Wednesday, November 7, 2012
Friday, September 7, 2012
|Beautiful produce shops like this one (at the base of the building we lived in) are scattered every few blocks throughout Buenos Aires. It's probably not organic produce, but it's delicious and cheap.|
Was this really news? I'd seen several studies with similar findings. And this new study turned out to be nothing more than a reanalysis of that past work. There have been a few critiques the study, but if you want my opinion (as someone that tries to sort substance from superstition about all things "natural") it's basically right. There's very little evidence that one person eating organic food is going to be getting superior nutrition. Yes, non-organic food has trace levels of pesticides (after reviewing the science, those don't worry me), and yes, non-organic meat is more likely to have antibiotic-resistant bacteria (this does worry me but it's primarily a public health problem, not a problem for individuals). But all the science really doesn't support the idea that organic food is a wonder drug that will keep you young.
At the same time, I think it's indisputably true that organic food is healthier. That is - if you are narrowly focused on how it will benefit you, about how the known molecules will interact with your metabolism for good for for ill, then organic and industrial food are pretty much the same (as far as we know with the current science). But if you take a broader view, things look different:
Wednesday, August 8, 2012
Then I tell myself not to get upset. My life is great. I'm in love with my wife. My daughter is delightful. My extended family is healthy and more sane than any of the families in the books.
Yes, but, I rejoinder, this is a big chance, I've got to make the most of it.
This conversation in my head took place as I was walking from the grocery store home, with my daughter in the carrier. It was the day before her first birthday. That year had just flown by. She closed her eyes and nestled her cheek against my chest. And I thought, I could say the same of this particular moment: This is a big chance, I've got to make the most of it. I wrapped a hand around the back of her head to keep it from bouncing. It's covered in cornsilk hair that sticks out in all directions. Don't screw this up, I thought, and that time, it didn't make me anxious.
Saturday, August 4, 2012
In researching the evidence about vaccines I started with David Kirby's Evidence of Harm. I should admit that going into this I was pretty sure that there was at least some kernel of truth in the suspicion of vaccines, and that the mainstream scientists were overlooking something. I wanted to start with this minority opinion in the hopes that it would contain some solid, overlooked, facts, or at least a legitimate hypothesis that I could flesh out by talking to scientists. It’s a riveting and well-reported
Wednesday, August 1, 2012
Monday, May 28, 2012
Out of all of that though I found one particularly arresting graph that shows just how strange breastfeeding practices are in this country. As you can see, we are distinctly abnormal.
|A comparison of age at weaning in the United States and in 64 traditional societies,|
reproduced from Stuart-Macadam & Dettwyler (1995)
Sunday, May 27, 2012
Friday, May 25, 2012
Shapiro doesn't go for the prophylactic C-section, and that prophecy comes true:"When I reached my due date, an ultrasound estimated that my baby weighed 9.4 pounds. I didn’t have gestational diabetes and had gained an average amount of weight, and fetal tests showed my baby was thriving. But the baby’s estimated size, combined with the fact that he hadn’t yet descended into my pelvis, worried my midwife.She wanted the baby out by 41 weeks, and to my surprise, she suggested I consider going straight to surgery without labor. She sent me to be evaluated by a doctor she worked with. “One way or another, this baby will be a C-section,” he said."
Wednesday, April 4, 2012
Tuesday, January 31, 2012
To start out, the question as I've just framed it (Is natural good?) presupposes a yes or no answer. But nature is wholesome, nurturing, and abundant at the same time that it is deadly. And the deeper problem has to do with that frame of mind that crosses its arms and says: "Well, which is it? It has to be one or the other." The people drawn to this binary distinction are the most extreme. They are the folks that take a wheelbarrow-load of herbs every day so that they will never die and they are also the people who demand surgery early and often in the vain hope that technical intervention will allow them to live, if not forever, at least until the next surgery can be arranged. These extremes--though at opposite poles when it comes to what they believe in--are strikingly similar in how they go about their lives.
Thursday, January 12, 2012
|Cholesterol (orange) buried within the transparent protein, including interaction with a lipid in the membrane (cyan). Credit: Grace Brannigan and Jerome Henin, University of Pennsylvania|
In a good article on the confusion over cholesterol, Johan Lehrer gets at tendency to assume that when we have a lot of detailed information about something we understand it. We have wheelbarrows of data on cholesterol, but have almost no idea how its related to heart disease. Lerher writes:
Saturday, December 10, 2011
|photo by matthewwu88|
Wednesday, November 16, 2011
About three months ago my daughter was born, and aside from sometimes looking like ET, and sometimes like Paul Giamatti with a hangover, she was perfect in every respect. Then we noticed that she had some little white patches in her mouth, which I assumed were just fatty milk residue but then had to admit were thrush. Yeasty thrush infection in the perfect baby mouth! Imagine my outrage. It got worse and worse until finally we called the doctor who gave us the Rx for Nystatin, an antifungal. It was this awful, sticky yellow stuff that had a disorienting viscosity and would always drip right when the baby had turned her head. So it got everywhere, and we were supposed to give it every couple of hours, and I felt like I was ruining my daughters palate by making her first significant exposure to a new taste this horrible sugary stuff. Also, it totally didn't work. We fed her the stuff for over a month, carefully spreading it all around. It seemed to fertilize the thrush.
Monday, October 3, 2011
Wednesday, June 1, 2011
But then there is the obvious counterargument that goes: wait a second, beauty is in the eye of the beholder. Yosemite may be sublime for you, but maybe an open-pit mine is sublime for me. It would be useful to know if we can move beyond or dismiss either argument. And next, it would be nice to know with some more specificity what we are really talking about with this feeling of the mountain high.
Friday, May 27, 2011
Monday, March 28, 2011
Friday, March 4, 2011
Friday, February 25, 2011
I have had this on my shelf for a long time. Every once and a while I take it down and work my way through a little more. Philosophy is always hard, and French philosophers in translation have scared me ever since some traumatic experiences alone in my college dorm room with no one to protect me from Jean Baudrillard. With Latour, unlike Baudrillard, I didn't get the sense that he was being deliberately difficult. But he still makes up an awful lot of words (or gives them special meaning which are different from their commonly understood meaning). Anyway - I've slogged through this enough that I think I can summarize in plain English. Though I'm sure I'm losing some of the nuance in translation. So here’s what (I think) Latour is saying in Politics of Nature:
Monday, January 24, 2011
|Banksy's Caveman, photographed by Lord Jim|
Hey Nate, I keep hearing about this damn "Paleo" diet, and it reminds me of your investigation into whether what's "natural" is "good." Seemingly intelligent people claim that humans are in fact best suited to a diet consisting only of what a caveman would have eaten. It seems absurd to me -- I mean, we've physically evolved since that time (pinkie toes have gotten smaller in response to wearing shoes), so how could eating grains that we've cultivated for 10,000 years be bad for us? Not to mention that these same people drive cars, work in buildings, etc.
My response: I'm inclined to agree (with significant caveats).
Thursday, January 13, 2011
Classes February 2nd from 6:30-9:00PM and February 2nd- March 23rd from 6:30-9:00PM
Saturday, December 4, 2010
This is not your average food chemist. He has a razor scooter in his office. Also there is some evidence that he is still Canadian at heart: There's a wooden mountie holding up his iPhone charger and a big illustration of a hockey goalie above his desk. He studies lipids - namely the lipids in milk and writes papers about pretty incomprehensible things like the milk fat globule membrane (MFGM) and cis-9, trans-11 conjugated linoleic acid, and yet when he talks about this stuff he consistently blows my mind. The following is mostly just notes to myself. Very rough...
Friday, December 3, 2010
One in a red font that crams exclamation marks into every letter reads: "Danger invisible laser radiation Avoid eye contact or skin exposure to direct or scattered radiation." A freezer is marked, "Biohazard," and someone has taped two blue napkins to it with the words, "Do not open" inked fiercely in red on each. A digital display on the door shows the interior temperature to be -30 degrees Celsius. Above the lab bench hangs a professionally carved wooden sign, the sort that on country houses display the surname of the inhabitants, which some wit has designed to say, "Spectrometry for the masses."
There are two blackboards on the wall covered in acronyms I don't understand with arrows pointing from one to the next. There is another freezer without frightening signs, and this one contains hundreds of test tubes and beakers and vials with frozen milk scabbed to the glass.
On the benches slim patches of workspace are scattered: a pair of blue cryo gloves (like oven mits), several blue pipettes, a plastic purple honeycomb half full of disposable pipette tips, a toaster-sized machine called the Mini Vortexer with a dial that goes from one to ten--it is turned to ten, and another machine for enzymatic cleaving. On the floor at the far end of the bench is a torpedo-like tank of helium, painted maroon. Next to it are two silver tanks of liquid nitrogen. A graduate student, her hair pulled back in tight braids opens the valve one one of these and then rests her elbow on top of the tank and watches as hissing ice clouds form around the hose leading to the big white mass spec machine which dominates a quarter of the room and looks as if it might have been stolen from the engine room of a steamship. This is one of the machined designed by Carlito Lebrilla, the man German calls "a wizard." This machine is essentially a scale, a scale so precise that it can divine the atomic composition of milk molecules simply by weighing them. "It's like weighing a battleship to see if there is a fly on the deck," German says, shaking his head in wonder.
Monday, October 18, 2010
But some wonder if they should admit that publicly:
Already feeling that they’re fighting to keep patients from turning to alternative medical treatments such as homeopathy, or misdiagnosing themselves on the Internet, or simply neglecting medical treatment altogether, many researchers and physicians aren’t eager to provide even more reason to be skeptical of what doctors do—not to mention how public disenchantment with medicine could affect research funding.John Ioannidis, the subject of David Freedman's story (check out his very interesting blog here), says hiding uncertainty is the wrong approach.
We could solve much of the wrongness problem, Ioannidis says, if the world simply stopped expecting scientists to be right. That’s because being wrong in science is fine, and even necessary—as long as scientists recognize that they blew it, report their mistake openly instead of disguising it as a success, and then move on to the next thing, until they come up with the very occasional genuine breakthrough. But as long as careers remain contingent on producing a stream of research that’s dressed up to seem more right than it is, scientists will keep delivering exactly that.
“Science is a noble endeavor, but it’s also a low-yield endeavor,” he says. “I’m not sure that more than a very small percentage of medical research is ever likely to lead to major improvements in clinical outcomes and quality of life. We should be very comfortable with that fact.”
I'm reading Bruno Latour's "Politics of Nature" right now, and he pins a lot of what's wrong in this world in our desire for science to deliver the answers relevantly and on time. We (mistakenly) think of the world as divided into two parts: nature and civilization. In civilization we talk a lot, we have opinions, we debate, we struggle over politics. Nature (according to this view of the world) has no talking, it's silent but it contains the truth. The trick then, is to send someone out into nature and bring back the truth to put an end to all the arguments. We call this person "a scientist."
The problem with this is that 1. Even scientists have trouble finding the truth (see above) and 2. They aren't above politics (see above again).
A more healthy system, according to Latour, would be to recognize that civilization is in nature and inextricable from it, and that science is not exempt from politics. He's not denying the existence of objective truth, but instead of saying X-Files style that "The truth is out there" he's saying "The truth is right here" but that we have to be honest about how little of it we can see - which means accepting that politics and debates about who's vision of the world is more correct are an essential part of governing. We can't hope for science to trump politics. Doing so get's us into a lot of trouble.
hat tip to Faith Gibson for sending the story to me...
Sunday, October 17, 2010
Here are a couple quotes from his review of "Walkabout"
"The price of living in the modern world is a feeling that we have fallen out of touch with the natural world. We long for an innocence that may have never existed but still exerts a significant hold on our imaginations."
Tuesday, June 22, 2010
|The Farm Midwifery Clinic|
I like to pretend I'm a rolling stone from time to time, but it sure does feel good to roll back to the piece of earth that's come to fit my contours over the years. I'm back in San Francisco after more than a week traveling in Kentucky and Tennessee. My most significant excursion was a trip down to The Farm, a hippie commune that's managed to persist in fine fettle since 1971. They don't do a lot of farming at The Farm, unless you count growing forests, and deer, and meadows full of ground-nesting birds. What they really focus on down at The Farm is growing people, and officiating the front end of this process is a coven of midwives. These are the women I went to meet - they offer a radically different mode of maternity care. It's a form of medicine that would shock and dismay hospital administrators around the country. It's low tech, often taking place in the woman's own home, far away from the transfusions and pain medications and operating rooms that hospitals rely on to save lives when something goes awry. In theory, this midwifery center should be producing a higher than average number of catastrophes. But that hasn't happened. In the 40 years they've been catching babies, the midwives have accumulated a significant corpus of data (about 3,000 births) and the results are fascinating. The birth safety record is far, far better than the national average.
But is this a comparison of apple and apples? There's a certain amount of self selection that happens - ie it's only fairly bourgeois, health-conscious women who would even think to seek out a midwife. (There's a similar cause and effect mix up with multivitamins: People who take them are healthier, but only because unhealthy people usually don't take 'em). And that's probably affecting things at the farm a little bit: There are women who have flown in from as far away as Tokyo, and Cairo, to give birth there. Those mommas have got to be A. Far more committed to going the extra mile for health in every way, and B. Rich enough to pay for quality care and live without a lot of stress. But when I got to The Farm and started talking to people it became clear that there were two counterbalancing factors. First, some of the people traveling to The Farm are attracted because the midwives there are some of the only people in America who can reliably do higher-risk births (like breech babies, twins, and birth after a cesarean) vaginally - so they attract a more difficult population. Second, about one third of the babies born there come from the (economically depressed) surrounding area - a lot of these are Amish women who wear their long dresses through the entire birth.
Ina May Gaskin, the head midwife, says that about a third of the births are Farm babies, a third are from the surrounding areas, and a third travel in from farther away. I understand that the midwives are organizing their data for a report - I hope they include information about the demographics of their patients to allow this kind of parsing. But regardless of demographics, the statistics are impressive. They seem to indicate that, for a healthy middle-class woman, this can be a superior form of care. There's another impressive indicator: The Farm Midwifery Clinic is still in business - which (I think) means that they've never been sued. If this form of natural birth really was causing more cases of baby brain damage - or any sort of catastrophe - I think you'd see some lawsuits over the course of 3,000 births.
I'll be writing more about my visit - hopefully before all the mosquito-bites I got there fade away. But for now I've got to catch up on the work I left when I went on the road - while enjoying the feeling of air that's not 90 degrees and 80 percent humidity.
Sunday, May 9, 2010
You wouldn't give your mama artificial love-
So why would you feast on artificial grub?
Full video below (if everything is working right...)
My favorite line:
This so called food aint meant for humans
If I eat this than my bowels won't be movin'
Word to Denis P. Burkitt.
Wednesday, April 28, 2010
"...when an environmental problem has been identified, no matter how complex the underlying ecological factors, it’s often packaged as a morality lesson highlighting the impact of a single, human-driven environmental sin."I totally agree. But it seems unfair to limit this critique to environmental groups. Every think tank (liberal or conservative) seems to fire off a volley of facile conclusions when something happens that touches their issues. Food and medical companies are quick to trumpet any shred of junk science supporting their products. It's how people work: We to try to make meaning from the seemingly random events occurring around us, to make theories about how the world functions, and then look for evidence (for, and even against if we're smart) in everything that comes up. And, it's worth noting, it's exactly what McWilliams did in his blog post.
Sunday, April 11, 2010
At the risk of upsetting manufacturers of artificial preservatives, colorings and flavorings, Jane and Joe Sixpack simply cannot be more clear in their growing distaste for “chemicals” in their food. And yes, this trend is on track to grow.That seems like it might be a positive indicator until we get to the next sentence:
Sunday, March 28, 2010
Growing awareness of the risks of scanning led F.D.A. scientists several years ago to begin demanding more and better information from manufacturers to prove that their devices actually were effective for such clinical applications as cancer screening and mapping blood flows in the brain.The problem is that these CT scans expose you to a lot of radiation, so a lot of scientists say we shouldn't use them unless we are pretty sure there is something wrong. But the manufacturers want everyone to use them, early and often, and they'd like the government to pay for it: "hundreds of millions of dollars annually."
But agency managers responded that suddenly changing the rules for the devices would be inappropriate and unfair to manufacturers, documents and interviews show.
General Electric, one of the biggest makers of the devices, told F.D.A. managers that the company wanted CT scans approved for colon cancer screenings because Medicare officials and private insurers were “actively discussing whether to reimburse for use of CTC for screening asymptomatic individuals” and “to assist their customers in reimbursement for procedures,” internal agency documents show.Great work Gardiner Harris!
Nathanael Johnson, a Bay Area radio reporter and freelance writer, has made a nice career examining the many ways Americans go overboard – from the food that we eat to the health treatments that we seek. He has written about the Orwellian world of pork farming and the radical raw milk movement for Harper's magazine. He has written about the surge in "functional beverages" for New York magazine. And he has written numerous features, including an insightful piece on excessive medical treatments, for his day job at KALW News.Nice huh? Thanks Bill!
In February, the Center for Investigative Reporting's California Watch published an investigation by Johnson that made the entire state — and large news outlets such as ABC World News with Diane Sawyer — sit up and take notice.
The mortality rate of California women who die from causes directly related to pregnancy has nearly tripled in the past decade, prompting doctors to worry about the dangers of obesity in expectant mothers and about medical complications of cesarean sections. For the past seven months, the state Department of Public Health declined to release a report outlining the trend.
This investigation had all the makings of a blockbuster. Innocent victims. Shocking trends. And the specter of government malfeasance. But it also had something else lacking in most investigations of this scope: a measured tone. Johnson made sure to underscore how few women actually die every year and, by contrast, how many healthy babies go home with healthy mothers.
Friday, March 12, 2010
Jennifer Block has a great piece timed with the release in Time Magazine.
And Gary Schwitzer summed it up with "A week of news on overtesting, overtreatment..."
Thursday, March 11, 2010
Tuesday, February 9, 2010
I think this news is finally hitting home. The piece ran on the front page of half a dozen major California newspapers, and on public radio's California Report. KCBS, the talk show Forum, and KALW asked me about it. Dozens of other outlets and scores of blogs reported on the story.
Tuesday, February 2, 2010
Tuesday, January 12, 2010
Sunday, January 10, 2010
Sunday, January 3, 2010
I’ve been meaning to write about my initiation into the select novitiate of the dark arts of bread-making, but I was particularly busy in the days leading up to the holidays and then particularly lazy during. Now that they are ending I feel a stirring of the communal sap—now that other people are girding up for a real working Monday, it is much easier to brush off the feeling that there might be some richer form of amusement out there for me to capture. Amazing how persuasive is that sense that other people are working – or playing – in convincing me that I should be doing the same.
All that is to say that this happened more than a month ago. It started when Beth and I went to the Liberty Café Bakery one morning for coffee and pastries. I love this bakery. It’s on top of the hill, in the “downtown” of our neighborhood, but tucked back behind the row of shops on the street so that you have to slip down a three-foot wide passageway between the buildings to find it. The bakery’s existence in this secret garden would not be enough, on its own to secure a permanent right of tenancy in one of the chambers of my heart—that guarantee was ensured by the cinnamon rolls. And then by the custard-like quiche whose essence is infinitely rich yet light – ephemeral on the tongue and on the plate.
Monday, December 14, 2009
Tuesday, December 8, 2009
Thursday, November 26, 2009
1. Children (even with their physical needs being met) can be physically stunted and developmentally retarded without love.
2. Mortality levels dip below expected levels for ethnic groups just before culturally significant days (Jews don't die the day before Passover).
3. The 200 women imprisoned by the Khmer Rouge who "cried until they could not see," seem to have been physically blinded by metaphor.
Tuesday, November 24, 2009
Before I get into that though, I'd like to pause to acknowledge the design of this book. It was such a pleasure to hold, so agreeable to observe.
Saturday, November 21, 2009
Manure pit-related explosions or flash fires have occurred recently in both Minnesota and Iowa livestock buildings. Luckily, the explosions, to date, have mainly resulted in building damage, with few animal losses and no personal injuries or fatalities reported.
Monday, November 16, 2009
Then there's this travel blog, Uprooted, which I find interesting mostly because it's author describes herself as, "post-hippie: dedicated to sustaining and improving the condition of our planetary systems, but not particularly excited about drum circles." Which is a lot like what I'm trying to get at (I may be more extreme - the idea of drum circles just makes be feel sad and tired - with top notes of nausea). The question Uprooted seems to have at it's core is: How does this generation go out and make meaning of the world without ending up resorting to cheap, shallow meaning - something that turns out to be our own version of drum circles? Both the author (Jessica Reeder), and I come to this search by way of our childhood indoctrination: we were given clear evidence that the earth needed saving but no feasible methods for dong anything about it. Jessica is from "Nevada City, California where hugging trees was part of my classroom curriculum." So am I. We were in the same second-grade class.
Sunday, November 15, 2009
Still not sure exactly what that is but Leonardo has some idea about what it isn't:
Thursday, November 12, 2009
Wednesday, November 11, 2009
The story here starts with Henri IV of France, (Henry of Navarre) trying to make everyone just get along as religious tensions between Catholics and Protestants grew. At that time people thought in a way that is remarkably recognizable to people today: Henri talked about tolerance and pluralism, his compatriot Michel de Montaigne wrote in a style that still speaks to the modern ear. There's a reason for this Toulmin says: humanists like Montaigne were on to something that we are just now getting back to after 300 years of diversion. We were sidetracked when an assassin (Francois Ravaillac) dove
Saturday, October 31, 2009
Monday, October 26, 2009
Wednesday, October 21, 2009
Okay this is off topic, but my profile of San Francisco politician/police commissioner/future icon Theresa Sparks just came out in San Francisco Magazine. I suppose it is on topic if you stretch to consider how people use the term natural in moral arguments. To me Theresa represents another realization as well: Natural can connote a sense of comfort. She may not have the body nature gave her, but spend 5 minutes with her and I guarantee that you'll forget about that. The conversation feels perfectly natural.
Sunday, October 18, 2009
Admittedly, there's a lot to health care reform that is utterly counterintuitive (eg more doctors competing drives the cost of care up, eg care can kill) and people like Shannon Brownlee have traversed this path before (actually it seemed like TAL was borrowing a lot from "Overtreated"). But still, hats off to TAL.
Wednesday, October 14, 2009
Friday, October 9, 2009
Sunday, October 4, 2009
Tuesday, September 29, 2009
grasshoppers that have to take measures to avoid spiders grow more slowly and lay fewer eggs than grasshoppers in spider-free zones. In areas of Yellowstone where wolves are abundant, female elk give birth to fewer young. Birds that perceive their breeding area to be full of animals that will eat their eggs or young may skip breeding altogether, or lay fewer eggs than usual. In other words, predators keep prey numbers down simply by being scary.
But aren't there many more examples where the opposite is true - where predation urges growth? Where - even more counter-intuitively - predator and prey are cooperating on some level? As my teacher Michael Pollan elegantly demonstrated in Botany of Desire, predator prey relationships can turn into mutualism: The apple tree, rather than trying to poison its predator, instead pulls a kind of evolutionary judo move and uses the fact that it's being eaten to its benefit. Of course the apple did this by luck (the right configuration of genes at the right moment), but the fable of the apple seems useful in this recessionary world: When someone comes to eat you, the impulse is to react like the grasshopper - but if you can figure out a way to act like the apple, that looks like a far better strategy.
Wednesday, September 16, 2009
But a fun story for those armchair naturalists who want to know why all these animals are having such a hard time this year.
Photo by Chad King/NOAA
Saturday, September 12, 2009
We were up in Downieville to run Pauly Creek (I don't have pictures but there are great ones here). It's a short run with lots of waterfalls and I was feeling great. I ran the big (20 foot or so) drop at the bottom which I'd never done before (because my friend Eric nearly died there and his stories spooked me). It was still early in the day so we drove back up to the top and I convinced a small contingent to hike a couple miles upstream to get a little more for our money. None of us had ever seen it before, and the light was starting to turn amber with evening as I led the crew down the first drop. Things went well until about the fifth rapid. I had lined up to charge from right to left, break through a hole, and end up in an eddy on the far side of the creek. But just as I reached for my first paddle stroke a hidden rock caught the downstream edge of my boat and stopped it dead. The rest of my body rotated around that pivot point like a cracking whip. As I went under, the paddle blade caught the water. You are supposed to have a loose hand - so that you release the paddle shaft in these situations were the opposing forces are getting big. I had a death grip. (more after the jump)
Friday, September 4, 2009
There's a tendency for us journalists to crave fundamental change - because it's exciting. And because we like to believe that good ideas can change the world (because that's our stock and trade). History is full of examples though, of big changes leading to big problems. There's more success when the changes are of the tinkering sort - a gradual sort of coevolutionary growth between insurers, government, business and medicine.
The all-natural-Heidi-force in me wants big change of course. It wants a system that doesn't push treatment (and kill hundreds of thousands a year with overtreatment). The inner Heidi applauds Bruce McCall's Shouts an Murmurs:
Did You Know: Human illness adds two trillion dollars annually to America’s gross domestic product. Are you contributing your fair share?
and this brilliant miniature:
Q. & A. of the Month
Q: My current statement lists two hundred and thirty-one charges for “brain surgery,” even though I have had no brain surgery. How can I rectify this?
A: Invalid question. Brain surgery is not covered under your plan.
Wednesday, September 2, 2009
In a landmark 2008 report, the prestigious Institute of Medicine reported that at most half of the care that doctors deliver is evidence-based.
This is important to the health care debate - people have been awful upset about comparative treatment reviews (the extremists think looking at how effective something is and how much it costs will lead to death panels). But at the same time nobody wants care that's not effective - we all want our doctors to know what treatments work and what don't. How to explain this contradiction? Well this poll explains it. People oppose comparative effectiveness research because they (65 percent) think their doctor already knows what's best for them. So a minority that sees this research as cover for a rationing regime is not drowned out by the reasonable majority who should be saying we want to stop spending so much (and being injured by) care that doesn't work.
All of the actors in health care—from doctors to insurers to pharmaceutical companies—work in a heavily regulated, massively subsidized industry full of structural distortions. They all want to serve patients well. But they also all behave rationally in response to the economic incentives those distortions create. Accidentally, but relentlessly, America has built a health-care system with incentives that inexorably generate terrible and perverse results. Incentives that emphasize health care over any other aspect of health and well-being. That emphasize treatment over prevention. That disguise true costs. That favor complexity, and discourage transparent competition based on price or quality. That result in a generational pyramid scheme rather than sustainable financing.
So far so good. I'm pretty convinced that we have too much medical treatment and that there are some foundational problems causing that. But Goldhill thinks these problems all come down to one thing: Lack of market pressure. It's an interesting point, but one that I think has some problems. But before I get to his proposal, here's one more interesting critique:
Saturday, August 29, 2009
So I was on vacation recently - away from the blog - and when I got back all my editors suddenly wanted drafts. The first breaths of the brisk winds of fall, I suppose. In any case I've been doing a lot of writing these days - for which I'm actually paid (rather than the prospective research and navel gazing that feeds this project). So spending a lot of time writing hurts the blog... but it does wonders for the plants that sit in the window to my right - just past the mouse. When I'm sitting there trying to force my brain to figure out a way to make a particularly improbable transition - or how to breath some narrative life in to a sterile series of facts - it sometimes plays tricks on me to get out of the chore. One of my brain's favorite tricks is the classic "OMG what's that!" caper. It usually plays out something like this:
Friday, July 24, 2009
KALW just aired two pieces that I did on the rising rate of pregnancy related deaths and the black-white disparity. You can see a longer post from June. I'm hoping this will get more media attention - it's a particularly troubling example of the broader problem that Atul Gawande and others (and still others) have identified. How does this tie in with Nature? Well when you live in a world we look to science for all the answers, science sometimes ends up providing best-guess answers when it should just be saying - "we don't know enough about that yet."
Wednesday, July 22, 2009
Finished Daniel Botkin's book "Discordant Harmonies" last night. It has a lot to offer, but what I'm most interested in is Botkin's perspective on the trajectory of thought on nature. We start out with competing myths: The earth is a divine creation with everything made according to a plan to foster life (Jewish creation story) - versus - The earth is a living organism passing through different stages of life (pagan/animist). And then around the industrial revolution - when people had complex machines available to refer to in their metaphor making, and when Newton's breakthroughs offered a vision of a universe governed by an elegant set of simple rules - a new myth grew and dominated the others: The earth is just an piece of machinery. There are several implications if you think of the world this way. The most important implication (to Botkin) is that the world tends toward a steady state - it should just keep chugging along unless we really screw things up.
Monday, July 20, 2009
Monday, July 13, 2009
I found this especially interesting:
"As a 19th-century position, romanticism never broke with rationalism: rather, it was rationalism's mirror-image," writes the historian and philosopher of science Stephen Toulmin.
"Descartes exalted a capacity for formal rationality and logical calculation as the supremely 'mental' thing in human nature, at the expense of emotional experience, which is a regrettable by-product of our bodily natures. From Wordsworth or Goethe on, romantic poets and novelists tilted the other way: human life that is ruled by calculative reason alone is scarcely worth living, and nobility attaches to a readiness to surrender to the experience of deep emotions. This is not a position that transcends 17th-century dualism: rather, it accepts dualism, but votes for the opposite side of every dichotomy."
This is my point exactly - that the fight between the techies and the all-naturals is stupid one and that we should stop arguing about it. (So thanks, Virginia, for introducing me to Mr. Toulmin) I think Postrel is proposing the same thing - though she wants to replace reason v. passion with what she calls dynamism. Dynamism sounds basically like libertarianism. Get a lot of minds working creatively on figuring out problems for themselves and then let the market and natural selection do its thing. Rather than trying to predict and control the future, she says, allow the process to take its course.
Hmm. What about cases where we are pretty darn sure of the future? Should we really cut down the last Truffula tree to improve our lives - knowing that we are eating off the plates of our children? Or climate change blah blah blah?
I'd now like to make up a new law - Nate's law if you will. I haven't thought about this at all and have no idea if it's really right - but hey, isn't that what blogging is all about?
Nate's law: Whenever a simple gesture toward a concept creates massive sales, it means we must have deep and (crucially) unexamined associations with that concept. ie, it's gotta be universal, and vague.
My explanation for the appeal of natural is that the pendulum swings back and forth between the desire for "natural goodness" (pristine waters blessed by the singing of tree sprites), and mechanical control. (Glaceau manages to have it both ways - check out this brilliant copy: "smartwater is inspired by the way mother nature makes water, known as the hydrologic cycle (you remember the ocean, cloud, raindrop diorama from fifth grade right? Actually, it's how we got our name too (hydro=water/logic=smart)." But then they "one up ma nature with electrolytes.") Anyway - I think we are still swinging toward natural but as we do we are going to see a lot more mixing like this - where products are going both back to the land and back to the lab. With any luck that will lead to confusion and a lot of tough questions about what's actually natural and what's not. Science is going to be prominent in this confusion: Is science natural? any sane smart person is on the side of science right? But as the graf below demonstrates (also from the Mintel presser) science (ie calorie, fortified) easily falls into the role of opposite to nature (ie pure, holistic, genuine).
"In the past, low-fat and low-calorie were the hallmarks of good nutrition and
dieting, but today, that lifestyle seems passé. On top of this, fortified
products are falling out of favor," comments Lynn Dornblaser. "Food and drink
manufacturers today realize that natural and pure have become healthy eating
ideals, as people look for holistic, genuine nutrition they can trust."
Wednesday, July 1, 2009
Watching the parade I started thinking about the way that "natural" has been used as a rhetorical bludgeon to fight the sort of celebration of difference that I was seeing. Now that we know there are gay dolphins and gay seagulls we should hear a change of tune from the people who argued that homosexuality was bad because it wasn't natural. But of course we won't. In cases like this the natural claim gets grafted on to support the belief - if something is bad it's unnatural.
Often, I think what we are really saying if we say something is unnatural is that it is foreign to our system of beliefs.
Wednesday, June 24, 2009
Just returned after four days in Sequoia National Park. We hiked out of Mineral King over Franklin Pass, to Forester Lake. Then we turned around and came back.
It's beautiful out there and being around all those peaks and clear cold lakes rubs off on my physical sense of well being. The fact that I'm looking way up at those snowy crags, then a few hours later climbing over them, contributes to the feeling of hale puissance. Franklin Pass is like that. You climb 3000 vertical feet from the trail head to Franklin Lake, then another 1500 feet up what looks like an impassible granite face. It's a narrow trail carved into the slope - a few inches of level ground in a vertical world. When we got to the top we lost the trail under snow and as I was looking for the route over the top, I found myself staring down into thin air - and granite hundreds of feet below.
So is it just the proximity to death that makes me feel so alive? (A note to the mother in law potentially reading this: we were never in any danger, any time you are up high and look down you get that thrill). Perhaps that's part of it, but I contend that there's more than that. Here we are up where it's hard to get enough oxygen, sleeping in what amounts to stress positions all night, getting sunburned and carrying packs over ankle-twisting trails and the net result is feeling healthier and stronger? It doesn't make sense. I think it has something to do with pushing the body. We spend so much time coddling ourselves with orthopedic comfort chairs, and medical treatments for every little ailment - and in the long run we end up getting worse. Perhaps a better solution would be to go out and get bruised, scratched and sunburnt.
Photo by pab_lo49 - yes neither of us brought a camera.