and the answers were certain.

Because top scientists are increasingly withdrawing from collaborative partnerships (in part because of the negative attitudes about them), this work gets left to less competitive scientists whose objectivity may be less clear because they rely upon this type of support more heavily. I think that is quite unfortunate.

2. How does one get drug-company money for research?

Generally speaking, a company representative approaches you because of your reputation and invites you to propose a study to accomplish a mutual goal (see my answer to #1 above). A study design is drawn up, circulated and discussed and finally approved.

3. How much easier is it to get drug-company money than to money from other sources (for the same research)?

It’s hard to say. Fewer people receive drug company funds. If a company is interested in your work and approaches you, it’s not that difficult to obtain the funds. But it is difficult to be recognized to do this kind of work.

4. When did you start getting drug-company money for your research? If you’re comfortable saying how much it has been over the years (per year), that would help clarify the implications of your decision.

As a graduate student, the laboratory in which I trained participated in some studies. As a faculty member myself, I have participated in two such efforts. The total amount of funding I have received from pharmaceutical companies in all my years at UCLA (a total of 8 years) is less than the budget I obtain in a single year on my RO1 grant. It is not an immense amount, and it certainly is not the kind of funding that I would need to sustain my research program.

Because of the negative perception of these sorts of activities, it is not worth continuing to engage in them. I don’t require those funding sources. That being said, I find it a bit unfortunate. Again, it’s in everyone’s best interest if the TOP scientists did those collaborations to ensure their quality and rigor. When I don’t do them, it is possible that a less objective party does. Second, every concept I have about novel treatments that isn’t pursued because of lack of such a relationship is a potential delay in moving basic science to real use.

5. What are some examples of how the animal-rights activists publicized and complained about your use of drug-company money?

After the bombing [his car was bombed in March 2009], statements were made on the web and in the press by animal rights groups saying that people such as me used animals needlessly in a drug-company-fueled manic process of animal killing in order to get rich. As I already mentioned, this is not the case, if only because people like me often have relatively few such grants, and their size is not large (again, usually not larger than a single year of funding on an RO1 grant). Because of this, I simply decided not to take any such grants in the future.

6. The car bombing (on top of other attacks) led to the decision to stop taking drug company money?

As you can discern from the fact that I only have accepted two such awards in 8 years, I already placed a good number of criteria on accepting them. I wanted them to be only projects that I considered to be of very high scientific merit, and I wanted them to be logically and obviously related to our broader research projects.

Additionally, there is already a good deal of “negative perception” of research funded by drug companies within academic circles, and so I had already batted around the question in my mind about whether I should accept further awards. When the extremist attack on me happened in March of this year (2009), I had not had such an award in some time. That was not because I had taken a decision about the matter – simply that I hadn’t found a situation I wanted to pursue. At that point, the decision solidified.

7. Your decision to not take drug company money — what effect do you think it will have or hope it will have?

I am certain a situation will arise where I will have an idea about a novel therapeutic based upon my research that I will be unable to pursue without such a relationship to a company. What is more, the compounds in development by companies are not being evaluated by me, so they may well be evaluated by someone with a little bit less rigor and objectivity.

I believe strongly that the academic enterprise gives a crucial “objective” check on novel therapeutics when leading scientists who are not “dependent” on drug company money examine them. The alternative is that others who are more dependent, and therefore less objective, will do it.

Med School Interview Questions

Seth Roberts1 Comment

Here is what Brent Pottenger was asked during a recent interview at USC medical school:

  • What drives/motivates you?
  • Describe a challenge you overcame?
  • Describe a fulfilling experience that made you want to be a physician?
  • Why USC?
  • What do you bring to the entering class?
  • What area of medicine are you interested in?
  • What would you do for health reform?
  • What do you do outside of school for fun?
  • If you could improve something about yourself, what would that be?
  • What are you looking for in a medical program?

The Price of an Unnecessary Operation

Seth Roberts2 Comments

A few years ago, a Berkeley surgeon named Eileen Consorti, to whom I was referred by my primary-care doctor, recommended that I have an operation to repair a hernia so small I couldn’t detect it. I have already written about how she kept saying there was evidence such operations were beneficial but as far as I can tell no such evidence exists. (Dr. Consorti has yet to provide the evidence she still seems to think exists.) Okay, she overstated benefits. What about costs?

During a conversation about whether the operation was a good idea, I said operations are dangerous. I didn’t want to have one unless there was a clear benefit. She replied that nobody had died from anesthesia during one of her operations. But of course death is only one of the things that can go wrong. It turns out the general category of bad things happening during anesthesia is called undesirable events and the rate of undesirable events has been measured. In this study, the rate was 100-150 undesirable events per 1000 hours of anesthesia. My operation was simple; I estimate it would have taken one hour. So my chances of having something bad happening to me as a result of an operation without any clear benefit to me — but considerable financial benefit to Dr. Consorti — was about 10%!

In a discussion of the costs and benefits of the operation, she didn’t tell me this.

How to Eliminate/Prevent a Skin Infection and What It Means (continued)

Seth Roberts15 Comments

A brief summary of my previous post is all I needed to do to cure/prevent a skin infection was buy more socks. Instead of buying 5 pairs every 6 months, buy 20 pairs every two years. That’s all. Costs nothing. No drugs. No special treatment of the socks. No special cycle on the washing machine. No following a hundred (or ten) instructions about how to avoid infection. Like my depressed friend, I had the reaction: Why didn’t my doctor tell me this? He didn’t tell me because he didn’t know, I realize. Why he didn’t know . . . is a harder question.

The whole practice of health care is called medicine, so focused is it on cure rather than prevention. There are medical schools, which turn out doctors. Schools of public health are the closest thing we have to schools based on prevention but they don’t even train nutritionists. Nor do they do experiments, in most cases. (They do little data collection besides epidemiology.) And they get much less money than medical schools. Scurvy and Vitamin C are the first examples of the new way of dealing with illness I’m talking about — finding the environmental deficiency and fixing that, which is inevitably extremely safe and extremely cheap. After the discovery of Vitamin C, similar examples were discovered and the broader term vitamin was coined. But I think there is a need for a similar term that includes non-vitamins. It would mean aspects of everyday life, food and non-food, that we need to be healthy.

Like Vitamin C, my discovery that more socks eliminates skin infection points to a cure/prevention agent that is perfectly safe and extremely cheap. So do all my posts about fermented foods. It costs basically nothing to let food ferment. You lose nothing and gain a lot. Yet bacteria are not vitamins — and it isn’t all bacteria we need, just the 99.999% that are harmless. (And other foreign stuff, like bee venom, can substitute for bacteria.) I began thinking there are non-food vitamin-like things (things we need to be healthy) when I discovered the effects of standing on sleep and morning faces on mood. So we need several things to sleep well, including morning light, and at least one thing for proper mood regulation. Insomnia and depression are non-infectious problems, like scurvy. We think of vitamins as preventing/curing non-infectious problems, so the analogy was obvious. And these examples (sleep and mood) involved the brain. So there were vitamins for the brain, you could say. But the socks/foot infection example and the fermented foods/many illnesses example both do not involve the brain and do involve infectious diseases and auto-immune diseases (which, although non-infectious, are quite different from scurvy). So the idea that there are bunch of extremely cheap, perfectly safe things we need to be healthy expands to cover more of health.

Vast amounts of money are spent on health research, much much more on the consequences of poor health, and truly incalculable suffering comes about because we don’t know what these things are. (Depression alone causes vast suffering. Now add to that poor sleep, autoimmune problems, much infectious disease . . . ) Yet because studying these things (a) will make money for no one, (b) won’t produce a steady stream of published papers and (c) is useful (= low status), they are nearly impossible to study.

How to Eliminate/Prevent a Skin Infection and What It Means

Seth Roberts32 Comments

Several years ago, during a routine checkup, my primary-care doctor pointed to some white lines on my right foot. (Curiously only one foot had them.) Fungus, he said. I had a fungus infection. What should I do? I asked. He suggested over-the-counter anti-foot-fungus medications, sold in every drugstore.

I tried a few of them. They didn’t work. The problem persisted.

A month ago I noticed the problem had gotten much worse. Yikes. What had gone wrong? I realized that in the previous few weeks I had changed two things:

  • Instead of putting my wash through an extra wash cycle without soap (to rinse it better), I had started doing my wash the way the rest of the world does it. I had stopped doing the extra cycle because I was no longer worried about becoming allergic to the soap.
  • I had bought 5 new pairs of socks and had been cycling though 4 of the new pairs again and again (washing them between wearings, of course), ignoring the rest of my socks.

This suggested a theory: My skin infection was due to my socks. The infectious agents get on my socks and are not completely removed by the washing machine. They survive a few days on the shelf. To wear socks with the infectious agent already present gives the infection a boost. Maybe my new socks supported the infectious agent better than the socks they replaced.

Based on this theory, I did three things:

  • Resumed putting my wash through an extra cycle without soap.
  • Took off my socks earlier in the evening.
  • Bought 12 new pairs of socks and made sure every sock went a long time (e.g., 3 weeks) between wearings.

I saw improvement right away. (The morning after I wore new socks.) A month later, the infection, present for at least several years, is entirely gone. It took about a month for it to clear up completely.

The essence of my discovery is that the infectious agent could survive my socks being washed conventionally (in a washing machine) and live for a few days without contact with my feet. Whereas a few weeks away from my skin killed it. I have been unable to find this info anywhere else. A very minor discovery, but unlike the work that won the most recent Nobel Prize in Medicine, useful right now. Cost: zero. I would have had to buy new socks anyway.

In Cities and the Wealth of Nations, Jane Jacobs tells about a reporter interviewing someone in an oil-rich Middle East country (Iran?). During the interview the interviewee tries to cut an apple with a knife. The knife breaks. We can’t even make knives, the interviewee says. That’s how backward our economy is. To develop economically, MIT professors had advised his country’s government to build a dam, at great expense. The MIT advisors thought that building a dam would be good for economic development. They were wrong, it turned out. Jacobs thought it was telling that after all that money invested, the local economy still couldn’t make something as basic as a good knife. Many industrial processes require cutting tools.

This is the same thing. Preventing and eliminating infection is at the core of medicine, just as cutting is at the core of manufacturing. My discovery reveals that my doctor — and by implication, the whole health care establishment — failed to know something basic and simple about this. If they understood what I figured out, there would be no need for anti-foot-fungus medicine. A gazillion dollars a year is spent on medical research, medical schools and research institutes around the world are full of faculty doing research — and they haven’t figured out something as basic and simple as this.
Gatekeeper Drugs. How to Avoid Infection: Something I Didn’t Know.

Rent Seeking and Our Health-Care System

Seth Roberts3 Comments

Does our health-care system (including researchers) engage in rent-seeking when they ignore simple cheap remedies, including prevention?

Here’s a simple example of rent-seeking. Some friends and I went to visit the Great Wall. On the path up to the wall was a man sitting in a chair. He demanded 30 cents to let us pass. There was no gate. He wasn’t a government official — just a man and a chair. There was a path to a goal. It was blocked unless we paid.

In the case of health there are many paths to the goal. Many ways to become healthier — many ways to relieve depression, for example. Prevention is one way, cure another. There are cheap cures and expensive cures. By ignoring prevention and cheap cures, the profession of psychiatry is blocking those paths (by failing to clear them) and thereby forcing us to take their expensive path (dangerous drugs), usage of which they control. It’s more subtle than the man with the chair but it amounts to the same thing.

Rent-seeking is annoying. I was annoyed by the man in the chair. The rent-seeking of our health-care system is disguised, not easy to make out. This makes it less of problem for health-care professionals, such as doctors; I think few people are aware of it. (For example, most people with acne don’t realize it is probably caused by their food.) But my friend with depression was annoyed, deeply annoyed, when he learned of a simple cheap (partial) solution to his problem.

Gatekeeper Drugs: Drugs that Require Gatekeepers

Seth Roberts8 Comments

A friend of mine suffered from depression. Like so many depressed persons, he went to sleep very late — maybe 3 am. I told him that was a very bad sign, no one should go to sleep that late. He starting going to sleep earlier and waking up earlier and felt better. He wondered why none of the many psychologists and psychiatrists he’d seen about his problem had told him what I said. The first time he asked I think my answer was that I cared more than they did about the relation of depression and sleep.

Recently he asked again: Why didn’t they tell him something so simple and helpful? Maybe I learned something in the intervening years because my answer was different. I said all health care professionals — not just doctors, all therapists/healers, mainstream, alternative, Western, non-Western — have no interest in treatments that they are not needed to administer. If all you need to do is to get up earlier in the morning, you don’t need a psychiatrist. Therefore a psychiatrist won’t tell you to do that. The only advice they are likely to give is advice they are needed to administer.

I could give dozens of examples. Does the Chinese herbalist tell my friend with an infection to eat fermented foods to boost his immune system? No, because that wouldn’t involve the herbalist. Instead he prescribes herbs that probably do the same thing. Does a dermatologist tell a teenager that his acne is caused by diet? No, dermatologists make the absurd claim that diet isn’t involved. Because if it were you wouldn’t need them. You’d just figure out what foods are causing your acne, and avoid those foods. Why do medical schools fail to teach nutrition? Because you don’t need a doctor to eat better. Why is prevention almost completely ignored? Because prevention doesn’t require any gatekeepers.

The economic term is rent seeking: health care professionals act in ways that require you to pay them. The usual economic examples of rent-seeking cause a kind of overhead you have to pay but the rent-seeking engaged in by the entire health care industry shortens our lives. Simple cheap safe solutions are ignored in favor of expensive and dangerous ones that don’t work as well. Our entire health system centers on gatekeeper drugs: drugs that require gatekeepers. The usual name is prescription drugs; their danger is part of their appeal to the doctors that prescribe them. Because it makes the doctor necessary.

What the Government — Any Government — Isn’t Telling You About Swine Flu

Seth Roberts13 Comments

How weak it is:

By any measure A/H1N1 is a benign flu virus. According to official statements, New Zealand, for example, usually has 400 deaths from flu each year. This year there were 17, so it could be argued that the pandemic has resulted in 383 lives being saved, which makes it more effective than any flu vaccine.

It is always good politics to scare people. Create a danger from which you protect them. It’s such an old and common ploy it’s curious how well it still works. Maybe the gullibility is hard-wired.