What a healthy child. And so full of organs!

Recently I decided to apply my unlikely super power “finding all sources of protein gross” to eating organ meats, on the theory that if I’m pushing myself to eat something it might as well be cheap and nutritious.  Organ meats have way more vitamins than muscle (compare chicken muscle with chicken liver).  Polar bear liver has so much vitamin A you can die from it.

death_by_polar_bear

But you can’t die from chicken liver, or at least I can’t, because I eat a few snips at a time.  Plus I had some chicken organs in my freezer from the time I went to a backyard farm and killed a chicken, which I expected to get a really great blog post out of but in the end my take away was “I am okay with this system but hope we develop a better one soon.”, which is not a great blog post.

I’m going to spare you my recipe because I really hope there are not that many people with my combination of digestive and chewing issues, but what I will tell you is that liver taste like crickets.   Maybe that is just what nutrition tastes like? Mostly this was an excuse to post my favorite Invader Zim clips.

Review: How to Be Sick (Toni Bernhard)

Everything this book says is absolutely true.  Mindfullness is awesome.  Spending energy being angry at reality for not living up to your expectations is not useful.  A calm acceptance of where you are now without attachment to the future is useful in almost any situation.  But my primary feeling reading the book was “This is fine for you, but I’m going to get better, so I’m just going to go wait for that.”  I told that to someone in the waiting room at the IV place who was probably suffering from something pretty serious*, thinking I was making a funny joke about how I had failed at zen, and she said “good for you, keep fighting.”

This captures a lot of the tension around health problems that are prolonged or chronic or ambiguous as to where they fall between the two.  If you “accept your limitations” too hard you end up putting yourself in smaller and smaller boxes until there’s nothing left.  If you don’t accept your limitations enough you push too hard and make yourself worse.  How to Be Sick isn’t falling into those traps.  It’s describing a third way, of zen acceptance that doesn’t overly narrow or widen your vision for the future because it’s not about the future.  The problem is that this is hard to teach.  The author had been practicing Buddhism for 10+ years when she fell ill, and most of the book feels more like describing the benefits or appearance of a mindfulness practice rather than how to achieve it.   I did get one really useful technique out of the book, enough to justify all of the time I spent reading it, and I suspect that will be true for a lot of people so I do recommend it.  It’s just not magic.

Although maybe it kind of is.  I ordered the book from the library when my doctor looked at me and said “maybe being pain free isn’t a realistic goal for you and you need to redirect your energy to learning to cope with it.”  But then I saw a specialist who told me that the damage was healing, would probably be finished in about a year, and in the meantime enjoy this pain medication that leaves you almost pain free.  So I can’t rule out that this book actually is magic, and if you are at the point where you’re considering books with subtitles like “A Buddhist-Inspired Guide for the Chronically Ill and Their Caregivers”, you probably are going to try weirder things in your attempt to heal yourself.  So give it a shot and please report back.

*I’m there to mainline protein because my teeth and stomach aren’t up to the task of eating enough to heal me, but a lot of people are there for debilitating but poorly understood collections of symptoms like fibromyalgia, or better understood but more terminal diagnoses like cancer.  Nothing makes me you feel grateful for your health after having dead bone scraped out of your jaw like seeing an eight year old get cancer treatment.

McDentistry

Sarrell Dental is a chain of dental clinics that serve children on public assistance almost exclusively.  Sarrell is a non-profit in that no one is an official owner collecting profits, but it is financed entirely be fees for its service; there are no donations.  Sarrell not only provides dental care to poor children for screamingly low reimbursement rates, but does outreach and education for free.

I have a few feelings on this.  First, the care could just be low quality, but that is not interesting, and providing care that is a pareto improvement over nothing (meaning it is doing some good and no harm) is not actually that hard.  Doing harm is not impossible, and humans are ingenious, but it is difficult.  So let’s assume for the sake of argument that they are maintaining an acceptable quality of care.  If that is true they are doing an amazing service: dental health is incredibly important for overall health.  Bad teeth are a class marker than often keeps adults who grew up poor down, regardless of their merits.  Getting poor children teeth cleanings is incredibly important and I am glad someone is finding a way to do it.

Second, I bristle at the comment that “This means that patients don’t always see the same dentist, and that can be a good thing on both sides of the drill. Dentists get a close look at their colleagues’ work and at the treatment plans they’ve suggested for their patients.”  If seeing a different dentist every time was so awesome, middle class people would do it.  They don’t because continuity of care is considered more valuable than a second pair of eyes.  But is that correct?  It seems entirely plausible to me that the ideal of continuity of care- a medic who knows you, who knows your history, who can spot subtle trends and probe for additional information- is absent for most people even if they are technically saying the same person repeatedly.  I saw the same orthopedist twice when I hurt my knee and had to remind him the problem wasn’t nor had ever been buckling under load five times in those 15 minute two visits.  I’m not sure seeing a different orthopedist for the second visit, or swapping in a different orthopedist halfway through a visit, would have reduced the quality of care noticeably.   The same could easily be true of dentists.

Moreover, I’ll bet Sarrell writes its records with an eye towards having each visit with a different dentist.  I find it plausible if not proven that this is better than the 10 minute rushed visit people get with a dentist who doesn’t write anything down because he’ll totally remember it.  This gels with my experience at those acute care clinics, which were much less personal but had systems in place to make sure everything ran smoothly.

Third, it seems great that more kids are getting dental care and education.  But I worry that this will run into the same problem we have with the pharmaceutical and adoption industries: we privatize the cost of a thing we consider a moral good and then are surprised when the system begins aligning with the interests of the people funding it.  This is true even if Sarrell’s current MO is a pareto improvement over nothing, and if no one does anything malicious or even intentional.  I don’t think it’s likely Sarrell will secretly encourage children to chug pixie sticks hourly, but could they maybe reinforce the requirement that cleanings be overseen by a dentist rather than a mid-level dental practitioner?  Seems plausible.

Which doesn’t mean I want to fight Sarrell, or McDentistry in general.  The fact that it’s not the platonic ideal doesn’t mean it’s not the best compromise we can get, and those kids need cleanings now.  But it’s important to remember that nothing is free.

Bug or Feature? SAT edition

A few weeks ago there was a Less Wrong thread about truly brilliant people, especially mathematicians, who often got good but not perfect SAT scores.  The consensus was that the SATs were a better test of how long you can go without making a mistake than of genius.  At the time I read this I (who got good but not perfect SAT scores) was all “yeah, the SATs are bad at measuring brilliance.  And I did better in more advanced classes than I did in the intro ones, because the intro ones were about how close you came to matching their expectations, and the advanced ones were about original thought.  In fact the smartest people will do worse, because this is so trivial to them it is boring.  I sure hope the SATs feel bad for failing to recognize my their brilliance.”

I was about 10% of the way through Safe Patients, Smart Hospitals when I realized that if I am recovering from dangerous surgery and need a central line*, it is more important that my doctor can follow the safety checklist without getting bored than that he be capable of original thought.  Like, way, way more important.  We need doctors capable of original thought somewhere, so they can invent new procedures and drugs and things, but outside of their magesteria they do more harm than good.

dr_house_brain
Gregory House would be terrible at inserting central lines. That’s why he has Taub.

So maybe the SATs are doing a valuable service by injecting a little bit of what it takes to succeed in the real world into their otherwise-pretty-much-an-IQ-test.  And maybe we should start selecting doctors for what they actually do most of the time.  Alternately, maybe we should move central-line-type work to techs and computer algorithms and use doctors for research and cases weird enough to be on TV.  But what we should definitely not do is select people for brilliance and make lives depend on their ability to work methodically.

*Central lines deliver fluids better than IVs but are more vulnerable to infections, which can be fatal, especially in people recently weakened by trauma or illness, which is everyone who is getting a central line.  You can greatly reduce the chance of an infection by following a fairly simple list of steps like “use gloves” and “sterilize skin”, but these are often skipped.

Review: Immune Defense Video Game

Medical-inspired video games have a long history of disappointing me.  For example, real pathogens don’t ride rocket ships around your organs (Trauma Center)

nor does every single member of the species worldwide suddenly develop a new trait all at once (Plague, Inc)

And Surgeon Simulator does not follow Atul Gawande’s best practice surgical checklists at all

Plus Trauma Centers’s difficulty curve is insane, and they found a way to make repeating unskippable cutscenes worse. But one of the nice things about game development getting cheaper is they can make games for me and the four other people who will appreciate a cross between an immunology textbook and Majesty, which is the best way to describe Immune Defense.  In Immune Defense you play as the immune system, releasing various immune cells (each with different skills, and customized to different pathogens), which you do not directly control (it isn’t pac-man) but can lure over to the bacteria with antibodies if the %^&*ing macrophages will stop eating them.  In place of the usual Hit Points it has an inflammation count, which is actually pretty reasonable.  It has some biological inaccuracies (I’m reasonably certain real neutrophils don’t change receptor types instantaneously), but it’s still overall educational. Note the lack of rocket ships in this trailer.

That said, it’s obviously still in beta, and if the phrase “immunology x majesty” doesn’t grab you, you’re probably better off waiting.  The tutorial is really lacking and they need to smooth out some of the controls.  But I had a ton of fun until tendinitis forced me to stop playing, and if “immunology x majesty” does inspire joy in your heart you will probably enjoy it a lot, so check out the IndieGoGo and demo.

Oral Probiotics for Dental Health

Bias disclosure: I started taking oral probiotics because my doctor told me to and I have vaguely positive feelings about probiotics.  I kept taking them because simple inspection with my tongue showed I was developing fewer dental plaques.  But the friend I recommended them to wanted actual data, so I did some digging.  The results were overwhelmingly positive.  They reduced not only cavities, but in the study that checked, total antibiotic usage.  In your face, friend who asked for data.

But only one of those tested a probiotic lozenge, the rest were milk products supplemented with Lactobacillus rhamnosus.  Not all Lactobacillus species scored so well, so I went to check what my supplement had.  Turns out it has no Lactobacillus at all.   So I went back to google scholar and checked the bacteria I was actually taking (Bacillus coagulans and Streptococcus salivarius).  Luckily the news was still good: in head to head trialsBacillus coagulans was found to be as effective as a mix of Lactobacillus rhamnosus and Bifidobacterium species, and Streptococcus salivarius also performed well.

Then I found the motherload: someone did a comparative survey.  This was less helpful to my cause.  Oral probiotics were almost universally found to be helpful to children, but results in adults were mixed.   My first argument is “well, yeah, adults develop fewer cavities per unit time than children, so you’d need a bigger sample over a longer time period to detect a difference.”  But the studies looked at intermediate results like “bad” bacteria presence, and even the 15 month trial in older and elderly people didn’t see a difference.

My conclusion is that oral probiotics are definitely good for children, and in light of the additional data for my personally, good for me, but possibly not for all adults.  I still feel confident recommending other people try them, but not that they stick with them if they don’t see results.

Activism Field Trip

One of my ongoing concerns about Effective Altruism is that it doesn’t handle activism or political change well, because the marginal value of any given activity is essentially zero.  You can do some relative effectiveness- Martin Luther King Jr apparently scouted out towns most likely to react violently to his nonviolent protests, in order to get more sympathetic publicity- but it’s no where near the certainty of Against Malaria Foundation’s cost per life saved (which itself has a huge confidence interval).  And yet, political activism is essential as a tool for improving the human condition.

Recently I participated in a FreePress.net-organized visit to one of my senators, to convince them to more vocally support net neutrality, and specifically Title II classifying cable utilities as common carriers.  This is a thing that seems important as long as cable has a stranglehold on broadband in the US, and my impression was that all I had to be helpful was live in the senator’s state (check) and show up.  That is within my power, and now was a relatively easy time to do it (still on leave for dental surgery but at a relative high in my ability to talk).  I think on some level I expected it to be a more fleshy version of phone calls for the EFF, where they do all the dialing and give you a script to read, and your job is just to demonstrate to powerful people how many unpowerful people are willing to spend their time annoying them over a specific issue.

The plusses: I was shocked by how diverse the delegation was.  I was expecting a bunch of 20-35 year old tech nerds, but the age range was probably 30-75, with me as the only programmer, and a wide range of political orientations.  Several of the people were longtime activists.  At the end of the visit the senator had agreed to do what we wanted.

The minuses:  the visit could have been much better organized.  There was a real disconnect between what FreePress said our senator’s position was, and what the senator’s aid said their position was.  We didn’t so much convince the senator to change positions as ask for something they were already doing.  Maybe FreePress didn’t bother to investigate, maybe the senator’s aid was weaselwording.  There was no one who knew and no one had the authority to shift our collective gears.

This was the first time in a while I’d experienced the gap between talking with EAs and talking with politically and socially active non-EAs.  The groups have different skills.  None of the people who took point could have persuaded anyone I know out to pour water out of a boot if the instructions were written on the bottom*, but they did organize rallies of 1000+ people, which I have never done and have never heard of being done in the history of effective altruism.  We’re more a blogging type of people.  And the dailykos reporter is better than me at that, in the sense of “many more people read him”.  This is bothersome when he is complaining about rising rents and construction in the same paragraph, but useful when shining light on police misconduct.

So EA is still my home, and probably will be for a while, even if I’m drawn to areas that don’t have any officially blessed EA charities, like mental health and first world education.  I would like us to have more thought diversity than we do, but really enjoy not having to explain why you can’t complain about rent and construction at the same time, or at a bare minimum knowing that if I do have to explain it I’ll have social support.

*”But what if there is a faster or less energy-intensive way to empty the boot?”