Plants & Plausibility

Are plants protective for cancer? The evidence has been mixed, to say the least. Evidence, that is, in the form of specific human interventions. And it's fairly ambiguous observationally. Recently yet another result from EPIC was published, looking at correlation between fruit and vegetable intake and cancer. Basically there was no difference. The best-case hazard ratio was only down to 0.97 (compared with a more encouraging HR of 0.72 for, um, eating lots of cheese ... oops!). Given uncertainty in figuring out what people actually ate over the period, and given uncertainty around "correcting" for variables (these corrections are built upon pyramids of observational studies, it's not an exact science, although it pretends to be), this is probably meaningless. The biggest worry for the pro-plant brigade should be that even with the flaws, we could expect a more dramatic difference in hazard ratio simply (or solely) from healthy user bias. So it's possible plants are causing cancer. Who knows. If you're choking down foliage by the bucket in the belief you're saving yourself from cancer, there's not much evidence for that. Eat them if you like them. Or maybe to foster a diverse ecology of gut flora, or to poop a lot.

In any case, lots of smart people are absolutely convinced that plants have magical health benefits. I think this stems from a problem that Pauling succumbed to -- the plausibility peril. In the lab, we can see specific interplay at the molecular level, and this builds up a promising avenue of research. The plausibility peril: once we come up with a plausible explanation for how something could or might work, the plausibility itself acts as evidence in support of the theory. Not even deliberately or intentionally, but nonetheless it becomes a bit of a trap. E.g. you sneak up on some cancer cells in a beaker, minding their own business, and hose them down with tocotrienols. They stop growing. Well, that's certainly promising. Tocotrienols are in plants, thus eating plants might slow or stop cancer growth. And freebasing vitamin C might cause immortality (sorry, Linus). But when you try it out in humans it actually has to work. And often it doesn't, no matter how plausible the story.

High Confusion & Heart Disease in Women

A recent study came out observing a higher risk of heart disease within a 30k+ sample of Italian women who consumed higher carbs, or higher GI foods, or higher GL foods. What fascinates me is not the study itself, but the description of the results by both the press and the study authors themselves. More on that in a bit, first the study.

It was a cohort study. Take it with a grain of salt. A big one. The analysis for the women in the study concluded the following, ordered by relative risk:

1. women with highest GL [glycemic load] diets had a relative risk of heart disease of 2.24
2. women with highest total carbohydrate intake had a relative risk of heart disease of 2.00
3. women with highest GI [glycemic index] diets had a relative risk of heart disease of 1.68

Even though this study would seem to confirm my own biases, I think it's mostly worthless. It's an observational study that assesses diets based on questionnaires, so the data should be treated as highly unreliable. Given that, relative risks should be very high before we get too worked up. Relative risks around 2 in a study like this are pretty boring. (And fewer than 1 in 200 women developed heart disease over the course of the study, compared with greater than 1 in 50 men.) Useful only to generate funding for further studies. Not at all useful for guiding public health policy. So this isn't really worth so much attention in the press.

That said, I'm fascinated by how it was described, even by its own authors. There seems to be a real disconnect between the data and the editorializing. Let's review from a few lines above: total carb intake showed a greater risk than just GI. High GL, which is essentially a combination of the two, showed the highest risk. The risks of total carbs and high GL were close to each other, with high GI trailing in third farther behind. Naturally, the press coverage focused on GI.

The headline from the BBC explicitly and only mentioned "High GI". The Independent says "Sugary". The BBC article even rolls out these head-scratchers:

"high GI foods, rather than carbohydrates per se, appear to pose a risk"

and

"Low GI carbohydrates, such as pasta, which release energy and raise blood sugar far slower, showed no such link with heart disease."

Maybe I'm losing my reading comprehension skills. Let me look at the study again.... As I remembered, carbohydrates per se not only appear to pose a risk, but they appear to do so to a greater extent than high GI foods. Both of those statements are demonstrably false if you take the very study they claim to be about at face value. How's that for spin?

Worse, the actual authors of the study are being dishonest, saying,

"Thus, a high consumption of carbohydrates from high-glycaemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease."

So the reporters are uncritically regurgitating how the study was described, rather than reporting on the study itself [likely the reporters never bothered to read the study], and the authors are misinterpreting their own results ["lying" is a strong word]. The study actually did in fact observe that "the overall quantity of carbohydrates consumed" influences the risk to a greater extent than high-GI foods does, yet the authors claim the opposite. Well, I'm baffled.

The only explanation I can come up with is that they've already decided carbs are good. Since most people keep protein intake within a fairly narrow range, the higher carb diet is the same as a lower fat diet, and vice versa. So in part what was observed was women eating more fat had lower risk of heart disease. This causes so much cognitive dissonance in the researchers they have to figure out a way to not say it. You already know the punchline, right?

"They could try broadening the types of bread and cereals they eat...."

That's right! Conclusion = Eat More Carbs!


____________________
bbc article
independent article

P.S. The only thing missing from the coverage was a recommendation for women to take statins.

Quiet Skies Over London

Speaking of air travel, there's been none of it here since Iceland has launched its Dr. Evil volcanic assault on the rest of europe. Once the blank skies were pointed out to me, I can't stop noticing. It's been beautiful and sunny and clear. The complete lack of anything in the sky is almost shocking. Odd and fascinating. And it's gone literally quiet as well. We're less than 5 miles from London City, which is a protected habitat and breeding ground for the endangered jumbolina, which makes a distinctive pitch-dropping sound on approach. We're also 15 miles from Stansted and about 18, as the heron flies, from Heathrow (a fact I try not to dwell on when I'm 90 minutes into an attempt to get there). There's never not metal criss-crossing the sky. Except now.

Domestic Air Travel in USA

or
"when did United become a discount airline?"
or
"you're doing it wrong!"

Flew United Airlines domestically for the first time in many years. I remember United as being one of the "premium" airlines, but from the moment I booked I was assaulted by piecemeal pricing and upgrades. Relentless pitches to upgrade my seat, my check-in, my luggage options, etc. The implied message, delivered repeatedly, was "our default service SUCKS! please pay more to make this journey bearable". At the airport, more weirdness. Upon check-in, I was given a "departure management card", rather than a boarding pass, that got me through security but I still had to check in again at the gate to get an actual seat. This didn't happen on the return trip, so I'm not sure what the deal was. The per-bag fee caused the predictable chaos. On the plane, united had put diagrams on the overheads as to how to align max-size carryons most efficiently in the bins. And the bins were full. Everyone had large roll-on carryons. Getting everyone on and off the plane took a loooong time. How is this helping anyone? How does this help the airline? I have no idea.

How and why did United decide to become a discount airline? Southwest Airlines is a true "cheap and cheerful" play. United's attempt is neither cheap nor cheerful.

First Dentist Visit Since The 90s

Been a while. Maybe 12 years. No cavities, no problems. I attribute my overall cavity-free streak to my gum-chewing habit. I have no evidence for that. The hygienist put a big hurt on me. Have to go back for a followup scraping session, too. Ouch. I will be upgrading my toothbrush to a sonicare. Yes, yes, and flossing.

Overall I'm having a hard time buying the every 6-12 month schedule the dentist recommends given the observed success of my once-a-decade scheme.

London Is Really Freaking Cold

London cold is a dense, damp thing. Seeps into homes & bones... seeps, settles, won't be sloughed.

London is (subjectively) the coldest place I've ever been. I've enjoyed January after January in Chicago (standing on an el platform in the dark of a subzero-F morning with a face full of windchill), brittle and bitter midwestern nights, razor-sharp snowy gusts in the alps... nothing makes me feel colder than a sunless & drizzly London spring day with the temp just above freezing.

Free Books On My iPad

[and you shall know them by the badness of their malts...]

Saw a rumor that the entire Project Gutenberg library will be freely available from the iPad bookstore, which would be fantastic. My first NeXT workstation in the early 90s had the Shakespeare plays pre-installed (for no good reason, but it was cool), so this would definitely be in keeping.

I have to assume the guy writing a heartfelt treatise on brewing never expected me to be reading a non-print copy nearly 300 years later...

The many Inhabitants of Cities and Towns, as well as Travellers, that have for a long time suffered great Prejudices from unwholsome and unpleasant Beers and Ales, by the badness of Malts, underboiling the Worts, mixing injurious Ingredients, the unskilfulness of the Brewer, and the great Expense that Families have been at in buying them clogg'd with a heavy Excise, has moved me to undertake the writing of this Treatise on Brewing, Wherein I have endeavour'd to set in sight the many advantages of Body and Purse that may arise from a due Knowledge and Management in Brewing Malt Liquors, which are of the greatest Importance, as they are in a considerable degree our Nourishment and the common Diluters of our Food; so that on their goodness depends very much the Health and Longevity of the Body.

Avoiding Irony Deficiency

Irony is a virus. Early exposure is crucial for health later in life. An irony deficiency can have dire consequences if left untreated too long. Best results are seen when exposing children to irony. Overly sterile environments can be detrimental. Ideally irony exposure starts at home at a young age. Often groups of children will develop irony at roughly the same time, but if someone in your child's social group catches irony early, it can be a good idea to schedule an irony party, allowing other neighborhood children to get enough exposure to their infected friends to get a healthy inoculation.

Weird Lower-Leg Cramping

I have strange lower-leg cramping -- calves, feet, toes -- only at night and only after either drinking alcohol or eating lots of sugar. The only thing that seems common between the two would be my liver (since fructose and alcohol are metabolized similarly in the liver), but how my liver would have some sort of neuromuscular impact on my lower legs while sleeping is beyond me.

I see no plausibility for the usual (mostly half-assed) explanations for cramps such as "dehydration" or deficiency of magnesium or potassium or "electrolytes". Very odd. The obvious solution, which I practice most days, is to simply neither eat sugar nor drink. Still, it's an odd one.

Scrubs == Mash

My 12-yr-old and his buddies love Scrubs. I enjoy it a lot. Nice and goofy. I only belatedly realized that for him it's basically what Mash was for me & my friends.

Personal Trainers

I get a kick out of watching the personal trainers do their thing at the club. They seem to operate out of the same playbook. The current script is to do something with kettlebells (lots of kettlebell swings), something with a box, and to do some mini squats in the cage with a barbell. The latter is especially clever because most of the people getting personal training would never approach a barbell or cage. I'm not sure why the trainers don't teach them actual squats. They put a barbell across the back and half them bend the knees just a little then back up. Makes me think of Tugg Speedman in Tropic Thunder, to the little kid with the stick figure: "I will call you... Half Squat." But they aren't even half squats. More like quarter squats.

In January the trendy trainer exercise was to get people to crouch on an inverted hemisphere. "For skiing", I bet. I saw a poster advertising the imminent arrival of some sort of weighted tube with handles that promises to be the next excellent exercise accessory. Looks like one of the battering rams cops use on doors. Can't wait to see that in action.

Health Care Reform In The USA

The health care reform that has just passed in the US is mainly concerned with insurance reform. It doesn't turn the US into Canada or the UK. It does make the US a lot more like Switzerland (or, oddly enough, Massachusetts). I find this interesting since I lived in Switzerland for a couple of years. I have never lived in Massachusetts, although I have seen nearly every episode of Cheers.

In Switzerland about twenty years ago insurance companies started pulling the same shenanigans they were pulling in the US -- aggressively dumping people off their coverage, expanding denial for "pre-existing conditions", that sort of thing. The Swiss shortly got annoyed and about 15 years ago enacted reform that cleaned up insurance practices and made insurance mandatory, along with public and subsidy provisions. The measure was passed by referendum. [Switzerland is much more of a democracy than the US, which is not always a good thing.] Private healthcare in Switzerland is still going strong and by all measures I can see, including anecdotal first-hand experience for myself and my family (we had private insurance), the overall system is of good quality.

The UK, on the other hand, seems to have adopted a typical "worst of both worlds" approach, trying to get the worst of capitalism and the worst of socialism and combining them, with the best will in the world, to yield something that kind of works, kind of fails, and is in perpetual CRISIS. From personal experience and observation, if you've got decent private insurance and/or enough money to pay for private healthcare, you can get fantastic quality care in the UK. If you are poor, you'll do much better for healthcare in the UK than in the US. The group that would really be better off in the US than the UK is the subset of the middle class that don't have private insurance through work, but likely would in the US doing equivalent jobs. But, seriously, if anyone's thinking of big-time reform, the UK would not be on the shortlist of models to emulate.

France, though, is a different story. I have never lived in France but by all accounts the quality of care is very good from top to bottom. For full universal health care with public options but still allowing private hospitals and doctors in private practice (I am more than happy for good doctors to get wealthy, it's an important job and they've earned it), France would top my shortlist.

Comparing Switzerland, France, and the US*:

• %GDP spent on healthcare is substantially higher in the US than in either France or Switzerland
  
• Total spent per capita on healthcare is substantially higher in the US than in either France or Switzerland
• despite percentage of costs covered by the government being lower in the US, per capita public expenditure is higher in the US than in either France or Switzerland
• life expectancy at birth, infant mortality rates, and some other gross markers of health are better in France and in Switzerland than in the US
• both France and Switzerland have substantially higher ratios of practicing physicians/population than the US
• Switzerland has more nurses per capita than the US, but the US has more than France

It will be interesting to see how this evolves in the US over the next decade or two.


*These numbers, and lots of others, along with pointers to the more comprehensive full report, available here.