Category: ignorance

Gatekeeper Syndrome

Seth Roberts9 Comments

If the original Milgram obedience experiment weren’t scary enough, in the 1960s a researcher named Hofling did a variant in which nurses were ordered to give twice the maximum dose of a certain drug. The drug was not on the hospital’s approved list, the order was given by phone, and the nurse didn’t know the doctor giving the order. Yet 21 out of 22 nurses obeyed. (They were stopped just before giving the drug.) Hofling concluded that of the several intelligences that might have been involved in the situation, one was absent.

I thought of this research when I learned about a remarkable case of anaesthesia dolorosa. Anaesthesia dolorosa is a condition where you lose sensation in part of your face and have great pain in that area. It’s rare; it’s usually caused by surgery. In 1999, Beth Taylor-Schott’s husband had an operation for trigeminal neuralgia that left him with this condition. In the ensuing years, all sorts of pain medications failed to solve the problem. Then he had another operation:

In January of 2008, David underwent a gamma knife procedure to ablate the sphenopalentine nerve bundle. Before the procedure, we were told that 16 other patients had had the procedure, and that all of them had experienced either complete recovery without drugs or an 80% reduction in pain. So we were optimistic going in. It was only after they had done the surgery that the doctors admitted that they had never done it on someone with AD before and that all those other patients had had atypical facial pain. The surgery had no effect as far as we could tell.

Shades of my surgeon claiming the existence of studies that didn’t exist. But that’s not the point. The point is this: After reading Atul Gawande’s article about mirror therapy for phantom limb pain, she and her husband tried it. “Within 2-3 days, his pain was down to zero.” It stayed there so long as they continued the mirror therapy. Soon after this they were able to eliminate his pain medication.

I asked Taylor-Schott what the reaction of her husband’s doctor was. She replied:

David’s actual pain doctor wrote back a single word, if I remember correctly, which was “fantastic.”

Wow. An incurable debilitating pain condition quickly and completely eliminated without drugs or danger or significant cost and . . . a pain doctor isn’t interested. Let’s call it gatekeeper syndrome: lack of interest in anything, no matter how important to your work, that doesn’t involve you being a gatekeeper.

I said that showed remarkably little curiosity. Taylor-Schott said that was typical. I agree. After I lost 30 pounds on the Shangri-La Diet, my doctor expressed no curiosity how I had done so. A friend of mine showed his doctor some data he had collected highly relevant to how to treat his condition; his doctor wasn’t interested.

Curiosity is part of intelligence. Not measured on IQ tests — a serious problem with those tests. To lack curiosity is to be just as brain-dead, in a different part of the brain, as those too-obedient nurses. Taylor-Schott speculated that curiosity was beaten out of doctors in medical school. Or perhaps much earlier. Curiosity doesn’t help you get good grades in college.

In my experience, college professors have their own problems along these lines. UC Berkeley has a fantastic selection of talks, year after year. I almost never saw a professor at a talk in a department different from his own — no psychology professor (other than me) would attend a talk in nutrition, for example. At statistics talks, I almost never saw a professor from another department. Curiosity had been beaten out of them too, perhaps. Professors who lack curiosity produce students who lack curiosity . . . it makes sense. It sort of explains why Berkeley professors had/have a such a narrow view of intelligence; to them being smart means being good at what college professors do. It also explains why the lack of measurement of curiosity on IQ tests is so rarely pointed out.

And it explains why Taylor-Schott and her husband learned about mirror therapy from a magazine article rather than from one of the many pain doctors they consulted.

FDA Hid Research Showing that Aspartame is Dangerous

Seth Roberts10 Comments

Here is a lot of information about this. The commercial name for aspartame is Nutrasweet. Because of worries about its neurotoxicity I switched to Splenda long ago. But if the FDA approval process is so deeply flawed they approved Nutrasweet, how safe is Splenda? In China, I’ve managed to pretty much avoid artificial sweeteners.

Who is “Totally Healthy”?

Seth Roberts3 Comments

I watched this 60 Minutes piece on swine flu. Of course nothing was said about boosting immunity as a defense. “The best way to reduce your chances of one of those terrible outcomes [hospitalization, death] is to be vaccinated,” said Anne Schuchat, who has a very high position at the Centers for Disease Control and Prevention.

This is just part of a bigger delusion. The story centers on a football player who gets seriously sick after a football game. Schuchat said this:

This is one of the tragic parts of this epidemic. That people who are in the prime of their life, totally healthy, can suddenly become so sick.

Totally healthy. This is the bigger delusion: That the average American who appears healthy is healthy. I believe that practically all Americans have grossly-impaired immunity. Their immune systems work much worse than they could. The poor performance is due to suboptimal sleep and far too little bacteria in their diet. The football player was near death because he had two out-of-control infections. That’s how poorly his immune system was working. And a top CDC official called him “totally healthy”! Apparently she has no idea that people’s immune systems can vary in how well they work. This is even worse than the UCLA medical school prof specializing in infectious disease who also failed to understand this. Schuchat is one of the top public health officials in America! Public health is about prevention. According to Wikipedia, Schuchat “has emphasized prevention of infectious diseases in children.”

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.

Does H. Pylori Cause Stomach Ulcers?

Seth Roberts17 Comments

In a previous post I said that the Nobel Prize to Barry Marshall and Robin Warren — for supposedly showing that H. pylori causes stomach ulcers — was a mistake. Because half the world has the bug in their stomach, and only a tiny fraction of them get ulcers, the true cause of those ulcers lies elsewhere, probably with an impaired immune system. Marshall famously drank a flask full of H. pylori and didn’t get an ulcer, yet took this to support his theory. A classic example of self-deception.

Recently Lam Shiu-kum, a former dean of medicine at the University of Hong Kong, was convicted of a giant fraud. He siphoning millions of dollars of medical fees into his own pocket:

Dr Lam, 66, brought a 39 year association with the university, his alma mater, to an abrupt end in March 2007 when the investigation into billing irregularities began. He is a distinguished gastroenterologist who conducted pioneering research into chemoprevention of stomach cancer through the eradication of Helicobacter pylori. His team also conducted the first double blind, controlled study into curing peptic ulcers by H pylori eradication.

I suppose this supports my case. As far as I know, almost all doctors and med school professors believe H. pylori causes stomach ulcers; I have never heard dissent about this.

More. What goes unsaid, and maybe unnoticed, in the debate about health care, is that it is hard to have decent health care (that is, decent health) when those in charge don’t know what they’re doing. The stomach-ulcer-etiology problem is a small example of a big thing. In case I’m not being blunt enough, let me be even more blunt: This example illustrates that the average doctor, the average med school professor, and at least two Nobel-Prize-winning med school professors (not to mention those who award Nobel Prizes) have a lot of room for improvement in their interpretation of simple facts. My previous example of the infectious-disease expert (a med school professor) who overlooked the immune system is another example of vast room for improvement. It’s hard to get good health care from people whose understanding of health is terribly incomplete yet don’t realize this.

Infectious Disease Specialist Ignores the Immune System

Seth Roberts3 Comments

A new book called Rising Plague by Brad Spellberg, a UCLA professor of medicine specializing in infectious disease, at County Harbor-UCLA Medical Center, is about the increase in drug-resistant bacteria. From an article about the not-yet-published book:

In the United States, more than 300,000 people die each year from infectious diseases such as influenza and pneumonia, often caused by drug-resistant bacteria.

“The scary thing is that many of these were healthy, young individuals,” said Robert Guidos, vice president of public policy and government relations for the Infectious Disease Society of America. “There are very few drugs, if any, to treat these bacteria, and there are almost none in the pipeline.”

I believe it is very likely that these “healthy” young people weren’t eating enough fermented food and thus had poorly-functioning immune systems. The article continues:

[Spellberg], however, argues in his book that drug companies are not solely responsible. Blame for the decline in antibiotics should also not be aimed at physicians for over-prescribing these drugs, nor hospitals for lacking sufficient standards in cleanliness or drug distribution.

“This problem is complex enough that it is not accurate and not helpful to blame any one group,” Spellberg said. “What we need to do is focus on solutions.”

Public awareness will go far in spurring change, he argues. Ultimately, legislators, drug companies, hospitals and doctors will have to devise a way to spur more production of new antibiotics, which become obsolete as bacteria change to survive.

“ Will have to“. As if there is no other alternative. The possibility of strengthening the immune system is not considered. Just as UC Berkeley epidemiology professors (along with the rest of their profession) ignore the immune system, here is a doctor ignoring it. Here is a longer statement by Spellberg that ignores the immune system. He’s a specialist in infectious disease. He’s repeating the conventional wisdom of his profession. UCLA is a top-ranked medical school. This is mental blindness on a massive scale with awful consequences.

Japanese Ice Ouca versus Bi-Rite Creamery

Seth Roberts2 Comments

Bi-Rite Creamery in San Francisco has the best ice cream I’ve had. The ice cream at Japanese Ice Ouca in Tokyo is maybe 95% as good but the presentation is so much better than Bi-Rite I was stunned. The prices are about the same at the two places. At Ouca you get a choice of three flavors (versus two at Bi-Rite). The three flavors are mixed in an attractive pattern. You get a pretty round wafer to add crunch. And you get a little bit of salty chewy seaweed to eat after you’re finished. Ouca doesn’t stand out from other high-end Japanese food, which is full of these sorts of effective small touches. In Iceland I met a Japanese teacher of English who said, “I like everything about America except the food.” American food is like barbarian food — except worse.
When she was a teenager, Jane Jacobs visited a relative of hers in isolated rural Pennsylvania. Her aunt had moved there to oversee the building of a church. The inhabitants had forgotten that buildings could be made out of stone. American cooking reveals a similar vast forgetting.

PayPal, the [Empty Promise] Way to Pay

Seth Roberts2 Comments

A few minutes after I sent gamesinwelt.com credit-card payment for a Wii via PayPal, I phoned PayPal asking them to cancel the transaction. Your payment did not go through, I was told. “Did not”. So there was no need to cancel it. I was safe. To warn others, I wrote my earlier post about this.

Well, I was misinformed. My payment was not unauthorized, i.e., dead — it was, rather, not-yet-authorized. When I phoned PayPal, it could have been canceled but it wasn’t. A few days later it went through. Maybe I am easily amazed but this is amazing. At PayPal customer service, the account history screen seen by employees does not distinguish between two meanings of unauthorized: “authorization failed” and “not yet authorized”. What is this, 1960?

I was pissed. I called PayPal and was told in part that this was somehow my fault. I should have known [something]. To file a dispute I must call another number. I called that number. I filed the dispute. You’re safe, I was told. Will I have to call again? I asked. No, I was told.

Well, I wasn’t safe. Although I won the dispute, there was no money in the seller’s account. A possibility that hadn’t been mentioned. Too bad for me.

So I phoned my credit card company. I was told I should get my money back from either PayPal or the credit-card company. Fearing more untrustworthiness from PayPal, I emptied my PayPal account.

Bonus PayPal helping scammers, from the comments:

Same story! $300 for a Wii and a Nintendo DS! The day after my husband ordered I tried to go back to the website and order some games. I got a message saying the company “could not accept PayPal at this time” I then emailed PayPal’s customer service and asked them if this meant that they were not a reputable company that I should not do business with. PayPal said, and I quote, “It does not mean that they are not reputable, they could be experiencing problems with their internet connection to PayPal.”

The Financial System and the Immune System

Seth Roberts22 Comments

In this interview, Nassim Taleb says, as he has often said, that booms and busts are a fact of financial life, what we should do is make the financial system robust against them. He put it like this:

Capitalism will always produce shocks and crashes. I want a society that has a buffer against shocks.

Likewise, I say bacteria are a fact of life. To be healthy we need to make our bodies resistant to them — which means having a well-functioning immune system.

These are not subtle or difficult points. What interests me is the difficulty that experts have appreciating them. To repeat a story I’ve told before on this blog, a few years ago I noticed that the UC Berkeley School of Public Health had a wide-ranging epidemiology course taught by someone I knew. I phoned him. “Will the course cover what makes us more or less susceptible to infection?” I asked. “No,” he said. I wasn’t exactly surprised — I have never seen this topic covered in any epidemiology textbook or even any epidemiology research paper — but still it is an amazing omission. They know we have an immune system, they just don’t think it matters! There’s an elephant in the room, and they’re ignoring it.

The parallel point about the financial system is that there is no study of what makes a financial system robust against shocks. Somehow finance professors, like epidemiology professors, haven’t grasped that something is missing.

Here are two more vast areas of ignorance:

1. Scientists know a lot about how to test ideas. They know almost nothing about how to come up with ideas worth testing. When a good way to generate ideas comes along — such as self-experimentation — they are dismissive. This is truly crippling: In an experimental science, for example, interesting new experimental effects aren’t discovered. Experimental psychology suffers from this problem. Experimental psychologists could self-experiment, but they don’t.

2. Economists know very little about how to generate new businesses — what makes the rate of new-business generation high or low. I came across a 500-page introductory economics textbook that had three empty paragraphs on the topic. Without new businesses to solve the problems created by old businesses (such as pollution), your society is in real trouble. The problems will pile up unsolved. This is what Jane Jacobs saw so clearly in The Economy of Cities and Jared Diamond completely missed in Collapse.