Seth's Blog

The Journal of Participatory Medicine has released two issues (first, second). They help explain what participatory medicine means. The best article I have found among them is called “What It Will Take to Embrace Participatory Medicine: One Patient’s View” by Kate Lorig. Here is one bit:

In one of my regular clinics, I am met with a sign that tells me that if I am a half hour late, my appointment will have to be rescheduled. I once asked what would happen if I were not seen in a half hour and was told to sit down and wait. Last year while waiting for scheduled appointments I read five full-length books (five hours each).

But overall the articles, even this one, are long on generalizations and short on specifics.

We evolved to like sour foods, foods with complex flavors, and umami foods, I believe, so that we would eat more bacteria-laden food. Why do we need to eat such food? Perhaps to get enough Vitamin K2. Vitamin K1 and Vitamin K2 are quite different. A brief introduction:

The term vitamin K refers to a group of compounds that have a 2-methyl-1,4-naphtoquinone ring in common but differ in the length and structure of their isoprenoid side chain at the 3-position. The 2 forms of vitamin K that occur naturally in foods are phylloquinone (vitamin K₁) and the group of menaquinones (vitamin K₂, MK-n), which vary in the number of prenyl units. Whereas phylloquinone is abundant in green leafy vegetables and some vegetable oils, menaquinones are synthesized by bacteria; therefore, they mainly occur in fermented products such as cheese.

A 2004 study found a huge protective effect of K2:

The scientists at Osaka City University gave 21 women with viral liver cirrhosis [which greatly increases your chances of liver cancer] a daily supplement of 45mg vitamin K2 (menaquinone) for a period of two years. A group of 19 women with the disease received a placebo for the same time. Liver cancer was detected in only two of the 21 women given vitamin K2 but nine of the 19 women in the control group, reports the team in today’s issue of JAMA (292:358-361). After adjustment for age, severity of disease and treatment, the researchers found the women receiving vitamin K supplementation were nearly 90 per cent less likely to develop liver cancer.

A huge effect, suggesting that K2 is necessary for a repair system to work properly. This recent article is more support for the idea that K2 protects against cancer. The effect is weaker, perhaps because there was less damage needing repair.

The title of Nicholson Baker’s chat about his New Yorker video-game article is “My Son is Killing Me”. Which is a far better title than the print title of the article: “Painkiller Deathstreak”. Why not give the article the much better title? Because another article in the same issue, a profile of Gil Scott-Heron, is called “New York is Killing Me.” Too late.

Gary Taubes pointed to this PNAS paper about climate change and noted that one of the authors, Stephen Schneider, had a big non-financial conflict of interest: If it turns out the whole argument is wrong, he looks like a fool. The accompanying statement (“The authors declare no conflict of interest”) is, if taken to mean the authors have no conflict of interest, wildly inaccurate. Readers unaware of Schneider’s history wouldn’t know this.

I came across a similar example today. A reader of this blog wrote extensive criticisms (here and here) of the idea that prenatal ultrasound may cause autism. He believed Caroline Rodgers, my source for that idea, misrepresented the evidence. In particular, Rodgers pointed to a study that found ultrasound disturbed neuronal migration in mouse fetuses. She said it supported her idea. The reader disagreed, saying,

The bottom line for me is that Dr. Rakic (from the mouse study) clarified, “Our study in mice does not mean that use of ultrasound on human fetuses for appropriate diagnostic and medical purposes should be abandoned. Instead, our study warns against its non-medical use.” Yes. Okay. No more boutiquey, keepsake ultrasounds. Great. But for Rodgers to skew this data (along with the FDA’s and others’) into claiming that ultrasounds under the care of an Obstetrics professional (and for medical use) are causing autism is disingenuous at best, unethical propaganda for the Midwifery Way at worst.

The reader is a professor who teaches composition. Maybe an English professor.  He or she takes Rakic seriously, where I completely ignore his statement because of a conflict of interest. If Rakic questions “appropriate” ultrasound, he will be attacked in many ways, making his life unpleasant. I have no idea whether this swayed Rakic, but he would be only human if it did.

Of course developing neurons are unable to distinguish appropriate and inappropriate ultrasound. Rakic’s statement is ridiculous as Rakic and all insiders (neuroscientists) know, I believe. All insiders know that there are dozens of examples where findings from mouse brains have turned out to be true for human brains, in spite of the many differences between them, and that there are thousands of grant proposals in which mouse brains are claimed to be a worthwhile model for human brains. All insiders know this, realize the pressure on Rakic to say what he said, and, like me, just ignore it. As far as I can tell, Rakic pays no price for misleading outsiders because the outsiders don’t know they are being misled. (Just as with political lobbying: the public doesn’t understand what’s happening.) The composition professor doesn’t know this, as far as I can tell.

Rodgers is not claiming that ultrasounds “are causing autism”. She is saying they might cause autism, that there are several reasons to think so, and therefore (a) the ultrasound-autism idea deserves further scrutiny and (b) ultrasounds should be avoided as much as possible until more is known.

I came across the Potti scandal while trying to find out about the trouble faced by a woman named Joan Evans because a statistical analysis couldn’t be reproduced. Robert Gentleman had mentioned this in a talk at the Joint Statistical Meetings in Vancouver. Look for The Cancer Letter, Gentleman said.

I now realize that Joan Evans is Joe Nevins, who co-authored a major paper with Potti.

Speaking of Potti, members of the Duke administration are said to “have warned people not to even Google the name ‘Anil Potti,’”