Thanks to Bryan Castañeda and Andy.
Oral rehydration therapy (ORT) is given to people (usually children) suffering from diarrhea, which before ORT was often fatal. It is very simple: The sufferer drinks water with sugar and salt ad libitum (as much as they want). You probably haven’t heard of ORT — at least, I hadn’t. Everyone has heard of antibiotics. Yet “in 10 years [ORT] saved more lives than penicillin had in 40.” Infant diarrhea was once (and may still be) the main cause of death in poor countries.
A history of its discovery supports several things I’ve said on this blog. One is Thorstein Veblen’s point about the disdain among professional scientists for useful research:
ORT might also have been developed long before 1968 but for the attitudes of the dominant medical establishment toward practical experimentation, which the Cholera Research Laboratory and the National Institutes for Health shared. Nalin believes that “the people at the lab … got kudos for the extent to which [their] work was not practical. As soon as it became practical it was discarded like a soiled towel–it was too common, too hands-on… so the prestige went to people who measured trans-intestinal fluxes or electrical currents”.
No one who has attended an elite law school, medical school, or graduate program in education will be surprised by this.
Another is the great resistance among the medical establishment to cheap and effective solutions:
The formidable and persistent ignorance of the Western medical establishment, which continues over twenty-five years after the discovery of ORT, is phenomenal. While its refusal to advocate ORT may be due in part to the notion that ORT is only necessary for people in the developing world, its actions appear to be driven also by financial considerations. Most hospitals do not train physicians in the use of ORT since they have no financial reason to do so. [I think "since" overstates what is known -- Seth] The use of intravenous therapy, which often involves keeping a dehydrated child overnight, assures [greater] insurance reimbursement. Sending children home with ORT would [reduce] profits. Furthermore, recent studies show that diarrhoeal illness among the elderly may incur even greater health care costs that could also be reduced by the use of ORT. At a time of heated discussion about cost-containment in health care, it seems all the more ironic and egregious that a superior, cheap, and proven therapy [fails to replace] a far more expensive one. Estimates based on the cost of hospitalizations and physician visits suggest that ORT could save billions of dollars annually.
As an example of the resistance of American doctors to a better therapy, an ORT researcher, who had used it on Apache reservations in America, told this story:
I had an anthropologist friend who adopted an Apache child from the [Arizona] reservation where we were working. He used to be the anthropologist on the reservation. And then he [left the reservation and] went to Arkansas to teach and the Apache child came down with severe diarrhea and he called me up and he said desperately, “Look, my son’s in the hospital and they’re giving him all sorts of intravenous fluids. The diarrhea’s not stopping, he’s losing weight, they’re not feeding him. I know that you did this work in Arizona [on the reservation] and it didn’t look like that. . . . Would you call this professor of pediatrics and just collegiately talk to him?” So I called up the professor and told him that in our experience with Apache children this is what we found and here’s the publication and so on. And he said to me, “Doctor, doctor, our [Arkansas] children are not the same as your [reservation] children”. He was treating an Apache child from the same reservation.
Shades of Downton Abbey (where Lady Sybil died because a London doctor was listened to instead of a rural doctor).
Encouraged by the success of the Quantified Self Meetup group, I have started a Meetup group called Make Yourself Healthy. It is about how non-experts — the rest of us — can improve on expert advice about health. The first meeting will be April 24 (Wed.) in the meeting room of the North Branch of the Berkeley Public Library, 6:00 pm to 7:30 pm.
The group is about solving your health problems yourself, before or after mainstream medicine fails to help or provides inferior solutions. Access to health information via the Internet makes this more and more possible; so does new technology, which make it easier to measure health problems.
The first important practitioner of Make Yourself Healthy was Richard Bernstein, a New York engineer with diabetes, who in the 1960s bought a new machine that could measure blood sugar with only a single drop of blood. Bernstein used it to measure his own blood sugar many times per day — in contrast to getting it measured once a month at a lab. What he learned from frequent measurements allowed him to stabilize his blood sugar level, which doctors’ advice had never managed to. His health greatly improved. His promotion of what he had done led to the glucometers you can find in any drugstore. Nowadays diabetics take self-measurement for granted.
I have managed to improve my health in many non-standard ways. Acne, sleep, mood, weight, and brain function, especially. On the face of it, you might think: He did a lot of self-experimentation and discovered cool stuff. At first, that’s how it looked to me. I wrote a paper called “Self-experimentation as a source of new ideas“. But that’s misleading. Self-experimentation wasn’t new, it was ancient. Yet my discoveries were quite new — quite different from what people already believed. What really led to my successes was: 1. Better information. Before the Internet, I spent thousands of dollars on a UC Berkeley library service called BAKER, which photocopied journal articles that I requested by phone and delivered the copies to my campus mailbox. Xerox machines made this possible. 2. The prison of professional science. There are so many things that professional scientists (such as medical school professors) cannot do. There are so many ideas they cannot test. They have left a lot to be discovered and it turns out that non-scientists (such as me — I was not a sleep researcher, a mood researcher, etc.) can discover at least some of it. In other words, I wasn’t successful just because I did self-experimentation, I was successful because I did wise self-experimentation. I chose wisely what to do.
Behind this Meetup group is my belief that anyone who does this — tries to do better than expert advice — probably can teach and learn from other people trying to do the same thing, even if their health issue is different from yours.
If you are coming to this Meetup and have experience (successful or unsuccessful) trying to improve on expert health advice, and are willing to share your experience, please contact me.
Thanks to Greg Pomerantz and Casey Manion.
Bryan Castañeda told me the following:
I was talking to a good friend of mine who’s a speech pathologist. He works for a woman who runs a private practice in Connecticut. Says that a third of his patients require the amount of treatment his boss recommends, a third require treatment but less than she recommends, and a third require no treatment at all. But his boss is skilled at preying on parents’ insecurities (and their clientele has a lot of money), so she makes a killing. He agreed with your advice that people should be more skeptical of the claims of medical professionals and do their own research to evaluate to those claims.
The woman who runs the practice has a Master’s in speech pathology, same as Bryan’s friend. I asked about the treatments. Bryan’s friend replied:
It depends on the diagnosis. If it’s a speech disorder, we do articulation therapy. Articulation therapy usually consists of drills, correcting erred sounds by shaping the articulators appropriately and then having the client produce the sound in isolation, at the word, phrase, and sentence levels, and then in reading aloud and in conversation until they’ve reached 100% or close to 100% accuracy.
If it’s a language disorder, we do language therapy. Language therapy is a little more complicated. We target specific language areas based on the results of previous testing. It can vary a lot, but some of the more common things I do is read passages and have the client answer questions about it, teach grammar, work on formulating sentences appropriately, teach vocabulary, and word classification activities. A lot of worksheets and games too — materials that my boss writes off at tax time. We bill by the hour, so more hours certainly equals more pay for her,” he says. “We are all salaried, so the tighter she crams our schedules the more she gets to keep at the end of the day.
At least the unhelpful treatments are harmless, in contrast to a large fraction of mainstream medicine, where children have their tonsils removed, and so on.
Thanks to Nandalal and Bryan Castañeda.
Thanks to Amish Mukharji.
Steven Brill has a great article in Time called Bitter Pill: Why Medical Costs are Killing Us. I found it nauseating and terrifying — and I have health insurance. It is nauseating that helpless sick people are billed huge amounts of money that bear little relation to costs. It is terrifying that our government has failed to protect us from this.
Brill’s article is about the details of health care costs in America, especially hospital costs. Markups are huge. One example is a test strip for measuring blood sugar. The patient was charged $18 for each strip. On Amazon, the strips cost $0.50 each. The patient had no choice and was not told the wildly-inflated price. Brill gives many examples of similar markups. Hospitals, including nonprofit hospitals, are large prosperous businesses with very well paid CEO’s (e.g., $1 million/year). Yet Americans pay far more for health care than people in any other country and, judged by life expectancy, get worse results than people in about 40 countries. Brill’s article begins to explain the discrepancy.
Asked to explain their prices, many hospitals refused. One of them, MD Andersen in Houston, gave a statement that Brill quotes in part:
The issues related to health care finance are complex for patients, health care providers, payers and government entities alike . . . MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.
Judging from the widespread refusals to explain and answers like this (“everyone does it”), the prices are indefensible.
The term stagnation — America is in the grip of profound stagnation — may be misleading because it makes it sound like things are staying the same. People point to a lack of increase in the median income over the last 30 years as indicating “stagnation”. Beneath stagnation is problems stacking up unsolved. (When they are solved, spread of the solutions produces an increase in income.) The problems aren’t staying the same: They’re getting worse. Health care costs are a good example. Health care costs have gone up faster than inflation for a long time, with plenty of signs that the American excess (the difference between what Americans pay and what everyone else pays) is completely wasted. (Or worse, given the many bad effects of drugs, surgery, and other high-tech medicine.) The American excess isn’t trivial, so median income, adjusted for it, has been going down for a long time, over the same period of time that median income in almost every other country has gone up. Quite a comment on the quality of our government.
As Brill says, the health care debate has been about who will pay? The question are prices too high? has been ignored. Jon Stewart said, “This should be a Silent Spring moment.”
In the 1960s, Edmund Wilson reviewed Vladimir Nabokov’s translation of Eugene Onegin. Wilson barely knew Russian and his review was a travesty. Everything was wrong. Nabokov wondered if it had been written that way to make sense when reflected in a mirror.
I thought of this when I read recent remarks by “celiac experts” in the New York Times. The article, about gluten sensitivity, includes an example of a woman who tried a gluten-free diet:
Kristen Golden Testa could be one of the gluten-sensitive. Although she does not have celiac, she adopted a gluten-free diet last year. She says she has lost weight and her allergies have gone away. “It’s just so marked,” said Ms. Golden Testa, who is health program director in California for the Children’s Partnership, a national nonprofit advocacy group. She did not consult a doctor before making the change, and she also does not know [= is unsure] whether avoiding gluten has helped at all. “This is my speculation,” she said. She also gave up sugar at the same time and made an effort to eat more vegetables and nuts.
Fine. The article goes on to quote several “celiac experts” (all medical doctors) who say deeply bizarre things.
“[A gluten-free diet] is not a healthier diet for those who don’t need it,” Dr. Guandalini [medical director of the University of Chicago’s Celiac Disease Center] said. These people “are following a fad, essentially.” He added, “And that’s my biased opinion.”
Where Testa provides a concrete example of health improvement and refrains from making too much of it, Dr. Guandalini does the opposite (provides no examples, makes extreme claims).
Later, the article says this:
Celiac experts urge people to not do what Ms. Golden Testa did — self-diagnose. Should they actually have celiac, tests to diagnose it become unreliable if one is not eating gluten. They also recommend visiting a doctor before starting on a gluten-free diet.
As someone put it in an email to me, “Don’t follow the example of the person who improved her health without expensive, invasive, inconclusive testing. If you think gluten may be a problem in your diet, you should keep eating it and pay someone to test your blood for unreliable markers and scope your gut for evidence of damage. It’s a much better idea than tracking your symptoms and trying a month without gluten, a month back on, then another month without to see if your health improves.”
Are the celiac experts trying to send a message to Edmund Wilson, who died many years ago?
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