Circling the parking lot = circling the drain

A couple weeks ago, I spent some time in a YMCA parking lot to do the Wichita Area Metropolitan Planning Organization's bike/pedestrian count. I was in a pretty rural area, and the bike/ped traffic was light. It gave me a chance to watch the steady stream of cars in and out of the lot, though. The Y was rocking, which made me happy, but I couldn't help but wonder about the goals of the people in the cars screeching in and out of the driveway.

A woman who worked in the office of a YMCA recently told me that one of the biggest safety issues the organization deals with is parking lot safety for pedestrians. So many people circle the parking lot in their fancy gas-powered wheelchairs during busy times that pedestrians crossing the lot were in danger of being run over.

This is not the kind of wheelchair I'm talking about. I might respect someone who circled the health club parking lot in this rig. By the way, there was a third dog riding on the scooter. Respect. This must have been a logistical nightmare to get out the door. 

She was talking about people circling the lot, mind you, so that they could walk the minimum distance to get into the building and walk...on a treadmill. Or ride a stationary bike or something. 

This problem is a bit of a throwback for me. I remember as a kid, when the remote controls for TVs were still mostly up-and-down affairs (hit the up arrow to scroll upward through channels, hit the down arrow to go the other way; ditto volume), I would, out of habit, walk all over the room looking for the remote so I could change the channel on the TV. I would walk multiples of the distance it would have taken me to simply get off the couch and walk to the TV and push a button. But like the Kodak people who couldn't imagine a world without film, I couldn't imagine a world without the satisfying weight of that remote, with its sleek aluminum Sony case, in my hand. 

Is there a name for this particular brand of self-defeating convenience? I've stretched Google's abilities to the limit and I can't identify one. But it clearly pre-dates modern technology. And don't get me wrong. I've ridden, and continue to ride, an absurd number of miles in cars. But I've felt like an asshole for almost all of those miles that didn't involve traveling outside of town. 

But back to parking. Scott Wadle of the City of WIchita likes to say that there's no such thing as free parking. While he means that we all subsidize the space that cars take up whether we mean to or not, I think of it in more cosmic terms. All that space could be used for something else. And the physical activity it would take us to park in vertical garages and walk to our destination, or the slightly greater physical activity it would take for us to bike to work would be a small price to pay to get green space and health back. An optimist's view of the coming autonomous fancy gas-powered wheelchairs is that we'll need far less parking, thus opening up more and more space for commerce and for public use. A pessimist's view is that we'll eventually transition to a WALL-E situation in which your autonomous gas-powered wheelchair picks you up at your door to deposit you in front of the door to your office, at which point a smaller, more Segway-inspired motorized device takes you to your desk. Where you sit. All day. 

I'm not going to talk about "productivity" or "optimization" here. There are plenty of places to get a dose of that perspective. But just consider this when it comes to the YMCA or your local health club: grinding away on a treadmill for 30 minutes a day after driving an oversize luxury wheelchair to the building is not my idea of freedom. It's a chore. But if I turn that chore into the choice to walk or ride by the health club while I watch all the wheelchair circle: that choice makes me unspeakably happy.

Links for Wednesday, September 27, 2017: Pennywise as a McDonald's shill, healthcare as a right, vitamin D and falls

Unsatisfied with limiting itself to its whopperCoin cryptocurrency, Burger king Russia is complaining that Pennywise the dancing clown gives McDonald's an unfair advantage.

What? There's no way any kid ever has confused Pennywise with the modern-day Ronald McDonald. The Willard Scott version, maybe:

But Willard's been out of the burger bidness for a while now. 

See also: Whoppercoin

Healthcare isn't a right, but access to it is vital to a functioning democracy. 

That's my take. Atul Gawande (disclosure: I'm a big fan) takes his surgical mind to the problem and, as usual, illuminates the complexity of the issue. What if we had a system that allowed trash to back up into the streets if people didn't buy exorbitantly expensive "garbage insurance?" I suspect we'd move toward a system like what we have now: mostly affordable, in many cases government-subsidized trash collection. Healthcare could follow a similar model.

USPSTF is putting the kibosh on vitamin D for fall prevention.

When I was a resident in the early oughts, vitamin D was the hottest thing going. We thought we were going to fix or prevent sooooo many problems by optimizing people's levels. Unfortunately, almost no intervention with vitamin D has proven successful. Vitamin D levels instead serve as kind of a generic marker of unwellness. Repleting those levels does not in and of itself fix the unwellness, though.

Links for Monday, September 25, 2017: how to read a chocolate bar label, nothing's stopping you from deleting Facebook, and Amish smartphones

How to read a chocolate bar label.

Phrases to Avoid:

Chocolaty...Made with chocolate...Chocolate liquor...Vegetable oil...Butter oil...Artificial sweeteners...Milk substitutes...PGPR...Vanillin...Distributed by...Product of. 

(link from marginal revolution)

Report: nothing's stopping you from deleting Facebook right now.

Sigh. Even the Amish have smartphones now.

This will distract from their naked butter churning over spring break.

Are triathlons dangerous?

First things first: I've never done a triathlon. I swim like a St. Bernard. But I've done a lot of endurance bike racing, and I've been at more than one event with a death, the most recent the 2017 Dirty Kanza. So I was interested that in the latest Annals of Internal Medicine, investigators looked into a sudden death database to identify 135 race-related deaths and cardiac arrests in American triathlons between 1985 and 2016. Interestingly, right at two-thirds of deaths and arrests happened in the swim part of races, which usually comes first, before the bike and run. The editorialists spend a lot of energy trying to link swimming to some special form of stress from cold water or other factors that might be extra-dangerous. But to me, the swimming link seems consistent with the finding that in autopsies, about half of subjects had cardiovascular abnormalities, most often old-fashioned atherosclerotic disease. Swimming caught most of these people simply because it was the first event. Had running or cycling come first, I suspect one of them might have been the death leader. I'm not convinced by their observation that most marathoners die toward the end of races; anyone who's seen the scrum at the beginning of a triathlon knows that it's inherently different than the often walking pace seen at the start of a marathon: 

From http://www.zwemza.com/?p=5515, triathletes tempting fate. 

85% of victims were male, but I'm not sure the significance of that number, since >60% of participants (at least in pro Ironman races) are male:

From https://www.outsideonline.com/1964906/fight-gender-equality-ironman

And if you look at total Ironman competitors, the distribution of sex comes much closer to the death/cardiac arrest statistics:

But sex aside, we're forced to see that cardiac arrest and death are not rare among triathletes. Between 2006 and 2016, their incidence was 1.74 per 100,000 participants in the study. The risk of death increased with increasing age, unsurprisingly. Don't let this dissuade you from being more active. The benefits of physical activity far, far outweigh the risks in almost everyone. If you're inactive now and thinking of becoming active, or if you're active now and thinking of doing really hard-core things like triathlon, consider taking the American College of Sports Medicine's new-ish algorithm to your doctor and talking it over before you hit it really hard:

We don't know how really weird stuff like performance enhancing drugs effects this. My suspicion is that it's not good. 

Links for September 18, 2017: American sperm, movement is life, neighborhoods and vascular disease risk, and Taiwanese fruit ghosts

Canada needs our sperm. America!

Background: It is illegal to pay for sperm donations in America's hat. 

"What Canada should do is legalize compensation for renewable bodily fluids in our own country. It would be the morally right thing to do. It would help make and save more lives, without harming anybody.

Until we realize our mistake, we need you Americans to keep rolling up your sleeves and unzipping your pants not just for the sake of lucre, but also for the sake of the thousands of current and future Canadians whose lives depend on you."

The more you move, the longer you live.

Bottom line up front (BLUF): Over 4.0 years of accelerometer use, total sedentary time was associated with an increased risk of dying. Not only that, but the longer the usual sedentary bout, the higher the risk of dying (roughly double for the highest quartile). This study is encouraging, in a way: you don't have to move that much to really affect your risk, you just have to move often. But this doesn't apply to you, dear reader, since you ride your bike to the grocery store and forsake social media. Don't you?

If you live in a disadvantaged neighborhood, the usual risk factors for heart disease probably underestimate your risk.

BLUF: In a group of patients from the Cleveland Clinic, the Pooled Cohort Equations Risk Model, or PCERM of the American College of Cardiology and American Heart Association underpredicted vascular disease risk in patients from disadvantaged communities (those with a high "Neighborhood Disadvantage Index," or NDI). For a patient from a disadvantaged community, the model only achieved a "concordance index," a measure of how well it predicts vascular disease, of 0.70. In Affluent communities, on the other hand, the concordance index was 0.80. That doesn't sound like a huge difference, but the NDI was much more powerful at predicting variation between census tracts than was the PCERM tool itself.

Fruit names do not invite ghosts, says Taiwanese government

"The seventh month of the lunar calendar is called Ghost Month, when the gate of the underworld is said to open and people prepare offerings for the dead.

People have refrained from offering bananas, plums, pears and pineapples, because the fruits’ names sound like they are inviting ghosts in Hoklo (also known as Taiwanese), the market’s Fu-te Temple (福德宮) chairman Lin Lai-fa (林來發) said.

In Hoklo pronunciation, banana sounds like “inviting” (tsio), plum like “you” (li), pear like “come” (lai) and pineapple like “prosperity” or “more” (ong), the combination of which sounds like an invitation for ghosts to stay in someone’s home."

Whatever, Taiwanese Agricultural and Food Agency. I've seen a Dragon Fruit. That thing's bound to attract demons.

Links for September 15, 2017: male infertility "crisis," adrenal fatigue, the horror of goop, and water>artificial sweeteners

The male infertility "crisis" is in the eye of the beholder

Anyone who wants a baby should be able to have one, and I'm glad we have thoughtful, careful reproductive endocrinologists and urologists working on the problem. But I think as we rocket toward 10 billion people on planet Earth, calling it a crisis is probably premature. 

FWIW: adrenal fatigue isn't a real thing, no matter what GOOP says

Speaking of GOOP, Olga Khazan takes on its mysterious enduring popularity

What would possess a person to think that inserting jade eggs (those are actual egg-shaped pieces of stone, mind you) into her vagina would make her feel better? I have two theories: first, stories are more powerful than data. Local Wichita public health dynamo Becky Tuttle says that stories are "data with soul," but that's only part of the story. People like the illusion of certainty where there is only doubt. I think that's what quacks have always offered. 

See also: Nuts! the film about the Kansas doctor who implanted goat testicles, and No, women should not insert jade eggs into their vaginas

Until we have definitive evidence on artificial sweeteners, we should all drink water

Confession: medical school turned me into an heroic Diet Coke drinker in the late '90s. /at first it was just because I needed a reliable source of caffeine to keep me awake, but later it became more of a habit. It may even have had some religious undertones. Short story author Amy Parker once called it "the national beverage," and it was true for me. Every drink felt like a sip of America herself. But in February, after a bout of severe insomnia, I decided to give up caffeine altogether (it helped). It was only by coincidence that 1) data had started to accumulate that diet drinks were certainly not a panacea, and might even be bad for us, and 2) most other artificially sweetened beverages taste the way I imagine ground Smurf would taste. So I mostly gave them up, too. I've probably had 5-10 caffeine-free diet drinks since, and unless someone can produce evidence that they're not bad for me, I'm done forever. Mostly.

See also: Why one cardiologist has drunk his last diet soda

Is it too early for a Halloween reading list?

I picked up a copy of We Have Always Lived in the Castle by Shirley Jackson last week at the library:

You'll be missed, Wichita Public Library. #brutalismforever

It is a Gothic masterwork, and the speculation it allows around the psychopathology of Merricat and the townsfolk who hate her and her sister and uncle is irresistible.

Even though I didn't choose it with the intention of kicking off any kind of Halloween-y creepy reading list, now that I've started The Handmaid's Tale by Margaret Atwood, it seems I've inadvertently waded into Gothic waters. Atwood is incredible, but I'm in the mood for something a little more straightforward. So I've made it official: my next book will be It by Stephen King. I was a voracious King reader as a high-schooler. And a copy of Salem's Lot I found in a call room nightstand once got me through a snowy, slow call night as a resident. I left the book there when I finished, and I have wondered many times since how many residents at Deaconess Medical Center have found that same book and killed a couple hours with it. I know, I know, that King is hardly literary. His is not necessarily the kind of reading that increases empathy, but since It is currently crushing it (see what I did there?) at the box office and in critical reviews, it's time.

Assuming I can get through It's 900+ pages in the next few weeks, what other creepy-crawly books should I attack before All Hallow's Eve?

"The greatest favor you can do is...put away your phone."

Sherry Turkle from the MIT Media Lab talks about the frequency she hears people say they'd "rather text than talk." People say they feel less vulnerable when they text than they feel in a face-to-face conversation. I agree. I feel less vulnerable texting, too. 

So don't be a phone worm. When I was in medical school in the late '90s, I remember classmates making fun of a woman in our class who was pathologically attached to her cell phone. We'd all just learned the word "pathologic," and our family members were already asking us for medical advice, so we all felt comfortable making the diagnosis. Anyway, hers was the phone that would ring its Nokia ringtone multiple times a day to interrupt class back when this was still a novel occurrence:

In the year 2017, I'm not sure she'd even hit the average cell phone use. Recently, at my kids' gymnastics lesson, I was flanked by two women on cell phones. The first one sat to my right, bouncing off my shoulder as she sat. I forgave her for this, because she couldn't see me past the smartphone glued to her left ear. Then she proceeded to scream intermittently at two kids who were not in the gymnastics class, all while never removing the phone from her ear. I didn't blame the kids for being wound up; it was after school, and they were stuck in a building watching a sister when they would've undoubtedly preferred to be outside on the playground. But she couldn't be bothered to interrupt what seemed like a very non-urgent conversation.

I moved to a quieter place, sacrificing my chair for the floor. Then, three feet away, a second person started talking at full voice on her cell phone, telling the unfortunate listener on the other end repeatedly how pissed she'd been earlier in the day. Keep in mind, it was sunny and 66 degrees outside. Either person stepping outside to take her call would have been healthful and humane. But both women, insofar as my amateur observational skills could tell, sat in the middle of a crowded room and talked on their phones for the duration of the one-hour practice, save for the intermittent screaming at their kids. One child actually begged lady number two not to talk on the phone anymore, and was told to "zip it." A third man, who I assume was also a parent, broke his phone conversation only to tell a toddler to "stop fucking around." The toddler did not heed his instruction, and the man was soon sufficiently lost in his talking and texting to allow, shall we say, ample f'ing around, toddler-style. 

Sherry Turkle doesn't get into this directly in the brief video above, but this is all consistent with her observations that technology is killing social skills. We collectively show decreased empathy and a decreased ability for self-reflection. A big part of my job is handling sometimes delicate negotiations within clinics or within medical systems or between payers and doctors. In those situations, vulnerability is key. If the interested parties can't look one another in the eye and feel insecure and feel like their decisions impact the other people around the table, we get nowhere. 

Don't get me wrong. I've taken my share of calls and texts in crowds. But I've felt like an asshole almost every time. So to keep from being a hypocrite, I've set my phone to no alerts for messages or emails, and I frequently put it on sleep mode, meaning it won't ring unless an immediate family member or neighbor calls (I figure the neighbors have the best view of my house burning down). And though I've occasionally feared that this would kill my productivity, I'm fairly certain now that it does the opposite. I'm more productive the more time I spend apart from my device. People think email is urgent, for example. According to psychologist Dan Ariely, it's not. Yuval Noah Harari, author of some incredible work including Sapiens, meditates for two hours a day. And the astonishingly productive computer scientist and self-help writer Cal Newport is "indifferent" to his smartphone, still subscribes to paper newspapers, and only upgraded from a flip phone because his wife guilted him into it when they had their first baby. 

So here's a challenge for this week: Go outside your phone (comfort) zone. The next time you're standing in line waiting for something to happen, or watching your kids jump on the trampoline, or between innings at a softball game, or waiting for a movie to start, leave your phone in your pocket. Better yet, take it to whatever vehicle brought you to the game (except your skateboard; skateboards are a bad place to store a phone). It'll be hard to do, but you have the strength. Concentrate on your breathing. Once you've safely stowed the phone away, look at the others around you. You might have to work for some eye contact, because they probably aren't following the same rules you are. While you're gyrating around trying to get them to look at you, think about their stories. It'll give you something to ask them about. If they won't talk to you, make like Yuval Harari and make this time your meditation. If you're not the meditative sort, think about what you want to accomplish with the rest of the day. Make a mental plan. For a few minutes, don't be a phone drone.

See also: CRANK UP THE BASS, HOW ELSE CAN YOU CRANK UP THE BASS?, SOCIAL MEDIA IS A SET OF COMMON PLATFORMS TO DRAW OUT OUR WORST TENDENCIES, HAVE SMARTPHONES DESTROYED A GENERATION? 

Links for September 12, 2017: Little Library Locator, Kerry to Cannondale's rescue, bike manners in China, and ICT flash dine

Ever wonder where to find a little library near your house? My 10-year old did. She found the answer at Little Locator.

Did John Kerry help save Cannondale-Drapac?

If so, bravo, Mr. Secretary. With Rigoberto Uran's podium at the 2017 Tour de France, things are looking up for one of only two American-sponsored teams in the UCI peleton.

Are stationless bike shares brining out people's bad manners in China?

I've never traveled to China, but my hunch is that the bikes being scattered all over Beijing have a lot more to do with 1) a lot of people in a small space, and 2) the Wild West unregulated atmosphere of bike shares there:

In many cities, the supply of bicycles far exceeds demand, bringing chaos to sidewalks, bus stops and intersections and prompting grumbles that excessive competitiveness — seen as a national trait — is spoiling a good thing. In Shanghai, where officials have struggled to maintain order, there is now one shared bike for every 16 people, according to government statistics.

In some places, the authorities have confiscated tens of thousands of bicycles and imposed parking restrictions. News outlets have documented the waste with astounding images of mountains of candy-colored bicycles, each hue representing a different bike-share company.

I'm signed up for the ICT Flash Dine. You should sign up, too:

Links for September 11, 2017: insect burgers, lessons from the PURE Study, death row food, and plastic in the water

I'm not bothered at all by the thought of insect larvae burgers. Are you?

For reasons I can't figure out, Swiss law allows use of only mealworm larvae, house crickets and migratory locusts. But apparently they taste fine:

The burger itself has little white specks of rice inside with traces of carrot, paprika, chili powder and pepper. After a hesitant bite, the main flavors that come out are the spices. The texture is curious, a bit like a meaty falafel with a crunch. An aftertaste lingered — but maybe that was just my subconscious playing tricks.

Sales are apparently brisk in a very limited release so far. 

See also: Chapul cricket bars, which are delicious, and the Impossible Burger.

Marion Nestle points out what we already know about the PURE Study (that's Prospective Urban Rural Epidemiology): Fruits, veggies, and legumes are good for us.

And refined carbohydrates and sugar are bad. The study's "high fat" diet didn't even approach the amount of fat that most of us eat (18-30% versus 35% in the US), so it's impossible to really say what the study proved in regards to fat intake. 

See also: David Katz on PURE, James Hamblin on PURE.

On death row, food rivals porn as an obsession for inmates.

Text below, in case you want to avoid reading the grisly details of a murdered family:

The second-most-prevalent obsession is food. Longo says he actually has two photo collections: nude women and gourmet cuisine. His letters to me are filled with food cravings: "a salt bagel with a full plain cream cheese schmeer from Einstein or Brueggers — toasted, of course"; "a cinnabon with a good cup of coffee"; "a pizza"; "honey-dripping baklava." To make the institutional meals more palatable, the men sometimes hold death-row dinner parties. Several inmates will pass their trays down the row to one cell — frequently, to Longo's. He'll combine all the food together, add commissary-bought items like hot sauce, peppers, and shredded cheese, then rebuild the plates "Cadillac style," as it's called, and send the trays back.

How all this plays into the choice of a last meal, I don't know.

94% of US tap water is contaminated by plastic fibers

I cannot find data on bottled water, but considering that most of it is packaged in plastic, I suspect it's no better. Why does this matter? Well, besides the ick factor, plastics have a notorious reputation in the endocrinology world as "endocrine disruptors," meaning that they exert a hormone-like effect on tissues. The most notorious chemical within plastics with this effect is bisphenol A, which among other effects acts as an estrogen mimic.

Links for Sept 5, 2017: books by the foot, Chilis, McDonalds as community center, and radiology job security

Where do decorative books in restaurants and bars come from?

Answer: Books by the Foot, mostly.

Inside the Church of Chilis

I grew up about twenty miles outside of a small town. So small that the addition of something like a Chili's would really set the place on fire. I still remember when we got a Wal-Mart and when we got a McDonald's. I can't say that either of those were great for the town on balance. I suppose they offered some low- to mid-range jobs, salary-wise. My mom had one of them at Wal-Mart for years. But no one that I know of ever felt the kind of devotion to either place that's described in the hard-core Chili's trainers in this article:

For the right kind of new person, though, Chili's is the righest kind of place. Her story echoes Sara's, which echoes everyone else's at their level: She was pursuing a different path (grad school for criminal justice), but kept being drawn back to Chili's, where she realized she was happiest. She was searching for something and found it there. For Nikki, now, it has grown into pure purpose. "I live and breathe for this company," she says. "This is totally what I was supposed to do. This is what makes me tick everyday. Everything I do is with Chili's. This is not a job for me—this is my life."

McDonald's is a surprisingly important meeting place

Speaking of McDonalds, the burger place occupies a special place in the communities in which it's found (I'd say serves, but I'm not there yet): 

In Sulfur Springs, Texas, in the late morning, Lew Mannon, 76, and Gerald Pinkham, 78, were sitting alone at a table, the last of the morning regulars to leave. She was needling him about politics. (“I like to tease the men who come, get them all riled up, tell them they just don’t want a female as president.”) Both are retired, Gerald from working for an airfreight company, and Lew after 28 years as a bank teller.

When I asked Lew about her life, she started to tear up, stopped for a second, and composed herself. “Life is hard. Very hard. Seven years ago I lost my husband to leukemia. Then three years ago I lost one of my sons. Health complications from diabetes. When my son died, I had nobody to help me, emotionally, except this community here. Gerald lost his wife three years ago, and we have helped support each other through that.”

She stopped again, unable to speak from tears. After a moment of silence: “I look composed on the outside. Many of us do. But I struggle a lot on the inside. This community here gives me the support to get by.”

When I was in second grade, I got to have my birthday in McDonald's. It was noteworthy for a couple reasons: first, birthday parties were always a little touch-and-go with me, since my birthday so often fell dead-center in corn harvest; and second, because I was the first person in my class to have his party at the new McDonald's in town. I remember it all: the faux-wood bent booths, the paper hats, the Happy Meal toys.

None of these kids are me, but they might as well be. (http://bit.ly/2x7DyOo)

I was so excited to leave school to take my friends there that my mom tried to slow my down and I fell on the cement and tore my jeans. I didn't even care.

Radiologists are (rightly) concerned about how artificial intelligence may affect their careers

"Radiology has become commoditized over the years," Kelley says. "People don't want interaction with a radiologist, they just want a piece of paper that says what the CT shows."

See also: Let's kill radiology and pathology and combine them into "Information Specialists." (paywall)

Links for September 1, 2017: building a better block, football broadcaster crisis of conscience, kibbutzing for happiness, meldonium, stem cell clinics, FSH, and whoppercoin

Ed Cunningham quit college football over concussion concerns.

That little click you just heard was another tiny domino falling in the decline of football. I've said before that the NFL was one thing, but it's such a small, relatively well-paid population that it doesn't mean much. Once concern starts spreading upstream into college, high school, and beyond, football is in trouble.

Can a Kibbutz make us happier?

In my neighborhood we've experimented with our version of Kibbutzing: we used to have a monthly (or so) breakfast where everyone in the neighborhood was invited to a single house for pancakes, breakfast burritos, etc. Like so much in life, though, it was overtaken by other Saturday morning chores. It's hard for even a breakfast burrito to compete with kids' soccer, the Home Depot, and volunteer duties. It's time to resurrect our Kibbutz. 

Caitlin Thompson doped like Maria Sharapova and liked it.

Caitlin brings up the possibility of this having been a placebo effect. I agree. It's hard to find clinical trial data on meldonium in English; almost all the trials are published in Russian:

And there are no systematic reviews. Wolfgang Schobersberger, Tobias Dünnwald, Günther Gmeiner, and Cornelia Blank wrote a nice narrative review (paywalled) on meldonium's transition to a performance-enhancing drug, though. The take-home from their article is right in the abstract:

The benefit of taking meldonium in view of performance enhancement in athletes is quite speculative, and is discussed without sound scientific evidence.

The FDA is (finally) taking on stem cell clinics.

A few years ago, a stem cell clinic opened here in Kansas, with surprising fanfare. IIRC, they convinced the Governor and even Kansas State Head Football Coach Bill Snyder to attend a grand opening. Coach Snyder is even in a video on their website. Not long after, I reached out to the docs in the clinic through their website to ask to talk about the evidence they were using to justify their treatment regimens. I never got a response. That clinic is not on the list, as far as I can see, of clinics that have been contacted by the FDA.

Is follicle stimulating hormone responsible for post-menopausal weight gain?

I'm skeptical. And I suspect the downstream effects of blocking FSH, which aren't completely known yet, might be worse than an extra 15 pounds.

Burger King is launching its own cryptocurrency that can only be used to buy whoppers. For real. 

I hope I'm not being burned by fake news here.

Once more to the lake for Labor Day

When I read the words in EB White's Once More to the Lake, I ache. His description of the smell of wood, the feel of the water, and the schedule set by the sun gives me a completely unearned sense of nostalgia. Most of my summer (and adult) trips to the lake have been marked by the anodyne scent of an RV air conditioner and the coconut-tainted slip and slide of sunscreen. But I ache for microwaved biscuits and gravy and cheese sandwiches and kool-aid. I can smell the fishy water covering the sandstone shore of Wilson Reservoir. I can see the treeless lunar landscape. 

Pics from http://www.wilsonks.com/

So this is your permission from me--not that you were seeking it--to engage in a Great American Pastime and head to the lake for Labor Day. Do it before the McMansions obliterate any of the charm that EB White talked about:

From http://www.tcbusinessnews.com/millennials-and-mcmansions-are-they-compatible/  Answer? No, I hope. 

Do it even though, unlike him, you won't be able to spend a month there. Do it because someday you'll wonder what you've done with your life, and the answer of "I took my [kids/wife/husband/friends/enemies] to the lake once in a while, and we had fun and made memories" is better than "I got high and played a lot of video games."

Links for August 30, 2017: self-propelled cyclists, what makes life worth living, and Google's depression test

In the Vuelta a Espana, riders frequently have to ride back over giant hills to get to their team buses from the finish line.  

What makes life worth living? 

These astounding things, which you will soon encounter and see for yourself, are so easy to lose sight of, and there are almost as many ways of doing that as there are people. That is why I am writing this book for you. I want to show you the world, as it is, all around us, all the time. Only by doing so will I myself be able to glimpse it. 

Google made a depression test  

More accurately, Google linked the Patient Health Questionnaire 9 (PHQ9) to search queries related to depression, the same way a calculator might pop up when you search "tsp to tbsp." 

Should a pharmacist be a bigger part of your practice?

Conflict of interest disclosure here: I receive some grant funding indirectly that works to get pharmacists and docs into collaborative practice agreements (CPAs).

But if the video above makes you think your practice ought to be using more pharmacy brainpower, take a look at the video below on how to establish a CPA:

How to make your BB30 bottom bracket stop creaking

Two things here: first, I'm trying out some YouTube content of my own. Second, I think the ability to fix your own stuff is a way to take control over your life and feel better about yourself.

Oh, and if you've never noticed, bikes are a pretty big deal for me. 

If you've ever experienced the annoying creak of a BB30 bottom bracket, consider yourself lucky. If you have, and if you've wondered about a quick, easy way to make it better, watch the video above.

What do I do with these eclipse glasses now that the eclipse is over?

I'll tell you what you do. You put them in an envelope and send them Astronomers Without Borders, who will forward them to school children around the world so that they can see eclipses in the future:

Explore Scientific
621 Madison Street,
Springdale, AR 72762

(link and address via All Hail the Black Market)

Links for Wednesday, August 23, 2017: metformin reframed as wonder drug, cane vs beet sugar, and medicine as an inefficient time suck

Does metformin "promise" to extend life?

It may promise a lot of things, but until I see RCT data, I'm not convinced that we should put an old anti-malarial drug in the water. Metformin, I mean. And that RCT would be the TAME Study. Observational studies of metformin and cancer have been promising, but...

In two controlled trials involving patients with advanced pancreatic cancer, a notoriously difficult cancer to treat, metformin failed to provide any benefit.

So I'll hold out ultimate judgement until after the TAME Study. But this smells a little like 20 years ago when pharma invented osteopenia to sell bisphosphonates, and then tried to encourage "prophylactic" treatment of even osteopenia. (metformin link via marginalrevolution.com)

Are our cooking efforts sabotaged by the substitution of beet sugar for cane sugar? 

Brown cane sugar -- a combination of sugar and molasses, both inherent in the sugarcane plant -- is produced naturally as part of the process of refining white cane sugar by the traditional method, crystallization.

Brown sugar from C & H Sugar Co. and other cane refiners uses the process, but beet sugar is different. It's made by refining the sugar all the way to the final white granular stage, stripping off all the molasses because beet molasses is unfit for human consumption (it's recycled as cattle feed). Then cane molasses is added back into the sugar through a process called "painting."

Painting coats the granules but does not necessarily penetrate them -- the molasses can sometimes be rubbed right off.

As with white sugar, these different types of sugars act differently in the kitchen.

The best medical analogy for this seems to be the auto-substitution of in-class medications by insurance formularies. Detemir substituted for glargine, for example. 

Is medicine a "low-impact" profession?

The folks at 80,000 hours think so, noting that the number of people whose lives will be extended by a single doctor is low, or "pretty modest," as they say:

This analysis confirms the contentions above: physician density is negatively correlated with burden of disease16; the social determinants of health explain more of the variance in health outcomes than physician density17; there are steeply diminishing returns between increases in physician density and decreases in burden of disease16. Further, the ‘bottom line’ figures (which are likely optimistic) suggest an additional doctor adds four health years for every year they work. This is a lot less than can be accomplished through even modest donations to effective charities, and so suggests the ‘direct impact’ of medicine is pretty modest.18

(link from slatestarcodex.com)

Happy eclipse day!

Before you see the sun obscured by the moon for yourself, read Annie Dillard's Total Eclipse.

I saw, early in the morning, the sun diminish against a backdrop of sky. I saw a circular piece of that sky appear, suddenly detached, blackened, and backlighted; from nowhere it came and overlapped the sun. It did not look like the moon. It was enormous and black. If I had not read that it was the moon, I could have seen the sight a hundred times and never thought of the moon once.