Health Kismet
The Problems With Health Science

There’s a decent video by a British doctor on the various problems with the health science industry. His talking is a bit scattered, but for the most part his opinions are interesting, and IMO correct.

If you don’t feel like watching, here are the take home points:

1). News that says “new study suggests x might cause y” should not be trusted. See my post about the problems with interpreting medical research results for more information.

2). The drug industry usually games studies to get things approved.

3). The placebo effect is powerful, but too much emphasis is placed on it in the clinical approval process.

4). Very few important medical decisions are made with appropriate information. Often they’re made with really crappy information.

He ends on a dour note, saying he doesn’t see an easy way to solve any of these problems at the moment, and ends with a vague call to action for an industry wide emphasis on transparency to bring more errors in the medical industry under public scrutiny.

Let me add a few thoughts.

1). I think the human intuition to break everything into discrete categories gets us in trouble with interpreting research results. Research is sort of like a garden with different plants always blooming and dieing, and the overall picture evolves like a kaleidoscope. To zero in on any particular correlation from one study is to commit sins of omission.

2). Experts tend to lament the ignorance of the poor common-folk in their particular field, and yearn for the day when everyone will be well informed about what it is they’re experts in, thus solving the dilemmas in their field. You see this attitude everywhere, and I think it’s a chimera. To really create a solution for something, it needs to work with ignorant people, because that’s not going to change. At least not quickly enough to allow someone’s pet plans to come to fruition.

3). On a similar note, it’s best not to focus on how to ensure people have as much information as possible, but instead focus on how to mitigate the bad consequences of someone making an un-informed decision.

Attitudes Towards Alternative Medicine

There was an interesting article in the LA Times that describes how more doctors are using alternative medicine……..on themselves.

While doctors are schooled in traditional Western medicine, a growing number like Michelfelder are turning to complementary and alternative medicine to stay healthy, then integrating the techniques into their medical practices.

A study published in the online version of Health Services Research in August found that 76 percent of health care workers and 83 percent of doctors and nurses used CAM (Complimentary Alternative Medicine), compared with 63 percent of the general population.

However, despite their personal acceptance of yoga, acupuncture, etc, as healing mechanisms, they’re slow to recommend it to their patients:

Doctors who work in hospital integrative medicine departments or use CAM methods in their own practices say their referrals from other physicians have been steadily increasing, though many physicians are still reluctant to suggest it. But doctors agree that patients themselves are the ones who have pushed much of the change in health care.

I don’t want to risk sounding anti-scientific, but I think most people enjoy the insulation that comes from deferring their health decisions to people with badges, and place too much emphasis on the perceived “rigor” of professional medicine. 

Doctors themselves might contribute to this problem by narrowly believing in what they were taught in medical school and adopting paternalistic attitudes towards their patients.

Food Addiction Skepticism

Eric Mittenthal has a good Op-Ed on the topic of food addictions.

He begins by casting doubt on the prevailing attitudes:

In the research that has been conducted on food behaviors for the last 20+ years, a limited  number of studies have shown some association of food impact on brain pathways in certain individuals, but overall, the science has been inconclusive.

He points out that identifying a pleasure sensation that occurs in the brain while you’re eating food is not the same thing as an addiction. You get strong sensations of happiness if you find a dollar on the ground, but that doesn’t make you addicted to money.

He then expresses a rather conservative opinion on food choices and personal responsibility:

The “addiction” issue is at the forefront right now because of the obesity epidemic in our country. Everyone is looking for the magic bullet that will solve the problem, and the idea that our food is addicting is powerful. If it were true, it means that we can’t be held responsible for our weight because we are powerless over the food we eat. The reality is not so simple though.

With this point, I have mixed opinions. I agree that focusing exclusively on the issue of addiction is convenient, and creates heroes and villains in a way that’s advantageous for people doing the talking.

However, I’ve slowly become less convinced about the power of free will over the years, and I’ve seen many people who’s relationships with food that would classify as functionally addictive, even if it doesn’t meet a technical definition.

Dietology: A Pornographic Fetish

Orthorexia is a pseudo-scientific condition for people who are obsessed with healthy eating to the point of physical and emotional harm. I don’t believe there’s an official term for it, but Dietorexia ought to be a condition as well.

Small bites wrote a critical article about the ranking of diets in the U.S. News and World Report:

Despite the hegemonic “battle of the diets” meme that often makes the media rounds, no one can argue against a whole-foods, plant-centric approach.

Interestingly, the better-rated plans (DASH, Mediterranean, etc.) aren’t so much strict diets as ‘good guidelines for health’ (i.e: prioritize fruits and vegetables, choose whole grains over refined, consume healthful fats, limit red meat and added sugars).

My first response was surprise that such a list existed. 

I think one of the reasons that diets are popular is because they’re pornographic. Pornography usually refers to sex, but more generally it’s the experience of realizing an elusive reward without being confronted with the challenges of obtaining it. Lots of movies are morality porn. Dietology is health porn.