Doctors: Then and Now.

It’s tough to find a doctor you can trust.

I’ve written before about Dr. Max Jacobson, a New York City physician that my mother loved dearly, and I was delighted to have had some personal experience with such a famous (or infamous, or notorious, depending on whom you talk to) character.

Subsequent searching turned up a little bit about Max in a book called Schmucks with Underwoods, Conversations with Hollywood’s Classic Screenwriters by Max Wilk:

“Have you ever ead Erich Maria Remarque’s novel Arch of Triumph, the one about the Paris hotel where arll the refugees are living? Well, there’s a character in there, a doctor, a German refugee, living in Paris, and in order to keep himself alive, he’s performing abortions in dirty kitchens… you know who that doctor really was? Dr. Max Jacobson… the same guy who is now in New York!”

The notorious Dr. Feelgood?

“The one and the same Dr. Feelgood!” said [Billy] Wilder. I knew him extremely well – in Berlin, he was my doctor. Talk about writers in exile! Here’s this doctor, in exile, he cannot get a diploma, so he performs abortions… You know how old this guy is today? He has to be in the early 70s! But what a difference from his days in Paris, eh? Whenever he comes out here to L.A., I see him . Or I meet him on planes, he is accompanying Mr. Cecil B. DeMille to Egypt, because Mr. DeMille is going to do a new version of The Ten Commandments, during which Mr. DeMille has himself a heart attack, but Dr. Feelgood pumps him full of his amphetamine magic shots, so Mr. DeMille can still climb ladders and shoot the scenes – with maybe 6,000 extras all standing around!”

And there is also a list of other famous show business and political people who were the patients of the same Dr. Max Jacobson, ranging from our late president Kennedy, with his bad back, to Alan Jay Lerner, and Tennessee Williams, to a raft of other such celebrities, all of them devotees of Dr. Feelgood’s little satchel full of magic elixir shots.”

That last sentence reminded me powerfully of the lovely story by C.M. Kornbluth, “The Little Black Bag,” a follow-up tale in the world of “The Marching Morons.” If only we had such doctors…

As an add-on, in the linked article I mentioned “a New York publication some time before 1968;” thanks to the miracle of the Internet, it turns out that the relevant article from New York magazine was actually published on February 8, 1971 – so I was close. Nobody who ever met Dr. Max could possibly misunderstand to whom “Doctor C” referred, and I remember people in my home discussing the article with much amusement as almost all of our visitors were either patients of or familiar with him.

But back to reality, the first doctor I ever knew was Dr. Arthur F. Anderson, my pediatrician.

dr-andy-november-1967

This photo is of Dr. Andy, as he was lovingly known to his patients and their families, was taken at his retirement celebration in 1967. He was an immensely kindly gentleman who always put me at ease, made me airplanes out of tongue depressors and rubber bands, and wrote with a fountain pen full of bright blue ink.

In an oral history of Dr. David Annunziato, an Amityville-based pediatrician who passed away in 1995, I found this little tidbit:

I had great teachers. Bill [William] Dock was the professor of medicine. Charlie [Charles A.] Weymuller was the professor of pediatrics. And Charlie Weymuller, though he was a quiet man, apparently knew everybody. You know he knew [Rustin] McIntosh at Columbia [University College of Physicians and Surgeons], [Luther Emmett] Holt [Jr.] at NYU [New York University], Sam [Samuel Z.] Levine at [Weill] Cornell [Medical College]. The man he told me was the smartest pediatrician in the world was a man I only met once, and he was at Lenox Hill [Hospital]. His name was Anderson.

That could be no one else but Dr. Andy; I had my tonsils out at Lenox Hill Hospital in 1954, and I’m pretty sure that he was watching over my case if he himself did not perform the surgery. Which makes it obligatory that I cross-post something from my Live Journal, because it’s relevant to Dr. Andy and Dr. Weymuller, and much better than what I could reconstruct here.

March 21, 2009

Memories come in the strangest ways.

Brooke McEldowney, in his webcomic Pibgorn, just finished up a story arc that lasted a few days short of two years. That’s not as tortuous as Freefall time, but still a good piece of slow-paced fiction.

The new arc which began last Tuesday is entitled (Note to Jef Mallett: Yes, that is an appropriate use of the word) “Pibgorn and the Volcano on 77th Street and Park Avenue.” Forum members immediately brought up satellite images of the intersection, and it turns out that Lenox Hill Hospital sits on that corner.

I grew up in New York, and that rang a bell. Ever since then, I’ve been trying to figure out why it was familiar, aside from the tragic recent death of Natasha Richardson). Was it where I was born? Nah, that was Lying-In Hospital, converted in 1981 to luxury condos (note the baby tondos still adorning the façade).

It just came to me. It’s where I had my tonsils out when I was around three. Unlike Bill Cosby and his ice cream, my memories are different. I remember being alone, shots, and starvation.

When you’re three, you hate shots anyway. Somehow, my beloved pediatrician, Dr. Arthur F. Anderson, managed to avoid being associated with needles, choosing instead to send his evil henchman, the sadistic Dr. Charles Weymuller (in actuality, probably a very nice man) to my home for the requisite torture sessions in which my delicate heinie was violated with ten-foot red hot pokers. But in the hospital, I have this memory of an endless line of nurses armed with jackhammers, marching into my room like clockwork every five minutes to give me shot, after shot, after shot. It was probably only one, but hey, I was three, and alone in a strange crib in a strange place. I still don’t especially care for needles.

Compounding the torment was the fact that they refused to feed me. I was so happy when they finally said I would get some chicken noodle soup. Well, if there was any chicken or any noodles in the soup they brought me, it must have been strained out by the underpaid kitchen staff to supplement their meager salaries, because “broth” would have been too generous an appellation. That hospital stay was not fun.

I was so hungry when I finally got home… they fixed me mashed potatoes with butter, and I was so famished that in my haste I accidentally bit the finger of whoever was feeding me.

And I hadn’t thought of these things for at least 30 years…

In the ensuing years I’ve had numerous other physicians, some better and some less so; bedside manner matters, but a doctor’s interest in you as a person – his or her willingness to address your issues above and beyond the 8 minutes per patient that seems to be standard these days – is critical. A couple of  bright stars stand out: I was privileged to have Dr. George Van Komen, a superb and caring physician, as my primary care provider for a time, and my current doctor is not only a physician but also a friend, which counts for a lot.

But I still miss Dr. Andy.

The Old Wolf has spoken.

 

Selling Snake Oil with Name-Dropping.

I don’t like scammers. I don’t like woo-peddlers. I don’t like people who take advantage of the gullible and/or the vulnerable to make money at any cost. I’ve written numerous times about snake-oil sales, and even got a cease-and-desist letter from some law firm because the manufacturer didn’t like being called a scumball.

But they’re still at it.

Back in 2015, Forbes wrote a legitimate article about “How Fake News Articles And Lies About Billionaires Were Used To Market An Iffy Dietary Supplement.” Forbes complained and followed up, and the spurious website vanished, the cockroaches scurrying back into the darkness that spawned them.

For what it’s worth, the crooks didn’t focus on Forbes, they also used CNN and probably many others to hawk their garbage.

The thing about cockroaches, however, is that they keep coming back; if anyone survives a nuclear winter, it will be these creatures. There’s enough money to be made selling worthless nostrums that the scammers can easily afford to reformulate and resurface. and the immense potential for fraud inherent in affiliate marketing (which I elaborated on here) means that this plague will be a difficult one to eradicate.

I keep getting popup tabs when I visit Newser.com, and this is a recent one:

hawking

The name of the junk product has changed – instead of BrainStorm Elite it’s now IQ+, and the source of the farticle (fake article, or advertorial) is http://www.healthreportz.com/, a website that has nothing to do with Forbes.

It goes without saying that the product is worthless, Hawking has nothing to do with this junk, and the interview with Anderson Cooper is being spun to appear as if it’s endorsing this particular product – which it’s not.

The IQ+ website looks really slick, includes the standard Quack Miranda¹, and after you give them your information and click the big red “Rush My Order!” button, you are taken to the confirmation page where you provide your all-important credit card information. That page also includes this text:

rush

That’s exactly how it looks, and is so easy to miss that most people won’t read it, which is what the bottom-feeders are hoping for. If you do click the Terms and Conditions, you find the industry-standard “gotcha” clause:

In-Trial Offer: A trial offer provides the customer an opportunity to try our product free of charge for 14 days from date of order, paying only shipping and handling fees of $4.98(USD). At the conclusion of the trial period, you will be billed the full purchase price of $89.97(USD) and enrolled in the monthly replenishment program.

So that special price of $4.98 is really $94.95, and you will be billed $89.97 every 30 days because you signed up (without reading the details) for their convenient auto-ship program. You can make a Wreave bet² on the fact that getting a refund for unexpected charges to your credit card will be harder than pulling hen’s teeth – their agents will be trained to make it nearly impossible to get your money back without the threat of legal action.  This is how the kiz-eaters make their money, and frankly, Scarlet, it stinks.

I notified Forbes of the most recent iteration of this scam, and hopefully they’ll look into it. As mentioned before, there’s so much money to be made with scams of this nature that they’ll be back . I have no illusions that my little essays will do anything to stem the tide, but if even one person reads them and saves their money, it will have been worth it.

The Old Wolf has spoken.


Notes:

¹ The “Quack Miranda” warning is required by the FDA on all nutritional supplements, some of which have proven value. The appearance of the standard wording does not mean a product is worthless, but a huge percentage of the garbage sold by nutritional companies have dubious value and all must carry the disclaimer.

² The Wreaves are a part of Frank Herbert’s ConSentiency universe. Their strict code of honor prevents them from gambling, hence a “Wreave bet” is a sure thing.

The World Wide Web of Deceit

I write regularly about scams and frauds on the Internet, in the hopes that some folks might stumble across my thoughts and save themselves both money and hassles. I’ve given extra attention to nutritional products, otherwise known as “Snake Oil.”

SnakeOil1

People use the Internet for accessing all sorts of knowledge, but the landscape has become so deceptive that it can be difficult even for experienced searchers to separate fact from fiction, wheat from chaff.

Here’s an example. My handheld device doesn’t filter out ads the way uBlock Origin or AdBlock Plus does with Chrome on a desktop, so I regularly see all sorts of deceptive garbage while I’m browsing.

One ad showed a picture of Stephen Hawking, with the claim that he owes his massive intellect to a specific supplement. So down the rabbit hole we went, and was taken to a page flogging “Intellux,” a supposed “smart drug” or “nootropic” compound, said to enhance memory or other cognitive functions.

The next thing  I did was to search for (intellux fraud | scam), and it’s interesting to note that almost every result is either

  1. a page that asks “Is Intellux a scam or the real thing” and then goes on to flog the product itself, or
  2. a page that lists in detail all the reasons why Intellux is a worthless fraud – and then goes on to flog another product.

A good example of this is “The Supplement Critique.” This page and this page are examples of what look like fair and balanced reviews of Intellux, Geniux, and Addium/Adderin. They describe in detail the mechanisms of advertorials, affiliate marketing, false tweets, totally fabricated stories and “user feedback,” and the general deceptive marketing techniques. It all looks perfectly legitimate – until you get to the point where the author begins flogging “Optimind,” a nootropic supplement for which he is suspiciously looking like an affiliate marketer.

Popups are pretty nasty, but a lot of pages use them – this is what I got when I explored The Supplement Critique:

Stupid

“No thanks, I like being stupid.” Well, that’s a great way to get people to feel guilty about not buying your e-book, which is doubtlessly tailored to guide people to the worthless snake oil that you yourself are peddling.

The fact remains that these pages are slick-looking enough to fool a lot of people into thinking they represent real science and real research, when in reality it’s all woo – smoke, mirrors, and pay no attention to that little man behind the curtain.

Behind_curtain

Just last February the Washington Post and others reported on a New York State investigation into adulterated or worthless “herbals” being sold by GNC, Target, Wal-Mart, and Walgreens. Among the findings:

The investigators tested 24 products claiming to be seven different types of herb — echinacea, garlic, gingko biloba, ginseng, saw palmetto, St. John’s wort and valerian root. All but five of the products contained DNA that was either unrecognizable or from a plant other than what the product claimed to be.

Additionally, five of the 24 contained wheat and two contained beans without identifying them on the labels — both substances are known to cause allergic reactions in some people.

It has long been known among scientists that the supplement industry is so unregulated that it’s very rare for the bottle to contain what’s on the label. You just don’t know what you’re getting, and despite FDA efforts, many products are hawked through disreputable channels by way of outrageous and unethical claims.

There are a few good supplements out there. About five companies I know of make a decent effort to put into their products what they claim is on the label. The rest are pretty much selling vain hope.

Be careful out there, and do your research. Look for companies that adhere to pharmaceutical Good Manufacturing Practices (which are far more stringent than food GMP’s) and submit their products to reputable external testing laboratories

The Old Wolf has spoken.

Holding back the grim reaper

Two relief sculptures on the side of the Fulton County Public Health Department in Atlanta, Georgia.

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The first is straightforward: the physician warding off death. It’s what they do, to the best of their ability.

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The second image is a bit more arcane, not shared as often but equally symbolic.

With thanks to redditor /u/queenbrewer:

“This counterpart bas relief clearly depicts a woman, presumably a nurse, holding a sword. The sword depicts Hygeia , Asclepius’ daughter and the goddess of hygiene, who holds a snake drinking from a bowl, typically symbolizing pharmacy. She fights against a man (perhaps Father Time) holding the mask of tragedy representing suffering in one hand and an hourglass representing aging in the other.”

The TL;DR here seems to be a variant of what I’ve heard around the medical community: “Doctors diagnose, nurses heal.”

Beautiful tributes to all dedicated healthcare workers.

The Old Wolf has spoken.

Rachael has now dropped sixteen dress sizes.

I wage war against spam, affiliate marketers, snake oil and general pseudo-scientific bulldust.

In a previous post about worthless nutritional supplements, I posted three identical advertorials from the “Every Day with Rachael” website, which is nothing more than an affiliate marketing portal for hawking useless weight-loss nostrums.

Yesterday I got another one.  I reproduce all four below:

rachael2

caralluma

rachael

Rachael Safflower

Notice: each one of these advertorials is based on a boilerplate – they’re identical.

Here at Everyday Health and Wellness, they’re skeptical of Forskolin, Caralluma, Garcinia Cambogia, and Safflower Oil. As a result, “Rachael” has volunteered to be a guinea pig each time. She would now have lost 100 lbs and 16 dress sizes, meaning that her “before” pictures are all a load of bulldust. While I can’t be positive, odds are that “Rachael” does not even exist.

Are we beginning to smell the foul stench of deception here?

Playing In the World Game rates “Everyday Health and Wellness” as

pants

“PANTS ON FIRE”

All of these products are basically worthless for weight release. They may have, in some way, benefits for some people, but there is no magic bullet, no magic pill that will let you lose weight without altering your caloric intake and exercise regime.

The affiliate marketers responsible for putting this spam into your inboxes, the manufacturers of these products, and everyone involved in trying to separate suckers from their money are soulless, immoral scammers. They will stop at nothing to get your money. Stay away from all products of this nature, or anything advertised in this manner.

The Old Wolf has spoken.

Every day is April Fool’s in nutrition.

“People who are desperate for reliable information face a bewildering array of diet guidance—salt is bad, salt is good, protein is good, protein is bad, fat is bad, fat is good—that changes like the weather. But science will figure it out, right? Now that we’re calling obesity an epidemic, funding will flow to the best scientists and all of this noise will die down, leaving us with clear answers to the causes and treatments.

Or maybe not.”

From a recent article at io9 by John Bohannon:

I Fooled Millions Into Thinking Chocolate Helps Weight Loss. Here’s How.

chocolate

With a poorly-crafted study that used a small sample and ignored how big the measured results actually were, a team of journalists managed to punk the nutrition-news circuit into publishing their study.

“A team of German researchers had found that people on a low-carb diet lost weight 10 percent faster if they ate a chocolate bar every day. It made the front page of Bild, Europe’s largest daily newspaper, just beneath their update about the Germanwings crash. From there, it ricocheted around the internet and beyond, making news in more than 20 countries and half a dozen languages. It was discussed on television news shows. It appeared in glossy print, most recently in the June issue of Shape magazine.”

But it was all a crock of dung. And sadly, I can guarantee that many people will continue to believe the lie, simply because it appeared in journals as “prestigious” as Prevention, regardless of this exposé or any further evidence to the contrary. Like the entire anti-Vax movement, nothing can kill a good excuse for mouth-foaming outrage, not even repeatedly-confirmed facts.

Read the article. It’s worth your time, if you’re interested in having accurate information on which to base your decisions.

A big part of the problem with modern “scientific” studies is the concept of “p-value.” It’s more complex than most people care about, but William Rozeboom wrote, “The use of P values and null hypothesis testing is ‘surely the most bone-headedly misguided procedure ever institutionalized in the rote training of science students.’ “

P value calculations tell you only the probability of seeing a result at least as big as what you saw if there is no real effect. (In other words, the P value calculation assumes the null hypothesis is true.) A small P value — low probability of the data you measured — might mean the null hypothesis is wrong, or it might mean that you just saw some unusual data. You don’t know which. And if there is a real effect, your calculation of a P value is rendered meaningless, because that calculation assumed that there wasn’t a real effect.

(ScienceNews – “P value ban: small step for a journal, giant leap for science”)

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And if Randall Munroe pillories something, you have a pretty good idea that there are legitimate questions about its validity.

significant

The takeaway: don’t be excited just because one study says something, and I’ve written about this elsewhere. Look at the study, determine the size of the sample used, and see if you can ferret out how big the measured differences were. There’s a lot more digging you could do, but this is a good place to start.

The Old Wolf has spoken.

Some thoughts on weight loss from a redditor

Every now and then I stumble across something on reddit that I think deserves a wider audience; there are a lot of folks out there who don’t have any idea what reddit is, or what to do with it.

In the CMV (Change My View) subreddit, people post viewpoints and ask others to convince them that they’re right or not. A recent position: “Any fat person can lose weight by simply adjusting their diet and exercise.”

I’ve posted about releasing weight before, usually in the context of the scammy nostrums people sell to take advantage of those who want to give up pounds but can’t seem to. Redditor /u/eavc posted the following response, which is cogent and relevant. I share it here for your consideration.

It is true that any person will lose weight if diet and exercise are properly adjusted. The important part of your question is whether any person can actually make the adjustments to diet and exercise to produce (and sustain) weight loss.

People are not robots. We are subject to forces of emotion, motivation, willpower, bias, and so on.

That which seems objectively simple to accomplish in isolation can be exceedingly difficult in practice. I believe that everyone can directly observe this to be true with a moment’s reflection on their own shortcomings and struggles.

  • “I’m not going to procrastinate anymore.”
  • “I won’t yell at him anymore.”
  • “I’m going to go running every day.”
  • “I’ll never again drink until I throw up.”
  • “I’m going to stop spending so much money.”
  • “I won’t let sports make me this angry again.”
  • “It’s irrational for me to be so jealous.”
  • “Why should I care if I’m not invited to some party?”

Pain, sadness, boredom, loneliness, routine, socially embedded temptation, fatigue, stress, cognitive biases, competing demands, family crisis, fear, money issues, disease, social learning, etc. — all of these are capable of derailing sincere efforts at personal change.

If there anything in your life you have decided to change and yet have not been able to change, then this argument should ring true.

A person has become fat because they are not good at regulating diet and exercise for whatever reason (biological, psychological, social-cultural, environmental/circumstantial, etc.). Almost by definition, these are people who struggle to adjust diet and exercise. It is therefore like saying “Any depressed person can be happier by simply adjusting their thoughts and feelings” or “Any anxious person … by caring less about the future” or “Sex addict … by choosing not to engage in sexual acts” or “debtor … by earning more and spending less” or “smoker .. by not smoking.” These are true but useless statements, because the person in question practically lacks the abilities required given their current set of circumstances. Advice for all of these kinds of problems centers on how to change psychology or circumstances rather than on the simple idea of the end goal (eat less, smoke less, yell less).

That is why there are books and communities and medicines and science and billions of dollars centered on these kinds of personal change efforts. What’s required is a change in the environment/circumstances or in the psychology – and that’s not easy to do at all.

Let me flip this around. Can you imagine a scenario where a person cannot successfully accomplish the needed adjustment to diet and exercise?

Go over to a place like /r/progresspics[1] and read comments on how people were able to accomplish their transformation. Generally, you’ll hear about some fairly specific set of factors that helped them start and then persist in their journey. New ideas, supportive friends, emotional growth, frightening experiences, a definite system, a change in life situation, regular efforts to stay motivated, and so on.

Now while reading something like that, start mentally deleting the factors that they are crediting. “I couldn’t have done it without the help of my wife” – take away the wife. “I found boxing and that was what clicked after years of nothing clicking” – boxing was never a sport. “I finally decided to prioritize my self and take care of myself” – they were struggling to make it day to day due to environmental stressors (small kids, money problems, work stress, emotionally abusive person in life) and couldn’t focus on personal growth. “The doctor said I would die before I was 50” – the complications of overweight not being as present for them and the doc never delivering that warning.

Then, there’s the reality that most of us are flawed or face challenge in many ways at once. It’s not just being overweight – it’s being overweight and poor. It’s not just being fat – it’s being fat and depressed. Fat and short-tempered. Fat and failing some classes. Fat and an emotionally absent father. Fat and financially irresponsible. Overweight and socially anxious. And generally the list is much longer than just two problems. Many people who want to be better people are pouring a lot of energy into working on something other than being overweight, and it leaves little for the other problem. Conversely, many who successfully lose a lot of weight do so by streamlining and focusing their attention on that specific problem at the expense of other things they could have focused on instead.

All this to say, personal change requires work, and some forms of personal change require so much work as to be practically impossible given the resources and energy available to accomplish that work. That’s why successful weight loss often requires much much more than just the idea of eating less and exercising more. And until the person finds that other thing that is required for their situational factors to shift enough to change the behavior, they are unlikely to be successful in adjusting diet and exercise over the long run.

EDIT: I want to add something to speak to the other side of the coin because some comments have rightly pointed out that this may come across as fatalistic. I’m a big proponent of personal responsibility and personal growth.

If you have something in your life causing problems or holding you back, I would encourage you to look for solutions and – if it’s important enough of a thing – to not give up. I have worked with a lot of people with mental health issues, for example, who say, “I can’t” to things that they absolutely are capable of doing and do go on to do. An attitude of pessimism is often a self-fulfilling prophecy and certainly limits the chances we have to get lucky with the solution to the puzzle or simply to break through due to persistence. The synthesis of my views would be this: we are shaped by many forces but are also capable of ingenuity, resiliency, and change. If you attempt something critically important and fail, either try again, try a new approach, or try something else.

Change is not as simple as ‘eat less’ because behavior is largely the product of a network of causal factors. And for the exact same reason, change is also rarely impossible – there are many factors that can be tweaked up and down the causal chain, though it can take A LOT of effort and probably resources and external support as well. The right small shift can alter the overall set of circumstances and tip the outcome in another direction. And sometimes, it’s something as simple as time or trying again.