Health

Unusual Bodies

Posted by Peter on June 21, 2006
Posted in: Book Reviews, Health, Miscellaneous.

Book Review: One of Us : Conjoined Twins and the Future of Normal by Alice Domurat Dreger
This book raises questions about peoples’ reactions to conjoined twins that may have important implications for many other unusual traits. It eloquently questions common assumptions about the desire to seem normal. It has led me to wonder about the extent to which healthcare is used to make people more normal at the cost of making them less healthy.
The book presents strong evidence that conjoined twins who remain conjoined are at least as well off as those who are separated, and some evidence that separations reduce the twins’ life expectancy, possibly by a significant amount.
Remarkably, of the twins who remained conjoined to adulthood, only one pair requested separation (they didn’t survive it), and among those whose refused separation are a number whose twin had just died (which meant that separation appeared to offer the only chance for the remaining twin to survive).
This doesn’t mean conjoined twins are better off that way (those who have been separated seem equally satisfied with their status), but it strongly suggests that decisions to perform separations are motivated by something other than concern over the twins wellbeing. And it suggests that people who claim things like “The proposed operation would give these children’s bodies the integrity that nature denied them” are imposing their values on others in ways which would be considered unacceptable if the victims had a little political power.
The book reports a fair number of statements by doctors (and occasionally parents) which suggest they consider a normal appearance worth risking health to achieve. The book also theorizes that having a normal child is an important enough part of parents’ identity to override their interest in their children’s’ wellbeing. The book also reports some indications that surgeons are biased toward surgery for unusual problems by the fame if can bring them.
Unfortunately, there isn’t as much evidence as there ought to be about the health effects of separations. The book claims (plausibly, but without supporting references), that “most medicine is not yet evidence-based”, with most surgical decisions being based on storytelling rather than careful studies.
The book raises some important questions about cases where doctors think the only way to save one twin is to kill the other. The author points out some strong similarities between the medical killing that is done in some of these cases and a hypothetical case where a heart is taken from a live singleton (i.e. not conjoined) donor to save another (which all would agree is wrong). One difference that she fails to consider is that if you consider the heart property, it looks like jointly owned property in one case and individually owned property in the other, and we should expect some differences to result from that (although doctors may still be more willing to kill one twin than that perspective would justify).
One interesting example that the book provides of medicalizing a difference is the attempt to get doctors to recognize Drapetomania, a “disease” which causes slaves to run away.
How widespread is the practice of impairing health to make people more normal? Surgeries on intersex children probably create modest health risks. Commonly used medicines to deal with ordinary colds suppress annoying symptoms that are tools the body uses to fight the disease, and tend to make the disease last longer (see the book Why We Get Sick : The New Science of Darwinian Medicine by Randolph Nesse). A child with 3 arms makes doctors want to chop it off, presumably at some risk.
Are these part of a wider pattern that would help explain why increased healthcare spending doesn’t seem to make us healthier?
On a loosely related note, I just ran across an unsettling complaint that Prozac seems to help too many people:

“There’s nobody nonsyndromal. You can give Prozac to anyone you want.”

Which is anathema to what medical science is supposed to be about. “We try to convince people there’s some specificity to what we do,” says Millman. “But this is embarrassing.”

Is this an indication that people don’t want drugs to do anything other than treat abnormal conditions (i.e. that they consider it wrong to improve on normal conditions)? Or does it reflect concern that there will be less demand for doctors’ skills if no diagnosis is relevant to the decision to use it? (This seems less likely given that they can still play a role in monitoring side effects).

I was inspired to read this book by a brief comment from Robin Zebrowski at the recent Human Enhancement Conference.

Human Enhancement Conference

Posted by Peter on June 2, 2006
Posted in: Health, Miscellaneous. Tagged: , , , .

The conference on Human Enhancement Technologies and Human Rights this past weekend had many boring parts and a few interesting tidbits.
Many of the speakers were left-wing ideologues who seemed to be directing their speeches only to others from the same small set of left-wing academics. There were fewer libertarians at the conference than I expected, but still enough that it was strange how much of a disconnect there was between the ideology shown in the speeches and the ideology I knew from elsewhere that many people held but were being quiet about.
There was plenty of concern about whether increased control over one’s body would decrease diversity, but I heard little that enlightened me on that subject. There have clearly been many technologies that increased diversity, such as tattoos. There are some that have decreased diversity because there is a substantial consensus about what’s best (e.g. eyesight – it’s unclear why we should be concerned about a shortage of people who can’t see well enough to drive). Then there are a few traits such as degree of autism where there’s some uncertainty whether reduced diversity would be good. There are some pontificators (I didn’t hear anyone this focused at the conference) who think they know better than the masses what the right amount of diversity is, and that their opinions should be imposed on the masses. But the evidence for the pontificators’ expertise and the masses propensity to make mistakes is generally underwhelming, so I can’t find much reason to be as concerned about the effects of enhancement technology as I am about the desire to impose expert opinion on those who don’t want it.
Hank Greely pointed out that the letter of the law authorizes the FDA to regulate anything that could be considered a body enhancement, including clothing. So only the FDA’s interest in obeying the spirit of the law will deter them from regulating external enhancements.
One amusing report of unwanted side effects of an enhancement technology is the increase in sexually transmitted diseases in seniors following the introduction of Viagra.
Aubrey de Grey made an interesting argument that the most effective approach to convincing people to support a cure for aging is to persuade them that they are being logically inconsistent when they fail to do so. He has a point, but it’s weaker than he thinks. He gave several examples of problems that were allegedly solved by persuading society to be more logically consistent, but I generally doubt that’s what happened. One example was tolerance of homosexuality. I see few signs that logical arguments had much effect on that. I think the biggest change came from peer pressure, which became increasingly popular as gays became able to migrate to places where there were enough gays to safely start exerting peer pressure. Another factor was the shift away from the belief that the main purpose of sex should be reproduction. That initially happened due to changing circumstances (reduced reliance on children to support elderly parents). I’d say that has generally produced beliefs that are more inconsistent as people abandon the least convenient symptoms of the belief (e.g. contraception) but are much slower to abandon symptoms that are remote from their experience. I think similar theories could be made about some other examples he gave (slavery becoming more expensive to enforce when railroads made it easier for slaves to escape to a non-slave state).

Diet and the Environment

Posted by Peter on April 21, 2006
Posted in: Health, Miscellaneous. Tagged: , .

A recent report says that switching from a meat-heavy diet to a vegetarian diet is as valuable for reducing greenhouse-gas emissions as switching to driving the right car. And that if you eat fish, switching from large fish to things like sardines and anchovies makes a big difference.
I’m unsure whether to believe the magnitudes of the differences, but the general idea appears right.

Fantastic Voyage

Posted by Peter on March 15, 2006
Posted in: Book Reviews, Health. Tagged: , , .

Book Review: Fantastic Voyage : Live Long Enough to Live Forever by Ray Kurzweil, Terry Grossman
This book provides a lot of interesting ideas for improving your health, but it is a bit too ambitious and I’m often left wondering whether they researched a particular idea well even that I should respect their opinion. They often seem to be more interested in showing off how many different topics they know something about than they are on focusing on the most important steps that a typical reader should be taking.
They are somewhat biased toward technological solutions, but occasionally surprise me with other approaches, such as pointing out some clear evidence that some kinds of meditation improve longevity.
I’m fairly suspicious of their advice about aluminum. It’s unclear why we should consider aluminum dangerous enough to be worth worrying about, but if it is then choosing the right baking powder and antacids are at least as important as the aluminum sources the book mentions (minor gripe: the index doesn’t have entries for aluminum or metals). Parts of the book leaves me wondering whether a close examination would reveal similar questionable aspects to their advice.

Accelerating Change Conference

Posted by Peter on September 26, 2005
Posted in: Artificial Intelligence, Health, Science and Technology, Virtual Worlds. Tagged: , , .

I was somewhat disappointed by the latest Accelerating Change Conference, which might have been great for people who have never been to that kind of conference before, but didn’t manage enough novelty to be terribly valuable to those who attended the first one. Here are a few disorganized tidbits I got from it.
Bruno Olshausen described our understanding of the neuron as pre-newtonian, and said a neuron might be as complex as a pentium.
Joichi Ito convinced me that Wikipedia has a wider range of uses than my stereotype of it as a dictionary/encyclopedia suggested. For example, its entry on Katrina seems to be a better summary of the news than what I can get via the traditional news media.
Cory Ondrejka pointed out the negative correlation between the availability of violent video games and some broad measure of U.S. crime. He hinted this might say something about causation, but reminded people of the appropriate skepticism by noting the correlation between the decline in pirates and global warming.
Someone reported that Second Life is growing at an impressive pace. I’ve tried it a little over a somewhat flaky wireless connection and wasn’t too excited; I’ll try to get my iBook connected to my dsl line and see if a more reliable connection makes it nicer.
Tom Malone talked about how declining communications costs first enabled the creation of large companies with centralized hierarchies and are now decentralizing companies. His view of Ebay was interesting – he pointed out that it could be considered a retailer with one of the largest number of employees, except that it has outsourced most of its employees (i.e. the people who make a living selling through Ebay). He also mentioned that Intel has some internal markets for resources such as manufacturing capacity.
Daniel Amen criticized modern psychiatry for failing to look at the brain for signs of physical damage. He provided strong anecdotal evidence that the brain imaging services he sell can sometimes tell people how to fix mental problems that standard psychiatry can’t diagnose, but left plenty of doubt as to whether his successes are frequent enough to justify his fees.
T. Colin Campbell described some evidence that eating animal protein is unhealthy. He didn’t convince me that he was a very reliable source of information, but his evidence against casein (a milk protein) sounded fairly strong.
One odd comment from Robin Raskin (amidst an annoying amount of thoughtless sensationalism) was that kids don’t use email anymore. They send about two emails per day [i.e. they’ve switch to IM]. The idea that sending two emails per day amounts to abandoning email makes me wonder to what extent I’m out of touch with modern communication habits.
An amusing joke, attributed to Eric Drexler:
Q: Why did Douglas Hofstadter cross the road?
A: To make this joke possible.

Contrary Views on Medicine and Parenting

Posted by Peter on June 2, 2005
Posted in: Health, The Human Mind. Tagged: .

Bryan Caplan writes about Robin Hanson’s contrarian views on the effectiveness of medicine and parenting.
Caplan’s conclusion about medicine involving a mix of beneficial and harmful practices is probably correct (and probably consistent with Robin’s views), but some of his reasoning is bogus:

Start with medicine. Modern techniques have clearly saved a lot of lives. If memory serves me, survival rates for premature babies have skyrocketed from 10% to 90%.

Part of Robin’s point is that we can’t tell from the improved survival rates that medicine was responsible. It may be that improved maternal nutrition has made babies better able to withstand premature birth. There is no easy way to distinguish the causes, and there’s some reason to think doctors are more effective at biasing consumers to credit them with improving peoples’ health than farmers are.
The evidence that medicine is less effective than most believe has fewer practical implications than a superficial glance suggests. It implies that you shouldn’t choose an expensive health plan over a cheap one, but leaves open the possibility that you should still see your doctor fairly often, and the possibility that you can “buy” health care that will slightly increase your life expectancy by moving from, say, Havana to San Francisco.
The argument (started by Judith Rich Harris) that parenting styles have little effect has a stronger conclusion. Caplan claims:

The same goes for parenting. We all know kids who let their parents plan their lives for them. Maybe it’s 100% genetic, but that’s a stretch. It’s more plausible to acknowledge that these pliable kids exist, but point out that they’re only half the story. We also all know kids who heard their parents’ plans for their future, and did exactly the opposite just to spite them.

I do not know kids who come close to fitting the first pattern after puberty. Essentially all kids need to demonstrate to their peers by about puberty that they are mature enough to be somewhat independent of their parents. And if you think about the sexual selection pressures on children around that age, you should expect that to be just one symptom of the pattern that Harris points out. Their reproductive success is heavily dependent on their ability to compete with and to impress people who are sufficiently close to their age to become a mate or to compete for a mate. That implies that it is important for them to adapt their personalities in ways that respond to evidence about their peers, and to treat parental opinions as much less relevant.
Unlike the arguments about the ineffectiveness of medicine, the evidence against the importance of parenting styles appears to show that all attempts to improve parenting styles (except for those, such as choosing the best school, which influence whom the child can have as peers) have failed to show benefits.
We have a large industry devoted to convincing parents to buy its advice on parenting styles. This creates a nontrivial incentive to provide evidence that some parenting styles work better than others. That includes incentives to distinguish children that will be helped by style X from those who will be helped by the opposite style. And unlike the evidence that some medical practices work, the evidence for the value of advice on parenting styles consistently fails when subjected to close scrutiny.
It is still possible that parenting styles are sometimes helping and sometimes hurting, but theory and the breadth of the evidence suggest betting against that. Eventually, given tools as drastic as manipulating the child’s genes, parents will someday find ways to manipulate their kids minds. But since there’s little reason to think that children are currently suffering from negligent parenting styles, and there are moderately good reasons to guess that youthful rebellion is mainly the result of children pursing their (gene’s?) interests, it’s hard to see why parents should be trying to alter their children’s behavioral strategies rather than ensuring that they have the resources to do what they want. (Unless, of course, parents have good reasons for pursuing different goals than their children. I’m having trouble analyzing that possibility.)

Fixing Social Security

Posted by Peter on May 27, 2005
Posted in: Health, U.S. Politics. Tagged: , .

Social Security was created based on the premise that people of certain ages are unable to support themselves due to poor and declining health. Yet Aubrey de Grey has made a fairly strong argument that this bad health can be cured (see Strategies for Engineered Negligible Senescence), so that the elderly will be as healthy as the young.
Since it’s probably inevitable that the government will end up paying for the initial round of anti-aging treatments, why not make government payments for such treatments conditional on the beneficiary leaving the Social Security system? This would probably save the government enough that it would be worthwhile for it to speed the research up by offering a few billion dollars in prizes for people who complete milestones such as extending the lifespans of lab animals.
There’s a good deal of doubt as to how many decades it will take to produce a good enough cure (and some ambiguity as to how good a cure would need to be to qualify). But the a combination of Aubrey de Grey’s arguments and those of Rob Freitas and Eric Drexler suggest that there’s a very good chance that it can be done before Social Security is expected to collapse. And anyone who thinks Congress might turn Social Security into a system that is certain to remain solvent is drastically overestimating the reliability of demographic forecasts and/or the far-sightedness of Congress.

VeganEssentials

Posted by Peter on February 15, 2005
Posted in: Health. Tagged: .

I highly recommend VeganEssentials.com as a source of healthy and tasty food for when it’s hard to have fresh fruits and veggies available (e.g. hiking, snowboarding, kayaking). Some of my favorites are the Larabar (made entirely of fruit and nuts) and the mushroom jerky.

Hunger

Posted by Peter on December 16, 2004
Posted in: Book Reviews, Health, Politics, The Flynn Effect. Tagged: , , , .

Book Review: The Escape from Hunger and Premature Death, 1700-2100 by Robert Fogel

This book presents good arguments that hunger was a major cause of health problems everywhere a century ago, and that the effects last long enough that even the richest countries are still suffering from problems caused by hunger. His arguments imply that experts persistently underestimate improvements in life expectancy, and even with little improvement in medical technology life expectancy will improve a good deal because people born today have much better nutrition than today’s elderly had as children.

This goes a long way toward explaining the Flynn effect (even though the book doesn’t mention Flynn or IQ). It correctly implies the biggest intelligence increase should be seen at the low end of the IQ range, unlike a number of other interesting theories I’ve come across.

Another peculiar fact that the book helps to explain is the high frequency with which the tallest presidential candidate wins. Fogel’s arguments that height has been one of the best indicators of health/wealth suggest that this is not an arbitrary criterion (although it is probably a selfish I-want-to-ally-with-a-winner strategy that may be obsolete).

The book is mostly non-idealogical, but occasionally has some good political arguments (page 42):

government transfers were incapable of solving the problems of beggary
and homelessness during the eighteenth and much of the nineteenth centuries,
because the root cause of the problems was chronic malnutrition. … At
the end of the eighteenth century British agriculture, even when supplemented
by imports, was simply not productive enough to provide more than 80 percent
of the potential labor force with enough calories to sustain regular manual
labor.

(page 106):

Readers may be surprised that I have not emphasized the extension of health insurance policies to the 15 percent of the population not currently insured. The flap over insurance has more to do with taxation than with health services. … Most proposals for extending health insurance involve taxing their wages for services they already receive.

See also Mike Linksvayer’s comments.