Epidemiology
Biological Immortality
There’s a scientific paradox in the world of nutrition about what the optimal diet is. A new theory may resolve the paradox. Oh, and help you live forever too.
The majority consensus is the “post-agricultural revolution diet” is best, which says that a majority of your intake should be vegetables and fruits, and that you should severely limit your animal product intake, especially red meats. Some proponents (like T. Colin Cambell of China Study fame) go as far as claiming that a strictly vegan diet is best.
The other camp argues for the “paleo” or “caveman” diet, which says we need to eat what our paleolithic ancestors ate: lots of foods high in animal fat and animal protein, and avoid industrialized grains altogether (some fermented natural grains are fine). Fermented foods in general are encouraged, honoring the fact that before preservation, refrigeration and pasteurization we evolved a symbiosis with bacterias that are critical for our digestion and processing of nutrients.
Both sides agree that processed …
Sunlight vs. Vitamin D
[This is part 3 of Epidemiology vs. Etiology]
You may have heard there is an epidemic of low vitamin D levels in the U.S. An estimated 60% of Americans are at a level that has been correlated with increased risk of nearly all chronic diseases, including cancer, heart disease, diabetes, autoimmune diseases, and depression. My personal belief is that the epidemiology is horribly flawed. But perhaps not in the way you might think….
As most people know by now, we humans photosynthesize vitamin D in our skin when it is exposed to direct sunlight. How fast depends on our ethnicity and amount of exposure. Since I’m light skinned and get a lot of sun in my normal life, it came as a huge surprise when some routine bloodwork I had done about 9 months ago indicated I was “dangerously low.”
My doctor immediately prescribed large doses of vitamin D supplement, but I was convinced that the result was spurious. Perhaps it was due to …
Medicine 2.0
Kim Scheinberg sent me a great article from The Atlantic that relates to my multi-thread rant on epidemiology. Since the article speaks for itself, I’m just quoting points I think are salient. The only words below that are not a direct quote are the headlines (i.e. “Did you know?”). The emphasis is mine as well.
Did you know?
- mammograms, colonoscopies, and PSA tests are far less useful cancer-detection tools than we had been told
- Zoloft, and Paxil were revealed to be no more effective than a placebo for most cases of depression
- staying out of the sun entirely can actually increase cancer risks
- taking fish oil, exercising, and doing puzzles doesn’t really help fend off Alzheimer’s disease
Medicine has caught a plague
…we think of the scientific process as being objective, rigorous, and even ruthless in separating out what is true from what we merely wish to be true, but in fact it’s easy to manipulate results, even unintentionally or unconsciously.
There is an
Epidemiology vs. Etiology
Over the last several years I’ve been digging into the science of cancer and systems biology, while at the same time looking at the epidemiology of disease and nutrition. And the more I learn, the more I’m convinced that there’s a gap that our scientific tools and methodologies cannot account for. While I’ve discussed this generally under the heading of Science 2.0 (also here), I’ve had a hard time putting into language the exact nature of the gap.
I’ve begun a series of posts that I hope will illustrate the gap, which I believe has to do with the fundamental difference between epidemiology (which is based on statistical observation) and etiology (which seeks to find causal mechanisms for observed phenomena):
- A1 vs. A2 Milk
- Medicine 2.0
- Sunlight vs. Vitamin D
- Animals vs. Plants
- Sugars
Once I’ve completed these posts, I’ll attempt to explain the nature of the gap and what it means for the future of scientific inquiry.…
A1 vs. A2 Milk
Large scale epidemiological studies have linked casein (a cow’s milk protein) to autoimmune disease and heart disease (see The China Study). I just ran across the following twist on this theme which purports to explain a mechanism: a genetic mutation many years ago in domesticated cows transformed the original, safe casein (“A2”) into a toxic form (“A1”). Most cow’s milk available today has both.
What do people think of this? Has anyone tried personally to ingest milk products that are exclusively A2?
Given the dubious connection between cholesterol and heart disease, could the bad rap on cheeses, cream and ice cream have more to do with A1 and sugar than the animal fat and cholesterol?…
The Most Important TV Show in America
Remember Jamie Oliver’s TED Prize Wish? Well tonight is the prime time season premiere of his Food Revolution show on ABC. The Huffington Post called Undercover Boss the most subversive show in America, and I can’t disagree. But in terms of importance to the future of America (and by extension every country which imports American TV and culture), Food Revolution I can’t imagine a more important show.
It’s not just the lives of individuals who eat crap (which is most of the country, frankly, even though they have no idea how toxic what they are eating is). It’s the happiness and achievement potential of today’s youth. It’s the emperor with no clothes at the center of the healthcare debate. And it’s a lynchpin for economic recovery and sustainability.
Watch the premiere, and spread the word……
How Many Calories for a Dollar?
Michael Pollan, as always, making perfect sense:
Egyptian Mummies Yield Ancient Secrets of Good Journalism
This is based on an LA Times article here
What strikes me most is how athlerosclerotic the science itself is. Or perhaps it’s just the reportage?
The opening line of the article is “CT scans of Egyptian mummies… show evidence of… hardening of the arteries, which is normally thought of as a disease caused by modern lifestyles….” One of the researching cardiologist draws this conclusion: “Perhaps atherosclerosis is part of being human.”
The LA Times reporter covering the story (Thomas Maugh) rightly points out at the end, “The high-status Egyptians ate a diet high in meat from cattle, ducks and geese, all fatty.” Which of course entirely negates the hypothesis of heart disease being part of the natural human condition.
It’s clear why the researchers — both cardiologists — would want ancient evidence to support the notion that heart disease is normal. But the fact is that the preponderance of evidence around the world in epidemiology as well as cardiology indicates that …
Inoculating Against the Anti-Vaccine Meme
The debate over vaccination is raging (c.f. Wired article) and it smacks of one of those conundrums that is unlikely to get resolved by scientific inquiry. I offer the following hypothesis and a way out of the dilemma.
Hypothesis: Vaccination is something that is good at the societal level but bad at the individual level. That is, it is a tragedy of the commons. You want all your neighbors to get vaccinated so they don’t pass on the germs to you, but there is enough risk from the vaccination process (at least for certain ones) that you’d rather not do it yourself.
The mathematics of the commons tragedies suggests that there are two ways out. One is to change the payout/incentive structure, in other words, make the vaccine’s less risky to the individual, or at least change the perception of the individual risk (as the Wired article suggests). The problem with manipulating perception is, what if you’re wrong? The marketplace of ideas …
Rafe Issues Challenge to Statin Industry
I have been trying to get the straight scoop on whether statins actually decrease mortality and morbidity in a significant way and I haven’t been able to find any real evidence that they do.
If you ask a cardiologist it’s clear that they believe unequivocally that statins work, mostly because they see what statins to do blood cholesterol levels. But remember, cholesterol numbers in and of themselves do not matter. They are a proxy variable for cardiovascular health. Plaque buildup matters. At one time blood cholesterol numbers were the only non-invasive indicator we had of plaque buildup, but that’s not true anymore. However, drug companies are highly incentivized to prove that statins improve health. So they fund lots of studies.
Notwithstanding the systemic bias when there are profit motives and publication motives, we can turn to these studies and see if statins actually work. The best way to remove bias is to look at large-scale meta-analyses, like this one. If you simply read the …
Should You Use Sunscreen?
This is a very complex topic, as the following talk suggests:
The main takeaways from this that I got are:
- Cancers for which sunlight deficit is a risk factor are orders of magnitude more prevalent than the few for which overexposure is a risk factor.
- People who are using sunscreen regularly are precisely the ones who shouldn’t be.
- We should be very careful and sparing about recommending sunscreen usage or sun avoidance, and always temper such advice with the tradeoffs of not getting enough sunlight.
As someone who wonders on a regular basis whether the public has the right information to make informed decisions about health-related tradeoffs, I am curious… does the above strike you as surprising? What do you currently do regarding sun exposure, and are you likely to change anything based on the above? What do you think the overall message that reaches the masses is regarding sun exposure?…
Celiac Disease on the Rise
…According to a new report in Gastroenterology (July 09), Celiac Disease is now 4 times more common in the US than it was during the 1950’s. The disease results from an intolerance to the protein gluten, found in wheat, barley, and rye. When celiac patients consume gluten, they suffer an inflammatory reaction within the small intestine that can lead to a host of manifestations, including abdominal pain, diarrhea, weight loss, anemia, infertility, malnutrition, and premature osteoporosis. It can develop at any age and is frequently misdiagnosed or undiagnosed because of its non-specific symptoms. Based on this new evaluation, about 1 in 100 people have it and many are not aware. Anyone with chronic gastrointestinal complaints or any of the features listed above, should be screened for this disease. A simple blood test can determine the diagnosis in most cases. Treatment entails lifelong adherence to a gluten-free diet. The “silver lining” for folks diagnosed with Celiac disease is that it largely and forever commits them to
Something Fishy About Mercury
Here is a fascinating discussion on NPR’s Forum from earlier this year on the subject of mercury and fish:
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If you’ve listened to this the whole way through (which you should), I’m curious as to how it will affect your habits, if at all. And why?…
Violence on the Decline
From Monday’s Washington Post:
The District, New York and Los Angeles are on track for fewer killings this year than in any other year in at least four decades. Boston, San Francisco, Minneapolis and other cities are also seeing notable reductions in homicides.
Full article is here, in which more sensible police approaches are given credit for the decline.…
Best Talk of Pop!Tech '08
The reason I like this talk so much (besides that it’s well-presented) is that it introduces us to the idea of invisible etiology. Such a powerful concept, one that I feel has the power to help us solve so many mysteries, once we take it seriously.
Something that I’ve been thinking about lately: does homelessness have an invisible etiology (or etiologies), and if so, what is it?…
Behavior and Emotions as Virus
We’ve talked about obesity as a virus and violence as a virus, both well-supported by the research. Now there’s happiness as a virus. Hardly a surprise, but I guess for new paradigms to become the accepted basis for organizing scientific thinking, they first have to become banal. So let’s bring it on, what’s the next human behavior or emotion that will be featured in a “surprising”study showing a viral etiology?
hat tip: Daniel Horowitz…
Invisible Etiology
One of the most poignant moments of this year’s Pop!Tech for me — which, BTW had many — was Gary Slutkin’s talk on the idea of violence being a virus. You may have heard about his work in stopping violence in Chicago in a NY Times Magazine cover article earlier this year. The premise is simple: if you throw out what you think you know about violence and just look at the etiology of how it manifests in the world, you find incredible similarities to the etiology of microbial viruses. This includes not only how it spreads from person to person, but also the larger epidemiological patterns, and importantly, how it can be stopped via interventions which logically follow from the hypothesis that violence is a virus. Not that violence is caused by those invisible critters we call viruses, but rather that violence itself is a virus.…
The Socioeconomics of Cancer
Pop Quiz: Which is a bigger determinant of cancer mortality in America, being poor or being black?
According to Dr. Harold Freeman of the National Cancer Institute, poverty is the bigger factor today, but it hasn’t always been so:
…Autism and Mercury
A recent study funded by the Centers for Disease Control and Prevention (CDC) in Atlanta claims that thimerosal, a mercury-based preservative used for many years in vaccines, is “not associated with problems in speech, intelligence, memory, coordination, attention, or other measures of childhood development.” For those unaware of the thimerosal controversy, it has been claimed by many that it causes or is a factor in the development of autism. Michael Goldstein, vice president of the American Academy of Neurology said of the CDC study that it was, “enough to convince me that this small amount of mercury … was not harmful to the children.”
However, there is a glaring problem with this study. While it seemed comprehensive with respect to thimerosal exposure, it apparently did so by combing health plan records, not by attempting to measure levels of mercury in the actual bodies of the children or their mothers during pregnancy.…