Wednesday, February 29, 2012

Statin Drugs, and the Congestive Failure of Pharma-centric Medicine

Disclaimer: Don't take medical advice from engineers.

The New York Times has an article out today about the side effects of statin drugs: Seems that the more time that goes by, the less clear it is that statins are actually worth taking. I'm not going to claim that statins don't help - if you're interested in that line of thought, read this, for example. But I do think the massive over-prescription of statins endemic in Western medicine is illustrative of the problem of treating symptoms rather than causes.

The line of thinking goes something like this: People with heart disease have been found to have elevated levels of bad cholesterol (LDLs - which incidentally aren't even cholesterol, but instead transport cholesterol). Statins lower LDLs. Thus people should take statins in order to reduce risk of heart disease. The goal, of course, is to go from this logically fallacious argument to then testing whether lowering bad cholesterol via statins actually decreases risk of heart disease. That is, do taking statins make you less likely to get heart disease, and one step further, less likely to die from heart disease? And it's here where the evidence is actually somewhat mixed. The best I've seen is that statins lower risk of cardiac events in people who already have heart disease, but do nothing to lower those risks for people without heart disease. Even more curiously, some scientists think that lower cholesterol levels have nothing to do with the benefit, and it's actually the anti-inflammatory properties of statins that convey their benefit to people already suffering from heart disease. So then why are tens of millions of people in this country alone on a daily regimen of statins?

I'm not writing this as a complete outsider. For some reason, my cholesterol seems to live in the borderline-high range, and when I was 21, my family doctor recommended that I start taking statins. I Googled it, and found that there are some potentially really bad side effects such as muscle degeneration.  At the time I was a competitive gymnast, and the potential for muscle degeneration in my twenties was actually quite horrifying to me. Not only that, but chronic diarrhea, cognitive impairment, and sexual dysfunction. Seriously? I mentioned it to my doctor, and he was basically of the opinion, "Well, statins lower your cholesterol, thus they are good". Having no other risk factors for heart disease, I politely declined. But how many millions of times did that conversation go the other way? Patient blindly trusts doctor, and ends up on a lifelong medication with potentially deleterious side effects and arguable benefits? At what point does prescribing these drugs cross the line from ignorance to negligence to criminal?

Anyway, the real answer to all this, as always, is to follow the money. Statins are a ginormous industry. Pfizer alone made over $12 billion from Lipitor in 2008. And there's nothing that big pharma likes more than finding a lifelong customer for an expensive drug. Once you're on a statin, you're on it for life. Cause the point isn't to actually cure anything (for their part, no drug company claims that statins cure heart disease, because they don't, and that was never the goal). Doctors don't make money prescribing exercise and dietary changes. And we, as healthcare consumers, like to focus on simple things like a number, because it's easier to view our health woes as the direct result of an aberrant metric than as extremely complex diseases with systemic causes and implications.

So, what to do? Exercise more. Eat more vegetables. Find ways to lower your stress. In other words, take responsibility for your health, because there's no miracle drug to do it for you.

Friday, February 10, 2012

Instagram for Hamburgers

Had an interesting conversation with a friend last night about innovation. I tend to align pretty squarely with the Peter Thiel school of thought, i.e., that innovation has stagnated massively in relative terms over the past 50 years, and we're generally not solving hard problems anymore. My friend thinks innovation is flourishing because "tools" and "frameworks" have gotten significantly better over the past 10 years or so, allowing people to go from  idea to prototype (or company) in record time. While that's true, I'd argue that this has actually led to a decrease in innovation rather than an increase, because it's so easy to build something silly and turn it into a play company.

For instance, most of you have probably seen the parody of stuff that Silicon Valley people say. But I actually hear about companies like this all the time. So today, I'd like to officially announce the pre-alpha release of BurgerFlux, a.k.a Instagram for Hamburgers.

BurgerFluxis a mobile social hyperlocal crowd-sourced culinary design platform that uses game dynamics to bring the most deliciously-imagined burger to fruition. Here's how it works. You, the hungry, burger-craving warrior, make your way to a local BurgerFlux Bistro, or a BurgerFlux Participating Partner (Burger PaPa). When you arrive at your imminent burger paradise, whip out your BurgerFlux Capacitor (a.k.a. iPhone 4 or above) and open up the sleekly-designed BurgerFlux Designer. With a few taps, you can select not only what goes on top of your FluxBurger, but also what the "buns" are made of. Fried eggs surrounding a kobe beef patty topped with locally-sourced dinosaur kale and heirloom tomatoes, with a ponzu dipping sauce? I'll have two. Once you're satisfied with your creation, simply hit the "Eat me" button, and your order will be instantly put on the queue, with payment deducted via NFC, or Square, or one of our roaming BurgerBankers, who will conveniently procure your payment from your back pocket while you are deciding on quail eggs versus extra carnitas.

But wait, there's more! Your burger design is instantly shared with all other BurgerFlux customers! Indecisive? No problem! Just order the most popular FluxBurger of the day, week, month, or millenium. Locally-designed burgers are automatically given higher weight, and the default view shows your friends' recently-imagined burgers immediately upon opening the app. But just like that second and third bite of a FluxBurger, it gets even better. If you submit a new burger design, and other people order your creation, you earn points towards a future burger purchase! Which is why your design is instantly shared to Facebook, Twitter, your own automatically-created automatically-created Tumblr (don't think too hard), with your BurgerFlux Bistro locale auto-checked into on Google Checkins, Foursquare, and Yelp (for experts). And it probably goes without saying, but we use Hadoop to process the BurgerLogs and track BurgerTrends, allowing us to align the BurgerGraph with your social graph and maximize your burger enjoyment vector.

BurgerFlux runs on node.js and will go public (launch and IPO) on or around April 1st, 2012.

Wednesday, February 01, 2012

Christopher Hitchens, and Secret Superpowers of Stammerers

I'm a bit ashamed to say that prior to Christopher Hitchens' death, I don't think I had seen any of his interviews. I started YouTubing around the other day, and I was amazed at the videos I found. Regardless of whether you agree with his beliefs, it's clear that he was an amazingly vibrant intellectual mind and an incredibly skilled debater.

So I was also surprised to discover shortly into the first video that Christopher Hitchens was a stutterer!

As a stutterer myself, I possess the strange ability to spot other stutterers that non-stutterers usually can't. I remember once during university, a very prominent politician came to give a talk, and it was clear in her opening remarks that she was a "covert stammerer" (i.e., pauses and substitutes words, but doesn't repeat syllables). I asked my friends afterwards if they noticed anything strange about her speech, and no one did. I told them she was a stutterer, and they were quite surprised.

In any case, since Christopher Hitchens was also one of the most fearsome debating powers in the world, I questioned my secret superpower, and decided to leave it to the Google. A quick search for "Christopher Hitchens stutterer" leads to a New Yorker profile that mentions how he used to have a "severe stutter", but overcame it via massive amounts of public speaking and debating. "Overcame" is somewhat of a misnomer here, as it never really went away, but needless to say, he was an unbelievably skilled speaker.

Which I suppose just goes to show you that communication involves far more than mere fluency of speech rhythm.