Dreaming Often Is Nonlinear Problem-Solving

(p. A15) Antonio Zadra and Robert Stickgold, two of the world’s leading researchers in the science of sleep and dreams, have written a remarkable account of what we know and don’t know about this mysterious thing that happens during the night.

. . .

To many, dreams are prophecies, implanted in our brains by God or angels; to others, they exist to encode our memories of the previous day, to others they are simply random neural firings.

. . .

The weight of the evidence supports a more elaborate, nuanced and wondrous version of the memory-encoding hypothesis. Messrs. Zadra and Stickgold have designed a conceptual model they call Nextup (“Network Exploration to Understand Possibilities”), using it to describe the progression of dreams throughout the four sleep stages and their different functions. They debunk the common myth that we only dream during REM sleep and show that, in fact, we are typically dreaming throughout the night and in nonREM sleep states. They tie all of this into the brain’s “default mode network,” in which our minds are wandering and, often, problem-solving. When we’re awake, our brains are so busy attending to the environment that we tend to favor linear connections and thinking; when we allow ourselves to daydream, we solve problems that have distant, novel or nonlinear solutions.

For the full review, see:

Daniel J. Levitin. “Destination Anywhere.” The Wall Street Journal (Saturday, March 6, 2021): C7.

(Note: ellipses added.)

(Note: the online version of the review was updated March 5, 2021, and has the title “‘When Brains Dream’ Review: Night Shift.”)

The book under review is:

Zadra, Antonio, and Robert Stickgold. When Brains Dream: Exploring the Science and Mystery of Sleep. New York: W. W. Norton & Company, 2021.

“Seems Ethernet Does Not Work in Theory, Only in Practice”

(p. A21) David Boggs, an electrical engineer and computer scientist who helped create Ethernet, the computer networking technology that connects PCs to printers, other devices and the internet in offices and homes, died on Feb. 19 [2022] in Palo Alto, Calif.

. . .

In the spring of 1973, just after enrolling as a graduate student at Stanford University, Mr. Boggs began an internship at Xerox PARC, a Silicon Valley research lab that was developing a new kind of personal computer. One afternoon, in the basement of the lab, he noticed another researcher tinkering with a long strand of cable.

The researcher, another new hire named Bob Metcalfe, was exploring ways of sending information to and from the lab’s new computer, the Alto. Mr. Metcalfe was trying to send electrical pulses down the cable, and he was struggling to make it work. So Mr. Boggs offered to help.

Over the next two years, they designed the first version of Ethernet.

“He was the perfect partner for me,” Mr. Metcalfe said in an interview. “I was more of a concept artist, and he was a build-the-hardware-in-the-back-room engineer.”

. . .

Before becoming the dominant networking protocol, Ethernet was challenged by several other technologies. In the early 1980s, Mr. Metcalfe said, when Mr. Boggs took the stage at a California computing conference, at the San Jose Convention Center, to discuss the future of networking, a rival technologist questioned the mathematical theory behind Ethernet, telling Mr. Boggs that it would never work with large numbers of machines.

His response was unequivocal. “Seems Ethernet does not work in theory,” he said, “only in practice.”

For the full obituary, see:

Cade Metz. “David Boggs, Co-Inventor of Ethernet, Dies at 71.” The New York Times (Tuesday, March 1, 2022): A21.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the obituary has the date Feb. 28, 2022, and has the same title as the print version.)

John List Shows Limitations of Randomized Controlled Trials (RCTs)

(p. A15) John List’s “The Voltage Effect” is marketed as a generic business title on how and whether to scale up an idea or product. Mr. List, an economics professor at the University of Chicago, explores why some ideas attain “voltage” and catch fire while others die out. This angle suggests that it will be another book about how to turn that great invention in your garage into the next Hewlett-Packard. But Mr. List is far too thoughtful to write something gimmicky or simple.

. . .

“The Voltage Effect” is a fine business book, though in many ways it works better as a meditation on the shortcomings of our increasingly data-driven world. The business community and academia have been taken over by data science. Mr. List seemingly argues that good and helpful data analysis may not scale well. It takes tremendous skill and talent to distinguish a scalable idea from one that is doomed to flop when you are working with a limited set of data and have an incentive to overhype your results. Data is the new currency; companies are presumed to have an unfair advantage if they have access to more of it. What gets less attention is the shortage of people who know how to make sense of statistical experiments and generalize them to a larger population.

The fields of business, policy and economics have all become enthralled with Randomized Control Trials. These are statistical experiments in which researchers take two populations: a “treatment” group that may be given cash or some other incentive and a “control” group that is not given anything. Researchers then observe any difference in outcomes from the experiment to make policy recommendations. RCTs can be a useful tool. But taking Mr. List’s lessons to heart, you see how limited they are.

Even the best-designed experiment may not give you insights that scale. For example, studies have found that it is more effective to give people cash in Kenya than to distribute aid through arcane development programs. The mantra in the development community has become “just give people money.” But just because cash is better than aid in Kenya, it doesn’t necessarily mean that a Universal Basic Income will work well in California.

For the full review, see:

Allison Schrager. “BOOKSHELF; Do We Have a Winner?” The Wall Street Journal (Monday, March 28, 2022): A15.

(Note: ellipsis added.)

(Note: the online version of the review has the date March 27, 2022, and has the title “BOOKSHELF; ‘The Voltage Effect’ Review: Do We Have a Winner?”)

The book under review is:

List, John A. The Voltage Effect: How to Make Good Ideas Great and Great Ideas Scale. New York: Currency, 2022.

CAR T Therapy Is a Durable “Cure” for Some Leukemia Cancers

(p. A17) Doug Olson was feeling kind of tired in 1996. When a doctor examined him she frowned. “I don’t like the feel of those lymph nodes,” she said, poking his neck. She ordered a biopsy. The result was terrifying. He had chronic lymphocytic leukemia, a blood cancer that mostly strikes older people and accounts for about a quarter of new cases of leukemia.

“Oh Lordy,” Mr. Olson said. “I thought I was done for.” He was only 49 and, he said, had always been healthy.

Six years went by without the cancer progressing. Then it started to grow. He had four rounds of chemotherapy but the cancer kept coming back. He had reached pretty much the end of the line when his oncologist, Dr. David Porter at the University of Pennsylvania, offered him a chance to be among the very first patients to try something unprecedented, known as CAR T cell therapy.

In 2010, he became the second of three patients to get the new treatment.

At the time, the idea for this sort of therapy “was way out there,” said Dr. Carl June, the principal investigator for the trial at Penn, and he had tempered his own expectations that the cells he was providing to Mr. Olson as therapy would survive.

“We thought they would be gone in a month or two,” Dr. June said.

Now, a decade later, he reports that his expectations were completely confounded. In a paper published Wednesday in Nature, Dr. June and his colleagues, Dr. J. Joseph Melenhorst and Dr. Porter, report that the CAR T treatment made the cancer vanish in two out of the three patients in that early trial. All had chronic lymphocytic leukemia. The big surprise, though, was that even though the cancer seemed to be long gone, the CAR T cells remained in the patients’ bloodstreams, circulating as sentinels.

“Now we can finally say the word ‘cure’ with CAR T cells,” Dr. June said.

Although most patients will not do as well, the results hold out hope that, for some, their cancer will be vanquished.

For the full story, see:

Gina Kolata. “Potential Leukemia Cure Leads to New Mysteries.” The New York Times (Thursday, February 3, 2022): A17.

(Note: the online version of the story has the date Feb. 2, 2022, and has the title “A Cancer Treatment Makes Leukemia Vanish, but Creates More Mysteries.”)

Modern Medical Consensus Supports Thousands of Years of Indian Ayurvedic Tradition of Nasal Rinsing

(p. D6) To the uninitiated, the neti pot may seem like yet another wellness trend. After all, the teapot-like vessel was popularized in the United States by the celebrity surgeon Dr. Mehmet Oz, who called it a “nose bidet” on “The Oprah Winfrey Show” and has been criticized for promoting unproven supplements and health products.

Rinsing warm saltwater through your nose — in one nostril and out the other — as an antidote for a variety of woes like sinus inflammation, congestion and allergies may seem strange and possibly scary;  . . .

But according to ear, nose and throat doctors, nasal rinsing, which traces back thousands of years to the Ayurvedic medical traditions of India, is an unusual example of a practice that is at once ancient, trendy and evidence-based. And, it’s safe and inexpensive to boot.

It has a “very, very high level of evidence, randomized controlled trial evidence, that shows that it does work and it does help,” said Dr. Zara Patel, an associate professor of otolaryngology at the Stanford University School of Medicine. Here’s what we know.

. . .

In 2021, an international team of experts published a consensus on how best to manage common sinus issues, like chronic inflammation of the nasal and sinus passages that can cause runny nose, congestion, impaired sense of smell and facial pressure or pain. They concluded, based on the best yet limited evidence, that regular rinsing with saltwater was one of the treatments most proven to be effective.

Other small studies have suggested that saltwater rinses can help with seasonal or environmental allergy symptoms like congestion, runny nose, itching and sneezing.

And there is some evidence that rinsing can help soothe symptoms of acute upper respiratory infections, like those caused by common cold or flu viruses, though there is less research on this use. One of the largest studies to date, published in 2008, was conducted on about 400 children aged 6 to 10 with colds or flus in the Czech Republic. Among the children who used saltwater rinses several times per day, their symptoms resolved more quickly and they were less likely to use fever medications, decongestants or antibiotics, or to have to miss school, than the children who didn’t rinse.

Dr. Patel, who practices in California, said that rinsing can also help clear fine particles from wildfire smoke, which can be irritating.

Though the evidence that rinsing helps with these various nasal issues is of mixed quality, experts say there are few downsides to trying it. “The risk is so low and the potential benefit so high for rinsers” that it’s worth giving it a go, said Dr. Nyssa Farrell, an assistant professor of otolaryngology at Washington University School of Medicine in St. Louis.

For the full story, see:

Alice Callahan. “What to Know About Nasal Irrigation.” The New York Times (Tuesday, February 1, 2022): D6.

(Note: ellipses added.)

(Note: the online version of the story was updated January 31, 2022, and has the title “Do Neti Pots Really Work?”)

The international consensus mentioned above was published as:

Orlandi RR, Kingdom TT, Smith TL, Bleier B, DeConde A, Luong AU, Poetker DM, Soler Z, Welch KC, Wise SK, Adappa N, Alt JA, Anselmo-Lima WT, Bachert C, Baroody FM, Batra PS, Bernal-Sprekelsen M, Beswick D, Bhattacharyya N, Chandra RK, Chang EH, Chiu A, Chowdhury N, Citardi MJ, Cohen NA, Conley DB, DelGaudio J, Desrosiers M, Douglas R, Eloy JA, Fokkens WJ, Gray ST, Gudis DA, Hamilos DL, Han JK, Harvey R, Hellings P, Holbrook EH, Hopkins C, Hwang P, Javer AR, Jiang RS, Kennedy D, Kern R, Laidlaw T, Lal D, Lane A, Lee HM, Lee JT, Levy JM, Lin SY, Lund V, McMains KC, Metson R, Mullol J, Naclerio R, Oakley G, Otori N, Palmer JN, Parikh SR, Passali D, Patel Z, Peters A, Philpott C, Psaltis AJ, Ramakrishnan VR, Ramanathan M Jr, Roh HJ, Rudmik L, Sacks R, Schlosser RJ, Sedaghat AR, Senior BA, Sindwani R, Smith K, Snidvongs K, Stewart M, Suh JD, Tan BK, Turner JH, van Drunen CM, Voegels R, Wang Y, Woodworth BA, Wormald PJ, Wright ED, Yan C, Zhang L, Zhou B. “International Consensus Statement on Allergy and Rhinology: Rhinosinusitis 2021.” International Forum of Allergy & Rhinology. 11, no. 3 (March 2021): 213-739. doi: 10.1002/alr.22741. PMID: 33236525.

Excessive Hygiene from Masking, Distancing, and Deep-Cleaning, Can Increase Allergies and Auto-Immune Diseases

(p. A17) The idea that exposure to some infectious agents is protective against immune-related disorders isn’t new and comes with significant scientific heft. The so-called hygiene hypothesis is constructed from epidemiologic evidence, laboratory studies and clinical trials that, put together, support the notion that an excessive emphasis on antisepsis is implicated in misalignments of the immune system that risk disease.

Allergic and autoimmune diseases are far less common in communities with less hygiene, and autoimmune disorders increase in children who migrate from areas with less emphasis on hygiene to areas with more emphasis. They are less common in agricultural communities, where exposure to dirt and animals is common, compared with neighboring communities with shared genetics but little farming. Children who attend daycare early in life—runny noses, colds and all—have less asthma and fewer allergies. Animal studies, laboratory experiments and small trials in humans all point in a similar direction: Avoiding exposure to some microbes prevents the immune system from training well and predisposes to autoimmune diseases.

. . .

This isn’t a paean to infections and poor hygiene but a reminder of the importance of balance. When I prescribe antibiotics, they have to be strong enough to treat my patient’s infection. But if I overtreat, I run the risk of giving the patient colitis (inflammation of the colon) without additional benefits. Current hygiene policies and practices need rebalancing.

. . .

The extreme concern for hygiene at the onset of Covid-19 was intuitive and understandable. The virus was spreading fast, information on routes of transmission was limited, and we as a society tried to protect one another from infection. But policies that were easy to support two years ago need re-evaluation. Distancing, deep-cleaning and masking aren’t “more is better” kinds of goods.

On the other side of the balance, health risks from extended intensive hygiene are credible. As Omicron recedes and we internalize the paucity of Covid-19 benefits from some hygiene practices, we should balance those against the benefits we lose by shielding our immune systems from normal exposures—and the ones we withhold from children by preventing the exchange of microbes through play and smiles.

For the full commentary, see:

Eran Bendavid. “Covid and the ‘Hygiene Hypothesis’.” The Wall Street Journal (Wednesday, February 2, 2022): A17.

(Note: ellipses added.)

(Note: the online version of the commentary has the date February 1, 2022, and has the same title as the print version.)

The Elite Experts Who Have Failed, Tend to Censor the Heterodox Outsiders Who They Fear

(p. 8) When you have a chronic illness and struggle to get better, you try to maintain a certain equilibrium by distinguishing yourself from all those other sick people, the ones who are trying truly crazy things while you are proceeding sensibly and moderately along the path to health.

. . .

These exotic treatments, from acupuncture to IV vitamin C to magnet therapy and more, weren’t the core of what helped me eventually gain ground and improve — strong and various doses of antibiotics played the central role. But they were the most educational part of my slow, still-continuing recovery, in the sense of what they revealed about the complexity and strangeness of the world.

The strangest of them all was the Rife machine.

. . .

Naturally, it worked.

What does “worked” mean, you may reasonably ask? Just this: By this point in my treatment, there was a familiar feeling whenever I was symptomatic and took a strong dose of antibiotics — a temporary flare of pain and discomfort, a desire to move or rub the symptomatic areas of my body, a sweating or itching feeling, followed by a wave of exhaustion and then a mild relief. I didn’t get this kind of reaction with every alternative treatment I tried. But with the Rife machine I got it instantly: It was like having a high dose of antibiotics hit the body all at once.

Of course, this was obviously insane, so to the extent that I was able I conducted experiments, trying frequencies for random illnesses to see if they elicited the same effect (they did not), setting up blind experiments where I ran frequencies without knowing if they were for Lyme disease or not (I could always tell).

. . .

When I set out to write about the entire chronic-illness experience, I hesitated over whether to tell this kind of story. After all, if you’re trying to convince skeptical readers to take chronic sickness seriously, and to make the case for the medical-outsider view of how to treat Lyme disease, reporting that you’ve been dabbling in pseudoscience and that it works is a good way to confirm every stereotype about chronic ailments and their treatment: It’s psychosomatic … it’s all the power of suggestion … it’s a classic placebo effect … poor Ross, taken in by the quacks … he’ll be ‘doing his own research’ on vaccination next


    But there are two good reasons to share this sort of story. The first is that it’s true, it really happened, and any testimony about what it’s like to fight for your health for years would be dishonest if it left the weird stuff out.

    The second is that this kind of experience — not the Rife machine specifically, but the experience of falling through the solid floor of establishment consensus and discovering something bizarre and surprising underneath — is extremely commonplace. And the interaction between the beliefs instilled by these experiences and the skepticism they generate (understandably) from people who haven’t had them, for whom the floor has been solid all their lives, is crucial to understanding cultural polarization in our time.

    On both sides of our national divides, insider and outsider, establishment and populist, something in human psychology makes us seek coherence and simplicity in our understanding of the world. So people who have a terrible experience with official consensus, and discover that some weird idea that the establishment derides actually seems to work, tend to embrace a new rule to replace the old one: that official knowledge is always wrong, that outsiders are always more trustworthy than insiders, that if Dr. Anthony Fauci or the Food and Drug Administration get some critical things wrong, you can’t trust them to get anything right.

    This impulse explains why fringe theories tend to cluster together, the world of outsider knowledge creating its own form of consensus and self-reinforcement. But it also explains the groupthink that the establishment often embraces in response, its fear that pure craziness automatically abounds wherever official knowledge fails, and its commitment to its own authority as the only thing standing between society and the abyss.

    This is a key dynamic in political as well as biomedical debates. The conspicuous elite failures in the last 20 years have driven many voters to outsider narratives, which blend plausible critiques of the system with outlandish paranoia. But the insiders only see the paranoia, the QAnon shaman and his allies at the gates. So instead of reckoning with their own failures, they pull up the epistemic drawbridge and assign fact checkers to patrol the walls. Which in turn confirms for outsiders their belief that the establishment has essentially blinded itself and only they have eyes to see.

    What we need, I’m convinced, are more people and institutions that sustain a position somewhere in between.

For the full commentary, see:

Ross Douthat. “How I Became Extremely Open-Minded.” The New York Times, SundayReview Section (Sunday, November 7, 2021): 8.

(Note: ellipses added.)

(Note: the online version of the commentary has the date November 6, 2021, and has the same title as the print version. The passages that are underlined above, were in italics in the original. In the underlined passages I use a hyphen were the original had ellipses.)

The passages quoted above are from a commentary adapted from Douthat’s book:

Douthat, Ross. The Deep Places: A Memoir of Illness and Discovery. New York: Convergent Books, 2021.

Change in Census Question-Wording Drove Seeming Decline in “White” Population

(p. A17) The most common reaction to the release of the 2020 census was summed up in the headline “Census Data show the number of white people fell.” The data show the number of whites declining by 8.6%. This observation was often coupled with a political projection: that while gerrymandering could benefit Republicans in 2022, the political future belongs to the Democratic Party, which commands large majorities among minorities.

. . .

In the 2010 census, 53% of those who said they were of Hispanic origin checked off only “white,” a 58% increase in numbers from 2000. That rise in white Hispanics helped account for the increase in the number of whites from the prior census. But in the 2020 census, a mere 20.3% of Hispanics checked off only “white,” contributing to the 8.6% decline in the total number of people identifying only as white.

That dramatic change probably stemmed not from a shift in social consciousness or demographics, but from a subtle change in the 2020 question about race. In 2010 the census asked respondents to check off whether they were white, black or African-American, American Indian or Alaska Native, various varieties of Asian or Pacific Islander, and “some other race.” They may check off as many race boxes as are applicable.

But in 2020 the census asked respondents who checked off “white” to specify their nationality: “Print, for example, German, Irish, Italian, Lebanese, Egyptian, etc.” No Spanish-speaking nationality was listed. That likely created the impression that Hispanic was another race, notwithstanding the previous question’s disclaimer that “Hispanic origins are not races.”

For the full commentary, see:

John B. Judis. “How the Census Misleads on Race.” The Wall Street Journal (Monday, August 30, 2021): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date August 29, 2021, and has the same title as the print version.)

Best New Climate Models Fail at Accurately “Hind-Casting” Past Temperatures

(p. A1) BOULDER, Colo.—For almost five years, an international consortium of scientists was chasing clouds, determined to solve a problem that bedeviled climate-change forecasts for a generation: How do these wisps of water vapor affect global warming?

They reworked 2.1 million lines of supercomputer code used to explore the future of climate change, adding more-intricate equations for clouds and hundreds of other improvements. They tested the equations, debugged them and tested again.

The scientists would find that even the best tools at hand can’t model climates with the sureness the world needs as rising temperatures impact almost every region.

When they ran the updated simulation in 2018, the conclusion jolted them: Earth’s atmosphere was much more sensitive to greenhouse gases than decades of previous models had predicted, and future temperatures could be much higher than feared—perhaps even beyond hope of practical remedy.

(p. A9) “We thought this was really strange,” said Gokhan Danabasoglu, chief scientist for the climate-model project at the Mesa Laboratory in Boulder at the National Center for Atmospheric Research, or NCAR.

. . .

As world leaders consider how to limit greenhouse gases, they depend heavily on what computer climate models predict. But as algorithms and the computer they run on become more powerful—able to crunch far more data and do better simulations—that very complexity has left climate scientists grappling with mismatches among competing computer models.

While vital to calculating ways to survive a warming world, climate models are hitting a wall. They are running up against the complexity of the physics involved; the limits of scientific computing; uncertainties around the nuances of climate behavior; and the challenge of keeping pace with rising levels of carbon dioxide, methane and other greenhouse gases. Despite significant improvements, the new models are still too imprecise to be taken at face value, which means climate-change projections still require judgment calls.

“We have a situation where the models are behaving strangely,” said Gavin Schmidt, director of the National Aeronautics and Space Administration’s Goddard Institute for Space Sciences, a leading center for climate modeling. “We have a conundrum.”

. . .

In its guidance to governments last year, the U.N. climate-change panel for the first time played down the most extreme forecasts.

Before making new climate predictions for policy makers, an independent group of scientists used a technique called “hind-casting,” testing how well the models reproduced changes that occurred during the 20th century and earlier. Only models that re-created past climate behavior accurately were deemed acceptable.

In the process, the NCAR-consortium scientists checked whether the advanced models could reproduce the climate during the last Ice Age, 21,000 years ago, when carbon-dioxide levels and temperatures were much lower than today. CESM2 and other new models projected temperatures much colder than the geologic evidence indicated. University of Michigan scientists then tested the new models against the climate 50 million years ago when greenhouse-gas levels and temperatures were much higher than today. The new models projected higher temperatures than evidence suggested.

For the full story, see:

Robert Lee Hotz. “Climate Scientists Encounter Computer Models’ Limits.” The Wall Street Journal (Monday, February 7, 2022): A1 & A9.

(Note: ellipses added.)

(Note: the online version of the story has the date February 6, 2022, and has the title “Climate Scientists Encounter Limits of Computer Models, Bedeviling Policy.”)

“People Are Now Coming to Their Own Conclusions About Covid”

(p. 3) Lauren Terry, 23, thought she would know what to do if she contracted Covid-19. After all, she manages a lab in Tucson that processes Covid tests.

But when she developed symptoms on Christmas Eve, she quickly realized she had no inside information.

“I first tried to take whatever rapid tests I could get my hands on,” Ms. Terry said. “I bought some over the counter. I got a free kit from my county library. A friend gave me a box. I think I tried five different brands.” When they all turned up negative, she took a P.C.R. test, but that too, was negative.

With clear symptoms, she didn’t believe the results. So she turned to Twitter. “I was searching for the Omicron rapid test efficacy and trying to figure out what brand works on this variant and what doesn’t and how long they take to produce results,” she said. (The Food and Drug Administration has said that rapid antigen tests may be less sensitive to the Omicron variant but has not identified any specific tests that outright fail to detect it.) “I started seeing people on Twitter say they were having symptoms and only testing positive days later. I decided not to see anybody for the holidays when I read that.”

She kept testing, and a few days after Christmas she received the result she had expected all along.

Though it’s been almost two years since the onset of the pandemic, this phase can feel more confusing than its start, in March 2020. Even P.C.R. tests, the gold standard, don’t always detect every case, especially early in the course of infection, and there is some doubt among scientists about whether rapid antigen tests perform as well with Omicron. And, the need for a 10-day isolation period was thrown into question after the Centers for Disease Control and Prevention announced that some people could leave their homes after only five days.

“The information is more confusing because the threat itself is more confusing,” said David Abramson, who directs the Center for Public Health Disaster Science at the N.Y.U. School of Global Public Health. “We used to know there was a hurricane coming at us from 50 miles away. Now we have this storm that is not well defined that could maybe create flood or some wind damage, but there are so many uncertainties, and we just aren’t sure.”

Many people are now coming to their own conclusions about Covid and how they should behave. After not contracting the virus after multiple exposures, they may conclude they can take more risks. Or if they have Covid they may choose to stay in isolation longer than the C.D.C. recommends.

And they aren’t necessarily embracing conspiracy theories. People are forming opinions after reading mainstream news articles and tweets from epidemiologists; they are looking at real-life experiences of people in their networks.

For the full story, see:

Alyson Krueger. “Covid Experts, the Self-Made Kind.” The New York Times, SundayStyles Section (Sunday, January 23, 2022): 3.

(Note: the online version of the story has the date January 21, 2022, and has the title “So You Think You’re a Covid Expert (but Are You?).”)

Expert Medical Advice Often Flip-Flops

(p. D6) A History of Medical Flip-Flops

Shifting medical advice is surprisingly common, and it tends to fall into three categories: emerging guidance, replacement advice and reversals.

Emerging guidance comes during times of crisis — like pandemics — and is destined to change quickly. In the past several months, guidance about the best way to treat Covid patients, masks to prevent transmission and the limits of vaccine protection have all shifted as knowledge of the coronavirus and its variants has evolved.

Sometimes it’s hard to tell the difference between replacement advice, which is issued when research improves on advice that came before it, and a full reversal, which comes about because a common medical practice got ahead of the science and never actually worked or even caused harm. Here are some examples of true medical flip-flops in recent years.

MENOPAUSE HORMONES TO PROTECT THE HEART: In 2002, decades of advice about the heart benefits of menopause hormones seemed to change overnight when a major study called the Women’s Health Initiative was halted after researchers detected more heart attacks in the women taking hormones. In hindsight, doctors had misinterpreted data from observational research. The current advice: Hormones can relieve menopause symptoms but shouldn’t be used for chronic disease prevention.

VIOXX AS A LOWER-RISK ARTHRITIS TREATMENT: In 1999, the Food and Drug Administration approved Vioxx as a breakthrough pain reliever because it lowered the risk of gastrointestinal problems. But by 2004, Merck had withdrawn the drug because studies showed it significantly raised the risk of heart attack.

ARTHROSCOPIC SURGERY ON AGING KNEES: For years, the partial removal of torn meniscus tissue was the most common orthopedic procedure in the United States, with about 700,000 performed a year. In 2013, a researcher in Finland compared the operation to a “sham” procedure and found there was no benefit. Most doctors now recommend physical therapy instead.

VITAMIN MEGADOSES TO LOWER CANCER AND HEART RISK: For years, doctors believed various vitamins could lower risk for cancer and heart disease, but a number of studies showed just the opposite. A study of beta carotene and vitamin A found that the supplements actually increased the risk of lung cancer in male smokers. A study of vitamin E and selenium, thought to protect against prostate cancer, increased risk for the disease.

STENTS FOR STABLE HEART DISEASE: Doctors used to insert stents — tiny wire mesh tubes that prop open arteries — in millions of otherwise stable patients with heart disease. A study found that the surgical procedure was no better than drug therapy for preventing heart attacks.

Dr. Vinay Prasad, associate professor at the University of California San Francisco, and Dr. Adam S. Cifu, a professor of medicine at the University of Chicago Department of Medicine, coined the term “medical reversal” and concluded that about 40 percent of common medical practices that they reviewed turned out to be useless or harmful. In their book, “Ending Medical Reversal: Improving Outcomes, Saving Lives,” they noted that most of these failed treatments were initially embraced because they were based on logical reasoning.

“The thing that’s often behind reversal: All of these things have a good story, they have good pathophysiological rationale,” Dr. Cifu said. “They should work. But things only work if they’ve been shown in people to work, and people are so complicated.”

For the full story, see:

Tara Parker-Pope. “Shifting Medical Advice Is a Feature, Not a Bug.” The New York Times (Tuesday, November 2, 2021): D6.

(Note: the online version of the story was updated Oct. 24, 2021, and has the title “Is the New Aspirin Advice a Medical Flip-Flop, or Just Science?” The paragraphs on menopause hormones to protect the heart and on vitamin megadoses to lower cancer and heart risk appear in the online version, but not in the print version.)

The book co-authored by Prasad and mentioned above is:

Prasad, Vinayak K., and Adam S. Cifu. Ending Medical Reversal: Improving Outcomes, Saving Lives. Baltimore: Johns Hopkins University Press, 2015.