Month: July 2009

Does Bad Medicine Drive Out Good? The Case of Eczema

Seth Roberts6 Comments

In an article on weight regulation I read this:

One subject . . . developed symptoms possible related to EFA [essential fatty acid] deficiency (ie, mild eczema relieved by the addition of fat to the diet).

In other words, the subject — in a metabolic ward at Rockefeller University where everything he ate was supplied by the researchers — developed eczema when fed a zero-fat diet. When fat was added, the eczema disappeared. The researchers understood that not enough fat in your food can cause eczema. This research was done around 1960. The conclusion is supported by dozens of reports from people doing the Shangri-La Diet who said that when they started drinking oil their skin improved. Dry areas disappeared. I found the same thing myself. (And judging by the large fraction of people who have dry skin, a lot of people aren’t eating enough fat.)

The notion that eczema can be cured by eating more fat — perhaps high in omega-3 — could hardly be simpler. Around 1960, at least some doctors understood this (in a situation, I admit, where it was easy to understand). Yet here is how eczema is treated today, according to Bottom Line/Women’s Health (April 2009, p. 9):

Eczema (dry, itchy, swollen skin) usually is treated with topical anti-inflammatory cream twice daily during flare-ups. Patients who applied tacrolimus (Protopic) twice weekly to lesion-prone areas even when no lesions were visible went 142 days between flare-ups, on average . . . versus 15 days for placebo users. Tacrolimus can cause nausea and muscle pain and may increase skin cancer risk — ask your doctor about the pros and cons of preventative eczema treatment.

The information comes from a study done by Sakari Reitamo, a professor of dermatology at University of Helsinki, and others published recently in Allergy.

The surface things — the things that impress many readers — appear good: large sample, big difference between groups, peer-reviewed journal, good university. Yet once you know that eczema can be cured by eating more fat, the whole thing sounds Orwellian.

The Mother of an Autistic Child Writes…

Seth Roberts1 Comment

Lisa Belkin, who blogs about parenting for the NY Times, prints an excellent letter from the mother of an autistic child about what it is like:

“Crying.†The study talks of the crying. [The mom wrote to Belkin to complain that a study Belkin described sugar-coated things.] The word pales in the face of our son’s dissolutions into tears. These days, if he hears a simple “no†or learns of some change in plans, he might launch into a 10-minute jag, where he argues fiercely with us in between the sobs. Then he can quickly escalate to ear-piercing screams lasting another 15 minutes or more. It’s a wonder none of our neighbors have misconstrued what they might have heard and called 911. The shrieking does subside, back into sobs, and that part is somehow harder to watch, reminding me how terrifying it must be to feel to be that out of control, especially when you’re a small, anxious child.

No good deed goes uncriticized. An autistic adult named Sarah writes to Belkin to complain:

Please, consider that autistic people read blogs and have feelings as well. Your blog entry claims to show “the unvarnished reality of autism,†but the feelings and perceptions of actual autistic people are sadly missing from your account.

What an idea: that no blogger should write something that might hurt the feelings of someone with autism. As for the “sadly missing,” the passage I quoted from the mom describes the “feelings and perceptions” of an autistic person at length. Sarah blogs here.

Autism and Digestive Problems

Seth Roberts6 Comments

The latest issue of Pediatrics has a study that asks whether autism is associated with digestive problems. The authors compared the medical records of about 100 autistics with about 200 matched controls. The controls came from an area in Minnesota, near the Mayo Clinic, in which almost everyone has a health record on file that the researchers could look at. So the controls are a good sample of the non-autistic population.

The New York Times described the results like this:

The scientists found no differences [should be difference, singular] in the overall frequency of gastrointestinal problems reported by the two groups.

This isn’t quite right. The study found that the proportions of persons in each group to have had at least one digestive problem by age 20 weren’t reliably different. For the autistic kids, the proportion was 77%; for the controls, 72%.

The study design seems fine but the data analysis has a lot of room for improvement. You have an idea you want to test, good; try to test it with one test. The authors boiled down all their data into “at least one problem by age 20″ — that’s just what epidemiologists are told to do — but this was a poor choice. First, there is a ceiling problem. If both groups had percentages in the 90′s, this would be obvious. Better to avoid the ceiling problem. Second. to combine different symptoms with the “at least one” rule is likely to be less sensitive to differences than a combination rule that takes amount into account. The analysis in the article treats someone with 1 problem as equal to someone with 50 problems. No justification is given. Third, it isn’t obvious that it makes sense to combine symptoms this way. What if Symptom 1 and Symptom 2 are uncorrelated? In other words, what if whether you have Symptom 1 doesn’t affect your chances of having Symptom 2? Then to combine them (as the authors do) makes no sense. Factor analysis is how you condense several correlated measures into a few uncorrelated measures.

The study separated digestive problems into five categories (constipation, diarrhea, and three others). In each of the five categories, persons in the autistic group were more likely to report the problem than persons in the control group; in four of the five categories, the difference was significant (with one-tailed p values; the authors misleadingly use two-tailed p values — without making that clear). In one of the five categories the difference isn’t anywhere close to significant — which supports the idea that that there are at least two dimensions here: one on which the two groups differ, and one on which they don’t.

In the discussion, the authors, not realizing that four out of five of their problem categories differed significantly in the predicted direction, try to explain away the two differences that were significant with two-tailed p values: in constipation and picky eating. They note that autistic children get more medication that normal children. “Many children with autism are treated with resperidone, and this may result in increased appetite and weight gain,” they write. Why a drug that causes weight gain would cause picky eating isn’t explained and, without explanation, doesn’t make sense. Weight gain — they mean too much weight gain — involves eating too much; picky eating involves eating too little. Nor do the authors explain why their results differed from many previous studies. My take on the paper is that their results confirm previous studies, so that would have been interesting to read.

What I’m Looking Forward to Reading

Seth Roberts4 Comments

In September, David Owen, a staff writer at The New Yorker, will publish Green Metropolis: Why Living Smaller, Living Closer, and Driving Less are the Keys to Sustainability. Or at least that’s what the print says; the picture has a different subtitle. The book expands on this New Yorker article. Owen criticizes Michael Pollan and Amory Lovins, among others. Maybe this is an example of the insider/outsider advantage I’ve blogged about. Owen is not the New Yorker‘s environmental reporter; that would be Elizabeth Kolbert. So he can say anything, criticize anybody, without worrying about his ability to write more on the same subject. He can always go back to golf. Kolbert is not so free. In any case, Owen’s book sounds better — less predictable — than Kolbert’s book on a similar subject.
A TV show on the subject. Owen on bridge.

Do They Eat Dogs? (Continued)

Seth Roberts3 Comments

In answer to the question “Don’t they eat dogs?” a blogger living in Taiwan stated flatly: “No. They don’t eat dogs.” Now, from a Beijing University student named Xiong Lilin, here is a definitive answer about Mainland China:

Yes, we do. But not every Chinese person eats dog and never for everyday meals. In some provinces, there are restaurants that serve dog meat in the winter. A few people will have one or two meals every year during the coldest days. Eating dog meat can make people warm and prevent colds. Although these kind of restaurants exist, they are disappearing. In fact, mutton has the same function as dog meat. In my home town, Chengdu, many people eat mutton on DONGZHI, the day winter begins according to the Chinese traditional calendar.

More In this New Yorker article, published today, Michael Savage, the radio host, contemplates eating dog. Xiong Lilin later wrote: “Yesterday, my roommate asked me what kind of dog we eat. She seems to think that we eat pet dogs. In fact, we do not eat pet dogs, the dogs we eat are raised specially for eating and belong to different kinds from the pet ones.”

More About Turmeric

Seth Roberts4 Comments

From the Shangri-La Diet forums:

I’ve begun taking turmeric and it’s been a miracle. I used to be really into rock climbing and this really messed up the big toe in my right foot. (Wearing shoes 2.5 sizes too small and bearing all my body weight on my toe joints will do that, apparently.) The podiatrist said it was arthritic in nature and that the only thing that would stop it was to stop climbing. So I did. One year later, the pain had lessened, but it still hurt, and I couldn’t start running again.

Last week, on a humbug, I tried turmeric. I made some vile anti-inflammatory spice concoction and managed to get a few tablespoons of it down. It probably would have ended there because it was so freaking disgusting, but I noticed later that day that my toe pain had diminished to a dim sensation that was barely uncomfortable. Desperate to come up with a non-disgusting means of taking my new “medicine,” I settled on mixing turmeric, cayenne, and yellow mustard into a paste. It tastes like grainy, spicy mustard and I take about a tablespoon in the morning and a tablespoon at night. I’m also trying to take some fenugreek, cinnamon, and cardamom. I mix the fenugreek with my green tea, allow it to steep and expand between brewings, and then eat the seeds once they get soft. The cinnamon and cardamom are pleasant enough, so I just chew on them. (I use mexican cinnamon, probably 1/3 to 1/2 stick per day.

Vile Spice Mixture = VSM. James Lind tried a VSM in his famous scurvy experiment; it had no effect.

The Wonders of Turmeric.

Thanks to Heidi.

Academic Horror Story (Stanford University)

Seth Roberts7 Comments

From the Washington Post:

At the open house, a STEP [Stanford Teacher Education Program] instructor asked [Michelle Kerr] if she planned to accept the offer of admission [to Stanford’s School of Education]. Anyone else would have said yes. But Kerr, who calls herself “fatally truthful,†said the tuition would be difficult to afford and admitted she was philosophically out of sync with the program. . . .

[Professor of Education Rachel Lotan, the director of STEP,] called Kerr in for a 45-minute session on her doubts about the STEP policy orientation. Wouldn’t she be more comfortable elsewhere? Even when university ombudsman David Arnot Rasch assured Kerr the offer of admission was binding, Lotan couldn’t let it go. According to Kerr, Lotan looked for legal grounds to keep Kerr out, something Kerr said she discovered when another official mistakenly sent her an email that was meant just for Lotan.

“I really can’t believe this response,†the official said of Kerr’s decision to accept admission and decline another meeting with Lotan. “Are you forwarding her response to the lawyer?â€

Kerr called Lotan “a ruthless political animal who believes she was protecting her program from enemy infiltration.” During a second meeting with Kerr, Lotan said that she asked a lawyer about the possibility of rescinding Kerr’s admission. The lawyer had told her that was untenable. “Unfortunately,” said Lotan.

After Kerr became a student at Stanford, Lotan tried to get her in trouble at her internship school. In an official letter to Kerr, Lotan complained “you raised your voice.”

More about this.

Tsinghua Dumplings

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Jennifer Lee, author of The Fortune Cookie Chronicles, has a nice post about dumplings, including this:

I once made 888 dumplings for a party, my personal record. . . . You might have crudites, warm cheese, stale hummus, left over at the end of the party. You will never have leftover dumplings — unless you burned them.

This reminds me how much I liked the dumplings a the Tsinghua student cafeterias. I think they were served at every meal but I associate them with breakfast, maybe because there was less choice at breakfast. Fresh and homemade and chewy and well-spiced and incredibly cheap (like all the cafeteria food). Maybe 6 for 25 cents. There was an optional vinegar-like sauce (speaking of fermented foods). There were two types (pork & ??) but I didn’t understand the Chinese names.

I tried to avoid them. They were too easy and familiar. But it takes a certain amount of stamina to eat strange food so if I was tired, I’d have dumplings.

Acid Reflux Cured by Kombucha?

Seth Roberts15 Comments

A friend of mine had acid reflux. When he ate certain foods — tea, chocolate, foods high in sugar or fat — and when he ate too much, he got a pain in his stomach. “Maybe I’ve got an ulcer,” he thought. He first noticed it after eating brussels sprouts, about a year or so ago. At the time it was only uncomfortable. He was taking Alleve for back pain around that time — that might have messed up his stomach. He was also worrying a lot at the time.

It got worse. Periodically he would have pain in his stomach in the middle of the night and during the day. In particular, after eating Oreo cookies. Mint tea, which he thought would help, made it worse. Friends suggested he try Prilosec OTC. A 14-day course seemed to clear it up. A month after the Prilosec ended, however, he went to a big party. He ate a lot of food, a lot of different things. He woke up in the middle of the night with the worst pain yet. So then he went to a doctor. The doctor said it was probably acid reflux; try Asiphex ($60 for two weeks), he said. It was less effective than the Prilosec. Then I suggested that some sort of fermented product might help. So he bought Activa yogurt. It wasn’t clear if it had any effect; maybe a small one.

Recently he was in Rainbow Grocery, in San Francisco. They sell kombucha. He bought some because I had spoken particularly highly of it. After four days of drinking it, he felt much better even though he’d only finished 3/4s of the bottle. His stomach doesn’t hurt any more. That improves his mood. His back feels a lot better — but that comes and goes. That might be a placebo effect, he says — “even though I don’t believe in kombucha, I think it’s bunk, but I have to admit that it works,” he says.

He’d heard of kombucha from his colleagues about three years ago. They raved about it but it seemed faddish to him. He’d tried it, but just to taste it. He doesn’t eat any fermented foods besides vinegar; he doesn’t drink wine or beer. Hadn’t been eating yogurt. He had gone on a vegan diet for a few months before the Prilosec. He’d thought the vegan diet would protect him from stomach problems, but he was wrong.

He has continued to drink small amounts of kombucha and the improvement has persisted, although recently something mint at a party caused a problem.

JAMA Editors Continue to Display Staggeringly Poor Judgment

Seth Roberts1 Comment

In an earlier post I called a certain JAMA editorial “the most self-righteous editorial I have ever read.” Perhaps the authors reluctantly agreed; the editorial, which used to be here, is gone. Since I quoted from it, you can still see what I was talking about. The BMJ has an article about the disappearance, which includes this:

The BMJ sent emails to JAMA’s editor, Catherine DeAngelis, and the journal’s media relations office asking about the disappearance of the March editorial. The BMJ also asked whether Dr DeAngelis could explain why the new July editorial had toned down the policy outlined in the March editorial.

The response from a JAMA spokeswoman was “no comment.”

Correct: It is indefensible. What I said earlier still holds: The whole incident — self-righteous editorial, trash-talking by DeAngelis to a WSJ blogger, deletion of the editorial, failure to explain the deletion — “sheds a hugely unflattering light on the very powerful doctors who run JAMA — and thus an hugely unflattering light on a culture in which such people, like Nemeroff, gain great power.”