This is a good example of the relevance of epistemology to life in a life-or-death kind of way. Potential treatments are not sufficiently investigated due to bad epistemology.
Yeah. It might work better for something more mild. Like if you were investigating b1ās effect on some mild chronic fatigue or something like that, it seems like you could more likely get people to sign up than for an investigation of something really serious.
Why I Left Orthodox Medicine: Healing for the 21st Century :
I attempted to carry out double-blind studies and found that they did not
work, for several reasons. First, TTFD makes the urine turn a tell-tale bright
yellow, for completely harmless reasons
I wonder if you could put something in a placebo pill that would have the same effect, and then let all participants know you did that, so they canāt use urine color as an indicator.
I think Lonsdaleās book is interesting but there are some claims or views I am skeptical of. Seemed worth mentioning one of those:
We have mentioned the daily rhythm of the computer, but it also has
a twenty-eight-day rhythm, at least in the female. It is not known whether the
twenty-eight-day cycle is coincident with the lunar cycle or whether the
gravitational force of the moon does have an effect upon the menstrual cycle.
It is fairly well-known that emergency rooms are filled with patients when the
moon is full, so this gravitational force does affect the human computer
Iām skeptical about the moonās gravity affecting the brain computer, and Iām skeptical of the factual claim about emergency rooms.
Regarding emergency rooms:
A full moon occurred 49 times during the study period. There were 150,999 patient visits to the ED during the study period, of which 34,649 patients arrived by ambulance. A total of 35,087 patients was admitted to the hospital and 11,278 patients were admitted to a monitored unit. No significant differences were found in total patient visits, ambulance runs, admissions to the hospital, or admissions to a monitored unit on days of the full moon. The occurrence of a full moon has no effect on ED patient volume, ambulance runs, admissions, or admissions to a monitored unit.
Theyāve studied psychiatric facilities as well, similar results.
The prevailing scientific evidence says no. Researchers in a 2017 studyTrusted Source analyzed emergency room records at a 140-bed hospital and found that people visited the ER because of a psychiatric condition in roughly equal numbers during all four phases of the moon.
A 2019 reviewTrusted Source of nearly 18,000 medical records from different facilities found the same thing: no relationship between lunar cycles and the length of hospital stays or the number of inpatient admissions or discharges at psychiatric facilities.
Apparently theyāve found some relationship between the lunar cycle and sleep, though, which is interesting.
Interestingly, one 2021 studyTrusted Source found that people fell asleep later and slept less overall on the nights before the full moon.
Other research suggestsTrusted Source that the full moon may be associated with less deep sleep and increased REM (rapid eye movement) latency.
Sleep latency is the period between when you first fall asleep and when you enter the first stage of REM sleep. So, increased latency means it takes a longer time to get to REM sleep.
Other causes of REM sleep latency can includeTrusted Source:
- sleep apnea
- alcohol use
- some medications
The deepest sleep occurs just before REM sleep begins.
Some comments I found talking about ER admissions (and assuming that maybe the moon-ER admission relationship was true) said perhaps the relationship was full moon ā more light ā more people doing stuff ā more admissions. Kinda like how crime goes up in the summer (I think that one is real?) because people can be outside more.
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Lonsdale has brought up the idea that doctors going on strike reduces mortality. I was skeptical. I found some stuff online. First, hereās a study abstract:
https://www.sciencedirect.com/science/article/abs/pii/S0277953608005066
A paradoxical pattern has been suggested in the literature on doctorsā strikes: when health workers go on strike, mortality stays level or decreases. We performed a review of the literature during the past forty years to assess this paradox. We used PubMed, EconLit and Jstor to locate all peer-reviewed English-language articles presenting data analysis on mortality associated with doctorsā strikes. We identified 156 articles, seven of which met our search criteria. The articles analyzed five strikes around the world, all between 1976 and 2003. The strikes lasted between nine days and seventeen weeks. All reported that mortality either stayed the same or decreased during, and in some cases, after the strike. None found that mortality increased during the weeks of the strikes compared to other time periods. The paradoxical finding that physician strikes are associated with reduced mortality may be explained by several factors. Most importantly, elective surgeries are curtailed during strikes. Further, hospitals often re-assign scarce staff and emergency care was available during all of the strikes. Finally, none of the strikes may have lasted long enough to assess the effects of long-term reduced access to a physician. Nonetheless, the literature suggests that reductions in mortality may result from these strikes.
I donāt follow their point about the reassignment of staff. Are they saying that e.g. maybe higher quality staff were available to do emergency care cuz of the strike? Anyways, this seems to say there is some relationship. Also the point about elective surgeries is interesting. I donāt think a random member of the public would typically assume that a postponement of elective surgeries would have a significant increase on mortality, so I think thereās some disconnect between what people assume is the typical risk profile of an elective surgery and what it actually is.
Hereās a more hostile/biased write up that gives some details about specific examples.
They go through some specific examples and say either the effect is minor and driven by elective surgery postponement, based on anec-data, or non-existent.
But they start off with:
As weāll see below, Jacob, itās not really so surprising that mortality statistics sometimes show a drop during a doctorsā strike. Whatās staggering is that a reasonable person could see such stats and for even an instant think: Holy crap, those doctors are killing us. Sure, thereāll always be a few alternative-medicine fringe dwellers who genuinely see the medical establishment as some sinister cabal presiding over a high-density feedlot of human misery. But the way this āfactā about doctorsā strikes gets passed around suggests that a lot more people are a little more nuts than youād want to imagine.
This is rhetoric attacking people asking certain questions and strawmanning alternative views (you donāt have to think the medical establishment is a āsinister cabalā to wonder whether it is using the best methods/approach).
The end of the article says:
So despite media suggestions to the contrary, doctorsā going on strike doesnāt seem to have much effect on the death rate one way or the other, and any reduction seen is probably the result of postponed or canceled nonemergency surgeries. And that figures: any surgery is risky, and some common procedures (like coronary bypass or aneurysm repair) have a death rate you just canāt ignore. But leaving the tummy tucks out of it, most elective surgeries boast a pretty serious payoff, either in quality-of-life improvement right now or in medical trouble avoided down the line. If 600 people die each year as a result of hip-replacement surgery, does that mean the 200,000-plus patients that pulled through were fools to go under the knife? Youāre welcome to calculate the odds however you like, and in certain cases it may well make sense to question the value of surgery. As a general proposition, though, if my health is on the line, Iām glad to hear that the doctor is in.
The article defends the general value of elective surgeries, which is fine, they can make that argument. But they started off attacking as nuts people who wonder whether treatment from standard doctors might be causing deaths. But their defense of the statistics is, yes, elective surgeries cause deaths, but itās worth it. They donāt seem to consider that maybe people donāt realize how risky any surgery is, and that it might be good that people are wondering about this doctor strike/mortality relationship since explaining that might allow people to update their model of medical procedure risk in a way that allows them to make better decisions. I have a family member who just had some serious complications from elective surgery, so this sort of biased framing on this topic particularly troubles me.
EDIT: Anyways, bottom line, just based on a quick googling, seems like thereās some kind of relationship here between doctors strikes and lower mortality, when even the defenders concede that elective surgeries may be a driving factor.
That claim stood out to me too. Lonsdale mentioned it more than once (possibly I read it outside the book, too). I hadnāt looked it up yet though.
In Lonsdaleās narrative ā which makes sense to me ā a significant portion of non-elective treatments are harmful. There are various reasons which Iām not going to cover in this post besides mentioning that Lonsdale said something about a study showing thiamin deficiency rates went up during hospital stays (you test thiamin for people right when theyāre admitted, and after theyāve been in the hospital a while, and compare).
I knew some stuff about that previously too. Hospitals have some dangers and should be avoided if you donāt have a compelling reason to be there. Some people overly trust medicine to be super advanced instead of somewhat crude ā to be much more like the House TV show than it is ā so may seek a lot of (non-elective) treatments where the cost/benefit isnāt actually worth it. For example, I think a lot of people just arenāt skeptical enough about surgery in general (including lasik laser eye surgery as a good but elective example, btw), and a lot of doctors are overly willing to do surgeries that are too often ineffective and have significant downsides. They often donāt understand the condition they are treating well enough to actually know the surgery is the right approach and is worth the downsides.
Doctors have wonderful miracle cures for some things, but they also donāt for a lot of other things, so thereās a much higher risk of ineffective bumbling in those other cases. More humility to admit when they donāt know would help here (doctors absolutely do admit they donāt have answers sometimes, but sometimes they say āitās all in your headā and send the patient to a psychiatrist rather than admit to not knowing, and sometimes they try treatments when they donāt know). Also medical culture seems to dismiss a ton of āside effectsā as not that big a deal while not placing an appropriately high value on clearly safer (and cheaper) options like taking some vitamins. Theyād do less harm if they were actually trying to calculate cost/benefit ratios more, but they donāt always seem to do that because theyāll suggest drugs with clear risks that they know donāt have much chance of working over vitamins.
Anyway, would doctorās non-elective mistakes outweigh the beneficial treatments? Perhaps not. But if they counter-weighted the majority of the benefit, then itād set the stage for the elective stuff to weigh things down to net negative.
Maybe thatās unclear so Iāll make up some numbers to illustrate.
Suppose 1/3 of treatments are elective and they have an average health value of -30 (Iām ignoring other non-health benefits like looking younger). Multiplying those two numbers we get a negative weight of -10 .
If the 2/3 non-elective are almost all beneficial and the average benefit is +30, then the positive weight there is +20. The overall weight is 20-10 = 10, a positive number.
But now letās split the non-elective procedures into half beneficial (+30 on average) and half are negative (since a lot of treatments doctors try donāt work). Weāll give the negative ones an average of only -15 (closer to neutral than the +30 or -30 stuff). Now we have +10 from the good treatments, -5 from the bad non-elective ones, and -10 from the elective ones, for a total sum of -5. The non-elective treatments contributed only +5 instead of +20 in this case, which was now close enough to 0 to let the elective procedures push things negative. It isnāt just elective procedures that are doing some harm.
Another issue is some treatments have a small risk right now but could be fatal (e.g. many surgeries, or also just a new med has a small chance at a very negative reaction which could kill you, especially if youāre already old/sick/frail). But that treatment is to help with a condition that was unlikely to kill you within the next year even if ignored. That doesnāt mean those treatments arenāt worth the risk, but it could mean doctor strikes lower short term mortality even if they raise mortality over longer time frames. A lot of medical treatments have risks immediately but arenāt aimed at preventing imminent death.
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Earlier in the covid pandemic, I remember reading about covid patients taking up all the ICU beds in some areas. I think the articles were saying this was raising morality for people who didnāt have covid (as well as for people who did have covid, and needed an ICU bed, but couldnāt get one). But I donāt remember specifics.
I remember looking into the effectiveness of microfracture surgery (a cartilage repair technique) and thinking the effectiveness seemed pretty questionable. I also looked into stuff like knee replacements (and other joint replacements) and was surprised at the limitations you had to deal with (e.g. no jogging); some replacements are basically a permanent downgrade from a normally functioning body part (might be better than a broken part! but you really have to set your expectations). Thereās newer stuff in the pipeline for lots of this stuff that is better, but the current āstandard of careā is pretty weak.
More from Why I Left Orthodox Medicine: Healing for the 21st Century:
There is a relatively common condition in children that is called school
phobia. As soon as a child with this problem gets to school, he develops
abdominal pain and may vomit. Sometimes there is an associated headache.
The teacher calls his mother to take him home and all symptoms disappear. It
is only natural to believe that this is āpsychologicalā if we follow Freudian
leadership. Such children are usually referred to a psychologist. I love to see
such children, because it is usually very easy to relieve by changing the
childās diet and providing a few nutrient supplements.
I was always interested in the fact that they are almost invariably bright
children who like the teacher, are popular with their friends, but are
compulsive about their school work. The real mechanism is that the computer
has become trigger-happy because of various nutritional abuses. Going to
school is an ordinary, everyday stress, just the same as for all the other
children. This normal stress causes the computer to fire off signals that are
unnecessary, resulting in the somatic symptoms described. The bowel is
signalled to action which is more powerful than usual, causing pain, and
reversed peristalsis in the stomach results in vomiting. The headache is
caused by changes in blood vessels supplying the scalp or brain and is much
like a migraine.
I disagree with this perspective. I personally experienced this physical-distress-before-school issue when younger. In my case, the issue was resolved by changing schools. I donāt think nutrition is the primary issue here - I think there is something about the school situation that is causing the child to be severely distressed and that this manifests physically. Lonsdale has made a couple of comments throughout the book that severely underrate the role of ideas/interpretations in causing human reactions to things, and I think that this is one of the clearer examples.
Note that itās plausible to me that there can be various relationships between physical states of the body and mood. E.g. if someone interprets tiredness as a reason to be irritable, as is very very common in our culture, then a lack of sleep can be said to produce irritability. Or there are chemicals that get released during running that people associate with happiness and so they run and feel happy for a while (Iāve experienced this many times). But I think the idea/interpretation in the human mind is important. Even if there were some nutritional problem that were causing the feelings in the body to be worse, 1) those feelings still need to be interpreted, and 2) thereās still the issue of the initial stressor, which, in various cases, might matter a lot more than some body chemical stuff. E.g. if youāre being viciously bullied at school every day, even the best nutrition might not really help. The nutrition isnāt the key issue.
More on the fear of school thing. Iāve tried finding studies specifically on nutrition and fear of school (also called Scolionophobia or school phobia) but havenāt found anything on point. Iāve found some general stuff saying various things like magnesium can help with anxiety (though this says a bunch of studies that were reviewed were based on self-reports, so thatās an issue). Assuming that there is some sort of relationship between nutritional factors, physical states, and peopleās common ideas and emotional reactions to certain physical states, it would make sense that that would apply to children as well.
Part of my skepticism re: nutrition being key factor here is that I think schools are actually quite awful and the experiences that children have in them, and that people take for granted, are bad. Lots of things in our society are awful, but kids are less used to the awfulness, less experienced, and have a hard time protecting themselves from it, so the awfulness hits them particularly hard. Some kids might react by throwing up their cereal every morning but thatās just one manifestation of suffering that I think hits a much larger group.
Also, Lonsdale says:
Going to
school is an ordinary, everyday stress, just the same as for all the other
children.
But itās actually not the same for kids who are, for example, being severely bullied and the like.
It can be nutrition and stress and ideas all contributing. Lonsdale says poor nutrition makes you more vulnerable to stress. That can be addressed with diet/vitamins or reducing stress (by changing schools or changing ideas).
Someone could be in a situation where changing to a less stressful school or changing their diet would both work (either alone would be adequate). Someone else could already be at a low stress school and therefore (without homeschooling) itād work better to change diet or ideas. Someone else could be at a high stress school with a bad diet, and merely changing to an average school wouldnāt be enough without also improving their diet (improving their ideas would also help).
I agree with that and that Lonsdale underestimates that. (I didnāt read him as downplaying severe bullying though. I think he was talking about kids in more usual school situations that regular people like him would think were OK, not school situations that regular people consider awful.)
Okay, makes sense, I agree.
Yeah okay, that seems like a reasonable reading to me.
I like the way Lonsdale uses analogies to explain things rather than tossing around a bunch of technical jargon, e.g.:
The simplest form of combustion is fire. Suppose that a camper decides
to build a log fire in a clearing in the forest. The purpose is to use the heat
energy to cook his dinner. He lights the fire and observes it as it increases in
intensity. He may throw lighter fluid on it or blow into the fire to accelerate it.
The heat is caused by the oxidation of wood, and the camper knows that he
can set the forest on fire. He makes the fire in a fireplace to guard against this
possibility but is worried when the fire is burning too vigorously because
sparks are formed and these can jump onto the grass, set it on fire, and thus
spread the fire to the forest. To prevent this process, the camper puts a wire
grill over the fireplace to catch the sparks. He is protecting the forest by
controlling the fire.
Each of our 100 trillion cells in the body has precisely the same
challenge. It must be emphasized again that oxygen is a dangerous gas. It is
capable of severe harm if its fundamental properties are not kept under
control. The exquisite genius of MN [Mother Nature] is that these facts have been dealt with
and the problems solved in the most efficient manner. It is indeed complex,
but can be easily understood through the analogy.
The fuel that the cell burns is, of course, the calorigenic component of
food: protein, fat, and carbohydrate. There are āfireplacesā in each cell, called
mitochondria, minute organelles within the cell where the fuel-burning
process takes place. Let us examine for a moment what happens when the
body is put under any form of stress. The computer orders an increased rate of
metabolism to supply the increased requirement of energy, causing oxidative
metabolism in each mitochondrion to accelerate. It begins to throw out
oxygen atoms, virtually like microscopic bullets, called free oxygen radicals.
Just like sparks in the log fire, they cause oxidation to occur where they hit
their target outside the mitochondrion. Like sparks, they are excited units of
energy.
In her primeval wisdom, MN knew that the use of oxygen would have its
dangers, and she therefore prepared a whole array of chemical substances
which work together to quench the free oxygen radicals as they shoot out of
the mitochondrion. This group of chemical substances works as a team and
can be compare with the wire grating or grill in the fireplace analogy. Each
one of the chemical substances is one wire in the grill. Some parts of the
chemical grill are made in the body and therefore are not part of our nutrition.
Many, however, must be consumed from external sources. They go by the
names vitamin C, vitamin E, selenium, beta carotene, and many others. These
non-calorigenic vitamins and minerals have to be taken into the body in our
food; they are called antioxidants because they protect a cell from damage by
its own oxygen. Just like a wire in the grill, they have to fit together in this
process of protection.
[EDITED FOR CLARITY OF SOURCE AND TO ADD A MINOR COMMENT]
Still reading Why I Left Orthodox Medicine. I thought this was an interesting claim by Lonsdale on the harm homogenization of milk can cause:
Raw milk, as obtained from
a cow, may be perfectly satisfactory, if the cow is certified and so forth, even though its worth is still only as a basic interim food for calves until they can eat grass! In the world of today, however, we have to follow the milk through processing, which alters the picture very considerably. Processing is performed essentially to give the milk longer shelf-life and sterility. One of the major things that is done to it is homogenization; the fat globules are mechanically broken down so that they no longer rise to the top of the container as cream. These tiny fat globules can pass through the intestinal wall and carry with them the chemical molecules associated with modem farming. This means, of course, that drugs such as antibiotics administered to the cow can be ingested with the milk.
Itās plausible to me that breaking down the fat globules due to homogenization could lead to them being able to carry unwanted things through the intestinal wall.
Since you liked that, FYI you can read concerns about milk in other books too and online. Itās much less unique than the thiamin stuff. Iāve seen several milk criticisms before though I forget specifically where. Anything in the vicinity of paleo would be a place to look.
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This sounds wrong to me and potentially biased. My initial guess is that milk is good food but it has some downsides. First, if the mother dies or dries up, a milk-reliant calf is in trouble, so thereās risk there. It also means the calf canāt get separated from its mother.
Also, how does the mom make milk? By eating grass then transforming it. That transformation must have an efficiency loss. I think the milk is costing resources to help the young cow ā the mom is taking grass and using resources to turn it into a particularly good food for the calf. Itās temporary because itās inefficient energy use overall so thatās only worth it when the calf is young and extra vulnerable, and also because dependence on the mom is problematic, and also because it would make no sense to have an adult female cow drinking milk from its mother while also breastfeeding, and also the parent is likely to eventually die before the child so children have to stop relying on their parents for food eventually. Itād also probably be problematic to breast feed all oneās children of many different ages at once ā the mom would have to eat and process more than the total regular grass intake needs of all those kids plus herself.
Anyway some members of the species have to eat something other than milk in order to bring new energy into the speciesā stomaches. Evolution had to design around milk being temporary/limited even if itās very healthy.
Just some speculations without research.
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I finished reading Lonsdaleās Why I Left Orthodox Medicine: Healing for the 21st Century. I liked it a lot. I plan to try some of his other books and read more of his articles.
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I liked it too. Thanks for writing about it, bringing it to my attention and discussing it in this thread.
