As a person who has multiple sclerosis, I read with great interest “STAT”, an article by Maria Bustillos that appeared recently on the Longreads website. (Click here to access the article). Bustillos describes her very unpleasant experiences when her 24-year-old daughter was diagnosed with MS. She also advances the hypothesis that animal fats are an important and overlooked factor in the cause and progression of MS.
If Bustillos is right, then removing animal fats from your diet should alleviate – or even eliminate – many symptoms of MS. I hope she’s right. Controlling MS through diet would be much simpler and less costly than many other alternatives. However, I have my doubts and want to summarize them here.
By way of background, I am a sixty-something Caucasian male who was diagnosed with MS in 2008. I have the remitting-relapsing form of the disease and have not had a relapse for almost eight years. I am also an active volunteer for the National MS Society (NMSS). I participate in their fundraisers – Bike MS, Walk MS, etc. – and I currently serve on the Board of Trustees for the Colorado-Wyoming chapter. It’s worth noting that the opinions stated here are mine alone.
The Animal Fats Hypothesis
Bustillos proposes that animal fats are a significant factor in causing MS and/or exacerbating its symptoms. She writes, “Animal fats appear to play a significant role in making MS patients sicker; fish oils help keep them healthier.” Based on this analysis, Bustillos recommends a vegan-plus-fish diet to manage MS. Let’s call this the animal fats hypothesis or AF for short.
While the AF hypothesis is useful, many other hypotheses about MS exist. One that I find especially intriguing is what I’ll call the clostridium hypothesis as proposed by Dr. Timothy Vartanian and his colleagues at the Weill Cornell Medical College.
The clostridium hypothesis derives from research conducted in the Faroe Islands, an isolated chain in the north Atlantic. Prior to World War II, the inhabitants of the Faroe Islands – the Faroese — had never recorded a case of MS. During World War II, the British established a naval resupply station in the islands and brought in scores of troops and pack animals, especially mules. The first recorded case of MS occurred in 1943 and heralded the beginning of an MS epidemic. Researchers have documented three successive epidemic waves since then. (Click here for more detail).
What changed in the Faroe Islands to enable the rise of MS? Dr. Vartanian and his colleagues suspect – but certainly haven’t proven – that the cause is a specialized subtype of the bacterium clostridium perfringens. The subtype produces the epsilon toxin, which can degrade the myelin sheath that protects the nervous system. Degraded myelin is a hallmark of MS.
Clostridium is associated with grazing animals and is often found in the soil where they feed. Vartanian’s team has found the epsilon-producing form of clostridium in soil samples from the Faroe Islands and also in stool samples of people who have MS – both in the Faroes and elsewhere. Dr. Vartanian and his team suspect that British pack animals introduced clostridium perfringens to the Faroe Islands and created an environmental trigger for MS. There’s no conclusive proof of this hypothesis but clostridium is certainly a bacterium of interest.
MS has traditionally been viewed as an autoimmune disease. For unknown reasons, the immune system attacks the body and degrades myelin. The clostridium hypothesis suggests that the immune system is reacting to a bacterial infection. It’s a very different model and potentially yields very different therapies.
Could a change in diet have caused the eruption of MS in the Faroe Islands? It’s possible but I haven’t found any evidence that the Faroese changed their diet substantially during or after World War II.
I’ve highlighted the clostridium hypothesis because I think it’s intriguing. But there are many other hypotheses as well. One, for instance, suggests that MS is related to a deficiency in Vitamin D. This is based on the observation that the incidence of MS is higher the farther one is from the equator. Presumably one gets less Vitamin D from the sun in far northern or southern latitudes. (Click here for more detail). My point is that there are many hypotheses and we shouldn’t consider the AF hypothesis in isolation. We can compare hypotheses to determine which one explains our observations best.
Norway and Colorado
Bustillo’s argument relies heavily on a study of the incidence of MS in post-war Norway. The study, by the neurologist Roy Swank, was published in 1952 in The New England Journal of Medicine. As Bustillos writes, Swank found that “…the incidence of MS in remote, mountainous dairy-farming regions, where there was a high consumption of beef and dairy products, was eight times higher than on the coast, where the predominant diet was based on fish.”
Bustillos and Swank conclude that diet was the causal factor behind these differences. That’s certainly possible but I’m not convinced. The evidence I would point to comes from my home state of Colorado, which also has an unusually high incidence of MS. In Colorado, the incidence of MS is about 182 cases per 100,000 people. In the United States as a whole, the ratio is 135 cases per 100,000 people.
Why the difference? Perhaps it’s Colorado’s altitude. That would fit nicely with the Norwegian study, which found that highlanders contracted the disease more frequently than coastal dwellers. Or perhaps it’s the fact that Colorado is the center of a large livestock industry. We have millions of grazing animals and I suspect our soil is chockfull of clostridium. This would lend credence to the clostridium hypothesis and the Faroe Island experience.
I can’t think of any dietary differences between Colorado and the rest of the nation that would account for the differences. As far as I can tell, the Colorado example doesn’t support the animal fats hypothesis — but doesn’t refute it either.
As Bustillos points out, Swank did considerable research on the vegan-plus-fish diet. Indeed, it’s often referred to as the Swank diet and is promoted by the Swank MS Foundation. (Click here for more detail). Bustillos claims that the National MS Society does not provide information on this diet. That’s not quite right. Here’s an article from 2008 on the NMSS website that summarizes a variety of diets, including Swank’s.
Beef Consumption and MS
If the AF hypothesis is correct, one surmises that there should be a correlation between beef consumption and the prevalence of MS. But I can’t find such a correlation in the available data.
Here, for instance, are the top five countries in terms of beef consumption per capita.
Hong Kong 123.51 pounds per capita per year
(Click here for the full table of 61 countries)
On average, the worldwide prevalence of MS is 30 cases per 100,000 people. Yet Argentina has only 18 cases per 100,000 people. Uruguay has 26. Brasil has 15. The USA has 135. (I couldn’t find data on MS in Hong Kong).
At the other end of the spectrum, Sweden and Norway don’t even rank in the top 61 countries in terms of beef consumption. Yet Norway has 160 MS cases per 100,000 people and Sweden has 189.
Based on the animal fats hypothesis, Bustillos concludes that a vegan-plus-fish diet is a good way – perhaps the best way – to manage MS. Let’s remember that other diets have also been proposed to manage MS.
In a popular YouTube video, for instance, Dr. Terry Wahls attributes her success in managing her MS symptoms to a diet rich in leafy greens, colored fruits and vegetables, seaweed, meat from grass-fed animals, and organ meats. She also stresses the need to reduce sugar and gluten as well as the need to reduce stress. Dr. Wahls’ MS symptoms were severe enough that she could no longer walk and was chronically fatigued. When she switched to her new regimen, she regained her energy and her ability to walk.
What intrigues me about Dr. Wahl’s diet is that it includes meat. In fact, her diet is quite similar to the popular paleo diet. Numerous testimonials suggest the paleo diet can help manage MS. (See here, here, and here, for instance).
All of these diets include meat, which a vegan-plus-fish diet excludes. If the AF hypothesis is correct, it seems that the paleo diet should exacerbate MS symptoms rather than alleviate them. It seems that either the vegan-plus-fish diet or the paleo diet might work to alleviate MS symptoms. But I’m hard pressed to explain how both could work. But perhaps we’ll soon find out as the National MS Society recently announced new research into both the Wahls and Swank diets. In cooperation with the Univeristy of Iowa, NMSS is investing $1 million in a 36 week clinical trial to measure the effectiveness of “…a low saturated fat diet (Swank diet) or a modified paleolithic diet (Wahls diet)”. Stay tuned. (Click here for more information).
Evidence Based Medicine
Bustillos writes a long critique of evidence-based medicine or EBM. She clearly believes that we should not accept EBM as the be-all and end-all of medical research. I agree. So does the medical establishment.
For some years now, medical researchers have used a hierarchy of evidence that includes at least four levels. The most stringent level of evidence – Level I – involves randomized, double blind experiments that are replicated in multiple locations. This is the gold standard of evidence-based medicine.
The least stringent level of evidence – Level IV – includes testimony from a panel of experts. Ideally, the panel will include experts from multiple institutions and represent multiple disciplines. The panel reviews the existing evidence and presents it in a public forum where interested parties can question their findings.
Based on what Bustillos writes, it appears that the animal fats hypothesis does not yet rise to the Level IV standard of evidence. Perhaps a useful next step for AF proponents — while we await the results of the NMSS/Iowa study — would be to organize a panel of experts and present their findings in public.
Bustillos offers sterling character references for researchers who agree with the AF hypothesis. She describes them as “distinguished”, “eminent”, “prominent”, and “highly qualified”.
I’m sure she’s right. I would similarly like to offer sterling character references for the neurologists, biologists, researchers, and clinicians that I have met in the MS community. Many of them have close personal connections to MS. Indeed, many of them have the disease themselves. On the whole, I find them to be highly professional, creative, and open-minded. They’re looking for answers and they’ll pursue any clue that seems promising.
I made my career in the computing industry and I recognize the Not Invented Here syndrome when I see it. I don’t see it in the MS community.
There are currently 14 FDA-approved disease modifying therapies (DMTs). None of these is a magic bullet that stops or reverses the course of the disease. However, the DMTs can slow the progression of the disease and produce useful outcomes in both the short term and long term.
Generally, the sooner one begins treatment with DMTs, the better off they are in the long run. Mark Freedman’s research, published in the journal Neurology (click here), suggests that, “…that early optimal treatment aimed at reducing disease activity can improve longer-term outcomes by delaying disease progression.”
Like Bustillos, I believe that good diet is essential to good health. I’m intrigued by the vegan-plus-fish diet. Yet, I’ve managed my MS symptoms successfully without it.
I eat a healthy diet but it’s not nearly as strict as vegan-plus-fish – or paleo for that matter. I follow the recommendations of various heath organizations like the American Heart Association. I don’t each much sugar but I don’t worry too much about gluten or dairy. I eat a lot of fish and vegetables but I also toss in a hamburger every now and then. Why? Because I believe that occasional pleasures are essential to good health as well.
I also do a lot of yoga. Perhaps that’s what makes the difference for me. Perhaps we should research yoga’s impact on MS more thoroughly. I think we could build a strong case for yoga – perhaps equally as strong as the case that Bustillos presents for the AF hypothesis.
The Newly Diagnosed Experience
Bustillos writes about her experiences in the immediate aftermath of her daughter’s diagnosis. By and large, she describes it as a nightmarish period in her life.
My own baptism into the MS world was more benign. The first thing my doctors told me was that there’s a lot that we don’t know. I accepted that and did a lot of research on my own. I discovered various therapies including the paleo diet, yoga, massage, and acupuncture. I adopted those that made most sense to me.
I’m sorry that Bustillos and her daughter had a negative experience. But I don’t think that’s relevant to whether we accept or reject the AF hypothesis. I think we should share as much information as we can about as many therapies as possible. But I don’t think we should promote the vegan-plus-fish diet as the one true solution. There’s just not enough evidence.
I’m interested in the vegan-plus-fish diet but not yet ready to convert. I’m well versed in Pascal’s Wager and I don’t require Level I evidence to pursue a potential therapy. But I would like to see some evidence that’s at least at Level IV. I have an open mind here but I need to know more.
I hope that Bustillos — and others who are intrigued by dietary therapies – will also keep an open mind about disease modifying therapies. The evidence is quite clear that it’s better to start DMT therapies earlier rather than later. It’s Level I evidence and it’s quite convincing.
If you met somebody from your third grade class, would you recognize her? How about someone you last saw a decade ago at a company where you used to work? How about a person you saw in a mug shot at the Post Office?
If you answered “yes” to any of these, you may be a super-recognizer. Super-recognizers literally never forget a face. They may also give us the next great leap forward in law enforcement.
We haven’t known about super recognizers for very long. Over the past 20 years or so, researchers have learned a great deal about the opposite condition known as prosopagnosia or face blindness. Some people – perhaps two percent of the population — just can’t remember faces. They’re “blind” to the faces around them. They can interact with you perfectly well while they’re with you but they won’t recognize you the next time they see you.
Researchers initially thought that this was a binary condition – either you were normal or you were face blind. Then someone had the bright idea that the ability to recognize faces might be distributed along a normal curve. If face blind people are clustered under one tail of the curve then the other tail should include people who are exceptionally good at recognizing faces – the super-recognizers.
It turns out that they were right. In 2009, Richard Russell and his colleagues published the first academic paper on the subject: “Super-recognizers: People with extraordinary face recognition ability”.
It seems like a typical academic topic but the story took an unusual twist when the Metropolitan Police Service in London took up the idea. As detailed in a recent story in The New Yorker, the Met experimented with super-recognizers as detectives. London has more security cameras than any other city in the world but couldn’t turn the images into a crime-fighting advantage. The city had millions of low-resolution images of potential criminals and nobody to interpret them.
The Met tried to change that with an organized team of super-recognizers. The super-recognizers browse through mug shots and then review footage from security cameras that have recorded a crime. In a surprising number of cases, the super-recognizer has an “aha” moment and links a miscreant to a mug shot.
How good are they? The Met calls super-recognizers “the third revolution in forensics” after fingerprints and DNA evidence. The Met solves about 2,000 cases a year with fingerprints and another 2,000 with DNA. By comparison, the super-recognizers solve about 2,500 cases.
At this point, you may be wondering just how good you are at recognizing faces. Here’s how to find out – the Cambridge Face Memory Test. Click here and you can take the same test that the Met uses to screen applicants for the super-recognizer team. If you get a high score, you might just apply for a position with your local police force.
Altruism is traditionally defined as: “behavior by an animal that is not beneficial to or may be harmful to itself but that benefits others of its species.” So here’s a simple question: why would anyone be altruistic?
One answer has to do with our relatives. Sociobiology suggests that all living creatures share one fundamental goal: to propagate our genes into future generations. Of course, the most direct way to propagate our genes is to reproduce.
But we can also propagate our genes by supporting our genetic relatives. So I might behave altruistically toward my sister because she shares much of my genome. If she reproduces successfully (and her children do as well), then some of my genetic heritage is passed on to future generations. So it pays to be nice to my sister. (It took me a long time to figure this out).
But why would anyone be altruistic toward someone who is not a genetic relative? According to Steven Arnocky’s recent paper in the British Journal of Psychology it has to do with another fundamental human drive: sex.
You may recall that competition for sex is a key element in maintaining the overall health of a species. When there is a fair amount of competition among males, females are remarkably good at picking out the best mates. What does “best” mean in this sense? The best men for producing healthy offspring who can in turn produce healthy offspring of their own.
So how do females know which males will produce the best offspring? Some of it is physical. For instance, females strongly prefer males who are symmetric rather than asymmetric. Being symmetric is, apparently, a good marker of genetic health.
Behavior also plays a role. We know, for instance, that creativity plays a strong role in mate selection – for both men and women. Ornamental creativity is especially attractive. Strictly speaking, ornamental creativity is not essential to survival. So those who display this trait are effectively advertising “I have more than enough to survive plus some left over for ornamentation. I have an abundance of what you want.”
According to Arnocky’s paper, non-kin altruism plays a similar role to creativity. It’s a behavior that is desirable to the opposite sex. The study used two different methods to measure altruism and then correlated the degree of altruism with sexual activity. Those who scored higher on altruism, “…reported having more sex partners, more casual sex partners, and having sex more often within relationships.” The correlation was stronger for men than women, suggesting that altruism is more important for women selecting men than for men selecting women.
In an interview, Arnocky summed up the results by noting that, “”It appears that altruism evolved in our species, in part, because it serves as a signal of other underlying desirable qualities, which helps individuals reproduce.”
Based on Arnocky’s findings, we may have been defining altruism improperly. The classic definition says that altruism doesn’t benefit the individual but does benefit the species. But Arnocky’s paper points out a very direct benefit to the individual – better mates and more of them. Given this, we need to re-phrase our initial question. It probably should be: why wouldn’t everyone be altruistic?
Want to get stuff done? You may need to compromise occasionally. Who’s better at that? Who do you think?
A recent study in the Journal Of Consumer Research (abstract here; pdf here) suggests that men working with men tend not to compromise. By contrast, men working with women or women working with women are more likely to find the middle ground.
The article, by Hristina Nikolova and Cait Lamberton – professors at Boston College and the University of Pittsburgh respectively — focuses on consumer behavior and is probably most relevant to marketing strategists. But I wonder if it doesn’t have much broader implications as well.
The study revolves around the compromise effect, which is well understood in marketing circles. Let’s say that you want to buy a car and you have two decision criteria: efficiency and prestige. Car X is clearly better on efficiency and OK on prestige. Car Y is clearly better on prestige and OK on efficiency. Car Y is also more expensive than Car X.
Which one do you buy? It’s a tough choice. So the salesperson introduces the even more expensive Car Z, which is even better on prestige than Car Y. Now Car Y is the compromise choice – it’s OK on efficiency and pretty good on prestige. With three choices available, Car Y is not the top of the line on either criterion but it’s acceptable on both criteria. The compromise effect suggests that you’ll buy Car Y.
The compromise effect has been demonstrated in any number of studies. Indeed, it’s why restaurants often add a very high-priced item to their menus. The item probably doesn’t sell very often but it makes everything else look more reasonable.
But what if you’re making the decision with another person? This hasn’t been studied before and Nikolova and Lamberton focus their attention on decisions made by two people acting together (also known as dyads). The authors looked at three different dyads:
Under five different conditions, Nikolova and Lamberton found essentially the same results. First, the compromise effect seems to work “normally” with female/female and female/male dyads. Second, the compromise effect has much less impact on male/male dyads. Such dyads tend to move toward one of the extremes – either Car X or Car Z in our example.
Why would this be? The authors suggest that it has to do with gender norms coupled with the act of being observed. They write, “Normative beliefs about women’s behavior suggest that women should be balanced, compassionate, conciliatory, accommodating, and willing to compromise….” Male gender norms, on the other hand require, “…men in social situations to be maximizers, assertive, dominant, active, and self-confident; their decisions should show leadership, … high levels of commitment … and decisiveness….”
For both genders, being observed influences the degree to which an individual adheres to the gender norms. If you know you’re being observed – and/or that you will need to defend your choice later – you’re more likely to behave according to your gender norm. Interestingly, men working with women tend to adopt more of the female gender norms.
Nikolova and Lamberton focus exclusively on consumer choice but I wonder if the same dynamic doesn’t apply in many other decision-making situations as well. Men may be willing to compromise but they don’t want to be seen as compromisers. If you need to compromise to get something done, it helps to add a woman into the mix.
Indeed, I was struck by the fact that the same day I discovered the Nikolova-Lamberton article, I also read about Tim Huelskamp, a Republican congressman from western Kansas. According to the New York Times, Huelskamp is a “hardline conservative member of the Freedom Caucus” who “quickly earned a reputation for frustrating Republican leaders…” after he was elected in 2010. Yesterday, a more moderate challenger defeated Huelskamp in the Republican primary. As one voter noted, ““I don’t mind [Huelskamp’s] independent voice, but you’ve got to figure out how to work with people.” Perhaps the good people of Kansas should elect a woman to replace him.
Four years ago, I wrote a somewhat pessimistic article about Jevons paradox. A 19th-century British economist, William Jevons, noted that as energy-efficient innovations are developed and deployed, energy consumption goes up rather than down. The reason: as energy grows cheaper, we use more of it. We find more and more places to apply energy-consuming devices.
Three years ago, I wrote a somewhat pessimistic article about the future of employment. I argued that smart machines would either: 1) augment knowledge workers, making them much more productive, or; 2) replace knowledge workers altogether. Either way, we would need far fewer knowledge workers.
What if you combine these two rather pessimistic ideas? Oddly enough, the result is a rather optimistic idea.
Here’s an example drawn a recent issue of The Economist. The process of discovery is often invoked in legal disputes between companies or between companies and government agencies. Each side has the right to inspect the other side’s documents, including e-mails, correspondence, web content, and so on. In complex cases, each side may need to inspect massive numbers of documents to decide which documents are germane and which are not. The actual inspecting and sorting has traditionally been done by highly trained paralegals – lots of them.
As you can imagine, the process is time-consuming and error-prone. It’s also fairly easy to automate through deep learning. Artificial neural networks (ANNs) can study the examples of which documents are germane and which are not and learn how to distinguish between the two. Just turn suitably trained ANNs loose on boxes and boxes of documents and you’ll have them sorted in no time, with fewer errors than humans would make.
In other words, artificial neural networks can do a better job than humans at lower cost and in less time. So this should be bad news for paralegal employment, right? The number of paralegals must be plummeting, correct? Actually no. The Economist tells us that paralegal employment has actually risen since ANNs were first deployed for discovery processes.
Why would that be? Jevons paradox. The use of ANNs has dramatically lowered the obstacles to using the discovery process. Hence, the discovery process is used in many more situations. Each discovery process uses fewer paralegals but there are many more discovery processes. The net effect is greater – not lesser – demand for paralegals.
I think of this as good news. As the cost of a useful process drops, the process itself – spam filtering, document editing, image identification, quality control, etc. – can be deployed to many more activities. That’s useful in and of itself. It also drives employment. As costs drops, demand rises. We deploy the process more widely. Each human is more productive but more humans are ultimately required because the process is far more widespread.
As a teacher, this concept makes me rather optimistic. Artificial intelligence can augment my skills, make me more productive, and help me reach more students. But that doesn’t mean that we’ll need fewer teachers. Rather, it means that we can educate many, many more students. That’s a good thing – for both students and teachers.