Archive for the 'health care stagnation' Category

Progress in Psychiatry and Psychotherapy: The Half-Full Glass

Saturday, September 28th, 2013

Here is an excellent introduction to cognitive-behavioral therapy (CBT) for depression, centering on a Stanford psychiatrist named David Burns. I was especially interested in this:

[Burns] currently draws from at least 15 schools of therapy, calling his methodology TEAM—for testing, empathy, agenda setting and methods. . . . Testing means requiring that patients complete a short mood survey before and after each therapy session. In Chicago, Burns asks how many of the therapists [in the audience] do this. Only three [out of 100] raise their hands. Then how can they know if their patients are making progress? Burns asks. How would they feel if their own doctors didn’t take their blood pressure during each check-up?

Burns says that in the 1970s at Penn [where he learned about CBT], “They didn’t measure because there was no expectation that there would be a significant change in a single session or even over a course of months.” Forty years later, it’s shocking that so little attention is paid to measuring whether therapy makes a difference. . . ”Therapists falsely believe that their impression or gut instinct about what the patient is feeling is accurate,” says May [a Stanford-educated Bay Area psychiatrist], when in fact their accuracy is very low.

When I was a graduate student, I started measuring my acne. One day I told my dermatologist what I’d found. “Why did you do that?” he asked. He really didn’t know. Many years later, an influential psychiatrist — Burns, whose Feeling Good book, a popularization of CBT, has sold millions of copies — tells therapists to give patients a mood survey. That’s progress.

But it is also a testament to the backward thinking of doctors and therapists that Burns didn’t tell his audience:

–have patients fill out a mood survey every day
–graph the results

Even more advanced:

–use the mood scores to measure the effects of different treatments

Three cheap safe things. It is obvious they would help patients. Apparently Burns doesn’t do these things with his own patients, even though his own therapy (TEAM) stresses “testing” and “methods”. It’s 2013. Not only do psychiatrists and therapists not do these things, they don’t even think of doing them. I seem to be the first to suggest them.

Thanks to Alex Chernavsky.

Stagnation in Psychiatry

Friday, August 23rd, 2013

A recent New York Times article lays it out:

Fully 1 in 5 Americans take at least one psychiatric medication. Yet when it comes to mental health, we are facing a crisis in drug innovation. . . . Even though 25 percent of Americans suffer from a diagnosable mental illness in any year, there are few signs of innovation from the major drug makers.

The author has no understanding of the stagnation, yet is opinionated:

The simple answer [to what is causing the stagnation] is that we don’t yet understand the fundamental cause of most psychiatric disorders [what does "fundamental cause" mean? -- Seth], in part because the brain is uniquely difficult to study; you can’t just biopsy the brain and analyze it. That is why scientists have had great trouble identifying new targets for psychiatric drugs.

The great increase in depression has an environmental cause. Meaning that depressed brains (aside from the effects of depression) are the same as non-depressed brains. Someone who knows that would not talk about biopsying the brain.

You come to a room with a door. If you don’t know how a door works, you are going to do a lot of damage getting inside. That is modern psychiatry. I described a new explanation for depression in this article (see Example 2).

Thanks to Alex Chernavsky.

The Truth in Small Doses: Interview with Clifton Leaf (Part 2 of 2)

Saturday, August 10th, 2013

Part 1 of this interview about Leaf’s book The Truth in Small Doses: Why We’re Losing the War on Cancer — and How to Win It was posted yesterday.

SR You say we should “let scientists learn as they go”. For example, reduce the need for grant proposals to require tests of hypotheses. I agree. I think most scientists know very little about how to generate plausible ideas. If they were allowed to try to do this, as you propose, they would learn how to do it. However, I failed to find evidence in your book that a “let scientists learn as they go” strategy works better (leaving aside Burkitt). Did I miss something?

CL Honestly, I don’t think we know yet that such a strategy would work. What we have in the way of evidence is a historical control (to some extent, we did try this approach in pediatric cancers in the 1940s through the 1960s) and a comparator arm (the current system) that so far has been shown to be ineffective.

As I tried to show in the book, the process now isn’t working. And much of what doesn’t work is what we’ve added in the way of bad management. Start with a lengthy, arduous, grants applications process that squelches innovative ideas, that funds barely 10 percent of a highly trained corps of academic scientists and demoralizes the rest, and that rewards the same applicants (and types of proposals) over and over despite little success or accountability. This isn’t the natural state of science. We BUILT that. We created it through bad management and lousy systems.
Same for where we are in drug development. We’ve set up clinical trials rules that force developers to spend years ramping up expensive human studies to test for statistical significance, even when the vast majority of the time, the question being asked is of little clinical significance. The human cost of this is enormous, as so many have acknowledged.

With regard to basic research, one has only to talk to young researchers (and examine the funding data) to see how badly skewed the grants process has become. As difficult (and sometimes inhospitable) as science has always been, it has never been THIS hard for a young scientist to follow up on questions that he or she thinks are important. In 1980, more than 40 percent of major research grants went to investigators under 40; today it’s less than 10 percent. For anyone asking provocative, novel questions (those that the study section doesn’t “already know the answer to,” as the saying goes), the odds of funding are even worse.

So, while I can’t say for sure that an alternative system would be better, I believe that given the current state of affairs, taking a leap into the unknown might be worth it.

SR I came across nothing about how it was discovered that smoking causes lung cancer. Why not? I would have thought we can learn a lot from how this discovery was made.

CL I wish I had spent more time on smoking. I mention it a few times in the book. In discussing Hoffman (pg. 34, and footnote, pg. 317), I say:

He also found more evidence to support the connection of “chronic irritation” from smoking with the rise in cancers of the mouth and throat. “The relation of smoking to cancer of the buccal [oral] cavity,” he wrote, “is apparently so well established as not to admit of even a question of doubt.” (By 1931, he would draw an unequivocal link between smoking and lung cancer—a connection it would take the surgeon general an additional three decades to accept.)

And I make a few other brief allusions to smoking throughout the book. But you’re right, I gave this preventable scourge short shrift. Part of why I didn’t spend more time on smoking was that I felt its role in cancer was well known, and by now, well accepted. Another reason (though I won’t claim it’s an excusable one) is that Robert Weinberg did such a masterful job of talking about this discovery in “Racing to the Beginning of the Road,” which I consider to be the single best book on cancer.

I do talk about Weinberg’s book in my own, but I should have singled out his chapter on the discovery of this link (titled “Smoke and Mirrors”), which is as much a story of science as it is a story of scientific culture.

SR Overall you say little about epidemiology. You write about Burkitt but the value of his epidemiology is unclear. Epidemiology has found many times that there are big differences in cancer rates between different places (with different lifestyles). This suggests that something about lifestyle has a big effect on cancer rates. This seems to me a very useful clue about how to prevent cancer. Why do you say nothing about this line of research (lifestyle epidemiology)?

CL Seth, again, I agree. I don’t spend enough time discussing the role that good epidemiology can play in cancer prevention. In truth, I had an additional chapter on the subject, which began by discussing decades of epidemiological work linking the herbicide 2-4-D with various cancers, particularly with prostate cancer in the wheat-growing states of the American west (Montana, the Dakotas and Minnesota). I ended up cutting the chapter in an effort to make the book a bit shorter (and perhaps faster). But maybe that was a mistake.

For what’s it worth, I do believe that epidemiology is an extremely valuable tool for cancer prevention.

[End of Part 2 of 2]

The Truth in Small Doses: Interview with Clifton Leaf (Part 1 of 2)

Friday, August 9th, 2013

I found a lot to like and agree with in The Truth in Small Doses: Why We’re Losing the War on Cancer — and How to Win It by Clifton Leaf, published recently. It grew out of a 2004 article in Fortune in which Leaf described poor results from cancer research and said that cancer researchers work under a system that “rewards academic achievement and publication over all else” — in particular, over “genuine breakthroughs.” I did not agree, however, with his recommendations for improvement, which seemed to reflect the same thinking that got us here. It reminded me of President Obama putting in charge of fixing the economy the people who messed it up. However, Leaf had spent a lot of time on the book, and obviously cared deeply, and had freedom of speech (he doesn’t have to worry about offending anyone, as far as I can tell) so I wondered how he would defend his point of view.

Here is Part 1 of an interview in which Leaf answered written questions. (more…)

Assorted Links

Thursday, June 6th, 2013

Thanks to Phil Alexander and Casey Manion.

Rent-Seeking Experts

Friday, January 4th, 2013

Two thought-provoking paragraphs from Matt Ridley:

From ancient Egypt to modern North Korea, always and everywhere, economic planning and control have caused stagnation; from ancient Phoenicia to modern Vietnam, economic liberation has caused prosperity. In the 1960s, Sir John Cowperthwaite, the financial secretary of Hong Kong, refused all instruction from his LSE-schooled masters in London to plan, regulate and manage the economy of his poor and refugee-overwhelmed island. Set merchants free to do what merchants can, was his philosophy. Today Hong Kong has higher per capita income than Britain.

In July 1948 Ludwig Erhard, director of West Germany’s economic council, abolished food rationing and ended all price controls on his own initiative. General Lucius Clay, military governor of the US zone, called him and said: “My advisers tell me what you have done is a terrible mistake. What do you say to that?” Erhard replied: “Herr General, pay no attention to them! My advisers tell me the same thing.” The German economic miracle was born that day; Britain kept rationing for six more years.

This is standard libertarianism. I like the stories but I don’t agree with the interpretation. I don’t think it is “economic planning and control” that causes stagnation in these examples.  I believe  it is expertise — more precisely, rent-seeking experts who know too little and extract too much rent. There are libertarian experts, too. They too are capable of doing immense damage (e.g., Alan Greenspan), contradicting Ridley’s view that “economic liberation” always causes  prosperity. In both of Ridley’s examples, the experts give advice that empowers the experts. In the first example, Cowperthwaite is told by “LSE-schooled” economists to “plan, regulate and manage the economy.” All that planning, regulation and management require expertise, in particular expertise similar to that of the experts who advised it. Which you cannot buy — you have to rent it. You must pay the experts year after year after year to plan, regulate, and manage. Because the advice must empower the experts, there is  a strong bias away from truth. That is the fundamental problem. (more…)

Movie Grosses and Nobel Prizes

Saturday, November 3rd, 2012

In Edward Jay Epstein’s new piece Gross Misunderstanding, in the Columbia Journalism Review, he writes

By focusing on the box-office race that is spoon-fed to them each week, journalists may entertain their audiences, but they are missing the real story.

Something similar happens with the Nobel Prizes. Journalists print what they are told — Scientists X and Y did beautiful “pure science” about this or that — and thereby miss the real story. In the case of Nobel Prizes in Medicine, the real story is the long-running lack of progress on major diseases (cancer, heart disease, depression, etc.).

Big Diet and Exercise Study Fails to Find Benefit

Tuesday, October 23rd, 2012

Persons with Type 2 diabetes have an increased risk of heart disease and stroke. They are usually overweight. A study of about 5000 persons with Type 2 diabetes who were overweight or worse asked if eating less and exercise — causing weight loss — would reduce the risk. of heart disease and stroke. The difficult treatment caused  a small amount of weight loss (5%), which was enough to reduce risk factors. The study ended earlier than planned because eating less and exercise didn’t help: “11 years after the study began, researchers concluded it was futile to continue — the two groups had nearly identical rates of heart attacks, strokes and cardiovascular deaths.” (more…)

The 2012 Nobel Prize in Physiology or Medicine

Friday, October 12th, 2012

As usual, there is plenty of disease and disability in the world: depression, diabetes, heart disease, cancer, stroke, obesity, autoimmune disease, and so on. As usual, the Nobel Prize in Physiology or Medicine — supposed to be given for the most useful research — is given for research with no proven benefit to anyone (except career-wise). Once again implying that the world’s best biomedical researchers — judging by who wins Nobel Prizes — either don’t want to or don’t know how to do useful research.

Once again the press release tries to hide this. “From surprising discovery to medical use” reads one heading. If you read the text, however, you learn there is no actual “medical use”. Here’s what it says:

These discoveries have also provided new tools for scientists around the world and led to remarkable progress in many areas of medicine. iPS cells can also be prepared from human cells. For instance, skin cells can be obtained from patients with various diseases, reprogrammed, and examined in the laboratory to determine how they differ from cells of healthy individuals. Such cells constitute invaluable tools for understanding disease mechanisms and so provide new opportunities to develop medical therapies.

Apparently you can make “remarkable progress” in medicine without helping a single person, which says a lot about what passes for medical progress. Although iPS cells are supposedly “invaluable tools” for understanding disease mechanisms, we are not told a single disease that has thereby been understood or a single therapy that has been developed.

The Guardian printed a roundup of responses to the award. I read it eagerly. Maybe one of the comments will explain how the prize-winning work actually helped someone (besides career-wise). After all, Yamanaka, one of the winners, had previously won the Finland Prize, given to research that “significantly improves the quality of human life today and for future generations”. Paul Nurse says the prize-winning work did such-and-such, “paving the way for important developments in the diagnosis and treatment of disease” unfortunately not saying what those “important developments” are. Martin Evans says:

The practical outcome is that now we not only know that it might be theoretically possible to convert one cell type into another but it is also practically possible. These are very important foundation studies for future cellular therapies in medicine.

Emphasis added. Another comment: “These breakthroughs will ultimately lead to new and better treatments for conditions like Parkinson’s and improve the lives of millions of people around the world.” A bold prediction, given that they have not yet improved the life of even one person. Julian Savescu, an ethicist at Oxford, says “This is as significant as the discovery of antibiotics. Given the millions, or more lives, which could be saved, this is a truly momentous award.”

Year after year, the Nobel Prize in Physiology or Medicine is given for research that, we are told by biologists with huge conflicts of interest, will — no doubt! — be incredibly valuable in the future. Indicating there was no research that might be honored that had already been useful. It is as if you have a baseball award for best hitter but all hitters all over the world strike out all the time so you end up giving the award to people who strike out best. They are the best hitters, you tell credulous sportswriters. They receive the prestigious award for best hitter at an elaborate ceremony, with toasts all around. Nobody says they cannot hit.

 

Assorted Links

Sunday, October 7th, 2012

Thanks to Bryan Castañeda.

Sleep and Mood Strongly Linked

Saturday, March 24th, 2012

I recently came across a 2005 survey, done in Texas, that found people with poor sleep were far more likely to be depressed or anxious than people with better sleep. Huge risk ratios:

People with insomnia . . . were 9.82 and 17.35 times as likely to have clinically significant depression and anxiety [than persons without insomnia.]

Other studies have found similar results. For example, a 1979 survey interviewed the same people twice, one year apart. People who had insomnia both times were 40 times more likely to be newly diagnosed with major depression during the intervening year than those who did not have insomnia at either time.

A simple thing to say about the sleep/mood correlation is that it supports my theory of depression, which says depression is often due to malfunction of two circadian oscillators (one controlled by light, the other by faces). If they are working properly (in sync, with large amplitude) you sleep well and are in a good mood when you are awake. If they are not working properly (e.g., not in sync) then you do not sleep well and are in a bad mood at least part of the time while you are awake. What is called depression (e.g., not wanting to do anything) is actually a good thing in the middle of the night. Not wanting to do anything — being still — is necessary to fall asleep.

A sad and more complicated thing about this correlation is that it is ignored. It is not explained by any theory of depression popular among psychotherapists, such as cognitive-behavioral therapy, not to mention a dozen other explanations of depression (psychoanalytic, etc.) that psychotherapists favor. Nor is it explained by any pharmacological theory of depression. In other words, if you seek treatment for depression within our healthcare system the treatment you will receive will derive from a theory that cannot explain this result. Yet the correlation is so strong it must be telling us something important.

You can read endlessly about the high cost of health care. What if the high cost is not the core problem? What if it is only a symptom of something less obvious? What if health care costs a lot because we have a poor understanding of health and disease (as the failure of popular theories of depression to explain the sleep/mood correlation suggests)? What if we have a poor understanding of health and disease because health research is too concerned with allowing healthcare providers to make money?

Assorted Links

Wednesday, November 23rd, 2011
  • Bruce Handy (who wrote for Spy) on Newsweek. “The second biggest problem is the way each issue begins with a miles-long slog of columns by A-list writers eager to champion the incontrovertible and rehash the already thoroughly hashed. . . . Niall Ferguson has discovered that, thanks to technology, “the human race is interconnected as never before.””
  • The Willat Effect in Venice, CA: side-by-side coffee comparisons at Intelligensia .
  • Why is the headline 28 Unexpected TV Ratings Facts more attractive than Unexpected TV Ratings Facts?
  • Engaging interview with Julia Schopick, creator of Honest Medicine. “After they [his surgeons] were done with him . . . “

“Allergic to the Practical”: Law Schools Imitating Academia

Tuesday, November 22nd, 2011

Thorstein Veblen might have gloated that this 2011 article — about the uselessness of law schools and legal scholarship — so thoroughly supports what he wrote in a book published in 1899 (see the last chapter of The Theory of the Leisure Class). Why are law schools useless? Because law professors feel compelled to imitate the rest of academia, which glorifies uselessness:

“Law school has a kind of intellectual inferiority complex, and it’s built into the idea of law school itself,” says W. Bradley Wendel of the Cornell University Law School, a professor who has written about landing a law school teaching job. “People who teach at law school are part of a profession and part of a university. So we’re always worried that other parts of the academy are going to look down on us and say: ‘You’re just a trade school, like those schools that advertise on late-night TV. You don’t write dissertations. You don’t write articles that nobody reads.’ And the response of law school professors is to say: ‘That’s not true. We do all of that. We’re scholars [i.e., useless], just like you.’ ”

Yeah. As I’ve said, there’s a reason for the term ivory tower. And seemingly useless research has value. Glorifying useless research has the useful result of diversifying research, causing a wider range of research directions to be explored. Many of my highly-useful self-experimental findings started or received a big boost from apparently useless research.

The pendulum can swing too far, however, and it has. A large fraction of health researchers, especially medical school researchers, have spent their entire careers refusing to admit, at least in public, the uselessness of what they do. Biology professors have some justification for useless research; medical school professors have none, especially given all the public money they get. Like law professors, they prefer prestige and conformity. The rest of us pay an enormous price for their self-satisfaction (“I’m scientific!” they tell themselves) and peace of mind. The price we pay is stagnation in the understanding of health. Like clockwork, every year the Nobel Prize in Medicine is given to research that has done nothing or very close to nothing to improve our health. And every year, like clockwork, science journalists (all of them!) fail to notice this. If someone can write the article I just quoted about law schools, why can’t even one science journalist write the same thing about medical schools — where it matters far more? What’s their excuse?

Evidence-Based Medicine Versus Innovation

Saturday, November 19th, 2011

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.

Testing Treatments: The Authors Respond

Saturday, November 12th, 2011

In a previous post I criticized the book Testing Treatments. Two of the authors, Paul Glasziou and Iain Chalmers, have responded. I have replied to their response. They did not respond to the main point of my post, which is that the preferences and values of their book — called evidence-based medicine — hinder innovation.

Sure, care about evidence. Of course. But don’t be an evidence snob.

Testing Treatments: Nine Questions For the Authors

Sunday, November 6th, 2011

From this comment (thanks, Elizabeth Molin) I learned of a British book called Testing Treatments (pdf), whose second edition has just come out. Its goal is to make readers more sophisticated consumers of medical research. To help them distinguish “good” science from “bad” science. Ben Goldacre, the Bad Science columnist, fulsomely praises it (“I genuinely, truly, cannot recommend this awesome book highly enough for its clarity, depth, and humanity”). He wrote a foreword. The main text is by Imogen Evans (medical journalist), Hazel Thornton (writer),  Iain Chalmers (medical researcher), and Paul Glaziou (medical researcher, editor of Journal of Evidence-Based Medicine).

To me, as I’ve said, medical research is almost entirely bad. Almost all medical researchers accept two remarkable rules: (a) first, let them get sick and (b) no cheap remedies. These rules severely limit what is studied. In terms of useful progress, the price of these limits has been enormous: near total enfeeblement. For many years the Nobel Prize in Medicine has documented the continuing failure of medical researchers all over the world to make significant progress on all major health problems, including depression, heart disease, obesity, cancer, diabetes, stroke, and so on. It is consistent with their level of understanding that some people associated with medicine would write a book about how to do something (good science) the whole field manifestly can’t do. Testing Treatments isn’t just a fat person writing a book about how to lose weight, it’s the author failing to notice he’s fat. (more…)

Grandmother Knows Best About Crohn’s Disease

Monday, October 10th, 2011

On Boing Boing  a post by me tell about a man who cured himself of Crohn’s Disease mainly by following what is called The Specific Carbohydrate Diet. He got the idea from his grandmother, who heard about it on the radio. The diet is about eighty years old. The version he used appeared in a book published in 1994 — 17 years ago. Still no clinical trial.

As I’ve said, if you have managed to cure yourself of a serious medical condition please let me know. I would like to learn from your experience and help others learn from it.

Why is Health Care So Expensive?

Friday, September 16th, 2011

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…)

Health Care Stagnation

Thursday, June 30th, 2011

In December, the Los Angeles Times reported — very briefly — that from 2007 to 2008, life expectancy in the United States declined by 0.1 year. It should have been the lead story of every newspaper in the country with the largest possible headlines (“LESS LIFE“). Did 9/11 reduce life expectancy this much? Of course not. Did World War II? Not in a visible way — American life expectancy rose during World War II. I can’t think any event in the last 100 years that made such a difference to Americans. The decline is even more newsworthy when you realize: 1. It is the continuation of trends. The yearly increase in life expectancy has been dropping for about the last 40 years. 2. Americans spend far more on health care than any other country. Meaning vast resources have been available to translate new discoveries into practice. 3. Americans spend far more on health research than any other country and should be the first to benefit from new discoveries.

Maybe I’m biased (because my research is health-related) but I think this is the biggest event of our time. It is the Industrial Revolution in reverse — progress grinding to a halt. For no obvious reason, just as the Industrial Revolution had no obvious reason. Health researchers have been given billions of dollars to improve our health, the whole system has been given tens of billions of dollars, and the result is … nothing. Worse than nothing.

No journalist, with the exception of Gary Taubes, seems the least bit aware of this. It is a difficult story to cover, true. But several journalists, such as health writers for The New Yorker (Atul Gawande, Michael Specter, and Jerome Groopman) are perfectly capable of covering it. They haven’t. With a few exceptions, they write about progress (e.g., Peter Provonost’s checklists). It is like only reporting instances when Dirk Nowitzki missed a free throw. Each instance is true but the big picture they create — he misses all free throws — is profoundly false.

Among academics, the stagnation has received a tiny amount of attention. In a recent paper (gated), two University of Southern California professors, considering a wider time period, point out that there has been some improvement in how long you live after you get sick, but no improvement in how long you live before getting sick. Here is how the discussion section of their article begins:

There is substantial evidence that we have done little to date [meaning: from the 1960s to the 1990s] to eliminate or delay disease or the physiological changes that are linked to age. For example, the incidence of a first heart attack has remained relatively stable between the 1960s and 1990s and the incidence of some of the most important cancers has been increasing until very recently. Similarly, there have been substantial increases in the incidence of diabetes in the last decades.

Here is my explanation of the paradox of: 1. Enormous and increasing health care costs. 2. Vast amounts spent on research. 3. No better health. Health researchers, such as medical school professors, shape their research to favor expensive treatments, such as expensive drugs. In fact, the best treatments would cost nothing (e.g., the Shangri-La Diet). To make the expensive treatments seem worth studying, they invent utterly false theories and claim to believe them. For an example (research about depression), see The Emperor’s New Drugs by Irving Kirsch. Because health researchers are forced to worship absurd theories, they are incapable of good research. Absence of good research is why there is no progress. The health care supply chain — everyone between you and the research, such as doctors, nurses, drug company employees, hospital employees, alternative medicine practitioners, medical device makers, and so on — is happy with the situation (useless research) because it ensures that little will change and they will continue to get paid. They are the supposed experts — and remain silent.

It is human nature that everyone in the supply chain remains silent. They are protecting their jobs. But the silence of the journalists is The Emperor’s New Clothes writ large. To explain why smart journalists fail to notice the stagnation, I think you have to go back to studies of conformity. When everyone you talk to — people in the supply chain  — says black = white (i.e., that progress is being made), you say the same thing.

Why is personal science, the main subject of this blog, important? Because it is a way out of this stagnation.