Lyme Disease and Bad Medicine

I got Cure Unknown: Inside the Lyme Epidemic (2008) by Pamela Weintraub from the library and found something surprising: an angry foreword. Weintraub is a science journalist; the foreword is by Hillary Johnson, another science journalist and apparently a friend of Weintraub’s.

In her anger, Johnson says several things I say on this blog. Continue reading “Lyme Disease and Bad Medicine”

Interview with Zeynep Ton, Author of The Good Jobs Strategy

The Good Jobs Strategy by Zeynep Ton, published in January, argues that retailers should change low-level jobs in four ways:

  1. Offer fewer choices — fewer versions of each product.
  2. Standardize common tasks and empower employees to handle unusual situations.
  3. Cross-train employees so that each employee can do several jobs.
  4. Operate with slack, that is, hire more employees than seemingly necessary.

The brilliance of this book is that it addresses a major problem (bad jobs), includes substantial evidence and persuasive argument, is practical, and is exceedingly non-obvious (judging by how many retailers already follow her recommendations). Ton is an MIT business school professor whose area of expertise is operations.

I interviewed her by email. Continue reading “Interview with Zeynep Ton, Author of The Good Jobs Strategy

The Idealist: Jeffrey Sachs and the Quest to End Poverty by Nina Munk

After I finished The Idealist: Jeffrey Sachs and the Quest to End Poverty by Nina Munk, I thought of something a graduate student in English had told me: A little Derrida goes a long way and a lot of Derrida goes a little way. It was literally true. A few sentences by Derrida, you could think about for days, maybe productively. A whole book by him was baffling and irritating. A lot of Jeffrey Sachs goes a little way, I thought.

When it came out (2005), I thought The End of Poverty by Sachs was the ravings of a lunatic. Munk’s book shows I was right but I had to admit that George Soros giving Sachs $100 million or whatever to put his ideas into practice (to “test” them) was considerably more interesting than the activities of the other billionaires Munk had written about before Sachs. Soros had an advisory board whose reaction to Sachs’s ideas was the same as mine but Soros overruled them. Soros was right. A tiny bit was learned from spending all that money, which is better than learning nothing. Certainly I learned more than if the money had been used to buy a private jet.

As an assistant professor doing animal learning experiments, I saw over and over that it was incredibly hard to learn anything. Anything. No doubt all science professors who are honest learn this. But then I saw something that is less easy to see: If doing the “right” thing pays off worse than we expect — Sachs’s flamboyant failure in Africa is an example — then doing the “wrong” thing should pay off better. If spending an enormous amount of money we learn less than expected, then when we spend very little money we should learn more than expected. This is the upside of ignorance. The less you know, the easier it is to learn more. And we know much less than famous professors, such as Sachs, say we know.

My personal science is the polar opposite of what Sachs did. He tried to help others (poor Africans), I try to help myself. He tries to help people he knows almost nothing about, I try to help myself — and I know a lot about myself. He tried to do something big (end poverty). I try to do something small (e.g., sleep better). What he did cost millions of dollars. What I do costs nothing. I can test a new idea about how to sleep better in days. Sachs took years to test his ideas. For me, failure costs almost nothing. Sachs’s failure cost him years of his life. You have to be an extraordinary person with great talent to do what Sachs did. Whereas anyone can do personal science.

Assorted Links

Thanks to Saul Sternberg, Bob Levinson and Alex Chernavsky.

Assorted Links

JFK Assassination Diary by Edward Jay Epstein

Edward Jay Epstein has just published a new book called The JFK Assassination Diary based on the diary he kept when he wrote Inquest. It is available on Kindle, Nook and as an Itunes ebook. It will soon be available in paperback.

He wrote me about it:

As you know I was the only person to interview the Warren Commission as well as its staff and liaisons with the intelligence services. I did these interviews as an undergraduate at Cornell with no credentials as a journalist, scholar, or author. My interviews also produced a revelation that shook the journalistic establishment, which had been blithely reporting until the publication of my book Inquest that the Commission had left no stone unturned in an exhaustive investigation. In fact, as I showed, it was a brief, sporadic, and incomplete investigation. Indeed one in which the senior staff lawyer in charge of the crime scene investigation quit after two days, and the young lawyer who took his place, Arlen Specter, was never able to view the single most crucial piece of evidence — the autopsy photographs. The Commission was never able to obtain them, nor other pieces of evidence, because Robert Kennedy blocked it. For the same reason, the Commission was not provided with any information about a parallel plot to kill Castro in 1963. The Commission could not connect dots to which it was denied access.

I had no problem getting this information. Many of the young lawyers on the staff were furious with the way the investigation had been handled and the time pressure imposed on them. So they gave me FBI reports, payroll records and their memos, without me even asking. This raises a question. As these lawyers and Commission members were not bound by any secrecy agreement, as amazing as that might seem nowadays, why had not journalists from major news organizations sought the same information from them? After all, in 1963, the Kennedy assassination was the crime of the century. Fifty years later, I still cannot answer this question.

A very good question. Why weren’t journalists from major news organizations more . . . enterprising? It is another variation on The Emperor’s New Clothes, where a Cornell undergraduate manages to see what many much more experienced and credentialed experts failed to see, or avoided seeing. I would answer Epstein’s question like this: The experts were disinterested in gathering evidence that might contradict their world view. That world view included a belief in the competence of exceedingly important government commissions. They didn’t want to gather evidence that might make them uncomfortable. I see this every year at Nobel Prize time. No journalist ever questions the claims in the press releases that accompany the prizes.

Assorted Links

  • How little is known about tinnitus
  • Michael Lewis on Greg Smith’s book. Published months ago. “The dystopia often imagined in the world of artificial intelligence—in which computers somehow take on a life of their own and come to rule mankind—has actually happened in the world of finance. The giant Wall Street firms have taken on lives of their own, beyond human control. The people flow into and out of them but have only incidental effect on their direction and behavior.”
  • The price of admission to the Chinese Academy of Sciences. “Businessmen seeking ministry contracts learned of Zhang’s nomination and offered to help. . . . Zhang, using a slush fund provided by the businessmen, cloistered 30 experts from mostly ministry-affiliated universities and research institutes in a hotel for 2 months, during which time they churned out three books on high-speed rail technology that were credited to Zhang.”
  • Why was Matthew Shepard killed? I have not yet read this book (I will) but it sounds so good I am happy to publicize it before that. It is being ignored. It supports a theme of Ron Unz and this blog, that lots of what we are told is wrong.
  • Someone leaving graduate school at École polytechnique fédérale de Lausanne explains why he is leaving only a few months before finishing his Ph.d. His complaints about professional (academic) science resemble mine — for example, the dominant role of will this help my career? in all decisions.

Thanks to Joyce Cohen and Allan Jackson.

The Truth in Small Doses: Interview with Clifton Leaf (Part 2 of 2)

Part 1 of this interview about Leaf’s book The Truth in Small Doses: Why We’re Losing the War on Cancer — and How to Win It was posted yesterday.

SR You say we should “let scientists learn as they go”. For example, reduce the need for grant proposals to require tests of hypotheses. I agree. I think most scientists know very little about how to generate plausible ideas. If they were allowed to try to do this, as you propose, they would learn how to do it. However, I failed to find evidence in your book that a “let scientists learn as they go” strategy works better (leaving aside Burkitt). Did I miss something?

CL Honestly, I don’t think we know yet that such a strategy would work. What we have in the way of evidence is a historical control (to some extent, we did try this approach in pediatric cancers in the 1940s through the 1960s) and a comparator arm (the current system) that so far has been shown to be ineffective.

As I tried to show in the book, the process now isn’t working. And much of what doesn’t work is what we’ve added in the way of bad management. Start with a lengthy, arduous, grants applications process that squelches innovative ideas, that funds barely 10 percent of a highly trained corps of academic scientists and demoralizes the rest, and that rewards the same applicants (and types of proposals) over and over despite little success or accountability. This isn’t the natural state of science. We BUILT that. We created it through bad management and lousy systems.
Same for where we are in drug development. We’ve set up clinical trials rules that force developers to spend years ramping up expensive human studies to test for statistical significance, even when the vast majority of the time, the question being asked is of little clinical significance. The human cost of this is enormous, as so many have acknowledged.

With regard to basic research, one has only to talk to young researchers (and examine the funding data) to see how badly skewed the grants process has become. As difficult (and sometimes inhospitable) as science has always been, it has never been THIS hard for a young scientist to follow up on questions that he or she thinks are important. In 1980, more than 40 percent of major research grants went to investigators under 40; today it’s less than 10 percent. For anyone asking provocative, novel questions (those that the study section doesn’t “already know the answer to,” as the saying goes), the odds of funding are even worse.

So, while I can’t say for sure that an alternative system would be better, I believe that given the current state of affairs, taking a leap into the unknown might be worth it.

SR I came across nothing about how it was discovered that smoking causes lung cancer. Why not? I would have thought we can learn a lot from how this discovery was made.

CL I wish I had spent more time on smoking. I mention it a few times in the book. In discussing Hoffman (pg. 34, and footnote, pg. 317), I say:

He also found more evidence to support the connection of “chronic irritation” from smoking with the rise in cancers of the mouth and throat. “The relation of smoking to cancer of the buccal [oral] cavity,” he wrote, “is apparently so well established as not to admit of even a question of doubt.” (By 1931, he would draw an unequivocal link between smoking and lung cancer—a connection it would take the surgeon general an additional three decades to accept.)

And I make a few other brief allusions to smoking throughout the book. But you’re right, I gave this preventable scourge short shrift. Part of why I didn’t spend more time on smoking was that I felt its role in cancer was well known, and by now, well accepted. Another reason (though I won’t claim it’s an excusable one) is that Robert Weinberg did such a masterful job of talking about this discovery in “Racing to the Beginning of the Road,” which I consider to be the single best book on cancer.

I do talk about Weinberg’s book in my own, but I should have singled out his chapter on the discovery of this link (titled “Smoke and Mirrors”), which is as much a story of science as it is a story of scientific culture.

SR Overall you say little about epidemiology. You write about Burkitt but the value of his epidemiology is unclear. Epidemiology has found many times that there are big differences in cancer rates between different places (with different lifestyles). This suggests that something about lifestyle has a big effect on cancer rates. This seems to me a very useful clue about how to prevent cancer. Why do you say nothing about this line of research (lifestyle epidemiology)?

CL Seth, again, I agree. I don’t spend enough time discussing the role that good epidemiology can play in cancer prevention. In truth, I had an additional chapter on the subject, which began by discussing decades of epidemiological work linking the herbicide 2-4-D with various cancers, particularly with prostate cancer in the wheat-growing states of the American west (Montana, the Dakotas and Minnesota). I ended up cutting the chapter in an effort to make the book a bit shorter (and perhaps faster). But maybe that was a mistake.

For what’s it worth, I do believe that epidemiology is an extremely valuable tool for cancer prevention.

[End of Part 2 of 2]

The Truth in Small Doses: Interview with Clifton Leaf (Part 1 of 2)

I found a lot to like and agree with in The Truth in Small Doses: Why We’re Losing the War on Cancer — and How to Win It by Clifton Leaf, published recently. It grew out of a 2004 article in Fortune in which Leaf described poor results from cancer research and said that cancer researchers work under a system that “rewards academic achievement and publication over all else” — in particular, over “genuine breakthroughs.” I did not agree, however, with his recommendations for improvement, which seemed to reflect the same thinking that got us here. It reminded me of President Obama putting in charge of fixing the economy the people who messed it up. However, Leaf had spent a lot of time on the book, and obviously cared deeply, and had freedom of speech (he doesn’t have to worry about offending anyone, as far as I can tell) so I wondered how he would defend his point of view.

Here is Part 1 of an interview in which Leaf answered written questions. Continue readingThe Truth in Small Doses: Interview with Clifton Leaf (Part 1 of 2)”

What I’m Reading

  • Republic of Outsiders: The Power of Amateurs, Dreamers, and Rebels by Alissa Quart
  • Brilliant Blunders: From Darwin to Einstein, Colossal Mistakes by Great Scientists that Changed our Understanding of Life and the Universe by Mario Livio
  • Fate of the States: The New Geography of American Prosperity by Meredith Whitney
  • Americanah by Chimamanda Ngozi Adichi, might set the record for largest value of letters in author’s name (21) minus letters in title (10) = 11
  • proofreading part of a new book by Edward Jay Epstein, described as a “Kennedy assassination diary”

Assorted Links

Thanks to Phil Alexander and Casey Manion.

Give and Take by Adam Grant

The publisher sent me a copy of Give and Take by Adam Grant after I sent several emails asking for a review copy. I expected it to be the best book about psychology in many years and it is.

The book’s main theme is the non-obvious advantages of being a “giver” (someone who helps others without concern about payback). Grant teaches at Wharton, whose students apparently enter Wharton believing (or are taught there?) that this is a poor strategy. With dozens of studies and stories, Grant argues that the truth is more complicated — that a giver, properly focussed, does better than others. Whether this reflects cause and effect (Grant seems to say it does) I have no idea. Perhaps “givers” are psychologically unusually sophisticated in many ways, not just a relaxed attitude toward payback, and that is why some of them do very well. Continue readingGive and Take by Adam Grant”

Assorted Links

Two Cents about Renata Adler

Renata Adler’s two novels, Speedboat (1976) and Pitch Dark (1988), have just been reissued by New York Review Books.  I was pleased to see a recent New York article about her. Here is my two cents:

1. Gone: The Last Days of The New Yorker (2000) is one of my favorite books. It can be summed up like this: Genius corrupts. I first came across it in the Berkeley Barnes & Noble. I couldn’t stop reading it. When I left the store hours later my scooter had a parking ticket.

2. Her libel lawsuit is described here.

3. She wrote a book about the Bilderberg Group called Private Capacity. It was announced then cancelled.

4. During a panel discussion televised on C-Span, she took a phone call. It appeared to be from her daughter.

5. For several years she taught journalism at Boston University. A student said she told great stories.

6. In a book review, she said that Woodward and Bernstein’s Deep Throat was made up. Apparently she was wrong about that.

7. During a dinner I had with Aaron Swartz last summer, he praised her article attacking Pauline Kael (“The Perils of Pauline”, 1980).

8. When her article about Kael came out, a friend of mine said, Now she’ll be known as the person who attacked Kael. My friend was wrong. She is better known as the person attacked by eight articles in the New York Times when Gone was published. One short non-best-selling book, eight negative articles from the most powerful pulpit on earth.

9. Gone and some books by Jane Jacobs were the only books I took to China. I also adore Totto-Chan but I suppose I have memorized it. I mostly read books by men, so I am puzzled that all my most favorite books are by women. A Chinese friend of mine stayed in my Beijing apartment while I was gone. Her English isn’t very good but she praised Gone, which she called Lost.

Assorted Links

Thanks to Bryan Castañeda.

Who Is Listened To? Science and Science Journalism

This book review of Spillover by David Quammen is quite unfavorable about Laurie Garrett, the Pulitzer-Prize-winning science journalist. Several years ago, at the UC Berkeley journalism school, I heard her talk. During the question period, I made a comment something like this: “It seems to me there is kind of a conspiracy between the science journalist and the scientist. Both of them want the science to be more important than it really is. The scientist wants publicity. The science journalist wants their story on the front page. The effect is that things get exaggerated, this or that finding is claimed to be more important than it really is.” Garrett didn’t agree. She did not give a reason. This was interesting, since I thought my point was obviously true.

The book review, by Edward Hooper, author of The River, a book about the origin of AIDS,  makes a more subtle point. It is about how he has been ignored.

When I wrote The River, I did my level best to interview each of the major living protagonists involved in the origins-of-AIDS debate. This amounted to well over 600 interviews, mostly of two hours or more, and about 500 of which were done face-to-face rather than down the phone. Although the authors of the three aforementioned books (Pepin, Timberg and Halperin, Nattrass) all devote time and several pages to The River, and to claims that I definitely got it wrong, not one of them bothered to contact me at any point – either to challenge my findings, or to ask me questions. However, I have been contacted by someone through my website (a lawyer and social scientist) who asked me several questions, to all of which I responded. Later, this man read the first two of these three pro-bushmeat books and contacted the authors of each by email, to ask them one or two simple questions about their dismissal of the OPV hypothesis [= the AIDS virus came from an oral polio vaccine]. His letters to Pepin, Timberg and Halperin (which he later forwarded to me) were courteous and non-confrontational, and in two instances he sent three separate letters, but apparently not one of the authors could be bothered to reply to any of these approaches.

In other words, there is a kind of moat. Inside the moat, are the respected people — the “real” scientists. Outside the moat are the crazy people, whom it is a good idea to ignore. Even if they have written a book on the topic. Hooper and those who agreed with him were outside the moat.

Hooper quotes Quammen:

“Hooper’s book was massive”, Quammen writes, “overwhelmingly detailed, seemingly reasonable, exhausting to plod through, but mesmerizing in its claims…”

I look forward to the day that the Shangri-La Diet is called “seemingly reasonable”. Quammen and Garrett (whose Coming Plague has yet to come) write about science for a living. I have a theory about their behavior. To acknowledge misaligned incentives (scientists, like journalists, care about other things than truth )  and power relationships (some scientists are in a position to censor other scientists and points of view they dislike) would make their jobs considerably harder. They are afraid of what would happen to them — would they be kicked out, placed on the other side of the moat? — if they took “crazy” views seriously. It is also time-consuming to take “crazy” views seriously (“massive . . . exhausting”). So they ignore them.

Late Comment on Battle Hymn of the Tiger Mother

Amy Chua wondered if all the pressure to practice (piano, older child, violin, younger child) she put on her two children was worth it. But then there were moments like these:

In a glass-windowed room overlooking the Mediterranean, Sophia played Mendelsohn’s Rondo Capriccioso, and got bravos and hugs from all the guests.

Which I found the most chilling sentence in the whole book. Her daughter’s recognition (“bravos and hugs”) made Chua very happy. But did it make Sophia happy? Chua doesn’t answer that question. She doesn’t follow the sentence I’ve quoted with “I could see how pleased she was” or “Years later she would say what a good time she had”. Nope, the chapter ends there.

“The Most Influential Tree in the World”

The title comes from Andrew Montford’s new book Hiding the Decline (copy given me by author) about Climategate. From an introductory section:

When the figures were published the extraordinary lack of data underlying the blade of the Yamal hockey stick caused a minor sensation. In fact the high point at the end of the graph was shown to have been based on only four trees, and only one of these had the hockey stick shape. McIntyre dubbed it ‘the most influential tree in the world’.

Most of Hiding the Decline is about the inquiries that followed Climategate. I enjoyed reading about smug powerful people making fools of themselves and the fairy-tale-like consternation created by two unlikely events: 1. A non-scientist (Steve McIntyre) gets involved in the global warming debate. As in a fairy tale, McIntyre is free to speak the truth. In particular, he is free to question. Professional climate scientists cannot speak the truth for fear of career damage. 2. The release of the Climategate emails. As in a fairy tale, a sudden burst of truth about bad behavior previously hidden. Continue reading ““The Most Influential Tree in the World””

Sleeping Pills are Very Dangerous

Do you know how dangerous prescription sleeping pills are? I didn’t, and I do sleep research.

I came across Dr. Daniel Kripke’s book Dark Side of Sleeping Pills while finishing yesterday’s post on undisclosed risks of medical treatments. I had written an almost-complete draft a year ago. One line in the draft said “undisclosed risks of sleeping pills” with no additional information. I couldn’t remember why I’d written that so I googled “dangers of sleeping pills” and found Dr. Kripke’s book. I was unaware the evidence was so strong. I asked Dr. Kripke to tell the story of how he came to write it. He replied:

It is almost a life-long story.

As a young psychiatrist, I learned that the American Cancer Society had done a questionnaire survey of a million people which showed mortality related to long and short sleep. [People who sleep less or more than average have higher death rates.] In 1975, I asked if they would collaborate with me on a more complete analysis of the data on sleep length and insomnia.  As a control variable, we included analysis of their one question about sleeping pill use.  To my surprise, it looked like sleeping pill use was a strong predictor of early death, while insomnia was not (if you controlled for sleeping pill use by insomniacs). Continue reading “Sleeping Pills are Very Dangerous”