Links for Thursday, October 25, 2018: edible cotton, microplastics in every nook and cranny, healthcare pollution, and Chicago tylenol murders

Edible cotton is coming

And I just can’t help but think about picking it out of my teeth. I know, I know, it’s the seeds that are edible. Still.

Microplastics are everywhere. In salt. In your poop.

I’ve been to Strataca in Hutchinson, Kansas, an old salt mine-turned-storage facility and tourist destination. I highly recommend it. One of the curiosities of Strataca is the ancient, undecomposed trash, having spent the last century in 70 degree dry air without UV light. So it was interesting that rock salt in this study was relatively free of microplastics:

“In another indicator of the geographic density of plastic pollution, microplastics levels were highest in sea salt, followed by lake salt and then rock salt.”

And levels varied according to geography, mostly in parallel with the amount of plastic pollution in the environment:

“…those from Asian brands were especially high, the study found. The highest quantities of microplastics were found in salt sold in Indonesia. Asia is a hot spot for plastic pollution, and Indonesia—with 34,000 miles (54,720 km) of coastline—ranked in an unrelated 2015 study as suffering the second-worst level of plastic pollution in the world.”

Why does this matter? Well, besides the very depressing thought that we’re polluting the planet with infinite amounts of unbiodegradable trash, plastic contains chemicals that fool our bodies into acting weird because we misinterpret those chemicals as signals. And while I worry that this will turn into some kind of fetishized quest for microplastics that will detract from bigger issues like the source of all that plastic pollution in the first place, the idea that there is invisible plastic in our environment that we’re almost powerless to avoid is…kind of scary.

Nine percent (9%!) of national greenhouse gas emissions are attributable to the healthcare sector

The Chicago “Tylenol Murders” of 1982 are still unsolved

Just like 40% of murders overall.

And did you know that Tylenol comes from the chemical name for acetaminophen? aceTYLaminophENOL

Links for Wednesday, October 24, 2018: OKC vs Seattle, the Bush thyroid mystery, and kangaroo carnism

First Oklahoma City killed Seattle’s supersonic transport business. Then it took Seattle’s basketball team named after Boeing’s supersonic transports

(fast forward to 23:50 in the podcast)

(but the rest of the podcast, about the land rush and the founding of OKC, is good, too)

(and please note the satisfying inclusion of a former Wichita State University Wheatshocker in the slightly racy video clip)

After President George H.W. Bush and First Lady Barbara Bush were diagnosed with Graves disease, and family Dog Millie was diagnosed with Lupus, the water at the White House, their personal residence, and the Vice President’s residence was tested for lead, iodine, and lithium

None were found

A school chef has been fired after feeding kangaroo meat in school lunches

Carnism is the belief system that conditions people to eat certain animals and not others. Firing a chef for serving kangaroo—a perfectly acceptable part of millions of people’s diets—is a manifestation of carnism.

Links for Friday, October 19, 2018: Angry legos, job prospects for 7-footers, fiction = empathy, and the value of social education

Lego minifigs are getting angrier over time

And it’s intentional:

‘Denise Lauritsen, a spokesperson for Lego, says that the “broad variety of minifigure emotions is to help encourage different kinds of role play; adventure, exploration, friendship, action, nurture, storytelling, mission, conflict play and so on…”’

If you’re an American male seven feet tall or taller, you have a 17% chance of playing in the NBA

If you’re “only” 6’8”? 0.07%

When you read fiction that makes you read between the lines to decipher the characters’ feelings, you get better at knowing people’s feelings in real life

‘In one study, kindergarten children heard stories such as Rosie’s Walk, in which a hen walks through a barnyard, appearing to be blithely unaware that she is being followed by a fox. A second group of children heard the same stories, but with mental states clearly identified. “Rosie heard the loud BUMP but did she figure out that the hungry fox was behind her? No, she didn’t turn around. She doesn’t know that he’s behind her.” The first group, forced to read between the lines, later performed better than the second group on a test that required them to infer the beliefs of others.’

See also: Read some fiction. It’s good for you

Should we teach skills to prevent loneliness in school?

My middle school-age daughter has to take a class once a week that is essentially “social education.” She does not love it. But her teachers might be on to something:

“…according to a recent report by the healthcare company Cigna, nearly half of adults in the U.S. reported sometimes or always feeling alone. Marriage rates and religious-participation rates are also dropping, which are both risk factors for social isolation and loneliness. And the prevalence of loneliness seems to be especially acute among young adults: One study last year found that Americans between the ages of 21 and 30 reported feeling lonely for twice as many days as adults between ages 50 and 70, despite having larger social networks. The health consequences of loneliness can be severe: Studies suggest chronic loneliness is linked to a variety of health issues, like decreased immunity to viral infections, poor sleep, and cardiovascular issues like hypertension.”

See also: Good neighboring is good medicine

Links for Thursday, October 18, 2018: the Tooz, menu hacking, and patient antibiotic satisfaction

John Matuszak, the former overall #1 NFL draft pick who played Sloth in The Goonies, died of a narcotic overdose at age 38

He was tragically ahead of his time.

There is a secret world of secret restaurant menus, visible only to those brave enough to order the “McLand, Air, and Sea”

I have a friend from college who is notorious—notorious—for ordering things from restaurants that are not on the menu. Nothing crazy. He doesn’t order shrimp cocktail at a hot-dog stand or anything. But asking for melted cheese to be spread on his burrito? Oh yeah. That’s the stuff. Turns out he’s not alone:

“That menu hacks are generally customer imposed, not instigated by the restaurants, shows in the character of the items themselves. They tend to be things that only those who don’t work in the kitchen would come up with. Such are composites of menu ingredients or entire items. At Taco Bell, one secret-menu item, known as the Incredible Hulk, consists of a five-layer burrito with guacamole instead of nacho cheese. That’s nothing but an ingredient swap.

Some well-known McDonald’s mash-ups are especially clunky. Secret-menu items such as The Pie McFlurry, a pie blended into a McFlurry shake; the McCrepe, a pancake filled with McDonald’s fruit-and-yogurt Parfait; and the McLand, Air, and Sea Burger—the innards of a burger, a chicken sandwich, and the Filet-O-Fish between the buns of one—are Frankensteinian.”

One of my co-fellows at UNC was fond of ordering pickle-less hamburgers from a McDonald’s on the West Virginia turnpike. His reasoning was that anything he special ordered would be guaranteed to be made on the spot. He didn’t like the texture of burgers that had been under the heat lamp. This seems reasonable and relatively kind to the workers at the restaurant, at least in comparison to some other tactics:

“Amid the din, once in a while, I heard a different voice. On social media, a restaurant worker would chime in, usually to counter a myth or plead for patience with or politeness to the restaurant staff. Here’s ‘Kathryn Erwin’ setting customers straight in the comments section of the ‘Nachos’ listing for Chipotle at HackTheMenu.com on December 2, 2015:

‘I work at a Chipotle and if you ask any of our crew members we will tell you that we do not have nachos. Nachos normally mean that the cheese is melted and we cannot melt the cheese for you. We can however put chips at the bottom of your bowl and then build a normal bowl for you. They are not called nachos though.’

It’s really her final line, however, that drives home the annoyance that menu hacking can bring for restaurant workers: ‘And please,’ Kathryn implores, ‘do not be rude to an employee if they refuse to call a bowl with chips nachos.’ In the conversations of menu hackers, I seldom heard such a distinctly labor point of view.”

Patients heart doctors who’ll prescribe them antibiotics for non-bacterial problems.

And they punish the docs who won’t:

“Few physicians achieved even the 50th percentile of satisfaction while maintaining low rates of antibiotic prescribing. To reach the top quartile, a physician had to prescribe antibiotics at least half the time; almost all physicians above the 90th percentile had a rate of antibiotic prescribing greater than 75%.”

Links for Wednesday, October 17, 2018: TV's first drug ad, does mold really make us sick? and big-ass Canadian pumpkins

Behold: the first television drug ad in the US

It was taken down after 48 hours. And now the US is one of only two countries worldwide to allow direct-to-consumer advertising of drugs.

Science has yet to prove that mold makes us sick

I grew up in a farmhouse that was originally an in-ground house and, well, you know how this ends. The basement, which was originally just called “the house,” leaked like a sieve. This led to chronic, unrelenting nighttime exposure to mold in the nooks and crannies of the place. I never felt like it made me sick, but relatives tell me it makes them feel bad. It’s a bummer that medicine can’t tell them whether they’re wrong or right.

Wikipedia

Canadians (Canadians!) are racing to grow their first one-ton pumpkin

In my day, we were happy with an orange decorative guord that you could hold in your hands and gently disembowel for purposes of internal illumination. We didn’t want anything to do with these monsters that gain 50 pounds a day to deform under their own weight and need a forklift for transportation. But I do admire they’re trying to do it a different way:

“…weights in the United States and Europe have long passed 2,000 pounds. In Canada, where regulations prohibit some of the chemicals used elsewhere, they have yet to hit this mark. Getting there has become a point of national pride.”

FYI: Pumpkinnook.com tells me the current world record is owned by German Mathia Willemijn at 2,624.6 lbs in October, 2016:

Pumpkinnook.com

Links for Tuesday, October 16, 2018: wine cheaters, tainted supplements, and stopping tractor rollovers

23 master sommeliers have been stripped of their title for allegedly cheating on the exam, and is there no one I can trust to tell me whether I’m drinking Mad Dog?

The candidates allegedly had insider info on the tasting portion of the exam, when they were expected to “clearly and accurately describe” six different wines, including grape varieties, origin, and vintage, in under 25 minutes.

I suspect (without any sommelier data to back it up) that this portion of the exam is poorly reproducible anyway. The American Board of Internal Medicine, but not other specialty boards, eliminated oral exams eons ago because of this.

If you’re taking an OTC supplement for sex, weight loss, or muscle mass, it’s astonishingly likely you’re getting a prescription drug mixed in with the sawdust

776 (!) tainted supplements were in the database from 2007 to 2016.

“Of the tainted products in the current study, 45.5 percent were marketed as aids for sexual enhancement, 40.9 percent for weight loss, and 11.9 percent for muscle building. They contained pharmaceuticals such as sildenafil, which is the active ingredient in Viagra; sibutramine, which is the active ingredient in Meridia, a weight loss drug removed from the market because of links to stroke and other cardiovascular events; and anabolic steroids or steroid-like substances.”

Original paywalled article here

Tractor rollovers are the #1 cause of death on American farms, but social marketing is a surprisingly cost-effective way to reduce death

Now if we could only use social media for good in other arenas…

Links for Monday, October 15, 2018: Uber quantifies the curb, non-yelling coaches, criminal malpractice, and handlebar shapes

Uber—not a bus company—has proposed a formula for optimization of curb space that makes buses look pretty good:

(quoting directly from the article)

Activity/(Time x Space)

“Activity” is the number of passengers using the curb space by a specific mode, “time” is the duration of their usage, and “space” is the total amount of curb footage dedicated to that use.

Here’s the example that the consultants use in their report, where a 20-foot length of curb is used for four hours as a parking spot by a single car carrying two people:

2 passengers/(4 hours x 20 feet) = .025 passengers/hour-feet, or 0.5 passengers per hour per 20 feet of curb

But if that space is instead used as part of an 80-foot bus stop serving 100 people in that four-hour block, the equation looks like this:

100 passengers/(4 hours x 80 feet) = .3125 passengers/hour-feet, or 6.25 passengers served per hour per 20 feet of curb

Clearly, the bus stop is a better use of public space. And naturally, those Uber cars that don’t take up curb parking look good, too. No surprise there, considering the source.

John Gagliardi is dead, which means that the Nick Saban school of coaching just got a little stronger. That’s a tragedy

My antipathy toward football is cresting (just search for “football” in this site and you’ll see why). But who can argue with a philosophy like this one?

“Gagliardi essentially preached a philosophy of anti-coaching, one that prized self-reliance and self-motivation and abhorred cruelty and authoritarianism. These were not bullshit, repackaged, supposedly out-of-the-box ideas like you find coming out of Silicon Valley. Gagliardi’s philosophy was deeply HUMAN, and deeply trusting. It also happened to be highly effective, so much so that similar techniques are now widely used in parenting books, academic teaching, and other fields.”

One thing the best coaches I’ve had did well—in sports, medicine, music, or other—was to make me feel good about what I was doing. They made me feel good about the process of improvement, no matter my starting point in terms of skill. They essentially told me, “I know you’re a person who tries hard. Let me help you direct that effort in the way that will get the most out of your foundational ability.”

A Texas neurosurgeon was so bad at his job that he got life in prison

When I was a resident, a local doc prescribed so many narcotics to so many patients at such outrageous doses that admitting one of his patients was a near certainty on any overnight call shift. But what did the guy in wasn’t that he was committing malpractice on a daily basis; it was that he improperly supervised his wife as a mid-level provider, leading to money laundering and conspiracy convictions.

We in medicine do a bad job of policing our own. The surgeon who body-checked Dr. Death away from the operating table in Texas deserves major credit.

On a lighter note, What Bars? lets you compare the shape, drop/rise, and weight of a few dozen different handlebars

Links for Thursday, October 11, 2018: British cowboys, kickers so white, email owns us, and the heart of your toilet paper

British Rodeo Cowboy Association, you say?

Don’t mind if I do.

Damn near every kicker and punter in college football is white, even at historically black schools

The average user spends 5.6 hours per day on email

Close this window, turn off your device, and go ride your bike or take a walk or read a book or go to the library or call a friend or volunteer at a charity or write a letter or…

There’s not really a heartbeat inside that toilet paper roll. It’s just….science!

I still think fitness devices are overrated, fwiw, regardless of what the Community Guide says.

Links for Tuesday, October 9, 2018: Overtreatment of subclinical hypothyroidism, altruism and specialty choice, and Roman wiping technology

Treating your TSH level of 10 mIU/L with thyroid hormone probably won’t make you feel better

But your doctor will probably try to talk you into it, anyway (paywall):

“Although current guidelines are at first sight cautious with treatment recommendations, more than 90% of persons with subclinical hypothyroidism and a thyrotropin level of less than 10 mIU/L would actually qualify for treatment. However, results of this meta-analysis are not consistent with these guideline recommendations.”

Are altruistic students more likely to choose lower-paying specialties in medicine?

This paper is complex and paywalled, and I won’t pretend to understand it. But yes, it does seem that altruism is related to choosing lower-paying specialties and more underserved areas:

<$300,000 per year is defined as a lower-paying specialty, which calls my career choices into doubt.

How did ancient Romans wipe without toilet paper?

Let’s all share a collective shiver at the thought of a communal, stall-less bathroom with sponges on sticks, shall we?

Links for Monday, October 8, 2018: Ashton Lambie, vibrator myths, really old-timey pumpkin spice, Mac is skinny, and the thyroid diet

Since I’ve been hustling to finish a couple big projects the last month, we’ve fallen behind. Got some catching up to do!

Meet Ashton Lambie, Kansan and new World Record Holder in the 4k Individual Pursuit

I've watched that giant 'stache ride away from me in approximately 1,000 gravel races.

Your favorite party story about how doctors used to manually "stimulate" the genitals of hysterical women with vibrators? That one? It's probably a myth.

And we're all worse off for it. 

Even prehistoric Asians couldn’t resist the #PSL

“Look, it's not that hard. All you need to do is lift weights six days a week, stop drinking alcohol, don't eat anything after 7 p.m., don't eat any carbs or sugar at all, in fact just don't eat anything you like, get the personal trainer from Magic Mike, sleep nine hours a night, run three miles a day, and have a studio pay for the whole thing over a six to seven month span. I don’t know why everyone’s not doing this. It’s a super realistic lifestyle and an appropriate body image to compare oneself to.”

No more cultivation of mass for Mac. I hate, hate, hate the culture that pretends that models and actors/actresses can eat all they want and somehow magically stay thin. Maybe Rob McElhenney gets to say things that actresses can’t.

Is there such a thing as the “thyroid diet?”

Within reason, no. (registration required)

Links for Wednesday, September 5, 2018: docs are nervous about weight loss meds, risky low-carb diets, why I'm not a pediatrician, and continuity of care is good

Why don't more docs prescribe weight loss medications?

Speculation: 1) cost (and by extension, prior authorization requests); 2) residual fear from fen-phen, as one of the docs interviewed alluded to. We can surely put this to bed, since the current crop of meds has been on the market much longer than fen-phen had been when its harm was revealed; 3) nihilism. Five percent weight loss is meaningful from a medical perspective, but unless the doc is consciously, prospectively measuring outcomes like blood pressure, lipids, and fasting sugars, it won't knock her socks off. Patients won't be thanking her for getting them ready for bikini season; and 4) the old Risk Evaluation and Mitigation Strategy (REMS) for Qsymia was such a PIA that it scarred some docs to prescribing these meds.

Can we stick a fork in low-carbohydrate diets? (Ba Dum Tss)

What's a 32% increase in mortality among friends? Investigators (in a study that, to my knowledge, has not yet been published, so caveat emptor) found an association between the lowest quartiles of carbohydrate intake and death:

NHANES data. Model 1 is unadjusted for other risk factors. Model 2 is adjusted. These are ugly, ugly numbers. 

Remember: we can't draw causality from this. There is some chance that people who are sick and more likely to die from heart disease, cancer, or stroke are more likely to adopt low-carbohydrate diets. But it doesn't seem likely. The people at highest risk in this study were those over age 55 and "non-obese."

Reason # 1,001 I'm not a pediatrician:

Can. Not. Do. It.

Special shout-out to the 100 cell phone text alerts during the video. 

If lack of continuity is a mark against telemedicine, then it's a mark against the hospitalist model in general

Links for Thursday, August 30, 2018: don't try ballpoint pen cricothyrotomy, the Peterson family beef cleanse, 100 great 2018 articles, and 10k steps

"A cricothyrotomy just with a ballpoint pen is virtually impossible"

Aaaaaand I've found my new favorite study. It replaces my old favorite, which included the line "Detailed retrospective history also confirmed accidental inhalation of the condom during fellatio."

Jordan Peterson's family seems to be on a "beef cleanse." Do we even need to point out that this is a bad idea?

No. We don't. But we do it anyway: 

[Jack Gilbert, the faculty director at the University of Chicago’s Microbiome Center and a professor of surgery] has done extensive research on how the trillions of microbes in our guts digest food, and the look on his face when I told him about the all-beef diet was unamused. He began rattling off the expected ramifications: “Your body would start to have severe dysregulation, within six months, of the majority of the processes that deal with metabolism; you would have no short-chain fatty acids in your cells; most of the by-products of gastrointestinal polysaccharide fermentation would shut down, so you wouldn’t be able to regulate your hormone levels; you’d enter into cardiac issues due to alterations in cell receptors; your microbiota would just be devastated.”

While much of the internet has been following this story in a somewhat snide way, Gilbert appeared genuinely concerned and saddened: “If she does not die of colon cancer or some other severe cardiometabolic disease, the life—I can’t imagine.”

Here's your weekend reading list

How many steps per day should a person get, really?

“A company [in Japan] there created a man-po-kei, a pedometer. And man stands for ‘10,000,’ po stands for ‘step,’ and kei stands for ‘meter’ or ‘gauge.’” Ten thousand, it turns out, “is a very auspicious number” in Japanese culture, said Theodore Bestor, a Harvard researcher of Japanese society and culture, in an email. “That is, it seems likely to me that the 10,000 steps goal was subsidiary to having a good-sounding name for marketing purposes.” Whatever the reason for the adoption of this particular number, “It resonated with people at the time, and they went man-po-kei-ing all over the place,” said Tudor-Locke.

Pubmed indexes 175 articles published since June 2015, the date of the linked article above, containing the phrase "10,000 steps". And as weird as its origin story is, the recommendation has been validated, more or less, and has gone on to be endorsed fairly universally.

Links for Wednesday, August 29, 2018: Dirty Kanza Promotions, Dangerous playground comeback, Dutch cycling politics

This Dirty Kanza video showed up in my email yesterday

And this cornball teared up a little watching it. I'll carry a torch for this race as long as I live. 

Playgrounds that are just a little bit dangerous are coming back, baby

When I visited my alma mater last spring, I was pretty bummed out that the old playground, made up largely of concrete pipe:

concretepipe.org

and buried tractor tires:

http://lapaceksorchard.blogspot.com/

had been completely replaced with the same safety-first playground equipment you can find anywhere:

Not Skyline's playground, but it might as well be. They all look alike. (playcreation.com)

The problem with this kind of playground isn't that it's ugly or unsafe. It's that it's boring. And kids don't want anything to do with a boring playground. It can't compete with omnipresent screens. Public playgrounds that allow for slightly riskier play (think swinging and teeter-tottering) on a variety of surfaces--nothing exotic, just sand, grass, gravel, and the like--see 53 percent more visitors than the ultra-safe playgrounds like the one above, and kids are 18 percent more physically active.

“The take-home message ... is: Stop setting your bar at the level of the most anxious parent. If you do that, you’re guaranteed to produce boring and dull playgrounds,” said Tim Gill ... “If you set your bar at the level of the average parent or maybe even at the level of the parents … who do want some more excitement and challenge in their kids’ lives, then, things start to look different.”

I like different. An abrasion, bruise, or even a broken bone here and there is the cost of doing business for raising interesting, innovative, resourceful kids.

The Dutch are known for their everyday, casual love of cycling. But their policies and infrastructure didn't come easily

"Rotterdam, for example, was completely obliterated during the Second World War and rebuilt in this post-war, modernist image — designing cities around the automobile, where people would live outside the city, commute by car into the city every day, and everyone would have more light and space and air. They’d be living happily in the suburbs.

It didn’t take long for Rotterdammers to realize this wasn’t the future they wanted. The spaces they were building were inhospitable to walking and cycling and public transit. Cycling rates were plummeting. There were more road fatalities.

So, not just in Rotterdam, but in cities across the Netherlands in the ’70s, there was a real rejection of this car-centric urban planning.

Some of them resisted better than others. In Rotterdam, they managed to reverse the tide and retrofit some of these spaces for other modes of transportation. But certainly a lot of Dutch cities made mistakes. In Utrecht, they paved over canals. In Amsterdam, they came just a single city council vote away from demolishing the Jewish quarter of their city to build a four-lane motorway."

But now cycling transcends politics:

Chris Bruntlett: ...We had conversations with politicians there and they made it perfectly clear: Even the right-wing in the Netherlands has to support more spending on cycling.

David Roberts: Because of public pressure, public opinion?

Chris Bruntlett: Exactly. It’s not a tenable or realistic position to win an election when probably 80 percent of the population cycles at least once a week.

Building on all that NZ pregnancy cycling momentum from last week. (Pic: Modacity/Vox)

Links for Tuesday, August 27, 2018: death by peroxide, NJ mushroom poisoning, and King of the Apples

"Food-Grade" hydrogen peroxide is hurting people, and for God's sake, people are amazing at finding new ways to harm each other

Remember the phrase "Suicide Blonde" (as in, she dyed by her own hand)? Well, this is a helluva lot worse than dealing with your roots showing.

New Jersey is dealing with a big jump in mushroom poisoning. You read that right

Number one on the watch list is the 'Death cap' (Amanita phalloides). Which makes it irresistible for me to post one of my favorite book beginnings of all time:

“My name is Mary Katherine Blackwood. I am eighteen years old, and I live with my sister Constance. I have often thought that with any luck at all, I could have been born a werewolf, because the two middle fingers on both my hands are the same length, but I have had to be content with what I had. I dislike washing myself, and dogs, and noise. I like my sister Constance, and Richard Plantagenet, and Amanita phalloides, the death-cup mushroom. Everyone else in our family is dead.” 
― Shirley Jackson, We Have Always Lived in the Castle

The King (of apples) is dead. Long live the King

The Red Delicious apple--possibly my least-favorite apple, even though it's beautiful--just fell from its 5-year perch as the #1 apple in the US. The Gala, which strikes me as having a better skin and a better texture, albeit in a smaller package, is the new numero uno.  My favorite the Honeycrisp is rising fast but still comes in at #5 overall.

Links for Tuesday, August 21, 2018: patients love good news. And weed. Patients love weed.

Patients liked a blood pressure app better because it was inaccurate

If I were to pick a single study that wraps all my angst about medicine up into a tidy bow, it would be this one:

"...user enjoyment and likelihood of future BP monitoring were negatively associated with higher-than-expected reported systolic BP. These data suggest reassuring app results from an inaccurate BP-measuring app may have improved user experience, which may have led to more positive user reviews and greater sales."

A better writer could hold forth on how doctors (and devices?) are so bad at giving negative but meaningful information to patients that patients simply avoid the process altogether, leading patients to seek a relationship with their doctors that more resembles that between a shaman and a subject than that of a modern, informed, dynamic doctor-patient exchange of information.

*head explodes*

Dr. Robert Badgett, on seeing this study, reminded me of a quote by Voltaire:

"The art of medicine consists in amusing the patient while nature cures the disease."

I certainly feel like I'm in the entertainment business some days.

With wider availability of cannabis comes wider use and wider abuse

"Public-health experts worry about the increasingly potent options available, and the striking number of constant users. 'Cannabis is potentially a real public-health problem,' said Mark A. R. Kleiman, a professor of public policy at New York University. 'It wasn’t obvious to me 25 years ago, when 9 percent of self-reported cannabis users over the last month reported daily or near-daily use. I always was prepared to say, ‘No, it’s not a very abusable drug. Nine percent of anybody will do something stupid.’ But that number is now [something like] 40 percent."

I knew guys in college who were stereotypical "potheads," and I think my bias at the time was that all but a few of them would be reined in by the relative difficulty of getting the drug (not that it was difficult). Now that the reins are off, we're stuck addressing possible solutions to the problem. This is not an argument for going back to hard-core criminalization. As Annie Lowrey points out, the US still arrests more people for marijuana offenses than it does for all violent crimes combined. That seems, shall we say, excessive. 

Links for Monday, August 20, 2018: non-sugar carbs are fine, paint your rooftop white

It turns out eating about half your calories as carbohydrates is associated with the longest life

This isn't surprising. But it's just so hard for this kind of data to survive in a world filled with Bulletproof Coffee and other B.S. Good dietary advice is sooooooooo boring: eat a modest amount of carbohydrates. Avoid processed sugars. Don't drink too much alcohol. Avoid animal proteins and fats. If you read that last two lines without nodding off, you're either really invested in dietary information, or you're a registered dietician. It doesn't have the zing of "Wheat Belly." *Sigh*

White rooftops are a sneaky good way to combat climate change

What a weird thing to post to a health blog. But climate change has health consequences. As in, killing hundreds of thousands of people consequences. And I can speak from experience: we installed white shingles on our house in 2014, and we saw an immediate reduction in summertime heating bills of about $80/month (!). 

Rose wine has a seedy underbelly

But it all tastes like Diet Cherry 7-Up to me.

Kiwi bikes to the hospital to have labor induced

The New Zealand Minister for Woman and Associate Minister for Transport and for Health tied together her two roles in government in a nice, tidy little bike ride. When I first read the headline, I thought she'd gone by bike after having her water break or after the onset of contractions. But alas, she was off for induction. Still, this represents a rare combination of toughness and media savvy. I love the part where she says the gas-powered wheelchair wouldn't fit everyone in the family, so they had to ride bikes. She was obviously not talking about an adult Tonka Toy.

Most of us have plenty of vitamin D. And Michael Holick apparently has plenty of money from trying to convince you otherwise

This is such a bummer. The Endocrine Society (I'm a member) has positioned itself as the kinder, gentler, more conservative (that's old-timey conservative, not Rush Limbaugh conservative) alternative to AACE. But they're as vulnerable to the actions of their members as any other group:

"Dr. Holick’s crucial role in shaping that debate occurred in 2011. Late the previous year, the prestigious National Academy of Medicine (then known as the Institute of Medicine), a group of independent scientific experts, issued a comprehensive, 1,132-page report on vitamin D deficiency. It concluded that the vast majority of Americans get plenty of the hormone naturally, and advised doctors to test only patients at high risk of certain disorders, such as osteoporosis.

A few months later, in June 2011, Dr. Holick oversaw the publication of a report that took a starkly different view. The paper, in the peer-reviewed Journal of Clinical Endocrinology & Metabolism, was on behalf of the Endocrine Society, the field’s foremost professional group, whose guidelines are widely used by hospitals, physicians and commercial labs nationwide, including Quest. The society adopted Dr. Holick’s position that “vitamin D deficiency is very common in all age groups” and advocated a huge expansion of vitamin D testing, targeting more than half the United States population, including those who are black, Hispanic or obese — groups that tend to have lower vitamin D levels than others."

Any supplement that gets an enthusiastic recommendation from Dr. Oz should be receivee with immediate, extreme skepticism. 

Links for August 17, 2018: bull riding is still a thing, Round-up for breakfast, and Thai food diplomacy

Eight seconds on a bull seems like forever. Forever. I'll now add bull riding to my list of sports in which you can smoke and still kick ass. The only other sport on the list is bowling, FYI. Curling is under consideration.

Round-Up is in all our food. All of it.

Well, at least all of it that's made of grain. I don't have conclusive evidence that this is a bad thing (The WHO International Agency for Research on Cancer said glyphosate was probably carcinogenic in 2015, but a subsequent WHO report said it was unlikely to be carcinogenic). But is sure as hell doesn't seem like a good thing. I always suspected I'd had my lifetime dose, having grown up on a farm, but we were total amateurs in the 90's compared to now:

USGS, https://on.doi.gov/2wb94bn

Thai restaurants are over-represented in America. It's not an accident.

"Using a tactic now known as gastrodiplomacy or culinary diplomacy, the government of Thailand has intentionally bolstered the presence of Thai cuisine outside of Thailand to increase its export and tourism revenues, as well as its prominence on the cultural and diplomatic stages. In 2001, the Thai government established the Global Thai Restaurant Company, Ltd., in an effort to establish at least 3,000 Thai restaurants worldwide. At the time, Thai deputy commerce minister Goanpot Asvinvichit told the Wall Street Journal that the government hoped the chain would be “like the McDonald’s of Thai food.” Apparently, the government had been training chefs at its culinary training facilities to send abroad for the previous decade, but this project formalized and enhanced these efforts significantly."

And the Thai government even has quality control:

"...Thai diplomats in the US have been charged with supporting Thai restaurants in both logistics and strategy. “When we received the award, the Ministry of Thai Trade actually came to my restaurant and we discussed about how we can promote more and how they will support us in getting more products from Thailand,” said John Sungkamee of Emporium Thai in LA. “She suggested I should look into promoting the Thai rice berry. She also recommended the suppliers to obtain them from.” Sungkamee told me that he and other Thai restaurant owners across the country maintain a group chat, and the now-former Thai Consul General in LA has been an active member."

Links are back! (for now, at least): Tuesday, August 15, 2018

The Gravel Boom Could Save Road Biking's Soul

This is true, and mostly for the reasons Aaron Gulley lays out: fewer cars and an attitude of adventure rather than competition. None of the assholery that turns up at road races is present at the majority of gravel races, unless you count a few people trying to change it for the worse.

Gravel Rides Are Saving Small-Town America

I guess gravel riding is "saving" a lot of things today. "Saving" is too strong a word for the effect of gravel races on small towns; a couple hundred riders one or two days a year is nice, but I doubt if it pays for that new school library. But no doubt I have traveled to and spent money in a dozen towns over the last few years I would have completely bypassed if not for gravel racing.

Med students don't go to class. This is not a new phenomenon

I don't mean to pull any kind of hard work card, because people work hard in every imaginable job. But it's hard to overstate how precious your time is in med school. The volume of information is overwhelming, and even a good lecturer can't typically deliver the material in a time-efficient way. It's much easier just to look at other people's notes (as in note service in my day) or to watch the lecture via podcast or webcast at double speed later. And most professors just aren't good lecturers. Not even Nobel laureates. Maybe particularly not Nobel laureates; the skill set that makes a good investigator is far removed from the skill set of a good teacher.

What's interesting here is that the move to pass-fail grading systems--which I completely agree with--has made performance on the national "step" exams that much more important. This, according to Orly Nadell Farber, is what is driving the further diminution of attendance at lectures. My response to this is for NBME to stop giving step scores to residency program directors.

Doctors are pulling their hair out trying to get parents to limit screentime

U.S. kids get an average of over 7 hours daily in front of screens, almost all of it because increased use of smartphones, tablets, and other devices. Not that anyone who has seen a kid in a grocery cart at the store lately needs to be told that. Why is this important? Because the more time you spend zonked out in front of a television, the more fat you tend to have (what we five-dollar-word types call "adiposity”). And adiposity means bad things later on, like heart disease and diabetes.

So the American Heart Association is recommending--again--that children and teens to get no more than 1–2 hours of recreational screen time a day. They also warmed my heart by continuing to recommend against having screens, including phones, in bedrooms and while eating.

PBS, The Atlantic, and this guy formerly of Google want you to take your life back

And me. I want you to take your life back from your devices, too. 

Links for Friday, December 29, 2017: food swamps, happiness from QI, and the persistence of ineffective treatments

So long, food deserts. Helloooo, food swamps

...food swamps had about four unhealthy options for each healthy one. Food swamps were a strong predictor of obesity rates—even stronger than food deserts were. The relationship between food swamps and obesity was especially strong in areas where people lacked both their own cars and access to public transportation.

See primary paper here.

Bob Badgett has thoughts on happiness and quality improvement

The Dunning-Kruger effect (which applies to docs) is the phenomenon in which difficulty in recognizing one's own incompetence leads to Inflated self-assessment. That is, the worse you are at your job, to some extent, the higher you rate your ability to do that job. Uplifting stuff when we think about management. 

Why do doctors keep recommending treatments that don’t work?

Tough question that Eric Patashnik does a good job of summarizing in a manageable length. We're all victims of our own status quo bias:

In the US, even modest reforms to use taxpayer money to fund research to learn what treatments work best, for which patients, have engendered controversy. Republicans famously charged that the establishment of the Patient-Centered Outcomes Research Institute (PCORI) through the Affordable Care Act, would lead to the creation of “death panels.” The politicians made that argument even though the agency only funds studies and was given no authority to make policy decisions or payment recommendations. PCORI has yet to have a significant impact on clinical practice. It faces a sunset date of 2019, and its future remains unclear.