Praise Thor & Pass The Lutefisk!

Things I learned this week from recent health news:

• eating meat makes you die more if you're American
  
• eating meat makes you die the same if you're British (although apparently the key to longevity for Brits is to be involved in an Oxford study)
• eating meat makes you die less if you're Scandinavian (and a good-natured Nordic "fuck you!" to those damn Mediterraneans!)

For true comedy, check out the US popular press coverage of that first study. If there's one thing even more entertaining than observational studies, it's the reporting on them.

Mechanetiquette

Lifts: I know it's exciting. You are ready to stride decisively into a metal box, to be whisked up or down to the office floor of your choosing. I get excited, too. Using a modern lift is quite thrilling. CONTAIN YOUR EXCITEMENT! When the doors open, please pause, for only the briefest of moments, to let me out before you march eagerly on to your elevation adventure.

Trains: As thrilling as lifts may be, they can't hold a candle to the giddy delight of travel on the Tube. Hold me back! I, too, simply cannot wait to spend as much time as possible inside an underground car. But again, if I could ask but the slightest imposition, that you allow me to get off the train when the doors first open, delaying your gratification the merest tick of the clock before you joyously bolt into the luxurious and welcoming interior.

Escalators: Stand on the right, walk on the left -- it can be hard to remember. And the signs can be so distracting! That's ok, I am happy to politely remind you. And I completely understand that the best place to stop, look around, and re-orient yourself is immediately after stepping off the escalator. But I hope you will likewise understand that I'm behind you on a moving piece of metal and I, too, might imminently need to occupy that same space. As unreasonable and inconvenient as it may be, if you could keep moving even after exiting the escalator, we could all simply put this regrettable situation behind us.

Revolving doors: The area immediately outside the circumference of a revolving door is even more inviting! The chance to pause, get your bearings, feel the soothing breeze of the twirling bulk at your back... ah, it was a fine fellow who dreamt up a spin on the ol' door. I know I'm being a bit of a bother again, but if you could step aside to allow me to de-revolve, I would be forever in your debt.

Unlucky

One of the charming things about British sports appreciation is the concept of luck. Or should I say "luck". No where else, certainly not in the states, have I heard so much attributed to bad luck. Your child kicks the ball gently into waiting arms of the goalkeeper? Unlucky. Your favorite pro misses the goal by a mile? Unlucky. (This goes well with the discussion, more prevalent in soccer than in any other sport, of which team "deserved" to win, regardless of score.)

This would make a good global export for broad usage. Wrong side of that credit default swap? Unlucky! Didn't get elected? Unlucky! Ran out of gas? Unlucky!

Age of Reductio

Are we in the reductio ad absurdum era? Sarah Palin, congressional hearings, Twitter....

And in the diet and health corner, we've got more and more great examples, from fat-blocking diet pills that make you shit your pants, to gastric bypass surgery (advertised on billboards in the US!), to "heart-healthy" potato chips. I'm optimistic about this in that if you take flawed hypotheses and treat them as true, the quicker you get to the end game that exposes the flaws, the better.

Watch Yer Graphs

It's pretty easy to get up to mischief with excel. Here's a wonderful post from the hyperlipid blog that recharts one of the results from Framingham in a more honest way. This seems like such a fundamental task of any science reporting: when presented with a graph, check the axes! Are they clear? Do you know what they mean? What's the scale? Good lord, what the hell is going on with the X axis? I guess the saving grace for mainstream reporting is that even the first graph would likely never make it to print (just the ostensible conclusion).

Apple Good, DSL Bad

I owe Apple an apology. I got prompt service from online chat support for mobileme. We didn't fix the problem, but went through a variety of logical steps beyond the obvious, and left it looking like a problem with my network or ISP. Which it turned out to be. Had to turn down the MTU setting to get it all to work. Which is either a Zen or a BT problem.

MobileMyAss

Apple's debaculous MobileMe offering has now completely hosed my mail. No sequence or combination or repetition of account deletion, creation, modification, or syncing has coaxed mail.app to grab any of my mac mail for non-web consumption. My latest attempt: mail's made nearly 1.4 million mach sys calls and consumed almost 8 minutes of CPU time (WTF is it doing?) and is displaying exactly 1 header, sans body, and nothing else. That's progress.

Week In Austria

Just spent a week skiing. Badly. But lots of fun. There are some things I only enjoy if I can do them well, and others I enjoy regardless of how unskilled I am. Skiing falls into the latter category. I think I may be trending to the latter category for almost any activity as I age, but we'll see.

I was entirely offline all week and watched virtually no news. Some of the guys I was with watched the news daily. Nothing they mentioned as being Big News was of any consequence or relevance to any of us. That's a tip-off that watching TV news, especially non-local news, is pretty much a huge waste of time (and angst-inducing, as Gavin De Becker has pointed out).

Now that I'm back, my mac email has stopped working. Apple's turned a [mostly useless, but nonetheless] functional but massively overpriced .mac service into a non-functioning yet still massively overpriced debacle that is "mobile me". Progress of the microsoftian strain. Apple is supposed to reduce the amount of mediocrity in the realm of technology, not increase it. What a joke.

Gary Taubes

I used to dismiss Atkins as a crank and assume it was all nonsense, despite those around me who actualy tried it doing well on it. Then Gary Taubes started writing about obesity (and salt, and cholesterol, and fat, and carbohydrates) and I perked right up. Back in the early 90s, Taubes had written a great book on the cold fusion debacle, so with me he already had a ton of credibility as a science journalist.

Meanwhile, it was getting harder and harder to ignore the increasing numbers of people I knew who had gone low-carb and shed fat like they were slimming down for the rapture. I'd gone through weight-loss cycles before, always focusing on exercise. It never lasted. Once the exercise stopped, for whatever reason, I'd find myself eating more ice cream, say (or beer). Last year I was incapacitated for a while after foot surgery, and tried cutting back on carbs. Even without being able to walk around, I lost weight. I forgot about it at the time and focused on trying to get back to running.

I still like exercise for the sake of exercise, and have fitness goals that (now) have nothing to do with weight, but I recently decided to go whole hog with the low-carb thing. After eight weeks, I've lost twenty pounds. And I feel really good. And it's all the fault of Gary Taubes.

I heartily recommend Good Calories, Bad Calories (in the UK it's got the better title, The Diet Delusion). It's not a diet book or a weight loss book. It's a fantastic piece of science journalism, and works as both a fascinating history and a study of the subject. It might be a daunting read (I admit it took me a while to get through the whole thing.) You can start with one of his lectures. He did one at Berkeley, which is sadly only available on RealPlayer, which blows goats, but here's one at the Stevens Institute of Technology. Well worth watching.

Are Sacks & Bray Taking The Piss?

Addendum to last post. Sorry, I just can't let it go. the USA Today article on it has a sidebar showing a sample 1-day menu for the low-carb plan. It's astonishing that these guys get away with calling this "low-carb" and that no one calls them on it. Your 1-day low-carb prescription includes: bagel, pasta, mashed potato, and a graham cracker! (Not to mention banana and raisin.) You have to work hard to find things with a higher glycemic index than mashed potato. Sacks and Bray are either stupid or dishonest.

Health Reporting, Fat, Sportswriting, & Zealotry

I know why there's such a strong pull towards zealotry in all this diet talk, and it gets me back to sportswriting. I've harped on political coverage before, specifically on the ways in which it falls short of sportswriting.

What seems obvious now is that the lack of good political coverage is what spawns such zealotry in amateur coverage. For eight years, a credulous and uncritical white house coverage pool would simply regurgitate whatever the government told them. The frustration of people who wanted to be informed by rationally critical coverage was palpable. Compare this with major-market sports coverage.

What do you get from sports coverage? You get, for one, easily accessible facts and stats of all manner. Want to know more about last night's game? You can easily find out what to a non-fan would be an astonishing array of facts and stats about seemingly the most trivial details in addition to the major points. It's public, undisputed, easily accessible. One of the nice effects of this is that you can't get away with abject bullshit in the same way you can with political coverage (or health coverage, more on that in a bit). For example, if you fancy yourself a sportswriter or sports expert, you cannot get away with constantly referring to the worst shooter in the NBA as "sweet shooting" unless you're being facetious. You lose credibility because everyone who doesn't already know the guy can't shoot can easily check his accuracy.

The other wonderful thing you get from sports coverage is thorough (arguably insanely thorough) coverage by knowledgeable skeptics. Imagine an NFL general manager says to the press that his priority for the off-season is quarterback. If this were major-market political or health coverage, that would be repeated at face value and that would be the end of it. Because this is sports, this utterance is dissected, dried, dissolved, and discussed ad infinitum. Without having to do any detective work yourself, you, the sports fan, will be told how realistic this is, what free agents might be available, whether they are restricted, which teams would likely sign them, who's available in the draft, what viable trade options are, what your teams salary cap would actually allow, etc. In short order there's a pretty good consensus about whether the GM was simply talking smack, being deliberately evasive, or being sincere.

In a nutshell what you can get from mainstream media sports coverage is a combination of facts and critical, informed reporting. This combination -- the accessibility and timeliness of the facts and stats, and events reported on by a critical, informed eye -- can make for a well-informed, critical public. The lack of these qualities in coverage can be striking. Which brings me to health reporting.

Good lord is it bad. What a dire state. (No wonder Ben Goldacre frequently sounds like he's on the brink of taking a hatchet to everyone in sight.) Here we have a (potentially literally) deadly combination: bad science + bad reporting. If the reporting were as thorough, fact-filled, and critical as good sportswriting, the bad science wouldn't be as much of a problem. But bad science reported by the credulous and ignorant is both damaging and enraging (thus the side-effect of zealotry).

Last week a report came out that makes for a perfect case study of both bad science and bad science journalism. Looking at the coverage in the NY Times, USA Today, US News & World, AP, etc., it's clear that the people reporting on it have not read the study. Practices that would get you fired from the sports desk (reporting on a game you didn't watch) are apparently perfectly acceptable when writing about less important matters such as health. So lead researchers Frank Sacks and George Bray publish the study in the New England Journal of Medicine, then summarize it and wax poetic for press consumption, and the press simply regurgitates their talking points. Add a catchy headline that compounds the error, and the public is none the wiser. The public has, in fact, just been made dumber. Reading mainstream health reports is a good way to lose IQ points.

In defense of the public, the facts are neither presented nor easily accessible. The reporting has not been done with an informed, critical eye. If you want to read the study, Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates, you go to pubmed and/or find it at the New England Journal of Medicine. Even after you do that, there's quite a lot you have to know to make sense of it, in particular to see how disingenuous these researchers are being. But the public that relies on these same health reporters for background and context simply won't have any of either.

Here are some sample headlines covering the study:

In 4-diet study, all lost weight if they watched their calories (USA Today)
Study Zeroes In on Calories, Not Diet, for Loss (NY Time)
Want to Lose Weight? Just Eat Less, Diet Study Suggests (U.S. News & World Report)
What's the best Diet? Eating Less Food (TIME)

And some typical ledes:

When all is said and done, it comes down to calories. A landmark study shows that people can lose weight on a variety of diets — including low-fat plans and low-carb ones — as long as they consume fewer calories. (USA Today)

For people who are trying to lose weight, it does not matter if they are counting carbohydrates, protein or fat. All that matters is that they are counting something. (NYT)

The researchers took a few hundred people, put each person on one of four diets, and tracked them for two years while offering support to help keep to the prescribed diets. These articles faithfully reproduce the researchers' talking points and you walk away thinking they tested, among others, low-carbohydrate diets. Only they didn't. The four target diets included fat/protein/carb ratios of (1) 20/15/65, (2) 20/25/55, (3) 40/15/45, and (4) 40/25/35. Note the first two are considered to be "low fat" while the latter is described as the "low carb" diet. The uncritical reporting fails dramatically here. A carb ratio of 35% is not a low-carb diet. (How would you know that if you were informed only by these journalists? You wouldn't.) Why not try an actual low carb diet (20%, or even better, 10%)? Sacks claimed doing so would not be "realistic". [If physicists did science this way, we wouldn't have quantum mechanics.]

It gets worse. The target diets were aiming for a calorie restriction of 750 kcals/day (i.e. a deficit of 750 calories relative to estimated metabolic rate for each person), but with a lower limit of 1200 calories a day. So even on the lowest-calorie plan, a 35% carb ratio means over 100g of carbs/day -- not low carb. The researchers also asked people to report on what they actually ate, and it turns out that the so-called "low carb" group didn't even average 35%, they averaged over 40% carbs.

What about the results? Basically the message is that all four of their diets were equally useless. Which would have been predictable because these types of calorie restriction diets simply don't work. The group on each diet pretty much lost the same amount of weight the first six months then gained some of it back over the remaining eighteen months. The results were modest: an average 6kg loss after 6 months, but backtracking to an average of 4kg after two years. Remember that the researchers buy into the (repeatedly debunked) caloric balance hypothesis (the sloth/gluttony hypothesis), and that their participants were pushed to follow a 750 calorie daily deficit. So if these guys believe their own theories, the participants should have lost 156 pounds of fat each over the two years. (Sounds ludicrous, but this is exactly the same bullshit that tells you if you switch from one can of coke to one can of diet coke for lunch every day you'll accrue a deficit on the order of 50,000 kcals over a year and thus lose over 14 pounds. And this is the same bullshit they're feeding the press when they say it's all about how much you put in your mouth.) So their theory predicts a loss of 156 pounds over 2 years, versus the observed result of about 9 pounds. Hm. The participants all had starting BMIs of 25-40. For someone 5' 10", this means a weight range of 174-279 lbs. A 9 lb loss shifts their BMI range to 23.7-38.7. An average loss of 6kg over 6 months equates to about half a pound of loss per week. Over two years this drops to less than 1/10th of a pound per week.

This should be enough for them to drop their caloric balance hypothesis. Or at least conclude that their four diets are equally worthless. But instead of headlines saying "High Carb Diets Don't Work" or "Four Tested Diets Ineffective", we get articles saying how vital it is to simply eat less, and how there's no truth to the effectiveness of low-carb diets, written by mainstream reporters credulously quoting the researchers without reading the study or asking difficult questions. It should not be susprising that this sort of thing leads to a bit of fervor amongst the dissenters.

Eat Nude. Not Too Much. Mostly Pants.

"Eat Food. Not Too Much. Mostly Plants" -- the rallying cry of Michael Pollan fans. Despite the haiku-like elegance of Pollan's seven-word summary, it really winds me up. Not because of disagreement with Pollan, but because of the prevalent use of it as a rejoinder to any discussion on food. In the hands of anyone other than Michael Pollan, it mostly comes across as facile and smug, dispensed by the internet ignorant as if making a wise and profound point that is the last word on the matter at hand.

As a big fan of both Fast Food Nation [great book] and Hugh Fairly Long Name, and as someone who has thought a lot about food sourcing, I haven't yet read Pollan's books because it seems like I would mostly heartily agree with them while not learning much. I take issue with the catchphrase on a couple counts: (1) "not too much" -- meaningless/tautological, and (2) "mostly plants" -- wheat is a plant, no? If I eat banana sandwiches washed down with orange juice, am I still following this dictum? I admit I have a strong carnivore bias, but still....