Jane Brody Misses Many Opportunities

Jane Brody has written about health for the New York Times for a long time. Recently, a blood test indicated that her total cholesterol was 222 and her LDL was 134, which she believed was too high.

Missed Opportunity #1: She had no idea of the error in these numbers. It would have been better to get a second measurement to get some idea of the error. What if the second measurement of total cholesterol was 180?

She made various non-drug changes. She stopped eating cheese and lost a few pounds. She believed this would lower her cholesterol. It didn’t. A new test found total cholesterol was 236 and LDL was 159.

Missed Opportunity #2: She still had no idea of the error in these numbers.

Missed Opportunity #3: If the change from 134 to 159 was not random error, it was possible that cheese was lowering her cholesterol — the opposite of what she believed. She failed to consider this possibility — at least, she doesn’t mention it.

She made more extreme changes:

Now it was time to further limit red meat (though I never ate it often and always lean), stick to low-fat ice cream, eat even more fish, increase my fiber intake and add fish oils to my growing list of supplements.

Her cholesterol numbers got even worse — total cholesterol was 248 and LDL 171.

Missed Opportunity #4: She still had no idea of the error in these numbers.

Missed Opportunity #5: She again failed to consider the possibility that what she was told was wrong — that things she did to lower her cholesterol actually raised it.

Her doctor tells her: “Your body is spewing out cholesterol and nothing you do to your diet is likely to stop it.”

Missed Opportunity #6: She failed to consider what this says about her doctor. If her doctor believes this, why didn’t he or she say so earlier?

Missed Opportunity #7: She failed to ask her doctor the basis for such an extraordinarily broad claim (“nothing you do”).

Missed Opportunity #8: She failed to realize her own data called this statement into question. Her own data suggests that diet made a difference (if the random error is small enough). She changed her diet, her cholestrol changed.

My own self-experimentation started with the discovery that some of what my dermatologist told me was wrong. A certain antibiotic was supposed to reduce my acne; if anything it increased my acne.

The classic case of a self-experimenter failing to learn something he could have learned is Barry Marshall, the Australian doctor who won a Nobel Prize for showing that bacteria cause ulcers. He drank a flask full of the bacteria — this was the self-experiment. Results: 1. He didn’t get an ulcer. 2. He became infected and the infection went away after treatment with a drug later found to have no effect against the bacteria. Warren might have concluded that some people can successfully fight off infection from the bacteria and that the people who get ulcers are not those who are exposed to the bacteria (which is probably almost everyone) but those who can’t fight it off. Warren’s self-experimental results, like Brody’s, supported a conclusion quite different from the conclusion he started with, and he failed to notice — or at least mention — this.

Self-Experimentation and the Nicotine Patch

Murray Jarvik, inventor of the nicotine patch, died recently. I learned:

When the researchers could not get approval to run experiments on any subjects, they tested their idea on themselves. “We put the tobacco on our skin and waited to see what would happen,” Jarvik recalls. “Our heart rates increased, adrenaline began pumping, all the things that happen to smokers.”

Why, I wonder, didn’t they start with self-experimentation?

Ditto Soda: Compliment or Coincidence?

Which of the following doesn’t belong?

  • Fanta
  • Dr. Pepper
  • Coke
  • Pepsi
  • Skipper
  • Parker
  • 7Up
  • Sprite
  • Mountain Dew
  • Mr. Pibb
  • Ditto

All are names of soft drinks. Ditto is the name of a new lemon-lime drink that is the Safeway house brand. It strikes me as so different than the other names on the list that I flatter myself to think that there is some connection with my invention of the term ditto food in The Shangri-La Diet. Soft drinks are prototypical ditto foods.
A few years before Nabokov’s novel Lolita was published, a short story by Dorothy Parker titled “Lolita” appeared in The New Yorker. Nabokov had published often in The New Yorker, and he wrote an angry letter to Katherine White, the fiction editor, complaining that the manuscript of Lolita that he had shown them in confidence had somehow leaked. White wrote back that it was a coincidence.

If Weston Price Had Been a Dermatologist

This review article — comparing several commonly-prescribed treatments for acne — ends up close to what I figured out as a graduate student via self-experimentation: that benzoyl peroxide works much better than antibiotics.

I like to think that in 100 years people will look back on current treatments for acne (and a hundred other things) as medieval, like leeches. If Weston Price had been a dermatologist, we would now have evidence, I’m sure, that certain traditional lifestyles produce very low rates of acne. Examination of those lifestyles would provide good clues about what aspects of our way of life cause acne. That would be a good starting point for experiments to zero in on what matters. Once we knew the environmental causes of acne, such as caffeine or soap, they could simply be avoided; no need for powerful dangerous expensive medicines. At the moment, however, determination of what aspects of modern life cause acne isn’t even close to being studied. You might think it is better to study safe cheap cures than dangerous expensive ones but you’d be wrong. At least now.

Calorie Learning: Better Design

I finished a better-designed calorie-learning experiment. I mixed 5 randomly-chosen spice mixes into one chunk of butter (Mix A) and another 5 spice mixes into another chunk of butter (Mix B). Then I alternated two types of trials:

1. 2 saltines spread with Mix A followed by a piece of bread eaten nose-clipped.

2. 2 saltines spread with Mix B followed by nothing.

On each trial I rated how good the saltines tasted on scale where 50 = neutral, 60 = slightly good, and 70 = somewhat good. Here are the results:

results

When a new flavor was followed by a piece of bread, it tasted better than a similar flavor not followed by a piece of bread. After several flavor-bread pairings, the difference became large.

Scaled-Up Self-Experimentation Proposed

From an article in Nature Medicine:

A British biotech entrepreneur named William Bains is proposing that self-experimenters should form collectives, pooling resources to make their findings more acceptable to the mainstream scientific community. Bains, who also lectures on the business of biotechnology at the University of Cambridge, UK, believes that the high costs and red tape associated with clinical trials have forced pharmaceutical companies to become increasingly conservative in the treatments they will test—leaving radical but potentially effective therapies out in the cold. . . . A radical alternative to conventional clinical trials, which he proposed in a paper published in April, is to have people who are willing to experiment on themselves band together and form what he calls ‘biomedical mutual organizations’ (BMOs) (Med. Hypotheses 70, 719—723; 2008). These collectives would pool resources to provide their members with more test subjects (each other), greater analytic capacity and access to more novel therapies, Bains claims.