Seth's Blog

Because health care costs have been increasing faster than other costs for a long time. Everyone knows that. But why is that happening? Not so clear. This excellent article (via Marginal Revolution) says that health care is not subject to the same pressures as industries where costs have come down. Off-shore manufacturing is one such pressure. For example, a cell phone used in California can easily be made in China. In contrast, the health care a person in California is likely to want (e.g., X-rays, check-ups) must be supplied locally.

Let me suggest other reasons: (more…)

• Jason Epstein on Jane Jacobs. He edited most of her books.
• How former Emory psychiatrist Charles “Disgraced” Nemeroff found a home at the University of Miami. A comment on the article put it well: “I am even more concerned as to the scientific truth and validity of the studies, drugs, treatments etc they [= Nemeroff and his supporters] have been involved in.” At the same time her university was hiring Nemeroff, the president of the University, Donna Shalala, sent out a letter boasting how the University of Miami was increasing the “integrity” of their medical school by improving policies related to conflicts of interest! “There is no room for compromise in this area,” wrote Shalala.
• More about Jane Jacobs

Thanks to Dave Lull, Paul Sas and Alex Chernavsky.

• A medical device expected to reduce strokes turns out to make them three times more likely. Revealing how well stroke researchers understand strokes.
• skin cancer diminished with marijuana oil
• why might current climate models — the ones supporting Anthropogenic Global Warming — be way off? Cosmic rays.

Thanks to Peter Spero and Alex Chernavsky.

Everyone knows Mad Men, The Good Wife, and Glee – especially Mad Men — are great TV. If you read about TV, you have read about them — especially Mad Men — endlessly. Not everyone knows that Downton Abbey (second season trailer), Switched At Birth, and Suits are also great TV.

Downton Abbey is great because Julian Fellowes, who also wrote Snobs and Gosford Park, is a great writer. The plot is good, the details are good. I’d read or watch anything he does. (After I wrote this post I came across this interview with Fellowes — apparently the NY Times saw the same gap in coverage as I did.)

Switched At Birth is great because to a perfectly good idea for a TV show (two girls are switched at birth, a fact discovered when they are teenagers) was added — by management, not the originators of the show — an excellent idea: one of the girls is deaf. This adds an attractive layer of complexity and novelty (deaf teenage life).

Suits appears formulaic: lawyer show, buddy show, cartoon villain, romantic plot connecting the episodes, every episode, the good guys win cleverly. But perhaps the formula, whatever it is, is really well-executed because I enjoy every episode and don’t feel dirty afterwards.

Recently the Guardian ran an article by David Colquhoun, a professor of pharmacology at University College London, complaining about peer review. His complaints were innocuous; what was interesting was his example. How bad is peer review? he said. Look what gets published! He pointed to a study of the efficacy of acupuncture and included graphs of the results. “It’s obvious at a glance that acupuncture has at best a tiny and erratic effect on any of the outcomes that were measured,” he wrote.

Except it wasn’t. There were four graphs. Each had two lines — one labelled “acupuncture,” the other labelled “control”. You might think to assess the effect of acupuncture you compare the two lines. That wasn’t true. The labels were misleading. The “acupuncture” group got acupuncture early in the experiment; the “control” group got acupuncture late in the experiment. Better names would have been early treatment and late treatment. You could not allow for this “at a glance”. It was too complicated. With this design, if acupuncture were effective the difference between the two lines should be “erratic”.

The paper’s data analysis is poor. To judge the efficacy of acupuncture, their main comparison used only the data from the first 26 weeks. They could have used data from all 52 weeks. That is, they ignored half of their data when trying to answer their main question. Colquhoun could have criticized that, but he didn’t.

Colquhoun’s criticism was so harsh and shallow, apparently he is biased against acupuncture. But there are two big things few pharmacology professors appear to know. One is how to stimulate the immune system. This should be central in pharmacology, but it isn’t. Half of why I think fermented foods are so important is that I think they stimulate the immune system. (The other half is they improve digestion.) There are plenty of less common ways to do this. The phenomenon of hormesis suggests that small doses of all sorts of poisons, including radiation, stimulate repair systems. The evidence behind the hygiene hypothesis suggests that dirt improves the immune systems of children. Bee stings have been used to treat arthritis. And so on. In this context, sticking needles into someone, which puts a small amount of bacteria into their blood, is not absurd. Acupuncture also allowed patients to share their symptoms, the value of which Jon Cousins has emphasized.

The other big thing Colquhoun doesn’t seem to know is the absurdity of the chemical imbalance theory of depression. Speaking of ridiculous, that’s ridiculous. Which plays a larger role in modern medicine — antidepressants or acupuncture? If you want criticize peer review, criticize the chemical imbalance theory. It is as if peer reviewers have been saying, yes, the earth really is flat for fifty years. Perhaps this is ending. During a talk that Robert Whitaker gave at the Massachusetts General Hospital in January, he was told by doctors there that the chemical-imbalance theory was an “outdated model”.

Thanks to Dave Lull and Gary Wolf.