Category: Twilight of Expertise

The Clouded Crystal Ball: A Psychic and Her Employees

Seth Roberts7 Comments

The New Yorke r used to have a mini-department called The Clouded Crystal Ball: examples of bad predictions taken from “newsbreaks” — little bits of text used to fill a column. In an interview, a friend of mine named Margaret Meklin told of a different sort of clouded crystal ball:

My first job in the U.S. was passing out flyers for a fortune teller on Powell and Market in San Francisco. She did not trust her psychic powers enough to guess who was doing a truly good job (it was me!), so she would periodically hide in the tourist crowds to check if we were passing out flyers quickly and efficiently and to a sufficient number of passersby. She gave a higher pay rate to my co-worker, thinking that he was more productive, but she had no idea that he would simply toss a whole stack of flyers into a trash can when she wasn’t watching him.​

Fear of Food: “The Hubris of Experts”

Seth Roberts5 Comments

At the end of Fear of Food: A History of Why We Worry about What We Eat by Harvey Levenstein (2012), an historian at McMaster University, the author summarizes what he has learned:

During the course of writing this book, I have often been asked what lessons I personally draw from it. . . . The hubris of experts confidently telling us what to eat has often been well-nigh extraordinary. In 1921, for example, the consensus among the nation’s nutritional scientists was that they knew 90% of what there was to know about food and health.

Yeah. Two questions for an expert giving advice, especially apocalyptic advice (“You’ll die if you don’t . . . “): 1. What fraction of what there is to be known on your subject do you know? 2. May I quote you?

When I was a freshman in college, I went to hear a talk (off campus) about the chance of life elsewhere in the universe (or was it the galaxy?). The speaker multiplied a bunch of numbers together and came up with an estimate. “What’s the error in that estimate?” I asked. The speaker had no answer. He didn’t know. It’s essentially the same thing.

Is Crohn’s Disease Really “Incurable”?

Seth Roberts8 Comments

I recently came across two different people who, diagnosed with Crohn’s disease, repeated the standard line that it “has no known cure”. Really? Never? The people who said this were just repeating what they had been told. Unlike twenty or thirty years ago, however, it is easy to do one’s own research. The people who said this gave no indication they had done any research. Because Crohn’s is so unpleasant, their passivity was curious.

I knew that calling Crohn’s disease “incurable” was an overstatement because I had written about Reid Kimball, who had found a way to eliminate via diet essentially all the symptoms. For practical purposes, he was cured. (Reid objects to the word “cure”.) I knew he was hardly the only one. But what if I started from ignorance? How hard would it be to challenge the conventional “incurable” line?

Not hard at all. I googled “Crohn’s success” (without quotation marks in the search query). The top search result (titled “Crohn’s Disease: Success with Diet and Probiotics”) included this:

I learned of a pediatric gastroenterologist, Dr. J. Rainer Poley, who had conducted extensive studies on the effect of certain sugars and starches on people with intestinal diseases. My husband and I decided to take our daughter to see this doctor for another opinion. When we asked him if there was any other treatment she could try besides medications, he explained that at a recent medical conference in Europe, he had learned of success medical doctors were having with probiotics. He instructed our daughter to eat plain yogurt every day and to take a specific probiotic capsule called Culturelle® containing Lactobacillus GG [Gorbach and Goldin] twice daily. Based on Dr. Poley’s research, he wanted her to limit the consumption of concentrated sugars (specifically table sugar, technically known as sucrose). The intent of the sucrose-restricted diet was to starve the harmful bacteria by taking away their major food source. The yogurt and Lactobacillus GG would help replenish the “good” bacteria. Since it has been well documented that an overgrowth of bacteria is prevalently seen in people with Crohn’s disease, this treatment sounded like a plausible solution.

Our daughter, feeling drained from the effects of Crohn’s disease, felt motivated to try the doctor’s recommendations. . . . After about two weeks, she began to feel better in general. At the follow-up doctor’s appointment three months later, she had gained six pounds and her lab work was ALL NORMAL! . . . She continues to remain well [over 7 years later] with normal lab work and without clinical symptoms.

I asked Ms. Kalichman how others had fared with this treatment. She replied:

Periodically, I hear from others who have tried the treatment that my daughter does, and it seems that many have been helped a lot. Unfortunately they don’t always continue to keep in touch, so I don’t have any idea how many are totally well. Our daughter continues to be well as she has been for almost 9 years now…no meds and no clinical symptoms.

That took about 5 minutes, including emailing Kalichman. She referred me to a video about it.

The Next Time a Top Economist Predicts Disaster…

Seth Roberts2 Comments

Shortly before Obama took office, many American banks, including the largest ones, were given a huge amount of money by the Federal government (“bailed out”). Why? Because Secretary of the Treasury Henry Paulson, Chairman of the Federal Reserve Ben Bernanke and other economists (not necessarily independent of Paulson and Bernanke) predicted a second Great Depression if they weren’t. I didn’t believe Paulson et al. — their track records of prediction were terrible. They hadn’t foreseen the crisis. Why should I think they knew how to fix it? I believed their predictions of disaster were too confident.

At the time I didn’t know this bit of history:

The blood-curdling threats [now] being issued by Eurocrats should sound familiar to British readers. We went through precisely the same experience 20 years ago, when we were stuck with an over-valued exchange rate in the Exchange Rate Mechanism.

As in Greece, our leaders – all the main parties, the CBI, the TUC, the Bank of England – assured us that leaving the ERM would be disastrous. On September 11, 1992, John Major solemnly told us that withdrawal was ‘the soft option, the inflationary option, the devaluer’s option, a betrayal of our country’s future’.

Four days later, we left the system, and our recovery began immediately. Inflation, interest rates and unemployment started falling, and we enjoyed 15 years of unbroken growth

Those who don’t know the past are doomed to over-trust experts.

The American Dietetics Association Wants No Competition

Seth Roberts4 Comments

Michael Ellsberg has an excellent article about the American Dietetic Association’s attempts to make it illegal for anyone they haven’t approved to give nutritional advice. In this document, they are frank that this is their goal. After Ellsberg drew attention to it, it was taken down. I look forward to learning why it was taken down.

The Washington State chapter of the ADA, now called the Washington State Academy of Nutrition and Dietetics, is responsible for taking down the document. The organization has this mission statement:

Empowering the people of Washington to improve health with safe, effective and reliable food and nutrition information.

Our Vision: Optimize the health and well being of Washington State individuals through food & nutrition.

Our Mission: Empower members to be Washington State’s food and nutrition leaders.

Long ago, in the civil rights or suffrage movements, for example, empowerment meant removal of barriers. This organization preaches empowerment by creation of barriers. Their empowerment is someone else’s disempowerment.

Climategate 2.0: How To Tell When an Expert Exaggerates

Seth Roberts15 Comments

The newly-released climate scientist emails (called Climategate 2.0) from University of East Anglia (Phil Jones) and elsewhere (Michael Mann and others) show that top climate scientists agree with me. Like me (see my posts on global warming), they think the evidence that humans have caused dangerous global warming is weaker than claimed. Unfortunately for the rest of us, they kept their doubts to themselves: “I just refused to give an exclusive interview to SPIEGEL because I will not cause damage for climate science.”

This is a big reason I have found self-experimentation useful. It showed me that experts exaggerate, that they overstate their certainty. At first I was shocked. My first useful self-experimental results were about acne. I found that one of the two drugs my dermatologist had prescribed didn’t work. He hadn’t said This might not work. He didn’t try to find out if it worked. He appeared surprised (and said “why did you do that?”) when I told him it didn’t work. Another useful self-experimental result was breakfast caused me to wake up too early. Breakfast is widely praised by dieticians (“the most important meal of the day”). I have never heard a dietician say It could hurt your sleep or even a modest There’s a lot we don’t know. My discoveries about morning faces and mood are utterly different than what psychiatrists and psychotherapists say about depression.

As anyone paying attention has noticed, it isn’t just climate scientists, doctors, dieticians, psychiatrists, and psychotherapists. How can you tell when an expert is exaggerating? His lips move. There are two types of journalism: 1. Trusts experts. 2. Doesn’t trust experts. I suggest using colored headlines to make them easy to distinguish: red = trusts experts, green = doesn’t trust experts.

The Twilight of Expertise (by-the-book professors)

Seth Roberts3 Comments

Imagine if, to get the news, you had to go somewhere and have it read to you! What a joke. From an article in the Washington Monthly about on-line education:

If Solvig needed any further proof that her online education was the real deal, she found it when her daughter came home from a local community college one day, complaining about her math course. When Solvig looked at the course materials, she realized that her daughter was using exactly the same learning modules that she was using at StraighterLine . . . The only difference was that her daughter was paying a lot more for them, and could only take them on the college’s schedule. And while she had a professor, he wasn’t doing much teaching. “He just stands there,” Solvig’s daughter said.

The excellent article misses something big, however:

A lot of silly, too-expensive things “vainglorious building projects, money-sucking sports programs, tenured professors who contribute little in the way of teaching or research” will fade from memory, and won’t be missed.

Via Aretae.

The Twilight of Expertise (mothers)

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A friend of mine, who lives in Shanghai, has a 3-year-old son. She gets all her parenting advice from the Internet. This would be uninteresting except that her mother lives with her. (So does her husband’s mother.) On a daily basis, in other words, whatever her mom thinks about how kids should be raised is being ignored. My guess is that her mom actually likes the situation because it removes a source of conflict. But I didn’t dare ask.

The American Health Paradox: What Causes It? (continued)

Seth Roberts8 Comments

Atul Gawande might be the best medical writer ever. He is the best medical writer at The New Yorker, at least, and the best one I’ve ever read. He consistently writes clearly, thoughtfully, and originally about the big issues in medicine. That is why his recent article about health care costs (my comment here) and his graduation speech at the Univesity of Chicago are so telling. And not in a good way, I’m afraid.

The graduation speech starts off with an excellent story:

The program, however, had itself become starved—of money. It couldn’t afford the usual approach. The Sternins had to find different solutions with the resources at hand.

So this is what they decided to do. They went to villages in trouble and got the villagers to help them identify who among them had the best-nourished children—who among them had demonstrated what Jerry Sternin termed a “positive deviance” from the norm. The villagers then visited those mothers at home to see exactly what they were doing.

Just that was revolutionary. The villagers discovered that there were well-nourished children among them, despite the poverty, and that those children’s mothers were breaking with the locally accepted wisdom in all sorts of ways—feeding their children even when they had diarrhea; giving them several small feedings each day rather than one or two big ones; adding sweet-potato greens to the children’s rice despite its being considered a low-class food. The ideas spread and took hold. The program measured the results and posted them in the villages for all to see. In two years, malnutrition dropped sixty-five to eighty-five per cent in every village the Sternins had been to. Their program proved in fact more effective than outside experts were.

Bill Gates, Jeffrey Sachs, are you listening? Gawande goes on to say that to improve medicine, there needs to be the same sort of study of “positive deviants”. Here is his first example:

I recently heard from one such positive deviant. He is a physician here in Chicago. He’d invested in an imaging center with his colleagues. But they found they were losing money. They had a meeting about what to do just a few weeks ago. The answer, they realized, was to order more imaging for their patients—to push the indications where they could. When he realized what he was being drawn to do by the structure he was in, he pulled out. He lost money. He angered his partners. But it was the right thing to do.

No kidding. The contrast between mothers who figure out creative iconoclastic new ways to feed children on tiny amounts of money and a doctor who merely refuses to be a scumbag could hardly be greater. But Gawande uses the same term (“positive deviant”) for both! This is the depth to which a writer and thinker of Gawande’s stature has to descend, given the straitjacket of how he thinks about medicine. Gawande thinks that doctors will improve medicine. He’s wrong. Just as farmers didn’t invent tractors — nor any of the big improvements in farming — neither will doctors be responsible for any big improvements in American health. The big improvements will come from outside. I’m sure they will involve both (a) advances in prevention and (b) patients taking charge of their care.

When these innovations happen, where will doctors be? Helping spread them or defending the status quo? That’s what Gawande should be writing about. One big advance in patients taking charge was home blood glucose testing. It came from an engineer named Richard Bernstein. Best thing for diabetics since the discovery of insulin. Doctors opposed it. When I invented the Shangri-La Diet, and lost 30 pounds, my doctor didn’t ask how I lost all that weight. Not one question. Like all doctors, he had many fat patients; the notion that I, a mere patient, could know something that would help his other patients didn’t cross his mind. When I was a grad student I did acne experiments on myself that revealed that antibiotics (hugely prescribed for acne) didn’t work. My dermatologist appeared irritated that I had figured this out. That’s a little glimpse of how doctors may react to outside innovation involving patients taking charge. Of course doctors, like dentists, cannot do good prevention research.

If Gawande took the first story he told to heart, he might realize it is saying that the improvements to health care won’t come from doctors, just as the improvements to the health of those village children didn’t come from experts. As I said earlier, doing my best to channel Jane Jacobs, a reasonable health care policy would empower those who benefit from change. That’s what the village nutrition program did. It empowered mothers who were innovating.

The Twilight of Expertise (psoriasis treatment)

Seth Roberts2 Comments

From BBC News:

A specialist light treatment for psoriasis is just as effective and safe when given at home as in hospital, say Dutch researchers. Phototherapy using UVB light is rarely used in the UK because of limited availability and the number of hospital visits required. But a study of 200 patients found the same results with home treatment. . . .

One reason that the treatment is usually done in hospital is because most dermatologists believe that home phototherapy is inferior and that it carries more risks.In the latest study, patients with psoriasis from 14 hospital dermatology departments were randomly assigned to receive either home UVB phototherapy or hospital-based treatment. Home treatment was equivalent to hospital therapy both in terms of safety and the effectiveness of clearing the condition. And those treated at home reported a significantly lower burden of treatment and were more satisfied.

There was a time when blood-glucose testing (for diabetes) was only done in laboratories, with blood drawn in doctors’ offices or hospitals.