How Bad is LDL Cholesterol? (continued)

If LDL cholesterol level predicts heart disease then persons with low LDL should be better off than persons with high LDL. Here is what some Norwegian doctors did:

They simply selected sequential patients with LDL cholesterol scores below 2.7mmol/l. . . . They ignored all people with LDL concentrations from 2.7 to 4.5mmol/l but did enroll all people with an LDL >4.5mmol . . .  So they then had two groups of people, those at catastrophic risk of LDL-blocked-arteries and those with [very] little LDL . . . They did the scheduled angiography and checked how many patients had >70% blockage of at least two coronary arteries in each group.

Guess what: LDL cholesterol doesn’t matter. They recruited 47 patients with low LDL-C, of whom 21 had significant CAD. They got 46 high LDL-C patients, of whom 24 turned out to have CAD.

Thanks to Dave Lull.

How bad is LDL cholesterol?

How Bad is LDL Cholesterol?

We all know the term bogeyman — a fictional monster that empowers its inventor. According to Wikipedia, “parents often say that if their child is naughty, the bogeyman will get them, in an effort to make them behave.” I always think of the Falkland Islands. In 1982, by acting as if the Argentine invasion actually mattered, Margaret Thatcher got herself a big boost in popularity. In the 1960s, by acting as if Berkeley student protests were dangerous, Reagan got elected president. The day after 9/11, I said my big fear was overreaction. I doubt the persons behind the bombing understood how useful they were to those in power. Bush got a boost in popularity that lasted years.

When it comes to health, cholesterol is one of the biggest bogeymen. Hyperlipid begins a post about LDL cholesterol like this:

You would be forgiven for thinking that the apoB100 protein (which defines the LDL or VLDL particle) has been evolved over the past 4.5 billion years to cause cardiovascular disease and the less of it you have the longer you will live. Listening to a cardiologist that is (or a BBC reporter on the Today Program grovelling before a cardiologist). The lower the better. It’s impossible to have too low an LDL concentration. Statins in the drinking water. You know the patter.

The scientific paper on which his post is based concludes:

Apolipoprotein B at homeostatic levels in blood is an essential innate defense effector against invasive S. aureus infection.

Thanks to Dave Lull.

How Safe is Melamine? Is This Funny or Horrifying?

From Natural News:

Up to 90 percent of the infant formula sold in the United States may be contaminated with trace amounts of melamine, the toxic chemical linked to kidney damage, according to recent tests. The FDA’s test results, which the agency hid from the public and only released after the Associated Press filed a Freedom of Information Act request, showed that Nestle, Mead Johnson and Enfamil infant formula products were all contaminated with melamine. . . .

Prior to these test results being made public, the FDA had published a document on its website that explained there was no safe level of melamine contamination in infant formula. Specifically, the FDA stated, “FDA is currently unable to establish any level of melamine and melamine-related compounds in infant formula that does not raise public health concerns.”

Once tests found melamine in U.S.-made formula products, however, the FDA changed its story. As of today, the FDA has now officially declared melamine to be safe in infant formula as long as the contamination level is less than one part per million (1 ppm).

Astonishingly: The FDA has no new science to justify its abrupt decision declaring melamine to be safe!

I would have loved to have been a fly on the wall when that decision was made.

The Emperor’s New Clothes: Meta-Analysis

In an editorial about the effect of vitamin-mineral supplements in the prestigious American Journal of Clnicial Nutrition, the author, Donald McCormick, a professor of nutrition at Emory University, writes:

This study is a meta-analysis of randomized controlled trials that were previously reported. Of 2311 trials identified, only 16 met the inclusion criteria.

That’s throwing away a lot of data! Maybe, just maybe, something could be learned from other 2295 randomized controlled trials?

Evidence snobs.

Citizen Science: What’s Your Sushi?

Self-experimentation is an example of the more general idea that non-experts can do valuable research. Another example is that two New York teenagers have shown that fish sold in New York City is often mislabeled. They gathered samples from 4 sushi restaurants and 10 grocery stores and sent them to a lab to be identified using a methodology and database called Barcode of Life. They found that “one-fourth of the fish samples with identifiable DNA were mislabeled  . . . [and concluded] that 2 of the 4 restaurants and 6 of the 10 grocery stores had sold mislabeled fish.”

The article, by John Schwartz, appeared in the Science section, which makes the following sentence highly unfortunate:

The sample size is too small to serve as an indictment of all New York fishmongers and restaurateurs, but the results are unlikely to be a mere statistical fluke.

This is a Samantha-Powers-sized blunder. It could hardly be more wrong. How much you can generalize from a sample to a population depends on how the samples were chosen. Sample size has very little to do with it. (John Tukey had the same complaint about the Kinsey Report: Stop boasting about your sample size, he said to Kinsey. Your sampling methods were terrible.) To know to what population we can reasonably generalize these results we’d need to know how the two teenagers decided what grocery stores and restaurants to sample from. (Which the article does not say.) If the 14 fish sellers were randomly sampled from the entire New York City population of grocery stores and restaurants, it would be perfectly reasonable to draw broad conclusions.

I have no idea what it could mean that the results are “a mere statistical fluke”.

The effect of these errors is that Mr. Schwartz places too low a value on this research. It’s impressive not only for its basic conclusion that there’s lots of mislabeling but also for showing what non-experts can do.

The end of the article did see the big picture:

In a way, Dr. Ausubel said, their experiment is a return to an earlier era of scientific inquiry. “Three hundred years ago, science was less professionalized,” he said, and contributions were made by interested amateurs. “Perhaps the wheel is turning again where more people can participate.”

The Professor Has No Clothes

In 1953 Harvard appointed an architect named Josep Sert to a powerful position. Sert had some amazing ideas. From a review of a new book about him:

With the help of Walter Gropius, [Sert] was appointed dean [of the architecture school] at Harvard in 1953, where he set up the world’s first course on urban design, a perfect platform from which to propagate the modernist Ciam agenda for shaping cities using new science, principles and forms. . . .

As propagandist for a type of urban thinking which would have disastrous consequences, Sert had a programmatic mind-set which could see the beauty of historic cities, but his totalitarian attitude insisted on extrapolating abstract systems out of their features. In 1953, for instance, he proposed that if repeated endlessly, the traditional patio house could make a whole city. . . Sert continued to insist that since the unplanned energy of cities is “chaotic” and “disorderly”, the planner must normalise and “overcome” it. He expressed these convictions in abstract terminologies about neighborhoods, scalar zones, urban functions, categories and so on, and in complacent assertions — “every city is composed of cells, and the role of planning is to put these cells into some kind of system or relationship.”

His 1952 plan for Havana is one shocking example. Commissioned by a group of speculators intent on carving up the city, Sert’s Pilot Plan “addressed the entire metropolitan area of Havana, applying Le Corbusier’s rules on classification of roads”, a totally abstract theory. Having destroyed the city’s historic streets and obliterated all memory of Old Havana, he proposed “clusters” of what he supposed would be “charming streets recalling the city’s origins”, but with dimensions that would use the completely abstract principles of Le Corbusier’s Modulor. This awful scenario was to be dominated by “tall towers for a new financial district” which would have wrecked Havana once and for all.

Thankfully, the 1959 Cuban revolution thwarted this insane plan.

I wonder what real-world events led Hans Christian Andersen to write “The Emperor’s New Clothes.”

Can You Change Something If You Don’t Love It?

At a bookstore reading, I learned that Elizabeth Pisani wrote The Wisdom of Whores — about doing HIV epidemiology among sex workers — because she wanted to have more of an effect on HIV prevention programs. Scientific papers didn’t have much effect unless a journalist wrote about them.  Journalists, she found, tended to focus on the exceptions rather than the rules. The exceptions — e.g., sex trafficing — were a poor basis for policy, of course. So she did what drug dealers call “jump the connection”: She wrote a book about the rules, illustrating them with good stories. Speaking directly to the public. It seems to be working, she said.

Jane Jacobs (whom Pisani hadn’t heard of) said something enormously relevant to her enterprise. I think it was in an interview. “It’s a funny thing,” Jacobs told the interviewer. “You can’t change something unless you love it.” What a broad statement, huh? Could it be true? HIV prevention programs, in Pisani’s experience, have mostly failed. She was hopeful that private foundations could do what governments could not. The Gates Foundation, for example — could they crush HIV the way Microsoft crushed Netscape? Jacobs would have been skeptical: Is the usual attitude at the Gates Foundation to love, or at least respect, sex workers? Well, probably not. Indeed, the closer Pisani got to private foundations, the more skeptical she became. They were getting advice from former CDC bureaucrats and the like, full of the same ideas that had already failed.

Pisani held up one country as an example of how to do it right: Brazil. Why Brazil? I asked. Funny thing: In Brazil, they respect sex workers. Unlike everywhere else. In this case, at least, Jacobs was right.

More: Here‘s one version of Jacobs saying this: “I think people [who] give prescriptions, who have ideas for improving things, ought to concentrate on the things that they love and that they want to nurture.”

“My Advantage Was Ignorance”

While both of us were waiting for a bus at the Oakland Airport, Andrew Sutherland asked me where I was going. He was from New Zealand, on a two-week visit to America. I asked him what he did. “I’m working on retirement,” he said. He’s in his mid-forties.

When he was 18 years old, he bought his first house for $1000. It was in terrible shape but he was good at making things so he was able to fix it up. Later he owned a bunch of houses in Denedin, where the University of Otago is located, and rented them to students.

“What advantage did you have over your competitors?” I asked.

“The main advantage I had was ignorance,” he said. He didn’t know all the things that could go wrong. “I wasn’t afraid.” Someone who knew more would have been. Geoffrey Bateson said something similar: If I’d known how hard everything was going to be, I would never have done anything. This is the upside of the ignorance that Nassim Taleb talks about.