Immortal Bird by Doron Weber, a program director at the Sloan Foundation, is about his son, Damon, who had a rare medical condition, and his son’s heart transplant operation (cost = $500,000) at New York Presbyterian/Columbia University Medical Center. Damon died after the operation. The post-operative care was so bad his father sued. “Three years into the lawsuit, the medical director [of the hospital] claimed Damon’s post-op records couldn’t be located,” said the New York Times.
How can such tragedies be prevented? To find out, I interviewed Doron Weber by email. (more…)
David A. Pfister, a Bay Area oncologist, was named “Best of the Bay Oncologist” in 2010 by KRON-TV, according to a Yelp reviewer. He was named one of America’s “Top Doctors” by US News, based on a “peer nomination process.” The biggest doctor rating site, at least in America, is HealthGrades. A HealthGrades survey of Dr. Pfister’s patients (n = 31) asked Would you recommend Dr. Pfister to family and friends? Dr. Pfister’s score — halfway between “mostly yes” and “definitely yes” — put him close to the national average. (more…)
The Health Care Blog post titled “The Empowered Patient” by Maggie Mahar exists, as far as I can tell, because much hospital care has considerable room for improvement and many mistakes are made — for example, patients are given the wrong drug. One commenter (MD as Hell) said he has worked in hospitals more than 30 years and has some advice, including
Never be alone in a hospital
Never go to a hospital unless you have no alternative
Do not let fear motivate you to be a consumer of any part of healthcare
In the comments, several doctors expressed their dislike of the whole idea of “patient participation”. For example,
Patients manage the process. Really? I’m sure your plumber or mechanic love you and this philosophy so much they hug you when you greet them.
Here is another argument against patient participation:
The huge problem that barely anyone wants to talk about is [the assumption] that patient (and family ) participation are always (or even just mostly) beneficial. This is a completely unfounded assumption. Please read Dr. Brawley’s book “How we do harm” to read 2 long and IMHO representative anecdotes of patient/family centeredness resulting in net harm. . . . Lack of patient involvement and medical errors are hardly on top of the list of pressing flaws of the US health care system . . . Profit centeredness resulting in overtreatment of the insured and undertreatment of the underinsured are the main issues.
If medical errors are the #3 cause of death in America, they are one of the most serious flaws of the US health care system. The doctors who dislike patient participation in this comment section do not propose a better way to reduce mistakes, a better way to spend the time and mental energy required by patient participation. Maybe their annoyance is a good thing. Maybe they will be so annoyed they will reduce errors in other ways.
It is bizarre that patient involvement cannot be easily dismissed. I cannot think of another profession (accountants, bus drivers, carpenters, dentists, elementary school teachers, and so on) where anyone says never be alone with them. Sure, hospital patients are highly vulnerable but that vulnerability is no secret. It could have led to a system, similar to flying (airplane passengers are highly vulnerable), with an extremely low rate of fatal error. My own experience supports patient involvement. The biggest motivation for my self-experimentation, at least at first, was my self-experimental discovery that a powerful acne medicine my dermatologist had prescribed (tetracycline, an antibiotic) was no help. My dermatologist had shown no signs of considering this a possibility. When I told him about my experiment (varying the dose of the antibiotic) and the results (no change in acne), he said, “Why did you do that?” Later a surgeon I consulted about a tiny hernia was completely misleading about the evidence for her recommendation that I have surgery for it.
Sitting down and getting up from floor test predicts longevity. Your score depends on how much support you need. “[The correlation with mortality] persisted when results were controlled for age, gender and body mass index, suggesting that the sitting-rising test score is a significant predictor of all-cause mortality; indeed, subjects in the [lowest] score range [score 0-3] had a 5-6 times higher risk of death than those in the reference group [score 8-10].”
It starts badly. Here is the stated reason for the page:
Because we are a startup organization working in areas we have little experience with, it is particularly important that we constantly recognize and learn from our shortcomings. We make this log public so as to be up front with any potential supporters about ways in which we need to improve.
The second sentence alone would have been fine.
The first item is called “overaggressive and inappropriate marketing.” I’d call it “dishonest marketing”.
I once attended a short talk, before PowerPoint, in which the speaker, Herb Terrace, a Columbia University psychology professor, put a slide in backwards. He struggled to fix it. It was funny and memorable. Maybe I should make similar mistakes on purpose, I thought. I have no idea if the GiveWell mistakes page is a reasonable summary of their mistakes. As Renata Adler pointed out, the New York Times corrects trivial mistakes and leaves major blunders uncorrected (“there are, as a rule, no genuine corrections. These departments are cosmetic”). But the GiveWell mistakes page does three things well. (a) It’s a readable summary of what they do and their goals. In contrast, I found their “About” pages unhelpful. (b) It makes them more attractive. As confessions of difficulties and problems and weaknesses usually do. (c) It draws attention to them. It is an original and thought-provoking thing to do. The next time I teach a class, should I include “mistakes I made last time I taught this class”? Maybe.
Ten strange self-experiments. One is different from the rest. “As a teenager, Frederick Hoelzel adopted a strange method of weight-loss. He curbed his appetite by eating non-caloric food substitutes such as corn cobs . . . . His favorite meal was surgical cotton cut up into small pieces, which became part of his daily diet.”
To do personal science well, what should you learn?
Professional scientists learn how to do science mostly in graduate school, mostly by imitation, although they might take a statistics class. Personal scientists rarely have anyone to imitate, so have more need to understand basic principles. There are five skills/dimensions that matter. Here are a few comments about each one: (more…)
David Healy talk about problems with evidence-based medicine. Example of Simpson’s paradox in suicide rates.
The ten worst mistakes of DSM-5. This is miserably argued. The author has two sorts of criticisms: 1. Narrow a diagnosis (e.g., autism): People who need treatment won’t get it! 2. Widen a diagnosis (e.g., depression) or add a new one (many examples): This will cause fads and over-medication! It isn’t clear how to balance the two goals (helping people get treatment, avoiding fads and over-medication) nor why the various changes being criticized will produce more bad than good. Allen Frances, the author, was chair of the committee in charge of DSM-4. He could have written: “When we wrote DSM-4, we made several mistakes . . . . The committee behind DSM-5 has not learned from our mistakes. . . .” That would have been more convincing. That the chair of the committee behind DSM-4, in spite of feeling strongly about it, cannot persuasively criticize DSM-5 speaks volumes.
The Lying Dutchman. “Very few social psychologists make stuff up, but he was working in a discipline where cavalier use of data was common. This is perhaps the main finding of the three Dutch academic committees which investigated his fraud. The committees found many bad practices: researchers who keep rerunning an experiment until they get the right result, who omit inconvenient data, misunderstand statistics, don’t share their data, and so on.”
This excellent article by Carl Zimmer gives a brief history of the development of antibiotics. It makes the usual points that the microbes within us improve our health and killing them (with antibiotics) can have bad effects. One study found that children given antibiotics had a higher risk of developing inflammatory bowel disease (IBD) later in life. Giving antibiotics to a child younger than one year was especially dangerous — the risk of IBD increased by a factor of 6.
The article makes the minor mistake of taking seriously what researchers say about number of species:
Each of us is home to several thousand [bacterial] species. . . . My own belly button, I’ve been reliably informed, contains at least 53 species.
Counting the number of species inside us is like measuring the length of the coast of England. The more closely you look (in the case of coastlines, the shorter the ruler you use), the larger the number you will arrive at. I’d be surprised if the researchers who count bacterial species adjust for this.
What I found most interesting about the article is it says nothing about fermented foods. Apparently the connection is not so obvious.
I have recently encountered three examples that suggest low-carb diets don’t work well long-term:
1. Alex Chernavsky tried a low-carb diet in 2002. Starting at 270 pounds, he lost 70 pounds. A year later, he started to rapidly regain the lost weight. He stopped the diet.
2. A “medical professional” started at about 260 pounds (she’s 5’3″). After reading Wheat Belly, she gave up wheat. “After several months of being wheat free I lost 10 lbs. But that’s where it stopped.” Then she did full low-carb. “From May to July I did what basically was Atkins induction. I lost 20 lbs but then the weight loss stopped.”
3. Jimmy Moore lost a lot of weight eating low-carb. Starting in 2004 at 410 pounds, he lost 180 pounds. Then he gained half of it back, ending up near 300 pounds in early 2012. (more…)
A good way to do the Shangri-La Diet is to drink flaxseed oil between meals. It pushes down your setpoint and also supplies omega-3. Alex Chernavsky, for example, has had success with this. You will probably want to make the flaxseed oil smell-less. Here’s how:
I read something on Amazon by one of the people who reviewed your book and it’s worked for me. I take a small sip of water and keep it in my mouth and then take the tablespoon [of flaxseed oil] with my nose closed with the water in still in my mouth and swallow. Then I take a another drink of water and then I swish my mouth out with water and after all of it is done I have no residue of flax oil taste. It sounds like a lot to do but it really isn’t.
Lately I’ve been doing the Shangri-La Diet by eating a daily bowl of yogurt, ground flaxseed (50 g), honey and fruit with my nose clipped shut. It tastes great because it is creamy, sour and sweet and has a variety of textures. It has a fair amount of calories (400?) so it’s good for weight loss. I have to push myself to drink flaxseed oil but I have no trouble eating this.
They say money cannot buy happiness [Adam's father is apparently rich], but when dealing with someone with a mental illness, it can go a long way toward paying to fix unhappiness — it can pay for good doctors, proper medication [emphasis added], care-givers/guardians, all the tools required to secure a property and keep the “patient” safe, AND giving the mentally ill person his ideal living situation, limiting the snits and tantrums that can lead to real anger, which, in turn can lead to acting out.
No doubt this particular commenter is smart and well-informed. Which makes the fact that he or she is perfectly sure that “proper medication” exists so scary, at least if this person had any control over me or anyone who mattered to me. It reminds me of people who think that if you’re fat all you have to do is eat less.
A new article emphasizes the benefits of cheese, especially “molded” cheese, such as Roquefort and Gorganzola. Fermentation, if that is the right word, is essential:
The advantageous properties of cheese appear dynamically during the ripening process. Cheese which has been ripened for longer has been shown to be more effective in restoration of glucose tolerance, prevention of steatosis [fat deposition inside a cell] and adipose tissue oxidative stress than short-ripened specimens. This data suggests that organic substances responsible for the health benefits of cheese emerge not merely due to mixing the ingredients required for cheese production, but rather as a result of a complex time-dependent enzymatic transformation of the cheese core controlled by probiota, temperature, humidity and possibly other factors.
Only in South Korea and Japan do people have less heart disease than in France, says the article. Readers of this blog will quickly see what South Korea, Japan, and France have in common. All of them eat much more fermented food than most people in rich countries. South Korea: kimchi. Japan: miso and pickles. France: cheese and wine.
Adam Lanza, the Sandy Hook shooter, was taking medication, according to a neighbor. Here’s what someone said in 2008: “Every young, male shooter [who] has gone on a killing spree in the United States also has a history of treatment with psychotropic drugs — typically SSRI antidepressants. These shootings have three things in common: 1) The shooters are young males. 2) The shooters exhibit a mind-numbed disconnect with reality. 3) The shooters have a history of taking psychiatric medications.”
Lanza was considered by his mom to have Asperger’s. No doubt that, and the associated isolation, had something to do with the medication. As I point out every year at Nobel Prize time, the research methods favored by the healthcare establishment have done little to reduce major diseases, such as depression. With few exceptions, year after year little progress is made on figuring out the environmental cause of anything, including Asperger’s and autism. The result of this lack of progress is that almost every serious health problem, including mental health problems, gets treated with drugs or surgery rather than prevented or treated safely with necessary nutrients (as scurvy is treated with lime juice). The little progress that is made in finding environmental causes is undervalued. The researchers who figured out that smoking causes lung cancer didn’t even get a Nobel Prize. The effect of failing year after year to find environmental causes is that people take more and more drugs with little-known or unknown side effects, which are almost always bad. The association of SSRI antidepressants and violence is still unknown to many people, for example. The problem has been made worse by drug companies hiding data. As Ben Goldacre says in Bad Pharma, one of the worst cases involved an antidepressant called paroxetine, whose manufacturer (GlaxoSmithKline) withheld data about its tendency to cause suicide. My work has suggested that a lot of depression may be due to lack of exposure to faces in the morning, an idea utterly different than the neurochemical theories of depression favored by psychiatrists. I am sure that seeing faces in the morning is safer than taking psychiatric drugs.
Japan is shrinking. How will it survive? The Japanese are healthier than people in other rich countries — that is one thing the rest of us can learn from them. A second is visual design. A third is perfectionism, or rather, how to instill perfectionism.
Quantified Self conference in China. A small error: I didn’t say “”Self-tracking and experimentation supports personal science.” I said “QS [= the QS movement] supports personal science”.
Is the QS movement a fad? “I see a lot of measuring but not much improvement.” A better question is: Do you see any improvement? All big things started small.
1. The Dictator’s Handbook: Why Bad Behavior is Almost Always Good Politics (published 2011) by Bruce Bueno de Mesquita and Alastair Smith. The best book about political science I have read. A leader always needs supporters. The essential difference between dictatorships and democracies is how many. Full of data and examples that this view — the whole theory is a bit more complicated — explains. Econtalk interviews.
2. Antifragile: Things that Gain From Disorder by Nassim Taleb (copy sent me by author). Full of original ideas. It may be unprecedented that a serious thinker so anti-establishment has so loud a voice. Much of the book is about a generalization of hormesis, the observation that a small amount of Treatment X can be beneficial even though a large amount of Treatment X is deadly. For example, a small amount of smoking is probably good for you. Taleb goes beyond this to say that in some things, the hormetic benefit (the benefit from small amounts) is much larger than in other similar things. You can fulfill the same function (governance, banking, science) with a system where the entities benefit a lot from small shocks (which Taleb calls “anti-fragile”) or a system where the entities benefit not at all from small shocks. Systems where small shocks cause benefits tend to suffer less when exposed to large shocks. In my personal science, I have benefited a lot from day-to-day changes in my life (e.g., it led me to discover that butter improves my brain function and flaxseed oil improves my balance). In large science, day-to-day variation is only harmful. The core idea is that hormesis-like dose-response functions exist outside of the drug/poison/mice/rat/health experiments in which they were discovered.
3. Confessions of a Microfinance Heretic: How Microlending Lost Its Way and Betrayed the Poor by Hugh Sinclair (copy sent me by publisher). By “microfinance” he means microcredit. Sinclair convinced me that the belief that microcredit is a wonderful thing for poor people is one of the big delusions of our time. It is a wonderful thing only for the institutions that give it out (at exorbitant interest rates, usually). Sinclair sums it up like this (pp. 217-8): “Give a man a fish and he’ll eat for a day. Give a woman a microcredit loan to buy a fishing boat, and the CEOs of the MFI [microfinance institute] and the microfinance funds will eat for a lifetime.” Sinclair continues: “There is too much at stake [for the CEO's] to allow any genuine scrutiny.”
This Amazon reviewer is almost always disappointed and his one-star reviews are fun to read. I suggest that ratings (book ratings, product ratings, etc.) compare the rating to other ratings given by the rater. A 5-star rating is more impressive if a rater’s average rating is 2 than if it is 5. I suggest percentiles. For example, rating = 5 (90%ile) is more impressive than rating = 5 (50%ile). I’d also like to know the average percentile across raters.
Brent Pottenger, who is a medical student at John Hopkins, writes:
Today, as a required activity for our Hopkins Med endocrinology course, we watched excerpts Supersize Me and Tom Naughton’s Fat Head. Our professor then engaged us in a discussion comparing the two films. Our professor told our class that the lipid hypothesis is incorrect, said that the USDA Food Pyramid is the product of corn and wheat subsidies (and lobbies), and definitely stirred up some uneasy responses from my classmates.
I asked Brent what had made them uneasy.
What the professor said contradicted what they believe. Every professor before this has demonized saturated fat, meats, etc., so this was the first time someone questioned that belief.
How did they express their unease?
They expressed unease by getting up and leaving the lecture hall, by whispering in disgust to their neighbors, etc. — you could see it on their faces. Then, some of the more curious classmates who are always inquisitive followed up with genuine questions, wanting to know more about the validity to the statements made in Tom’s movie about Ancel Keys, the McGovern Report, the USDA, the science of the lipid hypothesis, etc.
Why Quantified Self Matters is the title of a talk I gave yesterday at a Quantified Self conference in Beijing. I gave six examples of things I’d discovered via self-tracking and self-experiment (self-centered moi?), such as how to lose weight (the Shangri-La Diet) and be in a better mood. I said that the Quantified Self movement matters because it supports that sort of thing, i.e., personal science, which has several advantages over professional science. The Quantified Self movement supports learning from data, in contrast to trusting experts.
If I’d had more time, I would have said that personal science and professional science have different strengths. Personal science is good at both the beginning of research (when a new idea has not yet been discovered) and the end of research (when a new idea, after having been confirmed, is applied in everyday life). It is a good way to come up with plausible new ideas and a good way to develop them (assess their plausibility when they are still not very plausible, figure out the best dose, the best treatment details). That’s the beginning of research. Personal science is also a good way to take accepted ideas and apply them in everyday life (e.g., a medical treatment, an idea about deficiency disease) because it fully allows for human diversity (e.g., a medicine that works for most people doesn’t work for you, you have an allergy, whatever). That’s the end of research.
Professional science works well, better than personal science, when an idea is in a middle range of plausibility — quite plausible but not yet fully accepted. At that point it fits a professional scientist’s budget. Their research must be expensive (Veblen might have coined the term conspicuous research, in addition to “conspicuous consumption” and “conspicuous leisure”) and only quite plausible ideas are worth expensive tests. It also fits their other needs, such as avoidance of “crazy” ideas and a steady stream of publishable results (because ideas that are quite plausible are likely to produce usable results when tested). Professional science is also better than personal science for studying all sorts of “useless” topics. They aren’t actually useless but the value is too obscure and perhaps the research too expensive for people to study them on their own (e.g., I did research on how rats measure time).
In other words, the Quantified Self movement matters because it gives all of us a new scientific tool. A way to easily see where the scientific tools we already have cannot easily see.