Archive for the ‘Health’ Category
I was just reading (or, more accurately, re-reading) a passage in Timothy Wilson’s Strangers to Ourselves, that gives some insight into the Japanese military bureaucracy’s resistance to accepting a proven solution to a serious problem. Here’s the passage:
The adaptive unconscious is not governed by accuracy and accessibility alone. People’s judgments and interpretations are often guided by a quite different concern, namely the desire to view the world in the way that gives them the most pleasure—what can be called the “feel-good” criterion. Jane Eyre observed this motive in her aunt, Mrs. Reed, when she visited her on her deathbed: “I knew by her stony eye—opaque to tenderness, indissoluble to tears—that she was resolved to consider me bad to the last; because to believe me good would give her no generous pleasure: only a sense of mortification.”
One of the most enduring lessons from social psychology is that like Mrs. Reed, people go to great lengths to view the world in a way that maintains a sense of well-being. We are masterly spin doctors, rationalizers, and justifiers of threatening information. Daniel Gilbert and I have called this ability the “psychological immune system.” Just as we possess a potent physical immune system that protects us from threats to our physical well-being, so do we possess a potent psychological immune system that protects us from threats to our psychological well-being. When it comes to maintaining a sense of well-being, each of us is the ultimate spin doctor.
People who grow up in Western cultures and who have an independent view of the self tend to promote their sense of well-being by exaggerating their superiority over others. People who grow up in East Asian cultures and have a more interdependent sense of self are more likely to exaggerate their commonalities with group members. That is, people who grow up in cultures with an interdependent view of the self may be less likely to engage in tactics that promote a positive self-view, because they have less investment in the self as an entity separate from their social group. Nonetheless, nonconscious spin doctoring occurs in order to maintain a sense of well-being, though the form of the doctoring differs. What makes us feel good depends on our culture and our personalities and our level of self-esteem, but the desire to feel good, and the ability to meet this desire with nonconscious thought, are probably universal.
To what extent is the psychological immune system part of the adaptive unconscious? Sometimes we act on the “feel-good” motive quite consciously and deliberately, such as avoiding an acquaintance who is always criticizing us, or trying to convince ourselves that we failed to get a promotion not because we were unqualified, but because the boss was an insensitive ox. Given that the adaptive unconscious plays a major role in selecting, interpreting, and evaluating incoming information, though, it is no surprise that one of the rules it follows is “Select, interpret, and evaluate information in ways that make me feel good.” Furthermore, there is reason to believe that the adaptive unconscious is a better spin doctor than the conscious mind. As Freud noted, psychological defenses often work best when they operate in the back alleys of our minds, keeping us blind to the fact that any distortion is going on. If people knew that they were changing their beliefs just to make themselves feel better, the change would not be as compelling.
A key question concerns how the accuracy and “feel-good” criteria operate together, because they are often incompatible. Consider Jack, who failed to get an anticipated promotion. If accuracy were his only criterion, Jack might well conclude that he did not have the experience or ability to handle the new position. Instead, he uses the “feel-good” rule and concludes that his boss is an idiot. But is it really in his best interests to pat himself on the back and blame his boss? If he does not have the experience or ability to do the job, wouldn’t he be better off to swallow his pride and work harder?
The conflict between the need to be accurate and the desire to feel good about ourselves is one of the major battlegrounds of the self, and how this battle is waged and how it is won are central determinants of who we are and how we feel about ourselves. The best way to “win” this battle, in terms of being a healthy, well-adjusted person, is not always obvious. We must, of course, keep in touch with reality and know our own abilities well enough to engage in self-improvement. But it turns out that a dose of self-deception can be helpful as well, enabling us to maintain a positive view of ourselves and an optimistic view of the future.
You can see, in reading the account of Dr. Takaki’s struggle to get the military to accept an effective treatment for (and preventive of) beriberi, how the military establishment desperately wanted to think of itself as “modern,” being freed from the blind superstition of “folk medicine cures” (even when those cures worked). They wanted labs and microbe-caused diseases.
They show a profound misunderstanding what science is. Science does not necessarily mean laboratories. It means posing questions whose answers are obtained by observing what actually happens. It would have been easy to have one group follow the traditional diet and another a modified diet and see what happens—and that is what Dr. Takaki in fact did. But the military (the Navy, in this case) rejected the finding because the answer was not the sort of answer they wanted.
Voluntary blindness to facts and willful ignorance is always surprising. And it’s not a problem of the 19th century. For a 21st century example, see Oklahoma’s dim-witted approach to their earthquake problem: they refuse to see the answers they don’t want.
Is it possible to escape this idiotic refusal to look at the facts? I don’t think so. Institutions (business corporations, governments, bureaucracies) protect themselves—the institutional immune system—and we give great power to those institutions, so we have to accept that they will go to great lengths to ignore facts that threaten them. Another good example is the refusal to act to mitigate climate change: regardless of the magnitude of the threat, willful ignorance prevails and fights against effective action.
The story of Dr. Takaki, reported by James Simpson at War is Boring, is well worth reading. You can see the exactly analogies between the resistance to Dr. Takaki’s findings and Oklahoma’s resistance to understanding its earthquake problem and the resistance of the GOP to understanding climate change. Dr. Takaki’s story begins:
In August 1882 in Incheon Bay near Seoul, four Japanese warships were locked in a tense stand-off with two Chinese warships that had brought troops to quell a revolt on the Korean peninsula.
On paper, the Japanese flotilla outnumbered the Chinese, but the hulls of the Japanese ships hid a deadly secret. Less than half of their crews could man their stations.
The Korean peninsula erupted into conflict on July 23. A soldiers’ protest against ill treatment, unpaid wages and poor provisions turned into widespread mutiny. Ousted from power, the former regent of the king set the mutineers upon the government—and against the Japanese advisers working to modernize the Korean army.
Korean soldiers cornered the chief military adviser in his quarters and stabbed him to death. Another 3,000 mutineers attacked the Japanese Legation. The ambassador ordered his men to burn down the compound and then led his staff to a nearby harbor where they caught a ferry to Incheon.
In lashing rain, the rebels chased the Japanese all the way to the port, killing six and wounding five. The roughly two dozen survivors boarded a small boat and cast off. The next morning, the British sloop HMS Flying Fishspotted the row boat and carried the refugees to Nagasaki.
It was a humiliating blow, but the Japanese were not gone for long. The ambassador soon returned to Seoul. This time he had backup.
Four warships sailed alongside to ensure the safe arrival of the ambassador’s government schooner. As ground forces led the ambassador back to Seoul,Kongo, Nisshin, Hiei and Seiki anchored in Incheon Bay. Two Chinese ships also sailed into Incheon at the request of the Korean king.
Tensions between Japan, China and Korea were at an all-time high. Japan was East Asia’s first modern imperialist nation and its neighbors felt threatened by its new ways.
Unknown to the Chinese and Koreans, the Japanese ships were running far below fighting strength. Disease struck down 195 of Kongo’s 330 sailors. Similarly Hiei was down to a third of her regular strength, and Nisshin andKiyoteru weren’t faring much better. The sailors were lethargic, sluggish and—at worst—paralyzed.
There was no one to relieve them. The warship Fusou—designated to reinforce the mission—was in terrible shape back in Tokyo. The same disease had debilitated 180 of its 309 crew.
Sixteen per cent of all disease and injury in the Imperial Japanese Navy in 1882 stemmed from this one sickness. Beriberi. It was a great shame on the nation that one young doctor hoped to cure.
A beriberi big problem
Beriberi—kakke in Japanese—affected all levels of Japanese society, but it became especially prevalent among the urban residents of Edo, the classic name for Tokyo. The disease became known as the “Edo sickness.” Art from the period shows men in wheelchairs afflicted with beriberi.
The malady completely immobilizes its victim, as discussed by English explorer Isabella Bird in her 1880 book Unbeaten Tracks in Japan. “Its first symptoms are a loss of strength in the legs, ‘looseness in the knees,’ cramps in the calves, swelling and numbness.”
“The chronic [form] is a slow, numbing and wasting malady,” Bird continued, “which, if unchecked, results in death from paralysis and exhaustion in from six months to three years.”
At the time, the causes of the disease were unknown. It became the subject of great debate among Western medical personnel in Japan. Basil Hall Chamberlain, a preeminent Japanologist, demonstrated the lack of understanding of the disease’s causes in his 1890 Things Japanese: Being Notes on Various Subjects Connected with Japan.
“The disease springs, in the opinion of some medical authorities, not from actual malaria, as was formerly imagined, but from a climatic influence resembling malaria,” Chamberlain wrote. “Others have sought its origin in the national diet—some in rice, some in fish.”
“In favor of this latter view is to be set the consideration that the peasantry, who often cannot afford either rice or fish, and have to eat barley or millet instead, suffer much less than the townsfolk,” Chamberlain continued.
But the disease wasn’t contagious. We now know that beriberi stems from a lack of vitamin B1, which the body requires for metabolizing carbohydrates and maintaining neurological functions. Without it, a person succumbs to nerve damage and eventually death.
The source of the deficiency was the urban diet. . .
Continue reading. Read the whole thing.
My weight crept up, and when I read this post at DietDoctor.com, I realized why: I have fallen into eating more carbs. I like the Picadillo recipe, but I did not realize how intensely carb-heavy raisins are—and I get too many raisins in a portion. As he points out in the post:
And my latest HbA1C was not 5.7% as it has been, but 6.0%: pre-diabetic. (Got the lab report today.) That is probably due to a combination of more carbs and more weight. So now I’m watching it.
If I’m honest, it wasn’t just the raisins in the picadillo. There were also a number (in two digits) of chocolate truffles over the past few weeks, dessert when we ate dinner in a restaurant—plus the bread at the restaurant and in a sandwich… I’m sure if I had been tracking my food I would find plenty of carbs sneaking in.
No more. I’m now being extra careful (and the weight is dropping: last Thursday I was at 229.2; today, 223.1. (The Thursday figure was an overnight gain, so naturally it deflated quickly: the day before, on Wednesday, I was 227.8, which was more like a real weight. But still: down 4.7 lbs from that.)
When you observe both low carbs (less than 20g net carbs = total carbs – fiber) and also keep the total calories at a reasonable level, the weight melts off pretty quickly.
I really need to be more vigilant about carbs and truly avoid them.
Understanding is, I believe, a good thing to do. The drive to understand created philosophy, science (via natural philosophy), mathematics, and (arguably) literature, drama, and religion. Aristotle famously observed that “All men by nature desire to know,” but I think “All by nature desire to understand.” One reason arbitrary judgments are unsettling is that they cannot be understood: no rationale or reasoning is attached, and the need for understanding goes unfulfilled, leaving a kind of gasping for breath like a fish on shore.
In Religion Dispatches Michael Schulson takes a look at efforts to understand why some parents reject medical care that would have saved their children’s lives.
Collect all the evidence that vaccines cause autism and endanger children, and you will have a very, very thin file.
Collect all the evidence that there’s an appeal to believing that vaccines cause autism and endanger children, though, and you will have more than a file. You will have the work of an entire culture.
Just look around. Whole fields of marketing and spiritual counseling argue that there’s something inherently corrupt about modern society. There’s a cultural industry dedicated to encouraging us to break the rules, to “think different“; conforming to a big system is evil, rebellion is virtuous. Meanwhile, a whole library of religious traditions tell us that a better life can be found among the chosen, the saved, or the elect who obey a different set of rules from society at large.
When it comes to anti-vaxxers, critics don’t usually talk about culture or politics. Instead, they focus on the science, or on science outreach. (Collect all the writing detailing or examining the appeal of the anti-vaxxer stance, and you’d have another very thin file). But what could be more modern, and more conformist, than the government-recommended schedule of vaccines? The medical system is huge. It’s hierarchical. It’s powerful. It creates rules that apply to the entire population, and it works best when everyone participates.
Immunity is one of those elusive social goods that only works if (nearly) everyone opts in. When a population is thoroughly vaccinated, even the stray unimmunized child will be safe. No one is around to get her sick. There’s no cost for opting out, until enough people do so that the population is peppered with unvaccinated dissenters, and, bam: measles outbreak at Disneyland. It’s not just the children of anti-vaxxers who are falling sick, either. Low vaccination rates endanger kids too poor, too young, or too immunocompromised to have received the full suite of immunizations.
Today, children are falling ill from diseases that seem like relics of the 1950s. National attention is starting to pivot toward those parents who lodge conscientious objections against modern medicine. Lawmakers in North Carolina recently introduced legislation to make vaccines mandatory, with no exemption for religious objectors, such as Christian Scientists. (After backlash, the proposal’s bipartisan sponsors withdrew the legislation). Other states are following suit.
Meanwhile, the culture at large continues to idolize its principled renegades. Two recent releases—one a nonfiction book, the other a feature film—highlight our culture’s weird disconnect between semi-spiritual libertarian fantasies and the grim realities in which those rebel dreams, once enacted, can leave us mired.
‘Bad faith,’ sloppy analysis
In 2010, sixteen year-old Neal Beagley died from a bladder obstruction. Doctors can fix these kinds of blockages easily. But Beagley, a member of the Followers of Christ Church, in Oregon, had avoided medical treatment, in accordance with his church’s beliefs—and the wishes of his parents. “This is who we are,” his mother, Marci Beagley, told investigators. “This is what we do.”
Why do people like the Beagleys do what they do? That’s the question behind Bad Faith (Basic, 2015), Paul Offit’s new book about parents who seek to exempt their children from medical care on religious grounds.
A doctor, a vaccine educator, and a professor of vaccinology at the University of Pennsylvania, Offit has made his name rebutting anti-vaccination activists, most notably in his 2010 book Deadly Choices. As such, he is a practiced observer of postmodernity’s strangest class of conscientious objectors: those who, in the name of well being, exempt themselves from the most effective medical system in history.
It’s no surprise that Offit would eventually find his way to religion. Very, very few religious people avoid medicine entirely, but those who do so form a subculture large enough to merit national attention. One study mentioned in Bad Faith identified 172 deaths of children whose parents had withheld lifesaving medical treatments on religious grounds between 1975 and 1995. One of the authors of the study described the toll as “Jonestown in slow motion.”
It’s not just Christian Scientists. Small church movements around the country reject modern medicine, generally substituting some kind of faith healing. Constitutional law gives the state opportunities to intervene on behalf of children in these households. As Offit chronicles, though, states often do not.
To his credit, Offit doesn’t spin off into condemnations of religion, writ large. Instead, he digs into the New Testament, where he finds plenty of faith healings, but also plenty of calls to care for children, and nothing to imply that modern medicine would be corrupting. Ergo, religion must not be the problem, bad religion must be the problem.
Offit understands bad religion as a product of social coercion, mental illness, or clumsy interpretations of scripture. No doubt, he’s partly right: coercion happens. The line between religious fervor and mental illness is not always so easy to define. People interpret scripture in deadly ways.
Unfortunately, Offit is unable to look beyond his clumsy parceling of religion into good faith and bad faith. When it comes to religious objections to medical treatment, there are two other, more disturbing possibilities that Offit doesn’t seem equipped to even consider. The first is that there’s something legitimately frightening about the medical system for many Americans—a fear that’s absorbed into religious ideologies. Certainly, distrust of doctors can seem epidemic, and anti-vaccination activists play on fears of shadowy pharmaceutical cabals and deadly chemicals, some of which is rooted in legitimate fears.
A second possibility is that . . .
Our government has turned against its citizens in many areas, including the FDA. Instead, the government has taken on the mission of protecting businesses and their profits, abandoning its protection of the public. Anahad O’Connor reports in the NY Times:
Popular weight-loss and workout supplements on sale in hundreds of vitamin shops across the nation contain a chemical nearly identical to amphetamine, the powerful stimulant, and pose dangers to the health of those who take them, according to a new study. The Canadian health authorities in December called the chemical, BMPEA, “a serious health risk,” and pulled supplements that contain it from store shelves.
The Food and Drug Administration documented two years ago that nine such supplements contained the same chemical, but never made public the names of the products or the companies that made them. Neither has it recalled the products nor issued a health alert to consumers as it has done with other tainted supplements. The F.D.A. said in a statement that its review of supplements containing the stimulant “does not identify a specific safety concern at this time.”
But public health experts contend that the F.D.A.’s reluctance to act in this case is symptomatic of a broader problem. The agency is not effectively policing the $33 billion-a-year supplements industry in part because top agency regulators themselves come from the industry and have conflicts of interest, they say. In recent years, two of the agency’s top officials overseeing supplements — including one currently on the job — were former leaders of the largest supplement industry trade and lobbying group.
Daniel Fabricant, who ran the agency’s division of dietary supplement programs from 2011 to 2014, had been a senior executive at that trade group, the Natural Products Association, which has spent millions of dollars lobbying to block new laws that would hold supplement makers to stricter standards. He left the F.D.A. last year and returned to the association as its chief executive. His current replacement at the F.D.A.’s supplement division also comes from the trade group.
“To have former officials in the supplement industry become the chief regulators of that industry at the F.D.A. is like the fox guarding the hen house,” said Michael F. Jacobson, the executive director of the Center for Science in the Public Interest, a consumer advocacy group.
The Supplements Found To Contain BMPEA . . .
The Obama Administration at work, protecting businesses, ignoring the public interest.
Barry Estabrook writes in the NY Times:
PRESIDENT OBAMA didn’t need to issue a $1.2 billion National Action Plan for Combating Antibiotic-Resistant Bacteria, which he did last week, to figure out how the United States could reduce the antibiotic-resistant bacteria created by the country’s agriculture industry. He could have simply spent a day with Kaj Munck, a Danish hog farmer.
Mr. Munck is a husky, loquacious man who lives about an hour south of Copenhagen. His operation looks and smells a lot like the factory pig farms I have visited in the American Midwest. The 12,000 pigs he raises each year — making his operation larger than the average American producer — live in cramped stalls with hard floors inside low-slung warehouselike structures. Mr. Munck can produce pork at prices low enough to compete in the same international markets as American pork. In fact, a large number of the popular baby back ribs served in the United States are imported from Danish farms like his.
But there is one big difference between Danish hog farms and those in the United States that does meet the eye (or nose). Since 2000, Danish farmers have raised pigs without relying on regular doses of antibiotics — while in the United States, perfectly healthy pigs and other livestock are frequently given low levels of antibiotics in their food or water to prevent disease, a practice that also enhances their growth.
Such regular doses of antibiotics contribute to the development of drug-resistant “superbugs,” of the type that kill 23,000 Americans a year, according to the Centers for Disease Control and Prevention. One goal of the National Action Plan is to “eliminate the use of medically important antibiotics for growth promotion in food producing animals and bring other in-feed uses of antibiotics, for treatment and disease control and prevention of disease, under veterinary oversight” by 2020.
But even if the goal is met, American livestock farmers will still face far less stringent antibiotics regulations than their Danish counterparts already follow.
Leading me inside his barn, Mr. Munck unlocked a medicine cabinet that contained a dozen or so bottles of antibiotics. He said that he usually administered antibiotics to sick animals individually, but he could add medication to feed if an entire pen became infected. He told me that he could get the antibiotics only when they were prescribed by a veterinarian, and that he had to purchase them from a pharmacy.
Danish veterinarians cannot dispense antibiotics except in emergencies, removing any financial incentives to overprescribe. The pharmacy that Mr. Munck buys his drugs from enters information about his purchases into a national database that allows the government to track exactly how much of which antibiotics each vet prescribes and each farmer uses. And any antibiotics Mr. Munck acquires have to be administered or destroyed within 35 days.
Once a year, Danish veterinarians meet with government officials to . . .
Continue reading. The article concludes:
The Danish pork industry did have some early problems with mortality among young pigs. But it overcame those by allowing piglets to nurse longer, by feeding them more nourishing rations and by receiving monthly preventive visits to farms by vets. Overall use of antibiotics in livestock has fallen by 50 percent in Denmark, even as the hog herd has increased significantly in size. Levels of resistant bacteria on farms tumbled. Mr. Munck said his animals experienced no more bacterial infections than they used to. And despite predictions to the contrary, pigs in Denmark gain weight as efficiently as they did before the introduction of the antibiotic controls.
Farmers still use antibiotics frequently, mostly to cure diarrhea and treat infected wounds, Mr. Munck said. But that’s the purpose of antibiotics. “The idea is to use as little antibiotic as possible but as much as needed,” he said.
Researchers at Iowa State University ran numbers to determine what it would cost American pork producers to put a Danish-style control system in place. The total was only $4.50 per animal, less than three cents more for a pound of pork — a pittance if it means keeping antibiotics that save human lives effective.
Jane Brody reports in the NY Times:
. . . A series of large studies, including the Nurses’ Health Study of 76,464 women and the Health Professionals Follow-Up Study of 42,498 men, found that the more nuts people consumed, the less likely they were to die at any given age, especially of cancer or heart disease. And aclinical trial conducted in Spain showed that death rates were lower among those consuming a Mediterranean diet supplemented with extra nuts.
However, these studies were conducted almost entirely among relatively well-to-do, well educated, white individuals, and despite the researchers’ care in controlling for other factors that could have influenced the results, there remained the possibility that characteristics of the participants other than nut consumption could account for their reduced death rates.
Now, strong links between nuts and peanuts and better health have also been found in a major study of people from lower socioeconomic backgrounds and varied ethnic groups — blacks, whites and Asians — many of whom had serious risk factors for premature death, like smoking, obesity, high blood pressure and diabetes.
The results were published in March in JAMA Internal Medicine by researchers at Vanderbilt University School of Medicine. Their study, conducted among more than 200,000 men and women in the Southern United States and Shanghai, found that the more nuts people consumed, the lower their death rates from all causes and especially from heart disease and stroke.
And while it is true that more people today are allergic to nuts, and to peanuts in particular, than ever before, two recent studies have pointed to ways that may prevent children from developing a nut allergy. The first study, published last year in JAMA Pediatrics, found that women who consumed the most nuts or peanuts during their pregnancies were least likely to have children with this allergy. The reduction in risk was highest among children whose mothers ate nuts five or more times a month.
The second study, published in February in The New England Journal of Medicine, found that introducing peanuts into the diets of infants 4 to 11 months old who were considered at high risk of developing a peanut allergy actually greatly reduced their risk of being allergic at age 5. . .
All the misinformation that Ancel Keys forced onto the medical profession and the public—he was a consummate bully—is gradually being corrected. Eggs are not a problem. Bacon is not a problem. And now: beef is not a problem. (All that is from the dietary point of view: other considerations may apply.)
Aaron Carroll reports in the NY Times:
There are people in this country eating too much red meat. They should cut back. There are people eating too many carbs. They should cut back on those. There are also people eating too much fat, and the same advice applies to them, too.
What’s getting harder to justify, though, is a focus on any one nutrient as a culprit for everyone.
I’ve written Upshot articles on how the strong warnings against salt andcholesterol are not well supported by evidence. But it’s possible that no food has been attacked as widely or as loudly in the past few decades as red meat.
As with other bad guys in the food wars, the warnings against red meat are louder and more forceful than they need to be.
Americans are more overweight and obese than they pretty much have ever been. There’s also no question that we are eating more meat than in previous eras. But we’ve actually been reducing our red meat consumptionfor the last decade or so. This hasn’t resulted in a huge decrease in obesityrates or deaths from cardiovascular disease.
This is the real problem: We eat more calories than we need. But in much of our discussion about diet, we seek a singular nutritional guilty party. We also tend to cast everyone in the same light as “eating too much.”
I have seen many people point to a study from last year that found that increased protein intake was associated with large increases in mortality rates from all diseases, with high increases in the chance of death fromcancer or diabetes. A close examination of the manuscript, though, tells a different story.
This was a cohort study of people followed through the National Health and Nutrition Examination Survey, or Nhanes. It found that there were no associations between protein consumption and death from all causes or cardiovascular disease or cancer individually when all participants over age 50 were considered. It did detect a statistically significant association between the consumption of protein and diabetes mortality, but the researchers cautioned that the number of people in the analysis was so small that any results should be taken with caution.
The scary findings from two paragraphs up are from a subanalysis that looked at people only 50 to 65. But if you look at people over 65, the opposite was true. High protein was associated with lower levels of all-cause and cancer-specific mortality. If you truly believe that this study proves what people say, then we should advise people over the age of 65 to eat more meat. No one advises that.
Further, this study defined people in the “high protein” group as those eating 20 percent or more of their calories from protein. When the Department of Agriculture recommends that Americans get 10 to 35 percent of their calories from protein, 20 percent should not be considered high.
If I wanted to cherry-pick studies myself, I might point you to this 2013 study that used the same Nhanes data to conclude that meat consumption is not associated with mortality at all.
Let’s avoid cherry-picking, though. A 2013 meta-analysis of meat-diet studies, including those above, found . . .