Category: ignorance

“A Debt-Ceiling Breach Would be Very, Very, Very Bad”

Seth Roberts5 Comments

At the end of an article by Kevin Roose in New York about the effects of a debt-ceiling breach:

The bottom line: A debt-ceiling breach would be very, very, very bad.

Keep in mind that these are all hypothetical scenarios. Reality could be better, or much worse. The truth is that while we sort of know what a government shutdown would look like (since it’s happened in the past), we have no idea what chaos a debt-ceiling breach could bring. If, in a month, we reach the X Date, run out of money, and are stuck in political stalemate, we’ll be entering truly uncharted waters. And we’ll be dealing our already-fragile economy what could amount to a knockout blow.

This is an example of something common: Someone who has never correctly predicted anything (in this case, Roose) telling the rest of us what will happen with certainty. If Roose is repeating what experts told him, he should have said who, and their track record. Roose is far from the only person making scary predictions without any evidence he can do better than chance. Here is another example by Derek Thompson in The Atlantic.

The same thing happens with climate change, except that it is models, not people, making predictions. Models that have never predicted climate correctly — for example, none predicted the current pause in warming — are assumed to predict climate correctly. We are supposed to be really alarmed by their predictions. This makes no sense, but there it is. Hal Pashler and I wrote about this problem in psychology.

A third example is the 2008 financial crisis. People who failed to predict the crisis were put in charge of fixing it. By failing to predict the crisis, they showed they didn’t understand what caused it. It is transparently unwise to have your car fixed by someone who doesn’t understand how cars work, but that’s what happened. Only Nassim Taleb seems to have emphasized this. We expect scary predictions based on nothing from religious leaders — that’s where the word apocalypse comes from. From journalists and the experts they rely on, not so attractive.

I don’t know what will happen if there is a debt-ceiling breach. But at least I don’t claim to (“very very very bad”). And at least I am aware of a possibility that Roose (and presumably the experts he consulted) don’t seem to have thought of. A system is badly designed if a relatively-likely event (debt-ceiling breach) can cause disaster — as Roose claims. The apocalyptic possibilities give those in control of whether that event happens (e.g., Republican leaders in Congress) too much power — the power to scare credulous people. If there is a breach, we will find out what happens. If a poorly-built system falls down, it will be much easier to build a better one. Roose and other doom-sayers fail to see there are plausible arguments on both sides.

Assorted Links

Seth Roberts8 Comments
  • How little is known about tinnitus
  • Michael Lewis on Greg Smith’s book. Published months ago. “The dystopia often imagined in the world of artificial intelligence—in which computers somehow take on a life of their own and come to rule mankind—has actually happened in the world of finance. The giant Wall Street firms have taken on lives of their own, beyond human control. The people flow into and out of them but have only incidental effect on their direction and behavior.”
  • The price of admission to the Chinese Academy of Sciences. “Businessmen seeking ministry contracts learned of Zhang’s nomination and offered to help. . . . Zhang, using a slush fund provided by the businessmen, cloistered 30 experts from mostly ministry-affiliated universities and research institutes in a hotel for 2 months, during which time they churned out three books on high-speed rail technology that were credited to Zhang.”
  • Why was Matthew Shepard killed? I have not yet read this book (I will) but it sounds so good I am happy to publicize it before that. It is being ignored. It supports a theme of Ron Unz and this blog, that lots of what we are told is wrong.
  • Someone leaving graduate school at École polytechnique fédérale de Lausanne explains why he is leaving only a few months before finishing his Ph.d. His complaints about professional (academic) science resemble mine — for example, the dominant role of will this help my career? in all decisions.

Thanks to Joyce Cohen and Allan Jackson.

What Goes Unsaid: Self-Serving Health Research

Seth Roberts13 Comments

“The realization that the world is often quite different from what is presented in our leading newspapers and magazines is not an easy conclusion for most educated Americans to accept,” writes Ron Unz. He’s right. He provides several examples of the difference between reality and what we are told. In finance, there are Bernie Madoff and Enron. Huge frauds are supposed to be detected. In geopolitics, there is the Iraq War. Saddam Hussein’s Baathists and al-Quada were enemies. Invading Iraq because of 9/11 made as much sense as attacking “China in retaliation for Pearl Harbor” — a point rarely made before the war. In these cases, the national media wasn’t factually wrong. No one said Madoff wasn’t running a Ponzi scheme. The problem is that something important wasn’t said. No one said Madoff was running a Ponzi scheme.

This is how the best journalists (e.g., at The New Yorker and the New York Times) get it wrong — so wrong that “best” may be the wrong word. In the case of health, what is omitted from the usual coverage has great consequences. Health journalists fail to point out the self-serving nature of health research, the way it helps researchers at the expense of the rest of us.

The recent Health issue of the New York Times Magazine has an example. An article by Peggy Orenstein about breast cancer, meant to be critical of current practice, goes on and on about how screening has not had the promised payoff. As has been widely noted. What Orenstein fails to understand is that the total emphasis on screening was a terrible mistake to begin with. Before screening was tried, it was hard to know whether it would fail or succeed; it was worth trying, absolutely. But it was always entirely possible that it would fail — as it has. A better research program would have split the funds 50/50 between screening and lifestyle-focused prevention research.

The United States has the highest breast cancer incidence (age-adjusted) rates in the world — about 120 per 100,000 women, in contrast to 20-30 per 100,000 women in poor countries. This implies that lifestyle changes can produce big improvements. Orenstein doesn’t say this. She fails to ask why the Komen Foundation has totally emphasized cure (“race for the cure”) over prevention due to lifestyle change. In a long piece, here is all she says about lifestyle-focused prevention:

Many [scientists and advocates] brought up the meager funding for work on prevention. In February, for instance, a Congressional panel made up of advocates, scientists and government officials called for increasing the share of resources spent studying environmental links to breast cancer. They defined the term liberally to include behaviors like alcohol consumption, exposure to chemicals, radiation and socioeconomic disparities.

Nothing about how the “meager funding” was and is a huge mistake. Xeni Jardin of Boing Boing called Orenstein’s article “ a hell of a piece“. Fran Visco, the president of the National Breast Cancer Coalition, praised Orenstein’s piece and wrote about preventing breast research via a vaccine. Jardin and Visco, like Orenstein, failed to see the elephant in the room.

Almost all breast-cancer research money has gone to medical school professors (most of whom are men). They don’t do lifestyle research, which is low-tech. They do high-tech cure research. Breast cancer screening, which is high-tech, agrees with their overall focus. High-tech research wins Nobel Prizes, low-tech research does not. For example, those who discovered that smoking causes lung cancer never got a Nobel Prize. Health journalists, most of whom are women, apparently fail to see and definitely fail to write how they (and all women) are harmed by this allocation of research effort. The allocation helps the careers of the researchers (medical school professors); it hurts anyone who might get breast cancer.

Myopia Increases Innovation

Seth Roberts9 Comments

Big public works projects inevitably cost far more than the original budget. I heard a talk about this a few years ago. The speaker gave many examples, including Boston’s Big Dig. His explanation was that these projects would not be approved if voters were told the truth. The German newspaper magazine Der Spiegel has just published an interview with several architects responsible for recent German projects with especially large discrepancies between what people were told at the beginning and the unfolding reality — Berlin’s new airport, for example. The article’s headline calls them “debacles”. One architect gives the same explanation as the speaker I heard: “The pure truth doesn’t get you far in this business. The opera house in Sydney would never have been approved if they had known how much it would cost from the start.”

I disagree. I see the same massive underestimation of time and effort in projects that I do and that my colleagues and friends do, projects we do for ourselves that require no one’s approval. I think something will take an hour. It takes five hours. Plainly the world is more complicated than our mental model of it, sure, but there is more to it than that. Someone did a survey of people in Maryland who had been in a car accident so bad they had had to go to the hospital. Within only a year, a large fraction of them (half?) had forgotten about it. When asked if within the last year they had had an accident so bad they were hospitalized, they said no. Apparently we forget difficulties, even extreme ones, really fast. If you forget difficulties, you will underestimate them.

If I had realized how difficult everything would be, I couldn’t have done any of it is one explanation, which I’ve heard attributed to Gregory Bateson. From Malcolm Gladwell’s excellent review in this week’s New Yorker of a biography of Albert Hirschman, the economist, I learned that Hirschman — had he realized that this was human nature — would have had a different evolutionary explanation: We underestimate difficulties because this way of thinking increases innovation. Debacle . . . or opportunity? Difficulty is the mother of invention.

 

 

 

The Fate of the Tiananmen Students and the Story of Edward Snowden

Seth Roberts4 Comments

This post by Ron Unz made me wonder: What really happened when student protesters were removed from Tiananmen Square 25 years ago? Unz pointed to a strange website with undated blog posts (mentioned earlier), which claimed that the students were not harmed, in contrast to the usual Western view that many were harmed, even killed. I didn’t take the website seriously but I had to admit my ignorance.

I asked several Chinese friends about it. One dared reply. She wrote:

My mom once told me that she was near Beijing when the event happened. She said everything is a mess, no one can go into or out from Beijing. The army is everywhere and people are all in an angry mood, no matter the a-rmy (try to pass the possible check so use -) or the citizens. She said the students are innocent, they didn’t start the whole thing. And indeed the army was hurt first. But students are young and easy to be incited. Once the army began to take serious method, they didn’t care whether you are a student or a mob or a citizen, some innocent students hurt in the turmoil and other students try to gather together to fight back. Then everything began to lose control. After this event, all the students who participate in the sit-in were sent to poor countryside far away and never get a chance to get back to big cities in their whole life. (At that time, all the students are getting job position directly from the govern-ment, they don’t have options to choose.) My mom told me some female students were sent to countryside and raped by the local people, or have to marry to the local farmers even they have high education.

All the student protesters, according to my friend’s mother, “were sent to poor countryside” for the rest of their lives. I hadn’t read this anywhere, including Wikipedia. The fate of the protesters was far worse than I had been told by Western media.

My friend’s mother could be wrong. Even eyewitnesses can be wrong. But what people actually say, the story they tell, matters infinitely more than the truth.

I am optimistic that the story of Edward Snowden will begin to change how we talk about whistleblowing. Recent stories are not encouraging. Mark Whitacre (Archer Daniels Midland) spent 8 years in prison. That he suffered from bipolar disorder might be taken to mean that only crazy people whistleblow. Jeffrey Wigand (tobacco) was played in a movie by Russell Crowe but went from a $300,000+/year job to a $30,000/year job. Bradley Manning faces a very long prison sentence. Julian Assange has been living in the Ecuadorian embassy in London for a year, afraid to leave.

Whereas Edward Snowden, whose leaked information is at least as important, has not yet suffered terrible or even humiliating consequences. Maybe he will live the rest of his life in Iceland — as a hero. He won’t just have released enormously useful information, he will have set an encouraging example. That might be his biggest effect on the world.

Useful Knowledge: Arithmetic and Chinese

Seth Roberts2 Comments

Long ago, a friend told me that when she was in first grade, she had a lot of pennies. She knew how to add but not subtract so after she spent some, she would have to count them again to know how many were left.

I have finally reached the last lesson (Lesson 12) in my beginning Chinese textbook, which I have been using (fitfully) for more than a year. Later lessons build on earlier lessons. When I didn’t know a word in a later lesson, I scanned the new-word lists from earlier lessons to find it. I have just discovered there is a word index.

Impossible Things That Are True: The Shangri-La Diet and the Behavior of Goldman Sachs

Seth Roberts7 Comments

It simply cannot be that drinking sugar water causes weight loss. Sugar caused the obesity epidemic! It simply cannot be that eating fat will cause weight loss. Eating fat is why we’re fat! Everyone knows this. It simply cannot be that whether you smell a food while you eat it makes any difference. Weight loss is all about calories in, calories out. The Shangri-La Diet says all three things are true. I cannot think of an historical precedent. Science has uncovered all sorts of unlikely stuff but nothing so surprising that is also immediately useful.

I thought of the Shangri-La Diet when I read this description by Michael Lewis of what Goldman Sachs has recently done:

Stop and think once more about what has just happened on Wall Street: its most admired firm [Goldman Sachs] conspired to flood the financial system with worthless securities, then set itself up to profit from betting against those very same securities, and in the bargain helped to precipitate a world historic financial crisis that cost millions of people their jobs and convulsed our political system. In other places, or at other times, the firm would be put out of business, and its leaders shamed and jailed and strung from lampposts. (I am not advocating the latter.) Instead Goldman Sachs, like the other too-big-to-fail firms, has been handed tens of billions in government subsidies, on the theory that we cannot live without them. They were then permitted to pay politicians to prevent laws being passed to change their business, and bribe public officials (with the implicit promise of future employment) to neuter the laws that were passed—so that they might continue to behave in more or less the same way that brought ruin on us all.

“The theory that we cannot live without them” was advocated by some of the most prestigious economists in the country.

What Goldman Sachs did — impossible-seeming, but it happened — is a sin of commission. Visible, at least to Michael Lewis, and capable of being pointed out (as Lewis does here) and marveled at.

The Shangri-La Diet seems like a bizarre thing, the diet from outer space, the crazy diet, whatever. It can’t be true, but it is. Yet the Shangri-La Diet, strange as it sounds, is actually the only visible sign (at least, visible to many people) of a massive sin of omission: failure to do good research about health. Obesity has been a major health problem for a very long time, more than a hundred years, and an overwhelmingly large problem since about 1980, 30 years ago. Yet conventional thinking about it is so bad – because mainstream research is so impotent — that people still take seriously ideas that date back to the 1950s and before, such as calories in calories out. A weight loss method discovered more than a hundred years old (cutting carbs) is still a big deal. It is as if people were still marvelling at electricity.

The commonality of the two situations (Shangri-La Diet and Goldman Sachs) is that the people who are supposed to understand the world (health scientists in the case of SLD, economists in the case of Goldman Sachs) have in both cases so bungled their jobs that truly terrible things happened. In the case of SLD, the obesity epidemic happened. (Not to mention epidemics of depression, diabetes, auto-immune diseases, and so on. ) A slow-moving unmissable worldwide epidemic that has made hundreds of millions of people feel ashamed every time they look at themselves. In the case of Goldman Sachs, what happened was the 2008 financial crisis and subsequent poor recovery and the fact that the “solution” to the crisis left in place what had caused it.

Are Low-Carb Diets Dangerous?

Seth Roberts15 Comments

A link from dearieme led me to a recent study that found low-carb high-protein diets — presumably used to lose weight — associated with heart disease. The heart disease increase was substantial — as much as 60% in those with the most extreme diets. (A critic of the study, Dr. Yoni Freedhoff, called the increase in risk “ incredibly small“.) Four other studies of the same question have produced results consistent with this association. No study — at least, no study mentioned in the report — has produced results in the opposite direction (low-carb high-protein diets associated with a decrease in heart disease).

I find this interesting for several reasons.

1. I learned about the study from a Guardian article titled “What doctors won’t do”. A doctor named Tom Smith said, “I would never go on a low-carbohydrate, high-protein diet like Atkins, Dukan or Cambridge.” Fine. He didn’t say what he would do to lose weight. The psychological costs of obesity are huge. The popularity of low-carb diets probably has a lot — or everything — to do with the failure of researchers to find something better. I have never seen people who criticize low-carb diets appear aware of this. I disagree with a lot of Good Calories Bad Calories but I completely agree with its criticism of researchers.

2. There has never been a good explanation of the success of low-carb high-protein diets (why they cause weight loss), although this has been well-known for more than a century. (A good explanation would be a theory that made predictions that turned out to be true.) Such diets require a big change in what you eat. A big change is likely to have big health consequences in addition to the weight loss, and those side effects could be either good or bad. It now appears bad is more likely. With a good theory of weight control, you should be able to find a much smaller change that produces the same amount of weight loss as a low-carb high-protein diet. Because the change is much smaller, it should have much smaller side effects. Much smaller side effects (unknown whether they are good or bad) are much less likely, if bad, to outweigh the benefits of the weight loss. I have never come across a low-carb advocate who seemed to understand this (that we don’t know why they work and it would be a very good idea to find out).

3. The Japanese are remarkably healthy (live very long), slim, and have very little heart disease, yet eat lots of rice. Which makes absurd the notion that all high-carb diets are unhealthy or fattening.

4. The comments on the low-carb study are mostly critical and the criticisms are terrible. For example, Dr. Yoni Friedhoff, who blogs about weight control, says, “The paper’s basing all of its 15 years worth of conclusions off of a single, solitary, and clearly inaccurate, baseline food frequency questionnaire”. The authors of the study correctly reply that inaccuracy would reduce the associations.

5. Until nutrition scientists do better research, our best source of nutritional guidance may be what we like to eat. Evolution shaped us to like foods that are good for us, at least under ancient conditions. We like carbs and we don’t like foods high in protein (lean meat is barely edible) so a low-carb high-protein diet is on its face a bad idea. This is why I find it plausible that the low-carb high-protein association with heart disease reflects cause and effect (low-carb high-protein causes heart disease) and that in particular a high-protein diet causes heart disease. (Too little of the right fats?) We very much like fat. Under ancient conditions, the fat people ate was mostly animal fat and, before that, if you believe in aquatic apes, fish oil. It is quite plausible that lactose tolerance spread so quickly throughout the world because at the time everybody was starved of animal fat — high-fat mammals had been hunted to extinction — and dairy products were a good source of it.

 

 

Sleeping Pills are Very Dangerous

Seth Roberts8 Comments

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.

Undisclosed Risks of Common Medical Treatments

Seth Roberts10 Comments

Millions of tonsillectomies have been done, mostly to children. Were any of their parents told that tonsils are part of the immune system (taught in high school biology and known since the 1960s)? A Cochrane Review of tonsillectomies (the “highest standard” in evidence-based medicine) fails to mention that tonsils are part of the immune system. A recent study found tonsillectomies associated with a 50% increase in heart attacks. (I write about tonsillectomies here.)

Are tonsillectomies unusual? Several recent news stories suggest no, they aren’t. Failure to tell patients the full risks of medical treatment may be common:

1. Undisclosed risks of hernia surgery. From the Wall Street Journal: “More than 30% of patients may suffer from long-term chronic pain and restricted movement after surgery to fix a hernia . . . studies show.” The article says “many patients don’t consider” this risk — meaning they don’t know about it. A Berkeley surgeon named Eileen Consorti told me I should have surgery for a hernia I could not detect. I have previously written about her claim that evidence supported her recommendation when no such evidence existed — or, at least, no one including her has ever found it. I said I wanted to see the evidence because there were risks to surgery. She replied that none of her patients had died. I was shocked by the incompleteness of her answer. There are plenty of bad outcomes besides death — as the Wall Street Journal article shows.

2. Undisclosed risks of sleeping pills. A book called The Dark Side of Sleeping Pills by Daniel Kripke, a professor of psychiatry at UC San Diego, goes into great detail about risks of sleeping pills that few doctors tell their patients. For example, one study found that “patients who took sleeping pills died 4.6 times as often during follow-ups averaging 2.5 years [than matched patients who did not take sleeping pills]. Patients who took higher doses (averaging over 132 pills per year) died 5.3 times as often.” Insomnia alone was not associated with higher mortality. Tomorrow I will post Dr. Kripke’s answer to the question “why did you write this book?” Here is a website about the dangers of Ambien.

3. Undisclosed risks of anticholinergic drugs. From the NY Times: “After following more than 13,000 British men and women 65 or older for two years, researchers found that those taking more than one anticholinergic drug scored lower on tests of cognitive function than those who were not using any such drugs, and that the death rate for the heavy users during the course of the study was 68 percent higher. That finding, reported last July in The Journal of the American Geriatrics Society, stunned the investigators.” Anticholinergics are “very very common” said a researcher. They include many over-the-counter drugs, such as “allergy medications, antihistamines and Tylenol PM”.

4. Undisclosed risks of statins. A recent NY Times story says “the Food and Drug Administration has officially linked statin use with cognitive problems like forgetfulness and confusion, although some patients have reported such problems for years. Among the drugs affected are huge sellers like Lipitor, Zocor, Crestor and Vytorin.” Prior to this official linkage, the reports of forgetfulness and confusion were mere anecdotes that evidence-based medicine proponents ignore and tell the rest of us to ignore.

5. Undisclosed risks of metal-on-metal hip replacements. They leak dangerous amounts of metal (e.g., cobalt) into the rest of the body. “Despite the fact that these risks have been known and well documented for decades, patients have been kept in the dark,” says a recent article in the BMJ. By 2007, the danger was so clear that a British regulatory committee said that patients must sign a form saying they’ve been warned. This didn’t happen — a surgeon told the BMJ that “surgeons were unaware of these discussions.” Other materials could have been used.

These six treatments (tonsillectomy, hernia surgery, sleeping pills, anticholinergic drugs, statins, and hip replacement) are so common they raise a scary question: What fraction of the risks are patients usually told?

The surgeon or drug company gets paid no matter what happens to you. Malpractice lawsuits are very rare on a per-patient basis — and no one will be sued for performing a tonsillectomy on a child who gets a lot of colds or prescribing sleeping pills to someone who has trouble sleeping. In a Freakonomics podcast, Steve Levitt said that doctors terrify him. And his father is a doctor. Given the undisclosed risks of common treatments, he is right to be terrified.

Thanks to Allan Jackson, Alex Chernavsky and Tim Beneke.