Month: May 2010

Ernst Wynder on the Nurses’ Health Study

Seth Roberts22 Comments

It says a lot about the Nobel Prize in Medicine that Ernst Wynder, co-discoverer that smoking causes cancer, never got one. Wynder was also one of the founders of modern epidemiology. Here’s what he believed about the Nurses’ Health Study:

He had a strong skepticism about methods of dietary assessment, and always felt that the failure of analytic studies such as the Nurses’ Health Study to report associations between cancer and diet were due to a combination of random misclassification related to the imprecision of food frequency questionnaires and the narrow range of nutrient intake within a given population. I feel certain that he would have criticized the recent negative findings from the Women’s Health Study on dietary fat and breast and colon cancer on similar grounds. This was one area where he felt that international comparisons at the ecological [country-by-country] level provided better etiologic support than [more] analytic studies, and he published many studies over a period of decades to make just that point.

For example,

He developed a friendship with Kunio Aoki at the Aichi Cancer Research Institute in Nagoya, Japan, which resulted in our study which found that Japanese men with smoking habits similar to American men had considerably lower lung cancer risks.

I didn’t know that. It suggests that either Americans eat something that promotes cancer or the Japanese eat something that protects against it. I suspect it’s the latter — specifically, the big consumption of fermented food in Japan and not in America. I’m sure the food-frequency questionnaires Wynder criticizes, written by Americans, are tone-deaf to fermented food. I doubt they ask about kimchi or kefir or miso consumption, or distinguish between pickles aged for a day and pickles aged for a year. In Japan, people eat fermented food in many forms: vinegar drinks, yogurt, other fermented milk drinks, and alcoholic beverages. Above all, they eat miso and long-fermented pickles daily. They also have the longest life expectancy in the world.

Assorted Links

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Thanks to Mark Griffiths.

The Foxconn Suicides

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Foxconn, located on the coast of China, is the largest electronics manufacturer in the world. They make iPhones, Wiis, and many other famous products. You may have read about the epidemic of suicide that has broken out among its employees. There were two in the last few days, for example. The count now stands at something like a dozen suicides in about a month. The factory complex involved is gigantic, with perhaps 300,000 workers, but no question this is a terrible thing. The victims are all or mostly men in their early twenties. The median length of employment at Foxconn might be about a year.

Foxconn has appealed to my university (Tsinghua) and in particular my department (Psychology) for help. I’m told their assembly line was designed at Tsinghua. In any case, several people from my department (faculty and graduate students) have gone to the factory and tried to do something.

At a department meeting we discussed our department’s involvement. I said it’s really hard to make progress on such problems for reasons that might not be obvious. When I had trouble waking up too early, I started to study the problem via self-experimentation. All I cared about was solving the problem. Any answer was acceptable. I would spend as long as it took to find it. It took me 10 years to make visible progress. The first thing I figured out was that the problem was partly due to eating breakfast — which sleep researchers had failed to discover.
Consider the Foxconn suicides. It would be incredibly helpful to figure out what’s causing them. But few professors want to study a problem that they have no idea if they can solve nor how long it will take. They don’t want to wait ten years to write a paper. By then their funding will have run out. If funding is assured regardless of progress, then how does the funder ensure they are actually doing something? And few professors have total academic freedom. Their graduate school advisor, their academic friends, the people who control their career have certain beliefs. About which theories are good and which are bad. About which methods are “correct”. If their results contradict these beliefs, if they use a “wrong” method, they will suffer, just as all heretics suffer. So there is pressure to come up with an acceptable answer using proper methods. This gets in the way of coming up with the actual answer.

This doesn’t mean academic research is useless, but it does mean that professors work in shackles that outsiders are, in my experience, unaware of. I wrote about this in my Medical Hypotheses paper. It is a big reason my self-experimentation found new and surprising answers to old questions: I had total freedom. All I cared about was finding the answer. I didn’t care about publications. I didn’t worry about funding. I had as much time as it took.

The Unreasonable Effectiveness of My Self-Experimentation

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A good way to have new ideas, it’s said, is to talk about the ideas you already have. After I posted about advantages of self-experimentation, Bruce Charlton, the editor of Medical Hypotheses, invited me to write an editorial about it. Wondering what I thought gave me some new ideas and the editorial turned into a full-length article called “ The unreasonable effectiveness of my self-experimentation.” For 20 years I’d been mystified by this. I’m not exaggerating, I had no idea what I was doing right. I wanted to know — so I could do more of, or at least continue to do, whatever it was — but I just couldn’t figure it out.

Four Transitions: Population, Forests, Obesity, and Fast Food

Seth Roberts8 Comments

Long ago Paul Ehrlich, a Stanford professor, wrote The Population Bomb. Yet you probably know about the demographic transition: A sharp decrease in family size when countries reach a certain level of wealth. Which implies a big problem with Ehrlich’s forecasts. You probably don’t know about three related transitions:

1. Forests. For a long time humans destroyed forests and forest area decreased. More recently, however, forests have been regrowing as people leave rural areas for cities.

2. Obesity. In poor countries, rich people are fatter than poor people. In rich countries, the opposite is true: the poor are fatter than the rich, presumably because the rich eat less factory food.

3. Fast food. On a recent visit to Tokyo, I was told that the number of fast food restaurants in Tokyo is declining.

Excellent Jonathan Franzen Story

Seth Roberts7 Comments

The current issue of The New Yorker has an excellent story by Jonathan Franzen. I enjoyed reading it (unlike most recent New Yorker fiction, unfortunately) and it’s closely related to stuff I blog about.

It tells what happens after a girl is raped by a boy with powerful parents. Her coach wants her to report it but her parents dissuade her. They are afraid of what the boy’s parents would do to them. The mother is active in the local Democratic Party and says “I wish it had been anyone else.” They have three other children — this one, they seem to decide, is disposable.

The story is so wrenching because the parent-child bond is usually so strong. But smaller abandonments happen all the time. When I was a graduate student at Brown, I was a teaching assistant. One of the papers I graded turned out to be plagiarized. I told the professor about it; he did nothing. I’m sure I know why: It would have been costly for him. Time-consuming, for example. He abandoned the student. Teachers, like parents, should teach right and wrong.

I posted yesterday about a Columbia University valedictorian named Brian Corman who plagiarized part of his speech. Was this the first time he’s plagiarized? Of course not. It’s merely the first time he’s been punished for it. I believe he’s plagiarized many times and in some cases the teacher noticed. The teacher did nothing — thereby abandoning the student — because to do something would have been costly for the teacher. Had Corman been punished earlier, he would (a) not have been valedictorian (it would have gone to someone more deserving) and (b) not face ridicule for the rest of his life, since this episode will be preserved by Google. Likewise, Adam Wheeler — a flagrant liar who almost graduated from Harvard without being caught — will be ridiculed the rest of his life. He too was abandoned by his professors, who surely noticed before now that he plagiarized.

That Brown, Columbia, and Harvard professors put their own comfort ahead of doing right by their students is unsurprising, given the examples set by countless university presidents and underlings. (Examples here.) Why did Columbia University President Lee Bollinger show a shocking lack of understanding of the purpose of free speech? (He’s a law professor whose specialty is freedom of speech.) Because he thought it would be crowd-pleasing — and it was.

Restaurant With No Menu

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Today I had lunch at a Beijing restaurant with no menu. You choose dishes in discussion with your waiter. The restaurant’s theme is kung fu. Somehow having no menu is kung-fu-like. A sword hung on the wall and there were other martial-arts decorations. As we left, the wait staff said an ancient Chinese good-bye loudly in unison. It meant “the mountain and river will still be here [a metaphor for enduring friendship], let’s make a concrete date to meet again.” Only one of our two dishes was really good but I’ll go back.

Prenatal Ultrasound and Autism: Lack of Study

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Caroline Rodgers, whose ideas I blogged about yesterday, wrote to me about lack of research on the possibility that prenatal ultrasound causes autism:

I have heard confidentially that applications for funding of prenatal ultrasound studies (not specifically investigating autism) have been repeatedly denied over the years — which helps explain the great paucity of safety studies, especially since the early ’90s, when the FDA approved an allowable eightfold increase in acoustic output. As recently as this year, funding was denied an ambitious, multi-site study that would have investigated if there was a relationship between ultrasound and autism.

In 2006 when Yale neuroscientist Pasko Rakic announced the results of his study that found prenatal ultrasound interrupted neuronal migration in mice in a way that was consistent with the brains of autopsied autistics, I was surprised that several scientists, including Rakic, did their best to downplay the results. At the time, Rakic was one of many of Autism Speaks’s scientific advisors.

I have spoken with various people throughout the NIH about my concerns [about ultrasound]. They all pointed to various large studies they believe are investigating ultrasound as a possible environmental cause of autism — most recently, the National Children’s Study and EARLI, but when I tracked down the study designs, it turned out that ultrasound is not being studied.

In a report at the time Rakic’s study was published, he indeed downplayed the results:

Dr. Pasko Rakic, chairman of the Yale department of neurobiology and leader of the study, was quick to offer parents reassurance about the safety of ultrasound — done for the proper reasons — in human pregnancies.

“If I had a daughter and she was pregnant, I would recommend she had it for medical reasons,” Rakic said.

Another researcher agreed:

“I couldn’t agree with him more,” said Dr. Joshua Copel, a professor of obstetrics, gynecology and reproductive sciences at Yale and spokesman for the American College of Obstetrics and Gynecology (ACOG). He was not involved in the study. . .

The researchers noted that mice are very different from humans, so the results of their study must be interpreted with caution.

“The forms of migration [of brain cells] and the timing of migration differ in primates like humans than in mice,” Copel said. “In humans, there is a much longer period in which neurons [nerve cells] are migrating.”

Does that sound “very different”?

Autism and Prenatal Ultrasound (more)

Seth Roberts24 Comments

I blogged earlier about Caroline Rodgers’s idea that prenatal ultrasound may cause autism. She believes this idea isn’t getting the attention it deserves.

Recently she wrote to the head of Health and Human Services:

The latest autism prevalence figures released in December showed that while the overall autism rate increased more than 50% in the four years ending in 2006, there were significant differences across ethnic groups. White women had a much higher incidence of autism among their children than Black or Hispanic women. White mothers had 9.9 autistic children per 1,000, versus Black mothers who had 7.2 and Hispanic mothers who had 5.9.

There were also geographic differences. Among the 10 states with monitored sites, Alabama and Florida had the lowest autism rates, with averages of 4.2 and 4.6 per 1,000, respectively – far lower than the two states with the highest autism rates, Arizona and Missouri, which tied at 12.1 per 1,000. One interesting apparent statistical anomaly occurred among Alabama’s Hispanic population, which had a 68% decrease in autism while the overall national increase was 57%. In trying to understand why Alabama Hispanics had such a decrease in autism, I searched for evidence of public health policy changes. What I found was a surprise: according to a CDC multi-state surveillance report, Alabama and Florida were two of three states that had cutbacks in Medicaid funding for prenatal care during the time mothers in the study were pregnant. (The third state, West Virginia, was not among those monitored for autism in the latest study.)

Digging deeper, I turned up a CDC report on the timing of entry into prenatal care. The report showed that although most women started prenatal care in the first trimester, the percentages of both Black and Hispanic women who lacked early (first trimester) prenatal care were nearly twice that of White women . . . Over the span of the 10-year study, more women [in] all ethnic groups received early prenatal care, but the 2-to-1 ratio remained the same. . . .
Taken together, these three CDC reports tell a disturbing story: as more women . . . received more early prenatal care, the autism rate among their children increased, with those women receiving the most early prenatal care having the highest percentage of autistic children. . . .

A rigorous UC Davis study, published in January, of California children born between 1996 and 2000 identified 10 autism clusters . . . Highly educated women were much more likely to have children diagnosed with autism than parents who did not finish high school. In six of the clusters, the rate was as high as 4 to 1. Returning to the CDC Entry into Prenatal Care report, it is striking to note that in 1997 only 8.5% of pregnant women with some college education had delayed prenatal care, versus 29.9% of women who were not high school graduates – further [linking] early prenatal care [and] autism.

A study published in November on prenatal ultrasound trends from 1995-2006 found that the odds of a woman receiving an ultrasound during a prenatal visit nearly doubled over [those] 10 years. . . . The geographical and ethnic differences . . . dovetail with many of the geographical and ethnic differences found in the latest autism prevalence report. For instance, Southern women were 40% less likely to receive an ultrasound during a prenatal visit than Northeastern women, which could help explain why Florida and Alabama had the lowest autism rates among the states monitored. Also, Hispanics, who had the lowest overall autism prevalence rates in both the 2004 and 2006 CDC reports, were 20% less likely to receive an ultrasound during a prenatal than White women.

Not all the statistics available in these reports support the idea that prenatal ultrasound is causing autism. For instance, Southern states such as Georgia and North Carolina did not have low autism rates, but [perhaps this is because] the ultrasound trends study did not take into account “keepsake†ultrasound . . .

She also notes that a study by Yale neuroscientist Pasko Rakic “found that prenatal ultrasound disturbed neuronal migration in mice.”

Here is the broad argument. 1. Autism is correlated with wealth. It is absurd that autism causes wealth; it is unlikely that both are caused by something else. Thus this correlation makes it plausible that autism is caused by something that rich people have more of than poor people. Obviously rich people have more prenatal ultrasound. 2. A localized decrease in autism happened at the same time autism almost everywhere was increasing. At the same place and time prenatal ultrasound screening surely declined. This correlation is very difficult to explain with other ideas about what causes autism. Dozens of things (e.g., genes, diagnostic criteria) previously proposed as explanations of autism remained roughly constant at the same time as the decrease. 3. The mice data make the linkage considerably more plausible, assuming (a) the ultrasound dosage was reasonable and (b) humans with autism have unusual neural wiring that resembles the changes seen in the mice.

The full letter is on her blog. An article by Rodgers about this