If you might this blog, you might like…
I originally intended The Tale of the Dueling Neurosurgeons for epistemic spot checking, but it didn’t end up feeling necessary. I know just enough neurobiology and psychology to recognize some of its statements as true without looking them up, and more were consistent enough with what I knew and what good science and good science writing looks like; interrogating the book didn’t seem worth the trouble. I jumped straight to learning from it, and do not regret this choice. The first thing I actually looked up came 20% of the way into the book, when the author claimed the facial injuries of WWI soldiers inspired the look of the Splicers from BioShock.*
[*This is true. He used the word generic mutant, not the game-specific term Splicer, but I count that under “acceptable simplifications for the masses”. Also, he is quicker to point out that he is simplifying than any book I can remember.]
At this point it may be obvious why I think fans of this blog will really enjoy this book, beyond the fact that I enjoyed it. It has a me-like mix of history (historical color, “how we learned this fact”, and “here’s this obviously stupid alternate explanation and why it looked just as plausible if not more so at the time”*), actual science at just the right level of depth, and fun asides like “a lot of data we’ve been talking in this chapter on phantom limbs about comes from the Civil War. Would you like to know why there were so many lost limbs in the Civil War? You would? Well here’s two pages on the physics of rifles and bullets.”**
[*For example, the idea that the brain was at all differentiated was initially dismissed as phrenology 2.0.
**I’m just going to assume you want the answer: before casings were invented, rifles had a trade off between accuracy and ease of use. Bullets that precisely fit the barrel are very hard to load, bullets smaller than the barrel can’t be aimed with any accuracy. Some guy resolved this by creating bullets that expanded when shot. But that required a softer metal, so when the bullet hit it splattered. This does more damage and is much harder to remove.]
I am more and more convinced that at least through high school, teaching science independent of history of science is actively damaging, because it teaches scientific facts, and treating things as known facts damages the scientific mindset. “Here is the Correct Thing please regurgitate it” is the opposite of science. What I would really love to see in science classes is essentially historical reenactments. For very young kids, give them the facts as we knew them in 18XX, a few competing explanations, and experiments with which to judge them (biased towards practical ones you know will give them informative results), but let them come to their own conclusions. As they get older, abandon them earlier and earlier in the process; first let them create their own experiments, then their own hypotheses, and eventually their own topics. Before you know it they’re in grad school.
The Dueling Neurosurgeons would be a terrible textbook for the lab portion of that class because school districts are really touchy about inducing brain damage. But scientists had a lot of difficulty getting good data on the brain for the exact same reason, and Dueling Neurosurgeons is an excellent representation of that difficulty. How do we learn when the subject is immensely complex and experiments are straightjacketed? I also really enjoyed the exploration of the entanglement between what we know and how we know it. I walked away from high school science feeling those were separable, but they’re not.
You might like this book if you:
- like the style of this blog. In particular, entertaining asides that are related to the story but not the point. (These are mostly in footnotes so if you don’t like them you can ignore them).
- are interested in neurology or neuropsychology at a layman’s level.
- share my fascination with history of science.
- appreciate authors who go out of their way to call out simplifications, without drowning the text in technicalities.
You probably won’t like this book if you:
- need to learn something specific in a hurry.
- are squeamish about graphic descriptions of traumatic brain damage.
- are actually hoping to see neurosurgeons duel. That takes up like half a chapter, and by the standards of scientists arguing it’s not very impressive.
The tail end of the book is either less interesting or more familiar to me, so if you find your interest flagging it’s safe to let go.
This post supported by patreon
Pro-athletes as a group are terrible with money. It’s not merely that they’re bankrupt within a few years of leaving their sport; many don’t save enough cash to make it through the off season. You could blame the athletes, but the system is really set up to create this problem. You’re taking mostly poor 22 year olds, selected for their ability to take risks and disregard odds, telling them they’ve won their ultimate dream and giving them more money than anyone they know has ever had. Of course that goes poorly. I’ve watched programmers from middle class families go kind of nuts their first year working, and that’s a much smaller transition they’re much better prepared for.
The money goes to a few major places
- Status competitions with other athletes
- Helping out people the athlete genuinely wants to help- his loving mother, the little league he got started in.
- Helping out people the athlete doesn’t want to help, but can’t figure out how to say no to- abusive parent, cousin’s former neighbor’s boyfriend
- Child support
- Terrible investments. It’s hard to sort out good investments from bad when you’re 22 and everyone you know is in debt. Also overlaps with 3 a lot.
- Being 22.
I have a potential solution: hold back most of their salaries. Pay each athlete the same amount (say, whatever the lowest paid person makes now), and put the rest in a trust, invested in index funds or even bonds. After they retire, gradually shift more and more of the money into their control. Here’s why I think this would work:
Status competition is a zero sum game, so nothing is lost if you handicap everyone equally. 3 and 5 are essentially taxes on people knowing you have money, so they go away if you don’t have access to it. Child support is here to stay, but the current calculation is stupid: it’s based on current income only, which means athletes pay through the nose while they’re working and then need to go to court to get it lowered when they retire. Income smoothing for the athlete means income smoothing for the child as well, which is ultimately better for them. And being 22 will definitely be fixed with time. After retirement, when they’re a little older, a little more experienced with money, and have the time to learn how to invest, they’ll make better choices. Turning over the money gradually gives them space to learn without a single mistake ruining their lives.
This will slow down their ability to help the people they love. OTOH, a few years of largesse followed by a return to poverty isn’t very fun for the recipients either. We’d get fewer “I bought my mom a house” draft stories but also fewer “athlete’s entire extended family facing foreclosure on 9 different houses” retirement stories.
It would be paternalistic for a league to impose this on athletes, but I see no reason a players’ union couldn’t demand it. There’s precedent for solving player collective action problems with union demands (no one in the NHL wore helmets when they were optional because they reduce visibility and make you look like a worse, but their union demanded they be mandatory). They might even be able to demand some portion of endorsement money go into the trust
Also potentially useful tactic: focus athletes on what they will do after retirement. Warning them they probably won’t play that long and money doesn’t last forever doesn’t work because people who believe odds apply to them don’t become professional athletes in the first place. But “there will be time after football” isn’t an odd, it’s a fact. If we redirected children and college students to view sports as generating the seed money for their real life goal, they’ll develop more skills and think a little harder about spending money. Bonus: the 99.99999% of aspiring athletes that don’t become pro athletes will have useful skills to fall back on.
Content warning: fat, diet.
Epistemic status: plausible and interesting.
In Gary Taubes’s latest appearance on EconTalk, he gives an alternate explanation for weight gain. He dismisses Calories In/Calories Out as equivalent to saying “Bill Gates is rich because he made more money than he spent.” – it’s not actually wrong, but it’s not answering the question in any meaningful way. He offers the following explanation for a way that could work. I know enough to know that this explanation is plausible but haven’t looked into the evidence that it actually explains the data.
Insulin is a hormone that signals your cells to take in sugar from the blood stream. Different cells have different insulin sensitivity; I’d guess that this is to give the most important cells first call on sugar, but I’ve never heard anyone else say that. It’s possible for things to get out of whack such that your fat cells (which should really have last call on the sugar) become more sensitive than other cells. So you’re gaining fat even as your more functional cells are on rations. CICO is still technically true, as you’re not expending very many calories, but it’s unfixable by willpower. As long as the different sensitivities exist, you can only raise your calories out by taking in many more calories.
None of that is the speculative part. We can argue about the prevalence and importance, but “cells don’t respond to insulin” is the definition of type 2 diabetes, a thing that definitely happens and is associated with weight gain. Medical science has always assumed the causality started with fat, but it’s never actually proved it. The speculative part is Taubes’s explanation that this mismatch is caused by eating sugar, and his solution. Taube thinks you should get most of your calories in the form of fat, which does not trigger insulin production, so your working cells can get calories before your fat cells gobble them up. I have a few qualms about this.
- Your brain runs on sugar, resorting to protein only in the direst emergencies.
- Why aren’t the fat cells releasing fat later? This is less a qualm than a question, I find it entirely plausible that fat cells reaction to being well fed is not to release fat.
There’s a million weight loss fads (twenty years ago my mom was giving me Lucky Charms because at least it didn’t have fat like ice cream) and the human body is immensely complicated, so even if we knew the mechanism was true I wouldn’t automatically believe his prescriptions were correct. But it does highlight how useless Calories In/Calories out is.
[Content warning: dieting, weight loss]
Everyone knows every study shows people can’t lose weight and keep it off. Everyone knows people who say they lost weight and kept if off. Some of that may be they do not have a sufficiently long time horizon for “kept it off”, but I think something else is going on.
No one joins a university study as their first attempt at weight loss. The people who join have tried and failed multiple times. It seems entirely possible that those people can’t lose weight, but some subset of people succeed on their first try. Tellingly, I mostly hear “I tried everything and only lost weight on the penguin diet” from penguin diet commercials. In other contexts people only announce what worked for them. Maybe they don’t want to advertise their previous failures, but it seems at least as likely that their weight loss stemmed from things all diets have (e.g. paying more attention to food, initial progress leading to a virtuous cycle) and the penguin diet happened to be the one they tried.
Last month Sarah Constantin reported on a new potential treatment for sepsis (a life-threatening bacterial infection of the blood), developed by Dr. Paul Marik. The good news is that the ingredients are all pretty common off-patent vitamins and medications, so if approved it will be really cheap. I haven’t researched this treatment myself, but Sarah thinks it looks promising, and Sarah Constantin is the autodidact medical researcher I want to be when I grow up (she’s also a friend of mine). To quote her:
Sepsis is a really big deal. More people die from sepsis every year than from diabetes and COPD combined. Ten thousand people die of sepsis every day. A lot of these cases are from pneumonia in elderly people, or hospital-acquired infections. Curing sepsis would put a meaningful dent in the kind of hell that hospital-bound old people experience, that Scott described in Who By Very Slow Decay.
Sepsis is the destructive form of an immune response to infection. Normally the infection is managed with antibiotics, but the immune response still kills 30% of patients. Corticosteroids, which reduce the immune response, and vitamin C, which reduces blood vessel permeability so that organs are less susceptible to pro-inflammatory signals, can treat the immune response itself.
What evidence do we have for this treatment? It’s made up of individual ingredients known or suspected to fight sepsis, and in a retrospective study, 0% of Marik’s patients died of sepsis (although 8% died from their underlying illness), compared to half in the ~control group. But a retrospective study isn’t enough; we need the gold standard, a randomized control study.
The good news is this treatment is made from very common off patent medications, so if approved it will be very cheap. The bad news is that this treatment will be really cheap, so no there’s no monetary incentive to fund an RCT. To be clear: this is not the fault of pharmaceutical companies. No one is holding something back. They are merely responding to the incentives we have set up. But if you’d like to change the incentive system we live under, the principal investigator is now attempting to crowdfund an RCT of his treatment. Donations are handled through Eastern Virginia Medical School and are tax deductible.
My budget for substantial donations for the year is still exhausted by Tostan. But contributing to a better set of incentives for medical research is worth $20 out of my symbolism budget. Better incentives here means not just that treatments can be researched even if they aren’t monetizable, but that people like Sarah have an incentive to do this research and share it.* To that end, if you do decide to donate as a result of Sarah’s post, I’d really appreciate it if you also filled out her donation form so she can see how much she raised (for bonus points note acesounderglass.com as your immediate referrer so I can see how much I raised).
*”People like Sarah” technically includes me, since this is almost exactly the reasoning Ozy Brennan gave for donating to my favorite charity, Tostan.