What about obesity? We put a lot of social effort into fighting obesity: labeling foods, banning soda machines from school, banning large sodas from New York, programs in schools to promote healthy eating, doctors chewing people out when they gain weight, the profusion of gyms and Weight Watchers programs, and let’s not forget a level of stigma against obese people so strong that I am constantly having to deal with their weight-related suicide attempts. As a result, everyone … keeps gaining weight at exactly the same rate they have been for the past couple decades. Wouldn’t it be nice if increasing obesity was driven at least in part by changes in the intestinal microbiota that we could reverse through careful antibiotic use? Or by trans-fats?
What about poor school performance? From the social angle, we try No Child Left Behind, Common Core Curriculum, stronger teachers’ unions, weaker teachers’ unions, more pay for teachers, less pay for teachers, more prayer in school, banning prayer in school, condemning racism, condemning racism even more, et cetera. But the poorest fifth or so of kids show spectacular cognitive gains from multivitamin supplementation, and doctors continue to tell everyone schools should start later so children can get enough sleep and continue to be totally ignored despite strong evidence in favor.
Scott Alexander, “Society Is Fixed, Biology Is Mutable”, Slate Star Codex, 2014-09-10.
January 21, 2016
QotD: Obesity
January 20, 2016
QotD: Nursing
In the company of medical people who know the history of their craft you can get a good discussion going about the exact date after which medical attention was more likely to help than harm you. Opinions generally settle somewhere between 1910 and 1940.
That’s within living memory. People of the generation before my own had little to hope for from medicine. The more realistic among them knew this. My own father, born 1899, regarded the entire medical profession with fear and mistrust. A hospital, he believed, was a place where poor people went to die. A major theme in the background noise of my childhood was the voice of my mother — a professional nurse — nagging Dad to go see a doctor about some ailment he was suffering. “Why won’t you at least go see him? He won’t HURT you.” Dad knew better. Most things mend by themselves. He lived to be 85, dying at last of pneumonia, which was known to people of that generation as “the old man’s friend.”
It wasn’t all negatives before “the early 1950s, when medicine was turning into a science” (Lewis Thomas). There was nursing; there was surgery; there were a handful of useful drugs.
Nursing — the art of keeping patients clean, comfortable, and cheerful — must have saved far more lives than doctoring in the long dark ages before antibiotics. Florence Nightingale (a significant mathematician, by the way) has to be reckoned one of the great benefactors of humanity.
John Derbyshire, “The Scariest Science”, Taki’s Magazine, 2014-11-13.
January 19, 2016
QotD: Male brutality as an evolutionary advantage
Perhaps more important than piling up more examples to attest the phenomenon is giving a little thought to why female masochism occurs. Like other sex traits, it is an evolutionary adaptation. I am going to go way out on a limb and suggest that early hominid males may not have been quite so delicate as Tom Fleming, who becomes ill at the very thought of a woman being struck. African men are, by all accounts, pretty quick with their fists to this day. Gallantry is an achievement of civilization, not a part of our primitive nature.
Now, females in our “environment of evolutionary adaptation” were dependent on males for mating, protection, and access to resources. These males were bigger and stronger than females and could easily hurt them if angered or displeased. If our female ancestors had been delicate snowflakes unable to endure life with such brutes, we would not be here today. In other words, women adapted to male brutality, including occasional violence, learning how to get through or around it.
Think for a moment, men, how you would learn to behave if you were dependent for survival on an unpredictable and often violent creature larger and stronger than yourself. You would learn not simply to take what you wanted. You would learn to act when his back is turned, to use indirection, deception, manipulation. You would learn to conceal your true thoughts and keep Big Boy confused as to your true intentions. You would, in short, learn to act like a woman.
The battle of the sexes is a contest of force vs. cunning. Yes, civilized men learn to control their aggressive impulses and not beat women up every time they feel irritation with them. In the modern West, men have largely renounced the use of their natural weapon for controlling women, i.e., force. Have women renounced the use of their own weapons against men? Certainly we cannot expect women to shed millennial evolutionary adaptations automatically the instant men learn to behave.
F. Roger Devlin, “The Question of Female Masochism”, Counter-Currents Publishing, 2014-09-17.
January 11, 2016
Pre-agrarian life
Cedar Sanderson guest posts at According to Hoyt:
I’m currently studying the history of the world, prior to 1500. In the first chapter of the book we were assigned to read, the point is made that humans have been around for a very long time, it took a long time to develop agriculture, but there weren’t many of them pre-agriculture. The crux of the matter is the ability to grow more food than you could hunt, or gather, in a small group. Large groups, which would build societies and cities, simply could not exist on a subsistence diet.
One of my classmates, in a discussion forum, stated that humans were desperate for nutrients and one of the main ways to get food was to graze which made me do a head-desk, and then start thinking. We take abundant food for granted. The child (in college, but still, a child) who seems to think that humans grazed on grass in pre-history has no doubt never missed a meal in their life unless it was by choice. The world we live in offers enough variety, enough abundance, that people can be ‘vegan’ and still survive, although thriving and being healthy are different matters.
The book tells me that women didn’t have as many children before agriculture, and that’s why population was lower. I snort and mutter something impolite under my breath. In reality hunter-gatherers have more in common with herds of animals, and again, it’s about the food. They were reliant on what was growing right there, right then. They had no way of producing a surplus nor of storing same. If they overhunted an area they were forced to move or die. If the tribe’s population grew too large, they starved or succumbed to disease, just like a deer herd or the snowshoe hare population collapses every few years to build slowly back up, limited by the supply of available food.
Humans lived that way for a very long time. Women having less babies? Probably, only it wasn’t through some kind of arcane desire to keep the population down. It was through the lack of food – nursing a child in the modern era is not terribly effective birth control, but in the time of subsistence the woman’s body simply couldn’t handle the dual load of nursing and pregnancy. I became pregnant with two of my children while nursing full time, I can speak to the enormous drain it is even on a well-fed body.
Because it’s fat. I have fat, on me, and in my diet. Fat is something you just don’t see prior to agriculture, and there’s a reason so many cultures revere the plump woman (just look at all the Venus statues from around the world). A fat woman could have babies and she could survive nursing and this meant the family could go on. And while we’re on the makin’ babies topic, here’s something: my history book laments the rise of the patriarchy alongside the rise of civilization after agriculture, constraining women and making them be under the thumb of the male. Well, that’s not patriarchy, that’s food. Men could hunt, and bring in the meat that was desperately needed for survival. Women gathered, but the men were the hunters.
Why didn’t the women hunt? Well, babies. Pregnant, nursing, malnourished…. The women were managing all they could, and the men were taking care of them. Women were better able to survive (yes, I am counting death in childbirth) in that harsh world than men were. Men were a valuable commodity in a time when hunting and protection of the tribe-family against others who wanted the same food they needed to live menaced the women and children. Female infanticide was practiced long before recorded history, evidence shows. Men were more valuable to the hunter-gatherers and it wasn’t even questioned it seems. But my history book complains that it was the rise of civilization post-agriculture that was to blame for the oppression of women and the gender inequality. Prior to ‘society’ it claims men and women were equal.
January 6, 2016
QotD: De-institutionalization and mental health
Look, part of the whole problem with the deinstitutionalisation of the mentally ill, which goes all the way back to the early seventies at least, and as far as theory is concerned probably a lot further, is that health professionals started, DELIBERATELY blurring the lines between mental illness and mental health.
Part of this was – I think – a genuine effort to make it possible for some people classified as “mentally ill” to be able to make a go of it in the community. A lot of new psychiatric drugs had been discovered which, while they didn’t heal, masked the symptoms of mental illness and therefore made it possible for these people to integrate in normal society – provided they would take their meds (more on that later.)
The other part – I know, my SIL took the mental-health portion of her MD in the late seventies – was the insane “equivalence brigade” which tried very hard to convince themselves that the US too did EXACTLY the same things the USSR did. Since the USSR put political dissenters in mental hospitals, then the people in US hospitals MUST be also political dissenters. This was hard to prove, since the Soviet system provided ideological support for mental treatment of dissenters: i.e. the Marxist system was perfect, so anyone disagreeing must be mad, while the American system mostly tried to get people off the streets who would do harm to themselves and/or others. However the medical profession found their justification in an upside-down of the Marxist system. Since Capitalism was bad for humans and other living things, then everyone who went mad under capitalism were, ipso facto, political dissenters. So, if you happened to be a woman who liked to throw rocks at strangers and go into bizarre monologues on the subject of cabbage, you weren’t mad, you were a feminist protesting male aggression.
Now I have no proof this was intentional or a coordinated AGITPROP operation. It’s entirely possible it was (merely) the predictable mix of ill-intentioned agents and well-intentioned idiot fellow travelers.
However the end result was making people too crazy to live alone into political victims and incidentally to give the USSR room to claim the capitalist system created homelessness.
Sarah A. Hoyt, “I’m Not Crazy, I’m Just A Little Unwell – A blast from the past post 10/12”, According to Hoyt, 2015-10-12.
December 31, 2015
Blogging will continue to be light
I’m sharing this post from my iPhone while reclining in my bed in the Intensive Care Unit at Lakeridge Health in Oshawa. I’ve suffered a totally unexpected health setback on Tuesday evening and I don’t know when I’ll be able to resume blogging. There are still several postings in the queue, but once they’re posted, the blog may go quiet for some time.
My best wishes to all of you in 2016. I hope to be back to a relatively normal life as soon as medicine and rest will allow.
QotD: Some women really do dig jerks
Many of the “battered women” we are encouraged to sympathize with have a remarkable tendency to suffer from abuse at the hands of every man with whom they become involved. Tammy Wynette, the Country singer who gained fame with the song “Stand By Your Man,” was married to five men and left four of them (managing to die with her fifth marriage still intact). Most of her husbands are said to have abused her in some way, and teary-eyed retellings of her “tragic” life have been offered to the public.
I remind the reader of the central principle of male-female relations: women choose. They represent the supply; men represent the demand. If Tammy Wynette never took up with a man who failed to abuse her, there can be only one explanation: Tammy had a thing for nasty boys.
If you put a woman like this in a room with a dozen men, within five minutes she would be exclusively focused on the meanest, most domineering and brutal fellow in the room. Some women who had alcoholic fathers have a similar uncanny ability to detect the alcoholic in a room full of men, even if he is sober at the moment. “Women’s intuition” is a reality: it is an ability to pick up on tiny signals, slight nuances of facial expression that would go unnoticed by a man.
We are attracted to qualities in the opposite sex which our own sex lacks. For many women, this means an attraction to male brutality. Such women may claim to want a sensitive fellow who is in touch with his feelings, but this bears no relation to their behavior. What women say about men comes from their cerebral cortex; how they choose men depends upon their evolutionary more primitive limbic system. Even campus feminists choose arrogant jocks to “hook up” with, not male feminists in touch with their emotions. I have heard it suggested that the best reason not to strike a woman today is that you will never be able to get rid of her afterwards.
F. Roger Devlin, “The Question of Female Masochism”, Counter-Currents Publishing, 2014-09-17.
December 30, 2015
QotD: Medicine before antibiotics
Explanation was the real business of medicine. What the ill patient and his family wanted most was to know the name of the illness, and then, if possible, what had caused it, and finally, most important of all, how it was likely to turn out
[…]
During the third and fourth years of [medical] school it gradually dawned on us that we didn’t know much that was really useful, that we could do nothing to change the course of the great majority of the diseases we were so busy analyzing, that medicine, for all its façade as a learned profession, was in real life a profoundly ignorant occupation
[…]
Once you were admitted [to hospital] … it became a matter of waiting for the illness to finish itself one way or the other … Medicine made little or no difference.
Lewis Thomas, The Youngest Science, 1983, quoted by John Derbyshire in “The Scariest Science”, Taki’s Magazine, 2014-11-13.
December 29, 2015
QotD: The health benefits of moderate drinking
Should we consider mandatory graphic warning labels on bottles of booze? Our science reporter Tom Blackwell reviewed various Canadian discussions of the idea in these pages yesterday, suggesting that it is being looked at behind the scenes by addiction researchers. Labels with colour images of diseased esophagi on liquor labels would, of course, mimic the approach Canada has already taken toward cigarettes. So, well, why not? They say if you have a hammer, everything looks like a nail: by a similar token, if your field is addiction, no doubt everything that has addictive qualities looks like an unsolved problem.
But there is one very obvious way in which liquor is not like cigarettes: scientists are reasonably sure that light drinking has positive public-health consequences. If you don’t believe me, you can look up articles like the one I have in front of me here from a 2013 issue of Annals of Oncology: its title is “Light Drinking Has Positive Public Health Consequences.” As a layman I obviously can’t be certain I have summarized this editorial correctly, but you’ll have to trust me.
Colby Cosh, “The real problem with liquor warning labels — there’s such a thing as good drinking”, National Post, 2015-12-17.
December 26, 2015
Moderate drinking and statistical health outcomes
Aaron Carroll debunks some myths about booze and health:
Over the past year, I’ve tried to clear up a lot of the misconceptions on food and drink: about salt, artificial sweeteners, among others, even water.
Now let me take on alcohol: wine, beer and cocktails. Although I have written about the dangerous effects of alcohol abuse and misuse, that doesn’t mean it’s always bad. A part of many complex and delicious adult beverages, alcohol is linked to a number of health benefits in medical studies.
That doesn’t mean the studies provide only good news, either, or that the evidence in its favor is a slam dunk. You won’t be surprised to hear that, once again, my watchword — moderation — applies.
Research into how alcohol consumption affects health has been going on for a long time. A 1990 prospective cohort study included results of more than 275,000 men followed since 1959. Compared with those who never drank alcohol, those who consumed one to two drinks a day had a significantly reduced mortality rate from both coronary heart disease and “all causes.” Those who consumed three or more drinks a day still had a lower risk of death from coronary heart disease, but had a higher mortality rate over all.
A 2004 study came to similar conclusions. It followed about 6,600 men and 8,000 women for five years and found that compared with those who drank about one drink a day on average, those who didn’t drink at all and those who drank more than two drinks a day had higher rates of death. Results like these have been consistent across a number of studies in different populations. Even studies published in the journal Alcoholism: Clinical and Experimental Research agree that moderate drinking seems to be associated with a decreased risk of death over all.
However, alcohol seems to have different effects on different diseases. Almost all of the major benefits of drinking are seen in cardiovascular illnesses. In fact, with men, even consumption of a surprisingly large amount can seem protective.
December 16, 2015
To lower healthcare costs, increase the competition
At Mother Jones, Kevin Drum links to an article that explicitly shows the cost of having monopoly providers in healthcare:
Regular readers of this blog should know that when it comes to the price of hospital care, it’s competition that matters, not insurance companies. In areas with only a single hospital, insurance companies have no leverage and have to accept whatever price the hospital charges. If there are lots of hospitals, they have to compete with each other to earn the insurance company’s business.
But in case you’re still skeptical, a team of researchers has analyzed a huge database of health care claims in the US to check this out. They found enormous regional variation in hospital costs for the same procedure, and one of the biggest drivers of this variation was competition:
Hospital market structure stands out as one of the most important factors associated with higher prices, even after controlling for costs and clinical quality. We find that hospitals located in monopoly markets have prices that are about 15.3 percent higher than hospitals located in markets with four or more providers. This result is robust across multiple measures of market structure and is consistent in states where the HCCI data contributors (and/or Blue Cross Blue Shield insurers) have high and low coverage rates.
Chipotle gains “green cred PR opportunities” and worse health outcomes for customers
Henry Miller on the Faustian bargain Chipotle willingly made and is now paying for:
Chipotle, the once-popular Mexican restaurant chain, is experiencing a well-deserved downward spiral.
The company found it could pass off a fast-food menu stacked with high-calorie, sodium-rich options as higher quality and more nutritious because the meals were made with locally grown, genetic engineering-free ingredients. And to set the tone for the kind of New Age-y image the company wanted, Chipotle adopted slogans like, “We source from farms rather than factories” and, “With every burrito we roll or bowl we fill, we’re working to cultivate a better world.”
The rest of the company wasn’t as swift as the marketing department, however. Last week, about 140 people, all but a handful Boston College students, were recovering from a nasty bout of norovirus-caused gastroenteritis, a foodborne illness apparently contracted while eating Chipotle’s “responsibly raised” meats and largely organic produce.
And they’re not alone. The Centers for Disease Control and Prevention has been tracking another, unrelated Chipotle food poisoning outbreak in California, Illinois, Maryland, Minnesota, New York, Ohio, Oregon, Pennsylvania and Washington, in which victims have been as young as one year and as old as 94. Using whole genome sequencing, CDC investigators identified the DNA fingerprint of the bacterial culprit in that outbreak as E. coli strain STEC O26, which was found in all of the sickened customers tested.
Outbreaks of food poisoning have become something of a Chipotle trademark; the recent ones are the fourth and fifth this year, one of which was not disclosed to the public. A particularly worrisome aspect of the company’s serial deficiencies is that there have been at least three unrelated pathogens in the outbreaks – Salmonella and E. coli bacteria and norovirus. In other words, there has been more than a single glitch; suppliers and employees have found a variety of ways to contaminate what Chipotle cavalierly sells (at premium prices) to its customers.
QotD: The truth about beauty
There are certain practical realities of existence that most of us accept. If you want to catch a bear, you don’t load the trap with a copy of Catch-22 — not unless you rub it with a considerable quantity of raw hamburger. If you want to snag a fish, you can’t just slap the water with your hand and yell, “Jump on my hook, already!” Yet, if you’re a woman who wants to land a man, there’s this notion that you should be able to go around looking like Ernest Borgnine: If you’re “beautiful on the inside,” that’s all that should count. Right. And I should have a flying car and a mansion in Bel Air with servants and a moat.
Welcome to Uglytopia — the world reimagined as a place where it’s the content of a woman’s character, not her pushup bra, that puts her on the cover of Maxim. It just doesn’t seem fair to us that some people come into life with certain advantages — whether it’s a movie star chin or a multimillion-dollar shipbuilding inheritance. Maybe we need affirmative action for ugly people; make George Clooney rotate in some homely women between all his gorgeous girlfriends. While we wish things were different, we’d best accept the ugly reality: No man will turn his head to ogle a woman because she looks like the type to buy a turkey sandwich for a homeless man or read to the blind.
There is a vast body of evidence indicating that men and women are biologically and psychologically different, and that what heterosexual men and women want in partners directly corresponds to these differences. The features men evolved to go for in women — youth, clear skin, a symmetrical face and body, feminine facial features, an hourglass figure — are those indicating that a woman would be a healthy, fertile candidate to pass on a man’s genes.
These preferences span borders, cultures, and generations, meaning yes, there really are universal standards of beauty. And while Western women do struggle to be slim, the truth is, women in all cultures eat (or don’t) to appeal to “the male gaze.” The body size that’s idealized in a particular culture appears to correspond to the availability of food. In cultures like ours, where you can’t go five miles without passing a 7-Eleven and food is sold by the pallet-load at warehouse grocery stores, thin women are in. In cultures where food is scarce (like in Sahara-adjacent hoods), blubber is beautiful, and women appeal to men by stuffing themselves until they’re slim like Jabba the Hut.
Amy Alkon, “The Truth About Beauty”, Psychology Today, 2010-11-01.
December 15, 2015
Hillary Clinton’s well-intentioned plans will make the prescription medicine market even worse
Another older post from Megan McArdle on the nice-soundbites-but-terrible-economic-notions from the Hillary Clinton campaign to fix the prescription medicine marketplace:
Hillary Clinton thinks drug development should be riskier, and less profitable. Also, your health insurance premiums should be higher. And there should be fewer drugs available.
This is not, of course, how the Clinton campaign would put it. The official line is that Americans are just paying too darn much for drugs, and she has a plan to stop that:
- Regulate direct-to-consumer advertising more heavily, and strip its tax deductibility
- Require drug companies to spend a certain percentage of revenue on research and development, or face penalty payments and the loss of their R&D tax credit (I am inferring that this is what she is talking about, since the actual language of the proposal is long on paeans to the importance of federal research funding and short on details)
- Cap out-of-pocket costs for drugs
- Reduce the exclusivity period for biologic drugs
- Prohibit companies from making side payments to generic manufacturers to keep generic competition off the market
- Allow drug reimportation
- Require that new treatments be proved to be a substantial improvement over existing treatments — i.e., eliminate the dreaded “me too” drugs
- Allow Medicare to “negotiate” drug prices
Eliminating the side payments seems eminently sensible. (Yes, yes, you can strip my libertarian card, but market-rigging contracts shouldn’t be enforced.) It also seems reasonable to require some sort of comparative effectiveness research. Other provisions will certainly drive down drug prices, at the risk of also driving down innovation.
Still other provisions, however, are simply bad economics. In what other market do we worry about having a second product available that’s merely just as good as the first? Should we really only have one antidepressant, one statin, one blood pressure medication, and so forth? Might there be variation among patients so that drugs that are statistically about equally effective in large groups are nonetheless individually more or less effective for different people? Might one drug’s side effects be better tolerated by some patients than another’s? Might having two drugs in the category help keep prices down?
Then there is notion that we should force pharmaceutical companies to spend a set percentage of their revenues on R&D. This seems to me to be … what’s the word I am looking for? Ah, I’ve got it: “insane.”
[…]
Economically, large parts of this plan make little sense. Politically, many of these items would be very difficult to pass, not least because the Congressional Budget Office would assess the likely effects and would make it sound much less appealing than it does in a gauzy stump speech. But away from those harsh realities, purely as campaign rhetoric, it probably works very well.
