Archive for the 'fallibility of experts' Category

Lyme Disease and Bad Medicine

Saturday, April 19th, 2014

I got Cure Unknown: Inside the Lyme Epidemic (2008) by Pamela Weintraub from the library and found something surprising: an angry foreword. Weintraub is a science journalist; the forward is by Hillary Johnson, another science journalist and apparently a friend of Weintraub’s.

In her anger, Johnson says several things I say on this blog. (more…)

Pregnancy Gingivitis: Failure to Look for the Cause

Monday, April 14th, 2014

A few days ago, I learned from a Crest ad that a large fraction of pregnant women, such as half, suffer from gingivitis (inflamed gums). It’s called pregnancy gingivitis. The ad recommended better dental hygiene, such as brushing your teeth more.

Thirty years from now will people think how could they [meaning us] have been that stupid? Faced with pregnancy gingivitis, they brushed their teeth more? Pregnancy gingivitis is supposedly due to “hormones” that increase during pregnancy. In other words, a health expert actually thinks — or claims to think — that pregnancy gingivitis has a different explanation than other gingivitis. Yet he doesn’t know what causes other gingivitis. For example, here is what Mayo Clinic experts say causes gingivitis. This makes no sense. But it is worse than most nonsense, since fetal health is at stake.

Several years ago, I greatly increased my flaxseed intake because I discovered it improved my balance. My gums suddenly went from red (inflamed) to pink (not inflamed), no doubt because flaxseed has lots of omega-3, which is anti-inflammatory. Gingivitis is — usually? always? — caused by too little omega-3.

My theory: pregnancy gingivitis happens because pregnant women need more omega-3 than usual. A growing brain needs lots of omega-3.  If this theory turns out to be true, the gums of pregnant women should be monitored to make sure they are getting enough omega-3. Nowadays pregnant women are given omega-3 to take but there is no test to make sure it is enough. That pregnancy gingivitis is common suggests it often isn’t enough. Actually, everyone’s gums should be checked to make sure they are getting enough omega-3.

Questions for Jeffrey Sachs

Monday, March 31st, 2014

On Econtalk, Russ Roberts recently interviewed Jeffrey Sachs, author of The End of Poverty and head of the Millennium Village Project (MVP). I enjoyed it but thought Roberts was too easy on Sachs. Here’s what I wished he had asked:

Your book, The End of Poverty — did you get anything wrong?

What mistakes have you made with MVP?

You say Nina Munk [author of The Idealist] chose a non-representative village. [Sachs said that Munk spent her time in the only village in "a war zone."] Did you tell her that? If not, why not?

Munk was on your side when she began reporting, but changed her mind. Why is that?

Why was the project set up in such a way that evaluation is difficult? Why not pick ten villages and randomly select five for treatment?

You say the MVP project is successful because people are copying it — but those people are government officials. Is it plausible they are copying it because they see it as a good way to make money for themselves or improve their career? You must know many worthless medical treatments have been widely copied. Is this your best evidence of success?

No doubt your employees have often told you what you wanted to hear rather than the truth. What’s an example? What have you done to get honest assessments of how things are going?

What did you learn from Nina Munk’s book?

Roberts says he didn’t ask Sachs certain questions because there wasn’t enough time.

Larger Lesson of “We Were Wrong about Saturated Fat”

Friday, March 28th, 2014

My sister sent me a link to an article (“Butter is Back”) by Mark Bittman, the New York Times food columnist, about a recent review that found saturated fat didn’t cause heart disease. I told my sister I had clicked on the link but had forgotten to read the article.

My sister was incredulous. How could you not want to say “I told you so”? she wondered. (In a 2010 talk I questioned the danger of butter.)

Here is the relevant passage, according to my sister:

A meta-analysis published in the journal Annals of Internal Medicine found that there’s just no evidence to support the notion that saturated fat increases the risk of heart disease. (In fact, there’s some evidence that a lack of saturated fat may be damaging.) The researchers looked at 72 different studies.

I told you so. But this part interests me more:

No study is perfect and few are definitive. But the real villains in our diet — sugar and ultra-processed foods — are becoming increasingly apparent.

Uh-huh. The experts were staggeringly wrong about saturated fat…but they couldn’t possibly be wrong about “sugar and ultra-processed foods”. That makes no sense, but that’s what Bittman wrote (“increasingly apparent”). To me, what is increasingly apparent is that nutrition experts shouldn’t be trusted.

I don’t know what “ultra-processed foods” are but I am beginning to believe the experts are utterly wrong about sugar, too. As far as I can tell, sugar in the evening improves sleep — by a lot, if you get the details right — and nothing is more important than good sleep. If you have read The Shangri-La Diet, you already know that sugar alone cannot have caused the obesity epidemic. It is more complicated than that.

Why Do Sweet Foods Taste Good? The Importance of a Simple Observation

Sunday, March 23rd, 2014

Stuart King writes:

I was very hungry today at dinner and the thought of sweet food wasn’t appealing at all, but after filling up on some rice, chicken and coconut cream curry I immediately had ice cream and chocolate slice [= what Americans call a brownie], which had had no appeal 15 minutes or so before!

An everyday observation that anyone can make. Studies have shown what Stuart noticed: When you are hungry sweet foods are unappealing. This is why dessert is eaten after the rest of the meal.

The main way that psychologists explain an experimental effect — choose between explanations — is by finding out what makes the effect larger or smaller. For example, discovery of what makes learning more or less (what increases or decreases the effect of one learning trial) is the main way psychologists have chosen among different theories of learning. Different theories predict different interactions.

Why do we like sweet foods? The usual answers are that sweet foods are a “good source of energy” and they provide “quick energy”. But these explanations do nothing to explain what Stuart noticed. If sugar is a good (= better than average) source of energy, we should eat it before other foods (average sources of energy) when we are hungry (hunger signals lack of energy). The opposite is true. You may not want to call it a “contradiction” but there is no doubt the conventional view does not explain what Stuart noticed. Of course many nutrition experts, such as Weston Price, are/were entirely sure sugar is unhealthy.

As a tool for choosing among theories, Stuart’s observation is especially good because (a) it is very large (sweets go from unappealing to appealing) and (b) paradoxical (eating calories should make all calorie sources less appealing).

If you have been reading this blog, you know I explain Stuart’s observation by assuming that we need sugar in the evening to sleep well. Sugar (sucrose, fructose, glucose) eaten in the evening increases blood glucose, which increases glycogen. During sleep, glycogen becomes glucose, which the brain needs to work properly. Evolution shaped us to like sweet foods after a meal so that we will eat them closer to when we sleep. (The value of replenishing glycogen close to bedtime also explains why we eat sweet foods after dinner more than after breakfast or lunch.)

I can’t think of another case where what experts say is so out of line with what’s easily observed. For example, I’m sure cholesterol doesn’t cause heart disease, but there is no everyday observation that supports my belief.

I can’t think of another case where what experts say is so out of line with what’s easily observed. For example, I’m sure cholesterol doesn’t cause heart disease, but there is no everyday observation that supports my belief.

If sugar is helpful for sleep, why is it associated with diabetes? My guess is that sugar is almost always consumed in foods that taste exactly the same each time — what in The Shangri-La Diet I called ditto foods. For example, soft drinks. Ditto foods with sugar, because they have a strong precise CS (smell) and a strong fast US (calorie signal), produce an especially strong smell-calorie association. Such an association raises the body fat set point, thus causing obesity. Obesity causes diabetes. It’s also possible that eating sugar during the day — at the wrong time — hurts sleep. Maybe sugar during the day raises insulin and thus reduces the conversion of sugar to glycogen. Less glycogen causes bad sleep, bad sleep causes diabetes. My blood sugar levels clearly improved when I started eating sweets in the evening — opposite to what the sugar-diabetes link would predict.

Human Papilloma Virus and Cervical Cancer

Monday, March 10th, 2014

After I say that Nobel Prize in Medicine is usually given for research of little or no proven value, one counterexample I’ve heard is the 2008 prize for the discovery that cervical cancer is caused by the human papilloma virus (HPV). This should allow us to reduce cervical cancer via vaccination.

There are several things wrong with this example:

1. The predicted improvement has not been observed. The average age at which a woman is diagnosed with cervical cancer is 48 years old. To assess the effect of HPV vaccination — usually given to young girls — on cervical cancer you need to wait thirty years. Thirty years haven’t passed. The history of medicine is full of examples where treatments that supposedly worked — such as tonsillectomies, given to millions — when tested turned out to not work. The history of medicine is also full of examples where supposedly wonderful treatments (e.g., frontal lobotomies) turned out to have side effects so bad the treatment was stopped.

2. Cervical cancer is not a big source of death. In the United States, it kills perhaps five thousand women per year. Heart disease kills hundreds of thousands of people per year; so do all forms of cancer taken together. And pap smears, which cost little, actually work. “Cervical cancer is 100% curable if detected early,” says one website.

3. Because pap smears work well, it isn’t clear there is room for improvement. To find out you’d want to compare two groups: (a) pap smears plus HPV vaccination and (b) pap smears alone.

4. It isn’t clear the vaccine will work, even if HPV infection does cause cancer. There are at least 100 varieties of HPV; the vaccine protects against two. Does vaccination against two varieties increase infection by other varieties (because different viruses compete for the same niche)? Hard to rule this out. Again, there are many examples in medicine where actually helping people turned out to be far harder than experts had predicted, even when the initial idea wasn’t nonsense. An example is the oncogene theory of cancer, which also has a Nobel Prize associated with it.

In summary, not a counterexample.

Sleep and Depression: More Links

Friday, March 7th, 2014

In 1995, hoping to improve my sleep, I decided to watch TV early in the morning, for reasons explained here. One Monday morning I watched tapes of Jay Leno and David Letterman that I’d made. Nothing happened. On Tuesday, however, I woke up and felt great: cheerful, eager and yet somehow calm. I had never felt so good so early in the morning. Monday had been a normal day, I had slept a normal length of time. The good feeling was puzzling. Then I remembered the TV I had watched. It had seemed so innocuous. The notion that 20 minutes of ordinary TV Monday morning could make me feel better Tuesday but not Monday seemed preposterous. Absurd. Couldn’t possibly be true.

Except for one thing. I had done something to improve my sleep. Plenty of research connected sleep and depression. That research made it more plausible that something done to improve sleep would improve mood. I went on to confirm the morning faces/mood linkage in many ways. The research connecting sleep and depression had been the first signs of a hidden mechanism (we need to see morning faces for our mood regulatory system to work properly) I consider very important.

Two new studies further connect sleep and depression. One of them found that people who sleep normal amounts of time are less influenced by genes associated with depression than those who sleep longer or shorter lengths of time. The other found that teenagers who sleep less than usual are at greater risk of depression.

The theories that psychiatrists have used to justify anti-depressants (e.g., “chemical imbalance”) do not explain the many connections between sleep and depression. Depression is associated with lots of bad things, unsurprisingly, but the association with bad sleep is especially strong. It is not easily explained away. You might think that if you are depressed you are more tired than usual and therefore sleep more/better than usual. The opposite is true.  All this might have generated, among psychiatric researchers, a search for a better theory — an explanation of depression that can explain the sleep/depression connections — but it hasn’t.


The Polio Vaccine Disaster: Precursor of the Obamacare Website Fiasco

Wednesday, March 5th, 2014

When friends complain about evil government (e.g., NSA surveillance), I tell them “never underestimate the stupidity of government employees” — by which I mean their stupidity outweighs their self-interest. The Obamacare website fiasco is a good illustration. Everyone has heard “power corrupts” but closer to the truth is power makes you stupid.

The Obama website fiasco had many precursors. One was in the 1950s — in the details of the introduction of the polio vaccine.

Rather than staging a long series of careful field trials with appropriate scientific evaluation, Salk darted ahead on his own in the remainder of 1953 and 1954. The trials were successful. The foundation released the results to the press, and such were the nation’s expectations that from that point there was no turning back. In August 1954 the foundation ordered five drug companies to begin producing mass lots of vaccine, on the basis of a formula for inactivating the virus with formaldehyde, according to a procedure Salk himself had devised. . . . James Shannon remembered very well what happened next. At this point he had become the associate director of the NIH.  “I was working over the weekend and I got a telephone call from Los Angeles, and this is eight or nine o’clock on Friday night. It was the Health officer of the City of Los Angeles and he said they just had two reports of polio in some children who had been vaccinated nine days earlier. He wanted to know what should be done about it?”

One of the companies that contracted to make the vaccine, the Cutter Laboratories in Berkeley, California, had released several lots of vaccine that had been improperly inactivated. Live polio virus was being injected into children. The gratitude of the public turned to horror, as the cutter vaccine gave polio to almost 80 recipients; these children in turn went on to spread the disease to another 120 playmates and relatives; three quarters of the victims were paralysed and 11 died. . . . NIH’s Laboratory of Biologics Control, which had certified the Salk vaccine, had received advance warning of problems. . . .

In 1954 the rush was on. [Eddy's] lab had gotten samples of the inactivated polio vaccine to certify on a “due-yesterday” basis. “This was a product that had never been made before and they were going to use it right away,” she recalled. She and her staff worked around the clock. “We had eighteen monkeys. We inoculated these eighteen monkeys with each vaccine that came in. And we started getting paralyzed monkeys.” She reported to her superiors that the lots were Cutter’s, and sent pictures of the paralyzed monkeys along as well. “They were going to be injecting this thing into children. . . .They went ahead and released the vaccine anyway, a lot of it. The monkeys they just disregarded.”

Shannon called the Surgeon General Satur­day morning. Additional cases of paralysis continued to occur. “It seemed obvious that we had a crisis on our hands, the magnitude of which was unknown.” Late Saturday afternoon a working group of senior virus specialists, whose advice the polio foundation had started to ignore a year earlier, began meeting in Shannon’s office. Note that Shannon had completely taken charge of the crisis. “Sebrell was not the man to manage this,” DeWitt Stetten recalled. ‘James Shannon was a man of quite different character.”

Shannon had brought in the Surgeon General, who called polio chief Basil O’Connor in New York. On Monday evening O’Connor and his advisers came down to Bethesda. Shannon wanted to withdraw the vaccine, “It was a very stormy meeting,” he said. “O’Connor and the polio group in general disallowed any possibility of induced infections [as a result of the vaccine]. … So Basil O’Connor stormed out with dire warning of what he was going to do to the NIH and the Public Health Service. Further vaccination was stopped. I had many sleepless nights.”

The basic problem had really not been the carelessness of the Cutter company, which rightly or wrongly was exonerated in a later report. It was the difficulty in jumping from Salk’s lab experiments with killing (formalinizing) the virus to large-scale industrial production.

. . . Ruth Kirschstein, the director today of an important NIH institute, added, “The Cutter incident resulted in everybody up the line who had anything to do with it—very few people know this story—being dismissed because of it.” All went out: the director of the microbiology institute lost his post, as did the equivalent of the assistant secretary for health. Oveta Culp Hobby, the secretary of Health, Education and Welfare (or Oveta “Culpable” Hobby, as she was known), stepped down. Dr. Sebrell, the director of the NIH, resigned.

Whereas I think the “basic problem” was overestimating the competence of powerful people, especially powerful experts.

Assorted Links

Wednesday, February 26th, 2014

Evidence that Antioxidants Increase Cancer

Thursday, February 6th, 2014

Many researchers were shocked when a large 1984 experiment found that a beta-carotene supplement increased lung cancer. Because beta-carotene is a potent antioxidant, and epidemiology had linked eating vegetables with less cancer, it was supposed to decrease lung cancer. My Berkeley neighbor Bruce Ames was the foremost proponent of the idea that antioxidants will decrease cancer.

Now more evidence supports the idea that antioxidants may increase cancer.

A request for comment elicited this:

“It’s disappointing but not surprising that people’s beliefs are not modified by scientific evidence,” said Dr Paul Marantz, an epidemiologist at Albert Einstein College of Medicine in New York. “People so want to believe there is a magic bullet out there.”

One commenter on the article rightly says:

“It’s disappointing but not surprising that people’s beliefs are not modified by scientific evidence,” . . . Rather a snide comment considering the fact that it was science that spent years telling everyone that antioxidants and supplements were beneficial.


Who Will Make the Future Better than the Past? Professors or the Rest of Us?

Monday, January 20th, 2014

Stephen Hsu, who has an excellent blog, recently became Vice President for Research and Graduate Studies at Michigan State University. Before that, he was a professor of physics. At a dinner for faculty promoted to full professor, he said:

When an attorney prepares a case it is for her client. When a Google engineer develops a new algorithm, it is for Google — for money. Fewer than one in a thousand individuals in our society has the privilege, the freedom, to pursue their own ideas and creations. The vast majority of such people are at research universities. A smaller number are at think tanks or national labs, but most are professors like yourselves. It is you who will make the future better than the past; who will bring new wonders into existence.

In this blog, in thousands of posts, I have argued a much different view: everyone can make the future better than the past in the way Stephen is talking about, by adding to our understanding. In particular, anyone — not just professional researchers, such as professors at research universities — can increase our understanding of how to be healthy. This has already started to happen. Some examples: (more…)

Who Tests the Genetic Testers? And the Experts?

Wednesday, January 15th, 2014

In the New York Times, a writer named Kira Piekoff, a graduate student in Bioethics, tells how she sent her blood to three different companies, including 23andMe, for genetic analysis and got back results that differed greatly. As usual, none of the companies told her anything about the error of measurement in their reports, judging from what she wrote. So she’s naive and they’re naive (or dishonest). Fine.

I’m unsurprised that a graduate student in bioethics has no understanding of measurement error. What’s fascinating is that the experts she consulted didn’t either, judging by what they said.

A medical ethicist named Arthur L. Caplan weighed in. He said:

The ‘risk is in the eye of the beholder’ standard is not going to work.We need to get some kind of agreement on what is high risk, medium risk and low risk. [Irrelevant -- Seth] If you want to spend money wisely to protect your health and you have a few hundred dollars, buy a scale, stand on it, and act accordingly.

As if blood sugar and blood pressure measurements aren’t useful. A good scale costs $15.

A director of clinical genetics named Wendy Chung said:

Even if they are accurately looking at 5 percent of the attributable risk, they’ve ignored the vast majority of the other risk factors — the dark matter for genetics — because we as a scientific community haven’t yet identified those risk factors.

She changed the subject.

J. Craig Venter, the famous gene sequencer, does not understand the issue:

Your results are not the least bit surprising. Anything short of sequencing is going to be short on accuracy — and even then, there’s almost no comprehensive data sets to compare to.

The notion that “anything short of [complete] sequencing” cannot be helpful is absurd, if I understand what “short on accuracy” means. He reminds me of doctors who don’t understand that a t test corrects for sample size. They believe any study with less than 100 subjects cannot be trusted.

I told a friend recently that I have become very afraid of doctors. For exactly the reason illustrated in these quotes, from well-known experts who are presumably much more competent than any doctor I am likely to see. The experts were unable to comment usefully on something as basic as measurement error. Failing to understand basics makes them easy marks — for drug companies, for example — just as the writer of the article was an easy mark for the experts, who managed to be quoted in the Times, making them appear competent. Surely almost any doctor will be worse.

Science Critics Are Human: Cautionary Tale

Friday, January 3rd, 2014

One reason personal science is a good idea is it is simple and immediate (in the sense of near). You study one person, you do experiments (easier to interpret than surveys), you can easily repeat the experiment (so you are not confused by secular trends — big changes over time — and implausible statistical assumptions), you are aware of unusual events during the experiment (so you are less confused by anomalous results and outliers), you are close to the data collection (so you understand the limits and error rates of the measurements). These elements make good interpretation of your data much easier. Professional science generally lacks some of these elements. For example, the person who writes the paper may not have collected the data. This makes it harder to understand what the data mean.

I hear criticism of (professional) science more now than ten years ago. Lack of replicability, for example. What I rarely hear — actually, never — is how often science critics make big blunders. As far as I can tell, as often as those they criticize. This is not to say they are wrong — who knows. Just overstated.
An example is a critique of salt and blood pressure studies I read recently. Many people say salt raises blood pressure. The critique, by Michael Alderman, a professor of epidemiology at Albert Einstein College of Medicine, said, not so fast. The title is: “Salt, blood pressure and health: a cautionary tale.” It’s a good review, with lots of interesting data, but the reviewer, at the same time he is criticizing others, makes a major blunder.

He describes a study in which people were placed on a low-salt diet. Their blood pressure was measured twice, before the diet (Time 1) and after they had been on the diet for quite a while (Time 2). Comparison of the two readings showed a wide range of changes. Some people’s blood pressure went up, some people’s blood pressure stayed the same, and some people’s blood pressure went down. Alderman called this result “enormous variation between individuals on the effect of salt on pressure”. Oh no! He assumes that if your blood pressure is different at Time 2 than Time 1, it was because of the change in dietary salt. There are dozens of possible reasons a person’s blood pressure might differ at the two times (leaving aside measurement error, another possibility). Dozens of things that affect blood pressure were not kept constant.

Had there been a second group that did not change their diet and was also measured at Time 1 and Time 2 — and had the subjects given the low-salt diet showed a larger spread of Time 2/Time 1 difference scores than the no-change group, then you could reasonably conclude that there was variation in the response to the low-salt diet. To conclude “enormous variation” you’d want to see an enormous increase in difference-score variability. But there was no second group.

This is not some small detail. Alderman actually believes there is great variation in response to salt reduction. It is the main point of his article. Spy magazine had a great column called Review of Reviewers. Such as book and movie reviewers. Unfortunately there is no such thing in science.

Assorted Links

Saturday, December 28th, 2013

Thanks to Eugenia Loli.

Front Lines of Personal Science: Progress on Why I Slept So Well

Sunday, December 22nd, 2013

A few days ago I noted that I had slept unusually well. I wondered why. The previous day had been unusual in five ways (yogurt blueberries and honey 2 hours before bedtime, only one blackout curtain, chocolate, unusual timing of morning faces, new brand of honey). Was one of them responsible? Or was it random variation?

The next day I repeated four of the five unusual things: only one blackout curtain, chocolate, unusual timing of morning faces, new brand of honey. Result: I did not sleep unusually well. This pointed to either yogurt blueberries and honey or random variation as the explanation. Those happened to be the explanations I had considered most plausible (yogurt blueberries and honey) and least plausible (random variation).

Yesterday I repeated all five of the unusual things. Yesterday evening it took longer than usual to fall asleep. Usually I fall asleep within a minute, but this time it took about 4 minutes. As I was lying there, I attributed the long latency to lack of exercise that day. In the morning, for the first time in my whole life, I woke up what a friend called “full of jitters”. Very rested, yes, but also too much energy. As if I’d had too much caffeine. Usually I have a cup of black tea first thing in the morning. I started to make one and realized it would make things worse, not better. As I said, this has never happened before.

So it was the yogurt blueberries and honey. The first time I had it I had added the honey just for sweetener and hadn’t measured it. The second time I did measure the honey — 14 g, about 2 teaspoons. Probably more than I had used the first time, which may explain the different results (1st time: very rested, 2nd time: very rested and jittery). Both times I ate 125 g blueberries, which has 12 g sugar (half glucose, half fructose). I doubt the yogurt (homemade, no sugar added) matters.

Perhaps the best dose (for me) will turn out to be one teaspoon honey 2 hours before bedtime and one tablespoon of honey at bedtime. I had tried taking more than one tablespoon of honey at bedtime; it seemed to produce the same effect as one tablespoon.

I want to test with and without blueberries, of course, and different amounts of honey 2 hours before bedtime. If honey alone is powerful, then I will test different forms of sugar. I don’t want to be at the mercy of differences between brands of honey, although honey is very convenient.

Let’s say it turns out to be the sugar in honey that produces these big improvements in sleep. Then it will turn out that the nutritionists of the world have been even more wrong about sugar than they were about saturated fat. All the data is not yet in, let me repeat. But the data so far unquestionably point in a surprising direction. It is entirely possible that sugar — in the right amounts at the right times of day — will turn out to be the greatest health food of all.

Which would explain what has never been well-explained: why we like it so much.

Soy Can Cause Migraines

Monday, December 16th, 2013

After I posted that tofu made me stupid — made me slower on a reaction-time test — a reader named Ann, who lives in Florida, said she had discovered that her migraine headaches were caused by soy. How she discovered this:

I was 49 years old and in that hot flashes stage of life, had read that soy could help alleviate them and tried a soy capsule not at a meal, immediately noticed sinus pressure and itchiness.

So I started reading all labels and eliminated soy from my diet and my migraines and sinus headaches went away! The hot flashes eventually went away on their own. I was losing whole days every month to the migraines. Every now and then the soy sneaks in at a restaurant but not as bad as before. Whenever anyone says they have migraines I always suggest looking at soy. Regretfully my daughter has the same issue, but she has way fewer headaches after eliminating soy.

I used to blame a lot of my headaches on allergies, never thinking it could be something I was eating. At age 60 now, my cholesterol numbers are excellent and I weigh 122 pounds when so many of my friends are overweight.

I asked how long it had taken to discover this.

I had been having migraines for years, 10-20, but in the mid 90s they got worse (could have coincided with more soy in food).  Saw a doctor but he just prescribed imitrex which helped but did not prevent them. He never suggested looking for a food cause. It was dumb luck or divine intervention that I tried that soy capsule in 2001 or 2002. I am often amazed at how much better I feel health wise since then. Since soy is in so much processed food my diet is very basic “real” food. Raw fruits and veggies, plain nuts, fresh meat, real cheese, eggs, yogurt, any desserts I make from scratch with real butter. I’m always excited when I find a cracker that doesn’t have soy since that’s usually my bread substitute.

Let me repeat part of that: A doctor she saw because of migrains did not suggest trying to find an environmental cause. The same thing happened to a woman I wrote about for Boing Boing. Her doctor just prescribed one drug after another. Her migraines turned out to be caused by cleaning products. Not knowing that migraines often have environmental causes is like not knowing the germ theory of disease.

Few soy eaters realize the dangers of soy, as far as I can tell. I wrote to one of them, Virginia Messina, a nutritionist who has said “there is no reason to believe that eating soyfoods is harmful to brain aging.” She has not replied.

A long list of possible migraine triggers (from the UC Berkeley health service) does not list soy, although it does mention soy sauce. It says soy milk should be safe. In a 2006 interview,  one headache doctor recommended avoiding all soy. In the comments to this, a woman says:

SOY is the biggest trigger for my migraines.  For years I suffered daily from migraines but after watching EVERYTHING I eat and reading all labels and avoiding SOY as best I can I am doing better.  The biggest problem is that SOY is in everything!!!!  I think one day they will find out how bad it is for us.

Imagine that. Putting something that damages the brain in everything.

Bedtime Honey Doubles a Measure of Strength

Tuesday, December 3rd, 2013

A reader of this blog named Nile McAdams, who lives in Minnesota, wrote:

When I read your first blog post about honey I was gobsmacked. Not so much by the improved sleep — the idea of a bedtime snack improving sleep has been around a long time — but by the fact that a tablespoon of honey could double the time you were able to stand on one leg. [One bent leg. After being roughly constant for a year, the time doubled in two weeks. -- Seth] Impossible!! Not that I thought you were lying — I didn’t — it is just that a lot can go wrong between collecting the data and interpreting the data. So I had to try it for myself. (more…)

Dark Picture of Doctors

Monday, November 25th, 2013

A New York Times article about error in a risk calculator paints an unflattering picture of doctors:

1. The risk calculator supposedly tells you your risk of a heart attack, to help you decide if you should take statins. It overestimates risk by about 100%. The doctors in charge of it were told about the error a year ago. They failed to fix the problem.

2. The doctors in charge of the risk calculator are having trouble figuring out how to respond. The possibility of a simple retraction seems to not have occurred to them. As one commenter said, “That the researchers, once confronted with the evidence it was faulty, struggled with how to handle the issue is quite telling.”

3. In the comments, a retired doctor thinks the problem of causation of heart disease is very simple:

Statins . . . are only one component in the prevention and treatment of coronary artery disease. Item number one is to have a normal weight. Item two is never smoke. Item three is exercise. Four is to eat an intelligent diet. Five is to remove stress from your life as much as practical. If everybody did these five things (all of which are free), the incidence of coronary artery disease would plummet and many fewer would need statins.

This reminds me of a doctor who told me she knew why people are fat: They eat too much and exercise too little. She was sure.

4. In the comments, a former medical writer writes:

Several years ago, I wrote up, as internal reports, about two dozen transcripts recorded at meetings with local doctors that a major drug company held all around the country. The meetings concerned its statin. Two ideas presented at these meetings by the marketing team, and agreed with by the physician attendees, were: 1) the muscle pain reported by patients was almost never caused by the statin but was the result of excessive gardening, golfing, etc; 2) many children should be prescribed a statin and told that they would have to take the drug for life.

5. Another doctor, in the comments, says something perfectly reasonable, but even her comment makes doctors look bad:

I am a physician and I took statins for 2 years. Within the first 6 months, I developed five new serious medical problems, resulting in thousands of dollars spent on treatments, diagnostic tests, more prescription medications, and lost work. Neither I nor any of my 6 or 7 different specialists thought to suspect the statin as the source of my problems. I finally figured it out on my own. It took 3 more years for me to get back to my baseline state of health. I had been poisoned. I see this all the time now in my practice of dermatology. Elderly patients are on statins and feel lousy, some of whom are also on Alzheimer’s drugs, antidepressants, Neurontin for chronic pain, steroids for fibromyalgia. These poor people have their symptoms written off as “getting older” by their primary physicians, most of whom I imagine are harried but well intentioned, trying to follow guidelines such as these, and so focused on treating the numbers that they fail to see the person sitting in front of them. The new guidelines, with their de-emphasis on cholesterol targets, seem to tacitly acknowledge that cholesterol lowering has little to do with the beneficial actions of statins. The cholesterol hypothesis is dying. If statins “work” by exerting anti-inflammatory benefits, then perhaps we should seek safer alternative ways to accomplish this, without subjecting patients to metabolic derangement.

6. A patient:

My previous doctor saw an ultrasound of my Carotid Artery with a very small buildup and told me I needed to take crestor to make it go away. That was four years ago and I still suffer from some memory loss episodes as a result. The experience was terrible and he’s toast because he denied it could happen.

7. A bystander:

For the past couple of years my job has involved working with academic physicians at a major medical school. After watching them in action — more concerned with personal reputation, funding and internecine politics than with patients — it’s a wonder any of us are limping along. And their Mickey Mouse labs and admin organizations can barely organize the annual staff holiday potluck without confusion and strife. So these botched-up results don’t surprise me at all.

I am not leaving out stuff that makes doctors look good. Maybe this is a biassed picture, maybe not. What I find curious is the wide range of bad behavior. I cannot explain it. Marty Makary argued that doctors behave badly due to lack of accountability but that doesn’t easily explain ignoring a big error when pointed out (#1), an immature response (#2), a simplistic view of heart disease (#3), extraordinary callousness (#4) and so on.  In her last book (Dark Age Ahead), Jane Jacobs wrote about failure of learned professions (such as doctors) to police themselves. Again, however, I don’t see why better policing would improve the situation.

Thanks to Alex Chernavsky.

Assorted Links

Thursday, November 7th, 2013
  • Genetics less important than claimed…again and again. The article’s html name says “human genetics successes and failures” but the article is almost all about failure.
  • Why I left (tenured) academia. “We shouldn’t expect [a college president] whose experience is in leading gigantic, dominant corporations to create an environment that rewards original, interdisciplinary, potentially disruptive research. Their previous success (such as it is) is from operating in an inherently conservative environment, running an organization that thrives in the status quo.” It isn’t just the college president. That such people are chosen as college presidents shows how little people at the top understand or value innovation.
  • Monitor Me. BBC TV show about high-tech self-monitoring. My self-monitoring is mostly low-tech, except for brain tests done with a laptop. My experience is that I needed to do everything right — good understanding of previous research, good experimental design, good measurement, good data analysis — to make progress. A talk by Larry Smarr, one of the people in the BBC show, supports this. Smarr has colon inflammation. His design, measurement and data analysis are excellent. However, he chose to test treatments (antibiotics, steroids) known to be poor. They didn’t solve the problem. It would have been wiser to try to figure what in the environment might be causing the problem. It certainly wasn’t not eating enough antibiotics.
  • Fecal self-banking

Thanks to Linda Stein.

Back Pain Cured by Sarno’s Ideas

Saturday, November 2nd, 2013

Two years ago, a professor of decision science wrote me to say that Vitamin D3 in the morning greatly improved his sleep. Recently he wrote again:

Once again you have dramatically improved my life through your blog.

In this Assorted Links post you offered:

The back pain of a friend of mine, which had lasted 20 years and was getting worse, went away when he followed this doctor’s advice

I read the link about Dr. Sarno and went to Amazon to check out his book, “Healing Back Pain”. 700 reviews with a 4.5 star rating. I spent two hours reading the reviews. Person after person saying, “my back is better” and nobody really described what the book had them do. I bought it two weeks ago.

In a nutshell, Sarno says that this type of back pain is caused by oxygen deprivation of some back muscles/tendons, and that the mind has does this as a defense mechanism so I don’t have to confront my subconscious anger.

I don’t have to pinpoint the source of my anger. I don’t have to come to grips with it and stop being angry. I just have to acknowledge the anger. That’s it. I read half the book in one sitting. I thought, this is crazy, but it has 700 4+ stars at Amazon. Maybe it does work.

My wife and I have two cars. One of them is a small Saturn. I hate it. It hurts my back to get in or out of it, and if I drive for more than five minutes I have to squirm to keep the back pain under control. Last week I took the Saturn for two half hour drives with only one wince of pain. Today I took it to the gym (a five minute drive) but it didn’t hurt to get in or out.

In the morning, to get out of bed, I have to roll over and swing my legs out toward the floor and then prop myself up into a sitting position. At least, that’s how I’ve done it for the past year. This week, I just sat up in bed with no pain. Every morning.

I am still a bit weak in the lower back, after more than a year of restricted physical activity. But this is amazing.

Interview with Sarno on Larry King Live (1999).