Hygiene is the corruption of medicine by morality. It is impossible to find a hygienist who does not debase his theory of the healthful with a theory of the virtuous. The whole hygienic art, indeed, resolves itself into an ethical exhortation, and, in the sub-department of sex, into a puerile and belated advocacy of asceticism. This brings it, at the end, into diametrical conflict with medicine proper. The aim of medicine is surely not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The true physician does not preach repentance; he offers absolution.
H.L. Mencken, “Types of Men 5: The Physician”, Prejudices, Third Series, 1922.
June 23, 2015
QotD: The Physician
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June 22, 2015
QotD: Obesity
The most maddening example of this is, of course, the case of thin people, or folks who could really stand to lose ten pounds, lecturing the obese on how stupid they are for letting themselves get fat. […]
As a friend who really struggles with his weight points out, the author seems not to understand that for people with a weight problem, weight loss often involves both: you’re tired and miserable and overweight, and also, you’re spending a huge amount of mental energy counting calories and making time for exercise.
Moreover, this really underplays the amount of mental energy we’re talking about. When you talk to people who have successfully lost really large amounts of weight as adults — amounts that bring them from the really risky “super-obese” category into something more normal — you find two things. First, that most of them don’t keep it off, unless they have bariatric surgery, in which case, 50 percent of them keep it off. And second, that the people who are keeping the weight off without surgery are going to extreme lengths to maintain their weight loss, lengths that most of us would probably find difficult to fit into our lives: weighing every ounce of food they consume, counting calories obsessively, exercising for long periods every day, and constantly battling “intrusive thoughts of food.”
It’s not quite fair to say that most of the public health experts I’ve seen talking about obesity are thin people brightly telling fat people that “Everything would be fine if you’d just be more like me!” But it’s not really that far off the mark, either. In the words of another friend who struggled with his weight, and got quite testy when I suggested weight loss was easy, “You’ve hit the pick six in the genetic lottery, and you think you earned it.”
Megan McArdle, “Dinner, With a Side of Self-Righteousness”, Bloomberg View, 2015-03-27.
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June 18, 2015
Nutrition … what we thought we knew is wrong, again
At Real Clear Science, Ross Pomeroy explains how historical “expert knowledge” and government cheerleading pointed in exactly the opposite direction of today’s experts and government regulators:
For decades, the federal government has been advising Americans on what to eat. Those recommendations have been subject to the shifting sands of dietary science. And have those sands ever been shifting. At first, fat and cholesterol were vilified, while sugar was mostly let off the hook. Now, fat is fine (saturated fat is still evil, though), cholesterol is back, and sugar is the new bogeyman.
Why the sizable shift? The answer may be “bad science.”
Every five years, the Dietary Guidelines Advisory Committee, composed of nutrition and health experts from around the country, convenes to review the latest scientific and medical literature. From their learned dissection, they form the dietary guidelines.
But according to a new editorial published in Mayo Clinic Proceedings, much of the science they review is fundamentally flawed. Unlike experiments in the hard sciences of chemistry, physics, and biology, which rely on direct observational evidence, most diet studies are based on self-reported data. Study subjects are examined for height, weight, and health, then are questioned about what they eat. Their dietary choices are subsequently linked to health outcomes — cancer, mortality, heart disease, etc.
That’s a poor way of doing science, says Edward Archer, a research fellow with the Nutrition Obesity Research Center at the University of Alabama, and lead author of the report.
“The assumption that human memory can provide accurate or precise reproductions of past ingestive behavior is indisputably false,” he and his co-authors write.
Two of the largest studies on nutritional intake in the United States, the CDC’s NHANES and “What We Eat,” are based on asking subjects to recall precisely what and how much they usually eat.
But despite all of the steps that NHANES examiners take to aid recall, such as limiting the recall period to the previous 24 hours and even offering subjects measuring guides to help them report accurate data, the information received is wildly inaccurate. An analysis conducted by Archer in 2013 found that most of the 60,000+ NHANES subjects report eating a lower amount of calories than they would physiologically need to survive, let alone to put on all the weight that Americans have in the past few decades.
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June 16, 2015
Over-diagnosis as a root cause of the “addiction surge”
Stanton Peele is not happy with the latest version of the standard psychological diagnosis document:
The American Psychiatric Association creates the gold standard for diagnoses of mental disorders in the United States — and worldwide — through its Diagnostic and Statistical Manual of Mental Disorders. DSM-IV was published in 1994. In 2013, DSM-5 was released.
As I describe in the March, 2014 issue of Reason, there are several notable peculiarities about the manual. DSM-5
eliminates the distinction between dependence and abuse. Instead it classifies substance use disorders as mild, moderate, or severe. Thus the DSM-5 does not explicitly recognize such a thing as drug addiction or dependence. But under “Substance Use and Addictive Disorders” the manual includes a category called “Behavioral Addictions” that so far consists of a lone entry: “Gambling Disorder.”
These two major conceptual changes immediately aroused suspicion. Writing in the New York Times, investigative reporter Ian Urbina accused the psychiatric establishment and pharmaceutical industry of expanding the whole treatment enterprise by including “mild” substance use disorders, as well as recognizing things other than substances as being addictive. Keith Humphreys, a Stanford psychology professor, “predicted that as many as 20 million people who were previously not recognized as having a substance abuse problem would probably be included under the new definition.”
My argument is more fundamental. The ways of thinking about substance use and disorders embedded in DSM-5 and promoted by American psychiatry are actually causing an epidemic of these disorders.
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June 15, 2015
QotD: The modern Alcoholics Anonymous
I picked the wrong year to quit drinking.
If you’ve never been to an old-school AA meeting, imagine Vince Lombardi’s locker room if he’d been coaching Pilgrims with Tourette’s: a spartan, Quaker-meeting setup, all bootstrapping, no bullshit. A newcomer dumb enough to whine about their “feelings” gets ordered to scrub out the coffee urn by a gruff “old timer.”
That’s not what I slunk into in 1992, by which time then-faddish PBS fixture John “Finding Your Inner Child” Bradshaw had accidentally turned Alcoholics Anonymous into a New Age unicorn-and-rainbows therapeutic weep-fest that would’ve disgusted Greatest Generation founders Bill W. and Dr. Bob, who probably kept their fedoras on in the gutter.
Some meetings even served decaf.
Believe me: “Low self-esteem” is not your typical boozehound’s problem. Then again, about half the people I met in “the rooms” weren’t even alcoholics, just neurotics too cheap to get real therapy.
Remember, it was the 1990s, the era of The X-Files and Oprah at her tabloid low: at every 12-Step meeting, you’d meet “survivors of ritualistic Satanic abuse” and “recovered memory victims” and alien abductees and even “starseeds,” the self-proclaimed spawn of spacemen who’ve been sent to Earth to…do something or other. (Luckily the latter two never came to blows.)
There were so many “multiple personalities” at some meetings, we were probably breaking fire codes without knowing it.
And I lived in Boystown, so lots of the real drunks were gay, bi, trannies, lesbians of convenience, and even “two-spirited” (AKA gay Indians).
Despite all this, I never drank after my first meeting (ODAAT), worked the Steps, got a new job, and ten years later, I looked around at all the people who still hadn’t and thought, “I didn’t get sober so I could spend the rest of my life with these losers.”
It took me a decade to notice that none of the 12 Steps is “Go to meetings.” So I stopped. I couldn’t take the crazies. In retrospect, I was the crazy one for thinking I was rid of them.
Kathy Shaidle, “My Otherkin Headmate is a Two-Spirited Starseed!”, Taki’s Magazine, 2013-03-05.
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June 2, 2015
The Chemistry of Cannabis & Synthetic Cannabinoids
Compound Interest posted an infographic on cannabis and synthetic cannabinoids:
Click to see full-sized infographic.
In recent years, there’s been an increase in the number of media reports on users of synthetic cannabinoids. Commonly referred to by names such as ‘Spice’ or ‘K2′, the most recent reported case involved five UK students being hospitalised after use. But what are the chemicals present in ‘spice’ and similar drugs, and what are the chemical compounds in cannabis that they aim to mimic? That’s what this graphic and post attempt to answer.
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May 22, 2015
May 18, 2015
Your diet isn’t working. And neither is yours. And yours, too.
In the Washington Post, Roberto A. Ferdman dishes the dirt on every diet guru’s most brilliant brain-fart … they don’t actually work.
For centuries, men and women have worked tirelessly to fit the physical molds of their time. Diets, which have ranged from the straightforward to the colorful and kind of silly, have produced a wide range of results — and all sorts of followings.
Not long ago, the Atkins diet villainized carbohydrates and convinced millions to avoid starches of any kind. Today, the Paleo diet, which purports to emulate the eating habits and digestive systems of ancient humans who lived for many fewer years than people on average do today, is perhaps the most popular — or at least talked about — dietary fad. Soon there will be another fad that sweeps the dieting conversation. And another one.
The question that seems to hover over all this diet talk is whether any of the myriad weight loss schemes have worked. If one had, shouldn’t it have survived the test of time? And if we’ve gone this long without a diet that has been shown to work — according to science, not simply the sellers of the fad — will one ever emerge that actually does?
The short answer is no, according to Traci Mann, who teaches psychology at the University of Minnesota and has been studying eating habits, self-control and dieting for more than 20 years. Over the course of her research, largely conducted at the University of Minnesota’s Health and Eating Lab, Mann has repeatedly asked these sorts of questions, and always found the same disappointing answers.
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April 30, 2015
Organic wines as mere marketing buzz and gimickry
At VinePair, Kathleen Willcox explains why the “organic” label on your wine may be little more than a marketing ploy:
A lot of the buzz and imagery about organics appears to be just that – empty sound bites and gimmicks created by folks eager to cash in on the increasingly lucrative organic market. Where does that leave us? Not in an easy place.
Falling for marketers’ ploys is practically a full-time occupation in America (I’m not the only one who’s bought multiple cartons of fat-free ice cream hoping, this time, to finally find “creamy fat-free vanilla bliss” right?). Consumers’ perception of what organic agriculture is vs. the reality, and the halo of virtue with which it is bequeathed (and conventional agriculture’s implicit pair of devil’s horns) is, arguably, one of the biggest boondoggles in our culture today. More than half of Americans (55%) go organic because they believe it’s healthier. Meanwhile, there is really no evidence to back that assumption up. And even organic farmers use pesticides (sorry random lady at the bar). They just happen to be “natural.”
It’s never been a better time for organic marketers and companies. The market for organic food and beverages worldwide was estimated to be $80.4 billion in 2013 and is set to reach $161.5 billion in 2018, a compound annual growth rate of 15% per year. North America has the biggest market share, and will be responsible for roughly $66.2 billion by 2018.
But in the rush to get organic products out the door (and fulfill the public’s desire for healthier, more environmentally responsible products), some producers are often doing little more than following the letter of the USDA law to earn the “organic” label, consequences to the environment and our overall health be damned. In fact, from what producers and studies revealed, it may actually be worse for the environment and your body to buy organic wine from a large manufacturer instead of buying wine produced from grapes on a smaller vineyard sprayed judiciously with synthetic pesticides by a hands-on farmer.
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April 21, 2015
The statistical anomalies of sex
As the old saying has it, “everyone lies about sex“:
Straight men have had twice as many sexual partners, on average, as straight women. Sounds plausible, seeing that men supposedly think about sex every seven seconds. Except that it’s mathematically impossible: in a closed population with as many men as women (which roughly there are) the averages should match up. Someone is being dishonest, but who? And why? These questions, along with many others, are explored in Sex by numbers, a new book by David Spiegelhalter, Winton Professor for the Public Understanding of Risk at the University of Cambridge.
“Sex is a great topic,” says Spiegelhalter. “There’s lots of it going on, but we don’t know what goes on or how much of it, because most of the time it goes on behind closed doors. It’s a really difficult topic to investigate scientifically, and a real challenge for statistics.” Spiegelhalter’s aim is to get people interested in a critical approach to the numbers they hear about in the news and give them the tools to figure out if they can be believed. “It’s really a book about statistics, using sex as an example.”
Statistics about sex are not all equally good. Some, like the number of births in a given year, are cast-iron facts, but others are much harder to come by. The number of sexual partners is a good example. The mismatch above comes from the third The National Survey of Sexual Attitudes and Lifestyles (Natsal), conducted between 2010 and 2012, in which men reported having had 14 sexual partners, on average, and women 7. Studies have suggested that women give lower numbers when they fear the survey isn’t entirely confidential, something that doesn’t seem to affect men (contrary to my expectation, it doesn’t induce them to exaggerate). So that’s one possible explanation for the mismatch: sadly, women still need to fear social stigma.
But there are other explanations too. One is that men (more than women) may have some of their sexual experience with sex workers. These aren’t included in the surveys, so their experiences are missing from the female tally. Another is that there are different attitudes as to what counts as a sexual partner. If a woman feels she’s been coerced by a man, for example, she may not want to count him.
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April 19, 2015
The latest “breakthrough” in helping schizophrenics take their medicine
Scott Alexander recently attended a local psychiatry conference, with some essential themes being emphasized:
This conference consisted of a series of talks about all the most important issues of the day, like ‘The Menace Of Psychologists Being Allowed To Prescribe Medication’, ‘How To Be An Advocate For Important Issues Affecting Your Patients Such As The Possibility That Psychologists Might Be Allowed To Prescribe Them Medication’, and ‘Protecting Members Of Disadvantaged Communities From Psychologists Prescribing Them Medication’.
As somebody who’s noticed that the average waiting list for a desperately ill person to see a psychiatrist is approaching the twelve month mark in some places, I was pretty okay with psychologists prescribing medication. The scare stories about how psychologists might prescribe medications unsafely didn’t have much effect on me, since I continue to believe that putting antidepressants in a vending machine would be a more safety-conscious system than what we have now (a vending machine would at least limit antidepressants to people who have $1.25 in change; the average primary care doctor is nowhere near that selective). Annnnnyway, this made me kind of uncomfortable at the conference and I Struck A Courageous Blow Against The Cartelization Of Medicine by sneaking out without putting my name on their mailing list.
But before I did, I managed to take some notes about what’s going on in the wider psychiatric world, including:
– The newest breakthrough in ensuring schizophrenic people take their medication (a hard problem!) is bundling the pills with an ingestable computer chip that transmits data from the patient’s stomach. It’s a bold plan, somewhat complicated by the fact that one of the most common symptoms of schizophrenia is the paranoid fear that somebody has implanted a chip in your body to monitor you. Can you imagine being a schizophrenic guy who has to explain to your new doctor that your old doctor put computer chips in your pills to monitor you? Yikes. If they go through with this, I hope they publish the results in the form of a sequel to The Three Christs of Ypsilanti.
– The same team is working on a smartphone app to detect schizophrenic relapses. The system uses GPS to monitor location, accelerometer to detect movements, and microphone to check tone of voice and speaking pattern, then throws it into a machine learning system that tries to differentiate psychotic from normal behavior (for example, psychotic people might speak faster, or rock back and forth a lot). Again, interesting idea. But again, one of the most common paranoid schizophrenic delusions is that their electronic devices are monitoring everything they do. If you make every one of a psychotic person’s delusions come true, such that they no longer have any beliefs that do not correspond to reality, does that technically mean you’ve cured them? I don’t know, but I’m glad we have people investigating this important issue.
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April 18, 2015
Moral panics and “Shaken Baby Syndrome”
In L.A. Weekly, Amy Nicholson looks at a new documentary:
It’s never simple when science suffers a shakeup. The road to the truth is littered with fallen experts who were disgraced when they tried to disprove — or prove — the common wisdom, be it that the earth revolves around the sun or that witches float. Today’s researchers are fighting to restore logic in the debate over vaccinations, global warming, and the increasingly hazy medical condition called Shaken Baby Syndrome, whose adherents accuse, pursue and prosecute an estimated 250 parents, babysitters and other caretakers each year.
Veteran investigative journalist Susan Goldsmith has spent years examining the medical and legal industry that has arisen to promote its belief that vicious baby-shaking by enraged adults has killed thousands of infants, the subject of the new documentary, The Syndrome, researched by Goldsmith and directed by her cousin Meryl Goldsmith.
“I made a career writing about child abuse,” she says. Her child abuse investigations as a reporter for The Oregonian led to two new laws designed to better protect kids in foster care. Yet, she also sees extreme, unfounded reactions by well-meaning people when children are involved. Says Goldsmith, “When people hear ‘child abuse,’ all thinking just goes into shutdown mode.”
A diagnosis of Shaken Baby Syndrome was supposed to explain mysterious deaths in babies without bone fractures, bumps, bruises or neck injuries. How did they die? A theory arose that babies were under attack by loved ones. For decades, doctors in the U.S., and dozens of other countries were trained to look for three internal symptoms that experts claimed were proof of a powerful shaking assault on a tiny child: brain swelling, blood on the surface of the brain, and blood behind the eyes. Well-meaning doctors were instructed that these symptoms could only occur due to intense shaking — if a parent or babysitter said the child had fallen or suddenly fell ill, that was a lie.
Proponents of the theory grew so powerful in political circles, where elected officials were keen to show they supported helpless children, that laws were passed across the U.S. requiring a doctor who spotted any of the three symptom to alert authorities. Failure to report symptoms, even if a doctor found the parents’ explanation made sense, could result in fines, civil lawsuits, or even jail time.
We’ve been here before. The Syndrome rewinds back to the 1980s when the big public panic on behalf of children was Satanic Ritual Abuse, a Salem-like national frenzy in which prosecutors and juries in big cities and small towns sent daycare employees to jail for years for crimes as implausible as cutting off a gorilla’s finger while at the zoo, then flying the children over Mexico to molest them.
H/T to Amy Alkon for the link.
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Correlation, causation, and lobby money
Tim Harford‘s latest column on tobacco, research, and lobby money:
It is said that there is a correlation between the number of storks’ nests found on Danish houses and the number of children born in those houses. Could the old story about babies being delivered by storks really be true? No. Correlation is not causation. Storks do not deliver children but larger houses have more room both for children and for storks.
This much-loved statistical anecdote seems less amusing when you consider how it was used in a US Senate committee hearing in 1965. The expert witness giving testimony was arguing that while smoking may be correlated with lung cancer, a causal relationship was unproven and implausible. Pressed on the statistical parallels between storks and cigarettes, he replied that they “seem to me the same”.
The witness’s name was Darrell Huff, a freelance journalist beloved by generations of geeks for his wonderful and hugely successful 1954 book How to Lie with Statistics. His reputation today might be rather different had the proposed sequel made it to print. How to Lie with Smoking Statistics used a variety of stork-style arguments to throw doubt on the connection between smoking and cancer, and it was supported by a grant from the Tobacco Institute. It was never published, for reasons that remain unclear. (The story of Huff’s career as a tobacco consultant was brought to the attention of statisticians in articles by Andrew Gelman in Chance in 2012 and by Alex Reinhart in Significance in 2014.)
Indisputably, smoking causes lung cancer and various other deadly conditions. But the problematic relationship between correlation and causation in general remains an active area of debate and confusion. The “spurious correlations” compiled by Harvard law student Tyler Vigen and displayed on his website (tylervigen.com) should be a warning. Did you realise that consumption of margarine is strongly correlated with the divorce rate in Maine?
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April 6, 2015
When the Precautionary Principle meets wine corks
In Reason, Baylen Linnekin talks about wine corks and over-cautious would-be regulators:
We flew into Lisbon and drove across the Spanish border to San Vicente de Alcantara, near Caceres, where DIAM makes many of its corks. Once there, our daylong activities included a detailed tour of the DIAM factory and a visit to the nearby cork forest where DIAM obtains cork, which is made from the bark of the eponymous tree.
As I learned on the DIAM tour, the company’s agglomerated corks are made from natural cork that’s first pulverized. The impurities are then removed. Finally, the pure cork that remains is glued back together into the familiar wine cork shape.
Agglomerated corks have two key benefits over competing corks. First, they cost less than natural corks. Second, they eliminate the problem of cork “taint,” a musty taste caused by the presence of a substance found in cork, TCA, that often ruins wines before they’re ever opened.
Sounds great. Still, concern was raised by a wine writer last month, who suggested, quite wrongly in my opinion, that agglomerated corks may be illegal.
How’s that?
The writer, Lewis Purdue of Wine Industry Insight, suggested that the binding agent used by agglomerated cork makers could be leeching into wine. That agent, TDI, is listed as a potential carcinogen. If it were to migrate from cork to wine, that would be bad.
But testing by DIAM and others has shown no detectable level of TDI in wine, meaning there’s no evidence the substance migrates from cork to wine. DIAM also says, firmly, that no such migration occurs.
“Of course we guarantee there’s no TDI migration,” said François Margot, a sales manager with DIAM, told Wine Business writer Cyril Penn.
In that case, there’s no problem, says the FDA. As the FDA explains, agency rules generally permit food packaging to come into contact with food so long as it’s not “reasonably expected to result in substances becoming components of” food.
Why any fuss over agglomerated corks? It stems not from any FDA interest but, rather, from a push by competitors of agglomerated cork makers.
I dislike the kind of composite corks produced by companies like DIAM, but they’re still better than the plastic or other non-cork wine bottle closures a lot of American wineries are using these days.
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