Workout Differentiation

Finally getting some running fitness back, after peaking two years ago and having most of 2008 off. I'm just now getting to the point of differentiation in my workouts. At first, everything is slow and short. Then, as I get better, everything turns into a tempo workout. The trick is to be able to get enough speed that I can actually do a longer, slower workout. I've gotten a few intervals workouts in and that makes all the difference. Now I changeup between intervals, long & slow, and tempo runs, and I just barely have enough fitness and pace to make these meaningful. The problem on the long & slow days is not just turning it into a tempo run if I'm feeling good 15 minutes in.

Next goal: get back under my personal best for 10k by the end of the year.

Bottle Apostle

The new wine shop in the village opened a few weeks ago. Yes, I'm still sad that Frock's is gone, but the new business is really nice. Friendly and enthusiastic without being intimidating, welcoming of all levels of interest, from novice to experts, and with a really thoughtful and excellent inventory. And the automatic wine sampling machines are very cool. Good addition. It should do well.

Now Victoria Park really, really needs a fishmonger.

Shame About The Diesel, USA

Nice 4-dr you can cruise in at 130mph yet get over 40 mp[US]g? Excellent-looking new BMW. Better mileage stats than my Audi A2 (never available in the US), but goes 0-60 in 8s and tops out at 140mph.

Another Thing Missing From Cricket

Trouble on Green Street. I wonder if anyone's checked on the whereabouts of Elijah Wood. [That movie exceeds expectations, btw. Recommended.]

Cricketing Baseball

I'd love to see baseball try a slight cricket approach to the structure rather than alternating three outs. A 27-27 game would be interesting (should be higher scoring for sure) but a game of 9s could be perfect -- i.e. three 9-out innings.

Kendrick Essay on Heart Disease

Very good essay. A few years old, but new to me: http://www.thincs.org/Malcolm.htm#heart1

Reform Gone Missing

How's that healthcare thing going over in the US? A few short days ago, Howard Dean (accurately, imo), said of the public option:

There's only one piece of real reform in this bill for healthcare -- there's a couple of pieces of insurance reform which are worth doing -- but the only piece of healthcare reform that's worth doing, left, is the public option. The public option. And people say, "well, can't there be a compromise?" We have already compromised. The public option is the compromise between single payer and the private sector... We can't go any further. There's nothing else to do here. [watch from 06:15 of this video]

Now there are rumblings that the public option is being compromised away. No healthcare reform, then. Not surprising, really, given it was very poorly explained and sold by the administration, was too long, legalistic, and ambiguous, and, of course, the press coverage was often useless. Even the Guardian, which should know better, gets it wrong today, incorrectly labelling the public option as "NHS-style". Oh well.

Dollhouse

Although I am a big fan of the Whedon, I had not watched Dollhouse. Honestly, did not look too good at first. But the other night I watched what in the UK was described as the series 1 finale, but apparently was never aired in the US. It was fantastic! Had a great Joss/scifi/zombiegeddon riff, and I thought I detected a slight BSG vibe in there, too (Joss admittedly a fanatic). So I don't think I'm going to watch any more. Based on what I've read, it was the best episode. And I may have enjoyed it all the more because I didn't know what was going on. Anyway, if you've never seen it, just watch "Epitaph One".

harry potter and the half-assed wtf

Just saw the 6th movie and gosh did it suck. Wow. Lifeless, empty, hollow. What happened? Where did everyone go? The acting was a redeeming feature, good all around but Tom Felton had a nice (and important) turn, Broadbent was predictably perfect as slughorn, and Gambon finally grew on me in his best Dumbledore. The only other redeeming feature was that the "important memory" made a lot more sense in the movie than in the book (in the movie, unlike the book, they actually learn something from the memory). But overall it was appalling.

SAQ

It's high time I started my official Seldomly Asked Questions list.

Q: Pork blood: is it good to dip my paperback books into?
A: No.

Must Resist Kittens

I haven't had cats in about 10 years, but someone at work just sent round pics of free kittens, and a handwritten note just got tacked up down the street about another set of available kittens ("white with tabby or black spots"). It's likely my brain was long ago taken over by those cat-friendly parasites that make mice fearless (which helps expedite the repatriation of those parasites back to their preferred home, the digestive tract of cats), and maybe it's only a matter of time before I answer the call of my feline overlords and again provide a home for some.

Nation of Ninnies: why hide car performance specs?

Are Americans afraid of everything? I'm looking at cars in the US and notice that it's almost impossible to get 0-60 and top speed numbers for anything. In the UK, these are almost always included in available info as a matter of course.

Bad Health Reporting Associated With Higher Risk of Blogging

Last month a published systematic review concluded that there is no evidence that treating high blood pressure down to levels lower than 140/90 has any benefit. It is also true that a blood pressure of 115/70 is associated with a lower risk of cardiovascular "events" compared with a blood pressure of 140/90. These are not contradictory.

Another recent study showed that high cholesterol in midlife is associated with a higher risk of dementia later in life. Does this mean that if you are middle-aged and have high cholesterol, taking cholesterol-lowering medication will help prevent dementia? No.

If this is confusing, blame bad health reporting, combined with an American medical tendency to treat symptoms, which in itself is a symptom of a larger malaise of failing to focus on the bigger picture (overly specific focus while engaging in healthcare). More on that in a bit. First I want to share some exciting news from my lab, the Institute for the Advancement of Idiotic Analogies (I am the founder and CEO).

I have just concluded an observational study that shows visiting convenience stores is associated with higher risk of mortality from cancer. The effect is exposure-dependent, showing a positive correlation between frequency of visits and cancer mortality rates. Clearly this means that avoiding convenience stores will lower risk of cancer death, right? Well, I must sadly admit that my study shows nothing of the kind. Since it's an observational study, if something interesting has come of it, I should use that to generate hypotheses, then design studies to test them. Or I could just go to an uncritical health reporting pool and let them breathlessly warn against the dangers of convenience-store proximity. If I'm honest, which, unfortunately, I am, I also must admit that visiting convenience stores correlated positively with purchasing and, more importantly, smoking, cigarettes. So it's likely that the root cause of any increase in mortality is due to smoking and not due to the convenience stores themselves. In other words, frequency of visiting convenience stores is simply a marker that correlates with something else, and not a cause. So banning convenience stores, or following government advice to limit exposure, would actually not affect outcomes at all.

Likewise, is high cholesterol a cause of dementia? (No evidence of that so far. In fact, low HDL correlates with higher risk of dementia as you get older.) Or is whatever is causing high cholesterol also the cause of dementia? (Much more likely I think.) In that case, treating the cholesterol and not the root cause would likely have no effect, or possibly make things worse (side effects of drug treatment, ignoring causal factors because of focusing on a single measure of risk). Likewise, high (or low) blood pressure can be both a direct cause of some bad effects, but also an effect of some other cause. That's why bp-lowering drugs might be of no benefit, or even be harmful, when lowering bp to a level which in a non-treated person shows reduced risk of some poor health outcomes. Really, this should be pretty simple, it's amazing how many reporters don't get this. Suppose you are hypertensive because of stress. Stress has many effects on the body, not just blood pressure. But blood pressure is easy to measure and easy to focus on. So if you focus on one effect, and, say, take ACE-inhibitors to lower blood pressure, will that help? Maybe a bit. What if you focused on lifestyle changes to reduce stress, achieving the same lower blood pressure (without medication)? Seems like a better state, since you've addressed the root cause, and mitigated more effects than just the one you've measured, right?

Too narrow a focus on specific outcomes can be a dangerous medical myopia. If a drug decreases heart attack mortality you may find cardiologists prescribing it, even if it increases cancer mortality at an equal and offsetting rate. If sunlight exposure increases risk of skin cancer you may find dermatologists telling you to avoid it, even if it decreases risk of much more common and much more fatal internal cancers. Cardiologists don't care what you die of, as long as it's not cardiovascular disease. Dermatologists don't care what you die of, as long as it's not a skin disease. (Personally, avoiding a heart attack is not necessarily a big win if I instead die of cancer after developing dementia.)

Gosh, I've really babbled on here. Lemme sum up a bit.

• observational studies can be interesting, are great for generating testable hypotheses, but do not show cause
  
• risk association does not mean cause
• directly treating a risk measure does not necessarily mean you are doing anything preventive nor even lowering your risk
• most journalists, and even some doctors, don't understand those three points

Prehypertensive, Prediculous

Turns out I was right about the US being more aggessive about treating high blood pressure. In fact, a few years ago the US invented the word "prehypertensive" in their bp guidelines, to describe the range that in the UK is still known as "high normal". I wonder what impact this has on what I would call a patient's consent to be medicalized. Doesn't hurt with the ACE-inhibitor sales targets I'm sure. Take 2000 people in this range, tell 1000 of them their bp is "high normal" and tell the other 1000 they are "prehypertensive", then ask each of them if they'd like blood pressure medication. I wonder if the same percentage in each group would say yes.

I also wonder why stop there? Let's call systolic bp of 120-129 "pre-prehypertensive", and sub-120 "early onset possible pre-prehypertensive". Let's call low BMIs "pre-obese". No hardware in your arteries? "Pre-stented". My normal-functioning kidneys are operating in pre-failure mode, and I feel pretty good, in other words, pre-fluish. Can I get some tamiflu?

Goofy Shoes Go Urban

Although they make me look a little bit like I'm succumbing to a horrible smurf-hobbit mutation, I've taken them out and about London and I still like them a lot. The nubby surfaces before crosswalks are like little foot-massagers now. And any chance to walk on grass is a treat -- I find that I take any chance to pop off the tarmac.

It's not the salt: fun with blood pressure

My doctor is concerned, as am I, about my blood pressure, but I refuse to go on a low salt diet, because it's not the salt. It's work.

I was recently on holiday but unfortunately did not take hourly bp readings. I do, however, have readings I take at work. The "ranges", at least as far as the British are concerned, are along these lines:
systolic: <120: optimal, 120-129: normal, 130-139: high-normal, 140-159: mild hyper
diastolic: < 80: optimal, 80-84: normal, 85-89: high-normal, 90-99: mild hyper

In the US, medicalization is probably more aggressive. I wouldn't be surprised if guidelines called for drug therapy for anything at or above 121/81. Ithe rule of thumb used to be that systolic of 100 + your age should be considered perfectly normal. But the normal of Grampa's generation is now the hypertension of mine.

So, bracketing my holiday (shortly before, at work, and shortly after returning), my blood pressure eased down to a comfy 124-131/75-78. Diastolic in particular very good. By the end of a full week of working, had crept up to 141/85. Just for fun, I took a recreational dose of propanolol [How sad is it that my favorite drug is not psychoactive? I am a geezer. Or a goober. Or possibly both.], and it dropped to 123/72.