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9781623364182 A shout out to the readers who responded below. Many interesting comments, and I learned a lot. It’s a thread that I have actually reread several times. For what it’s worth, I got a copy of The Lean Muscle Diet, mostly because I want to start learning more about the topic, not because I’m taking it as gospel. But one thing I’ve started doing immediately was cut back on the running on frequency, but increase intensity/pace. Also, I’m working in more pull-ups and chin-ups into my routine, and hitting machines less frequently. The squat racks at the gym always have a line out the door, so perhaps I’ll have to buy one myself at some point, because I don’t have the patience to wait 20 minutes (also, there’s going to be a line behind me once I do make it to the rack). Considering the amount of usage they might get it seems like an investment that might pay off? Does anyone have suggestions?

• Tags: Health, Miscellaneous 
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71qnces9omL._SX450_ Over a year ago at my friend David Mittleman’s recommendation I got a Fitbit Aria Wi-Fi Smart Scale. The reason was two-fold. First, I’d been monitoring my weight since 2010 by using a spreadsheet, but I liked the idea of just jumping on the scale, and having it automatically record the weight. Yes, definitely a “First World Problem”, but it reduces even the need to think about recording my weight. Second, the scale also purports to measure body fat percentage. I say purports because many people are skeptical of the results because it utilizes bioelectrical impedance. But I still thought it was worth it because as long as it was precise, even if not accurate, I could see a possible trendline. Over the past year my body fat percentage has declined from ~20% to ~18%. This seems validated by the fact that my waist has also gone down an inch, as I can easily fit into 29 inches instead of 30 (my target is 28, which is where I’m at when I’m genuinely lean).

Obviously what you look like and what you can fit into is the best measure of your body fat. But I’m a bit of a quant nerd, so when a reader suggested that the Omron Body Fat Loss Monitor was better than the Aria, I purchased it. It uses the same method, but while the Aria is a scale, the Omron is a device which you grip two-handed. Yesterday I tested the Omron three times. The results came back in the 17 to 18 percent range. Perfectly in line with the Aria. I also had a few friends of various sizes and male and female use the Omron, and it seemed to make sense. My friend who came back at 7%, is totally believable at 7%. And the women always came back with higher proportions for their build than the men.

webpreview_htm_be9c6222 So how do I measure up? Below is the data from the CDC drawn from a survey of American males in the early 2000s. I’m definitely below average in my age class, but the curve here is not particularly strenuous (in fact, I might just fall into the “ideal” range for my age, though that’s contingent on the reading being accurate and population typicality). My ultimate goal is get below 15%. At that point I’ll stop caring much besides maintenance. Most of the guidelines seem to suggest that the border between fit and average body type is 17%, but I’m of South Asian ancestry, so I’m at higher risk for metabolic diseases. I suspect I’ll have to reduce my body fat percentage down further than the population wide guidelines to obtain the same risk value as the average person. Contrary to Aaron Lewis’ song a few extra pounds could hurt. I still have too much fat around my mid-section.

• Category: Science • Tags: Health 
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41o2X6mtArL._SY344_BO1,204,203,200_ Another article, More scientists doubt salt is as bad for you as the government says, in the respectable Washington Post, arguing that the salt dietary guidelines in vogue for the last generation were not based on strong science. The problem here is that bureaucratic organizations are making decisions about the health of hundreds of millions on correlational science. The incentives are skewed, and the decisions are not without cost. In the piece the journalist reports on studies which suggest that excessively low sodium content might be associated with health problems, but perhaps more important than that is that most people love salty food. Withholding salt is another way to diminish the simple pleasures of life from the populace at large.

An interesting twist on this public health issue is that it turns out that some of the original scholars argued against salt on “Paleo” grounds. That is, the small-scale and Pleistocene societies likely had very low salt intake, suggesting we were not well adapted for it. But the fact that until recently the salt guidelines for African Americans and those over 50 were more stringent implies that even then there are individual differences. Populations likely vary on “optimal” salt (or fat or sugar) intake.

• Category: Science • Tags: Health 
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David & "Tyler Durden"

David & “Tyler Durden”

Men’s Journal has an expansive story up chronicling the rise of intensive training as a necessary condition for being a leading man in Hollywood today, Building a Bigger Action Hero. But there is a qualification on the “bigger” aspect, as the beau ideal today is not the steroid inflated archetype of Stallone or Schwarzenegger, but the sleek and hungry physique cultivated by Brad Pitt in his iconic role as Tyler Durden in Fight Club. The regimen seems to involve both training to bulk up sufficiently, but perhaps even more critically burn away all the fat so that one’s definition becomes all the more salient.

In modern Hollywood this trend began with the 2007 film 300, which showcased relative unknowns whose bodies were reshaped by trainers into something that could impart the verisimilitude of being warriors born, bred, and trained from their youth as a cohesive unit. With the rise of the “comic book” movie one has seen the decline of marquee leading men, and emergence of a formula which can substitute bodies, with a minimum of charisma required from the actors. The edge then is not on acting chops, but the perfect idealized form, which serves to anchor the action sequences.

The tone of the piece seems clearly disapproving of the trend, and is in line with the thought that the flabbier bodies of leading men from decades past were somehow more respectable and honest. But that too was just a cultural trend. I can’t for example agree with this section:

Six-packs and bulky chests can look freakishly anachronistic in a prestige period picture: It’s not just that Tudor princes and Victorian lotharios didn’t have waxed chests and 12-packs – it’s that almost nobody had bodies like these until the last decades of supplements and fitness science.

If such bodies are freaks of modern science it is peculiar that Michelangelo’s David seems to resemble Brad Pitt in Fight Club. More to the point I remember being struck in 1990 in rural Bangladesh by the cut physique of a young farmer who was attending to his rice paddy. He was small and compact, but his low body fat and constant toil sculpted a form which was not anachronistic at all.

Science allows modern humans to be incredibly wealthy in terms of what we can consume in services and materials. We can make a better version of ourselves, and be the best we can be. Beauty of body and acuity of mind are within our grasp if we could shake off our sloth. Contemporary norms are such as we are told to love who we are, but that neglects the reality that who we could be is within our grasp. The extremities which drive actors to reduce their body fat to 3 percent are not necessary, and may be injurious, but we shouldn’t take from that the lesson that sculpted bodies with definition are somehow a freak artifact of modern Frankenstein science.

• Tags: Health, Miscellaneous 
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Yesterday I tweeted out Obesity Rate for Young Children Plummets 43% in a Decade. This is a big deal, and many people retweeted it. Here’s the summary in The New York Times:

But the figures on Tuesday showed a sharp fall in obesity rates among all 2- to 5-year-olds, offering the first clear evidence that America’s youngest children have turned a corner in the obesity epidemic. About 8 percent of 2- to 5-year-olds were obese in 2012, down from 14 percent in 2004.

They helpfully link to the paper in The Journal of the American Medical Association, Prevalence of Childhood and Adult Obesity in the United States, 2011-2012. And actually, if you read the paper the authors themselves seem very unsure about the robustness of this specific result. I quote from the paper:

…Tests for differences by age in children were evaluated with the following comparisons: aged 2 to 5 vs 6 to 11 years, 2 to 5 vs 12 to 19 years, and 6 to 11 vs 12 to 19 years. Similarly, in adults comparisons were made between aged 20 to 39 and 40 to 59 years, 20 to 39 and 60 years or older, and 40 to 59 and 60 years or older. P values for test results are shown in the text but not the tables. Adjustments were not made for multiple comparisons.

…Similarly, there was no significant change in obesity prevalence among adults between 2003-2004 and 2011-2012. In subgroup analyses, the prevalence of obesity among children aged 2 to 5 years decreased from 14% in 2003-2004 to just over 8% in 2011-2012, and the prevalence increased in women aged 60 years and older, from 31.5% to more than 38%. Because these age subgroup analyses and tests for significance did not adjust for multiple comparisons, these results should be interpreted with caution.

In the current analysis, trend tests were conducted on different age groups. When multiple statistical tests are undertaken, by chance some tests will be statistically significant (eg, 5% of the time using α of .05). In some cases, adjustments are made to account for these multiple comparisons, and a P value lower than .05 is used to determine statistical significance. In the current analysis, adjustments were not made for multiple comparisons, but the P value is presented.

The p-value here is 0.03 for the difference in question. That passes the conventional threshold of significance (0.05), but it is close enough to the border that I’m quite suspicious. Here is the full conclusion of the paper:

Overall, there have been no significant changes in obesity prevalence in youth or adults between 2003-2004 and 2011-2012. Obesity prevalence remains high and thus it is important to continue surveillance.

Granted, these may turn out to be real true results. And the age class that showed a decline in obesity is definitely one we should focus on. But public health is a serious matter, and therefore we shouldn’t get ahead of ourselves.

One hypothesis that presents itself in regards to this paper is that a reviewer asked explicitly about the multiple comparisons problem. The authors acknowledged the problem, without actually checking to see if the results hold after a correction, and then the editor let the paper through. Of course this is just a model. I haven’t tested it, so can’t even offer up a p-value, even if I was a frequentist.

Note: The raw data is here.

• Category: Science • Tags: Health, Medicine, Obesity 
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I don’t currently have time to read Emily Oster’s Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong and What YouReally Need to Know, but I am very excited that it came out. Having had a pregnant wife and becoming a parent has made it clear to me that much of ‘conventional wisdom’ in regards to both parenting and pregnancy are socially enforced norms which have marginal empirical grounding (this is clear when you look at the huge variation in cross-cultural expectations even in developing societies). So I’m glad that Oster is pushing this issue in a somewhat more rational and hard-headed fashion that has previously been the case (i.e., some of people who I think have good ideas about skepticism of the idea that every pregnancy is a medical emergency waiting to happen at any moment, also try to sell you on ‘alternative medicine’ more generally). It doesn’t help that she’s within the penumbra of University of Chicago’s academic celebrity.

But the reason I’m posting right now is that the book’s Amazon page is a case in point in regards to the intersection between pregnancy and the culture wars. Of 50 reviews as of this writing 20 give it five stars, 2 give it two stars, and 28 give it 1 star!

• Category: Science • Tags: Health 
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Update 2: No longer accepting comments on this post. Please stop submitting. Thanks.

Update: Due to the vociferous and emotive nature of many comments, I am not publishing over half submitted on this post. Just so you know your chances…

One thing that I have read repeatedly is that circumcision rates in the United States have fallen over the past generation. For non-Americans in the readership, yes, American males are customarily circumcised even if they are not from a religious or cultural tradition where this is the norm (i.e., they are not Muslim, Jewish, or East or West African). For Americans, yes, circumcision has nothing to do with Christianity (something that would be obvious if more Americans actually read the New Testament, instead of just quoting selective passages from it). But looking more closely at the data it seems that the decline in circumcision is predominantly a function of its collapse as a normative practice in the western states!

One might think that this is due to demographic changes in the West, as Hispanics have lower rates of circumcision than non-Hispanics (black or white). But while California had circumcision rates of 22% in 2009, Washington state’s was 15%. It seems that Medicaid coverage has a strong effect, but this can’t explain all of the variation. In the late 1970s the western states had the same circumcision rates as the northeastern states. Today northeastern states have circumcision rates two to three times higher than in the west. And it doesn’t map onto politics either. Extremely conservative (and western) Utah has circumcision rates of 42%. Blue Rhode Island has rates of 76%.

Finally, I want to observe here that the males who were born during the era of diverging circumcision rates are now entering sexual maturity en masse. This is going to shape the expectations of both sexes, and perhaps result in some surprises for those who relocate to the other coast as they transition to adulthood….

• Category: Science • Tags: Circumcision, Culture, Health 
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Pancreatic cancer tissue

George Johnson is out with a new book, The Cancer Chronicles: Unlocking Medicine’s Deepest Mystery, and is also now at the center of a host of controversies due to some of his conclusions after years of research and writing. You can keep track of the volleys back and forth at his blog, Fire in the Mind. But I want to you pay close attention in particular to a new piece in Discover (print edition), Prehistoric Times: The idea that cancer is a modern disease is a common misconception — one that the fossil record reveals to be untrue. Here’s the big bold assertion: correcting for the greater longevity of modern people the rate of cancer is no higher today than it was in the human past. This is a shocking claim, and bound to cause controversy.

Though I am not able to judge the validity of this assertion in the specifics, it is not implausible on the face of it. Many of the claims for correlations between particular chemicals or environmental inputs and disease later on in life are subject to the problem of numerous confounds. It’s hard to pull signal out of the noise. But it is possible in some cases; the rates of lung cancer for long time smokers being one of the best socially relevant examples. And yet this itself illustrates and important caveat: there are those who don’t seem to have any of the environmental risk factors for lung cancer who nevertheless develop lung cancer. I know this in part because there are individuals who report that once they are diagnosed with lung cancer others whom they encounter begin to subject them to a battery of questions relating to whether they ever smoked, or, whether they lived with a smoker, because the impression is that this sort of cancer demands a lifestyle prior.

Why? An effect demands a cause. This is a common cognitive bias, and we regularly extract spurious patterns to establish transparent causality on the world. Ultimately there is causality…but it is not always so transparent. A lot of biological process is subject to noise and randomness at the level of our perception. Consider that inbred isogenic lineages of simple organisms kept under perfectly homogenized environments such as C. elegans still exhibit phenotypic diversity. Stuff happens for a reason, but we will never really know what the reason is. So we bracket that under “random.”

And this is probably true for cancer as well, and that is tragic and results in existential crises. The real answer to the question “Why me?” is quite often “No one knows, no one will ever know.” It may be that some cancer are due to clear and causal environmental inputs. But almost surely much of it is outside our practical control. On the margin George Johnson may be wrong (e.g., cancer rates may be 10% higher than the past due to toxic chemicals), but in the broader point that cancer has been a biological fact of multicellular existence which strikes somewhat randomly, I believe he is probably right.

This is not an emotionally palatable answer, so Johnson will remain on the receiving end of many attacks for some time to come. He bears a message which is deeply disquieting for the human need for order and just deserts.

• Category: Science • Tags: Cancer, Health 
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Fetus at ~12 weeks

I am going to get back to the eugenics debate at some point, but it is hard to motivate myself. This is due to a combination of complacency and sanguinity. Many of those who use eugenics as a “scare word” or are “very concerned about it” don’t really seem to get past generalities when it comes to the present situation (i.e., there is detailed exploration of past atrocities, and some exploration of rather unrealistic scenarios, such as occurred with the “Chinese eugenic” story, but little concrete engagement with realities such as the high abortion rates for positive tests for Down syndrome). In more crass and intellectually vapid discussions liberals and conservatives tend to use eugenics as a term of selectively useful instrumental rhetoric, a bludgeoning instrument only in the mindless screaming discourse.

Meanwhile, we have advances like the whole genome sequencing of second trimester fetuses. This is still basic science, but in genomics basic science is translated really fast to the consumer market. I’m ~90 percent sure my daughter will have a 10 x whole genome sequence by the end of 2014 (I might even get her parents in on the game for a trio). So, submitted for your interest are two papers on first trimester noninvasive screens for Down syndrome due to aneuploidies (and other syndromes). Non-Invasive First Trimester Blood Test Reliably Detects Down’s Syndrome and Other Genetic Fetal Abnormalities:

An Ultrasound in Obstetrics & Gynecology study by Kypros Nicolaides, MD, of the Harris Birthright Research Centre for Fetal Medicine at King’s College London in England, and his colleagues is the first to prospectively demonstrate the feasibility of routine screening for trisomies 21, 18, and 13 by cfDNA testing. Testing done in 1005 pregnancies at 10 weeks had a lower false positive rate and higher sensitivity for fetal trisomy than the combined test done at 12 weeks. Both cfDNA and combined testing detected all trisomies, but the estimated false-positive rates were 0.1% and 3.4%, respectively.

A second Ultrasound in Obstetrics & Gynecology study by the group, which included pregnancies undergoing screening at three UK hospitals between March 2006 and May 2012, found that effective first-trimester screening for Down’s syndrome could be achieved by cfDNA testing contingent on the results of the combined test done at 11 to 13 weeks. The strategy detected 98% of cases, and invasive testing was needed for confirmation in less than 0.5% of cases.

We did CVS. We’d rather not have to in the future. The key is to move positive tests into the first trimester. No matter the reality that most couples who receive a positive result in early second trimester choose to terminate, when it comes to killing a fetus every week counts. You can see what I mean when you look at how abortions are performed as a function of fetal development. Not only that, if you read the source papers you see that the typical woman who receives these sorts of screens is 35-40 years of age, and in that case with the fertility clock ticking every week is of the essence.


  1. Implementation of maternal blood cell-free DNA testing in early screening for aneuploidies.Ultrasound in Obstetrics & Gynecology, 2013; DOI:10.1002/uog.12504
  2. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing. Ultrasound in Obstetrics & Gynecology, 2013; DOI:10.1002/uog.12511
• Category: Science • Tags: Abortion, Down Syndrome, Eugenics, Health 
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Normally I don’t post “read the whole thing,” but this really applies in the case of Virginia Hughes’ new piece in Nature, The big fat truth. The ‘counter-intuitive’ finding is that in some age groups the slightly overweight have the lowest mortality rates. This is not totally surprising news, though there has been a long term debate on whether this is an artifact or not. Hughes notes:

If the obesity-paradox studies are correct, the issue then becomes how to convey their nuances. A lot of excess weight, in the form of obesity, is clearly bad for health, and most young people are better off keeping trim. But that may change as they age and develop illnesses.

The key here is that one-size-fits-all public health jeremiads are probably counter-productive in the long term. The question isn’t whether to present nuances, it is how to do it well. It doesn’t seem the status quo is working out so well after all.

• Category: Science • Tags: Health 
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Larry Moran has a post up, Who Owns Your Genome?, where he mentions me apropos of the HeLa genome disclosure:

In my opinion, there is no excuse for publishing this genome sequence without consent.

Razib Khan disagrees. He thinks that he can publish his genome sequence without obtaining consent from anyone else and I assume he feels the same way about the sequence of the HeLa genome [Henrietta Lacks’ genome, and familial consent].

In response to Larry, I don’t have a definitive opinion about the HeLa genome disclosure in terms of whether it was ethical to release it or not. “Both sides” have positions which I see the validity of. I think ultimately the root issues really date to the 1950s, not today, and they don’t have to do with personal genomics as such. Also, I’d recommend Joe Pickrell’s post, Henrietta Lacks’s genome sequence has been publicly available for years.

Larry also has a question in the comments:

Let’s try a thought experiment. Everyone is free to answer. I’d prefer a simple “yes” or “no” followed by an explanation.

Imagine that you have paid to have your entire genome sequenced. You announce that you intend to upload it to a public site so that anyone can see it. Your parents, your siblings, and your children, all object, saying that this would violate their privacy.

Do you upload it anyway? (“Yes” or “no.” Please respect the rules of a thought experiment and don’t try to quibble about the scenario.)

Yes, I’d upload it, and I will (since I’ve committed to uploading it when I have it done). Also note that my daughter is too young right now to give consent, and she probably will be too young when I upload the genome, so I’m going to do something which might impact her as a child.

One nuance I would like to add though is that decisions may vary given circumstance. For example, if you have one of the high penetrance BRCA mutations, you may not want to expose your family’s information for pragmatic reasons. But my question would be: why do people talk about their highly heritable illnesses in public forums already? I’ve seen media profiles of women with a BRCA mutation, with female relatives. By talking about this they’re exposing their family’s genetic information implicitly. Therefore, I suspect many of the pragmatic concerns are moot, because though there is privacy in regards to health information, there isn’t a taboo about discussing one’s health status in public. Most of the time people who have these diseases want their story put out there to aid in medical advancement and consciousness raising (though obviously there are exceptions).

And that is a subset of the primary issue I have with many worries about privacy and policy and the genome. Just transpose the structure of worries into other fields, and you wonder where the analogous concern is elsewhere. For example, in regards to health I’d argue diet is a much larger issue than genomics, at least for non-aged morbidity. But there is a huge industry of diet books, and very few people see licensed nutritionists. The point here isn’t to argue for paternalism or anti-paternalism, it’s to suggest that genetics isn’t special. It is important, it is cool, and it is fascinating. But so are many other things.

• Category: Science • Tags: Health, Personal Genomics 
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Egg freezing enters clinical mainstream:

Egg freezing is no longer an experimental procedure, according to the American Society for Reproductive Medicine (ASRM), which on 22 October issued new guidelines on the controversial practice. The change in policy is expected to accelerate the growth of clinics that offer egg freezing to women who face fertility-damaging treatment for cancer or other conditions, and to women wishing to delay having a baby — although the society stopped short of endorsing the procedure for that purpose

You can read the full guidelines, with caveats, online. Last I checked this costs on the order of $10,000. Nothing to sneeze at, but definitely not insane when you consider how much money many couples spend on fertility technologies when women are between 35 and 40.

And of course I recommend freezing sperm too. That’s far less costly.

• Category: Science • Tags: Fertility, Health 
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Recently I was at the dentist and I was told that because I did not have any caries at this age, I would probably not have to worry about that in the future (in contrast, I do have some issues with gingivitis). I wasn’t surprised that I didn’t have caries, I have no great love of sweet confections. I had chalked up my evasion of this dental ailment to my behavior. To make a long story short my dentist disabused me of the notion that dental pathologies are purely a function of dental hygiene and diet. Rather, he explained that many of these ailments exhibit strong family and ethnic patterns, and are substantially heritable. My mother did suffer from periodontal disease a few years back, and that has made me much more proactive of my own dental health.

As someone who is quite conscious of the power of genetics, I was quite taken aback by this blind spot. I realized that not only did I attribute my own rather fortunate dental health (so far) to my personal behaviors, but, I had long suspected those with dental issues of less than optimal habits. Obviously environment (e.g., high sugar diet) does matter. But apparently a great deal of the variation in the trait is heritable. If you are still curious, here’s a paper which might interest you, Heritable patterns of tooth decay in the permanent dentition: principal components and factor analyses.

• Category: Science • Tags: Health, Heritability 
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Anti-obesity: The new homophobia?:

Consider the many parallels between the treatments advocated by those who claim being gay is a disease, and those being pushed by our public health establishment to “cure” fat children and adults of their supposedly pathological state.

The advocates of so-called conversion or reparative therapy believe that “homosexuality” is a curable condition, and that a key to successful treatment is that patients must want to be cured, which is to say they consider same-sex sexual orientation volitional. These beliefs mirror precisely those of the obesity establishment, which claims to offer the means by which fat people who want to choose to stop being fat can successfully make that choice.

Those who seek to cure homosexuality and obesity have tended to react to the failure of their attempts by demanding ever more radical interventions. For example, in the 1950s Edmund Bergler, the most influential psychoanalytical theorist of homosexuality of his era, bullied and berated his clients, violated patient confidentiality and renounced his earlier, more tolerant attitude toward gay people as a form of enabling. Meanwhile, earlier this year a Harvard biology professor declared in a public lecture that Mrs. Obama’s call for voluntary lifestyle changes on the part of the obese constituted an insufficient response to the supposed public health calamity overwhelming the nation, and that the government should legally require fat people to exercise.

My first thought was, is this for real? You have to read the whole thing. I can’t but help wonder if some of the same issues that cropped up during our recent Down syndrome discussion isn’t reflected in this sort of thing. The author is Paul Campos, a law professor and gadfly, who himself is not overweight from what I can tell. It seems that as a society we now have a difficulty acknowledging that state A is preferable to state B, without that acknowledgment being assumed to be a license to strip all dignity from those who are in state B.

I have to be honest and admit that I think there’s some bias in the attitudes you see such as the ones that the Harvard professor above expressed. A few years back Sydney Brenner said some really strange things about overweight people, including specific overweight people in the room! Obesity has a negative economic correlation in the West, and is strongly stratified by class. For whatever reason fat people are not yet a class toward which sensitivity is warranted. And so boorish behavior is not uncommon.

Because honest differences in human quality are not acknowledged we have to remain silent. Beauty and intelligence are social constructs. And now you have the strangeness of people seemingly claim that some people are just born fat, and if they are born fat there is no way that they should be judged to be any less than someone who is of normal size. The very use of the term normal privileges a particular somatotype as normative. The default. The ideal. And I’m fine with that. I think we’d be healthier as a society if we could learn to talk about these issues, rather than get boxed into being card-carrying members of NAAFA or fat-nazis. Similarly I think being heteronormative is fine. Most people are heterosexual, and will be for the foreseeable future. This may change in the future, but we don’t live in the future. We live in the now.

Image credit: Wikipedia.

• Category: Science • Tags: Health 
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There’s a lot of buzz about a new paper in Nature (yes, I know there’s always buzz about some Nature paper or other), Impact of caloric restriction on health and survival in rhesus monkeys from the NIA study. You’ve probably heard about calorie restriction before. For me the issue I have with it is that people who are very knowledgeable (i.e., researchers who know a great deal abut human physiology, etc.) have given me contradictory assessments of this strategy of life extension. But it’s not totally crazy, there are serious scientists at top-tier universities who practice calorie restriction themselves. This isn’t the final word, but I wouldn’t be surprised if it is going to take decades for it to resolve itself for humans specifically (because some people will always be, and perhaps rightly, extrapolating from short-lived organisms to humans when it comes to modulations of lifespan in the laboratory). The New York Times piece had a really strange coda:

Dr. de Cabo, who says he is overweight, advised people that if they want to try a reduced-calorie diet, they should consult a doctor first. If they can handle such a diet, he said, he believes they would be healthier, but, he said, he does not know if they would live longer.

Some scientists still have faith in the low-calorie diets. Richard Weindruch, a director of the Wisconsin study, said he was “a hopeless caloric-restriction romantic,” but added that he was not very good at restricting his own calories. He said he might start trying harder, though: “I’m only 62. It isn’t too late.”

Then there is Mark Mattson, chief of the laboratory of neurosciences at the National Institute on Aging, who was not part of the monkey study. He believes there is merit to caloric restriction. It can help the brain, he said, as well as make people healthier and probably make them live longer.

Dr. Mattson, who is 5-foot-9 and weighs 130 pounds, skips breakfast and lunch on weekdays and skips breakfast on weekends.

• Category: Science • Tags: Diet, Health 
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The New York Times has a piece on an update to the American Academy of Pediatrics position statement on circumcision (shifting toward a more pro-circumcision position of neutrality). In the United States the rates of circumcision for infant boys has gone from 80-90% to ~50% (there are regional variations, so only a minority of boys in the Pacific Northwest are circumcised). A few years ago Jesse Bering put up a post, Is male circumcision a humanitarian act?, where he actually wrote “Nobody knows where your child will live as an adult (perhaps Africa), or how rampant HIV will be there….” I like taking probabilities into account, but this is ridiculous.

Let’s ignore Jewish ritual circumcision, which has to be done in early infancy from what I know. The vast majority of the world’s circumcised men live in Africa and the Muslim world, with a substantial minority in the USA and American-influenced cultures.* So you don’t need to focus on infant circumcision at all. In Turkey circumcision is performed on boys who are considerably older. I understand that an 11 year old boy is not an adult, but if sexually transmitted diseases are your primary concern, then why not diminish some of the ethical concerns (granted, you will not abolish them) with surgery upon infants by pushing back the timeline? You could even push the age to 18 and still gain a lot of your preventive bang-for-the-buck in the United States. A substantial minority of 18 year old adults are virgins, and most of those who have had sex have not had many partners. In Africa free adult circumcisions have been reputedly popular in some areas, so I don’t see the problem if adults are offered this procedure for free.**

* South Korea and Philippines both have widespread circumcision due to American influence. Interestingly, a large number of Americans think that circumcision is a religious mandate for Christians. I’ve had Catholic friends explain it exactly this way, making it quite clear that the stereotype about Catholics not reading the Bible has a lot of validity.

** For the record, I do accept that in Africa male circumcision has some preventative value (there are also cross-country comparisons in Southeast Asia). But it seems like a totally irrelevant issue in most of the developed world. There’s no difference in the AIDS epidemic in South Korea vs. Japan, because both are advanced developing countries, and a society-wide heterosexual AIDS epidemic seems to never materialize in such nations.

• Category: Science • Tags: Circumcision, Health, Public Health 
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I often criticize Lefty readers for their lack of reality-basis. Specifically, they often want to align reality with their own normative preferences, even though normative preferences aren’t necessarily contingent upon reality (e.g., sex differences). My post on Down Syndrome has elicited similar responses, but from people one might term social conservatives. So, for example, Ursula and Matthew Hennessey have taken to denouncing me on Twitter, albeit for statements that they no doubt find extremely objectionable. Not too surprising. But I found this post, A gift named Magdalena, particularly instructive:

But we aren’t victims. In fact, we’re the opposite. We are supremely lucky. Magdalena isn’t sick. Down syndrome is not a disease; it’s merely a collection of traits, all of which occur, though not all at once, in so-called “normal” people.

But how could Down syndrome be a gift? Surely that’s taking it too far. How could a lifetime of likely dependency be a gift? How could impaired cognitive development be a gift? How could gastroesophageal reflux disease and its expensive, twice daily medicine be a gift? How could two full years of potty training with no end in sight be a gift?

The truth is that there is no objective bright line between trait and disease. In fact, nature does not know trait or disease, it only knows phenotypes. Being white skinned in a pre-modern world is a disease at the equator, and being black skinned in Scandinavia would also have been a disease. In theory you could argue that Down Syndrome is not a disease either. The Hennessey’s are correct that the collection of traits of DS individuals can be found elsewhere. So imagine that a chemical exposure or some such thing functionally transformed a child with a normal karyotype into one with Down Syndrome. How would most people feel about this? Would parents view it as a gift?

Unlike some people who support abortion rights I don’t think that being pro-life is a malevolent anti-woman position. I think it is a sincerely held normative stance which has a basis in some straightforward logic. If you are pro-life, and you think abortion is the killing of a person, you don’t need to outline to me how valuable a human life is. That is something we begin with a priori. As it is, the reaction of some social conservatives to the reality of the abortion of individuals with congenital defects seems to me to resemble the caricature of Leibniz’s solution to theodicy. Instead of plainly stating why it is wrong, they seem to want to abolish the reasons which people give for having an abortion as reasons at all. The reasons may be valid even if the action is not right.

In any case, the Hennessey’s response is not that unusual in the specifics. Many people have had to take care of family members who are ill or infirm. They often state that these experiences build their character, and there is no doubt that their actions are the right, proper, and moral thing to do. But that does not entail that illness and infirmity are not things to be avoided if that possibility was available!

More broadly my point is that as a society we don’t have a good way to talk about human difference. We accept moral equality, but then implicitly go beyond that to destroy the distinctions between us, horizontal (e.g., male vs. female) and vertical (e.g., intelligent vs. not intelligent). The paradox is that in our choices we continue to acknowledge the power of difference, likely because our cognitive intuitions are keen toward detecting and sifting across differences.

• Category: Science • Tags: Down Syndrome, Health 
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‘Ashley treatment’ on the rise amid concerns from disability rights groups:

A controversial procedure to limit the growth of severely disabled children to keep them forever small – which ignited a fiery debate about the limits of medical intervention when it was first revealed five years ago – has begun to spread among families in America, Europe and beyond.

Five years ago details first emerged of Ashley, a nine-year-old girl living near Seattle. She was born with developmental disabilities that meant she was unable to talk or walk, and continues to have the cognitive ability of an infant.

The core of the treatment was hormone therapy: high estrogen doses to bring forward the closure of the growth plates in her bones, which would in turn stop her growing. In addition, surgical interventions included removal of her nascent breast buds to avoid the discomfort of fully-formed breasts later in life, and a hysterectomy to avoid menstruation.


Silvia Yee, a lawyer with the Disability Rights Education & Defense Fund that is run jointly by disabled people themselves and parents of children with disabilities, said: “This is what we were fearing. It is becoming just one more choice on the menu of possibilities – a medical operation that will change a person’s life. Who has the right to decide to change an individual into a different entity?

There are two dimensions of evaluation here. The positive, and the normative. As alluded to above the menu of possibilities are going to expand radically in the foreseeable future. So there’s no point in putting our heads in the sand on this. You start out with preimplanation genetic screening, and move all the way to irreversible physical changes as outlined in the story at the link. In the specific case the rationale for these changes is pretty straightforward; humans with the minds of infants or toddlers but the bodies of adults can be extremely difficult to control. I have a little personal experience in this area, as I worked with a mentally handicapped young man as his “minder” for a term in secondary school. His cognitive profile was probably similar in many ways to a one to two year old, but he was of average height and somewhat above average weight. One of the major issues with this young man is that he needed to be kept under surveillance, as he had a tendency throw fits and assault random people. Conventional moral reasoning simply did not work with him, because as I said he was barely a toddler mentally (he has a very minimal comprehension of language). Now expand this to the problem which parents and relatives have in caring for an individual with the physical capacities of an adult, but the mental aptitudes of a very young child. Imagine the temper tantrums of a two year old in the body of a thirty year old. This is a reality for many.

But let’s move to the normative dimension: who makes these decisions, and who decides who and what an individual becomes? The former is to a great extent a prosaic matter of power politics. Parents and institutions, civil and governmental, have long battled over children. But the latter is a deeper philosophical issue. What makes you you? There are many individuals for whom their religious identity is simply an essential part of who they are, but usually that identity is conferred upon them by their parents. Do the parents have the right to create such an individual, with a particular sense of self? My point is that when you moot the issue of identity in a deep fundamental manner you open up a huge can of worms, and broader issues which go back to David Hume and further deep into the mists of antiquity.

Finally, as a new parent these sorts of stories have a heightened salience for me. They are usually presented in a narrative style which strips away the substance of lived experience, and pits several actors and agents against each other. Here you have the parents and a group of activists, along with the governments and hospitals. But the organic reality of living decades as a caregiver for a profoundly disabled individual is removed from the picture. The impact that it might have on other children, or on your social relations more generally are not present in the narrative. We live in a world where many parents neglect their children, or enter into the stage of life of being a parent with relative casual interest or focus. But these particular parents, who are put in a position of extreme difficult emotionally and materially, are monitored with great care, and have a whole cadre of public interest lawyers devoted to making sure they do the right thing (the “right thing” being what others determine).

The root problem we have as a society about discussing these issues is that we don’t have a fully fleshed out explicit model for what the good life is. There are some activists in the disability rights movement who deny that the lives of people we generally classify as disabled lacking in anything. This is a complex question, because to some extent we are all imperfect. But is a world without children in wheelchairs or children with Down syndrome a lesser world? Too often the arguments in favor of allowing for nature to take its course in these matters are reminiscent to me of the arguments of Leibniz. I lean against the idea that we need the physical and mentally disabled, at least more than the suffering which these disabilities impose upon individuals who are the subjects of the suffering, or the families around them. I do not believe that we must evaluate all questions as matters of individual utility, but that is certainly where we should start.

• Category: Science • Tags: Culture, Health 
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I just attended a presentation where a researcher outlined how epigenomics could help patients with various grave illnesses. Normally I don’t focus on human medical genetics too much because it always depresses me. I don’t understand how medical geneticists don’t start wondering what hidden disease everyone around them has. In any case the researcher outlined how epigenomic information allowed for better treatment, so as to extend the lives of patients. All well and good. But then one individual in the audience began asking pointed questions as to the medical ethics of the enterprise, and whether the researcher had cleared some legally sanctioned hurdles. More specifically, there was a question whether exploring someone’s epigenomic profile might expose private information of their relatives! (because relatives share epigenomic and genomic profiles to some extent)

Frankly I began to get enraged at this point. People are suffering from terminal illnesses, and considerations of the genetic privacy of their near relatives are looming large? Seriously? The reality is that manifestation of a disease itself gives one information about the risks of their relatives. In any case, the researcher admitted that further progress in this area is probably going to be due to the investments of wealthy individuals (e.g., people like Steve Jobs who have illnesses) as well as outside of the United States. You’re #1 America!

• Category: Science • Tags: Health, Human Genetics, Human Genomics, Medicine 
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My main current interest in personal genomics right now is pure recreation. I don’t expect much utility out of it, because a lot of correlations between genes (SNPs, etc. ) and traits/diseases are rather weak. But there are some exceptions. Recently I was temporarily put on a prescription medication and I wanted to check if I was a fast or slow metabolizer. The material you see in the medical literature is that Europeans tend to be slow metabolizers, while Asians tend to be fast metabolizers. Since I’m Asian, I’m probably a fast metabolizer, right? Not so fast! Though I’m geographically Asian (my family hails from Asia), in terms of ancestry South Asians tend to be closer to Europeans, though with some affinity to East Eurasian populations as well. But another issue for me is that I clearly have 10-15% more recent East Asian ancestry, which is not typical in South Asians. In other words, I can’t infer with any confidence from generalizations about Asians and Europeans in the American medical literature to my personal status.


But that’s OK. It turns out that one locus determines most of the effect of this trait, and that locus has been genotyped in 23andMe. Using Promethease I ran my genotype, and it concluded I was a slow metabolizer. This has some utility in terms of when I take my medication. And it’s the first time that I can think of 23andMe giving me “actionable” information.

More broadly I realized that this sort of genotyping service is particularly useful for those of us who fall between the European/East Asian/African categories used in much of the American medical literature. The main concern is that genetic background might matter. That is, a SNP or set of makers correlated with a disease or trait in one population may not be correlated in another population. But this concern is less of an issue for me now after the past few years. Though some different risk alleles are being found across populations, by and large they’re pretty portable. Though the utility of this service for South Asians is obvious, in the American context it will probably be most useful to mixed-race Latinos, who are going to segregate out in traits at large effect loci between their parental populations (if those traits do differ).

• Category: Science • Tags: Genomics, Health, Personal Genomics 
Razib Khan
About Razib Khan

"I have degrees in biology and biochemistry, a passion for genetics, history, and philosophy, and shrimp is my favorite food. If you want to know more, see the links at"