Seth's Blog

Many people think that personal genomics will change medicine. Doctors will choose treatments based on your genome, learning your genome will tell you what diseases you are at high risk of so you can take precautions, and so on. One person who believes this is Eric Topol. In his new book, The Creative Destruction of Medicine, he writes:

The biggest leap came in the first decade of the twenty-first century. The six billion bases of the human genome were sequenced, and this led to the discovery of the underpinnings of over one hundred common diseases, including most cancers, heart disease, diabetes, autoimmune disorders, and neurologic conditions.

Here is the founder of a company that makes sequencers: ““I believe that the impact on the medical community of whole human genome sequencing at a cost comparable to a comprehensive blood test will be profound.”

I disagree. I have seen nothing that suggests genes make a big difference in any common disease and plenty that suggests environment makes a big difference. My self-experimentation led me to one powerful environmental factor after another, for example. Biologists have invested heavily in the study of genes for reasons that have nothing to do with practical applications, as Thorstein Veblen would be the first to point out.

In 1999, New Yorker staff writer Michael Specter wrote an admiring article about a neurology professor named Kari Stefansson. Stefansson had returned to his native Iceland to take advantage of Iceland’s genetic homogeneity to find genes for common diseases. “In the past, drugs were discovered almost by chance,” Specter wrote, as if this would soon change. The wishful thinking involved is indicated by passages like this:

[Stefansson] and Gulcher selected the five per cent of Icelanders among the hundreds of thousands in their genealogical database who had lived the longest— most of them over ninety. The database allowed the two scientists to seek an answer to a simple question: Are these people who live so long related to each other more often than the average in Iceland? The answer quickly became apparent. People over ninety are much more closely related to each other than people in the general population are, and their children are more likely to live longer than the children of others. That provides strong evidence that the trait is inherited.

“Strong” evidence? The “people over ninety” observation is strong evidence that longevity is inherited only if relatives share nothing but genes. The “their children are more likely” observation is strong evidence of genetic control only if parents pass on to their children only genes. Both assumptions are highly unlikely. For example, surely an Icelandic person lives closer to his relatives than to randomly selected Icelanders.

The article quotes no one with my view (geneticists are overstating the practical value of their work), but it does say that “Stefansson set out to raise capital at a time [1996] when investors had become skeptical about the many unfulfilled promises made by companies claiming that genetic research would solve the ills of humanity.”

Will reality overtake hype? Here is an indication this is happening:

Kari [Stefansson], a neurologist, was a Harvard professor when he co-founded deCODE in 1996. Two years later, Iceland’s parliament gave deCODE access to one of the country’s unique resources—health records of the genetically homogenous population. DeCODE debuted on the NASDAQ stock exchange in 2000, and it made dramatic discoveries of genetic factors associated with cancer, heart disease and other conditions. But the company never turned a profit and filed for bankruptcy protection in 2009.

In a recent post I wondered what’s a good word to describe the next step in economic progress after specialization — when making/doing X is done by the general public (not as a job) instead of just by paid specialists (as a job).  For example, the introduction of cheap cameras allowed the general public, not just professional photographers, to take pictures. Personal science is an example of such a shift, of course. Thank you for your many suggestions, such as laitization, deguilding, promethization, and several more. The combination of Keimpe Wiersma’s suggestion (DIY) and wobbly’s suggestion (deguilding) led me to DIYing and DIYization.

DIYing, I learned, is an existing word with a different meaning (to do DIY). Although ordinary DIY (Home Depot) is associated with men, women appear to use DIYing far more than men and they use it to describe traditionally feminine activities (see this). For example, there is a blog DIYing To Be Domestic by a woman. This is irrelevant to whether I use it — it’s just interesting.

DIYization is much rarer. It appears in a 2005 essay called “Scandinavian Dreams: DIY, Democratisation and IKEA” where it refers not to a change in an activity but to a change in society — toward more DIY. IKEA, says the essayist, is an example of “the DIYization of society.”

DIYing is shorter. DIYization is more self-explanatory, less likely to be confused with dying, and makes clearer the connection with specialization. Not to mention it is more pompous — more Veblenesque. In the last chapter of The Theory of The Leisure Class, Veblen used long rare words to say that academics show off their uselessness using by using long rare words.

SOPA is an example of what Thorstein Veblen called “the vested interests” trying to prevent change. In an essay called “The Vested Interests and the Common Man” he pointed out “the existence of powerful vested interests which stand to gain from the persistence of the existing, but outdated system of law and custom.” Jane Jacobs said much the same thing. The most important conflict in any society, she wrote at the end of The Economy of Cities, isn’t between the rich and poor or management and labor; it is between those who benefit from the status quo and those who benefit from change. If those who benefit from the status quo usually win, problems stack up unsolved.

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?

To rehabilitate his reputation, Alfred Nobel, in his will, established the Nobel Prizes, the crucial element of which was that they honor the most useful research. Nobel wanted to be associated with good works. This has become a considerable problem for the committee that awards the Physiology and Medicine prize because, if you haven’t noticed, the most prestigious research — the stuff done at great expense in gleaming new laboratories — isn’t useful. The uselessness of high-prestige academic research was emphasized  by Thorstein Veblen in The Theory of the Leisure Class. Unfortunately Nobel died shortly before it was published.

For a long time, the Nobel prize-winning research in Medicine hasn’t provided significant help with major health problems (depression, obesity, diabetes, cancer, stroke, heart disease, etc.). Sometimes it has been a tiny bit helpful. Most often the prize-winning research has been, at the time of the award, no clear help at all. This is one of those years. The press release announcing the 2011 prize tries to hide this important truth. Here is the “what use is it?” section of this year’s press release:

From fundamental research to medical use

The discoveries that are awarded the 2011 Nobel Prize have provided novel insights into the activation and regulation of our immune system. They have made possible the development of new methods for preventing and treating disease, for instance with improved vaccines against infections and in attempts to stimulate the immune system to attack tumors. These discoveries also help us understand why the immune system can attack our own tissues, thus providing clues for novel treatment of inflammatory diseases.

“They have made possible the development of new methods for preventing and treating disease.” False (and, uh, just a wee bit grandiose). Such development was already possible. Note what isn’t said: “They led to new methods for preventing and treating disease.”

“Improved vaccines against infections.” I have heard nothing about this, in spite of the plural (vaccines rather than vaccine). In any case, this is faint praise because the improvement might be a small percentage. If you know whether this claim is true, please leave a comment. Again note what isn’t said: “New vaccines”. According to this article, the work led to a vaccine against prostate cancer. (With no noticeable benefit so far.) Does the press release writer think  prostate cancer is infectious?

“Attempts to stimulate the immune system to attack tumors.” Attempts? As in failed attempts? Apparently.

The final sentence (“These discoveries also help us understand . . . “) is out of place. The section is about actually helping people (“medical use”) not ivory-tower stuff like “providing clues”. Whoever wrote this is like a student with not enough to say trying to meet a teacher’s minimum word count.

There you have it. The practical value of the research awarded the most prestigious prize in the world — a prize that Alfred Nobel’s will said should be given to “those who, during the preceding year, shall have conferred the greatest benefit on mankind.”

To make your immune system work better, I am sure there are two simple, practical and powerful ways of doing so: deepen your sleep and eat fermented foods.

I like this essay by Brad DeLong about the failure of economics professors. They didn’t just fail to predict the recent economics crisis but they have failed, as far as he can tell, to learn from it. If you are naive, of course this is astonishing — but DeLong is not naive. Yet he is “astonished”. That’s interesting.

It’s hard to imagine DeLong doesn’t know what I am about to say. I imagine anybody with any academic sophistication is aware of it — especially economists. As Thorstein Veblen (an economist) pointed out in The Theory of the Leisure Class (1899), a great deal of what professors do, including economics professors, is about signaling high status. In economics, this is done by being highly mathematical. (Same in statistics. In art history, it is done by using big words. In engineering it is done by being theoretical. In many areas of science, it is done by using expensive equipment and having a large lab. In many fields it is done by being useless — e.g., preferring “pure” research over “applied” research.) This is no mystery. Economists think a lot about signaling. Michael Spence wrote an influential paper (which included Veblen’s phrase “conspicuous consumption”) and book about it, for example, for which he won a Nobel Prize. (More examples from economics.) But DeLong ignores the signaling of economists. Let me propose why economists haven’t taken the steps DeLong is astonished they haven’t taken: Because it would make them more useful and less mathematical. Thereby signaling lower status.

Why is signaling so common? It is basic biology, yes. But it is also convenient. Here is what Veblen didn’t say: It is so much easier to signal than to make progress. Among animals, it is much easier to signal you will win a fight than to actually win one. Among professors, it is easier to use big words than to write clearly. DeLong wants economists to choose progress over signaling. Shouldn’t an economist not be astonished when the lower-priced option is chosen?

Felix Salomon argues that fancy restaurants often manage to make their food a Veblen good — something that becomes more desirable when the price goes up. Restaurant food is a way to show off your wealth, in other words. (more…)

• “As reprehensible as many [drug] industry practices are, I [Marcia Angell] believe the behavior of much of the medical profession is even more culpable.”
• Richard Posner, judge and erstwhile economist, reveals he is unfamiliar with Thorstein Veblen.
• Notes on nonviolence by Gene Sharp. “They struggled against slavery, achieved voting rights for the disenfranchised, seceded from empires,
  undermined dictatorships, broke down racial segregation, strengthened exploited workers with the tools of the strike and economic boycott, restored independence to colonized nations, freed intended victims of the Holocaust, spread and defended civil liberties, achieved higher standards of living, ended discrimination, paralyzed an empire, and even defeated totalitarian systems.”
• Careerism in the military. Many similarities with careerism in health science. Careerism in health science is one reason many health problems, such as obesity and autism, are getting worse.

A friend of mine majored in design at Tsinghua and is now working as a designer. Her opinion of her education has gone down. Designers from other schools are better trained than she is, she sees.

At Tsinghua, her teachers denigrated learning to use this or that software program. To design something using a computer program was to be a design farmer, they said. They preferred to talk about big ideas. “I hate big ideas,” said my friend.

Her comments reminded me of law professors who would rather teach philosophy than how to be a lawyer (and are surprised when students play solitaire during class) and education professors who don’t teach their students how to teach.

From an excellent Atlantic article about John Ioannidis, who has published several papers saying that medical research is far less reliable than you might think:

A different oak tree at the site provides visitors with a chance to try their own hands at extracting a prophecy. “I [bring] all the researchers who visit me here, and almost every single one of them asks the tree the same question,” Ioannidis tells me . . . “‘Will my research grant be approved?’”

A good point. I’d say his main contribution, based on this article, is pointing out the low rate of repeatability of major medical findings. Until someone actually calculated that rate, it was hard to know what it was, unless you had inside experience. The rate turned out to be lower than a naive person might think. It was not lower than an insider might think, which explains lack of disagreement:

David Gorski . . . noted in his prominent medical blog that when he presented Ioannidis’s paper on [lack of repeatability of] highly cited research at a professional meeting, “not a single one of my surgical colleagues was the least bit surprised or disturbed by its findings.”

I also like the way Ioannidis has emphasized the funding pressure that researchers face, as in that story about the oak tree.  Obviously it translates into pressure to get positive results, which translates into overstatement.

I also think his critique of medical research has room for improvement:

1. Black/white thinking. He talks in terms of right and wrong. (“We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine.”) This is misleading. There is signal in all that medical research he criticizes; it’s just not as strong a signal as the researchers claimed. In other words the research he says is “wrong” has value. He’s doing the same thing as all those meta-analyses that ignore all research that isn’t of “high quality”.

2. Nihilism (which is a type of black/white thinking). For example,

How should we choose among these dueling, high-profile nutritional findings? Ioannidis suggests a simple approach: ignore them all.

I’ve paid a lot of attention to health-related research and benefited greatly.  Many of the treatments I’ve studied through self-experimentation were based on health-related research. An example is omega-3. There is plenty of research suggesting its value and this encouraged me to try it. Likewise, there is plenty of evidence supporting the value of fermented foods. That evidence and many other studies (e.g., of hormesis) paint a large consistent picture.

3. Bias isn’t the only problem, but, in this article, he talks as if it is. Bias is a relatively minor problem: you can allow for it. Other problems you can’t allow for. One is the Veblenian tendency to show off. Thus big labs are better than small ones, regardless of which would make more progress. Big studies better than small, expensive equipment better than cheap, etc. And, above all, useless is better than useful. The other is a fundamental misunderstanding about what causes disease and how to fix it. A large fraction of health research money goes to researchers who think that studying this or that biochemical pathway or genetic mechanism will make a difference — for a disease that has an environmental cause. They are simply looking in the wrong place. I think the reason is at least partly Veblenian: To study genes is more “scientific” (= high-tech = expensive) than studying environments.

Thanks to Gary Wolf.