Wednesday, March 27, 2013

The Paleo Diet Marches On...

The new figure of opera
8 Food Trends The Paleo Diet Has Crushed

Not too surprising in light of regular stories like this:

Male opera singer loses 5 stone [70 lbs] thanks to the caveman diet and just 12 minutes of exercise a day

Monday, March 25, 2013

"...The Difference Between Knowledge and Wisdom"

The Scientific Approach of Weston Price, Part 6: Conclusions — Real Food, and the Difference Between Knowledge and Wisdom:
"...The problem was that many, once they obtained some new knowledge, were tempted to sacrifice the wisdom of previous generations rather than using their knowledge to further enrich the pool of accumulated wisdom. Price was humble enough to learn from the Swiss, who “recognize the superior quality of their June butter, and without knowing exactly why, pay it due homage.” Others would simply discard this recognition because it wasn’t rooted in the superior epistemology of modern science, considering it perhaps even worthless precisely because the Swiss paid this homage “without knowing exactly why.”

"Of course it would be just as problematic to discard the scientific method and blindly accept every human tradition. It would be similarly problematic to discard our own experience in deference to either of these sources of knowledge. How are we to respect and embrace the wisdom of our ancestors, while using science and our personal experience to refine and enrich the pool of accumulated wisdom? In the next and final post of this series, I will address these questions...
Discarding things that you do not understand is not "superior", but profoundly misguided.

Thursday, March 21, 2013

Gordo Goes Head to Head: The Merrell Vapor Glove, Trail Glove, and the Inov8 Bare-XF 210

First 5k, first age-group win.
Gordo is one of the many terrific people I've met through barefoot running. An engineer, he has the discerning and demanding approach to things which that discipline requires. Gordo is a dedicated barefoot runner, but not a zealot. Shoes are tools, and Gordo gets that. But few have met his high standards.

Gordo and I ran the Run for Rwanda 5k a few years back. It was Gordo's first running race, and he ran in bare feet, on asphalt and gravel. As a lark the Race Director had added a barefoot category, to show solidarity with the simultaneous sister race run in Rwanda. Gordo not only won the RD's age-group, but did so in his bare feet, thereby winning the barefoot category too. Flabbergasted doesn't begin to describe the RD's face.

So when Gordo has an opinion on something, it's usually a good idea to listen. Below is a review that he posted of a couple of my favorites shoes, and a third shoe.


Garden of the Gods
I got my new Merrell Vapor Gloves a couple of days ago and decided to run over to Garden of the Gods and do a little bouldering on sandstone friction slabs. I went for a little run first, of course. ;)

First, my impressions. I love the Vapors. They are the shoe I expected when Merrell announced the Barefoot line. They are so close to perfect that any complaints I have are quibbles. I ordered both 10 and 10.5s. When I tried on the size 10s, my first thought was "I shouldn't have bothered with the other size." Then I started getting pickier. The rubber toe cap that wraps over the top of the shoe (one of my pet peeves – who the heck runs on the tops of their feet?) was hitting one of my big toes when I walked. Annoying. I tried them on with the neoprene socks I wear for canyoneering. Hmmm, these are now pretty darn tight across the midfoot. So I tried on the 10.5s. And never looked back. They're wider through the midfoot, don't hit my toe funny, let my toes splay, etc. The heel cup is exactly what I like; minimal and clean. The construction is typical Merrell, which is to say very high quality.

I ran three miles of moderate trail in the Vapor Gloves and then switched to the Inov-8 XF-210s (size 11). They felt somewhat tight and pushed against my left little toe in an annoying way. When I took the insoles out, they were fine. I really disliked the big padded heel cup. The ground feel was similar to the Vapor Gloves, as was the traction on dirt, gravel, and rock. I didn't notice the strange flex pattern [reported in another review] at all, they're quite flexible under the BOF and stiff elsewhere. I have no idea what this is supposed to buy you, it's the BOF that gets the heavy loading when you run. I didn't run in the Trail Gloves over that section, but from what I recall, their traction is about the same but the ground feel is much less. [These are the v1 TGs, there's a v2 out soon.] All three shoes felt like too much shoe for the trail, but this is a trail that I regularly run barefoot. It's moderately rough sandstone, which tends to be barefoot friendly.

Next, I headed over to a friction slab for the main event, testing stickiness. I found a smooth, low-angle slab close to the ground and went for a little traverse in the Vapor Gloves. They didn't work as well as I might have hoped, but they weren't awful with my heels down. About what I expected. When I placed my feet sideways, the shoe rolled and slipped badly (Duh). Next up, the XF-210s with the "sticky" rubber. This was a major disappointment. I don't know what Inov-8 is smoking, but their sticky rubber did no better than that on the VG. If that's their sticky rubber, I want nothing to do with the regular stuff. Sideways, with the insole in, they were much better. No surprise. Next up, the Trail Gloves (original, size 10.5). The first thing I noticed was that putting the left shoe on was a bit difficult. OK. Then the right, which I had modified a year or so ago. I could barely get the sucker on and it was so tight that it became uncomfortable in minutes. Off I went across the slab. Exactly the same performance as the other two with heels down and the same as the Inov-8 sideways. It's clear that I'm going to have to extend the cut in the upper much farther toward my ankle on the right shoe if I'm to keep wearing them.

To say I was disappointed is an understatement. The Merrells performed exactly as expected, so the disappointment was entirely with the Inov-8s. I'm really glad I only paid $55 (delivered) for them and have a couple of trips coming up this summer that should reduce their life by half. To be fair, they aren't a bad shoe if you don't care about traction and your feet are narrow.

On the way back to the car, I ran across some 3 - 4" crushed rock half embedded in the ground with a scattering of 1" crushed rock on top where the park is trying to control erosion. Hmmm. On went the VGs. I could run comfortably and carefree across the stuff. Cool. Inov-8, up next, performed at the same level. I really couldn't tell much difference feel-wise. Trail Gloves (these are going to kick ass, right?) Wrong. They were a little better than the other two shoes, but not nearly enough to outweigh their negatives - the extra cushion, pointy toe box, and the stiff, rockered forefoot. Then, for calibration, I ran the section barefoot. I know, I know. ;) I slowed considerably, had to pick my way, and experienced enough pain that I stopped half way through the section. I guess shoes do have a use or two. ;)

Conclusions: The Vapor Glove is a fabulous shoe. Merrell hit this one out of the park. If they ever get discontinued, I'm going to pull a Harry and fill the closet. Seriously. It's enough shoe to just blast over moderate/moderate plus trails and thin and flexible enough to feel like I'm not running in combat boots. The lack of any real cleats will be the biggest limiting factor, closely followed by probably not quite enough protection on really sharp rocks. The Inov-8 wasn't bad, but it wasn't particularly good, either. Middle of the road, if it fits you and it's cheap, go for it. The sticky rubber is strictly marketing BS. The original Trail Glove, for reference and calibration to my tastes, is both too much shoe and too little shoe at the same time. It's too thick and stiff to be a real minimal shoe but it doesn't have the cleats necessary to be a real trail shoe. Neither fish nor fowl. Not recommended. I'll be interested in trying on the TG2 to see if the improvements make enough of a difference to put it back on my short list. But if they don't have better cleats, that's not going to matter. The Vapor Glove is all the shoe I need for anything that the original Trail Glove can handle.

Caveats: I have fairly narrow US10.5D feet that are pretty thick. Think bricks with toes. If you have wide feet, none of these shoes will work for you. The Vapor Gloves are the widest. I normally run moderate/moderate plus trails barefoot, so I tend to automatically place my feet. I did try to intentionally land on some of the pointy rocks in the challenging section, but I may not have succeeded very well. I might be pretty hard wired at this point to avoid such stupidity. You may or may not be able to run carefree across similar terrain. If you try it and it sucks, it's not my fault. ;) I could feel my feet getting pretty worked. If your feet aren't stupid strong, best not to try a rough trail ultra in them.

— Gordo

Originally posted here. Scroll down at that link for the discussion; reposted with permission, lightly edited.

I'll observe that there's only one truism about the perfect shoe: my perfect shoe isn't your perfect shoe. I continue to love my original Trail Gloves, but I'm not Gordo, and he's not me. :) Nice to see we both agree 100% on the Vapor Glove. And it's a shame that Inov-8 continues to disappoint. I have friends that swear by them, but I just don't see it, personally.

Friday, March 15, 2013

What Google Reader Could Learn...

What Google Reader Could Learn From The Veronica Mars Kickstarter:
"...Over in Mountain View, Google executives have a product on their hands that is not only widely used and beloved, but monopolistic. There are third-party apps for feed-reading, but Google Reader remains both the dominant client and nearly the only back-end syncing service underpinning the entire RSS experience (a position the company actively pursued). Since Google put Reader on the clock, the Internet has exploded in anger and despair, with a grassroots force even larger than the one capitalized on by the Veronica Mars movie. Not that we should be surprised. The service has at least 24 million users, by one measure, a number that dwarfs most television fan bases."
This is a case study in corporate stupidity. And pretty scary news for finding an alternative. None of the "competing" sites are more than a start up or a hobby... Not one is going to be able to handle this kind of volume.

You Are The Long-Term Test (Part 5): Niacin (Tredaptive)

Cholesterol-modifying drug that does more harm than good is withdrawn from sale:
"...Anyway, on the basis of its cholesterol-‘improving’ effects, niacin became an established therapy. And in 2008 the European Medicines Agency gave the green light to combination drug known as Tredaptive. This product contained niacin combined with another agent known as laropiprant, which had the ability to reduce the propensity for niacin to cause flushing (a common side effect of niacin that is generally experienced as heat and redness in the face and/or body).

Tredaptive was available in dozens of countries, but in January of this year its manufacturers (Merck) announced that it was being withdrawn. This week saw the presentation of the results of a study on Tredaptive that explains the withdrawal.

The study involved more than 25,000 people who had a previous history of cardiovascular disease (such as a previous heart attack or stroke). All the individuals in the study were on cholesterol-reducing medication (the statin simvastatin with or without the drug ezetimibe). Individuals were randomised to get Tredaptive or placebo (dummy pill). The average length of treatment was about 5 years.

The addition of Tredaptive was found to bring no benefits at all in terms of risk of heart attack, stroke or overall risk of death.

However, those taking Tredaptive were at increased risk of certain side effects...
Prescribe first, test later. I think one has to be crazy to take any drug that hasn't been around for a couple of generations.

And even then you're better off avoiding them, unless you have no choice.

Dr. Briffa's blog is excellent. I highly recommend it.

Thursday, March 14, 2013

Debunking the Paleo Diet

Christina Warinner at TEDxOU:



She shows 4 books on one of her first slides, two of them are The Paleo Diet and The Primal Blueprint. She's not read either of them.

Her first "rebuttal" of the paleo diet is to point out that we can't get by on meat alone since we need to eat vegetables for vitamin C.

  1. Neither of those books advocates eating only meat. Both encourage you to eat organ meats and lots of vegetables.
  2. She's wrong on the facts. You do not, in fact, need to eat vegetables to get vitamin C. You can, in fact, get all you need on a diet of 100% meat. This was demonstrated almost 100 years ago in a famed experiment where Arctic explorer Vilhjalmur Stefansson ate meat under medical supervision for a year:

    "In 1928, to convince skeptics, he and a young colleague spent a year on an Americanized version of the diet under medical supervision at Bellevue Hospital in New York City. The pair ate steaks, chops, organ meats like brain and liver, poultry, fish, and fat with gusto. “If you have some fresh meat in your diet every day and don’t overcook it,” Stefansson declared triumphantly, “there will be enough [vitamin] C from that source alone to prevent scurvy.”"
She proceeds to attack a bunch of other claims that the paleo diet doesn't make, or she gets her facts wrong.

Falsus in uno, falsus in omnibus

P.S. Robb Wolf does a nice analysis of this video. While I appreciate his effort, and it's nice of him to point out that she does eventually raise some interesting points, I stand by my summary above. Life's too short to sit through work by people who can't be bothered to do the homework. If they can't be bothered, I can't be bothered. I believe that was Mat Lalonde's point, in one of his talks...

"The First Generation To Grow Up Exercising"

This may be the stupidest thing I've ever read in the New York Times, and that's saying something:
"...It is not terribly surprising that when orthopedists open their doors, they see more and more baby boomers in their waiting rooms. After all, there are so many of them. But there is evidence that boomers may be seeking knee treatment in disproportionate numbers.

Some have suggested that this may be because members of the first generation to grow up exercising have put a lot of wear and tear on their bodies. But that is not clear.

“We say that, but we’re not sure of that,” said Dr. Letha Griffin, a staff member at the Peachtree Orthopaedic Clinic in Atlanta and a team physician for Georgia State University. Dr. Griffin noted that one of the best ways to avoid arthritis is to keep fit — and that means exercise."
Did reporter Eric Nagourney not read the next paragraph? Did he not stop for a second to think? Can he think? What about "the layers of fact checkers and editors" that the Times employs?

The mind reels.

More On Google Reader

Scientists and Google Reader's Demise

He posts this:

The Ultimate Google Reader Alternatives List

Which looks pretty decent.  I'm only interested in online feed readers, as I use too many devices for a machine-specific reader to hold any appeal. 

I've not decided what to do.  I'm going to keep using Reader until things sort themselves out a bit.

Former Google Reader product manager confirms our suspicions: Its demise is all about Google+



“I have seen a lot worse decisions than this... Monetization abilities were never tried.”
Apparently even within Google this isn't a popular decision.

Wednesday, March 13, 2013

How Google Reader Saved My Life

Google Reader is shutting down.

Hey Google, We Still Love Reader

I'm in shock.

This blog is about barefoot running and healthy, paleo-style diets.  These two topics have utterly changed my and my family's life in the past five years.

I learned about the barefoot running movement, like most of us, from Chris McDougall's Born to Run.

I've gotten to know Chris, and Barefoot Ted, ran a race with Caballo Blanco, toured Dan Lieberman's lab, helped design some shoes, and helped some folks fix their diets and change their lives.

I learned about Born to Run from an ad at the bottom of an item in Google Reader.

I clicked the link, watched the video, and at the end Chris put on a pair of Vibram Fivefinger Sprints.  In the three years I'd had my Sprints, this was the only time I'd seen another human being who had a pair.  I immediately bought the book.  Thank God.

Through that book, I learned about the paleo diet from Justin Owings, who sent me a link to this post at Stephan Guyenet's Whole Health Source.  The fact that diet could control dental development (my dental development was seriously impaired growing up) blew my mind, and I started following that blog in Google Reader.  Six months later, I fixed my diet and changed my life.

I had a stroke at 38, a colon resection after coming close to dying from a perforated colon at 40, and I strongly suspect I was getting osteoporosis.  I don't know where I'd be today.  Those problems are gone thanks to what I found by dumb luck through Google Reader.

As I said, I'm in shock.  This is a big step back for the Internet Revolution.

We're Not As Smart As We Think We Are...

AMERICANS ARE FAT. THE COUNTRY IS BROKE. We’re subsidizing the sugar industry. What’s wrong with this picture?

Monday, March 11, 2013

Barefoot Josh's Merrell Vapor Glove Review

The Last Review:

"I have no idea how my last three less-than-glowing reviews of their products were received by Merrell; I hope they were at least entertained and appreciated my candor. I like to think that maybe in some way my criticisms were helpful. Probably not, but weirder things have happened I suppose. From my perspective, I really appreciate the risk they’ve taken by listening to and applying the opinions and ideas of people who think shoes are pointless much/most of the time. I also appreciate their efforts to educate runners on gentle running form, and their initiatives to get people active and outside. Of course, I’m also really happy they made the Vapor Glove."

Josh, I think they listened.

Genetically Engineered Foods To Be Labeled At Whole Foods

Good for Whole Foods:
"Accordingly, we have set a deadline that, by 2018, all products in our U.S. and Canadian stores must be labeled to indicate whether they contain genetically modified organisms (GMOs). Whole Foods Market is the first national grocery chain to set a deadline for full GMO transparency."
Now if only they'd stop using canola oil for every item in their food bar. One day I saw something made with lard, and I nearly fell over. They've not repeated the mistake, sadly. I agree with Joel Salatin; it's much better to do this without getting the ham-handed, corrupt regulators involved.

Friday, March 8, 2013

My Merrell Vapor Glove Review

"The perfect running shoe should be something like a heavy-duty ballet slipper - simply an extra layer of protective material around the foot, like a glove." — Gordon Pirie
Originally this was going to be a "first impressions" post, but I didn't get around to it. At this point, from the time the shoe fairy dropped this off at my house to now, I've spent enough time in them to feel that I've got a solid opinion.

Fresh from the Shoe Fairy...
We in the minimalist (barefoot) shoe community have oft noted how silly shoe companies are to offer their wares at the end of the winter, for the spring and summer running season.  We need these for the winter!  When it's warm out, who needs shoes?  Happily, there's still some winter left, and so to differentiate my review, I used these for some winter runs and activities.

Tough Glove on left, Vapor Glove on right
The first thing you note when you hold these shoes is how light they are.  The first thing you notice when you put them on is how little effect they have on your foot.  In the picture to the right, you can see the difference in the toe between my old pair of Tough Gloves (like the Trail Glove, but in leather: one of the shoes I regularly wear to the office), and the Vapor Glove.  The older shoe has a more tapered toe, this is especially evident in the line from the ball of the foot to the big toe.  But there's also a lot more room on the outside of the shoe for your toes to spread out. Room for your toes to splay is one of the required features for a proper barefoot-style shoe, in my opinion.

The upper material is a light mesh, which breathes well enough that you can can feel the draft as you're walking around the house. The lacing system is also excellent, and an improvement over the Trail Glove, as it's wider, making them easier to get on. In fact, I've found that once I've laced them up I can slip them on and off my sock-covered foot like a slipper, while still having my foot located well enough that I can run up and down hills without slipping around. This might not appeal to everyone, but I think it's terrific.

After a run. Those are my footprints from the run...
My first run in them was the morning after they arrived. Happily, we'd just gotten a few inches of snow over night, so the conditions were perfect, with temps in the high twenties. So I donned my favorite summer-weight socks, and off I went.  My feet were a bit chilly at first, but after a few minutes they warmed up nicely.  The thin sole combined with the light wool sock offers just enough insulation to insulate the foot from the cold ground, and once I'd warmed up, my feet were toasty, while being well-ventilated from the mesh.  Perfect for a winter running shoe, in other words.

Vibram Newporter ice-compound sole
And suprisingly, they have excellent traction in the snow.  The first real minimalist shoe that I got was the Russell Mocassin protoype.  I used (and still use) those for running in really cold, snowy conditions, and one of the things that made those shoes excellent was the sole, which was made originally for people working on slippery kitchen floors.  Russell made my shoe with a softer ice-compound version, and those have been my favorite winter shoe when I'm not wearing ski boots ever since. I'm wearing them now, in fact.

Vapor Glove sole
And now along comes the Vapor Glove.  While I probably won't be wearing these to run up and down snow-covered mountains in Vermont (I'd use the Russells or Merrell's excellent Sonic Glove soft-shell sneaker), these did just fine, and as you can see, the sole is quite similar, sort of a Newporter-lite.

I've done several more runs in these, up to 10 miles, both with and without socks. Mostly not in the snow.  While I think the idea of a sockless shoe that won't cause any chafing or blistering is a bit of a chimera, so far I've not had any problems.  Knock on wood.

8 inches, he's ready to go - and barefoot!
The sole is thin enough that you can feel pebbles through it, but offers enough protection that the pebbles don't hurt.  On this morning's run in 8 inches of snow (the roads were mostly plowed) I could feel the salt crystals as I ran down the road.  Needless to say, my feet were a bit chilly while running through the deep snow, but were fine once I got to the plowed bits. (I wore this sock for this morning's run.)  I decided to run one of the hilliest routes around my house.  Traction was excellent.  My feet slipped a few times, but it was never anything that made me feel like I might fall.  They are outstanding in the snow!

To really test the Vapor Glove as a winter minimalist shoe, I decided to continue wearing them when I got back from my run to clear the driveway.  I used my barely-adequate push snowblower which tested the traction of my Vapor Gloves far more than my run did. I tried to keep my feet out of the deepest snow, but didn't entirely succeed, and the entire enterprise wound up taking over an hour, in temps in the high 20s. The Vapor Glove did surprisingly well: while my fingers got cold, my feet remained reasonably warm, although the socks did get pretty well soaked. Yes, I have excellent circulation in my feet. No, these will not be my snow-blowing shoes in the future, but it was an excellent experiment.

I've also worn these to work on Friday, and to the gym a number of times.  They were fine in both situations, and unlike Vibrams, do not draw any attention, while offering a similar level of protection and feel.

Needless to say, while close-fitting, they have no arch support; barely any structure at all, in fact, and hardly any cushion underfoot.

The shoe that the Vapor Glove most reminds me of is the VivoBarefoot Ultra, without the quirks that make that shoe less-than-perfect.  And while these shoes did yeoman's work in the snow, practically speaking, they're not a winter shoe.  They will give my beloved Vibram Speeds tough competition when I start doing some road races this spring.  That's going to be a really tough choice, as I think the Vapor Gloves could be worn sockless in a race, while the Vibrams are a little too scratchy...

I've come to realize that this is Pirie's dream shoe, without requiring his caveat: "Unfortunately, the ideal running shoe is not offered by most major manufacturers." It is now, and Merrell's a class act as companies, and shoe companies, go.  If Merrell's somewhat narrow last fits your foot, this shoe is a real winner.

P.S.: Here's an excellent Merrell promotional video for the Vapor Glove, featuring a cut-away shoe, which really gives you an idea of how radically minimal this shoe actually is.



P.P.S. Thanks to Patrick's comment, a note on sizing. In my experience the Vapor Glove has sizing that is similar to the Road Glove, but about 1/2 size off the Trail Glove. So I wear a 9.5 in the Trail Glove, but a 9 in the Road Glove and the Vapor Glove. Unlike the Road Glove, the Vapor Glove does not have anything under your arch, so there is not the same amount of arch support that you find in the Road Glove.

P.P.P.S. 2013-03-16. So, joke's on me. I went out for a nice, long run with my dog today, without checking the weather. 15 miles, 1/2 rocky, gnarly trail, the other road. Half-way through the temperature drops, and it starts snowing. Did I mention I did not check the weather?

I was wearing the Vapor Gloves with no socks (I had a pair in my pocket, just in case) shorts, an IceBreaker wool T, and a wind-breaker. Happily I had a fleece headband/ear-warmer.

By the time I got home, my hands were so cold they had trouble moving. But my feet were fine! And I never needed to put the socks on. It didn't occur to me until I got home that I should have put the socks on my hands...

They passed the trail-run test with flying colors. Enough feedback to make you watch your step, but enough protection so that you can keep up the pace, and obviously they kept my feet off the cold, wet ground.

These are magnificent shoes.

Oh, and 15 miles; no socks; no blisters or abrasions. I find that you want to tie them loose toward the bottom, and snug toward the top. Did Merrell find the chimera?

P.P.P.P.S. OK, I did another 15 mile run. Got an abrasion on top of the first metatarsal head on each foot. So much for the perfect, sock-free shoe. Although this has been the best sock-free shoe I've ever experienced. So kudos to Merrell, even if they've not found the Chimera.

Thursday, March 7, 2013

"Research Study Looks at Foot Injuries from Transitioning to Vibram FiveFingers"

Interesting.

"Science, Political Ignorance, and Deference to “Authoritative” Experts"

A great post:
"Scientific truth cannot be established by the endorsement of an authoritative body such as the NAS or the CDC. And if people start to take the pronouncements of such expert bodies as gospel, there is an obvious potential for abuse."
We're about a hundred years into the "abuse" part. Hopefully it's not too late to fix the problem.
"Given the near-inevitability of deference to experts, can we avoid the pitfalls Friedman rightly emphasizes? There’s no perfect solution. But some rules of thumb can help. First, deference to expertise is more warranted in cases where there is an expert consensus that crosses ideological lines. Like the rest of us, experts are prone to ideological bias. Thus, if experts of differing ideologies converge on the same conclusion, that’s a sign that the resulting opinion is really driven by expertise rather than bias. It doesn’t prove that the experts are right, of course, but it does justify a stronger presumption in their favor. When, on the other hand, experts do split along ideological lines, that suggests the issue is more disputable, and that bias may be influencing their judgment. It doesn’t mean that the experts are wrong or that their expertise is useless. Their views are still probably worth listening to more than those of laypeople. But it does mean that we should be more cautious about concluding that an expert pronouncement must be correct simply because the person or the institution making it has impressive credentials."
Read the whole thing.

Wednesday, March 6, 2013

Cholesterol-Lowering Medicines To Bite The Dust?

Cholesterol limits lose their lustre:
"...Soon after Joseph Francis learned that his levels of ‘bad’ LDL cholesterol sat at twice the norm, he discovered the short­comings of cholesterol-lowering drugs — and of the clinical advice guiding their use. Francis, the director of clinical analysis and reporting at the Veterans Health Administration (VA) in Washington DC, started taking Lipitor (atorvastatin), a cholesterol-lowering statin and the best-selling drug in pharmaceutical history. His LDL plummeted, but still hovered just above a target mandated by clinical guidelines. Adding other medications had no effect, and upping the dose of Lipitor made his muscles hurt — a rare side effect of statins [not rare at all, just rarely reported by doctors -Tucker], which can cause muscle breakdown.

"So Francis pulled back to moderate Lipitor doses and decided that he could live with his high cholesterol. Later, he learned that other patients were being aggressively treated by doctors chasing stringent LDL targets. But Francis found the science behind the target guidelines to be surprisingly ambiguous. “You couldn’t necessarily say lowering LDL further was going to benefit the patient,” he says.

"The standard advice may soon change. For the first time in more than a decade, the US National Heart, Lung and Blood Institute is revising the clinical guidelines that shaped Francis’s treatment (see ‘How low can you go?’). Expected to be released later this year, the fourth set of guidelines, called [Adult Treatment Panel] IV, has been drawn up by an expert panel of 15 cardiologists appointed by the institute. The guidelines will set the tone for clinical practice in the United States and beyond, and will profoundly influence pharmaceutical markets. They will also reflect the growing debate over cholesterol targets, which have never been directly tested in clinical trials....

"“We can’t just assume that modifying the risk factor is modifying risk,” says Harlan Krumholz, a cardiologist at Yale University in New Haven, Connecticut. “We’ve been burned so many times in the past decade by that assumption.”...

"...In 2011, US doctors wrote nearly 250 million prescriptions for cholesterol-lowering drugs, creating a US$18.5-billion market, according to IMS Health, a health-care technology and information company based in Danbury, Connecticut. “The drug industry in particular is very much in favour of target-based measures,” says Joseph Drozda, a cardiologist and director of outcomes research at Mercy Health in Chesterfield, Missouri. “It drives the use of products.” [Which is good for pharmaceutical companies, less so for patients -Tucker]

"ATP III reflected a growing consensus among physicians that sharply lowering cholesterol would lessen the likelihood of heart attacks and strokes, says Richard Cooper, an epidemiologist at the Loyola University of Chicago Stritch School of Medicine in Illinois, who served on the committee that compiled the guidelines. The committee drew heavily on clinical data, but also took extrapolations from basic research and post hoc analyses of clinical trials. LDL targets were set to be “less than” specific values to send a message, Cooper says. “We didn’t want to explicitly say ‘the lower the better’ because there wasn’t evidence for that,” he says. “But everybody had the strong feeling that was the correct answer.”

"By contrast, the ATP IV committee has pledged to hew strictly to the science and to focus on data from randomized clinical trials, says committee chairman Neil Stone, a cardiologist at Northwestern University School of Medicine in Chicago. If so, Krumholz argues, LDL targets will be cast aside because they have never been explicitly tested. Clinical trials have shown repeatedly that statins reduce the risk of heart attack and stroke, but lowering LDL with other medications does not work as well. The benefits of statins may reflect their other effects on the body, including fighting inflammation, another risk factor for heart disease....

"...“Short people have a higher risk of heart disease,” he says. “But wearing high heels does not lower your risk.”...
From Dr. Eades: Yes, sticking to the science is probably a good idea. Nice to see the medical profession is finally coming around to it. Now maybe someone can tell these knuckleheads.

"Despite an increasingly vegetarian diet, Francis’s cholesterol has not budged."
Oh brother.

"Unreported Side Effects of Drugs Found Using Internet Data"

From John Markoff in the NY Times:
"Using data drawn from queries entered into Google, Microsoft and Yahoo search engines, scientists at Microsoft, Stanford and Columbia University have for the first time been able to detect evidence of unreported prescription drug side effects before they were found by the Food and Drug Administration's warning system.

"Using automated software tools to examine queries by 6 million Internet users taken from Web search logs in 2010, the researchers looked for searches relating to an antidepressant, paroxetine, and a cholestorol lowering drug, pravastatin. They were able to find evidence that the combination of the two drugs caused high blood sugar.

"The study, which was reported in the Journal of the American Medical Informatics Association on Wednesday, is based on data-mining techniques similar to those employed by services like Google Flu Trends, which has been used to give early warning of the prevalence of the sickness.

"Currently, the F.D.A. asks physicians to report side effects through a system known as the Adverse Event Reporting System. But its scope is limited by the fact that data is generated only when a physician notices something and takes the initiative to report it...."

"...The researchers first identified individual searches for the terms paroxetine and pravastatin, as well as searches for both terms, in 2010. They then computed the likelihood that users in each group would also search for hyperglycemia as well as roughly 80 of its symptoms — words or phrases like “high blood sugar,” “blurry vision,” “frequent urination” or “dehydration.”...

"...They were able to determine that people who searched for both drugs during the 12-month period were significantly more likely to search for terms related to hyperglycemia, compared with those who searched for just one of the drugs. (Approximately 10 percent, compared with 5 percent and 4 percent for just one drug.)...

"...The researchers said they were surprised by the strength of the “signal” that they were able to detect in the millions of Web searches and argued that it would be a valuable tool for the F.D.A. to add to its current system for tracking adverse effects...."
This is pretty revolutionary, for a number of reasons.

  1. People (I'm using a neutral term, rather than patients or victims, although both sprung to mind...) were able to realize that something was wrong, and that there was a pretty good likelihood that it was the result of a drug interaction.
  2. Rather than go to the doctor who prescribed the medication and rely on his advice they decided to do some research on their own.
  3. Apparently they were pretty good at searching for terms that would produce useful results, given that the researchers were able to back-engineer the process to pretty reliably find these folks.
  4. Researchers are figuring out that the stories that people are telling (through what they're looking for via search engines) are pretty reliable. More reliable than a doctor reporting symptoms...
  5. It turns out that the plural of anecdote really is data! (Note the author of that piece is a medical doctor, and a "skeptic".)
Perhaps the medical profession will start figuring out that what their patients tell them really is a reliable source of information, and not just the ravings of lunatics.

One needs to be skeptical, but one also needs to have a good understanding of what the scientific process actually entails. Anecdotes can be valuable sources of information, if they come from a reliable source.

Medical doctors who are willing to treat you as a partner in the health process can be a huge help: they generally have a lot of experience dealing with this stuff, and so long as you recognize the flaws in their profession, can be very valuable. Especially when dealing with trauma.

I'm a big fan of Dr. Google, if you've not figured that out already. I've used it a number of times to determine in real-time that the advice I was getting from a Dr. was not correct.

My "Are Fevers Paleo" post was a compendium of research that I did when my younger daughter came down with dengue hemorrhagic fever. Our pediatrician (from Harvard, and a vegetarian, which is two strikes but we keep her anyway) was upset that I refused to put her on ibuprofen to control the fever. (She was running around the house yelling about spiders at one point. It was pretty alarming.)

As the symptoms progressed, and she started getting some bleeding, the doc texted in a panic that we not give her ibuprofen, after telling us for three days that we should. We assured her that we'd been ignoring her advice, and that we'd not been giving her any. Ibuprofen makes bleeding worse...

P.S. Don't forget, you are the long-term test.