Published on 13 Feb 2017
Filmed at Romagne 14-18 museum: http://romagne14-18.com
Plastic and reconstructive surgery saw rapid development during World War 1. Modern medical care and better equipment increased the chances of survival for the soldiers. But these survivors were often disfigured or lost limbs as a result. To help them return to a somewhat normal life, reconstructive surgeons developed methods to restore their faces and aided them with prosthetics.
February 14, 2017
Reconstructive and Plastic Surgery During World War 1 I THE GREAT WAR Special
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February 5, 2017
Smoking – Hearing Protection – Sanitation I OUT OF THE TRENCHES
Published on 4 Feb 2017
This week Indy talks about the smoking habits of the soldiers, how sanitation was organised in the trenches and how soldiers protected their ears during fighting.
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February 3, 2017
February 2, 2017
Obesity and the adoption of a “western” diet
Gary Taubes says the “case against sugar isn’t so easily dismissed”:
My concern in my essay and my books is a simple and regrettable fact: the epidemics worldwide of obesity and diabetes that occur whenever populations pass through a nutrition transition from a traditional diet and lifestyle, whatever that may be, to a western one. Something is causing that, and because obesity and diabetes, particularly type 2, are intimately linked to insulin resistance, we should be looking ultimately and desperately for the cause of insulin resistance. Geneticists would say we’re looking for the environmental trigger that reliably and often dramatically increases the prevalence of the obese and diabetic phenotype, regardless of the underlying human genotype. And because insulin resistance, obesity, and diabetes are all intimately linked to heart disease, that trigger is almost assuredly going to be a cause of coronary heart disease as well.
But in this country, nutrition and chronic disease research from the 1950s onward was obsessively focused on a very different question: the dietary cause of heart disease in the United States and Europe. When the researchers decided on the basis of exceedingly premature evidence that dietary fat was the culprit, that drove all public health debates and thinking ever after. Even hypotheses about the cause of obesity and diabetes had to be reconcilable with the belief that saturated fat caused heart disease. As such, the evidence implicating insulin resistance in the disorder (and so the carbohydrate content of the diet) was delayed by 30 years in its acceptance, as I discussed in Good Calories, Bad Calories. Its implications are still not accepted because they clash with what remains of the dogmatic belief that saturated fat causes heart disease. And this all happened because researchers were asking the wrong question (and they got the wrong answer even to that): “why CHD in America now,” rather than “why obesity, diabetes, and insulin resistance in populations worldwide whenever they westernize?”
[…]
Now that we’re almost literally neck deep in obesity and diabetes, the right question is vitally important to answer. If the sugar hypothesis is wrong, it is critically important that it be refuted definitively. That can only happen on the strength of far, far stronger evidence than Dr. Guyenet provides in his somewhat flip and casual response. And if the sugar hypothesis is unambiguously refuted, whatever hypothesis steps up as the next prime suspect has to be very carefully considered. (i.e., not the simplistic notion that people eat too much and move too little). We need a hypothesis that holds the promise of explaining the epidemics everywhere.
In stopping an epidemic, nothing is more important than correctly identifying its cause. Where we are today with obesity and diabetes reminds me of where infectious disease specialists were through most of the 19th century, when they blamed malaria and other insect-born diseases on miasma, or the bad air that came out of swamps. That was mildly effective, in that it was an explanation for why the rich in any particular town preferred to build their homes on hills, high above the miasma and, incidentally, away from the swamps and lowlands and slums where the vectors of these diseases were breeding. But only by identifying the vectors and the actual disease agents do we help everyone avoid them and eradicate the diseases. Only by unambiguously identifying the cause can we effectively design treatments to cure it. The kinds of explanations that Dr. Guyenet and Freedhoff put forth – highly palatable foods or ultra-processed foods – are the nutritional equivalents of the miasma explanation. They sound good; they might help some people incidentally eat the correct diets or offer a description of why other people already do, but they’re not the proximate cause of these epidemics. And there is a proximate cause. We have to find it. I can guarantee it’s not saturated fat, regardless of the effect of that nutrient on heart disease risk. What is it?
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January 29, 2017
QotD: Perverse incentives for journalists
Unfortunately, the incentives of both academic journals and the media mean that dubious research often gets more widely known than more carefully done studies, precisely because the shoddy statistics and wild outliers suggest something new and interesting about the world. If I tell you that more than half of all bankruptcies are caused by medical problems, you will be alarmed and wish to know more. If I show you more carefully done research suggesting that it is a real but comparatively modest problem, you will just be wondering what time Game of Thrones is on.
Megan McArdle, “The Myth of the Medical Bankruptcy”, Bloomberg View, 2017-01-17.
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January 28, 2017
The “fantasy of addiction”
Peter Hitchens explains how he started an argument that “will probably still be going on when I die”.
I never meant to start an argument about addiction. I had carried my private doubts on the subject around in my head for years, in the “heresy” section where I keep my really risky thoughts. And I don’t recommend disagreeing in public with Hollywood royalty, either, which is how it happened. In such a clash, most people will think you are wrong and Hollywood is right, especially if your opponent is Chandler Bing, the beloved character from Friends. Of course, he wasn’t really Chandler Bing, just an actor called Matthew Perry — but an actor with an entourage so big it filled an entire elevator at the BBC’s new studios in central London where we quarreled.
Our debate wasn’t even supposed to be about addiction. I’d been asked onto the corporation’s grand but faded late-night current affairs show Newsnight to talk about drug courts, one of many stupid ideas suggested by the idea of addiction. I reckoned my main opponent would be the other guest, Baroness (Molly) Meacher, whose name sounds like something out of The Beggar’s Opera. While she looks like the sort of harmless, kindly housewife who knits next to you on the bus, she is in fact a campaigner for the wilder sorts of drug liberalization. If this Chandler Perry wanted to horn in, well and good. Who cared? Yet when I began to sense sarcasm mingled with unearned superiority oozing from the character from Friends, I decided to let my impatience show.
Hence my rash, irreversible plunge into an argument which has been going on ever since, consuming billions of electrons on social media, and which will probably still be going on when I die. I heard myself using the words “the fantasy of addiction.” There. I’d done it. Let the heavens fall.
Chandler Bing called me various names and was even more sarcastic than before. He is extremely good at sarcasm, even if he understands very little about the drug problem. I have never heard the words “your book” pronounced with such eloquent contempt. The final “k” seemed to contain two whole syllables. Is this a Canadian thing? He was referring to my modest volume on the topic The War We Never Fought, so energetically ignored by reviewers and booksellers that it is known among London publishers as The Book They Never Bought.
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January 23, 2017
Five easy fixes to improve US federal health policies
Scott Alexander finds, to his surprise, that two of the candidates for the post of FDA commissioner in the Trump administration are following his blog or social media profile. To mark that, he offers five easy-to-implement policy fixes that would make a difference:
1. Medical reciprocity with Europe and other First World countries […] Right now, Europe has a licensing agency about as strict as the FDA approving medications invented in Europe. Any pharma company that wants their medication approved in both the US and Europe has to spend a billion or so dollars getting it approved by the FDA, and then another billion or so dollars getting it approved by the Europeans. A lot of pharma companies don’t want to bother, with the end result that Europe has many good medications that America doesn’t, and vice versa. Just in my own field, amisulpride, one of the antipsychotics with the best safety/efficacy balance, has been used successfully in Europe for twenty years and is totally unavailable here despite a real need for better antipsychotic drugs. If the FDA agreed to approve any medication already approved by Europe (or to give it a very expedited review process), we could get an immediate windfall of dozens of drugs with unimpeachable records for almost no cost. Instead, in the real world, we’re cracking down on imported Canadian pharmaceuticals because the Canadians don’t have exactly our same FDA which means that for all we know they might be adding thalidomide to every pill or something. This is exactly the sort of silly anti-competitive cronyist practice that a principled intelligent libertarian could do away with.
2. Burdensome approval process for generic medications […] How come Martin Shkreli can hike the dose of an off-patent toxoplasma drug 5000%, and everyone just has to take it lying down even though the drug itself is so easy to produce that high school chemistry classes make it just to show they can? The reason is that every new company that makes a drug, even a widely-used generic drug that’s already been proven safe, has to go through a separate approval process that costs millions of dollars and takes two to three years – and which other companies in the market constantly try to sabotage through legal action. Shkreli can get away with his price hike because he knows that by the time the FDA gives anyone permission to compete with him, he’ll have made his fortune and moved on to his next nefarious scheme. If the FDA allowed reputable pharmaceutical companies in good standing to produce whatever generic drugs they wanted, the same as every other company is allowed to make whatever products they want, scandals like Daraprim and EpiPens would be a thing of the past, and the price of many medications could decrease by an order of magnitude. […]
3. Stop having that thing allowing companies to “steal” popular and effective drugs that have been in the public domain for years, claim them as their private property, shut down all competitors, and jack up the price 10x just by bringing them up to date with modern FDA bureaucracy.
4. Stop having that thing where drug companies can legally bribe other companies not to compete with them. I like this one because it sounds anti-libertarian (we’re imposing a new regulation on what companies can do!) but I think it’s exactly the sort of thing that the crony capitalists would never touch but which principled intelligent libertarians like O’Neill and Srinivasan might be open to, in order to bring more actors into the marketplace.
5. Stop thwarting consumer diagnostic products and genetic tests […] Srinivasan comes from the genetic testing world himself, so he’s likely to be extra sympathetic to this.
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January 13, 2017
Jonathan Haidt on the rise of the “microaggression” concept
He is commenting on an article in Perspectives on Psychological Science (PDF):
The microaggression program teaches students the exact opposite of ancient wisdom. Microaggression training is — by definition — instruction in how to detect ever-smaller specks in your neighbor’s eye. Microaggression training tells students that “life itself is exactly what you think it is — you have a direct pipeline to reality, and the person who offended you does not, so go with your feelings.” Of course, the ancients could be wrong on these points, but the empirical evidence for the importance of appraisal and the ubiquity of bias and hypocrisy is overwhelming (I review it in chapters 2 and 4 of The Happiness Hypothesis). As Lilienfeld shows, the empirical evidence supporting the utility and validity of the microaggression concept is minimal at best.
I think the section of Lilienfeld’s article that should most make us recoil from the microaggression program is the section on personality traits, particularly negative emotionality and the tendency to perceive oneself as a victim. These are traits — correlated with depression and anxiety disorders — that some students bring with them from high school to college. Students who score high on these traits perceive more microaggressions in ambiguous circumstances. These traits therefore bring misery and anger to the students themselves, and these negative emotions and the conflicts they engender are likely to radiate outward through the students’ social networks (Christakis & Fowler, 2009). How should colleges (and other institutions) respond to the presence of high scorers in their midst? Should they offer them cognitive behavioral therapy or moral validation? Should they hand them a copy of The Dhammapada or a microaggression training manual?
It’s bad enough to make the most fragile and anxious students quicker to take offense and more self-certain and self-righteous. But what would happen if you took a whole campus of diverse students, who arrive from all over the world with very different values and habits, and you train all of them to react with pain and anger to ever-smaller specks that they learn to see in each other’s eyes?
And what would happen if the rise of the microaggression concept coincided with the rise of social media, so that students can file charges against each other — and against their professors — within minutes of any perceived offense? The predictable result of welcoming the microaggression program to campus is turmoil, distrust, and anger. It is the end of the open environment we prize in the academy, where students feel free to speak up and challenge each other, their professors, and orthodox ideas. On a campus that polices microaggressions, everyone walks on eggshells.
H/T to David Thompson for the link.
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That demon sugar
Last week, Ronald Bailey reviewed a new book on whether the rise in obesity in western society can be blamed on our collective sweet-tooth: The Case Against Sugar, by Gary Taubes.
Less than 1 percent of Americans — 1.6 million people — were diagnosed with Type 2 diabetes in 1958. As of 2014, that figure had risen to 9.3 percent, or 29.1 million. If current trends continue, the figure could rise to more than 33 percent by 2050. Something has clearly gone wrong with American health.
The rising rate of diabetes is associated with the rising prevalence of obesity. Since the early 1960s, the percent of Americans who are obese — that is, whose body mass index is greater than 30 — has increased from 13 percent to 35.7 percent today. (Nearly 70 percent of Americans are overweight, meaning their BMIs are over 25.) Roughly put, the prevailing theory is that rising fatness causes rising diabetes.
But what if both are caused by something else? That is the intriguing and ultimately persuasive argument that Gary Taubes, author Why We Get Fat (2011) and cofounder of the Nutrition Science Initiative, makes in his new book, The Case Against Sugar.
For Taubes, sugar — be it sucrose or high-fructose corn syrup — is “the principal cause of the chronic diseases that are most likely to kill us, or at least accelerate our demise,” explains Taubes at the outset. “If this were a criminal case, The Case Against Sugar would be the argument for the prosecution.” In making his case, Taubes explores the “claim that sugar is uniquely toxic — perhaps having prematurely killed more people than cigarettes or ‘all wars combined,’ as [diabetes epidemiologist] Kelly West put it.”
Taubes surveys the admittedly sparse research on sugar’s psychoactive effects. For example, researchers have found that eating sugar stimulates the release of dopamine, a neurotransmitter that is also released when consuming nicotine, cocaine, heroin, or alcohol. Researchers are still debating the question of whether or not sugar is, in some sense, addictive.
Interestingly, in my most recent discussion with a doctor earlier this week, he specifically said that the dietary information we’ve been depending on for generations is incorrect and that we should avoid excess sugar in our diet rather than fat (keeping in mind total calorie count, of course).
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January 10, 2017
“The very concept of a moral absolute […] is alien to them”
David Warren calls for moral and ethical resistance against “assisted dying” being accepted in society:
Through the casual review of polls, over the years, I have become aware that the general public can itself be moved from approximately 80/20 to approximately 20/80 (four fingers and a thumb to four thumbs and a finger) by any specious argument, if it is repeated constantly, and the Left are able to impose a fait accompli through the courts. Among intellectuals, the swings may be wider and quicker. They are not pendular, however, for once various civilized taboo lines have been crossed, there is no inevitable return, and the only way back is through a field of carnage.
Today, unlike “yesterday” (i.e. a few short years ago) there is 80 percent support for what goes in Canada under the euphemism “assisted dying,” and everywhere under the older euphemism, “euthanasia.” As loyal Christians (or Jews, and many others) we must never surrender to public opinion of this kind. Yet we must recognize that it is pointless to argue with the great mass who, in Canada as in places like Nazi Germany, can so easily be persuaded that down is up, and that words now have new meanings. They simply haven’t the equipment to follow a thread longer than the short slogans in which progressives specialize. Not if their moral schooling was defective, leaving consciences deformed.
People can be “educated” or “catechized” or awakened only one by one, and with their own participation. There is always hope, for as Thomas Sowell says, though everyone is born ignorant, not everyone is born stupid. But in practice, they are retrieved from catastrophic error, only by catastrophe.
At this point in our societal degeneration, “the people” are obedient to what beloved Benedict XVI called the “dictatorship of relativism.” This is understandable because few were raised in anything else. The very concept of a moral absolute (e.g. “thou shalt do no murder”) is alien to them. At the gut level, they may still individually recoil against an evil, but only if they have watched, and found the spectacle “icky.”
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December 17, 2016
December 16, 2016
QotD: Pre-Traumatic Stress Disorder
… it might have been worth mentioning that, whatever the validity of PTSD as a diagnosis, most people who experience a traumatic event in life do not suffer from it. As is to be expected of a creature as protean as Man, people respond differently to their experiences. They do not forget the trauma, but its memory does not affect their subsequent lives in any pathological way. I once met an American psychiatrist, John E. Nardini, who had been a prisoner of the Japanese for more than three years, who had seen half his fellow prisoners die of hunger and disease, and who had himself suffered from beriberi, but who felt that the appalling experience, which of course he would have wished on no one, had actually strengthened him. The development of PTSD does not follow from trauma as the night does the day, but depends on many things — no doubt the culture of the traumatized among them.
In any case, PTSD is largely irrelevant to what Heer is writing about. He isn’t writing about post-traumatic stress disorder at all, but rather, a new diagnosis of pre-traumatic stress disorder. I can’t help but recall the case of Mr. Podsnap, in Charles Dickens’s Our Mutual Friend:
A certain institution in Mr. Podsnap’s mind which he called “the young person” may be considered to have been embodied in Miss Podsnap, his daughter. It was an inconvenient and exacting institution, as requiring everything in the universe to be filed down and fitted to it. The question about everything was, would it bring a blush into the cheek of the young person? And the inconvenience of the young person was, that, according to Mr. Podsnap, she seemed always liable to burst into blushes when there was no need at all. There appeared to be no line of demarcation between the young person’s excessive innocence, and another person’s guiltiest knowledge.
What is most interesting from the cultural point of view about the preposterous nonsense of trigger warnings for Victorian books is the obvious thirst or desire for victimization that they express. Victims are the heroes of the politically correct; their victimhood confers unique moral authority upon them ex officio. And since many would like to be a unique moral authority, it follows that they would like to be a victim. The fact soon follows the wish, at least in their own estimation; and this, of course, provides much work and justifies much power for the self-proclaimed protectors of victims. University teachers become the curators of figurines of the finest porcelain, which only they are allowed to touch.
This is a case in which caricature is the best way of capturing truth.
Theodore Dalrymple, “Pre-Traumatic Stress Disorder: On the phenomenon of campus ‘trigger” warnings’, City Journal, 2015-05-27.
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December 5, 2016
QotD: Wine merchants using alarmist tactics to sell wine
I’m a mom of three young kids. That means I like to have a glass of wine
with breakfast, lunch, and dinnernow and then. And since my kids seem to grow out of their clothes and shoes seconds after I’ve purchased them, I like to get a good deal on aboxbottle or two. Luckily for me, there is stiff competition in the wine industry, which means I can get wines from around the world at prices I can afford.Yet with competition comes increased need to attract customers. And some companies are resorting to a new strategy: Alarmism.
Consider the recent suggestion by some wine companies that some corks are not just inferior, but dangerous. That might seem silly to some or just a lousy marketing stunt to others, but it’s a familiar and all-too-effective tactic used on moms who are constantly encouraged to police their homes for threats to their families.
Julie Gunlock, “Wine Alarmists Should Stick a Cork In It: Stop whining about the non-existent dangers of certain wine corks, and start drinking”, The Federalist, 2015-05-19.
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December 3, 2016
Trudeau government to approach legalizing marijuana as an explicitly crony capitalist exercise
Jay Currie was woken up at an ungodly early hour to talk on a radio show about the leaked portions of the Canada Marijuana Task Force Report. It’s apparently not good news for consumers but really great news for the existing favoured “legal” producers:
The leak itself is interesting and more than a little outrageous. The Report clearly favours Health Canada Licenced Medical Marijuana growers and many of those corporate grow shows are publically traded companies. Allowing the report to come out in dribs and drabs (because “translation”) could cause deep uncertainty in the public markets. The government should release the report, in toto, immediately.
Substantively, the Report apparently recommends that legalization efforts be directed at “getting rid of the $7-billion-a year black market. Sources familiar with the report, which is expected to be made public Dec. 21, say all the other recommendations flow from that guiding principle.”
It is not clear whether that “black market” includes the grey market of dispensaries and pot shops which has grown up in Canada and which continues to expand.
Using “legalization” as a weapon against the “black market” is pretty much the level of restrictive thinking I expected from the Task Force. Rather than seeing legalization as an opportunity to regularize the marijuana market, the language suggests a resumption of the war on drugs by other means.
The Task Force is apparently suggesting that the 40 Health Canada approved licencees remain the only legal source of marijuana and proposes that recreational pot, like medicinal pot, continue to be delivered by Canada Post. A nostalgic bow to the mail and a suggestion pretty certain to keep dispensaries and “Bob on the corner” in business for the foreseeable future. Here is a free clue for the Liberal government: recreational pot users are impulse buyers. As I say in my book, “The most common triggers for the decision is that, by their lights, a customer is running low on pot, has run out of pot or has been out of pot for some time but only now has the money to buy more pot.” In short, not likely to wait a week for Canada Post to deliver.
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QotD: Gender and transgender
The Oxford English Dictionary defines transgender as ‘[d]enoting or relating to a person whose sense of personal identity and gender does not correspond with their birth sex’. It is a relatively new term. According to equality-law professor and trans activist Stephen Whittle, the term ‘transvestite’ was first used in 1910 by the German sexologist Magnus Hirschfeld, who would later found the Berlin Institute where the very first sex-change operations took place. ‘Transsexual’ was not coined until 1949; ‘transgender’ not until 1971; and ‘trans’, which is a very British term, not until 1996.
The first reported sex-change operation may have taken place at Hirschfeld’s Berlin Institute in 1931, but the procedure only became widely known after American Christine (George) Jorgensen travelled to Denmark in 1952 to undergo sex-change surgery. In 1954, following Jorgensen’s transition, US endocrinologist Harry Benjamin began using the term ‘transsexualism’ to describe a unique condition of sex and gender role disorientation.
Throughout the 1960s, transsexualism, and the clinical response to it, remained a contentious issue. Medical professionals in the US were largely opposed to the idea of offering sex-change surgery. A 1965 survey showed that just three per cent of US surgeons would take seriously a request for a sex-change operation. And yet, by the early 1980s, thousands of sex-change operations had taken place.
The Hopkins Hospital, affiliated with Johns Hopkins University, became the most prominent institution to offer transsexual surgery during the 1970s. Under the guidance of psychologist John Money, psychiatrist Eugene Meyer and plastic surgeon Milton Edgerton, the Hopkins Hospital utilised the ‘single theme’ method for diagnosing transsexuals. This involved determining whether or not the patient had an intense conviction to be the other sex.
But, as the rate of referrals increased, by the late-1970s, some of the negative after-effects of sex-change surgery became apparent. These included: medical complications, demands for reverse surgery and suicide attempts. Moreover, it was discovered that, due to the self-diagnostic nature of the ‘single theme’ method for determining treatment, some patients had learned what kinds of things they needed to say in order to receive surgery.
Hopkins Hospital eventually stopped performing the operations in 1979, after Jon Meyer, the chair of the sexual behaviours unit, conducted a study comparing 29 patients who had the surgery and 21 who didn’t, and concluded that those who had the surgery were no more adjusted to society than those who did not have the surgery. As Meyer told the New York Times in 1979: ‘My personal feeling is that surgery is not proper treatment for a psychiatric disorder, and it’s clear to me that these patients have severe psychological problems that don’t go away following surgery.’
While physicians and commentators argued over whether or not medical intervention benefited the patient, for some of those who chose to undergo treatment, it was a lifeline.
Naomi Firsht, “The Rise of Transgender: In the space of a century, transgenderism has become a mainstream concern”, Spiked, 2016-10-28.
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