Cheap Accurate Home HbA1c Test

Walmart sells a kit for home measurement of HbA1c (brand name ReliOn) that costs $9 and provides results by email. It’s sold only at Walmart. I have been paying $30 for the same measurement at a test center (about 30 minutes away). If you use insurance, copay might be $15. Without insurance, a doctor’s office test might cost $90. The reviews suggest the test has roughly the same variability and average as a lab test. A few people had trouble getting enough blood on the dots but at $9 there is plenty of room for repeat testing.

My blood sugar improved when I started to walk an hour per day and when I started intermittent fasting (eating about half as much as usual every other day). I noticed the effects with blood sugar tests but frequent HbA1c tests (say, once/week) would have been much better.

Diabetes has become an enormous problem in China, where 10% of adults have Type 2 diabetes, roughly the same as in America. Americans often think obesity causes diabetes but this doesn’t explain why smoking — which makes people thinner — is associated with diabetes. People get diabetes who don’t smoke and aren’t fat. Whether anyone who walks an hour/day gets diabetes is less clear.

Thanks to Shant Mesrobian.

Truth to Power: Eric Lander’s Reddit AMA

A year ago, Eric Lander, who identified himself as “President and Founding Director of the Broad Institute of Harvard and MIT [and] one of the principal leaders of the Human Genome Project, directing the largest center in the international project” did a Reddit AMA (Ask Me Anything). One of the questions did not go as expected:

Question As an advisor to the President, what is being done or do you think will be done to increase the attractiveness of students finishing PhD programs in science?

Lander We need to shorten the time for getting a PhD and for a first faculty job. Young people should get out into the scientific world early, when they have lots of fresh ideas. We should encourage grants to young scientists and should encourage them to take big risks. When you’re taking big risks, science is amazingly fun.

The response to this answer was very negative.

With all due respect, this is a ludicrous statement. . . The true problem is the way in which you fund science. You fund projects and proposals. In order to get these projects funded, the preliminary data has to be essentially the whole project being done. Then you fund at a 6% percent line. It leads to cronyism in the peer review process and a general sense of despair in scientists. How about you radically change the funding system for PIs?

I too am disappointed with Dr. Lander’s response to possibly THE most important question here regarding training basic scientists.

Do you truly believe this? . . . There is no reason to encourage more students to go into science if there is not enough government funding to support their careers.

Alas, this is not important. It just pleased me that someone questioned Dr. Lander’s absurd claims, which he makes often. “We should encourage young scientists to take big risks”. Yes, I agree, does he really believe this? Do he really believe that someone coming up for tenure should take big risks?

Heart Emergencies by Appointment at Mt. Sinai Hospital

A recent Bloomberg News article looked into why Mt. Sinai Hospital in New York did a very large number of heart procedures, making its cardiologists very well-paid. One reason, the journalists discovered, is that patients had been told to lie:

On a pair of representative Sundays in 2012, 10 patients told ER workers they’d been instructed to arrive there before their cath-lab appointments, according to internal hospital correspondence. Two of them said they’d been coached to say they were having acute symptoms of heart disease, according to the exchanges.

Even more remarkable, the journalists found, was that many patients had cardiology appointments before they showed up at the emergency room:

Certain patients who showed up at Mount Sinai Hospital’s emergency room on Sunday mornings stood out [because] they already had appointments. Each was scheduled for a procedure at Mount Sinai’s catheterization lab, where cardiologists thread wires and tubes into blood vessels to detect disease and insert cardiac stents. The New York hospital’s cath lab has regularly scheduled such emergencies-by-appointment, according to three doctors and another medical professional, all of whom said they had direct knowledge of the practice.

Larry Husten, a medical columnist at Forbes, argues that this is an example of a widespread problem.

The Wisdom of Google: “Dessert”, “Honey” and “Fruit” Closer to “Dinner” than “Breakfast” or “Lunch”

I have blogged many times that bedtime honey improves sleep. I learned this from Stuart King, an Australian musician. He also pointed out we eat dessert with dinner more than with other meals. which others who have described the honey effect have not said. The dessert observation suggests that other sweets, not just honey, improve sleep. After I repeated the dessert observation, a friend said I of all people should know it isn’t universal. The Chinese don’t eat dessert, she said. Yes, I said, but where I lived in Beijing there seemed to be lots of sweets eaten in the evening, and lots of street vendors selling fruit in the evening. Continue reading “The Wisdom of Google: “Dessert”, “Honey” and “Fruit” Closer to “Dinner” than “Breakfast” or “Lunch””

Assorted Links

Thanks to Steve Hansen.

“Dawn of Genomic Medicine”

According to the headline of a Yahoo News article, “the dawning of the age of genomic medicine” is upon us. There has been little impact of genomics but “that is finally changing,” says Julie Steenhuysen, the author of the article.

I was curious how this would be argued. Here’s how:

Sambrookes had been very athletic as a young teen, but as she matured, she noticed a heaviness in her legs. By age 20, running left her tired. At 40, she needed a pacemaker, just like her mother did at that age.

“I started thinking there is something to this,” said Sambrookes, now 56, who lives in Michigan City, Indiana.

After some dead ends, she found McNally, who cast a wide net, testing for more than two dozen genes that could account for Sambrookes’ heart and muscle problems.

The culprit turned out to be a mutation in a gene called Lamin that causes Limb-girdle muscular dystrophy. The disease can cause weakness and wasting of the muscles between the shoulders and knees. The mutation can also cause electrical disturbances of the heart.

McNally recommended Sambrookes replace her pacemaker with an implantable cardiac defibrillator that could protect against sudden cardiac death.

That proved to be the right call. Last August, Sambrookes’ heart stopped three times. Each time, the defibrillator shocked her back to life.

“She literally tried to die three times,” McNally recalls of her patient. “It still takes my breath away.”

Because someone recommended a pacemaker be replaced with a defibrillator, genomic medicine is a good idea. The benefits of genomic medicine must remain elusive if you have to use such a poor example to support it.

Assorted Links

Thanks to Patrick Vlaskovits.

Nick Szabo is Satoshi Nakamoto, the Inventor of Bitcoin

There were many funny things about Leah Goodman’s claim in Newsweek that a California engineer invented bitcoin. One was her observation that he put two spaces after a period — just like the inventor of bitcoin. Another was her observation that his relatives said he was “brilliant”, without giving any examples. His brilliance had remained perfectly hidden — until now. A third was her conclusion that he was obsessed with secrecy and distrusted government — just like the inventor of bitcoin (according to her). Felix Salmon was quite wrong when he said there are some very strange coincidences and the pieces of her argument “fit elegantly together”. Actually, her argument is worthless from top to bottom. Salmon was right, however, when he said that the engineer’s English shows he couldn’t possibly have invented bitcoin. As Salmon says, Goodman ignored this itty-bitty problem.

Who is the inventor of bitcoin? I’m sure it’s Nick Szabo, a former law professor at George Washington University. This idea first surfaced a few months ago in an anonymous blog post based on textual analysis. Szabo used certain phrases in the original bitcoin description far more than a bunch of other possible candidates. That is real evidence. The hypothesis that Szabo is the inventor passes several other tests as well: Continue reading “Nick Szabo is Satoshi Nakamoto, the Inventor of Bitcoin”

Human Papilloma Virus and Cervical Cancer

After I say that Nobel Prize in Medicine is usually given for research of little or no proven value, one counterexample I’ve heard is the 2008 prize for the discovery that cervical cancer is caused by the human papilloma virus (HPV). This should allow us to reduce cervical cancer via vaccination.

There are several things wrong with this example:

1. The predicted improvement has not been observed. The average age at which a woman is diagnosed with cervical cancer is 48 years old. To assess the effect of HPV vaccination — usually given to young girls — on cervical cancer you need to wait thirty years. Thirty years haven’t passed. The history of medicine is full of examples where treatments that supposedly worked — such as tonsillectomies, given to millions — when tested turned out to not work. The history of medicine is also full of examples where supposedly wonderful treatments (e.g., frontal lobotomies) turned out to have side effects so bad the treatment was stopped.

2. Cervical cancer is not a big source of death. In the United States, it kills perhaps five thousand women per year. Heart disease kills hundreds of thousands of people per year; so do all forms of cancer taken together. And pap smears, which cost little, actually work. “Cervical cancer is 100% curable if detected early,” says one website.

3. Because pap smears work well, it isn’t clear there is room for improvement. To find out you’d want to compare two groups: (a) pap smears plus HPV vaccination and (b) pap smears alone.

4. It isn’t clear the vaccine will work, even if HPV infection does cause cancer. There are at least 100 varieties of HPV; the vaccine protects against two. Does vaccination against two varieties increase infection by other varieties (because different viruses compete for the same niche)? Hard to rule this out. Again, there are many examples in medicine where actually helping people turned out to be far harder than experts had predicted, even when the initial idea wasn’t nonsense. An example is the oncogene theory of cancer, which also has a Nobel Prize associated with it.

In summary, not a counterexample.

The Coming Reunification of Korea

A few years ago, a Korean friend of mine spent a college year abroad in Tanzania. In South Korea, access to information about North Korea on the Internet was blocked. In Tanzania, it wasn’t. Impressed by what she learned, she cut-and-pasted some of it into an email to her sister.

After she sent the email, she remembered that in South Korea it was illegal to cut-and-paste from a website. She called her mom to tell her sister not to read the email. The message was successfully conveyed and her sister deleted the email without reading it.

In the last year, however, the South Korean government has changed its policy and is now trying to educate citizens about life in North Korea. Information is no longer blocked. Now and then people escape. They are put on show and tell about North Korean life many times. The intention is to prepare for the coming reunification. Special committees have been formed to discuss how to solve the anticipated problems.

We are used to hearing about the advantages of dividing one country into two, but my friend had no trouble explaining why the South Korean government wanted reunification. One reason was that the war with North Korea was very expensive. Another was that families had been divided. A third was that since North Korea has nuclear weapons, reunification will mean that South Korea has them. (My friend had not read a certain newspaper article the day she said that.) This article suggests that the real reason cannot be said out loud. It is that reunification will allow South Korea to take advantage of the land and people freed by the collapse of North Korea.

“What have you learned from the reunification of Germany?” I asked.

“There will be chaos for a long time,” she said.


Defenders of the Indefensible: Jim Dean, University of North Carolina

Starting in 2011, Carolyn Willingham, a tutor at the University of North Carolina, complained to the press about fake classes for athletes. In place of an education, she said, athletes, some of whom could barely read, were encouraged to take fake classes, such as classes that never met.

Jim Dean, executive vice chancellor and provost, responded to her charges like this:

Dean asked Willingham to provide raw test data supporting her analysis. She declined, explaining that she’d obtained the confidential information by promising the university’s Institutional Review Board not to share it with anyone. She told Dean he could obtain the data directly from the athletic department, which gathered it in the first place. He declined to do as she suggested. “If she had the proof,” Dean says, “why wouldn’t she share the proof?”

Later Dean handled Willingham’s charges like this:

Dean said of Willingham: “She’s said our students can’t read, our athletes can’t read, and that’s a lie.”

In fact, Willingham had said

18 out of the 183 special admit athletes whose records she assessed read at roughly a third-grade level. An additional 110 of the athletes, she said, read at between fourth- and eighth-grade levels. She never said that most, let alone all, of the 800 athletes at UNC are illiterate, and she said nothing at all about the other 18,000 undergraduates.

When challenged, Dean conceded he’d misspoken.

Even the reporter, apparently, finds Dean’s defense repugnant. An important detail is that Willingham, who is wealthy, did not need the job. She was free to say whatever she wanted.

Sleep and Depression: More Links

In 1995, hoping to improve my sleep, I decided to watch TV early in the morning, for reasons explained here. One Monday morning I watched tapes of Jay Leno and David Letterman that I’d made. Nothing happened. On Tuesday, however, I woke up and felt great: cheerful, eager and yet somehow calm. I had never felt so good so early in the morning. Monday had been a normal day, I had slept a normal length of time. The good feeling was puzzling. Then I remembered the TV I had watched. It had seemed so innocuous. The notion that 20 minutes of ordinary TV Monday morning could make me feel better Tuesday but not Monday seemed preposterous. Absurd. Couldn’t possibly be true.

Except for one thing. I had done something to improve my sleep. Plenty of research connected sleep and depression. That research made it more plausible that something done to improve sleep would improve mood. I went on to confirm the morning faces/mood linkage in many ways. The research connecting sleep and depression had been the first signs of a hidden mechanism (we need to see morning faces for our mood regulatory system to work properly) I consider very important.

Two new studies further connect sleep and depression. One of them found that people who sleep normal amounts of time are less influenced by genes associated with depression than those who sleep longer or shorter lengths of time. The other found that teenagers who sleep less than usual are at greater risk of depression.

The theories that psychiatrists have used to justify anti-depressants (e.g., “chemical imbalance”) do not explain the many connections between sleep and depression. Depression is associated with lots of bad things, unsurprisingly, but the association with bad sleep is especially strong. It is not easily explained away. You might think that if you are depressed you are more tired than usual and therefore sleep more/better than usual. The opposite is true.  All this might have generated, among psychiatric researchers, a search for a better theory — an explanation of depression that can explain the sleep/depression connections — but it hasn’t.


“We Need Only One Santa”: My Answer to Grand Health Promises

“We need only one Santa” is a line from a video by Icelandic’s Best Party, which won enough support that its leader, Jon Gnarr, became mayor.

“We need only one Santa” would have been a good response to any big health promise in the last 20 years. Not one has come true, just as there is no Santa Claus. “Beating cancer now is a realistic ambition because, at long last, we largely know its true genetic and chemical characteristics,” wrote James D. Watson, co-discoverer of the structure of DNA, in 2009. We need only one Santa, Dr. Watson.

At the NIH, “one of our biggest projects is the BRAIN initiative . . . We are bringing together the best and the brightest people from a variety of disciplines to figure out, over the next 10 years, exactly how the brain works,” said Francis Collins, head of the NIH, a few days ago. We need only one Santa, Dr. Collins.

The Polio Vaccine Disaster: Precursor of the Obamacare Website Fiasco

When friends complain about evil government (e.g., NSA surveillance), I tell them “never underestimate the stupidity of government employees” — by which I mean their stupidity outweighs their self-interest. The Obamacare website fiasco is a good illustration. Everyone has heard “power corrupts” but closer to the truth is power makes you stupid.

The Obama website fiasco had many precursors. One was in the 1950s — in the details of the introduction of the polio vaccine.

Rather than staging a long series of careful field trials with appropriate scientific evaluation, Salk darted ahead on his own in the remainder of 1953 and 1954. The trials were successful. The foundation released the results to the press, and such were the nation’s expectations that from that point there was no turning back. In August 1954 the foundation ordered five drug companies to begin producing mass lots of vaccine, on the basis of a formula for inactivating the virus with formaldehyde, according to a procedure Salk himself had devised. . . . James Shannon remembered very well what happened next. At this point he had become the associate director of the NIH.  “I was working over the weekend and I got a telephone call from Los Angeles, and this is eight or nine o’clock on Friday night. It was the Health officer of the City of Los Angeles and he said they just had two reports of polio in some children who had been vaccinated nine days earlier. He wanted to know what should be done about it?”

One of the companies that contracted to make the vaccine, the Cutter Laboratories in Berkeley, California, had released several lots of vaccine that had been improperly inactivated. Live polio virus was being injected into children. The gratitude of the public turned to horror, as the cutter vaccine gave polio to almost 80 recipients; these children in turn went on to spread the disease to another 120 playmates and relatives; three quarters of the victims were paralysed and 11 died. . . . NIH’s Laboratory of Biologics Control, which had certified the Salk vaccine, had received advance warning of problems. . . .

In 1954 the rush was on. [Eddy’s] lab had gotten samples of the inactivated polio vaccine to certify on a “due-yesterday” basis. “This was a product that had never been made before and they were going to use it right away,” she recalled. She and her staff worked around the clock. “We had eighteen monkeys. We inoculated these eighteen monkeys with each vaccine that came in. And we started getting paralyzed monkeys.” She reported to her superiors that the lots were Cutter’s, and sent pictures of the paralyzed monkeys along as well. “They were going to be injecting this thing into children. . . .They went ahead and released the vaccine anyway, a lot of it. The monkeys they just disregarded.”

Shannon called the Surgeon General Satur­day morning. Additional cases of paralysis continued to occur. “It seemed obvious that we had a crisis on our hands, the magnitude of which was unknown.” Late Saturday afternoon a working group of senior virus specialists, whose advice the polio foundation had started to ignore a year earlier, began meeting in Shannon’s office. Note that Shannon had completely taken charge of the crisis. “Sebrell was not the man to manage this,” DeWitt Stetten recalled. ‘James Shannon was a man of quite different character.”

Shannon had brought in the Surgeon General, who called polio chief Basil O’Connor in New York. On Monday evening O’Connor and his advisers came down to Bethesda. Shannon wanted to withdraw the vaccine, “It was a very stormy meeting,” he said. “O’Connor and the polio group in general disallowed any possibility of induced infections [as a result of the vaccine]. … So Basil O’Connor stormed out with dire warning of what he was going to do to the NIH and the Public Health Service. Further vaccination was stopped. I had many sleepless nights.”

The basic problem had really not been the carelessness of the Cutter company, which rightly or wrongly was exonerated in a later report. It was the difficulty in jumping from Salk’s lab experiments with killing (formalinizing) the virus to large-scale industrial production.

. . . Ruth Kirschstein, the director today of an important NIH institute, added, “The Cutter incident resulted in everybody up the line who had anything to do with it—very few people know this story—being dismissed because of it.” All went out: the director of the microbiology institute lost his post, as did the equivalent of the assistant secretary for health. Oveta Culp Hobby, the secretary of Health, Education and Welfare (or Oveta “Culpable” Hobby, as she was known), stepped down. Dr. Sebrell, the director of the NIH, resigned.

Whereas I think the “basic problem” was overestimating the competence of powerful people, especially powerful experts.

Who is the Smartest Person Who Believes Climate Change Fear-Mongering?

A few days ago I read about Apple CEO Tim Cook’s response to a shareholder complaint about sustainability programs:

At a shareholders meeting on Friday, CEO Tim Cook angrily defended Apple’s environmentally-friendly practices against a request from the conservative National Center for Public Policy Research (NCPPR) to drop those practices if they ever became unprofitable.

I support the practices Cook defended. But the incident was summarized by a headline writer like this: “Tim Cook tells off climate change deniers.” I am a climate change denier in the sense that I don’t believe that there is persuasive evidence that humans are dangerously warming the planet.

The headline — not what actually happened — reminded me of something surprising and puzzling I noticed soon after I became an assistant professor at Berkeley. I attended several colloquium talks — hour-long talks about research, usually by a visitor, a professor from somewhere else — every week. Now and then the speaker would omit essential information. Such as what the y axis was. Or what the points were. The missing information made it impossible to understand what the speaker was saying.

I didn’t expect graduate students to interrupt to ask for the missing info but surely, I thought, one of the five or eight professors in the room would. We all need to know this, I thought. Yet none of them spoke up. I cannot think of a single example of a professor speaking up when this happened (except me). Even now I am unsure why this happened (and no doubt still happens). Maybe it reflects insecurity.

I mention climate change on this blog because it is interesting that so many intelligent supposedly independent-thinking people actually believe, or claim to believe, that humans are dangerously warming the planet. The evidence for the supposedly undeniable claim (“97% of scientists agree!”) is indistinguishable from zero. Of course journalists, such as Elizabeth Kolbert of The New Yorker and Bill McKibben (a former journalist), are often English majors and intimidated by scientists. I don’t expect them to question what scientists say, although questioning authority is half their job. Of course actual climate scientists do not dissent, for fear of career damage. It is when smart people who are not journalists or climate scientists take this stuff seriously that I am impressed. Just as I was impressed by Berkeley professors who did nothing when they didn’t understand what they were being told.

It seems to me that the smarter you are the more easily you can see that climate change fear-mongering is nonsense. There must be some other important human quality (conformity? religiosity? diffidence? status-seeking? fear of failure?) that interferes with intelligence in non-trivial ways. To try to figure out what the quality is, I ask: who is the smartest person you know who believes global warming fear-mongering? Does that person do other extreme or unusual things? These might shed light on what the intelligence-opposing personality trait is.

People talk about intelligence quite often (“you’re so smart!” “she’s very bright”). Many people, including me, think it matters. There are tests for it. But this other trait, which can negate intelligence and therefore is just as important…not so much. In my experience, not at all. My fellow Berkeley professors were very smart. But they were also something else, much less apparent.

How to Brew Black Tea

After I discovered the Shangri-La Diet (2000), I started drinking lots of tea. Tea has smell without calories, which complemented the calories without smell of the diet. Mostly I drink black tea — more complexity than green or oolong tea. Until recently, I made it the usual (Western) way. 1. Add hot water to tea. 2. Wait 3-4 minutes. 3. Add cream and sweetener. 4. Drink. 5. Throw away tea.
Continue reading “How to Brew Black Tea”

Brain Test Phenomenology: Bad Beijing Restaurant?

2014-02-25 bad restaurant maybe

This graph shows recent results from the test I used to track my brain function. The test is a choice reaction task done on my laptop: see a digit (e.g.,”2″), press the corresponding key as fast as possible. The x axis shows the time of the test. The ticks (“Sat”, etc.) mark the beginning of the associated days. The y axis shows the average percentile of the reaction times. Higher percentile = faster. (Let me explain what “percentile” means: Each reaction time is compared to earlier reaction times with the same stimulus, and its percentile is computed. For example, a percentile of 60 means that 60% of previous responses were slower.) An average of 60 is quite good and 40 is quite bad. I usually do two tests per day, one right after the other, in the late afternoon (e.g., 4:30 pm). Continue reading “Brain Test Phenomenology: Bad Beijing Restaurant?”

Fermented Foods, Eczema, and the Room for Improvement in Medicine

When I was a graduate student, I had acne. Via self-experiment, I discovered that the antibiotic my dermatologist had prescribed didn’t work. He appeared unaware of this possibility, although antibiotics were (and are) very commonly prescribed for acne. “Why did you do that?” he said when I told him my results. As I’ve said before, I was stunned that in a few months I could figure out something important that he, the expert, didn’t know. He had years of training, practice, and so on. I had no experience at all. Eventually I gathered additional and more impressive examples — cases where I, an outsider with no medical training, managed to make a big contribution with tiny resources. The underlying message seemed to be that professional medicine rested on weak foundations, in the sense that big conclusions could be overturned with little effort.

Two recent posts  (here and here) on this blog argue that eczema, which afflicts about 10% of Americans, can be cured and prevented with fermented foods. This observation makes perfect sense because of two pre-existing ideas: 1. Eczema is due to an overactive immune system. 2. Fermented foods “cool down” that system (a variant of the hygiene hypothesis). Professors of dermatology failed to put them together, but people outside medicine were able to.

After I learned that eczema could be cured easily and safely, statements by medical professionals about eczema became horrifying. A dermatologist recently wrote about eczema on Reddit:

Eczema is a chronic condition, which includes hand eczema. It’s a condition of dry and sensitive skin. Topical steroids are a useful adjunct in getting your skin clear, and – in certain cases – keeping your skin clear. I tell my patients that the most important thing in management of eczema is the skin care regimen. This means avoidance of irritating factors and restoration of the skin barrier.

The National Eczema Association:

The exact causes of eczema are unknown. You might have inherited a tendency for eczema.. . . Many doctors think eczema causes are linked to allergic disease, such as hay fever or asthma. Doctors call this the atopic triad. Many children with eczema (up to 80%) will develop hay fever and/or asthma.

The Mayo Clinic website: “The cause of atopic dermatitis is unknown, but it may result from a combination of inherited tendencies for sensitive skin and malfunction in the body’s immune system.”  The various remedies listed have nothing to do with the immune system.

What else don’t they know? Doctors have great power over our well-being. Imagine learning that the driver of the car you are in is nearly blind.