Health Care

A thought in light of the last post:

I strongly suspect that our national health would be better on average if, rather than subsidizing prescription drugs, the federal government actually banned or restricted many prescription drugs -- NOT all, to be sure -- and plowed those billions of dollars into subsidizing the production and purchase of vegetables and fruits instead.

Not that this would be the ideal policy solution starting from scratch, of course. But it might be far better than what we have now, where the government first effectively subsidizes foods that cause obesity and inflammation-related diseases, and then helps older people buy cholesterol and heart treatments that don't work.

Useless Health Care

A while back, I noticed that I had seen several news stories about treatments or medications that turned out to be useless or even harmful. So I started keeping a file that I've been regularly updating (I'm aware, of course, that this could be seen as an exercise in confirmation bias).

The list has grown long enough that I'm putting it here for reference.

1. Knee operations can be more harmful than plain old rehab. One randomized experiment found that exercise was as good as surgery at helping with patello-femoral syndrome, and another study found that placebo surgery was as good as actual surgery at helping with osteoarthritis. A more recent article broadly claims that "evidence of benefit is lacking for many common ways of treating osteoarthritis of the knee."

2. 20 million people a year may be unnecessarily exposed to radiation from CT scans (potentially causing the future cancer rate to rise).

3. Honey works better than over-the-counter cough medicines (which don't work at all).

4. One recent study found that the "typical child who gets ear tube surgery does not have disease severe enough to warrant the operation."

5. Nortin Hadler found that "the number of people whose lives are saved by bypass surgery, angiograms, and cholesterol-lowering drugs is statistically insignificant."

6. Much of the money spent on back surgery or back pain treatment may be wasted. According to the Los Angeles Times:

Yet, for all of the spending, they found people with spine problems actually felt worse.

"Healthcare expenditures for people with spinal problems have increased substantially -- 65% since 1997. Within that, we found pharmaceutical expenditures have increased 171%," said Brook Martin of the University of Washington in Seattle, whose study appears in the Journal of the American Medical Assn.

"If we are spending that much money on spine problems, we would expect to see improvements in the health of the population," Martin said in a telephone interview.

"What this study shows is we are not seeing commensurate improvements among people with spine problems."

7. Antibiotics are ineffective at treating many conditions for which they are prescribed. These can include sinus infections, ear infections (see also here), bronchitis, and conjunctivitis.

8. The findings of the Dartmouth Atlas group:

Comparing resource inputs and outcomes among populations living in the 306 hospital referral regions . . . in the United States has been the focus of the Dartmouth Atlas Project. The studies consistently show that more resource inputs and utilization do not result in better outcomes. For example, in a recent study, researchers in the Dartmouth Atlas group examined outcomes for three patient cohorts: people who had had hip fractures, heart attacks, or colectomies for colon cancer. The patients were followed for up to five years after their initial events. The study's major finding was that regions with greater care intensity had increased mortality rates.

9. Shannon Brownlee's recent book, OVERTREATED: Why Too Much Medicine is Making Us Sicker and Poorer. From the Washington Post's review:

But in her persuasive Overtreated, Shannon Brownlee, a medical journalist and senior fellow at the New America Foundation, argues that too much medicine -- for many patients, much of the time -- is doing serious damage to the nation's health, while also costing us an arm and a leg. "We spend between one fifth and one third of our health care dollars . . . on care that does nothing to improve our health," she points out. Many treatments that have become widely accepted in recent years -- including proton pump inhibitors for ulcers, arthroscopic knee surgery for arthritis, hormone replacement therapy for menopause and high-dose chemotherapy for breast cancer -- "have ultimately been shown to be unnecessary, ineffective, more dangerous than imagined, or sometimes more deadly than the diseases they were intended to treat."

10. One recent study from the New England Journal of Medicine found that much so-called "preventive" care is not cost-justified.

11. Cholesterol drugs -- on which we spend billions every year -- may be much less effective than once thought, and what effectiveness they do have might be just from reducing inflammation in the way that aspirin does. Said Business Week:

James M. Wright, is no ordinary family physician. A professor at the University of British Columbia, he is also director of the government-funded Therapeutics Initiative, whose purpose is to pore over the data on particular drugs and figure out how well they work. Just as Winn started on his treatment, Wright's team was analyzing evidence from years of trials with statins and not liking what it found.

Yes, Wright saw, the drugs can be life-saving in patients who already have suffered heart attacks, somewhat reducing the chances of a recurrence that could lead to an early death. But Wright had a surprise when he looked at the data for the majority of patients, like Winn, who don't have heart disease. He found no benefit in people over the age of 65, no matter how much their cholesterol declines, and no benefit in women of any age.

He did see a small reduction in the number of heart attacks for middle-aged men taking statins in clinical trials. But even for these men, there was no overall reduction in total deaths or illnesses requiring hospitalization—despite big reductions in "bad" cholesterol. "Most people are taking something with no chance of benefit and a risk of harm," says Wright.

* * *

One dirty little secret of modern medicine is that many drugs work only in a minority of people. "There's a tendency to assume drugs work really well, but people would be surprised by the actual magnitude of the benefits," says Dr. Steven Woloshin, associate professor of medicine at Dartmouth Medical School.

And from the New York Times:

A clinical trial of Zetia, a cholesterol-lowering drug prescribed to about 1 million people a week, failed to show that the drug has any medical benefits, Merck and Schering-Plough said on Monday. * * *

While Zetia lowers cholesterol by 15 percent to 20 percent in most patients, no trial has ever shown that it can reduce heart attacks and strokes — or even that it reduces the growth of the fatty plaques in arteries that can cause heart problems.

This trial was designed to show that Zetia could reduce the growth of those plaques. Instead, the plaques actually grew almost twice as fast in patients taking Zetia along with Zocor than in those taking Zocor alone.

According to the Washington Post:

Part of the problem, Krumholz, Nissen and others say, is how the government sometimes evaluates drugs, relying on "surrogate endpoints" instead of medications' ability to treat or prevent illnesses. Cholesterol-lowering drugs, for example, can be approved based on their power to cut cholesterol and not on whether they protect against heart attacks or strokes. Diabetes drugs can be approved based on whether they reduce a protein known as hemoglobin A1C -- a measure of blood sugar -- and not on their effect on complications caused by high blood sugar.

"There are a lot of things we do in this country where we treat these surrogate measures with very little evidence that we are actually treating the patient," said Nortin M. Hadler, a professor of medicine at the University of North Carolina.

If one drug prevents heart attacks by lowering cholesterol, that does not guarantee that another will do the same if it works differently, critics argue. And drugs may have unforeseen hazards that outweigh any benefits, or they may not produce secondary effects, such as lowering inflammation, that add to their usefulness.

12. Diabetes medicine. From that same Business Week story:

Take Avandia, GlaxoSmithKline's (GSK) drug for preventing the deadly progression of diabetes. The blockbuster, with $2.6 billion in U.S. sales in 2006, made headlines in 2007 when an analysis of clinical trial data showed it increased the risk of heart attacks. The largely untold story: There's little evidence the drug actually helps patients. Yes, Avandia is very good at lowering blood sugar, just as statins lower cholesterol levels. But that doesn't translate into preventing the dire consequences of diabetes, including heart disease, strokes, and kidney failure. Clinical trials "failed to find a significant reduction in cardiovascular events even with excellent glucose control," wrote Dr. Clifford J. Rosen, chair of the Food & Drug Administration committee that evaluated Avandia, in a recent commentary in The New England Journal of Medicine. "Avandia is almost the poster child for everything wrong with our system," says UCLA's Hoffman.

Cleo Hill

From ESPN's "Black Magic" series on basketball players from historically black colleges, there's a good video about Cleo Hill. As one article points out:

Had he played for another team or in another time, maybe you'd know Cleo Hill's name. Maybe most everyone would.

CBS analyst Billy Packer saw him play in college and considers him a forerunner to David Thompson and Michael Jordan.

Hill was "probably the greatest player of his time, black or white," sportswriter Howie Evans contends in "Black Magic," a two-part documentary premiering Sunday on ESPN that explores lives of players from historically black schools during the civil rights movement.

Such promise prompted then-St. Louis Hawks executive Marty Blake to pick Hill eighth overall in the 1961 NBA draft. Blake marvels still at Hill's array of shots, including right- and left-handed hooks from what today would be 3-point range, that enabled him to average about 27 points as a senior at Winston Salem Teacher's College.

"He came into the league with abilities that were 40 years ahead of his time," said Blake, 80, the NBA scouting director.

The video shows Hill making some of those long-range hook shots.

Hill never had much success in the NBA; the video attributes this to jealousy from his white teammates, and to the team's owners who demanded that the white coach keep Hill on the bench. The coach refused, and he got fired instead.

Overcoming Bias

I have another short post at Overcoming Bias, featuring a quote from Lenny Bruce.

Funny Line

From an article about high school graduation rates in America:

Still, Congress did not make dropouts a central focus of the law. And when states negotiated their plans to carry it out, the Bush administration allowed them to use dozens of different ways to report graduation rates.

As an example, New Mexico defined its rate as the percentage of enrolled 12th graders who received a diploma. That method grossly undercounts dropouts by ignoring all students who leave before the 12th grade.

The law also allowed states to establish their own goals for improving graduation rates. . . . Daniel J. Losen, who has studied dropout reporting for the Civil Rights Project at the University of California, Los Angeles, said he once pointed out to a state official that, at that pace, it would take California 500 years to meet its graduation goal.

“In California, we’re patient,” Mr. Losen recalled the official saying.

Arthur C. Clarke

In light of science fiction author Arthur Clarke's recent death, I recalled this anecdote of Clarke's friendship with C.S. Lewis:

As a young man, Clarke was pals with some of Britain’s fastest-rising literary stars, including C.S. Lewis and J.R.R. Tolkien. That was before he made a name for himself in 1953 with Childhood’s End and before he fell in love with the Indian Ocean’s coral reefs. “I came for the sea diving,” he told me of his move to Sri Lanka in 1956. “Underwater was the closest I could come to the weightlessness of space.”

While we talked, something reminded him of his London days, and although he could hardly recall his latest book, conversations from decades ago still rang clear in his mind. “C.S. Lewis! I just remembered our parting words,” he said. “We were at a pub. The Eastgate. Fleet Street.” He leaned back in his chair, chasing the memory down the street and finally cornering it. “Ah,” he continued. “As we staggered out into the street, Lewis turned to us. He said, ‘I think you are very wicked people, but wouldn’t the world be a dull place if everyone was good?’ ”

Clarke laughs uproariously at this gentle rebuke, slapping his desk and shaking his head.

Also worth noting is that a series of letters between Lewis and Clarke have been published.

William Buckley

I think this may be my favorite William Buckley anecdote:

William F. Buckley was a man who had a great capacity for fun and for amusing himself by amazing others.

Example: Dick Clurman of Time magazine, an affable gent, was a guest on the Buckley yacht in the Caribbean. After dinner, Bill B., leafing through a TV log, announced that “The Wizard of Oz” would be starting in half an hour — in English, broadcast from Puerto Rico. Clurman was delighted and confessed to never having seen it.

At the appointed time the set was switched on, but to everyone’s chagrin it seemed the movie had already been on for a good half hour. Bill had read the starting time wrong. Clurman’s disappointment was visible.

“Let’s see if my name cuts any ice down here,” his host said. The incredulous Clurman later described how his friend grabbed the phone, rang up the station in Puerto Rico, managed to get through to the engineer, explained his guest’s disappointment, and asked if it would be too much trouble to start the movie over!

In disbelief, Clurman saw the screen go blank, followed by a frantic display of jumbling and flashing. And then — the opening credits and the comforting strains of “Over the Rainbow.” The movie began anew. Clurman declared that never until then had he known the full meaning of “chutzpah.”

I think Bill decided to let a year go by, giving Clurman time to regale all his friends and acquaintances with the tale of the Oz miracle. It was then, still reluctantly, that the magician revealed his secret. The movie had not been broadcast at all that night — except on Bill’s tape deck, which he had secretly manipulated with his unseen left arm while “talking on the phone” using the other.

Overcoming Bias

Another post of mine at Overcoming Bias.

Eisley on Tour

One of my favorite bands -- Eisley -- is going on a nationwide tour in April and May. They've opened for other bands before (including Coldplay, Switchfoot, Snow Patrol, and Mute Math), but this is a headlining tour.






Clicking that banner will show the dates. Locations include Houston, Austin, Oklahoma City, Tulsa, Lawrence KS, St. Louis, Nasvhille, Southern Pines NC, Atlanta, Birmingham, Gainesville FL, Tallahassee, Orlando, Ft. Lauderdale, Tampa, Carrboro NC, Washington DC, Hoboken NJ, NYC, Pittsburgh, Philadelphia, Boston, Montreal, Toronto, Detroit, Chicago, Milwaukee, Minneapolis, Des Moines, Denver, Salt Lake City, Boise, Portland, Seattle, Sacramento, San Francisco, Los Angeles, San Diego, Pomona, Phoenix, Tucson, Corpus Christi, Dallas, San Antonio, and McAllen TX.

Here are two videos:




I think this is one of their catchiest songs:

Iceberg Lettuce

I enjoyed Dr. Boli's rant about iceberg lettuce:

Structurally, iceberg lettuce consists of a thin membrane of greenish plastic stretched over a certain quantity of dishwater. Culinarily, its primary use is to take up space, which it does with ruthless efficiency. So-called “salads” made almost entirely of iceberg lettuce are routinely served in restaurants across North America, in clear violation of the Universal Declaration of Human Rights, to say nothing of local rules on consumer fraud, but nothing ever seems to be done about it.

Friends with Blogs

My friend Rick Garnett of Notre Dame Law emails to say that the group blog Mirror of Justice is at a new location here, given that the old domain name was somehow hijacked (hopefully temporarily).

Also, Southern Appeal is back.

New Orleans Accents

On browsing through YouTube videos of accents, I loved this clip featuring many different New Orleans accents:



Am I wrong to think that the very first woman in the video sounds like a New Yorker? The narrator later (at about 4:20) mentions people who "talk the famous Brooklyn-ese of the older city neighborhoods, the so-called 'yat' talk." Then, from about 5:25 to the very end, there are a couple of women who really sound like New Yorkers to me. They're hilarious.

UPDATE: Wikipedia confirms that the "Yat" dialect does sound like people from Brooklyn. Awesome. Although it's no wonder that real New Orleanians reportedly get very irritated whenever they're portrayed in movies as speaking like Scarlett O'Hara from Gone With the Wind.


As for the video below with Amy Walker speaking in 21 accents, here's a video that shows what some real Texans sound like. Also some Kentuckians from Appalachia, who have a delightfully thick accent.



The radio show at the beginning of that video brings back memories of growing up in Arkansas. I think it was my grandma who used to listen to exactly the same sort of radio program, where random local citizens would just call in to describe anything that they wanted to sell or just get rid of. It was like classified ads for poor or lower middle class people.

Probably the thickest accent I've ever heard (from a native English speaker) is in this next video. The guys who are sitting on a bench (42 seconds onwards) do seem to be speaking English, but darned if I can make out more than one or two words. At least they understand each other, which is what counts.

Links

1. This reminds me of X-Men for some reason.

2. When I see that there is a World Freehand Circle Drawing Championship and a World Beard and Moustache Championship, I'm reminded of Will Wilkinson's point that there are an indefinite number of areas wherein people find ways to seek status.

3. Lots of people are linking to this video of a woman performing 21 different accents.



First reaction: Brilliant. (Howard Gardner should update his list of multiple intelligences!) Second reaction: The two accents with which I'm most familiar (Texas and South Carolina) didn't ring quite true -- they were close, but something was just a little bit off. I wonder if people who are really from Belfast or Moscow, etc., would have a similar reaction.

Overcoming Bias

I have a post at Overcoming Bias.

More Reasons that Sprinting is Good for You

Perhaps I should issue a disclaimer here: I'm not a doctor, and I'm not giving medical advice here. Indeed, if you're out of shape or have a heart condition, maybe you shouldn't be sprinting at all. Nonetheless, here are a few more reasons that sprinting can be good for your health:

1. Improves learning ability and brain function.
2. Greater improvement in cardiovascular health, as compared to slower running:
3. Improves fat-burning capacity.
4. Improves muscle fitness and endurance.

The supporting studies that I've found:

1. Improves learning ability and brain function.

Winter B, Breitenstein C, Mooren FC, Voelker K, Fobker M, Lechtermann A, Krueger K, Fromme A, Korsukewitz C, Floel A, Knecht S., “High impact running improves learning,” Neurobiol Learn Mem. 87 vol. 4 (May 2007): 597-609.

Regular physical exercise improves cognitive functions and lowers the risk for age-related cognitive decline. Since little is known about the nature and the timing of the underlying mechanisms, we probed whether exercise also has immediate beneficial effects on cognition. Learning performance was assessed directly after high impact anaerobic sprints, low impact aerobic running, or a period of rest in 27 healthy subjects in a randomized cross-over design. Dependent variables comprised learning speed as well as immediate (1 week) and long-term (>8 months) overall success in acquiring a novel vocabulary. Peripheral levels of brain-derived neurotrophic factor (BDNF) and catecholamines (dopamine, epinephrine, norepinephrine) were assessed prior to and after the interventions as well as after learning. We found that vocabulary learning was 20 percent faster after intense physical exercise as compared to the other two conditions. This condition also elicited the strongest increases in BDNF and catecholamine levels. More sustained BDNF levels during learning after intense exercise were related to better short-term learning success, whereas absolute dopamine and epinephrine levels were related to better intermediate (dopamine) and long-term (epinephrine) retentions of the novel vocabulary. Thus, BDNF and two of the catecholamines seem to be mediators by which physical exercise improves learning.

Ferris LT, Williams JS, Shen CL., “The effect of acute exercise on serum brain-derived neurotrophic factor levels and cognitive function,” Med Sci Sports Exerc. 39 no. 4 (April 2007): 728-34.

Brain-derived neurotrophic factor (BDNF) is one of a family of neurotrophic factors that participates in neuronal transmission, modulation and plasticity. Previous studies using animals have demonstrated that acute and chronic exercise leads to increases in BDNF in various brain regions. PURPOSE: To determine the effects of acute exercise on serum BDNF levels in humans, and to determine the relationship between exercise intensity and BDNF responses. Additionally, the relationship between changes in BDNF and cognitive function was examined. METHODS: Fifteen subjects (25.4 +/- 1.01 yr; 11 male, 4 female) performed a graded exercise test (GXT) for the determination of VO2max and ventilatory threshold (VTh) on a cycle ergometer. On separate days, two subsequent 30-min endurance rides were performed at 20% below the VTh (VTh - 20) and at 10% above the VTh (VTh + 10). Serum BDNF and cognitive function were determined before and after the GXT and endurance rides with an enzyme-linked immunosorbent assay (ELISA) and the Stroop tests, respectively. RESULTS: The mean VO2max was 2805.8 +/- 164.3 mL x min(-1) (104.2 +/- 7.0% pred). BDNF values (pg x mL(-1)) increased from baseline (P<0.05) after exercise at the VTh + 10 (13%) and the GXT (30%). There was no significant change in BDNF from baseline after the VTh - 20. Changes in BDNF did not correlate with VO2max during the GXT, but they did correlate with changes in lactate (r=0.57; P<0.05). Cognitive function scores improved after all exercise conditions, but they did not correlate with BDNF changes.

CONCLUSION: BDNF levels in humans are significantly elevated in response to exercise, and the magnitude of increase is exercise intensity dependent. Given that BDNF can transit the blood-brain barrier in both directions, the intensity-dependent findings may aid in designing exercise prescriptions for maintaining or improving neurological health.

2. Greater improvement in cardiovascular health, as compared to slower running:

Kemi, O. J., Haram, P. M., Loennechen, J. P., Osnes, J. B., Skomedal, T., Wisløff, U., and Ellingsen, O., “Moderate vs. high exercise intensity: differential effects on aerobic fitness, cardiomyocyte contractility, and endothelial function,” Cardiovascular Research 67 no. 1 (2005): 161-172.

Abstract:

Current guidelines are controversial regarding exercise intensity in cardiovascular prevention and rehabilitation. Although high-intensity training induces larger increases in fitness and maximal oxygen uptake (VO2max), moderate intensity is often recommended as equally effective. Controlled preclinical studies and randomized clinical trials are required to determine whether regular exercise at moderate versus high intensity is more beneficial. We therefore assessed relative effectiveness of 10-week HIGH versus moderate (MOD) exercise intensity on integrative and cellular functions. Method: Sprague-Dawley rats performed treadmill running intervals at either 85%-90% (HIGH) or 65%-70% (MOD) of VO2max 1 h per day, 5 days per week. Weekly VO2max-testing adjusted exercise intensity. Results: HIGH and MOD increased VO2max by 71% and 28%, respectively. This was paralleled by intensity-dependent cardiomyocyte hypertrophy, 14% and 5% in HIGH and MOD, respectively. Cardiomyocyte function (fractional shortening) increased by 45% and 23%, contraction rate decreased by 43% and 39%, and relaxation rate decreased by 20% and 10%, in HIGH and MOD, respectively. Ca2+ transient time-courses paralleled contraction/relaxation, whereas Ca2+ sensitivity increased 40% and 30% in HIGH and MOD, respectively. Carotid artery endothelial function improved similarly with both intensities. EC50 for acetylcholine-induced relaxation decreased 4.3-fold in HIGH (p<0.05) and 2.8-fold in MOD (p<0.20) as compared to sedentary; difference HIGH versus MOD 1.5-fold (p=0.72). Multiple regression identified rate of systolic Ca2+ increase and diastolic myocyte relengthening as main variables associated with VO2max. Cell hypertrophy, contractility and vasorelaxation also correlated significantly with VO2max.

Conclusions: The present study demonstrates that cardiovascular adaptations to training are intensity-dependent. A close correlation between VO2max, cardiomyocyte dimensions and contractile capacity suggests significantly higher benefit with high intensity, whereas endothelial function appears equivalent at moderate levels. Thus, exercise intensity emerges as an important variable in future preclinical and clinical investigations.

3. Improves fat-burning capacity.

Ethlyn Gail Trapp, “Effect of High Intensity Exercise on Fat Loss in Young Overweight Women,” PhD Diss., University of New South Wales, 2006:

Both exercise groups increased VO2peak. The [sprint] group had a significant loss of total body mass (TBM) and fat mass (FM) when compared to the other groups. There was no change in dietary intake.

Jason L. Talanian, Stuart D. R. Galloway, George J. F. Heigenhauser, Arend Bonen, and Lawrence L. Spriet, “Two weeks of high-intensity aerobic interval training increases the capacity for fat oxidation during exercise in women,” J Appl Physiol 102 (2007): 1439-1447.

Our aim was to examine the effects of seven high-intensity aerobic interval training (HIIT) sessions over 2 wk on skeletal muscle fuel content, mitochondrial enzyme activities, fatty acid transport proteins, peak O2 consumption (VO2 peak), and whole body metabolic, hormonal, and cardiovascular responses to exercise. Eight women (22.1 ± 0.2 yr old, 65.0 ± 2.2 kg body wt, 2.36 ± 0.24 l/min VO2 peak) performed a VO2 peak test and a 60-min cycling trial at ~60% VO2 peak before and after training. Each session consisted of ten 4-min bouts at ~90% VO2 peak with 2 min of rest between intervals. Training increased VO2 peak by 13%. After HIIT, plasma epinephrine and heart rate were lower during the final 30 min of the 60-min cycling trial at ~60% pretraining VO2 peak. Exercise whole body fat oxidation increased by 36% (from 15.0 ± 2.4 to 20.4 ± 2.5 g) after HIIT. Resting muscle glycogen and triacylglycerol contents were unaffected by HIIT, but net glycogen use was reduced during the posttraining 60-min cycling trial. HIIT significantly increased muscle mitochondrial beta-hydroxyacyl-CoA dehydrogenase (15.44 ± 1.57 and 20.35 ± 1.40 mmol•min–1•kg wet mass–1 before and after training, respectively) and citrate synthase (24.45 ± 1.89 and 29.31 ± 1.64 mmol•min–1•kg wet mass–1 before and after training, respectively) maximal activities by 32% and 20%, while cytoplasmic hormone-sensitive lipase protein content was not significantly increased. Total muscle plasma membrane fatty acid-binding protein content increased significantly (25%), whereas fatty acid translocase/CD36 content was unaffected after HIIT.

In summary, seven sessions of HIIT over 2 wk induced marked increases in whole body and skeletal muscle capacity for fatty acid oxidation during exercise in moderately active women.

4. Improves muscle fitness and endurance.

Kirsten A. Burgomaster, Scott C. Hughes, George J. F. Heigenhauser, Suzanne N. Bradwell, and Martin J. Gibala, “Six sessions of sprint interval training increases muscle oxidative potential and cycle endurance capacity in humans,” J Appl Physiol 98 (2005): 1985-1990.

Parra et al. (Acta Physiol. Scand 169: 157–165, 2000) showed that 2 wk of daily sprint interval training (SIT) increased citrate synthase (CS) maximal activity but did not change "anaerobic" work capacity, possibly because of chronic fatigue induced by daily training. The effect of fewer SIT sessions on muscle oxidative potential is unknown, and aside from changes in peak oxygen uptake (O2 peak), no study has examined the effect of SIT on "aerobic" exercise capacity. We tested the hypothesis that six sessions of SIT, performed over 2 wk with 1–2 days rest between sessions to promote recovery, would increase CS maximal activity and endurance capacity during cycling at ~80% O2 peak. Eight recreationally active subjects [age = 22 ± 1 yr; O2 peak = 45 ± 3 ml•kg–1•min–1 (mean ± SE)] were studied before and 3 days after SIT. Each training session consisted of four to seven "all-out" 30-s Wingate tests with 4 min of recovery. After SIT, CS maximal activity increased by 38% (5.5 ± 1.0 vs. 4.0 ± 0.7 mmol•kg protein–1•h–1) and resting muscle glycogen content increased by 26% (614 ± 39 vs. 489 ± 57 mmol/kg dry wt) (both P < 0.05). Most strikingly, cycle endurance capacity increased by 100% after SIT (51 ± 11 vs. 26 ± 5 min; P < 0.05), despite no change in O2 peak. The coefficient of variation for the cycle test was 12.0%, and a control group (n = 8) showed no change in performance when tested ~2 wk apart without SIT. We conclude that short sprint interval training (~15 min of intense exercise over 2 wk) increased muscle oxidative potential and doubled endurance capacity during intense aerobic cycling in recreationally active individuals.

.
Rodas G, Ventura JL, Cadefau JA, Cussó R, Parra J., “A short training programme for the rapid improvement of both aerobic and anaerobic metabolism,” Eur J Appl Physiol. 82 vol. 5-6 (Aug. 2000):480-86.

The aim of this study was to evaluate the changes in aerobic and anaerobic metabolism produced by a newly devised short training programme. Five young male volunteers trained daily for 2 weeks on a cycle ergometer. Sessions consisted of 15-s all-out repetitions with 45-s rest periods, plus 30-s all-out repetitions with 12-min rest periods. The number of repetitions was gradually increased up to a maximum of seven. Biopsy samples of the vastus lateralis muscle were taken before and after training. Performance changes were evaluated by two tests, a 30-s all-out test and a maximal progressive test. Significant increases in phosphocreatine (31%) and glycogen (32%) were found at the end of training. In addition, a significant increase was observed in the muscle activity of creatine kinase (44%), phosphofructokinase (106%), lactate dehydrogenase (45%), 3-hydroxy-acyl-CoA dehydrogenase (60%) and citrate synthase (38%). After training, performance of the 30-s all-out test did not increase significantly, while in the maximal progressive test, the maximum oxygen consumption increased from mean (SD) 57.3 (2.6) ml x min(-1) x kg(-1) to 63.8 (3.0) ml min(-1) x kg(-1), and the maximum load from 300 (11) W to 330 (21) W; all changes were significant. In conclusion, this new protocol, which utilises short durations, high loads and long recovery periods, seems to be an effective programme for improving the enzymatic activities of the energetic pathways in a short period of time.

See my previous post: Why Doing Sprints is Great for Your Health.

Blogging Heads

Bloggingheads.tv has had some great dialogues lately. There was Randy Kennedy and John McWhorter (I had Randy's "Race and the Law" class at Harvard, and enjoyed it immensely); Joshua Cohen and Charles Fried, and Henry Farrell and Cass Sunstein, among others.

Bad Arguments for Intermittent Fasting

I've been reading a bit on "intermittent fasting," which is basically the notion that your health might improve from occasionally skipping a meal or two (or a day of eating). I'm agnostic on such fasting, and one reason is that I keep seeing this argument:

We modern humans have become acculturated to the three square meals per day regimen. Animals in the wild, particularly carnivorous animals, don’t eat thrice per day; they eat when they make a kill. I would imagine that Paleolithic man did the same. If I had to make an intelligent guess, I would say that Paleolithic man probably ate once per day or maybe even twice every three days. In data gathered from humans still living in non-Westernized cultures in the last century, it appears that they would gorge after a kill and sleep and lay around doing not much of anything for the next day or so. When these folks got hungry, they went out and hunted and started the cycle again.

If you buy into the idea that the Paleolithic diet is the optimal diet for us today because it is the diet we were molded by the forces of natural selection to perform best on, then you should probably also buy into the idea that a meal timing schedule more like that of Paleolithic mean would provide benefit as well.

The bolded phrase strikes me as especially uncertain. The Paleolithic diet was obviously something that humanity was able to survive, in the sense that it didn't totally kill us off, but that doesn't mean that we evolved to perform best on such a diet. Think of it this way: We may have evolved to be able to last for three days without water, but that in no way implies that it is ideal for us to try to drink as little as possible. (I wonder when we'll start seeing "intermittent water" diets purporting to mimic the experience of the Paleolithic hunter who ran out of water and spent three days looking for a new supply.)

Statements of Facts in Supreme Court Briefs

Two interesting but contradictory opinions about statements of facts.

1. When I took a Supreme Court litigation seminar with Charles Fried (who, of course, had been Solicitor General of the United States under Reagan), he was very emphatic in his belief that a brief's statement of facts section contributes "50 percent" to that brief's effectiveness. The statement of facts, in his view, was your chance to show the Court that you could describe the case in a neutral and balanced fashion, thus lending credibility to the rest of your arguments.

2. But in this video (about 3-4 minutes in), Justice Thomas tells Bryan Garner that he "never" reads the statement of facts section in a brief. He says that instead, he reads the appellate court's opinion, and he'll learn about the facts from there; this seemed to be because the appellate court isn't as likely to have had an agenda in describing the facts. He does clarify that in complicated factual cases, briefing can be helpful. He gives one example of an electrical case years ago (not sure which case this was), in which a group of engineers filed a "wonderful" and "well-written" amicus brief that just explained the "nature of a grid." I wonder how many Justices share this view.

Quote for the Day

From Randall Collins, "Credential Inflation and the Future of Universities," in The Future of the City of Intellect: The Changing American University, ed. by Steven Brint (Stanford Univ. Press, 2002), pp. 29-30:

In principle, educational expansion and credential inflation could go on endlessly, until janitors need PhD.s, and household workers and babysitters will be required to hold advanced degrees in household appliances and childcare. Persons could be kept in school at increasing ages, up through their thirties and forties . . . It may even happen in some distant future that a species of socialism will come about in which virtually the entire population is on stipend in school, or working for the school system, while the material work of society is done by computers and robots.

Class Size

One recent re-analysis of the Tennessee STAR project (which randomly assigned some kids to smaller classes) shows that smaller classes don't reduce the achievement gap:

A Northwestern University study investigating the effects of class size on the achievement gap between high and low academic achievers suggests that high achievers benefit more from small classes than low achievers, especially at the kindergarten and first grade levels.

"While decreasing class size may increase achievement on average for all types of students, it does not appear to reduce the achievement gap within a class," said Spyros Konstantopoulos, assistant professor at Northwestern's School of Education and Social Policy.

Konstantopoulos' study, which appears in the March issue of Elementary School Journal, questions commonly held assumptions about class size and the academic achievement gap -- one of the most debated and perplexing issues in education today.
* * *

Konstantopoulos found that that the children who already were high achievers were the primary beneficiaries of the extra attention smaller classes afforded.

"It is likely that high achievers are more engaged in learning opportunities and take advantage of the teaching practices that take place in smaller classes, or that they create opportunities for their own learning in smaller classes," said Konstantoupoulos.

"Given that class size reduction is an intervention that benefits all students, it's tempting to expect that it also will reduce the achievement gap," he added. Previous research, however, has provided weak or no evidence that class reduction benefited lower-achieving students more than others. The Northwestern study underscores that research.

Quote for the Day

From Randall Collins, "Credential Inflation and the Future of Universities," in The Future of the City of Intellect: The Changing American University, ed. by Steven Brint (Stanford Univ. Press, 2002), p. 29:

The combination of ideologies favoring education -- technological progress plus democratic opportunity -- also operates as a protective ideology for those who make their livings in the educational system.

* * * Credential inflation is the dirty secret of modern education; if everyone admitted it publicly -- worse yet, if it became a topic for political discussion -- it would force us to face head-on the issue of class inequality and indeed growing class inequality, in part directly tied to the expansion of credentialing.