Know Your Chances - Steve Woloshin, Lisa M. Schwartz, H. Gilbert Welch

At first I wasn't going to recommend this book, because I thought it was too simple. But I'm finding myself using the ideas they develop every time I read an article about health, and they are useful.

They point out that benefits of drugs are often talked about in terms of relative improvement: "Drug X reduces your risk of heart attack by 20%." But without knowing your absolute risk of having a heart attack, you can't tell if this is important or not. If your risk of having a heart attack is 1%, and the drug reduces it to 0.8%, this is obviously a different matter than if your risk is 50%, and the drug reduces it to 40%. And even the better case, do you care about at reduction from 50% to 40%? What are the side effects like?

I'm extrapolating a bit here, but I think the authors would like to see the FDA require drug companies to put a standard chart in ads and product literature that lists the effectiveness (and side effect percentages) of placebo and drug treatment. This would be a standard drug information label like the standard nutrition labels we have on all our foods. I was certainly startled to see how small the effects of many interventions are.

For instance, folic acid supplementation is recommended for all women of child-bearing age. The March of Dimes has run ads comparing not taking folic acid to letting your baby crawl out into traffic. And yet without folic acid supplements, you have a 2/1000 risk of neural tube defects, and with folic acid a 1/1000 risk. So it's worth taking folic acid because the cost and side effects are negligible, but it is making a very small risk even smaller.

The authors also cover risks and benefits of mammograms and PSA testing, which are now being better discussed by the media. I'd think very hard before having either one.

A deceptively easy read, because the ideas are so important and relevant.

Know Your Chances: Understanding Health Statistics
Steve Woloshin, Lisa M. Schwartz, H. Gilbert Welch
2008
Available from Amazon

Goo Gone

Every house should have Goo Gone. And now I have a new use for it.

I went to duplicate a DVD I had made a couple of years ago and discovered that my computer could not read it. It turns out when I had made the DVD, I had labeled it with an paper adhesive label by Avery, and that paper adhesive labels (all of them, not just AbverY) do something to the DVD (render it unbalanced? make it too heavy? warp the disk?) so that computer drives eventually can’t read them. The DVD worked fine in the DVD player attached to my TV, but not in my computer, perhaps because the computer drive spins the disk faster. Let me just say here that I am dumbfounded that anyone sells a label for DVDs that renders the DVD inoperable. Dumbfounded.

Through the wonder of the Internet, I learned that you can fix your DVD by removing the label, and that Goo Gone is the method of choice. So, with much trepidation (this was a DVD of my kids, so it mattered to me), I poured Goo Gone in a bread plate, put the DVD in label-side down, let it soak for 15 minutes, removed the label, and then washed and dried the disk. And voila! The DVD worked again. Of course, then I spent the next 3 hours with a little factory of bread plates soaking the labels off all my DVDs and labeling them with a Sharpie marker.

I love Goo Gone. It’s great for getting stick stuff off whatever. You can buy it at pretty much any hardware store or grocery store.

Goo Gone
Available from Lowe’s and a million other hardware/grocery/super stores

Rapture Ready – Daniel Radosh

Daniel Radosh sets out to explore Christian pop culture. I was cautious about picking this book up, because I didn’t want to read some screed against religion or something that denigrated believers in a general sense. But it did neither of these things. It is a respectful, thoughtful examination of Christian pop culture by an outsider. I feel like it helped me understand American evangelicals better, as well as understand more of their world view and the differences within the community. Plus, it was an incredibly engaging work. Radosh is a fun tour guide, well-versed in secular culture, and now, apparently, in Christian culture as well.

Rapture Ready! Adventures in the Parallel Universe of Christian Pop Culture
Daniel Radosh
2008
Available from Amazon

Medicine, Meaning and the “Placebo Effect” – Daniel E. Moerman

I picked up this book because David H. Newman mentions it several time in his book Hippocrates’ Shadow. He mentions it to make the point that medicine is not as effective as it seems, and that the human body, through things like the placebo response, does a lot of the healing work that we attribute to medicine.

Daniel E. Moerman is a medical anthropologist who dislikes the term placebo effect, because it is often used pejoratively and because it downplays the breadth of healing initiated by the body. He prefers the term “meaning response”, because our bodies are responding to the meaning we attach to the intervention. If someone is unaware they have been given a placebo, they don’t respond. For instance, studies have shown acupuncture to be effective for pain relief, but acupuncture given while the patient is under general anesthesia for some other reason have no effect on pain.

Moerman observes that the meaning response is so powerful it makes sense for medicine to invoke it as much as possible. Patients who respond to placebos are often seen as gullible or naïve, but he points out that no one has been able to establish any common characteristics of placebo responders. The beliefs of the medical professionals seem to be at least as important as the beliefs of the patient. In one study, patients were told they would be given either placebo, naloxone, or fentanyl for dental surgery pain. Placebo or naloxone would not reduce their pain, but fentanyl would reduce it markedly. The medical professionals were told that because of an administrative mistake, no patients would receive fentanyl in the first week of the experiment – that is no patients would get active medicine. Thereafter, patients might receive any of the treatments. All the patients were given placebo, and the study found that in the first week (when providers thought there was no chance the patients were getting fentanyl), patients had no decrease in pain. But after the first week, patients had significant pain relief from the placebo they received. Somehow the doctors were conveying to the patients that there was now a chance that they would get pain relief, and the patients were responding to that message.

I thought this book was interesting and important for medical professionals and patients, but also for counselors. He has two chapters on the meaning response in psychotherapy. One of the puzzles of psychotherapy is that psychotherapy is more effective than no treatment, but all methods of psychotherapy are about as effective as each other. Moerman argues that psychotherapy is invoking the meaning response, and lays out a framework for understanding it.

This is a more academic work than most books I read, but still very readable. I wish it was more widely read, because I thought it was an important book.

Medicine, Meaning and the “Placebo Effect”
Daniel E. Moerman
2002
Available from Amazon