To see faces early in the morning, I have a one-hour Chinese lesson every day at 6 a.m. Today my teacher said, “I feel very happy.”
“Why?” I asked.
“I don’t know,” she said.
“It’s because you see my face every morning,” I said.
“No, it isn’t that,” she said.
The Department of Energy has a prize, called the L Prize, for a new light bulb that gives off same light as a 60-watt incandescent bulb but uses much less energy. Philips has submitted what it believes will be the winning entry. For the last decade, I’ve tried to avoid fluorescent lights at night. Ordinary fluorescent lamps emit light with far more blue than incandescent lamps and mess up my circadian-timing system. That systems appears insensitive to incandescent light. Squirrels are like me, a study suggests.
Fluorescent lights are close enough to sunlight to affect our circadian system; incandescent lights, being much cooler than the sun, are invisible to it. The timing of exposure matters if it varies from day to day; exposure to fluorescent lights at varying times is like travelling back and forth across time zones. Everybody grasps that travelling across time zones makes it hard to sleep at the right time; what is less understood is that time-zone-crossing travel affects the depth of sleep because it reduces the amplitude of the circadian oscillation. If you are exposed to fluorescent lights at night now and then, you will sleep less deeply. So I try hard to avoid fluorescent lights at night. I avoid supermarkets and subways, for example.
I discovered all this when I discovered the effects of morning faces on my mood. After I travelled back and forth across time zones, the effect took three weeks to fully return. Nothing else had changed. I conclude that it took three weeks in the same place for my circadian oscillator to return to maximum amplitude. And one evening in which I was exposed to an hour of fluorescent light was enough to get rid of the faces effect for a few weeks. The ubiquity of fluorescent lighting has made it hard to study this effect in other people.
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.
In an amusing comment on health care, Jonathan Rauch (via Marginal Revolution) imagines an airline system as archaic and inefficient as our health care system.
“Cynthia, I have filled out my travel history half a dozen times already this year. I’ve told six different airlines that I flew to Detroit twice and Houston once. Every time I fly, I answer the same battery of questions. At least a dozen airlines have my travel history. Why don’t you get it from them?”
“We have no way we could do that. We do not have access to other companies’ records, and our personnel have our own system for collecting travel history.”
The health care system, in other words, is full of problems that have built up unsolved. Solutions exist — the problems are not impossible — but haven’t been implemented. Jane Jacobs’s great point, in The Economy of Cities, is that this is what happens when those who benefit from the status quo have too much power relative to those who benefit from change. The stagnation in American health care is profound. It isn’t solved by universal health insurance. There would remain the horrible dependence on expensive dangerous drugs that don’t work very well (e.g., antidepressants, Accutane) and the complete lack of interest in prevention. The underlying problem, the source of many visible problems, is too little innovation.
Someone read this blog and wrote this:
The one that was most interesting to me was “standing on one foot”,
because I’ve definitely felt a difference in sleep after doing lots of
work. Â (I used to sleep really well when I did a 54-mile commute on my
bike.) Â Maybe standing on one foot (knee bent) until failure causes the
muscles to send similar chemical signals to intense exercise which are
picked up elsewhere? Â Whatever, it was free, easy, and safe, so I tried
it. Â You can’t do a double-blind experiment on yourself, of course, but
at least some of the time when I’ve tried it I definitely felt as
though I slept more soundly when I got up the next day.
I still do this. Lately I have been varying the dose — how many times I stand on one leg. So far three (e.g., right leg, left leg, right leg) produces slightly worse sleep than four (right leg, left leg, right leg, left leg). If I eat plenty of meat, my legs get stronger and stronger; if I eat little meat, they don’t.
T. R. Reid has just published a new book called The Healing of America that compares American health care to health care in other countries. One comparison is with Japan:
The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.
Life expectancy is better. Even though the Japanese smoke more than Americans. Is it all those MRI scans? (Which in Japan cost a small fraction of what they cost in America?) Or all those trips to the doctor (where, by American standards, nothing appears to happens — that is, expensive drugs are rarely prescribed — judging by overall costs)?
I believe that that Japanese do so much better because of a factor that Reid probably doesn’t consider: They eat tons more fermented food than Americans do. In a Tokyo restaurant, the woman sitting next to me, a nurse, said she believes that regular consumption of fermented foods is important for health. Does everyone in Japan think this? I asked. A large minority, she said.
The eating habits of the Japanese, as far as I could tell, bear this out. On a Japanese food blog, the writer described a breakfast that had five fermented foods: pickles, miso, yogurt, natto, and kimchi. The Japanese eat miso at every meal, more or less. They also eat lots of pickles. Natto is popular in some parts of the country but not others. They eat lots of yogurt; they are the country that gave us Yakult. They drink vinegar drinks. (Whereas in America only health nuts drink apple cider vinegar.) In other words, their diet is loaded with fermented foods. If I’m right about this, Japanese rates of autoimmune diseases should be much lower than American rates.
When people get sick much less, health care costs go way down.
They are closely related. I’ve been reading James Stewart’s excellent blow-by-blow of the early days of the crisis. As Nassim Taleb has emphasized, the crisis happened because the people running the financial system didn’t understand how it works. They vastly overrated their understanding — their ability to predict. (As Taleb has also emphasized, they still fail to grasp their ignorance.)
Surely it isn’t just the financial system. Surely we don’t overrate our knowledge just here. Much more likely, we overrate our knowledge about everything. This creates a great opportunity. It goes like this: 1. We overrate our knowledge about a large thing (the financial system). 2. We probably overrate our knowledge about everything. 3. We probably overrate our knowledge about small things. 4. There is more to be learned from studying small things than we realize. 5. Small things can be studied experimentally — an especially effective learning method.
Self-experimentation is an example of studying small things experimentally. These experiments taught me far more than I ever expected. Because I knew less than I thought. (Without realizing this fact.) Here are three examples:
1. Acne. I discovered that my beliefs about the two medicines my dermatologist has prescribed were exactly wrong. The one I thought worked, didn’t work; the one I thought didn’t work, did work.
2. Sleep. My self-experimentation led to new ideas about the control of sleep that no one had thought of. I didn’t know experimentation could do that so often. (I thought that such discoveries were very rare.)
3. Mood. My conclusions about mood are really different than what researchers usually say. I never expected to learn anything so radical.
These examples cover three dimensions. In the acne example, I learned I was completely wrong very quickly — that’s speed of learning. The sleep example is about number of discoveries; the mood example is about the “size” of one discovery.
Two New Zealand teenagers humbled GlaxoSmithKline, one of the world’s biggest food companies:
Their school science experiment found that [GlaxoSmithKline’s] ready-to-drink Ribena contained almost no trace of vitamin C.
Students Anna Devathasan and Jenny Suo tested the blackcurrant cordial against rival brands to test their hypothesis that cheaper brands were less healthy.
Instead, their tests found that the Ribena contained a tiny amount of vitamin C, while another brand’s orange juice drink contained almost four times more. . . .
GSK said the girls had tested the wrong product, and it was concentrated syrup which had four times the vitamin C of oranges. But when the commerce commission investigated, it found that although blackcurrants have more vitamin C than oranges, the same was not true of Ribena. It also said ready-to-drink Ribena contained no detectable level of vitamin C.
The students used iodine titration to determine Vitamin C levels. Why had the students managed to see something important that the food giant overlooked? My guess is that an unusual processing step (e.g., high storage temperature) destroyed the Vitamin C and those who knew about the anomaly didn’t want to consider the possibility that it had done damage. The possibility that someone outside the company might notice didn’t occur to them. Just as those who mislabel fish in New York restaurants and markets never realized that two students could uncover their deception. I found that the omega-3 in a Chinese brand of flaxseed oil was probably destroyed before it got to me.
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.