The Continued Existence of Acne Reveals the Perverse Incentives of Modern Medicine

Yesterday I wrote how Alexandra Carmichael’s headache story illustrated a large and awful truth about modern healthcare: It happily provides expensive relief of symptoms while ignoring investigation of underlying causes. If we understood underlying causes (e.g., causes of migraines), prevention would be easy. Let people get sick so that we can make money from them. There should be a name for this scam. In law enforcement, it’s called entrapment.

Sensible prevention research would start small. Not by trying to prevent breast cancer, or heart disease, or something like that: They take many years to develop and therefore are hard to study. Sensible prevention research would focus on things that are easy to measure and happen soon after their causative agents. One example is migraines. Migraines happen hours after exposure. The fact that Chemical X causes migraines means it is likely that Chemical X is bad for us, even if it doesn’t cause migraines in everyone. This is the canary-in-a-coal-mine idea. Migraines are the canary.

Acne is another canary. Acne is easy to measure. Figuring out how to prevent it would be a good way to begin prevention research. To prevent acne would be to take the first steps toward preventing many more diseases. A high-school student could do ground-breaking research — research that would improve the lives of hundreds of millions of people — about how to prevent acne but somehow this never happens. In spite of this possibility, grand-prize-winning high-school science projects, from the most brilliant students in the whole country, are always about trivia.

A just-published review in The Lancet reveals once again the unfortunate perspective of medical school professors. The abstract ends with this:

New research is needed into the therapeutic comparative effectiveness and safety of the many products available, and to better understand the natural history, subtypes, and triggers of acne.

Actually, finding out what causes acne is all that’s needed.

To figure out what causes acne (and thereby how to prevent it) three things are necessary: (a) study of environmental causes, such as diet, (b) starting with n=1, and (c) willingness to test many ideas that might be wrong (because it’s far from obvious how to prevent acne). All three of these things are exactly what the current healthcare research system opposes. It opposes prevention research because drug companies don’t fund it. It opposes n=1 studies because they are small and cheap, which is low-status. To do such a study would be like driving a Corolla. It opposes studies that could take indefinitely long because such studies are bad for a researcher’s career. Researchers need a steady stream of publications.

High school students, who aren’t worried about status or number of publications, could make a real contribution here. You don’t need fancy equipment to measure acne.

Thanks to Michael Constans.

19 Responses to “The Continued Existence of Acne Reveals the Perverse Incentives of Modern Medicine”

  1. Valtsu Says:

    Re causes of acne,

    You might find this n=1 experiment interesting!
    http://www.acne.org/messageboard/Zinc-Zinc-Regimen-Adul-t243340.html

    Here are some real studies with nice results:
    http://www.lipidworld.com/content/7/1/36
    http://www.ncbi.nlm.nih.gov/pubmed/16871775
    http://www.ncbi.nlm.nih.gov/pubmed/20666829

  2. Acnefreenow Says:

    Systemic Inflammation is the primary cause of acne. It causes the tissue around pores to swell up, blocking the pores, which causes oil, etc. to build up, and bacteria to be trapped inside and swell up, resulting in infection.

    Anything that reduces such inflammation reduces acne. Eating a non-inflammatory diet such as one that excludes refined flours and sugars, helps for example.

    If you want to convince yourself, conduct your own N=1 experiment by reading up on non-inflammatory nutrition, cut out flours and sugars, and you’ll see a massive difference in two weeks.

  3. Seth Roberts Says:

    “Systemic Inflammation is the primary cause of acne.” what is your evidence for this?

    A student I know cut way down on sugar to test this theory. It helped, but did not make a “massive difference”.

  4. Nancy Lebovitz Says:

    Nitpick: I know someone who gets migraine a few days after eating seafood, so it’s not always hours. Still, your general point stands.

  5. Acnefreenow Says:

    Seth,

    Evidence 1: acne-free primitive peoples that go from paleo diets to modern inflammation-promoting diets achieve acne incident rates the same as people in the developed world

    Evidence 2: at age 44, I have found that like clockwork, when I go off a good paleo/anti-inflammatory lifestyle too far, I still get acne coming back like a teenager, every time, but virtually never when I stay on track

    I’m not surprised your student didn’t see much effect from just reducing sugar. I would recommend they read up on which foods and supplements promote and reduce systemic inflammation, and make whatever changes make sense to them for a full two weeks. At a minimum, I would expect they would need to eliminate ALL sugars and flours for a full two weeks to cool down the body’s cytokine levels and other markers of inflammation.

  6. Acnefreenow Says:

    The reason I suggest people look at all factors that go in to an anti-inflammatory lifestyle, and not just, say, reduce sugar, is that if your student is unaware that their bad oral hygiene, for example, is an even bigger source of inflammation than their diet, then dietary changes may not be enough. That being said, a good paleo diet plus things like plenty of flax seed oil can go a long way towards reducing orally caused inflammation even if the patient is not a regular brusher/flosser. Other lifestyle factors, like exercise, can also help reduce inflammation. Self-experimentation is the only way to determine what will work for oneself.

  7. MikeW Says:

    Well, I’ll agree with the end of the previous comment, “self-experimentation is the only way to determine what will work”. I challenged my acne-prone skin with a load of sugar that would horrify any paleo follower: 3 pounds of jelly bellies over the course of a week. (No lie – I find JB’s incredibly addictive.) Result: my skin was perfectly clear, so clear I joked to myself that I had found a cure.

    Yet one handful of dried blueberries with citric acid added, or so-called fruit snacks (also with citric acid), I immediately feel a tingling in my mouth, a little heat on my face, and within a day I have a few pimples. So in my case I think it’s local inflammation, not systemic. I don’t know why I have such a reaction to added citric acid – something to do with the mold or yeast they use to produce it industrially I guess.

    I know there are many good reasons to avoid sugar, but in my experience acne isn’t one of them.

  8. bjk Says:

    I tried many different approaches, this is what worked.

    First, cut out all omega-6 from diet. Especially soybean oil, but also nuts, peanut butter, olive oil, and some other stuff you wouldn’t expect to have it (I know, because I’ll eat a large amount (lots of peanut butter, for instance) and then get acne).

    Second, FCLO daily, not the unfermented kind, that didn’t work at all. I like the FCLO with the vitamin K etc etc, don’t know if that works better than just plain FCLO.

    Third, daily benzoyl peroxide regime adds to the effectiveness.

    I know all of this works because when I don’t follow the regime, I get acne. When I do, no acne. My skin also feels much softer and cooler.

  9. john Says:

    I haven’t eaten any junk in about a year, but I still have very mild acne. I eat starches and fruits, but I’m relatively low carb. I do eat high calorie though, as I’ve never seemed to gain body fat, so that might be a factor. I’m skeptical of the idea that we simply need to do enough “anti-inflammatory” things, as I eat quite a lot of n-3s from fish and have tried flaxseed oil (didn’t notice anything) and get a decent amount of sun. I do eat significant amounts of dairy and a coffee every other day, so maybe that’d be a good place to start.

  10. Brent Says:

    I thought this problem was definitively solved in 2006 with Professor Cordain’s book, The Dietary Cure for Acne.

    http://www.amazon.com/Dietary-Cure-Ph-D-Loren-Cordain/dp/0978510917

    -B

  11. Seth Roberts Says:

    Brent, this long discussion suggests a different cause of acne than the ones theorized by Cordain:
    http://www.acne.org/messageboard/Zinc-Zinc-Regimen-Adul-t243340.html

  12. bjk Says:

    “I’m skeptical of the idea that we simply need to do enough “anti-inflammatory” things, as I eat quite a lot of n-3s from fish and have tried flaxseed oil (didn’t notice anything) and get a decent amount of sun.”

    I found flaxseed oil didn’t work. It has high omega-3:omega-6 ratio, but the absolute level of omega-6 is too high. That’s my experience, not saying I could pass an exam on the difference, but lowering the absolute level has made a noticeable difference on my skin.

  13. Jeff Says:

    As a high school student myself, I experience firsthand the poor environment most of my peers live in and see the possibility of what could be. However, I do not feel I could “do groundbreaking research.” Cooperation would be hard, if not impossible, to come by. To be honest with you, the majority of my peers could care less about their health. I can not even bring up my dietary opinions in casual conversations with some of my peers because they simply do not want to hear that their two-Gatorade-a-day habit could be detrimental to their health. I’m ashamed to admit this, but this close-minded, apathetic attitude has led me to keep my mouth shut when discussions of health and diet do happen to arise. I would love to make a contribution, but have no idea where to start. No mother would allow some teenager to be guiding her child’s nutritional habits. Additionally, who would listen to a teenager? We are stereotyped as immature and irresponsible as it is, therefore have no credibility, even if one did have sound data pointing to a sound conclusion.

    -Jeff

  14. Seth Roberts Says:

    Jeff, you can study yourself, if you have acne.

  15. Acne here, acne there, acne acne everywhere! | Personal Influence Says:

    [...] Seth Roberts posted this week encouraging high school students to take on big pharma and the medical establishment with some n=1 [...]

  16. Diet, Acne, and n=1 Experimentation | A Mom On A Mission . . . . . . to nurture and nourish her family Says:

    [...] found an interesting blog post the other day over at Seth’s blog about the perverse incentives of the modern healthcare system [...]

  17. Maria Schröder Says:

    Hello all !
    I am new to forums that discuss Acne and other skin imperfections. I have been suffering for many years and sometimes almost given up on mingling with other people bacause of my looks. I can never talk to anyone unless I feel that the person is looking at my ugly blackheads, whiteheads and scars.
    I write to day because I am stuck. I heard last week of a new formula that was so powerful that a person with my skin problems would get rid off the acne in just 2 or 3 months and could stay acne free by using the formula once a month. But the person that told me this had forgotten where this formula was obtained from. The only thing she remembered was “wonderful scandinavia”.
    Has anyone of you people heard about this fomula ? I really would appreciate the info if this is as good as the story was.
    Maria Schröder
    maria@myndabankinn.is

  18. Maria Says:

    I had the worst cystic acne you ever saw from the time I was 16 until age 27. It was hard for me to even look at myself in the mirror. Like most people facing that I went from doctor to doctor and tried every medication available but nothing really helped much. Then In starting taking Accutane and everything changed. In a couple of weeks the cysts were gone and when I finished taking all the prescribed pills the cysts were gone and never came back. I know that Accutane won’t prevent or cure acne but it sure delivered the knockout punch to my cystic acne.

  19. Ted Says:

    My acne cleared up after I had been taking lots of fish oil (6 grams) every day for 5 months. After a couple of years, though, I noticed that the fish oil, while improving my skin and initially my mood, was starting to make me feel sluggish and depressed. So I cut way down on fish oil (half a gram a day) and instead eliminated as much omega-6 from my diet as I possibly could. My skin remained clear and I stopped feeling sluggish and depressed. (Off-topic, but when I cut gluten out of my diet, my lifelong dandruff disappeared within a couple of weeks and has never returned.)