Seth's Blog

• Salem Comes to the National Institutes of Health. Dr. Herbert Needleman is harassed by the lead industry, with the help of two psychology professors.
• Climate scientists “perpetuating rubbish”.
• A humorous article in the BMJ that describes evidence-based medicine (EBM) as a religion. “Despite repeated denials by the high priests of EBM that they have founded a new religion, our report provides irrefutable proof that EBM is, indeed, a full-blown religious movement.” The article points out one unquestionable benefit of EBM — that some believers “demand that [the drug] industry divulge all of its secret evidence, instead of publishing only the evidence that favours its products.” Of course, you need not believe in EBM to want that. One of the responses to the article makes two of the criticisms of EBM I make: 1. Where is the evidence that EBM helps? 2. EBM stifles innovation.
• What really happened to Dominique Strauss-Kahn? Great journalism by Edward Jay Epstein.  This piece, like much of Epstein’s work, sheds a very harsh light on American mainstream media. They were made fools of by enemies of Strauss-Kahn. Epstein is a freelance journalist. He uncovered something enormously important that all major media outlets — NY Times, Washington Post, The New Yorker, ABC, NBC, CBS (which includes 60 Minutes), the AP, not to mention French news organizations, all with great resources — missed.

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…)

In a paper (and blog post), Andrew Gelman writes:

As a statistician, I was trained to think of randomized experimentation as representing the gold standard of knowledge in the social sciences, and, despite having seen occasional arguments to the contrary, I still hold that view, expressed pithily by Box, Hunter, and Hunter (1978) that “To find out what happens when you change something, it is necessary to change it.”

Box, Hunter, and Hunter (1978) (a book called Statistics for Experimenters) is well-regarded by statisticians. Perhaps Box, Hunter, and Hunter, and Andrew, were/are unfamiliar with another quote (modified from Beveridge): “Everyone believes an experiment except the experimenter; no one believes a theory except the theorist.” (more…)

Here is a comment left on my earlier canker-sore post by a reader named Ted:

I found out quite by accident WALNUTS get rid of [canker sores] quite quickly. The first sign of an ulcer I chew walnuts and leave the paste in my mouth for a little while (30 seconds or so).

The first time was by accident, my ulcers disappeared so quickly I knew it had to be something I ate. And the only thing I had eaten differently the past day was walnuts.

Flaxseed oil and walnuts differ in lots of ways but both are high in omega-3. My gums got much better around the time I started taking flaxseed oil. I neither noticed nor expected this; my dentist pointed it out. Several others have told me the same thing. Tyler Cowen’s gums got dramatically better. One reader started and stopped and restarted flaxseed oil, making it blindingly clear that the gum improvement is caused by flaxseed oil. There is plenty of reason to think the human diet was once much higher in omega-3. All this together convinces me that omega-3 can both prevent and cure canker sores. Not only that, I’m also convinced that canker sores are a sign of omega-3 deficiency. You shouldn’t just get rid of them with walnuts; you should change your diet. Omega-3 has other benefits (better brain function, less inflammation, probably others).

Let’s say I’m right about this — canker sores really are prevented and cured by omega-3. Then there are several things to notice.

1. Web facilitation. It was made possible by the internet. My initial interest in flaxseed oil came from reading the Shangri-La Diet forums. I didn’t have to read a single book about the Aquatic Ape theory; I could learn enough online. Tyler Cowen’s experience was in his blog. Eric Vlemmix contacted me by email. No special website was involved.

2. Value of self-experimentation. My flaxseed oil self-experimentation played a big part, although it had nothing to do with mouth health. These experiments showed dramatic benefits — so large and fast that something in flaxseed oil, presumably omega-3, had to be a necessary nutrient. Because of these results, I blogged about omega-3 a lot, which is why Eric emailed me about his experience.

3. Unconventional evidence. All the evidence here, not just the self-experimentation, is what advocates of evidence-based medicine and other evidence snobs criticize. Much of it is anecdotal. Yet the evidence snobs have, in this case, nothing to show for their snobbery. They missed this conclusion completely. Nor do you need a double-blind study to verify/test this conclusion. If you have canker sores, you simply drink flaxseed oil or eat walnuts and see if they go away. Maybe this omnipresent evidence snobbery is . . . completely wrong? Maybe this has something to do with the stagnation in health research?

4. Lack of credentials. No one involved with this conclusion is a nutrition professor or dentist or medical doctor, as far as I know. Apparently you don’t need proper credentials to figure out important things about health. Of course, we’ve been here before: Jane Jacobs, Elaine Morgan.

5. Failure of “trusted” health websites. Health websites you might think you could trust missed this completely. The Mayo Clinic website lists 15 possible causes — none of them involving omega-3. (Some of them, we can now see, are correlates of canker sores, also caused by lack of omega-3.) If canker sores can be cured with walnuts, the Mayo list of treatments reads like a list of scurvy cures from the Middle Ages. The Harvard Medical School health website is even worse. “Keep in mind that up to half of all adults have experienced canker sores at least once,” it says. This is supposed to reassure you. Surely something this common couldn’t be a serious problem.

6. Failure of the healthcare establishment. Even worse, the entire healthcare establishment, with its vast resources, hasn’t managed to figure this out. Canker sores are not considered a major health problem, no, but, if I’m right, that too is a mistake. They are certainly common. If they indicate an important nutritional deficiency (too little omega-3), they become very important and their high prevalence is a major health problem.

In an editorial about the effect of vitamin-mineral supplements in the prestigious American Journal of Clnicial Nutrition, the author, Donald McCormick, a professor of nutrition at Emory University, writes:

This study is a meta-analysis of randomized controlled trials that were previously reported. Of 2311 trials identified, only 16 met the inclusion criteria.

That’s throwing away a lot of data! Maybe, just maybe, something could be learned from other 2295 randomized controlled trials?

Evidence snobs.