Love triumphs over ignorance

That’s a pompous choice of words, but nothing summarizes better how I feel about the Finnish parliament’s decision to allow same-sex marriage today. I’m happy, happy for myself and for my gay friends to whom I know this is huge thing.

The new law is a historic one, naturally from the equality perspective but also because it was the first “popular initiative” to pass in the parliament.

The opposing front (besides quoting the Bible) has mainly expressed concern over children’s wellbeing in same-sex families. This, as peer-reviewed literature has it, is rubbish.

The Art of Thinking Clearly

The Art of Thinking Clearly is a 2011 pop-sci book by Rolf Dobelli: a catalogue of common cognitive biases that in a systematic manner cause people to act irrationally and often against their best interest. Each bias is introduced in a short chapter with a few entertaining examples and some speculation of its background in evolutionary psychology.

Health professionals are not immune to cognitive errors and the book serves as a healthy reminder about that. Among the many intellectual traps doctors can fall into is action bias: tendency to perform dramatic interventions even when watchful waiting would be better. Availability bias – e.g. overusing a diagnostic or therapeutic procedure just because it’s on top of one’s mind – is well documented, too (when all you have is a hammer… urology edition). Omission bias might manifest in failing to use lifesaving medicines for the fear of their side effects (must be particularly true in the U.S. and other countries where liability cases are easily triggered).

On the other hand, patients and caregivers alike are prone to regression to the mean. If today’s back pain is worse than ever, it is likely to improve by tomorrow for purely statistical reasons, not necessarily because you saw a doctor/chiropractor/homeopath today. Survivorship bias means a few vocal people praising the efficiency of a particular intervention may hide the fact that a thousand others used the same product without help.

Etc.

The Art of Thinking Clearly
is not a scientific treatise or a psychology textbook (but readers hungry for more information will find references in the end). Despite the name, it’s not a handbook to better thinking either, more like a collection of anecdotes.

Still, the book is clever, accessible and fun (a fairly quick read, too), and will hopefully do a small favor to the world by raising awareness of the fallibility of our minds and by culling some bad argumentation.

Winter Is Coming

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After a month of traveling and meeting friends and relatives, I am now back in N, re-adapting to my country GP life. And it’s alright, even surprisingly so. My patients seem to like me and I like them (well, most of them, anyway) and the little town actually begins to feel a little like home.

But I know I won’t stay for ever. Despite many good experiences, I don’t feel like I belong here. At its core, N is a quiet, conservative backwater with an aging population and withering economy – rural to urban transition in progress. I’m a product of the capital city region.

And then again, my roots are here. My grandparents left N decades ago to settle elsewhere, but in the town cemetary, maybe one in ten tombstones still bears my family name. A neurologist I know told me that as a result of centuries of inbreeding, this region is home to some interesting hereditary disorders.

That’s a line of thought probably best not explored too far.

The temperature has dropped below zero but I still carry on with my new hobby: Nordic walking. I primarily used to run but during the fall I’ve found I prefer walking with poles to jogging. To be honest, running always felt like a chore, something I mostly did out of sense of duty. On the other hand, Nordic walking is fun, it lets one work on one’s upper body as well, and walking on asphalt is not half as dull as jogging on asphalt.

I have also begun to record my exercises in Sports Tracker (which brings wicked joy to the spreadsheet-loving part of me). I also tried Endomondo which seemed nice and had more features, but in the end I decided to go with Sports Tracker for its cleaner interface and straightforward functionality.

I took the above photo on a 9 km walk along the edges of the town yesterday. Today when I woke up, the first snow had covered the ground.

“Best buys” to reducing economic impact from non-communicable diseases

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From the 2011 report by WHO & World Economic Forum.

Homeopathic Emergency Department


Chuckle of the day. By Mitchell and Webb.

Dodging Alzheimer’s

A recent Lancet Neurology paper concludes:

around a third of Alzheimer’s diseases cases worldwide might be attributable to potentially modifiable risk factors.

That is, education, physical inactivity, smoking, hypertension, obesity, diabetes and depression.

Dementia is a frightening matter, and one quite familiar to many people in our aging society, either through personal experience or the media. Should the grim prospect of Alzheimer’s disease – and the possibility of avoiding it – be more heavily utilized in public health messaging?

Generally speaking, coercing people into healthy behavior through threatening them with terrible complications unless they change may not be the best tactic to promote wellbeing.

But people do need to realize the consequences of their lifestyle choices, and while heart attacks and strokes should be concrete enough menaces, the idea of losing grip of the cognitive processes that constitute the very you might be what’s needed to propel somebody out of, say, smoking.

A greater chance of surviving into old age with your wits intact – consider adding this to your phrasebook of health promotion.

New data on alcohol-cardiovascular health link

Souvenir from Dahab. Never had the courage to touch the contents.

Souvenir from Dahab, 2009. Never had the courage to touch the contents.

Is alcohol healthy when consumed in moderate amounts?

The topic is controversial. Observational studies have found light to moderate drinking to be associated with less cardiovascular illness, but a recent research article in BMJ tips the scale in favor of ”probably not”.

In many previous studies, alcohol consumption and mortality have appeared to have a ”J”-shaped relationship: while heavy drinkers have a high risk of cardiovascular illness and mortality, light and moderate drinkers seem to enjoy smaller risk than teetotals (see e.g. these two much-quoted papers, and a more recent meta-analysis).

(The definition of moderate drinking, in case you were wondering, depends on who wrote the recommendations but generally means something like 1 or 2 drinks a day. Contrary to popular belief, red wine has not been proven superior to beer or spirits; in the studies mentioned above, only the amount of pure alcohol had significance.)

The way the J-shaped curve has traditionally been interpreted is that moderate alcohol consumption would prevent cardiovascular illness and prolong one’s life span. Biological mechanisms for how this might take place have also been proposed (see e.g. here).

But in the end it’s a correlation-causation thing: we only know there seems to be a connection but cannot tell if one really causes the other. (For entertaining examples of bizarre correlations, see here – movie appearances by Nicolas Cage vs. drowning deaths is my favorite.) Maybe the teetotals are abstinent because their underlying illnesses keep them from drinking alcohol? Maybe the people with “civilized” drinking patterns also have higher education, better incomes and more healthy behavior in general? The only way to find out for sure would be to run a randomized controlled trial, and this is unlikely to ever happen.

What the BMJ authors Holmes and Dale (and a lengthy list of collaborators) did was to look at a gene (a particular allele of alcohol dehydrogenase) that is known to be associated with lower alcohol consumption. While not a substitute for a clinical trial, this is quite a smart method really: gene alleles are randomly assigned to individuals (kind of), people cannot falsify them (like they might downplay their actual consumption of alcohol) and cannot be changed by lifestyle (so there is no possibility of the causation working two ways).

They conclude:

From the U shaped association seen in observational studies, we would expect that for drinkers below the nadir (12-25 units/week), a reduction of 17.2% in alcohol consumption — would lead to a small increase in the risk of coronary heart disease — Contrary to these expectations, however, we found that individuals below the nadir with a genetic predisposition to consume less alcohol had lower odds of developing coronary heart disease at all categories of alcohol consumption — bringing the hypothesised cardioprotective effect of alcohol into question.

So is moderate drinking healthy or not? The only really accurate answer at present is, we still don’t know. The new BMJ paper does not present definite evidence of alcohol’s causal effect because it uses a gene as a proxy and there may be confounding factors. However, it gets closer to proving causation than the older ”J-curve” studies.

The new study is welcome because it challenges the popular (but scientifically poorly founded) belief that moderate drinking is good for you. We need more info. The health effect of moderate drinking – be it positive or negative – may not be big from individual point of view – but given the very large alcohol-consuming population of the world, knowing the true answer to the question would have great importance to health policy.

Meanwhile, there is a lot we do know about the health effects of too much booze (it remains among the three leading risk factors for death and disability worldwide) and the practical advice regarding drinking stays largely the same.

If you’re an abstainer, there is no reason to start drinking because 1) there is no real proof that alcohol is beneficial; 2) even if it were, the gains would most likely be small, plus 3) you would risk drifting into the “heavy drinker” sector, which is unambiguously harmful. If you’re a moderate drinker, that’s probably OK; what the new BMJ paper hints, though, is that you might still be better off consuming less. I find it credible.