The gluten-free contagion

 

NewImage

Another good piece of journalism by Michael Specter writing for the New Yorker Magazine What’s So Bad About Gluten? Yes, that’s the same Michael Specter who wrote the excellent expose of Vandana Shiva [I'm a card-carrying anti-Shiva activist].

People seem to be afraid of an increasing range of things, and gluten anxiety has grown until it seems to be the hot new ingredient to avoid.

Why? We know that about 1% of the population has Celiac disease – which means truly dangerous gluten intolerance. There is some evidence that the incidence grew since the 1950’s to that 1% level. Since the chemistry of wheat is unchanged the implication is the cause is environmental. But the gluten panic isn’t about Celiac disease – it seems to be largely self-diagnosed quite possibly just a popular myth.

Here’s a couple of excerpts from Michael’s essay that will give you some hints:

Myhrvold wasn’t in town that day, but I caught up with him later. He is highly opinionated, and delights in controversy; saying the words “gluten-free” to him was like waving a red flag at a bull. “When I was a kid, I would watch National Geographic specials all the time,’’ he told me. “Often, they would travel to remote places and talk to shamans about evil spirits. It was an era of true condescension; the idea was that we know better and these poor people are noble, but they think that spirits are everywhere. That is exactly what this gluten-free thing is all about.” He stressed that he was not referring to people with celiac disease or questioning the possibility that some others might also have trouble eating gluten. “For most people, this is in no way different from saying, ‘Oh, my God, we are cursed.’ We have undergone what amounts to an attack of evil spirits: gluten will destroy your brain, it will give you cancer, it will kill you. We are the same people who talk to shamans.

(…snip…)

Peter H. R. Green, the director of the celiac-disease center at the Columbia University medical school and one of the nation’s most prominent celiac doctors, says that the opposition to gluten has followed a similar pattern, and that it is harming at least as many people as it is helping. “This is a largely self-diagnosed disease,’’ Green said, when I visited his office, at New York-Presbyterian Hospital. “In the absence of celiac disease, physicians don’t usually tell people they are sensitive to gluten. This is becoming one of the most difficult problems that I face in my daily practice.”

He went on, “I recently saw a retired executive of an international company. He got a life coach to help him, and one of the pieces of advice the coach gave him was to get on a gluten-free diet. A life coach is prescribing a gluten-free diet. So do podiatrists, chiropractors, even psychiatrists.’’ He stopped, stood up, shook his head as if he were about to say something he shouldn’t, then shrugged and sat down again. “A friend of mine told me his wife was seeing a psychiatrist for anxiety and depression. And one of the first things the psychiatrist did was to put her on a gluten-free diet. This is getting out of hand. We are seeing more and more cases of orthorexia nervosa”—people who progressively withdraw different foods in what they perceive as an attempt to improve their health. “First, they come off gluten. Then corn. Then soy. Then tomatoes. Then milk. After a while, they don’t have anything left to eat—and they proselytize about it. Worse is what parents are doing to their children. It’s cruel and unusual treatment to put a child on a gluten-free diet without its being indicated medically. Parental perception of a child’s feeling better on a gluten-free diet is even weaker than self-perception.”

(…snip…)

FODMAPs, an acronym for a series of words that few people will ever remember: fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Not all carbohydrates are considered FODMAPs, but many types of foods contain them, including foods that are high in fructose, like honey, apples, mangoes, and watermelon; dairy products, like milk and ice cream; and fructans, such as garlic and onions.

Most people have no trouble digesting FODMAPs, but these carbohydrates are osmotic, which means that they pull water into the intestinal tract. That can cause abdominal pain, bloating, and diarrhea. When the carbohydrates enter the small intestine undigested, they move on to the colon, where bacteria begin to break them down. That process causes fermentation, and one product of fermentation is gas. In Gibson’s new study, when the subjects were placed on a diet free of both gluten and FODMAPs, their gastrointestinal symptoms abated. After two weeks, all of the participants reported that they felt better. Some subjects were then secretly given food that contained gluten; the symptoms did not recur. The study provided evidence that the 2011 study was wrong—or, at least, incomplete. The cause of the symptoms seemed to be FODMAPs, not gluten; no biological markers were found in the blood, feces, or urine to suggest that gluten caused any unusual metabolic response.

In fact, FODMAPs seem more likely than gluten to cause widespread intestinal distress, since bacteria regularly ferment carbohydrates but ferment protein less frequently. Although a FODMAP-free diet is complicated, it permits people to eliminate individual foods temporarily and then reintroduce them systematically to determine which, if any, are responsible for their stomach problems. FODMAPs are not as trendy as gluten and not as easy to understand. But, biologically, their role makes more sense, Murray says.

Michael Specter happens to be a dedicated whole wheat baker. Based on what he learned researching this story, he says he has dumped his vital gluten additive in the trash. ” I have returned to baking whole-wheat bread the way it is supposed to be made: water, yeast, flour, and salt. I will try to live without the magic wand. But I am certainly not going to live without gluten. That just seems silly.”

Science funding is broken. Thinkable wants to help fix it.

Logo thinkable

Thinkable is a promising new crowd funding connection between researchers and sponsors (including the public at large). Founded by oceanographer and chief scientist Ben McNeil “the idea for Thinkable comes out of Ben’s frustration over the lack of funding for basic research and a passion for blue-sky thinking.” Ben’s recent arstechnica essay is a good introduction to why he believes science funding is broken; paired with the solution proposed by Thinkable: Is there a creativity deficit in science? If so, the current funding system shares much of the blame.

I won’t try to outline how the Thinkable platform and ecosystem works — the Thinkable website is very well-designed, so you’ll learn more about the venture by just jumping in — and be sure to sign up in your role as a sponsor or a researcher. I decided that the best way to evaluate Thinkable is to participate: I’ve subscribed to sponsor Martin Rees whose current project funding is passing the 50% level: How can we stop blood vessels becoming damaged and sticky during inflammation?

Here’s some of the reasons I’m excited about Thinkable:

  1. Taking risks is absolutely fundamental to real progress in science and technology. The existing institutional funding channels are highly risk averse — “crazy ideas need not apply here”.
  2. The path to breakthroughs is cobbled by mistakes. Mistakes are where most of the learning happens.
  3. Those characteristics are familiar to entrepreneurs who are successful innovators. The venture capitalists who consistently make superior returns know this very well. That’s why Silicon Valley slang is peppered with phrases like “Fail fast” and “Pivot”. “Let’s invest through the pivot” has probably been spoken more than once by a VC looking at superb founders (translation: “these guys are so good we want to work with them, even though their idea is probably going to fail”).
  4. Thinkable looks to be administratively very lightweight — so that funding goes to support research, not overheads. I understand that 87% of sponsor funding is delivered: after 10% to support the Thinkable platform and about 3% for payment processing fees (Visa etc. Note that once Thinkable can rely on crypto currency payment processing that 3% will fall near to zero) 

In my next post on Thinkable I hope to be able to explain who is funding the venture. Please help spread awareness of the Thinkable platform. If this takes off in a big way we could be helping to Change the World.

Should we force drunks to drive? Compulsory Voting: For and Against

Choice

I’ve not yet read the June-release of Compulsory Voting: For and Against, but it comes well-recommended. Here are two blurbs by George Mason colleagues of the authors:

“The frustrating thing about arguments over citizenship in democracies is that everyone is right, meaning that everyone is also wrong. There are powerful arguments in favor of asking citizens to act on a moral obligation to become informed, so as to move toward an ideal world. In that view, argued ably here by Jason Brennan, anyone who fails to become informed should voluntarily abstain. Lisa Hill argues that Brennan has it backwards: ‘good’ elections are not the result of an informed citizenry. Rather, a broadly accepted electoral process, legitimated by universal participation, is what creates an informed citizenry. Who is right? An extraordinary and very fair-minded treatment of significant issues in democracy around the world.”
Michael Munger, Duke University

“Should the government force citizens to vote? Brennan and Hill’s Compulsory Voting crisply presents the strongest case in favor as well as the strongest case against mandatory participation in the electoral process. Although the two authors defend opposite conclusions, both show that philosophy is better with careful social science – and that social science is better with careful philosophy. A book full of ideas, clarity, and candor.”
Bryan D. Caplan, George Mason University

Incidentally, prof. Bryan Caplan is the author of one of our favorite Public Choice books The Myth of the Rational Voter.

For more background try my post Public Choice: rational ignorance, pork and rent-seeking.

How will we know if the ACA is working?

I don’t know the answer to these five concise questions formulated by Tyler Cowen. Do you?

I have read a good deal on this topic and I am not very satisfied with most of it, from either side.  Too often citing and then refuting weaker claims from the other side is conflated with showing that one’s own view is right.  Here are a few issues we ought to consider and indeed focus on:

1. Five to ten years from now, how much do we think employment will have gone down as a result of ACA?  (That is from the employer mandate, high implicit marginal tax rates because of the subsidies, and also from a lesser need to stay employed to have health insurance.)  By the way, you can’t in other contexts believe strongly in rigidities and then confidently point to a small employment response within a one year time frame and claim to know these labor market effects are small ones.

1b. How will the effort to introduce greater equality of health care consumption fare if wage and income inequality continue to rise?  Will this attempt at consumption near-equalization require massively distorting incentives?

2. Given your answer to #1, and given how much employment itself boosts health, will ACA even have improved overall health in America?  Whatoutcome indicators might show this?

3. Given that prices in the individual insurance market already seem to have gone up 14-28 percent, and may go up more once political scrutiny of insurance companies lessens, what is the overall individual welfare calculation from this policy change?  I mean using actual economic policy analysis, of the CBA sort, not just noting that more people have health insurance.

4. Given supply side constraints, how much did ACA increase the consumption of health services in the United States?  (I take the near-universal bafflement over the first quarter gdp revision a sign of how poorly we understand what is going on.)  And how good or bad a thing is the ongoing but accelerated shift to narrow provider networks?

5. How much of the apparent slowdown of health care cost inflation is a) permanent, b) not just due to the slow economy, and c) due to ACA?  Or how about d) the result of trends which have been operating slowly for the last 10-20 years?

I have lifted Tyler’s complete post to serve as a checklist for monitoring the results. It will take a while – especially solid outcomes data. It isn’t at all obvious how the outcomes can be measured.

Chemical-Free Products: The Complete List

Derek Lowe

Here’s a comprehensive review of chemical-free consumer products, courtesy of Nature Chemistry. I’m flattered to have been listed as a potential referee for this manuscript, which truly does provide the most complete list possible of chemical-free cleaners, cosmetics, and every other class of commercially available product. Along similar lines, I can also recommend (…snip…)

Source: by research chemist Derek Lowe. Derek is a remarkable insider source on preclinical drug discovery.  

The world’s deadliest animals

World s deadliest animals

During the Gates Notes Mosquito Week Bill Gates posted this Chart-of-the-Year.

(…snip…) What makes mosquitoes so dangerous? Despite their innocuous-sounding name—Spanish for “little fly”—they carry devastating diseases. The worst is malaria, which kills more than 600,000 people every year; another 200 million cases incapacitate people for days at a time. It threatens half of the world’s population and causes billions of dollars in lost productivity annually. Other mosquito-borne diseases include dengue fever, yellow fever, and encephalitis.

There are more than 2,500 species of mosquito, and mosquitoes are found in every region of the world except Antarctica. During the peak breeding seasons, they outnumber every other animal on Earth, except termites and ants. They were responsible for tens of thousands of deaths during the construction of the Panama Canal. And they affect population patterns on a grand scale: In many malarial zones, the disease drives people inland and away from the coast, where the climate is more welcoming to mosquitoes.

What the Tamiflu saga tells us about drug trials and big pharma

We have been subscribers to the All Trials network since founded by physician Ben Goldacre in Jan 2013. The mission statement is simple “All Trials Registered | All Results Reported”. The above-captioned article by Dr. Goldacre will make it clear why this initiative is so important:

Today we found out that Tamiflu doesn’t work so well after all. Roche, the drug company behind it, withheld vital information on its clinical trials for half a decade, but the Cochrane Collaboration, a global not-for-profit organisation of 14,000 academics, finally obtained all the information. Putting the evidence together, it has found that Tamiflu has little or no impact on complications of flu infection, such as pneumonia.

That is a scandal because the UK government spent £0.5bn stockpiling this drug in the hope that it would help prevent serious side-effects from flu infection. But the bigger scandal is that Roche broke no law by withholding vital information on how well its drug works. In fact, the methods and results of clinical trials on the drugs we use today are still routinely and legally being withheld from doctors, researchers and patients. It is simple bad luck for Roche that Tamiflu became, arbitrarily, the poster child for the missing-data story.

And it is a great poster child. The battle over Tamiflu perfectly illustrates the need for full transparency around clinical trials, the importance of access to obscure documentation, and the failure of the regulatory system. Crucially, it is also an illustration of how science, at its best, is built on transparency and openness to criticism, because the saga of the Cochrane Tamiflu review began with a simple online comment.

Tamiflu being made by Roche

 

(…snip…)

This is a pivotal moment in the history of medicine. Trials transparency is finally on the agenda, and this may be our only opportunity to fix it in a decade. We cannot make informed decisions about which treatment is best while information about clinical trials is routinely and legally withheld from doctors, researchers, and patients. Anyone who stands in the way of transparency is exposing patients to avoidable harm. We need regulators, legislators, and professional bodies to demand full transparency. We need clear audit on what information is missing, and who is withholding it.

Finally, more than anything – because culture shift will be as powerful as legislation – we need to do something even more difficult. We need to praise, encourage, and support the companies and individuals who are beginning to do the right thing. This now includes Roche. And so, paradoxically, after everything you have read above, with the outrage fresh in your mind, on the day when it feels harder than any other, I hope you will join me in saying: Bravo, Roche. Now let’s do better.

• Ben Goldacre is a doctor and the author of Bad Pharma.

You can help the All Trials mission. Join and sign the petition here. Spread the word, lean on your politicians, get involved.

Will Obama Ever Enforce His Health Law?

Megan McArdle's analysis and outlook has been accurate so far. She is increasingly pessimistic:

This is President Obama’s signature legislative achievement, the program for which he will be remembered. And he doesn’t have the courage to defend it, even when he is no longer facing re-election. If he won’t stand up for the hard choices his law requires, he can’t think that anyone else will either.

Megan's Intelligence Squared debate was excellent: Resolved: Obamacare Is Now Beyond Rescue.

 

The Trouble With ‘Scientific’ Research Today: A Lot That’s Published Is Junk

A number of empirical studies show that 80-90% of the claims coming from supposedly scientific studies in major journals fail to replicate.

Henry I. Miller surveys the wreckage of sloppy medical research.

…Another worrisome trend is the increasing publication of the results of flawed “advocacy research” that is actually designed to give a false result that provides propaganda value for activists and can be cited long after the findings have been discredited.

Dr. Miller is referring to the Gilles-Eric Séralini scandal:

(Séralini has made a specialty of methodologically flawed, irrelevant, uninterpretable — but over-interpreted — experiments intended to demonstrate harm from genetically engineered plants and the herbicide glyphosate in various highly contrived scenarios.)

Megan McArdle asks: “Where have all the uninsured gone?”

So far Obamacare has signed up roughly 15% of the 5 million uninsured that were used to justify the ACA. Megan puzzles over what this means:

(…) You’d expect the early numbers to be somewhat weighted toward the previously insured, who probably want to maintain continuous coverage. Still, this is a fairly wild skew, and it leaves us with a burning question: Where are the uninsured? Did hardly any of them want coverage beginning Jan. 1?
(…)
Maybe they were buying insurance directly from the insurance companies. But industry expert Bob Laszewski seems to say no, that’s not the case: “This is consistent with anecdotal reports from insurers I have talked to that are seeing very little net growth in their overall individual and small group markets as of January 1.”

That leaves us with two possibilities: First, would-be applicants may simply be waiting until March. They’ve gone without insurance a long time; why not wait a few more months and save on premiums?

The second possibility is more troubling: There may be something seriously wrong with our understanding of who the uninsured are, and what they are willing and able to buy in the way of insurance. I don’t know exactly what the fault may be in our understanding. But if the numbers stay this low, I’d say we need to reassess the state of our knowledge about the uninsured — and the vast program we created to cover them.