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All Medical Science is Wrong within a 95 % Confidence Interval

bbgm 17y ago
How does one get from a very narrow discussion of medicine to all medical science? Without questioning the merits of the post (happen to agree with a good chunk of it), that's a sliver of what one might call medical science, albeit a rather lucrative sliver.
deleted 17y ago
[deleted]
iamelgringo 17y ago
Nutrition != Medicine.
- Oxryly 17y ago
  If you're talking about the title, I'll agree it's a tad sensationalistic. If it's your view that the statement has wider meaning, I'd say turn it on its head: consider nutrition to be the first and best application of medicine. If you had a chronic health condition (e.g. thyroid problem, diabetes, cardiovascular disease, migraines, etc etc) and you had three options: diet change, drugs, or surgery. Which would you choose every time? Which do you think would be healthier for you overall? Lead to more longevity, better quality of life, etc? Nutrition certainly is medicine, and medicine at its cheapest and most effective.
  - iamelgringo 17y ago
    Diabetes: I'd much rather have a surgery or procedure that could replace my Islet of Langerhans rather than take insulin 2 times a day and live with a strict diet the rest of my life. Many diabetics I know would agree. We don't have that treatment yet. Migraines: Poorly understood and generally poorly treated with pain medicines. Anyone that says that they can be cured with diet is trying to sell you something. Again, if a simple procedure could be devised to end people's needless suffering from migraines, I'm sure vast numbers of people would elect the surgery. Cardiovascular disease: One of the top killers in the US. Most people end up treating this with a procedure (Cardiac Stenting or Bypass Surgery). It's certainly not ideal, but that's what the majority of people in this country choose. Dietary treatment is somewhat helpful for this, but genetics play a huge roll in this, and pure dietary treatment isn't going to solve the problem. Thyroid: The treatment for this is generally taking a dose of thyroid medicine every day. For some people with an overactive thyroid which can be life threatening, a thyroidectomy is done. Otherwise, daily doses of medicine are about as unpleasant as being constantly vigilant about your diet.
    - Oxryly 17y ago
      Diabetes: do you have type 1 or type 2? Dietary (coupled with lifestyle) changes can produce lower inflammation and better blood sugar control. These two things attained early and often enough are enough to help avoid obesity, type 2 diabetes, hypertension, cardiovascular disease, arthritis, various auto-immune diseases. These changes will leave you healthier overall, something that cannot be said of surgery or drugs.
joe_the_user 17y ago
The article is quite interesting. But it has two different parts to it. One part is how dubious and unreliable much of medical science is. The other part is a plausible argument for the causes of "life style diseases". Both arguments are interesting but they are somewhat at odds with each other. If there is so much uncertainty in medical research and medical advice, then shouldn't we have something like a call to step and spend some time just evaluating our methods and figuring how to increase the objectivity of the process rather than jumping to yet another not yet full substantiated approach - not that the approach itself sound particular bad or dubious but the juxtaposition of the two arguments gives me pause.
lincolnq 17y ago
See also (some conflicting views), the Hacker's Diet : http://www.fourmilab.ch/hackdiet/www/hackdiet.html http://www.fourmilab.ch/hackdiet/www/hackdiet.html
- radu_floricica 17y ago
  Not necessarily at odds. Hacker's Diet is about how one individual can get a substantial weight loss in a short time, and keep it with maintenance. This article is about long time effects of a certain diet. They don't contradict.
  - Oxryly 17y ago
    They contradict where the Hacker's Diet makes no attempt to differentiate between types of calories. For the Hacker Diet, all calories count against your total the same way. There's no concept of calories that throw off your blood sugar and consequently your insulin, and those that help maintain it. Therefore there's no attempt to manage the core fat building or fat burning mechanism of the body. It just pretends that food = bad and exercise = good.
    - ZeroGravitas 17y ago
      That's a very harsh review of the hacker's diet. More accurate would be food = energy, exercise = energy expenditure, obesity = prolonged energy surplus stored as fat, and weight loss = prolonged calorie deficit leading to fat reduction. While I agree that there are wrinkles due to when, how and what you eat, I can't see a problem with that basic maths. You could say a 'bad' calories is one that triggers you to eat more calories, whether that's through habit, or addiction, or stomach stretching, or sugar rushes and crashes leading to hunger. But that still reduces down to more calories. This book seems to be suggesting that the energy you store as fat comes from somewhere other than the food you eat. That's entering creationism or perpetual motion machine territory for me, and as you would then expect is accompanied by claims that the whole field is crooked. The rebuttal linked from the article (by one of the "villains" of the book) suggests that the weird data comes down to people lying about what they eat to researchers. Not only do they not record everything they eat, they lie even more about their consumption of fatty foods which (correctly or not) the average person thinks are bad. This makes it seem like people are gaining weight mysteriously, and that carbs are over-represented. Given the choice between overweight people misrepresenting what they eat and a whole branch of science being corrupt I'll take the former. Particularly if the book writer is happy to cherry pick out the results that he likes and ignore the rest of the field.
derefr 17y ago
The article cites a hypothesis that boils down to "all of these things are bad because they make you produce more insulin." The proposed solution is to do less of all of those things. Why not, instead, modulate insulin? Then, if the cited hypothesis is right, we could eat however we wanted and be perfectly healthy and thin. I'm curious as to the correlations between diabetes or hypoglycemia and the diseases mentioned in the article.
- sho 17y ago
  That would be the wonderful sci-fi solution, it would seem, but I don't think the technology (or even the theory) is there yet.
- lena 17y ago
  This is why you should exercise, and why people in other countries, who eat lots of carbohydrates, even refined ones, do not have high rates of diabetes and obesity.
  - electromagnetic 17y ago
    Let's please be accurate here. People in other countries generally have lower rates of obesity not because they exercise, but because they actually have to do physical work and don't sit on their asses in an office all day. People say exercise and everyone tends to think the gym. However this is total BS, you don't need to go to the gym to stay healthy, the only thing you need to do to stay healthy when eating lots of carbohydrates is to do an activity to burn them. The other major misconception is people think thin=healthy when really all the 'healthy' (women especially) people on TV are definitely not healthy. In fact, unless you're very careful with a calorie restricted diet (lots of vitamins and enough protein to maintain your muscle tissue) you are doing significantly more damage to your body than if you were overweight. It's been shown anorexia can shorten your life by 25 years. Being moderately obese (30-35 on the BMI) can take 2-4 years off your life and extremely obese (40-45) can take 8-10 years off your life expectancy. People who are in the overweight group don't see a reduction in life expectancy, unless they smoke. Then it also depends on how healthy you are when you're obese. Many sportsmen and soldiers are obese to significantly obese, and I don't think you'll find a single one who's of normal weight. However, many of these men will live longer than the average normal weight person (assuming they don't use steroids), due simply to the fact that building muscle tissue usually helps build your heart tissue too, meaning you stand to live significantly longer.
larryfreeman 17y ago
I am especially bothered by one sentence: "Prior to my introduction to the world of low-carbohydrate diet, I hadn't paid too much attention to nutritional science. I worked on biophysics, where I formed the opinion that medical science was mostly garbage." It's hard for me to take someone seriously who once believed that medical science is 'mostly garbage.'
- Ardit20 17y ago
  Why?
  - pierrefar 17y ago
    Because he clearly is biased against "medicine" and then finds a book that fits his bias and is trumpeting it as the eternal truth. He's committing the same offense he speaks out against in the same article.
    - jerf 17y ago
      Is he "biased against medicine", or is he "biased in favor of five-sigma+ results"? Does medicine use 95% confidence intervals because it is actually sufficient to base a medical science off of, or do they use 95% confidence interval because it is all they can get? The problem is, the universe doesn't care if all you can get is a 95% result. And he is right that at least some people in the softer sciences don't understand their confidence intervals in the slightest. That crack he made about standard deviations being computed for non-Gaussian distributions won't resonate with you unless you have a lot of statistical training, but it a damning criticism; doing that sort of thing is basically proof your entire analysis isn't worth the paper it's written on, in proportion to the deviation from Gaussianess. I've been witness to the training procedure on experimental stats for undergrad biologists, which consists mostly of endless hammering in of the p-value as mantra, with understanding neither asked for nor given (unsurprising, as given the math prereqs up to that point the true meaning of the p-value can't really be taught). At the time I wouldn't have realized how wrong it is to apply p-value analysis to a bi-valued distribution, but I bet they were asked to. I know there's a grad-level course on the topic for them, but I fear it may be the blind leading the blind there. I'm less willing to write off medicine as a whole. It has had some undeniable success in some areas (but it should be observed that weight management with much less than stomach stapling hasn't really been one of them). I'm playing a bit of devil's advocate here, because I think you may not have given the article a fair reading after you flipped the idiot flag on the author.
radu_floricica 17y ago
Interesting article. The only question I have: Atkins diet exists for some time. If so, then why hasn't it been a wild success? I know it works very well short time, but I also know no diet, including Atkins, managed to do well long term (2+ years). Except fringe cases of people who dedicate half of their life to weight maintenance, specific diets tend to hurt more then help. Also I'd like some specific opinion on rice. It's carb, but I haven't yet seen a fat Japanese. Anyways, one thing is worth taking from all this: don't mix carbs with rich meals. A cake should be fine by itself, but fries with steak not so much.
- xiaoma 17y ago
  I agree. This guy's claims are flatly contradicted by world evidence. As I've posted here before, the Japanese diet derives half its calories from rice, and well over 70% from carbohydrates in general. Two generations ago, it was nearly 70% just from rice. As many know, the Japanese live longer and have fewer "life-style diseases" than anyone else. Korea, Hong Kong and Taiwan are similar, both in terms of diet and in exception life expectancy as compared to economic development. All around the world, there's a pretty consistent relationship between groups of big protein eaters and big people. Americans get more calories of protein than anybody else and are fatter than anyone else. Mexicans and British are close behind in both categories. Furthermore, research on high vs low protein diets has been pretty conclusive: http://news.ycombinator.com/item?id=613745 http://news.ycombinator.com/item?id=613745
  - defen 17y ago
    Yes but have you seen the serving sizes in Japan? A meal there would barely count as an appetizer for your average (overweight) American.
    - xiaoma 17y ago
      Just think how people like me feel when visiting America and seeing "no vegetables" as an selling point for double or even triple stack whoppers. It's overwhelming, sickening and yet fascinating all at the same time.
magoghm 17y ago
It's easy to see that most nutriton specialists aren't very scientific: they refer to meat as "proteins" and measure everything in "calories" (which are really kilocalories) instead of joules.
tokenadult 17y ago
Link to the primary research finding, "Why Most Published Research Findings Are False," from PLoS Medicine: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124 http://www.plosmedicine.org/article/info:doi/10.1371/journal...
ZeroGravitas 17y ago
Can someone explain the entropy and thermodynamics bit? He appears to be arguing against the concept of calories in minus calories burned equals calories stored, but he lost me. He's got "entropy" in his blog name so you'd think this is his area, however, it sounds fishy to me.
duncanj 17y ago
It seems to me that he is leaving out a discussion of slow-twitch and fast-twitch muscles. Slow-twitch muscles are used in maintaining posture and light activity and burn primarily fat. Fast-twitch muscles are used for strength and burn primarily glucose. Hard exercise like he suggests would use mostly glucose. Walking slowly while working 8 hrs a day (treadmill desk) would presumably use more fat. It would be interesting to see if that is actually the case (within a 95% confidence interval, of course ;) )

bbgm 17y ago

How does one get from a very narrow discussion of medicine to all medical science? Without questioning the merits of the post (happen to agree with a good chunk of it), that's a sliver of what one might call medical science, albeit a rather lucrative sliver.

deleted 17y ago

[deleted]

iamelgringo 17y ago

Nutrition != Medicine.

Oxryly 17y ago
If you're talking about the title, I'll agree it's a tad sensationalistic. If it's your view that the statement has wider meaning, I'd say turn it on its head: consider nutrition to be the first and best application of medicine. If you had a chronic health condition (e.g. thyroid problem, diabetes, cardiovascular disease, migraines, etc etc) and you had three options: diet change, drugs, or surgery. Which would you choose every time? Which do you think would be healthier for you overall? Lead to more longevity, better quality of life, etc? Nutrition certainly is medicine, and medicine at its cheapest and most effective.
- iamelgringo 17y ago
  Diabetes: I'd much rather have a surgery or procedure that could replace my Islet of Langerhans rather than take insulin 2 times a day and live with a strict diet the rest of my life. Many diabetics I know would agree. We don't have that treatment yet. Migraines: Poorly understood and generally poorly treated with pain medicines. Anyone that says that they can be cured with diet is trying to sell you something. Again, if a simple procedure could be devised to end people's needless suffering from migraines, I'm sure vast numbers of people would elect the surgery. Cardiovascular disease: One of the top killers in the US. Most people end up treating this with a procedure (Cardiac Stenting or Bypass Surgery). It's certainly not ideal, but that's what the majority of people in this country choose. Dietary treatment is somewhat helpful for this, but genetics play a huge roll in this, and pure dietary treatment isn't going to solve the problem. Thyroid: The treatment for this is generally taking a dose of thyroid medicine every day. For some people with an overactive thyroid which can be life threatening, a thyroidectomy is done. Otherwise, daily doses of medicine are about as unpleasant as being constantly vigilant about your diet.
  - Oxryly 17y ago
    Diabetes: do you have type 1 or type 2? Dietary (coupled with lifestyle) changes can produce lower inflammation and better blood sugar control. These two things attained early and often enough are enough to help avoid obesity, type 2 diabetes, hypertension, cardiovascular disease, arthritis, various auto-immune diseases. These changes will leave you healthier overall, something that cannot be said of surgery or drugs.

joe_the_user 17y ago

The article is quite interesting. But it has two different parts to it. One part is how dubious and unreliable much of medical science is. The other part is a plausible argument for the causes of "life style diseases". Both arguments are interesting but they are somewhat at odds with each other. If there is so much uncertainty in medical research and medical advice, then shouldn't we have something like a call to step and spend some time just evaluating our methods and figuring how to increase the objectivity of the process rather than jumping to yet another not yet full substantiated approach - not that the approach itself sound particular bad or dubious but the juxtaposition of the two arguments gives me pause.

lincolnq 17y ago

See also (some conflicting views), the Hacker's Diet : http://www.fourmilab.ch/hackdiet/www/hackdiet.html http://www.fourmilab.ch/hackdiet/www/hackdiet.html

radu_floricica 17y ago
Not necessarily at odds. Hacker's Diet is about how one individual can get a substantial weight loss in a short time, and keep it with maintenance. This article is about long time effects of a certain diet. They don't contradict.
- Oxryly 17y ago
  They contradict where the Hacker's Diet makes no attempt to differentiate between types of calories. For the Hacker Diet, all calories count against your total the same way. There's no concept of calories that throw off your blood sugar and consequently your insulin, and those that help maintain it. Therefore there's no attempt to manage the core fat building or fat burning mechanism of the body. It just pretends that food = bad and exercise = good.
  - ZeroGravitas 17y ago
    That's a very harsh review of the hacker's diet. More accurate would be food = energy, exercise = energy expenditure, obesity = prolonged energy surplus stored as fat, and weight loss = prolonged calorie deficit leading to fat reduction. While I agree that there are wrinkles due to when, how and what you eat, I can't see a problem with that basic maths. You could say a 'bad' calories is one that triggers you to eat more calories, whether that's through habit, or addiction, or stomach stretching, or sugar rushes and crashes leading to hunger. But that still reduces down to more calories. This book seems to be suggesting that the energy you store as fat comes from somewhere other than the food you eat. That's entering creationism or perpetual motion machine territory for me, and as you would then expect is accompanied by claims that the whole field is crooked. The rebuttal linked from the article (by one of the "villains" of the book) suggests that the weird data comes down to people lying about what they eat to researchers. Not only do they not record everything they eat, they lie even more about their consumption of fatty foods which (correctly or not) the average person thinks are bad. This makes it seem like people are gaining weight mysteriously, and that carbs are over-represented. Given the choice between overweight people misrepresenting what they eat and a whole branch of science being corrupt I'll take the former. Particularly if the book writer is happy to cherry pick out the results that he likes and ignore the rest of the field.

derefr 17y ago

The article cites a hypothesis that boils down to "all of these things are bad because they make you produce more insulin." The proposed solution is to do less of all of those things. Why not, instead, modulate insulin? Then, if the cited hypothesis is right, we could eat however we wanted and be perfectly healthy and thin. I'm curious as to the correlations between diabetes or hypoglycemia and the diseases mentioned in the article.

sho 17y ago
That would be the wonderful sci-fi solution, it would seem, but I don't think the technology (or even the theory) is there yet.
lena 17y ago
This is why you should exercise, and why people in other countries, who eat lots of carbohydrates, even refined ones, do not have high rates of diabetes and obesity.
- electromagnetic 17y ago
  Let's please be accurate here. People in other countries generally have lower rates of obesity not because they exercise, but because they actually have to do physical work and don't sit on their asses in an office all day. People say exercise and everyone tends to think the gym. However this is total BS, you don't need to go to the gym to stay healthy, the only thing you need to do to stay healthy when eating lots of carbohydrates is to do an activity to burn them. The other major misconception is people think thin=healthy when really all the 'healthy' (women especially) people on TV are definitely not healthy. In fact, unless you're very careful with a calorie restricted diet (lots of vitamins and enough protein to maintain your muscle tissue) you are doing significantly more damage to your body than if you were overweight. It's been shown anorexia can shorten your life by 25 years. Being moderately obese (30-35 on the BMI) can take 2-4 years off your life and extremely obese (40-45) can take 8-10 years off your life expectancy. People who are in the overweight group don't see a reduction in life expectancy, unless they smoke. Then it also depends on how healthy you are when you're obese. Many sportsmen and soldiers are obese to significantly obese, and I don't think you'll find a single one who's of normal weight. However, many of these men will live longer than the average normal weight person (assuming they don't use steroids), due simply to the fact that building muscle tissue usually helps build your heart tissue too, meaning you stand to live significantly longer.

larryfreeman 17y ago

I am especially bothered by one sentence: "Prior to my introduction to the world of low-carbohydrate diet, I hadn't paid too much attention to nutritional science. I worked on biophysics, where I formed the opinion that medical science was mostly garbage." It's hard for me to take someone seriously who once believed that medical science is 'mostly garbage.'

Ardit20 17y ago
Why?
- pierrefar 17y ago
  Because he clearly is biased against "medicine" and then finds a book that fits his bias and is trumpeting it as the eternal truth. He's committing the same offense he speaks out against in the same article.
  - jerf 17y ago
    Is he "biased against medicine", or is he "biased in favor of five-sigma+ results"? Does medicine use 95% confidence intervals because it is actually sufficient to base a medical science off of, or do they use 95% confidence interval because it is all they can get? The problem is, the universe doesn't care if all you can get is a 95% result. And he is right that at least some people in the softer sciences don't understand their confidence intervals in the slightest. That crack he made about standard deviations being computed for non-Gaussian distributions won't resonate with you unless you have a lot of statistical training, but it a damning criticism; doing that sort of thing is basically proof your entire analysis isn't worth the paper it's written on, in proportion to the deviation from Gaussianess. I've been witness to the training procedure on experimental stats for undergrad biologists, which consists mostly of endless hammering in of the p-value as mantra, with understanding neither asked for nor given (unsurprising, as given the math prereqs up to that point the true meaning of the p-value can't really be taught). At the time I wouldn't have realized how wrong it is to apply p-value analysis to a bi-valued distribution, but I bet they were asked to. I know there's a grad-level course on the topic for them, but I fear it may be the blind leading the blind there. I'm less willing to write off medicine as a whole. It has had some undeniable success in some areas (but it should be observed that weight management with much less than stomach stapling hasn't really been one of them). I'm playing a bit of devil's advocate here, because I think you may not have given the article a fair reading after you flipped the idiot flag on the author.

radu_floricica 17y ago

Interesting article. The only question I have: Atkins diet exists for some time. If so, then why hasn't it been a wild success? I know it works very well short time, but I also know no diet, including Atkins, managed to do well long term (2+ years). Except fringe cases of people who dedicate half of their life to weight maintenance, specific diets tend to hurt more then help. Also I'd like some specific opinion on rice. It's carb, but I haven't yet seen a fat Japanese. Anyways, one thing is worth taking from all this: don't mix carbs with rich meals. A cake should be fine by itself, but fries with steak not so much.

xiaoma 17y ago
I agree. This guy's claims are flatly contradicted by world evidence. As I've posted here before, the Japanese diet derives half its calories from rice, and well over 70% from carbohydrates in general. Two generations ago, it was nearly 70% just from rice. As many know, the Japanese live longer and have fewer "life-style diseases" than anyone else. Korea, Hong Kong and Taiwan are similar, both in terms of diet and in exception life expectancy as compared to economic development. All around the world, there's a pretty consistent relationship between groups of big protein eaters and big people. Americans get more calories of protein than anybody else and are fatter than anyone else. Mexicans and British are close behind in both categories. Furthermore, research on high vs low protein diets has been pretty conclusive: http://news.ycombinator.com/item?id=613745 http://news.ycombinator.com/item?id=613745
- defen 17y ago
  Yes but have you seen the serving sizes in Japan? A meal there would barely count as an appetizer for your average (overweight) American.
  - xiaoma 17y ago
    Just think how people like me feel when visiting America and seeing "no vegetables" as an selling point for double or even triple stack whoppers. It's overwhelming, sickening and yet fascinating all at the same time.

magoghm 17y ago

It's easy to see that most nutriton specialists aren't very scientific: they refer to meat as "proteins" and measure everything in "calories" (which are really kilocalories) instead of joules.

tokenadult 17y ago

Link to the primary research finding, "Why Most Published Research Findings Are False," from PLoS Medicine: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124 http://www.plosmedicine.org/article/info:doi/10.1371/journal...

ZeroGravitas 17y ago

Can someone explain the entropy and thermodynamics bit? He appears to be arguing against the concept of calories in minus calories burned equals calories stored, but he lost me. He's got "entropy" in his blog name so you'd think this is his area, however, it sounds fishy to me.

duncanj 17y ago

It seems to me that he is leaving out a discussion of slow-twitch and fast-twitch muscles. Slow-twitch muscles are used in maintaining posture and light activity and burn primarily fat. Fast-twitch muscles are used for strength and burn primarily glucose. Hard exercise like he suggests would use mostly glucose. Walking slowly while working 8 hrs a day (treadmill desk) would presumably use more fat. It would be interesting to see if that is actually the case (within a 95% confidence interval, of course ;) )