Seth's Blog

• Doctoring to the test. Megan McArdle describes the medical equivalent of “teaching to the test”. Although she had the usual symptoms of too-little thyroid hormone, her doctor would not give her more synthetic hormone because her Thyroid Stimulating Hormone (TSH) level was within “normal range”.
• The Rotten Heart of Europe: The Dirty War for Europe’s Money by Bernard Connolly is out of print, but you can buy a used copy  ($600) or download it (free).
• More evidence that butter is good for you.
• The trouble with lab mice. Nobel Prizes in Medicine, I’ve said, show the continuing failure of researchers to make significant progress on all major diseases. This article is a closer look at the problem. “We’ve had thousands of mouse studies of tuberculosis, yet not one of them has ever been used to pick a new drug regimen that succeeded in clinical trials. ‘This isn’t just true for TB; it’s true for virtually every disease,’ he tells me.”

Thanks to Ivy Hsieh and Allan Jackson.

A reader of this blog named Heidi noticed the discussion of “kombucha” made by fermenting fruit juice with a kombucha culture (SCOBY) started by Parker Bohn. She wrote as follows:

I read somewhere on the internet that kombucha was traditionally brewed with rosehips and elderberries.  Since then I’ve been combining tea (either green, black, or raspberry leaf) with several kinds of wild fruit and making some absolutely amazing kombucha!  (Before then I experimented with lots of different herbal kombuchas with different medicinal properties.)  Black current, rosehips, elderberries, sumac berries, autumn olive berries, black cherries, and raspberries all made excellent kombucha.  The best results seemed to be from tea combined with two different fruits, one tart and the other with a unique flavor.  I also tried wild grape juice and hawthorn fruits but wasn’t as happy with the results, though the kombucha was still good. Also the SCOBY grows thicker with the tea and fruit combos.

I still used the same amounts of sugar and tea that I had been using, but I was using tart wild fruits that weren’t as sweet as store brought juice.  My brew of tea, wild fruits, and sugar was a lot stronger and more flavorful than the weak tea and sugar combo that most people use. I would have two or more people sample the results.  Different people would have different favorites, but everyone agreed that the fruit and tea combos were the best kombucha they’d ever had.

I also created herbal kombuchas to target different health issues that people had. For example I made a kombucha with wormwood and other parasite killing herbs. After awhile, I pushed it too far with the herbs though, and the SCOBY stopped fermenting well and started to mold.  I was able to nurse it back to life though. Certain herbs work much better than others.

Perhaps a mixture roughly half tea and sugar, half fruit juice will work best. At least, that’s where I’ll start exploring these possibilities. I may never go back to traditional kombucha. Because they are more complex, I can easily believe these newfangled brews taste better. It’s interesting they aren’t available commercially. Flavored kombucha drinks in stores are kombucha with small amounts of fruit juice added at the end.

In this interview, a doctor who does research on biofilms named Randall Wolcott makes the same point I made about Testing Treatments — that evidence-based medicine, as now practiced, suppresses innovation:

I take it you [meaning the interviewer] are familiar with evidence-based medicine? It’s the increasingly accepted approach for making clinical decisions about how to treat a patient. Basically, doctors are trained to make a decision based on the most current evidence derived from research. But what such thinking boils down to [in practice -- theory is different] is that I am supposed to do the same thing that has always been done – to treat my patient in the conventional manner – just because it’s become the most popular approach. However, when it comes to chronic wound biofilms, we are in the midst of a crisis – what has been done and is accepted as the standard treatment doesn’t work and doesn’t meet the needs of the patient.

Thus, evidence-based medicine totally regulates against innovation. Essentially doctors suffer if they step away from mainstream thinking. Sure, there are charlatans out there who are trying to sell us treatments that don’t work, but there are many good therapies that are not used because they are unconventional. It is only by considering new treatment options that we can progress.

Right on. He goes on to say that he is unwilling to do a double-blind clinical trial in which some patients do not receive his new therapy because “we know we’ve got the methods to save most of their limbs” from amputation.

Almost all scientific and intellectual history (and much serious journalism) is about how things begin. How ideas began and spread, how inventions are invented. If you write about Steve Jobs, for example, that’s your real subject. How things fail to begin — how good ideas are killed off — is at least as important, but much harder to write about. This is why Tyler Cowen’s The Great Stagnation is such an important book. It says nothing about the killing-off processes, but at least it describes the stagnation they have caused. Stagnation should scare us. As Jane Jacobs often said, if it lasts long enough, it causes collapse.

Thanks to Heidi.

• Scientific heresy, a lecture by Matt Ridley mostly about climate change. “Jim Hansen of NASA told us in 1988 to expect 2-4 degrees [of warming] in 25 years. We are experiencing about one-tenth of that.”
• The continuing influence of Jane Jacobs. “Rouse spoke first, recalling the words of Daniel Burnham, “Make no little plans, for they have no magic to stir men’s blood,” he said. Jacobs followed and began, “Funny, big plans never stirred women’s blood. Women have always been willing to consider little plans.”"
• A self-experimental study of lactose intolerance. ” I came across an article that pointed out that levels of [lactase, the enzyme that digests lactose]  peak in the morning and evening hours. So I experimented with having either ricotta products or a half cup of milk with my supper. It worked like a charm, and sure enough, if I tried having any between 11 AM and about 4 PM, I would get sick.”
• A rather dramatic Google bug. Google the phrase “first let them get sick”. You will be told there are hundreds of thousands of results — perhaps 250,000. Look through them and you will see the correct number is much less (recently, 47).
• Lorrie Moore reads one of my favorite short stories, “Day-Old Baby Rats” by Julie Hayden. “[In a confessional:] ‘I have missed Mass.’ ‘How many times?’ ‘Every time.’”

Thanks to Dave Lull and Nile McAdams.

In yesterday’s post I described how searching the medical literature helped me avoid a dangerous surgery with no obvious benefit. The surgeon I consulted, who recommended the surgery, said that published evidence backed her up. I could not find that evidence, however. Others found evidence that contradicted her recommendation.

Among the comments on that post were similar stories: Searching/reading the medical literature had been helpful. Learning what had happened (in research studies) was better than relying on an expert (a doctor). Here is an example:

A little over two years ago, I was “depressed”. My psychiatrist wanted to prescribe an SNRI [serotonin-norepinephrine reuptake inhibitor]. I related, once again, my poor experience with an SSRI and asked for evidence that an SNRI would be any more effective. He said there was evidence that SSRIs [selective serotonin reuptake inhibitors] worked. I pointed out the 2004 meta-analysis that showed no meaningful difference between SSRIs and placebos. Then I asked whether there was any better evidence for SNRIs. Since he wasn’t able to provide any, I told him that since we know that extremely low Vitamin D blood levels, poor diet, no exercise, and no social life can cause depression (all things I had at the time), I’ll try fixing those things first and then resort to drugs if that fails. It did not fail and I quit seeing him.

None of the stories in the comments described the opposite outcome: Knowing the data made things worse.

Are there exceptions? Is it always helpful (or at least not harmful) to know what happened (i.e., know research outcomes)? Has anyone reading this had an experience where knowing health research data was harmful?