• Make yourself healthy: Searching for the cause of acne

    Martha Rotter, a software engineer, grew up near St. Louis. She did not have skin problems in high school or college. After college, she spent six years in Seattle. Her skin got a little worse. In 2007, she moved to Dublin to work for an Irish branch of Microsoft. Six months after the move, she noticed her skin was worse than it had been in Seattle. In Seattle she would get a little acne or blemishes for a week or so and then they would go away. In Dublin, they weren't going away.

    Her skin got worse. A year after moving to Dublin, it was always bad. The spots and sores were always uncomfortable — "a headache on my face," she says. They were painful to touch. At one point Martha got a massage. Forgetting her warning, the masseuse rubbed oil on Martha's face. She screamed. "One of the most painful things ever," she says.

    Is my job making my skin bad? she wondered. She was working a lot, taking clients out, losing sleep. She started to go out less so that she could get more sleep. She stopped working on weekends. This didn't help.

    She tried many skin creams and face washes. "Neutrogena and Clearasil make a lot of products," she says. "On a bad day I could easily drop $50 on two or three things." For several months, she spent $100/month on creams, astringents, and soaps trying to find something that worked. Nothing did.

    She tried fitness. She went to the gym four or five times per week. She took yoga. Maybe this would help her relax and improve her mood, she thought. Her skin stayed bad.

    In the summer of 2008, she read The Acne Prescription (2003) by Nicholas Perricone. The book says that certain foods, such as salmon, blueberries, and spinach, will make your skin better. It had many before and after pictures. "Now people would be more cynical because of his skin care line and vitamins," she says. "Back then they weren't around or I didn't know about them." Perricone's advice didn’t help.

    In December 2008, she went home for Christmas. She hadn't seen her family for nine months. "They were surprised by my face," she says. They asked about it. "When a family member mentions something, that makes you realize it's obvious to everyone." She had been pretending to herself that other people didn't notice. After her family's comments, she didn't want to leave the house or have any pictures taken.


  • Make Yourself Healthy: Daughter Knows Best about Kidney Disease and Gluten Intolerance

    (I'm very interested in the Quantified Self movement, which involves self-experimentation and self-tracking to gain self-knowledge. Seth Roberts, a professor of psychology at Tsinghua University in Beijing and emeritus professor of psychology at the University of California at Berkeley, is one of the pioneers of the modern Quantified Self movement. From time-to-time, he's going to contribute a "Make Yourself Healthy" essay for Boing Boing. — Mark)

    Gail, who is now 70, grew up near Toronto. As early as she can remember, she had digestive problems — pain after meals and troublesome bowel movements (diarrhea and constipation). Her father, a doctor, sent her to specialists. They couldn't find anything wrong and implied it was all in her head. She had the impression her parents agreed. (Her mother had headaches for years. Her husband — Gail's father, the doctor — said it was all in her head. It turned out her mother had a brain tumor.)

    Gail's digestive trouble got worse in her teens. She remembers eating a hot dog on the beach and doubling over in pain. Since then she had at least some discomfort all the time.

    When she was in her thirties, an annual checkup found a tiny amount of blood in her urine, a condition called microscopic hematuria. It had none of the well-known causes (e.g., tumor). Her doctors shrugged.  That's interesting, they said. No one said she should be alarmed. "Microscopic hematuria is an incidental finding, and whether physicians should test for hematuria in asymptomatic patients remains at issue," said a 2001 policy statement from the American Urological Association. Sometimes it goes away. Gail's hematuria never went away. It was observed again and again in annual checkups.

    In her forties, she had gallstones and had her gall bladder removed. Her doctors told her you don't need a gall bladder.

    In her fifties, she was diagnosed with Hashimoto's thyroiditis, a disease in which the thyroid is attacked by the immune system. She also had a lump in her thyroid. She had most of her thyroid removed and has been taking thyroid medicine ever since.


  • Tonsillectomy Confidential: doctors ignore polio epidemics and high school biology


    Seth Roberts is the author of The Shangri-La Diet and posts at Seth's Blog about personal science, self-experimentation, and the scientific method.

    In 2008, Rachael Hoffman-Dachelet's eight-year-old son started having frequent sore throats. He'd run a fever, feel stiff and tired, and miss a few days of school. After six sore throats in a year, her pediatrician said This is crazy. I'm going to refer you to an ear nose and throat specialist. I think he'll recommend a tonsillectomy (tonsil removal).

    Rachael and her son saw the specialist, who did recommend a tonsillectomy. Tonsils are part of the lymphatic system, a network of tiny tubes and nodes all over the body. It is mostly a drainage system. Lymph drains into the tubes, which carry it to the heart, where it reenters the blood. En route to the heart, lymph passes through nodes. How can lymph move through the system if you remove part of it? Rachael asked the specialist. If there were any bad long-term consequences we'd know because so many tonsillectomies have been done, he said. The correct answer is that lymph does not pass through the tonsils. Rachael asked about the benefits of the surgery. Your son will miss a lot less school, he said.

    Rachael teaches art at a Minnesota middle school. Her experience with doctors had made her skeptical of their predictions. To decide for herself if a tonsillectomy was a good idea, she googled "pubmed tonsillectomy meta-analysis" and found a Cochrane Review about tonsillectomies and tonsillitis. There are thousands of Cochrane Reviews. Each tries to summarize the evidence about the effect of a treatment on a health problem (e.g., "Antibiotics for sore throats"). They are meant to be practical — to help everyone, including outsiders like Rachael, make treatment decisions (such as "should my son have a tonsillectomy?"). They are produced by the Cochrane Collaboration, a British non-profit, which says its reviews are "internationally recognised as the highest standard in evidence-based health care".

    The Cochrane Review that Rachael found ("Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis") was published in 2009. It describes four experiments that compared tonsillectomy to the care a sick child would otherwise receive. All four involved children like Rachael's son, and all four had similar results: Tonsillectomies had only a small benefit. (Contrary to what Rachael was told.) During the year after random assignment to treatment — the point at which some children had their tonsils removed, other children did not — children whose tonsils were removed had one less sore throat than children who were not operated on (two instead of three for children like Rachael's son). Because the benefits were small, the decision was easy. "The time, expense, and risk of surgery vs. one [sore throat]," Rachael wrote on my blog, "Not a tough choice."

  • Seth Roberts: Grandmother knows best about Crohn's Disease

    Seth Roberts is the author of The Shangri-La Diet and posts at Seth's Blog about personal science, self-experimentation, and the scientific method.

    [Video Link] Crohn's Disease is a type of inflammation of the digestive tract. In most cases, it causes unremitting diarrhea, several times per day. In America, about 1 person in 1000 has it.

    According to the National Institutes of Health (NIH) website, the usual treatments for Crohn's are "drugs, nutrition supplements, [and] surgery." The drugs include anti-inflammatory drugs, steroids, immune-system suppressors, and antibiotics. Surgery is common. According to the NIH website, "two-thirds to three-quarters of patients with Crohn's disease will require surgery." Require surgery? Those are strong words. It's a digestive problem, what about diet? No, says the NIH website. "No special diet has been proven effective for preventing or treating Crohn's disease. . . . There are no consistent dietary rules to follow that will improve a person's symptoms." Other authorities agree. "There's no firm evidence that what you eat actually causes inflammatory bowel disease," says the Mayo Clinic. According to the Crohn's and Colitis Foundation of America, "there is no evidence that any particular foods cause or contribute to Crohn's disease."

    Reid Kimball disagrees. Reid, who lives in Oregon, designs video games. He grew up in Massachusetts. During his junior year of high school, he came down with Crohn's. It was embarrassing. One day in class, he raised his hand to go to the bathroom. By the time the teacher called on him, it was too late. A few months later, a colonoscopy showed inflammation at the junction of his small and large intestines. The surface should been smooth; instead, it looked cobblestoned.

    His gastroenterologist prescribed Pentasa, an anti-inflammatory drug. If Reid had bought it himself, it would have cost $600/month. There's no cure, said the doctor. If Pentasa works, he'd need to take it for the rest of his life.