Month: March 2008

Praying With Lior and Labors of Love

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Last night I saw Praying with Lior, a documentary about the bar mitzvah of a boy with Down’s Syndrome. Easily the best movie I’ve seen this year, better than There Will Be Blood, Mary Poppins (leaving aside the great song Feed the Birds), Blade Runner, and several documentaries, for example. I asked a friend why she liked the TV show ER. “It makes you feel happy and sad,” she said. Praying for Lior made me sad again and again, which is part of why I liked it so much. I also liked seeing someone with a handicap struggle and succeed; Praying with Lior has a lot in common with My Left Foot, one of my favorite movies.

The person responsible for the film is Ilana Tractman, who met Lior at a religious retreat. Her day job is making television documentaries. She got the money to make the film — from a large number of foundations and people — while she was making it. As far as I can tell, she had almost total freedom, in contrast to her TV documentaries. I use the term superhobby to describe activities that combine the skills and resources of a professional with the freedom of a hobbyist. All of the blogs I read regularly are superhobbies. My self-experimentation was (and is) a superhobby. Writing open-source software is a superhobby. Most books are superhobbies. When a superhobby produces art, we call the product a labor of love. As we get richer and richer — thus can afford more freedom — and skills and knowledge improve, these labors of love become better, more possible, and more common.

The Praying with Lior website revealed to me that the film had/has a “mission”: “to change the way people with disabilities are perceived and received by faith communities.” Perhaps that is another reason why such a good film was made: This purpose helped it get funding and other help (a lot of people worked on it). And maybe it was part of why Ms. Tractman began and continued a difficult and uncertain project.

Human Subjects Research at Drexel University

Seth Roberts5 Comments

I am visiting Philadelphia. Yesterday I learned that if you want to do human subjects research at Drexel University you must:

1. Include indemnification language in the consent form. The subject must promise to not sue Drexel no matter what happens. This is a bluff: You cannot sign away your ability to sue. Of course this requirement leaves subjects more vulnerable, not less, the usual purpose of consent forms. Shades of twisted skepticism.

2. Never contact subjects via email.

3. Never advertise your research on the web.

4. Never contact subjects who have been in a previous experiment.

The Drexel IRB (Institutional Review Board) will never approve any study that involves giving any drug to a non-patient. This means the very important studies by David Healy that involved giving Prozac to ordinary (non-depressed) people — some of whom became suicidal — wouldn’t be possible.

I suppose it’s no surprise that Drexel IRB members, such as literature professors, criticize research designs. In an NPR piece, a former IRB member boasted about the accomplishments of her membership, which included correcting faulty designs. At UC Berkeley a few years ago, I submitted to the animal research IRB a proposal to test with rats a key observation behind the Shangri-La Diet: Drinking sugar water caused me to lose weight. The proposal was turned down: It couldn’t possibly be true that sugar water can cause weight loss, said the IRB. Testing this idea was a waste of time.

IRB Watch. Earlier post about IRBs.

Blood Sugar Measurements?

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Speaking of blegs, Howard Wainer, a renowned statistician at the National Board of Medical Examiners, is looking for sets of blood sugar measurements in Excel format. The ideal set would be measurements six or more times per day for several months. He is writing a paper about better ways to analyze such measurements, which are commonly made by diabetics and persons at risk for diabetes. He has collected such measurements himself; he wants to see how well the methods he developed using data from himself work with data from someone else. You can reach him at hwainer at nmbe dot org.

I told Howard: You will be the first statistician (a) to use your professional skills to improve your own life and (b) publish the results. (Which is what I did with my self-experimentation.) Lots of statisticians must have done something similar, said Howard. For example? I asked. He mentioned John Tukey making traffic measurements to help his wife push a change in traffic rules. However, Tukey didn’t publish the results and the relevance to Tukey’s own life was tiny. If anyone reading this knows of an example, please let me know. Statistics is hundreds of years old; there are thousands of professional statisticians. It seems strange that it has taken this long for such a thing to happen but that seems to be the case.

Cramps and Self-Experimentation

Seth Roberts2 Comments

Does too little potassium cause cramps? Quite possibly:

Dr. Stephen Liggett, a professor of medicine and physiology at the University of Maryland, . . . got terrible cramps in his calf during yoga. The culprit, he decided, was the drugs he takes for asthma, which can diminish the body’s supply of potassium. He knew that potassium is sold over the counter. But because high levels of potassium can be dangerous, store-bought potassium supplements are not very strong. . . . Before he does yoga, he measures the potassium levels in his blood before and after taking what he describes as a hefty dose of over-the-counter supplement. Then he calculates how much additional potassium he thinks he needs, securing it from concentrated potassium tablets from his research lab — how much he declined to say.”I didn’t want to drink two gallons of Gatorade,” Dr. Liggett explained. He hasn’t had cramps since he began ”preloading,” as he calls it, with potassium. But, he said, ”I haven’t done a controlled trial.”

Thanks to Evelyn Mitchell.

Addendum. Someone commented that the potassium/cramps connection is widely known. And he or she is right. No wonder Dr. Liggett didn’t do a “controlled trial”.

Comparison of Strategies for Sustaining Weight Loss

Seth Roberts9 Comments

A recent issue of JAMA has an article titled “Comparison of Strategies for Sustaining Weight Loss: The Weight Loss Maintenance Randomized Controlled Trial”. It reports an experiment that compared three ways to keep from regaining weight you’ve lost.

If you want to lose weight it paints a discouraging picture. It was an very expensive study, 27 authors, five grants. About 1000 subjects. Four years just to collect the data. The whole thing might have taken seven years. Must have cost millions of dollars. Might have cost tens of millions of dollars.

Given the huge expense, surely the subjects got the best possible establishment-approved weight loss advice. They did lose 19 pounds in six months. Here’s how the advice was described in the article:

Intervention goals were for participants to reach 180 minutes per week of moderate physical activity (typically walking); reduce caloric intake; adopt the Dietary Approaches to Stop Hypertension dietary pattern . . . and lose approximately 1 to 2 lb per week. Participants were taught to keep food and physical activity self-monitoring records and to calculate caloric intake.

Shades of Marion Nestle’s “move more, eat less”! Aside from the DASH “dietary pattern,” which was meant to reduce blood pressure, not weight, this advice could have been given fifty years ago. Apparently, those who did the study and those who funded it — who are representative of the larger research establishment, I assume — believe there has been no theoretical or empirical progress since then.

Many fields haven’t progressed in 50 years. Fifty years ago, 2 + 2 equaled 4. The basic principles of thermodynamics and inorganic chemistry were the same then as they are now. Lack of progress in weight loss advice would be fine if the advice actually worked but the whole study derived from the fact that the advice is poor — the weight loss it produces cannot be sustained.

To help people sustain their weight loss, the study compared three methods: 1. Monthly contact. Usually a 10-minute phone call (“with an interventionist”), every 4th month a hour face-to-face visit. Although the article claims this treatment was “practical,” I suspect it is too expensive for widespread use. 2. Encouragement to visit an interactive website. The website helped you set goals, allowed you to graph your results, and had a bulletin board, plus several other features. This was the focus of the whole huge research project: the effect of this website. It could be offered to everyone practically free, except that if the subject didn’t log on after email reminders she got a phone call. 3. “A self-directed comparison condition in which participants got minimal intervention [that is, nothing].”
The personal contact condition was slightly better than nothing. By the end of the study, the website was no better than nothing. And nothing was bad. The subjects regained about two-thirds of the lost weight during the maintenance year and, looking at the weight-versus-time graph, were apparently going to regain the rest of the lost weight during the coming year. Subjects in all three conditions continued to regain the lost weight throughout the year of maintenance.

In other words, this exceedingly expensive study could be summed up like this: We tried something new, it didn’t work. The abstract didn’t face this truth squarely. It concluded: “The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level.”

It’s a Catch-22: Without a good theory, it’s hard to find experimental effects. You’re just guessing. Most of what you will try will fail. Without strong experimental effects, it’s hard to build a good theory. I was in this situation with regard to early awakening. I had no idea what the cause was. It took me ten years of trying everything I could think of, dozens of possibilities, before I managed to find something that made a difference. From that I managed to build a little bit of a theory, which helped enormously in finding more experimental effects.

The people who did this study had no good theory about weight control. Nothing wrong with that, we all start off ignorant. The website they tested was just the usual common-sense stuff. What’s discouraging for anyone who wants to lose weight is how little progress was made for such a huge amount of time and money. If it takes seven years and ten million dollars and a small army of researchers to test one little point in a vast space of possibilities . . . you are unlikely to find anything useful during the lifetime of anyone now alive (or any of their children). The people behind the study also had a poor grasp of experimental design. With 300 people in the website group, it would have been easy to test many website design variations: weight-loss graph (yes or no), bulletin board (yes or no), etc., using factorial or fractional factorial designs. Their study merely showed that one particular website didn’t work. They learned nothing about all other possible websites. They might have been able to say: no likely website will work. They can’t because the study was badly designed. The study cost something like $10 million and that was the statistical advice they got!

The huge expense and the lack of progress in the last 50 years go together. The methodological dogmatism I discussed recently has bad consequences. It leads to studies that are more expensive and take longer. The proponents of the methodological rigidity say they are “better” not taking account of the cost: continued ignorance about health. A better research strategy would be to fund and encourage much cheaper ways of testing new ideas.

The Amish and Organic Farming

Seth Roberts1 Comment

One modern invention accepted by Pennsylvania Amish farmers is pesticides: They use horses to pull pesticide dispensers. This may play a part in an increase in birth defects in their community, which are usually explained by inbreeding. (However, large increases over short periods of time are almost always due to environmental changes.) A few years ago, Sally Fallon, head of the Weston A. Price Foundation, was part of a group visiting an Amish farm that had recently become organic (i.e., stop using pesticides). Someone asked the farmer why he had decided to change. Show them, he told his son, who had been standing with his arms behind his back. One of his arms had no forearm. We took that as a sign from God, said the farmer.

Bryan Caplan on How to Lose Weight

Seth Roberts4 Comments

My self-experimentation inspired Bryan Caplan to do his own self-experiment: Could he lose weight by eating less without discomfort? He did two things:

1. Stopped eating when he wasn’t hungry. During a meal he began to pay close attention to how hungry he was. When he stopped being hungry, he stopped eating, even if it meant leaving food on his plate. Before this he rarely left food on his plate. Now it was common.

2. Cut down on his soda consumption. Previously he was drinking at least two cans/day of Coke or IBC Root Beer (both non-diet). He reduced this to one can/day, which he found was enough to keep his energy up.

Bryan is 5′ 10″. When this started he weighed about 178 pounds. Over 9 months, his weight went down to 155, where it has remained for 9 months. “Is this something I’m willing to do for the rest of my life?” he asks. “Yes.”

I’m sure that non-diet soft drinks — primo ditto food — are very fattening but it isn’t easy for me to believe that cutting back on them could cause so much weight loss. Did the don’t-eat-when-not-hungry rule also help Bryan lose weight? I don’t know of research that answers this question.

Tyler Cowen on Blogging

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“I can say what I really think,” said Tyler about blogging a few days ago. Not only that, (a) this truth-speaking is on a topic he cares about, (b) what he says is based on considerable knowledge (what an ignorant person “really thinks” about something isn’t helpful), and (c) a lot of people listen. This is a potent mix.

The magic of blogging is that when you start you can tell the truth because no one is listening. With zero audience, it makes sense — it feels good — to tell the truth. If you are an expert like Tyler, this sort of thing is irresistible to readers (economics confidential) so your audience grows. Now it is too late to start censoring yourself; people are reading your blog because you tell the truth.

Tyler’s blog.