The best things I’ve read recently (2/4/2016)

Free trade, strong leaders and cancer scams

Trade, Labor, and Politics by Paul Krugman (New York Times)

“What all this means, as I said, is that the Democratic nominee won’t have to engage in saber-rattling over trade. She (yes, it’s still overwhelmingly likely to be Hillary Clinton) will, rightly, express skepticism about future trade deals, but she will be able to address the problems of working families without engaging in irresponsible trash talk about the world trade system. The Republican nominee won’t.

And there’s a lesson here that goes beyond this election. If you’re generally a supporter of open world markets — which you should be, mainly because market access is so important to poor countries — you need to know that whatever they may say, politicians who espouse rigid free-market ideology are not on your side.”

We must stop worshipping the false god of the strong leader by Archie Brown (Aeon)

“Prime ministers and party leaders – unless they are as well grounded as a Stanley Baldwin or an Attlee – acquire an unrealistic belief in the exceptional quality of their judgment and corresponding right to pull rank and determine policy, sustained as these convictions are by their entourage and the ambitions of some of those around them. It is not altogether surprising that leaders should fall prey to arrogance and to seeing themselves as being above the party that elevated them to its leadership. What is more astonishing is that so many of the rest of us should undervalue collegial and collective decision-making. Party leaders and prime ministers were not chosen because they were deemed to have a monopoly of wisdom. It is time we stopped worshipping the false god of the strong individual leader.”

Cancer cons, phoney accidents and fake deaths: meet the internet hoax buster by Rachel Monroe (Guardian)

“The kindness of strangers has helped families pay for treatment, raised money for research and provided support in dark times. But, through her hoax-exposing work, Wright has also seen how the online cancer community can sometimes become vicious. As Wright became increasingly well-known online, she began to receive messages asking her to investigate parents. Many of these emails mentioned one woman in particular, who frequently posted on charity websites requesting video games for her special needs son, Jayden.“I got emails about her, maybe 10 a day, saying look into this, look into that,” Wright recalled.

But the problem was that Jayden’s mother was not a hoaxer. “Their concern wasn’t the legitimacy,” said Wright. Instead, Jayden’s mother’s critics accused her of asking for too many video games, and she had responded to their snide comments by lashing out. Such tantrums are deviant behaviour in a community that is all about gratitude, heart emojis and inspirational quotations about hope.”

Bernie Sanders: he’s not the messiah, he’s a very muddled guy


Bernie Sanders has the aspect of an old testament prophet. Most politicians make great play of showing that they have a life outside politics. But Sanders’s furious insistence that the nation has become corrupt and must amend its ways is largely unleavened by such frivolities.  The messenger is the message and he apparently intends that it be taken most earnestly, for if he is not heeded pestilence awaits.

The response from the Clinton campaign is essentially that Sanders is a false prophet. They’ve taken his dramatic sounding proposals and begun to unpick them. Suggesting, for example, that his plan to break up the big banks neglects issues like shadow banking.

Their scepticism is lent support by a report from Kenneth Thorpe, an economist at Emory University. As Dylan Matthews reports for Vox, Thorpe advocates the US introducing a single payer healthcare system. That would mean Americans paying for their healthcare through taxes rather than insurance premiums. His preference for such a system is in part due to the fact he believes it would be much cheaper than the current mixed system.

Bernie Sanders also supports a single payer system and argues it would save America a substantial amount. Yet Thorpe appears sceptical about this proposal. He has released a paper suggesting that Sanders has overstated the savings he can find by $1.1 trillion.

That’s politically significant because while a single payer system might be expected to reduce total healthcare spending, it nonetheless requires an increase in government spending. That spending has to be paid for through extra taxes. So if someone says Sanders is overestimating the savings of a single payer system by $1.1 trillion, then by extension they are also saying he is underestimating the tax rises he’d need to introduce $1.1 trillion.

The efforts to introduce such a system in Sanders’ home state of Vermont floundered on the political infeasibility of raising taxes enough to make it work. Thorpe’s report indicates that Sanders has yet to find a way to avoid the recurrence of this problem.

Now at this point you might be wondering who to believe Sanders or Thorpe? Let me answer that question with a quote from Matthews’ reporting:

Sanders assumes $324 billion more per year in prescription drug savings than Thorpe does. Thorpe argues that this is wildly implausible. “In 2014 private health plans paid a TOTAL of $132 billion on prescription drugs and nationally we spent $305 billion,” he writes in an email. “With their savings drug spending nationally would be negative.” (Emphasis mine.) The Sanders camp revised the number down to $241 billion when I pointed this out.

That reflects terribly on Sanders’ team and their policy making. It’s hard to decide what is worse:

a) that they included an assumption that’s arithmetically impossible. It’s like an individual budgeting to save $324 a year by cancelling a gym membership that only cost $241.


b) that by their own implicit admission they  were wrong by an amount that was – at least – the equivalent of the GDP of Belarus.


c) that the budgeting for a central policy proposal was so flimsy that they are making corrections amounting to tens of billions of dollars because of a single email from a journalist.

Now there’s nothing wrong per se with amending policies. For example, Barack Obama opposed an individual mandate during the 2008 primary but then included one in Obamacare. Apparently the negative response to his plans from experts convinced him to change stance. But what Sanders is doing is rather different. Most obviously, it’s amateurish. More important, however, is that it’s not so easily rectified. Obama’s path was clear: include an individual mandate in the law after all. Sanders by contrast would a large amount of additional tax revenue in addition to plans that are already .

I submit that this is a telling error, which points to a broader problem with Sanders’ candidacy.

He is asking Democrats to believe that American voters who generally punish parties for choosing a candidate far from the mainstream, will this time reward them with such enthusiasm that it will trigger a “political revolution”. And that he will then achieve radical change within a system of government specifically designed to prevent it. This is not implausible in the way the US having negative spending on medicine is. Nonetheless, it is an extraordinary claim demanding extraordinary evidence.

An appropriately compelling case has not been forthcoming. His strategy seems to be predicated on winning back low income white voters, the Democrats haven’t actually lostIt also seems to wish away the high probability that Republicans will retain control of the House and therefore be able to sink his legislative as they have Obama’s. Nor does his single minded focus on income inequality seem well suited to an election where voters appear less concerned about economic security than the regular kind of security.

Perhaps he would be better off running for Governor of Vermont rather than President. In the laboratory of America’s most liberal he might be able to concrete results that other states and the Federal government could replicate. But the prophet Bernie wants to be America’s saviour rather its John the Baptist. He would need to perform miracles to fulfil his chosen role and he’s not shown that he can. Therefore, the appropriate response is doubt rather than faith.

La vie sans sucre: 5 things I’ve learned by avoiding sweet foods



I’m now 9 days away from finishing my month without sweet food and drink to raise money for Mind. Thanks to Tom, Sarah, Helen and Duncan who’ve donated already. If you would like to join them then please visit my page on Just Giving.

Here are 5 things I’ve learned so far:

1. A tougher rule can actually be easier to follow

I’ve spent more of the past few years than not trying to moderate how much sugar I ate. Frankly it’s been a bit of a waste of time. If I try only to eat sugar on ‘special occasions’ then an awful lot of occasions become special. If I resolve to only to eat small amounts, I start noticing that the marginal impact of a ‘little bit more’ is insignificant, and eat a little bit a lot. If I limit myself to certain days, then they become a 24 hour long bout of gorging.

Having a blanket month long ban, removes these loopholes. That makes it harder for me to defeat my own good intentions.

2. That said it’s still hard because sweet things are so nice

I’ve spent a fair amount of time looking longingly through the windows of bakeries or into supermarket freezer cabinets. There’s something uniquely tempting about sugary foods. Eating a muffin gives me a warm feeling that say a packet of crisps just doesn’t. Sweet foods feel so much lighter and smoother than most savoury ones.

There is science that explains why I feel like this. The brain rewards us when we eat pleasant foods by releasing a chemical called dopamine. With most foods, the more reguarly we eat them the less dopamine is released when we do. However, with

3. It’s hard to snack without eating sugar

This is a not unrelated point. A chocolate bar or a pastry are by far the simplest way to pick up something quick yet pleasant on the go. If they are not an option I’ve found I’ll often opt to go hungry instead.

4. It’s harder to give myself a treat

This is – besides the taste of chocolate – the thing I miss the most. I’ve come to realise that before this month that if I wanted to celebrate or cheer myself up then the way I did it would almost invariably involve sugar in some way.

5. My mood swings around a lot less than it did

This has been a definite upside, which tempts me to continue going without sugar beyond this month. I don’t know if this is a real effect, a placebo or just something I’m imagining but I do feel like more stable blood sugar levels have translated into my mood and energy levels also being more stable. For me that’s a big deal.


Mental illnesses are also physical

We make a distinction between physical and mental illnesses, and too often that means making a distinction between illnesses that are ‘real’ and those that ‘are all ‘in someone’s head.’

Obviously this way of looking at the distinction doesn’t make sense but does the distinction itself? I’d argue that in a very meaningful sense mental illnesses are physical conditions.

In fact, distinguishing the mental and the physical in any context is dubious. What we call thoughts represent physical changes in the brain and humans only experience the physical world through our thought processes.

Even if we get past this philosophical problem there are still problems applying the divide to mental illnesses. Let’s take depression as an example. As the video below makes clear, while there is little consensus about what causes it, there does seem to be a physical component, be it a chemical imbalance in the brain or changes to its structure.

What is more it actually has physical symptoms. NHS choices lists the following examples:

  • moving or speaking more slowly than usual
  • change in appetite or weight (usually decreased, but sometimes increased)
  • constipation
  • unexplained aches and pains
  • lack of energy or lack of interest in sex (loss of libido)
  • changes to your menstrual cycle
  • disturbed sleep (for example, finding it hard to fall asleep at night or waking up very early in the morning)

As a final kicker there are physical conditions that have the same symptoms – both mental and physical – as depression. For example, it is quite normal for Doctors to administer a blood test to someone they suspect might have depression in order to rule out the possibility that they have anemia.

Which all begs the question, why there is an additional stigma around mental illnesses when they are ultimately not that different from other conditions.

Dry January? Great but how about going dry all year round?

Dry January seems to be in fashion but might those giving up alcohol for a month find it even better to give it up all together?

The New Scientist seems to have turned some of its staff over to the UCL medical school as lab rats for an experiment in what difference giving up booze for a month made:


First off, he revealed that there had been no significant changes in any of the parameters measured for the four people who didn’t give up alcohol.

But the changes were dramatic and consistent across all 10 abstainers (see charts).

Liver fat fell on average by 15 per cent, and by almost 20 per cent in some individuals. Jalan says this is highly significant, because fat accumulation on the liver is a known prelude to liver damage. It can cause inflammation, resulting in liver disease. “This transition is the harbinger first for temporary scarring called fibrosis and ultimately a non-reversible type of scarring that destroys liver structure, called cirrhosis,” says Jalan. Although our livers were all judged to be generally healthy, the fat reductions would almost certainly help to retard liver deterioration, he says.

Then came another surprise. The blood glucose levels of the abstainers dropped by 23 per cent on average, from 5.1 to 4.3 millimoles per litre. The normal range for blood glucose is between 3.9 and 5.6 mmol/l. “I was staggered,” says Kevin Moore, consultant in liver health services at UCLMS. “I don’t think anyone has ever observed that before.”

Glucose was measured using a fasting blood glucose test taken after participants had refrained from eating or drinking anything but water for 8 hours. This stimulates production of the hormone glucagon, which releases glucose from body stores into the blood. In a healthy person, a rise in glucose triggers the production of insulin, which tells certain cells to take up glucose from the blood to maintain a safe blood sugar level.

Type 2 diabetes results when cells no longer respond to insulin, leading to high blood sugar. A drop in circulating glucose in our tests could mean that our bodies had become more sensitive to insulin, removing more glucose from the blood – a sign of improved blood sugar control. We also lost weight, by 1.5 kilograms on average.

Total blood cholesterol, a risk factor for heart disease, dropped by almost 5 per cent, from 4.6 to 4.4 mmol/l. A healthy amount is considered anything below 5.2 mmol/l. “Basically, you’re getting improved glucose and cholesterol management,” says Moore.

The benefits weren’t just physical. Ratings of sleep quality on a scale from 1 to 5 rose by just over 10 per cent, improving from 3.9 to 4.3. Ratings of how well we could concentrate soared 18 per cent from 3.8 to 4.5. “It represents a significant effect on quality of life and work performance,” says Jalan, although he acknowledges that self-reported experiences are open to bias.

The only negative was that people reported less social contact.

Now this is only one study and might be mistaken – I don’t have the training to judge. But I’ve already blogged here about other evidence suggesting that abstinence has many benefits. What makes this new study particularly interesting its subjects were not problem drinkers. However, they still benefited from avoiding alcohol.

I wonder whether rather than being a validation of not drinking this study actually queries why we drink at all. Why given the apparent benefits of giving up alcohol, are we so enamoured of the idea of being a moderate drinker? Why not treat it like smoking something that is inherently undesirable and should ideally be cut out altogether?

The answer I suspect lies in the final sentence of the extract above: we Britons seem to have developed an almost insoluble mental link between alcohol and socialising. There are responses to this at both an individual and a social level.

As an individual, you can still go to the pub, a restaurant or a bar. Just order a soft drink. That’s what I do. If your friends make that uncomfortable for you – get better friends!

As a society, we could perhaps start thinking of less booze sodden venues for socialising. This shouldn’t really be too hard. Many cultures focus on coffee rather than alcohol and of course most us spent the first decade and a bit of our lives managing to hang out with our friends without needing alcohol. We could even hang onto pubs and clubs but have them serve soft drinks instead.

Alcohol is a remarkably destructive social crutch that we can and should learn to do without.

Disclaimer: I am emphatically not advocating prohibition. The war on drugs is enough of a failure without adding a war on booze to it. However, saying something should be legal is quite different from saying it is a good thing.

A medical case for teetotalism

Alcohol is icky – so much so that not drinking at all seems like the best idea.

Professor David Nutt – the man sacked as chairman of the Advisory Council on the Misuse of Drugs for relying on statistics not sensationalism – argues that the safest approach to alcohol is to avoid it altogether:

The myth of a safe level of drinking is a powerful claim. It is one that many health professionals appear to believe in and that the alcohol industry uses to defend its strategy of making the drug readily available at low prices. However, the claim is wrong and the supporting evidence flawed.

There is no safe dose of alcohol for these reasons:

• Alcohol is a toxin that kills cells such as microorganisms, which is why we use it to preserve food and sterilise skin, needles etc. Alcohol kills humans too. A dose only four times as high as the amount that would make blood levels exceed drink-driving limits in the UK can kill. The toxicity of alcohol is worsened because in order for it to be cleared from the body it has to be metabolised to acetaldehyde, an even more toxic substance. Any food or drink contaminated with the amount of acetaldehyde that a unit of alcohol produces would be immediately banned as having an unacceptable health risk.

• Although most people do not become addicted to alcohol on their first drink, a small proportion do. As a clinical psychiatrist who has worked with alcoholics for more than 30 years, I have seen many people who have experienced a strong liking of alcohol from their very first exposure and then gone on to become addicted to it. We cannot at present predict who these people will be, so any exposure to alcohol runs the risk of producing addiction in some users.

• The supposed cardiovascular benefits of a low level of alcohol intake in some middle-aged men cannot be taken as proof that alcohol is beneficial. To do that one would need a randomised trial where part of this group drink no alcohol, others drink in small amounts and others more heavily. Until this experiment has been done we don’t have proof that alcohol has health benefits. A recent example of where an epidemiological association was found not to be true when tested properly was hormone replacement therapy. Population observations suggested that HRT was beneficial for post-menopausal women, but when controlled trials were conducted it was found to cause more harm than good.

• For all other diseases associated with alcohol there is no evidence of any benefit of low alcohol intake – the risks of accidents, cancer, ulcers etc rise inexorably with intake.

Are night owls particuarly prone to depression?

PsyBlog reports a new study suggests it might:

In the new research on 59 participants, those who were confirmed night owls (preferring late to bed and late to rise) had lower integrity of the white matter in various areas of the brain (Rosenberg et al., 2014).

Lower integrity in these areas has been linked to depression and cognitive instability.

This research doesn’t tell us what the relationship is, but the authors guess that it may be related to ‘social jet-lag’.

Social jet-lag comes about because night owls are forced to live–as most of us are–like early risers. Work, school and other institutions mostly require early rising, which, for night owls, causes problems.

As night owls find it difficult to get to sleep early, they tend to carry large amounts of sleep debt. In other words, they’re exhausted all the time.

The high cost of social jetlag


Maria Konnikovan – the author of the rather good Mastermind: How to Think Like Sherlock Holmes – has written an article for the New Yorker which looks at the challenges of having our sleep regulated by actual clocks rather than our body clock. It includes some rather startling facts about just how dangerous this can be:

Roenneberg and the psychologist Marc Wittmann have found that the chronic mismatch between biological and social sleep time comes at a high cost: alcohol, cigarette, and caffeine use increase—and each hour of social jetlag correlates with a roughly thirty-three per cent greater chance of obesity. “The practice of going to sleep and waking up at ‘unnatural’ times,” Roenneberg says, “could be the most prevalent high-risk behaviour in modern society.” According to Roenneberg, poor sleep timing stresses our system so much that it is one the reasons that night-shift workers often suffer higher-than-normal rates of cancer, potentially fatal heart conditions, and other chronic disease, like metabolic syndrome and diabetes. Another study, published earlier this year and focussing on medical-school performance, found that sleep timing, more than length or quality, affected how well students performed in class and on their preclinical board exams. It didn’t really matter how long they had slept or whether they saw themselves as morning people or not; what made a difference was when they actually went to bed—and when they woke up. It’s bad to sleep too little; it’s also bad, and maybe even worse, to wake up when it’s dark.

Ruby Wax: ‘your pets are happier than you’

A few years back at a talk for new students at Kellogg College, I turned round and looked at the students sitting behind me. And the thought that struck me? “Wow, that women looks remarkably like Ruby Wax.” It turns out it was. She was studying a Masters in mindfulness based cognitive therapy.

She gave a TED talk recently about mental illness. She’s a brilliant guide to the subject. She combines her skills as a comedian with the knowledge gained both from her studies and being a bipolar sufferer to produce a funny, enlightening and profound talk.

The story of my favourite blog post

depression xalt

My favourite blog post ever is Hyperbole and a half’s wonderful explanation of what it’s like to have depression. Salon carries an interview with its author Allie Brosh.

Having known several people who suffer from depression, I know it’s a hard thing to talk about — let alone share with the world. Why did you write about depression?

I thought a lot about this, and I think that putting it out there was sort of my way of owning it. You know, taking this scary thing, the worst thing that has ever happened to me, and just looking at it, and examining how absurd it is, was really liberating.

I’ve been working on [the post] for a very long time. Probably over a year. Once the depression got bad – my way of sorting through things and finding out how to progress during a difficult time in my life is really to think about it. I’m sort of a self-fixer — where if something’s wrong I just go into my head and just think about it and think about it until I find some way to either fix it or deal with it mentally, and in the process of that, I do a lot of writing, just to sort things out. So I’d written part one, and I thought it was over after I’d written that, like, “Oh yeah, that was my experience with depression and it’s done now!” That was not the case. Very much not the case.

What kind of feedback did you get?

I got a lot of feedback – depression is such an isolating experience, and because of that it’s sort of surprising to see how many people sort of feel the same way or identify with this totally isolating experience I went through. And yeah, I like seeing how helpful it was to people; there were some people who didn’t even realize they were depressed, and they got help because of it. People who wouldn’t have felt comfortable talking about it, were coming up and talking to me about it. So it was helpful, it was helpful to me to see – as it would be helpful for a reader to see this and think, I’m not alone, it was helpful for me to get that feedback from people.