One unhelpful question I keep thinking is: what leads people to use drugs and novel psychoactive substances like fentanyl? I think the authors have demonstrated that some people are going to use drugs, and a better policy is to reduce harm in those who do.
I wonder why the US is so resistant to the type of progressive policies that are implemented in other countries. It just doesn't make sense to me that we choose to put drug users in jail at a higher cost than putting them in medication assisted treatment. Because some people are always going to do drugs and for all the people who got addicted to opioids through prescriptions from a doctor, I hope we can embrace policies that lead to harm reduction and improve the quality of life for those who are addicted....more
An incredibly moving story. It didn't leave me completely inspired - it took a medical student afflicted with the disease in question who had already An incredibly moving story. It didn't leave me completely inspired - it took a medical student afflicted with the disease in question who had already created a patient/caregiver network to make significant progress in a rare disease. His case, his mother's case, and the patients' cases he provided were heartrending (especially the children). But to make a breakthrough, it took a well connected (the people he knew in data tech and industry are a who's who), highly motivated, afflicted individual to accomplish what he did. As inspiring as his story is, I was left in a little despair at how progress is going to be made in other diseases....more
This book does a good job of telling a horrible history. I've read the book Dreamland, and as Beth Macy wrote, her book is a complementary piece. In mThis book does a good job of telling a horrible history. I've read the book Dreamland, and as Beth Macy wrote, her book is a complementary piece. In my opinion the book does best in telling the story of Purdue Pharma (manufacturer of MS Contin and Oxycontin) and the devastation opioids caused in rural Appalachia. The light shined on Purdue Pharma does not paint the company in a good light (e.g., marketing charts showing that oxycontin has a constant release while their actual scientific study showed peaks and valleys). It is so bad, the company touted a paper citing a 1% addiction rate for years before it became widely known that the cited article did not apply.
The stories of individual families was extremely disheartening. The ease with which a company was allowed to market highly addictive substances compared to the difficulty in providing medication assistance to addicts (to manage their addiction) seems irrational. The lives destroyed because of prescription opioids, heroin and fentanyl was depressing. She told the stories from interviews with addicts and their parents across a multi-year timeline. The story of Tessa was one of the saddest things I've read.
As the author points out, it is so frustrating that this was allowed to happen. The Harrison Narcotics Act was passed in the 1910s because society was ravaged by opium, and the government kept the highly addictive stuff restricted to cancer pain until oxycontin....more
First, I want to thank St. Martin's Press for the advance reader copy.
Unfortunately for me, I didn't like it as much as his last book, Let There Be WFirst, I want to thank St. Martin's Press for the advance reader copy.
Unfortunately for me, I didn't like it as much as his last book, Let There Be Water. In Let There Be Water, I came away thinking that most of the narrative was fact based and fairly presented. I think he does a good job of being fact-based in Troubled Waters, but he makes little effort to fairly present the issue. I think my main takeaway is disappointment. I think Seth points out many failures in the regulation of drinking water. I may be more skeptical about his studies on contaminants, but the chapter on lead pipes is horrific - I googled my water company after reading it. I hope some progress is made, especially with better water treatment infrastructure. My main problem with the studies on contaminants, without seeing them, is that I assume the people conducting them have incentives to show a problem because they will lose their funding if the don't find a problem. He quotes someone at an environmental group as saying something along those lines - I'll list in the quotes below.
Page 15, "Some of the drinking water contaminants may prove to be benign, but the safer route is to have a higher level of caution." - My issue with this logic is that California tried to list coffee as a carcinogen. Twelve thousand doctors want cheese listed as a carcinogen (https://vegnews.com/2019/10/12000-doc...) This issue comes up throughout the novel. Just because a study is conducted, doesn't mean the methods are good.
Page 27, "Whether all, some or none of these were caused by the drinking water is impossible to say with absolute certainty, but it is likewise, impossible to know what future diseases or birth defects might be lurk..." - I don't know how he can say "it is impossible to know", and then list the worse possible outcome. He is anchoring the reader's expectation for the worse possible outcomes throughout the book, even where he doesn't have evidence.
Stopping here for now. I have many more pages marked to comment on....more
I feel bad giving this book 2 stars, but I had to force myself to read it. It started off strong - lots of biologic science, but developed almost intoI feel bad giving this book 2 stars, but I had to force myself to read it. It started off strong - lots of biologic science, but developed almost into social science. It appears that they have conducted a very strong systematic review of the literature, but I think they imply a lot more than is known. They do try to highlight this, where the direction of relationships between telomere length and an exposure is unknown (like depression and telomere length), but the book is full of correlations and evidence that "appears" to say...
Telomerase is the enzyme responsible for restoring the DNA lost during cell divisions. I thought the did a great job of documenting and explaining the consequences of people without properly functioning telomerase. I was surprised to learn how early their research (1980's) began. I remember when I took genetics in 2004, the books didn't recognize the full potential impact.
However, after the first 70 pages, they turn to examining the evidence for lengthening telomeres and increasing telomerase activity. They are extensive and cover as much as they feel confident. This article does a great job of explaining why I tend to be critical of many of their statements: http://slatestarcodex.com/2014/12/12/... - Beware the Man of One Study. I find that most of the people talking about juvenescence state outright that traditional statistical methods of measuring associations can't be applied. They (I'm thinking of Dr. Peter Attia) make the argument (probably correctly) that we won't be able to measure associations in this area as firmly as we would like and will have to rely on what makes sense based on the totality of evidence.
Anyway, that later 3/4 of the book is probably helpful, but I'm not sure the correlations are related to causality (as in a healthy diet will result in longer telomeres, maybe people who are willing to eat such foods do so because they have longer telomeres). ...more
CRISPR and the process leading to its discovery was a fascinating and interesting read. Unfortunately, the first 10% of the book was more about the auCRISPR and the process leading to its discovery was a fascinating and interesting read. Unfortunately, the first 10% of the book was more about the author, and the last half of the book was her almost apologizing for her discovery. This might be my first autobiographical book I've read, so I might just not be used to this genre, but I found her arrogant. The start of the book is so bad (constantly mentioning her accomplishments) that I didn't read the book for 4 months. In fact, I only finished it because I left the physical book I was reading at home and only had my kindle to read.
Once I got into the science, I thought the book was great. It was written at a perfect level for me - 13 years out of college where I had taken a lot of biology classes. I'm not sure if you can enjoy the book without a biology background. I highlighted a lot of terms that I plan to find more out about. So many things I was unaware of - like "Gene drive" and "Selfish genes."
Her hand-wringing at the end of the book seemed fairly balanced to me. I just thought the section was far too long. But ultimately, as she wrote, there's simply no way to unlearn this new knowledge, so we must embrace it. Same concept applies to artificial intelligence.
Anyway, all in all, I'm sure you can find a better youtube video on CRISPR than this book....more
Wow. This book covers an awful subject. The author, Sam Quinones, has done a vast amount of research and many interviews in compiling his book. The inWow. This book covers an awful subject. The author, Sam Quinones, has done a vast amount of research and many interviews in compiling his book. The interview style of his novel is interesting and griping. The stories from parents about how their children died are wrenching. The telling of the Walmart/opiate economy are interesting. The details on the pill mills and pharmaceutical marketing practices are outrageous. The background on Xalisco, Nayarit is so detailed and fascinating (except for the horrible implications).
Unfortunately, despite the increased awareness of heroin problems since 2014 (with the death of Philip Seymour Hoffman), the problem is still out of control. Well, heroin and fentanyl and fentanyl derivatives. I checked on the CDC's website (https://www.cdc.gov/drugoverdose/data...) and while deaths from prescription opioids have leveled off since 2013, deaths from heroin and fentanyl derivatives are surging.
The saddest part for me was the role of the medical community. I remember going to pharmacy school (in the mid 2000's) and hearing about pain being the fifth vital sign and that physicians could be down graded if they didn't assess pain. I was also taught that opioids caused physical dependence even when used appropriately, so caution should always be used in prescribing them. Thus, I was shocked, and dismayed, to read that prescription drug use was the primary problem that led to heroin use. ...more
Wow! If there was ever someone I agreed with wholeheartedly who I never knew existed, it is Dr. Gilbert Welch. This book is amazing; I am tempted to bWow! If there was ever someone I agreed with wholeheartedly who I never knew existed, it is Dr. Gilbert Welch. This book is amazing; I am tempted to buy a copy for everyone I know in the healthcare field. Unfortunately, I think his conclusion is fairly accurate 5 years later: there are penalties for under-diagnosis (e.g., malpractice lawsuits) and not penalties for over-diagnosis. I am sure, as the author asserts, that most healthcare providers realize we are ordering too many tests and procedures. Unfortunately, all the incentives push providers in that direction. Lawyers wait for a patient with "bad luck" and then sue every provider who saw their patient before the final bad news diagnosis. Additionally, hospitals administrators recognize the huge amount of revenue available from preventative screening and encourage all their providers to recommend screening.
I particularly like his description of lead in bias and 5 year survival. Anytime preventative screening is conducted at a younger age than when the disease of interest becomes symptomatic, the 5 year survival must be lower for the screened group than for the control group. Researchers are doing screening in a group that wouldn't be symptomatic anyway. The researchers need to follow the screened patients to the same age as the control group to tell if screening provides a benefit. In studies where the patients are followed (e.g., mammography), the result can actually be that the screened group does worse.
Our healthcare system is a mess. Dr Welch does a great job of exploring what one tiny corner of the mess looks like. :)...more
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