Bloodletting, leeches, and other FDA-approved treatments
Bloodletting, leeches, and other FDA-approved treatments
Links and updates for Summer 2024
This is the quarterly links and updates post, a roundup of the stuff I’ve been reading and doing for the past few months.
GENERAL INTEREST LINKS, SUITABLE FOR ALL AUDIENCES, FORMATTED TO FIT YOUR SCREEN
(1/12) Bloodletting is supposed to be one of those canonical “good thing we don’t do that anymore!” kind of treatments, the sort of thing where we tut tut at our ancestors for being so silly and backward.
So I was mildly surprised to learn that bloodletting is the standard treatment for hemochromatosis, which is where you have too much iron in your blood. And then I was really surprised to find that researchers are still running randomized-controlled trials on bloodletting for hypertension. This appears to be a traditional Chinese medicine thing—the RCTs are done in China and published in Mandarin. According to this systematic review, letting someone bleed for a while is not obviously worse than giving someone blood pressure meds. I don’t put much stock in this, though, because that same review admits that all of the studies are so bad that we don’t really know what’s going on. I’m just astounded that there are people out there who show up to a medical study and someone’s like “yeah so you’ve been randomized to the condition where you have less blood.”
(2/12) Related: “Medicinal leeches are a US Food and Drug Administration-approved treatment for venous congestion in graft tissue.”
(3/12) It often feels like we’re living through the extinction of privacy, and that might be true. But it’s also true that when cameras were first getting popular, if you had your picture taken at a photo studio, someone could just walk into that studio after you, buy a copy of your portrait, insert it into an advertisement for flour or face cream or whatever, and print thousands of copies, and there was nothing you could do about it.
(4/12) I recently assembled a list of all-time great blog posts. One category that I should have included was “posts written by someone who has both encyclopedic knowledge of a niche subject and a biting wit, who leads you through some arcane history that doesn’t exactly have a thesis or a moral, but does show you some of the back alleys of our world that you would never see otherwise, therefore giving you a richer understanding of your epistemic environs.” Anyway, this post about car phones is one of those posts.
(5/12) You know how old buildings have all these beautiful intricate features, while new buildings are minimalist and boring? The standard explanation is that labor is much more expensive now, so nobody can pay a bunch of stonemasons to carve gargoyles on the facade of their government building. (The non-standard explanation is that we’ve forgotten how to make nice buildings because of a secret apocalypse that happened ~150 years ago, which the government covered up.) Sam Hughes argues that we’ve got it all wrong: we could still have gargoyles if we wanted them, we just don’t want them:
The supply-side theory says that ornament declined because it became prohibitively expensive, which suggests that it would vanish from budget housing first and gradually fade from elite building types later. In fact, budget housing is almost the only place we find it clinging on.
[...]
The explanation, in other words, is a matter of what people demand, not of what the industry is capable of supplying: ornament survives in the housing of the less affluent because they still want it.
(6/12) A fun fact from
: within 20 years after World War II, a musician from all three of the former Axis powers had a number one hit in America:“Nel Blu Dipinto di Blu” by Domenico Modugno in 1958
“Wonderland by Night” by Bert Kaempfert in 1961
“Sukiyaki” by Kyu Sakamoto in 1963
(7/12) The cure for hiccups exists. (via Slime Mold Time Mold)
(8/12) Apparently jalapeños are getting less spicy. The majority of jalapeños are sent directly to factories that turn them into salsas, Flamin’ Hot Cheetos, etc., and those producers want predictable peppers. That’s driven demand for standardized strands, which have less heat. (also via Slime Mold Time Mold)
(9/12) Goodhart’s Law in a tweet:
(10/12) These days, ether and nitrous oxide are mainly for root canals and getting high in the parking lot outside of Insane Clown Posse shows. For decades, though, people used them to plumb the depths of philosophy.
(11/12) I happened upon this old post from The Last Psychiatrist that still slaps. Here, he’s talking about the “maintenance of certification” exam that practicing psychiatrists must take periodically to maintain their license:
If the test is unreliable and 99% pass, why have a test at all? Which reveals the gimmick: the point of the test isn’t to measure competence, but to convey the impression that competence was measured. The point of the test is to say that a test was given-- and nothing else.
[...]
Let me anticipate your retorts: that the questions are carefully constructed for their validity; that the test itself “incentivizes” learning; that not everyone prescribes Xanax; that if I’m such a smartypants, what system would I use? If these are your replies, you have missed my point: a flawed system isn’t better than no system at all, it is worse than no system at all, because at least with no system we are forced to be accountable to ourselves for our education. “Not everyone will be so dedicated.” Correct, but now those same undedicated people get an official blessing of their ignorance.
(12/12) Just a periodic reminder: in the 1960s, the CIA drugged unwitting American citizens with LSD, lured them back to an apartment to have sex with a prostitute, and observed them through one-way mirrors. The goal of the program was to figure out what happens when you drug citizens with LSD and lure them back to an apartment to have sex with a prostitute, and it was a resounding success.
LINKS ABOUT SCIENCE AND SCIENCE-SHAPED THINGS (ONLY CONSUME UNDER THE SUPERVISION OF A DOCTOR)
(1/6) Systematic reviews and meta-analyses are supposed to be the pinnacle of scientific evidence. But they suffer from a garbage-in, garbage-out problem: if they ingest flawed or fraudulent studies, the results of the review will also be worthless. (And that’s just the beginning of the problems, see this Data Colada series for more.)
Richard Smith, former editor of the British Medical Journal (and Experimental History commenter) argues that the problem of fraud and fake data is so bad that reviews are often worthless. For instance, one guy discovered that his systematic review included a bunch of studies that never happened:
They all had a lead author who purported to come from an institution that didn’t exist and who killed himself a few years later. The trials were all published in prestigious neurosurgery journals and had multiple co-authors. None of the co-authors had contributed patients to the trials, and some didn’t know that they were co-authors until after the trials were published.
Another guy analyzed 526 trials that had been submitted to the journal Anaesthesia and discovered that 14% of them had false data and 8% were “zombie” trials—as in, they never happened. Smith concludes:
We have now reached a point where those doing systematic reviews must start by assuming that a study is fraudulent until they can have some evidence to the contrary.
(2/6) Speaking of fraud, it is really, really hard to do anything about it.
The Data Colada bloggers have received death threats and lawsuits for pointing out obvious research misconduct. I recently came across this blog post by Joe Hilgard where he details the painful and mostly fruitless process of trying to alert people to bogus data:
The clearest consequence of my actions has been that Zhang [the alleged fraudster] has gotten better at publishing. Every time I reported an irregularity with his data, his next article would not feature that irregularity. In essence, each technique for pointing out the implausibility of the data can be used only once, because an editor’s or university’s investigation consists of showing the authors all the irregularities and asking for benign explanations. This is a serious problem when even weak explanations like “I didn’t understand what randomized assignment means” or “I’m just very bad at statistics” are considered acceptable.
[...]
In total, trying to get these papers retracted has been much more difficult, and rather less rewarding, than I had expected. The experience has led me to despair for the quality and integrity of our science.
(3/6) I appreciate what Hilgard, Data Colada, and folks like them are trying to do; it’s both prosocial and thankless. But I disagree with the way fraud-detection work often gets framed. Here’s how Hilgard begins his piece:
Science is supposed to be self-correcting. To test whether science is indeed self-correcting, I tried reporting this misconduct via several mechanisms of scientific self-correction.
Science is not self-correcting in the sense that “the gatekeepers inevitably come around to believing and promoting true things instead of false things.” Some of those gatekeepers will keep believing and promoting false things until they die. Science is self-correcting in that “true things are more powerful than false things.” Truth wins in the long run because you can use it to do more stuff.
(See also: Science is a strong-link problem and Psychology might be a big stinkin’ load of hogwash, and that’s just fine.)
It’s hard to see that right now in psychology because we don’t have enough true things. We have nothing to correct with, and so we think that “correcting” means “rooting out all the fraud,” rather than “coming up with better ideas.”
(4/6)
, a developmental psychologist and occasional Experimental History sparring partner, argues that a lot of developmental psychology isn’t worth doing. I think the same thing is true about social psychology as well, and the reason for both of our debacles is the same: our fields are pre-paradigmatic.(5/6) The phrase “publish or perish” has been around since at least 1942, maybe even earlier.
(6/6) Here’s physicist Freeman Dyson:
You became a professor at Cornell without ever having received a Ph.D. You seem almost proud of that fact.
Oh, yes. I’m very proud of not having a Ph.D. I think the Ph.D. system is an abomination. It was invented as a system for educating German professors in the 19th century, and it works well under those conditions. It’s good for a very small number of people who are going to spend their lives being professors. But it has become now a kind of union card that you have to have in order to have a job, whether it’s being a professor or other things, and it’s quite inappropriate for that. It forces people to waste years and years of their lives sort of pretending to do research for which they’re not at all well-suited. In the end, they have this piece of paper which says they’re qualified, but it really doesn’t mean anything. The Ph.D. takes far too long and discourages women from becoming scientists, which I consider a great tragedy. So I have opposed it all my life without any success at all.
(via Ben Reinhardt, I think? Sorry I forgot, sometimes I just save stuff thinking, “I’ll always remember where I found this” and then I immediately forget where I found it)
LINKS FOR LIZARDS (HUMANS: KEEP SCROLLING)
[These are updates from the burgeoning science-on-the-internet movement. See the original post here: An invitation to a secret society, or why you should be a lizard.]
(1/6) I’m always going on about how basic dental recommendations are not supported by any good evidence. For example, this systematic review of flossing studies concludes: “The evidence is low to very low-certainty. The effects observed may not be clinically important.” So I was thrilled when Experimental History reader Patrick O’Donaghue sent me this report of his DIY flossing study:
I tried a “can dentists tell whether or not I floss” experiment. I went to a hygienist 3 times over 18 months ish at roughly 6-9 month intervals. I had never flossed before in my life. At my first session, I confessed with a shameful air that I didn’t floss. And my hygienist looked inside my mouth and told me that she could tell, that it was giving my gingivitis, and that I needed to start flossing right away. So I dutifully took the floss that she gave to me and then proceeded to _not_ floss a single time for another 6-9 months. At my next visit, I lied and, with pride in my voice, said that I was really enjoying my new habit of flossing. And, indeed, she reported that my mouth now looked much better. “Keep it up!” she said. And then, just for fun, I did start flossing religiously. But when I went back to the hygienist, I pretended that I had started to go lax, and was basically forgetting to floss half the time, or finding myself abroad without floss in my bag, and months were flying by without any floss. And she told me that, though my mouth was “okay”, it wasn’t looking “great”, and she suggested that I needed to get back on top of flossing ASAP or else all my teeth might fall out one day or whatever it is that happens when one doesn’t floss.
If you run a flossing study, please email me about it: experimentalhistory@substack.com. Or better yet, post it on the internet and email me the link!
(2/6) Another admirable example of empiricism from an Experimental History reader: I put a toaster in the dishwasher.
(3/6) Independent scientists are building an open-source battery.
(4/6) This guy never got a degree and spent 15 years building a flower lab in his house.
(5/6) If you’re looking for money to support your independent thing, here’s a list of grants you might be eligible for. (It’s unfortunately a little out of date.)
(6/6) Speculative Technologies is running some 1-day workshops “to help ambitious researchers learn more about coordinated research programs and develop ideas for them.”
NEWS FROM EXPERIMENTAL HISTORY HQ
(1/6) Transparent Replications transparently replicated Study 5b from a paper I published called The Illusion of Moral Decline. All the main results came out the same: people think morality started declining sometime after they were born, regardless of when that was. See the Experimental History version of the paper for more.
(2/6) I was on Radio New Zealand talking about talking.
(3/6) Friend of the blog Hot Pink Death Machine has a new single: “Vampire Sundae”
(4/6)
has the top comment on my recent post about moonshots:I went to the White House for a Cancer Moonshot meeting as part of VP Biden’s Cancer Initiative about 12 years ago. About 30 of us sat around a big table for a day and at the end of it, we agreed to have an intern try to improve the API for retrieving clinical trial descriptions. Not that that did much good because pharma companies gain competitive advantage from keeping the important details of their trials secret. That was our moonshot.
It’s not all bad news though.
There is unlikely to be a single cure for cancer because cancer is lots of different diseases but targeted therapy and immunotherapy has been close to a miracle for some cancers. Kidney cancer, for example, has gone from practically no treatments to 50% five-year survival over the space of about ten years. Maybe not quite a moon landing yet but they are maybe orbiting the moon. The government rules do their best to thwart the people shooting for the moon with forms filled out in triplicate though.
I have terminal brain cancer and there have been no new treatments for gliomas for about twenty years. There’s a new targeted therapy — vorasedinib — that was so successful that they called an early halt to its phase 3 trials to get it out to real patients in a rush job. It was given Fast Track Designation in February 2023 and should receive actual approval later this year. Fast Track indeed.
There are people shooting for the moon but they are blocked by people with clipboards. It’s all very sad.
> “I gotta laugh at that because otherwise I’d cry.”
(5/6) I got over 100 submissions for the Summer 2024 Experimental History Blog Post Competition, Extravaganza, and Jamboree. Thanks to everyone who sent something in! I’m very pleased so far. Already, I’ll be writing a post and I’ll think to myself, “Ooh, I know a great piece relevant to what I’m saying here, I’ll link to that,” and then I’ll remember it was one of the submissions and it’s not published yet. So I’m reading as fast as I can so that these pieces can get out into the world. I’ll notify everyone before the end of August, and if I pick your piece, I’ll give you the heads up so you can post it before I link to it (if you want to).
(6/6) And finally, here’s a deep cut from the Experimental History archives, which is about the time I was a supporting actor in a movie that has a 3% on Rotten Tomatoes:
> Atlantic: The cure for hiccups exists and it's free! But nobody knows because there's no money to be made in disseminating it!
> Puts article behind paywall
Genius
I have a DIY flossing study! For most of my life, I would have 2-3 cavities per dentist visit i.e. every 6 months. This was for years. My mouth is half filling at this point. I did the things, brushed regularly, prescription mouthwash, water pic, you name it. Didn't help. Notably most of my cavities were between teeth.
Then, I developed adhd for flossing and simply must floss after every meal. After every snack, after every sugary drink. Even at work, even on travel. Sometimes I floss 2 or 3 times between food. I brush less than once per day i.e. usually once per day but not always. I haven't had a single cavity in years. My last filling must have been 5 years ago or longer, I'm still doing regular visits.