Another Unintentionally Revealing Response From the American Medical Association

A few weeks ago I blogged about the lame response of the American Medical Association to HealthTap, a website that solicits doctors’ answers to medical questions. Their criticism was so weak it amounted to praise.

More recently, the AMA was asked about its position on doctor rating websites. Here’s what happened:

Robert Mills, a spokesman, sent me a statement that he said was from the A.M.A.’s president, Dr. Peter W. Carmel, that read, in part, “Anonymous online opinions of physicians should be taken with grain of salt and should not be a patient’s sole source of information when looking for a new physician.” This, however, is almost exactly the same statement it provided to its own publication, American Medical News, in 2008, when it was attributed to Dr. Nancy H. Nielsen, the president-elect of the A.M.A. at the time.

Such plagiarism is more consistent with what Jane Jacobs in Systems of Survival called guardian values (where honesty is unimportant) than commercial values (where honesty is very important). When you grasp that doctors follow guardian values rather than commercial ones their behavior becomes far more predictable — and plainly in need of control by outsiders. That doctors are allowed to charge for their services resembles allowing policemen to write as many parking tickets as they like and pocket the fines.

Thanks to Bryan Castañeda.

Gary Shteyngart is a Very Funny Guy

I heard Gary Shteyngart (latest book Super Sad True Love Story) at the Beijing Bookworm. No better job of authorial self-promotion have I seen. He was born in Leningrad in 1972, he grew up hearing jokes from his parents. For example: The 1980 Summer Olympics were in Moscow. At the time, Brezhnev was in charge. He was going senile. At an Olympic ceremony,  he gave a speech. His hands shook holding the text of his talk.

“Ohhhhhh…..” he read.

He paused.


He paused.


An apparatchik ran up to him. “Senior Comrade Brezhnev, those are the Olympic Rings!”

The moderator asked Shteyngart what he thought of Putin’s plan to require every Russian teenager to read a specified 100 great books by graduation. “These things never work,” said Shteyngart. “American cities have done this. Everyone’s supposed to read a certain book, usually To Kill a Mockingbird. Never tell someone what to read.” However, he said one of his favorite authors is Karen Russell. (For a New Yorker podcast, he read a story by Andrea Lee.)

I asked about his favorite TV shows. He mentioned The Sopranos, The Wire, and Breaking Bad. “Who would have guessed that TV would become a great art form?” He is writing a show for HBO about Brooklyn immigrants.

I learned that he was interviewed by a magazine called Modern Drunkard. The interviewer — not Shteyngart — mentions an Russian saying: “The church is near, but the road is icy. The bar is far away, but I will walk carefully.” How true.




Assorted Links

Thanks to Anne Weiss.

Vitamin D3 in Morning: Moving D3 & Fish Oil from Evening to Morning Improves Sleep (Story 22)

A few weeks ago I got an email from a reader named Alexander Vinther:

I take Vitamin D3 (2000 units) in the morning (between 7 and 9 am) together with fish oil. My sleep is deeper and I don’t wake up at odd times during the night. I tried increasing my intake 3-fold [= to 6000 IU] but felt too energetic/restless when going to bed (regardless of the time). I stopped taking Vitamin D3 (the regular dose) for a while to check my results only to start waking up in the night (or waking up early).  Before this, my intake of D3 and fish oil was usually in the evening (everybody seems to recommend taking vitamins in the evening). The change from evening to morning was with both fish oil and D3 (I have always been taking them simultaneously) with huge improvement in sleep.

This is especially interesting because he made the evening-to-morning change long before I blogged about it. I asked for details.

Tell me about yourself.

Male, 24 years old. I live in Denmark and study philosophy. I exercise a lot (6 times a week, crossfit).

What were your sleep and energy like before you started taking D3 and fish oil in the morning?

My energy levels during the day would change a lot, sometimes with a huge surge in energy in the evening making falling asleep difficult. This would lead to few hours of sleep or a general feeling of not having slept at all (this in comparison to what I feel now, the feeling of “deep” sleep). [This is what happened when he was taking D3 and fish oil in the evening. –Seth]

Have you tried other D3 dosages?

I started out with 1400 units of Vitamin D3. I now take a multivitamin which has a small amount of D3, hence the 2000 units. I didn’t notice a difference between 1400 and 2000 units, but 6000 made me giddy/restless for the first week, which is for as long as I tried that particular dosage. 4000 units seems to have the same effect as 2000 units, but it is a dosage I haven’t taken for more than a week.

How long have you been taking Vitamin D3 in the morning?

I switched the time (from evening to morning) of my D3 intake about a year ago. Stumbling upon your blog confirmed my belief in or underlined the evidence for a difference in morning/evening intake.

How soon after you started D3 and fish oil in the morning (instead of the evening) did you notice better sleep?

I would say I see improvements in my sleep 3-4 days after D3 intake

What brands of Vitamin D3 and fish oil do you use?

My D3 brand is Danish: Naturdrogeriet D Mega. My fish oil brand is Biosym EPA-GLA+. I take 2 capsules containing a total of 1200 mg fish oil (DHA, EPA, GLA), 600 mg Borago oil and 700 mg soyalecithin.

Genomics Confidential: Iceland Not So Wonderful

Many people think that personal genomics will change medicine. Doctors will choose treatments based on your genome, learning your genome will tell you what diseases you are at high risk of so you can take precautions, and so on. One person who believes this is Eric Topol. In his new book, The Creative Destruction of Medicine, he writes:

The biggest leap came in the first decade of the twenty-first century. The six billion bases of the human genome were sequenced, and this led to the discovery of the underpinnings of over one hundred common diseases, including most cancers, heart disease, diabetes, autoimmune disorders, and neurologic conditions.

Here is the founder of a company that makes sequencers: ““I believe that the impact on the medical community of whole human genome sequencing at a cost comparable to a comprehensive blood test will be profound.”

I disagree. I have seen nothing that suggests genes make a big difference in any common disease and plenty that suggests environment makes a big difference. My self-experimentation led me to one powerful environmental factor after another, for example. Biologists have invested heavily in the study of genes for reasons that have nothing to do with practical applications, as Thorstein Veblen would be the first to point out.

In 1999, New Yorker staff writer Michael Specter wrote an admiring article about a neurology professor named Kari Stefansson. Stefansson had returned to his native Iceland to take advantage of Iceland’s genetic homogeneity to find genes for common diseases. “In the past, drugs were discovered almost by chance,” Specter wrote, as if this would soon change. The wishful thinking involved is indicated by passages like this:

[Stefansson] and Gulcher selected the five per cent of Icelanders among the hundreds of thousands in their genealogical database who had lived the longest— most of them over ninety. The database allowed the two scientists to seek an answer to a simple question: Are these people who live so long related to each other more often than the average in Iceland? The answer quickly became apparent. People over ninety are much more closely related to each other than people in the general population are, and their children are more likely to live longer than the children of others. That provides strong evidence that the trait is inherited.

“Strong” evidence? The “people over ninety” observation is strong evidence that longevity is inherited only if relatives share nothing but genes. The “their children are more likely” observation is strong evidence of genetic control only if parents pass on to their children only genes. Both assumptions are highly unlikely. For example, surely an Icelandic person lives closer to his relatives than to randomly selected Icelanders.

The article quotes no one with my view (geneticists are overstating the practical value of their work), but it does say that “Stefansson set out to raise capital at a time [1996] when investors had become skeptical about the many unfulfilled promises made by companies claiming that genetic research would solve the ills of humanity.”

Will reality overtake hype? Here is an indication this is happening:

Kari [Stefansson], a neurologist, was a Harvard professor when he co-founded deCODE in 1996. Two years later, Iceland’s parliament gave deCODE access to one of the country’s unique resources—health records of the genetically homogenous population. DeCODE debuted on the NASDAQ stock exchange in 2000, and it made dramatic discoveries of genetic factors associated with cancer, heart disease and other conditions. But the company never turned a profit and filed for bankruptcy protection in 2009.


Assorted Links

  • Kombucha news: new scientific studies. Plus an expert says: ““When diets are fads, they never seem to last long.”
  • University of Pennsylvania clears medical school professors of ghost-writing. “‘It’s important to note,” [said the Penn report,]  ‘that the results of the study were negative to the sponsor’s product [and] were so characterized in the publication’ . . . But Lisa Lehmann, the director of the Center for Bioethics at Brigham and Women’s Hospital in Boston, notes that the study’s findings were not unequivocally negative. ‘Penn noted that the study was negative and seems to imply that diminishes concerns about bias, but this is not entirely true. There is a segment of the population, those with low serum lithium levels, for whom the study recommends the medication.’ “
  • Jeffrey Sachs apparently believes in AGW (Anthropogenic Global Warming). He also believes, according to Felix Salmon, “that development is easy, we know how to do it, and that given enough money, it’s relatively trivial to spend that money in an effective way to reduce poverty around the world.” Results from the Millennium Project do not support his beliefs.
  • 5 years of success with the Shangri-La Diet

Thanks to Alex Chernavsky.

Ten Years of Weights, Including Two Years on the Shangri-La Diet

Here’s a new graph I’ve made of Alex Chernavsky’s data. In 2001, he started weighing himself and recording his weight with the hope that it would help him lose weight. His data shows several interesting things:

1. Long walks really helped. The walks lasted 1.5-2 hours. They weren’t sustainable but the weight loss they caused lasted a remarkably long time — years, apparently, in the sense that it took years to regain the lost weight.

2. A low-carb diet worked well, but only at first. Alex lost a lot of weight initially but then started to regain it. Just before he became vegetarian, he was regaining weight quickly. I don’t know if this is typical. The popularity of low-carb diets has not been matched by availability of data about long-term effects, where by “long-term” I mean four years. Even though low-carb diets are 150 years old (Banting wrote in 1863).

3. The Shangri-La Diet is working better than other alternatives. There’s a difference between (a) showing that a diet causes weight loss and (b) showing that it works better than other ways of losing weight. In this comparison, it appears more sustainable than long walks and the weight loss it causes appears more sustainable than the weight loss from a low-carb diet.

Alex originally used Shangri-La Diet principles by ingesting 4 tablespoons of flaxseed oil washed down with water. (Details here.) He lost weight but then started to slowly regain it. I suggested he increase his intake of flavorless calories so he started to eat 1 tablespoon of coconut oil (about 100 calories) each day with his nose clipped. He stopped slowly gaining weight.

I asked Alex why he has persisted weighing himself so long. He replied:

I had at best a vague idea of what I wanted to do with the data.  When I was in graduate school [in neuroscience], I enjoyed plotting the results of my experiments, so I thought it would be fun to have a dataset that consisted of my own weight measures.  After I started the SLD, I had a more-concrete reason why I needed to collect the data.  I explicitly set out to test the diet.



Assorted Links

Thanks to David Cramer, Jahed Momand and Nancy Evans.

The Value of Moodscope

In 2007, Jon Cousins started tracking his mood to help NHS psychiatrists decide if he was cyclothymic (a mild form of bipolar disorder). After a few months of tracking, he started sharing his scores with a friend, who expressed concern when his score was low. Jon’s mood sharply improved, apparently because of the sharing. This led him to start Moodscope, a website that makes it easy to track your mood and share the results.

I was curious about the generality of what happened to Jon — how does sharing mood ratings affect other people? In January, Jon kindly posted a short survey about this. More than 100 people replied. Continue reading “The Value of Moodscope”

Vitamin D3 in Morning: 7000 IU Improves Sleep (Story 21)

Someone who wishes to be anonymous wrote me:

I had been taking 400 IU D3+calcium morning noon and night for years. I usually fell asleep fitfully. My sleep was rarely uninterrupted throughout the night.

After reading your blog, I started taking all three pills in the morning. Getting to sleep was easier, but sleep was still usually fitful.

After more reading of your blog, I stopped the D3+calcium and switched to 7000 IU of D3 every morning. Within a couple days, my usual pattern became that I fell asleep quickly and slept soundly through the night.

It is now three weeks, and I continue to enjoy excellent sleep. I noticed no changes in energy or mood.

I asked some questions.

Tell me about yourself.

I’m an academic (professor of decision sciences), 52 years old. I live in Philadelphia.

What you mean by “I fell asleep fitfully”?

Even if I was tired, sleep did not come easily. I had no worries, so it wasn’t that.

How long did/does it usually took/take you to fall asleep under the three conditions?

Original 400 IU D3+ calcium 3 times/day: 1/2 hour was usual.
All 3 are taken in morning: 15-30 minutes, but still awakening in the night frequently
7000 IU in morning: 10-15 minutes, and sleeping like a log.

What time do you wake up? What time do you take the 7000 IU?

I usually wake between 7 and 7:15.  Sometimes I head straight for the kitchen (where the vitamins are stored) and I take them immediately.  Other times I head for the shower and then to the kitchen, whereupon I take the vitamins.

What brand of Vitamin D3 do you take now?

Vitamin Shoppe


How Accurate are the QuackWatchers? Mercury Amalgam Fillings

From Amalgam Myths and Facts (amalgam here means mercury-containing amalgams used by dentists):

Myth 10: Amalgam has been banned in Germany and Sweden and therefore should be banned in the United States.

Fact 10: Dental amalgam has not been banned in any country in the European Union.

From a 2009 press release:

The [Swedish] Government today decided to introduce a blanket ban on mercury. The ban means that the use of dental amalgam in fillings will cease.

In response to the Swedish ban, the American Dental Association put out a press release that said such a ban was “not necessary” in America because dentists do such a good job recycling the amalgam that doesn’t go into your mouth. Moreover, “a recent economic impact study published in the journal Public Health Reports indicates dental care costs in the U.S. would increase up to $8.2 billion in the first year alone if amalgam use was discontinued.” I don’t know what “up to” means. Perhaps it means that dental care costs would increase by a trivial amount “up to” $8.2 billion. Mercury-containing amalgam fillings are about half mercury.

Soon after I had two mercury fillings removed, I slowly became faster at arithmetic.

More About the Lawsuits Against Law Schools

New York magazine has just published a long article about the lawsuits against law schools for deceptive reporting of job prospects. This is the most radical (in the sense of challenging what “every reasonable person knows”) article I’ve seen in a major magazine in a long time. Gary Taubes’s article (“What if It’s All Been a Big Fat Lie?”) is a good example of such an article. It was published in 2002. Long long ago The New Yorker published a series of articles by Paul Brodeur (published as a book in 1989) arguing that power lines cause cancer. So long ago that Brodeur has retired. Unlike what Taubes and Brodeur wrote, the New York article is not investigative journalism. It was much easier to write. But that does not change the similarity of basic message — that powerful respected people have been lying to us.

Beyond the sheer existence of this article, it’s also interesting that nobody interviewed for the article said the allegations were false. For example, here’s a dean at New York Law School, one of the defendants:

“We teach critical thinking, and writing, and so forth,” Buckler said. “And that’s always been the case, and those skills have always been useful. I guess I would say that it’s never been a good reason to go to law school or any grad school, because you think there’s a guarantee at the end. Whether that was twenty years ago or ten years ago or this year.”

In other words: It doesn’t matter if we publish false or misleading data because (a) we teach useful skills and (b) the data don’t matter — right-thinking people ignore such data (“it’s never been a good reason to go to law school” because you think it will provide a job). Recent graduates of New York Law School do an even worse job of defending the school:

“Mathematically, it’s a ton of graduates, yes, and no, there aren’t enough jobs for them,” Daniel Gershburg, a 2006 graduate of NYLS and an attorney with a successful practice in Manhattan, says. “At the same time, what are schools supposed to say? ‘No, no, don’t come here! Run for your lives! . . . ’” [That is: Of course they lied.] Julia Shapiro, who graduated from NYLS in 2007—and who works as a lawyer in Los Angeles—puts it this way: “Suing the school is not going to help them find a job. I would not put my energy into wallowing in my sorrows.” [That is: Get over it.]

In contrast, it’s easy to make a case that the schools intentionally deceived prospective students. One of the lawyers behind the lawsuits said:

“NYLS [New York Law School] has to put students in seats,” Strauss said. “That’s the system they set up for themselves. They’ve got a huge new building, gleaming classrooms, but they’re cutting corners on transparency. They’ve created this reality where the only way they can put [enough] people in seats is by misleading them.”

A commenter put it like this:

Over the past 20+ years (since the advent of the U.S. News Rankings, really), the non-elite law schools have perpetrated a pervasive and dynamic fraud aimed at luring unsuspecting college students to throw away their financial futures [due to] reliance upon utterly fraudulent salary-and-employment data. The goal is obvious: to keep the student-loan teat gushing into administrative pockets.

As I said earlier
, there’s an old joke: Why do students go to law school? They’re bad at math. Apparently law school administrators are also bad at math. The existence of this story suggests that average reader of New York magazine is not inclined to forgive them.

Assorted Links

  • In praise of Rush Limbaugh.
  • Shangri-La Diet experience (“Bottom line: I lost three pounds in a week and a half”) of an artist named Elizabeth Periale.
  • Long interview with Tucker Max. “His fridge . . . is in one way very different: where you’d expect the six-pack of cold ones waiting for the game, instead you’ll find rows and rows of kombucha, the fermented health beverage.”
  • End of college campuses. Megan McArdle imagines a world in which college is replaced by distance learning. “95% of tenure-track jobs will be eliminated.” Jane Jacobs, in Systems of Survival, divided jobs into taking and trading. Teaching is trading if the student really wants to learn the subject. Teaching is taking if the student is forced to take (and pay for) the class. Scary thought: Every college student is asked about every class: would you take this class if you didn’t need to (and didn’t need to take other classes)?

The Parable of the SAMe

SAMe is a drug well known to help depression. For example, “a popular dietary supplement called SAMe may help depressed patients who don’t respond to prescription antidepressant treatment, a new study shows.” But there’s something important few people know about SAMe.

While talking to a Seattle woman about how Vitamin D3 first thing in the morning helped her with depression, she told me the following story:

When I was 47, I just wanted to be healthier. I kept gaining weight. I knew what foods are healthy. I just didn’t seem to eat them. A naturopath suggested SAMe. I tried it — Twin Labs SAMe. That was really fabulous for me. For the first time I got a glimpse of what being not depressed was like. Cravings weren’t there any more. Went from a size 24 to a size 14. Lost 70 pounds. I’m 5′ 8″. I didn’t feel deprived. I was eating plenty of food. going to yoga. Feeling really great.

Then Twin Labs discontinued it. It was made in Japan. I tried every other SAMe out there, eight different brands. None of them worked. I gave each of them a month. I tried different dosages.

I started slipping back into depression. Not being able to cope. I was sleeping more. Sugar cravings returned.

[why did Twin Labs stop making it?]

It wasn’t a good seller for them. So fucking wrong. I wrote letters to try to get them to start making it again. I did a campaign. People found pockets of what was left in the country and sent it to me. But it finally ran out.

The moral(s) of the story? 1. So much for word of mouth. You might have thought it would make the good SAMe sell well, better than the bad SAMe. Apparently not. 2. So much for the placebo effect. 3. Clinical studies (e.g., of SAMe) may higher-quality versions of what they are testing than the versions available to the rest of us. 4. So much for quality control in the supplement industry — except maybe in Japan. There can be substantial quality variation among supplements, undetected by the industry. I have to believe the companies selling the useless SAMe didn’t realize it. Surely they thought that good SAMe would be a better product for them than bad SAMe.

This resembles the Vitamin D3 story I have been telling. Tara Grant said she’d heard countless times that Vitamin D is good. She hadn’t heard once that it must be taken in the morning. I’ve heard countless times that SAMe is good. This was the first time I heard about huge quality control issues. In both cases individual self-observation uncovered a crucial truth that an industry had overlooked. They didn’t want to miss it. The Vitamin D Council didn’t want to miss the time-of-day effect. They just did.

This also resembles what I said about ultrasound machines: A lot of them are broken, unbeknownst to their operators and the people (often pregnant women) being scanned. The countless “experts” (doctors) who recommend ultrasound don’t seem to know this.

Which is why personal science (trusting data, not experts) is more valuable than experts want you to think.

“Thou Shalt Not Testify Against Another Doctor”

First do no harm . . . As Robin Hanson has said, what does that mean? In contrast, the rule illustrated by this story, from Bryan Castañeda, who works for a Los Angeles law firm, is quite clear:

At the old firm I used to work at, I was talking to one of the senior attorneys and the topic of medical malpractice cases came up. He said he avoids them. Why, I asked. He said — I’m paraphrasing here — “Because you won’t find a doctor who will testify against another doctor in open court. They may advise you in private, ‘Oh yeah, so-and-so definitely screwed up,’ but you won’t get them to say that on the stand. They all protect each other.”

Judging by this story, if your doctor makes a mistake, the only person who will suffer consequences is you. Thank heavens the rest of us have more power than ever beforeA recent survey of doctors found that  “more than a 10th (11.3%) admitted to telling patients something that was not true.” The survey did not ask about lies of omission (when silence is misleading); unwillingness to testify that someone else made a mistake is that sort of lie. The survey also showed that doctors (at least, those who took the survey) have a self-serving interpretation of the term not true. Although only about 10% said they had said something “that was not true” — meaning something that they knew wasn’t true — “more than half had described a patient’s prognosis more optimistically than warranted.” Apparently they consider such descriptions not instances of “not true”.

In Systems of Survival, Jane Jacobs described two moral systems (lists of rules/values): The guardian syndrome and the commercial syndrome. In certain areas of life (e.g., military), the guardian syndrome prevailed; in other areas (e.g., small business), the commercial syndrome prevailed. Loyalty (e.g., “never testify against a fellow doctor”) is a guardian value — indeed, the main guardian value. In contrast, honesty is the main commercial value. Jacobs said that the two syndromes corresponded to two ways of making a living: taking and trading. Doctors do not represent themselves as predatory (= taking). But, according to Jacobs, this sort of rule (“never testify against a fellow doctor”) puts them squarely in that camp.

I asked Jim Jacobs, one of Jane Jacobs’s sons, for comment. He replied:

Exactly right. Jane experienced this herself, unfortunately. It’s really a major problem. I see the very same behavior among medical researchers too.

Vitamin D3 in Morning: Mixed Evidence From PaleoHacks

Paleo Hacks has a thread about timing of Vitamin D3. Better in morning (my and several other people’s experience) or evening (Robb Wolf’s experience)?

This answer supports morning:

I prefer taking it in the morning. I think it helps set my circadian rhythm.

This answer supports night:

I prefer it at night. I find I sleep better.

This answer supports morning:

I had trouble sleeping when I started Paleo and was taking my D3 at night before bed. Was nervous and couldn’t seem to settle down. No problems since I went to morning, I have them with my fish oil right after breakfast.

By the time you read this there will probably be more evidence.

Thanks to Melissa McEwen.

Tucker Max on How to Eat an Egg

A few months ago I blogged that a rat had persuaded me to eat more eggs.  This particular rat liked scrambled eggs. Rats are omnivores, like humans. Unlike humans, they ignore advertising, nutrition fads and disinformation. Related to this, Tucker Max emailed me:

Have you thought about eating your egg raw? It sounded weird to me at first, but after looking extensively into it, there was a lot of good evidence that cooking an egg destroys a lot of the beneficial nutrients/enzymes in it. Once I started doing this, I noticed a HUGE increase in energy from the egg. It was like I almost eating a different food. In fact, the very first time I did it was at night, like 9pm, and I couldn’t get to sleep until 3am I had such a huge burst of energy. It’s not quite like that anymore, but I take it about an hour or two before I work out, and its like taking a red bull (I may be a bit vitamin B12 deficient, which would explain this).

As to how I do it, I just crack the egg into a coffee cup, and swallow it whole. It has pretty much no flavor. I also only do it with organic pasture-raised eggs. I don’t think I’d do this with normal, crappy store bought eggs.

I replied:

On my blog I said that butter and egg were in that way different from other foods — butter or at least milk must be a complete nutrient since it is the only food the baby gets. Other foods are under no such evolutionary pressure.

Tucker replied:

Which is why its SO important to get raw milk/butter from grassfed cows. Almost a completely different food than normal grocery store milk.

Yeah. When I get back to California I will compare raw and cooked eggs. In Beijing I eat mainly fermented eggs.

Personal Science and Varieties of DIY

How does personal science (using science to solve a problem yourself rather than paying experts to solve it) compare to other sorts of DIY?

Here’s an example of personal science. When I became an assistant professor, I started to wake up too early in the morning. I didn’t consider seeing a doctor about it for several reasons: 1. Minor problem. Unpleasant but not painful. 2. Doctors usually prescribe drugs. I didn’t want to take a drug. 3. Sleep researchers, based on my reading of the sleep literature, had almost no idea what caused early awakening. They would have said it was due a bad phase shift of your circadian rhythm. They often used the term circadian phase disorder but never used the term circadian amplitude disorder — apparently they didn’t realize that such a thing was possible. I decided to try to solve the problem myself — an instance of DIY. Except that, if I made any progress,  that would be better than what the experts could provide, which I considered worthless.

There are thousands of instances of DIY, from fixing your car yourself to sewing your own clothes to word processing. Here is one dimension of DIY:

1. Quality of the final product. Better, equal, or worse to what you would get from professionals. Richard Bernstein’s introduction of home blood glucose testing led him to much better control of his blood glucose levels than his doctors had managed. Same as my situation: DIY produced acceptable results, the experts did not.

In contrast to Bernstein, who reduced his blood glucose variability within months, it took me years to improve my sleep.  That is another dimension:

2. Time needed. Personal science, compared to other DIY, is orders of magnitude slower.

Here are some more dimensions:

3. Training needed. I don’t know how much training personal science requires. On the face of it, not much. I had acne in high school. I could done self-experimentation at that point. It just didn’t occur to me. On the other hand, I think effective personal science requires wise narrowing of the possibilities that you test. For most health problems, you can find dozens of proposed remedies. How wise you need to be, I don’t know.

4. Commercialization. Some forms of DIY are entirely the creation of businesses — cheap cameras, home perms, IKEA, etc. Bernstein’s work happened because of a new product that required only a drop of blood. The company that made it wanted doctors to do DIY: measure blood glucose levels in their office (fast) rather than having the measurement made in a lab (slow).  When I started to study my sleep, no business was involved. Now, of course, companies like Zeo and the makers of FitBit want users to do personal science.

5. Price. My sleep research cost nothing, which in the DIY world is unusual. The term DIY is almost entirely a commercial category: Certain books and goods are sold to help you DIY.

6. Customization possible. Some kinds of DIY give you the tools to build one thing (e.g., IKEA, home perms). Other kinds (e.g., Home Depot, word processing) give you the tools to build a huge range of things. This dimension is variation in how close what you buy is to the finished product (Ikea = very close, word processing = very far). Personal science allows huge customization. It can adjust to any biology (e.g., your genome) and environment (your living conditions).

7. Benefit to society.  If I or anyone else can find new ways to sleep better — especially safe cheap easy ways — and these solutions can be spread, there is great benefit to society,  by comparison to DIY that allows non-professionals to reproduce what a professional would create (e.g, IKEA).

You might say that personal science isn’t really DIY because, compared to other DIY, (a) it is much slower and (b) the potential benefit to society is much greater. But those features are due to the nature of science. Any form of DIY has unique elements.

My mental picture of DIY is that there are two sides, producers and consumers, and in many domains (health, car maintenance, word processing, etc.) they creep toward each other in the sense that what producers can make slowly increases and what consumers are capable of slowly increases.  When they meet, DIY begins. In some cases, the business has done most of the changing; the DIY is very easy (e.g., Ikea).  In other cases, the consumer has changed a lot (literacy — not easy to acquire). Either way, the new DIY causes professionals who provided that service or good for a living to lose business.

Assorted Links

Thanks to Ryan Holiday, Matt Cassel, Tom George and Dave Lull.